Antegrade persufflation of porcine kidneys improves renal function after warm ischemia.

Introduction: Transplantation of kidneys from expanded criteria donors (ECD), including after circulatory death (DCD), is associated with a higher risk of adverse events compared to kidneys from standard criteria donors. In previous studies, improvements in renal transplant outcomes have been seen when kidneys were perfused with gaseous oxygen during preservation (persufflation, PSF). In the present study, we assessed ex-vivo renal function from a Diffusion Contrast Enhanced (DCE)-MRI estimation of glomerular filtration rate (eGFR); and metabolic sufficiency from whole-organ oxygen consumption (WOOCR) and lactate production rates. Methods: Using a porcine model of DCD, we assigned one kidney to antegrade PSF, and the contralateral kidney to static cold storage (SCS), both maintained for 24 h at 4°C. Post-preservation organ quality assessments, including eGFR, WOOCR and lactate production, were measured under cold perfusion conditions, and biopsies were subsequently taken for histopathological analysis. Results: A significantly higher eGFR (36.6 ± 12.1 vs. 11.8 ± 4.3 ml/min, p < 0.05), WOOCR (182 ± 33 vs. 132 ± 21 nmol/min*g, p < 0.05), and lower rates of lactate production were observed in persufflated kidneys. No overt morphological differences were observed between the two preservation methods. Conclusion: These data suggest that antegrade PSF is more effective in preserving renal function than conventional SCS. Further studies in large animal models of transplantation are required to investigate whether integration with PSF of WOOCR, eGFR or lactate production measurements before transplantation are predictive of post-transplantation renal function and clinical outcomes.

Tumor enhancement and shrinkage pattern in dynamic contrast-enhanced magnetic resonance imaging for predicting pathologic complete response after human epidermal growth factor receptor 2 (HER2)-targeted therapy in breast cancer.

Background: Targeted therapy with neoadjuvant chemotherapy for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer has increased the rates of pathological complete response (pCR) and breast preservation surgery and improved the overall disease-free survival rate. This study aimed to determine whether tumor enhancement and shrinkage patterns in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can predict the efficacy of targeted therapy in patients with HER2-positive breast cancer and differentiate pCR from non-pCR. Methods: The data of 64 patients with HER2-positive breast cancer who received targeted therapy prior to surgery were retrospectively collected. All patients had complete postoperative pathological data. The pretreatment evaluation of the tumor enhancement pattern and the shrinkage pattern after two treatment cycles were assessed. The difference in the enhancement and shrinkage patterns between the pCR and non-pCR groups was evaluated via the χ2 test. Logistic regression analysis was used to assess the value of enhancement and shrinkage patterns for predicting pCR in patients with HER2-positive breast cancer. Results: There were statistically significant differences in tumor size, estrogen receptor (ER) status, lymph node metastasis, enhancement pattern, and shrinkage pattern between the pCR and non-pCR cases. Patients with a tumor size ≤20 mm were likely to achieve pCR. ER status, lymph node metastasis, and enhancement and shrinkage patterns each had good precision for predicting pCR, and the combination of enhancement and shrinkage patterns had the highest prediction accuracy. Multivariate logistic regression analysis indicated that only enhancement pattern had a significant predictive value. Conclusions: Among patients with HER2-positive breast cancer, those with tumor size ≤20 mm, ER-negative status, no lymph node metastases, and mass enhancement and concentric shrinkage patterns are more likely to achieve pCR. Mass enhancement combined with concentric shrinkage had the highest accuracy in predicting pCR, indicating that preoperative imaging may be useful for guiding clinical decisions regarding targeted treatments.

Blood-brain barrier breakdown in dementia with Lewy bodies.

BACKGROUND: Blood-brain barrier (BBB) dysfunction has been viewed as a potential underlying mechanism of neurodegenerative disorders, possibly involved in the pathogenesis and progression of Alzheimer's disease (AD). However, a relation between BBB dysfunction and dementia with Lewy bodies (DLB) has yet to be systematically investigated. Given the overlapping clinical features and neuropathology of AD and DLB, we sought to evaluate BBB permeability in the context of DLB and determine its association with plasma amyloid-ß (Aß) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS: For this prospective study, we examined healthy controls (n = 24, HC group) and patients diagnosed with AD (n = 29) or DLB (n = 20) between December 2020 and April 2022. Based on DCE-MRI studies, mean rates of contrast agent transfer from intra- to extravascular spaces (Ktrans) were calculated within regions of interest. Spearman's correlation and multivariate linear regression were applied to analyze associations between Ktrans and specific clinical characteristics. RESULTS: In members of the DLB (vs HC) group, Ktrans values of cerebral cortex (p = 0.024), parietal lobe (p = 0.007), and occipital lobe (p = 0.014) were significantly higher; and Ktrans values of cerebral cortex (p = 0.041) and occipital lobe (p = 0.018) in the DLB group were significantly increased, relative to those of the AD group. All participants also showed increased Ktrans values of parietal ( ß  = 0.391; p = 0.001) and occipital ( ß  = 0.357; p = 0.002) lobes that were significantly associated with higher scores of the Clinical Dementia Rating, once adjusted for age and sex. Similarly, increased Ktrans values of cerebral cortex ( ß  = 0.285; p = 0.015), frontal lobe ( ß  = 0.237; p = 0.043), and parietal lobe ( ß = 0.265; p = 0.024) were significantly linked to higher plasma Aß1-42/Aß1-40 ratios, after above adjustments. CONCLUSION: BBB leakage is a common feature of DLB and possibly is even more severe than in the setting of AD for certain regions of the brain. BBB leakage appears to correlate with plasma Aß1-42/Aß1-40 ratio and dementia severity.

