Correlation between late gadolinium enhancement sequences in MRI and pathologic response after neoadjuvant chemotherapy in breast cancer / Correlación entre secuencias de realce tardío de gadolinio en RM y respuesta patológica tras quimioterapia neoadyuvante en cáncer de mama

Objectives: To study the correlation between radiologic response observed by late enhancement sequences in MRI and pathologic response after neoadjuvant chemotherapy in patients with breast cancer. Material and methods: Retrospective observational study of 132 patients with 136 tumors (4 with bilateral disease), treated consecutively with neoadjuvant chemotherapy at our institution between 2011 and 2017. In all cases, we performed 3 breast MRI's, using late enhancement gadolinium sequences: the first prior to neoadjuvant chemotherapy, the second half way through treatment, and the third at the completion of therapy. Following treatment, contrast medium uptake in tumor bed was evaluated based on the Response Evaluation Criteria for Solid Tumors (RECIST). All patients underwent conservative or radical surgery. We compared the radiologic response estimated by MRI, with the pathologic response observed in the surgical specimen, according to Miller and Payne grading system. We calculated the sensitivity, specificity, and predictive values of the test, and used the Spearman correlation coefficient to stablish correlations between the parameters analyzed. Results: Complete pathologic response (pCR) was observed in 58.1% (79/136). The percentage of global radio-pathologic correlation was 88.97%. MRI showed a sensitivity of 78.9%, a specificity of 79.7%, a positive-predictive value (PPV) of 73.8% and a negative-predictive value (NPV) of 84%. In patients with partial response, the Spearman correlation was positive (rho = 1, P < .001). According to surrogate subtypes of breast cancer, we observed moderate correlation for luminal tumors (rho = 0.63, P < .001) and poor correlation for non-luminal types (rho = 0,4, P < .01). (AU)

Objetivos: Estudiar la correlación entre la respuesta radiológica observada mediante secuencias de realce tardío en resonancia magnética y la respuesta patológica después de quimioterapia neoadyuvante en pacientes con cáncer de mama. Material y métodos: Estudio observacional retrospectivo de 132 pacientes con 136 tumores (cuatro con enfermedad bilateral), tratados consecutivamente con quimioterapia neoadyuvante en nuestra Institución entre 2011 y 2017. En todos los casos se realizaron tres resonancias magnéticas de mama, utilizando secuencias de realce tardío de gadolinio: la primera antes de la quimioterapia neoadyuvante, la segunda a mitad del tratamiento y la tercera al finalizar la terapia. Después del tratamiento, la captación media de contraste en el lecho tumoral se evaluó en función de los Criterios de Evaluación de la Respuesta para Tumores Sólidos (RECIST). Todas las pacientes se sometieron a cirugía conservadora o radical. Comparamos la respuesta radiológica estimada por resonancia magnética, con la respuesta patológica observada en la pieza quirúrgica, valorada según clasificación de Miller y Payne. Se calcularon sensibilidad, especificidad, valores predictivos y correlacion de Spearman para establecer correlaciones entre los parametros analizados. Resultados: Se observó respuesta patológica completa (pCR) en el 58,1% (79/136). El porcentaje de correlación radiopatológica global fue del 88,97%. La RM mostró una sensibilidad del 78,9%, una especificidad del 79,7%, un valor predictivo positivo (VPP) del 73,8% y un valor predictivo negativo (VAN) del 84%. En pacientes con respuesta parcial, la correlación de Spearman fue positiva (rho = 1, p < 0,001). De acuerdo con los tipos subrogados de cáncer de mama, observamos una correlación moderada para los tumores luminales (rho = 0,63, p < 0,001) y una correlación deficiente para los tipos no luminales (rho = 0,4, p < 0,01). (AU)

White-Matter Lesions and Cortical Cerebral Blood Flow Evaluation by 3D Arterial Spin-Labeled Perfusion MRI in Asymptomatic Divers: Correlation with Patent Foramen Ovale Ocurrence.

