Retrospective analysis for evaluation of the value of contrast-enhanced MRI in patients treated with breast conservative therapy

Purpose The aim of this study was to assess the value of contrast-enhanced (c.-e.) MRI in the follow-up of patients with conservatively treated breast cancer since detection and exclusion of malignancy may interfere significantly with posttherapeutic changes within the treated breast. Material and methods A total of 207 patients with a history of limited surgery and radiation therapy underwent MR imaging, 40 patients were examined 0–12 months and 167 patients were examined later than 12 months after radiotherapy. Suspicious or indeterminate findings were suggested by clinical examination or conventional imaging in 80 studies. In 127 women, MRI was performed within breast tissue that was difficult to assess due to scarring or dense breast tissue. Results Recurrent carcinoma was confirmed in 27 patients by surgical biopsy. All 27 carcinomas, except for one with a slow signal increase, demonstrated early rise of signal intensity on dynamic T1-weighted contrast enhanced images. During the first year after therapy, the diagnostic accuracy could not be improved by additional use of c.-e. MRI. Differentiation between posttherapeutic changes and recurrent carcinoma was frequently not possible because of strong and sometimes early and ill-circumscribed enhancement. Later than 12 months after therapy enhancement decreased significantly, thus the false positive calls could be reduced from 49 (conventional imaging) to 12 (conventional imaging plus MRI). A total of 12 of 26 recurrences and multifocality in 4/5 cases were diagnosed by MR imaging alone at this time interval. Conclusion In the first year after therapy, c.-e. MRI is only indicated in selected cases. The results later than 12 months emphasize that c.-e. MRI may contribute significant additional information. It allows better distinction of posttherapeutic fibrosis from recurrent carcinoma and proved to be able to detect recurrent disease more sensitive and at an earlier stage.     

7 T renal MRI: challenges and promises

The progression to 7 Tesla (7 T) magnetic resonance imaging (MRI) yields promises of substantial increase in signal-to-noise (SNR) ratio. This increase can be traded off to increase image spatial resolution or to decrease acquisition time. However, renal 7 T MRI remains challenging due to inhomogeneity of the radiofrequency field and due to specific absorption rate (SAR) constraints. A number of studies has been published in the field of renal 7 T imaging. While the focus initially was on anatomic imaging and renal MR angiography, later studies have explored renal functional imaging. Although anatomic imaging remains somewhat limited by inhomogeneous excitation and SAR constraints, functional imaging results are promising. The increased SNR at 7 T has been particularly advantageous for blood oxygen level-dependent and arterial spin labelling MRI, as well as sodium MR imaging, thanks to changes in field-strength-dependent magnetic properties. Here, we provide an overview of the currently available literature on renal 7 T MRI. In addition, we provide a brief overview of challenges and opportunities in renal 7 T MR imaging.     

Clinical assessment of myocardial viability using MRI during a constant infusion of Gd-DTPA

This study assessed the accuracy and feasibility of magnetic resonance imaging (MRI) during a constant infusion of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) for the determination of myocardial viability in patients with recent acute myocardial infarction (AMI). Nine patients were studied within 10 days of AMI. Rest-redistribution 201Thallium (201Tl) single photon emission computed tomography (SPECT) was used as a gold standard for viability. Using MRI, regional perfusion was assessed using dynamic imaging during a bolus injection of Gd-DTPA and viability was assessed during a continuous infusion. Finally, cine MR images were acquired at baseline, during low-dose dobutamine infusion and after recovery. To assess viability, the left ventricle was divided into 16 segments and signal intensity in corresponding MRI and redistribution SPECT segments were compared. Wall thickening index (WTI) was determined at each step during the dobutamine study. The results revealed that in five patients, reduced perfusion in infarcted regions was observed qualitatively during dynamic first pass imaging. There was a significant inverse correlation between 201Tl uptake and MRI signal intensity, i.e. infarcted tissue (low 201Tl uptake) had increased MR signal intensity. Segments were separated into normal (201Tl uptake > 90%) and infarcted (< 601%). lnfarcted MRI segments had greater signal intensity than normal segments (179 +/- 50 vs. 102 +/- 14%; P < 0.0001). WTI in normal segments increased by 18 +/- 8.5% (P < 0.0001) from baseline to 10 microg/kg per min of dobutamine while infarcted tissue WTI decreased 2.8 +/- 7.2% (P = 0.17). Thus regions of myocardium that were infarcted as defined by reduced 201Tl uptake and absent contractile reserve showed greatly increased MRI signal intensity during a constant infusion of Gd-DTPA. The use of MRI during a constant infusion of Gd-DTPA is accurate and feasible for the determination of myocardial necrosis in a clinical setting.     