Comparison of golden-angle radial sparse parallel (GRASP) and conventional cartesian sampling in 3D dynamic contrast-enhanced mri for bladder cancer: a preliminary study.

PURPOSE: To compare the image quality, inter-reader agreement, and diagnostic capability for muscle-invasive bladder cancer (MIBC) of the reconstructed images in sections orthogonal to the bladder tumor obtained by 3D Dynamic contrast-enhanced (DCE)-MRI using the Golden-angle Radial Sparse Parallel (GRASP) technique with the images directly captured using the Cartesian sampling. MATERIALS AND METHODS: This study involved 68 initial cases of bladder cancer examined with DCE-MRI (GRASP: n = 34, Cartesian: n = 34) at 3 Tesla. Four radiologists conducted qualitative evaluations (overall image quality, absence of motion artifact, absence of streak artifact, and tumor conspicuity) using a five-point Likert scale (5 = Excellent/None) and quantitative signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements. The areas under the receiver-operating characteristic curves (AUCs) for the Vesical Imaging-Reporting and Data System (VI-RADS) DCE score for MIBC assessment were calculated. Inter-reader agreement was also assessed. RESULTS: GRASP notably enhanced overall image quality (pooled score: GRASP 4 vs. Cartesian 3, P < 0.0001), tumor conspicuity (5 vs. 3, P < 0.05), SNR (Median 38.2 vs. 19.0, P < 0.0001), and CNR (7.9 vs. 6.0, P = 0.005), with fewer motion artifacts (5 vs. 3, P < 0.0001) and minor streak artifacts (5 vs. 5, P > 0.05). Although no significant differences were observed, the GRASP group tended to have higher AUCs for MIBC (pooled AUCs: 0.92 vs. 0.88) and showed a trend toward higher inter-reader agreement (pooled kappa-value: 0.70 vs. 0.63) compared to the Cartesian group. CONCLUSIONS: Using the GRASP for 3D DCE-MRI, the reconstructed images in sections orthogonal to the bladder tumor achieved higher image quality and improve the clinical work flow, compared to the images directly captured using the Cartesian. GRASP tended to have higher diagnostic ability for MIBC and showed a trend toward higher inter-reader agreement compared to the Cartesian.

Preoperative prediction of microvascular invasion risk in hepatocellular carcinoma with MRI: peritumoral versus tumor region.

OBJECTIVES: To explore the predictive performance of tumor and multiple peritumoral regions on dynamic contrast-enhanced magnetic resonance imaging (MRI), to identify optimal regions of interest for developing a preoperative predictive model for the grade of microvascular invasion (MVI). METHODS: A total of 147 patients who were surgically diagnosed with hepatocellular carcinoma, and had a maximum tumor diameter ≤ 5 cm were recruited and subsequently divided into a training set (n = 117) and a testing set (n = 30) based on the date of surgery. We utilized a pre-trained AlexNet to extract deep learning features from seven different regions of the maximum transverse cross-section of tumors in various MRI sequence images. Subsequently, an extreme gradient boosting (XGBoost) classifier was employed to construct the MVI grade prediction model, with evaluation based on the area under the curve (AUC). RESULTS: The XGBoost classifier trained with data from the 20-mm peritumoral region showed superior AUC compared to the tumor region alone. AUC values consistently increased when utilizing data from 5-mm, 10-mm, and 20-mm peritumoral regions. Combining arterial and delayed-phase data yielded the highest predictive performance, with micro- and macro-average AUCs of 0.78 and 0.74, respectively. Integration of clinical data further improved AUCs values to 0.83 and 0.80. CONCLUSION: Compared with those of the tumor region, the deep learning features of the peritumoral region provide more important information for predicting the grade of MVI. Combining the tumor region and the 20-mm peritumoral region resulted in a relatively ideal and accurate region within which the grade of MVI can be predicted. CLINICAL RELEVANCE STATEMENT: The 20-mm peritumoral region holds more significance than the tumor region in predicting MVI grade. Deep learning features can indirectly predict MVI by extracting information from the tumor region and directly capturing MVI information from the peritumoral region. KEY POINTS: We investigated tumor and different peritumoral regions, as well as their fusion. MVI predominantly occurs in the peritumoral region, a superior predictor compared to the tumor region. The peritumoral 20 mm region is reasonable for accurately predicting the three-grade MVI.

