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3.
BMC Musculoskelet Disord ; 24(1): 41, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36650496

RESUMO

BACKGROUND: To study deep learning segmentation of knee anatomy with 13 anatomical classes by using a magnetic resonance (MR) protocol of four three-dimensional (3D) pulse sequences, and evaluate possible clinical usefulness. METHODS: The sample selection involved 40 healthy right knee volumes from adult participants. Further, a recently injured single left knee with previous known ACL reconstruction was included as a test subject. The MR protocol consisted of the following 3D pulse sequences: T1 TSE, PD TSE, PD FS TSE, and Angio GE. The DenseVNet neural network was considered for these experiments. Five input combinations of sequences (i) T1, (ii) T1 and FS, (iii) PD and FS, (iv) T1, PD, and FS and (v) T1, PD, FS and Angio were trained using the deep learning algorithm. The Dice similarity coefficient (DSC), Jaccard index and Hausdorff were used to compare the performance of the networks. RESULTS: Combining all sequences collectively performed significantly better than other alternatives. The following DSCs (±standard deviation) were obtained for the test dataset: Bone medulla 0.997 (±0.002), PCL 0.973 (±0.015), ACL 0.964 (±0.022), muscle 0.998 (±0.001), cartilage 0.966 (±0.018), bone cortex 0.980 (±0.010), arteries 0.943 (±0.038), collateral ligaments 0.919 (± 0.069), tendons 0.982 (±0.005), meniscus 0.955 (±0.032), adipose tissue 0.998 (±0.001), veins 0.980 (±0.010) and nerves 0.921 (±0.071). The deep learning network correctly identified the anterior cruciate ligament (ACL) tear of the left knee, thus indicating a future aid to orthopaedics. CONCLUSIONS: The convolutional neural network proves highly capable of correctly labeling all anatomical structures of the knee joint when applied to 3D MR sequences. We have demonstrated that this deep learning model is capable of automatized segmentation that may give 3D models and discover pathology. Both useful for a preoperative evaluation.


Assuntos
Lesões do Ligamento Cruzado Anterior , Imageamento Tridimensional , Articulação do Joelho , Joelho , Adulto , Humanos , Joelho/anatomia & histologia , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Redes Neurais de Computação
5.
Phys Imaging Radiat Oncol ; 25: 100417, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36718357

RESUMO

Background and purpose: Measuring rectal tumour response to radiation is pivotal to restaging patients and for possibly stratification to a watch-and-wait strategy. Recognizing the importance of the tumour microenvironment, we investigated a less explored quantitative imaging marker assessing tumour blood flow (BF) for its potential to predict overall survival (OS). Materials and methods: 24 rectal cancer patients given curative-intent neoadjuvant radiotherapy underwent a multi-echo dynamic magnetic resonance imaging (MRI) sequence with gadolinium contrast for quantification of tumour BF before either 25x2 Gy (n = 18) with concomitant chemotherapy or 5x5 Gy (n = 6). CD34 staining of excised tumour tissue was performed and baseline blood samples were analysed for lactate dehydrogenase (LDH) and angiopoietin-2 (ANGPT-2). Tumour volumes were measured before and after treatment. After subsequent surgery, ypTN scoring assessed tumour response. Cox regression for 5-year OS analysis and t-test for group comparisons were performed. Results: The change in tumour BF (ΔBF) during neoadjuvant radiotherapy was a significant marker of OS, whereas tumour stage and volume were not related to OS. All patients with >20 % decline in BF were long-term survivors. Separating cases in two groups based on ΔBF revealed that patients with increase or a low decrease had higher baseline LDH (p = 0.032) and ANGPT-2 (p = 0.028) levels. Conclusion: MRI-assessed tumour ΔBF during neoadjuvant treatment is a significant predictor of OS in rectal cancer patients, making ΔBF a potential quantitative imaging biomarker for treatment stratification. Blood LDH and ANGPT-2 indicate that non-responding tumours may have a hypoxic microenvironment resistant to radiotherapy.

