Quantitative Magnetic Resonance Imaging Parameters Research Articles

The dilemma of mediastinal lymphadenopathy between invasive and non-invasive procedures: ROC analysis of T2WI and DWI-MRI advanced parameters correlated with PET-CT and biopsy

BackgroundThe characterization of pathologically enlarged mediastinal lymph nodes is clinically essential for effective disease management and accurate prognosis. Malignancy (metastases and lymphoma) and granulomatous conditions (sarcoidosis and tuberculosis) are the most common causes. Magnetic resonance imaging (MRI) is a good modality to characterize the mediastinal pathologically enlarged lymph nodes based on the excellent soft tissue contrast. It can save high-risk patients from radiation exposure and hazards of intervention such as general anesthesia and biopsy.Aim of the workTo estimate the accuracy of different advanced MRI quantitative parameters in the differentiation between benign and malignant mediastinal lymphadenopathy. This would involve the lesion-to-cord signal intensity ratio (SIR) in the T2-WI and diffusion weighted image (DWI), the lesion-to-chest wall muscle SIR in T2-WI and DWI, and the mean apparent diffusion coefficient (ADC) values. These values would be correlated with the prospective pathological data and the results of the positron emission tomography (PET-CT).ResultsProspectively, the study was conducted during the period between June 2022 and September 2023 on 45 patients with indeterminate or suspicious mediastinal lymphadenopathy identified by CT. MRI examination, PET-CT, and biopsy were applied for all patients. The intra-class correlation coefficient ranged between 0.89 and 0.95. (A) The lesion-to-cord SIR in T2-WI in the malignant group (1.49 ± 0.30) was higher than that in the benign group (0.83 ± 0.24) with P < 0.001. The statistically calculated cutoff value (> 1.2) estimated 90% sensitivity, 100% specificity, with AUC = 0.989. (B) The lesion-to-chest wall muscle SIR in T2-WI in malignant nodes (3.13 ± 0.84) was significantly higher than that in the benign nodes (1.90 ± 0.80) with P < 0.001. The statistically calculated cutoff value (> 2.4) estimated 86.67% sensitivity, 86.67% specificity, with AUC = 0.88. (C) The lesion-to-cord signal SIR in b500-DWI in the malignant node (1.80 ± 0.54) was higher than that in the benign group (0.75 ± 0.29) with P < 0.001. The statistically calculated cutoff value (> 1.2) estimated 100% sensitivity and specificity with AUC = 1.00. (D) The lesion-to-chest wall SIR in b500-DWI in the malignant node (6.43 ± 1.28) was higher than that in the benign node (2.63 ± 0.94) with P < 0.001. The statistically calculated cutoff value (> 4.1) estimated 96.67% sensitivity, 100% specificity, with AUC = 0.997. € The mean ADC values in the malignant nodes (0.83 ± 0.20 × 10–3 mm2/s) were significantly lower than that in the benign nodes (1.85 ± 0.19 × 10−3 mm2/s) with P < 0.001. The statistically calculated cutoff value (≤ 1.2) estimated 100% sensitivity and specificity with AUC = 1.00.ConclusionsBiopsy remains the main diagnostic modality for the characterization of mediastinal lymphadenopathy despite its hazards and limitations. This study proved that MRI could be accepted as an alternative non-invasive imaging tool that can overcome the PET-CT limitations. The lesion signal-to-cord and to-muscle ratios in both T2-WI and DWI-MRI side by side with the mean ADC value showed high statistical accuracy.

Abstract PO1-28-04: PILHLE-001: neoadjuvant pyrotinib combined with chemotherapy in HR-positive, HER2-low (IHC 2+/FISH-negative) early breast cancer