Glioma Type Prediction with Dynamic Contrast-Enhanced MR Imaging and Diffusion Kurtosis Imaging-A Standardized Multicenter Study.

The aim was to explore the performance of dynamic contrast-enhanced (DCE) MRI and diffusion kurtosis imaging (DKI) in differentiating the molecular subtypes of adult-type gliomas. A multicenter MRI study with standardized imaging protocols, including DCE-MRI and DKI data of 81 patients with WHO grade 2-4 gliomas, was performed at six centers. The DCE-MRI and DKI parameter values were quantitatively evaluated in ROIs in tumor tissue and contralateral normal-appearing white matter. Binary logistic regression analyses were performed to differentiate between high-grade (HGG) vs. low-grade gliomas (LGG), IDH1/2 wildtype vs. mutated gliomas, and high-grade astrocytic tumors vs. high-grade oligodendrogliomas. Receiver operating characteristic (ROC) curves were generated for each parameter and for the regression models to determine the area under the curve (AUC), sensitivity, and specificity. Significant differences between tumor groups were found in the DCE-MRI and DKI parameters. A combination of DCE-MRI and DKI parameters revealed the best prediction of HGG vs. LGG (AUC = 0.954 (0.900-1.000)), IDH1/2 wildtype vs. mutated gliomas (AUC = 0.802 (0.702-0.903)), and astrocytomas/glioblastomas vs. oligodendrogliomas (AUC = 0.806 (0.700-0.912)) with the lowest Akaike information criterion. The combination of DCE-MRI and DKI seems helpful in predicting glioma types according to the 2021 World Health Organization's (WHO) classification.

The value of diffusion kurtosis imaging and dynamic contrast-enhanced magnetic resonance imaging in the differential diagnosis of parotid gland tumors.

Background: Parotid gland tumors (PGTs) are the most common benign tumors of salivary gland tumors. However, the diagnostic value of relative values of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion kurtosis imaging (DKI) parameters for PGTs has not been extensively studied. Therefore, this study aimed to evaluate the diagnostic performance of combined DKI and DCE-MRI for differentiating PGTs by introducing the concept of relative value. Methods: The DCE-MRI and DKI imaging data of 142 patients with PGTs between June 2018 and August 2022 were collected. Patients were divided into four groups by histopathology: malignant tumors (MTs), pleomorphic adenomas (PAs), Warthin tumors (WTs), and basal cell adenomas (BCAs). All MRI examinations were conducted using a 3 T MRI scanner with a 20-channel head and neck coil. Quantitative parameters of DCE-MRI and DKI and their relative values were determined. Kruskal-Wallis H test, post-hoc test with Bonferroni correction, one-way analysis of variance (ANOVA) and post-hoc test with least significant difference (LSD) method, and the receiver operating characteristic (ROC) curve were used for statistical analysis. Statistical significance was set at P<0.05. Results: Only the combination of DKI and DCE-MRI parameters could reliably distinguish BCAs from other PGTs. PAs demonstrated the lowest transfer constant from plasma to extravascular extracellular space (Ktrans) value [0.09 (0.06, 0.20) min-1], relative Ktrans (rKtrans) [-0.24 (-0.64, 1.00)], rate constant from extravascular extracellular space to plasma (Kep) value [0.32 (0.22, 0.53) min-1], relative Kep (rKep) [0.32 (0.22, 0.53) min-1], and initial area under curve (iAUC) value [0.15 (0.09, 0.26) mmol·s/kg] compared with WTs, BCAs, and MTs (all P<0.05). The Ktrans values for MTs were substantially lower [0.17 (0.10, 0.31) min-1] than those for WTs (P=0.01). The Kep values for MTs [0.71 (0.52, 1.28) min-1] were substantially lower (all P<0.05) than those for WTs and BCAs. PAs and BCAs had higher diffusion coefficient (D) values and lower diffusion kurtosis (K) values and relative K (rK) values than MTs and WTs. However, the D and K values did not differ significantly even in their relative values of PAs and BCAs (all P>0.05). By using logistic regression, the combination of K value and rKep value further enhanced their discriminatory power between PAs and WTs [area under the ROC curve (AUC), 0.986], the combination of K and rKep value further enhanced their discriminatory power between PAs and MTs (AUC, 0.915), and the combination of D and Kep value further enhanced their discriminatory power between BCAs and MTs (AUC, 0.909). Conclusions: DKI and DCE-MRI can be used to differentiate PGTs quantitatively and can complement each other. The combined use of DKI and DCE-MRI parameters can improve the diagnostic accuracy of distinguishing PGTs.

