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Li Y, Chen Y, Fu C, Li Q, Liu H, Zhang Q. MR Diffusion Kurtosis Imaging (DKI) of the Normal Human Uterus in Vivo During the Menstrual Cycle. J Magn Reson Imaging 2024; 60:471-480. [PMID: 37994206 DOI: 10.1002/jmri.29153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The uterus undergoes dynamic changes throughout the menstrual cycle. Diffusion kurtosis imaging (DKI) is based on the non-Gaussian distribution of water molecules and can perhaps represent the changes of uterine microstructure. PURPOSE To investigate the temporal changes in DKI-parameters of the normal uterine corpus and cervix during the menstrual cycle. STUDY TYPE Prospective. POPULATION 21 healthy female volunteers (26.64 ± 4.72 years) with regular menstrual cycles (28 ± 7 days). FIELD STRENGTH/SEQUENCE Readout segmentation of long variable echo-trains (RESOLVE)-based DKI and fast spin-echo T2-weighted sequences at 3.0T. ASSESSMENT Each volunteer was scanned during the menstrual phase, ovulatory phase, and luteal phase. Regions of interest (ROI) were manually delineated in the endometrium, junctional zone, and myometrium of the uterine body, and in the mucosal layer, fibrous stroma layer, and loose stroma layer of the cervix. The mean Kapp (diffusion kurtosis coefficient), Dapp (diffusion coefficient), and ADC (apparent diffusion coefficient) values were measured in the ROI. STATISTICAL TESTS ANOVA with Bonferroni or Tamhane correction. Intraclass correlation coefficient (ICC) for assessing agreement. P < 0.05 was considered statistically significant. RESULTS During the menstrual cycle, the highest Kapp (0.848 ± 0.184) and lowest Dapp (1.263 ± 0.283 *10-3 mm2/sec) values were found in the endometrium during the menstrual phase. The Dapp values for the myometrium were significantly higher than those of the endometrium and the junctional zone in every phase. Meanwhile, the Dapp values for the three zonal structures of the cervix during ovulation were significantly higher than those during the luteal phase. However, there was no significant difference in the ADC values of the loose stroma between ovulation and the luteal phase (P = 0.568). The reproducibility of DKI parameters was good (ICC, 0.857-0.944). DATA CONCLUSION DKI can show dynamic changes of the normal uterus during the menstrual cycle. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yajie Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Ye Chen
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Qing Li
- MR Collaborations, Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Hanqiu Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qi Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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Abdul-Latif M, Tharmalingam H, Tsang Y, Hoskin PJ. Functional Magnetic Resonance Imaging in Cervical Cancer Diagnosis and Treatment. Clin Oncol (R Coll Radiol) 2023; 35:598-610. [PMID: 37246040 DOI: 10.1016/j.clon.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
Cervical Cancer is the fourth most common cancer in women worldwide. Treatment with chemoradiotherapy followed by brachytherapy achieves high local control, but recurrence with metastatic disease impacts survival. This highlights the need for predictive and prognostic biomarkers identifying populations at risk of poorer treatment response and survival. Magnetic resonance imaging (MRI) is routinely used in cervical cancer and is a potential source for biomarkers. Functional MRI (fMRI) can characterise tumour beyond anatomical MRI, which is limited to the assessment of morphology. This review summarises fMRI techniques used in cervical cancer and examines the role of fMRI parameters as predictive or prognostic biomarkers. Different techniques characterise different tumour factors, which helps to explain the variation in patient outcomes. These can impact simultaneously on outcomes, making biomarker identification challenging. Most studies are small, focussing on single MRI techniques, which raises the need to investigate combined fMRI approaches for a more holistic characterisation of tumour.
