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OBJECTIVES: Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) acquisition and advanced processing can accelerate acquisition time and improve MR image quality. This study evaluated the image quality and apparent diffusion coefficient (ADC) measurements of free-breathing DWI acquired from patients with liver metastases using a prototype SMS-DWI acquisition (with/without an advanced processing option) and conventional DWI. METHODS: Four DWI schemes were compared in a pilot 5-patient cohort; three DWI schemes were further assessed in a 24-patient cohort. Two readers scored image quality of all b-value images and ADC maps across the three methods. ADC measurements were performed, for all three methods, in left and right liver parenchyma, spleen, and liver metastases. The Friedman non-parametric test (post-hoc Wilcoxon test with Bonferroni correction) was used to compare image quality scoring; t-test was used for ADC comparisons. RESULTS: SMS-DWI was faster (by 24%) than conventional DWI. Both readers scored the SMS-DWI with advanced processing as having the best image quality for highest b-value images (b750) and ADC maps; Cohen's kappa inter-reader agreement was 0.6 for b750 image and 0.56 for ADC maps. The prototype SMS-DWI sequence with advanced processing allowed a better visualization of the left lobe of the liver. ADC measured in liver parenchyma, spleen, and liver metastases using the SMS-DWI with advanced processing option showed lower values than those derived from the SMS-DWI method alone (t-test, p < 0.0001; p < 0.0001; p = 0.002). CONCLUSIONS: Free-breathing SMS-DWI with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. CLINICAL RELEVANCE STATEMENT: Free-breathing simultaneous multi-slice- diffusion-weighted imaging (DWI) with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. KEY POINTS: ⢠Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) can accelerate acquisition time and improve image quality. ⢠Apparent diffusion coefficients (ADC) measured in liver parenchyma, spleen, and liver metastases using the simultaneous multi-slice DWI with advanced processing were significantly lower than those derived from the simultaneous multi-slice DWI method alone. ⢠Simultaneous multi-slice DWI sequence with inline advanced processing was faster and demonstrated better image quality in liver patients.
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Neoplasias Hepáticas , Respiração , Humanos , Reprodutibilidade dos Testes , Neoplasias Hepáticas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Imagem Ecoplanar/métodosRESUMO
BACKGROUND: Textural features extracted from MRI potentially provide prognostic information additional to volume for influencing surgical management of cervical cancer. PURPOSE: To identify textural features that differ between cervical tumors above and below the volume threshold of eligibility for trachelectomy and determine their value in predicting recurrence in patients with low-volume tumors. METHODS: Of 378 patients with Stage1-2 cervical cancer imaged prospectively (3T, endovaginal coil), 125 had well-defined, histologically-confirmed squamous or adenocarcinomas with >100 voxels (>0.07 cm3) suitable for radiomic analysis. Regions-of-interest outlined the whole tumor on T2-W images and apparent diffusion coefficient (ADC) maps. Textural features based on grey-level co-occurrence matrices were compared (Mann-Whitney test with Bonferroni correction) between tumors greater (n = 46) or less (n = 79) than 4.19 cm3. Clustering eliminated correlated variables. Significantly different features were used to predict recurrence (regression modelling) in surgically-treated patients with low-volume tumors and compared with a model using clinico-pathological features. RESULTS: Textural features (Dissimilarity, Energy, ClusterProminence, ClusterShade, InverseVariance, Autocorrelation) in 6 of 10 clusters from T2-W and ADC data differed between high-volume (mean ± SD 15.3 ± 11.7 cm3) and low-volume (mean ± SD 1.3 ± 1.2 cm3) tumors. (p < 0.02). In low-volume tumors, predicting recurrence was indicated by: Dissimilarity, Energy (ADC-radiomics, AUC = 0.864); Dissimilarity, ClusterProminence, InverseVariance (T2-W-radiomics, AUC = 0.808); Volume, Depth of Invasion, LymphoVascular Space Invasion (clinico-pathological features, AUC = 0.794). Combining ADC-radiomic (but not T2-radiomic) and clinico-pathological features improved prediction of recurrence compared to the clinico-pathological model (AUC = 0.916, p = 0.006). Findings were supported by bootstrap re-sampling (n = 1000). CONCLUSION: Textural features from ADC maps and T2-W images differ between high- and low-volume tumors and potentially predict recurrence in low-volume tumors.