Abstract Background: Hormone receptor (HR)-positive/HER2-low (IHC 2+/FISH negative or IHC 1+) breast cancers (BCs) represent the largest proportion of breast carcinomas. However, its response to neoadjuvant chemotherapy or endocrine therapy is the lowest, with a residual cancer burden (RCB) 0/I rate around 15%. Previous studies have demonstrated that pyrotinib (P), a pan-HER tyrosine kinase inhibitor, exhibits excellent response in HER2-positive early or advanced BC (E/ABC). In-vitro experiments have shown that pyrotinib can effectively inhibit colony formation in HER2-low (IHC 2+/FISH negative) BC cells. This PILHLE-001 study (NCT05165225) aimed to evaluate the efficacy and safety of neoadjuvant pyrotinib plus chemotherapy in HR-positive/HER2-low (IHC 2+/FISH negative) EBC patients with potential biomarkers. Methods: PILHLE-001, as a single-arm, single-center phase Ⅱ trial, enrolled patients with previously untreated HR-positive (ER or PR &amp;gt; 1%) and HER2-low (IHC 2+/FISH negative) invasive EBC (TNM stage II-III) to receive pyrotinib 320mg QD and four Q3W of epirubicin-cyclophosphamide followed by four Q3W of docetaxel. MammaPrint/BluePrint at baseline (t0) was assessed. Breast magnetic resonance imaging (MRI) was conducted at t0, the end of cycle 2 neoadjuvant therapy (t1), and the end of all neoadjuvant therapy. Immune cell subpopulations assay and gene sequencing of tumor tissues with whole blood control samples were performed at t0 and surgery (t2). Additional core biopsy was administered to reassess Ki67 and tumor infiltrating lymphocytes (TILs) at t1. The primary outcome was RCB 0/I rate. The short-term secondary outcomes included pathological complete response (pCR, ypT0/is ypN0) rate, objective response rate (ORR), breast conservation surgery (BCS) rate, safety, and exploratory biomarkers analysis. Results: From July 2021 to March 2023, 48 patients were enrolled and treated. The median age of the patients was 48 years (range 28-66), 43 (90%) had cT1-2 tumors, 30 (63%) showed no node involvement, 37 (77%) had tumours with TNM stage II, and 47 (98%) had ER expression ≥ 50%. Twenty-eight (61%) of 46 patients had MammaPrint high risk. Out of the 48 patients, 26 (54.2%) achieved RCB 0/I, with a 95% confidence interval of 39.2% to 68.6%. The RCB 0/I rate was particularly higher in tumors with no lymph node involvement (73.3%), TNM stage II (64.9%), or abundant tumor-infiltrating lymphocytes (66.7%). Three (6.3%) patients obtained a pCR. The rate of BCS was 60.4% (29/48). The ORR was 45.8% (22/48) at t1 and 81.3% (39/48) at the end of all neoadjuvant therapy, respectively. No patients had progressive disease. All treatment-related adverse events (AEs) were mostly of grade 1 or 2 severity. Grade ≥ 3 AEs occurred in 21 (44%) patients, with the most prevalent being diarrhea [10 (21%)]. All AEs were reversible with symptomatic treatment and no treatment-related deaths occurred. Patients with MammaPrint risk-low BC had a lower RCB 0/I rate than those with risk-high BC (60.7% vs. 44.4%), although the difference was not statistically significant. Baseline specific immune cell subpopulations (lower PD-1, higher CD3, etc.) or the presence of non-altered PIK3CA were significantly associated with a higher likelihood of achieving RCB 0/I. Similarly, objective response, greater declines in specific MRI quantitative parameters (Ktrans and Kep), greater declines in Ki67, or more increased TILs at t1 were also significantly associated with a higher rate of RCB 0/I. Conclusions: The PILHLE-001 trial first revealed that neoadjuvant pyrotinib plus chemotherapy has encouraging efficacy and acceptable toxicity in patients with HR-positive/HER2-low (IHC 2+/FISH negative) EBC, and this regimen warrants further investigation in phase III randomized controlled trials. Citation Format: Chang Gong, Yuan Xia, Yingying Zhu, Yaping Yang, Wenqian Yang, Louis W.C. Chow, Li Ling, Yunjie Zeng, Jiajie Zhong, Ziliang Cheng, Jun Shen, Qun Lin, Yinduo Zeng, Qiang Liu, Erwei Song. PILHLE-001: neoadjuvant pyrotinib combined with chemotherapy in HR-positive, HER2-low (IHC 2+/FISH-negative) early breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-28-04.

The value of T2-weighted MRI contrast ratio combined with DWI in evaluating the pathological grade of solid lung adenocarcinoma

To assess the predictive value of T2-weighted (T2W) magnetic resonance imaging (MRI) in combination with diffusion-weighted imaging (DWI) for determining the pathological grading of solid lung adenocarcinoma. The clinical and imaging data from 153 cases of solid lung adenocarcinoma (82 men, 71 women, mean age 63.2 years) confirmed at histopathology in The First Affiliated Hospital of Xi'an Jiaotong University from January 2017 to May 2022 were analysed retrospectively. Adenocarcinomas were classified into low-grade (G1 and G2) and high-grade (G3) groups following the 2020 pathological grading system proposed by the International Association for the Study of Lung Cancer. The T2-weighted contrast ratio (T2CR), calculated as the T2 signal intensity of the lung mass/nodule divided by the T2 signal intensity of the right rhomboid muscle was utilised. Two experienced radiologists reviewed the MRI images independently, measured the T2CR, and obtained apparent diffusion coefficient (ADC) values. The Mann-Whitney U-test was used to compare general characteristics (sex, age, maximum diameter), T2CR, and ADC values between the low-grade and high-grade groups. The non-parametric Kruskal-Wallis test determined differences in T2CR and ADC values among the five adenocarcinoma subtypes. Receiver characteristic curve (ROC) analysis, along with area under the curve (AUC) calculation, assessed the effectiveness of each parameter in distinguishing the pathological grade of lung adenocarcinoma. A Z-test was used to compare the AUC values. Among the 153 patients with adenocarcinoma, 103 had low-grade adenocarcinoma, and 50 had high-grade adenocarcinoma. The agreement between T2CR and ADC observers was good (0.948 and 0.929, respectively). None of the parameters followed a normal distribution (p<0.05). The ADC value was lower in the high-grade adenocarcinoma group compared to the low-grade adenocarcinoma group (p=0.004), while the T2CR value was higher in the high-grade group (p=0.011). Statistically significant differences were observed in maximum diameter and gender between the two groups (p<0.001 and p=0.005, respectively), while no significant differences were noted in age (p=0.980). Among the five adenocarcinoma subtypes, only the lepidic and micropapillary subtypes displayed statistical differences in ADC values (p=0.047), with the remaining subtypes showing no statistical differences (p>0.05). The AUC values for distinguishing high-grade adenocarcinoma from low-grade adenocarcinoma were 0.645 for ADC and 0.627 for T2CR. Combining T2CR, ADC, sex, and maximum diameter resulted in an AUC of 0.778, sensitivity of 70%, and specificity of 75%. This combination significantly improved diagnostic efficiency compared to T2CR and ADC alone (p=0.008, z=2.624; p=0.007, z=2.679). The MRI quantitative parameters are useful for distinguishing the pathological grades of solid lung adenocarcinoma, offering valuable insights for precise lung cancer treatment.

