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Objective:To investigate the value of multi-stage dynamic contrast enhanced MRI (DCE-MRI) histogram in predicting survival of patients undergoing surgical treatment of colorectal cancer (CRC).Methods:The retrospective cohort study was conducted. The clinico-pathological data of 81 patients with CRC who were admitted to the Jiuquan City People′s Hospital from January 2018 to February 2019 were collected. There were 47 males and 34 females, aged (62±6)years. All patients underwent routine MRI and DCE-MRI examination to extract relevant imaging parameters. Observation indicators: (1) treatment, imaging examination and follow-up; (2) imaging factors influencing postoperative disease-free survival of patients with CRC. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Univariate and multivariate analyses were conducted using the COX proportional risk model. Pearson correlation test was used to analyze and exclude factors with correlation in univariate analysis, and the multi-variate analysis was conducted on the rest of factors. The Kaplan-Meier method was used to calculate survival rates, and Log-Rank test was used for survival analysis. Results:(1) Treatment, imaging examination and follow-up. All 81 patients underwent preoperative MRI plain scan, enhanced imaging, and diffusion weighted imaging. After complete examination, all patients underwent radical resection of CRC and received postoperative chemotherapy using the FOLFOX regimen. All 81 patients were followed up for 42(range, 11-61)months after surgery. The 1-, 3-, 5-year overall survival rate of 81 patients after surgery was 98.8%, 96.3%, 93.8%, respectively. During the follow-up period, 56 of the 81 patients survived from disease-free and 25 patients had disease progressed. (2) Imaging factors influencing postoperative disease-free survival of patients with CRC. Results of multivariate analysis showed that the kurtosis value and skewness value of positive enhancement integral (PEI) were independent imaging factors influencing postoperative disease-free survival of patients of CRC ( odds ratio=1.840, 1.243, 95% confidence interval as 1.403-2.412, 1.020-1.516, P<0.05). Taking the median values of kurtosis value and skewness value of PEI as 4.864 and 5.042 for further analysis. The postoperative 5-year disease-free survival rate of patients with kurtosis value of PEI <4.864 and ≥4.864 was 89.7% and 10.3%, showing a significant difference between them ( χ2=31.265, P<0.05). The postoperative 5-year disease-free survival rate of patients with skewness value of PEI<5.042 and ≥5.042 was 63.4% and 36.6%, showing a significant difference between them ( χ2=8.164, P<0.05). Conclusions:The kurtosis value and skewness value of PEI in DCE-MRI are independent imaging factors influencing postoperative disease-free survival of patients of CRC. The DCE-MRI histogram can effectively evaluate the postoperative prognosis of patients of CRC.
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Objective:To assess the role of arterial spin labeling (ASL) in detecting the blood-brain barrier (BBB) permeability of cerebral infarction lesions in patients with anterior circulation subacute ischemic stroke (SIS), and to evaluate the value of ASL in predicting hemorrhagic transformation (HT) of SIS patients after endovascular recanalization.Methods:A prospective analysis was performed. Patients with anterior circulation SIS who received endovascular treatment (EVT) in our hospital from January 2021 to September 2021 were enrolled. At 24 h before EVT and immediately after EVT, MRI scans of ASL sequences and dynamic contrast-enhanced magnetic resonance (DCE) sequence were completed, and Xper CT was performed; accordingly, imaging typing was performed. Head CT scan was performed 24-48 h after EVT to observe HT; according to the presence or absence of HT, these patients were divided into HT group and non-HT group; the relative cerebral blood flow (rCBF) values of ASL sequence parameters, volume transfer constant (K trans) of DCE sequence parameters and the differences of ASL, DCE and Xper CT imaging types between the two groups were compared. The weighted Kappa coefficient was used to test the consistency among ASL, DCE and Xper CT imaging types. Results:Among 22 eligible patients, 5 patients occurred HT (5/22, 22.72%). As compared with those in the non-HT group (1.14±0.04; 0.032[0.024, 0.039]/min), patients in the HT group had significantly higher rCBF value (1.57±0.18) and K trans (0.072[0.0455, 0.117]/min, P<0.05). There were significant differences in the distribution of ASL, DCE and Xper CT imaging types between the two groups ( P<0.05); among them, 4 out of 6 patients with ASL imaging type III, 4 out of 6 patients with DCE imaging type III, and 4 out of 5 patients with Xper CT imaging type III had HT. ASL sequence and DCE sequence had a high consistency in the imaging types (Kappa coefficient=0.941, 95%CI: 0.862-1.020, P<0.001). Conclusion:ASL can effectively evaluate the BBB permeability of cerebral infarction lesions in patients with anterior circulation SIS; patients with ASL imaging type III have a relatively high risk of HT.