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Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , Prognóstico , Estudos Prospectivos , Traquelectomia , Carga Tumoral , Neoplasias do Colo do Útero/patologia , Adulto JovemRESUMO
OBJECTIVES: To determine the ability of multi-parametric, endogenous contrast MRI to detect and quantify fibrosis in a chemically-induced rat model of mammary carcinoma. METHODS: Female Sprague-Dawley rats (n=18) were administered with N-methyl-N-nitrosourea; resulting mammary carcinomas underwent nine-b-value diffusion-weighted (DWI), ultrashort-echo (UTE) and magnetisation transfer (MT) magnetic resonance imaging (MRI) on a clinical 1.5T platform, and associated quantitative MR parameters were calculated. Excised tumours were histologically assessed for degree of necrosis, collagen, hypoxia and microvessel density. Significance level adjusted for multiple comparisons was p=0.0125. RESULTS: Significant correlations were found between MT parameters and degree of picrosirius red staining (r > 0.85, p < 0.0002 for ka and δ, r < -0.75, p < 0.001 for T1 and T1s, Pearson), indicating that MT is sensitive to collagen content in mammary carcinoma. Picrosirius red also correlated with the DWI parameter fD* (r=0.801, p=0.0004) and conventional gradient-echo T2* (r=-0.660, p=0.0055). Percentage necrosis correlated moderately with ultrashort/conventional-echo signal ratio (r=0.620, p=0.0105). Pimonidazole adduct (hypoxia) and CD31 (microvessel density) staining did not correlate with any MR parameter assessed. CONCLUSIONS: Magnetisation transfer MRI successfully detects collagen content in mammary carcinoma, supporting inclusion of MT imaging to identify fibrosis, a prognostic marker, in clinical breast MRI examinations. KEY POINTS: ⢠Magnetisation transfer imaging is sensitive to collagen content in mammary carcinoma. ⢠Magnetisation transfer imaging to detect fibrosis in mammary carcinoma fibrosis is feasible. ⢠IVIM diffusion does not correlate with microvessel density in preclinical mammary carcinoma.
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Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Mamárias Experimentais/diagnóstico por imagem , Neoplasias Mamárias Experimentais/patologia , Animais , Meios de Contraste , Feminino , Fibrose/diagnóstico por imagem , Humanos , Necrose/diagnóstico por imagem , Nitroimidazóis , Molécula-1 de Adesão Celular Endotelial a Plaquetas , Ratos Sprague-DawleyRESUMO
OBJECTIVES: To examine repeatability of parameters derived from non-Gaussian diffusion models in data acquired in children with solid tumours. METHODS: Paediatric patients (<16 years, n = 17) were scanned twice, 24 h apart, using DWI (6 b-values, 0-1000 mm-2 s) at 1.5 T in a prospective study. Tumour ROIs were drawn (3 slices) and all data fitted using IVIM, stretched exponential, and kurtosis models; percentage coefficients of variation (CV) calculated for each parameter at all ROI histogram centiles, including the medians. RESULTS: The values for ADC, D, DDCα, α, and DDCK gave CV < 10 % down to the 5th centile, with sharp CV increases below 5th and above 95th centile. K, f, and D* showed increased CV (>30 %) over the histogram. ADC, D, DDCα, and DDCK were strongly correlated (ρ > 0.9), DDCα and α were not correlated (ρ = 0.083). CONCLUSION: Perfusion- and kurtosis-related parameters displayed larger, more variable CV across the histogram, indicating observed clinical changes outside of D/DDC in these models should be interpreted with caution. Centiles below 5th for all parameters show high CV and are unreliable as diffusion metrics. The stretched exponential model behaved well for both DDCα and α, making it a strong candidate for modelling multiple-b-value diffusion imaging data. KEY POINTS: ⢠ADC has good repeatability as low 5th centile of the histogram distribution. ⢠High CV was observed for all parameters at extremes of histogram. ⢠Parameters from the stretched exponential model showed low coefficients of variation. ⢠The median ADC, D, DDC α , and DDC K are highly correlated and repeatable. ⢠Perfusion/kurtosis parameters showed high CV variations across their histogram distributions.
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Imagem de Difusão por Ressonância Magnética/estatística & dados numéricos , Modelos Teóricos , Neoplasias/diagnóstico por imagem , Adolescente , Criança , Estudos de Coortes , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) have been used as imaging biomarkers in adults with high-grade gliomas (HGGs). We incorporated free-breathing DW-MRI and DCE-MRI, at a single time point, in the routine follow-up of five children (median age 9 years, range 8-15) with histologically confirmed HGG within a prospective imaging study. It was feasible to incorporate DW-MRI and DCE-MRI in routine assessments of children with HGG. DW and DCE parameters were repeatable in paediatric HGG. Higher median ADC100-1000 significantly correlated with longer survival in our sample.
