Magnetic Resonance Imaging Morphological Features Research Articles

MODERN IMAGING TECHNIQUES IN THE ASSESSMENT
 OF MALIGNANCY IN GLIAL BRAIN TUMORS:
 LITERATURE REVIEW

Relevance: Gliomas represent a major group of primary central nervous system tumors, accounting for approximately 80% of all
 malignant brain neoplasms. Recent advances in molecular diagnostics, including the identification of mutations in the isocitrate dehydrogenase(IDH) gene, offer new opportunities to improve the classification of gliomas and to understand the mechanisms of their development. IDH
 mutations, which are found in a large proportion of gliomas, are associated with a better prognosis and represent an important biomarker
 for the development of targeted therapeutic strategies. Diagnostic techniques, particularly magnetic resonance imaging (MRI), also play
 an important role, providing additional ways to assess the morphological and biological characteristics of gliomas, contributing to a more
 accurate determination of tumor malignancy and molecular profile, which is key to treatment decisions.
 The purpose: To study the possibilities of magnetic resonance imaging in assessing the degree of malignancy of glial brain tumors.
 Method: A literature review was performed using the keywords: glioma, IDH mutation, IDH wild-type, MRI, magnetic resonance
 spectroscopy (MRS), apparent diffusion coefficient (ADC), diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), diffusion kurtosis
 image (DKI), Susceptibility Weighted Imaging (SWI) in PubMed, BMC Medicine, and Google Scholar databases. The review includes the results
 of an analysis of 45 literature reviews on the diagnostic capabilities of molecular diagnostics and MRI to assess the malignancy of gliomas.
 Results: This review highlights the importance of current approaches to the diagnosis of gliomas, demonstrating that different grades of
 malignancy and IDH mutation status are associated with unique features on MR imaging, including differences in localization, signal, and
 enhancement patterns. DTI and DWI extend the ability of MRI to assess tissue microstructure, allowing for more precise tumor characterization.
 Studies combining MRI morphologic features, ADC and DTI parameters offer a non-invasive approach to glioma prognosis, highlighting the
 importance of integrated use of imaging modalities to improve diagnosis and therapy.
 Conclusion: The use of magnetic resonance imaging allows for more accurate morphologic and metabolic characterization of gliomas
 in assessing the degree of malignancy, allowing physicians to make more accurate prognostic assessments and select the most appropriate
 treatment strategy.
 Keywords: Glioma, IDH mutation, wild-type IDH, MRI, magnetic resonance spectroscopy, ADC, DWI, DTI, DKI, SWI

Predicting the microvascular invasion and tumor grading of intrahepatic mass-forming cholangiocarcinoma based on magnetic resonance imaging radiomics and morphological features.

Preoperative diagnosis of microvascular invasion (MVI) and tumor grading of intrahepatic mass-forming cholangiocarcinoma (IMCC) using imaging findings can facilitate patient treatment decision-making. This study was conducted to establish and validate nomograms based on magnetic resonance imaging (MRI) radiomics and morphological features for predicting the MVI and tumor grading of IMCC before radical hepatectomy. A total of 235 patients with resected IMCC at the Chinese Academy of Medical Sciences and Peking Union Medical College were divided into a training set (n=167) and a validation set (n=68), retrospectively. Clinical data and MRI morphological features were recorded. Univariate and multivariate analyses were conducted to identify the significant features for the prediction of MVI and tumor grading. Radiomics features were extracted from T2-weighted imaging fat-suppressed and diffusion-weighted imaging (DWI). Radiomics signatures (rad_scores) were built based on the least absolute shrinkage and selection operator (LASSO) method. Then, the nomograms were constructed by combining the rad_scores and the significant clinical or MRI morphologic features. The predictive performances for MVI and tumor grading were evaluated by the area under the receiver operating characteristic curve (AUC), calibration, and clinical utility. Totals of 16 and 9 radiomics features were selected to build the rad_scores for the prediction of MVI and tumor grading for the training and validation set, respectively. The nomogram for the prediction of MVI comprised the morphologic features including number of tumors, tumor margin, and rad_score. For the prediction of tumor grading, the nomogram comprised the number of tumors, tumor necrosis, and rad_score. The best discriminations were observed in the training and validation sets for the MVI nomogram [AUCs of 0.874, 95% confidence interval (CI): (0.822-0.926) and 0.869 (0.783-0955)] and tumor grading nomogram [AUCs of 0.827 (0.763-0.891) and 0.848 (0.759-0.937)]. Decision curve analysis (DCA) further confirmed the clinical utilities of the nomograms. Nomograms based on MRI radiomics and morphological features can effectively predict the individualized risks of MVI and tumor grading for IMCC.