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Objective:To assess the role of arterial spin labeling (ASL) in detecting the blood-brain barrier (BBB) permeability of cerebral infarction lesions in patients with anterior circulation subacute ischemic stroke (SIS), and to evaluate the value of ASL in predicting hemorrhagic transformation (HT) of SIS patients after endovascular recanalization.Methods:A prospective analysis was performed. Patients with anterior circulation SIS who received endovascular treatment (EVT) in our hospital from January 2021 to September 2021 were enrolled. At 24 h before EVT and immediately after EVT, MRI scans of ASL sequences and dynamic contrast-enhanced magnetic resonance (DCE) sequence were completed, and Xper CT was performed; accordingly, imaging typing was performed. Head CT scan was performed 24-48 h after EVT to observe HT; according to the presence or absence of HT, these patients were divided into HT group and non-HT group; the relative cerebral blood flow (rCBF) values of ASL sequence parameters, volume transfer constant (K trans) of DCE sequence parameters and the differences of ASL, DCE and Xper CT imaging types between the two groups were compared. The weighted Kappa coefficient was used to test the consistency among ASL, DCE and Xper CT imaging types. Results:Among 22 eligible patients, 5 patients occurred HT (5/22, 22.72%). As compared with those in the non-HT group (1.14±0.04; 0.032[0.024, 0.039]/min), patients in the HT group had significantly higher rCBF value (1.57±0.18) and K trans (0.072[0.0455, 0.117]/min, P<0.05). There were significant differences in the distribution of ASL, DCE and Xper CT imaging types between the two groups ( P<0.05); among them, 4 out of 6 patients with ASL imaging type III, 4 out of 6 patients with DCE imaging type III, and 4 out of 5 patients with Xper CT imaging type III had HT. ASL sequence and DCE sequence had a high consistency in the imaging types (Kappa coefficient=0.941, 95%CI: 0.862-1.020, P<0.001). Conclusion:ASL can effectively evaluate the BBB permeability of cerebral infarction lesions in patients with anterior circulation SIS; patients with ASL imaging type III have a relatively high risk of HT.
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BACKGROUND: Although traditional plain scan and enhanced magnetic resonance imaging has been used for skeletal muscle imaging for many years, it is not enough to evaluate the microscopic changes of diseased tissue or the activity of diseased tissue. Dynamic contrast-enhanced magnetic resonance imaging can capture this information and advantages are shown in orthopedic imaging examination. OBJECTIVE: To review the progress of dynamic contrast-enhanced magnetic resonance imaging in orthopedics clinics. METHODS: The relevant documents from January 1900 to February 2020 were retrieved in the CNKI database, PubMed database, Web of Science and Wanfang database by computer. The search terms were “dynamic contrast-enhanced magnetic resonance imaging; skeletal muscle tumor; arthritis; spine; fracture” in Chinese, and “dynamic contrast enhanced magnetic resonance imaging (DCE-MRI); osteomuscular tumor; arthritis; spinal surgery; fracture” in English. RESULTS AND CONCLUSION: (1) At present, there is a general lack of consensus on the best scanning method for acquiring dynamic contrast-enhanced magnetic resonance imaging images and the ideal method for analyzing such images in clinical applications. The parameter analysis methods are mainly qualitative, semi-quantitative and quantitative analysis. (2) Dynamic contrast-enhanced magnetic resonance imaging has been widely used in non-invasive detection, qualitative and therapeutic monitoring of different diseases such as heart failure, breast cancer, prostate cancer, renal rejection and liver tumors. The clinical application in orthopedics is not mature enough, but has unlimited potential: It can be used to assess the blood flow after femoral neck fracture and to predict the viability of the femoral head, the regional perfusion of nonunion after fracture, bone perfusion of arthritis and other entities, and detection of deformed blood vessels. Compared with conventional imaging, in contrast, dynamic contrast-enhanced magnetic resonance imaging can also better assess the relationship between changes in lumbar spine perfusion, disc degeneration, and endplate perfusion at different stages.