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Neoplasias Encefálicas/diagnóstico , Meios de Contraste , Imagem de Difusão por Ressonância Magnética/métodos , Glioma/diagnóstico , Processamento de Imagem Assistida por Computador/métodos , Adolescente , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Criança , Estudos de Viabilidade , Feminino , Seguimentos , Glioma/diagnóstico por imagem , Humanos , Masculino , Gradação de Tumores , Prognóstico , Adulto JovemRESUMO
BACKGROUND: To investigate the combined use of intravoxel incoherent motion (IVIM) diffusion-weighted (DW) and blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) to assess rat renal function using a 1.5T clinical platform. METHODS: Multiple b-value DW and BOLD MR images were acquired from adult rats using a parallel clinical coil arrangement, enabling quantitation of the apparent diffusion coefficient (ADC), IVIM-derived diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (f), and the transverse relaxation time T2*, for whole kidney, renal cortex, and medulla. Following the acquisition of two baseline datasets to assess measurement repeatability, images were acquired following i.v. administration of hydralazine, furosemide, or angiotensin II for up to 40 min. RESULTS: Excellent repeatability (CoV <10 %) was observed for ADC, D, f and T2* measured over the whole kidney. Hydralazine induced a marked and significant (p < 0.05) reduction in whole kidney ADC, D, and T2*, and a significant (p < 0.05) increase in D* and f. Furosemide significantly (p < 0.05) increased whole kidney ADC, D, and T2*. A more variable response to angiotensin II was determined, with a significant (p < 0.05) increase in medulla D* and significant (p < 0.05) reduction in whole kidney T2* established. CONCLUSIONS: Multiparametric MRI, incorporating quantitation of IVIM DWI and BOLD biomarkers and performed on a clinical platform, can be used to monitor the acute effects of vascular and tubular modulating drugs on rat kidney function in vivo. Clinical adoption of such functional imaging biomarkers can potentially inform on treatment effects in patients with renal dysfunction.
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Difusão/efeitos dos fármacos , Rim/diagnóstico por imagem , Rim/metabolismo , Imageamento por Ressonância Magnética/métodos , Oxigênio/metabolismo , Angiotensina II/farmacologia , Animais , Anti-Hipertensivos/farmacologia , Imagem de Difusão por Ressonância Magnética/métodos , Diuréticos/farmacologia , Feminino , Furosemida/farmacologia , Hidralazina/farmacologia , Rim/fisiologia , Oxigênio/sangue , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Vasoconstritores/farmacologiaRESUMO
BACKGROUND: This open-label phase I dose-escalation study investigated the safety, efficacy, pharmacokinetics (PK), and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) effects of the oral angiokinase inhibitor nintedanib in patients with advanced solid tumors. METHODS: Nintedanib was administered once daily continuously, starting at 100 mg and later amended to allow evaluation of 250 mg b.i.d. The primary endpoint was maximum tolerated dose (MTD). DCE-MRI studies were performed at baseline and on days 2 and 28. RESULTS: Fifty-one patients received nintedanib 100-450 mg once daily (n = 40) or 250 mg b.i.d. (n = 11). Asymptomatic reversible liver enzyme elevations (grade 3) were dose limiting in 2 of 5 patients at 450 mg once daily. At 250 mg b.i.d., 2 of 11 patients experienced dose-limiting toxicity (grade 3 liver enzyme elevation and gastrointestinal symptoms). Common toxicities included fatigue, diarrhea, nausea, vomiting, and abdominal pain (mainly grade ≤2). Among 45 patients, 22 (49%) achieved stable disease; 7 remained on treatment for >6 months. DCE-MRI of target lesions revealed effects in some patients at 200 and ≥400 mg once daily. CONCLUSION: Nintedanib is well tolerated by patients with advanced solid malignancies, with MTD defined as 250 mg b.i.d., and can induce changes in DCE-MRI. Disease stabilization >6 months was observed in 7 of 51 patients.
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Antineoplásicos/uso terapêutico , Indóis/uso terapêutico , Neoplasias/tratamento farmacológico , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacocinética , Meios de Contraste , Esquema de Medicação , Inibidores Enzimáticos/uso terapêutico , Humanos , Indóis/administração & dosagem , Indóis/efeitos adversos , Indóis/farmacocinética , Imageamento por Ressonância Magnética , Dose Máxima Tolerável , Neoplasias/patologia , Resultado do TratamentoRESUMO
OBJECTIVES: The objectives are to examine the reproducibility of functional MR imaging in children with solid tumours using quantitative parameters derived from diffusion-weighted (DW-) and dynamic contrast enhanced (DCE-) MRI. METHODS: Patients under 16-years-of age with confirmed diagnosis of solid tumours (n = 17) underwent free-breathing DW-MRI and DCE-MRI on a 1.5 T system, repeated 24 hours later. DW-MRI (6 b-values, 0-1000 sec/mm(2)) enabled monoexponential apparent diffusion coefficient estimation using all (ADC0-1000) and only ≥100 sec/mm(2) (ADC100-1000) b-values. DCE-MRI was used to derive the transfer constant (K(trans)), the efflux constant (kep), the extracellular extravascular volume (ve), and the plasma fraction (vp), using a study cohort arterial input function (AIF) and the extended Tofts model. Initial area under the gadolinium enhancement curve and pre-contrast T1 were also calculated. Percentage coefficients of variation (CV) of all parameters were calculated. RESULTS: The most reproducible cohort parameters were ADC100-1000 (CV = 3.26%), pre-contrast T1 (CV = 6.21%), and K(trans) (CV = 15.23%). The ADC100-1000 was more reproducible than ADC0-1000, especially extracranially (CV = 2.40% vs. 2.78%). The AIF (n = 9) derived from this paediatric population exhibited sharper and earlier first-pass and recirculation peaks compared with the literature's adult population average. CONCLUSIONS: Free-breathing functional imaging protocols including DW-MRI and DCE-MRI are well-tolerated in children aged 6 - 15 with good to moderate measurement reproducibility. KEY POINTS: ⢠Diffusion MRI protocol is feasible and well-tolerated in a paediatric oncology population. ⢠DCE-MRI for pharmacokinetic evaluation is feasible and well tolerated in a paediatric oncology population. ⢠Paediatric arterial input function (AIF) shows systematic differences from the adult population-average AIF. ⢠Variation of quantitative parameters from paired functional MRI measurements were within 20%.