Dynamic contrast-enhanced and diffusion-weighted MRI of cervical carcinoma: Correlations with Ki-67 proliferation status.

OBJECTIVES: To investigate the association of quantitative parameter (apparent diffusion coefficient [ADC]) from diffusion-weighted imaging (DWI) and various quantitative and semiquantitative parameters from dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with Ki-67 proliferation index (PI) in cervical carcinoma (CC). METHODS: A total of 102 individuals with CC who received 3.0 T MRI examination (DWI and DCE MRI) between October 2016 and December 2022 were enrolled in our investigation. Two radiologists separately assessed the ADC parameter and various quantitative and semiquantitative parameters including (volume transfer constant [Ktrans], rate constant [kep], extravascular extracellular space volume fraction [ve], volume fraction of plasma [vp], time to peak [TTP], maximum concentration [MaxCon], maximal slope [MaxSlope] and area under curve [AUC]) for each tumor. Their association with Ki-67 PI was analyzed by Spearman association analysis. The discrepancy between low-proliferation and high-proliferation groups was subsequently analyzed. The receiver operating characteristic (ROC) curve analysis utilized to identify optimal cut-off points for significant parameters. RESULTS: Both ADC (ρ = -0.457, p < 0.001) and Ktrans (ρ = -0.467, p < 0.001) indicated a strong negative association with Ki-67 PI. Ki-67 PI showed positive correlations with TTP, MaxCon, MaxSlope and AUC (ρ = 0.202, 0.231, 0.309, 0.235, respectively; all p values<0.05). Compared with the low-proliferation group, high-Ki-67 group presented a significantly lower ADC (0.869 ± 0.125 × 10-3 mm2/s vs. 1.149 ± 0.318 × 10-3 mm2/s; p < 0.001) and Ktrans (1.314 ± 1.162 min-1vs. 0.391 ± 0.390 min-1; p < 0.001), also significantly higher MaxCon values (0.756 ± 0.959 vs. 0.422 ± 0.341; p < 0.05) and AUC values (2.373 ± 3.012 vs. 1.273 ± 1.000; p < 0.05). The cut-offs of ADC, Ktrans, MaxCon and AUC for discrimating low- and high-Ki-67 groups were 0.920 × 10-3 mm2/s, 0.304 min-1, 0.209 and 1.918, respectively. CONCLUSIONS: ADC, Ktrans, TTP, MaxCon, MaxSlope and AUC are associated with Ki-67 PI. ADC and Ktrans exhibited high performance to discriminate low and high Ki-67 status of CC.

Radiomics-based analysis of dynamic contrast-enhanced magnetic resonance image: A prediction nomogram for lymphovascular invasion in breast cancer.

OBJECTIVE: To develop and validate a nomogram for quantitively predicting lymphovascular invasion (LVI) of breast cancer (BC) based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) radiomics and morphological features. METHODS: We retrospectively divided 238 patients with BC into training and validation cohorts. Radiomic features from DCE-MRI were subdivided into A1 and A2, representing the first and second post-contrast images respectively. We utilized the minimal redundancy maximal relevance filter to extract radiomic features, then we employed the least absolute shrinkage and selection operator regression to screen these features and calculate individualized radiomics score (Rad score). Through the application of multivariate logistic regression, we built a prediction nomogram that integrated DCE-MRI radiomics and MR morphological features (MR-MF). The diagnostic capabilities were evaluated by comparing C-indices and calibration curves. RESULTS: The diagnostic efficiency of the A1/A2 radiomics model surpassed that of the A1 and A2 alone. Furthermore, we incorporated the MR-MF (diffusion-weighted imaging rim sign, peritumoral edema) and optimized Radiomics into a hybrid nomogram. The C-indices for the training and validation cohorts were 0.868 (95% CI: 0.839-0.898) and 0.847 (95% CI: 0.787-0.907), respectively, indicating a good level of discrimination. Moreover, the calibration plots demonstrated excellent agreement in the training and validation cohorts, confirming the effectiveness of the calibration. CONCLUSION: This nomogram combined MR-MF and A1/A2 Radiomics has the potential to preoperatively predict LVI in patients with BC.