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Objective To analyze the features and diagnostic value of 3.0T multiparametric MRI for prostate cancer(PCa).Methods The clinical and MRI data of 48 patients with PCa and 52 patients with benign prostatic hyperplasia (BPH)were analyzed retrospectively. All patients underwent plain MRI,DWI,DCE-MRI and MRS.Results The PCa were hyperintensity on DWI and hypointensity on ADC,respectively.There was significant difference in the ADC values between the benign and malignant lesions.DWI using the high b-value was sensitivitive to diagnosing the PCa.The distribution of the S-I T was significant difference between the two groups.The SI-T curves of the PCa were type Ⅲ in 40 cases,type Ⅱ in 5 cases and type Ⅰ in 3 cases.The SI-T curves of the BPH were type Ⅰ in 27 cases,type Ⅱ in 23 cases and type Ⅲ in 2 cases.The peak value of choline (Cho)increased and citrate (Cit)decreased on MRS.The ratio of (Cho+Cre)value/Cit value of the PCa was increased.Conclusion DWI,DCE-MRI and MRS can present the specific findings of PCa.The combining application of the three technics could increase the accuracy in diagnosing PCa.
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Objective@#To investigate the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters for the efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer.@*Methods@#Sixty-five patients with locally advanced gastric cancer (LAGC) confirmed by gastroscopy and received neoadjuvant chemotherapy (NCT) were enrolled in this study. Quantitative DCE-MRI was performed before NCT, and the quantitative parameters were measured, including volume transfer constant (Ktrans), rate constant (Kep), volume fraction of extravascular extracellular space (Ve) and volume fraction of plasma (Vp). After NCT, all patients received radical gastrectomy. According to postoperative pathological tumor regression grade, patients were divided into response group and non-response group, and the differences of DCE quantitative parameters between the two groups were compared. ROC curve was utilized to analyze the predictive efficacy of DCE quantitative parameters for NCT response of LAGC, and multivariate logistic regression analysis was performed to analyze the predictive efficacy of combined parameters.@*Results@#Thirty-seven patients were in response group and 28 patients were in non-response group. The pretreatment Ktrans in the response group were [0.216 min-1 (0.130 min-1, 0.252 min-1)], significantly higher than [0.091 min-1 (0.069 min-1, 0.146 min-1)] of non-response group (P<0.001), and Ve in the response group were [0.354(0.228, 0.463)], significantly higher than [0.200(0.177, 0.253)]of non-response group (P<0.001). ROC analysis showed the AUCS of Ktrans and Ve in predicting NCT efficacy were 0.881 and 0.756, respectively. Multiple logistic regression analysis showed that the combination of the two parameters could improve the AUC to 0.921, with the sensitivity and specificity of 86.5% and 89.3%, respectively.@*Conclusion@#DCE-MRI quantitative parameters could help to predict the NCT response of LAGC, and the combination of parameters could improve the predictive efficacy.
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Objective: To explore the value of dynamic enhanced MRI (DCE-MRI) quantitative parameter global histogram in differential diagnosis of breast ductal carcinoma in situ (DCIS) and DCIS with micro-invasion (DCIS-Mi). Methods: Totally 41 patients with DCIS-Mi and 37 patients with DCIS underwent DCE-MRI before operation. The volume transport constant (Ktrans), rate constant (Kep) and plasma volume fraction (Vp) were calculated, and the parameters of the global histogram were recorded, including mean, median and the quantiles of 10%, 25%, 50%, 75% and 90% (P10, P25, P50, P75 and P90). The parameters were compared between DCIS-Mi and DCIS patients, and the diagnostic values were evaluated. Results: The mean and percentiles of Ktrans parameters, the mean, median, P50, P75 and P90 of Kep parameters, the mean, median, P25, P50 and P75 of Vp parameters of DCIS-Mi patients were all higher than those of DCIS patients (all P0.80. The joint variable Logistic regression model had the highest AUC (0.968), and its cut-off value, sensitivity and specificity was 2.152, 0.962 and 0.947, respectively. Conclusion: DCE-MRI global histogram analysis can quantitatively reflect tumor characteristics, accurately differentiate breast DCIS and DCIS-Mi.