Assessment of Lymphovascular Invasion in Breast Cancer Using a Combined MRI Morphological Features, Radiomics, and Deep Learning Approach Based on Dynamic Contrast-Enhanced MRI.

Assessment of lymphovascular invasion (LVI) in breast cancer (BC) primarily relies on preoperative needle biopsy. There is an urgent need to develop a non-invasive assessment method. To develop an effective model to assess the LVI status in patients with BC using magnetic resonance imaging morphological features (MRI-MF), Radiomics, and deep learning (DL) approaches based on dynamic contrast-enhanced MRI (DCE-MRI). Cross-sectional retrospective cohort study. The study included 206 BC patients, with 136 in the training set [97 LVI(-) and 39 LVI(+) cases; median age: 51.5 years] and 70 in the test set [52 LVI(-) and 18 LVI(+) cases; median age: 48 years]. 1.5 T/T1-weighted images, fat-suppressed T2-weighted images, diffusion-weighted imaging (DWI), and DCE-MRI. The MRI-MF model was developed with conventional MR features using logistic analyses. The Radiomic feature extraction process involved collecting data from categorized DCE-MRI datasets, specifically the first and second post-contrast images (A1 and A2). Next, a DL model was implemented to determine LVI. Finally, we established a joint diagnosis model by combining the MRI-MF, Radiomics, and DL approaches. Diagnostic performance was compared using receiver operating characteristic curve analysis, confusion matrix, and decision curve analysis. Rim sign and peritumoral edema features were used to develop the MRI-MF model, while six Radiomics signature from the A1 and A2 images were used for the Radiomics model. The joint model (MRI-MF + Radiomics + DL models) achieved the highest accuracy (area under the curve [AUC] = 0.857), being significantly superior to the MRI-MF (AUC = 0.724), Radiomics (AUC = 0.736), or DL (AUC = 0.740) model. Furthermore, it also outperformed the pairwise combination models: Radiomics + MRI-MF (AUC = 0.796), DL + MRI-MF (AUC = 0.796), or DL + Radiomics (AUC = 0.826). The joint model incorporating MRI-MF, Radiomics, and DL approaches can effectively determine the LVI status in patients with BC before surgery. 4 TECHNICAL EFFICACY: Stage 2.

Predictive role of magnetic resonance imaging in the distinction of isocitrate dehydrogenase (IDH) mutant grade 4 astrocytomas versus glioblastomas.

Isocitrate dehydrogenase (IDH) mutation status is a crucial prognostic factor in high-grade glial tumors. To investigate whether magnetic resonance imaging (MRI) features can display a diagnostic performance in the determination of IDH mutation in high-grade gliomas. A total of 170 patients including 24 IDH mutant grade 4 astrocytomas and 146 glioblastomas (GBM) were retrospectively examined via contrast-enhanced (CE) MRI before surgery. Immunohistochemistry and genomic sequence analyses were performed on specimen materials for the determination of IDH mutational status. Certain morphological and diffusion-weighted imaging (DWI) parameters were utilized to see if they could play a role to be non-invasive potential imaging predictors in the discrimination of IDH mutant versus wild-type (WT) high-grade gliomas. On histopathological examination, IDH mutation was detected in 24 patients with high-grade glioma and 146 of the patients were found to be WT. Certain morphological criteria of tumor location and involvement, tumor margins, visual detection of diffusion restriction on DWI, and quantitative apparent diffusion coefficient (ADC) parameters consisting of ADCmean, ADCmin, and ADCr could be used as imaging predictors in the discrimination of high-grade IDH mutant versus WT tumors. Certain MRI morphologic features and visual detection of diffusion restriction on DWI and quantitative ADC parameters consisting of ADCmean, ADCmin, and ADCr can be considered non-invasive, significant independent imaging predictors in the discrimination and can obviate invasive procedures for histopathological diagnosis.