7.
Front Neuroinform ; 16: 1056068, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36743439

RESUMO

Introduction: Management of patients with brain metastases is often based on manual lesion detection and segmentation by an expert reader. This is a time- and labor-intensive process, and to that end, this work proposes an end-to-end deep learning segmentation network for a varying number of available MRI available sequences. Methods: We adapt and evaluate a 2.5D and a 3D convolution neural network trained and tested on a retrospective multinational study from two independent centers, in addition, nnU-Net was adapted as a comparative benchmark. Segmentation and detection performance was evaluated by: (1) the dice similarity coefficient, (2) a per-metastases and the average detection sensitivity, and (3) the number of false positives. Results: The 2.5D and 3D models achieved similar results, albeit the 2.5D model had better detection rate, whereas the 3D model had fewer false positive predictions, and nnU-Net had fewest false positives, but with the lowest detection rate. On MRI data from center 1, the 2.5D, 3D, and nnU-Net detected 79%, 71%, and 65% of all metastases; had an average per patient sensitivity of 0.88, 0.84, and 0.76; and had on average 6.2, 3.2, and 1.7 false positive predictions per patient, respectively. For center 2, the 2.5D, 3D, and nnU-Net detected 88%, 86%, and 78% of all metastases; had an average per patient sensitivity of 0.92, 0.91, and 0.85; and had on average 1.0, 0.4, and 0.1 false positive predictions per patient, respectively. Discussion/Conclusion: Our results show that deep learning can yield highly accurate segmentations of brain metastases with few false positives in multinational data, but the accuracy degrades for metastases with an area smaller than 0.4 cm2.

8.
Med Phys ; 48(10): 6020-6035, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34405896

RESUMO

PURPOSE: Magnetic resonance (MR) imaging is an essential diagnostic tool in clinical medicine. Recently, a variety of deep-learning methods have been applied to segmentation tasks in medical images, with promising results for computer-aided diagnosis. For MR images, effectively integrating different pulse sequences is important to optimize performance. However, the best way to integrate different pulse sequences remains unclear. In addition, networks trained with a certain subset of pulse sequences as input are unable to perform when given a subset of those pulse sequences. In this study, we evaluate multiple architectural features and characterize their effects in the task of metastasis segmentation while creating a method to robustly train a network to be able to work given any strict subset of the pulse sequences available during training. METHODS: We use a 2.5D DeepLabv3 segmentation network to segment metastases lesions on brain MR's with four pulse sequence inputs. To study how we can best integrate MR pulse sequences for this task, we consider (1) different pulse sequence integration schemas, combining our features at early, middle, and late points within a deep network, (2) different modes of weight sharing for parallel network branches, and (3) a novel integration level dropout layer, which will allow the networks to be robust to performing inference on input with only a subset of pulse sequences available at the training. RESULTS: We find that levels of integration and modes of weight sharing that favor low variance work best in our regime of small amounts of training data (n = 100). By adding an input-level dropout layer, we could preserve the overall performance of these networks while allowing for inference on inputs with missing pulse sequences. We illustrate not only the generalizability of the network but also the utility of this robustness when applying the trained model to data from a different center, which does not use the same pulse sequences. Finally, we apply network visualization methods to better understand which input features are most important for network performance. CONCLUSIONS: Together, these results provide a framework for building networks with enhanced robustness to missing data while maintaining comparable performance in medical imaging applications.