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Meios de Contraste , Imagem de Difusão por Ressonância Magnética/métodos , Aumento da Imagem , Neoplasias/diagnóstico , Adolescente , Criança , Estudos de Coortes , Estudos de Viabilidade , Feminino , Gadolínio , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Projetos Piloto , Reprodutibilidade dos Testes , Respiração , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To evaluate the effect on diffusion-weighted image-derived parameters in the apparent diffusion coefficient (ADC) and intra-voxel incoherent motion (IVIM) models from choice of either free-breathing or navigator-controlled acquisition. MATERIALS AND METHODS: Imaging was performed with consent from healthy volunteers (n = 10) on a 1.5T Siemens Avanto scanner. Parameter-matched free-breathing and navigator-controlled diffusion-weighted images were acquired, without averaging in the console, for a total scan time of â¼10 minutes. Regions of interest were drawn for renal cortex, renal pyramid, whole kidney, liver, spleen, and paraspinal muscle. An ADC diffusion model for these regions was fitted for b-values ≥ 250 s/mm(2) , using a Levenberg-Marquardt algorithm, and an IVIM model was fitted for all images using a Bayesian method. RESULTS: ADC and IVIM parameters from the two acquisition regimes show no significant differences for the cohort; individual cases show occasional discrepancies, with outliers in parameter estimates arising more commonly from navigator-controlled scans. The navigator-controlled acquisitions showed, on average, a smaller range of movement for the kidneys (6.0 ± 1.4 vs. 10.0 ± 1.7 mm, P = 0.03), but also a smaller number of averages collected (3.9 ± 0.1 vs. 5.5 ± 0.2, P < 0.01) in the allocated time. CONCLUSION: Navigator triggering offers no advantage in fitted diffusion parameters, whereas free-breathing appears to offer greater confidence in fitted diffusion parameters, with fewer outliers, for matched acquisition periods.
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Imagem de Difusão por Ressonância Magnética , Respiração , Adulto , Algoritmos , Teorema de Bayes , Suspensão da Respiração , Feminino , Voluntários Saudáveis , Humanos , Processamento de Imagem Assistida por Computador , Rim/patologia , Córtex Renal/patologia , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Músculos Paraespinais/patologia , Baço/patologiaRESUMO
PURPOSE: To evaluate dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for monitoring and assessing treatment response in patients with neuroendocrine liver metastases treated using yttrium 90 ((90)Y)-labeled octreotide ((90)Y-DOTATOC). MATERIALS AND METHODS: The study was approved by the local research and ethics committee and patient informed consent was obtained. Twenty patients with liver metastases from neuroendocrine tumors underwent T1-weighted DCE MR imaging of the liver before and at 2 months after intravenous (90)Y-DOTATOC treatment. Regions of interest were drawn around target lesions, as well as along liver outlines for each patient. A dual-input single-compartment model was used to compute parameters including fractional distribution volume and the arterial flow fraction. Pre- and posttreatment values were compared using Wilcoxon signed rank test. Treatment response was defined as showing a greater than 50% reduction in the nadir chromogranin A level within the 1st year after treatment. Pretreatment values of responders and nonresponders were compared using the Mann-Whitney test. A two-tailed P value of .008 or less, which accounts for multiple testing, was considered to indicate a significant difference. RESULTS: In responders, tumor and whole liver distribution volume significantly increased after treatment (median tumor distribution volume, 0.182 vs 0.244; median whole liver distribution volume, 0.175 vs 0.207; P = .008). The pretreatment whole liver distribution volume was significantly lower in responders (median, 0.175 vs 0.248; P = .003), while pretreatment tumor arterial flow fraction was significantly higher in responders (median, 1.000 vs 0.7 ± 1, P = .006). CONCLUSION: DCE MR imaging may be used to monitor the effects of peptide receptor radiolabeled targeted therapy in patients with neuroendocrine tumors liver metastases; a lower pretreatment distribution volume and high arterial flow fraction was associated with a better response to treatment.
