Magnetic Resonance Imaging Staging Research Articles

A comparison between computerised tomography and magnetic resonance imaging in the primary staging of bladder cancer as compared to final histology

Introduction: Accurate and effective imaging to determine the stage of the primary tumour is crucial in deciding whether patients should be treated conservatively, or with surgical or radiochemotherapeutic treatment. There are still concerns about the staging accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) scanners. Methods: We conducted a retrospective analysis of 254 single-surgeon radical cystectomies on a population destined for potentially curative surgery (without evidence of metastatic disease) over 14 years. We compared the staging accuracy of 245 CT scans against 62 conventional T2-weighted MRI scans and compared them to the absolute gold standard, histological analysis using the TNM staging system. Results: Overall, when comparing all the scanner results from 1999 to 2016, the following was observed: • MRI initially appears to be better than CT in staging the primary tumour as either localised or locally advanced disease; and • CT is significantly better than MRI for nodal staging. However, when comparing the more recent results using 53 patients who had both CT and MRI prior to operation, from 2005 to 2016, we find CT improves to match MRI in both primary tumour staging and nodal staging with ‘fair’ kappa scores ( p = 0.84). Conclusions: We confirm that MRI is better at staging extravesical disease and CT better at staging localised disease. Regarding primary tumour accuracy, the volume of the tumour has an influence on its correct staging. Regarding nodal accuracy, the presence of extracapsular extension had no influence. Knowing these limitations of the two modalities should enable better counselling of patients, regardless of their subsequent treatment regimen.

PRE- AND POSTOPERATIVE IMAGING METHODS IN COLORECTAL CANCER.

ABSTRACT Introduction: Among the screening tests for colorectal cancer, colonoscopy is currently considered the most sensitive and specific technique. However, computed tomography colonography (CTC), magnetic resonance imaging (MRI), and transrectal ultrasonography have gained significant ground in the clinical practice of pre-treatment, screening and, more recently, post-treatment and surgical evaluation. Objective: To demonstrate the high accuracy of CT and MRI for pre and postoperative colorectal cancer staging. Methods: Search and analysis of articles in Pubmed, Scielo, Capes Periodicals and American College of Radiology with headings “colorectal cancer” and “colonography”. Weew selected 30 articles that contained radiological descriptions, management or statistical data related to this type of neoplasia. The criteria for radiological diagnosis were the American College of Radiology. Results : The great majority of patients with this subgroup of neoplasia is submitted to surgical procedures with the objective of cure or relief, except those with clinical contraindication. CTC colonography is not the most commonly used technique for screening; however, it is widely used for treatment planning, assessment of the abdomen for local complications or presence of metastasis, and post-surgical evaluation. MRI colonography is an alternative diagnostic method to CT, recommended by the American Society of Gastrointestinal Endoscopy. Although there are still no major studies on the use of MRI for screening, the high resolution examination has now shown good results for the American Joint Committee on Cancer TNM classification. Conclusion: MRI and CT represent the best means for colorectal neoplasm staging. The use of these methods as screening tools becomes beneficial to decrease complications and discomfort related to colonoscopy.

Can MRI help assess aggressiveness of endometrial cancer?

To identify potential magnetic resonance imaging (MRI) biomarkers to predict the aggressiveness of endometrial cancer. Seventy-one patients with endometrial cancer who underwent MRI staging were analysed retrospectively. The signal intensity (SI) of the tumours was assessed on sagittal T2-weighted imaging (WI) and sagittal T1WI sequences). The depth of myometrial invasion, tumour grade and subtype, lymphovascular invasion, and microsatellite stability status were assessed histopathologically, and these findings were compared with MRI findings using logistic regression. The log-rank test was used to assess differences in survival among groups defined by different MRI measurements. Tumours with qualitative higher signal than that of normal myometrium on the late T1WI DCE image sequences were more likely to have lymphovascular space invasion (p<0.001). Tumours that had a higher SI tumour ratio (T1 post-contrast arterial/T1 precontrast) had a higher chance of being microsatellite stable (odds ratio 2.36). The SI ratio of the tumour to the myometrium showed that lower T2 tumour/T2 myometrial ratio correlated with ≥50% depth of myometrial invasion as determined by imaging (p=0.006). Endometrial tumours showing a SI of >209 on delayed T1WI sequences had longer recurrence-free survival than those with tumours showing a SI ≤209 (p=0.014). Tumour subtype and grade were not associated with MRI findings. The SI of endometrial cancer on MRI may be used to predict the aggressiveness of the tumour and microsatellite stability status. Further studies are needed to confirm these findings.

