Value Of Dynamic Contrast-enhanced MRI Research Articles

The assessment of pathological response to neoadjuvant chemotherapy in muscle-invasive bladder cancer patients with DCE-MRI and DWI: a systematic review and meta-analysis.

The purpose of this meta-analysis was to determine the value of dynamic contrast-enhanced-MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in evaluating the pathological response of muscle invasive bladder cancer (MIBC) to neoadjuvant chemotherapy (NAC), and further indirectly compare the diagnostic performance of DCE-MRI and DWI. Literatures associated to DCE-MRI and DWI in the evaluation of pathological response of MIBC to NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The quality assessment of diagnostic accuracy studies 2 tool was used to assess the quality of studies. Pooled sensitivity (SE), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curves (AUC) with their 95% confidence intervals (CIs) were calculated to evaluate the diagnostic performance of DCE-MRI and DWI in predicting the pathological response to NAC in patients with MIBC. There were 11 studies involved, 6 of which only underwent DCE- MRI examination, 4 of which only underwent DWI examination, and 1 of which underwent both DCE- MRI and DWI examination. The pooled SE, SP, PLR, NLR, DOR of DCE-MRI were 0.88 (95% CI: 0.78-0.93), 0.88 (95% CI: 0.67-0.96), 7.4 (95% CI: 2.3-24.2), 0.14 (95% CI: 0.07-0.27), and 53 (95% CI: 10-288), respectively. The pooled SE, SP, PLR, NLR, DOR of DWI were 0.83 (95% CI: 0.75-0.88), 0.88 (95% CI: 0.81-0.93), 7.1 (95% CI: 4.3-11.7), 0.20 (95% CI: 0.14-0.28), and 36 (95% CI:18-73), respectively. The AUCs of SROC curve for DCE-MRI and DWI were 0.93 (95% CI: 0.91-0.95) and 0.92 (95% CI: 0.89-0.94), respectively. There were no significant differences between DWI and DCE-MRI for SE, SP, and AUC. This meta-analysis demonstrated high diagnostic performance of both DCE-MRI and DWI in predicting the pathological response to NAC in MIBC. DWI might be a potential substitute for DCE-MRI, with no significant difference in diagnostic performance between the two. However, caution should be taken when applying our results, as our results were based on indirect comparison. No previous studies have comprehensively analysed the value of DCE-MRI and DWI in evaluating the pathological response to NAC in MIBC. According to the current study, both DCE-MRI and DWI yielded high diagnostic performance, with the AUCs of 0.93 and 0.92, respectively. Indirect comparison no significant difference in the diagnostic performanceof DCE-MRI and DWI.

[The value of dynamic contrast-enhanced MRI in the differentiation between benign and malignant lacrimal epithelial tumors].

