Multiparametric MRI for prostate cancer localization in correlation to whole‐mount histopathology

Purpose:

To prospectively evaluate multiparametric magnetic resonance imaging (MRI) for accurate localization of intraprostatic tumor nodules, with whole‐mount histopathology as the gold standard.

Materials and Methods:

Seventy‐five patients with biopsy‐proven, intermediate, and high‐risk prostate cancer underwent preoperative T2‐weighted (T2w), dynamic contrast‐enhanced (DCE) and diffusion‐weighted (DW) MRI at 1.5T. Localization of suspicious lesions was recorded for each of 24 standardized regions of interest on the different MR images and correlated with the pathologic findings. Generalized estimating equations (GEE) were used to estimate the sensitivity, specificity, accuracy, positive, and negative predictive value for every MRI modality, as well as to evaluate the influence of Gleason score and pT‐stage. Tumor volume measurements on histopathological specimens were correlated with those on the different MR modalities (Pearson correlation).

Results:

DW MRI had the highest sensitivity for tumor localization (31.1% vs. 27.4% vs. 44.5% for T2w, DCE, and DW MRI, respectively; P < 0.005), with more aggressive or more advanced tumors being more easily detected with this imaging modality. Significantly higher sensitivity values were obtained for the combination of T2w, DCE, and DW MRI (58.8%) as compared to each modality alone or any combination of two modalities (P < 0.0001). Tumor volume can most accurately be assessed by means of DW MRI (r = 0.75; P < 0.0001).

Conclusion:

Combining T2w, DCE, and DW imaging significantly improves prostate cancer localization. J. Magn. Reson. Imaging 2013;37:1392–1401. © 2012 Wiley Periodicals, Inc.     

Multiple‐bolus dynamic contrast‐enhanced MRI in the pancreas during a glucose challenge

Purpose:

To assess the feasibility of multiple‐bolus dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) in the pancreas; to optimize the analysis; and to investigate application of the method to a glucose challenge in type 2 diabetes.

Materials and Methods:

A 4‐bolus DCE‐MRI protocol was performed on five patients with type 2 diabetes and 11 healthy volunteers during free‐breathing. Motion during the dynamic time series was corrected for using a model‐driven nonlinear registration. A glucose challenge was administered intravenously between the first and second DCE‐MRI acquisition in all patients and in seven of the healthy controls.

Results:

Image registration improved the reproducibility of the DCE‐MRI model parameters across the repeated bolus‐acquisitions in the healthy controls with no glucose challenge (eg, coefficient of variation for K^trans improved from 38% to 28%). Native tissue T₁ was significantly lower in patients (374 ± 68 msec) compared with volunteers (519 ± 41 msec) but there was no significant difference in any of the baseline DCE‐MRI parameters. No effect of glucose challenge was observed in either the patients or healthy volunteers.

Conclusion:

Multiple bolus DCE‐MRI is feasible in the pancreas and is improved by nonlinear image registration but is not sensitive to the effects of an intravenous glucose challenge. J. Magn. Reson. Imaging 2010;32:622–628. © 2010 Wiley‐Liss, Inc.     

Quantification of renal perfusion: comparison of arterial spin labeling and dynamic contrast-enhanced MRI

Purpose:

To provide the first comparison of absolute renal perfusion obtained by arterial spin labeling (ASL) and separable compartment modeling of dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI). Moreover, we provide the first application of the dual bolus approach to quantitative DCE‐MRI perfusion measurements in the kidney.

Materials and Methods:

Consecutive ASL and DCE‐MRI acquisitions were performed on six rabbits on a 1.5 T MRI system. Gadolinium (Gd)‐DTPA was administered in two separate injections to decouple measurement of the arterial input function and tissue uptake curves. For DCE perfusion, pixel‐wise and mean cortex region‐of‐interest tissue curves were fit to a separable compartment model.