Cerebral white-matter lesions (cWML) can be caused by dilation of Virchow-Robin spaces or may correspond to true lacunar ischemic lesions. The aim of our study was to evaluate in asymptomatic divers the relationship between the presence of patent foramen ovale (PFO) and cWML, as well as their possible effects on cortical cerebral blood flow (CBF) by magnetic resonance (MRI) through the arterial spin labeling (ASL) sequence. Transthoracic echocardiography was performed for the identification of PFO, and cerebral magnetic resonance including the 3D-ASL sequence for CBF quantification. Thirty-eight divers, with a mean age 45.8 ± 8.6 years, were included. Nineteen healthy volunteers, mean age 41 ± 15.2 years, served as the control group. A total of 28.9% of divers had completed more than 1000 dives. It was found that 26.3% of divers presented with PFO in the echocardiographic study. cWML was evidenced in 10.5% of diver MRI studies. There was no statistically significant relationship between the presence of PFO and cWML (p = 0.95). We observed a lower blood flow in all brain areas assessed by the 3D-ASL sequence in the group of divers, compared with the control group. We did not find statistical differences in CBF as a function of the presence or absence of PFO, number of dives, or cWML evidence.

Comparative Cardiac Magnetic Resonance-Based Feature Tracking and Deep-Learning Strain Assessment in Patients Hospitalized for Acute Myocarditis.

This study sought to examine the correlation between left ventricular (LV) myocardial feature tracking (FT) and deep learning-based strain (DLS) analysis in the diagnostic (CMRd) and follow-up (CMRf) cardiac magnetic resonance imaging of patients with acute myocarditis. The retrospective study included 17 patients with acute myocarditis and 20 healthy controls. The CMRd took place within 14 days of symptom onset, while the CMRf took place at least 2 months after the event. The global-circumferential FT (FTc) and global-circumferential DLS (DLSc) were analyzed. The continuous variables were compared using paired t-tests or the Wilcoxon test, whereas Pearson's test or Spearman's test was used to evaluate the correlation between the continuous variables. The time between the CMRd and CMRf was 5 months [3-11]. The LV ejection fraction (LVEF) was 55 ± 6 and 59 ± 4%, p = 0.008, respectively, and 94.1% of the patients showed late gadolinium enhancement (LGE) and myocardial edema on the CMRd. Significantly lower FTc (-16.1 ± 2.2% vs. -18.9 ± 1.9%, p = 0.001) and DLSc (-38.1 ± 5.2% vs. -41.3 ± 4.5%, p = 0.015) were observed with respect to the controls. Significant increases in the FTc (-16.1 ± 2.2 vs. -17.5 ± 1.9%, p = 0.016) and DLSc (-38.1 ± 5.2 vs. -39.8 ± 3.9%, p = 0.049) were found between the CMRd and CMRf, which were unrelated to the LGE. The LVEF correlated well with the FTc (r = 0.840) and DLSc (r = 0.760). Both techniques had excellent reproducibility, with high intra- (FTc = 0.980, DLSc = 1.000) and inter-observer (FTc = 0.970, DLSc = 0.980) correlation. There was correlation between the LV DLSc/FTc and LVEF in the patients with acute myocarditis according to the CMRd and CMRf.

4D-Flow Cardiac Magnetic Resonance Imaging in Chronic Aortic Dissection Assessment: A Powerful Qualiquantitative Diagnostic Tool.

4-dimensional-flow cardiac magnetic resonance in patients with aortic dissection in chronic/post repair phase as a complementary diagnostic tool for anatomic-functional evaluation. Quali-quantitative analysis of 3 patients with this pathology clearly showing the true/false lumen, quantitative flow in false lumen, and helping in discerning lumen origin from different arterial vessels. (Level of Difficulty: Advanced.).

A papillary fibroelastoma with myxoma camouflage: a case report.