Beneficial effects of Chinese martial arts on the lumbar spine: A case series analysis of intervertebral disc, paraspinal muscles and vertebral body

PurposeChinese Martial arts is becoming increasingly prevalent worldwide. There is insufficient evidence to prove the health effects of martial arts due to methodological weaknesses. The aim of this study was to better understand the effects of Chinese martial arts on the skeletal and muscular status of the lumbar spine by quantitative magnetic resonance imaging (MRI). MethodsNine elite martial arts athletes, eighteen amateurs, and eighteen sedentary volunteers underwent T2 mapping and q-Dixon imaging of the lumbar spine on a 3T (Tesla) system. T2 (Transverse) relaxation times were measured in different regions of interest of the intervertebral disc (IVD). Fat Fraction (FF) was measured in the paraspinal muscles and vertebral body. ResultsCompared to the sedentary controls, martial arts athletes showed: (1) increased T2 times in the nucleus pulposus, especially in the central nucleus pulposus (P = 0.004); (2) decreased FF in the multifidus and erector spinae (all P < 0.04), and increased cross-sectional area in the psoas, quadratus lumborum, and multifidus (all P < 0.03); (3) decreased FF in vertebral body (P = 0.001). There was no significant difference in all quantitative MRI parameters between athletes and amateur enthusiasts. Besides, paraspinal muscle FF was negatively correlated with IVD T2 times (ρ = −0.221; P = 0.014) and positively correlated with vertebral body FF (ρ = 0.314; P < 0.001). ConclusionsChinese martial arts has a positive effect on lumbar tissues, manifesting as better disc hydration, paraspinal muscle hypertrophy and reduced fat infiltration, and lower vertebral body fat content. Our study suggests a possible mechanism: martial arts practice enhances paraspinal muscles to maintain spinal stability, indirectly contributing to slowing down bone marrow conversion and promoting IVD hydration.

An experimental study for quantitative assessment of fatty infiltration and blood flow perfusion in quadriceps muscle of rats using IDEAL-IQ and BOLD-MRI for early diagnosis of sarcopenia

BackgroundSevere sarcopenia may result in severe disability. Early diagnosis is currently the key to enhancing the treatment of sarcopenia, and there is an urgent need for a highly sensitive and dependable tool to evaluate the course of early sarcopenia in clinical practice. This study aims to investigate longitudinally the early diagnosability of magnetic resonance imaging (MRI)-based fat infiltration and blood flow perfusion technology in sarcopenia progression. Methods48 Sprague-Dawley rats were randomly assigned into six groups that were based on different periods of dexamethasone (DEX) injection (0, 2, 4, 6, 8, 10 days). Multimodal MRI was scanned to assess muscle mass. Grip strength and swimming exhaustion time of rats were measured to assess muscle strength and function. Immunofluorescence staining for CD31 was employed to assess skeletal muscle capillary formation, and western blot was used to detect vascular endothelial growth factor-A (VEGF-A) and muscle ring finger-1 (MuRF-1) protein expression. Subsequently, we analyzed the correlation between imaging and histopathologic parameters. A receiver operating characteristic (ROC) analysis was conducted to assess the effectiveness of quantitative MRI parameters for discriminating diagnosis in both pre- and post-modeling of DEX-induced sarcopenic rats. ResultsSignificant differences were found in PDFF, R2* and T2 values on day 2 of DEX-induction compared to the control group, occurring prior to the MRI-CSA values and limb grip strength on day 6 of induction and swimming exhaustion time on day 8 of induction. There is a strong correlation between MRI-CSA with HE-CSA values (r = 0.67; p < 0.001), oil red O (ORO) area with PDFF (r = 0.67; p < 0.001), microvascular density (MVD) (r = −0.79; p < 0.001) and VEGF-A (r = −0.73; p < 0.001) with R2*, MuRF-1 with MRI-CSA (r = −0.82; p < 0.001). The AUC of PDFF, R2*, and T2 values used for modeling evaluation are 0.81, 0.93, and 0.98, respectively. ConclusionImaging parameters PDFF, R2*, and T2 can be used to sensitively evaluate early pathological changes in sarcopenia. The successful construction of a sarcopenia rat model can be assessed when PDFF exceeds 1.25, R2* exceeds 53.85, and T2 exceeds 33.88.

Quantitative dynamic contrast-enhance MRI parameters for rectal carcinoma characterization: correlation with tumor tissue composition

ObjectiveTo investigate the relationship between dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) measurements and the potential composition of rectal carcinoma.MethodsTwenty-four patients provided informed consent for this study. DCE-MRI was performed before total mesorectal excision. Quantitative parameters were calculated based on a modified Tofts model. Whole-mount immunohistochemistry and Masson staining sections were generated and digitized at histological resolution. The percentage of tissue components area was measured. Pearson correlation analysis was used to evaluate the correlations between pathological parameters and DCE-MRI parameters.ResultsOn the World Health Organization (WHO) grading scale, there were significant differences in extracellular extravascular space (Ktrans) (F = 9.890, P = 0.001), mean transit time (MTT) (F = 9.890, P = 0.038), CDX-2 (F = 4.935, P = 0.018), and Ki-67 (F = 4.131, P = 0.031) among G1, G2, and G3. ECV showed significant differences in extramural venous invasion (t = − 2.113, P = 0.046). Ktrans was strongly positively correlated with CD34 (r = 0.708, P = 0.000) and moderately positively correlated with vimentin (r = 0.450, P = 0.027). Interstitial volume (Ve) was moderately positively correlated with Masson’s (r = 0.548, P = 0.006) and vimentin (r = 0.417, P = 0.043). There was a moderate negative correlation between Ve and CDX-2 (r = − 0.441, P = 0.031). The rate constant from extracellular extravascular space to blood plasma (Kep) showed a strong positive correlation with CD34 expression (r = 0.622, P = 0.001). ECV showed a moderate negative correlation with CDX-2 (r = − 0.472, P = 0.020) and a moderate positive correlation with collagen fibers (r = 0.558, P = 0.005).ConclusionThe dynamic contrast-enhanced MRI-derived parameters measured in rectal cancer were significantly correlated with the proportion of histological components. This may serve as an optimal imaging biomarker to identify tumor tissue components.