Microprocessor-based UHS relaying for distance protection usingadvanced generation signal processing

UHS (ultra high speed) refers to operating times of less than 5 ms on 50 Hz power systems. Three distinct types of UHS relaying realization in distance protection via advanced-generation digital signal processing, possible with cheap and readily available VLSI chips, are considered. Type I is the correlator detector: Type II and III are the spectrum and cepstrum analyzers, respectively. The performance of these detectors is evaluated with respect to varying system configurations that complicate the post fault signals. Microprocessor implementation of these techniques show that 5 ms limit is achieved in Type I and II detectors, whereas the Type III detector can operate in 3 ms     

Monitoring kidney and renal cyst volumes applying MR approaches on a rapamycin treated mouse model of ADPKD

Object  The aim of our study was to determine total cystic volume in a mouse model of PKD using MR imaging to monitor therapeutic effects in vivo. Materials and methods  We imaged eight female pcy-mice in two groups: four belonged to an untreated control group and four were treated with the anticystic agent rapamycin, which has proven to be effective in reducing cystogenesis in animal models. The mice were imaged using a 9.4 Tesla animal scanner. MRI measurements were taken at six time points during the therapy. Total renal volumes and total cyst volumes were calculated using a thresholding approach. Results  During the course of the treatment, the total cyst volume increased significantly faster than the total renal volume in the untreated group, indicating that growth of the total renal volume in the untreated group was primarily due to the growth of the cysts, rather than the parenchyma. The measured total renal volume in the control (placebo) group was significantly higher than the volume in the treated group. Conclusion  Using MRI, we were able to monitor the cystic volume in a mouse model of PKD to assess the therapeutic effect of anticystic treatment.     

Clinical assessment of myocardial viability using MRI during a constant infusion of Gd-DTPA

This study assessed the accuracy and feasibility of magnetic resonance imaging (MRI) during a constant infusion of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) for the determination of myocardial viability in patients with recent acute myocardial infarction (AMI). Nine patients were studied within 10 days of AMI. Rest-redistribution²⁰¹Thallium (²⁰¹Tl) single photon emission computed tomography (SPECT) was used as a gold standard for viability. Using MRI, regional perfusion was assessed using dynamic imaging during a bolus injection of Gd-DTPA and viability was assessed during a continuous infusion. Finally, cine MR images were acquired at baseline, during low-dose dobutamine infusion and after recovery. To assess viability, the left ventricle was divided into 16 segments and signal intensity in corresponding MRI and redistribution SPECT segments were compared. Wall thickening index (WTI) was determined at each step during the dobutamine study. The results revealed that in five patients, reduced perfusion in infarcted regions was observed qualitatively during dynamic first pass imaging. There was a significant inverse correlation between²⁰¹Tl uptake and MRI signal intensity, i.e. infarcted tissue (low²⁰¹Tl uptake) had increased MR signal intensity. Segments were separated into normal (²⁰¹Tl uptake >90%) and infarcted (<60%). Infarcted MRI segments had greater signal intensity than normal segments (179±50 vs. 102±14%;P<0.0001). WTI in normal segments increased by 18±8.5% (P<0.0001) from baseline to 10 μg/kg per min of dobutamine while infarcted tissue WTI decreased 2.8±7.2% (P=0.17). Thus regions of myocardium that were infarcted as defined by reduced²⁰¹Tl uptake and absent contractile reserve showed greatly increased MRI signal intensity during a constant infusion of Gd-DTPA. The use of MRI during a constant infusion of Gd-DTPA is accurate and feasible for the determination of myocardial necrosis in a clinical setting.     

