1
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Larson PEZ, Bernard JML, Bankson JA, Bøgh N, Bok RA, Chen AP, Cunningham CH, Gordon J, Hövener JB, Laustsen C, Mayer D, McLean MA, Schilling F, Slater J, Vanderheyden JL, von Morze C, Vigneron DB, Xu D. Current methods for hyperpolarized [1- 13C]pyruvate MRI human studies. Magn Reson Med 2024; 91:2204-2228. [PMID: 38441968 PMCID: PMC10997462 DOI: 10.1002/mrm.29875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 03/07/2024]
Abstract
MRI with hyperpolarized (HP) 13C agents, also known as HP 13C MRI, can measure processes such as localized metabolism that is altered in numerous cancers, liver, heart, kidney diseases, and more. It has been translated into human studies during the past 10 years, with recent rapid growth in studies largely based on increasing availability of HP agent preparation methods suitable for use in humans. This paper aims to capture the current successful practices for HP MRI human studies with [1-13C]pyruvate-by far the most commonly used agent, which sits at a key metabolic junction in glycolysis. The paper is divided into four major topic areas: (1) HP 13C-pyruvate preparation; (2) MRI system setup and calibrations; (3) data acquisition and image reconstruction; and (4) data analysis and quantification. In each area, we identified the key components for a successful study, summarized both published studies and current practices, and discuss evidence gaps, strengths, and limitations. This paper is the output of the "HP 13C MRI Consensus Group" as well as the ISMRM Hyperpolarized Media MR and Hyperpolarized Methods and Equipment study groups. It further aims to provide a comprehensive reference for future consensus, building as the field continues to advance human studies with this metabolic imaging modality.
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Affiliation(s)
- Peder EZ Larson
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
| | - Jenna ML Bernard
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | - James A Bankson
- Department of Imaging Physics, MD Anderson Medical Center,
Houston, TX, USA
| | - Nikolaj Bøgh
- The MR Research Center, Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
| | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | | | - Charles H Cunningham
- Physical Sciences, Sunnybrook Research Institute, Toronto,
Ontario, Canada
- Department of Medical Biophysics, University of Toronto,
Toronto, Ontario, Canada
| | - Jeremy Gordon
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North
Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University
Medical Center Schleswig-Holstein (UKSH), Kiel University, Am Botanischen Garten 14,
24118, Kiel, Germany
| | - Christoffer Laustsen
- The MR Research Center, Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
| | - Dirk Mayer
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
- Greenebaum Cancer Center, University of Maryland School
of Medicine, Baltimore, MD, USA
| | - Mary A McLean
- Department of Radiology, University of Cambridge,
Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of
Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
| | - Franz Schilling
- Department of Nuclear Medicine, School of Medicine,
Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich,
Germany
| | - James Slater
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | | | | | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
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Sushentsev N, Hamm G, Richings J, McLean MA, Menih IH, Ayyappan V, Mills IG, Warren AY, Gnanapragasam VJ, Barry ST, Goodwin RJA, Gallagher FA, Barrett T. Imaging tumor lactate is feasible for identifying intermediate-risk prostate cancer patients with postsurgical biochemical recurrence. Proc Natl Acad Sci U S A 2023; 120:e2312261120. [PMID: 38011568 PMCID: PMC10710070 DOI: 10.1073/pnas.2312261120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023] Open
Abstract
While radical prostatectomy remains the mainstay of prostate cancer (PCa) treatment, 20 to 40% of patients develop postsurgical biochemical recurrence (BCR). A particularly challenging clinical cohort includes patients with intermediate-risk disease whose risk stratification would benefit from advanced approaches that complement standard-of-care diagnostic tools. Here, we show that imaging tumor lactate using hyperpolarized 13C MRI and spatial metabolomics identifies BCR-positive patients in two prospective intermediate-risk surgical cohorts. Supported by spatially resolved tissue analysis of established glycolytic biomarkers, this study provides the rationale for multicenter trials of tumor metabolic imaging as an auxiliary tool to support PCa treatment decision-making.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, CB2 0QQCambridge, United Kingdom
| | - Gregory Hamm
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, Research & Development, AstraZeneca, CambridgeCB2 0AA, United Kingdom
| | - Jack Richings
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, Research & Development, AstraZeneca, CambridgeCB2 0AA, United Kingdom
| | - Mary A. McLean
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, CB2 0QQCambridge, United Kingdom
| | - Ines Horvat Menih
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, CB2 0QQCambridge, United Kingdom
| | - Vinay Ayyappan
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, CB2 0QQCambridge, United Kingdom
| | - Ian G. Mills
- Patrick G. Johnston Centre for Cancer Research, Genito-Urinary and Prostate Focus Group, Queen’s University Belfast, BelfastBT9 7AE, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, OxfordOX3 7DQ, United Kingdom
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen5021, Norway
| | - Anne Y. Warren
- Department of Pathology, Cambridge University Hospitals National Health Service Foundation Trust, CB2 0QQCambridge, United Kingdom
| | - Vincent J. Gnanapragasam
- Department of Urology, Cambridge University Hospitals National Health Service Foundation Trust, CambridgeCB2 0QQ, United Kingdom
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke’s Hospital, CambridgeCB2 0QQ, United Kingdom
| | - Simon T. Barry
- Bioscience, Discovery, Oncology Research & Development, AstraZeneca, CambridgeCB20AA, United Kingdom
| | - Richard J. A. Goodwin
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, Research & Development, AstraZeneca, CambridgeCB2 0AA, United Kingdom
| | - Ferdia A. Gallagher
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, CB2 0QQCambridge, United Kingdom
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, CB2 0QQCambridge, United Kingdom
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Larson PE, Bernard JM, Bankson JA, Bøgh N, Bok RA, Chen AP, Cunningham CH, Gordon J, Hövener JB, Laustsen C, Mayer D, McLean MA, Schilling F, Slater J, Vanderheyden JL, von Morze C, Vigneron DB, Xu D, Group THCMC. Current Methods for Hyperpolarized [1-13C]pyruvate MRI Human Studies. ArXiv 2023:arXiv:2309.04040v2. [PMID: 37731660 PMCID: PMC10508833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
MRI with hyperpolarized (HP) 13C agents, also known as HP 13C MRI, can measure processes such as localized metabolism that is altered in numerous cancers, liver, heart, kidney diseases, and more. It has been translated into human studies during the past 10 years, with recent rapid growth in studies largely based on increasing availability of hyperpolarized agent preparation methods suitable for use in humans. This paper aims to capture the current successful practices for HP MRI human studies with [1-13C]pyruvate - by far the most commonly used agent, which sits at a key metabolic junction in glycolysis. The paper is divided into four major topic areas: (1) HP 13C-pyruvate preparation, (2) MRI system setup and calibrations, (3) data acquisition and image reconstruction, and (4) data analysis and quantification. In each area, we identified the key components for a successful study, summarized both published studies and current practices, and discuss evidence gaps, strengths, and limitations. This paper is the output of the HP 13C MRI Consensus Group as well as the ISMRM Hyperpolarized Media MR and Hyperpolarized Methods & Equipment study groups. It further aims to provide a comprehensive reference for future consensus building as the field continues to advance human studies with this metabolic imaging modality.
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Urquhart C, Fleming B, Harper I, Aloj L, Armstrong R, Hook L, Long AM, Jackson C, Gallagher FA, McLean MA, Tarpey P, Kosmoliaptsis V, Nicholson J, Hendriks AEJ, Casey RT. The use of temozolomide in paediatric metastatic phaeochromocytoma/paraganglioma: A case report and literature review. Front Endocrinol (Lausanne) 2022; 13:1066208. [PMID: 36440187 PMCID: PMC9681996 DOI: 10.3389/fendo.2022.1066208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022] Open
Abstract
There is increasing evidence to support the use of temozolomide therapy for the treatment of metastatic phaeochromocytoma/paraganglioma (PPGL) in adults, particularly in patients with SDHx mutations. In children however, very little data is available. In this report, we present the case of a 12-year-old female with a SDHB-related metastatic paraganglioma treated with surgery followed by temozolomide therapy. The patient presented with symptoms of palpitations, sweating, flushing and hypertension and was diagnosed with a paraganglioma. The primary mass was surgically resected six weeks later after appropriate alpha- and beta-blockade. During the surgery extensive nodal disease was identified that had been masked by the larger paraganglioma. Histological review confirmed a diagnosis of a metastatic SDHB-deficient paraganglioma with nodal involvement. Post-operatively, these nodal lesions demonstrated tracer uptake on 18F-FDG PET-CT. Due to poor tumour tracer uptake on 68Ga-DOTATATE and 123I-MIBG functional imaging studies radionuclide therapy was not undertaken as a potential therapeutic option for this patient. Due to the low tumour burden and lack of clinical symptoms, the multi-disciplinary team opted for close surveillance for the first year, during which time the patient continued to thrive and progress through puberty. 13 months after surgery, evidence of radiological and biochemical progression prompted the decision to start systemic monotherapy using temozolomide. The patient has now completed ten cycles of therapy with limited adverse effects and has benefited from a partial radiological and biochemical response.
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Affiliation(s)
- Calum Urquhart
- Department of Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ben Fleming
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ines Harper
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Luigi Aloj
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Armstrong
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Liz Hook
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Anna-May Long
- Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Claire Jackson
- Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Mary A. McLean
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Patrick Tarpey
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of Surgery and NIHR Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James Nicholson
- Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - A. Emile J. Hendriks
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatric Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ruth T. Casey
- Department of Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
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5
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Sushentsev N, McLean MA, Warren AY, Brodie C, Jones J, Gallagher FA, Barrett T. The potential of hyperpolarised 13C-MRI to target glycolytic tumour core in prostate cancer. Eur Radiol 2022; 32:7155-7162. [PMID: 35731287 PMCID: PMC9474577 DOI: 10.1007/s00330-022-08929-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
Hyperpolarised [1-13C]pyruvate MRI (HP-13C-MRI) is an emerging metabolic imaging technique that has shown promise for evaluating prostate cancer (PCa) aggressiveness. Accurate tumour delineation on HP-13C-MRI is vital for quantitative assessment of the underlying tissue metabolism. However, there is no consensus on the optimum method for segmenting HP-13C-MRI, and whole-mount pathology (WMP) as the histopathological gold-standard is only available for surgical patients. Although proton MRI can be used for tumour delineation, this approach significantly underestimates tumour volume, and metabolic tumour segmentation based on HP-13C-MRI could provide an important functional metric of tumour volume. In this study, we quantified metabolism using HP-13C-MRI and segmentation approaches based on WMP maps, 1H-MRI-derived T2-weighted imaging (T2WI), and HP-13C-MRI-derived total carbon signal-to-noise ratio maps (TC-SNR) with an SNR threshold of 5.0. 13C-labelled pyruvate SNR, lactate SNR, TC-SNR, and the pyruvate-to-lactate exchange rate constant (kPL) were significantly higher when measured using the TC-SNR-guided approach, which also corresponded to a significantly higher tumour epithelial expression on RNAscope imaging of the enzyme catalysing pyruvate-to-lactate metabolism (lactate dehydrogenase (LDH)). However, linear regression and Bland-Altman analyses demonstrated a strong linear relationship between all three segmentation approaches, which correlated significantly with RNA-scope-derived epithelial LDH expression. These results suggest that standard-of-care T2WI and TC-SNR maps could be used as clinical reference tools for segmenting localised PCa on HP-13C-MRI in the absence of the WMP gold standard. The TC-SNR-guided approach could be used clinically to target biopsies towards highly glycolytic tumour areas and therefore to sample aggressive disease with higher precision. KEY POINTS: • T2WI- and TC-SNR-guided segmentations can be used in all PCa patients and do not explicitly require WMP maps. • Agreement between the three segmentation approaches is biologically validated by their strong relationship with epithelial LDH mRNA expression. • The TC-SNR-guided approach can potentially be used to identify occult disease on 1H-MRI and target the most glycolytically active regions.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Mary A McLean
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cara Brodie
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Julia Jones
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Ferdia A Gallagher
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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Kaggie JD, Khan AS, Matys T, Schulte RF, Locke MJ, Grimmer A, Frary A, Menih IH, Latimer E, Graves MJ, McLean MA, Gallagher FA. Deuterium metabolic imaging and hyperpolarized 13C-MRI of the normal human brain at clinical field strength reveals differential cerebral metabolism. Neuroimage 2022; 257:119284. [PMID: 35533826 DOI: 10.1016/j.neuroimage.2022.119284] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 12/01/2022] Open
Abstract
Deuterium metabolic imaging (DMI) and hyperpolarized 13C-pyruvate MRI (13C-HPMRI) are two emerging methods for non-invasive and non-ionizing imaging of tissue metabolism. Imaging cerebral metabolism has potential applications in cancer, neurodegeneration, multiple sclerosis, traumatic brain injury, stroke, and inborn errors of metabolism. Here we directly compare these two non-invasive methods at 3 T for the first time in humans and show how they simultaneously probe both oxidative and non-oxidative metabolism. DMI was undertaken 1-2 h after oral administration of [6,6'-2H2]glucose, and 13C-MRI was performed immediately following intravenous injection of hyperpolarized [1-13C]pyruvate in ten and nine normal volunteers within each arm respectively. DMI was used to generate maps of deuterium-labelled water, glucose, lactate, and glutamate/glutamine (Glx) and the spectral separation demonstrated that DMI is feasible at 3 T. 13C-HPMRI generated maps of hyperpolarized carbon-13 labelled pyruvate, lactate, and bicarbonate. The ratio of 13C-lactate/13C-bicarbonate (mean 3.7 ± 1.2) acquired with 13C-HPMRI was higher than the equivalent 2H-lactate/2H-Glx ratio (mean 0.18 ± 0.09) acquired using DMI. These differences can be explained by the route of administering each probe, the timing of imaging after ingestion or injection, as well as the biological differences in cerebral uptake and cellular physiology between the two molecules. The results demonstrate these two metabolic imaging methods provide different yet complementary readouts of oxidative and reductive metabolism within a clinically feasible timescale. Furthermore, as DMI was undertaken at a clinical field strength within a ten-minute scan time, it demonstrates its potential as a routine clinical tool in the future.
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Affiliation(s)
- Joshua D Kaggie
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.
| | - Alixander S Khan
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Tomasz Matys
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | | | - Matthew J Locke
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Ashley Grimmer
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Amy Frary
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Ines Horvat Menih
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Elizabeth Latimer
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge UK
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
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7
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James AD, Leslie TK, Kaggie JD, Wiggins L, Patten L, Murphy O'Duinn J, Langer S, Labarthe MC, Riemer F, Baxter G, McLean MA, Gilbert FJ, Kennerley AJ, Brackenbury WJ. Sodium accumulation in breast cancer predicts malignancy and treatment response. Br J Cancer 2022; 127:337-349. [PMID: 35462561 PMCID: PMC9296657 DOI: 10.1038/s41416-022-01802-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer remains a leading cause of death in women and novel imaging biomarkers are urgently required. Here, we demonstrate the diagnostic and treatment-monitoring potential of non-invasive sodium (23Na) MRI in preclinical models of breast cancer. METHODS Female Rag2-/- Il2rg-/- and Balb/c mice bearing orthotopic breast tumours (MDA-MB-231, EMT6 and 4T1) underwent MRI as part of a randomised, controlled, interventional study. Tumour biology was probed using ex vivo fluorescence microscopy and electrophysiology. RESULTS 23Na MRI revealed elevated sodium concentration ([Na+]) in tumours vs non-tumour regions. Complementary proton-based diffusion-weighted imaging (DWI) linked elevated tumour [Na+] to increased cellularity. Combining 23Na MRI and DWI measurements enabled superior classification accuracy of tumour vs non-tumour regions compared with either parameter alone. Ex vivo assessment of isolated tumour slices confirmed elevated intracellular [Na+] ([Na+]i); extracellular [Na+] ([Na+]e) remained unchanged. Treatment with specific inward Na+ conductance inhibitors (cariporide, eslicarbazepine acetate) did not affect tumour [Na+]. Nonetheless, effective treatment with docetaxel reduced tumour [Na+], whereas DWI measures were unchanged. CONCLUSIONS Orthotopic breast cancer models exhibit elevated tumour [Na+] that is driven by aberrantly elevated [Na+]i. Moreover, 23Na MRI enhances the diagnostic capability of DWI and represents a novel, non-invasive biomarker of treatment response with superior sensitivity compared to DWI alone.
