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Li Y, Su X, Shang Y, Liu H, Wang W, Zhang A, Shi G. Comparative evaluation of imaging methods for prognosis assessment in esophageal squamous cell carcinoma: focus on diffusion-weighted magnetic resonance imaging, computed tomography and esophagography. Front Oncol 2024; 14:1397266. [PMID: 39026975 PMCID: PMC11256006 DOI: 10.3389/fonc.2024.1397266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Objective To identify the most sensitive imaging examination method to evaluate the prognosis of esophageal squamous cell carcinoma (ESCC). Materials and methods Thirty patients with esophageal squamous cell carcinoma (ESCC) participated in the study and underwent chemoradiotherapy (CRT). They were divided into two groups based on their survival status: the survival group and non-survival group. The diagnostic tests were utilized to determine the most effective imaging examination method for assessing the prognosis. Results 1. There were no significant differences in tumor length shown on esophagography or computed tomography (CT) or the maximal esophageal wall thickness shown on CT at the specified time points between the two groups. 2. The tumor length on diffusion-weighted imaging (DWI) in the survival group was significantly lower than in the non-survival group at the end of the sixth week of treatment (P=0.001). The area under the ROC curve was 0.840 (P=0.002), and the diagnostic efficiency was moderately accurate. 3. The apparent diffusion coefficient (ADC) values of the survival group were significantly higher than those in the non-survival group at the end of the fourth week and sixth week of treatment (both P<0.001). Areas under the curve were 0.866 and 0.970, with P values of 0.001 and <0.001 and good diagnostic accuracy. Cox regression analyses indicated the ADC at the end of the sixth week of treatment was an independent risk factor. Conclusions Compared with esophagography and CT, DW-MRI has certain advantages in predicting the prognosis of ESCC.
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Affiliation(s)
- Yang Li
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaohua Su
- Department of Oncology, Hebei General Hospital, Shijiazhuang, China
| | - Yuguang Shang
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Liu
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weishuai Wang
- CS Service AP, Siemens Healthineers Digital Health Technology (Shanghai) Co., Ltd. Beijing Branch, Beijing, China
| | - Andu Zhang
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gaofeng Shi
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Chen Y, Yang P, Fu C, Bian Y, Shao C, Ma C, Lu J. Variabilities in apparent diffusion coefficient (ADC) measurements of the spleen and the paraspinal muscle: A single center large cohort study. Heliyon 2023; 9:e18166. [PMID: 37519768 PMCID: PMC10372245 DOI: 10.1016/j.heliyon.2023.e18166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Evaluation of the variabilities in apparent diffusion coefficient (ADC) measurements of the spleen (ADCspleen) and the paraspinal muscles (ADCmuscle) to identify the reference organ for normalizing the ADC from the abdominal diffusion weighted imaging (DWI). Methods Two MRI scanners, with 314 abdominal exams on the GE and 929 on the Siemens system, were used for MRI examinations including DWI (b-values, 50 and 800 s/mm2). For a subset of 73 exams on the Siemens system a second exam was conducted. Four regions of interest (ROIs) in each exam were placed to measure the ADCspleen and the bilateral ADCmuscle. ADC variability between patients (on each scanner separately), ADC variability due to ROI placement between the two ROIs in each organ, and variability in the subset between the first and second exams were assessed. Results The ADCspleen was more scattered and variable than the ADCmuscle in the comparability (n = 929 and 314 for two MRI scanners, respectively) and repeatability (n = 73) datasets. The Bland-Altmann bias and limits of agreement (LoAs) for the ADCspleen (ICC, 0.47; CV, 0.070) and ADCmuscle (ICC, 0.67; CV, 0.023) in the repeatability datasets (n = 73) were -0.1 (-25.7%-25.6%) and -0.3 (-8.8%-8.1%), respectively. For the Siemens system, the Bland-Altmann bias and LoAs for the ADCspleen (ICC, 0.72; CV, 0.061) and ADCmuscle (ICC, 0.53; CV, 0.030) in the comparability datasets (n = 929) were 2.1 (-20.0%-24.2%) and 0.7 (-10.0%-11.4%), respectively. Similar findings have been found in the GE system (n = 314). The CVs for the ADCmuscle measurements were lower than those of the ADCspleen both in the repeatability and the comparability analyses (all p < 0.001). Conclusion Paraspinal muscles demonstrate better reference characteristics than the spleen in estimating ADC variability of abdominal DWI.
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Affiliation(s)
- Yukun Chen
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Panpan Yang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Caixia Fu
- Application Developments, Siemens Shenzhen Magnetic Resonance Ltd., Siemens Healthineers, Shenzhen, 518057, China
| | - Yun Bian
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
- College of Electronic and Information Engineering, Tongji University, Shanghai, 201804, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
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Slotman DJ, Bartels LW, Zijlstra A, Verpalen IM, van Osch JAC, Nijholt IM, Heijman E, van 't Veer-Ten Kate M, de Boer E, van den Hoed RD, Froeling M, Boomsma MF. Diffusion-weighted MRI with deep learning for visualizing treatment results of MR-guided HIFU ablation of uterine fibroids. Eur Radiol 2022; 33:4178-4188. [PMID: 36472702 DOI: 10.1007/s00330-022-09294-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES No method is available to determine the non-perfused volume (NPV) repeatedly during magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablations of uterine fibroids, as repeated acquisition of contrast-enhanced T1-weighted (CE-T1w) scans is inhibited by safety concerns. The objective of this study was to develop and test a deep learning-based method for translation of diffusion-weighted imaging (DWI) into synthetic CE-T1w scans, for monitoring MR-HIFU treatment progression. METHODS The algorithm was retrospectively trained and validated on data from 33 and 20 patients respectively who underwent an MR-HIFU treatment of uterine fibroids between June 2017 and January 2019. Postablation synthetic CE-T1w images were generated by a deep learning network trained on paired DWI and reference CE-T1w scans acquired during the treatment procedure. Quantitative analysis included calculation of the Dice coefficient of NPVs delineated on synthetic and reference CE-T1w scans. Four MR-HIFU radiologists assessed the outcome of MR-HIFU treatments and NPV ratio based on the synthetic and reference CE-T1w scans. RESULTS Dice coefficient of NPVs was 71% (± 22%). The mean difference in NPV ratio was 1.4% (± 22%) and not statistically significant (p = 0.79). Absolute agreement of the radiologists on technical treatment success on synthetic and reference CE-T1w scans was 83%. NPV ratio estimations on synthetic and reference CE-T1w scans were not significantly different (p = 0.27). CONCLUSIONS Deep learning-based synthetic CE-T1w scans derived from intraprocedural DWI allow gadolinium-free visualization of the predicted NPV, and can potentially be used for repeated gadolinium-free monitoring of treatment progression during MR-HIFU therapy for uterine fibroids. KEY POINTS • Synthetic CE-T1w scans can be derived from diffusion-weighted imaging using deep learning. • Synthetic CE-T1w scans may be used for visualization of the NPV without using a contrast agent directly after MR-HIFU ablations of uterine fibroids.
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Affiliation(s)
- Derk J Slotman
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands.
- Imaging & Oncology Division, Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Lambertus W Bartels
- Imaging & Oncology Division, Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aylene Zijlstra
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Inez M Verpalen
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Edwin Heijman
- Faculty of Medicine and University Hospital of Cologne, Institute of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
- Philips Research Eindhoven, High Tech Campus, Eindhoven, The Netherlands
| | | | - Erwin de Boer
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Martijn Froeling
- Imaging & Oncology Division, Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
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Wang J, Ma C, Yang P, Wang Z, Chen Y, Bian Y, Shao C, Lu J. Diffusion-Weighted Imaging of the Abdomen: Correction for Gradient Nonlinearity Bias in Apparent Diffusion Coefficient. J Magn Reson Imaging 2022. [PMID: 36373955 DOI: 10.1002/jmri.28529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gradient nonlinearity (GNL) introduces spatial nonuniformity bias in apparent diffusion coefficient (ADC) measurements, especially at large offsets from the magnet isocenter. PURPOSE To investigate the effects of GNL in abdominal ADC measurements and to develop an ADC bias correction procedure. STUDY TYPE Retrospective. PHANTOM/POPULATION Two homemade ultrapure water phantoms/25 patients with histologically confirmed pancreatic ductal adenocarcinoma (PDAC). FIELD STRENGTH/SEQUENCE A 3.0 T/diffusion-weighted imaging (DWI) with single-shot echo-planar imaging sequence. ASSESSMENT ADC bias was computed in the three orthogonal directions at different offset locations. The spatial-dependent correctors of ADC bias were generated from the ADCs of phantom 1. The ADCs were estimated before and after corrections for the phantom 1 with both the proposed approach and the theoretical GNL correction method. For the patients, ADCs were measured in abdominal tissues including left and right liver lobes, PDAC, spleen, bilateral kidneys, and bilateral paraspinal muscles. STATISTICAL TEST Friedman tests and Wilcoxon tests. RESULTS The ADC bias measured by phantom 1 was 9.7% and 12.6% higher in the right-left and anterior-posterior directions and 9.2% lower in the superior-inferior direction at the 150 mm offsets from the magnetic isocenter. The corrected vs. the uncorrected ADCs measurements (median: 2.20 × 10-3 mm2 /sec for both the proposed method and the theoretical GNL method vs. 2.31 × 10-3 mm2 /sec, respectively) and their relative ADC errors (0.014, 0.016, and 0.054, respectively) were lower in the phantom 1. The relative ADC errors substantially decreased after correction in the phantom 2 (median: 0.048 and -0.008, respectively). The ADCs of all the abdominal tissues were lower after correction except for the left liver lobes (P = 0.13). DATA CONCLUSION GNL bias in abdominal ADC can be measured by a DWI phantom. The proposed correction procedure was successfully applied for the bias correction in abdominal ADC. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Jian Wang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, China
| | - Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, China.,College of Electronic and Information Engineering, Tongji University, Shanghai, China
| | - Panpan Yang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, China
| | - Zhen Wang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, China
| | - Yufei Chen
- College of Electronic and Information Engineering, Tongji University, Shanghai, China
| | - Yun Bian
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, China
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Paquier Z, Chao SL, Bregni G, Sanchez AV, Guiot T, Dhont J, Gulyban A, Levillain H, Sclafani F, Reynaert N, Bali MA. Pre-trial quality assurance of diffusion-weighted MRI for radiomic analysis and the role of harmonisation. Phys Med 2022; 103:138-146. [DOI: 10.1016/j.ejmp.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
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Marija C, Kresimir D, Ognjen B, Iva P, Nenad K, Matija B. Estimation of colon cancer grade and metastatic lymph node involvement using DWI/ADC sequences. Acta Radiol 2022; 64:1341-1346. [PMID: 36197524 DOI: 10.1177/02841851221130008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The potential benefit of neoadjuvant chemotherapy (NAC) in colon cancer is under evaluation. There is a need to improve preoperative non-invasive diagnostics using techniques that provide more accurate staging information in assessing patient eligibility for NAC. PURPOSE To investigate the link between the tumor grade (pathohistological confirmed) and the N status (corresponding to lymph node involvement) with apparent diffusion coefficient (ADC) values. MATERIAL AND METHODS A total of 17 patients planned for surgical resection had a biopsy confirming colon carcinoma and participated in the study. Abdominal magnetic resonance imaging with diffusion-weighted imaging/ADC sequence was recorded before surgery. The tumor and all visible lymph nodes were manually delineated directly on a grayscale ADC map for every single slice and detected to access the total tumor and summarized lymph node volume. The mean ADC value was further calculated for the mean tumor and mean lymph node values. RESULTS Low-grade tumors had a mean ADC equivalent to 1225 ± 170×10-6 mm2/s, and the coefficient of high-grade tumors was 1444 ± 69×10-6 mm2/s. The group of patients with positive lymph nodes in operative tissue samples (N+) exhibited lower mean ADC values (1023 ± 142×10-6 mm2/s) as opposed to the group without metastatic lymph nodes (N-) with ADC values of 1260 ± 231×10-6 mm2/s. CONCLUSION The mean whole-tumor ADC is associated with the histological tumor grade, and the mean ADC value of whole-volume abdominal lymph nodes could assume real nodal infiltration.