Machine learning using multimodal clinical, electroencephalographic, and magnetic resonance imaging data can predict incident depression in adults with epilepsy: A pilot study.

This study was undertaken to develop a multimodal machine learning (ML) approach for predicting incident depression in adults with epilepsy. We randomly selected 200 patients from the Calgary Comprehensive Epilepsy Program registry and linked their registry-based clinical data to their first-available clinical electroencephalogram (EEG) and magnetic resonance imaging (MRI) study. We excluded patients with a clinical or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)-based diagnosis of major depression at baseline. The NDDI-E was used to detect incident depression over a median of 2.4 years of follow-up (interquartile range [IQR] = 1.5-3.3 years). A ReliefF algorithm was applied to clinical as well as quantitative EEG and MRI parameters for feature selection. Six ML algorithms were trained and tested using stratified threefold cross-validation. Multiple metrics were used to assess model performances. Of 200 patients, 150 had EEG and MRI data of sufficient quality for ML, of whom 59 were excluded due to prevalent depression. Therefore, 91 patients (41 women) were included, with a median age of 29 (IQR = 22-44) years. A total of 42 features were selected by ReliefF, none of which was a quantitative MRI or EEG variable. All models had a sensitivity > 80%, and five of six had an F1 score ≥ .72. A multilayer perceptron model had the highest F1 score (median = .74, IQR = .71-.78) and sensitivity (84.3%). Median area under the receiver operating characteristic curve and normalized Matthews correlation coefficient were .70 (IQR = .64-.78) and .57 (IQR = .50-.65), respectively. Multimodal ML using baseline features can predict incident depression in this population. Our pilot models demonstrated high accuracy for depression prediction. However, overall performance and calibration can be improved. This model has promise for identifying those at risk for incident depression during follow-up, although efforts to refine it in larger populations along with external validation are required.

Temperature correction of post mortem quantitative magnetic resonance imaging using real-time forehead temperature acquisitions

Performing magnetic resonance imaging (MRI) of deceased is challenging due to altered body temperatures compared to in vivo temperatures and, hence, requires a temperature correction. This study investigates the possibility to correct brain MRI parameters real-time and non invasively based on the forehead temperature.17 post mortem cases were included and their forehead temperatures were measured continuously during the in situ brain MRI protocol consisting of a diffusion tensor imaging, multi-contrast spin echo, multi-echo gradient echo and inversion recovery spin echo sequence. Linear models were fitted to the quantitative MRI parameters in a forensically interesting temperature range for white matter, cerebral cortex and deep gray matter, separately, and the influence of the forehead temperature on the MRI parameters was determined.A statistically significant temperature sensitivity was found for T2 and mean diffusivity in white matter, for T1 in cerebral cortex, as well as for T1 and mean diffusivity in deep gray matter.Linear models were computed to temperature correct these MRI parameters in in situ post mortem scans to allow their comparison regardless of temperature.The here presented real-time and non invasive temperature correction method for the brain presents a crucial precondition for quantitative in situ post mortem MRI.

Value of synthetic MRI quantitative parameters in preprocedural evaluation for TRUS/MRI fusion-guided biopsy of the prostate.

Transrectal ultrasonography (TRUS)/magnetic resonance imaging (MRI) fusion-guided biopsy has a high clinical application value. However, this technique has some limitations, which limit its use in routine clinical practice. Therefore, the selection of suitable proatate lesions for this technique is worthy of our attention. Synthetic MRI (SyMRI) is capable of quantifying multiple relaxation parameters, which might have potential value in preprocedural evaluation for TRUS/MRI fusion-guided biopsy of the prostate. The aim of our study is to examine the value of SyMRI quantitative parameters in preprocedural evaluation for TRUS/MRI fusion-guided biopsy of the prostate. We prospectively selected 148 lesions in 137 patients who underwent prostate biopsy in our hospital. Next, 2-4 needles of TRUS/MRI fusion-guided biopsy combined with 10 needles of system biopsy(SB) were used as the protocol for prostate biopsy. Before biopsy, the MAGiC sequences of the MRI images of the enrolled patients underwent post-processing, and the longitudinal relaxation time (T1), transverse relaxation time (T2), and proton density (PD) were extracted. The biopsy pathology results were used as a gold standard to compare the differences in SyMRI quantitative parameters between benign and malignant prostate lesions in the peripheral and transitional zones. The receiver operating characteristic (ROC) curves were plotted to confirm the optimal SyMRI quantitative parameter for prostate lesion benignancy/malignancy performance, and the cutoff values of these parameters were used for grouping the lesions. The single-needle biopsy prostate cancer (PCa)-positivity rates (number of positive biopsy needles/total biopsy needles) and PCa overall detection rates by TRUS/MRI fusion-guided biopsy and SB were compared in different subgroups. The T1 and T2 values can determine the benignancy/malignancy of prostate transition lesions(p < 0.01), and the T2 value has a greater diagnostic performance (p = 0.0376). The T2 value can determine the benignancy/malignancy of prostate peripheral lesions. The optimal diagnostic cutoff values for T2 were 77 and 81 ms, respectively. The single-needle PCa positivity rate of TRUS/MRI fusion-guided biopsy was higher than SB for any prostate lesions in different subgroups (p < 0.01). However, only in the subgroup of transition zone lesions with T2 ≤ 77 ms, the PCa overall detection rate of TRUS/MRI fusion-guided biopsy was significantly higher than that of SB (p = 0.031). SyMRI-T2 value can provide a theoretical basis for the selection of suitable lesions for TRUS/MRI fusion-guided biopsy.