Diagnostic accuracy of magnetic resonance imaging for tumour staging of bladder cancer: systematic review and meta-analysis.

The purpose of this study is to evaluate accuracy of magnetic resonance imaging (MRI) for local staging of bladder cancer for four clinical scenarios (T-stage thresholds) considered against current standards for clinical staging and secondarily to identify sources for variability in accuracy. Systematic review of patients with bladder cancer undergoing T-staging MRI to evaluate the diagnostic accuracy using bivariate random-effects meta-analysis. Sub-group analysis was done to explore variability; risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. The search identified 30 studies (5156 patients). Pooled accuracy at multiple T-stage thresholds: ≤T1 vs ≥T2 = sensitivity 87% (95% confidence interval [CI] 82-91), specificity 79% (95% CI 72-85); T-any vs T0 = sensitivity 65% (95% CI 23-92), specificity 90% (95% CI 83-94); ≤T2 vs ≥T3 = sensitivity 83% (95% CI 75-88), specificity 87% (95% CI 78-93); and <T4b vs pT4b = sensitivity 85% (95% CI 63-95), specificity 98% (95% CI 95-99). For ≤T1 vs ≥T2, accuracy was higher in studies at low risk of bias. No variability in accuracy was identified for: field strength, transurethral resection of bladder tumour status, publication date, index test parameters. For ≤T1 vs ≥T2, accuracy was higher than reported for clinical staging. For T-any vs T0 accuracy was lower than clinical staging. For ≤T2 vs ≥T3, sensitivity was slightly lower than clinical staging but specificity was considerably higher. For <T4b vs pT4b sensitivity exceeded the estimated accuracy for clinical staging. Limitations: two scenarios had few studies (T-any vs T0; <T4b vs pT4b) and several studies were at high risk of bias. MRI staging for ≤T1 vs ≥T2, ≤T2 vs ≥T3, and <T4b vs pT4b should be considered as potentially superior to the current standard for clinical staging. MRI accuracy for T-any vs T0 may not be superior to clinical staging. However, cautious interpretation is warranted related to risk of bias and sample size; validation in trials comparing clinical staging strategies vs MRI is warranted.

Evaluation of magnetic resonance imaging in staging of rectal cancer and its relationship with P16 expression.

To explore the use of magnetic resonance imaging (MRI) in the staging of rectal cancer and its relationship with p16 expression. A total of 75 patients with rectal cancer treated in Oncology Department of our hospital from March 2013 to March 2017 were randomly included in this study. The entire pelvis was scanned by MRI, and clinicopathological staging was diagnosed. Subsequently, all patients underwent total mesorectal excision (TME). Histopathological gold standard [hematoxylin-eosin (HE) staining] was used to determine the stage. Immunohistochemistry (IHC) was adopted to detect the expression of p16 in cancer tissues and cancer-adjacent tissues. Compared with the results of the pathological examination, the accuracy of MRI diagnosis was analyzed. The relationship between p16 expression and MRI diagnostic materials was analyzed. Compared with the results of the pathological examination, the total accuracy of MRI in the evaluation of T staging was 76.0% (57/75), and the excessive staging rate and insufficient staging rate were 8.0% (6/75) and 16.0% (12/75), respectively in the assessment of tumor T staging. IHC indicated that the positive expression rate of p16 in the tumor tissues was significantly lower than that in the tumor-adjacent tissues [34.67% (26/75) vs. 85.33% (64/75), p<0.05]. The chi-square test showed that the expression of p16 in the tumors was notably correlated with T staging, N staging, and myometrial invasion diagnosed with MRI. P16 is significantly deficient in the rectal cancer tissues. MRI examination and identification are helpful for clinical diagnosis of rectal cancer staging. The combination of the two items may be helpful for the diagnosis of clinical rectal cancer staging and the establishment of reasonable treatment regimens.

Pre-operative MRI staging of endometrial cancer in a multicentre cancer network: can we match single centre study results?