Results:

Absolute renal cortex perfusion estimates obtained by DCE and ASL were in close agreement: 3.28 ± 0.59 mL/g/min (ASL), 2.98 ± 0.60 mL/g/min (DCE), and 3.57 ± 0.96 mL/g/min (pixel‐wise DCE). Renal medulla perfusion was 1.53 ± 0.35 mL/g/min (ASL) but was not adequately described by the separable compartment model.

Conclusion:

ASL and DCE‐MRI provided similar measures of absolute perfusion in the renal cortex, offering both noncontrast and contrast‐based alternatives to improve current renal MRI assessment of kidney function. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Added value of breathhold diffusion‐weighted MRI in detection of small hepatocellular carcinoma lesions compared with dynamic contrast‐enhanced MRI alone using receiver operating characteristic curve analysis

Purpose

To evaluate the added value of single‐breathhold diffusion‐weighted MRI (DWI) in detection of small hepatocellular carcinoma (HCC) lesions (≤2 cm) in patients with chronic liver disease, by comparing the detection sensitivity of combined DWI/conventional dynamic contrast‐enhanced (DCE)‐MRI to that of conventional DCE‐MRI alone.

Materials and Methods

A total of 37 patients with chronic liver diseases underwent abdominal MRI at 1.5T, including T1‐weighted imaging (T1WI), T2‐weighted imaging (T2WI), and 2D conventional DCE. For each patient study, axial DWI was performed with a single‐shot echo‐planar imaging (EPI) sequence using a modified sensitivity‐encoding (mSENSE) technique with b‐value of 500 seconds/mm². A total of 20–24 slices were obtained during a 15–17‐second breathhold. Two observers independently interpreted the combined DWI/conventional DCE‐MRI images and the conventional DCE‐MRI images alone in random order. For all small HCC lesions, the diagnostic performance using each imaging set was evaluated by receiver operating characteristic (ROC) curve analysis. Sensitivity and positive predictive values were also calculated and analyzed.

Results

A total of 47 small HCCs were confirmed as final result. The area under the ROC curve (Az) of combined DWI/conventional DCE‐MRI images (observer 1, 0.922; observer 2, 0.918) were statistically higher than those of conventional DCE‐MRI alone (observer 1, 0.809; observer 2, 0.778) for all small HCC lesions (P < 0.01). The lesion detection sensitivities using the combined technique for both observers were significantly higher than those using conventional DCE‐MRI alone (P < 0.01). The sensitivity values for two observers using the combined technique were 97.87% and those using conventional DCE‐MRI alone were 85.11% to 82.98%. The positive predictive values for two observers using the combined imaging technique (97.87%) were slightly higher than those using conventional DCE‐MRI alone (92.86–93.02%), but there was no significant difference between the two imaging sets.

Conclusion

Combined use of breathhold DWI with conventional DCE‐MRI helped to provide higher sensitivities than conventional DCE‐MRI alone in the detection of small HCC lesions in patients with chronic liver disease. J. Magn. Reson. Imaging 2009;29:341–349. © 2009 Wiley‐Liss, Inc.     

Dynamic contrast-enhanced magnetic resonance imaging and invasive breast cancer: primary lesion kinetics correlated with axillary lymph node extracapsular extension

Purpose

To determine if dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) peak enhancement (PE) of primary breast cancer can predict the presence of lymph node extracapsular extension (LNECE) in patients with axillary metastatic disease.

Materials and Methods

In all, 167 patients treated with radiotherapy for invasive breast cancer from January 1, 2006 to November 1, 2007 were retrospectively identified. Patients with DCE‐MRI and surgical axillary staging were included in this study. PE of primary tumors was compared according to axillary nodal status: negative, positive without LNECE, or positive with LNECE. A receiver operator characteristic curve (ROC) was plotted to determine accuracy of PE to predict LNECE.

Results

Forty‐six patients met the study criteria. Thirty‐two (70%) were node‐negative, 9 (19%) were node‐positive without LNECE, and 5 (11%) were node‐positive with LNECE. PE was greater for patients with LNECE (mean 365%) compared to node‐positive patients without LNECE (mean 183%) P = 0.05 and node‐negative patients (mean 144%) P = 0.0012. Area under the ROC curve was 0.93.