Assuntos
Neoplasias Encefálicas , Aprendizado Profundo , Neoplasias Encefálicas/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Redes Neurais de Computação
9.
NPJ Digit Med ; 4(1): 33, 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33619361

RESUMO

The purpose of this study was to assess the clinical value of a deep learning (DL) model for automatic detection and segmentation of brain metastases, in which a neural network is trained on four distinct MRI sequences using an input-level dropout layer, thus simulating the scenario of missing MRI sequences by training on the full set and all possible subsets of the input data. This retrospective, multicenter study, evaluated 165 patients with brain metastases. The proposed input-level dropout (ILD) model was trained on multisequence MRI from 100 patients and validated/tested on 10/55 patients, in which the test set was missing one of the four MRI sequences used for training. The segmentation results were compared with the performance of a state-of-the-art DeepLab V3 model. The MR sequences in the training set included pre-gadolinium and post-gadolinium (Gd) T1-weighted 3D fast spin echo, post-Gd T1-weighted inversion recovery (IR) prepped fast spoiled gradient echo, and 3D fluid attenuated inversion recovery (FLAIR), whereas the test set did not include the IR prepped image-series. The ground truth segmentations were established by experienced neuroradiologists. The results were evaluated using precision, recall, Intersection over union (IoU)-score and Dice score, and receiver operating characteristics (ROC) curve statistics, while the Wilcoxon rank sum test was used to compare the performance of the two neural networks. The area under the ROC curve (AUC), averaged across all test cases, was 0.989 ± 0.029 for the ILD-model and 0.989 ± 0.023 for the DeepLab V3 model (p = 0.62). The ILD-model showed a significantly higher Dice score (0.795 ± 0.104 vs. 0.774 ± 0.104, p = 0.017), and IoU-score (0.561 ± 0.225 vs. 0.492 ± 0.186, p < 0.001) compared to the DeepLab V3 model, and a significantly lower average false positive rate of 3.6/patient vs. 7.0/patient (p < 0.001) using a 10 mm3 lesion-size limit. The ILD-model, trained on all possible combinations of four MRI sequences, may facilitate accurate detection and segmentation of brain metastases on a multicenter basis, even when the test cohort is missing input MRI sequences.

10.
Phys Med Biol ; 65(22): 225020, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33200748

RESUMO

Dynamic susceptibility contrast (DSC) imaging is a widely used technique for assessment of cerebral blood volume (CBV). With combined gradient-echo and spin-echo DSC techniques, measures of the underlying vessel size and vessel architecture can be obtained from the vessel size index (VSI) and vortex area, respectively. However, how noise, and specifically the contrast-to-noise ratio (CNR), affect the estimations of these parameters has largely been overlooked. In order to address this issue, we have performed simulations to generate DSC signals with varying levels of CNR, defined by the peak of relaxation rate curve divided by the standard deviation of the baseline. Moreover, DSC data from 59 brain cancer patients were acquired at two different 3 T-scanners (N = 29 and N = 30, respectively), where CNR and relative parameter maps were obtained. Our simulations showed that the measured parameters were affected by CNR in different ways, where low CNR led to overestimations of CBV and underestimations of VSI and vortex area. In addition, a higher noise-sensitivity was found in vortex area than in CBV and VSI. Results from clinical data were consistent with simulations, and indicated that CNR < 4 gives highly unreliable measurements. Moreover, we have shown that the distribution of values in the tumour regions could change considerably when voxels with CNR below a given cut off are excluded when generating the relative parameter maps. The widespread use of CBV and attractive potential of VSI and vortex area, makes the noise-sensitivity of these parameters found in our study relevant for further use and development of the DSC imaging technique. Our results suggest that the CNR has considerable impact on the measured parameters, with the potential to affect the clinical interpretation of DSC-MRI, and should therefore be taken into account in the clinical decision-making process.