Principles and methods for automatic and semi-automatic tissue segmentation in MRI data

The development of magnetic resonance imaging (MRI) revolutionized both the medical and scientific worlds. A large variety of MRI options have generated a huge amount of image data to interpret. The investigation of a specific tissue in 3D or 4D MR images can be facilitated by image processing techniques, such as segmentation and registration. In this work, we provide a brief review of the principles and methods that are commonly applied to achieve superior tissue segmentation results in MRI. The impacts of MR image acquisition on segmentation outcome and the principles of selecting and exploiting segmentation techniques tailored for specific tissue identification tasks are discussed. In the end, two exemplary applications, breast and fibroglandular tissue segmentation in MRI and myocardium segmentation in short-axis cine and real-time MRI, are discussed to explain the typical challenges that can be posed in practical segmentation tasks in MRI data. The corresponding solutions that are adopted to deal with these challenges of the two practical segmentation tasks are thoroughly reviewed.     

MR T2-weighted image of subacute cerebral infarct can be isointense to the surrounding brain: MR fogging in cerebral infarct

Cerebral infarcts initially showing as markedly hyperintense on magnetic resonance (MR)T ₂-weighted images decreased in intensity and became nearly isointense to normal brain tissue in subsequent MR studies. This MR fogging was observed in 7 (23%) out of 31 cases of cortical infarct and 4 (20%) out of 20 cases of perforator infarct in the second to sixth weeks of the disease. In all fogging cases, significant contrast enhancement (CE) was seen in the fogging area after intravenous administration of MR contrast agent. The CE study is recommended in MR of cerebral infarct during the subacute and early chronic stage.     

Novel revascularization therapies — TMLR and growth factor-induced angiogenesis monitored with cardiac MRI

4. Summary Employment of cardiac MRI techniques (cine MRI, wall thickening analysis, quantitative MRFPP, MR tissue tagging) allowed non-invasive localization and assessment of early and late changes in myocardial function and perfusion produced by these new approaches of myocardial revascularization. With its precision in assessment of myocardial perfusion and collateral-dependent territories, cardiac MRI techniques may be of excellent use for the evaluation of effects on myocardial function and perfusion as well as longitudinal outcomes in clinical trials with TMLR and angiogenesis therapies in patients with CAD. As growth factor therapies approach phase III clinical trials, such vital questions as the most effective delivery system, dosages and techniques used for treatment-monitoring parameters remain unanswered. In addition, better definitions of patient selection criteria for TMLR and angiogenesis therapies for both short- and long-term maximum benefits are needed at this time. Large-scale clinical trials with cardiac MRI techniques are needed to reliably assess functional and perfusion reserves of the myocardium pre and post TMLR and angiogenesis therapies. MR-based outcome parameters may aid in answering questions pertinent to the new revascularization treatments.     

The correlation between 1H MRS choline concentrations and MR diffusion trace values in human brain tumors