Conclusion

DCE‐MRI PE may be a surrogate marker for LNECE. If validated, DCE‐MRI may provide noninvasive kinetic information informing axillary nodal status for patients who receive chemotherapy prior to surgical axillary staging or forego axillary dissection after a positive sentinel node biopsy. J. Magn. Reson. Imaging 2011;33:96–101. © 2010 Wiley‐Liss, Inc.     

Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrast‐enhanced MRI alone and in combination: Preliminary experience

Purpose:

To report our preliminary experience with the use of intravoxel incoherent motion (IVIM) diffusion‐weighted magnetic resonance imaging (DW‐MRI) and dynamic contrast‐enhanced (DCE)‐MRI alone and in combination for the diagnosis of liver cirrhosis.

Materials and Methods:

Thirty subjects (16 with noncirrhotic liver, 14 with cirrhosis) were prospectively assessed with IVIM DW‐MRI (n = 27) and DCE‐MRI (n = 20). IVIM parameters included perfusion fraction (PF), pseudodiffusion coefficient (D*), true diffusion coefficient (D), and apparent diffusion coefficient (ADC). Model‐free DCE‐MR parameters included time to peak (TTP), upslope, and initial area under the curve at 60 seconds (IAUC60). A dual input single compartmental perfusion model yielded arterial flow (Fa), portal venous flow (Fp), arterial fraction (ART), mean transit time (MTT), and distribution volume (DV). The diagnostic performances for diagnosis of cirrhosis were evaluated for each modality alone and in combination using logistic regression and receiver operating characteristic analyses. IVIM and DCE‐MR parameters were compared using a generalized estimating equations model.

Results:

PF, D*, D, and ADC values were significantly lower in cirrhosis (P = 0.0056–0.0377), whereas TTP, DV, and MTT were significantly increased in cirrhosis (P = 0.0006–0.0154). There was no correlation between IVIM‐ and DCE‐MRI parameters. The highest Az (areas under the curves) values were observed for ADC (0.808) and TTP‐DV (0.952 for each). The combination of ADC with DV and TTP provided 84.6% sensitivity and 100% specificity for diagnosis of cirrhosis.

Conclusion:

The combination of DW‐MRI and DCE‐MRI provides an accurate diagnosis of cirrhosis. J. Magn. Reson. Imaging 2010;31:589–600. © 2010 Wiley‐Liss, Inc.     

Principal component analysis of breast DCE‐MRI adjusted with a model‐based method

Purpose:

To investigate a fast, objective, and standardized method for analyzing breast dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) applying principal component analysis (PCA) adjusted with a model‐based method.

Materials and Methods:

3D gradient‐echo DCE breast images of 31 malignant and 38 benign lesions, recorded on a 1.5T scanner, were retrospectively analyzed by PCA and by the model‐based three‐timepoints (3TP) method.

Results:

Intensity‐scaled (IS) and enhancement‐scaled (ES) datasets were reduced by PCA yielding a first IS‐eigenvector that captured the signal variation between fat and fibroglandular tissue; two IS‐eigenvectors and the two first ES‐eigenvectors captured contrast‐enhanced changes, whereas the remaining eigenvectors captured predominantly noise changes. Rotation of the two contrast‐related eigenvectors led to a high congruence between the projection coefficients and the 3TP parameters. The ES‐eigenvectors and the rotation angle were highly reproducible across malignant lesions, enabling calculation of a general rotated eigenvector base. Receiver operating characteristic (ROC) curve analysis of the projection coefficients of the two eigenvectors indicated high sensitivity of the first rotated eigenvector to detect lesions (area under the curve [AUC] > 0.97) and of the second rotated eigenvector to differentiate malignancy from benignancy (AUC = 0.87).

Conclusion:

PCA adjusted with a model‐based method provided a fast and objective computer‐aided diagnostic tool for breast DCE‐MRI. J. Magn. Reson. Imaging 2009;30:989–998. © 2009 Wiley‐Liss, Inc.     

