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Zhang X, Qiu Y, Jiang W, Yang Z, Wang M, Li Q, Liu Y, Yan X, Yang G, Shen J. Mean Apparent Propagator MRI: Quantitative Assessment of Tumor-Stroma Ratio in Invasive Ductal Breast Carcinoma. Radiol Imaging Cancer 2024; 6:e230165. [PMID: 38874529 PMCID: PMC11287226 DOI: 10.1148/rycan.230165] [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: 09/25/2023] [Revised: 04/07/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024]
Abstract
Purpose To determine whether metrics from mean apparent propagator (MAP) MRI perform better than apparent diffusion coefficient (ADC) value in assessing the tumor-stroma ratio (TSR) status in breast carcinoma. Materials and Methods From August 2021 to October 2022, 271 participants were prospectively enrolled (ClinicalTrials.gov identifier: NCT05159323) and underwent breast diffusion spectral imaging and diffusion-weighted imaging. MAP MRI metrics and ADC were derived from the diffusion MRI data. All participants were divided into high-TSR (stromal component < 50%) and low-TSR (stromal component ≥ 50%) groups based on pathologic examination. Clinicopathologic characteristics were collected, and MRI findings were assessed. Logistic regression was used to determine the independent variables for distinguishing TSR status. The area under the receiver operating characteristic curve (AUC) and sensitivity, specificity, and accuracy were compared between the MAP MRI metrics, either alone or combined with clinicopathologic characteristics, and ADC, using the DeLong and McNemar test. Results A total of 181 female participants (mean age, 49 years ± 10 [SD]) were included. All diffusion MRI metrics differed between the high-TSR and low-TSR groups (P < .001 to P = .01). Radial non-Gaussianity from MAP MRI and lymphovascular invasion were significant independent variables for discriminating the two groups, with a higher AUC (0.81 [95% CI: 0.74, 0.87] vs 0.61 [95% CI: 0.53, 0.68], P < .001) and accuracy (138 of 181 [76%] vs 106 of 181 [59%], P < .001) than that of the ADC. Conclusion MAP MRI may serve as a better approach than conventional diffusion-weighted imaging in evaluating the TSR of breast carcinoma. Keywords: MR Diffusion-weighted Imaging, MR Imaging, Breast, Oncology ClinicalTrials.gov Identifier: NCT05159323 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Wei Jiang
- From the Department of Radiology (X.Z., Y.Q., W.J., Z.Y., J.S.),
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene
Regulation, Medical Research Center (X.Z., Y.Q., W.J., Z.Y., Q.L., Y.L., J.S.),
and Department of Pathology (Q.L., Y.L.), Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120,
People’s Republic of China; Department of Radiology, the First
People’s Hospital of Kashi Prefecture, Kashi, People’s Republic of
China (Y.Q.); Department of MR Scientific Marketing, Siemens Healthineers,
Guangzhou, People’s Republic of China (M.W., X.Y.); and Shanghai Key
Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East
China Normal University, Shanghai, People’s Republic of China
(G.Y.)
| | - Zehong Yang
- From the Department of Radiology (X.Z., Y.Q., W.J., Z.Y., J.S.),
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene
Regulation, Medical Research Center (X.Z., Y.Q., W.J., Z.Y., Q.L., Y.L., J.S.),
and Department of Pathology (Q.L., Y.L.), Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120,
People’s Republic of China; Department of Radiology, the First
People’s Hospital of Kashi Prefecture, Kashi, People’s Republic of
China (Y.Q.); Department of MR Scientific Marketing, Siemens Healthineers,
Guangzhou, People’s Republic of China (M.W., X.Y.); and Shanghai Key
Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East
China Normal University, Shanghai, People’s Republic of China
(G.Y.)
| | - Mengzhu Wang
- From the Department of Radiology (X.Z., Y.Q., W.J., Z.Y., J.S.),
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene
Regulation, Medical Research Center (X.Z., Y.Q., W.J., Z.Y., Q.L., Y.L., J.S.),
and Department of Pathology (Q.L., Y.L.), Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120,
People’s Republic of China; Department of Radiology, the First
People’s Hospital of Kashi Prefecture, Kashi, People’s Republic of
China (Y.Q.); Department of MR Scientific Marketing, Siemens Healthineers,
Guangzhou, People’s Republic of China (M.W., X.Y.); and Shanghai Key
Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East
China Normal University, Shanghai, People’s Republic of China
(G.Y.)
| | - Qin Li
- From the Department of Radiology (X.Z., Y.Q., W.J., Z.Y., J.S.),
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene
Regulation, Medical Research Center (X.Z., Y.Q., W.J., Z.Y., Q.L., Y.L., J.S.),
and Department of Pathology (Q.L., Y.L.), Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120,
People’s Republic of China; Department of Radiology, the First
People’s Hospital of Kashi Prefecture, Kashi, People’s Republic of
China (Y.Q.); Department of MR Scientific Marketing, Siemens Healthineers,
Guangzhou, People’s Republic of China (M.W., X.Y.); and Shanghai Key
Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East
China Normal University, Shanghai, People’s Republic of China
(G.Y.)
