Problem Solving MRI to Reduce False-Positive Biopsy Related to Breast US: Conductivity vs. DWI vs. Abbreviated Contrast-Enhanced MRI

BACKGROUND

While breast ultrasound (US) is a useful tool for diagnosing breast masses, it can entail false-positive biopsy results because of some overlapping features between benign and malignant breast masses and subjective interpretation.

PURPOSE

To evaluate the performance of conductivity imaging for reducing false-positive biopsy results related to breast US, as compared to diffusion-weighted imaging (DWI) and abbreviated MRI consisting of one pre- and one post-contrast T1-weighted imaging.

STUDY TYPE

Prospective.

SUBJECTS

Seventy-nine women (median age, 44 years) with 86 Breast Imaging Reporting and Data System (BI-RADS) category 4 masses as detected by breast US.

FIELD STRENGTH/SEQUENCE

3-T, T2-weighted turbo spin echo sequence, DWI, and abbreviated contrast-enhanced MRI (T1-weighted gradient echo sequence).

ASSESSMENT

US-guided biopsy (reference standard) was obtained on the same day as MRI. The maximum and mean conductivity parameters from whole and single regions of interest (ROIs) were measured. Apparent diffusion coefficient (ADC) values were obtained from an area with the lowest signal within a lesion on the ADC map. The performance of conductivity, ADC, and abbreviated MRI for reducing false-positive biopsies was evaluated using the following criteria: lowest conductivity and highest ADC values among malignant breast lesions and BI-RADS categories 2 or 3 on abbreviated MRI.

STATISTICAL TESTS

One conductivity parameter with the maximum area under the curve (AUC) from receiver operating characteristics was selected. A P-value <0.05 was considered statistically significant.

RESULTS

US-guided biopsy revealed 65 benign lesions and 21 malignant lesions. The mean conductivity parameter of the single ROI method was selected (AUC = 0.74). Considering conductivity (≤0.10 S/m), ADC (≥1.60 × 10-3  mm2 /sec), and BI-RADS categories 2 or 3 reduced false-positive biopsies by 23% (15 of 65), 38% (25 of 65), and 43% (28 of 65), respectively, without missing malignant lesions.

DATA CONCLUSION

Conductivity imaging may show lower performance than DWI and abbreviated MRI in reducing unnecessary biopsies.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 2.

Technical note: Multi-receiver combination method for phase-based electrical property tomography of the breast

BACKGROUND

Phase-based electrical property tomography (EPT) is a technique that allows conductivity reconstruction with only phase of the B₁ field under the assumption that the magnitude of the B₁ fields are homogeneous. The more this assumption is violated, the less accurate the reconstructed conductivity. Thus, a method that ensures homogeneity of | B 1 - | $| {{\rm{B}}_1^ - } |$ field is important for breast image using multi-receiver coil.

PURPOSE

To develop a method for multi-receiver combination for phase-based EPT usable for breast EPT imaging in the clinic.

METHODS

Theory of the proposed method is presented. To validate the proposed method, the phantom and in-vivo experiments were conducted. Conductivity images were reconstructed using the transceive phase of the combined image and results were compared with another combination method.

RESULTS

The proposed method's conductivity results were more stable than those of the previous method when | B 1 + | $| {{\rm{B}}_1^ + } |$ was not homogeneous and when the homogeneous contrast region was small. The phantom and in-vivo results indicate that the proposed method produces improved conductivity images than the previous method. The proposed combination method also increased the conductivity contrast between benign and cancerous tissues.

CONCLUSION

The proposed method produced more stable multi-receiver combination for phase-based EPT of the breast in a clinical environment.

Mapping electric bulk conductivity in the human heart

PURPOSE

To explore the technical feasibility of mapping the electric bulk conductivity in the human heart, and to determine quantitative conductivity values of myocardium and blood from a small group of volunteers.

METHODS

Using a 3T MR system, 6 healthy male volunteers were measured. For all volunteers, a time-resolved 2D sequence over the cardiac cycle was applied (electrocardiogram [ECG]-triggered SSFP acquired in breath-hold). From these data, a dedicated, so-called "2D conductivity" has been derived in the framework of electrical properties tomography (EPT). To validate the concept of 2D conductivity, a static 3D sequence (ECG-triggered and respiratory-gated SSFP 3D whole heart acquisition, allowing the full 3D reconstruction of conductivity) as well as a Q-flow sequence (for investigating the relation between flow and reconstruction errors of the conductivity) have been applied for one of the volunteers.