Objective  The aim of this study was to develop a method for evaluating the spatial distribution of human brain gliomas in individual subjects by evaluating the correlation between the Choline (Cho) signal intensity and the diffusion trace (Tr_ADC) values. Materials and methods  Eleven patients with different histopathologic diagnoses and five healthy subjects were examined with diffusion-weighted EPI-trace sequence and ¹H MR spectroscopic imaging. The calculation of the correlation between choline and Tr_ADC values on a pixel-by-pixel basis and simulations estimating the influence of partial volume effects on the result were performed. Results  Statistical evaluation of the data in the patients with a glioblastoma showed that pixels corresponding to different tissue states are situated in different areas in the Cho–Tr_ADC correlation graph. Namely, points forming an inverse linear dependence interpreted as an area of an active tumor were observed. Different types of correlations were found in grade II and III gliomas. No statistically significant correlation was found in healthy subjects. Simulations proved that the observed linear dependence cannot be attributed solely to partial volume effects. Conclusion  The analysis of the correlation between Cho concentrations and Tr_ADC values on a pixel-by-pixel basis should help the regional identification of the pathological state of a tissue in patients with a glioblastoma.     

Prediction of pathological tumor volume in clinically localized prostate cancer: value of endorectal coil magnetic resonance imaging

The purpose of this study was to determine whether endorectal coil magnetic resonance imaging (MRI) enables accurate assessment of pathologic tumor volume in patients with clinically localized prostate carcinoma. Twenty-four patients with biopsy-proved prostate carcinoma underwent MRI at 0.5 T before radical prostatectomy. Tumor volumes were determined independently on axial fast-spin-echo (SE) T₂-weighted MR images and whole-mount pathology slides of the surgical specimens. At pathology, tumor volumes ranged from 0.17 to 9.42 cm³ (mean±SD, 3.11±2.99 cm³). A strong correlation (r=.944) was found between measurements of tumor volume based on MR images and pathological specimens. The error was less than 0.5 cm³ in 14 cases, in the range of 0.5–1 cm³ in 7 cases, and more than 1 cm³ in 3 cases. By using an MR tumor volume of 2 cm³ as cutoff value, extracapsular tumor spread could be predicted with a sensitivity of 81.2%, a specificity of 100%, and an accuracy of 87.5%. Tumor volume determinations based on MR images seem to be accurate enough to be helpful in clinical decision-making.     

Magnetic resonance imaging in patients with granulomatosis with polyangiitis (Wegener’s) and subglottic stenosis

Objective

To evaluate the ability of MRI to detect subglottic stenosis and to differentiate between active and inactive subglottic inflammation in patients with granulomatosis with polyangiitis (GPA).

Materials and methods

MRI studies of the larynx of 18 GPA patients with suspected SGS were included. The MRI protocol included T1- and T2-weighted and STIR-sequences, dynamic contrast enhancement (DCE) and diffusion weighted imaging (DWI). Two independent observers reviewed the MR images. SGS were identified and quantified, inflammatory activity was assessed using edema imaging, DCE and DWI. Final MRI diagnoses were compared to the clinical, laryngoscopic and histopathologic results.

Results

MRI confirmed SGS in all GPA patients with significant narrowing of the airway lumen and thickening of subglottic wall. Assessing the subglottic inflammatory activity, MRI showed a sensitivity of 87.5 % and a specificity of 60.0 %. Interrater agreement was κ = 0.769. Of the different MR technical approaches tested, edema imaging was most sensitive and specific. DWI led to significant differences in the apparent diffusion coefficient between active and inactive subglottic inflammation. No significant differences were found with DCE imaging.

Conclusion

MR imaging has shown the ability to detect and grade SGS in patients with GPA. It non-invasively assesses the status of inflammatory activity utilizing edema sensitive sequences and DWI.     

PET/MRI in cancer patients: first experiences and vision from Copenhagen

Combined PET/MRI systems are now commercially available and are expected to change the medical imaging field by providing combined anato-metabolic image information. We believe this will be of particular relevance in imaging of cancer patients. At the Department of Clinical Physiology, Nuclear Medicine & PET at Rigshospitalet in Copenhagen we installed an integrated PET/MRI in December 2011. Here, we describe our first clinical PET/MR cases and discuss some of the areas within oncology where we envision promising future application of integrated PET/MR imaging in clinical routine. Cases described include brain tumors, pediatric oncology as well as lung, abdominal and pelvic cancer. In general the cases show that PET/MRI performs well in all these types of cancer when compared to PET/CT. However, future large-scale clinical studies are needed to establish when to use PET/MRI. We envision that PET/MRI in oncology will prove to become a valuable addition to PET/CT in diagnosing, tailoring and monitoring cancer therapy in selected patient populations.     