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Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Imageamento por Ressonância Magnética/métodos , Tumores Neuroendócrinos/patologia , Octreotida/análogos & derivados , Compostos Radiofarmacêuticos/uso terapêutico , Adulto , Idoso , Área Sob a Curva , Meios de Contraste , Análise Discriminante , Feminino , Gadolínio DTPA , Humanos , Interpretação de Imagem Assistida por Computador , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Octreotida/farmacocinética , Octreotida/uso terapêutico , Valor Preditivo dos Testes , Estudos Prospectivos , Compostos Radiofarmacêuticos/farmacocinética , Estatísticas não Paramétricas , Taxa de Sobrevida , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do TratamentoRESUMO
Picture archiving and communication systems (PACS) provide limited flexibility for the development of novel research methods. By contrast, the research model of data access is more flexible but has vulnerabilities in numerous areas. No single monolithic application can fulfill the diverse and rapidly changing needs of the clinical imaging research community. Instead, the focus should be on the interoperability of preexisting systems. To a large extent, this can be achieved by means of a unified interface for storing and retrieving data. The concept of a research PACS combines the advantages of the clinical and research models of data access while eliminating the disadvantages. A research PACS streamlines the data management process. Instead of a single software program, it consists of a confederation of independent applications brought together by the ability to store and retrieve data in a common database. A prototype research PACS has been developed that is based on the Extensible Neuroimaging Archive Toolkit (XNAT) in association with two new in-house tools: a data selection tool and a data archiving tool. By taking as an example the comparison of regions of interest in multifunctional liver data, it was demonstrated that this framework allows a number of in-house and open-source applications originally designed to work on a stand-alone basis to be integrated into a unified workflow, with minimal redevelopment effort.
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Pesquisa Biomédica/organização & administração , Ensaios Clínicos como Assunto/métodos , Internet/organização & administração , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas de Informação em Radiologia/organização & administração , Interface Usuário-Computador , Informática Médica/métodos , Informática Médica/organização & administração , Integração de Sistemas , Estados UnidosRESUMO
This study was conducted to determine if engineered nanoparticles are released into the air when nanocomposite parts are shredded for recycling. Test plaques made from polypropylene resin reinforced with either montmorillonite nanoclay or talc and from the same resin with no reinforcing material were shredded by a granulator inside a test apparatus. As the plaques were shredded, an ultrafine condensation particle counter; a diffusion charger; a photometer; an electrical mobility analyzer; and an optical particle counter measured number, lung-deposited surface area, and mass concentrations and size distributions by number in real-time. Overall, the particle levels produced were both stable and lower than found in some occupational environments. Although the lowest particle concentrations were observed when the talc-filled plaques were shredded, fewer nanoparticles were generated from the nanocomposite plaques than when the plain resin plaques were shredded. For example, the average particle number concentrations measured using the ultrafine condensation particle counter were 1300 particles/cm(3) for the talc-reinforced resin, 4280 particles/cm(3) for the nanoclay-reinforced resin, and 12,600 particles/cm(3) for the plain resin. Similarly, the average alveolar-deposited particle surface area concentrations measured using the diffusion charger were 4.0 µm(2)/cm(3) for the talc-reinforced resin, 8.5 µm(2)/cm(3) for the nanoclay-reinforced resin, and 26 µm(2)/cm(3) for the plain resin. For all three materials, count median diameters were near 10 nm during tests, which is smaller than should be found from the reinforcing materials. These findings suggest that recycling of nanoclay-reinforced plastics does not have a strong potential to generate more airborne nanoparticles than recycling of conventional plastics.