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Objective To evaluate the diagnostic efficacy of MRI diffusion kurtosis imaging (DKI) and quantitative dynamic contrast enhancement MRI (DCE-MRI) in benign and malignant breast lesions, and to explore the differential diagnosis ability for different pathological types and molecular subtype lesions. Methods Sixty four females were retrospectively enrolled in the study of MRI diffusion kurtosis imaging and quantitative dynamic contrast enhancement between November 20 and May 2017. All of them were confirmed to have benign or malignant lesions after surgical resection or puncture. All patients underwent axial T1WI, DKI and DCE-MRI examinations. The mean kurtosis (MK) and mean diffusivity (MD) values were calculated by the DKI model, and the hemodynamic parameters were obtained by quantitative dynamic contrast enhancement, including volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular space distribute volume per unit tissue volume (Ve) and blood volume fraction (Vp). Pathological analysis was performed to monitor the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2) and nuclear proliferation index Ki67. The breast cancer was divided into Luminal A type, Luminal B type, HER-2 positive and triple-negative 4 subtypes. The differences of DKI parameters and DCE-MRI parameters between benign and malignant breast lesions were compared using two independent samples t test (normal distribution and homogeneity of variance) or Mann-Whitney U test (skewed distribution or variance). ROC analysis was used to evaluate the value of DKI and DCE-MRI parameters in differential diagnosis of benign and malignant breast lesions with pathological results as the gold standard. The Mann-Whitney U test and Kruskal-Wallis H test were used to compare the differences of DKI and DCE-MRI parameters among different prognostic factors and molecular subtypes of breast cancer. Spearman rank correlation analysis was used to evaluate the correlation between DKI and DCE-MRI parameters and different prognostic factors. Results Sixty-four cases were single lesions, with breast cancer in 23 cases and 41 cases of benign lesions. In breast cancer, there were 9 cases of Luminal A type, 7 cases of Luminal B type, 3 cases of HER-2 positive type and 4 cases of triple negative type. The positive numbers of ER, PR and HER-2 were 14, 11 and 10 cases respectively. Nineteen cases showed high expression of Ki67, while 4 cases showed low expression. There were significant differences in MK, MD, Ktrans and Kep between benign and malignant lesions (P<0.05). However, there was no significant difference between Ve and Vp (P>0.05). The area under the ROC for the differential diagnosis of benign and malignant breast lesions were 0.897, 0.808, 0.844 and 0.842, respectively. The combined multi-parameter differential diagnosis improved the efficacy. Combined with the above four parameters, the area under the ROC was 0.950. The diagnosis Sensitivity, specificity and accuracy were 0.870, 0.951 and 0.922 respectively. The Ktrans and Vp values of patients with ER positive and ER negative, as well as Ve value of deferent lymph node status, were significantly different (P<0.05), but there was no significant difference between the other prognostic factors (P>0.05). There was a moderate positive correlation between ER and Ktrans and Vp values. There was a low positive correlation between lymph node status and Ve value (r= 0.6, 0.5 and 0.4, respectively, P<0.05). No correlation was found among other parameters and prognostic factors (P>0.05). There were no significant differences in DKI and DCE-MRI parameters among different subtypes of breast cancer patients (all P>0.05). Conclusion DKI combined with DCE-MRI can improve the differential diagnosis of breast lesions and some DCE-MRI parameters are related to prognostic factors.
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PURPOSE: The purpose of this study is to compare the performance of the T1 3D subtraction technique and the conventional 2D dynamic contrast enhancement (DCE) technique in diagnosing Cushing's disease. MATERIALS AND METHODS: Twelve patients with clinically and biochemically proven Cushing's disease were included in the study. In addition, 23 patients with a Rathke's cleft cyst (RCC) diagnosed on an MRI with normal pituitary hormone levels were included as a control, to prevent non-blinded positive results. Postcontrast T1 3D fast spin echo (FSE) images were acquired after DCE images in 3T MRI and image subtraction of pre- and postcontrast T1 3D FSE images were performed. Inter-observer agreement, interpretation time, multiobserver receiver operating characteristic (ROC), and net benefit analyses were performed to compare 2D DCE and T1 3D subtraction techniques. RESULTS: Inter-observer agreement for a visual scale of contrast enhancement was poor in DCE (κ = 0.57) and good in T1 3D subtraction images (κ = 0.75). The time taken for determining contrast-enhancement in pituitary lesions was significantly shorter in the T1 3D subtraction images compared to the DCE sequence (P < 0.05). ROC values demonstrated increased reader confidence range with T1 3D subtraction images (95% confidence interval [CI]: 0.94–1.00) compared with DCE (95% CI: 0.70–0.92) (P < 0.01). The net benefit effect of T1 3D subtraction images over DCE was 0.34 (95% CI: 0.12–0.56). For Cushing's disease, both reviewers misclassified one case as a nonenhancing lesion on the DCE images, while no cases were misclassified on T1 3D subtraction images. CONCLUSION: The T1 3D subtraction technique shows superior performance for determining the presence of enhancement on pituitary lesions compared with conventional DCE techniques, which may aid in diagnosing Cushing's disease.