Objective: To investigate the diagnostic performance of multiparametric dynamic contrast-enhanced MRI(DCE-MRI) for the differentiation between benign and malignant larcrimal gland epithelial tumors. Methods: The clinical and imaging data of 104 patients with epithelial tumors of the lacrimal gland who underwent orbital MRI scan and met the inclusion criteria in Beijing Tongren Hospital from January 2011 to December 2017 were retrospectively collected, including 48 males and 56 females, aged from 12 to 77 (43±7) years. Sixty-three cases of benign epithelial tumors and 41 cases of malignant epithelial tumors were examined by DCE-MRI. The parameters of semiquantitative analysis including: time to peak enhancement (Tpeak), maximum enhancement ratio (ERmax), Slope, washout ratio (WR) and time-signal intensity curve (TIC) types. The parameters of quantitative analysis including: volume transfer constant (Ktrans), the extravascular extracellular volume fraction (Ve) and rate constant (Kep). Receiver operating characteristic (ROC) curve analysis was performed for DCE-MRI parameters with statistically significant differences, the area under the curve (AUC) was calculated, the diagnostic threshold was determined, and the diagnostic performance was evaluated. Logistic regression analysis was used to determine the best parameters for differential diagnosis of benign and malignant epithelial tumors of the lacrimal gland. Results: For the semiquantitative analysis of DCE-MRI, malignant lacrimal gland epithelial tumor had a significantly shorter Tpeak than benign masses [(103.77±57.87) s vs (187.80±77.01) s,P<0.001)], while had a higher value in ERmax, Slope [M(Q1,Q3)] and WR in malignant masses compared with benign one [1.55±0.39 vs 1.36±0.33; 1.76 (0.97,2.27) vs 0.62 (0.50,0.93); 7.70%(1.40%, 21.60%)% vs 0(0, 0),all P<0.05)].The TICs of benign lacrimal tumors mainly showed a persistent type (49/63),while most malignant lacrimal tumors mainly showed a plateau type (25/41). For the quantitative analysis of DCE-MRI, the values of Ktrans and Kep[M(Q1,Q3)] in malignant tumors were significantly greater than those of benign tumors (0.99±0.52/min vs 0.43±0.23/min, P<0.001; 1.33(0.83, 1.55)/min vs 0.55(0.46, 0.68)/min, P<0.001). No significant difference in Ve was found between the groups (0.76±0.20 vs 0.73±0.22,P=0.467). Through the statistical analysis, TIC types (OR=3.887,95%CI: 1.409-10.725) and Ktrans(OR=50.979,95%CI: 6.046-429.830) can provide superior diagnostic performance for predicting malignant lacrimal gland epithelial tumors, with a sensitivity of 78.05%, specificity of 77.78%,and sensitivity of 70.73%, specificity of 95.24%, respevtively. Furthermore, the comprehensive diagnostic performance of Ktrans in AUC was proven to be significantly better than that of TIC [0.875 (0.796-0.932) vs 0.798 (0.708-0.870),P=0.049]. Conclusions: Multiparametric DCE-MRI is helpful for the differential diagnosis of benign and malignant epithelial tumors of lacrimal gland. TIC type and Ktrans have higher diagnostic value, and the diagnostic performance of Ktrans is better than that of TIC.

The Value of Dynamic Contrast-Enhanced MRI in Predicting the Response of Idiopathic Granulomatous Mastitis to Steroid Therapy and Comparison of Clinical and Radiological Outcomes

Background: The aim of this study was to investigate the value of pre-treatment dynamic contrast-enhanced MRI (DCE-MRI) findings in predicting clinical and radiological response to treatment in patients with idiopathic granulomatous mastitis (IGM) receiving steroid therapy and to compare clinical and DCE-MRI results after treatment. Methods: Pre- and post-treatment MRI examinations of 86 patients (with a mean age of 33.8 years; range, 20–57 years) diagnosed with IGM between January 2014 and September 2022 were retrospectively evaluated. Lesion characteristics and longest diameter, number of involved quadrants, retroareolar involvement, and presence of fistula or lymphadenopathy were noted. Patients were categorized into clinical complete response (CCR), clinical non-response (CNR) groups based on clinical response and into radiological complete response (RCR) and radiological non-response (RNR) groups based on radiological response.  Results: The analyses revealed no relationship between the lesion type (abscess, NME, abscess, and NME), presence of lymphadenopathy or fistula, number of involved quadrants, retroareolar involvement, and treatment response on pre-treatment MRI (p&gt;0.05). The longest lesion diameter was smaller in the CCR group than in the CNR group (p = 0.02). After treatment, 40.7% (35/86) of the patients achieved RCR + CCR, while 16.3% (14/86) achieved RNR + CNR. On the other hand, 43% (37/86) of the patients achieved CCR + RNR. Conclusion: CCR is more common in patients with smaller lesions. Other pre-treatment MRI findings were not correlated with radiological or clinical response. A significant proportion of patients with CCR had residual lesions radiologically.

Value of dynamic contrast-enhanced MRI and DWI in diagnosis of prostate cancer and its pathological comparison

Value of dynamic contrast-enhanced MRI and DWI in diagnosis of prostate cancer and its pathological comparison

Predictive value of DCE-MRI and IVIM-DWI in osteosarcoma patients with neoadjuvant chemotherapy.