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Affiliation(s)
- Cavar Marija
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Split, Croatia
| | - Dolic Kresimir
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Split, Croatia
| | - Barcot Ognjen
- Department of Abdominal Surgery, 162037University Hospital Split, Split, Croatia
| | - Peric Iva
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Split, Croatia
| | - Kunac Nenad
- Clinical Department for Pathology, Forensic Medicine and Cytology, University Hospital Split, Split, Croatia
| | - Boric Matija
- Department of Abdominal Surgery, 162037University Hospital Split, Split, Croatia
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Sertic M, Kilcoyne A, Catalano OA, Lee SI. Quantitative imaging of uterine cancers with diffusion-weighted MRI and 18-fluorodeoxyglucose PET/CT. Abdom Radiol (NY) 2022; 47:3174-3188. [PMID: 34302185 DOI: 10.1007/s00261-021-03218-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/18/2023]
Abstract
Imaging plays an important role in the diagnosis and treatment of women with uterine cervical and endometrial cancers. Quantitative imaging, through MRI, PET/CT, and hybrid PET/MRI, allows for characterization of primary tumors beyond anatomic and qualitative descriptors. MRI diffusion-weighted imaging (DWI) yields an apparent diffusion coefficient (ADC), which can be applied in both the pre-and post-treatment assessment of uterine tumors. PET/CT assesses metabolic activity, and measurement of tumor standardized uptake value (SUV) is a useful metric in the staging of uterine malignancies. Hybrid PET/MRI is an emerging modality that combines the soft tissue contrast of MRI with the molecular imaging capability of PET. This review provides an overview of these quantitative imaging modalities, and their current and potential roles in the assessment of uterine cervical and cancer.
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Affiliation(s)
- Madeleine Sertic
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Ye S, Lim JY, Huang W. Statistical considerations for repeatability and reproducibility of quantitative imaging biomarkers. BJR Open 2022; 4:20210083. [PMID: 36452056 PMCID: PMC9667479 DOI: 10.1259/bjro.20210083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/05/2022] Open
Abstract
Quantitative imaging biomarkers (QIBs) are increasingly used in clinical studies. Because many QIBs are derived through multiple steps in image data acquisition and data analysis, QIB measurements can produce large variabilities, posing a significant challenge in translating QIBs into clinical trials, and ultimately, clinical practice. Both repeatability and reproducibility constitute the reliability of a QIB measurement. In this article, we review the statistical aspects of repeatability and reproducibility of QIB measurements by introducing methods and metrics for assessments of QIB repeatability and reproducibility and illustrating the impact of QIB measurement error on sample size and statistical power calculations, as well as predictive performance with a QIB as a predictive biomarker.
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Affiliation(s)
- Shangyuan Ye
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, United States
| | - Jeong Youn Lim
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, United States
| | - Wei Huang
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, United States
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9
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Hoang-Dinh A, Nguyen-Quang T, Bui-Van L, Gonindard-Melodelima C, Souchon R, Rouvière O. Reproducibility of apparent diffusion coefficient measurement in normal prostate peripheral zone at 1.5T MRI. Diagn Interv Imaging 2022; 103:545-554. [PMID: 35773099 DOI: 10.1016/j.diii.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to quantify the influence of factors of variability on apparent diffusion coefficient (ADC) estimation in the normal prostate peripheral zone (PZ). MATERIALS AND METHODS Fifty healthy volunteers underwent in 2017 (n = 17) or 2020 (n = 33) two-point (0, 800 s/mm²) prostate diffusion-weighted imaging in the morning on 1.5 T scanners A and B from different manufacturers. Additional five-point (50, 150, 300, 500, 800 s/mm²) acquisitions were performed on scanner B in the morning and evening. ADC was measured in PZ at midgland using ADC maps reconstructed with various b-value combinations. ADC distributions from 2017 and 2020 were compared using Wilcoxon rank sum test. ADC obtained in the same volunteers were compared using Bland Altman methodology. The 95% confidence interval upper limit of the repeatability/reproducibility coefficient defined the lowest detectable ADC difference. RESULTS Forty-nine participants with a mean age of 24.6 ± 3.8 [SD] years (range: 21-37 years) were finally included. ADC distributions from 2017 and 2020 were not significantly different and were combined. Despite high individual variability, there was no significant bias (10 × 10-6 mm²/s, P = 0.58) between ADC measurements made on both scanners. On scanner B, differences in lowest b-values chosen within the 0-500 s/mm² range for two-point ADC computation induced significant biases (56-109 × 10-6 mm²/s, P < 0.0001). ADC was significantly lower in the morning (bias: 33 × 10-6 mm²/s, P = 0.006). The number of b-values had little influence on ADC values. The lowest detectable ADC difference varied from 85 × 10-6 to 311 × 10-6 mm²/s across scanners, b-value combinations and periods of the day. CONCLUSIONS The MRI scanner, the lowest b-value used and the period of the day induce substantial variability in ADC computation.
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Affiliation(s)
- Au Hoang-Dinh
- Hanoï Medical University Hospital, Dong Da, Hanoi, Viet Nam
| | | | - Lenh Bui-Van
- Hanoï Medical University Hospital, Dong Da, Hanoi, Viet Nam
| | | | | | - Olivier Rouvière
- LabTAU, INSERM, U1032, 69000, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Vascular and Urinary Imaging, 69000, Lyon, France; Université de Lyon, Lyon 69003, France; Université Lyon 1, Lyon France; Faculté de Médecine, Lyon Est, 69003, Lyon, France.
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10
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Gu H, Cui W, Luo S, Deng X. Diagnostic Performance of Diffusion Kurtosis Imaging for Benign and Malignant Breast Lesions: A Systematic Review and Meta-Analysis. Appl Bionics Biomech 2022; 2022:2042736. [PMID: 35721236 PMCID: PMC9203235 DOI: 10.1155/2022/2042736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Magnetic resonance imaging (MRI) has a high sensitivity for differentiating between malignant and non-malignant breast lesions but is sometimes limited due to its low specificity. Here, we performed a meta-analysis to evaluate the diagnostic performance of mean kurtosis (MK) and mean diffusivity (MD) values in magnetic resonance diffusion kurtosis imaging (DKI) for benign and malignant breast lesions. Methods Original articles on relevant topics, published from 2010 to 2019, in PubMed, EMBASE, and WanFang databases were systematically reviewed. According to the purpose of the study and the characteristics of DKI reported, the diagnostic performances of MK and MD were evaluated, and meta-regression was conducted to explore the source of heterogeneity. Results Fourteen studies involving 1,099 (451 benign and 648 malignant) lesions were analyzed. The pooled sensitivity, pooled specificity, positive likelihood ratio, and negative likelihood ratio for MD were 0.84 (95% confidence interval (CI), 0.81-0.87), 0.83 (95% CI, 0.79-0.86), 4.44 (95% CI, 3.54-5.57), and 0.18 (95% CI, 0.13-0.26), while those for MK were 0.89 (95% CI, 0.86-0.91), 0.86 (95% CI, 0.82-0.89), 5.72 (95% CI, 4.26-7.69), and 0.13 (95% CI, 0.09-0.19), respectively. The overall area under the curve (AUC) was 0.91 for MD and 0.95 for MK. Conclusions Analysis of the data from 14 studies showed that MK had a higher pooled sensitivity, pooled specificity, and diagnostic performance for differentiating between breast lesions, compared with MD.
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Affiliation(s)
- Hongyu Gu
- Department of Radiology, Affiliated Aoyang Hospital of Jiangsu University, Jiangsu 215600, China
| | - Wenjing Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu 210029, China
| | - Song Luo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Xiaoyi Deng
- Department of Radiology, Affiliated Aoyang Hospital of Jiangsu University, Jiangsu 215600, China
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11
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Sulieman I, Mohamed S, Elmoghazy W, Alaboudy A, Khalaf H, Elaffandi A. The value of diffusion-weighted imaging in diagnosing gallbladder malignancy: performance of a new parameter. Clin Radiol 2021; 76:709.e7-709.e12. [PMID: 34119303 DOI: 10.1016/j.crad.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/12/2021] [Indexed: 02/07/2023]
Abstract
AIM To assess the value of the ratio of signal intensities at high and low b-values (b800/b0 ratio) during diffusion-weighted imaging (DWI) for gallbladder cancer diagnosis. MATERIALS AND METHODS All patients presenting with suspicious gallbladder lesions between January 2011 and December 2016 who underwent DWI and histopathological diagnoses of the lesions were assessed. RESULTS Thirty-two patients (24 men, eight women) were identified. Eighteen patients had benign gallbladder lesions while 14 had malignant lesions. The mean apparent diffusion coefficient (ADC) value was 1.62 (±0.57)×10-3 mm2/s for benign cases and 1.27 (±0.39)×10-3 mm2/s for malignant cases; this difference was not significant (p=0.0773). The mean b800/b0 ratio was 0.31 (±0.19) for benign cases and 0.48 (±0.13) for malignant cases; this difference was significant (p=0.007). The ROC curve for b800/b0 had an AUC of 0.782 (95% confidence interval [CI]: 0.616-0.947) with a sensitivity and specificity of 85.7% and 72.2%, respectively, at a cut-off point of 0.33. CONCLUSION The b800/b0 ratio can help differentiate benign and malignant gallbladder lesions and may be more reliable than ADC values in quantitative DWI assessments.