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Humanos , Imageamento por Ressonância Magnética , Curva ROC , Técnica de SubtraçãoRESUMO
OBJECTIVE: To simulate the B₁-inhomogeneity-induced variation of pharmacokinetic parameters on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS: B₁-inhomogeneity-induced flip angle (FA) variation was estimated in a phantom study. Monte Carlo simulation was performed to assess the FA-deviation-induced measurement error of the pre-contrast R₁, contrast-enhancement ratio, Gd-concentration, and two-compartment pharmacokinetic parameters (K(trans), v(e), and v(p)). RESULTS: B₁-inhomogeneity resulted in −23–5% fluctuations (95% confidence interval [CI] of % error) of FA. The 95% CIs of FA-dependent % errors in the gray matter and blood were as follows: −16.7–61.8% and −16.7–61.8% for the pre-contrast R₁, −1.0–0.3% and −5.2–1.3% for the contrast-enhancement ratio, and −14.2–58.1% and −14.1–57.8% for the Gd-concentration, respectively. These resulted in −43.1–48.4% error for K(trans), −32.3–48.6% error for the v(e), and −43.2–48.6% error for v(p). The pre-contrast R₁ was more vulnerable to FA error than the contrast-enhancement ratio, and was therefore a significant cause of the Gd-concentration error. For example, a −10% FA error led to a 23.6% deviation in the pre-contrast R₁, −0.4% in the contrast-enhancement ratio, and 23.6% in the Gd-concentration. In a simulated condition with a 3% FA error in a target lesion and a −10% FA error in a feeding vessel, the % errors of the pharmacokinetic parameters were −23.7% for K(trans), −23.7% for v(e), and −23.7% for v(p). CONCLUSION: Even a small degree of B₁-inhomogeneity can cause a significant error in the measurement of pharmacokinetic parameters on DCE-MRI, while the vulnerability of the pre-contrast R₁ calculations to FA deviations is a significant cause of the miscalculation.
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Encéfalo , Substância Cinzenta , Imageamento por Ressonância Magnética , Método de Monte Carlo , Imagens de FantasmasRESUMO
Objective To evaluate the differential diagnostic value of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI) and diffusion weighted imaging(DWI) in adenosis of the breast and breast cancer.Methods 30 cases of adenosis and 45 cases of breast cancer with pathological verification were scanned with DCE-MRI and DWI.The MRI features of the lesions were analyzed, including shape,margin,T2WI singal, features of enhancement, time intensity curve(TIC) type, early enhancement rate(EER),peak time, background enhancement and ADC value.Results The irregular margin with or without spiculation and the heterogeneous enhancement were mostly seen in breast cancer (P=0.002,P=0.009, respectively).The TIC type Ⅲ, EER larger than 100% and peak time within 2 minutes were mostly seen in breast cancer(P0.05).Conclusion DCE-MRI combined with DWI will be helpful to the diagnosis of breast lesions.
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Objective To compare the accuracy of dynamic contrast-enhanced magnetic resonance (DCE-MRI) and SPECT in the measurement of glomerular filtration rate (GFR) in renal allografts.Methods Sixty renal transplant recipients were enrolled in this study.DCE-MRI and SPECT were used to measure the GFR of the transplanted kidneys,and compared with the endogenous creatinine clearance rate (Ccr).Bias,precision,correlation and Bland-Altman agreement were calculated for each modality compared with the endogenous Ccr.Results In 60 renal transplant recipients,the corrected Ccr was (60.63 ± 24.83) ml · min-1 · 1.73 m-2.The GFR measured by SPECT was (65.31 ± 17.08) ml · min-1 · 1.73 m-2,and (50.44 ± 22.78) ml · min-1 · 1.73 m-2 by MRI,respectively.The bias of GFR-SPECT was 4.69 ml·min-1 · 1.73 m-2,and the precision was 23.76 ml·min-1 1.73 m-2.The bias of GFR-MRI was-10.18 ml·min-1 ·1.73 m-2,and the precision was 13.87 ml·min-1 · 1.73 m-2.Correlation analysis showed that GFR-MRI and the endogenous Ccr had a good correlation (r=0.833,P＜0.01),GFR-SPECT and the endogenous Ccr had a moderate correlation (r=0.406,P＜0.01),and GFR-MRI and GFR-MRI had a poor correlation (r=0.342,P ＜0.01).Bland-Altman analysis showed a confidence interval of 95.3 ml·min-1 ·1.73 m-2 for GFR-SPECT and 62.3 ml· min-1 · 1.73 m-2 for GFR-MRI.Conclusion DCE-MRI can be used as confidently as SPECT to evaluate the renal function of transplanted kidneys in the same time of determining anatomical information.
