Chang Kyung Lee

Prostate Cancer Detection on Dynamic Contrast-Enhanced MRI: Computer-Aided Diagnosis Versus Single Perfusion Parameter Maps

OBJECTIVE The purpose of this article is to assess the value of computer-aided diagnosis (CAD) for prostate cancer detection on dynamic contrast-enhanced MRI (DCE-MRI). MATERIALS AND METHODS DCE-MRI examinations of 42 patients with prostate cancer were used to generate perfusion parameters, including baseline and peak signal intensities, initial slope, maximum slope within the initial 50 seconds after the contrast injection (slope(50)), wash-in rate, washout rate, time to peak, percentage of relative enhancement, percentage enhancement ratio, time of arrival, efflux rate constant from the extravascular extracellular space to the blood plasma (k(ep)), first-order rate constant for eliminating gadopentetate dimeglumine from the blood plasma (k(el)), and constant depending on the properties of the tissue and represented by the size of the extravascular extracellular space (A(H)). CAD for cancer detection was established by comprehensive evaluation of parameters using a support vector machine. The diagnostic accuracy of single perfusion parameters was estimated using receiver operating characteristic analysis, which determined threshold and parametric maps for cancer detection. The diagnostic performance of CAD for cancer detection was compared with those of T2-weighted imaging (T2WI) and single perfusion parameter maps, using histologic results as the reference standard. RESULTS The accuracy, sensitivity, and specificity of CAD were 83%, 77%, and 77%, respectively, in the entire prostate; 77%, 91%, and 64%, respectively, in the transitional zone; and 89%, 89%, and 89%, respectively, in the peripheral zone. Values for k(ep), k(el), initial slope, slope(50), wash-in rate, washout rate, and time to peak showed greater area under the curve values (0.803-0.888) than did the other parameters (0.545-0.665) (p < 0.01) and were compared with values for CAD. In the entire prostate, accuracy was greater for CAD than for all perfusion parameters or T2WI (63-77%); sensitivity was greater for CAD than for T2WI, initial slope, wash-in rate, slope(50), and washout rate (38-77%); and specificity was greater for CAD than for T2WI, k(ep), k(el), and time to peak (59-68%) (p < 0.05). CONCLUSION CAD can improve the diagnostic performance of DCE-MRI in prostate cancer detection, which may vary according to zonal anatomy.

Perfusion Assessment Using Intravoxel Incoherent Motion-Based Analysis of Diffusion-Weighted Magnetic Resonance Imaging: Validation Through Phantom Experiments.

ObjectivesThe aims of this study were to demonstrate the theoretical meaning of intravoxel incoherent motion (IVIM) parameters and to compare the robustness of 2 biexponential fitting methods through magnetic resonance experiments using IVIM phantoms. Materials and MethodsIntravoxel incoherent motion imaging was performed on a 3 T magnetic resonance imaging scanner using 15 b values (0–800 s/mm2) for 4 phantoms with different area fractions of the flowing water compartment (FWC%), at the infusion flow rates of 0, 1, 2, and 3 mL/min. Images were quantitatively analyzed using monoexponential free biexponential, and segmented biexponential fitting models. ResultsThere were some inconsistent variations in Dslow with changing flow rates. The perfusion fraction, f, showed a significant positive correlation with the flow rate for both the free and segmented fitting methods (&rgr; = 0.838 to 0.969; P < 0.001). The fast diffusion coefficient, Dfast, had a significant positive correlation with the flow rate for segmented fitting (&rgr; = 0.745 to 0.969; P < 0.001), although it showed an inverse correlation with the flow rate for free fitting (&rgr; = −0.527 to −0.791; P ⩽ 0.017). Significant positive correlations with the FWC% of the phantoms were noted for f (P = 0.510 for free fitting and P = 0.545 for segmented fitting, P < 0.001). ConclusionsThe IVIM model allows for an approximate segmentation of molecular diffusion and perfusion, with a minor contribution of the perfusion effect on Dslow. The f and Dfast can provide a rough estimation of the flow fraction and flow velocity. Segmented fitting may be a more robust method than free fitting for calculating the IVIM parameters, especially for Dfast.

