Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer.

OBJECTIVES: To evaluate whether visual assessment of T2-weighted imaging (T2WI) or an apparent diffusion coefficient (ADC) could predict lymphovascular invasion (LVI) status in cases with clinically node-negative invasive breast cancer. MATERIALS AND METHODS: One hundred and thirty-six patients with 136 lesions underwent MRI. Visual assessment of T2WI, tumour-ADC, peritumoral maximum-ADC and the peritumour-tumour ADC ratio (the ratio between them) were compared with LVI status of surgical specimens. RESULTS: No significant relationship was found between LVI and T2WI. Tumour-ADC was significantly lower in the LVI-positive (n = 77, 896 ± 148 × 10(-6) mm(2)/s) than the LVI-negative group (n = 59, 1002 ± 163 × 10(-6) mm(2)/s; p < 0.0001). Peritumoral maximum-ADC was significantly higher in the LVI-positive (1805 ± 355 × 10(-6) mm(2)/s) than the LVI-negative group (1625 ± 346 × 10(-6) mm(2)/s; p = 0.0003). Peritumour-tumour ADC ratio was significantly higher in the LVI-positive (2.05 ± 0.46) than the LVI-negative group (1.65 ± 0.40; p < 0.0001). Receiver operating characteristic curve analysis revealed that the area under the curve (AUC) of the peritumour-tumour ADC ratio was the highest (0.81). The most effective threshold for the peritumour-tumour ADC ratio was 1.84, and the sensitivity, specificity, positive predictive value and negative predictive value were 77% (59/77), 76% (45/59), 81% (59/73) and 71% (45/63), respectively. CONCLUSIONS: We suggest that the peritumour-tumour ADC ratio can assist in predicting LVI status on preoperative imaging. KEY POINTS: • Tumour ADC was significantly lower in LVI-positive than LVI-negative breast cancer. • Peritumoral maximum-ADC was significantly higher in LVI-positive than LVI-negative breast cancer. • Peritumour-tumour ADC ratio was significantly higher in LVI-positive breast cancer. • Diagnostic performance of the peritumour-tumour ADC ratio was highest for positive LVI. • Peritumour-tumour ADC ratio showed higher diagnostic ability in postmenopausal than premenopausal patients.

Luminal-type breast cancer: correlation of apparent diffusion coefficients with the Ki-67 labeling index.

PURPOSE: To evaluate the correlation between apparent diffusion coefficient ( ADC apparent diffusion coefficient ) values and the Ki-67 labeling index for luminal-type (estrogen receptor-positive) breast cancer not otherwise specified ( NOS not otherwise specified ) diagnosed by means of biopsy. MATERIALS AND METHODS: The institutional review board approved this retrospective study, and the requirement for informed consent was waived. Between December 2009 and December 2012, 86 patients with 86 lesions with luminal-type invasive breast cancer NOS not otherwise specified underwent magnetic resonance imaging, including dynamic contrast material-enhanced imaging and diffusion-weighted imaging with b values of 0 and 1000 sec/mm(2). Conventional measurement of the minimum and mean ADC apparent diffusion coefficient s by placing regions of interest and histogram analysis of pixel-based ADC apparent diffusion coefficient data of the entire tumor were performed by two observers independently and correlated with the Ki-67 labeling index of surgical specimens. RESULTS: For the interobserver reliability, interclass correlation coefficients for all parameters with the exception of the minimum ADC apparent diffusion coefficient exceeded 0.8, indicating almost perfect agreement. The minimum ADC apparent diffusion coefficient and mean ADC apparent diffusion coefficient and the 25th, 50th, and 75th percentiles of the histograms showed negative correlations with the Ki-67 labeling index (r = -0.49, -0.55, -0.54, -0.53, and -0.48, respectively). Receiver operating characteristic curve analysis for the differential diagnosis between the high-proliferation (Ki-67 ≥ 14; n = 44) and low-proliferation (Ki-67 < 14; n = 42) groups revealed that the most effective threshold for the mean ADC apparent diffusion coefficient was lower than 1097 × 10(-6) mm(2)/sec, with sensitivity and specificity of 82% and 71%, respectively. The area under the receiver operating characteristic curve (AUC) was 0.81 for the mean ADC apparent diffusion coefficient . There were no significant differences in the AUC among the parameters. CONCLUSION: Considering convenience for routine practice, the authors suggest that the mean ADC apparent diffusion coefficient of the conventional method would be practical to use for estimating the Ki-67 labeling index.

Detection of invasive components in cases of breast ductal carcinoma in situ on biopsy by using apparent diffusion coefficient MR parameters.