Radiogenomics nomogram based on MRI and microRNAs to predict microvascular invasion of hepatocellular carcinoma.

Purpose: This study aimed to develop and validate a radiogenomics nomogram for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC) on the basis of MRI and microRNAs (miRNAs). Materials and methods: This cohort study included 168 patients (training cohort: n = 116; validation cohort: n = 52) with pathologically confirmed HCC, who underwent preoperative MRI and plasma miRNA examination. Univariate and multivariate logistic regressions were used to identify independent risk factors associated with MVI. These risk factors were used to produce a nomogram. The performance of the nomogram was evaluated by receiver operating characteristic curve (ROC) analysis, sensitivity, specificity, accuracy, and F1-score. Decision curve analysis was performed to determine whether the nomogram was clinically useful. Results: The independent risk factors for MVI were maximum tumor length, rad-score, and miRNA-21 (all P < 0.001). The sensitivity, specificity, accuracy, and F1-score of the nomogram in the validation cohort were 0.970, 0.722, 0.884, and 0.916, respectively. The AUC of the nomogram was 0.900 (95% CI: 0.808-0.992) in the validation cohort, higher than that of any other single factor model (maximum tumor length, rad-score, and miRNA-21). Conclusion: The radiogenomics nomogram shows satisfactory predictive performance in predicting MVI in HCC and provides a feasible and practical reference for tumor treatment decisions.

Comparison of lung lesion assessment using free-breathing dynamic contrast-enhanced 1.5-T MRI with a golden-angle radial stack-of-stars VIBE sequence and CT.

BACKGROUND: Few studies have investigated the feasibility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using a free-breathing golden-angle radial stack-of-stars volume-interpolated breath-hold examination (FB radial VIBE) sequence in the lung. PURPOSE: To investigate whether DCE-MRI using the FB radial VIBE sequence can assess morphological and kinetic parameters in patients with pulmonary lesions, with computed tomography (CT) as the reference. MATERIAL AND METHODS: In total, 43 patients (30 men; mean age = 64 years) with one lesion each were prospectively enrolled. Morphological and kinetic features on MRI were calculated. The diagnostic performance of morphological MR features was evaluated using a receiver operating characteristic (ROC) curve. Kinetic features were compared among subgroups based on histopathological subtype, lesion size, and lymph node metastasis. RESULTS: The maximum diameter was not significantly different between CT and MRI (3.66 ± 1.62 cm vs. 3.64 ± 1.72 cm; P = 0.663). Spiculation, lobulation, cavitation or bubble-like areas of low attenuation, and lymph node enlargement had an area under the ROC curve (AUC) >0.9, while pleural indentation yielded an AUC of 0.788. The lung cancer group had significantly lower Ktrans, Ve, and initial AUC values than the other cause inflammation group (0.203, 0.158, and 0.589 vs. 0.597, 0.385, and 1.626; P < 0.05) but significantly higher values than the tuberculosis group (P < 0.05). CONCLUSION: Morphology features derived from FB radial VIBE have high correlations with CT, and kinetic analyses show significant differences between benign and malignant lesions. DCE-MRI with FB radial VIBE could serve as a complementary quantification tool to CT for radiation-free assessments of lung lesions.

Detail-preserving image warping by enforcing smooth image sampling.

Multi-phase dynamic contrast-enhanced magnetic resonance imaging image registration makes a substantial contribution to medical image analysis. However, existing methods (e.g., VoxelMorph, CycleMorph) often encounter the problem of image information misalignment in deformable registration tasks, posing challenges to the practical application. To address this issue, we propose a novel smooth image sampling method to align full organic information to realize detail-preserving image warping. In this paper, we clarify that the phenomenon about image information mismatch is attributed to imbalanced sampling. Then, a sampling frequency map constructed by sampling frequency estimators is utilized to instruct smooth sampling by reducing the spatial gradient and discrepancy between all-ones matrix and sampling frequency map. In addition, our estimator determines the sampling frequency of a grid voxel in the moving image by aggregating the sum of interpolation weights from warped non-grid sampling points in its vicinity and vectorially constructs sampling frequency map through projection and scatteration. We evaluate the effectiveness of our approach through experiments on two in-house datasets. The results showcase that our method preserves nearly complete details with ideal registration accuracy compared with several state-of-the-art registration methods. Additionally, our method exhibits a statistically significant difference in the regularity of the registration field compared to other methods, at a significance level of p < 0.05. Our code will be released at https://github.com/QingRui-Sha/SFM.

Predicting disease recurrence in breast cancer patients using machine learning models with clinical and radiomic characteristics: a retrospective study.