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Affiliation(s)
- I Sulieman
- Department of Surgery, Division of Organ Transplant, Hamad General Hospital, PO Box 3050, Doha, Qatar.
| | - S Mohamed
- Department of Radiology, Hamad General Hospital, PO Box 3050, Doha, Qatar; Department of Diagnostic Radiology, National Cancer Institute, Cairo University, Egypt
| | - W Elmoghazy
- Department of Surgery, Division of Organ Transplant, Hamad General Hospital, PO Box 3050, Doha, Qatar; Department of Surgery, Sohag University, Sohag, Egypt
| | - A Alaboudy
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University, Sohag 82-524, Egypt
| | - H Khalaf
- Department of Surgery, Division of Organ Transplant, Hamad General Hospital, PO Box 3050, Doha, Qatar; Department of Surgery, College of Medicine, Qatar University, Qatar
| | - A Elaffandi
- Department of Surgery, Division of Organ Transplant, Hamad General Hospital, PO Box 3050, Doha, Qatar; Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt
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Coolens C, Gwilliam MN, Alcaide-Leon P, de Freitas Faria IM, Ynoe de Moraes F. Transformational Role of Medical Imaging in (Radiation) Oncology. Cancers (Basel) 2021; 13:cancers13112557. [PMID: 34070984 PMCID: PMC8197089 DOI: 10.3390/cancers13112557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary Onboard, imaging techniques have brought about a huge transformation in the ability to deliver targeted radiation therapies. Each generation of these technologies enables us to better visualize where to deliver lethal doses of radiation and thus allows the shrinking of necessary geometric margins leading to reduced toxicities. Alongside improvements in treatment delivery, advances in medical imaging have also allowed us to better define the volumes we wish to target. The development of imaging techniques that can capture aspects of the tumor’s biology before, during and after therapy is transforming how treatment can be delivered. Technological changes have further made these biological imaging techniques available in real-time providing the opportunity to monitor a patient’s response to treatment closely and often before any volume changes are visible on conventional radiological images. Here we discuss the development of robust quantitative imaging biomarkers and how they can personalize therapy towards meaningful clinical endpoints. Abstract Onboard, real-time, imaging techniques, from the original megavoltage planar imaging devices, to the emerging combined MRI-Linear Accelerators, have brought a huge transformation in the ability to deliver targeted radiation therapies. Each generation of these technologies enables lethal doses of radiation to be delivered to target volumes with progressively more accuracy and thus allows shrinking of necessary geometric margins, leading to reduced toxicities. Alongside these improvements in treatment delivery, advances in medical imaging, e.g., PET, and MRI, have also allowed target volumes themselves to be better defined. The development of functional and molecular imaging is now driving a conceptually larger step transformation to both better understand the cancer target and disease to be treated, as well as how tumors respond to treatment. A biological description of the tumor microenvironment is now accepted as an essential component of how to personalize and adapt treatment. This applies not only to radiation oncology but extends widely in cancer management from surgical oncology planning and interventional radiology, to evaluation of targeted drug delivery efficacy in medical oncology/immunotherapy. Here, we will discuss the role and requirements of functional and metabolic imaging techniques in the context of brain tumors and metastases to reliably provide multi-parametric imaging biomarkers of the tumor microenvironment.
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Affiliation(s)
- Catherine Coolens
- Department of Medical Physics, Princess Margaret Cancer Centre & University Health Network, Toronto, ON M5G 1Z5, Canada;
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
- Department of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
- TECHNA Institute, University Health Network, Toronto, ON M5G 1Z5, Canada
- Correspondence:
| | - Matt N. Gwilliam
- Department of Medical Physics, Princess Margaret Cancer Centre & University Health Network, Toronto, ON M5G 1Z5, Canada;
| | - Paula Alcaide-Leon
- Joint Department of Medical Imaging, University Health Network, Toronto, ON M5G 1Z5, Canada;
| | | | - Fabio Ynoe de Moraes
- Department of Oncology, Division of Radiation Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada;
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Wang YXJ, Huang H, Zheng CJ, Xiao BH, Chevallier O, Wang W. Diffusion-weighted MRI of the liver: challenges and some solutions for the quantification of apparent diffusion coefficient and intravoxel incoherent motion. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2021; 11:107-142. [PMID: 34079640 PMCID: PMC8165724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
Diffusion-weighted imaging (DWI) is sensitive to the mobility of water molecule at cellular and macromolecular level, much smaller than the spatial resolution of the images. It is commonly based on single shot echo-planar imaging sequence with the addition of motion-probing gradient pulses and fat suppression. DWI is increasingly incorporated into routine body magnetic resonance imaging protocols. However, the liver is particularly affected by physiological motions such as respiration; the left liver is also affected by cardiac motion artifacts and susceptibility artefact due to contents in the stomach. Intravoxel incoherent motion (IVIM) DWI data analysis requires high-quality data acquisition using multiple b-values and confidence in the measurements at low b-values. This article reviews the technical developments of DWI and its applications in the liver. Challenges and some solutions for the quantification of apparent diffusion coefficient and intravoxel incoherent motion are discussed. Currently, acquisition protocols vary between research groups; patient preparation and data post-processing are not standardized. Increased standardization, both in data acquisition and in image analysis, is imperative so to allow generation of reliable DW-MRI biomarker measures that are broadly applicable.
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Affiliation(s)
- Yi Xiang J Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong KongNew Territories, Hong Kong SAR, China
| | - Hua Huang
- Department of Radiology, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious DiseasesShenzhen, Guangdong Province, China
| | - Cun-Jing Zheng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong KongNew Territories, Hong Kong SAR, China
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong KongNew Territories, Hong Kong SAR, China
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, Université de BourgogneDijon, France
| | - Wei Wang
- Department of Radiology, The Third Xiangya Hospital, Central South UniversityChangsha, Hunan Province, China
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Michoux NF, Ceranka JW, Vandemeulebroucke J, Peeters F, Lu P, Absil J, Triqueneaux P, Liu Y, Collette L, Willekens I, Brussaard C, Debeir O, Hahn S, Raeymaekers H, de Mey J, Metens T, Lecouvet FE. Repeatability and reproducibility of ADC measurements: a prospective multicenter whole-body-MRI study. Eur Radiol 2021; 31:4514-4527. [PMID: 33409773 DOI: 10.1007/s00330-020-07522-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/31/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Multicenter oncology trials increasingly include MRI examinations with apparent diffusion coefficient (ADC) quantification for lesion characterization and follow-up. However, the repeatability and reproducibility (R&R) limits above which a true change in ADC can be considered relevant are poorly defined. This study assessed these limits in a standardized whole-body (WB)-MRI protocol. METHODS A prospective, multicenter study was performed at three centers equipped with the same 3.0-T scanners to test a WB-MRI protocol including diffusion-weighted imaging (DWI). Eight healthy volunteers per center were enrolled to undergo test and retest examinations in the same center and a third examination in another center. ADC variability was assessed in multiple organs by two readers using two-way mixed ANOVA, Bland-Altman plots, coefficient of variation (CoV), and the upper limit of the 95% CI on repeatability (RC) and reproducibility (RDC) coefficients. RESULTS CoV of ADC was not influenced by other factors (center, reader) than the organ. Based on the upper limit of the 95% CI on RC and RDC (from both readers), a change in ADC in an individual patient must be superior to 12% (cerebrum white matter), 16% (paraspinal muscle), 22% (renal cortex), 26% (central and peripheral zones of the prostate), 29% (renal medulla), 35% (liver), 45% (spleen), 50% (posterior iliac crest), 66% (L5 vertebra), 68% (femur), and 94% (acetabulum) to be significant. CONCLUSIONS This study proposes R&R limits above which ADC changes can be considered as a reliable quantitative endpoint to assess disease or treatment-related changes in the tissue microstructure in the setting of multicenter WB-MRI trials. KEY POINTS • The present study showed the range of R&R of ADC in WB-MRI that may be achieved in a multicenter framework when a standardized protocol is deployed. • R&R was not influenced by the site of acquisition of DW images. • Clinically significant changes in ADC measured in a multicenter WB-MRI protocol performed with the same type of MRI scanner must be superior to 12% (cerebrum white matter), 16% (paraspinal muscle), 22% (renal cortex), 26% (central zone and peripheral zone of prostate), 29% (renal medulla), 35% (liver), 45% (spleen), 50% (posterior iliac crest), 66% (L5 vertebra), 68% (femur), and 94% (acetabulum) to be detected with a 95% confidence level.
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Affiliation(s)
- Nicolas F Michoux
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium.
| | - Jakub W Ceranka
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Frank Peeters
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Pierre Lu
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Julie Absil
- Radiology Department, Université libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Perrine Triqueneaux
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Yan Liu
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | | | - Olivier Debeir
- LISA (Laboratories of Image Synthesis and Analysis), Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Stephan Hahn
- LISA (Laboratories of Image Synthesis and Analysis), Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | | | | | - Thierry Metens
- Radiology Department, Université libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Frédéric E Lecouvet
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
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Cancer Detection and Quantification of Treatment Response Using Diffusion-Weighted MRI. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Roccia E, Neji R, Benkert T, Kiefer B, Goh V, Dregely I. Distortion-free 3D diffusion imaging of the prostate using a multishot diffusion-prepared phase-cycled acquisition and dictionary matching. Magn Reson Med 2020; 85:1441-1454. [PMID: 32989765 DOI: 10.1002/mrm.28527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE To achieve three-dimensional (3D) distortion-free apparent diffusion coefficient (ADC) maps for prostate imaging using a multishot diffusion prepared-gradient echo (msDP-GRE) sequence and ADC dictionary matching. METHODS The msDP-GRE sequence is combined with a 3D Cartesian, centric k-space trajectory with center oversampling. Oversampled k-space center averaging and phase cycling are used to address motion- and eddy current-induced magnitude corruption. Extended-phase-graph (EPG) simulations and ADC dictionary matching are used to compensate for T1 effects. To shorten the acquisition time, each volume is undersampled by a factor of two and reconstructed using iterative sensitivity encoding. The proposed approach is characterized using simulations and validated in a kiwifruit phantom, comparing the msDP-GRE ADC maps obtained using both standard monoexponential fitting and dictionary matching with the clinical standard single-shot diffusion weighted-echo planar imaging (ssDW-EPI) ADC. Initial in vivo feasibility is tested in three healthy subjects, and geometric distortion is compared with anatomical T2 -weighted-turbo spin echo. RESULTS In the kiwifruit phantom experiment, the signal magnitude could be recovered using k-space center averaging and phase cycling. No statistically significant difference was observed in the ADC values estimated using msDP-GRE with dictionary matching and clinical standard DW-EPI (P < .05). The in vivo prostate msDP-GRE scans were free of geometric distortion caused by off-resonance susceptibility, and the ADC values in the prostate were in agreement with values found in the published literature. CONCLUSION Nondistorted 3D ADC maps of the prostate can be achieved using a msDP sequence and dictionary matching.
