Abstract
PurposeTo determine whether q-space imaging (QSI), an advanced diffusion-weighted MRI method, provides a higher effect gradient to assess tumor cellularity than existing diffusion imaging methods, and fidelity to cellularity obtained from histologic analysis.Materials and MethodsIn this prospective study, diffusion-weighted images were acquired from 20 whole-breast tumors freshly excised from participants (age range, 35–78 years) by using a clinical 3.0-T MRI unit. Median and skewness values were extracted from the histogram distributions obtained from QSI, monoexponential model, diffusion kurtosis imaging (DKI), and stretched exponential model (SEM). The skewness from QSI and other diffusion models was compared by using paired t tests and relative effect gradient obtained from correlating skewness values.ResultsThe skewness obtained from QSI (mean, 1.34 ± 0.77 [standard deviation]) was significantly higher than the skewness from monoexponential fitting approach (mean, 1.09 ± 0.67; P = .015), SEM (mean, 1.07 ± 0.70; P = .014), and DKI (mean, 0.97 ± 0.63; P = .004). QSI yielded a higher effect gradient in skewness (percentage increase) compared with monoexponential fitting approach (0.26 of 0.74; 35.1%), SEM (0.26 of 0.74; 35.1%), and DKI (0.37 of 0.63; 58.7%). The skewness and median from QSI were significantly correlated with the skewness (ρ = −0.468; P = .038) and median (ρ = −0.513; P = .021) of cellularity from histologic analysis.ConclusionQSI yields a higher effect gradient in assessing breast tumor cellularity than existing diffusion methods, and fidelity to underlying histologic structure.Keywords: Breast, MR-Diffusion Weighted Imaging, MR-Imaging, Pathology, Tissue Characterization, Tumor ResponseOnline supplemental material is available for this article.Published under a CC BY 4.0 license.
Highlights
O test the study hypothesis, we conducted a prospective study in participants with breast cancer on a clinical MRI unit by using a series of DWI examinations performed on whole tumors freshly excised from participants
q-space imaging (QSI) has been shown to be feasible on clinical MRI units because of recent hardware advances meeting the demand on magnetic field gradient, with application demonstrated in brain malignancies [22]
We hypothesized that measurements of breast tumor cellularity obtained with QSI have a higher effect gradient compared with other existing DWI techniques, and fidelity to the cellularity obtained from histologic analysis
Summary
O test the study hypothesis, we conducted a prospective study in participants with breast cancer on a clinical MRI unit by using a series of DWI examinations performed on whole tumors freshly excised from participants. Participants were enrolled consecutively from Aberdeen Royal Infirmary (Aberdeen, Scotland) between August 2016 and June 2017 (Fig 1). The study was approved by the North West–Greater Manchester East Research Ethics Committee (identifier: 16/NW/0221) and signed written informed consent was obtained from the participants prior to entry into the study. Authors had control of data and information submitted for publication. Philips Healthcare (Best, the Netherlands) is acknowledged in this study for providing clinical scientist support
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