Diffusion weighted imaging of female pelvic cancers: Concepts and clinical applications

Early applications of diffusion weighted magnetic resonance imaging (DWI) were limited to neuroimaging, concentrating either on stroke or brain tumours. With recent advances in MRI hardware and software DWI is now increasingly being investigated for cancer assessment throughout the body.Clinical applications of DWI relating to female pelvic cancers have largely concentrated on detection, localisation and staging of disease. More recently investigators have started to evaluate the ability of DWI for determining tumour histology and even predicting the outcome of chemoradiation treatment.This article reviews the physical concepts of MR diffusion weighting, illustrates the biophysical basis of diffusion contrast and reports the clinical applications of DWI for cervical, endometrial, ovarian, rectal and bladder tumours.     

Prostate cancer measurements on serial MRI during active surveillance: it’s time to be PRECISE

Objective:The PRECISE criteria for reporting multiparametric MRI in patients on active surveillance (AS) for prostate cancer (PCa) score the likelihood of clinically significant change over time using a 1–5 scale, where 4 or 5 indicates radiological progression. According to the PRECISE recommendations, the index lesion size can be reported using different definitions of volume (planimetry or ellipsoid formula) or by measuring one or two diameters. We compared different measurements using planimetry as the reference standard and stratified changes according to the PRECISE scores.Methods:We retrospectively analysed 196 patients on AS with PCa confirmed by targeted biopsy who had two MR scans (baseline and follow-up). Lesions were measured on T₂ weighted imaging (T₂WI) according to all definitions. A PRECISE score was assessed for each patient.Results:The ellipsoid formula exhibited the highest correlation with planimetry at baseline (ρ = 0.97) and follow-up (ρ = 0.98) imaging, compared to the biaxial measurement and single maximum diameter. There was a significant difference (p < 0.001) in the yearly percentage volume change between radiological regression/stability (PRECISE 2–3) and progression (PRECISE 4–5) for planimetry (39.64%) and for the ellipsoid formula (46.78%).Conclusion:The ellipsoid formula could be used to monitor tumour growth during AS. Evidence of a significant yearly percentage volume change between radiological regression/stability (PRECISE 2-3) and progression (PRECISE 4-5) has been also observed.Advances in knowledge:The ellipsoid formula is a reasonable surrogate for planimetry in capturing tumour volume changes on T₂WI in patients on imaging-led AS. This is also associated with radiological changes using the PRECISE recommendations.     

Nephrogenic systemic fibrosis: non-gadolinium options for the imaging of CKD/ESRD patients

Nephrogenic systemic fibrosis (NSF) is a severe systemic disorder developing apparently exclusively in patients in advanced renal failure who receive a gadolinium chelate contrast-enhancing agent for magnetic resonance imaging. Some other apparent risk factors have been identified but their status remains uncertain. Physicians are frequently confronted with patients at risk of NSF who need imaging. An approach to planning imaging in patients at risk to develop NSF is outlined.     

VERDICT‐AMICO: Ultrafast fitting algorithm for non‐invasive prostate microstructure characterization

VERDICT (vascular, extracellular and restricted diffusion for cytometry in tumours) estimates and maps microstructural features of cancerous tissue non‐invasively using diffusion MRI. The main purpose of this study is to address the high computational time of microstructural model fitting for prostate diagnosis, while retaining utility in terms of tumour conspicuity and repeatability. In this work, we adapt the accelerated microstructure imaging via convex optimization (AMICO) framework to linearize the estimation of VERDICT parameters for the prostate gland. We compare the original non‐linear fitting of VERDICT with the linear fitting, quantifying accuracy with synthetic data, and computational time and reliability (performance and precision) in eight patients. We also assess the repeatability (scan‐rescan) of the parameters. Comparison of the original VERDICT fitting versus VERDICT‐AMICO showed that the linearized fitting (1) is more accurate in simulation for a signal‐to‐noise ratio of 20 dB; (2) reduces the processing time by three orders of magnitude, from 6.55 seconds/voxel to 1.78 milliseconds/voxel; (3) estimates parameters more precisely; (4) produces similar parametric maps and (5) produces similar estimated parameters with a high Pearson correlation between implementations, r² > 0.7. The VERDICT‐AMICO estimates also show high levels of repeatability. Finally, we demonstrate that VERDICT‐AMICO can estimate an extra diffusivity parameter without losing tumour conspicuity and retains the fitting advantages. VERDICT‐AMICO provides microstructural maps for prostate cancer characterization in seconds.     

Quantitative MRI of colonic mural enhancement: segmental differences exist in endoscopically proven normal colon

Objectives Abnormal contrast enhancement on MRI is advocated as a biomarker for inflammation in colitis, although the enhancement kinetics of normal colon are poorly described. Our purpose was to quantitatively assess mural enhancement in normal colon and test for intersegmental differences. Methods Eight patients without prior history of inflammatory bowel disease underwent standard MRI colonography followed by normal same-day colonoscopy. Acquired sequences included a volumetric interpolated breath-hold examination (VIBE) to encompass the whole colonic volume, performed at 5°, 10° and 35° flip angles for T(1) quantitation and then at a fixed 35° flip angle three times prior to and every 30 s following intravenous gadoterate meglumine for 220 s. Ascending colon, descending colon and rectal R(1) (1/T(1)) was plotted against time. Mean pre-contrast R(1), initial change of R(1) (ΔR(1)), early and late "plateau phase" enhancement and the area under the R(1)-time (AUC-R(1)) curve were compared between segments using the Student's paired t-test. Results There was no significant difference of pre-contrast R(1) between segments (p=0.49 to 0.62). ΔR(1) was higher for ascending colon compared with descending colon (0.0023±0.0012 ms(-1) vs 0.0010±0.0011 ms(-1), p=0.03). There was no significant difference for early or late plateau phase R(1) between colonic segments (p=0.08 to 1.00). AUC-R(1) was greater for ascending than descending colon (0.54±0.19 vs 0.30±0.14, p=0.03). Conclusions Intersegmental differences in colonic enhancement are present and should be considered when interpreting differential segmental enhancement.     

Interface corrosion in amalgam-to-amalgam and amalgam-to-nonprecious metal crown couplings

This study examined the contact surface area in the coupling of a class II amalgam restoration with another class II amalgam restoration or with a stainless steel or nickel-chrome crown in 1% NaCl solution. The characterization of interfaces was carried out by using SEM and EDX microanalysis. The results indicate that the coupling of an amalgam-stainless steel crown and an amalgam-inconel crown in NaCl solution forms a deposit on the crown surfaces. This deposit contains all the constituents of corrodible phases of amalgam, including Zn. If amalgam restorations in adjoining teeth are contemplated, non-Zn-containing amalgam alloys of the same composition should be considered.     

Degree of polymerization between adjacent visible light-cured composite areas

The degree of polymerization between 2 adjacent visible light-cured composite areas was characterized by hardness measurements and scanning electron microscopy. It was observed that minimum of 20 s exposure for 1 mm overlap and 40 s for 0.5 mm overlap, between 2 light-exposed areas, produced optimal hardness. The interface between the areas was uniformly cured. The 1 mm overlap would produce a homogeneous structure, optimal hardness and eliminate any possibility of partially cured area in the filling.