To evaluate the staging accuracy of magnetic resonance imaging (MRI) for endometrial cancer in daily practice over a 3-year period at a tertiary referral centre receiving scans from a large number of hospitals with varying protocols. To compare these daily practice results to published data from single-centre studies. After ethical approval, MRI staging records for 270 studies from nine network and three centre hospitals were retrospectively collected and compared with final operative histopathology. The International Federation of Gynaecology and Obstetrics (FIGO) stage, depth of invasion assessment and cervical stromal invasion were analysed and reasons for discrepancies reviewed. MRI-based complete FIGO stage was fully concordant with histopathology in 65.6%. MRI accuracy for depth of myometrial invasion and cervical stromal invasion was 73.3% and 89.3% respectively. Our results did not match the high accuracy previously reported in studies based on single centres. Published MRI staging accuracy from small single-centre studies were not replicated in a tertiary referral centre receiving scans with heterogeneous protocols over a 3-year period. These results highlight the challenges faced in daily practice and may reflect achievable and realistic MRI staging accuracies in large rapid throughput referral networks. Adherence to standardised high-quality protocols may help to improve future results. • Three-year MRI-staging accuracy for endometrial cancer in a multicentre cancer network • Daily practice MRI-staging accuracy did not meet results of single-centre studies • Large scale cancer network MRI-staging accuracies should be further evaluated • Treatment recommendations should be based on achievable MRI-staging accuracies.

How Is Rectal Cancer Managed: a Survey Exploring Current Practice Patterns in Canada.

Locally advanced rectal cancers are most often treated with neoadjuvant chemoradiation followed by surgical resection. However, there are differing opinions surrounding management of rectal cancer, including a lack of consensus on the optimal time interval between chemoradiation and surgery, and the management of patients with complete clinical response following neoadjuvant therapy. This study seeks to summarize management trends for rectal cancer among a sample of Canadian surgeons. A 14-question survey was distributed to surgeons across Canada managing rectal cancer. Surgeons were identified from the membership lists of the Canadian Association of General Surgeons and the Canadian Society of Colon and Rectal Surgeons. Web-based questionnaires were distributed by email. A total of 115 surgeons were emailed the survey with a response rate of 38.4%. Approximately 50% of surgeon responders had been in practice for more than 10years, with the majority practicing in academic centers. Half were considered high-volume rectal cancer surgeons with more than 20 cases per year. All surgeons used magnetic resonance imaging for staging of rectal cancer, but only 50% presented all rectal cancer cases at multidisciplinary cancer conferences. The majority of surgeons applied minimally invasive techniques for surgical resection, including the utilization of transanal endoscopic microsurgery (TEMs) and transanal minimally invasive surgery (TAMIS); however, only a small fraction performed high-volume transanal total mesorectal excision (taTME). Regarding the management of complete clinical response (cCR) following neoadjuvant chemoradiation, less than 5% chose the watch and wait management strategy for all patients and 40% did not use it at all. The majority of surgeons reported waiting between eight and 10weeks between chemoradiation and surgery, and 40% made that decision regardless of patient or tumor factors. The majority of surveyed surgeons use MRI for pelvic staging and discuss rectal cancer cases at multidisciplinary cancer conference. Many are using minimally invasive techniques; however, the use of taTME is not yet widespread. Surgeons currently favor longer intervals from neoadjuvant chemoradiation to surgery, and the management strategy for patients with complete clinical response remains controversial. Great variability exists in rectal cancer management, thus presenting an opportunity for improvements by adopting standardization and centralization of rectal cancer management.