BACKGROUND: The goal is to use three different machine learning models to predict the recurrence of breast cancer across a very heterogeneous sample of patients with varying disease kinds and stages. METHODS: A heterogeneous group of patients with varying cancer kinds and stages, including both triple-negative breast cancer (TNBC) and non-triple-negative breast cancer (non-TNBC), was examined. Three distinct models were created using the following five machine learning techniques: Adaptive Boosting (AdaBoost), Random Under-sampling Boosting (RUSBoost), Extreme Gradient Boosting (XGBoost), support vector machines (SVM), and Logistic Regression. The clinical model used both clinical and pathology data in conjunction with the machine learning algorithms. The machine learning algorithms were combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) imaging characteristics in the radiomic model, and the merged model combined the two types of data. Each technique was evaluated using several criteria, including the receiver operating characteristic (ROC) curve, precision, recall, and F1 score. RESULTS: The results suggest that the integration of clinical and radiomic data improves the predictive accuracy in identifying instances of breast cancer recurrence. The XGBoost algorithm is widely recognized as the most effective algorithm in terms of performance. CONCLUSION: The findings presented in this study offer significant contributions to the field of breast cancer research, particularly in relation to the prediction of cancer recurrence. These insights hold great potential for informing future investigations and clinical interventions that seek to enhance the accuracy and effectiveness of recurrence prediction in breast cancer patients.

Fibrosarcomatous Transformation in Dermatofibrosarcoma Protuberans of the Male Breast and its Association with Magnetic Resonance Imaging and Immunohistopathologic Features.

BACKGROUND: Dermatofibrosarcoma Protuberans (DFSP) is a rare soft tissue sarcoma, accounting for approximately 1% of all tumors; however, DFSP of the breast is extremely rare. Moreover, DFSP generally has a low malignant potential and is characterized by a high rate of local recurrence along with a small but definite risk of metastasis. The risk of metastasis is higher in fibrosarcomatous transformation in DFSP than in ordinary DFSP. CASE REPORT: We have, herein, reported a case of a 61-year-old male patient with fibrosarcomatous transformation in DFSP. Preoperative Dynamic Contrastenhanced Magnetic Resonance Imaging (DCE-MRI) of the breast revealed an oval-shaped mass with heterogeneous internal enhancement, a large vessel embedded within, and a washout curve pattern on kinetic curve analysis. The mass exhibited a hyperintense signal on Diffusion-weighted Imaging (DWI), with a low apparent diffusion coefficient value. Histologically, the bland spindle tumor cells were arranged in a storiform pattern. Areas with the highest histological grade demonstrated increased cellularity, cytological atypia, and mitotic activity. Immunohistochemically, Ki-67 and p53 were highly expressed. CONCLUSION: Recognizing the risk and accurately diagnosing fibrosarcomatous transformation in male breast DFSP are critical for improving prognosis and establishing appropriate treatment and follow-up plans. This emphasizes the significance of combining immunohistopathological features with DCE-MRI and DWI to assist clinicians in the early and accurate diagnosis of sarcomas arising from male breast DFSP.

Reproducibility and reliability of pancreatic pharmacokinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging.

BACKGROUND: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with an extended Tofts linear (ETL) model for tissue and tumor evaluation has been established, but its effectiveness in evaluating the pancreas remains uncertain. PURPOSE: To understand the pharmacokinetics of normal pancreas and serve as a reference for future studies of pancreatic diseases. MATERIAL AND METHODS: Pancreatic pharmacokinetic parameters of 54 volunteers were calculated using DCE-MRI with the ETL model. First, intra- and inter-observer reliability was assessed through the use of the intra-class correlation coefficient (ICC) and coefficient of variation (CoV). Second, a subgroup analysis of the pancreatic DCE-MRI pharmacokinetic parameters was carried out by dividing the 54 individuals into three groups based on the pancreatic region, three groups based on age, and two groups based on sex. RESULTS: There was excellent agreement and low variability of intra- and inter-observer to pancreatic DCE-MRI pharmacokinetic parameters. The intra- and inter-observer ICCs of Ktrans, kep, ve, and vp were 0.971, 0.952, 0.959, 0.944 and 0.947, 0.911, 0.978, 0.917, respectively. The intra- and inter-observer CoVs of Ktrans, kep, ve, vp were 9.98%, 5.99%, 6.47%, 4.76% and 10.15%, 5.22%, 6.28%, 5.40%, respectively. Only the pancreatic ve of the older group was higher than that of the young and middle-aged groups (P = 0.042, 0.001), and the vp of the pancreatic head was higher than that of the pancreatic body and tail (P = 0.014, 0.043). CONCLUSION: The application of DCE-MRI with an ETL model provides a reliable, robust, and reproducible means of non-invasively quantifying pancreatic pharmacokinetic parameters.