Magnetic resonance imaging correlation with molecular and epigenetic markers in assessment of breast cancer

BackgroundBreast cancer is a heterogeneous disease with a wide range of clinical behavior, histologic subtypes, therapeutic options, and outcomes. The different biology and histology of breast cancer display different tumor morphology at breast magnetic resonance imaging (MRI). However, few studies have examined the relationship between the MRI morphological, kinetic features and molecular and epigenetic markers in breast cancer assessment. The study aimed to evaluate the correlation between MRI morphological and kinetic features, molecular and an epigenetic marker (linc-ITGB1) in breast cancer cases. A total of 115 women (80 cases and 35 controls) with BIRAD 4 category breast lesions were included. The association between the MRI morphological & kinetic features, apparent diffusion coefficient (ADC) values, and molecular and the epigenetic marker (linc-ITGB1) was evaluated using Mann–Whitney and Chi-square tests.ResultsThe shape (p = 0.009), size of the lesion (p = 0.003), and pattern of enhancement (p ≤ 0.001) were significantly correlated with the molecular markers. Luminal subtypes are more likely to be presented with irregular shaped and non-circumscribed margin masses (97% for luminal A and 94.1% for luminal B). Triple-negative cancers are frequently presented with regular masses, circumscribed margins, and peripheral rim enhancement (50% of TN tumors). HER2-positive cancers are more likely to be multifocal/multicentric and are more associated with non-mass pattern of enhancement as compared to HER2-negative cancers. Perilesional edema was also significantly correlated with HER2-positive lesions (p = 0.009). Although the epigenetic marker linc-ITGB1 was overexpressed by 4.85-folds in breast cancer cases compared to benign controls, we could not find any significant correlation between its expression level and the MRI features or molecular subtypes (p = 0.948).ConclusionsMRI features can be a reliable predictor of breast cancer molecular subtypes. The epigenetic marker linc-ITGB1 has a potential role in breast cancer pathogenesis but with no significant correlation with either the MRI features or molecular subtypes of the lesions.

MRI-based radiomics analysis in differentiating solid non-small-cell from small-cell lung carcinoma: a pilot study

To investigate the ability of a T2-weighted (W) magnetic resonance imaging (MRI)-based radiomics signature to differentiate solid non-small-cell lung carcinoma (NSCLC) from small-cell lung carcinoma (SCLC). The present retrospective study enrolled 152 eligible patients (NSCLC=125, SCLC=27). All patients underwent MRI using a 3 T scanner and radiomics features were extracted from T2W MRI. The least absolute shrinkage and selection operator (LASSO) logistic regression model was used to identify the optimal radiomics features for the construction of a radiomics model to differentiate solid NSCLC from SCLC. Threefold cross validation repeated 10 times was used for model training and evaluation. The conventional MRI morphology features of the lesions were also evaluated. The performance of the conventional MRI morphological features, and the radiomics signature model and nomogram model (combining radiomics signature with conventional MRI morphological features) was evaluated using receiver operating characteristic (ROC) curve analysis. Five optimal features were chosen to build a radiomics signature. There was no significant difference in age, gender, and the largest diameter. The radiomics signature and conventional MRI morphological features (only pleural indentation and lymph node enlargement) were independent predictive factors for differentiating solid NSCLC from SCLC. The area under the ROC curves (AUCs) for MRI morphological features, and the radiomics model, and nomogram model was 0.69, 0.85, and 0.90 (ROC), respectively. The T2W MRI-based radiomics signature is a potential non-invasive approach for distinguishing solid NSCLC from SCLC.

The value of multi-parameter diffusion and perfusion magnetic resonance imaging for evaluating epithelial-mesenchymal transition in rectal cancer