Diagnostic efficacy of diffusion-weighted imaging and semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging in salivary gland tumors.

Increased use of functional magnetic resonance imaging (MRI) methods such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI consisting of sequential contrast series, allows us to obtain more information on the microstructure, cellularity, interstitial distance, and vascularity of tumors, which has increased the discrimination power for benign and malignant salivary gland tumors (SGTs). In the last few years, quantitative DCE MRI data containing T1 perfusion parameters (Ktrans, Kep and Ve), were reported to contribute to the differentiation of benign or malignant subtypes in SGTs. To evaluate the diagnostic efficacy of DWI and semiquantitative and quantitative perfusion MRI parameters in SGTs. Diffusion MRI [apparent diffusion coefficient (ADC) value] with a 1.5 T MR machine, semiquantitative perfusion MRI [time intensity curve (TIC) pattern], and quantitative perfusion MRI examinations (Ktrans, Kep and Ve) of 73 tumors in 67 patients with histopathological diagnosis performed from 2017 to 2021 were retrospectively evaluated. In the ADC value and semiquantitative perfusion MRI measurements, cystic components of the tumors were not considered, and the region of interest (ROI) was manually placed through the widest axial section of the tumor. TIC patterns were divided into four groups: Type A = Tpeak > 120 s; type B = Tpeak ≤ 120 s, washout ratio (WR) ≥ 30%; type C = Tpeak ≤ 120 s, WR < 30%; and type D = flat TIC. For the quantitative perfusion MRI analysis, a 3D ROI was placed in the largest solid component of the tumor, and the Ktrans, Kep and Ve values were automatically generated. The majority of SGTs were located in the parotid glands (86.3%). Of all the SGTs, 68.5% were benign and 31.5% were malignant. Significant differences were found for ADC values among pleomorphic adenomas (PMAs), Warthin's tumors (WTs), and malignant tumors (MTs) (P < 0.001). PMAs had type A and WTs had type B TIC pattern while the vast majority of MTs and other benign tumors (OBTs) (54.5% and 45.5%, respectively) displayed type C TIC pattern. PMAs showed no washout, while the highest mean WR was observed in WTs (59% ± 11%). Ktrans values of PMAs, WTs, OBTs, and MTs were not significantly different. Kep values of PMAs and WTs were significantly different from those of OBTs and MTs. Mean Ve value of WTs was significantly different from those of PMAs, OBTs, and MTs (P < 0.001). The use of quantitative DCE parameters along with diffusion MRI and semiquantitative contrast-enhanced MRI in SGTs could improve the diagnostic accuracy.

Quantitative magnetic resonance imaging biomarkers for cortical pathology in multiple sclerosis at 7 T.

Substantial cortical gray matter tissue damage, which correlates with clinical disease severity, has been revealed in multiple sclerosis (MS) using advanced magnetic resonance imaging (MRI) methods at 3T and the use of ultra-high field, as well as in histopathology studies. While clinical assessment mainly focuses on lesions using - and -weighted MRI, quantitative MRI (qMRI) methods are capable of uncovering subtle microstructural changes. The aim of this ultra-high field study is to extract possible future MR biomarkers for the quantitative evaluation of regional cortical pathology. Because of their sensitivity to iron, myelin, and in part specifically to cortical demyelination, , , , and susceptibility mapping were performed including two novel susceptibility markers; in addition, cortical thickness as well as the volumes of 34 cortical regions were computed. Data were acquired in 20 patients and 16 age- and sex-matched healthy controls. In 18 cortical regions, large to very large effect sizes (Cohen's d ≥1) and statistically significant differences in qMRI values between patients and controls were revealed compared with only four regions when using more standard MR measures, namely, volume and cortical thickness. Moreover, a decrease in all susceptibility contrasts ( , , and values indicates that the role of cortical demyelination might outweigh inflammatory processes in the form of iron accumulation in cortical MS pathology, and might also indicate iron loss. A significant association between susceptibility contrasts as well as of the caudal middle frontal gyrus and disease duration was found (adjusted R2 : 0.602, p= 0.0011). Quantitative MRI parameters might be more sensitive towards regional cortical pathology compared with the use of conventional markers only and therefore may play a role in early detection of tissue damage in MS in the future.