Cognitive phenotypes of sequential staging in amyotrophic lateral sclerosis

Sequential spread of TDP-43 load in the brain may be a pathological characteristic of amyotrophic lateral sclerosis (ALS). Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) based marker of this pathological feature. Cognitive deficits known to be present in a subset of ALS patients might act as an additional in vivo clinical marker of disease spread.N = 139 patients with ALS were tested with the Edinburgh Cognitive and Behavioural ALS screen (ECAS) in addition to DTI brain measures of pathological spread. Executive function, memory and disinhibited behaviour were selected for Cognitive-Staging criteria, as these cognitive functions are attributed to cerebral areas analogous to the pattern of MRI markers of TDP-43 pathology. ROC curve analyses were performed to define cut-off scores for cognitive stages 2 (executive function), stage 3 (disinhibited behaviour) and stage 4 (memory), and staging was performed according to the cognitive profile subsequently. Associations of Cognitive-Staging (stage 2–4) and MRI-Staging measures were determined.In total, 77 patients (55%) performed below ROC cut-off scores in either executive function or memory or both and/or were reported to have disinhibited behaviour which permitted Cognitive-Staging. The cognitive profile of patients with discrete MRI stages 2–4 correlated significantly with DTI parameters. For those patients with cognitive impairment, there was a high congruency between MRI and Cognitive-Staging with high specificity and sensitivity of executive functions for MRI stage 2, disinhibited behaviour for MRI stage 3 and moderate of memory for MRI stage 4.Cognitive impairment follows specific patterns in ALS and these patterns can be used for Cognitive-Staging with a high specificity compared to MRI-Staging. For the individual, cognitive screening is a fast and easy to apply measurement of cerebral function giving valuable information in a clinical context.

Is the accuracy of preoperative MRI stage in rectal adenocarcinoma influenced by tumour height?

Aim: To our knowledge, no prior studies have addressed the possible effects of tumour height on the accuracy of preoperative magnetic resonance imaging (MRI)-based staging relative to postoperative histopathological assessments in patients with adenocarcinoma of the rectum (RC). This study aimed to investigate whether the accuracy of preoperative MRI stage in RC is influenced by tumour height.Methods: A total of 489 consecutive RC patients scheduled for curative treatment between 2009 and 2013 were included. Of the 489 patients, 133 patients had preoperative chemoradiotherapy (CRT), and 356 patients underwent primary surgery. Low, mid and high RC were defined as a tumour <5 cm, 5–10 cm and >10 cm from the anal verge, respectively. Diagnostic MRI and, for patients with CRT, re-staging MRI features including tumour T-stage (mrT), distance between the tumour border and the distance to the mesorectal fascia (mrMRF), extramural tumour depth (mrEMD), extramural vascular invasion (mrEMVI) and nodal involvement (mrN) were correlated with the corresponding postoperative histopathological findings.Results: There were 115, 186 and 188 patients with low RC, mid RC and high RC, respectively. For all patients, the correlations between mrT and pT and between mrMRF and pCRM were not influenced by tumour height. None of the correlations between mrEMD, mrEMVI and mrN and the corresponding postoperative histopathological findings significantly differed for tumours of different heights. For patients with CRT, a remarkable proportion with low RC were overstaged as ymrT3 compared to ypT0-2.Conclusions: The ability to preoperatively use MRI to accurately stage is not influenced by tumour height. For patients with preoperative CRT, low RC may be MRI overstaged due to post-radiation fibrosis. We found that mrEMD predicts pEMD reliably and should therefore be considered in treatment decisions. Although new MRI techniques are emerging, preoperative RC staging remains incompletely definitive in daily clinical practice.

18F]FDG-PET/CT and MRI for initial pelvic lymph node staging in patients with cervical carcinoma: The potential usefulness of [18F]FDG-PET/MRI.

The current study aimed to determine the optimum diagnostic imaging technique out of magnetic resonance imaging (MRI), 18F-fludeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT, otherwise known as PET/CT) and [18F]FDG-PET/MRI (otherwise known as PET/MRI) for the pelvic lymph node staging (N-staging) of untreated cervical carcinoma (CC). A total of 27 patients were included in the present study. All patients had undergone pre-treatment with PET/CT and MRI ≤45 days prior to undergoing a lymphadenectomy. The results from PET (separated from PET/CT), MRI and the statistically combined results of (virtual) PET/MRI were compared to those from histological analyses (the gold standard). A per-patient-based analysis of the detection of pelvic lymph node metastases indicated that PET/MRI had a sensitivity of 64%. The specificity of PET/CT and MRI were 69 and 62%, respectively. The positive predictive value (PPV) was 69 and 64% for PET/CT and MRI, respectively. The negative predictive value (NPV) was 64 and 62% for PET/CT and MRI, respectively. The sensitivity of the PET-guided PET/MRI and the MRI-guided PET/MRI was 64% for both. The specificity of the PET-guided PET/MRI and the MRI-guided PET/MRI was 77 and 62%, respectively. The PPV was 75% for PET-guided PET/MRI and 64% for MRI-guided PET/MRI, and the NPV was 67 and 62%, respectively. PET/CT and the virtual PET/MRI exhibited the same low sensitivity (64%). PET/MRI exhibited slightly better results than PET/CT regarding specificity (77 vs. 69%, respectively), PPV (75 vs. 69%, respectively) and NPV (67 vs. 64%, respectively). The results of the present study suggested that PET/CT and MRI are not optimal diagnostic modalities, and that PET/MRI does not necessarily lead to better results than PET/CT, in the pelvic N-staging of CC.