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Affiliation(s)
- Andrew D James
- Department of Biology, University of York, York, UK
- York Biomedical Research Institute, University of York, York, UK
| | | | - Joshua D Kaggie
- Department of Radiology & NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | | | - Lewis Patten
- Department of Mathematics, University of York, York, UK
| | | | - Swen Langer
- Bioscience Technology Facility, Department of Biology, University of York, York, UK
| | | | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital Bergen, Bergen, Norway
| | - Gabrielle Baxter
- Department of Radiology & NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Department of Radiology & NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology & NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Aneurin J Kennerley
- York Biomedical Research Institute, University of York, York, UK
- Department of Chemistry, University of York, York, UK
| | - William J Brackenbury
- Department of Biology, University of York, York, UK.
- York Biomedical Research Institute, University of York, York, UK.
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8
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Zaccagna F, McLean MA, Grist JT, Kaggie J, Mair R, Riemer F, Woitek R, Gill AB, Deen S, Daniels CJ, Ursprung S, Schulte RF, Allinson K, Chhabra A, Laurent MC, Locke M, Frary A, Hilborne S, Patterson I, Carmo BD, Slough R, Wilkinson I, Basu B, Wason J, Gillard JH, Matys T, Watts C, Price SJ, Santarius T, Graves MJ, Jefferies S, Brindle KM, Gallagher FA. Imaging Glioblastoma Metabolism by Using Hyperpolarized [1- 13C]Pyruvate Demonstrates Heterogeneity in Lactate Labeling: A Proof of Principle Study. Radiol Imaging Cancer 2022; 4:e210076. [PMID: 35838532 PMCID: PMC9360994 DOI: 10.1148/rycan.210076] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 01/20/2023]
Abstract
Purpose To evaluate glioblastoma (GBM) metabolism by using hyperpolarized carbon 13 (13C) MRI to monitor the exchange of the hyperpolarized 13C label between injected [1-13C]pyruvate and tumor lactate and bicarbonate. Materials and Methods In this prospective study, seven treatment-naive patients (age [mean ± SD], 60 years ± 11; five men) with GBM were imaged at 3 T by using a dual-tuned 13C-hydrogen 1 head coil. Hyperpolarized [1-13C]pyruvate was injected, and signal was acquired by using a dynamic MRI spiral sequence. Metabolism was assessed within the tumor, in the normal-appearing brain parenchyma (NABP), and in healthy volunteers by using paired or unpaired t tests and a Wilcoxon signed rank test. The Spearman ρ correlation coefficient was used to correlate metabolite labeling with lactate dehydrogenase A (LDH-A) expression and some immunohistochemical markers. The Benjamini-Hochberg procedure was used to correct for multiple comparisons. Results The bicarbonate-to-pyruvate (BP) ratio was lower in the tumor than in the contralateral NABP (P < .01). The tumor lactate-to-pyruvate (LP) ratio was not different from that in the NABP (P = .38). The LP and BP ratios in the NABP were higher than those observed previously in healthy volunteers (P < .05). Tumor lactate and bicarbonate signal intensities were strongly correlated with the pyruvate signal intensity (ρ = 0.92, P < .001, and ρ = 0.66, P < .001, respectively), and the LP ratio was weakly correlated with LDH-A expression in biopsy samples (ρ = 0.43, P = .04). Conclusion Hyperpolarized 13C MRI demonstrated variation in lactate labeling in GBM, both within and between tumors. In contrast, bicarbonate labeling was consistently lower in tumors than in the surrounding NABP. Keywords: Hyperpolarized 13C MRI, Glioblastoma, Metabolism, Cancer, MRI, Neuro-oncology Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Fulvio Zaccagna
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Mary A. McLean
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - James T. Grist
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Joshua Kaggie
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Richard Mair
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Frank Riemer
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Ramona Woitek
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Andrew B. Gill
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Surrin Deen
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Charlie J. Daniels
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Stephan Ursprung
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Rolf F. Schulte
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Kieren Allinson
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Anita Chhabra
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Marie-Christine Laurent
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Matthew Locke
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Amy Frary
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Sarah Hilborne
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Ilse Patterson
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Bruno D. Carmo
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Rhys Slough
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Ian Wilkinson
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Bristi Basu
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - James Wason
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Jonathan H. Gillard
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Tomasz Matys
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Colin Watts
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Stephen J. Price
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Thomas Santarius
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Martin J. Graves
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Sarah Jefferies
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Kevin M. Brindle
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
| | - Ferdia A. Gallagher
- From the Departments of Radiology (F.Z., J.T.G., J.K., F.R., R.W.,
A.B.G., S.D., C.J.D., S.U., M.C.L., M.L., A.F., S.H., J.H.G., T.M., M.J.G.,
F.A.G.), Clinical Neurosciences (R.M., C.W., S.J.P., T.S.), and Medicine (I.W.),
University of Cambridge School of Clinical Medicine, Cambridge, England; Cancer
Research UK Cambridge Institute (M.A.M., S.U., K.M.B.), Medical Research Council
Biostatistics Unit (J.W.), and Department of Biochemistry (K.M.B.), University
of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, England;
Department of Biomedical Imaging and Image-guided Therapy, Medical University of
Vienna, Vienna, Austria (R.W.); GE Healthcare, Munich, Germany (R.F.S.);
Department of Pathology (K.A.), Cambridge Cancer Trials Centre (A.C.),
Department of Radiology (I.P., B.D.C., R.S.), and Department of Oncology (B.B.,
S.J.), Cambridge University Hospitals National Health Service Foundation Trust,
Cambridge, England; and Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, England (J.W.)
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9
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Deen SS, McLean MA, Gill AB, Crawford RAF, Latimer J, Baldwin P, Earl HM, Parkinson CA, Smith S, Hodgkin C, Jimenez-Linan M, Brodie CR, Patterson I, Addley HC, Freeman SJ, Moyle PM, Graves MJ, Sala E, Brenton JD, Gallagher FA. Magnetization transfer imaging of ovarian cancer: initial experiences of correlation with tissue cellularity and changes following neoadjuvant chemotherapy. BJR Open 2022; 4:20210078. [PMID: 36105417 PMCID: PMC9459873 DOI: 10.1259/bjro.20210078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To investigate the relationship between magnetization transfer (MT) imaging and tissue macromolecules in high-grade serous ovarian cancer (HGSOC) and whether MT ratio (MTR) changes following neoadjuvant chemotherapy (NACT). Methods This was a prospective observational study. 12 HGSOC patients were imaged before treatment. MTR was compared to quantified tissue histology and immunohistochemistry. For a subset of patients (n = 5), MT imaging was repeated after NACT. The Shapiro-Wilk test was used to assess for normality of data and Spearman's rank-order or Pearson's correlation tests were then used to compare MTR with tissue quantifications. The Wilcoxon signed-rank test was used to assess for changes in MTR after treatment. Results Treatment-naïve tumour MTR was 21.9 ± 3.1% (mean ± S.D.). MTR had a positive correlation with cellularity, rho = 0.56 (p < 0.05) and a negative correlation with tumour volume, ρ = -0.72 (p = 0.01). MTR did not correlate with the extracellular proteins, collagen IV or laminin (p = 0.40 and p = 0.90). For those patients imaged before and after NACT, an increase in MTR was observed in each case with mean MTR 20.6 ± 3.1% (median 21.1) pre-treatment and 25.6 ± 3.4% (median 26.5) post-treatment (p = 0.06). Conclusion In treatment-naïve HGSOC, MTR is associated with cellularity, possibly reflecting intracellular macromolecular concentration. MT may also detect the HGSOC response to NACT, however larger studies are required to validate this finding. Advances in knowledge MTR in HGSOC is influenced by cellularity. This may be applied to assess for cell changes following treatment.
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Affiliation(s)
| | | | - Andrew B Gill
- Department of Radiology, Box 218, University of Cambridge, Cambridge, United Kingdom, CB2 0QQ
| | - Robin A F Crawford
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | - John Latimer
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | - Peter Baldwin
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | | | - Christine A Parkinson
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | - Sarah Smith
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | | | - Mercedes Jimenez-Linan
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | - Cara R Brodie
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom, CB2 0RE
| | - Ilse Patterson
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | - Helen C Addley
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | - Susan J Freeman
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
| | - Penelope M Moyle
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom, CB2 0QQ
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10
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Sushentsev N, McLean MA, Warren AY, Benjamin AJV, Brodie C, Frary A, Gill AB, Jones J, Kaggie JD, Lamb BW, Locke MJ, Miller JL, Mills IG, Priest AN, Robb FJL, Shah N, Schulte RF, Graves MJ, Gnanapragasam VJ, Brindle KM, Barrett T, Gallagher FA. Author Correction: Hyperpolarised 13C-MRI identifies the emergence of a glycolytic cell population within intermediate-risk human prostate cancer. Nat Commun 2022; 13:1274. [PMID: 35256616 PMCID: PMC8901739 DOI: 10.1038/s41467-022-28979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Arnold J V Benjamin
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Cara Brodie
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Amy Frary
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Andrew B Gill
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Julia Jones
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Joshua D Kaggie
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - Matthew J Locke
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Jodi L Miller
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Ian G Mills
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | | | - Nimish Shah
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Martin J Graves
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Ferdia A Gallagher
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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11
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Ehrhardt MJ, Gallagher FA, McLean MA, Schönlieb CB. Enhancing the spatial resolution of hyperpolarized carbon-13 MRI of human brain metabolism using structure guidance. Magn Reson Med 2022; 87:1301-1312. [PMID: 34687088 DOI: 10.1002/mrm.29045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Dynamic nuclear polarization is an emerging imaging method that allows noninvasive investigation of tissue metabolism. However, the relatively low metabolic spatial resolution that can be achieved limits some applications, and improving this resolution could have important implications for the technique. METHODS We propose to enhance the 3D resolution of carbon-13 magnetic resonance imaging (13 C-MRI) using the structural information provided by hydrogen-1 MRI (1 H-MRI). The proposed approach relies on variational regularization in 3D with a directional total variation regularizer, resulting in a convex optimization problem which is robust with respect to the parameters and can efficiently be solved by many standard optimization algorithms. Validation was carried out using an in silico phantom, an in vitro phantom and in vivo data from four human volunteers. RESULTS The clinical data used in this study were upsampled by a factor of 4 in-plane and by a factor of 15 out-of-plane, thereby revealing occult information. A key finding is that 3D super-resolution shows superior performance compared to several 2D super-resolution approaches: for example, for the in silico data, the mean-squared-error was reduced by around 40% and for all data produced increased anatomical definition of the metabolic imaging. CONCLUSION The proposed approach generates images with enhanced anatomical resolution while largely preserving the quantitative measurements of metabolism. Although the work requires clinical validation against tissue measures of metabolism, it offers great potential in the field of 13 C-MRI and could significantly improve image quality in the future.
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Affiliation(s)
- Matthias J Ehrhardt
- Department of Mathematical Sciences, University of Bath, Bath, UK
- Institute for Mathematical Innovation, University of Bath, Bath, UK
| | | | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Carola-Bibiane Schönlieb
- Department for Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
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12
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Sushentsev N, McLean MA, Warren AY, Benjamin AJV, Brodie C, Frary A, Gill AB, Jones J, Kaggie JD, Lamb BW, Locke MJ, Miller JL, Mills IG, Priest AN, Robb FJL, Shah N, Schulte RF, Graves MJ, Gnanapragasam VJ, Brindle KM, Barrett T, Gallagher FA. Hyperpolarised 13C-MRI identifies the emergence of a glycolytic cell population within intermediate-risk human prostate cancer. Nat Commun 2022; 13:466. [PMID: 35075123 PMCID: PMC8786834 DOI: 10.1038/s41467-022-28069-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/02/2021] [Indexed: 02/08/2023] Open
Abstract
Hyperpolarised magnetic resonance imaging (HP 13C-MRI) is an emerging clinical technique to detect [1-13C]lactate production in prostate cancer (PCa) following intravenous injection of hyperpolarised [1-13C]pyruvate. Here we differentiate clinically significant PCa from indolent disease in a low/intermediate-risk population by correlating [1-13C]lactate labelling on MRI with the percentage of Gleason pattern 4 (%GP4) disease. Using immunohistochemistry and spatial transcriptomics, we show that HP 13C-MRI predominantly measures metabolism in the epithelial compartment of the tumour, rather than the stroma. MRI-derived tumour [1-13C]lactate labelling correlated with epithelial mRNA expression of the enzyme lactate dehydrogenase (LDHA and LDHB combined), and the ratio of lactate transporter expression between the epithelial and stromal compartments (epithelium-to-stroma MCT4). We observe similar changes in MCT4, LDHA, and LDHB between tumours with primary Gleason patterns 3 and 4 in an independent TCGA cohort. Therefore, HP 13C-MRI can metabolically phenotype clinically significant disease based on underlying metabolic differences in the epithelial and stromal tumour compartments.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Arnold J V Benjamin
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Cara Brodie
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Amy Frary
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Andrew B Gill
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Julia Jones
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Joshua D Kaggie
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - Matthew J Locke
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Jodi L Miller
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Ian G Mills
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | | | - Nimish Shah
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Martin J Graves
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Ferdia A Gallagher
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Ursprung S, Woitek R, McLean MA, Priest AN, Crispin-Ortuzar M, Brodie CR, Gill AB, Gehrung M, Beer L, Riddick ACP, Field-Rayner J, Grist JT, Deen SS, Riemer F, Kaggie JD, Zaccagna F, Duarte JAG, Locke MJ, Frary A, Aho TF, Armitage JN, Casey R, Mendichovszky IA, Welsh SJ, Barrett T, Graves MJ, Eisen T, Mitchell TJ, Warren AY, Brindle KM, Sala E, Stewart GD, Gallagher FA. Hyperpolarized 13C-Pyruvate Metabolism as a Surrogate for Tumor Grade and Poor Outcome in Renal Cell Carcinoma-A Proof of Principle Study. Cancers (Basel) 2022; 14:335. [PMID: 35053497 PMCID: PMC8773685 DOI: 10.3390/cancers14020335] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/01/2023] Open
Abstract
Differentiating aggressive clear cell renal cell carcinoma (ccRCC) from indolent lesions is challenging using conventional imaging. This work prospectively compared the metabolic imaging phenotype of renal tumors using carbon-13 MRI following injection of hyperpolarized [1-13C]pyruvate (HP-13C-MRI) and validated these findings with histopathology. Nine patients with treatment-naïve renal tumors (6 ccRCCs, 1 liposarcoma, 1 pheochromocytoma, 1 oncocytoma) underwent pre-operative HP-13C-MRI and conventional proton (1H) MRI. Multi-regional tissue samples were collected using patient-specific 3D-printed tumor molds for spatial registration between imaging and molecular analysis. The apparent exchange rate constant (kPL) between 13C-pyruvate and 13C-lactate was calculated. Immunohistochemistry for the pyruvate transporter (MCT1) from 44 multi-regional samples, as well as associations between MCT1 expression and outcome in the TCGA-KIRC dataset, were investigated. Increasing kPL in ccRCC was correlated with increasing overall tumor grade (ρ = 0.92, p = 0.009) and MCT1 expression (r = 0.89, p = 0.016), with similar results acquired from the multi-regional analysis. Conventional 1H-MRI parameters did not discriminate tumor grades. The correlation between MCT1 and ccRCC grade was confirmed within a TCGA dataset (p < 0.001), where MCT1 expression was a predictor of overall and disease-free survival. In conclusion, metabolic imaging using HP-13C-MRI differentiates tumor aggressiveness in ccRCC and correlates with the expression of MCT1, a predictor of survival. HP-13C-MRI may non-invasively characterize metabolic phenotypes within renal cancer.