ObjectiveTo investigate the predictive value of dynamic contrast enhanced MRI (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for clinical outcomes of osteosarcoma patients with neoadjuvant chemotherapy.MethodsThe present prospective single-arm cohort study enrolled 163 patients of osteosarcoma during July 2017 to July 2022. All patients received the same treatment strategy of neoadjuvant chemotherapy. Both DCE-MRI and IVIM-DWI were conducted for the patients before the chemotherapy, as well as after one or two chemotherapy treatment cycles. The imaging parameters of contrast agent transfer rate between blood and tissue (Ktrans ), contrast agent back-flux rate constant (Kep ), extravascular extracellular fractional volume (Ve ), as well as pure diffusion coefficient (D value), pseudo-diffusion coefficient (D* value), apparent diffusion coefficient (ADC) and the perfusion fraction (f value) were recorded. RECIST standard [complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD)] was used as the main clinical outcome.ResultsAfter two treatment cycles, 112 (68.71%) cases were with CR and PR, 31 (19.02%) cases were with SD and 20 cases (12.27%) were with PD. After 1~2 treatment cycles, patients with CR/PR showed significantly markedly lower Ktrans , Kep , Ve values, while higher D, ADC and f values compared with SD or PD patients. Alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were positively correlated with values of Ktrans , Kep , and Ve , while negative correlation was observed between ALP and values of D, ADC and f, as well as between LDH and D and ADC after the whole treatment. D and Kep values after two treatment cycles showed the best predictive value for diagnosis of PD. The values of Ktran , Kep , ADC as well as ALP and LDH were all risk factors for PD after neoadjuvant chemotherapy.ConclusionDCE-MRI and IVIM-DWI have the potential to predict clinical outcomes of osteosarcoma patients with neoadjuvant chemotherapy.

Impact of dynamic contrast-enhanced MRI in 1.5 T versus 3 T MRI for clinically significant prostate cancer detection

PurposeThis study analyzes the value of dynamic contrast-enhanced MRI (DCE) of the prostate on 1.5 T and 3 T examinations in patients within PI-RADS category 4. MethodsIn this retrospective, bi-centric, cohort study all consecutive patients classified as PI-RADS 4 in mpMRI with 100 verified prostate cancers (PCa) in subsequent MRI/US-guided fusion biopsy were included for 1.5 T and 3 T, each. PCa detection in index lesions (IL) upgraded to PI-RADS 4 based on positive DCE findings was compared between 1.5 T and 3 T. Secondary objectives are subgroup analysis of PZ lesions and comparison of ISUP grade group distribution between 1.5 T and 3 T. ResultsIn total, 293 patients within PI-RADS category 4, including 152 (mean 66 ± 8y; median PSA 6.4 ng/ml;116 PZ IL) in the 1.5 T group and 141 (mean 65 ± 8y; median PSA 7.2 ng/ml;100 PZ IL) in the 3 T group were included. Overall amount of PCa (66 % vs 71 %; p = 0.346) and portion of upgraded IL (28 % vs 21 %; p = 0.126) did not differ significantly. At 1.5 T PCa detection was higher in upgraded PZ lesions compared to 3 T (23 % vs 14 %; p = 0.048). The amount of upgraded PZ lesions with ISUP grade group 2–5 PCa was significantly higher at 1.5 T versus 3 T (13.8 % vs 4.0 %; p = 0.007). 33 % (11/33; 1.5 T) and 32 % (10/31; 3 T) of the ISUP grade group 1 PCa of the PZ lesions were detected in upgraded lesions (10% of all PZ index lesions, respectively). ConclusionDCE enabled the detection of a substantial amount of additional clinically significant PCa in prostate mpMRI at 1.5 T. The effect was smaller at 3 T and was accompanied in relation to 1.5 T by higher risk of overdiagnosis due to detection of additional low-risk PCa.

Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility.