Assuntos
Vasos Sanguíneos/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Razão Sinal-Ruído , Adulto , Neoplasias Encefálicas/irrigação sanguínea , Neoplasias Encefálicas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Radiology ; 297(2): 352-360, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32870132

RESUMO

Background MRI is the standard tool for rectal cancer staging. However, more precise diagnostic tests that can assess biologic tumor features decisive for treatment outcome are necessary. Tumor perfusion and hypoxia are two important features; however, no reference methods that measure these exist in clinical use. Purpose To assess the potential predictive and prognostic value of MRI-assessed rectal cancer perfusion, as a surrogate measure of hypoxia, for local treatment response and survival. Materials and Methods In this prospective observational cohort study, 94 study participants were enrolled from October 2013 to December 2017 (ClinicalTrials.gov: NCT01816607). Participants had histologically confirmed rectal cancer and underwent routine diagnostic MRI, an extended diffusion-weighted sequence, and a multiecho dynamic contrast agent-based sequence. Predictive and prognostic values of dynamic contrast-enhanced, dynamic susceptibility contrast (DSC), and intravoxel incoherent motion MRI were investigated with response to neoadjuvant treatment, progression-free survival, and overall survival as end points. Secondary objectives investigated potential sex differences in MRI parameters and relationship with lymph node stage. Statistical methods used were Cox regression, Student t test, and Mann-Whitney U test. Results A total of 94 study participants (mean age, 64 years ± 11 [standard deviation]; 61 men) were evaluated. Baseline tumor blood flow from DSC MRI was lower in patients who had poor local tumor response to neoadjuvant treatment (96 mL/min/100 g ± 33 for ypT2-4, 120 mL/min/100 g ± 21 for ypT0-1; P = .01), shorter progression-free survival (hazard ratio = 0.97; 95% confidence interval: 0.96, 0.98; P < .001), and shorter overall survival (hazard ratio = 0.98; 95% confidence interval: 0.98, 0.99; P < .001). Women had higher blood flow (125 mL/min/100 g ± 27) than men (74 mL/min/100 g ± 26, P < .001) at stage 4. Volume transfer constant and plasma volume from dynamic contrast-enhanced MRI as well as ΔR2* peak and area under the curve for 30 and 60 seconds from DSC MRI were associated with local malignant lymph nodes (pN status). Median area under the curve for 30 seconds was 0.09 arbitrary units (au) ± 0.03 for pN1-2 and 0.19 au ± 0.12 for pN0 (P = .001). Conclusion Low tumor blood flow from dynamic susceptibility contrast MRI was associated with poor treatment response in study participants with rectal cancer. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Quimiorradioterapia , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Idoso , Velocidade do Fluxo Sanguíneo , Meios de Contraste , Progressão da Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neovascularização Patológica , Prognóstico , Estudos Prospectivos , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Fatores Sexuais , Taxa de Sobrevida
12.
Neurooncol Adv ; 2(1): vdaa028, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32642687

RESUMO

BACKGROUND: MRI may provide insights into longitudinal responses in the diffusivity and vascular function of the irradiated normal-appearing brain following stereotactic radiosurgery (SRS) of brain metastases. METHODS: Forty patients with brain metastases from non-small cell lung cancer (N = 26) and malignant melanoma (N = 14) received SRS (15-25 Gy). Longitudinal MRI was performed pre-SRS and at 3, 6, 9, 12, and 18 months post-SRS. Measures of tissue diffusivity and vascularity were assessed by diffusion-weighted and perfusion MRI, respectively. All maps were normalized to white matter receiving less than 1 Gy. Longitudinal responses were assessed in normal-appearing brain, excluding tumor and edema, in the LowDose (1-10 Gy) and HighDose (>10 Gy) regions. The Eastern Cooperative Oncology Group (ECOG) performance status was recorded pre-SRS. RESULTS: Following SRS, the diffusivity in the LowDose region increased continuously for 1 year (105.1% ± 6.2%; P < .001), before reversing toward pre-SRS levels at 18 months. Transient reductions in microvascular cerebral blood volume (P < .05), blood flow (P < .05), and vessel densities (P < .05) were observed in LowDose at 6-9 months post-SRS. Correspondingly, vessel calibers in LowDose transiently increased at 3-9 months (P < .01). The responses in HighDose displayed similar trends as in LowDose, but with larger interpatient variations. Vascular responses followed pre-SRS ECOG status. CONCLUSIONS: Our results imply that even low doses of radiation to normal-appearing brain following cerebral SRS induce increased diffusivity and reduced vascular function for up until 18 months. In particular, the vascular responses indicate the reduced ability of the normal-appearing brain tissue to form new capillaries. Assessing the potential long-term neurologic effects of SRS on the normal-appearing brain is warranted.