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Affiliation(s)
- Stephan Ursprung
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Ramona Woitek
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Mary A. McLean
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Andrew N. Priest
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Mireia Crispin-Ortuzar
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
| | - Cara R. Brodie
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
| | - Andrew B. Gill
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Marcel Gehrung
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
| | - Lucian Beer
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Antony C. P. Riddick
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
| | - Johanna Field-Rayner
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - James T. Grist
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Surrin S. Deen
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Frank Riemer
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Joshua D. Kaggie
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Fulvio Zaccagna
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Joao A. G. Duarte
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Matthew J. Locke
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Amy Frary
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Tevita F. Aho
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
| | - James N. Armitage
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
| | - Ruth Casey
- Department of Endocrinology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Iosif A. Mendichovszky
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Sarah J. Welsh
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Oncology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Tristan Barrett
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Martin J. Graves
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Tim Eisen
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Oncology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Thomas J. Mitchell
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
- Wellcome Sanger Institute, Hinxton CB10 1RQ, UK
| | - Anne Y. Warren
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Pathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Kevin M. Brindle
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
| | - Evis Sala
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Grant D. Stewart
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Ferdia A. Gallagher
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
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Woitek R, McLean MA, Ursprung S, Rueda OM, Manzano Garcia R, Locke MJ, Beer L, Baxter G, Rundo L, Provenzano E, Kaggie J, Patterson A, Frary A, Field-Rayner J, Papalouka V, Kane J, Benjamin AJV, Gill AB, Priest AN, Lewis DY, Russell R, Grimmer A, White B, Latimer-Bowman B, Patterson I, Schiller A, Carmo B, Slough R, Lanz T, Wason J, Schulte RF, Chin SF, Graves MJ, Gilbert FJ, Abraham JE, Caldas C, Brindle KM, Sala E, Gallagher FA. Hyperpolarized Carbon-13 MRI for Early Response Assessment of Neoadjuvant Chemotherapy in Breast Cancer Patients. Cancer Res 2021; 81:6004-6017. [PMID: 34625424 PMCID: PMC7612070 DOI: 10.1158/0008-5472.can-21-1499] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/14/2021] [Accepted: 10/06/2021] [Indexed: 01/09/2023]
Abstract
Hyperpolarized 13C-MRI is an emerging tool for probing tissue metabolism by measuring 13C-label exchange between intravenously injected hyperpolarized [1-13C]pyruvate and endogenous tissue lactate. Here, we demonstrate that hyperpolarized 13C-MRI can be used to detect early response to neoadjuvant therapy in breast cancer. Seven patients underwent multiparametric 1H-MRI and hyperpolarized 13C-MRI before and 7-11 days after commencing treatment. An increase in the lactate-to-pyruvate ratio of approximately 20% identified three patients who, following 5-6 cycles of treatment, showed pathological complete response. This ratio correlated with gene expression of the pyruvate transporter MCT1 and lactate dehydrogenase A (LDHA), the enzyme catalyzing label exchange between pyruvate and lactate. Analysis of approximately 2,000 breast tumors showed that overexpression of LDHA and the hypoxia marker CAIX was associated with reduced relapse-free and overall survival. Hyperpolarized 13C-MRI represents a promising method for monitoring very early treatment response in breast cancer and has demonstrated prognostic potential. SIGNIFICANCE: Hyperpolarized carbon-13 MRI allows response assessment in patients with breast cancer after 7-11 days of neoadjuvant chemotherapy and outperformed state-of-the-art and research quantitative proton MRI techniques.
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Affiliation(s)
- Ramona Woitek
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
| | - Stephan Ursprung
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Oscar M Rueda
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Raquel Manzano Garcia
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
| | - Matthew J Locke
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Lucian Beer
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gabrielle Baxter
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Leonardo Rundo
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Elena Provenzano
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Oncology, Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Joshua Kaggie
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Andrew Patterson
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Amy Frary
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Johanna Field-Rayner
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Vasiliki Papalouka
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Justine Kane
- Department of Oncology, Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Arnold J V Benjamin
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Andrew B Gill
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Andrew N Priest
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - David Y Lewis
- Molecular Imaging Laboratory Cancer Research UK Beatson Institute, Glasgow, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Roslin Russell
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
| | - Ashley Grimmer
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Brian White
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Beth Latimer-Bowman
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Ilse Patterson
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Amy Schiller
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Bruno Carmo
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rhys Slough
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - James Wason
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | - Suet-Feung Chin
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Fiona J Gilbert
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jean E Abraham
- Department of Oncology, Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
- Department of Oncology, Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Evis Sala
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ferdia A Gallagher
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom.
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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15
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Kaggie JD, Lanz T, McLean MA, Riemer F, Schulte RF, Benjamin AJV, Kessler DA, Sun C, Gilbert FJ, Graves MJ, Gallagher FA. Combined 23 Na and 13 C imaging at 3.0 Tesla using a single-tuned large FOV birdcage coil. Magn Reson Med 2021; 86:1734-1745. [PMID: 33934383 DOI: 10.1002/mrm.28772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/07/2021] [Accepted: 02/24/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE An unmet need in carbon-13 (13 C)-MRI is a transmit system that provides uniform excitation across a large FOV and can accommodate patients of wide-ranging body habitus. Due to the small difference between the resonant frequencies, sodium-23 (23 Na) coil developments can inform 13 C coil design while being simpler to assess due to the higher naturally abundant 23 Na signal. Here we present a removable 23 Na birdcage, which also allows operation as a 13 C abdominal coil. METHODS We demonstrate a quadrature-driven 4-rung 23 Na birdcage coil of 50 cm in length for both 23 Na and 13 C abdominal imaging. The coil transmit efficiencies and B 1 + maps were compared to a linearly driven 13 C Helmholtz-based (clamshell) coil. SNR was investigated with 23 Na and 13 C data using an 8-channel 13 C receive array within the 23 Na birdcage. RESULTS The 23 Na birdcage longitudinal FOV was > 40 cm, whereas the 13 C clamshell was < 32 cm. The transmit efficiency of the birdcage at the 23 Na frequency was 0.65 µT/sqrt(W), similar to the clamshell for 13 C. However, the coefficient of variation of 23 Na- B 1 + was 16%, nearly half that with the 13 C clamshell. The 8-channel 13 C receive array combined with the 23 Na birdcage coil generated a greater than twofold increase in 23 Na-SNR from the central abdomen compared with the birdcage alone. DISCUSSION This 23 Na birdcage coil has a larger FOV and improved B 1 + uniformity when compared to the widely used clamshell coil design while also providing similar transmit efficiency. The coil has the potential to be used for both 23 Na and 13 C imaging.
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Affiliation(s)
- Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
| | | | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
| | - Frank Riemer
- Mohn Medical Imaging and Visualisation Centre (MMIV), Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | | | - Arnold J V Benjamin
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
| | - Dimitri A Kessler
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Chang Sun
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
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16
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Lau D, McLean MA, Priest AN, Gill AB, Scott F, Patterson I, Carmo B, Riemer F, Kaggie JD, Frary A, Milne D, Booth C, Lewis A, Sulikowski M, Brown L, Lapointe JM, Aloj L, Graves MJ, Brindle KM, Corrie PG, Gallagher FA. Multiparametric MRI of early tumor response to immune checkpoint blockade in metastatic melanoma. J Immunother Cancer 2021; 9:e003125. [PMID: 34561275 PMCID: PMC8475139 DOI: 10.1136/jitc-2021-003125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors are now standard of care treatment for many cancers. Treatment failure in metastatic melanoma is often due to tumor heterogeneity, which is not easily captured by conventional CT or tumor biopsy. The aim of this prospective study was to investigate early microstructural and functional changes within melanoma metastases following immune checkpoint blockade using multiparametric MRI. METHODS Fifteen treatment-naïve metastatic melanoma patients (total 27 measurable target lesions) were imaged at baseline and following 3 and 12 weeks of treatment on immune checkpoint inhibitors using: T2-weighted imaging, diffusion kurtosis imaging, and dynamic contrast-enhanced MRI. Treatment timepoint changes in tumor cellularity, vascularity, and heterogeneity within individual metastases were evaluated and correlated to the clinical outcome in each patient based on Response Evaluation Criteria in Solid Tumors V.1.1 at 1 year. RESULTS Differential tumor growth kinetics in response to immune checkpoint blockade were measured in individual metastases within the same patient, demonstrating significant intertumoral heterogeneity in some patients. Early detection of tumor cell death or cell loss measured by a significant increase in the apparent diffusivity (Dapp) (p<0.05) was observed in both responding and pseudoprogressive lesions after 3 weeks of treatment. Tumor heterogeneity, as measured by apparent diffusional kurtosis (Kapp), was consistently higher in the pseudoprogressive and true progressive lesions, compared with the responding lesions throughout the first 12 weeks of treatment. These preceded tumor regression and significant tumor vascularity changes (Ktrans, ve, and vp) detected after 12 weeks of immunotherapy (p<0.05). CONCLUSIONS Multiparametric MRI demonstrated potential for early detection of successful response to immune checkpoint inhibitors in metastatic melanoma.
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Affiliation(s)
- Doreen Lau
- Department of Radiology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Andrew N Priest
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew B Gill
- Department of Radiology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Francis Scott
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Ilse Patterson
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Bruno Carmo
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Amy Frary
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Doreen Milne
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Catherine Booth
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Arthur Lewis
- Clinical Pharmacology & Safety Sciences, AstraZeneca PLC, Cambridge, Cambridgeshire, UK
| | - Michal Sulikowski
- Clinical Pharmacology & Safety Sciences, AstraZeneca PLC, Cambridge, Cambridgeshire, UK
| | - Lee Brown
- Clinical Pharmacology & Safety Sciences, AstraZeneca PLC, Cambridge, Cambridgeshire, UK
| | - Jean-Martin Lapointe
- Clinical Pharmacology & Safety Sciences, AstraZeneca PLC, Cambridge, Cambridgeshire, UK
| | - Luigi Aloj
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin M Brindle
- Cancer Research UK Cambridge Research Institute, Cambridge, UK
| | - Pippa G Corrie
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
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17
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McLean MA, Hinks RS, Kaggie JD, Woitek R, Riemer F, Graves MJ, McIntyre DJO, Gallagher FA, Schulte RF. Characterization and correction of center-frequency effects in X-nuclear eddy current compensations on a clinical MR system. Magn Reson Med 2021; 85:2370-2376. [PMID: 33274790 PMCID: PMC7898706 DOI: 10.1002/mrm.28607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of the study was to investigate whether incorrectly compensated eddy currents are the source of persistent X-nuclear spectroscopy and imaging artifacts, as well as methods to correct this. METHODS Pulse-acquire spectra were collected for 1 H and X-nuclei (23 Na or 31 P) using the minimum TR permitted on a 3T clinical MRI system. Data were collected in 3 orientations (axial, sagittal, and coronal) with the spoiler gradient at the end of the TR applied along the slice direction for each. Modifications to system calibration files to tailor eddy current compensation for each X-nucleus were developed and applied, and data were compared with and without these corrections for: slice-selective MRS (for 23 Na and 31 P), 2D spiral trajectories (for 13 C), and 3D cones trajectories (for 23 Na). RESULTS Line-shape distortions characteristic of eddy currents were demonstrated for X-nuclei, which were not seen for 1 H. The severity of these correlated with the amplitude of the eddy current frequency compensation term applied by the system along the axis of the applied spoiler gradient. A proposed correction to eddy current compensation, taking account of the gyromagnetic ratio, was shown to dramatically reduce these distortions. The same correction was also shown to improve data quality of non-Cartesian imaging (2D spiral and 3D cones trajectories). CONCLUSION A simple adaptation of the default compensation for eddy currents was shown to eliminate a range of artifacts detected on X-nuclear spectroscopy and imaging.
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Affiliation(s)
- Mary A. McLean
- Department of RadiologyUniversity of CambridgeCambridgeUnited Kingdom
- Cancer Research UK Cambridge InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | | | - Joshua D. Kaggie
- Department of RadiologyUniversity of CambridgeCambridgeUnited Kingdom
| | - Ramona Woitek
- Department of RadiologyUniversity of CambridgeCambridgeUnited Kingdom
| | - Frank Riemer
- MMIV, Department of RadiologyHaukeland University HospitalBergenNorway
| | - Martin J. Graves
- Department of RadiologyUniversity of CambridgeCambridgeUnited Kingdom
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18
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Maiter A, Riemer F, Allinson K, Zaccagna F, Crispin-Ortuzar M, Gehrung M, McLean MA, Priest AN, Grist J, Matys T, Graves MJ, Gallagher FA. Investigating the relationship between diffusion kurtosis tensor imaging (DKTI) and histology within the normal human brain. Sci Rep 2021; 11:8857. [PMID: 33893338 PMCID: PMC8065051 DOI: 10.1038/s41598-021-87857-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/26/2021] [Indexed: 01/13/2023] Open
Abstract
Measurements of water diffusion with MRI have been used as a biomarker of tissue microstructure and heterogeneity. In this study, diffusion kurtosis tensor imaging (DKTI) of the brain was undertaken in 10 healthy volunteers at a clinical field strength of 3 T. Diffusion and kurtosis metrics were measured in regions-of-interest on the resulting maps and compared with quantitative analysis of normal post-mortem tissue histology from separate age-matched donors. White matter regions showed low diffusion (0.60 ± 0.04 × 10-3 mm2/s) and high kurtosis (1.17 ± 0.06), consistent with a structured heterogeneous environment comprising parallel neuronal fibres. Grey matter showed intermediate diffusion (0.80 ± 0.02 × 10-3 mm2/s) and kurtosis (0.82 ± 0.05) values. An important finding is that the subcortical regions investigated (thalamus, caudate and putamen) showed similar diffusion and kurtosis properties to white matter. Histological staining of the subcortical nuclei demonstrated that the predominant grey matter was permeated by small white matter bundles, which could account for the similar kurtosis to white matter. Quantitative histological analysis demonstrated higher mean tissue kurtosis and vector standard deviation values for white matter (1.08 and 0.81) compared to the subcortical regions (0.34 and 0.59). Mean diffusion on DKTI was positively correlated with tissue kurtosis (r = 0.82, p < 0.05) and negatively correlated with vector standard deviation (r = -0.69, p < 0.05). This study demonstrates how DKTI can be used to study regional structural variations in the cerebral tissue microenvironment and could be used to probe microstructural changes within diseased tissue in the future.
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Affiliation(s)
- Ahmed Maiter
- Department of Radiology, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Frank Riemer
- Department of Radiology, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- MMIV, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Kieren Allinson
- Department of Pathology, Addenbrooke's Hospital NHS Foundation Trust, Cambridge, UK
| | - Fulvio Zaccagna
- Department of Radiology, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | | | - Marcel Gehrung
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Grist
- Department of Radiology, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Tomasz Matys
- Department of Radiology, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK.
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Grist JT, Riemer F, Hansen ESS, Tougaard RS, McLean MA, Kaggie J, Bøgh N, Graves MJ, Gallagher FA, Laustsen C. Visualization of sodium dynamics in the kidney by magnetic resonance imaging in a multi-site study. Kidney Int 2020; 98:1174-1178. [PMID: 32585166 PMCID: PMC7652549 DOI: 10.1016/j.kint.2020.04.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 12/23/2022]
Abstract
Sodium magnetic resonance imaging (MRI) is a powerful, non-invasive technique to assess sodium distribution within the kidney. Here we undertook pre-clinical and clinical studies to quantify the corticomedullary sodium gradient in healthy individuals and in a porcine model of diuresis. The results demonstrated that sodium MRI could detect spatial differences in sodium biodistribution across the kidney. The sodium gradient of the kidney changed significantly after diuresis in the pig model and was independent of blood electrolyte measurements. Thus, rapid sodium MRI can be used to dynamically quantify sodium biodistribution in the porcine and human kidney.