Background: Benign cardiac tumours are infrequent in clinical practice and, of these, cardiac myxoma is the one with the highest incidence. Given that a left intraventricular presentation is rare, other differential diagnoses such as papillary fibroelastoma should be considered. Case summary: A 73-year-old woman patient with cardiac mass detected in transthoracic echocardiography (TTE) after a transient ischaemic attack. At TTE 2D-3D, a left intraventricular mass anchored at the level of the anterolateral papillary muscle was detected. Subsequently, cardiac magnetic resonance (CMR) was performed for mass characterization. This revealed behaviour in T1 (isointense with respect to myocardium), T2 (hyperintense), very prolonged T1-mapping (1848 msg), and T2-mapping (161 msg) values, without gadolinium uptake in the first-pass perfusion sequence, but with intense uptake in late enhancement sequences. Previous findings were compatible with a diagnosis of papillary fibroelastoma. The mass was resected intraoperatively and, although its macroscopic appearance pointed to a diagnosis of cardiac myxoma, it was finally confirmed to be a papillary fibroelastoma by pathological anatomy. Discussion: In cases where the size of the mass and its mobility allow tissue characterization by CMR, a diagnosis of papillary fibroelastoma and its differentiation with cardiac myxoma are feasible by this cardiac imaging technique.

MRI for Evaluation of Complications of Breast Augmentation.

Breast augmentation is one of the most common aesthetic procedures performed in the United States. Several techniques of breast augmentation have been developed, including the implantation of breast prostheses and the injection of autologous fat and other materials. The most common method of breast augmentation is to implant a prosthesis. There are different types of breast implants that vary in shape, composition, and the number of lumina. The rupture of breast implants is the leading cause of implant removal. The rupture rate increases substantially with the increasing age of the implant. Most implant ruptures are asymptomatic. Implant complications can be grouped into two categories: local complications in the breast and adjacent soft tissue, and systemic complications associated with rheumatologic or neurologic symptoms. The onset of local complications may be early (infection and periprosthetic collections including seromas, hematomas, or abscesses) or late (capsular contraction, implant rupture, gel bleed, or breast implant-associated anaplastic large cell lymphoma). Although mammography is the imaging modality for breast cancer screening, noncontrast breast MRI is the imaging modality of choice for evaluation of the integrity of breast implants and the complications of breast augmentation, for equivocal findings at conventional imaging, and as a supplement to mammography in patients with free injectable materials. The fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) provides a systematic outline for MRI evaluation of patients with breast implants. Silicone- and water-selective sequences provide useful supplemental information to confirm intracapsular and extracapsular rupture. Breast MRI for evaluation of implant integrity does not require intravenous contrast material. The use of MRI contrast material in patients with breast augmentation is indicated when infection or malignancy is suspected. Radiologists should have a thorough understanding of the different techniques for breast augmentation, normal imaging features, and complications specific to breast augmentation. An invited commentary by Ojeda-Fournier is available online. ©RSNA, 2022.

Cardiac magnetic resonance in recovering COVID-19 patients. Feature tracking and mapping analysis to detect persistent myocardial involvement.

BACKGROUND: Post-COVID-19 patients may incur myocardial involvement secondary to systemic inflammation. Our aim was to detect possible oedema/diffuse fibrosis using cardiac magnetic resonance imaging (CMR) mapping and to study myocardial deformation of the left ventricle (LV) using feature tracking (FT). METHODS: Prospective analysis of consecutively recruited post-COVID-19 patients undergoing CMR. T1 and T2 mapping sequences were acquired and FT analysis was performed using 2D steady-state free precession cine sequences. Statistical significance was set to p < 0.05. RESULTS: Included were 57 post-COVID-19 patients and 20 healthy controls, mean age 59 ± 15 years, men 80.7%. The most frequent risk factors were hypertension (33.3%) and dyslipidaemia (36.8%). The contact-to-CMR interval was 81 ± 27 days. LV ejection fraction (LVEF) was 61 ± 10%. Late gadolinium enhancement (LGE) was evident in 26.3% of patients (19.3%, non-ischaemic). T2 mapping values (suggestive of oedema) were higher in the study patients than in the controls (50.9 ± 4.3 ms vs 48 ± 1.9 ms, p < 0.01). No between-group differences were observed for native T1 nor for circumferential strain (CS) or radial strain (RS) values (18.6 ± 3.3% vs 19.2 ± 2.1% (p = 0.52) and 32.3 ± 8.1% vs 33.6 ± 7.1% (p = 0.9), respectively). A sub-group analysis for the contact-to-CMR interval (<8 weeks vs ≥ 8 weeks) showed that FT-CS (15.6 ± 2.2% vs 18.9 ± 2.6%, p < 0.01) and FT-RS (24.9 ± 5.8 vs 33.5 ± 7.2%, p < 0.01) values were lower for the shorter interval. CONCLUSIONS: Post-COVID-19 patients compared to heathy controls had raised T2 values (related to oedema), but similar native T1, FT-CS and FT-RS values. FT-CS and FT-RS values were lower in post-COVID-19 patients undergoing CMR after < 8 weeks compared to ≥ 8 weeks.