Development and Validation of a Nomogram Based on DCE-MRI Radiomics for Predicting Hypoxia-Inducible Factor 1α Expression in Locally Advanced Rectal Cancer.

RATIONALE AND OBJECTIVES: The expression levels of hypoxia-inducible factor 1 alpha (HIF-1α) have been identified as a pivotal marker, correlating with treatment response in patients with locally advanced rectal cancer (LARC). This study aimed to develop and validate a nomogram based on dynamic contrast-enhanced MRI (DCE-MRI) radiomics and clinical features for predicting the expression of HIF-1α in patients with LARC. MATERIALS AND METHODS: A total of 102 patients diagnosed with locally advanced rectal cancer were divided into training (n = 71) and validation (n = 31) cohorts. The expression statuses of HIF-1α were histopathologically classified, categorizing patients into high and low expression groups. The intraclass correlation coefficient (ICC), minimum redundancy maximum relevance (mRMR), and the least absolute shrinkage and selection operator (LASSO) were employed for feature selection to construct a radiomics signature and calculate the radiomics score (Rad-score). Univariate and multivariate analyses of clinical features and Rad-score were applied, and the clinical model and the nomogram were constructed. The predictive performance of the nomogram incorporating clinical features and Rad-score was assessed using Receiver Operating Characteristics (ROC) curves, decision curve analysis (DCA), and calibration curves. RESULTS: Seven radiomics features from DCE-MRI were used to build the radiomics signature. The nomogram incorporating CEA, Ki-67 and Rad-score had the highest AUC values in the training cohort and in the validation cohort (AUC: 0.918 and 0.920). Decision curve analysis showed that the nomogram outperformed the clinical model and radiomics signature in terms of clinical utility. In addition, the calibration curve for the nomogram demonstrated good agreement between prediction and actual observation. CONCLUSION: The nomogram based on DCE-MRI radiomics and clinical features showed favorable predictive efficacy and might be useful for preoperatively discriminating the expression of HIF-1α.

Fully automatic quantification for hand synovitis in rheumatoid arthritis using pixel-classification-based segmentation network in DCE-MRI.

PURPOSE: A classification-based segmentation method is proposed to quantify synovium in rheumatoid arthritis (RA) patients using a deep learning (DL) method based on time-intensity curve (TIC) analysis in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS: This retrospective study analyzed a hand MR dataset of 28 RA patients (six males, mean age 53.7 years). A researcher, under expert guidance, used in-house software to delineate regions of interest (ROIs) for hand muscles, bones, and synovitis, generating a dataset with 27,255 pixels with corresponding TICs (muscle: 11,413, bone: 8502, synovitis: 7340). One experienced musculoskeletal radiologist performed ground truth segmentation of enhanced pannus in the joint bounding box on the 10th DCE phase, or around 5 min after contrast injection. Data preprocessing included median filtering for noise reduction, phase-only correlation algorithm for motion correction, and contrast-limited adaptive histogram equalization for improved image contrast and noise suppression. TIC intensity values were normalized using zero-mean normalization. A DL model with dilated causal convolution and SELU activation function was developed for enhanced pannus segmentation, tested using leave-one-out cross-validation. RESULTS: 407 joint bounding boxes were manually segmented, with 129 synovitis masks. On the pixel-based level, the DL model achieved sensitivity of 85%, specificity of 98%, accuracy of 99% and precision of 84% for enhanced pannus segmentation, with a mean Dice score of 0.73. The false-positive rate for predicting cases without synovitis was 0.8%. DL-measured enhanced pannus volume strongly correlated with ground truth at both pixel-based (r = 0.87, p < 0.001) and patient-based levels (r = 0.84, p < 0.001). Bland-Altman analysis showed the mean difference for hand joints at the pixel-based and patient-based levels were -9.46 mm3 and -50.87 mm3, respectively. CONCLUSION: Our DL-based DCE-MRI TIC shape analysis has the potential for automatic segmentation and quantification of enhanced synovium in the hands of RA patients.

Machine learning models based on quantitative dynamic contrast-enhanced MRI parameters assess the expression levels of CD3+, CD4+, and CD8+ tumor-infiltrating lymphocytes in advanced gastric carcinoma.