| | - Yeqing Liu
- From the Department of Radiology (X.Z., Y.Q., W.J., Z.Y., J.S.),
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene
Regulation, Medical Research Center (X.Z., Y.Q., W.J., Z.Y., Q.L., Y.L., J.S.),
and Department of Pathology (Q.L., Y.L.), Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120,
People’s Republic of China; Department of Radiology, the First
People’s Hospital of Kashi Prefecture, Kashi, People’s Republic of
China (Y.Q.); Department of MR Scientific Marketing, Siemens Healthineers,
Guangzhou, People’s Republic of China (M.W., X.Y.); and Shanghai Key
Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East
China Normal University, Shanghai, People’s Republic of China
(G.Y.)
| | - Xu Yan
- From the Department of Radiology (X.Z., Y.Q., W.J., Z.Y., J.S.),
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene
Regulation, Medical Research Center (X.Z., Y.Q., W.J., Z.Y., Q.L., Y.L., J.S.),
and Department of Pathology (Q.L., Y.L.), Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120,
People’s Republic of China; Department of Radiology, the First
People’s Hospital of Kashi Prefecture, Kashi, People’s Republic of
China (Y.Q.); Department of MR Scientific Marketing, Siemens Healthineers,
Guangzhou, People’s Republic of China (M.W., X.Y.); and Shanghai Key
Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East
China Normal University, Shanghai, People’s Republic of China
(G.Y.)
| | - Guang Yang
- From the Department of Radiology (X.Z., Y.Q., W.J., Z.Y., J.S.),
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene
Regulation, Medical Research Center (X.Z., Y.Q., W.J., Z.Y., Q.L., Y.L., J.S.),
and Department of Pathology (Q.L., Y.L.), Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120,
People’s Republic of China; Department of Radiology, the First
People’s Hospital of Kashi Prefecture, Kashi, People’s Republic of
China (Y.Q.); Department of MR Scientific Marketing, Siemens Healthineers,
Guangzhou, People’s Republic of China (M.W., X.Y.); and Shanghai Key
Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East
China Normal University, Shanghai, People’s Republic of China
(G.Y.)
| | - Jun Shen
- From the Department of Radiology (X.Z., Y.Q., W.J., Z.Y., J.S.),
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene
Regulation, Medical Research Center (X.Z., Y.Q., W.J., Z.Y., Q.L., Y.L., J.S.),
and Department of Pathology (Q.L., Y.L.), Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120,
People’s Republic of China; Department of Radiology, the First
People’s Hospital of Kashi Prefecture, Kashi, People’s Republic of
China (Y.Q.); Department of MR Scientific Marketing, Siemens Healthineers,
Guangzhou, People’s Republic of China (M.W., X.Y.); and Shanghai Key
Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East
China Normal University, Shanghai, People’s Republic of China
(G.Y.)
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Bartsch SJ, Brožová K, Ehret V, Friske J, Fürböck C, Kenner L, Laimer-Gruber D, Helbich TH, Pinker K. Non-Contrast-Enhanced Multiparametric MRI of the Hypoxic Tumor Microenvironment Allows Molecular Subtyping of Breast Cancer: A Pilot Study. Cancers (Basel) 2024; 16:375. [PMID: 38254864 PMCID: PMC10813988 DOI: 10.3390/cancers16020375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Tumor neoangiogenesis is an important hallmark of cancer progression, triggered by alternating selective pressures from the hypoxic tumor microenvironment. Non-invasive, non-contrast-enhanced multiparametric MRI combining blood-oxygen-level-dependent (BOLD) MRI, which depicts blood oxygen saturation, and intravoxel-incoherent-motion (IVIM) MRI, which captures intravascular and extravascular diffusion, can provide insights into tumor oxygenation and neovascularization simultaneously. Our objective was to identify imaging markers that can predict hypoxia-induced angiogenesis and to validate our findings using multiplexed immunohistochemical analyses. We present an in vivo study involving 36 female athymic nude mice inoculated with luminal A, Her2+, and triple-negative breast cancer cells. We used a high-field 9.4-tesla MRI system for imaging and subsequently analyzed the tumors using multiplex immunohistochemistry for CD-31, PDGFR-β, and Hif1-α. We found that the hyperoxic-BOLD-MRI-derived parameter ΔR2* discriminated luminal A from Her2+ and triple-negative breast cancers, while the IVIM-derived parameter fIVIM discriminated luminal A and Her2+ from triple-negative breast cancers. A comprehensive analysis using principal-component analysis of both multiparametric MRI- and mpIHC-derived data highlighted the differences between triple-negative and luminal A breast cancers. We conclude that multiparametric MRI combining hyperoxic BOLD MRI and IVIM MRI, without the need for contrast agents, offers promising non-invasive markers for evaluating hypoxia-induced angiogenesis.
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Affiliation(s)
- Silvester J. Bartsch
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Structural and Molecular Preclinical Imaging, Medical University of Vienna, 1090 Vienna, Austria
| | - Klára Brožová
- Department of Experimental and Laboratory Animal Pathology, Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
| | - Viktoria Ehret
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, 1090 Vienna, Austria
| | - Joachim Friske
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Structural and Molecular Preclinical Imaging, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Fürböck
- Computational Imaging Research Laboratory, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Lukas Kenner
- Department of Experimental and Laboratory Animal Pathology, Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
- Comprehensive Cancer Center, Medical University Vienna, 1090 Vienna, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Medical University Vienna, 1090 Vienna, Austria
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
| | - Daniela Laimer-Gruber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Structural and Molecular Preclinical Imaging, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas H. Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Structural and Molecular Preclinical Imaging, Medical University of Vienna, 1090 Vienna, Austria
| | - Katja Pinker
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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