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Affiliation(s)
- James T Grist
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Esben S S Hansen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rasmus S Tougaard
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge, UK; Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Joshua Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Nikolaj Bøgh
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin J Graves
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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20
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Serrao EM, Kessler DA, Carmo B, Beer L, Brindle KM, Buonincontri G, Gallagher FA, Gilbert FJ, Godfrey E, Graves MJ, McLean MA, Sala E, Schulte RF, Kaggie JD. Magnetic resonance fingerprinting of the pancreas at 1.5 T and 3.0 T. Sci Rep 2020; 10:17563. [PMID: 33067515 PMCID: PMC7567885 DOI: 10.1038/s41598-020-74462-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Abstract
Magnetic resonance imaging of the pancreas is increasingly used as an important diagnostic modality for characterisation of pancreatic lesions. Pancreatic MRI protocols are mostly qualitative due to time constraints and motion sensitivity. MR Fingerprinting is an innovative acquisition technique that provides qualitative data and quantitative parameter maps from a single free-breathing acquisition with the potential to reduce exam times. This work investigates the feasibility of MRF parameter mapping for pancreatic imaging in the presence of free-breathing exam. Sixteen healthy participants were prospectively imaged using MRF framework. Regions-of-interest were drawn in multiple solid organs including the pancreas and T1 and T2 values determined. MRF T1 and T2 mapping was performed successfully in all participants (acquisition time:2.4-3.6 min). Mean pancreatic T1 values were 37-43% lower than those of the muscle, spleen, and kidney at both 1.5 and 3.0 T. For these organs, the mean pancreatic T2 values were nearly 40% at 1.5 T and < 12% at 3.0 T. The feasibility of MRF at 1.5 T and 3 T was demonstrated in the pancreas. By enabling fast and free-breathing quantitation, MRF has the potential to add value during the clinical characterisation and grading of pathological conditions, such as pancreatitis or cancer.
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Affiliation(s)
- Eva M Serrao
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cancer Research UK, Cambridge, UK
| | - Dimitri A Kessler
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Bruno Carmo
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lucian Beer
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cancer Research UK, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cancer Research UK, Cambridge, UK
| | - Edmund Godfrey
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cancer Research UK, Cambridge, UK
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cancer Research UK, Cambridge, UK
| | | | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK.
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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21
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Grist JT, Hansen ES, Sánchez‐Heredia JD, McLean MA, Tougaard R, Riemer F, Schulte RF, Kaggie JD, Ardenkjaer‐Larsen JH, Laustsen C, Gallagher FA. Creating a clinical platform for carbon-13 studies using the sodium-23 and proton resonances. Magn Reson Med 2020; 84:1817-1827. [PMID: 32167199 PMCID: PMC8638662 DOI: 10.1002/mrm.28238] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Calibration of hyperpolarized 13 C-MRI is limited by the low signal from endogenous carbon-containing molecules and consequently requires 13 C-enriched external phantoms. This study investigated the feasibility of using either 23 Na-MRI or 1 H-MRI to calibrate the 13 C excitation. METHODS Commercial 13 C-coils were used to estimate the transmit gain and center frequency for 13 C and 23 Na resonances. Simulations of the transmit B1 profile of a Helmholtz loop were performed. Noise correlation was measured for both nuclei. A retrospective analysis of human data assessing the use of the 1 H resonance to predict [1-13 C]pyruvate center frequency was also performed. In vivo experiments were undertaken in the lower limbs of 6 pigs following injection of hyperpolarized 13 C-pyruvate. RESULTS The difference in center frequencies and transmit gain between tissue 23 Na and [1-13 C]pyruvate was reproducible, with a mean scale factor of 1.05179 ± 0.00001 and 10.4 ± 0.2 dB, respectively. Utilizing the 1 H water peak, it was possible to retrospectively predict the 13 C-pyruvate center frequency with a standard deviation of only 11 Hz sufficient for spectral-spatial excitation-based studies. CONCLUSION We demonstrate the feasibility of using the 23 Na and 1 H resonances to calibrate the 13 C transmit B1 using commercially available 13 C-coils. The method provides a simple approach for in vivo calibration and could improve clinical workflow.
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Affiliation(s)
- James T. Grist
- Department of RadiologyUniversity of CambridgeCambridgeUnited Kingdom
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUnited Kingdom
| | | | | | - Mary A. McLean
- Department of RadiologyUniversity of CambridgeCambridgeUnited Kingdom
- CRUKCambridge InstituteCambridgeUnited Kingdom
| | | | - Frank Riemer
- Department of RadiologyUniversity of CambridgeCambridgeUnited Kingdom
| | | | - Joshua D. Kaggie
- Department of RadiologyUniversity of CambridgeCambridgeUnited Kingdom
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Sánchez-Heredia JD, Olin RB, McLean MA, Laustsen C, Hansen AE, Hanson LG, Ardenkjær-Larsen JH. Multi-site benchmarking of clinical 13C RF coils at 3T. J Magn Reson 2020; 318:106798. [PMID: 32755748 PMCID: PMC7501735 DOI: 10.1016/j.jmr.2020.106798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 05/06/2023]
Abstract
A quality assurance protocol for RF coils is proposed, which can be used for volume (Tx/Rx) and surface (Rx) coils. Following this protocol, a benchmarking of seven coils (from three different MR sites) dedicated to 13C MRI at 3T is reported. Coil performance is particularly important for 3T MRI at the 13C frequency, since the coil-to-sample noise ratio is typically high. The coils are evaluated experimentally using the proposed protocol based on MR spectroscopic imaging performed with two different phantoms: one head-shaped, and one with cylindrical shape and nearly twice the volume of the first one. To achieve an unbiased SNR comparison of volume and array coils, coil combination was done using sensitivity profiles extracted from the data. SNR, noise correlation matrices and example g-factor maps are reported. For globally calibrated, equal excitation angles, the measured SNR shows large differences for the volume coils of up to 115% at the phantom center for a head phantom. The arrays show lower differences in superficial SNR. The sample surface depth at which the volume coils outperform the arrays is estimated to 7 cm, and SNR furthest away from the coil surface is 28% lower for the best array compared to the best volume coil. A broad set of coils for 13C at 3T have been benchmarked. The results reported, and the method used to benchmark them, should guide the 13C community to choose the most suitable coil for a given experiment.
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Affiliation(s)
| | - Rie B Olin
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars G Hanson
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Jan Henrik Ardenkjær-Larsen
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark; GE Healthcare, Brøndby, Denmark.
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23
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Woitek R, McLean MA, Gill AB, Grist JT, Provenzano E, Patterson AJ, Ursprung S, Torheim T, Zaccagna F, Locke M, Laurent MC, Hilborne S, Frary A, Beer L, Rundo L, Patterson I, Slough R, Kane J, Biggs H, Harrison E, Lanz T, Basu B, Baird R, Sala E, Graves MJ, Gilbert FJ, Abraham JE, Caldas C, Brindle KM, Gallagher FA. Hyperpolarized 13C MRI of Tumor Metabolism Demonstrates Early Metabolic Response to Neoadjuvant Chemotherapy in Breast Cancer. Radiol Imaging Cancer 2020; 2:e200017. [PMID: 32803167 PMCID: PMC7398116 DOI: 10.1148/rycan.2020200017] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/24/2020] [Accepted: 04/15/2020] [Indexed: 04/12/2023]
Abstract
Purpose To compare hyperpolarized carbon 13 (13C) MRI with dynamic contrast material-enhanced (DCE) MRI in the detection of early treatment response in breast cancer. Materials and Methods In this institutional review board-approved prospective study, a woman with triple-negative breast cancer (age, 49 years) underwent 13C MRI after injection of hyperpolarized [1-carbon 13 {13C}]-pyruvate and DCE MRI at 3 T at baseline and after one cycle of neoadjuvant therapy. The 13C-labeled lactate-to-pyruvate ratio derived from hyperpolarized 13C MRI and the pharmacokinetic parameters transfer constant (K trans) and washout parameter (k ep) derived from DCE MRI were compared before and after treatment. Results Exchange of the 13C label between injected hyperpolarized [1-13C]-pyruvate and the endogenous lactate pool was observed, catalyzed by the enzyme lactate dehydrogenase. After one cycle of neoadjuvant chemotherapy, a 34% reduction in the 13C-labeled lactate-to-pyruvate ratio resulted in correct identification of the patient as a responder to therapy, which was subsequently confirmed via a complete pathologic response. However, DCE MRI showed an increase in mean K trans (132%) and mean k ep (31%), which could be incorrectly interpreted as a poor response to treatment. Conclusion Hyperpolarized 13C MRI enabled successful identification of breast cancer response after one cycle of neoadjuvant chemotherapy and may improve response prediction when used in conjunction with multiparametric proton MRI.Published under a CC BY 4.0 license.
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Affiliation(s)
- Ramona Woitek
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Mary A. McLean
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Andrew B. Gill
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - James T. Grist
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Elena Provenzano
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Andrew J. Patterson
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Stephan Ursprung
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Turid Torheim
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Fulvio Zaccagna
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Matthew Locke
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Marie-Christine Laurent
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Sarah Hilborne
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Amy Frary
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Lucian Beer
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Leonardo Rundo
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Ilse Patterson
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Rhys Slough
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Justine Kane
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Heather Biggs
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Emma Harrison
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Titus Lanz
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Bristi Basu
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Richard Baird
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Evis Sala
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Martin J. Graves
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Fiona J. Gilbert
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Jean E. Abraham
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Carlos Caldas
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Kevin M. Brindle
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
| | - Ferdia A. Gallagher
- From the Departments of Radiology (R.W., A.B.G., J.T.G., A.J.P., S.U., F.Z., M.L., M.C.L., S.H., A.F., L.B., L.R., E.S., M.J.G., F.J.G., F.A.G.), Oncology (J.K., H.B., E.H., B.B., R.B., J.E.A., C.C.), and Biochemistry (K.M.B.), the Cambridge Breast Cancer Research Unit (E.P., J.K., H.B., E.H., R.B., J.E.A., C.C.), University of Cambridge, Cambridge, England; Departments of Radiology (A.J.P., I.P., R.S., M.J.G., F.J.G., F.A.G.) and Histopathology (E.P.), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England; Cancer Research UK Cambridge Centre, Cambridge, England (R.W., M.A.M., E.P., T.T., L.B., L.R., E.S., J.E.A., C.C., K.M.B., F.A.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria (R.W., L.B.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., T.T., C.C., K.M.B.); and RAPID Biomedical, Rimpar, Germany (T.L.)
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24
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Grist JT, Miller JJ, Zaccagna F, McLean MA, Riemer F, Matys T, Tyler DJ, Laustsen C, Coles AJ, Gallagher FA. Hyperpolarized 13C MRI: A novel approach for probing cerebral metabolism in health and neurological disease. J Cereb Blood Flow Metab 2020; 40:1137-1147. [PMID: 32153235 PMCID: PMC7238376 DOI: 10.1177/0271678x20909045] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 12/13/2022]
Abstract
Cerebral metabolism is tightly regulated and fundamental for healthy neurological function. There is increasing evidence that alterations in this metabolism may be a precursor and early biomarker of later stage disease processes. Proton magnetic resonance spectroscopy (1H-MRS) is a powerful tool to non-invasively assess tissue metabolites and has many applications for studying the normal and diseased brain. However, the technique has limitations including low spatial and temporal resolution, difficulties in discriminating overlapping peaks, and challenges in assessing metabolic flux rather than steady-state concentrations. Hyperpolarized carbon-13 magnetic resonance imaging is an emerging clinical technique that may overcome some of these spatial and temporal limitations, providing novel insights into neurometabolism in both health and in pathological processes such as glioma, stroke and multiple sclerosis. This review will explore the growing body of pre-clinical data that demonstrates a potential role for the technique in assessing metabolism in the central nervous system. There are now a number of clinical studies being undertaken in this area and this review will present the emerging clinical data as well as the potential future applications of hyperpolarized 13C magnetic resonance imaging in the brain, in both clinical and pre-clinical studies.
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Affiliation(s)
- James T Grist
- Institute of Cancer and Genomic Sciences, University of
Birmingham, Birmingham, UK
- Department of Radiology, University of Cambridge, Cambridge,
UK
| | - Jack J Miller
- Department of Physiology, Anatomy, and Genetics, University of
Oxford, Oxford, UK
- Department of Physics, Clarendon Laboratory, University of
Oxford, Oxford, UK
- Oxford Centre for Clinical Magnetic Resonance Research, John
Radcliffe Hospital, Oxford, UK
| | - Fulvio Zaccagna
- Department of Radiology, University of Cambridge, Cambridge,
UK
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge,
UK
- CRUK Cambridge Institute, Cambridge, UK
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge,
UK
| | - Tomasz Matys
- Department of Radiology, University of Cambridge, Cambridge,
UK
| | - Damian J Tyler
- Department of Physiology, Anatomy, and Genetics, University of
Oxford, Oxford, UK
- Oxford Centre for Clinical Magnetic Resonance Research, John
Radcliffe Hospital, Oxford, UK
| | | | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge,
Cambridge, UK
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25
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Gallagher FA, Woitek R, McLean MA, Gill AB, Manzano Garcia R, Provenzano E, Riemer F, Kaggie J, Chhabra A, Ursprung S, Grist JT, Daniels CJ, Zaccagna F, Laurent MC, Locke M, Hilborne S, Frary A, Torheim T, Boursnell C, Schiller A, Patterson I, Slough R, Carmo B, Kane J, Biggs H, Harrison E, Deen SS, Patterson A, Lanz T, Kingsbury Z, Ross M, Basu B, Baird R, Lomas DJ, Sala E, Wason J, Rueda OM, Chin SF, Wilkinson IB, Graves MJ, Abraham JE, Gilbert FJ, Caldas C, Brindle KM. Imaging breast cancer using hyperpolarized carbon-13 MRI. Proc Natl Acad Sci U S A 2020; 117:2092-2098. [PMID: 31964840 PMCID: PMC6995024 DOI: 10.1073/pnas.1913841117] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Our purpose is to investigate the feasibility of imaging tumor metabolism in breast cancer patients using 13C magnetic resonance spectroscopic imaging (MRSI) of hyperpolarized 13C label exchange between injected [1-13C]pyruvate and the endogenous tumor lactate pool. Treatment-naïve breast cancer patients were recruited: four triple-negative grade 3 cancers; two invasive ductal carcinomas that were estrogen and progesterone receptor-positive (ER/PR+) and HER2/neu-negative (HER2-), one grade 2 and one grade 3; and one grade 2 ER/PR+ HER2- invasive lobular carcinoma (ILC). Dynamic 13C MRSI was performed following injection of hyperpolarized [1-13C]pyruvate. Expression of lactate dehydrogenase A (LDHA), which catalyzes 13C label exchange between pyruvate and lactate, hypoxia-inducible factor-1 (HIF1α), and the monocarboxylate transporters MCT1 and MCT4 were quantified using immunohistochemistry and RNA sequencing. We have demonstrated the feasibility and safety of hyperpolarized 13C MRI in early breast cancer. Both intertumoral and intratumoral heterogeneity of the hyperpolarized pyruvate and lactate signals were observed. The lactate-to-pyruvate signal ratio (LAC/PYR) ranged from 0.021 to 0.473 across the tumor subtypes (mean ± SD: 0.145 ± 0.164), and a lactate signal was observed in all of the grade 3 tumors. The LAC/PYR was significantly correlated with tumor volume (R = 0.903, P = 0.005) and MCT 1 (R = 0.85, P = 0.032) and HIF1α expression (R = 0.83, P = 0.043). Imaging of hyperpolarized [1-13C]pyruvate metabolism in breast cancer is feasible and demonstrated significant intertumoral and intratumoral metabolic heterogeneity, where lactate labeling correlated with MCT1 expression and hypoxia.