Measurements of T1 and T2 relaxation times of colon cancer metastases in rat liver at 7 T

The purpose of this study was to investigate the magnetic resonance imaging (MRI) characteristics of colon cancer metastases in rat liver at 7 T. A dedicated RF microstrip coil of novel design was built in order to increase the signal-to-noise ratio and, in combination with respiratory triggering, to minimize motion artifacts. T₁- and T₂-weighted MR imaging was performed to follow tumor growth. T₁-weighted images provided a good anatomical delineation of the liver structure, while the best contrast between metastases and normal liver tissue was achieved with T₂-weighted images.Measurements of T₁ and T₂ relaxation times were performed with inversion recovery FLASH and Carr–Purcell–Meiboom–Gill and inversion recovery FLASH imaging sequences, respectively, for quantitative MR characterization of metastases. Both the T₁ and T₂ of the metastases were significantly higher than those of normal liver tissue. Further, an increase in the T₁ relaxation time of the metastases was observed with tumor growth. These findings suggest that quantitative in vivo MR characterization provides information on tumor development and possibly response to therapy, though additional studies are needed to elucidate the correlation between the changes in relaxation times and tumor microenvironment.     

ESMRMB 2016, 33rd Annual Scientific Meeting,Vienna, AT,September 29–October 1: Abstracts,Thursday

Objective

To evaluate the feasibility of in vivo measurement of the fatty acid (FA) composition of breast adipose tissue by MRS on a clinical platform.

Material and methods

MRS experiments were performed at 3 T, using a STEAM sequence, on 25 patients diagnosed with breast cancer. MR spectra, acquired on healthy breast tissue, were analysed with the LCModel.

Results

The measured values of the saturated fatty acid (SFA), mono-unsaturated fatty acid (MUFA) and poly-unsaturated fatty acid (PUFA) fractions were 23.8 ± 7.1 %, 55.4 ± 6.8 % and 20.8 ± 4.4 %, respectively.The values of SFA, MUFA and PUFA observed in the current study are in the same range as those found in two previous studies performed at 7 T.

Conclusion

The results of the current study show that it is possible to quantify the fatty acid composition of breast tissue in vivo in a clinical setting (3 T).

     

Magnetic resonance imaging of the pulsing brain: a systematic review

Objective

To perform a systematic review of the literature exploring magnetic resonance imaging (MRI) methods for measuring natural brain tissue pulsations (BTPs) in humans.

Methods

A prospective systematic search of MEDLINE, SCOPUS and OpenGrey databases was conducted by two independent reviewers using a pre-determined strategy. The search focused on identifying reported measurements of naturally occurring BTP motion in humans. Studies involving non-human participants, MRI in combination with other modalities, MRI during invasive procedures and MRI studies involving externally applied tests were excluded. Data from the retrieved records were combined to create Forest plots comparing brain tissue displacement between Chiari-malformation type 1 (CM-I) patients and healthy controls using an independent samples t-test.

Results

The search retrieved 22 eligible articles. Articles described 5 main MRI techniques for visualisation or quantification of intrinsic brain motion. MRI techniques generally agreed that the amplitude of BTPs varies regionally from 0.04 mm to ~ 0.80 mm, with larger tissue displacements occurring closer to the centre and base of the brain compared to peripheral regions. Studies of brain pathology using MRI BTP measurements are currently limited to tumour characterisation, idiopathic intracranial hypertension (IIH), and CM-I. A pooled analysis confirmed that displacement of tissue in the cerebellar tonsillar region of CM-I patients was + 0.31 mm [95% CI 0.23, 0.38, p < 0.0001] higher than in healthy controls.