Assessment of vascular remodeling under antiangiogenic therapy using DCE‐MRI and vessel size imaging

Purpose

To assess vascular remodeling in tumors during two different antiangiogenic therapies with dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) and vessel size imaging and to evaluate the vessel size index (VSI) as a novel biomarker of therapy response.

Materials and Methods

In two independent experiments, nude mice bearing human skin squamous cell carcinoma xenografts were treated with a vascular endothelial growth factor (VEGF) inhibitor (bevacizumab) or a multitargeted tyrosine kinase inhibitor (SU11248). Changes in tumor vascularity were assessed by DCE‐MRI and vessel size imaging. DCE‐MRI data were analyzed applying a two‐compartment model (Brix), calculating the parameters Amplitude and k_ep.

Results

For both experiments Amplitude decreased significantly in treated tumors while k_ep did not change significantly. VSI showed controversial results. VSI was significantly increased in SU11248‐treated A431 tumors, whereas no changes were found in bevacizumab‐treated HaCaT‐ras‐A‐5RT3 tumors. Immunohistology confirmed these results and suggest differences in the maturation of tumor vascularization as a possible explanation.

Conclusion

DCE‐MRI and vessel size imaging provide reliable and supplementing biomarkers of antiangiogenic therapy response. The results of both methods are in excellent agreement with histology. Nevertheless, our results also indicate that vascular remodeling is complex and that a uniform response cannot be expected for different tumors and therapies. J. Magn. Reson. Imaging 2009;29:1125–1133. © 2009 Wiley‐Liss, Inc.     

Reproducibility of black blood dynamic contrast‐enhanced magnetic resonance imaging in aortic plaques of atherosclerotic rabbits

Purpose:

To investigate the short‐term reproducibility of black‐blood dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) in atherosclerotic rabbits to evaluate the potential of this technique to be a reliable readout of plaque progression and/or regression upon therapeutic intervention.

Materials and Methods:

Atherosclerotic rabbits were imaged at baseline and 24 hours later with DCE‐MRI on a 1.5T MRI system. DCE‐MRI images were analyzed by calculating the area under the signal intensity versus time curve (AUC). Intraclass correlation coefficients (ICCs) were used to evaluate interscan, intraobserver, and interobserver reproducibility. In addition, the test–retest coefficient of variation (CoV) was evaluated.

Results:

Statistical analyses showed excellent interscan, intraobserver, and interobserver agreement. All ICCs were greater than 0.75, P < 0.01 indicating excellent agreement between measurements.

Conclusion:

Experimental results show good interscan and excellent intra‐ and interobserver reproducibility, suggesting that DCE‐MRI could be used in preclinical settings as a read‐out for novel therapeutic interventions for atherosclerosis. This preliminary work encourages investigating the reproducibility of DCE‐MRI also in clinical settings, where it could be used for monitoring high‐risk patients and in longitudinal clinical drug trials. J. Magn. Reson. Imaging 2010;32:191–198. © 2010 Wiley‐Liss, Inc.     

Vascular staging of renal and adrenal malignancies with a noncontrast enhanced steady state free precession technique

Purpose:

To compare a noncontrast enhanced balanced steady state free precession (bSSFP) MRI technique with a conventional dynamic contrast‐enhanced (DCE) three‐dimensional (3D) spoiled gradient recalled echo (SPGR) imaging in the vascular staging of renal and adrenal malignancies.

Materials and Methods:

Sixty‐three MRIs with both bSSFP and DCE acquisitions performed for initial staging of renal and adrenal malignancies were retrospectively evaluated for presence and extent of thrombus in the renal veins and inferior vena cava (IVC). Thrombus characterization was also evaluated. DCE imaging was used as the standard‐of‐reference. Histopathology was available in 46 of 63 cases as an additional external standard.

Results:

There is very good agreement between bSSFP and DCE imaging for determining the presence or absence of thrombus in the renal veins (r = 0.95; P < 0.0001) and IVC (r = 0.91; P < 0.0001). BSSFP is less successful at distinguishing bland from tumor thrombus.