The role of dynamic contrast-enhanced-MRI (DCE-MRI) for Prostate Imaging-Reporting and Data System (PI-RADS) scoring is a controversial topic. In this retrospective study, we aimed to measure the added value of DCE-MRI in combination with T2-weighted (T2W) and diffusion-weighted imaging (DWI) using PI-RADS v2.1, in terms of reproducibility and diagnostic accuracy, for detection of prostate cancer (PCa) and clinically significant PCa (CS-PCa, for Gleason Score ≥ 7). 117 lesions in 111 patients were identified as suspicion by multiparametric MRI (mpMRI) and addressed for biopsy. Three experienced readers independently assessed PI-RADS score, first using biparametric MRI (bpMRI, including DWI and T2W), and then multiparametric MRI (also including DCE). The inter-rater and inter-method agreement (bpMRI- vs. mpMRI-based scores) were assessed by Cohen’s kappa (κ). Receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic accuracy for PCa and CS-PCa detection among the two scores. Inter-rater agreement was excellent for the three pairs of readers (κ ≥ 0.83), while the inter-method agreement was good (κ ≥ 0.73). Areas under the ROC curve (AUC) showed similar high-values (0.8 ≤ AUC ≤ 0.85). The reproducibility of PI-RADS v2.1 scoring was comparable and high among readers, without relevant differences, depending on the MRI protocol used. The inclusion of DCE did not influence the diagnostic accuracy.

The value of dynamic contrast-enhanced MRI in the diagnosis and management of triple-negative breast cancer

BackgroundBreast cancer is undoubtedly the world’s most frequent cancer among women. Triple-negative breast cancer (TNBC) is a subtype of breast cancer that does not express estrogen, progesterone, or human epidermal growth factor receptors, yet its imaging is considered a challenge to radiologists having imprecise features.In this study, we aimed at defining the MRI characteristics of triple-negative breast cancer to validate its impact on management.ResultsMost of the TNBCs in this study showed malignant pattern kinetic curves (types II and III), 87/104 (83.7%), and P value 0.673 (not significant), and regarding the type of lesion enhancement, 104/172 cases (60.5%) showed mass enhancement compared to 52/172 (30.2%) non-mass enhancement and 16/172 (9.3%) focus enhancement, P value 0.185 (not significant). As for the internal enhancement pattern of mass lesions, rim internal enhancement was predominant in TNBC mass lesions, 48/104 (46.2%), as well as intratumoral bright signal intensity on T2-weighted images, 108/172 (62.8%), P value 0.001 (highly significant).ConclusionTriple-negative breast cancers (TNBC) are larger, better defined, and more necrotic than conventional cancers. On MRI, necrosis yields high T2-weighted signal intensity.

The value of dynamic contrast-enhanced MRI in differentiating triple-negative breast cancer from other subtypes

BackgroundBreast cancer is a broad spectrum disease, including tumors showing different clinical, pathologic, molecular, and imaging features. Triple-negative breast cancer (TNBC) has an extra aggressive clinical course and poor prognosis being considered a diagnostic challenge to breast radiologists, yet it presented quite a lot of predictors on DCE-MRI; these could be valuable in identifying TNBC from other breast cancer subtypes.In this study, we aimed at assessing the DCE-MRI features of triple-negative breast cancer in comparison to other subtypes of breast cancer.ResultsThere was a significant difference between both groups regarding the internal enhancement pattern of mass lesions (P value 0.001), as well as intratumoral bright signal intensity on T2-weighted images (P value < 0.001). However, most of the breast cancer subtypes in this study showed malignant pattern kinetic curves type II and III showing no significant difference (P value 0.673).ConclusionTNBC presented several features with significant differences from other breast cancer molecular subtypes on DCE-MRI including the shape of the lesion and pattern of enhancement as well as high T2 signal intensity, thus improving the diagnosis of TNBC.