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Affiliation(s)
- Elisa Roccia
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,MR Research Collaboration, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Thomas Benkert
- Oncology Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Berthold Kiefer
- Oncology Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Vicky Goh
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Isabel Dregely
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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van Houdt PJ, Kallehauge JF, Tanderup K, Nout R, Zaletelj M, Tadic T, van Kesteren ZJ, van den Berg CAT, Georg D, Côté JC, Levesque IR, Swamidas J, Malinen E, Telliskivi S, Brynolfsson P, Mahmood F, van der Heide UA. Phantom-based quality assurance for multicenter quantitative MRI in locally advanced cervical cancer. Radiother Oncol 2020; 153:114-121. [PMID: 32931890 DOI: 10.1016/j.radonc.2020.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE A wide variation of MRI systems is a challenge in multicenter imaging biomarker studies as it adds variation in quantitative MRI values. The aim of this study was to design and test a quality assurance (QA) framework based on phantom measurements, for the quantitative MRI protocols of a multicenter imaging biomarker trial of locally advanced cervical cancer. MATERIALS AND METHODS Fifteen institutes participated (five 1.5 T and ten 3 T scanners). Each institute optimized protocols for T2, diffusion-weighted imaging, T1, and dynamic contrast-enhanced (DCE-)MRI according to system possibilities, institutional preferences and study-specific constraints. Calibration phantoms with known values were used for validation. Benchmark protocols, similar on all systems, were used to investigate whether differences resulted from variations in institutional protocols or from system variations. Bias, repeatability (%RC), and reproducibility (%RDC) were determined. Ratios were used for T2 and T1 values. RESULTS The institutional protocols showed a range in bias of 0.88-0.98 for T2 (median %RC = 1%; %RDC = 12%), -0.007 to 0.029 × 10-3 mm2/s for the apparent diffusion coefficient (median %RC = 3%; %RDC = 18%), and 0.39-1.29 for T1 (median %RC = 1%; %RDC = 33%). For DCE a nonlinear vendor-specific relation was observed between measured and true concentrations with magnitude data, whereas the relation was linear when phase data was used. CONCLUSION We designed a QA framework for quantitative MRI protocols and demonstrated for a multicenter trial for cervical cancer that measurement of consistent T2 and apparent diffusion coefficient values is feasible despite protocol differences. For DCE-MRI and T1 mapping with the variable flip angle method, this was more challenging.
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Affiliation(s)
- Petra J van Houdt
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | | | - Kari Tanderup
- Department of Clinical Medicine, Aarhus University Hospital, Denmark
| | - Remi Nout
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - Marko Zaletelj
- Department of Radiotherapy, Institute of Oncology Ljubljana, Slovenia
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Canada
| | - Zdenko J van Kesteren
- Department of Radiation Oncology, Amsterdam University Medical Center, the Netherlands
| | | | - Dietmar Georg
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University Of Vienna, Austria
| | - Jean-Charles Côté
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Canada
| | - Ives R Levesque
- Medical Physics Unit and Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - Jamema Swamidas
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Norway
| | - Sven Telliskivi
- Department of Radiation Oncology, North-Estonia Medical Centre, Tallinn, Estonia
| | - Patrik Brynolfsson
- Department of Translational Sciences, Skåne University Hospital, Lund, Sweden
| | - Faisal Mahmood
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Uulke A van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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Hagiwara A, Fujita S, Ohno Y, Aoki S. Variability and Standardization of Quantitative Imaging: Monoparametric to Multiparametric Quantification, Radiomics, and Artificial Intelligence. Invest Radiol 2020; 55:601-616. [PMID: 32209816 PMCID: PMC7413678 DOI: 10.1097/rli.0000000000000666] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 12/19/2022]
Abstract
Radiological images have been assessed qualitatively in most clinical settings by the expert eyes of radiologists and other clinicians. On the other hand, quantification of radiological images has the potential to detect early disease that may be difficult to detect with human eyes, complement or replace biopsy, and provide clear differentiation of disease stage. Further, objective assessment by quantification is a prerequisite of personalized/precision medicine. This review article aims to summarize and discuss how the variability of quantitative values derived from radiological images are induced by a number of factors and how these variabilities are mitigated and standardization of the quantitative values are achieved. We discuss the variabilities of specific biomarkers derived from magnetic resonance imaging and computed tomography, and focus on diffusion-weighted imaging, relaxometry, lung density evaluation, and computer-aided computed tomography volumetry. We also review the sources of variability and current efforts of standardization of the rapidly evolving techniques, which include radiomics and artificial intelligence.
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Affiliation(s)
- Akifumi Hagiwara
- From the Department of Radiology, Juntendo University School of Medicine, Tokyo
| | | | - Yoshiharu Ohno
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shigeki Aoki
- From the Department of Radiology, Juntendo University School of Medicine, Tokyo
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Diagnostic test accuracy of ADC values for identification of clear cell renal cell carcinoma: systematic review and meta-analysis. Eur Radiol 2020; 30:4023-4038. [PMID: 32144458 DOI: 10.1007/s00330-020-06740-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To perform a systematic review on apparent diffusion coefficient (ADC) values of renal tumor subtypes and meta-analysis on the diagnostic performance of ADC for differentiation of localized clear cell renal cell carcinoma (ccRCC) from other renal tumor types. METHODS Medline, Embase, and the Cochrane Library databases were searched for studies published until May 1, 2019, that reported ADC values of renal tumors. Methodological quality was evaluated. For the meta-analysis on diagnostic test accuracy of ADC for differentiation of ccRCC from other renal lesions, we applied a bivariate random-effects model and compared two subgroups of ADC measurement with vs. without cystic and necrotic areas. RESULTS We included 48 studies (2588 lesions) in the systematic review and 13 studies (1126 lesions) in the meta-analysis. There was no significant difference in ADC of renal parenchyma using b values of 0-800 vs. 0-1000 (p = 0.08). ADC measured on selected portions (sADC) excluding cystic and necrotic areas differed significantly from whole-lesion ADC (wADC) (p = 0.002). Compared to ccRCC, minimal-fat angiomyolipoma, papillary RCC, and chromophobe RCC showed significantly lower sADC while oncocytoma exhibited higher sADC. Summary estimates of sensitivity and specificity to differentiate ccRCC from other tumors were 80% (95% CI, 0.76-0.88) and 78% (95% CI, 0.64-0.89), respectively, for sADC and 77% (95% CI, 0.59-0.90) and 77% (95% CI, 0.69-0.86) for wADC. sADC offered a higher area under the receiver operating characteristic curve than wADC (0.852 vs. 0.785, p = 0.02). CONCLUSIONS ADC values of kidney tumors that exclude cystic or necrotic areas more accurately differentiate ccRCC from other renal tumor types than whole-lesion ADC values. KEY POINTS • Selective ADC of renal tumors, excluding cystic and necrotic areas, provides better discriminatory ability than whole-lesion ADC to differentiate clear cell RCC from other renal lesions, with area under the receiver operating characteristic curve (AUC) of 0.852 vs. 0.785, respectively (p = 0.02). • Selective ADC of renal masses provides moderate sensitivity and specificity of 80% and 78%, respectively, for differentiation of clear cell renal cell carcinoma (RCC) from papillary RCC, chromophobe RCC, oncocytoma, and minimal-fat angiomyolipoma. • Selective ADC excluding cystic and necrotic areas are preferable to whole-lesion ADC as an additional tool to multiphasic MRI to differentiate clear cell RCC from other renal lesions whether the highest b value is 800 or 1000.
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Synthetic Apparent Diffusion Coefficient for High b-Value Diffusion-Weighted MRI in Prostate. Prostate Cancer 2020; 2020:5091218. [PMID: 32095289 PMCID: PMC7035570 DOI: 10.1155/2020/5091218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose It has been reported that diffusion-weighted imaging (DWI) with ultrahigh b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher Materials and Methods. Fifteen patients (7 malignant and 8 benign) were included in this study retrospectively with the institutional ethical committee approval. All images were acquired at a 3T MR scanner. The ADC values were calculated using a monoexponential model. Synthetic ADC (sADC) for higher b-value increases the diagnostic power of prostate cancer. DWI with higher Results No significant difference was observed between actual ADC and sADC for b-value increases the diagnostic power of prostate cancer. DWI with higher p=0.002, paired t-test) in sDWI as compared to DWI. Malignant lesions showed significantly lower sADC as compared to benign lesions (p=0.002, paired t-test) in sDWI as compared to DWI. Malignant lesions showed significantly lower sADC as compared to benign lesions (Discussion/ Conclusion Our initial investigation suggests that the ADC values corresponding to higher b-value can be computed using log-linear relationship derived from lower b-values (b ≤ 1000). Our method might help clinicians to decide the optimal b-value for prostate lesion identification.b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher
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Bologna M, Corino VDA, Montin E, Messina A, Calareso G, Greco FG, Sdao S, Mainardi LT. Assessment of Stability and Discrimination Capacity of Radiomic Features on Apparent Diffusion Coefficient Images. J Digit Imaging 2019; 31:879-894. [PMID: 29725965 PMCID: PMC6261192 DOI: 10.1007/s10278-018-0092-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The objectives of the study are to develop a new way to assess stability and discrimination capacity of radiomic features without the need of test-retest or multiple delineations and to use information obtained to perform a preliminary feature selection. Apparent diffusion coefficient (ADC) maps were computed from diffusion-weighted magnetic resonance images (DW-MRI) of two groups of patients: 18 with soft tissue sarcomas (STS) and 18 with oropharyngeal cancers (OPC). Sixty-nine radiomic features were computed, using three different histogram discretizations (16, 32, and 64 bins). Geometrical transformations (translations) of increasing entity were applied to the regions of interest (ROIs), and the intra-class correlation coefficient (ICC) was used to compare the features computed on the original and modified ROIs. The distribution of ICC values for minimal and maximal entity translations (ICC10 and ICC100, respectively) was used to adjust thresholds of ICC (ICCmin and ICCmax) used to discriminate between good, unstable (ICC10 < ICCmin), and non-discriminative features (ICC100 > ICCmax). Fifty-four and 59 radiomic features passed the stability-based selection for all the three histogram discretizations for the OPC and STS datasets, respectively. The excluded features were similar across the different histogram discretizations (Jaccard’s index 0.77 ± 0.13 and 0.9 ± 0.1 for OPC and STS, respectively) but different between datasets (Jaccard’s index 0.19 ± 0.02). The results suggest that the observed radiomic features are mainly stable and discriminative, but the stability depends on the region of the body under observation. The method provides a way to assess stability without the need of test-retest or multiple delineations.