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Objective To evaluate the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)for the differential diagnosis of the adenoid cystic carcinoma and pleomorphic adenoma of the head and neck.Methods Thirty-one pa-tients with histopathologically proved adenoid cystic carcinoma and pleomorphic adenoma were examined with DCE-MRI,in which 10 cases were benign and 21 cases were malignant.The data of the conventional 3.0T DCE-MRI were improved by the 3D fast spoiled gradient-echo sequence (FSPGR)method.Z-test was performed on the quantitative parameters for benign and malignant le-sions,including volume transfer constant (Ktrans ),rate constant (Kep )and extravascular extracellular space fraction (Ve ).The re-ceiver operating characteristic (ROC)curves were plotted to investigate the diagnosis.Results The mean Ktranss of the adenoid cystic carcinoma group and pleomorphic adenoma group were (0.266 ± 0.103 )min-1 and (0.1 55 ± 0.080)min-1 respectively,and the difference between them were statistically significant (Z =-2.699,P 0.05).The areas under the ROC curves of the Ktrans and kep were 0.813 and 0.763 respectively.Choosing the optimal diagnostic cut-off points corresponding to the maximum Youden indexes 0.173 min-1 and 0.818 min-1 ,the sensitivities of Ktrans and kep for identifying the adenoid cystic carcinoma and pleomorphic adenoma were 90.9% and 81.8%,and the specificities were 77.8% and 66.7%.Ktrans was of the highest sensitivity and specificity for the identification of the adenoid cystic carcinoma and pleomorphic adenoma.Conclu-sion The dynamic contrast-enhanced parameter Ktrans plays a certain role in the differential diagnosis of the adenoid cystic carcinoma and pleomorphic adenoma of the head and neck.
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Multiparametric MR (mpMR) imaging is rapidly evolving into the mainstay in prostate cancer (PCa) imaging. Generally, the examination consists of T2-weighted sequences, diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) evaluation, and less often proton MR spectroscopy imaging (MRSI). Those functional techniques are related to biological properties of the tumor, so that DWI correlates to cellularity and Gleason scores, DCE correlates to angiogenesis, and MRSI correlates to cell membrane turnover. The combined use of those techniques enhances the diagnostic confidence and allows for better characterization of PCa. The present article reviews and illustrates the technical aspects and clinical applications of each component of mpMR imaging, in a practical approach from the urological standpoint.
O estudo por ressonância magnética multiparamétrica, ou funcional, vem evoluindo para se tornar o pilar fundamental no manejo diagnóstico de pacientes com câncer de próstata. Geralmente, o exame consiste em imagens pesadas em T2, difusão, realce dinâmico pelo contraste (permeabilidade), e cada vez menos frequentemente espectroscopia de prótons. Tais técnicas funcionais relacionam-se com propriedades biológicas do tumor, de modo que a difusão se relaciona com a celularidade e os escores de Gleason, a permeabilidade se relaciona com a angiogênese, e a espectroscopia de prótons se relaciona com o metabolismo da membrana celular. O uso destas técnicas em combinação aumenta a confiança diagnóstica e permite uma melhor caracterização do câncer de próstata. Este artigo tem o objetivo de revisar e ilustrar os aspectos técnicos e as aplicações clínicas de cada componente do estudo de ressonância magnética multiparamétrica da próstata, mediante uma abordagem prática.
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Objective To investigate the optimal combination and the value of functional magnetic resonance imaging in the diagnosis of breast tumors. Methods One hundred and forty patients who had been clinically and pathologically diagnosed as breast tumors in our hospital during the period of 2009 to 2013 were collected. 63 of whom had breast cancer and 77 had benign tumor. All the patients received 1H-MRS, DWI and dynamic enhanced MRI at the same time. The obtained images were analyzed and then compared with the pathological findings. The accuracy, sensitivity, and specificity of MRS combined with DWI or dynamic enhanced MRI, or DwI combined with enhanced MRI in the diagnosis of breast cancer were obtained. Results All the diagnosis were pathologically confirmed. The accuracy, sensitivity, and specificity were 89.8%, 90.1%, and 90.0% for DWI combined with dynamic contrast-enhanced MRI; 77.9%, 77.3% and 79.3% for MRS in combination with enhanced MRI; and 76.3%, 77.8% and 77.1% for DWI combined with MRS. There were significant differences among the three kinds of combination detection in diagnosis of breast cancer , χ2= 9.057, P = 0.011. Conclusions The sensitivity, specificity and accuracy is the highest in DWI combined with dynamic enhanced MRI in the diagnosis of breast tumor , which can be used as the best combination imaging for breast tumor.