Comparison of clinical value of dynamic contrast-enhanced MRI and SPECT renal dynamic imaging of GFR measurement in the evaluation of renal function in renal transplantation

Objective: To compare the clinical value of dynamic contrast-enhanced MRI (DCE-MRI) and single-photon emission computed tomography (SPECT) renal dynamic imaging in the measurement of glomerular filtration rate (GFR) in the evaluation of renal function in renal transplantation.Methods: A total of 70 recipients who underwent renal transplantation in Baogang Hospital of Inner Mongolia from April of 2015 to April of 2018 were selected as research objects. GFR was measured in renal transplant recipients by use of DCE-MRI and SPECT (GFR-MRI and GFR-SPECT respectively), and was compared with creatinine clearance rate (Ccr). The safety of contrast media was evaluated in DCE-MRI detection.Results: The bias of GFR-MRI against Ccr value was higher than that of GFR-SPECT against Ccr value, with 30% and 50% accuracy of GFR-MRI higher than that of GFR-SPECT, and the difference was statistically significant (p &lt; .05). Pearson correlation analysis showed that GFR-MRI and GFR-SPECT values were positively correlated to Ccr (p &lt; .05), and the correlation coefficient of GFR-MRI and Ccr was higher than that of GFR-SPECT and Ccr, with the difference statistically significant (p &lt; .05). By Bland-Altman analysis, 95% confidence interval of GFR-SPECT was 95.49 ml/(min·1.73 m2), and 95% confidence interval of GFR-MRI was 62.35 ml/(min·1.73m2), which was much narrower. Only 2 cases of patients developed mild rash among 70 cases of patients, and recovered spontaneously without any treatment.Conclusions: Compared with SPECT, the bias of GFR measured by DCE-MRI against Ccr is much greater. However, DCE-MRI has a higher accuracy, correlation and consistency in comparison with Ccr, and it has a narrower confidence interval. DCE-MRI can more accurately evaluate renal function in renal transplantation by measuring GFR, and it has a high safety.

716 - The Value of Dynamic Contrast-Enhanced MRI in the Treatment of Symmetric Uterine Anomalies

716 - The Value of Dynamic Contrast-Enhanced MRI in the Treatment of Symmetric Uterine Anomalies

Dynamic contrast-enhanced magnetic resonance imaging for differentiating osteomyelitis from acute neuropathic arthropathy in the complicated diabetic foot

The main purpose of this study was to investigate the diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) in differentiating osteomyelitis from acute neuropathic arthropathy in the diabetic foot. This prospective study was carried out on 30 diabetic foot patients, with a mean age of 51years. The patients all underwent clinical examinations, laboratory examinations and DCE-MRI. The DCE-MRI parameters (Ktrans, Kep and Ve) of the regions of acute neuropathic arthropathy and osteomyelitis were calculated. Receiver operating characteristic curves (ROCs) were used to identify the DCE-MRI parameters that showed the highest accuracy in differentiating the acute neuropathic arthropathy from the osteomyelitic regions. Pearson correlation coefficients were used to assess the correlations among the DCE-MRI parameters, the level of C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR). The Ktrans, Kep and Ve values of the osteomyelitic regions were higher than those of the acute neuropathic arthropathy regions, and significant differences were found between the two groups (P = 0.000, P = 0.000, P = 0.000). The ROC analysis showed that Ktrans and Ve performed best in differentiating osteomyelitis from acute neuropathic arthropathy, both with an area under the curve of 0.938. The Pearson correlation coefficients showed that the DCE-MRI parameters correlated significantly with the level of CRP and ESR (P = 0.000, P = 0.014, P = 0.000; P = 0.000, P = 0.000, P = 0.013). Our results showed that DCE-MRI may provide reproducible parameters that can reliably differentiate osteomyelitis from acute neuropathic arthropathy.