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Poluentes Ocupacionais do Ar/análise , Monitoramento Ambiental/métodos , Nanocompostos , Nanopartículas/análise , Reciclagem , Bentonita/análise , Monitoramento Ambiental/instrumentação , Microscopia Eletrônica de Varredura , Polipropilenos/análise , Resinas Sintéticas/análise , Talco/análiseRESUMO
Objective: This study aims to determine local treatment response and long-term survival outcomes in patients with localised muscle-invasive bladder cancer (MIBC) patients receiving neoadjuvant chemotherapy (NAC) using diffusion-weighted MRI (DWI) and apparent diffusion coefficient (ADC) analysis. Methods: Patients with T2-T4aN0-3M0 bladder cancer suitable for NAC were recruited prospectively. DWI was performed prior to NAC and was repeated following NAC completion. Conventional response assessment was performed with cystoscopy and tumour site biopsy. Response was dichotomised into response (
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PURPOSE: To investigate whether early changes in vascular parameters determined with dynamic contrast material-enhanced magnetic resonance (MR) imaging after two cycles of neoadjuvant chemotherapy (NAC) are predictive of disease-free and overall survival in primary breast cancer. MATERIALS AND METHODS: Institutional ethics approval and informed consent were obtained. Patients with primary breast cancer (median age, 45 years; age range, 22-70 years) recruited from January 2001 to September 2008 underwent dynamic contrast-enhanced MR imaging before and after two cycles of NAC. Quantitative and semiquantitative kinetic parameters were calculated, including the volume transfer constant (K(trans)) and the initial area under the gadolinium concentration-time curve over 60 seconds (IAUGC(60)). Cut points optimized to the receiver operating characteristic curve were used to dichotomize MR imaging data for Kaplan-Meier survival analysis. MR imaging parameters and known prognostic indicators in primary breast cancer were correlated with disease-free and overall survival by using the Cox proportional hazards model for univariate and multivariate analyses. RESULTS: MR imaging was performed before (n = 62) and after (n = 58) two cycles of NAC. The median follow-up time was 43.9 months for disease-free survival and 60.3 months for overall survival. There were 28 recurrences; 26 patients had distant metastases (two had additional local recurrence) and two had local recurrence only. There were 20 deaths, all of which were related to breast cancer. At univariate analysis, progesterone receptor status, the type of surgery performed, higher posttreatment K(trans) (P = .048), and larger posttreatment IAUGC(60) (P = .035) were significant predictors of worse disease-free survival. At multivariate analysis, progesterone receptor status (P = .002) and mean transit time (P = .025) were significant predictors of disease-free survival. Univariate analysis showed that clinical tumor stage (P = .005), progesterone receptor status (P = .025), and type of surgery performed (P = .017) were significant predictors of overall survival. Higher posttreatment K(trans) (P = .043), larger IAUGC(60) (P = .029), and larger tumor size at posttreatment MR imaging were predictive of worse overall survival (P = .018). Of these variables, K(trans) remained an independent indicator of overall survival (P = .038). CONCLUSION: Higher posttreatment tumor vascularization as depicted with dynamic contrast-enhanced MR imaging may be associated with higher recurrence and lower survival rates. Dynamic contrast-enhanced MR imaging parameters, in conjunction with traditional prognostic factors, have the potential to be prognostic biomarkers for disease-free and overall survival in primary breast cancer.
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Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/mortalidade , Gadolínio DTPA , Imageamento por Ressonância Magnética/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Quimioterapia Adjuvante/mortalidade , Meios de Contraste , Inglaterra , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Prevalência , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
The detection and prognosis of prostate cancer in its early stages are critically important. It is therefore essential to improve the existing dynamic contrast-enhanced MRI (DCE MRI) techniques commonly used for the assessment of the tumour vascular environment. The goal of this study was to describe a method for the estimation of the arterial input function (AIF) in DCE MRI by measuring R(2) * values in the femoral artery of patients with early-stage prostate cancer. The calculation of contrast agent concentrations was based on calibration curves determined in whole blood samples for a range of normal haematocrit (HCT) values (HCT = 0.35-0.525). Individual AIFs corrected for HCT were compared with individual AIFs calibrated with a mean whole blood [R(2)*-Gd-DTPA-BMA] [Gd-DTPA-BMA, gadolinium diethylenetriaminepentaacetate-bis(methylamide) (gadodiamide)] curve at an assumed HCT = 0.44, as well as a population AIF at an assumed HCT = 0.45. The area under the curve of the first-pass bolus ranged between 0.6 min mM at HCT = 0.53 and 1.3 min mM at HCT = 0.39. Significant differences in magnitude at peak contrast agent concentrations (HCT = 0.36, [Gd-DTPA-BMA](max) = 9 ± 0.4 mM; HCT = 0.46, [Gd-DTPA-BMA](max) = 4.0 ± 0.2 mM) were found. Using model-based simulations, the accuracy of the kinetic parameters estimated using individual AIFs corrected for HCT demonstrated that, for the use of individual calibration curves with HCT values differing by more than 10%, K(trans) and k(ep) values were largely underestimated (up to 60% difference for K(trans)). Moreover, blood volume estimates were severely underestimated. Estimates of kinetic parameters in early-stage prostate cancer patients demonstrated that the efflux rate constant (k(ep)) was influenced significantly by the definition of AIF. Regardless of whether an individually calibrated AIF or a population AIF (average of all individually calibrated AIFs) was used, pixel-by-pixel mapping of k(ep) and v(b) in the prostate gland appeared to be more sensitive than with the usual biexponential approach.