Conclusion:

Noncontrast enhanced bSSFP is an acceptable alternative to DCE imaging for vascular staging of locally advanced renal/adrenal malignancies, with somewhat limited ability to distinguish bland from tumor thrombus. J. Magn. Reson. Imaging 2011;33:1406–1413. © 2011 Wiley‐Liss, Inc.     

Resolving arterial phase and temporal enhancement characteristics in DCE MRM at high spatial resolution with TWIST acquisition

Purpose:

To investigate the potential of a view‐sharing 3D fast gradient‐echo sequence using pseudo random trajectories (TWIST) to achieve very short acquisition times with high in‐plane resolution and good volume coverage and its application to dynamic contrast‐enhanced (DCE) breast magnetic resonance imaging (MRI).

Materials and Methods:

Two versions of a 3D fast gradient echo TWIST sequence were implemented and applied to patients: First, an ultrafast TWIST acquisition (TA = 5.7 sec) in combination with a routine DCE MRM protocol to allow the extraction of arterial input functions and to resolve the first pass of the contrast agent. Second, a dynamic full coverage TWIST DCE acquisition (TA = 10.6 sec) in a repeat examination, replacing the routine DCE MRM sequence.

Results:

The ultrafast acquisition enabled extraction of arterial input functions and the monitoring of the contrast agent's first pass through vessels and lesions. The dynamic full coverage TWIST acquisition captured the initial dynamic slope of the signal time curve of lesions accurately, in contrast to the routine protocol.

Conclusion:

TWIST acquisitions proved very robust and offer high flexibility in protocol timing. The ultrafast protocol achieved 5.7 seconds time resolution with good image quality and can be combined with any established routine protocol. The full dynamics TWIST DCE protocol offers improved time resolution of the CE dynamic time‐course and closely matches the image quality of the routine protocol. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Reconstruction of 3D dynamic contrast-enhanced magnetic resonance imaging using nonlocal means

Purpose

To develop and test a nonlocal means‐based reconstruction algorithm for undersampled 3D dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) of tumors.

Materials and Methods

We propose a reconstruction technique that is based on the recently proposed nonlocal means (NLM) filter which can relax trade‐offs in spatial and temporal resolutions in dynamic imaging. Unlike the original application of NLM for image denoising, the MR reconstruction framework here can offer high‐quality images from undersampled k‐space data. The method is based on enforcing similarity constraints in terms of neighborhoods of pixels rather than individual pixels. The method was applied on undersampled 3D DCE imaging of breast and brain tumor datasets and the results were compared to sliding window reconstructions and to a compressed sensing method using total variation constraints on the images.

Results

Undersampling factors of up to five were obtained with the proposed approach while preserving the spatial and temporal characteristics. The NLM reconstruction method offered improved performance over the sliding window and the total variation constrained reconstruction techniques.

Conclusion

The reconstruction framework here can give high‐quality images from undersampled DCE MRI data and has the potential to improve the quality of DCE tumor imaging. J. Magn. Reson. Imaging 2010;32:1217–1227. © 2010 Wiley‐Liss, Inc.     

Impact of nonrigid motion correction technique on pixel-wise pharmacokinetic analysis of free-breathing pulmonary dynamic contrast-enhanced MR imaging

Purpose:

To investigates the impact of nonrigid motion correction on pixel‐wise pharmacokinetic analysis of free‐breathing DCE‐MRI in patients with solitary pulmonary nodules (SPNs). Misalignment of focal lesions due to respiratory motion in free‐breathing dynamic contrast‐enhanced MRI (DCE‐MRI) precludes obtaining reliable time–intensity curves, which are crucial for pharmacokinetic analysis for tissue characterization.

Materials and Methods:

Single‐slice 2D DCE‐MRI was obtained in 15 patients. Misalignments of SPNs were corrected using nonrigid B‐spline image registration. Pixel‐wise pharmacokinetic parameters K^trans, v_e, and k_ep were estimated from both original and motion‐corrected DCE‐MRI by fitting the two‐compartment pharmacokinetic model to the time–intensity curve obtained in each pixel. The “goodness‐of‐fit” was tested with χ²‐test in pixel‐by‐pixel basis to evaluate the reliability of the parameters. The percentages of reliable pixels within the SPNs were compared between the original and motion‐corrected DCE‐MRI. In addition, the parameters obtained from benign and malignant SPNs were compared.