Objective: To explore the effectiveness of machine learning classifiers based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the expression levels of CD3+, CD4+, and CD8+ tumor-infiltrating lymphocytes (TILs) in patients with advanced gastric cancer (AGC). Methods: This study investigated 103 patients with confirmed AGC through DCE-MRI and immunohistochemical staining. Immunohistochemical staining was used to evaluate CD3+, CD4+, and CD8+ T-cell expression. Utilizing Omni Kinetics software, radiomics features (Ktrans, Kep, and Ve) were extracted and underwent selection via variance threshold, SelectKBest, and LASSO methods. Logistic regression (LR), support vector machine (SVM), random forest (RF), and eXtreme Gradient Boosting (XGBoost) are the four classifiers used to build four machine learning (ML) models, and their performance was evaluated using 10-fold cross-validation. The model's performance was evaluated and compared using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. Results: In terms of CD3+, CD4+, and CD8+ T lymphocyte prediction models, the random forest model outperformed the other classifier models in terms of CD4+ and CD8+ T cell prediction, with AUCs of 0.913 and 0.970 on the training set and 0.904 and 0.908 on the validation set, respectively. In terms of CD3+ T cell prediction, the logistic regression model fared the best, with AUCs on the training and validation sets of 0.872 and 0.817, respectively. Conclusion: Machine learning classifiers based on DCE-MRI have the potential to accurately predict CD3+, CD4+, and CD8+ tumor-infiltrating lymphocyte expression levels in patients with AGC.

Correlation of MRI quantitative perfusion parameters with EGFR, VEGF and EGFR gene mutations in non-small cell cancer.

To explore the relationship between quantitative perfusion histogram parameters of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) with the expression of tumor tissue epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and EGFR gene mutations in non-small cell lung cancer (NSCLC). A total of 44 consecutive patients with known NSCLC were recruited from March 2018 to August 2021. Histogram parameters (mean, uniformity, skewness, energy, kurtosis, entropy, percentile) of each (Ktrans, Kep, Ve, Vp, Fp) were obtained by Omni Kinetics software. Immunohistochemistry staining was used in the detection of the expression of VEGF and EGFR protein, and the mutation of EGFR gene was detected by PCR. Corresponding statistical test was performed to compare the parameters and protein expression between squamous cell carcinoma (SCC) and adenocarcinoma (AC), as well as EGFR mutations and wild-type. Correlation analysis was used to evaluate the correlation between parameters with the expression of VEGF and EGFR protein. Fp (skewness, kurtosis, energy) were statistically significant between SCC and AC, and the area under the ROC curve were 0.733, 0.700 and 0.675, respectively. The expression of VEGF in AC was higher than in SCC. Fp (skewness, kurtosis, energy) were negatively correlated with VEGF (r = - 0.527, - 0.428, - 0.342); Ktrans (Q50) was positively correlated with VEGF (r = 0.32); Kep (energy), Ktrans (skewness, kurtosis) were positively correlated with EGFR (r = 0.622, r = 0.375, 0.358), some histogram parameters of Kep, Ktrans (uniformity, entropy) and Ve (kurtosis) were negatively correlated with EGFR (r = - 0.312 to - 0.644). Some perfusion histogram parameters were statistically significant between EGFR mutations and wild-type, they were higher in wild-type than mutated (P < 0.05). Quantitative perfusion histogram parameters of DCE-MRI have a certain value in the differential diagnosis of NSCLC, which have the potential to non-invasively evaluate the expression of cell signaling pathway-related protein.

Deconvolution-Based Pharmacokinetic Analysis to Improve the Prediction of Pathological Information of Breast Cancer.

Pharmacokinetic (PK) parameters, revealing changes in the tumor microenvironment, are related to the pathological information of breast cancer. Tracer kinetic models (e.g., Tofts-Kety model) with a nonlinear least square solver are commonly used to estimate PK parameters. However, the method is sensitive to noise in images. To relieve the effects of noise, a deconvolution (DEC) method, which was validated on synthetic concentration-time series, was proposed to accurately calculate PK parameters from breast dynamic contrast-enhanced magnetic resonance imaging. A time-to-peak-based tumor partitioning method was used to divide the whole tumor into three tumor subregions with different kinetic patterns. Radiomic features were calculated from the tumor subregion and whole tumor-based PK parameter maps. The optimal features determined by the fivefold cross-validation method were used to build random forest classifiers to predict molecular subtypes, Ki-67, and tumor grade. The diagnostic performance evaluated by the area under the receiver operating characteristic curve (AUC) was compared between the subregion and whole tumor-based PK parameters. The results showed that the DEC method obtained more accurate PK parameters than the Tofts method. Moreover, the results showed that the subregion-based Ktrans (best AUCs = 0.8319, 0.7032, 0.7132, 0.7490, 0.8074, and 0.6950) achieved a better diagnostic performance than the whole tumor-based Ktrans (AUCs = 0.8222, 0.6970, 0.6511, 0.7109, 0.7620, and 0.5894) for molecular subtypes, Ki-67, and tumor grade. These findings indicate that DEC-based Ktrans in the subregion has the potential to accurately predict molecular subtypes, Ki-67, and tumor grade.