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Affiliation(s)
- Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - Ramona Woitek
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom;
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - Andrew B Gill
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Raquel Manzano Garcia
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - Elena Provenzano
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospital National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Joshua Kaggie
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Anita Chhabra
- Pharmacy Department, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Stephan Ursprung
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - James T Grist
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Charlie J Daniels
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Fulvio Zaccagna
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | | | - Matthew Locke
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Sarah Hilborne
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Amy Frary
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Turid Torheim
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - Chris Boursnell
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - Amy Schiller
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Ilse Patterson
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Rhys Slough
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Bruno Carmo
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Justine Kane
- Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospital National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Heather Biggs
- Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospital National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Emma Harrison
- Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospital National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Surrin S Deen
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Andrew Patterson
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Titus Lanz
- RAPID Biomedical GmbH, 97222 Rimpar, Germany
| | - Zoya Kingsbury
- Medical Genomics Research, Illumina, Great Abington, Cambridge CB21 6DF, United Kingdom
| | - Mark Ross
- Medical Genomics Research, Illumina, Great Abington, Cambridge CB21 6DF, United Kingdom
| | - Bristi Basu
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Department of Oncology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Richard Baird
- Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospital National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - David J Lomas
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - James Wason
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne NE2 4AX, United Kingdom
| | - Oscar M Rueda
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - Suet-Feung Chin
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - Ian B Wilkinson
- Department of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Jean E Abraham
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospital National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Department of Oncology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
| | - Carlos Caldas
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cambridge Breast Cancer Research Unit, Addenbrooke's Hospital, Cambridge University Hospital National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Department of Oncology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Kevin M Brindle
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom
- Department of Biochemistry, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
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Casey RT, McLean MA, Challis BG, McVeigh TP, Warren AY, Mendil L, Houghton R, De Sanctis S, Kosmoliaptsis V, Sandford RN, Gallagher FA, Maher ER. Fumarate Metabolic Signature for the Detection of Reed Syndrome in Humans. Clin Cancer Res 2020; 26:391-396. [PMID: 31636096 DOI: 10.1158/1078-0432.ccr-19-1729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/30/2019] [Accepted: 10/11/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Inherited pathogenic variants in genes encoding the metabolic enzymes succinate dehydrogenase (SDH) and fumarate hydratase predispose to tumor development through accumulation of oncometabolites (succinate and fumarate, respectively; ref. 1). Noninvasive in vivo detection of tumor succinate by proton magnetic resonance spectroscopy (1H-MRS) has been reported in SDH-deficient tumors, but the potential utility of this approach in the management of patients with hereditary leiomyomatosis and renal cell cancer syndrome or Reed syndrome is unknown. EXPERIMENTAL DESIGN Magnetic resonance spectroscopy (1H-MRS) was performed on three cases and correlated with germline genetic results and tumor IHC when available. RESULTS Here, we have demonstrated a proof of principle that 1H-MRS can provide a noninvasive diagnosis of hereditary leiomyomatosis and renal cell cancer syndrome or Reed syndrome through detection of fumarate accumulation in vivo. CONCLUSIONS This study demonstrates that in vivo detection of fumarate could be employed as a functional biomarker.
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Affiliation(s)
- Ruth T Casey
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre, Cambridge, United Kingdom.
- Department of Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, United Kingdom
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Benjamin G Challis
- Department of Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, United Kingdom
| | - Terri P McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anne Y Warren
- Department of Histopathology, Cambridge University NHS Foundation Trust and Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Lee Mendil
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Richard Houghton
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Stefano De Sanctis
- Department of Histopathology, Cambridge University NHS Foundation Trust and Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Richard N Sandford
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Ferdia A Gallagher
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
- Department of Radiology, Cambridge University NHS Foundation Trust, Cambridge, United Kingdom
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
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Barrett T, Riemer F, McLean MA, Kaggie JD, Robb F, Warren AY, Graves MJ, Gallagher FA. Molecular imaging of the prostate: Comparing total sodium concentration quantification in prostate cancer and normal tissue using dedicated 13 C and 23 Na endorectal coils. J Magn Reson Imaging 2020; 51:90-97. [PMID: 31081564 DOI: 10.1002/jmri.26788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/30/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There has been recent interest in nonproton MRI including hyperpolarized carbon-13 (13 C) imaging. Prostate cancer has been shown to have a higher tissue sodium concentration (TSC) than normal tissue. Sodium (23 Na) and 13 C nuclei have a frequency difference of only 1.66 MHz at 3T, potentially enabling 23 Na imaging with a 13 C-tuned coil and maximizing the metabolic information obtained from a single study. PURPOSE To compare TSC measurements from a 13 C-tuned endorectal coil to those quantified with a dedicated 23 Na-tuned coil. STUDY TYPE Prospective. POPULATION Eight patients with biopsy-proven, intermediate/high risk prostate cancer imaged prior to prostatectomy. SEQUENCE 3T MRI with separate dual-tuned 1 H/23 Na and 1 H/13 C endorectal receive coils to quantify TSC. ASSESSMENT Regions-of-interest for TSC quantification were defined for normal peripheral zone (PZ), normal transition zone (TZ), and tumor, with reference to histopathology maps. STATISTICAL TESTS Two-sided Wilcoxon rank sum with additional measures of correlation, coefficient of variation, and Bland-Altman plots to assess for between-test differences. RESULTS Mean TSC for normal PZ and TZ were 39.2 and 33.9 mM, respectively, with the 23 Na coil and 40.1 and 36.3 mM, respectively, with the 13 C coil (P = 0.22 and P = 0.11 for the intercoil comparison, respectively). For tumor tissue, there was no statistical difference between the overall mean tumor TSC measured with the 23 Na coil (41.8 mM) and with the 13 C coil (46.6 mM; P = 0.38). Bland-Altman plots showed good repeatability for tumor TSC measurements between coils, with a reproducibility coefficient of 9 mM; the coefficient of variation between the coils was 12%. The Pearson correlation coefficient for TSC between coils for all measurements was r = 0.71 (r2 = 0.51), indicating a strong positive linear relationship. The mean TSC within PZ tumors was significantly higher compared with normal PZ for both the 23 Na coil (45.4 mM; P = 0.02) and the 13 C coil (49.4 mM; P = 0.002). DATA CONCLUSION We demonstrated the feasibility of using a carbon-tuned coil to quantify TSC, enabling dual metabolic information from a single coil. This approach could make the acquisition of both 23 Na-MRI and 13 C-MRI feasible in a single clinical imaging session. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:90-97.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Anne Y Warren
- Department of Histopathology, Cambridge University Hospitals and University of Cambridge, Cambridge, UK
| | - Martin J Graves
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
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Riemer F, McHugh D, Zaccagna F, Lewis D, McLean MA, Graves MJ, Gilbert FJ, Parker GJ, Gallagher FA. Measuring tissue sodium concentration: Cross-vendor repeatability and reproducibility of 23 Na-MRI across two sites. J Magn Reson Imaging 2019; 50:1278-1284. [PMID: 30859655 PMCID: PMC6767101 DOI: 10.1002/jmri.26705] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sodium MRI (23 Na-MRI)-derived biomarkers such as total sodium concentration (TSC) have the potential to provide information on tumor cellularity and the changes in tumor microstructure that occur following therapy. PURPOSE To evaluate the repeatability and reproducibility of TSC measurements in the brains of healthy volunteers, providing evidence for the technical validation of 23 Na-MRI-derived biomarkers. STUDY TYPE Prospective multicenter study. SUBJECTS Eleven volunteers (32 ± 6 years; eight males, three females) were scanned twice at each of two sites. FIELD STRENGTH/SEQUENCE Comparable 3D-cones 23 Na-MRI ultrashort echo time acquisitions at 3T. ASSESSMENT TSC values, quantified from calibration phantoms placed in the field of view, were obtained from white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF), based on automated segmentation of coregistered 1 H T1 -weighted images and hand-drawn regions of interest by two readers. STATISTICAL TESTS Coefficients of variation (CoVs) from mean TSC values were used to assess intrasite repeatability and intersite reproducibility. RESULTS Mean GM TSC concentrations (52.1 ± 7.1 mM) were ∼20% higher than for WM (41.8 ± 6.7 mM). Measurements were highly repeatable at both sites with mean scan-rescan CoVs between volunteers and regions of 2% and 4%, respectively. Mean intersite reproducibility CoVs were 3%, 3%, and 6% for WM, GM, and CSF, respectively. DATA CONCLUSION These results demonstrate technical validation of sodium MRI-derived biomarkers in healthy volunteers. We also show that comparable 23 Na imaging of the brain can be implemented across different sites and scanners with excellent repeatability and reproducibility. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1278-1284.
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Affiliation(s)
- Frank Riemer
- Department of RadiologyUniversity of CambridgeCambridgeUK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge & ManchesterUK
| | - Damien McHugh
- CRUK & EPSRC Cancer Imaging Centre in Cambridge & ManchesterUK
- Division of Neuroscience & Experimental PsychologyThe University of ManchesterManchesterUK
| | - Fulvio Zaccagna
- Department of RadiologyUniversity of CambridgeCambridgeUK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge & ManchesterUK
| | - Daniel Lewis
- CRUK & EPSRC Cancer Imaging Centre in Cambridge & ManchesterUK
| | - Mary A. McLean
- Cancer Research UK Cambridge InstituteUniversity of CambridgeCambridgeUK
| | | | - Fiona J. Gilbert
- Department of RadiologyUniversity of CambridgeCambridgeUK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge & ManchesterUK
| | - Geoff J.M. Parker
- CRUK & EPSRC Cancer Imaging Centre in Cambridge & ManchesterUK
- Division of Neuroscience & Experimental PsychologyThe University of ManchesterManchesterUK
- Bioxydyn Ltd.ManchesterUK
| | - Ferdia A. Gallagher
- Department of RadiologyUniversity of CambridgeCambridgeUK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge & ManchesterUK
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Zaccagna F, Riemer F, Priest AN, McLean MA, Allinson K, Grist JT, Dragos C, Matys T, Gillard JH, Watts C, Price SJ, Graves MJ, Gallagher FA. Non-invasive assessment of glioma microstructure using VERDICT MRI: correlation with histology. Eur Radiol 2019; 29:5559-5566. [PMID: 30888488 PMCID: PMC6719328 DOI: 10.1007/s00330-019-6011-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE This prospective study evaluated the use of vascular, extracellular and restricted diffusion for cytometry in tumours (VERDICT) MRI to investigate the tissue microstructure in glioma. VERDICT-derived parameters were correlated with both histological features and tumour subtype and were also used to explore the peritumoural region. METHODS Fourteen consecutive treatment-naïve patients (43.5 years ± 15.1 years, six males, eight females) with suspected glioma underwent diffusion-weighted imaging including VERDICT modelling. Tumour cell radius and intracellular and combined extracellular/vascular volumes were estimated using a framework based on linearisation and convex optimisation. An experienced neuroradiologist outlined the peritumoural oedema, enhancing tumour and necrosis on T2-weighted imaging and contrast-enhanced T1-weighted imaging. The same regions of interest were applied to the co-registered VERDICT maps to calculate the microstructure parameters. Pathology sections were analysed with semi-automated software to measure cellularity and cell size. RESULTS VERDICT parameters were successfully calculated in all patients. The imaging-derived results showed a larger intracellular volume fraction in high-grade glioma compared to low-grade glioma (0.13 ± 0.07 vs. 0.08 ± 0.02, respectively; p = 0.05) and a trend towards a smaller extracellular/vascular volume fraction (0.88 ± 0.07 vs. 0.92 ± 0.04, respectively; p = 0.10). The conventional apparent diffusion coefficient was higher in low-grade gliomas compared to high-grade gliomas, but this difference was not statistically significant (1.22 ± 0.13 × 10-3 mm2/s vs. 0.98 ± 0.38 × 10-3 mm2/s, respectively; p = 0.18). CONCLUSION This feasibility study demonstrated that VERDICT MRI can be used to explore the tissue microstructure of glioma using an abbreviated protocol. The VERDICT parameters of tissue structure correlated with those derived on histology. The method shows promise as a potential test for diagnostic stratification and treatment response monitoring in the future. KEY POINTS • VERDICT MRI is an advanced diffusion technique which has been correlated with histopathological findings obtained at surgery from patients with glioma in this study. • The intracellular volume fraction measured with VERDICT was larger in high-grade tumours compared to that in low-grade tumours. • The results were complementary to measurements from conventional diffusion-weighted imaging, and the technique could be performed in a clinically feasible timescale.
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Affiliation(s)
- Fulvio Zaccagna
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Frank Riemer
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Andrew N Priest
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Kieren Allinson
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James T Grist
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Carmen Dragos
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tomasz Matys
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Jonathan H Gillard
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, Birmingham Brain Cancer Program, University of Birmingham, Birmingham, UK
| | - Stephen J Price
- Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Martin J Graves
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Ferdia A Gallagher
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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Li C, Wang S, Serra A, Torheim T, Yan JL, Boonzaier NR, Huang Y, Matys T, McLean MA, Markowetz F, Price SJ. Multi-parametric and multi-regional histogram analysis of MRI: modality integration reveals imaging phenotypes of glioblastoma. Eur Radiol 2019; 29:4718-4729. [PMID: 30707277 PMCID: PMC6682853 DOI: 10.1007/s00330-018-5984-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Integrating multiple imaging modalities is crucial for MRI data interpretation. The purpose of this study is to determine whether a previously proposed multi-view approach can effectively integrate the histogram features from multi-parametric MRI and whether the selected features can offer incremental prognostic values over clinical variables. METHODS Eighty newly-diagnosed glioblastoma patients underwent surgery and chemoradiotherapy. Histogram features of diffusion and perfusion imaging were extracted from contrast-enhancing (CE) and non-enhancing (NE) regions independently. An unsupervised patient clustering was performed by the multi-view approach. Kaplan-Meier and Cox proportional hazards regression analyses were performed to evaluate the relevance of patient clustering to survival. The metabolic signatures of patient clusters were compared using multi-voxel spectroscopy analysis. The prognostic values of histogram features were evaluated by survival and ROC curve analyses. RESULTS Two patient clusters were generated, consisting of 53 and 27 patients respectively. Cluster 2 demonstrated better overall survival (OS) (p = 0.007) and progression-free survival (PFS) (p < 0.001) than Cluster 1. Cluster 2 displayed lower N-acetylaspartate/creatine ratio in NE region (p = 0.040). A higher mean value of anisotropic diffusion in NE region was associated with worse OS (hazard ratio [HR] = 1.40, p = 0.020) and PFS (HR = 1.36, p = 0.031). The seven features selected by this approach showed significantly incremental value in predicting 12-month OS (p = 0.020) and PFS (p = 0.022). CONCLUSIONS The multi-view clustering method can provide an effective integration of multi-parametric MRI. The histogram features selected may be used as potential prognostic markers. KEY POINTS • Multi-parametric magnetic resonance imaging captures multi-faceted tumor physiology. • Contrast-enhancing and non-enhancing tumor regions represent different tumor components with distinct clinical relevance. • Multi-view data analysis offers a method which can effectively select and integrate multi-parametric and multi-regional imaging features.
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Affiliation(s)
- Chao Li
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167 Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
- Department of Neurosurgery, Shanghai General Hospital (originally named "Shanghai First People's Hospital"), Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- The Centre for Mathematical Imaging in Healthcare, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK.
| | - Shuo Wang
- The Centre for Mathematical Imaging in Healthcare, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Angela Serra
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Institute of Biosciences and Medical Technologies (BioMediTech), Tampere, Finland
- NeuRoNe Lab, DISA-MIS, University of Salerno, Fisciano, SA, Italy
| | - Turid Torheim
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge, UK
| | - Jiun-Lin Yan
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167 Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Natalie R Boonzaier
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167 Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Yuan Huang
- The Centre for Mathematical Imaging in Healthcare, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
| | - Tomasz Matys
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Florian Markowetz
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge, UK
| | - Stephen J Price
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167 Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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31
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Deen SS, Priest AN, McLean MA, Gill AB, Brodie C, Crawford R, Latimer J, Baldwin P, Earl HM, Parkinson C, Smith S, Hodgkin C, Patterson I, Addley H, Freeman S, Moyle P, Jimenez-Linan M, Graves MJ, Sala E, Brenton JD, Gallagher FA. Diffusion kurtosis MRI as a predictive biomarker of response to neoadjuvant chemotherapy in high grade serous ovarian cancer. Sci Rep 2019; 9:10742. [PMID: 31341212 PMCID: PMC6656714 DOI: 10.1038/s41598-019-47195-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023] Open
Abstract
This study assessed the feasibility of using diffusion kurtosis imaging (DKI) as a measure of tissue heterogeneity and proliferation to predict the response of high grade serous ovarian cancer (HGSOC) to neoadjuvant chemotherapy (NACT). Seventeen patients with HGSOC were imaged at 3 T and had biopsy samples taken prior to any treatment. The patients were divided into two groups: responders and non-responders based on Response Evaluation Criteria In Solid Tumours (RECIST) criteria. The following imaging metrics were calculated: apparent diffusion coefficient (ADC), apparent diffusion (Dapp) and apparent kurtosis (Kapp). Tumour cellularity and proliferation were quantified using histology and Ki-67 immunohistochemistry. Mean Kapp before therapy was higher in responders compared to non-responders: 0.69 ± 0.13 versus 0.51 ± 0.11 respectively, P = 0.02. Tumour cellularity correlated positively with Kapp (rho = 0.50, P = 0.04) and negatively with both ADC (rho = -0.72, P = 0.001) and Dapp (rho = -0.80, P < 0.001). Ki-67 expression correlated with Kapp (rho = 0.53, P = 0.03) but not with ADC or Dapp. In conclusion, Kapp was found to be a potential predictive biomarker of NACT response in HGSOC, which suggests that DKI is a promising clinical tool for use oncology and radiology that should be evaluated further in future larger studies.