Comparison of MDCT, MRI and MRI with diffusion-weighted imaging in evaluation of focal renal lesions: The defender, challenger, and winner!

Purpose:To compare the diagnostic performance of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and MRI with diffusion-weighted imaging (DWI) in the characterization of focal renal lesions. We also compared MDCT and MRI in the staging of renal cell carcinoma (RCC).Materials and Methods:One hundred and twenty adult patients underwent MDCT (40-row and 128-row scanners), MRI (at 1.5 T), and DWI (at b-values of 0 and 500 s/mm2) for characterization of 225 renal lesions. There were 65 malignant neoplasms (44 RCCs), 25 benign neoplasms, 25 abscesses, 45 pseudotumors, 15 hemorrhagic cysts, and 50 benign cysts. A composite gold standard including histology, typical imaging criteria, and follow-up imaging was employed. To determine the diagnostic performance of imaging modalities, area-under-curve (AUC) was calculated by receiver-operating-characteristic analysis and compared. Fisher's exact test was used to compare the diagnostic accuracies and confidence levels with MDCT, MRI, and MRI + DWI. Cross-tabulation was used to assess the precision of MDCT and MRI in RCC staging.Results:AUC for MDCT (0.834) and MRI (0.841) in the classification of benign and malignant lesions were within corresponding 95% confidence interval (CI) (P = 0.88) whereas MRI + DWI had significantly better performance (AUC 0.968, P = 0.0002 and 0.0004, respectively). Both CT and MRI had low specificity (66.9% and 68.8%, respectively), which increased substantially with DWI (93.8%) owing to correct diagnosis of pseudotumors. MRI was superior to CT in diagnosing necrotic RCC and hemorrhagic cysts. MRI + DWI had the highest accuracy (94.2%) in assigning the definitive diagnosis and 97.6% lesions were diagnosed with very high confidence, significantly better than CT and MRI. Both CT and MRI had the same accuracy (86.1%) in RCC staging and evaluation of intravascular thrombi.Conclusions:Characterization of renal lesions was most accurate with MRI + DWI. The latter is also the most suitable modality in diagnosing pseudotumors and evaluating patients with renal dysfunction. CT and MRI were equivalent in RCC staging.

The Value of Magnetic Resonance Imaging for Staging and Breast Conserving Surgery Planning

The Value of Magnetic Resonance Imaging for Staging and Breast Conserving Surgery Planning

The Value of Magnetic Resonance Imaging for Staging and Breast Conserving Surgery Planning

The Value of Magnetic Resonance Imaging for Staging and Breast Conserving Surgery Planning

Correlation of high-resolution magnetic resonance imaging with surgico-pathological findings in rectal carcinoma patients

Background: Colorectal cancer is the third most common cancer in men, and it is second most common in women worldwide. Magnetic resonance imaging (MRI) is free of ionizing radiation and imparts highest soft tissue contrast; therefore, it can provide the best assessment of evaluation of local spread. The available data show that only a few studies have been done describing the role of high-resolution MRI (HRMRI) in staging of rectal cancer in Indian population. Objectives: The present study attempts to find the correlation and level of agreement between HRMRI and Surgico-pathological findings in rectal carcinoma patients. Materials and Methods: This hospital-based prospective study was conducted on patients diagnosed with rectal cancer. MR study for pre-operative evaluation was done on 97 patients. 60 operated cases who gave the consent were included in the final study. Findings from MR study were compared with surgical and histopathological findings. Results: Result showed that mean tumor size was 7.43 ± 3.12, 6.88 ± 3.04, and 5.67 ± 2.50 by MRI, surgical, and histological methods (P < 0.001). Overall agreement between MRI and operative finding and histopathological finding was 0.95 and 0.75 respectively (P < 0.001), showing good absolute agreement between the methods. Conclusions: There was good agreement between the MR, surgical, and histopathological findings for local staging and pre-operative planning of rectal carcinoma.