Triglycerides and Residual Atherosclerotic Risk.

BACKGROUND: Even when low-density lipoprotein-cholesterol (LDL-C) levels are lower than guideline thresholds, a residual risk of atherosclerosis remains. It is unknown whether triglyceride (TG) levels are associated with subclinical atherosclerosis and vascular inflammation regardless of LDL-C. OBJECTIVES: This study sought to assess the association between serum TG levels and early atherosclerosis and vascular inflammation in apparently healthy individuals. METHODS: An observational, longitudinal, and prospective cohort study, including 3,754 middle-aged individuals with low to moderate cardiovascular risk from the PESA (Progression of Early Subclinical Atherosclerosis) study who were consecutively recruited between June 2010 and February 2014, was conducted. Peripheral atherosclerotic plaques were assessed by 2-dimensional vascular ultrasound, and coronary artery calcification (CAC) was assessed by noncontrast computed tomography, whereas vascular inflammation was assessed by fluorine-18 fluorodeoxyglucose uptake on positron emission tomography. RESULTS: Atherosclerotic plaques and CAC were observed in 58.0% and 16.8% of participants, respectively, whereas vascular inflammation was evident in 46.7% of evaluated participants. After multivariate adjustment, TG levels ≥150 mg/dl showed an association with subclinical noncoronary atherosclerosis (odds ratio [OR]: 1.35; 95% confidence interval [CI]: 1.08 to 1.68; p = 0.008). This association was significant for groups with high LDL-C (OR: 1.42; 95% CI: 1.11 to 1.80; p = 0.005) and normal LDL-C (OR: 1.85; 95% CI: 1.08 to 3.18; p = 0.008). No association was found between TG level and CAC score. TG levels ≥150 mg/dl were significantly associated with the presence of arterial inflammation (OR: 2.09; 95% CI: 1.29 to 3.40; p = 0.003). CONCLUSIONS: In individuals with low to moderate cardiovascular risk, hypertriglyceridemia was associated with subclinical atherosclerosis and vascular inflammation, even in participants with normal LDL-C levels. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).

Association Between Left Ventricular Noncompaction and Vigorous Physical Activity.

BACKGROUND: Left ventricular (LV) hypertrabeculation fulfilling noncompaction cardiomyopathy criteria has been detected in athletes. However, the association between LV noncompaction (LVNC) phenotype and vigorous physical activity (VPA) in the general population is disputed. OBJECTIVES: The aim of this study was to assess the relationship between LVNC phenotype on cardiac magnetic resonance (CMR) imaging and accelerometer-measured physical activity (PA) in a cohort of middle-aged nonathlete participants in the PESA (Progression of Early Subclinical Atherosclerosis) study. METHODS: In PESA participants (n = 4,184 subjects free of cardiovascular disease), PA was measured by waist-secured accelerometers. CMR was performed in 705 subjects (mean age 48 ± 4 years, 16% women). VPA was recorded as total minutes per week. The study population was divided into 6 groups: no VPA and 5 sex-specific quintiles of VPA rate (Q1 to Q5). The Petersen criterion for LVNC was evaluated in all subjects undergoing CMR. For participants meeting this criterion (noncompacted-to-compacted ratio ≥2.3), 3 more restrictive LVNC criteria were also evaluated (Jacquier, Grothoff, and Stacey). RESULTS: LVNC phenotype prevalence according to the Petersen criterion was significantly higher among participants in the highest VPA quintile (Q5 = 30.5%) than in participants with no VPA (14.2%). The Jacquier and Grothoff criteria were also more frequently fulfilled in participants in the highest VPA quintile (Jacquier Q5 = 27.4% vs. no VPA = 12.8% and Grothoff Q5 = 15.8% vs. no VPA = 7.1%). The prevalence of the systolic Stacey LVNC criterion was low (3.6%) and did not differ significantly between no VPA and Q5. CONCLUSIONS: In a community-based study, VPA was associated with a higher prevalence of CMR-detected LVNC phenotype according to diverse established criteria. The association between VPA and LVNC phenotype was independent of LV volumes. According to these data, vigorous recreational PA should be considered as a possible but not uncommon determinant of LV hypertrabeculation in asymptomatic subjects.