Muscle quantitative MRI as a novel biomarker in hereditary transthyretin amyloidosis with polyneuropathy: a cross-sectional study

BackgroundThe development of reproducible and sensitive outcome measures has been challenging in hereditary transthyretin (ATTRv) amyloidosis. Recently, quantification of intramuscular fat by magnetic resonance imaging (MRI) has proven as a sensitive marker in patients with other genetic neuropathies. The aim of this study was to investigate the role of muscle quantitative MRI (qMRI) as an outcome measure in ATTRv.MethodsCalf- and thigh-centered multi-echo T2-weighted spin-echo and gradient-echo sequences were obtained in patients with ATTRv amyloidosis with polyneuropathy (n = 24) and healthy controls (n = 12). Water T2 (wT2) and fat fraction (FF) were calculated. Neurological assessment was performed in all ATTRv subjects. Quantitative MRI parameters were correlated with clinical and neurophysiological measures of disease severity.ResultsQuantitative imaging revealed significantly higher FF in lower limb muscles in patients with ATTRv amyloidosis compared to controls. In addition, wT2 was significantly higher in ATTRv patients. There was prominent involvement of the posterior compartment of the thighs. Noticeably, FF and wT2 did not exhibit a length-dependent pattern in ATTRv patients. MRI biomarkers correlated with previously validated clinical outcome measures, Polyneuropathy Disability scoring system, Neuropathy Impairment Score (NIS) and NIS-lower limb, and neurophysiological parameters of axonal damage regardless of age, sex, treatment and TTR mutation.ConclusionsMuscle qMRI revealed significant difference between ATTRv and healthy controls. MRI biomarkers showed high correlation with clinical and neurophysiological measures of disease severity making qMRI as a promising tool to be further investigated in longitudinal studies to assess its role at monitoring onset, progression, and therapy efficacy for future clinical trials on this treatable condition.

Preoperative Multiparametric Quantitative Magnetic Resonance Imaging Correlates with Prognosis and Recurrence Patterns in Pancreatic Ductal Adenocarcinoma.

Simple SummaryMagnetic resonance imaging (MRI) has been considered a noninvasive prognostic biomarker in some cancers; however, the correlation with pancreatic ductal adenocarcinoma (PDAC) remains inconclusive. The aim of our study was to identify quantitative MRI parameters associated with prognosis and recurrence patterns. In an analysis of data from the 136 patients ultimately included in this study, we found that the value of the pure diffusion coefficient D in intravoxel incoherent MRI is an independent risk factor for overall survival (OS) and recurrence-free survival (RFS), while a low value of D is significantly associated with a higher risk of local recurrence. All the patients have been operated on with histopathology for further evaluation. Based on the results of our research, we believe that it is possible in clinical practice to stratify patients based on quantitative MRI data in order to guide treatment strategies, reduce the risk of local tumor recurrence, and improve patients’ prognosis.Magnetic resonance imaging (MRI) has been shown to be associated with prognosis in some tumors; however, the correlation in pancreatic ductal adenocarcinoma (PDAC) remains inconclusive. In this retrospective study, we ultimately included 136 patients and analyzed quantitative MRI parameters that are associated with prognosis and recurrence patterns in PDAC using survival analysis and competing risks models; all the patients have been operated on with histopathology and immunohistochemical staining for further evaluation. In intravoxel incoherent motion diffusion-weighted imaging (DWI), we found that pure-diffusion coefficient D value was an independent risk factor for overall survival (OS) (HR: 1.696, 95% CI: 1.003–2.869, p = 0.049) and recurrence-free survival (RFS) (HR: 2.066, 95% CI: 1.252–3.409, p = 0.005). A low D value (≤1.08 × 10−3 mm2/s) was significantly associated with a higher risk of local recurrence (SHR: 5.905, 95% CI: 2.107–16.458, p = 0.001). Subgroup analysis revealed that patients with high D and f values had significantly better outcomes with adjuvant chemotherapy. Distant recurrence patients in the high-D value group who received chemotherapy may significantly improve their OS and RFS. It was found that preoperative multiparametric quantitative MRI correlates with prognosis and recurrence patterns in PDAC. Diffusion coefficient D value can be used as a noninvasive biomarker for predicting prognosis and recurrence patterns in PDAC.

Correlations between dynamic-enhanced magnetic resonance imaging quantitative parameters and postoperative recurrence or metastasis and clinicopathological features in breast cancer patients-a retrospective cohort study.

BackgroundFew related studies focused on the correlations between the quantitative parameters of dynamic-enhanced magnetic resonance imaging (MRI) and the clinical pathological characteristics of patients with invasive breast cancer have been conducted to date. This study sought to explore the value of quantitative parameters of dynamic-enhanced MRI in predicting postoperative recurrence or metastasis in breast cancer patients and their correlations with clinical pathological features, so as to provide clinicians with understanding of MRI in breast cancer.MethodsFrom January 2016 to June 2017, 214 invasive breast cancer patients admitted to Affiliated Kunshan Hospital of Jiangsu University were retrospectively enrolled in this study. Dynamic-enhanced MRI was performed to analyze the relationship between quantitative parameters of dynamic-enhanced MRI and recurrence or metastasis, and analyze their correlations with clinical pathological features in patients with invasive breast cancer.ResultsThe apparent diffusion coefficient and peak time had certain diagnostic value for postoperative recurrence or metastasis in breast cancer patients, and the areas under the curve were 0.821 [95% confidence interval (CI): 0.732–0.911; P<0.001] and 0.691 (95% CI: 0.609–0.774; P<0.001), respectively. An apparent diffusion coefficient <0.78×10−3 mm2/s, a peak time <167.50 s, tumor staging (T staging) ≥2, vascular tumor thrombus, and positive lymph nodes were risk factors for postoperative recurrence or metastasis in breast cancer patients (odds ratio: 19.768, 95% CI: 2.577–151.619, P=0.004; 5.708, 95% CI: 1.088–29.947, P=0.039; 122.474, 95% CI: 5.334–2,812.360, P=0.003; 28.304, 95% CI: 1.372–583.914, P=0.030; 314.407, 95% CI: 10.617–9,310.547, P=0.001), and high estrogen receptor (ER) expression was a protective factor for postoperative recurrence or metastasis in breast cancer patients (odds ratio: 0.056, 95% CI: 0.004–0.795, P=0.033). The apparent diffusion coefficient was related to the site of onset, T staging, vascular tumor thrombus, and positive lymph nodes in breast cancer patients (P<0.05). Peak time was related to a high nuclear-associated antigen Ki-67 index, high ER expression, and high progesterone receptor (PR) expression in breast cancer patients (P<0.05).ConclusionsThe quantitative parameters of MRI were associated with clinical pathological characteristics and recurrence or metastasis in breast cancer after surgery.