Differentiating between benign and malignant sinonasal lesions using dynamic contrast-enhanced MRI and intravoxel incoherent motion

PurposeTo explore the value of dynamic contrast-enhanced MRI (DCE-MRI) and intravoxel incoherent motion (IVIM) for distinguishing between benign and malignant sinonasal lesions and investigate the correlations between the two methods. Methods and materialsPatients with sinonasal lesions (42 benign and 31 malignant) who underwent DCE-MRI and IVIM before confirmation by histopathology were enrolled in this prospective study. Parameters derived from DCE-MRI and IVIM were measured, the optimal cut-off values for differential diagnosis were determined, and the correlations between the two methods were evaluated. Statistical analyses were performed using the Wilcoxon rank sum test, receiver operating characteristic (ROC) curve analysis, and Spearman’s rank correlation. ResultsSignificantly higher Ktrans and Kep values but lower D and f values were found in malignant lesions than in benign lesions (all p<0.001). There were no significant differences in the Ve and D* values between the two groups. The area under the curve (AUC) of Ktrans was significantly higher than those of other parameters. There was no significant difference between the AUCs of DCE-MRI and IVIM with parameters combined (p=0.86). Significant inverse but weak correlations were found between D and Ktrans (r=−0.46, p<0.001), f and Ktrans (r=−0.41, p<0.001), D and Kep (r=−0.37, p=0.008), and f and Kep (r=−0.33, p=0.004). ConclusionsDCE-MRI and IVIM can effectively differentiate between benign and malignant sinonasal lesions. IVIM findings correlate with DCE-MRI results and may represent an alternative to DCE-MRI.

Differentiation of pancreatic carcinoma and mass-forming focal pancreatitis: qualitative and quantitative assessment by dynamic contrast-enhanced MRI combined with diffusion-weighted imaging.

Differentiation between pancreatic carcinoma (PC) and mass-forming focal pancreatitis (FP) is invariably difficult. For the differential diagnosis, we qualitatively and quantitatively assessed the value of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in PC and FP in the present study. This study included 32 PC and 18 FP patients with histological confirmation who underwent DCE-MRI and DWI. The time-signal intensity curve (TIC) of PC and FP were classified into 5 types according to the time of reaching the peak, namely, type I, II, III, IV, and V, respectively, and two subtypes, namely, subtype-a (washout type) and subtype-b (plateau type) according to the part of the TIC profile after the peak. Moreover, the mean and relative apparent diffusion coefficient (ADC) value between PC and FP on DWI were compared. The type V TIC was only recognized in PC group (P < 0.01). Type IV b were more frequently observed in PC (P = 0.036), while type- IIa (P < 0.01), type- Ia (P = 0.037) in FP. We also found a significant difference in the mean and relative ADC value between PC and FP. The combined image set of DCE-MRI and DWI yielded an excellent sensitivity, specificity, and diagnostic accuracy (96.9%, 94.4%, and 96.0%). The TIC of DCE-MRI and ADC value of DWI for pancreatic mass were found to provide reliable information in differentiating PC from FP, and the combination of DCE-MRI and DWI can achieve a higher sensitivity, specificity, and diagnostic accuracy.

Value of dynamic contrast-enhanced MRI in predicting response to neoadjuvant chemoradiation in locally advanced rectal cancer