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Affiliation(s)
- Marco Bologna
- Departement of Electronics, Information and Bioengineering, Milan, Italy.
| | | | - Eros Montin
- Departement of Electronics, Information and Bioengineering, Milan, Italy
| | | | | | | | - Silvana Sdao
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca T Mainardi
- Departement of Electronics, Information and Bioengineering, Milan, Italy
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Dhar D, Raina K, Kant R, Wempe MF, Serkova NJ, Agarwal C, Agarwal R. Bitter melon juice-intake modulates glucose metabolism and lactate efflux in tumors in its efficacy against pancreatic cancer. Carcinogenesis 2019; 40:1164-1176. [PMID: 31194859 PMCID: PMC7384253 DOI: 10.1093/carcin/bgz114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
The established role of bitter melon juice (BMJ), a natural product, in activating master metabolic regulator adenosine monophosphate-activated protein kinase in pancreatic cancer (PanC) cells served as a basis for pursuing deeper investigation into the underlying metabolic alterations leading to BMJ efficacy in PanC. We investigated the comparative metabolic profiles of PanC cells with differential KRAS mutational status on BMJ exposure. Specifically, we employed nuclear magnetic resonance (NMR) metabolomics and in vivo imaging platforms to understand the relevance of altered metabolism in PanC management by BMJ. Multinuclear NMR metabolomics was performed, as a function of time, post-BMJ treatment followed by partial least square discriminant analysis assessments on the quantitative metabolic data sets to visualize the treatment group clustering; altered glucose uptake, lactate export and energy state were identified as the key components responsible for cell death induction. We next employed PANC1 xenograft model for assessing in vivo BMJ efficacy against PanC. Positron emission tomography ([18FDG]-PET) and magnetic resonance imaging on PANC1 tumor-bearing animals reiterated the in vitro results, with BMJ-associated significant changes in tumor volumes, tumor cellularity and glucose uptake. Additional studies in BMJ-treated PanC cells and xenografts displayed a strong decrease in the expression of glucose and lactate transporters GLUT1 and MCT4, respectively, supporting their role in metabolic changes by BMJ. Collectively, these results highlight BMJ-induced modification in PanC metabolomics phenotype and establish primarily lactate efflux and glucose metabolism, specifically GLUT1 and MCT4 transporters, as the potential metabolic targets underlying BMJ efficacy in PanC.
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Affiliation(s)
- Deepanshi Dhar
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | - Komal Raina
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmaceutical Sciences, South Dakota State University, Brookings, SD, USA
| | - Rama Kant
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | - Michael F Wempe
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | - Natalie J Serkova
- Department of Radiology, Animal Imaging Shared Resources, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | - Chapla Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
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23
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Mongula J, Bakers F, Slangen B, van Kuijk S, Kruitwagen R, Mihl C. Evaluation of various apparent diffusion coefficient measurement techniques in pre-operative staging of early cervical carcinoma. Eur J Radiol 2019; 118:101-106. [DOI: 10.1016/j.ejrad.2019.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 02/08/2023]
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24
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Westphalen AC, Fazel F, Nguyen H, Cabarrus M, Hanley-Knutson K, Shinohara K, Carroll PR. Detection of clinically signifi cant prostate cancer with PIRADS v2 scores, PSA density, and ADC values in regions with and without mpMRI visible lesions. Int Braz J Urol 2019; 45:713-723. [PMID: 31136112 PMCID: PMC6837611 DOI: 10.1590/s1677-5538.ibju.2018.0768] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/06/2019] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To determine if PSAD, PSADtz, and ADC values improve the accuracy of PI-RADS v2 and identify men whose concurrent systematic biopsy detects clinically significant cancer on areas without mpMRI visible lesions. MATERIALS AND METHODS Single reference-center, cross-sectional, retrospective study of consecutive men with suspected or known low to intermediate-risk prostate cancer who underwent 3T mpMRI and TRUS-MRI fusion biopsy from 07/15/2014 to 02/17/2018. Cluster-corrected logistic regression analyses were utilized to predict clinically significant prostate cancer (Gleason score ≥3+4) at targeted mpMRI lesions and on systematic biopsy. RESULTS 538 men (median age=66 years, median PSA=7.0ng/mL) with 780mpMRI lesions were included. Clinically significant disease was diagnosed in 371 men. PI-RADS v2 scores of 3, 4, and 5 were clinically significant cancer in 8.0% (16/201), 22.8% (90/395), and 59.2% (109/184). ADC values, PSAD, and PI-RADS v2 scores were independent predictors of clinically significant cancer in targeted lesions (OR 2.25-8.78; P values <0.05; AUROC 0.84, 95% CI 0.81-0.87). Increases in PSAD were also associated with upgrade on systematic biopsy (OR 2.39-2.48; P values <0.05; AUROC 0.69, 95% CI 0.64-0.73). CONCLUSIONS ADC values and PSAD improve characterization of PI-RADS v2 score 4 or 5 lesions. Upgraded on systematic biopsy is slightly more likely with PSAD ≥0.15 and multiple small PI-RADS v2 score 3 or 4 lesions.
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Affiliation(s)
- Antonio C. Westphalen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Farhad Fazel
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Hao Nguyen
- Department of Urology, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Miguel Cabarrus
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Katryana Hanley-Knutson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Katsuto Shinohara
- Department of Urology, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Peter R. Carroll
- Department of Urology, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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25
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Ye ZM, Dai SJ, Yan FQ, Wang L, Fang J, Fu ZF, Wang YZ. DCE-MRI-Derived Volume Transfer Constant (K trans) and DWI Apparent Diffusion Coefficient as Predictive Markers of Short- and Long-Term Efficacy of Chemoradiotherapy in Patients With Esophageal Cancer. Technol Cancer Res Treat 2019; 17:1533034618765254. [PMID: 29642773 PMCID: PMC5900808 DOI: 10.1177/1533034618765254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This study aimed to evaluate both the short- and long-term efficacies of chemoradiotherapy in relation to the treatment of esophageal cancer . This was achieved through the use of dynamic contrast-enhanced magnetic resonance imaging–derived volume transfer constant and diffusion weighted imaging–derived apparent diffusion coefficient . Patients with esophageal cancer were assigned into the sensitive and resistant groups based on respective efficacies in chemoradiotherapy. Dynamic contrast-enhanced magnetic resonance imaging and diffusion weighted imaging were used to measure volume transfer constant and apparent diffusion coefficient, while computed tomography was used to calculate tumor size reduction rate. Pearson correlation analyses were conducted to analyze correlation between volume transfer constant, apparent diffusion coefficient, and the tumor size reduction rate. Receiver operating characteristic curve was constructed to analyze the short-term efficacy of volume transfer constant and apparent diffusion coefficient, while Kaplan-Meier curve was employed for survival rate analysis. Cox proportional hazard model was used for the risk factors for prognosis of patients with esophageal cancer. Our results indicated reduced levels of volume transfer constant, while increased levels were observed in ADCmin, ADCmean, and ADCmax following chemoradiotherapy. A negative correlation was determined between ADCmin, ADCmean, and ADCmax, as well as in the tumor size reduction rate prior to chemoradiotherapy, whereas a positive correlation was uncovered postchemoradiotherapy. Volume transfer constant was positively correlated with tumor size reduction rate both before and after chemoradiotherapy. The 5-year survival rate of patients with esophageal cancer having high ADCmin, ADCmean, and ADCmax and volume transfer constant before chemoradiotherapy was greater than those with respectively lower values. According to the Cox proportional hazard model, ADCmean, clinical stage, degree of differentiation, and tumor stage were all confirmed as being independent risk factors in regard to the prognosis of patients with EC. The findings of this study provide evidence suggesting that volume transfer constant and apparent diffusion coefficient as being tools allowing for the evaluation of both the short- and long-term efficacies of chemoradiotherapy esophageal cancer treatment.
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Affiliation(s)
- Zhi-Min Ye
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Shu-Jun Dai
- 2 Department of Intense Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Feng-Qin Yan
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Lei Wang
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Jun Fang
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Zhen-Fu Fu
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Yue-Zhen Wang
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
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26
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Albrecht J, Polenz D, Kühl AA, Rogasch JMM, Leder A, Sauer IM, Babos M, Mócsai G, Beindorff N, Steffen IG, Brenner W, Koziolek EJ. Diffusion-weighted magnetic resonance imaging using a preclinical 1 T PET/MRI in healthy and tumor-bearing rats. EJNMMI Res 2019; 9:21. [PMID: 30796555 PMCID: PMC6386759 DOI: 10.1186/s13550-019-0489-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
Background Hybrid positron emission tomography and magnetic resonance imaging (PET/MRI) scanners are increasingly used for both clinical and preclinical imaging. Especially functional MRI sequences such as diffusion-weighted imaging (DWI) are of great interest as they provide information on a molecular level, thus, can be used as surrogate biomarkers. Due to technical restrictions, MR sequences need to be adapted for each system to perform reliable imaging. There is, to our knowledge, no suitable DWI protocol for 1 Tesla PET/MRI scanners. We aimed to establish such DWI protocol with focus on the choice of b values, suitable for longitudinal monitoring of tumor characteristics in a rat liver tumor model. Material and methods DWI was first performed in 18 healthy rat livers using the scanner-dependent maximum of 4 b values (0, 100, 200, 300 s/mm2). Apparent diffusion coefficients (ADC) were calculated from different b value combinations and compared to the reference measurement with four b values. T2-weighted MRI and optimized DWI with best agreement between accuracy, scanning time, and system performance stability were used to monitor orthotopic hepatocellular carcinomas (HCC) in five rats of which three underwent additional 2-deoxy-2-(18F)fluoro-d-glucose(FDG)-PET imaging. ADCs were calculated for the tumor and the surrounding liver parenchyma and verified by histopathological analysis. Results Compared to the reference measurements, the combination b = 0, 200, 300 s/mm2 showed the highest correlation coefficient (rs = 0.92) and agreement while reducing the acquisition time. However, measurements with less than four b values yielded significantly higher ADCs (p < 0.001). When monitoring the HCC, an expected drop of the ADC was observed over time. These findings were paralleled by FDG-PET showing both an increase in tumor size and uptake heterogeneity. Interestingly, surrounding liver parenchyma also showed a change in ADC values revealing varying levels of inflammation by immunohistochemistry. Conclusion We established a respiratory-gated DWI protocol for a preclinical 1 T PET/MRI scanner allowing to monitor growth-related changes in ADC values of orthotopic HCC liver tumors. By monitoring the changes in tumor ADCs over time, different cellular stages were described. However, each study needs to adapt the protocol further according to their question to generate best possible results. Electronic supplementary material The online version of this article (10.1186/s13550-019-0489-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jakob Albrecht
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Dietrich Polenz
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Anja A Kühl
- iPATH.Berlin - Immunopathology for Experimental Models, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Core Unit, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Julian M M Rogasch
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Annekatrin Leder
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Magor Babos
- Mediso Medical Imaging Systems, Laborc utca 3, Budapest, 1037, Hungary
| | - Gabor Mócsai
- Mediso Medical Imaging Systems, Laborc utca 3, Budapest, 1037, Hungary
| | - Nicola Beindorff
- Berlin Experimental Radionuclide Imaging Center (BERIC), Charité - Universitätsmedizin Berlin, Südstraße 3, 13353, Berlin, Germany
| | - Ingo G Steffen
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Berlin Experimental Radionuclide Imaging Center (BERIC), Charité - Universitätsmedizin Berlin, Südstraße 3, 13353, Berlin, Germany
| | - Eva J Koziolek
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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27
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Goldenberg JM, Cárdenas-Rodríguez J, Pagel MD. Machine learning improves classification of preclinical models of pancreatic cancer with chemical exchange saturation transfer MRI. Magn Reson Med 2019; 81:594-601. [PMID: 30277270 PMCID: PMC6258293 DOI: 10.1002/mrm.27439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE We sought to assess whether machine learning-based classification approaches can improve the classification of pancreatic tumor models relative to more simplistic analysis methods, using T1 relaxation, CEST, and DCE MRI. METHODS The T1 relaxation time constants, % CEST at five saturation frequencies, and vascular permeability constants from DCE MRI were measured from Hs 766 T, MIA PaCa-2, and SU.86.86 pancreatic tumor models. We used each of these measurements as predictors for machine learning classifier algorithms. We also used principal component analysis to reduce the dimensionality of entire CEST spectra and DCE signal evolutions, which were then analyzed using classification methods. RESULTS The T1 relaxation time constants, % CEST amplitudes at specific saturation frequencies, and the relative Ktrans and kep values from DCE MRI could not classify all three tumor types. However, the area under the curve from DCE signal evolutions could classify each tumor type. Principal component analysis was used to analyze the entire CEST spectrum and DCE signal evolutions, which predicted the correct tumor model with 87.5% and 85.1% accuracy, respectively. CONCLUSIONS Machine learning applied to the entire CEST spectrum improved the classification of the three tumor models, relative to classifications that used % CEST values at single saturation frequencies. A similar improvement was not attained with machine learning applied to T1 relaxation times or DCE signal evolutions, relative to more simplistic analysis methods.