Correlation of magnetic resonance imaging quantitative parameters and apparent diffusion coefficient value with pathological breast cancer.

BACKGROUNDChina ranks 120th worldwide for the incidence of breast cancer and 163rd for mortality. Early screening, diagnosis, and timely determination of the optimal treatment plan can help ensure clinical efficacy and prognosis.AIMTo investigate the relationship between quantitative magnetic resonance imaging parameters, apparent diffusion coefficient value, pathological immunohistochemical status, and patient prognosis.METHODSA total of 108 patients with breast cancer (breast cancer group) and 110 patients with benign breast tumors (benign group) confirmed by pathological examination at our Hospital from September 2013 to August 2016 were selected. All patients had undergone preoperative magnetic resonance imaging (MRI) examinations, and the quantitative parameters of MRI and apparent diffusion coefficient (ADC) values for the two groups were compared. The MRI quantitative parameters and ADC values of patients with different estrogen receptor (ER), progesterone receptor, and human epidermal growth factor receptor-2 expression were statistically analyzed. The relationship between the quantitative parameters of MRI and ADC values and patient recurrence was analyzed using receiver operating curves.RESULTSThe measured values of the quantitative parameters of MRI- Ktrans, Kep, and Ve in the breast cancer group were higher than those in the benign group; the ADC value in the breast cancer group was lower than that in the benign group, and the difference was statistically significant (P < 0.05). The Ktrans, Ve, and ADC values in patients with ER-positive breast cancer were significantly lower than those in patients with negative ER expression (P < 0.05). After 5 years of follow-up, 22 patients with breast cancer experienced postoperative recurrence. The Kep, Ve, and ADC values of the recurrence group were significantly lower than those of the non-recurrence group, and the difference was statistically significant (P < 0.05). CONCLUSIONMRI quantitative parameters and ADC are related to the expression of breast cancer-related immunological receptor factors and have certain clinical value in assessing postoperative recurrence in patients.

Post mortem evaluation of brain edema using quantitative MRI

The post mortem assessment of brain edema is routinely performed during autopsy by forensic pathologists who evaluate the macroscopically visible signs. In this study, the suitability of magnetic resonance imaging (MRI) for a differentiation between edematous and nonedematous brains was examined as an objective, noninvasive and quantitative rating method. In this study, 22 deceased underwent post mortem in situ MRI prior to regular autopsy. Acquired MRI sequences allowed the computation of the quantitative MRI parameters T1, T2, T2*, fractional anisotropy (FA) and mean diffusivity for the cortex, white matter and deep gray matter separately. Beside the autopsy results, which represent the gold standard for rating brain edema, also the normalized cerebral weight (NCW) was determined by dividing the brain weight by the intracranial volume as developed by Bauer et al. [10]. For further examination of the relation of MRI parameters with the NCW, linear regression models were calculated. The results revealed highly significant correlations of the MRI parameters T2 and FA with the NCW in the cortex. These combinations additionally showed the best fitting results of the linear regression models. In conclusion, quantitative MRI is suitable for differentiating edematous from nonedematous brains by calculating T2 and FA in the cortex. A post mortem in situ MRI scan of the brain can, besides delivering morphological information, add relevant and objective information on the edema status of the brain prior to autopsy or when no autopsy is ordered.

Combining Magnetic Resonance Diffusion-Weighted Imaging with Prostate-Specific Antigen to Differentiate Between Malignant and Benign Prostate Lesions.

BackgroundWe aimed to develop a combined model of quantitative parameters derived from 3 different magnetic resonance imaging (MRI) diffusion models and laboratory data related to prostate-specific antigen (PSA) for differentiating between prostate cancer (PCa) and benign lesions.Material/MethodsEighty-four patients pathologically confirmed as having PCa or benign disease were enrolled. All patients underwent multiparametric MRI before biopsy, added intravoxel incoherent motion (IVIM) imaging, and diffusion kurtosis imaging (DKI). The following data were collected: quantitative parameters of diffusion-weighted imaging (DWI), IVIM, and DKI, preoperative total PSA, free/total PSA ratio, and PSA density (PSAD) values. A combined logistic regression model was established by above MRI quantitative parameters and PSA data to diagnose PCa. The Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) was used to assess the lesions for comparison.ResultsThirty-two patients had PCa and 52 patients had benign lesions. In multivariate logistic regression analysis, only apparent diffusion coefficient (ADC) and PSAD were significant variables (P<0.05) and were thus retained in the model. The area under curve value of the combined model (0.911) was higher than that of ADC, PSAD, and PI-RADS v2 (0.887, 0.861, and 0.859, respectively) in univariate analysis, but without any statistically significant differences. The combined model generated greater clinical benefit than the independent application of ADC, PSAD, and PI-RADS v2.ConclusionsADC and PSAD were the 2 most important metrics for distinguishing PCa from benign lesions. The combined model of ADC and PSAD demonstrated satisfactory discrimination and improved clinical net benefit.

Investigating the effect of ARHGEF10L gene on tumor growth in gastric cancer in a nude mouse model using quantitative MRI parameters.