Objective To determine the value of dynamic contrast enhanced (DCE- MRI) in predicting treatment response before preoperative chemoradiotherapy in locally advanced rectal cancer. Methods A cohort of consecutive patients with histologically confirmed rectal adenocarcinoma treated with preoperative chemoradiotherapy followed by total mesorectal excision (TME) surgery was enrolled in a prospective, pilot trial. All enrolled patients were examined using DCE-MRI at two time points: 2 to 5 days before neoadjuvant chemoradiation, 1 to 4 days before surgery. The following perfusion parameters (Ktrans, Kep, Ve) were measured for tumor. The patients were classified into pathological complete response (pCR) and non -pCR group according to the pathological results after operation. Those perfusion parameters were compared between the pCR and the non-pCR group and between before and after CRT in pCR and the non-pCR group with thet test. Receiver-operating curves (ROC) were constructed to further investigate the predictive value of Ktrans, Kep, Ve before neoadjuvant chemoradiation and were used to determine a threshold value at which patents with pCR could be distinguished from patients without complete response. Results The final study population consisted of 38 patients. There were 12 patients with a pCR and 26 patients with non-pCR. Before neoadjuvant chemoradiation, the mean tumor Ktrans, Kep and Ve for pCR group were (1.25±0.56)/min, (2.10±1.61)/min and 0.73±0.34, respectively, for non-pCR group they were (0.46±0.39)/min, (1.15±0.77)/min and 0.32±0.12, respectively. All perfusion parameters showed significant difference between those two groups (t values were 3.45,5.67 and 6.23 respectively, allP 0.05), as well as the changes before and after neoadjuvant chemoradiation in those groups (P>0.05) . ROC analysis for Ktrans pre-treatment revealed that Ktrans had an AUC of 0.837 in predicting pCR. A Ktrans of 0.66/min was emerged as the optimal cut- off for distinguishing pCR from non- pCR and for Ktrans>0.66/min, the sensitivity and specificity for predicting pCR were 75.0% (9/12) and 96.2% (25/26). Kep and Ve showed an AUC of 0.655 and 0.654 in predicting pCR. Conclusions In locally advanced rectal cancer, DCE-MRI can aid in predicting treatment response before preoperative chemoradiotherapy. Ktrans may become a better predictor to classify which patients will benefit from neoadjuvant chemoradiation. Key words: Rectal neoplasms; Magnetic resonance imaging; Comparative study

The clinical value of dynamic contrast-enhanced MRI in differential diagnosis of malignant and benign ovarian lesions.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is widely used in preoperative diagnosis of various tumors. We investigated the clinical value of DCE-MRI in differential diagnosis of malignant and benign ovarian lesions. The study involved 48 subjects with surgical pathology-confirmed ovarian tumors with solid components. Early dynamic phase enhancement performances of the ovarian lesions in patients were assessed, including the enhancement pattern, time-signal intensity curve (TIC), signal intensity rate at the initial 60 s (SI60), time to peak within 200 s (TTP200), and slope ratio. There were significant differences in enhancement patterns between benign and malignant ovarian tumors (P <  .05). A total of 30 malignant tumors (30/31) displayed type I TIC, 8 benign tumors (8/13) showed type III TIC, and significant differences were found in TIC type between malignant and benign ovarian lesions (P < 0.01). Benign ovarian tumors showed lower SI60 (%) and slope ratio, as well as significantly prolonged TTP20, compared to malignant ovarian tumors (all P < 0.01). The microvessel count (MVC) of malignant tumors was significantly higher than that of benign tumors (P < 0.05). Receiver operating characteristic (ROC) curve analyses revealed that DCE-MRI provided an optimal diagnostic performance with threshold values of SI60 at 83.40 %, TTP200 at 77.65 s, and slope ratio at 4.12. These findings revealed that DCE-MRI provides critical information required for differential diagnosis of malignant and benign ovarian lesions.

C233: Value of dynamic contrast-enhanced MRI in differentiation renal tumors

C233: Value of dynamic contrast-enhanced MRI in differentiation renal tumors

Improving Bladder Cancer Imaging Using 3-T Functional Dynamic Contrast-Enhanced Magnetic Resonance Imaging