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Affiliation(s)
| | | | - Y Tsang
- Mount Vernon Cancer Centre, Northwood, UK; Radiation Medicine Programme, Princess Margaret Cancer Centre, Toronto, Canada
| | - P J Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
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Li S, Liu J, Zhang W, Lu H, Wang W, Lin L, Zhang Y, Cheng J. T1 mapping and multimodel diffusion-weighted imaging in the assessment of cervical cancer: a preliminary study. Br J Radiol 2023; 96:20220952. [PMID: 37183908 PMCID: PMC10392640 DOI: 10.1259/bjr.20220952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE To evaluate the clinical feasibility of T1 mapping and multimodel diffusion-weighted imaging (DWI) for assessing the histological type, grade, and lymphovascular space invasion (LVSI) of cervical cancer. METHODS Eighty patients with cervical cancer and 43 patients with a normal cervix underwent T1 mapping and DWI with 11 b-values (0-2000 s/mm2). Monoexponential, biexponential, and kurtosis models were fitted to calculate the apparent diffusion coefficient (ADC), pure molecular diffusion (D), pseudo-diffusion (D*), perfusion fraction (f), mean diffusivity (MD), and mean kurtosis (MK). Native T1 and DWI-derived parameters (ADCmean, ADCmin, Dmean, Dmin, D*, f, MDmean, MDmin, MKmean, and MKmax) were compared based on histological type, grade, and LVSI status. RESULTS Native T1 and DWI-derived parameters differed significantly between cervical cancer and normal cervix (all p < 0.05), except D* (p = 0.637). Native T1 and MKmean varied significantly between squamous cell carcinoma (SCC) and adenocarcinoma (both p < 0.05). ADCmin, Dmin, and MDmin were significantly lower while MKmax was significantly higher in the high-grade SCC group than in the low-grade SCC group (all p < 0.05). LVSI-positive SCC had a significantly higher MKmean than LVSI-negative SCC (p < 0.05). CONCLUSION Both T1 mapping and multimodel DWI can effectively differentiate cervical cancer from a normal cervix and cervical adenocarcinoma from SCC. Furthermore, multimodel DWI may provide quantitative metrics for non-invasively predicting histological grade and LVSI status in SCC patients. ADVANCES IN KNOWLEDGE Combined use of T1 mapping and multimodel DWI may provide more comprehensive information for non-invasive pre-operative evaluation of cervical cancer.
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Affiliation(s)
- Shujian Li
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Liu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenhua Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huifang Lu
- Department of Gynecology and Obstetrics, Huaihe Hospital of Henan University, Kaifeng, China
| | - Weijian Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liangjie Lin
- Advanced Technical Support, Philips Healthcare, Beijing, China
| | - Yong Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Monoexponential, biexponential, stretched-exponential and kurtosis models of diffusion-weighted imaging in kidney assessment: comparison between patients with primary aldosteronism and healthy controls. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1340-1349. [PMID: 36745206 DOI: 10.1007/s00261-023-03833-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE This study used various diffusion-weighted imaging (DWI) models (including monoexponential, biexponential, stretched-exponential and kurtosis models) in renal magnetic resonance imaging (MRI) to compare whether there were differences in each diffusion parameter between patients with primary aldosteronism (PA) and healthy volunteers. MATERIALS AND METHODS Twenty-two (female:male, 14:8; age, 48 ± 10 years) patients with PA and 22 age- and sex-matched healthy controls (HCs) underwent MRI examinations of the kidneys. The independent-sample t test or the Mann‒Whitney U test was used to detect differences in the diffusion metrics of the kidneys between the two groups. Univariable and multivariable linear regression were applied to analyze the correlations between diffusion parameters and the clinical indicators. RESULTS The mean diffusivity (MD, p < 0.001) and radial diffusivity (Dr, p < 0.001) values in the medulla were lower in the PA group than in the HC group. The medullary fractional anisotropy (FA, p < 0.001) was higher than that of HCs. The FA (p < 0.001) and axial diffusivity (Da, p < 0.001) values in the cortex were lower in the PA group. The cortical α (anomalous exponent term, p = 0.016) was higher in the PA patients than in the HCs. Linear regression analysis showed that log(plasma aldosterone concentration) and the estimated glomerular filtration rate (eGFR) were correlated with medullary FA. CONCLUSION The stretched-exponential model (cortical α) and the kurtosis model (FA, MD and Dr in the medulla and FA and Da in the cortex) showed significant differences between PA patients and healthy volunteers and may have potential for noninvasive renal assessment in PA patients.
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Ciulla S, Celli V, Aiello AA, Gigli S, Ninkova R, Miceli V, Ercolani G, Dolciami M, Ricci P, Palaia I, Catalano C, Manganaro L. Post treatment imaging in patients with local advanced cervical carcinoma. Front Oncol 2022; 12:1003930. [PMID: 36465360 PMCID: PMC9710522 DOI: 10.3389/fonc.2022.1003930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 10/29/2023] Open
Abstract
Cervical cancer (CC) is the fourth leading cause of death in women worldwide and despite the introduction of screening programs about 30% of patients presents advanced disease at diagnosis and 30-50% of them relapse in the first 5-years after treatment. According to FIGO staging system 2018, stage IB3-IVA are classified as locally advanced cervical cancer (LACC); its correct therapeutic choice remains still controversial and includes neoadjuvant chemo-radiotherapy, external beam radiotherapy, brachytherapy, hysterectomy or a combination of these modalities. In this review we focus on the most appropriated therapeutic options for LACC and imaging protocols used for its correct follow-up. We explore the imaging findings after radiotherapy and surgery and discuss the role of imaging in evaluating the response rate to treatment, selecting patients for salvage surgery and evaluating recurrence of disease. We also introduce and evaluate the advances of the emerging imaging techniques mainly represented by spectroscopy, PET-MRI, and radiomics which have improved diagnostic accuracy and are approaching to future direction.