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Affiliation(s)
- Joshua M. Goldenberg
- Department of Pharmaceutical Sciences, University of Arizona, Tucson, AZ
- Department of Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Mark D. Pagel
- Department of Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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28
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Shukla-Dave A, Obuchowski NA, Chenevert TL, Jambawalikar S, Schwartz LH, Malyarenko D, Huang W, Noworolski SM, Young RJ, Shiroishi MS, Kim H, Coolens C, Laue H, Chung C, Rosen M, Boss M, Jackson EF. Quantitative imaging biomarkers alliance (QIBA) recommendations for improved precision of DWI and DCE-MRI derived biomarkers in multicenter oncology trials. J Magn Reson Imaging 2018; 49:e101-e121. [PMID: 30451345 DOI: 10.1002/jmri.26518] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/14/2022] Open
Abstract
Physiological properties of tumors can be measured both in vivo and noninvasively by diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging. Although these techniques have been used for more than two decades to study tumor diffusion, perfusion, and/or permeability, the methods and studies on how to reduce measurement error and bias in the derived imaging metrics is still lacking in the literature. This is of paramount importance because the objective is to translate these quantitative imaging biomarkers (QIBs) into clinical trials, and ultimately in clinical practice. Standardization of the image acquisition using appropriate phantoms is the first step from a technical performance standpoint. The next step is to assess whether the imaging metrics have clinical value and meet the requirements for being a QIB as defined by the Radiological Society of North America's Quantitative Imaging Biomarkers Alliance (QIBA). The goal and mission of QIBA and the National Cancer Institute Quantitative Imaging Network (QIN) initiatives are to provide technical performance standards (QIBA profiles) and QIN tools for producing reliable QIBs for use in the clinical imaging community. Some of QIBA's development of quantitative diffusion-weighted imaging and dynamic contrast-enhanced QIB profiles has been hampered by the lack of literature for repeatability and reproducibility of the derived QIBs. The available research on this topic is scant and is not in sync with improvements or upgrades in MRI technology over the years. This review focuses on the need for QIBs in oncology applications and emphasizes the importance of the assessment of their reproducibility and repeatability. Level of Evidence: 5 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;49:e101-e121.
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Affiliation(s)
- Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dariya Malyarenko
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Wei Huang
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Susan M Noworolski
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark S Shiroishi
- Division of Neuroradiology, Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Harrison Kim
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine Coolens
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Boss
- Applied Physics Division, National Institute of Standards and Technology, Boulder, Colorado, USA
| | - Edward F Jackson
- Departments of Medical Physics, Radiology, and Human Oncology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
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29
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Dregely I, Prezzi D, Kelly‐Morland C, Roccia E, Neji R, Goh V. Imaging biomarkers in oncology: Basics and application to MRI. J Magn Reson Imaging 2018; 48:13-26. [PMID: 29969192 PMCID: PMC6587121 DOI: 10.1002/jmri.26058] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/26/2018] [Indexed: 12/12/2022] Open
Abstract
Cancer remains a global killer alongside cardiovascular disease. A better understanding of cancer biology has transformed its management with an increasing emphasis on a personalized approach, so-called "precision cancer medicine." Imaging has a key role to play in the management of cancer patients. Imaging biomarkers that objectively inform on tumor biology, the tumor environment, and tumor changes in response to an intervention complement genomic and molecular diagnostics. In this review we describe the key principles for imaging biomarker development and discuss the current status with respect to magnetic resonance imaging (MRI). LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 5 J. Magn. Reson. Imaging 2018;48:13-26.
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Affiliation(s)
- Isabel Dregely
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
| | - Davide Prezzi
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
| | - Christian Kelly‐Morland
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
| | - Elisa Roccia
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
| | - Radhouene Neji
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
- MR Research CollaborationsSiemens HealthcareFrimleyUK
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
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30
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Brizmohun Appayya M, Adshead J, Ahmed HU, Allen C, Bainbridge A, Barrett T, Giganti F, Graham J, Haslam P, Johnston EW, Kastner C, Kirkham AP, Lipton A, McNeill A, Moniz L, Moore CM, Nabi G, Padhani AR, Parker C, Patel A, Pursey J, Richenberg J, Staffurth J, van der Meulen J, Walls D, Punwani S. National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection - recommendations from a UK consensus meeting. BJU Int 2018; 122:13-25. [PMID: 29699001 PMCID: PMC6334741 DOI: 10.1111/bju.14361] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify areas of agreement and disagreement in the implementation of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in the diagnostic pathway. MATERIALS AND METHODS Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving nine NHS centres to provide for geographical spread) participated in a consensus meeting following the Research and Development Corporation and University of California-Los Angeles (UCLA-RAND) Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer. Each item was rated for agreement on a 9-point scale. A panel median score of ≥7 constituted 'agreement' for an item; for an item to reach 'consensus', a panel majority scoring was required. RESULTS Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mpMRI in the UK. Key findings include prostate mpMRI requests should be made in consultation with the urological team; mpMRI scanners should undergo QA checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with unsuspicious prostate mpMRI might consider avoiding an immediate biopsy. CONCLUSIONS Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high-quality prostate mpMRI as a diagnostic test before biopsy in men at risk.
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Affiliation(s)
- Mrishta Brizmohun Appayya
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Jim Adshead
- Department of UrologyHertfordshire and Bedfordshire Urological Cancer CentreLister HospitalStevenageHertfordshireUK
| | - Hashim U. Ahmed
- Division of Surgery and Interventional ScienceFaculty of Medical SciencesUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Division of SurgeryDepartment of Surgery and CancerImperial College London and Imperial UrologyImperial College Healthcare NHS TrustLondonUK
| | - Clare Allen
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Alan Bainbridge
- Department of Medical PhysicsUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Tristan Barrett
- Department of RadiologyAddenbrooke's Hospital and University of CambridgeCambridgeUK
| | - Francesco Giganti
- Division of Surgery and Interventional ScienceFaculty of Medical SciencesUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - John Graham
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Phil Haslam
- Department of RadiologyFreeman HospitalNewcastle upon TyneUK
| | - Edward W. Johnston
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Christof Kastner
- Department of UrologyAddenbrooke's Hospital and University of CambridgeCambridgeUK
| | - Alexander P.S. Kirkham
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | | | - Alan McNeill
- Department of UrologyNHS LothianWestern General HospitalEdinburghUK
| | | | - Caroline M. Moore
- Division of SurgeryDepartment of Surgery and CancerImperial College London and Imperial UrologyImperial College Healthcare NHS TrustLondonUK
- Department of UrologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Ghulam Nabi
- Division of Cancer ResearchNinewells HospitalDundeeUK
| | - Anwar R. Padhani
- Paul Strickland Scanner CentreMount Vernon HospitalNorthwoodMiddlesexUK
| | - Chris Parker
- Department of Academic UrologyRoyal Marsden HospitalSuttonSurreyUK
| | - Amit Patel
- Department of RadiologyLister HospitalStevenageHertfordshireUK
| | | | - Jonathan Richenberg
- Department of RadiologyRoyal Sussex County Hospital Brighton and Brighton and Sussex Medical SchoolBrightonSussexUK
| | - John Staffurth
- Division of Cancer and GeneticsSchool of MedicineCardiff UniversityCardiffUK
| | | | - Darren Walls
- Division of Nuclear MedicineUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Shonit Punwani
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
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31
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Klaassen R, Gurney-Champion OJ, Engelbrecht MRW, Stoker J, Wilmink JW, Besselink MG, Bel A, van Tienhoven G, van Laarhoven HWM, Nederveen AJ. Evaluation of Six Diffusion-weighted MRI Models for Assessing Effects of Neoadjuvant Chemoradiation in Pancreatic Cancer Patients. Int J Radiat Oncol Biol Phys 2018; 102:1052-1062. [PMID: 29891208 DOI: 10.1016/j.ijrobp.2018.04.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/03/2018] [Accepted: 04/23/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare 6 diffusion-weighted imaging (DWI) MRI models for response evaluation in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS DWI images were acquired at 3T for b = 0-600 s/mm2 in fourteen patients with advanced PDAC during 2 separate pretreatment sessions and 9 patients with (borderline) resectable PDAC pre and post neoadjuvant chemoradiation. Data was fitted with a mono-exponential (ADC), double mono-exponential to b = 0 and 100 s/mm2 (ADCfast), and b = 100 and 600 s/mm2 (ADCslow), IVIM model with D* free (D, f, D*) and fixed (D, f), tri-exponent (D, f1, f2), and stretched exponent model (DDC, α). Goodness of fit (adjusted R2), tumor to normal tissue contrast, repeatability (coefficient of variation), and parameter correlations (Spearman's rho) were assessed for the repeated measures. Treatment induced changes were assessed and compared to the repeatability. RESULTS The mono-exponential model had the lowest goodness of fit in both tumor (R2 = 0.94) and normal-appearing pancreas (R2 = 0.88). Tumour to normal tissue contrast was higher for the 'non-diffusion' parameters (ADCfast, f, D*, f1, f2, α), with better repeatability for the diffusion parameters (ADC, ADCslow, D, DDC). Diffusion parameters were strongly correlated between the models (rho ≥0.81) and showed a general treatment associated increase. All models were able to identify individual treatment effects, showing a change greater than the repeatability in 5 out of 9 patients for at least one of the parameters. CONCLUSIONS Individual treatment evaluation is possible with all investigated DWI models, with treatment associated changes exceeding the repeatability. The double monoexponential fit with ADCfast and ADCslow is able to discriminate between non-diffusion and diffusion related effects, is measured fast and can be performed on most commercial scanners, making it an attractive alternative for the more advanced multiparametric models in radiotherapy treatment evaluation.