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Artérias/fisiologia , Meios de Contraste/farmacocinética , Hematócrito , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Artérias/anatomia & histologia , Gadolínio DTPA/farmacocinética , Humanos , Masculino , Neoplasias da Próstata/irrigação sanguínea , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/metabolismo , Fluxo Sanguíneo RegionalRESUMO
OBJECTIVES: Triple-negative (ER-/PR-/HER2-) breast carcinomas (TNBC) are aggressive tumours with underexplored imaging features. This study investigates whether their vascular characteristics as assessed by dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast-enhanced (DSC) MRI are distinct from the prognostically more favourable ER+/PR+/HER2- cancers. METHODS: Patients with primary breast cancer underwent MRI before neoadjuvant chemotherapy and were identified as ER-/PR-/HER2- or ER+/PR+/HER2- from core biopsy specimens. MRI parameters reflecting tissue perfusion, permeability, and extracellular leakage space were measured. Values for inflow transfer constant (K(trans)), outflow rate constant (k(ep)), leakage space (v(e)), area under the gadolinium curve (IAUGC(60) ), relative blood volume (rBV) and flow (rBF), and Mean Transit Time (MTT) were compared across receptor status and with known prognostic variables. RESULTS: Thirty seven patients were assessable in total (16 ER-/PR-/HER2-, 21 ER+/PR+/HER2-). Lower v(e) (p = 0.001), shorter MTT (p = 0.007) and higher k(ep) values (p = 0.044) were observed in TNBC. v(e) was lower across all T stages, node-negative (p = 0.004) and low-grade TNBC (p = 0.037). v(e) was the best predictor of triple negativity (ROC AUC 0.80). CONCLUSIONS: TNBC possess characteristic features on imaging, with lower extracellular space (higher cell density) and higher contrast agent wash-out rate (higher vascular permeability) suggesting a distinctive phenotype detectable by MRI.
Assuntos
Neoplasias da Mama/irrigação sanguínea , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Área Sob a Curva , Biópsia por Agulha , Velocidade do Fluxo Sanguíneo , Volume Sanguíneo , Neoplasias da Mama/patologia , Meios de Contraste/farmacocinética , Feminino , Gadolínio DTPA/farmacocinética , Humanos , Hibridização in Situ Fluorescente , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fenótipo , Prognóstico , Curva ROC , Receptor ErbB-2/análise , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Estudos Retrospectivos , Estatísticas não ParamétricasRESUMO
This article describes a highly tailorable exposure assessment strategy for nanomaterials that enables effective and efficient exposure management (i.e., a strategy that can identify jobs or tasks that have clearly unacceptable exposures), while simultaneously requiring only a modest level of resources to conduct. The strategy is based on strategy general framework from AIHA® that is adapted for nanomaterials and seeks to ensure that the risks to workers handling nanomaterials are being managed properly. The strategy relies on a general framework as the basic foundation while building and elaborating on elements essential to an effective and efficient strategy to arrive at decisions based on collecting and interpreting available information. This article provides useful guidance on conducting workplace characterization; understanding exposure potential to nanomaterials; accounting methods for background aerosols; constructing SEGs; and selecting appropriate instrumentation for monitoring, providing appropriate choice of exposure limits, and describing criteria by which exposure management decisions should be made. The article is intended to be a practical guide for industrial hygienists for managing engineered nanomaterial risks in their workplaces.
Assuntos
Poluentes Ocupacionais do Ar/análise , Monitoramento Ambiental/métodos , Nanoestruturas/análise , Exposição Ocupacional/análise , Monitoramento Ambiental/instrumentação , Humanos , Nanoestruturas/efeitos adversos , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Medição de Risco , Gestão da Segurança , Fatores de Tempo , Local de TrabalhoRESUMO
PURPOSE: To evaluate robustness and repeatability of magnetic resonance imaging (MRI) texture features in water and tissue phantom test-retest study. MATERIALS AND METHODS: Separate water and tissue phantoms were imaged twice with the same protocol in a test-retest experiment using a 1.5-T scanner. Protocols were acquired to favour signal-to-noise ratio and resolution. Forty-six features including first order statistics and second-order texture features were extracted, and repeatability was assessed by calculating the concordance correlation coefficient. Separately, base image noise and resolution were manipulated in an in silico experiment, and robustness of features was calculated by assessing percentage coefficient of variation and linear correlation of features with noise and resolution. These simulation data were compared with the acquired data. Features were classified by their degree (high, intermediate, or low) of robustness and repeatability. RESULTS: Eighty percent of the MRI features were repeatable (concordance correlation coefficient > 0.9) in the phantom test-retest experiment. The majority (approximately 90%) demonstrated a strong or intermediate correlation with image acquisition parameter, and 19/46 (41%) and 13/46 (28%) of features were highly robust to noise and resolution, respectively (coefficient of variation < 5%). Agreement between the acquired and simulation data varied, with the range of agreement within feature classes between 11 and 92%. CONCLUSION: Most MRI features were repeatable in a phantom test-retest study. This phantom data may serve as a lower limit of feature MRI repeatability. Robustness of features varies with acquisition parameter, and appropriate features can be selected for clinical validation studies.