Evaluation of Cardiac Shunts With 4D Flow Cardiac Magnetic Resonance: Intra- and Interobserver Variability.

BACKGROUND: In the last decade, the capacity of magnetic resonance (MR) to evaluate congenital anomalies has improved substantially. To date, only a few studies have evaluated the value of 4D-flow MRI in shunt assessments. PURPOSE/HYPOTHESIS: To assess the intra- and interobserver variability of 4D-flow MRI in patients diagnosed with cardiac/extracardiac shunt. Secondarily, to assess the feasibility of directly measuring the shunt and to determine the prognostic correlation with the pulmonary-to-systemic (Qp/Qs) flow ratio. STUDY TYPE: Retrospective. POPULATION: In all, 18 patients with cardiac shunt diagnosis. FIELD STRENGTH/SEQUENCE: 1.5 T/4D phase-contrast MRI. ASSESSMENT: Pulmonary and systemic flows were measured at different locations to assess the internal consistency by two observers (twice by one, and once by the other). The Qp/Qs ratio was calculated. When feasible, direct flow was quantified by planimetry. STATISTICAL TESTS: Spearman's rho correlation coefficient was used to assess the relationship between pulmonary/systemic flows measured at different levels and to compare the jet characteristics with prognostic data as right ventricle volume. Intra- and interobserver variability were determined by Bland-Altman plots and interobserver correlation. RESULTS: The most common shunt type (n = 10; 55.5%) was ostium secundum atrial septal defect (ASD). Direct visualization and quantification of shunt flow was possible in all studies. Pulmonary and systemic flows showed a strong correlation between these measures (Spearman's rho [r] of 0.872 and 0.899). The mean Qp/Qs ratio was 1.61(0.62). Mean flow rate was 2.01(1.68) l/min. The mean jet diameter was 11.88 (5.44) mm. Intraobserver (r = 0.97) and interobserver correlation (ICC = 0.95) for the Qp/Qs calculation were both excellent. Direct measurement of flow was strongly correlated (r = 0.98; ICC = 0.95). Correlation was strong between Qp/Qs and direct jet flow (r = 0.76 and 0.77), Qp/Qs and mean jet diameter (r = 0.79 and 0.94), and Qp/Qs with jet area (r = 0.77 and 0.94). DATA CONCLUSION: Measurement of the Qp/Qs ratio and direct shunt quantification using 4D-flow MRI was feasible, and highly reproducible. Internal consistency was excellent, with low intra- and interobserver variability. Correlation between the Qp/Qs ratio, direct flow measurement, mean diameter, and jet area was strong. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2 J. Magn. Reson. Imaging 2020;52:1055-1063.

Neurovascular Relations of the Trigeminal Nerve in Asymptomatic Individuals Studied with High-Resolution Three-Dimensional Magnetic Resonance Imaging.