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Affiliation(s)
- Surrin S Deen
- Department of Radiology, Box 218, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom.
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom.
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom.
| | - Andrew N Priest
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Andrew B Gill
- Department of Radiology, Box 218, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Cara Brodie
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Robin Crawford
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - John Latimer
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Peter Baldwin
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Helena M Earl
- Department of Radiology, Box 218, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Christine Parkinson
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Sarah Smith
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Charlotte Hodgkin
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Ilse Patterson
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Helen Addley
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Susan Freeman
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Penny Moyle
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Mercedes Jimenez-Linan
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Martin J Graves
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Evis Sala
- Department of Radiology, Box 218, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - James D Brenton
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Ferdia A Gallagher
- Department of Radiology, Box 218, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
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Buonincontri G, Biagi L, Retico A, Cecchi P, Cosottini M, Gallagher FA, Gómez PA, Graves MJ, McLean MA, Riemer F, Schulte RF, Tosetti M, Zaccagna F, Kaggie JD. Multi-site repeatability and reproducibility of MR fingerprinting of the healthy brain at 1.5 and 3.0 T. Neuroimage 2019; 195:362-372. [PMID: 30923028 DOI: 10.1016/j.neuroimage.2019.03.047] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/08/2019] [Accepted: 03/20/2019] [Indexed: 12/19/2022] Open
Abstract
Fully-quantitative MR imaging methods are useful for longitudinal characterization of disease and assessment of treatment efficacy. However, current quantitative MRI protocols have not been widely adopted in the clinic, mostly due to lengthy scan times. Magnetic Resonance Fingerprinting (MRF) is a new technique that can reconstruct multiple parametric maps from a single fast acquisition in the transient state of the MR signal. Due to the relative novelty of this technique, the repeatability and reproducibility of quantitative measurements obtained using MRF has not been extensively studied. Our study acquired test/retest data from the brains of nine healthy volunteers, each scanned on five MRI systems (two at 3.0 T and three at 1.5 T, all from a single vendor) located at two different centers. The pulse sequence and reconstruction algorithm were the same for all acquisitions. After registration of the MRF-derived M0, T1 and T2 maps to an anatomical atlas, coefficients-of-variation (CVs) were computed to assess test/retest repeatability and inter-site reproducibility in each voxel, while a General Linear Model (GLM) was used to determine the voxel-wise variability between all confounders, which included test/retest, subject, field strength and site. Our analysis demonstrated an excellent repeatability (CVs of 2-3% for T1, 5-8% for T2, 3% for normalized-M0) and a good reproducibility (CVs of 3-8% for T1, 8-14% for T2, 5% for normalized-M0) in grey and white matter.
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Affiliation(s)
- Guido Buonincontri
- IMAGO7 Foundation, Pisa, Italy; IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Laura Biagi
- IMAGO7 Foundation, Pisa, Italy; IRCCS Fondazione Stella Maris, Pisa, Italy
| | | | - Paolo Cecchi
- Department of Radiology, University of Pisa, Italy
| | | | | | - Pedro A Gómez
- Munich School of Bioengineering, Technical University of Munich, Germany
| | - Martin J Graves
- Department of Radiology, University of Cambridge, United Kingdom
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, United Kingdom
| | - Frank Riemer
- Department of Radiology, University of Cambridge, United Kingdom
| | | | - Michela Tosetti
- IMAGO7 Foundation, Pisa, Italy; IRCCS Fondazione Stella Maris, Pisa, Italy.
| | - Fulvio Zaccagna
- Department of Radiology, University of Cambridge, United Kingdom
| | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, United Kingdom
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Kaggie JD, Deen S, Kessler DA, McLean MA, Buonincontri G, Schulte RF, Addley H, Sala E, Brenton J, Graves MJ, Gallagher FA. Feasibility of Quantitative Magnetic Resonance Fingerprinting in Ovarian Tumors for T 1 and T 2 Mapping in a PET/MR Setting. IEEE Trans Radiat Plasma Med Sci 2019; 3:509-515. [PMID: 32066996 PMCID: PMC7025887 DOI: 10.1109/trpms.2019.2905366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Multiparametric magnetic resonance imaging (MRI) can be used to characterize many cancer subtypes including ovarian cancer. Quantitative mapping of MRI relaxation values, such as T 1 and T 2 mapping, is promising for improving tumor assessment beyond conventional qualitative T 1- and T 2-weighted images. However, quantitative MRI relaxation mapping methods often involve long scan times due to sequentially measuring many parameters. Magnetic resonance fingerprinting (MRF) is a new method that enables fast quantitative MRI by exploiting the transient signals caused by the variation of pseudorandom sequence parameters. These transient signals are then matched to a simulated dictionary of T 1 and T 2 values to create quantitative maps. The ability of MRF to simultaneously measure multiple parameters, could represent a new approach to characterizing cancer and assessing treatment response. This feasibility study investigates MRF for simultaneous T 1, T 2, and relative proton density (rPD) mapping using ovarian cancer as a model system.
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Affiliation(s)
- Joshua D. Kaggie
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, U.K.; Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, U.K
| | - Surrin Deen
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, U.K.; Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, U.K
| | - Dimitri A. Kessler
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, U.K.; Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, U.K
| | - Mary A. McLean
- Cancer Research U.K. Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, U.K
| | | | | | - Helen Addley
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, U.K.; Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, U.K
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, U.K.; Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, U.K.; Cancer Research U.K. Cambridge Institute, Cambridge CB2 0RE, U.K
| | - James Brenton
- Cancer Research U.K. Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, U.K
| | - Martin J. Graves
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, U.K.; Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, U.K
| | - Ferdia A. Gallagher
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, U.K.; Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, U.K
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Li C, Yan JL, Torheim T, McLean MA, Boonzaier NR, Zou J, Huang Y, Yuan J, van Dijken BRJ, Matys T, Markowetz F, Price SJ. Low perfusion compartments in glioblastoma quantified by advanced magnetic resonance imaging and correlated with patient survival. Radiother Oncol 2019; 134:17-24. [PMID: 31005212 PMCID: PMC6486398 DOI: 10.1016/j.radonc.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/10/2018] [Accepted: 01/09/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma exhibits profound intratumoral heterogeneity in perfusion. Particularly, low perfusion may induce treatment resistance. Thus, imaging approaches that define low perfusion compartments are crucial for clinical management. MATERIALS AND METHODS A total of 112 newly diagnosed glioblastoma patients were prospectively recruited for maximal safe resection. The apparent diffusion coefficient (ADC) and relative cerebral blood volume (rCBV) were calculated from diffusion and perfusion imaging, respectively. Based on the overlapping regions of lowest rCBV quartile (rCBVL) with the lowest ADC quartile (ADCL) and highest ADC quartile (ADCH) in each tumor, two low perfusion compartments (ADCH-rCBVL and ADCL-rCBVL) were identified for volumetric analysis. Lactate and macromolecule/lipid levels were determined from multivoxel MR spectroscopic imaging. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier's and multivariate Cox regression analyses, to evaluate the effects of compartment volume and lactate level on survival. RESULTS Two compartments displayed higher lactate and macromolecule/lipid levels compared to contralateral normal-appearing white matter (each P < 0.001). The proportion of the ADCL-rCBVL compartment in the contrast-enhancing tumor was associated with a larger infiltration on FLAIR (P < 0.001, rho = 0.42). The minimally invasive phenotype displayed a lower proportion of the ADCL-rCBVL compartment than the localized (P = 0.031) and diffuse phenotypes (not significant). Multivariate Cox regression showed higher lactate level in the ADCL-rCBVL compartment was associated with worsened survival (PFS: HR 2.995, P = 0.047; OS: HR 4.974, P = 0.005). CONCLUSIONS Our results suggest that the ADCL-rCBVL compartment may potentially indicate a clinically measurable resistant compartment.
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Affiliation(s)
- Chao Li
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, UK; Department of Neurosurgery, Shanghai General Hospital (originally named "Shanghai First People's Hospital"), Shanghai Jiao Tong University School of Medicine, China; EPSRC Centre for Mathematical Imaging in Healthcare, University of Cambridge, UK.
| | - Jiun-Lin Yan
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, UK; Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Turid Torheim
- Cancer Research UK Cambridge Institute, University of Cambridge, UK; CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge, UK
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, UK
| | - Natalie R Boonzaier
- Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London, UK
| | - Jingjing Zou
- Statistical Laboratory, Centre for Mathematical Sciences, University of Cambridge, UK
| | - Yuan Huang
- EPSRC Centre for Mathematical Imaging in Healthcare, University of Cambridge, UK; Department of Radiology, University of Cambridge, UK
| | - Jianmin Yuan
- Department of Radiology, University of Cambridge, UK
| | - Bart R J van Dijken
- Department of Radiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Tomasz Matys
- Statistical Laboratory, Centre for Mathematical Sciences, University of Cambridge, UK; Cancer Trials Unit Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Florian Markowetz
- Cancer Research UK Cambridge Institute, University of Cambridge, UK; CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge, UK
| | - Stephen J Price
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, UK; Wolfson Brain Imaging Centre, Department of Clinical Neuroscience, University of Cambridge, UK
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Deen SS, Riemer F, McLean MA, Gill AB, Kaggie JD, Grist JT, Crawford R, Latimer J, Baldwin P, Earl HM, Parkinson CA, Smith SA, Hodgkin C, Moore E, Jimenez-Linan M, Brodie CR, Addley HC, Freeman SJ, Moyle PL, Sala E, Graves MJ, Brenton JD, Gallagher FA. Sodium MRI with 3D-cones as a measure of tumour cellularity in high grade serous ovarian cancer. Eur J Radiol Open 2019; 6:156-162. [PMID: 31032385 PMCID: PMC6477161 DOI: 10.1016/j.ejro.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/10/2019] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to assess the feasibility of rapid sodium MRI (23Na-MRI) for the imaging of peritoneal cancer deposits in high grade serous ovarian cancer (HGSOC) and to evaluate the relationship of 23Na-MRI with tumour cellularity. 23Na-MRI was performed at 3 T on twelve HGSOC patients using a 3D-cones acquisition technique. Tumour biopsies specimens were collected after imaging and cellularity was measured from histology. Total 23Na-MRI scan time for each patient was approximately 11 min. At an isotropic resolution of 5.6 mm, signal-to-noise ratios (SNRs) of 82.2 ± 15.3 and 15.1 ± 7.1 (mean ± standard deviation) were achieved for imaging of tumour tissue sodium concentration (TSC) and intracellular weighted sodium concentration (IWS) respectively. Tumour TSC and IWS concentrations were: 56.8 ± 19.1 mM and 30.8 ± 9.2 mM respectively and skeletal muscle TSC and IWS concentrations were 33.2 ± 16.3 mM and 20.5 ± 9.9 mM respectively. There were significant sodium concentration differences between cancer and skeletal muscle, Wilcoxon signed-rank test, P < 0.001 for TSC and P = 0.01 for IWS imaging. Tumour cellularity displayed a strong negative correlation with TSC, Spearman's rho = -0.92, P < 0.001, but did not correlate with IWS. This study demonstrates that 23Na-MRI using 3D-cones can rapidly assess sodium concentration in peritoneal deposits of HGSOC and that TSC may serve as a biomarker of tumour cellularity.
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Affiliation(s)
- Surrin S. Deen
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Mary A. McLean
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Andrew B. Gill
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Joshua D. Kaggie
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - James T. Grist
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Robin Crawford
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - John Latimer
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Peter Baldwin
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Helena M. Earl
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Christine A. Parkinson
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Sarah A. Smith
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Charlotte Hodgkin
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Elizabeth Moore
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Mercedes Jimenez-Linan
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Cara R. Brodie
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Helen C. Addley
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Susan J. Freeman
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Penelope L. Moyle
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Martin J. Graves
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - James D. Brenton
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | - Ferdia A. Gallagher
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
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Grist JT, McLean MA, Riemer F, Schulte RF, Deen SS, Zaccagna F, Woitek R, Daniels CJ, Kaggie JD, Matys T, Patterson I, Slough R, Gill AB, Chhabra A, Eichenberger R, Laurent MC, Comment A, Gillard JH, Coles AJ, Tyler DJ, Wilkinson I, Basu B, Lomas DJ, Graves MJ, Brindle KM, Gallagher FA. Quantifying normal human brain metabolism using hyperpolarized [1- 13C]pyruvate and magnetic resonance imaging. Neuroimage 2019; 189:171-179. [PMID: 30639333 PMCID: PMC6435102 DOI: 10.1016/j.neuroimage.2019.01.027] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 01/14/2023] Open
Abstract
Hyperpolarized 13C Magnetic Resonance Imaging (13C-MRI) provides a highly sensitive tool to probe tissue metabolism in vivo and has recently been translated into clinical studies. We report the cerebral metabolism of intravenously injected hyperpolarized [1-13C]pyruvate in the brain of healthy human volunteers for the first time. Dynamic acquisition of 13C images demonstrated 13C-labeling of both lactate and bicarbonate, catalyzed by cytosolic lactate dehydrogenase and mitochondrial pyruvate dehydrogenase respectively. This demonstrates that both enzymes can be probed in vivo in the presence of an intact blood-brain barrier: the measured apparent exchange rate constant (kPL) for exchange of the hyperpolarized 13C label between [1-13C]pyruvate and the endogenous lactate pool was 0.012 ± 0.006 s-1 and the apparent rate constant (kPB) for the irreversible flux of [1-13C]pyruvate to [13C]bicarbonate was 0.002 ± 0.002 s-1. Imaging also revealed that [1-13C]pyruvate, [1-13C]lactate and [13C]bicarbonate were significantly higher in gray matter compared to white matter. Imaging normal brain metabolism with hyperpolarized [1-13C]pyruvate and subsequent quantification, have important implications for interpreting pathological cerebral metabolism in future studies.