Results:

The percentage of reliable pixels in the motion‐corrected DCE‐MRI was significantly larger than the original DCE‐MRI (P = 4 × 10^?7). Both K^trans and k_ep derived from the motion‐corrected DCE‐MRI showed significant differences between benign and malignant SPNs (P = 0.024, 0.015).

Conclusion:

The study demonstrated the impact of nonrigid motion correction technique on pixel‐wise pharmacokinetic analysis of free‐breathing DCE‐MRI in SPNs. J. Magn. Reson. Imaging 2011;33:968–973. © 2011 Wiley‐Liss, Inc.

     

Differentiation of malignant and benign breast lesions using magnetization transfer imaging and dynamic contrast‐enhanced MRI

Purpose:

To evaluate feasibility of using magnetization transfer ratio (MTR) in conjunction with dynamic contrast‐enhanced MRI (DCE‐MRI) for differentiation of benign and malignant breast lesions at 3 Tesla.

Materials and Methods:

This prospective study was IRB and HIPAA compliant. DCE‐MRI scans followed by MT imaging were performed on 41 patients. Regions of interest (ROIs) were drawn on co‐registered MTR and DCE postcontrast images for breast structures, including benign lesions (BL) and malignant lesions (ML). Initial enhancement ratio (IER) and delayed enhancement ratio (DER) were calculated, as were normalized MTR, DER, and IER (NMTR, NDER, NIER) values. Diagnostic accuracy analysis was performed.

Results:

Mean MTR in ML was lower than in BL (P < 0.05); mean DER and mean IER in ML were significantly higher than in BL (P < 0.01, P < 0.001). NMTR, NDER, and NIER were significantly lower in ML versus BL (P < 0.007, P < 0.001, P < 0.001). IER had highest diagnostic accuracy (77.6%), sensitivity (86.2%), and area under the ROC curve (.879). MTR specificity was 100%. Logistic regression modeling with NMTR and NIER yielded best results for BL versus ML (sensitivity 93.1%, specificity 80%, AUC 0.884, accuracy 83.7%).

Conclusion:

Isolated quantitative DCE analysis may increase specificity of breast MR for differentiating BL and ML. DCE‐MRI with NMTR may produce a robust means of evaluating breast lesions. J. Magn. Reson. Imaging 2013;37:138–145. © 2012 Wiley Periodicals, Inc.     

MRI of tumor angiogenesis

Angiogenesis has long been established as a key element in the pathophysiology of tumor growth and metastasis. Increasingly, new molecularly targeted antiangiogenic drugs are being developed in the fight against cancer. These drugs bring with them a need for an accurate means of diagnosing tumor angiogenesis and monitoring response to treatment. Imaging techniques can offer this in a noninvasive way, while also providing functional information about the tumor. Among the many clinical imaging techniques available, MRI alone can provide relatively good spatial resolution and specificity, without ionizing radiation and with limited side effects. Arterial spin labeling (ASL) and blood oxygenation level-dependent (BOLD) imaging techniques can be employed to confer indirect measures of angiogenesis, such as blood flow and blood volume, without the need for external contrast agents. Dynamic contrast-enhanced (DCE)-MRI is rapidly emerging as a standard method for directly measuring angiogenesis during angiogenesis-inhibitor drug trials. As macromolecular MR contrast agents become available, they will inevitably be utilized in the assessment of tumor perfusion and vessel permeability. Meanwhile, technological advances have made imaging at a molecular level a possibility. They have brought the potential to directly target MR contrast agents to markers of angiogenesis, such as the alpha(v)beta(3) integrin. Before this is used clinically, however, substantial gains in sensitivity brought about by improved coils, pulse sequences, and contrast agents will be needed. Herein we discuss the techniques currently available for MRI of angiogenesis, along with their respective advantages and disadvantages, and what the future holds for this evolving field of imaging.     