13.
J Magn Reson Imaging ; 51(1): 175-182, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31050074

RESUMO

BACKGROUND: Detecting and segmenting brain metastases is a tedious and time-consuming task for many radiologists, particularly with the growing use of multisequence 3D imaging. PURPOSE: To demonstrate automated detection and segmentation of brain metastases on multisequence MRI using a deep-learning approach based on a fully convolution neural network (CNN). STUDY TYPE: Retrospective. POPULATION: In all, 156 patients with brain metastases from several primary cancers were included. FIELD STRENGTH: 1.5T and 3T. [Correction added on May 24, 2019, after first online publication: In the preceding sentence, the first field strength listed was corrected.] SEQUENCE: Pretherapy MR images included pre- and postgadolinium T1 -weighted 3D fast spin echo (CUBE), postgadolinium T1 -weighted 3D axial IR-prepped FSPGR (BRAVO), and 3D CUBE fluid attenuated inversion recovery (FLAIR). ASSESSMENT: The ground truth was established by manual delineation by two experienced neuroradiologists. CNN training/development was performed using 100 and 5 patients, respectively, with a 2.5D network based on a GoogLeNet architecture. The results were evaluated in 51 patients, equally separated into those with few (1-3), multiple (4-10), and many (>10) lesions. STATISTICAL TESTS: Network performance was evaluated using precision, recall, Dice/F1 score, and receiver operating characteristic (ROC) curve statistics. For an optimal probability threshold, detection and segmentation performance was assessed on a per-metastasis basis. The Wilcoxon rank sum test was used to test the differences between patient subgroups. RESULTS: The area under the ROC curve (AUC), averaged across all patients, was 0.98 ± 0.04. The AUC in the subgroups was 0.99 ± 0.01, 0.97 ± 0.05, and 0.97 ± 0.03 for patients having 1-3, 4-10, and >10 metastases, respectively. Using an average optimal probability threshold determined by the development set, precision, recall, and Dice score were 0.79 ± 0.20, 0.53 ± 0.22, and 0.79 ± 0.12, respectively. At the same probability threshold, the network showed an average false-positive rate of 8.3/patient (no lesion-size limit) and 3.4/patient (10 mm3 lesion size limit). DATA CONCLUSION: A deep-learning approach using multisequence MRI can automatically detect and segment brain metastases with high accuracy. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:175-182.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Aprendizado Profundo , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
J Magn Reson Imaging ; 50(4): 1114-1124, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30945379