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Affiliation(s)
- James T Grist
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Surrin S Deen
- Department of Radiology, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Fulvio Zaccagna
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Ramona Woitek
- Department of Radiology, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | | | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tomasz Matys
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Ilse Patterson
- Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Rhys Slough
- Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Andrew B Gill
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Anita Chhabra
- Pharmacy, Cambridge University Hospitals, Cambridge, UK
| | | | | | - Arnaud Comment
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK; GE Healthcare, Chalfont St Giles, UK
| | | | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Damian J Tyler
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Ian Wilkinson
- Department of Medicine, University of Cambridge and Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - David J Lomas
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
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Barrett T, Riemer F, McLean MA, Kaggie J, Robb F, Tropp JS, Warren A, Bratt O, Shah N, Gnanapragasam VJ, Gilbert FJ, Graves MJ, Gallagher FA. Quantification of Total and Intracellular Sodium Concentration in Primary Prostate Cancer and Adjacent Normal Prostate Tissue With Magnetic Resonance Imaging. Invest Radiol 2018; 53:450-456. [PMID: 29969108 DOI: 10.1097/rli.0000000000000470] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The aim of this study was to measure the tissue sodium concentration (TSC) within tumors and normal prostate in prostate cancer patients, using prostatectomy as pathological criterion standard. MATERIALS AND METHODS Fifteen patients with biopsy-proven, magnetic resonance imaging (MRI) visible, intermediate- or high-risk prostate cancer underwent a dedicated research sodium MRI, before treatment with radical prostatectomy. All participants signed written informed consent for this institutional review board-approved prospective study. 3 T MRI acquired using a dedicated multinuclear clamshell transmit coil and a bespoke dual-tuned H/Na endorectal receive coil, with intracellular-sodium imaging acquired using inversion recovery sequences; a phantom-based calibration enabled quantitative sodium maps. Regions of interest were defined for normal peripheral zone (PZ) and transition zone (TZ) and tumor regions, referenced from histopathology maps. A 1-way analysis of variance compared normal and tumor tissue, using Tukey test for multiple comparisons. RESULTS Two patients were excluded due to artifact; software error resulted in 1 further intracellular-sodium failure. Fifteen tumors were detected (13 PZ, 2 TZ) in 13 patients: Gleason 3 + 3 (n = 1), 3 + 4 (6), 3 + 5 (2), 4 + 3 (5), 4 + 5 (1). Both mean TSC and intracellular-sodium were significantly higher in normal PZ (39.2 and 17.5 mmol/L, respectively) versus normal TZ (32.9 and 14.7; P < 0.001 and P = 0.02). Mean TSC in PZ tumor (45.0 mmol/L) was significantly higher than both normal PZ and TZ tissue (P < 0.001). Intracellular sodium in PZ tumors (19.9 mmol/L) was significantly higher than normal TZ (P < 0.001) but not normal PZ (P = 0.05). Mean TSC and intracellular-sodium was lower in Gleason ≤3 + 4 tumors (44.4 and 19.5 mmol/L, respectively) versus ≥4 + 3 (45.6 and 20.2), but this was not significant (P = 0.19 and P = 0.29). CONCLUSIONS Tissue sodium concentration and intracellular sodium concentrations of prostate tumors were quantified, with PZ tumors demonstrating a significantly increased TSC.
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Affiliation(s)
| | | | | | | | | | | | | | - Ola Bratt
- Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Nimish Shah
- Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
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Zaccagna F, Grist JT, Deen SS, Woitek R, Lechermann LMT, McLean MA, Basu B, Gallagher FA. Hyperpolarized carbon-13 magnetic resonance spectroscopic imaging: a clinical tool for studying tumour metabolism. Br J Radiol 2018; 91:20170688. [PMID: 29293376 PMCID: PMC6190784 DOI: 10.1259/bjr.20170688] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 01/09/2023] Open
Abstract
Glucose metabolism in tumours is reprogrammed away from oxidative metabolism, even in the presence of oxygen. Non-invasive imaging techniques can probe these alterations in cancer metabolism providing tools to detect tumours and their response to therapy. Although Positron Emission Tomography with (18F)2-fluoro-2-deoxy-D-glucose (18F-FDG PET) is an established clinical tool to probe cancer metabolism, it has poor spatial resolution and soft tissue contrast, utilizes ionizing radiation and only probes glucose uptake and phosphorylation and not further downstream metabolism. Magnetic Resonance Spectroscopy (MRS) has the capability to non-invasively detect and distinguish molecules within tissue but has low sensitivity and can only detect selected nuclei. Dynamic Nuclear Polarization (DNP) is a technique which greatly increases the signal-to-noise ratio (SNR) achieved with MR by significantly increasing nuclear spin polarization and this method has now been translated into human imaging. This review provides a brief overview of this process, also termed Hyperpolarized Carbon-13 Magnetic Resonance Spectroscopic Imaging (HP 13C-MRSI), its applications in preclinical imaging, an outline of the current human trials that are ongoing, as well as future potential applications in oncology.
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Affiliation(s)
- Fulvio Zaccagna
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - James T Grist
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Surrin S Deen
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Ramona Woitek
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, UK
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Grist JT, Riemer F, McLean MA, Matys T, Zaccagna F, Hilborne SF, Mason JP, Patterson I, Slough R, Kaggie J, Deen SS, Graves MJ, Jones JL, Coles AJ, Gallagher FA. Imaging intralesional heterogeneity of sodium concentration in multiple sclerosis: Initial evidence from 23Na-MRI. J Neurol Sci 2018; 387:111-114. [PMID: 29571845 PMCID: PMC5884312 DOI: 10.1016/j.jns.2018.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 12/02/2022]
Abstract
Sodium MRI (23Na-MRI) has been used to non-invasively quantify tissue sodium but has been limited by low spatial resolution. Here we demonstrate for the first time that high resolution 23Na-MRI reveals the spatial heterogeneity of sodium concentration within a multiple sclerosis (MS) lesion. A patient with treatment-naïve relapsing-remitting MS and a ring-enhancing lesion was imaged using 23Na-MRI. The periphery of the lesion demonstrated an elevated total sodium content compared to the normal appearing white and grey matter (p<0.01), as well as a heterogeneous distribution of both the total tissue sodium concentration and the intracellular-weighted sodium concentration.
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Affiliation(s)
- James T Grist
- Department of Radiology, University of Cambridge, Cambridge, UK.
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - Tomasz Matys
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Fulvio Zaccagna
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Jackie P Mason
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Ilse Patterson
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Rhys Slough
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Joshua Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Surrin S Deen
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Martin J Graves
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Joanne L Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
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Casey RT, McLean MA, Madhu B, Challis BG, Ten Hoopen R, Roberts T, Clark GR, Pittfield D, Simpson HL, Bulusu VR, Allinson K, Happerfield L, Park SM, Marker A, Giger O, Maher ER, Gallagher FA. Translating in vivo metabolomic analysis of succinate dehydrogenase deficient tumours into clinical utility. JCO Precis Oncol 2018; 2:1-12. [PMID: 30949620 PMCID: PMC6445359 DOI: 10.1200/po.17.00191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Mutations in the mitochondrial enzyme succinate dehydrogenase (SDH) subunit genes are associated with a wide spectrum of tumours including phaeochromocytoma and paraganglioma (PPGL) 1, 2, gastrointestinal stromal tumours (GIST) 3, renal cell carcinoma (RCC) 4 and pituitary adenomas5. SDH-related tumorigenesis is believed to be secondary to accumulation of the oncometabolite succinate. Our aim was to investigate the potential clinical applications of MRI spectroscopy (1H-MRS) in a range of suspected SDH-related tumours. PATIENTS AND METHODS Fifteen patients were recruited to this study. Respiratory-gated single-voxel 1H-MRS was performed at 3T to quantify the content of succinate at 2.4 ppm and choline at 3.22 ppm. RESULTS A succinate peak was seen in six patients, all of whom had a germline SDHx mutation or loss of SDHB by immunohistochemistry. A succinate peak was also detected in two patients with a metastatic wild-type GIST (wtGIST) and no detectable germline SDHx mutation but a somatic epimutation in SDHC. Three patients without a tumour succinate peak retained SDHB expression, consistent with SDH functionality. In six cases with a borderline or absent peak, technical difficulties such as motion artefact rendered 1H-MRS difficult to interpret. Sequential imaging in a patient with a metastatic abdominal paraganglioma demonstrated loss of the succinate peak after four cycles of [177Lu]-DOTATATE, with a corresponding biochemical response in normetanephrine. CONCLUSIONS This study has demonstrated the translation into clinical practice of in vivo metabolomic analysis using 1H-MRS in patients with SDH-deficient tumours. Potential applications include non-invasive diagnosis and disease stratification, as well as monitoring of tumour response to targeted treatments.
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Affiliation(s)
- Ruth T Casey
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre, CB2 OQQ, United Kingdom
- Department of Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, CB2 OQQ, United Kingdom
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Basetti Madhu
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Benjamin G Challis
- Department of Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, CB2 OQQ, United Kingdom
| | - Rogier Ten Hoopen
- Department of Pathology, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Thomas Roberts
- Haematology Oncology Diagnostic Service (HODS), Cambridge University NHS Foundation Trust, Cambridge, CB2 OQQ, United Kingdom
| | - Graeme R Clark
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre, CB2 OQQ, United Kingdom
| | - Deborah Pittfield
- Department of Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, CB2 OQQ, United Kingdom
| | - Helen L Simpson
- Department of Diabetes and Endocrinology, University College London Hospitals, NHS Foundation Trust, London, NW1 2PG UK
| | - Venkata R Bulusu
- Department of Medical Oncology, Cambridge University NHS Foundation Trust, Cambridge, CB2 OQQ, United Kingdom
| | - Kieran Allinson
- Department of Histopathology Cambridge University NHS Foundation Trust and Cancer Research UK Cambridge Centre Cambridge, CB2 0QQ, United Kingdom
| | - Lisa Happerfield
- Department of Immunohistochemistry, Cambridge University NHS Foundation Trust, Cambridge, CB2 OQQ, United Kingdom
| | - Soo-Mi Park
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre, CB2 OQQ, United Kingdom
| | - Alison Marker
- Department of Histopathology Cambridge University NHS Foundation Trust and Cancer Research UK Cambridge Centre Cambridge, CB2 0QQ, United Kingdom
| | - Olivier Giger
- Department of Pathology, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre, CB2 OQQ, United Kingdom
| | - Ferdia A Gallagher
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
- Department of Radiology, Cambridge University NHS Foundation Trust, CB2 OQQ, United Kingdom
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Bedair R, Priest AN, Patterson AJ, McLean MA, Graves MJ, Manavaki R, Gill AB, Abeyakoon O, Griffiths JR, Gilbert FJ. Assessment of early treatment response to neoadjuvant chemotherapy in breast cancer using non-mono-exponential diffusion models: a feasibility study comparing the baseline and mid-treatment MRI examinations. Eur Radiol 2017; 27:2726-2736. [PMID: 27798751 PMCID: PMC5486805 DOI: 10.1007/s00330-016-4630-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess the feasibility of the mono-exponential, bi-exponential and stretched-exponential models in evaluating response of breast tumours to neoadjuvant chemotherapy (NACT) at 3 T. METHODS Thirty-six female patients (median age 53, range 32-75 years) with invasive breast cancer undergoing NACT were enrolled for diffusion-weighted MRI (DW-MRI) prior to the start of treatment. For assessment of early response, changes in parameters were evaluated on mid-treatment MRI in 22 patients. DW-MRI was performed using eight b values (0, 30, 60, 90, 120, 300, 600, 900 s/mm2). Apparent diffusion coefficient (ADC), tissue diffusion coefficient (D t), vascular fraction (ƒ), distributed diffusion coefficient (DDC) and alpha (α) parameters were derived. Then t tests compared the baseline and changes in parameters between response groups. Repeatability was assessed at inter- and intraobserver levels. RESULTS All patients underwent baseline MRI whereas 22 lesions were available at mid-treatment. At pretreatment, mean diffusion coefficients demonstrated significant differences between groups (p < 0.05). At mid-treatment, percentage increase in ADC and DDC showed significant differences between responders (49 % and 43 %) and non-responders (21 % and 32 %) (p = 0.03, p = 0.04). Overall, stretched-exponential parameters showed excellent repeatability. CONCLUSION DW-MRI is sensitive to baseline and early treatment changes in breast cancer using non-mono-exponential models, and the stretched-exponential model can potentially monitor such changes. KEY POINTS • Baseline diffusion coefficients demonstrated significant differences between complete pathological responders and non-responders. • Increase in ADC and DDC at mid-treatment can discriminate responders and non-responders. • The ƒ fraction at mid-treatment decreased in responders whereas increased in non-responders. • The mono- and stretched-exponential models showed excellent inter- and intrarater repeatability. • Treatment effects can potentially be assessed by non-mono-exponential diffusion models.
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Affiliation(s)
- Reem Bedair
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Andrew N Priest
- Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Andrew J Patterson
- Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Mary A McLean
- Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, CB2 0RE, UK
| | - Martin J Graves
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Roido Manavaki
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Andrew B Gill
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Oshaani Abeyakoon
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - John R Griffiths
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, CB2 0RE, UK
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
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Ainsworth NL, McLean MA, McIntyre DJ, Honess DJ, Brown AM, Harden SV, Griffiths JR. Quantitative and textural analysis of magnetization transfer and diffusion images in the early detection of brain metastases. Magn Reson Med 2017; 77:1987-1995. [PMID: 27279574 PMCID: PMC5412685 DOI: 10.1002/mrm.26257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The sensitivity of the magnetization transfer ratio (MTR) and apparent diffusion coefficient (ADC) for early detection of brain metastases was investigated in mice and humans. METHODS Mice underwent MRI twice weekly for up to 31 d following intracardiac injection of the brain-homing breast cancer cell line MDA-MB231-BR. Patients with small cell lung cancer underwent quarterly MRI for 1 year. MTR and ADC were measured in regions of metastasis and matched contralateral tissue at the final time point and in registered regions at earlier time points. Texture analysis and linear discriminant analysis were performed to detect metastasis-containing slices. RESULTS Compared with contralateral tissue, mouse metastases had significantly lower MTR and higher ADC at the final time point. Some lesions were visible at earlier time points on the MTR and ADC maps: 24% of these were not visible on corresponding T2 -weighted images. Texture analysis using the MTR maps showed 100% specificity and 98% sensitivity for metastasis at the final time point, with 77% sensitivity 2-4 d earlier and 46% 5-8 d earlier. Only 2 of 16 patients developed metastases, and their penultimate scans were normal. CONCLUSIONS Some brain metastases may be detected earlier on MTR than conventional T2 ; however, the small gain is unlikely to justify "predictive" MRI. Magn Reson Med 77:1987-1995, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Nicola L. Ainsworth
- Cancer Research UK Cambridge InstituteUniversity of CambridgeLi Ka Shing CentreRobinson WayCambridgeCB2 0RE
| | - Mary A. McLean
- Cancer Research UK Cambridge InstituteUniversity of CambridgeLi Ka Shing CentreRobinson WayCambridgeCB2 0RE
| | - Dominick J.O. McIntyre
- Cancer Research UK Cambridge InstituteUniversity of CambridgeLi Ka Shing CentreRobinson WayCambridgeCB2 0RE
| | - Davina J. Honess
- Cancer Research UK Cambridge InstituteUniversity of CambridgeLi Ka Shing CentreRobinson WayCambridgeCB2 0RE
| | - Anna M. Brown
- Cancer Research UK Cambridge InstituteUniversity of CambridgeLi Ka Shing CentreRobinson WayCambridgeCB2 0RE
| | - Susan V Harden
- Department of OncologyAddenbrooke's HospitalHills RoadCambridgeCB2 0QQ
| | - John R. Griffiths
- Cancer Research UK Cambridge InstituteUniversity of CambridgeLi Ka Shing CentreRobinson WayCambridgeCB2 0RE
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Wallace TE, Patterson AJ, Abeyakoon O, Bedair R, Manavaki R, McLean MA, O'Connor JPB, Graves MJ, Gilbert FJ. Detecting gas-induced vasomotor changes via blood oxygenation level-dependent contrast in healthy breast parenchyma and breast carcinoma. J Magn Reson Imaging 2016; 44:335-45. [PMID: 26898173 PMCID: PMC4949641 DOI: 10.1002/jmri.25177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/19/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate blood oxygenation level-dependent (BOLD) contrast changes in healthy breast parenchyma and breast carcinoma during administration of vasoactive gas stimuli. MATERIALS AND METHODS Magnetic resonance imaging (MRI) was performed at 3T in 19 healthy premenopausal female volunteers using a single-shot fast spin echo sequence to acquire dynamic T2 -weighted images. 2% (n = 9) and 5% (n = 10) carbogen gas mixtures were interleaved with either medical air or oxygen in 2-minute blocks, for four complete cycles. A 12-minute medical air breathing period was used to determine background physiological modulation. Pixel-wise correlation analysis was applied to evaluate response to the stimuli in breast parenchyma and these results were compared to the all-air control. The relative BOLD effect size was compared between two groups of volunteers scanned in different phases of the menstrual cycle. The optimal stimulus design was evaluated in five breast cancer patients. RESULTS Of the four stimulus combinations tested, oxygen vs. 5% carbogen produced a response that was significantly stronger (P < 0.05) than air-only breathing in volunteers. Subjects imaged during the follicular phase of their cycle when estrogen levels typically peak exhibited a significantly smaller BOLD response (P = 0.01). Results in malignant tissue were variable, with three out of five lesions exhibiting a diminished response to the gas stimulus. CONCLUSION Oxygen vs. 5% carbogen is the most robust stimulus for inducing BOLD contrast, consistent with the opposing vasomotor effects of these two gases. Measurements may be confounded by background physiological fluctuations and menstrual cycle changes. J. Magn. Reson. Imaging 2016;44:335-345.