PurposeEpithelial-mesenchymal transition (EMT) is characterized by a decreased expression of E-cadherin and an increased expression of vimentin, which is associated with poor prognosis in rectal cancer. This study aimed to explore the feasibility of using multi-parameter diffusion and perfusion magnetic resonance imaging (MRI) to evaluate the expression of E-cadherin and vimentin. MethodsOne hundred and ten patients with rectal cancer, who underwent preoperative multi-parameter diffusion and perfusion MRI and subsequent radical resection of rectal carcinoma, were included in this prospective study. The expression of E-cadherin, vimentin, vascular endothelial growth factor (VEGF), and Ki67 was identified by immunohistochemical test and MRI morphology features; quantitative parameters were analyzed and combined diagnostic models were created by binary logistic regression. The receiver operating characteristics curve with area under the curve (AUC) was used to evaluated diagnostic performance. Interobserver agreement for MRI parameters was evaluated by intraclass correlation coefficient. ResultsIn the low expression E-cadherin group, the VEGF expression was significantly higher than the high expression group (60.5% vs 37.3%, P < 0.05), and the Ki67 expression had no significant difference (P > 0.05). In the high expression vimentin group, the Ki67 expression was significantly higher than the low expression group (77.3% vs 56.1%, P < 0.05), and the VEGF expression was not significantly significant (P > 0.05). MRI morphological features had no significant diagnostic efficacy for E-cadherin and vimentin expression in rectal cancer (P > 0.05). There were positive and negative correlations between apparent diffusion coefficient (ADC) values with E-cadherin and vimentin expression (P < 0.05), the Ktrans and Kep values were negatively and positively correlated with the expression of E-cadherin and vimentin (P < 0.05). The ADC value (b = 3000 s/mm2) had mild significant diagnostic efficiencies for low E-cadherin expression and high vimentin expression (AUC = 0.63 and 0.644, P < 0.05), the Ktrans and Kep values had significant diagnostic efficiencies (AUC = 0.801 and 0.724, P < 0.05; AUC = 0.722 and 0.628, P < 0.05, respectively). The combined model of ADC, Ktrans, and Kep values had good diagnostic efficiencies for low E-cadherin expression and high vimentin expression (AUC = 0.814 and 0.728, P < 0.05). ConclusionThe quantitative parameters of diffusion (with ultra-high b-values) and perfusion MRI can assess the major biomarkers of EMT in rectal cancer, and the combined diagnostic model could further improve the evaluating efficiency for EMT, which possibly can provide valuable information for non-invasive and preoperative assessment of the tumor microenvironment.

Magnetic Resonance Imaging-Based Radiomics Nomogram for Prediction of the Histopathological Grade of Soft Tissue Sarcomas: A Two-Center Study.

Preoperative prediction of soft tissue sarcoma (STS) grade is important for treatment decisions. Therefore, formulation an STS grade model is strongly needed. To develop and test an magnetic resonance imaging (MRI)-based radiomics nomogram for predicting the grade of STS (low-grade vs. high grade). Retrospective POPULATION: One hundred and eighty patients with STS confirmed by pathologic results at two independent institutions were enrolled (training set, N=109; external validation set, N=71). Unenhanced T1-weighted (T1WI) and fat-suppressed T2-weighted images (FS-T2WI) were acquired at 1.5T and 3.0T. Clinical-MRI characteristics included age, gender, tumor-node-metastasis (TNM) stage, American Joint Committee on Cancer (AJCC) stage, progression-free survival (PFS), and MRI morphological features (ie, margin). Radiomics feature extraction were performed on T1WI and FS-T2WI images by minimum redundancy maximum relevance (MRMR) method and least absolute shrinkage and selection operator (LASSO) algorithm. The selected features constructed three radiomics signatures models (RS-T1， RS-FST2, and RS-Combined). Univariate and multivariate logistic regression analysis were applied for screening significant risk factors. Radiomics nomogram was constructed by incorporating the radiomics signature and risk factors. Clinical-MRI characteristics were performed by a univariate analysis. Model performances (discrimination, calibration, and clinical usefulness) were validated in the external validation set. The RS-T1 model, RS-FST2 model, and RS-Combined model had an area under curves (AUCs) of 0.645, 0.641, and 0.829, respectively, in the external validation set. The radiomics nomogram, incorporating significant risk factors and the RS-Combined model had AUCs of 0.916 (95%CI, 0.866-0.966, training set) and 0.879 (95%CI, 0.791-0.967, external validation set), and demonstrated good calibration and good clinical utility. The proposed noninvasive MRI-based radiomics models showed good performance in differentiating low-grade from high-grade STSs. 3 TECHNICAL EFFICACY STAGE: 2.

Improved discrimination of molecular subtypes in invasive breast cancer: Comparison of multiple quantitative parameters from breast MRI