Relationship of temporal resolution to diagnostic performance for dynamic contrast enhanced MRI of the breast

Purpose:

To investigate the relationship between temporal resolution of dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) and classification of breast lesions as benign versus malignant.

Materials and Methods:

Patients underwent T₁‐weighted DCE MRI with 15 s/acquisition temporal resolution using 1.5 Tesla (n = 48) and 3.0T (n = 33) MRI scanners. Seventy‐nine patients had pathologically proven diagnosis and 2 had 2 years follow‐up showing no change in lesion size. The temporal resolution of DCE MRI was systematically reduced as a postprocessing step from 15 to 30, 45, and 60 s/acquisition by eliminating intermediate time points. Average wash‐in and wash‐out slopes, wash‐out percentage changes, and kinetic curve shape (persistently enhancing, plateau, or wash‐out) were compared for each temporal resolution. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to compare kinetic parameters and diagnostic accuracy.

Results:

Sixty patients (74%) had malignant lesions and 21 patients (26%) had benign lesions. All temporal‐resolution parameters significantly predicted benign versus malignant diagnosis (P < 0.05). However, 45 s/acquisition and higher temporal‐resolution datasets showed higher accuracy than the 60 s/acquisition dataset by ROC curve analysis (0.72 versus 0.69 for average wash‐in slope; 0.85 versus 0.82, for average wash‐out slope; and 0.88 versus 0.80 for kinetic curve shape assessment, for 45 s/acquisition versus 60 s/acquisition temporal‐resolution datasets, respectively (P = 0.027).

Conclusion:

DCE MRI data with at least 45‐s temporal resolution maximized the agreement between the kinetic parameters and correct classification of benign versus malignant diagnosis. J. Magn. Reson. Imaging 2009;30:999–1004. © 2009 Wiley‐Liss, Inc.     

Application of a biodegradable macromolecular contrast agent in dynamic contrast‐enhanced MRI for assessing the efficacy of indocyanine green‐enhanced photothermal cancer therapy

Purpose

To investigate the effectiveness of a polydisulfide‐based biodegradable macromolecular contrast agent, (Gd‐DTPA)‐cystamine copolymers (GDCC), in assessing the efficacy of indocyanine green‐enhanced photothermal cancer therapy using dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI).

Materials and Methods

Breast cancer xenografts in mice were injected with indocyanine green and irradiated with a laser. The efficacy was assessed using DCE‐MRI with GDCC of 40 kDa (GDCC‐40) at 4 hours and 7 days after the treatment. The uptake of GDCC‐40 by the tumors was fit to a two‐compartment model to obtain tumor vascular parameters, including fractional plasma volume (f^PV), endothelium transfer coefficient (K^PS), and permeability surface area product (PS).

Results

GDCC‐40 resulted in similar tumor vascular parameters at three doses, with larger standard deviations at lower doses. The values of f^PV, K^PS, and PS of the treated tumors were smaller (P < 0.05) than those of untreated tumors at 4 hours after the treatment and recovered to pretreatment values (P > 0.05) at 7 days after the treatment.

Conclusion

DCE‐MRI with GDCC‐40 is effective for assessing tumor early response to dye‐enhanced photothermal therapy and detecting tumor relapse after the treatment. GDCC‐40 has a potential to noninvasively monitor anticancer therapies with DCE‐MRI. J. Magn. Reson. Imaging 2009;30:401–406. © 2009 Wiley‐Liss, Inc.     

Evaluation of the tibial tunnel after intraoperatively administered platelet‐rich plasma gel during anterior cruciate ligament reconstruction using diffusion weighted and dynamic contrast‐enhanced MRI

Purpose:

To evaluate effect of platelet‐rich plasma gel (PRPG), locally administered during the anterior cruciate ligament (ACL) reconstruction, with two MRI methods. The proximal tibial tunnel was assessed with diffusion weighted imaging (DWI) and with dynamic contrast‐enhanced imaging (DCE‐MRI).