Feasibility of FAIR imaging for evaluating tumor perfusion

To evaluate the feasibility of flow‐sensitive alternating inversion recovery (FAIR) for measuring blood flow in tumor models.

Simultaneous evaluation of vascular morphology, blood volume and transvascular permeability using SPION‐based, dual‐contrast MRI: imaging optimization and feasibility test

Exploiting ultrashort‐TE (UTE) MRI, T1‐weighted positive contrast can be obtained from superparamagnetic iron oxide nanoparticles (SPIONs), which are widely used as a robust T2‐weighted, negative contrast agent on conventional MR images. Our study was designed (a) to optimize the dual‐contrast MRI method using SPIONs and (b) to validate the feasibility of simultaneously evaluating the vascular morphology, blood volume and transvascular permeability using the dual‐contrast effect of SPIONs. All studies were conducted using 3 T MRI. According to numerical simulation, 0.15 mM was the optimal blood SPION concentration for visualizing the positive contrast effect using UTE MRI (TE = 0.09 ms), and a flip angle of 40° could provide sufficient SPION‐induced enhancement and acceptable measurement noise for UTE MR angiography. A pharmacokinetic study showed that this concentration can be steadily maintained from 30 to 360 min after the injection of 29 mg/kg of SPIONs. An in vivo study using these settings displayed image quality and CNR of SPION‐enhanced UTE MR angiography (image quality score 3.5; CNR 146) comparable to those of the conventional, Gd‐enhanced method (image quality score 3.8; CNR 148) (p > 0.05). Using dual‐contrast MR images obtained from SPION‐enhanced UTE and conventional spin‐ and gradient‐echo methods, the transvascular permeability (water exchange index 1.76–1.77), cerebral blood volume (2.58–2.60%) and vessel caliber index (3.06–3.10) could be consistently quantified (coefficient of variation less than 9.6%; Bland–Altman 95% limits of agreement 0.886–1.111) and were similar to the literature values. Therefore, using the optimized setting of combined SPION‐based MRI techniques, the vascular morphology, blood volume and transvascular permeability can be comprehensively evaluated during a single session of MR examination. Copyright

Diagnosis of lymph node metastasis in uterine cervical cancer: usefulness of computer-aided diagnosis with comprehensive evaluation of MR images and clinical findings

Background Lymph node (LN) status is an important parameter for determining the treatment strategy and for predicting the prognosis for patients with uterine cervical cancer. Computer-aided diagnosis (CAD) can be feasible for differentiating metastatic from non-metastatic lymph nodes in patients with uterine cervical cancer Purpose To determine the usefulness of CAD that comprehensively evaluates MR images and clinical findings for detecting LN metastasis in uterine cervical cancer. Material and Methods In 680 LNs from 143 patients who underwent radical hysterectomy for uterine cervical cancer, the CAD system using the Bayesian classifier estimated the probability of metastasis based on MR findings and clinical findings. We compared the diagnostic accuracy for detecting metastatic LNs in the CAD and MR findings. Results Metastasis was diagnosed in 70 (12%) LNs from 34 (24%) patients. The area under ROC curves of CAD (0.924) was greater than those of the mean ADC (0.854), minimum ADC (0.849), maximum ADC (0.827), short-axis diameter (0.856) and long-axis diameter (0.753) (P < 0.05). The specificity and accuracy of the CAD (86%, 86%) were greater than those of the mean ADC (77%, 77%), maximum ADC (77%, 77%), minimum ADC (68%, 70%), and short-axis diameter (65%, 67%) (P < 0.05). Conclusion CAD system can improve the diagnostic performance of MR for detecting metastatic LNs in uterine cervical cancer.

Is apparent diffusion coefficient reliable and accurate for monitoring effects of antiangiogenic treatment in a longitudinal study

To evaluate the reliability and accuracy of the apparent diffusion coefficient (ADC) for monitoring antiangiogenic treatment in a longitudinal study.