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Affiliation(s)
- S Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - A A Aiello
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - S Gigli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - R Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - G Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - M Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - P Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - I Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Rome, Italy
| | - C Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - L Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
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Guo Y, Chen J, Zhang Y, Guo Y, Jiang M, Dai Y, Yao X. Differentiating Cytokeratin 19 expression of hepatocellular carcinoma by using multi-b-value diffusion-weighted MR imaging with mono-exponential, stretched exponential, intravoxel incoherent motion, diffusion kurtosis imaging and fractional order calculus models. Eur J Radiol 2022; 150:110237. [DOI: 10.1016/j.ejrad.2022.110237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/02/2022] [Accepted: 03/03/2022] [Indexed: 12/25/2022]
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Dolciami M, Capuani S, Celli V, Maiuro A, Pernazza A, Palaia I, Di Donato V, Santangelo G, Rizzo SMR, Ricci P, Della Rocca C, Catalano C, Manganaro L. Intravoxel Incoherent Motion (IVIM) MR Quantification in Locally Advanced Cervical Cancer (LACC): Preliminary Study on Assessment of Tumor Aggressiveness and Response to Neoadjuvant Chemotherapy. J Pers Med 2022; 12:jpm12040638. [PMID: 35455755 PMCID: PMC9027075 DOI: 10.3390/jpm12040638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to determine whether quantitative parameters obtained from intravoxel incoherent motion (IVIM) model at baseline magnetic resonance imaging (MRI) correlate with histological parameters and response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer (LACC). Methods: Twenty patients with biopsy-proven cervical cancer, staged as LACC on baseline MRI and addressed for neoadjuvant chemotherapy were enrolled. At treatment completion, tumor response was assessed with a follow-up MRI evaluated using the revised response evaluation criteria in solid tumors (RECIST; version 1.1), and patients were considered good responders (GR) if they had complete response or partial remission, and poor responders/non-responders (PR/NR) if they had stable or progressive disease. MRI protocol included conventional diffusion-weighted imaging (DWI; b = 0 and 1000 s/mm2) and IVIM acquisition using eight b-values (range: 0–1500 s/mm2). MR-images were analyzed using a dedicated software to obtain quantitative parameters: diffusion (D), pseudo-diffusion (D*), and perfusion fraction (fp) from the IVIM model; apparent diffusion coefficient (ADC) from conventional DWI. Histologic subtype, grading, and tumor-infiltrating lymphocytes (TILs) were assessed in each LACC. Results: D showed significantly higher values in GR patients (p = 0.001) and in moderate/high TILs (p = 0.018). Fp showed significantly higher values in squamous cell tumors (p = 0.006). Conclusions: D extracted from the IVIM model could represent a promising tool to identify tumor aggressiveness and predict response to therapy.
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Affiliation(s)
- Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (M.D.); (V.C.); (A.P.); (P.R.); (C.D.R.); (C.C.)
| | - Silvia Capuani
- CNR Institute for Complex Systems (ISC), Physics Department, Sapienza University of Rome, 00161 Rome, Italy;
| | - Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (M.D.); (V.C.); (A.P.); (P.R.); (C.D.R.); (C.C.)
| | | | - Angelina Pernazza
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (M.D.); (V.C.); (A.P.); (P.R.); (C.D.R.); (C.C.)
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.S.)
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.S.)
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.S.)
| | - Stefania Maria Rita Rizzo
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (M.D.); (V.C.); (A.P.); (P.R.); (C.D.R.); (C.C.)
- Unit of Emergency Radiology, Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy
| | - Carlo Della Rocca
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (M.D.); (V.C.); (A.P.); (P.R.); (C.D.R.); (C.C.)
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (M.D.); (V.C.); (A.P.); (P.R.); (C.D.R.); (C.C.)
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (M.D.); (V.C.); (A.P.); (P.R.); (C.D.R.); (C.C.)
- Correspondence: ; Tel.: +39-3338151295
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