The objective of this study was to assess the capability of T2-weighted magnetic resonance imaging (T2W-MRI) and the additional diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) using multitransmit 3 T in the localization of bladder cancer. This prospective study was approved by the local institutional review board. Thirty-six patients were included in the study and provided informed consent. Magnetic resonance imaging scans were performed with T2W-MRI and DCE-MRI on a 3-T multitransmit system. Two observers (with 12 and 25 years of experience) independently interpreted T2W-MRI before DCE-MRI data (maps of pharmacokinetic parameters) to localize bladder tumors. The pathological examination of cystectomy bladder specimens was used as a reference criteria standard. The McNemar test was performed to evaluate the differences in sensitivity, specificity, and accuracy. Scores of κ were calculated to assess interobserver agreement. The sensitivity, specificity, and accuracy of the localization with T2W-MRI alone were 81% (29/36), 63% (5/8), and 77% (34/44) for observer 1 and 72% (26/36), 63% (5/8), and 70% (31/44) for observer 2. With additional DCE-MRI available, these values were 92% (33/36), 75% (6/8), and 89% (39/44) for observer 1 and 92% (33/36), 63% (5/8), and 86% (38/44) for observer 2. Dynamic contrast-enhanced MRI significantly (P<0.01) improved the sensitivity and accuracy for observer 2. For the 23 patients treated with chemotherapy, DCE-MRI also significantly (P<0.02) improved the sensitivity and accuracy of bladder cancer localization with T2W-MRI alone for observer 2. Scores of κ were 0.63 for T2W-MRI alone and 0.78 for additional DCE-MRI. Of 7 subcentimeter malignant tumors, 4 (57%) were identified on T2W images and 6 (86%) were identified on DCE maps. Of 11 malignant tumors within the bladder wall thickening, 6 (55%) were found on T2W images and 10 (91%) were found on DCE maps. Compared with conventional T2W-MRI alone, the addition of DCE-MRI improved interobserver agreement as well as the localization of small malignant tumors and those within bladder wall thickening.

The Added Diagnostic Value of Dynamic Contrast-Enhanced MRI at 3.0 T in Nonpalpable Breast Lesions

ObjectiveTo investigate the added diagnostic value of 3.0 Tesla breast MRI over conventional breast imaging in the diagnosis of in situ and invasive breast cancer and to explore the role of routine versus expert reading.Materials and MethodsWe evaluated MRI scans of patients with nonpalpable BI-RADS 3–5 lesions who underwent dynamic contrast-enhanced 3.0 Tesla breast MRI. Initially, MRI scans were read by radiologists in a routine clinical setting. All histologically confirmed index lesions were re-evaluated by two dedicated breast radiologists. Sensitivity and specificity for the three MRI readings were determined, and the diagnostic value of breast MRI in addition to conventional imaging was assessed. Interobserver reliability between the three readings was evaluated.ResultsMRI examinations of 207 patients were analyzed. Seventy-eight of 207 (37.7%) patients had a malignant lesion, of which 33 (42.3%) patients had pure DCIS and 45 (57.7%) invasive breast cancer. Sensitivity of breast MRI was 66.7% during routine, and 89.3% and 94.7% during expert reading. Specificity was 77.5% in the routine setting, and 61.0% and 33.3% during expert reading. In the routine setting, MRI provided additional diagnostic information over clinical information and conventional imaging, as the Area Under the ROC Curve increased from 0.76 to 0.81. Expert MRI reading was associated with a stronger improvement of the AUC to 0.87. Interobserver reliability between the three MRI readings was fair and moderate.Conclusions3.0 T breast MRI of nonpalpable breast lesions is of added diagnostic value for the diagnosis of in situ and invasive breast cancer.

Diagnostic value of dynamic contrast-enhanced MRI in the staging of endometrial cancer

Objective To explore the relationship between the characteristics of dynamic contrast-enhanced MRI (DCE-MRI) and the stages of endometrial cancer. Methods A retrospective analysis of DCE-MRI manifestation in 55 patients with scratch-pathologically confirmed endometrial cancer was performed.All patients were divided into different groups according to differentiation,muscle layer infiltration,cervix involvement and metastasis.The enhanced rate,including the arterial phase relative signal increase ratio (ARSI%),the maximal relative signal increase ratio (MRSI%) and the signal enhancement ratio (SER%),was calculated at different time (i.e.16 s,32 s,48 s,64 s and 300 s),respectively.Time-intensity curves (TIC) of lesions were also obtained and divided into 4 subtypes.Two sample t test was performed to compare the MRSI% among groups,and the Mann-WhitneyUtest was performed in ARSI% and SER% as well. Results The early phase enhanced rate of normal tissue was 894±355,higher than that of tumor 716±215 (t=-2.911,P<0.01).The delayed phase enhanced rate of normal tissue was 1111±289,higher than that of tumor 803±289 (t Key words: Endometrial neoplasms; Magnetic resonance imaging