RESULTS

For both, blood and myocardium, quantitative values of obtained 2D conductivity were approximately two-thirds of the obtained 3D conductivity, as expected from Maxwell's equations. Furthermore, the quantitative conductivity values agreed with corresponding literature values. Conductivity of left-ventricular blood volume showed characteristic over- and under-shooting at specific time points during the cardiac cycle for all volunteers investigated. This over- and under-shooting correlated with the phase pattern caused by blood flow into/out of the ventricle.

CONCLUSION

The study demonstrated the technical feasibility of cardiac conductivity measurements using standard MR systems and standard MR sequences, and therefore, may open new options for MR-based cardiac diagnosis.

Multishot echo-planar MREIT for fast imaging of conductivity, current density, and electric field distributions

PURPOSE

Magnetic resonance electrical impedance tomography (MREIT) sequences typically use conventional spin or gradient echo-based acquisition methods for reconstruction of conductivity and current density maps. Use of MREIT in functional and electroporation studies requires higher temporal resolution and faster sequences. Here, single and multishot echo planar imaging (EPI) based MREIT sequences were evaluated to see whether high-quality MREIT phase data could be obtained for rapid reconstruction of current density, conductivity, and electric fields.

METHODS

A gel phantom with an insulating inclusion was used as a test object. Ghost artifact, geometric distortion, and MREIT correction algorithms were applied to the data. The EPI-MREIT-derived phase-projected current density and conductivity images were compared with simulations and spin-echo images as a function of EPI shot number.

RESULTS

Good agreement among measures in simulated, spin echo, and EPI data was achieved. Current density errors were stable and below 9% as the shot number decreased from 64 to 2, but increased for single-shot images. Conductivity reconstruction relative contrast ratios were stable as the shot number decreased. The derived electric fields also agreed with the simulated data.

CONCLUSIONS

The EPI methods can be combined successfully with MREIT reconstruction algorithms to achieve fast imaging of current density, conductivity, and electric field. Magn Reson Med 79:71-82, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Simultaneous imaging of in vivo conductivity and susceptibility

PURPOSE

Approaches for quantitative mapping of electric conductivity and magnetic susceptibility using MRI have been developed independently. The purpose of this study is to present a method to simultaneously acquire information on conductivity and susceptibility and to produce images based on these properties.

METHODS

A 3D multiecho gradient-echo sequence was used. Phase evolution during the multiecho was used to produce quantitative susceptibility maps, while the phase value at zero echo time was retrieved, and used to generates quantitative conductivity maps. Electromagnetic simulations were performed to evaluate the phase distribution due to conductivity variations. Phantom and in vivo data were also acquired to assess the quality of images produced.

RESULTS

Simulations demonstrated that phase differences across objects increases with size and conductivity. For an accurate conductivity estimate, the maximum echo time was approximately equal to the true T2* value in order to achieve signal-to-noise ratio maximization. The most accurate susceptibility was obtained when separating phase contribution from conductivity. Phantom and in vivo results showed good quality images representing the electromagnetic properties.

CONCLUSION

A simultaneous quantitative electromagnetic property imaging approach is demonstrated here. The approach not only improves the efficiency of mapping electromagnetic properties, but can also improve the accuracy of susceptibility mapping by separating image phases introduced by conductivity and susceptibility.

Single-step 3-d image reconstruction in magnetic induction tomography: theoretical limits of spatial resolution and contrast to noise ratio

Magnetic induction tomography (MIT) is a low-resolution imaging modality for reconstructing the changes of the complex conductivity in an object. MIT is based on determining the perturbation of an alternating magnetic field, which is coupled from several excitation coils to the object. The conductivity distribution is reconstructed from the corresponding voltage changes induced in several receiver coils. Potential medical applications comprise the continuous, non-invasive monitoring of tissue alterations which are reflected in the change of the conductivity, e.g. edema, ventilation disorders, wound healing and ischemic processes. MIT requires the solution of an ill-posed inverse eddy current problem. A linearized version of this problem was solved for 16 excitation coils and 32 receiver coils with a model of two spherical perturbations within a cylindrical phantom. The method was tested with simulated measurement data. Images were reconstructed with a regularized single-step Gauss-Newton approach. Theoretical limits for spatial resolution and contrast/noise ratio were calculated and compared with the empirical results from a Monte-Carlo study. The conductivity perturbations inside a homogeneous cylinder were localized for a SNR between 44 and 64 dB. The results prove the feasibility of difference imaging with MIT and give some quantitative data on the limitations of the method.