Diffusion weighted magnetic resonance imaging in bladder cancer, is it time to replace biopsy?

IntroductionTo assess if the apparent diffusion coefficient (ADC) value of magnetic resonance imaging (MRI) can discriminate between the cell type, histological grade and improve staging of urinary bladder cancer (BC).Material and methods102 patients with urinary bladder masses underwent MRI using a 1.5 T machine. T2 weighted and diffusion weighted imaging (DWI) using b values of 0, 150, 500 and 1000 s/mm2 were done. The ADC values of bladder masses were measured. These values were correlated with the histopathologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of T2WI, DWI and T2WI plus DWI for detecting bladder lesions were evaluated.RESULTSThe cut-off ADC value for diagnosing malignant bladder wall pathologies was ≤1 x 10-3 mm2/s with 94.5% sensitivity and 87.5% specificity. The mean ADC value of different malignant cell types was statistically insignificant. A significant difference in ADC values was found between G1 and G3 (P = 0.000), G2 and G3 (P = 0.045) but not between G1 and G2 (p = 0.066). Staging accuracy for differentiation between invasive and non-invasive lesions was nearly the same for all MRI data sets. For differentiation between organ confined (pT1–pT2) and non-organ confined lesions (pT3–pT4), staging accuracy was better in T2WI plus DWI (83%) as compared to DWI alone (77%) or T2WI alone (75%).ConclusionsAdding DWI and the ADC value to T2WI improve the accuracy of MRI in BC detection and staging. However, at this time point, MRI cannot replace transurethral resection (TUR) biopsy or distinguish sharply between all different histologic grades and cell types.

Magnetic Resonance Imaging for Staging of Primary Rectal Cancer: Imaging Prognosticators

Magnetic Resonance Imaging for Staging of Primary Rectal Cancer: Imaging Prognosticators

Prevalence and Characteristics of Intracranial Hemorrhages in Neonates with Hypoxic Ischemic Encephalopathy.

The risk factors of intracranial hemorrhages (ICH) in the context of neonatal hypoxic ischemic encephalopathy (HIE) and related interventions are unclear. This article examines the prevalence and risk factors associated with ICH in neonates with HIE. This is a retrospective cohort study of neonates with HIE in Southern Alberta. ICH (subdural [SDH], subarachnoid [SAH], intraventricular [IVH], intraparenchymal [IPH]) were diagnosed by magnetic resonance imaging (MRI). Perinatal and neonatal characteristics were examined. Relation of hemorrhages with hypoxic changes on MRI and HIE stages were assessed. Number of HIE patients, n = 157; brain MRI was done in 138 infants; median gestation, 40 weeks; and cooled = 103 (66%). Prevalence of SDH, IPH, IVH, and SAH were 47, 22, 11, and 10 (34.1%, 15.9%, 7.8%, 7.2%), respectively. There was no significant increase in hemorrhage with mode of delivery, seizures, hypo/hypercarbia, severe thrombocytopenia, or deranged coagulation. All hemorrhages increased with higher HIE stage, regardless of the HIE severity in MRI. Adjusting for HIE staging, cooling, and gestation, IPH was observed more in infants who received inotropes (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.20, 9.20). SDH followed by IPH were the most common ICH. Thrombocytopenia and deranged coagulation did not increase risk of hemorrhages in HIE. Our study was not powered to determine the impact of inotrope use on the risk of IPH.

Progress in application of magnetic resonance imaging in diagnosis and radiotherapy for esophageal cancer

At present, although magnetic resonance imaging (MRI) is not a routine examination of esophageal cancer, the preliminary results of some studies have indicated that MRI may become an important alternative for esophageal cancer staging, radiotherapy target delineation, and efficacy assessment. This article mainly discusses the value of MRI in the staging and radiotherapy for esophageal cancer. Key words: Esophageal neoplasms/radiotherapy; Magnetic resonance imaging

Is breast magnetic resonance imaging (MRI) useful for diagnosis of additional sites of disease in patients recently diagnosed with pure ductal carcinoma in situ (DCIS)?