PurposeTo compare multiple quantitative parameters from breast magnetic resonance imaging (MRI) with the synthetic MRI sequence included for discrimination of molecular subtypes of invasive breast cancer. Materials and methodsBetween March 2019 and September 2020, two hundred breast cancer patients underwent preoperative breast multiparametric MRI examinations including synthetic MRI, diffusion weighted imaging (DWI) and dynamic contrast enhancement (DCE)-MRI sequences. MRI morphological features, T1 and T2 relaxation times (T1, T2) and proton density (PD) values from synthetic MRI, Ktrans, Kep, and Ve from DCE-MRI, mean apparent diffusion coefficient (ADC) from DWI and tumor volume were measured. Quantitative parameters were compared according to molecular markers and subtypes. Logistic regression were performed to find the related MRI parameters and establish combined parameters. The comparison between single and combined quantitative parameters by using DeLong tests. ResultsT1, T2 values were significantly higher in hormone receptor (HR)- negative and Ki67 > 14% tumors (p < 0.05). Human epidermal growth factor receptor 2 (HER2)-positive tumors demonstrated significantly higher Ktrans and Kep (p < 0.01). Mean ADC values were significantly decreased in HR-positive and Ki67 > 14% tumors (p < 0.01). Tumor volumes were significantly higher in HER2-positive and Ki67 > 14% tumors (p < 0.05). Independent influencing factors were lower T2 values (p < 0.001), smaller tumor volume (p = 0.031) and higher mean ADC (p = 0.002) associated with luminal A subtype, while T1 values (p = 0.007) was the only quantitative parameter associated with triple-negative subtype. The diagnostic efficiency of combined parameters (T2 + mean ADC + volume) (AUC = 0.765) was significantly higher than that of mean ADC (AUC = 0.666, p = 0.031 by DeLong test) and volume (AUC = 0.650, p = 0.008 by DeLong test) for separating luminal A subtype. ConclusionsMRI quantitative parameters could help distinguish molecular markers and subtypes. The emerging synthetic MRI parameters - T1 values were associated with the TN subtype, and combined parameters with added T2 values might improve the discrimination of the luminal A subtype. Application of synthetic MRI can enrich quantitative descriptors from breast MRI.

Magnetic resonance imaging of the quadriceps fat pad oedema pattern in relation to patellofemoral joint pathologies.

PurposeQuadriceps fat pad is located posterior to the quadriceps tendon. Increased signal intensity of this fat pad is seen on routine knee magnetic resonance imaging (MRI) examinations, but the exact mechanism and related pathologies are not clear. In this study we aimed to evaluate the relationship between MRI signal intensity and morphological features of quadriceps fat pad, as well as various pathologies of the patellofemoral joint.Material and methodsSixty-one knees with quadriceps fat pad oedema out of 457 knee MRI examinations were included. Quadriceps fat pad signal intensity, dimensions, posterior indentation, and various parameters related to patellofemoral joint such as trochlear facet asymmetry, trochlear depth and sulcus angle, and the Insall-Salvati ratio were evaluated.ResultsThere was no statistically significant correlation between quadriceps fat pad oedema intensity and its dimensions, but it was significant when compared to posterior indentation. There was no correlation between fat pad oedema and each of the pathologies. However, there was a significant correlation between the presence of fat pad oedema and the presence of at least one of the pathologies related to patellofemoral joint.ConclusionsQuadriceps fat pad oedema detected in MRI examinations should warn the radiologist against the presence of various pathologies related to the patellofemoral joint.

Morphological and Semiquantitative Kinetic Analysis on Dynamic Contrast Enhanced MRI in Triple Negative Breast Cancer Patients

The aim of this study was to retrospectly investigate the association between different breast cancer (BC) immunohistochemical subtypes and morphological and semiquantitative kinetic analysis on breast magnetic resonance imaging (MRI) performed before surgery treatment. Specifically we aimed to assess MRI features of triple-negative breast cancer (TNBC) compared to the other BC subtypes (nTNBC). Patients undergone to breast MRI and then diagnosed with BC by core-needle biopsy were included. The MRI morphological and kinetic features were studied. Parametric and non-parametric tests were used, as appropriate. Seventy-five BC patients were considered, 30 patients included in TNBC Group and 45 patients included in nTNBC Group. We found in TNBC Group a greater mean lesion size (P <0.001), a rim enhancement imaging (P=0.003), and a higher intratumoral signal intensity on T2-weighted images (P=0.03) with respect to nTNBC Group. We noticed that TNBC patients presented a lower grade of BPE when compared to the nTBC Group (P< 0.02). TNBC Group showed lower EPeak values (P=0.003) and higher SER values (P=0.02) with respect to the nTNBC Group. In addition, stratifying kinetics parameters according to the tumor grade, the TNBC Group presented higher tumor grade (G3) (P< 0.005) and this subgroup had higher SER values when compared to TNBCs showing a lower tumor grade (G1 and G2) (P=0.03). After validation by large-scale studies, the morphological and semiquantitative kinetic analysis on dynamic contrast enhanced MRI may help in the pretreatment risk stratification of patients with TNBC and in evidence-based clinical decision support.