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Affiliation(s)
- Remy Klaassen
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands; Cancer Center Amsterdam, LEXOR (Laboratory for Experimental Oncology and Radiobiology), Academic Medical Center, Amsterdam, The Netherlands.
| | - Oliver J Gurney-Champion
- Department of Radiology & Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc R W Engelbrecht
- Department of Radiology & Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology & Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Johanna W Wilmink
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology & Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Multiparametric Magnetic Resonance Imaging of the Prostate: Repeatability of Volume and Apparent Diffusion Coefficient Quantification. Invest Radiol 2018; 52:538-546. [PMID: 28463931 PMCID: PMC5544576 DOI: 10.1097/rli.0000000000000382] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the repeatability of a region of interest (ROI) volume and mean apparent diffusion coefficient (ADC) in standard-of-care 3 T multiparametric magnetic resonance imaging (mpMRI) of the prostate obtained with the use of endorectal coil. MATERIALS AND METHODS This prospective study was Health Insurance Portability and Accountability Act compliant, with institutional review board approval and written informed consent. Men with confirmed or suspected treatment-naive prostate cancer scheduled for mpMRI were offered a repeat mpMRI within 2 weeks. Regions of interest corresponding to the whole prostate gland, the entire peripheral zone (PZ), normal PZ, and suspected tumor ROI (tROI) on axial T2-weighted, dynamic contrast-enhanced subtract, and ADC images were annotated and assessed using Prostate Imaging Reporting and Data System (PI-RADS) v2. Repeatability of the ROI volume for each of the analyzed image types and mean ROI ADC was summarized with repeatability coefficient (RC) and RC%. RESULTS A total of 189 subjects were approached to participate in the study. Of 40 patients that gave initial agreement, 15 men underwent 2 mpMRI examinations and completed the study. Peripheral zone tROIs were identified in 11 subjects. Tumor ROI volume was less than 0.5 mL in 8 of 11 subjects. PI-RADS categories were identical between baseline-repeat studies in 11/15 subjects and differed by 1 point in 4/15. Peripheral zone tROI volume RC (RC%) was 233 mm (71%) on axial T2-weighted, 422 mm (112%) on ADC, and 488 mm (119%) on dynamic contrast-enhanced subtract. Apparent diffusion coefficient ROI mean RC (RC%) were 447 × 10 mm/s (42%) in PZ tROI and 471 × 10 mm/s (30%) in normal PZ. Significant difference in repeatability of the tROI volume across series was observed (P < 0.005). The mean ADC RC% was lower than volume RC% for tROI ADC (P < 0.05). CONCLUSIONS PI-RADS v2 overall assessment was highly repeatable. Multiparametric magnetic resonance imaging sequences differ in volume measurement repeatability. The mean tROI ADC is more repeatable compared with tROI volume in ADC. Repeatability of prostate ADC is comparable with that in other abdominal organs.
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Woo S, Kim SY, Cho JY, Kim SH. Apparent diffusion coefficient for prediction of parametrial invasion in cervical cancer: a critical evaluation based on stratification to a Likert scale using T2-weighted imaging. Radiol Med 2017; 123:209-216. [PMID: 29058233 DOI: 10.1007/s11547-017-0823-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/03/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate the value of apparent diffusion coefficient (ADC) for determining parametrial invasion (PMI) in cervical cancer, by stratifying them into subgroups based on a Likert scale using T2-weighted imaging (T2WI). MATERIALS AND METHODS This retrospective study included 87 patients with FIGO stage IA2-IIB cervical cancer who underwent preoperative MRI followed by radical hysterectomy. Radiological PMI was assessed on T2WI using a six-point Likert scale and ADC values of the tumors were measured. MRI findings were compared between patients with and without PMI. Differences in ADC according to the Likert scale were also assessed. RESULTS 19 (21.8%) patients had pathological PMI. The prevalence of PMI was significantly associated with Likert scale (P < 0.001). ADC values significantly differed according to Likert scale (P < 0.001). However, only tumors with a Likert score of 0 (MRI-invisible) had significantly greater ADC than others (P < 0.001) while no significant difference was observed among tumors with Likert scores of 1-5 (P = 0.070-0.889). Patients with PMI had significantly lower ADC values than those without PMI (P = 0.034). However, no significant difference was seen between patients with and without PMI within each Likert score group (P = 0.180-0.857). CONCLUSION T2WI-based Likert score for radiological PMI and ADC values of the tumor were significantly associated with pathological PMI. However, the apparent association seen between ADC values and PMI may be due to contribution of high ADC values of MRI-invisible tumors rather than reflecting their relationship.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.,Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 110-744, Republic of Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.,Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 110-744, Republic of Korea
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Adubeiro N, Nogueira ML, Nunes RG, Ferreira HA, Ribeiro E, La Fuente JMF. Apparent diffusion coefficient in the analysis of prostate cancer: determination of optimal b-value pair to differentiate normal from malignant tissue. Clin Imaging 2017; 47:90-95. [PMID: 28917137 DOI: 10.1016/j.clinimag.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Determining optimal b-value pair for differentiation between normal and prostate cancer (PCa) tissues. METHODS Forty-three patients with diagnosis or PCa symptoms were included. Apparent diffusion coefficient (ADC) was estimated using minimum and maximum b-values of 0, 50, 100, 150, 200, 500s/mm2 and 500, 800, 1100, 1400, 1700 and 2000s/mm2, respectively. Diagnostic performances were evaluated when Area-under-the-curve (AUC)>95%. RESULTS 15 of the 35 b-values pair surpassed this AUC threshold. The pair (50, 2000s/mm2) provided the highest AUC (96%) with ADC cutoff 0.89×10-3mm2/s, sensitivity 95.5%, specificity 93.2% and accuracy 94.4%. CONCLUSIONS The best b-value pair was b=50, 2000s/mm2.
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Affiliation(s)
- Nuno Adubeiro
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Department of Radiology, School of Health of Porto/Polytechnic Institute of Porto (ESS/IPP), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal.
| | - Maria Luísa Nogueira
- Department of Radiology, School of Health of Porto/Polytechnic Institute of Porto (ESS/IPP), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
| | - Rita G Nunes
- Institute for Systems and Robotics and Department of Bioengineering, LARSyS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Hugo Alexandre Ferreira
- Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016 Lisboa, Portugal
| | - Eduardo Ribeiro
- Department of Radiology, MRI Unit, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal; Department of Radiology, School of Health of Porto (ESS), Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
| | - José Maria Ferreira La Fuente
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.; Department of Urology, Center Hospitalar Porto (CHP), Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
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Dam C, Lindebjerg J, Jakobsen A, Jensen LH, Rahr H, Rafaelsen SR. Local staging of sigmoid colon cancer using MRI. Acta Radiol Open 2017; 6:2058460117720957. [PMID: 28804643 PMCID: PMC5533262 DOI: 10.1177/2058460117720957] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/23/2017] [Indexed: 02/01/2023] Open
Abstract
Background An accurate radiological staging of colon cancer is crucial to select patients who may benefit from neoadjuvant chemotherapy. Purpose To evaluate the diagnostic accuracy of preoperative magnetic resonance imaging (MRI) in identifying locally advanced sigmoid colon cancer, poor prognostic factors, and the inter-observer variation of the tumor apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI). Material and Methods Using 1.5 T MRI with high resolution T2-weighted (T2W) imaging, DWI, and no contrast enhancement, 35 patients with sigmoid colon cancer were assessed. T-stage, N-stage, extramural vascular invasion (EMVI), and ADC values of the tumors were assessed and blindly compared by two observers using postoperative histopathological examination as the gold standard. Early tumors were defined as T1 to T3ab, and advanced tumors as T3cd or T4. Results The accuracy of the two radiologists in staging early versus advanced tumors, N-stage, and identification of EMVI was 94%/89%, 60%/66%, and 77%/60% with an inter-observer agreement of к = 0.86 (95% confidence interval [CI] = 0.67–1.00), к = 0.64 (95% CI = 0.39–0.90), and к = 0.52 (95% CI = 0.23–0.80). All the measured mean ADC values were below 1.0 × 10−3 mm2/s with an intra-class correlation coefficient in T3cd–T4 tumors of 0.85. Conclusion Preoperative MRI can identify locally advanced sigmoid colon cancer and has potential as the imaging of choice to select patients for neoadjuvant chemotherapy. Initial experience with ADC measurement was achieved with an excellent inter-observer agreement in advanced tumors.