RESUMO

BACKGROUND: Dynamic contrast-based MRI and intravoxel incoherent motion imaging (IVIM) MRI are both methods showing promise as diagnostic and prognostic tools in rectal cancer. Both methods aim at measuring perfusion-related parameters, but the relationship between them is unclear. PURPOSE: To investigate the relationship between perfusion- and permeability-related parameters obtained by IVIM-MRI, T1 -weighted dynamic contrast-enhanced (DCE)-MRI and T2 *-weighted dynamic susceptibility contrast (DSC)-MRI. STUDY TYPE: Prospective. SUBJECTS: In all, 94 patients with histologically confirmed rectal cancer. FIELD STRENGTH/SEQUENCE: Subjects underwent pretreatment 1.5T clinical procedure MRI, and in addition a study-specific diffusion-weighted sequence (b = 0, 25, 50, 100, 500, 1000, 1300 s/mm2 ) and a multiecho dynamic contrast-based echo-planer imaging sequence. ASSESSMENT: Median tumor values were obtained from IVIM (perfusion fraction [f], pseudodiffusion [D*], diffusion [D]), from the extended Tofts model applied to DCE data (Ktrans , kep , vp , ve ) and from model free deconvolution of DSC (blood flow [BF] and area under curve). A subgroup of the excised tumors underwent immunohistochemistry with quantification of microvessel density and vessel size. STATISTICAL TEST: Spearman's rank correlation test. RESULTS: D* was correlated with BF (rs = 0.47, P < 0.001), and f was negatively correlated with kep (rs = -0.31, P = 0.002). BF was correlated with Ktrans (rs = 0.29, P = 0.004), but this correlation varied extensively when separating tumors into groups of low (rs = 0.62, P < 0.001) and high (rs = -0.06, P = 0.68) BF. Ktrans was negatively correlated with vessel size (rs = -0.82, P = 0.004) in the subgroup of tumors with high BF. DATA CONCLUSION: We found an association between D* from IVIM and BF estimated from DSC-MRI. The relationship between IVIM and DCE-MRI was less clear. Comparing parameters from DSC-MRI and DCE-MRI highlights the importance of the underlying biology for the interpretation of these parameters. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1114-1124.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias Retais/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Estudos Prospectivos , Reto/diagnóstico por imagem , Reprodutibilidade dos Testes
15.
Adv Radiat Oncol ; 3(4): 559-567, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30370356

RESUMO

PURPOSE: This study aimed to investigate the hemodynamic status of cerebral metastases prior to and after stereotactic radiation surgery (SRS) and to identify the vascular characteristics that are associated with the development of pseudoprogression from radiation-induced damage with and without a radionecrotic component. METHODS AND MATERIALS: Twenty-four patients with 29 metastases from non-small cell lung cancer or malignant melanoma received SRS with dose of 15 Gy to 25 Gy. Magnetic resonance imaging (MRI) scans were acquired prior to SRS, every 3 months during the first year after SRS, and every 6 months thereafter. On the basis of the follow-up MRI scans or histology after SRS, metastases were classified as having response, tumor progression, or pseudoprogression. Advanced perfusion MRI enabled the estimation of vascular status in tumor regions including fractions of abnormal vessel architecture, underperfused tissue, and vessel pruning. RESULTS: Prior to SRS, metastases that later developed pseudoprogression had a distinct poor vascular function in the peritumoral zone compared with responding metastases (P < .05; number of metastases = 15). In addition, differences were found between the peritumoral zone of pseudoprogressing metastases and normal-appearing brain tissue (P < .05). In contrast, for responding metastases, no differences in vascular status between peritumoral and normal-appearing brain tissue were observed. The dysfunctional peritumoral vasculature persisted in pseudoprogressing metastases after SRS. CONCLUSIONS: Our results suggest that the vascular status of peritumoral tissue prior to SRS plays a defining role in the development of pseudoprogression and that advanced perfusion MRI may provide new insights into patients' susceptibility to radiation-induced effects.

16.
J Magn Reson Imaging ; 46(1): 194-206, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28001320

RESUMO

PURPOSE: To implement a dynamic contrast-based multi-echo MRI sequence in assessment of rectal cancer and evaluate associations between histopathologic data and the acquired dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) -MRI parameters. MATERIALS AND METHODS: This pilot study reports results from 17 patients with resectable rectal cancer. Dynamic contrast-based multi-echo MRI (1.5T) was acquired using a three-dimensional multi-shot EPI sequence, yielding both DCE- and DSC-data following a single injection of contrast agent. The Institutional Review Board approved the study and all patients provided written informed consent. Quantitative analysis was performed by pharmacokinetic modeling on DCE data and tracer kinetic modeling on DSC data. Mann-Whitney U-test and receiver operating characteristics curve statistics was used to evaluate associations between histopathologic data and the acquired DCE- and DSC-MRI parameters. RESULTS: For patients with histologically confirmed nodal metastasis, the primary tumor demonstrated a significantly lower Ktrans and peak change in R2*, R2*-peakenh , than patients without nodal metastasis, showing a P-value of 0.010 and 0.005 for reader 1, and 0.043 and 0.019 for reader 2, respectively. CONCLUSION: This study shows the feasibility of acquiring DCE- and DSC-MRI in rectal cancer by dynamic multi-echo MRI. A significant association was found between both Ktrans and R2*-peakenh in the primary tumor and histological nodal status of the surgical specimen, which may improve stratification of patients to intensified multimodal treatment. LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:194-206.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imagem Multimodal/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Aumento da Imagem/métodos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
17.
J Magn Reson Imaging ; 42(1): 180-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25211038