Discussion

MRI techniques used for measurements of brain motion are at an early stage of development with high heterogeneity across the methods used. Further work is required to provide normative data to support systematic BTPs characterisation in health and disease.

     

Mri and mrs of human tendon xanthoma at 1.5 t: Anin vivo study

We studied a xanthomatous Achilles tendon and a normal Achilles tendon with the proton magnetic resonance imaging (MRI) and spectroscopy (MRS) at 1.5 T in a standard head coil. TheT ₂ maps and the localized proton spectra of the Achilles tendon were reconstructed. The normal tendon revealed no MR signal, whereas the xanthomatous tendon image consisted of variable signal intensities, for which the value ofT ₂ was significantly shorter (p=0.0002) than that of adipose tissue. The proton spectrum of this tendon xanthoma showed an increased water peak and unsaturated olefinic group intensity compared with the spectrum of the normal Achilles tendon area. The complex cholesterol molecule itself cannot be proven directly in a xanthomatous tendon, but its presence can be revealed with the help of the increased methyl and methylene groups of the fatty acids of the cholesteryl esters. This and other typical features describedin vitro for atheromatous tissue can be detectedin vivo in xanthomas.Additional reprints of this chapter may be obtained from the Reprints Department, Chapman & Hall, One Penn Plaza, New York, NY 10119.     

Multiproject–multicenter evaluation of automatic brain tumor classification by magnetic resonance spectroscopy

Justification  Automatic brain tumor classification by MRS has been under development for more than a decade. Nonetheless, to our knowledge, there are no published evaluations of predictive models with unseen cases that are subsequently acquired in different centers. The multicenter eTUMOUR project (2004–2009), which builds upon previous expertise from the INTERPRET project (2000–2002) has allowed such an evaluation to take place. Materials and Methods  A total of 253 pairwise classifiers for glioblastoma, meningioma, metastasis, and low-grade glial diagnosis were inferred based on 211 SV short TE INTERPRET MR spectra obtained at 1.5 T (PRESS or STEAM, 20–32 ms) and automatically pre-processed. Afterwards, the classifiers were tested with 97 spectra, which were subsequently compiled during eTUMOUR. Results  In our results based on subsequently acquired spectra, accuracies of around 90% were achieved for most of the pairwise discrimination problems. The exception was for the glioblastoma versus metastasis discrimination, which was below 78%. A more clear definition of metastases may be obtained by other approaches, such as MRSI + MRI. Conclusions  The prediction of the tumor type of in-vivo MRS is possible using classifiers developed from previously acquired data, in different hospitals with different instrumentation under the same acquisition protocols. This methodology may find application for assisting in the diagnosis of new brain tumor cases and for the quality control of multicenter MRS databases.     

Magnetic resonance findings in scuba diving-related spinal cord decompression sickness

Scuba diving is associated with risk of severe decompression sickness (DCS type II), which results from rapid reduction of the environmental pressure sufficient to cause the formation into tissue or blood of inert gas bubbles previously loaded within tissues as a soluble phase. DCS type II constitutes a unique subset of ischemic insults to the central nervous system (CNS) with primarily involvement of the spinal cord. Ten patients with diving-related barotrauma underwent neurologic examination. Two of them presented progressive sensory and motor loss in the extremities at admission and were presumed affected by spinal cord DCS. Magnetic resonance imaging (MRI) demonstrated abnormalities in the white-matter tracts of the spinal cord in these patients, in each case corresponding to an area of the cord believed to be clinically involved. After a course of therapeutic recompressions, one patient was able to stand and walk a short distance,and MRI revealed a decreased extension of areas of spinal cord abnormalities. MRI has proved to be reliable in the detection of pathologic changes of spinal cord decompression sickness that were previously undetectable by other neuroimaging methods and also has proved to be useful in the follow-up during therapeutic hyperbaric recompressions.