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Objective To explore the combination of dynamic contrast enhancement and diffusion weighted imaging in the diagno-sis of breast diseases.Methods 67 patients with breast mass proven by operation or biopsy underwent dynamic contrast enhance-ment and diffusion weighted imaging.Fischer scoring system and BI-RADS were used to distinguish the benign lesions from the ma-lignant mass.The optimal boundary value of ROC curve was set as the threshold in DWI.The independent and conj unctive diagnos-tic efficacy of DCE and DWI were calculated and compared.The conj unctive methods included combinated properly method and DCE used as the chief diagnostic method while DWI as the adj unctive method.Results the best diagnostic boundary of ADC values was 1.1×10-3 mm2/s,The sensitivity,specificity and diagnostic accuracy of DWI and DCE were 71.4%,88.6%,80% and 100%, 80%,90%,respectively.The value was 85.7%,94.3%,90%,when using DCE chiefly and DWI adjunctively,while it was 91.4%respectively in combinating properly method.Conclusion DWI can improve the specificity of MRI in diagnosing breast lesions while it can reduce the sensitivity,which can results in the missed diagnosis of malignant diseases.DWI can used as an auxiliary examina-tion method to increase the diagnostic confidence of DCE method.
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ObjectiveUsing dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate the hemodynamic perfusion characteristics of bone marrow infiltration in patients with acute leukemia (AL). MethodsForty-seven patients with AL received coronal pelvic T1WI DCE-MRI with fast low angle shot (FLASH) sequence. Among them, 25 were initial onset untreated (IOU) patients, 22 were treated AL patients, including 14 with complete remission (CR) and 8 with non-remission ( NR). The hemodynamic perfusion parameters including maximum percentage of enhancement ( Emax ) and slope were determined based on enhancement-time curves ( ETCs ) of iliac and lumbar vertebra. The proportion of marrow myeloblasts was recorded.For all patients, quantitative perfusion parameters of bone marrow infiltration in ilium were compared with those in lumbar. The values of Emax and ES were compared among IOU,CR and NR patients.Correlations between perfusion parameters and histopathological results were assessed. ResultsIn all the 47 patients, the Emax values of bilateral iliac bone marrow ( 15.70 ± 7.06)were slightly higher than that of lumbar bone marrow ( 11. 28 ± 5.52 ), and the difference was statistically significant (P ＜0. 01 ).There was no significant difference in the slop value between bilateral iliac bone marrow (0. 82 ± 0. 12 ) and lumbar bone marrow (0. 80 ± 0. 09 ) ( P ＞ 0. 05 ). In the 25 untreated patients,the Emax and slop values were 17. 15 ± 5.75 and 0. 98 ± 0. 13, respectively; in the 14 CR patients, they were 8. 76 ±3.93 and 0. 26 ± 0. 04, respectively, and in the 8 NR patients, they were 21.62 ± 6. 50 and 1. 38 ± 0. 02, respectively. There was significant difference in the Emax and slop values among the three groups (P＜0. 05).Compared with IOU and NR patients, both the Emax and slop values decreased significantly in iliac bone marrow of AL patients with CR (P ＜ 0. 05 ). There was no significant difference between IOU and NR patients ( P ＞ 0. 05 ). A significant positive correlation was found between Emax value of iliac bone marrow and the proportion of marrow myeloblasts ( r ＝0. 501 ,P ＜0. 05 ). There was a negative correlation between slop value of iliac bone marrow and the proportion of marrow myeloblasts ( r ＝0. 235 ,P ＞0.05).ConclusionsDCE-MRI can beused for evaluating the hemedynamic characteristics of microcirculation of bone marrow infiltration in patients with AL, which can provide useful information in evaluating prognosis and monitoring therapeutic effect.
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OBJECTIVE: To investigate the significance of the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters of diffuse spinal bone marrow infiltration in patients with hematological malignancies. MATERIALS AND METHODS: Dynamic gadolinium-enhanced MR imaging of the lumbar spine was performed in 26 patients with histologically proven diffuse bone marrow infiltration, including multiple myeloma (n = 6), acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 5), chronic myeloid leukemia (n = 7), and non-Hodgkin lymphoma (n = 2). Twenty subjects whose spinal MRI was normal, made up the control group. Peak enhancement percentage (Emax), enhancement slope (ES), and time to peak (TTP) were determined from a time-intensity curve (TIC) of lumbar vertebral bone marrow. A comparison between baseline and follow-up MR images and its histological correlation were evaluated in 10 patients. The infiltration grade of hematopoietic marrow with plasma cells was evaluated by a histological assessment of bone marrow. RESULTS: Differences in Emax, ES, and TTP values between the control group and the patients with diffuse bone marrow infiltration were significant (t = -11.51, -9.81 and 3.91, respectively, p 0.05). A positive correlation was found between Emax, ES values and the histological grade of bone marrow infiltration (r = 0.86 and 0.84 respectively, p < 0.01). A negative correlation was found between the TTP values and bone marrow infiltration histological grade (r = -0.54, p < 0.01). A decrease in the Emax and ES values was observed with increased TTP values after treatment in all of the 10 patients who responded to treatment (t = -7.92, -4.55, and 5.12, respectively, p < 0.01). CONCLUSION: DCE-MRI of spine can be a useful tool in detecting diffuse marrow infiltration of hematological malignancies, while its parameters including Emax, ES, and TTP can reflect the malignancies' histological grade.