PurposeTo determine if breast MRI is useful for detecting additional or invasive sites of disease in patients initially diagnosed with pure DCIS. Materials and methodsA retrospective review of women diagnosed with pure DCIS who underwent a breast MRI for evaluation of extent of disease was performed at a single institution from January 2013 to April 2015. Data analysis included imaging (mammography, ultrasound and MRI) and pathology characteristics (histology and biomarker status) of the primary DCIS as well as descriptors for the additional sites of disease incidentally found by breast MRI. ResultsA total of 108 patients were diagnosed with pure DCIS during this time period. A breast MRI for staging was recommended for all patients. 76 patients had an MRI performed, ages ranging from 38 to 79 years old (median, 53 years); sizes ranging from 0.3 to 10cm (mean, 2.2cm). A total of 52 patients (68%) either had suspicious new finding(s) (n=27, 36%) or bigger tumor size than originally visualized on mammography (n=43, 57%). A total of twenty-seven patients (36%) had other MRI findings suspicious for additional sites of disease in either breast (four in the ipsilateral breast and twenty-three in the contralateral breast). From this group of patients, twenty-three (85%) patients underwent MRI-guided biopsy as recommended. The four patients who did not have the recommended MRI guided-biopsy either underwent total mastectomies or refused the biopsy. Six out of the twenty-three patients (26%) were diagnosed with an additional site of cancer (5 DCIS and 1 IDC) (7.9%, CI=3.7%, 16.2%). All of the six patients had contralateral disease (100%) and none had a second site of disease in the ipsilateral breast. The size of the additional sites of disease ranged from 0.4 to 8cm (mean, 3.1cm) and the size of the primary lesion in this selected group ranged from 0.1 to 10.9cm (mean, 5.6cm). Ages ranged from 44 to 63 years old (median, 52.5 years). Five out 6 patients (83%) presented with the first site of disease as pure DCIS with estrogen (ER) and progesterone (PR) receptors positive and one case (17%) was pure DCIS ER/PR- negative. The second incidental lesion found on MRI demonstrated 5 cases of contralateral pure DCIS and 1 case of contralateral invasive disease. From this group, we did not have the data for biomarker analysis for the second site of disease in 2 cases and 3 cases showed concordant biomarker status between the first and second sites of disease. The 1 case that presented with an invasive component in the contralateral side of the initially biopsy-proven pure DCIS had discordant biomarkers compared to the first site of disease: the first site of pure DCIS was ER/PR-negative and the second site of invasive ductal carcinoma (IDC) presented with ER/PR-positive status. ConclusionFrom a total of 76 patients with recent diagnosis of pure DCIS who underwent staging breast MRI examination for diagnosis of additional sites of disease, approximately 8% (95% confidence interval=3.7%, 16.2%) was diagnosed with an additional site of cancer and 1.3% (95% confidence interval=0.2%, 7%) of the total cases had invasive disease in the additional sites with different biomarker status; changing their management and prognosis.

The value of delayed phase enhanced imaging in malignant pleural mesothelioma.

Cross-sectional imaging of malignant pleural mesothelioma (MPM) can underestimate the presence of local tumor invasion. Since accurate staging is vital optimal choice of therapy, techniques that optimize pleural imaging are needed. Here we estimate the optimal timing of MPM enhancement on magnetic resonance imaging (MRI). All MPM patients with intravenous (IV) contrast enhanced staging MRI between 2000-2016 at our institution were retrospectively selected for image analysis. Patients with incomplete imaging protocol and maximum pleural tumor thickness <1 cm were excluded. Quantitative measurements of tumor signal intensity were obtained on pre-contrast and post-contrast phases where MRI acquisition parameters were fixed. Using best-fit model curves, predicted maximum time points of enhancement were determined using a simulation of predicted values. Additionally, a qualitative assessment of tumor conspicuity was performed at all IV contrast time delays imaged. A statistical analysis assessed for correlation between qualitative lesion conspicuity and quantitative tumor enhancement. Of the 42 MPM patients who had undergone staging MRI during the study period, 12 patients met the study criteria. Peak tumor enhancement was between 150 and 300 sec following IV contrast administration. Within this time window, 80% of patients are projected to have reached >80%, >85%, and >90% peak tumor enhancement. There was a statistically significant correlation between increasing tumor enhancement and subjective lesion conspicuity. Optimal MPM enhancement on MRI likely occurs at a time delay between 2.5-5 min following IV contrast administration. Further study of delayed phase enhancement of MPM with dynamic contrast enhanced MRI is warranted.