Dynamic contrast-enhanced MRI for monitoring antiangiogenic treatment: determination of accurate and reliable perfusion parameters in a longitudinal study of a mouse xenograft model.

Objective To determine the reliable perfusion parameters in dynamic contrast-enhanced MRI (DCE-MRI) for the monitoring antiangiogenic treatment in mice. Materials and Methods Mice, with U-118 MG tumor, were treated with either saline (n = 3) or antiangiogenic agent (sunitinib, n = 8). Before (day 0) and after (days 2, 8, 15, 25) treatment, DCE examinations using correlations of perfusion parameters (Kep, Kel, and AH from two compartment model; time to peak, initial slope and % enhancement from time-intensity curve analysis) were evaluated. Results Tumor growth rate was found to be 129% ± 28 in control group, -33% ± 11 in four mice with sunitinib-treatment (tumor regression) and 47% ± 15 in four with sunitinib-treatment (growth retardation). Kep (r = 0.80) and initial slope (r = 0.84) showed strong positive correlation to the initial tumor volume (p < 0.05). In control mice, tumor regression group and growth retardation group animals, Kep (r : 0.75, 0.78, 0.81, 0.69) and initial slope (r : 0.79, 0.65, 0.67, 0.84) showed significant correlation with tumor volume (p < 0.01). In four mice with tumor re-growth, Kep and initial slope increased 20% or greater at earlier (n = 2) than or same periods (n = 2) to when the tumor started to re-grow with 20% or greater growth rate. Conclusion Kep and initial slope may a reliable parameters for monitoring the response of antiangiogenic treatment.

The Effects of Breathing Motion on DCE-MRI Images: Phantom Studies Simulating Respiratory Motion to Compare CAIPIRINHA-VIBE, Radial-VIBE, and Conventional VIBE

Objective To compare the breathing effects on dynamic contrast-enhanced (DCE)-MRI between controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA)-volumetric interpolated breath-hold examination (VIBE), radial VIBE with k-space-weighted image contrast view-sharing (radial-VIBE), and conventional VIBE (c-VIBE) sequences using a dedicated phantom experiment. Materials and Methods We developed a moving platform to simulate breathing motion. We conducted dynamic scanning on a 3T machine (MAGNETOM Skyra, Siemens Healthcare) using CAIPIRINHA-VIBE, radial-VIBE, and c-VIBE for six minutes per sequence. We acquired MRI images of the phantom in both static and moving modes, and we also obtained motion-corrected images for the motion mode. We compared the signal stability and signal-to-noise ratio (SNR) of each sequence according to motion state and used the coefficients of variation (CoV) to determine the degree of signal stability. Results With motion, CAIPIRINHA-VIBE showed the best image quality, and the motion correction aligned the images very well. The CoV (%) of CAIPIRINHA-VIBE in the moving mode (18.65) decreased significantly after the motion correction (2.56) (p < 0.001). In contrast, c-VIBE showed severe breathing motion artifacts that did not improve after motion correction. For radial-VIBE, the position of the phantom in the images did not change during motion, but streak artifacts significantly degraded image quality, also after motion correction. In addition, SNR increased in both CAIPIRINHA-VIBE (from 3.37 to 9.41, p < 0.001) and radial-VIBE (from 4.3 to 4.96, p < 0.001) after motion correction. Conclusion CAIPIRINHA-VIBE performed best for free-breathing DCE-MRI after motion correction, with excellent image quality.

Feasibility of free-breathing dynamic contrast-enhanced MRI of the abdomen: a comparison between CAIPIRINHA-VIBE, Radial-VIBE with KWIC reconstruction and conventional VIBE.