Neurovascular compression (NVC) is considered the main cause of classic trigeminal neuralgia (TN) and may be surgically addressed with microvascular decompression (MVD). Preoperative high-resolution three-dimensional magnetic resonance has proven a reliable tool to diagnose NVC in patients with refractory TN undergoing MVD. However, there is still scarce data regarding the rate, degree, and characteristics of neurovascular compression in asymptomatic individuals. This article describes the vascular relations of the trigeminal nerve in the cerebellopontine angle (CPA) in 100 subjects without known TN studied with 3.0T FIESTA (Fast Imaging Employing Steady-state Acquisition) MRI sequence. A NVC was observed in 142 (71%) of the 200 nerves with a 75% rate of bilateral NVC. Of the nerves with NVC, 92.3% showed a mere contact (Grade 1) without distortion and 78% occurred at the cisternal segment. This most common vessel causing the NVC was a vein (66%) followed by the superior cerebellar artery (28%). No significant reduction in diameter suggesting atrophy was seen in the nerves with NVC. The results indicate a high rate of mild, distal and predominantly venous vascular contact with the trigeminal nerve at the CPA in asymptomatic individuals. This clearly contrasts with the usual pattern of NVC observed in TN that is generally a severe, proximal, and arterial compression. Knowledge about the frequent NVC in asymptomatic individuals and its features is essential for interpreting preoperative MRI in patients with refractory classical TN considered for surgery. Anat Rec, 302:639-645, 2019. © 2018 Wiley Periodicals, Inc.

4D Flow Cardiovascular Magnetic Resonance Versus 3D Transesophageal Echocardiography in a Mitral Paravalvular Leak.

Three-dimensional transesophageal echocardiography and 4-dimensional flow magnetic resonance imaging as complementary techniques in the preoperative planning of a mitral paravalvular leak allow the evaluation of its location, shape, and size and qualitative-quantitative analysis of mitral regurgitant orifice. (Level of Difficulty: Intermediate.).

Ecografía automática de mama para la detección de lesiones mamarias: Comparación con la ecografía mamaria convencional / Automated breast ultrasound for the detection of breast lesions: comparison with hand-held ultrasound

Objetivos: Comparar la ecografía convencional frente a la ecografía automática de mama (ABUS) y la mamografía con tomosíntesis aislada en la detección y el diagnóstico de lesiones mamarias. Sujetos y métodos: Se incluyeron 155 mujeres sintomáticas y asintomáticas con mamas densas. Todas se realizaron mamografía y seguidamente ecografía manual y ABUS, que fueron interpretadas por 2 radiólogos diferentes. Los estudios fueron categorizados según el Breast Imaging Reporting and Data System (BI-RADS). Resultados: El índice kappa de concordancia fue de 0,83, p<0,05. Los 5 carcinomas encontrados fueron diagnosticados por ambas técnicas de imagen de ultrasonidos, siendo en 2 de ellos la mamografía normal. ABUS detectó 2 lesiones benignas no vistas con la ecografía manual. Conclusión: ABUS demostró alta correlación con la ecografía manual detectando más lesiones benignas. El diagnóstico de las malignas fue equivalente con ambas técnicas, que fueron superiores a la mamografía de forma aislada. ABUS podría sustituir a la ecografía manual para complementar a la mamografía en la detección de cáncer de mama en mujeres con mama densa

Objectives: To compare automated breast ultrasound (ABUS) with hand-held ultrasound (HHUS) and tomosynthesis mammography in the detection and characterisation of breast lesions. Subjects and methods: A total of 155 symptomatic and asymptomatic women with dense breasts underwent tomosynthesis followed by ABUS and HHUS. The studies were read and graded by two different radiologists according to the Breast Imaging Reporting and Data System (BI-RADS). Results: The kappa index of agreement was 0.83, p<0.05. All of the 5 carcinomas found were diagnosed by ABUS and HHUS. Tomosynthesis was normal in 2 out of 5 cases. ABUS identified 2 benign lesions not detected with HHUS. Conclusion: This study found a high correlation between ABUS and HHUS. More benign lesions were identified by ABUS while malignant lesions were detected equally by both techniques. ABUS and HHUS were superior to tomosynthesis in the detection of lesions. ABUS could replace HHUS, complementing mammography in the detection of lesions in women with dense breasts