Incorporating endorectal MR elastography into multi-parametric MRI for prostate cancer imaging: Initial feasibility in volunteers.

PURPOSE: To investigate the tolerability and technical feasibility of performing endorectal MR elastography (eMRE) in human volunteers within the representative age group commonly affected by prostate cancer. MATERIALS AND METHODS: Endorectal MRE was conducted on seven volunteers in a 1.5 Tesla (T) MR imager using a rigid endorectal coil. Another five volunteers were imaged on a 3T MR imager using an inflatable balloon type endorectal coil. Tolerability was accessed for vibration amplitudes of ±1-50 µm and for frequencies of 100-300 Hz. RESULTS: All 12 volunteers tolerated the displacements necessary to successfully perform eMRE. Shear waves with frequencies up to 300 Hz could propagate across the entire prostate using both coil designs. CONCLUSION: The results of this study motivate further investigation of eMRE in prostate cancer patients to help determine if there is an added value of integrating eMRE into existing multi-parametric prostate MRI exams.

Differences in natural history between breast cancers in BRCA1 and BRCA2 mutation carriers and effects of MRI screening-MRISC, MARIBS, and Canadian studies combined.

BACKGROUND: It is recommended that BRCA1/2 mutation carriers undergo breast cancer screening using MRI because of their very high cancer risk and the high sensitivity of MRI in detecting invasive cancers. Clinical observations suggest important differences in the natural history between breast cancers due to mutations in BRCA1 and BRCA2, potentially requiring different screening guidelines. METHODS: Three studies of mutation carriers using annual MRI and mammography were analyzed. Separate natural history models for BRCA1 and BRCA2 were calibrated to the results of these studies and used to predict the impact of various screening protocols on detection characteristics and mortality. RESULTS: BRCA1/2 mutation carriers (N = 1,275) participated in the studies and 124 cancers (99 invasive) were diagnosed. Cancers detected in BRCA2 mutation carriers were smaller [80% ductal carcinoma in situ (DCIS) or ≤10 mm vs. 49% for BRCA1, P < 0.001]. Below the age of 40, one (invasive) cancer of the 25 screen-detected cancers in BRCA1 mutation carriers was detected by mammography alone, compared with seven (three invasive) of 11 screen-detected cancers in BRCA2 (P < 0.0001). In the model, the preclinical period during which cancer is screen-detectable was 1 to 4 years for BRCA1 and 2 to 7 years for BRCA2. The model predicted breast cancer mortality reductions of 42% to 47% for mammography, 48% to 61% for MRI, and 50% to 62% for combined screening. CONCLUSIONS: Our studies suggest substantial mortality benefits in using MRI to screen BRCA1/2 mutation carriers aged 25 to 60 years but show important clinical differences in natural history. IMPACT: BRCA1 and BRCA2 mutation carriers may benefit from different screening protocols, for example, below the age of 40.

Imaging articular cartilage under compression--cartilage elastography.

We constructed a device to compress small samples of articular cartilage while the samples were imaged in a 1.5 T imager. With the use of a piezoelectric piston, the device compressed 1-cm-diameter cylindrical samples of articular cartilage (200 microm) at a rate of 2 Hz. Simultaneously, we imaged the samples with a displacement-sensitive stimulated-echo acquisition mode (STEAM) sequence. We validated the technique using tissue that mimicked silicone samples. We compared the results from the same cartilage samples before and after they were degraded by digestion in trypsin. The extent of degradation was visualized from T(1)-weighted images of the samples after they were soaked in 0.5 mmolar of GdDTPA. The resulting elastographic images show compression and differential strain in directions both parallel and perpendicular to the surface of the cartilage. The static elastographic images that depict compression made before digestion and after 5 and 15 hr of trypsin digestion show that the elastic modulus of the samples decreased with a spatial variation consistent with the enzymatic digestion as revealed by the T(1) images. We believe this technique will be useful in studies of the mechanical properties of articular cartilage and other tissues, and may in the future be extended to the clinical setting.