OBJECTIVES: To evaluate whether apparent diffusion coefficient (ADC) parameters could identify invasive components in cases with ductal carcinoma in situ (DCIS) diagnosed by biopsy. METHODS: This retrospective study was approved by the institutional review board and the requirement to obtain informed consent was waived. Sixty-nine consecutive women with 70 lesions diagnosed with DCIS by biopsy underwent breast magnetic resonance (MR) imaging. Multiple regions of interest were placed (as many as possible) within the lesion on ADC maps. The minimum ADC values and the ADC difference values obtained as the difference between minimum and maximum ADCs were evaluated. RESULTS: Surgical specimens revealed 51 lesions with pure DCIS and the remaining 19 lesions with DCIS with invasive components (DCIS-IC). The minimum ADC value for DCIS-IC (0.99 ± 0.04 × 10(-3) mm(2)/s) was significantly lower than that of pure DCIS (1.15 ± 0.03 × 10(-3) mm(2)/s) (P  =  0.0037). The ADC difference value for DCIS-IC (0.38 ± 0.05 × 10(-3) mm(2)/s) was significantly higher than that of pure DCIS (0.17 ± 0.03 × 10(-3) mm(2)/s). ROC curve analysis for differentiating DCIS-IC from pure DCIS revealed that the area under the curve was 0.71 for minimum ADC value and 0.77 for ADC difference value. CONCLUSIONS: The minimum ADC values and ADC difference values could suggest the presence of invasive components. KEY POINTS: • Identification of invasive components in DCIS before treatment is clinically important. • Diffusion-weighted MR imaging can help lesion assessment in breast cancer. • The minimum ADC value may suggest the presence of an invasive component in DCIS. • The ADC difference value also suggests the presence of an invasive component in DCIS. • Preoperative evaluation of diffusion-weighted MR imaging may help surgical planning for DCIS.

Endovascular aneurysmal models at the external iliac artery of dogs.

INTRODUCTION: Establishing an aneurysm model using simple and easy operative techniques is desirable to develop new endovascular treatment devices such as stent grafts. We developed an aneurysm model using the external iliac arteries (EIAs) of adult Beagles, a relatively large animal that we thought would be easy to handle, using simple and less complicated endovascular procedures. In addition, we evaluated the generated aneurysm model histologically and determined the factors that were necessary for creating more dilated aneurysms. METHODS: Experimental animals consisted of 16 beagles (average weight, 14.0 kg). The animals were divided into four groups (S, E, B+S, and B+E). Eight Beagles were in the S and E groups, without balloon dilation. S group Beagles were injected with normal saline into the right EIA and served as a control group. Elastase was injected into the left EIA of the same Beagles (E group). Eight Beagles were in the B+S and B+E groups with balloon dilation. After balloon dilation, normal saline was injected into right EIA of the B+S group. Elastase was injected into the left EIA of the same Beagles (B+E). After 4 weeks, we measured the EIA diameter using abdominal ultrasound imaging from a body surface. Both sides of the EIA were harvested. We evaluated the dilation rate of the EIA diameter, and histologically, evaluated the disappearance of the internal elastic lamina, degeneration and disappearance of medial smooth muscle and the external elastic lamina, and neointimal thickening. RESULTS: Inner diameters were dilated more in the B+E group vs the other groups. The B+E group internal elastic lamina had almost disappeared, with significantly more severe degeneration and disappearance of external elastic lamina. CONCLUSIONS: We developed a muscular artery aneurysm model using the EIA arteries of adult Beagles and a simple endovascular procedure. Histologically, internal and external elastic lamina degeneration was an important factor to create significantly dilated aneurysms in this muscular artery model.

Properties of N-butyl cyanoacrylate-iodized oil mixtures for arterial embolization: in vitro and in vivo experiments.

PURPOSE: To examine the properties of N-butyl cyanoacrylate (NBCA) and iodized oil (lipiodol [Lip]) in vitro and in vivo for safe and effective embolization. MATERIALS AND METHODS: Viscosity, polymerization time, and diffusing capacity were evaluated according to the NBCA/Lip ratio in vitro. Additionally, the effect of the NBCA/Lip ratio on arterial embolization was evaluated in vivo; various ratios of NBCA/Lip were injected into the renal arteries of adult beagles, after which the embolization effect following transcatheter arterial embolization was quantitatively investigated histopathologically and using computed tomography (CT) volumetry. RESULTS: The viscosity of NBCA/Lip increased, polymerization time was prolonged, and diffusing capacity increased as the NBCA density decreased. As the NBCA density decreased, embolic material was recognized in smaller diameter arteries, and embolization of a larger vascular bed was accomplished. The NBCA/Lip mixture with a low density of NBCA was located more peripherally from the catheter tip, and embolization of more peripheral and smaller diameter arteries was achieved. CONCLUSIONS: The relationships of properties of NBCA/Lip in vitro and embolization effects in vivo of various ratios of NBCA/Lip were quantitatively examined and compared. The results of this study are useful for safe and effective embolization.

Effective apparent diffusion coefficient parameters for differentiation between mass-forming autoimmune pancreatitis and pancreatic ductal adenocarcinoma.