OBJECTIVE To evaluate the feasibilities of controlled aliasing in parallel imaging results in higher acceleration with volumetric interpolated breath-hold examination (CAIPIRINHA-VIBE), radial acquisition of VIBE (Radial-VIBE) with k-space-weighted image contrast (KWIC) reconstruction (KWIC-Radial-VIBE) and conventional-VIBE (c-VIBE) for free-breathing dynamic contrast-enhanced (DCE)-MRI of the abdomen. METHODS 23 prospectively enrolled patients underwent DCE-MRI of the abdomen with CAIPIRINHA-VIBE (n = 10), KWIC-Radial-VIBE (n = 6) or c-VIBE (n = 7). Qualitative image quality of the DCE-MR images and perfusion maps was independently scored by two abdominal radiologists using a 5-point scale (from 1, uninterpretable, to 5, very good). For quantitative analysis, the signal-to-noise ratio (SNR) of the liver and goodness-of-fit (GOF) of the time-intensity curve were measured. RESULTS In the three tested sequences, DCE-MRI had good temporal (5 s) and spatial resolution (1.48 × 1.48 × 4 mm/voxel). Interobserver agreement in the qualitative analysis was good (ĸ = 0.753; 95% confidence interval, 0.610-0.895). Therefore, the mean scores were used in the data analysis. Overall image quality was comparable between CAIPIRINHA-VIBE (3.52 ± 0.55) and KWIC-Radial-VIBE (3.72 ± 0.37; p = 1.000), and both were significantly better than c-VIBE (2.71 ± 0.34; p < 0.001). Perfusion map quality score was highest with KWIC-Radial-VIBE (4.33 ± 0.65), followed by CAIPIRINHA-VIBE (3.70 ± 0.73) and c-VIBE (3.14 ± 0.66), but without statistical significance between CAIPIRINHA-VIBE and KWIC-Radial-VIBE (p = 0.167). The SNR of the liver and GOF of the time-intensity curve did not significantly differ between the three sequences (p = 0.116 and 0.224, respectively). CONCLUSION CAIPIRINHA-VIBE and KWIC-Radial-VIBE provide comparably better performance than c-VIBE. Both can be feasible sequences with acceptable good image quality for free-breathing DCE-MRI. ADVANCES IN KNOWLEDGE CAIPIRINHA-VIBE and KWIC-Radial-VIBE provide comparably better quality of free-breathing DCE-MRIs than c-VIBE.

Spatiotemporal heterogeneity of tumor vasculature during tumor growth and antiangiogenic treatment: MRI assessment using permeability and blood volume parameters

Tumor heterogeneity is an important concept when assessing intratumoral variety in vascular phenotypes and responses to antiangiogenic treatment. This study explored spatiotemporal heterogeneity of vascular alterations in C6 glioma mice during tumor growth and antiangiogenic treatment on serial MR examinations (days 0, 4, and 7 from initiation of vehicle or multireceptor tyrosine kinase inhibitor administration). Transvascular permeability (TP) was quantified on dynamic‐contrast‐enhanced MRI (DCE‐MRI) using extravascular extracellular agent (Gd‐DOTA); blood volume (BV) was estimated using intravascular T2 agent (SPION). With regard to region‐dependent variability in vascular phenotypes, the control group demonstrated higher TP in the tumor center than in the periphery, and greater BV in the tumor periphery than in the center. This distribution pattern became more apparent with tumor growth. Antiangiogenic treatment effect was regionally heterogeneous: in the tumor center, treatment significantly suppressed the increase in TP and decrease in BV (ie, typical temporal change in the control group); in the tumor periphery, treatment‐induced vascular alterations were insignificant and BV remained high. On histopathological examination, the control group showed greater CD31, VEGFR2, Ki67, and NG2 expression in the tumor periphery than in the center. After treatment, CD31 and Ki67 expression was significantly suppressed only in the tumor center, whereas VEGFR2 and α‐caspase 3 expression was decreased and NG2 expression was increased in the entire tumor. These results demonstrate that MRI can reliably depict spatial heterogeneity in tumor vascular phenotypes and antiangiogenic treatment effects. Preserved angiogenic activity (high BV on MRI and high CD31) and proliferation (high Ki67) in the tumor periphery after treatment may provide insights into the mechanism of tumor resistance to antiangiogenic treatment.