The quantitative magnetic resonance imaging (MRI) parameters were initially used in the study of central nervous system diseases and has since been widely used in the diagnosis of breast, liver, rectum, and prostate diseases. In our study, we aimed to evaluate the effect of ARHGEF10L gene on tumor growth in gastric cancer in nude mice using quantitative MRI parameters. A nude mice model of gastric cancer was established, and the mice were divided into a control group and an shARHGEF10L group (N = 10). T2-fs and intravoxel incoherent motions (IVIM) imaging were performed in the mice coil with a 3.0 T MR system. The differences in quantitative parameters (apparent diffusion coefficient [ADC], D, D *, f values) were compared between both groups, and the effect of ARHGEF10L expression on tumor growth in tumor-bearing mice was investigated. The data were analyzed using Statistical Package for the Social Sciences (SPSS) 17.0 software package. The ADC and D values of tumor imaging in the shARHGEF10L group were higher than those in the control group, and the differences were statistically significant. There was no significant difference in the D* or F values between both groups. The ADC and D values of the quantitative IVIM imaging parameters can be used to effectively assess the growth of gastric cancer in nude mice, suggesting that ARHGEF10L may promote the growth of tumor cells.

Relaxometry and brain myelin quantification with synthetic MRI in MS subtypes and their associations with spinal cord atrophy

Immune-mediated demyelination and neurodegeneration are pathophysiological hallmarks of Multiple Sclerosis (MS) and main drivers of disease related disability. The principal method for evaluating qualitatively demyelinating events in the clinical context is contrast-weighted magnetic resonance imaging (MRI). Moreover, advanced MRI sequences provide reliable quantification of brain myelin offering new opportunities to study tissue pathology in vivo. Towards neurodegenerative aspects of the disease, spinal cord atrophy – besides brain atrophy – is a powerful and validated predictor of disease progression. The etiology of spinal cord volume loss is still a matter of research, as it remains unclear whether the impact of local lesion pathology or the interaction with supra- and infratentorial axonal degeneration and demyelination of the long descending and ascending fiber tracts are the determining factors.Quantitative synthetic MR using a multiecho acquisition of saturation recovery pulse sequence provides fast automatic brain tissue and myelin volumetry based on R1 and R2 relaxation rates and proton density quantification, making it a promising modality for application in the clinical routine. In this cross sectional study a total of 91 MS patients and 31 control subjects were included to investigate group differences of global and regional measures of brain myelin and relaxation rates, in different MS subtypes, using QRAPMASTER sequence and SyMRI postprocessing software. Furthermore, we examined associations between these quantitative brain parameters and spinal cord atrophy to draw conclusions about possible pathophysiological relationships.Intracranial myelin volume fraction of the global brain exhibited statistically significant differences between control subjects (10.4%) and MS patients (RRMS 9.4%, PMS 8.1%). In a LASSO regression analysis with total brain lesion load, intracranial myelin volume fraction and brain parenchymal fraction, the intracranial myelin volume fraction was the variable with the highest impact on spinal cord atrophy (standardized coefficient 4.52). Regional supratentorial MRI metrics showed altered average myelin volume fraction, R1, R2 and proton density in MS patients compared to controls most pronounced in PMS. Interestingly, quantitative MRI parameters in supratentorial regions showed strong associations with upper cord atrophy, suggesting an important role of brain diffuse demyelination on spinal cord pathology possibly in the context of global disease activity. R1, R2 or proton density of the thalamus, cerebellum and brainstem correlated with upper cervical cord atrophy, probably reflecting the direct functional connection between these brain structures and the spinal cord as well as the effects of retrograde and anterograde axonal degeneration.By using Synthetic MR-derived myelin volume fraction, we were able to effectively detect significant differences of myelination in relapsing and progressive MS subtypes. Total intracranial brain myelin volume fraction seemed to predict spinal cord volume loss better than brain atrophy or total lesion load. Furthermore, demyelination in highly myelinated supratentorial regions, as an indicator of diffuse disease activity, as well as alterations of relaxation parameters in adjacent infratentorial and midbrain areas were strongly associated with upper cervical cord atrophy.

Quantitative Evaluation of Extramural Vascular Invasion of Rectal Cancer by Dynamic Contrast-Enhanced Magnetic Resonance Imaging.

This study was carried out to explore the preoperative predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in extramural vascular invasion (EMVI) in patients with rectal cancer. 124 patients with rectal cancer were randomly divided into two groups, with 62 groups in each group. One group used conventional magnetic resonance imaging (MRI) and was recorded as the control group. The other group used DCE-MRI and was recorded as the experimental group. The diagnostic value was evaluated by comparing the MRI quantitative parameters of EMVI positive and EMVI negative patients, as well as the area under the curve (AUC) of the receiver operating characteristic curve (ROC), diagnostic sensitivity, and specificity of the two groups. The results showed that the Ktrans and Ve values of EMVI positive patients in the experimental group and the control group were 1.08 ± 0.97 and 1.03 ± 0.93, and 0.68 ± 0.29 and 0.65 ± 0.31, respectively, which were significantly higher than those in EMVI negative patients (P < 0.05). The AUC of EMVI diagnosis in the experimental group and the control group were 0.732 and 0.534 (P < 0.05), the sensitivity was 0.913 and 0.765 (P < 0.05), and the specificity was 0.798 and 0.756 (P > 0.05), respectively. In conclusion, DCE-MRI has a higher diagnostic value than conventional MRI in predicting EMVI in patients with rectal cancer, which was worthy of further clinical promotion.