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Affiliation(s)
- Claus Dam
- Danish Colorectal Cancer Center South, Vejle Hospital, Denmark
| | - Jan Lindebjerg
- Danish Colorectal Cancer Center South, Vejle Hospital, Denmark
| | - Anders Jakobsen
- Danish Colorectal Cancer Center South, Vejle Hospital, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Lars Henrik Jensen
- Danish Colorectal Cancer Center South, Vejle Hospital, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Hans Rahr
- Danish Colorectal Cancer Center South, Vejle Hospital, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Søren Rafael Rafaelsen
- Danish Colorectal Cancer Center South, Vejle Hospital, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Denmark
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van Houdt PJ, Agarwal HK, van Buuren LD, Heijmink SWTPJ, Haack S, van der Poel HG, Ghobadi G, Pos FJ, Peeters JM, Choyke PL, van der Heide UA. Performance of a fast and high-resolution multi-echo spin-echo sequence for prostate T 2 mapping across multiple systems. Magn Reson Med 2017; 79:1586-1594. [PMID: 28671331 DOI: 10.1002/mrm.26816] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/18/2017] [Accepted: 06/09/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the performance of a multi-echo spin-echo sequence with k-t undersampling scheme (k-t T2 ) in prostate cancer. METHODS Phantom experiments were performed at five systems to estimate the bias, short-term repeatability, and reproducibility across all systems expressed with the within-subject coefficient of variation (wCV). Monthly measurements were performed on two systems for long-term repeatability estimation. To evaluate clinical repeatability, two T2 maps (voxel size 0.8 × 0.8 × 3 mm3 ; 5 min) were acquired at separate visits on one system for 13 prostate cancer patients. Repeatability was assessed per patient in relation to spatial resolution. T2 values were compared for tumor, peripheral zone, and transition zone. RESULTS Phantom measurements showed a small bias (median = -0.9 ms) and good short-term repeatability (median wCV = 0.5%). Long-term repeatability was 0.9 and 1.1% and reproducibility between systems was 1.7%. The median bias observed in patients was -1.1 ms. At voxel level, the median wCV was 15%, dropping to 4% for structures of 0.5 cm3 . The median tumor T2 values (79 ms) were significantly lower (P < 0.001) than in the peripheral zone (149 ms), but overlapped with the transition zone (91 ms). CONCLUSIONS Reproducible T2 mapping of the prostate is feasible with good spatial resolution in a clinically reasonable scan time, allowing reliable measurement of T2 in structures as small as 0.5 cm3 . Magn Reson Med 79:1586-1594, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Petra J van Houdt
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harsh K Agarwal
- Philips Research NA, Cambridge, Massachusetts, USA.,National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laurens D van Buuren
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Søren Haack
- Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Henk G van der Poel
- Department of Urology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ghazaleh Ghobadi
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Peter L Choyke
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Uulke A van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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Martín Noguerol T, Martínez Barbero J. Advanced diffusion MRI and biomarkers in the central nervous system: A new approach. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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38
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Corino VDA, Montin E, Messina A, Casali PG, Gronchi A, Marchianò A, Mainardi LT. Radiomic analysis of soft tissues sarcomas can distinguish intermediate from high-grade lesions. J Magn Reson Imaging 2017; 47:829-840. [PMID: 28653477 DOI: 10.1002/jmri.25791] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/26/2017] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To assess the feasibility of grading soft tissue sarcomas (STSs) using MRI features (radiomics). MATERIALS AND METHODS MRI (echo planar SE, 1.5T) from 19 patients with STSs and a known histological grading, were retrospectively analyzed. The apparent diffusion coefficient (ADC) maps, obtained by diffusion-weighted imaging acquisitions, were analyzed through 65 radiomic features, intensity-based (first order statistics, FOS) and texture (gray level co-occurrence matrix, GLCM; and gray level run length matrix, GLRLM) features. Feature selection (sequential forward floating search) and classification (k-nearest neighbor classifier) were performed to distinguish intermediate- from high-grade STSs. Classification was performed using the three different sub-groups of features separately as well as all the features together. The entire dataset was divided in three subsets: the training, validation and test set, containing, respectively, 60, 30, and 10% of the data. RESULTS Intermediate-grade lesions had a higher and less disperse ADC values compared with high-grade ones: most of FOS related to intensity are higher for the intermediate-grade STSs, while FOS related to signal variability were higher in the high grade (e.g., the feature variance is 2.6*105 ± 0.9*105 versus 3.3*105 ± 1.6*105 , P = 0.3). The GLCM features related to entropy and dissimilarity were higher in the high-grade. When performing classification, the best accuracy is obtained with a maximum of three features for each subgroup, FOS features being those leading to the best classification (validation set: FOS accuracy 0.90 ± 0.11, area under the curve [AUC] 0.85 ± 0.16; test set: FOS accuracy 0.88 ± 0.25, AUC 0.87 ± 0.34). CONCLUSION Good accuracy and AUC could be obtained using only few Radiomic features, belonging to the FOS class. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:829-840.
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Affiliation(s)
- Valentina D A Corino
- Department of Electronic, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Eros Montin
- Department of Electronic, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Paolo G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology and Haematology/Oncology Department, University of Milan, Italy
| | | | | | - Luca T Mainardi
- Department of Electronic, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
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Martín Noguerol T, Martínez Barbero JP. Advanced diffusion MRI and biomarkers in the central nervous system: a new approach. RADIOLOGIA 2017; 59:273-285. [PMID: 28552216 DOI: 10.1016/j.rx.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/13/2017] [Accepted: 04/16/2017] [Indexed: 01/08/2023]
Abstract
The introduction of diffusion-weighted sequences has revolutionized the detection and characterization of central nervous system (CNS) disease. Nevertheless, the assessment of diffusion studies of the CNS is often limited to qualitative estimation. Moreover, the pathophysiological complexity of the different entities that affect the CNS cannot always be correctly explained through classical models. The development of new models for the analysis of diffusion sequences provides numerous parameters that enable a quantitative approach to both diagnosis and prognosis as well as to monitoring the response to treatment; these parameters can be considered potential biomarkers of health and disease. In this update, we review the physical bases underlying diffusion studies and diffusion tensor imaging, advanced models for their analysis (intravoxel coherent motion and kurtosis), and the biological significance of the parameters derived.
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Affiliation(s)
- T Martín Noguerol
- Sección de Neurorradiología. Clínica las Nieves. SERCOSA. Grupo HealthTime, Jaén, España.
| | - J P Martínez Barbero
- Sección de Neurorradiología. Clínica las Nieves. SERCOSA. Grupo HealthTime, Jaén, España
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Everyman's prostate phantom: kiwi-fruit substitute for human prostates at magnetic resonance imaging, diffusion-weighted imaging and magnetic resonance spectroscopy. Eur Radiol 2017; 27:3362-3371. [PMID: 28058480 DOI: 10.1007/s00330-016-4706-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/09/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To apply an easy-to-assemble phantom substitute for human prostates in T2-weighted magnetic resonance imaging (T2WI), diffusion-weighted imaging (DWI) and 3D magnetic resonance spectroscopy (MRS). METHODS Kiwi fruit were fixed with gel hot and cold compress packs on two plastic nursery pots, separated by a plastic plate, and submerged in tap water inside a 1-L open-spout plastic watering can for T2WI (TR/TE 7500/101 ms), DWI (5500/61 ms, ADC b50-800 s/mm2 map) and MRS (940/145 ms) at 3.0 T, with phased array surface coils. One green kiwi fruit was additionally examined with an endorectal coil. Retrospective comparison with benign peripheral zone (PZ) and transitional zone (TZ) of prostate (n = 5), Gleason 6-7a prostate cancer (n = 8) and Gleason 7b-9 prostate cancer (n = 7) validated the phantom. RESULTS Mean contrast between central placenta (CP) and outer pericarp (OP, 0.346-0.349) or peripheral placenta (PP, 0.364-0.393) of kiwi fruit was similar to Gleason 7b-9 prostate cancer and PZ (0.308) in T2WI. ADC values of OP and PP (1.27 ± 0.07-1.37 ± 0.08 mm2/s × 10-3) resembled PZ and TZ (1.39 ± 0.17-1.60 ± 0.24 mm2/s × 10-3), while CP (0.91 ± 0.14-0.99 ± 0.10 mm2/s × 10-3) resembled Gleason 7b-9 prostate cancer (1.00 ± 0.25 mm2/s × 10-3). MR spectra showed peaks of citrate and myo-inositol in kiwi fruit, and citrate and "choline+creatine" in prostates. The phantom worked with an endorectal coil, too. CONCLUSIONS The kiwi fruit phantom reproducibly showed zones similar to PZ, TZ and cancer in human prostates in T2WI and DWI and two metabolite peaks in MRS and appears suitable to compare different MR protocols, coil systems and scanners. KEY POINTS • Kiwi fruit appear suitable as phantoms for human prostate in MR examinations. • Kiwi fruit show zonal anatomy like human prostates in T2-weighted MRI and DWI. • MR spectroscopy reliably shows peaks in kiwi fruit (citrate/inositol) and human prostates (citrate/choline+creatine). • The kiwi fruit phantom works both with and without an endorectal coil. • EU regulation No. 543/2011 specifies physical and biochemical properties of kiwi fruit.
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Brunsing RL, Schenker-Ahmed NM, White NS, Parsons JK, Kane C, Kuperman J, Bartsch H, Kader AK, Rakow-Penner R, Seibert TM, Margolis D, Raman SS, McDonald CR, Farid N, Kesari S, Hansel D, Shabaik A, Dale AM, Karow DS. Restriction spectrum imaging: An evolving imaging biomarker in prostate MRI. J Magn Reson Imaging 2016; 45:323-336. [PMID: 27527500 DOI: 10.1002/jmri.25419] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/25/2016] [Indexed: 12/28/2022] Open
Abstract
Restriction spectrum imaging (RSI) is a novel diffusion-weighted MRI technique that uses the mathematically distinct behavior of water diffusion in separable microscopic tissue compartments to highlight key aspects of the tissue microarchitecture with high conspicuity. RSI can be acquired in less than 5 min on modern scanners using a surface coil. Multiple field gradients and high b-values in combination with postprocessing techniques allow the simultaneous resolution of length-scale and geometric information, as well as compartmental and nuclear volume fraction filtering. RSI also uses a distortion correction technique and can thus be fused to high resolution T2-weighted images for detailed localization, which improves delineation of disease extension into critical anatomic structures. In this review, we discuss the acquisition, postprocessing, and interpretation of RSI for prostate MRI. We also summarize existing data demonstrating the applicability of RSI for prostate cancer detection, in vivo characterization, localization, and targeting. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:323-336.
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Affiliation(s)
- Ryan L Brunsing
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | | | - Nathan S White
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - J Kellogg Parsons
- Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Christopher Kane
- Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Joshua Kuperman
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Hauke Bartsch
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Andrew Karim Kader
- Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Tyler M Seibert
- Department of Radiation Medicine, University of California San Diego, San Diego, California, USA
| | - Daniel Margolis
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Steven S Raman
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Nikdokht Farid
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Santosh Kesari
- Department of Translational Neuro-Oncology and Neurotherapeutics, Pacific Neuroscience Institute and John Wayne Cancer Institute at Providence Saint John's Health Center, Los Angeles, California, USA
| | - Donna Hansel
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Ahmed Shabaik
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Anders M Dale
- Department of Radiology, University of California San Diego, San Diego, California, USA.,Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - David S Karow
- Department of Radiology, University of California San Diego, San Diego, California, USA
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