Assuntos
Imageamento por Ressonância Magnética , Imagens de Fantasmas , Razão Sinal-RuídoRESUMO
BACKGROUND: Most MRI radiomics studies to date, even multi-centre ones, have used "pure" datasets deliberately accrued from single-vendor, single-field-strength scanners. This does not reflect aspirations for the ultimate generalisability of AI models. We therefore investigated the development of a radiomics signature from heterogeneous data originating on six different imaging platforms, for a breast cancer exemplar, in order to provide input into future discussions of the viability of radiomics in "real-world" scenarios where image data are not controlled by specific trial protocols but reflective of routine clinical practice. METHODS: One hundred fifty-six patients with pathologically proven breast cancer underwent multi-contrast MRI prior to neoadjuvant chemotherapy and/or surgery. From these, 92 patients were identified for whom T2-weighted, diffusion-weighted and contrast-enhanced T1-weighted sequences were available, as well as key clinicopathological variables. Regions-of-interest were drawn on the above image types and, from these, semantic and calculated radiomics features were derived. Classification models using a variety of methods, both with and without recursive feature elimination, were developed to predict pathological nodal status. Separately, we applied the same methods to analyse the information carried by the radiomic features regarding the originating scanner type and field strength. Repeated, ten-fold cross-validation was employed to verify the results. In parallel work, survival modelling was performed using random survival forests. RESULTS: Prediction of nodal status yielded mean cross-validated AUC values of 0.735 ± 0.15 (SD) for clinical variables alone, 0.673 ± 0.16 (SD) for radiomic features only, and 0.764 ± 0.16 (SD) for radiomics and clinical features together. Prediction of scanner platform from the radiomics features yielded extremely high values of AUC between 0.91 and 1 for the different classes examined indicating the presence of confounding features for the nodal status classification task. Survival analysis, gave out-of-bag prediction errors of 19.3% (clinical features only), 36.9-51.8% (radiomic features from different combinations of image contrasts), and 26.7-35.6% (clinical plus radiomics features). CONCLUSIONS: Radiomic classification models whose predictive ability was consistent with previous single-vendor, single-field strength studies have been obtained from multi-vendor, multi-field-strength data, despite clear confounding information being present. However, our sample size was too small to obtain useful survival modelling results.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/radioterapia , Imageamento por Ressonância Magnética/métodos , Terapia Neoadjuvante/métodos , Radiometria/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama , Neoplasias da Mama/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Adulto JovemRESUMO
BACKGROUND: Diffusion weighted imaging (DWI) with intravoxel incoherent motion (IVIM) modelling can inform on tissue perfusion without exogenous contrast administration. Dynamic-contrast-enhanced (DCE) MRI can also characterise tissue perfusion, but requires a bolus injection of a Gadolinium-based contrast agent. This study compares the use of DCE-MRI and IVIM-DWI methods in assessing response to anti-angiogenic treatment in patients with colorectal liver metastases in a cohort with confirmed treatment response. METHODS: This prospective imaging study enrolled 25 participants with colorectal liver metastases to receive Regorafenib treatment. A target metastasis > 2 cm in each patient was imaged before and at 15 days after treatment on a 1.5T MR scanner using slice-matched IVIM-DWI and DCE-MRI protocols. MRI data were motion-corrected and tumour volumes of interest drawn on b=900 s/mm2 diffusion-weighted images were transferred to DCE-MRI data for further analysis. The median value of four IVIM-DWI parameters [diffusion coefficient D (10-3 mm2/s), perfusion fraction f (ml/ml), pseudodiffusion coefficient D* (10-3 mm2/s), and their product fD* (mm2/s)] and three DCE-MRI parameters [volume transfer constant Ktrans (min-1), enhancement fraction EF (%), and their product KEF (min-1)] were recorded at each visit, before and after treatment. Changes in pre- and post-treatment measurements of all MR parameters were assessed using Wilcoxon signed-rank tests (P<0.05 was considered significant). DCE-MRI and IVIM-DWI parameter correlations were evaluated with Spearman rank tests. Functional MR parameters were also compared against Response Evaluation Criteria In Solid Tumours v.1.1 (RECIST) evaluations. RESULTS: Significant treatment-induced reductions of DCE-MRI parameters across the cohort were observed for EF (91.2 to 50.8%, P<0.001), KEF (0.095 to 0.045 min-1, P<0.001) and Ktrans (0.109 to 0.078 min-1, P=0.002). For IVIM-DWI, only D (a non-perfusion parameter) increased significantly post treatment (0.83 to 0.97 × 10-3 mm2/s, P<0.001), while perfusion-related parameters showed no change. No strong correlations were found between DCE-MRI and IVIM-DWI parameters. A moderate correlation was found, after treatment, between Ktrans and D* (r=0.60; P=0.002) and fD* (r=0.67; P<0.001). When compared to RECIST v.1.1 evaluations, KEF and D correctly identified most clinical responders, whilst non-responders were incorrectly identified. CONCLUSION: IVIM-DWI perfusion-related parameters showed limited sensitivity to the anti-angiogenic effects of Regorafenib treatment in colorectal liver metastases and showed low correlation with DCE-MRI parameters, despite profound and significant post-treatment reductions in DCE-MRI measurements. TRIAL REGISTRATION: NCT03010722 clinicaltrials.gov; registration date 6th January 2015.