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Affiliation(s)
- Tess E Wallace
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, UK
| | - Andrew J Patterson
- NIHR Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, UK
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Oshaani Abeyakoon
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, UK
| | - Reem Bedair
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, UK
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, UK
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | | | - Martin J Graves
- NIHR Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, UK
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, UK
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44
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Bedair R, Graves MJ, Patterson AJ, McLean MA, Manavaki R, Wallace T, Reid S, Mendichovszky I, Griffiths J, Gilbert FJ. Effect of Radiofrequency Transmit Field Correction on Quantitative Dynamic Contrast-enhanced MR Imaging of the Breast at 3.0 T. Radiology 2016; 279:368-77. [PMID: 26579563 DOI: 10.1148/radiol.2015150920] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the effects of radiofrequency transmit field (B1(+)) correction on (a) the measured T1 relaxation times of normal breast tissue and malignant lesions and (b) the pharmacokinetically derived parameters of malignant breast lesions at 3 T. MATERIALS AND METHODS Ethics approval and informed consent were obtained. Between May 2013 and January 2014, 30 women (median age, 58 years; range, 32-83 years) with invasive ductal carcinoma of at least 10 mm were recruited to undergo dynamic contrast material-enhanced magnetic resonance (MR) imaging before surgery. B1(+) and T1 mapping sequences were performed to determine the effect of B1(+) correction on the native tissue relaxation time (T10) of fat, parenchyma, and malignant lesions in both breasts. Pharmacokinetic parameters were calculated before and after correction for B1(+) variations. Results were correlated with histologic grade by using the Kruskal-Wallis test. RESULTS Measurements showed a mean 37% flip angle difference between the right and left breast, which resulted in a 61% T10 difference in fat and a 41.5% difference in parenchyma between the two breasts. The T1 of lesions in the right breast increased by 58%, whereas that of lesions in the left breast decreased by 30% after B1(+) correction. The whole-tumor transendothelial permeability across the vascular compartment(K(trans)) of lesions in the right breast decreased by 41%, and that of lesions in the left breast increased by 46% after correction. A systematic increase in K(trans) was observed, with significant differences found across the histologic grades (P < .001). The effect size of B1(+) correction on K(trans) calculation was large for lesions in the right breast and moderate for lesions in the left breast (Cohen effect size, d = 0.86 and d = 0.59, respectively). CONCLUSION B1(+) correction demonstrates a substantial effect on the results of quantitative dynamic contrast-enhanced analysis of breast tissue at 3 T, which propagates into the pharmacokinetic analysis of tumors that is dependent on whether the tumor is located in the right or left breast.
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Affiliation(s)
- Reem Bedair
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Martin J Graves
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Andrew J Patterson
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Mary A McLean
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Roido Manavaki
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Tess Wallace
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Scott Reid
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Iosif Mendichovszky
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - John Griffiths
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Fiona J Gilbert
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
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Daniels CJ, McLean MA, Schulte RF, Robb FJ, Gill AB, McGlashan N, Graves MJ, Schwaiger M, Lomas DJ, Brindle KM, Gallagher FA. A comparison of quantitative methods for clinical imaging with hyperpolarized (13)C-pyruvate. NMR Biomed 2016; 29:387-99. [PMID: 27414749 PMCID: PMC4833181 DOI: 10.1002/nbm.3468] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 05/07/2023]
Abstract
Dissolution dynamic nuclear polarization (DNP) enables the metabolism of hyperpolarized (13)C-labelled molecules, such as the conversion of [1-(13)C]pyruvate to [1-(13)C]lactate, to be dynamically and non-invasively imaged in tissue. Imaging of this exchange reaction in animal models has been shown to detect early treatment response and correlate with tumour grade. The first human DNP study has recently been completed, and, for widespread clinical translation, simple and reliable methods are necessary to accurately probe the reaction in patients. However, there is currently no consensus on the most appropriate method to quantify this exchange reaction. In this study, an in vitro system was used to compare several kinetic models, as well as simple model-free methods. Experiments were performed using a clinical hyperpolarizer, a human 3 T MR system, and spectroscopic imaging sequences. The quantitative methods were compared in vivo by using subcutaneous breast tumours in rats to examine the effect of pyruvate inflow. The two-way kinetic model was the most accurate method for characterizing the exchange reaction in vitro, and the incorporation of a Heaviside step inflow profile was best able to describe the in vivo data. The lactate time-to-peak and the lactate-to-pyruvate area under the curve ratio were simple model-free approaches that accurately represented the full reaction, with the time-to-peak method performing indistinguishably from the best kinetic model. Finally, extracting data from a single pixel was a robust and reliable surrogate of the whole region of interest. This work has identified appropriate quantitative methods for future work in the analysis of human hyperpolarized (13)C data.
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Affiliation(s)
- Charlie J Daniels
- Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | | | | | - Andrew B Gill
- Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Nicholas McGlashan
- Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Markus Schwaiger
- Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - David J Lomas
- Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
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46
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Brown AM, Nagala S, McLean MA, Lu Y, Scoffings D, Apte A, Gonen M, Stambuk HE, Shaha AR, Tuttle RM, Deasy JO, Priest AN, Jani P, Shukla‐Dave A, Griffiths J. Multi-institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion-weighted MRI. Magn Reson Med 2016; 75:1708-16. [PMID: 25995019 PMCID: PMC4654719 DOI: 10.1002/mrm.25743] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/05/2015] [Accepted: 04/02/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Ultrasound-guided fine needle aspirate cytology fails to diagnose many malignant thyroid nodules; consequently, patients may undergo diagnostic lobectomy. This study assessed whether textural analysis (TA) could noninvasively stratify thyroid nodules accurately using diffusion-weighted MRI (DW-MRI). METHODS This multi-institutional study examined 3T DW-MRI images obtained with spin echo echo planar imaging sequences. The training data set included 26 patients from Cambridge, United Kingdom, and the test data set included 18 thyroid cancer patients from Memorial Sloan Kettering Cancer Center (New York, New York, USA). Apparent diffusion coefficients (ADCs) were compared over regions of interest (ROIs) defined on thyroid nodules. TA, linear discriminant analysis (LDA), and feature reduction were performed using the 21 MaZda-generated texture parameters that best distinguished benign and malignant ROIs. RESULTS Training data set mean ADC values were significantly different for benign and malignant nodules (P = 0.02) with a sensitivity and specificity of 70% and 63%, respectively, and a receiver operator characteristic (ROC) area under the curve (AUC) of 0.73. The LDA model of the top 21 textural features correctly classified 89/94 DW-MRI ROIs with 92% sensitivity, 96% specificity, and an AUC of 0.97. This algorithm correctly classified 16/18 (89%) patients in the independently obtained test set of thyroid DW-MRI scans. CONCLUSION TA classifies thyroid nodules with high sensitivity and specificity on multi-institutional DW-MRI data sets. This method requires further validation in a larger prospective study. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance.
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Affiliation(s)
- Anna M. Brown
- Cancer Research UK Cambridge Institute, University of CambridgeLi Ka Shing CentreRobinson WayCambridgeUnited Kingdom
- Duke University School of MedicineDurhamNorth CarolinaUSA
| | - Sidhartha Nagala
- Addenbrooke's Hospital Department of OtolaryngologyCambridgeUnited Kingdom
| | - Mary A. McLean
- Cancer Research UK Cambridge Institute, University of CambridgeLi Ka Shing CentreRobinson WayCambridgeUnited Kingdom
| | - Yonggang Lu
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Daniel Scoffings
- Addenbrooke's Hospital Department of RadiologyCambridgeUnited Kingdom
| | - Aditya Apte
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Mithat Gonen
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Hilda E. Stambuk
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Ashok R. Shaha
- Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - R. Michael Tuttle
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Joseph O. Deasy
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Andrew N. Priest
- Addenbrooke's Hospital Department of RadiologyCambridgeUnited Kingdom
| | - Piyush Jani
- Cambridge Teaching Hospitals ENT DepartmentCambridgeUnited Kingdom
| | - Amita Shukla‐Dave
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - John Griffiths
- Cancer Research UK Cambridge Institute, University of CambridgeLi Ka Shing CentreRobinson WayCambridgeUnited Kingdom
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47
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Price SJ, Young AMH, Scotton WJ, Ching J, Mohsen LA, Boonzaier NR, Lupson VC, Griffiths JR, McLean MA, Larkin TJ. Multimodal MRI can identify perfusion and metabolic changes in the invasive margin of glioblastomas. J Magn Reson Imaging 2016; 43:487-94. [PMID: 26140696 PMCID: PMC5008200 DOI: 10.1002/jmri.24996] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/23/2015] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To use perfusion and magnetic resonance (MR) spectroscopy to compare the diffusion tensor imaging (DTI)-defined invasive and noninvasive regions. Invasion of normal brain is a cardinal feature of glioblastomas (GBM) and a major cause of treatment failure. DTI can identify invasive regions. MATERIALS AND METHODS In all, 50 GBM patients were imaged preoperatively at 3T with anatomic sequences, DTI, dynamic susceptibility perfusion MR (DSCI), and multivoxel spectroscopy. The DTI and DSCI data were coregistered to the spectroscopy data and regions of interest (ROIs) were made in the invasive (determined by DTI), noninvasive regions, and normal brain. Values of relative cerebral blood volume (rCBV), N-acetyl aspartate (NAA), myoinositol (mI), total choline (Cho), and glutamate + glutamine (Glx) normalized to creatine (Cr) and Cho/NAA were measured at each ROI. RESULTS Invasive regions showed significant increases in rCBV, suggesting angiogenesis (invasive rCBV 1.64 [95% confidence interval, CI: 1.5-1.76] vs. noninvasive 1.14 [1.09-1.18]; P < 0.001), Cho/Cr (invasive 0.42 [0.38-0.46] vs. noninvasive 0.35 [0.31-0.38]; P = 0.02) and Cho/NAA (invasive 0.54 [0.41-0.68] vs. noninvasive 0.37 [0.29-0.45]; P = < 0.03), suggesting proliferation, and Glx/Cr (invasive 1.54 [1.27-1.82] vs. noninvasive 1.3 [1.13-1.47]; P = 0.028), suggesting glutamate release; and a significantly reduced NAA/Cr (invasive 0.95 [0.85-1.05] vs. noninvasive 1.19 [1.06-1.31]; P = 0.008). The mI/Cr was not different between the three ROIs (invasive 1.2 [0.99-1.41] vs. noninvasive 1.3 [1.14-1.46]; P = 0.68). In the noninvasive regions, the values were not different from normal brain. CONCLUSION Combining DTI to identify the invasive region with perfusion and spectroscopy, we can identify changes in invasive regions not seen in noninvasive regions.
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Affiliation(s)
- Stephen J Price
- Neurosurgery Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Adam M H Young
- Neurosurgery Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - William J Scotton
- Neurosurgery Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jared Ching
- Neurosurgery Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Laila A Mohsen
- University Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Natalie R Boonzaier
- Neurosurgery Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Victoria C Lupson
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - John R Griffiths
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - Timothy J Larkin
- Neurosurgery Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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48
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Price SJ, Young AM, Scotton W, Boonzaier NR, McLean MA, Larkin TJ. OP51METABOLIC ACTIVITY OF THE INVASIVE MICROENVIRONMENT OF GLIOBLASTOMAS DETERMINES TIME PROGRESSION: A MULITOMODAL MRI STUDY. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov284.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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49
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Egerton A, Stone JM, Chaddock CA, Barker GJ, Bonoldi I, Howard RM, Merritt K, Allen P, Howes OD, Murray RM, McLean MA, Lythgoe DJ, O'Gorman RL, McGuire PK. Relationship between brain glutamate levels and clinical outcome in individuals at ultra high risk of psychosis. Neuropsychopharmacology 2014; 39:2891-9. [PMID: 24917199 PMCID: PMC4180719 DOI: 10.1038/npp.2014.143] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/25/2014] [Accepted: 05/26/2014] [Indexed: 12/31/2022]
Abstract
Alterations in brain glutamate levels may be associated with psychosis risk, but the relationship to clinical outcome in at-risk individuals is unknown. Glutamate concentration was measured in the left thalamus and anterior cingulate cortex (ACC) using 3-Tesla proton magnetic resonance spectroscopy in 75 participants at ultra high risk (UHR) of psychosis and 56 healthy controls. The severity of attenuated positive symptoms and overall functioning were assessed. Measures were repeated in 51 UHR and 33 Control subjects after a mean of 18 months. UHR subjects were allocated to either remission (no longer meeting UHR criteria) or non-remission (meeting UHR or psychosis criteria) status on follow-up assessment. Thalamic glutamate levels at presentation were lower in the UHR non-remission (N=29) compared with the remission group (N=22) (t(49)=3.03; P=0.004), and were associated with an increase in the severity of total positive symptoms over time (r=-0.33; df=47; P=0.02), most notably abnormal thought content (r=-0.442; df=47; P=0.003). In the UHR group, ACC glutamate levels were lower at follow-up compared with baseline (F(80)=4.28; P=0.04). These findings suggest that measures of brain glutamate function may be useful as predictors of clinical outcome in individuals at high risk of psychosis.
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Affiliation(s)
- Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK,Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK, Tel: +44 (0) 207 848 0879, Fax: +44 (0) 207 848 0976, E-mail:
| | - James M Stone
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Christopher A Chaddock
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Gareth J Barker
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Rachel M Howard
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Kate Merritt
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - David J Lythgoe
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Ruth L O'Gorman
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, UK,MR-Center, University Children's Hospital, Zurich, Switzerland
| | - Philip K McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
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50
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Taviani V, Nagala S, Priest AN, McLean MA, Jani P, Graves MJ. 3T diffusion-weighted MRI of the thyroid gland with reduced distortion: preliminary results. Br J Radiol 2013; 86:20130022. [PMID: 23770539 PMCID: PMC3745056 DOI: 10.1259/bjr.20130022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/23/2013] [Accepted: 06/07/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Single-shot diffusion-weighted (DW) echo planar imaging (EPI), which is commonly used for imaging the thyroid, is characterised by severe blurring and distortion. The objectives of this work were: 1, to show that a reduced-field of view (r-FOV) DW EPI technique can improve image quality; and 2, to investigate the effect of different reconstruction strategies on the resulting apparent diffusion coefficients (ADCs). METHODS We implemented a single-shot, r-FOV DW EPI technique with a two-dimensional radiofrequency excitation pulse for DW imaging of the thyroid at 3T. Images were reconstructed using root sum of squares (SOS) and an optimal-B1 reconstruction (OBR). Phantom and in vivo experiments were performed to compare r-FOV and conventional full-FOV DW EPI with root SOS and OBR. RESULTS r-FOV with OBR substantially improved image quality at 3T. In phantoms, r-FOV gave more accurate ADCs than full-FOV. In vivo r-FOV always gave lower ADC values with respect to the full-FOV technique irrespective of the reconstruction used and whether only two or multiple b-values were used to compute the ADCs. CONCLUSION r-FOV DW EPI can reduce image blurring and distortion at the expense of a low signal-to-noise ratio. OBR is a promising reconstruction technique for accurate ADC measurements in lower signal-to-noise ratio regimes, although further studies are needed to characterise its performance. ADVANCES IN KNOWLEDGE DW imaging of the thyroid at 3T could potentially benefit from r-FOV acquisition strategies, such as the r-FOV DW EPI technique proposed in this paper.
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Affiliation(s)
- V Taviani
- Department of Radiology, University of Cambridge, Cambridge, UK.
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