Materials and Methods:

In 50 patients, standard arthroscopic ACL reconstructions were performed. The patients in the PRPG group (n = 25) received a local application of PRPG. The proximal tibial tunnel was examined by DWI and DCE‐MRI, which were used to calculate apparent diffusion coefficient (ADC) values, as well as the contrast enhancement gradient (G_enh) and enhancement factor (F_enh) values.

Results:

At 1 month, the calculated average ADC value in the PRPG group was significantly lower than in the control group. At 2.5 and at 6 months, G_enh was significantly higher in the PRPG group. There were no significant differences in F_enh between the groups at any control examination.

Conclusion:

DWI and DCE‐MRI measurements indicate a reduced extent of edema during the first postoperative month as well as an increased vascular density and microvessel permeability in the proximal tibial tunnel at 1 and 2.5 postoperative months as the effect of the application of PRPG. J. Magn. Reson. Imaging 2013;37:928–935. © 2012 Wiley Periodicals, Inc.     

Limitations of dynamic contrast-enhanced MRI in monitoring radiation-induced changes in the fraction of radiobiologically hypoxic cells in human melanoma xenografts

Purpose

To investigate the potential of gadopentetate dimeglumine (Gd‐DTPA)‐based dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) in detecting radiation‐induced changes in the fraction of radiobiologically hypoxic cells in A‐07 human melanoma xenografts.

Materials and Methods

A‐07 tumors were randomly assigned to an unirradiated control group or a group given a single radiation dose of 20 Gy. DCE‐MRI and measurement of fraction of hypoxic cells were performed immediately before and 24 h after the radiation exposure. Tumor images of E · F (E is the initial extraction fraction of Gd‐DTPA and F is blood perfusion) and λ (λ is proportional to extracellular volume fraction) were produced by subjecting DCE‐MRI series to Kety analysis. Fraction of hypoxic cells was measured by using a radiobiological assay based on the paired survival curve method.

Results

Fraction of radiobiologically hypoxic cells was higher in irradiated tumors (26.2 ± 5.8%) than in unirradiated tumors (7.5 ± 2.7%) by a factor of 3.5 ± 1.5 (P = 0.0093), whereas only minor radiation‐induced changes in E · F and λ could be detected.

Conclusion

DCE‐MRI does not seem to offer insight into the changes in fraction of radiobiologically hypoxic cells occurring in A‐07 tumors within 24 h after irradiation with 20 Gy. J. Magn. Reson. Imaging 2008;28:1209–1218. © 2008 Wiley‐Liss, Inc.     

Predicting survival and early clinical response to primary chemotherapy for patients with locally advanced breast cancer using DCE‐MRI

Purpose

To evaluate dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) as a tool for early prediction of response to neoadjuvant chemotherapy (NAC) and 5‐year survival in patients with locally advanced breast cancer.

Materials and Methods

DCE‐MRI was performed in patients scheduled for NAC (n = 24) before and after the first treatment cycle. Clinical response was evaluated after completed NAC. Relative signal intensity (RSI) and area under the curve (AUC) were calculated from the DCE‐curves and compared to clinical treatment response. Kohonen and probabilistic neural network (KNN and PNN) analysis were used to predict 5‐year survival.

Results

RSI and AUC were reduced after only one cycle of NAC in patients with clinical treatment response (P = 0.02 and P = 0.08). The mean and 10th percentile RSI values before NAC were significantly lower in patients surviving more than 5 years compared to nonsurvivors (P = 0.05 and 0.02). This relationship was confirmed using KNN, which demonstrated that patients who remained alive clustered in separate regions from those that died. Calibration of contrast enhancement curves by PNN for patient survival at 5 years yielded sensitivity and specificity for training and testing ranging from 80%–92%.

Conclusion

DCE‐MRI in locally advanced breast cancer has the potential to predict 5‐year survival in a small patient cohort. In addition, changes in tumor vascularization after one cycle of NAC can be assessed. J. Magn. Reson. Imaging 2009;29:1300–1307. © 2009 Wiley‐Liss, Inc.