Value of MRI morphologic features with pT1-2 rectal cancer in determining lymph node metastasis.

To investigate the different features between metastatic lymph node and nonmetastatic lymph node on magnetic resonance imaging (MRI) and the relationship between the rectal lesion and lymph node metastasis (LNM). Eighty-two patients with retrospectively consecutive pT1-2 stage rectal cancer in 2016 were divided into lymph node metastasis (LNM+) and lymph node nonmetastasis (LNM-) group based on their histopathologic examinations. We evaluated the following features of lymph nodes: number, shape, signal heterogeneity, border, and diameter of the largest lymph node on T2-weight images. We also calculated tumor apparent diffusion coefficient ratio and tumor percent enhancement. Fisher's exact test was applied for inspecting lymph node numbers on MRI and logistic regression analysis in examining risk factors for LNM. The MR-LN number was significantly different between the LNM+ and LNM- group (median: 4 vs 1, P = 0.001). Multivariate logistic regression analysis exhibited that the diameter of the largest lymph node and the tumor percent enhancement of the arterial phase were independent risk factors of LNM (P = 0.005 vs 0.021, respectively). The largest lymph node's diameter and the tumor percent enhancement of arterial phase on MRI were helpful in determining LNM in pT1-2 rectal cancer.

US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications.

The aim of this study was to assess diagnostic accuracies of ultrasonography (US) and magnetic resonance imaging (MRI) in lesions that manifest as mammographic BI-RADS 4 and 5 microcalcifications, in the setting of conjoined use of mammography, US, and MRI. Patients with mammographic BI-RADS 4 or 5 microcalcifications, without additional findings, were included in this prospective study. All patients subsequently underwent breast US and MRI. Histopathologic diagnosis, obtained by US-guided core-needle biopsy or surgical excision, served as a reference standard. Diagnostic accuracies of US and MRI were calculated, and positive predictive value for different MRI BI-RADS imaging features were determined. The study group consisted of 113 women with 125 areas of suspicious microcalcifications. MRI reached sensitivity, specificity, positive predictive value 3 (PPV3), and negative predictive value (NPV) of 100%, 70.1%, 67.6%, and 100%, respectively. Statistically significant differences in MRI morphologic features and kinetic enhancement curves were observed between malignant and benign microcalcifications. Sensitivity, specificity, PPV3, and NPV for US were: 85.4%, 66.2%, 61.2%, and 87.9%. There was statistically significant difference in presentation of malignant and benign microcalcifications at US. In the setting of conjoined use of mammography, US, and MRI, MRI can reliably exclude malignancy in suspicious microcalcifications. Thus, negative MRI findings may influence the decision to biopsy the microcalcifications.

Quantitative MRI morphology of invasive breast cancer: correlation with immunohistochemical biomarkers and subtypes

Breast cancer is a heterogeneous disease with intrinsic molecular subtypes. The different biology and histology of breast cancer exhibit different tumor morphology at breast magnetic resonance imaging (MRI). However, few studies have examined the quantitative relationship between the MRI morphological and immunohistochemical features in breast cancer. To investigate the correlations between tumor roundness, as quantitatively assessed with MRI and biomarkers or subtypes of breast cancer. A total of 280 women (mean age, 51 years; range, 28-79 years) with 282 invasive breast cancers (<5 cm) were included. The associations between the tumor roundness (1-100%), as measured using MRI software, and immunohistochemical (e.g. estrogen receptor [ER], progesterone receptor [PR], human epidermal growth factor receptor 2 [HER2], and Ki67) features were evaluated using Pearson's or Spearman's rank correlation coefficients and multiple linear regression analysis. An inverse correlation was observed between the ER (r = -0.408, P < 0.001) or PR (r = -0.248, P < 0.001) scores and tumor roundness, whereas a positive correlation was observed between the Ki67 index and tumor roundness (r = 0.354, P < 0.001). In multiple linear regression, the ER score (P < 0.001) and Ki67 index (P = 0.003) were independent factors determining tumor roundness. Triple-negative tumors (ER, PR, and HER2 negative) showed the highest mean roundness scores compared with the other subtypes (e.g. 67.3% for triple-negative, relative to 55.9% for HER2-enriched, 53.8% for luminal B, and 51.7% for luminal A, P < 0.001). Our results suggest that breast tumors with lower ER expression and higher cellular proliferation or biologically aggressive triple-negative tumors are likely to manifest with relatively benign morphologic features.

