31P MR spectroscopy to evaluate the efficacy of hepatic artery embolization in the treatment of neuroendocrine liver metastases.

BACKGROUND: It is common to treat patients with metastatic disease from gastrointestinal neuroendocrine (NE) tumors with surgical reduction to prolong survival. This can be combined with hepatic arterial embolization (HAE) and medical treatment to reduce hormonal symptoms. Today there are no rapid and reliable methods to evaluate the efficacy of HAE in the treatment of neuroendocrine liver metastasis. PURPOSE: To investigate metabolic changes in hepatic metastases of NE tumors following HAE, and to establish if there are any early spectral patterns that might indicate therapeutic efficacy based on in vivo (31)P MRS data. MATERIAL AND METHODS: Volume selective (31)P MRS was used to study 11 patients with disseminated NE tumors with regional lymph nodes and bilobar liver metastases. Measurements were performed before and 1 and 3 days after HAE. RESULTS: Non-responders had significantly higher PME/Pi and αNTP/ΣNTP ratios than the responders before HAE (P < 0.05). Three days after HAE, non-responders still had significantly higher αNTP/ΣNTP than the responders did (P < 0.05). We also observed trends for increased PME ratios 3 days after HAE, decreased ATP-levels, and liberated Pi in responders. CONCLUSION: This (31)P-MRS study showed significant differences in PME/Pi and αNTP/ΣP ratios between responders and non-responders on the day before HAE, which is an interesting finding that may reflect intrinsic properties of the tumor tissue. We also observed trends for cell membrane renewal and increased energy consumption in responders after HAE. These results demonstrate potentials for (31)P-MRS to predict individual responsiveness prior to HAE.

Contrast agent influences MRI phase-contrast flow measurements in small vessels.

Contrast-enhanced MR angiography is often combined with phase contrast (PC) flow measurement to answer a particular clinical question. The contrast agent that is administered during contrast-enhanced MR angiography may still be present in the blood during the consecutive PC flow measurement. The aim of this work was to evaluate the influence of contrast agent on PC flow measurements in small vessels. For that purpose, both in vivo measurements and computer simulations were performed. The dependence of the PC flow quantification on the signal amplitude difference between blood and stationary background tissue for various vessel sizes was characterized. Results show that the partial-volume effect strongly affects the accuracy of the PC flow quantification when the imaged vessel is small compared to the spatial resolution. A higher blood-to-background-contrast level during imaging significantly increases the partial-volume effect and thereby reduces the accuracy of the flow quantification. On the other hand, a higher blood-to-background-contrast level facilitated the segmentation of the vessel for flow rate determination. PC flow measurements should therefore be performed after contrast agent administration in large vessels, but before contrast agent administration in small vessels.

Quantitative phase-contrast flow MRI measurements in the presence of a second vessel closely positioned to the examined vessel.

PURPOSE: To examine the influence of the truncated sampling of k-space data on the accuracy of phase-contrast (PC) flow quantifications in the presence of nearby vessels. MATERIALS AND METHODS: Computer simulations were performed along with some experimental validations on a flow phantom and a normal subject. RESULTS: The accuracy of the PC flow quantification decreased when a second vessel was positioned closely to the examined vessel. The effect strongly depended on the peak flow velocity in the second vessel relative to the velocity encoding (venc) level of the MRI acquisition, and on the position and area of the second vessel. CONCLUSION: Due to the truncated sampling of the k-space data, signal leaked from nearby vessels and distorted the PC flow quantification in the examined vessel. The presented results suggest specific experimental conditions to minimize this flow quantification error.

The magnitude of signal errors introduced by ISIS in quantitative 31P MRS.

It is well known that the quality of a quantitative 31P MRS measurement relies largely on the performance of the volume selection method, and that image selected in vivo spectroscopy (ISIS) suffers from contaminating signal caused mostly by T1 smearing. However, these signal errors and their magnitude are seldom addressed in clinical studies. The aim of this study was therefore to investigate the magnitude of signal errors in 31P MRS when using ISIS. The results from the measurements with a homogeneous head phantom are as follows: at low TR/T1 ratios the contamination increases rapidly, especially for small (<27 cm3) VOI sizes; at TR/T1=1, the signal from a 27 cm3 VOI was 20% too high, and from an 8 cm3 VOI 150% too high. The signal obtained from different VOI positions varied between 80 and 127%. The signal varied linearly with the 31P concentration in the object. However, a too high signal was obtained when the concentration was lower in the region of interest (inner container) than in the rest of the phantom. The agreement between the simulations and measurements shows that the results of this study are generally applicable to the measurement geometry and the ISIS experiment order rather than being specific for the MR system studied. The errors obtained both experimentally and in computer simulations are too large to be ignored in clinical studies using the ISIS pulse sequence.