PURPOSE: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) parameters by region of interest (ROI) methods in differentiating mass-forming autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC). METHODS: The institutional review board approved this retrospective study and the requirement for informed consent was waived. Twenty-three patients with mass-forming AIP and 144 patients with PDAC underwent diffusion-weighted imaging with b-values of 0 s/mm2 and 800 s/mm2. The minimum, maximum, and mean ADC values obtained by placing ROIs within lesions and percentile ADC values (10th, 25th, 50th, 75th, and 90th) from entire-lesion histogram analysis were compared between the two groups by using Mann-Whitney U tests. The diagnostic performance was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: The minimum, maximum, and mean ADC values were significantly different between mass-forming AIP and PDAC groups. ROC curve analysis showed that the maximum ADC had the highest diagnostic performance (0.92), while the minimum ADC value had the lowest diagnostic performance (0.72). The AUC of minimum ADC was significantly lower than that of maximum or mean ADC (P < 0.0001, P < 0.0001). The AUC was lowest in 10th percentile ADC value and highest in 90th percentile value. The AUC increased along with the increase of percentile values. CONCLUSION: Either the maximum or mean ADC value was effective in differentiating mass-forming AIP from the PDAC group, while the minimum ADC value might not be recommended.

Ultrafast Dynamic Contrast-Enhanced Breast MRI: Kinetic Curve Assessment Using Empirical Mathematical Model Validated with Histological Microvessel Density.

RATIONALE AND OBJECTIVES: To evaluate whether parameters from empirical mathematical model (EMM) for ultrafast dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) correlate with histological microvessel density (MVD) in invasive breast cancer. MATERIALS AND METHODS: Ninety-eight consecutive patients with invasive breast cancer underwent an institutional review board-approved ultrafast DCE-MRI including a pre- and 18 postcontrast whole breast ultrafast scans (3 seconds) followed by four standard scans (60 seconds) using a 3T system. Region of interest was placed within each lesion where the highest signal increase was observed on ultrafast DCE-MRI, and the increase rate of enhancement was calculated as follows: ΔS = (SIpost - SIpre)/SIpre. The kinetic curve obtained from ultrafast DCE-MRI was analyzed using a truncated EMM: ΔS(t) = A(1 - e-αt), where A is the upper limit of the signal intensity, α (min-1) is the rate of signal increase. The initial slope of the kinetic curve is given by Aα. Initial area under curve (AUC30) and time of initial enhancement was calculated. From the standard DCE-MRI, the initial enhancement rate (IER) and the signal enhancement ratio (SER) were calculated as follows: IER = (SIearly - SIpre)/SIpre, SER = (SIearly - SIpre)/(SIdelayed - SIpre). The parameters were compared to MVD obtained from surgical specimens. RESULTS: A, α, Aα, AUC30, and time of initial enhancement significantly correlated with MVD (r = 0.29, 0.40, 0.51, 0.43, and -0.32 with p = 0.0027, p < 0.0001, p < 0.0001, p < 0.0001, and p = 0.0012, respectively), whereas IER and SER from standard DCE-MRI did not. CONCLUSION: The parameters of the EMM, especially the initial slope or Aα, for ultrafast DCE-MRI correlated with MVD in invasive breast cancer.

Quantitative Analysis of Contrast-Enhanced Ultrasound Imaging in Invasive Breast Cancer: A Novel Technique to Obtain Histopathologic Information of Microvessel Density.

We examined whether enhancement area ratios obtained by the new bubble detection method correlate with histologic microvessel density in invasive breast cancer. Forty consecutive patients with invasive breast cancer lesions underwent contrast-enhanced ultrasound. The ratio of enhanced area to manually segmented tumor area (enhancement area ratio) was obtained with the new method at peak and delayed phases (50-54, 55-59, 60-64 and 65-69 s). We also analyzed time-intensity curves to obtain peak intensity and area under curve. Enhancement area ratios in both peak and delayed phases (50-54, 55-59, 60-64 and 65-69 s) were significantly correlated with microvessel density (r = 0.57, 0.62, 0.68, 0.61 and 0.58; p = 0.0001, <0.0001, <.0001, <.0001 and 0.0001, respectively). In time-intensity curve analysis, peak intensity was significantly correlated (r = 0.43, p = 0.0073), whereas area under the curve was not (r = 0.29, p = 0.0769). Enhancement area ratios obtained by the new method were correlated with microvessel density in invasive breast cancer.

Evaluation of self-expandable, FK506-coated, covered stents in canine animal model.

This study aimed to evaluate whether drug coating of the recently developed covered SENDAI stents--self-expandable stents covered with segmented polyurethane (SPU) films--reduces neointimal thickening in animal model. FK506, which is one of the most effective immunosuppressants, was used. Bare stents; non-coated, covered stents; and FK506-coated, covered stents were placed bilaterally in the external iliac arteries of beagle dogs. After 1-month observation period, angiography did not show significant stent-induced stenosis. Histological evaluation revealed a completely endothelialized intravascular lumen and the absence of thrombus formation. The area of the intimal thickening induced by the FK506-coated stents was significantly smaller than that induced by the non-coated stents, whereas it was larger in the case of both the covered stents than that in the case of the bare stent. In conclusion, FK506 treatment of the self-expandable, covered stents was confirmed to effectively inhibit intimal thickening, although the SPU film used for covering functioned as a drug carrier in addition to a scaffold for intimal formation.