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Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias da Medula Óssea/patologia , Meios de Contraste , Gadolínio DTPA , Neoplasias Hematológicas/patologia , Aumento da Imagem/métodos , Leucemia/patologia , Transtornos Linfoproliferativos/patologia , Imageamento por Ressonância Magnética/métodos , Variações Dependentes do Observador , Estudos Prospectivos , Neoplasias da Coluna Vertebral/patologiaRESUMO
Objective To evaluate the advantages of MR LAVA multi-phase dynamic contrast enhancement in abdominal MRI.Methods 42 cases which clinically suspected liver lesions and 15 normal volunteers underwent MRI examination,including routine T_1WI and T_2WI scan,T_1W 2D and 3D FSPGR,LAV A multi-phase contrast enhancement.The detecting rates of 2D,3D and LAVA images were analysed and the signal noise ratio(SNR)of the liver and spleen was observed.Results 68 lesions were detected by LAVA sequence,the detecting rate was 100%,the accurate rate of diagnosis was 95.6%(65/68),while the detecting rates of the lesions were 91.2%(62/68)and 89.7%(61/68)with 3D T1W FSPGR and 2D T1W FSPGR,respectively,the accurate rates in diagnosing the lesions were 76.5%(52/68)and 70.6%(48/68)with 3D and 2D sequences,respectively.The SNR of liver,spleen of 15 normal volunteers were:29.68±2.31 in liver,36.21 ±3.67 in spleen at LAVA plain scan,46.21 ±5.32 in liver,58.75±4.68 in spleen at 2D T_1W FSPGR,19.79±2.23 in liver,23.63±2.14 in spleen at 3D T_1W FSPGR,41.75±5.13 in liver,57.96±6.13 in spleen at LAVA contrast enhancement,56.33±5.63 in liver,63.21±5.32 in spleen at 2D contrast enhancement,29.05±4.68 in liver,46.37±5.17 in spleen at 3D contrast enhancement sequence.Conclusion LAVA multi-phase dynamic contrast enhancement is more predominant than T1W 2D and 3D and 3D FSPGR in displaying the lesions and blood vessels of liver.
RESUMO
Objective To explore the value of MR dynamic contrast-enhancement in diagnosis and differential diagnosis of infiltrating ductal carcinoma of breast at 3.0T MR magneton.Methods 17 cases of breast infiltrating ductal carcinoma underwent plain MRI and MR dynamic contrast-enhanced scan using 3.0T MR scanners with dedicated breast coil.All cases were confirmed by surgery and pathology.MRI signal intensity,morphology and hemodynamic characteristics of lesions were analysed.Results 17 breast infiltrating ductal carcinomas in 17 cases all appeared as masses,low(8/17)or equal(9/17)signal intensity on T_1WI,high(14/17)or equal(3/17)signal intensity on T_2WI.On morphology,the lesions were irregular and lobulated in shape(82.4%,14/17);undefinite margins(12/17)or non-smooth margins(15/17),glitch sign or astral sign(7/17);the lesions showed non-uniform marked enhancement(10/17)or ring enhancement(5/17)after intravenous administration of contrast agent.82.4%(14/17)of the lesions,the blood vessels could be seen gathering around the lesions on the maximum intensity projection(MIP)image.On hemodynamics,the early enhanced ratio for all cases was over 90%;88.2%(15/17)of the lesions,peak enhancement was less than three minutes;the time-signal intensity curve of the lesions appeared as type Ⅱ was 35.3%(6/17)and type Ⅲ was 58.8%(10/17)mostly.Conclusion Dynamic contrast-enhanced MRI manifestations of breast infiltrating ductal carcinoma are of certain characteristics,which may contribute to the diagnosis and differential diagnosis.