Effect of Oral Glucosamine on Joint Structure in Individuals With Chronic Knee Pain: A Randomized, Placebo‐Controlled Clinical Trial

To determine the short-term efficacy of oral glucosamine supplementation by evaluating structural lesions in the knee joints, as assessed using 3T magnetic resonance imaging (MRI). This study was designed as a randomized, double-blind, placebo-controlled trial. Recruitment was performed via mass mailings and an arthritis registry in southwestern Pennsylvania. In total, 201 participants with mild-to-moderate pain in one or both knees, as defined by a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score ≥25 and ≤100, were enrolled. Of these subjects, 69.2% had a Kellgren/Lawrence grade ≥2 in at least 1 knee. Participants received 24 weeks of treatment with 1,500 mg glucosamine hydrochloride in beverage form or a placebo beverage. The primary outcome was decreased worsening of cartilage damage on 3T MRI of both knees, assessed according to a validated scoring system, the Whole-Organ MRI Score (WORMS). Secondary outcomes included change in bone marrow lesion (BML) scores in all knees and change in excretion of urinary C-terminal crosslinking telopeptide of type II collagen (CTX-II). The adjusted odds ratio (OR) for the likelihood of decreased cartilage damage over 24 weeks in any WORMS-scored subregion of the knee in the glucosamine treatment group compared to the control group was 0.938 (95% confidence interval [95% CI] 0.528, 1.666). Compared to subjects treated with glucosamine, control subjects showed more improvement in BMLs (adjusted OR 0.537, 95% CI 0.291, 0.990) but no difference in worsening BMLs (adjusted OR 0.691, 95% CI 0.410, 1.166) over 24 weeks. There was no indication that treatment with glucosamine decreased the excretion of urinary CTX-II (β = -0.10, 95% CI -0.21, 0.002). The results of this short-term study provide no evidence of structural benefits (i.e., improvements in MRI morphologic features or urinary CTX-II excretion) from glucosamine supplementation in individuals with chronic knee pain.

Magnetic Resonance Imaging Features in Triple-Negative Breast Cancer: Comparison With Luminal and HER2-Overexpressing Tumors

BackgroundIt has been ascertained that triple-negative (TN) breast cancer is characterized by an aggressive clinical course and a poor prognosis. The purpose of our study was to compare the magnetic resonance imaging (MRI) features of the 3 major different breast cancer subtypes (TN, luminal, and human epidermal growth factor receptor 2 [HER2]-overexpressing) and to suggest the criteria that might predict TN phenotype. Materials and MethodsFrom October 2007 to April 2011, we studied 77 patients with histologically confirmed TN breast cancer who underwent breast MRI. We randomly included 148 patients with non-TN breast cancer (110 luminal and 38 HER-overexpressing) as a control group. We evaluated the clinicopathologic data, the MRI morphologic and kinetic features, the signal intensity on T2-weighted images, and the apparent diffusion coefficient (ADC). ResultsOur results confirmed that TN tumors are more aggressive, are usually diagnosed at a younger age compared with the other study groups, and show benign morphologic features with MRI. Backward stepwise logistic regression identified some parameters as independent predictors of TN-type lesions: age, size, shape, presence of edema, and infiltrative characteristics. The receiver operating characteristic (ROC) curve, built with 4 of 5 these factors as criteria to predict TN status, showed a 0.664 area under the curve (AUC) value (sensitivity 58.4%, specificity 73.2%). The inclusion of the fifth criterion showed a 0.699 AUC value (sensitivity, 49.4%; specificity, 89.4%). ConclusionWe identified the clinicoradiologic parameters that are independent predictors of TN breast lesions, which might be helpful for earlier prediction of the TN status of a breast lesion.

Magnetic Resonance Imaging Morphologic Features of Advanced Breast Cancer Predict Surgical and Pathologic Outcomes after Neoadjuvant Chemotherapy.