RESUMO

PURPOSE: To test the split dynamic magnetic resonance imaging (MRI) technique in the assessment of breast masses in which high spatial resolution and dual-echo high temporal resolution data are acquired during a single bolus injection. MATERIALS AND METHODS: Forty-four women with breast masses were examined using split dynamic MRI. Quantitative analysis was performed with pharmacokinetic modeling on T1 -weighted images and estimation of maximum peak change in R2 * images (R2 *-peakenh ). High spatial resolution data were interpreted by two radiologists using the Breast Imaging Reporting and Data System (BI-RADS). Mann-Whitney tests were used to determine the parameters ability for establishing or excluding malignancy. For both readers, diagnostic accuracy, with and without information from the quantitative analysis, was determined using receiver operating characteristic (ROC) analysis, and evaluated using pairwise comparison of the areas under the ROC curve (Az ) and McNemar tests. RESULTS: Significant parameters for establishing or excluding malignancy were R2 *-peakenh (P < 0.001), plasma volume (P = 0.006), and time-to-peak enhancement (P = 0.003) showing an Az of 0.928 combined. For one out of the two readers, diagnostic accuracy was significantly improved when adding quantitative kinetic analysis to the BI-RADS score (P = 0.017). CONCLUSION: High temporal resolution T1 -weighted and R2 * dynamic information combined with BI-RADS interpretations improved the diagnostic performance in differentiating malignant from benign breast masses compared to BI-RADS interpretations alone.


Assuntos
Neoplasias da Mama/patologia , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Meglumina/análogos & derivados , Compostos Organometálicos/administração & dosagem , Adolescente , Adulto , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Feminino , Humanos , Meglumina/administração & dosagem , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
18.
J Magn Reson Imaging ; 39(3): 673-82, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23913511

RESUMO

PURPOSE: To test the feasibility of a novel "split dynamic" method in which high temporal and high spatial resolution dynamic MR images are acquired during a single bolus injection. MATERIALS AND METHODS: High temporal resolution images were acquired using a three-dimensional (3D) dual-echo EPI sequence. The high spatial resolution images were acquired using a 3D T1 -weighted turbo field echo sequence. Simulations were performed to test the split dynamic method in terms of accuracy relative to a continuous acquisition and for temporal sampling requirements for accurate estimation of kinetic parameters. The method was tested in four patients where pharmacokinetic parameters were extracted from the high temporal resolution data. RESULTS: The split dynamic method enabled quantitative evaluation of both T1- and T2*-weighted characteristics. Simulations showed that splitting the dynamic acquisition does not significantly influence the reliability of parameter estimations. Simulation showed a required temporal resolution of 13, 16, and 8 s for accurate estimates of Ktrans, ve, and vp, respectively, and an optimal sampling interval between 2 and 6 s for peak R2*. CONCLUSION: The split dynamic sequence enabled detailed assessment of dynamic T1- and T2*-weighted contrast kinetics without compromising guidelines concerning spatial resolution.


Assuntos
Mama/patologia , Imagem Ecoplanar/métodos , Gadolínio DTPA/farmacocinética , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Meios de Contraste/farmacocinética , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Método de Monte Carlo , Projetos Piloto , Sensibilidade e Especificidade
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