Abstract Background: Neoadjuvant therapy is becoming more widely used for locally advanced breast cancer. Magnetic resonance imaging (MRI) has been shown to be the most accurate imaging modality to determine initial extent of disease, early disease response to therapy, and residual viable tumor at completion of therapy. However, the relationship between the morphologic tumor patterns on MRI and clinical outcomes have not been widely studied. Materials and Methods: A total of 237 women with locally advanced breast cancer were enrolled in CALGB150007/ACRIN6657, a multi-institutional study of serial MRI imaging during neoadjuvant therapy. All women received four cycles of anthracycline-cytoxan (AC) therapy, with the majority also receiving four subsequent cycles of paclitaxel (T) therapy, followed by surgery. Residual cancer burden (RCB) was determined by central pathology review. MRI was performed at baseline, after AC#1, after AC#4, and before surgery. MRI morphologic features at baseline were scored locally by the site radiologist on a five point scale, indicating increasing degrees of tumor dispersion. Longest diameter lesion sum (LD) and volumetric tumor measures were obtained at each time point. Percent deviation of tumor from ideal sphere (%dev) was calculated by dividing the true MRI volume to that of the idealized spherical volume: (4π/3)*(LD/2)3, and subtracting from 100%. Results: Imaging results were available for 215/237 women. Of these, surgical management information and RCB results available for 207 and 194 women, respectively. Women with either type 1 (unifocal confined mass) or type 2 (multi-lobular mass) morphology were more likely to receive lumpectomy over mastectomy (53 vs. 40, 57% breast conservation rate), than were women whose disease was less confined prior the chemotherapy (36 vs. 75, 32% breast conservation rate, p&amp;lt;0.001 for difference between morphology groups). In addition, women with confined disease at baseline (morphology type 1 or 2) demonstrated lower RCB at surgery (RCB=1.60) than those with more dispersed baseline morphologies (RCB=2.04, p=0.042). Percent deviation from idealized spherical volume at baseline was greater for patients with more dispersed morphologies (%dev=81%) than for those with contained morphologies (%dev=51%, p&amp;lt;0.001). This difference decreased after four (74% vs. 85%, p=0.013) and eight cycles of chemotherapy (76% vs. 85%, p=0.023). Discussion: Baseline tumor morphology by MRI is a strong predictor of RCB following neoadjuvant chemotherapy, and can be used to gauge likelihood of successful down-staging of tumor for potential breast conservation therapy. Radiologist-graded tumor morphologies detect differences in tumor deviation from ideal spheres at baseline, although this distinction decreases as tumors respond to neoadjuvant chemotherapy. Supported by NIH grant CA080098 Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4016.

Fetal MRI of the cardiovascular system: role of steady-state free precession sequences for the evaluation of normal and pathological appearances

This study aimed to evaluate the feasibility of fetal magnetic resonance imaging (MRI) with steady-state free precession (SSFP) sequences to visualise the normal and pathological appearances of the cardiovascular system. This is a prospective observational study of 83 pregnant women who underwent fetal cardiac MRI: 43 patients (cases) had echocardiographic suspicion of congenital heart disease; 40 patients (controls) did not. Fetal cardiac MRI consisted of a static phase with multiplanar SSFP sequences and a dynamic phase with real-time SSFP sequences. Two radiologists evaluated the diagnostic quality of the SSFP images in both the controls and cases, the MRI morphological and functional features in the controls and the MRI signs of congenital heart disease in the cases. In both groups, SSFP sequences produced goodquality MR images and good visualisation of morphological features. Functional data appeared to be unavailable due to the current small temporal resolution and the technical impossibility of fetal cardiac triggering. MRI detected direct signs of congenital heart disease in 21 fetuses, indirect signs in six and both signs in 15. SSFP sequences are effective in demonstrating the morphological features of the cardiovascular system, whereas dynamic SSFP cine-MRI sequences may provide adjunctive albeit suboptimal functional information.

Magnetic resonance imaging appearances of different discovertebral lesions.

Magnetic resonance imaging (MRI) is not only an excellent imaging modality for the demonstration of morphological changes but is also capable of providing pathophysiological and pathoanatomic information about various spinal diseases. Different techniques offer opportunities to demonstrate the degree of water content, the vascularity of tissue components, the accumulation of fat, and new bone production. Thus MRI closely reflects the initial phase as well as the progression of pathoanatomic changes during the evolution of a disease. Due to the high sensitivity of MRI, abnormalities are often established at an early stage of discovertebral disease, when etiological diagnosis may be difficult. The specificity of MRI findings lags behind its sensitivity; similar changes can be demonstrated in etiologically different disease entities, which reflects the limited reactive possibilities of the osteoarticular system. In fact, the MRI morphological and signal intensity features of different discovertebral lesions are commonly determined more by their location and by the reactive capabilities of disc and bone than by their etiology. Early and exact MRI differentiation of various discovertebral lesions is of the utmost clinical importance for prompt institution of appropriate therapy.