Current and Future Trends in Magnetic Resonance Imaging Assessments of the Response of Breast Tumors to Neoadjuvant Chemotherapy

The current state-of-the-art assessment of treatment response in breast cancer is based on the response evaluation criteria in solid tumors (RECIST). RECIST reports on changes in gross morphology and divides response into one of four categories. In this paper we highlight how dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted MRI (DW-MRI) may be able to offer earlier, and more precise, information on treatment response in the neoadjuvant setting than RECIST. We then describe how longitudinal registration of breast images and the incorporation of intelligent bioinformatics approaches with imaging data have the potential to increase the sensitivity of assessing treatment response. We conclude with a discussion of the potential benefits of breast MRI at the higher field strength of 3T. For each of these areas, we provide a review, illustrative examples from clinical trials, and offer insights into future research directions

Towards real-time topical detection and characterization of FDG dose infiltration prior to PET imaging

To dynamically detect and characterize 18F-fluorodeoxyglucose (FDG) dose infiltrations and evaluate their effects on positron emission tomography (PET) standardized uptake values (SUV) at the injection site and in control tissue

Detection of Acute Brain Injury in Intensive Care Unit Patients on ECMO Support Using Ultra-Low-Field Portable MRI: A Retrospective Analysis Compared to Head CT

Early detection of acute brain injury (ABI) is critical to intensive care unit (ICU) patient management and intervention to decrease major complications. Head CT (HCT) is the standard of care for the assessment of ABI in ICU patients; however, it has limited sensitivity compared to MRI. We retrospectively compared the ability of ultra-low-field portable MR (ULF-pMR) and head HCT, acquired within 24 h of each other, to detect ABI in ICU patients supported on extracorporeal membrane oxygenation (ECMO). A total of 17 adult patients (median age 55 years; 47% male) were included in the analysis. Of the 17 patients assessed, ABI was not observed on either ULF-pMR or HCT in eight patients (47%). ABI was observed in the remaining nine patients with a total of 10 events (8 ischemic, 2 hemorrhagic). Of the eight ischemic events, ULF-pMR observed all eight, while HCT only observed four events. Regarding hemorrhagic stroke, ULF-pMR observed only one of them, while HCT observed both. ULF-pMR outperformed HCT for the detection of ABI, especially ischemic injury, and may offer diagnostic advantages for ICU patients. The lack of sensitivity to hemorrhage may improve with modification of the imaging acquisition program

Detection of Acute Brain Injury in Intensive Care Unit Patients on ECMO Support Using Ultra-Low-Field Portable MRI: A Retrospective Analysis Compared to Head CT

Early detection of acute brain injury (ABI) is critical to intensive care unit (ICU) patient management and intervention to decrease major complications. Head CT (HCT) is the standard of care for the assessment of ABI in ICU patients; however, it has limited sensitivity compared to MRI. We retrospectively compared the ability of ultra-low-field portable MR (ULF-pMR) and head HCT, acquired within 24 h of each other, to detect ABI in ICU patients supported on extracorporeal membrane oxygenation (ECMO). A total of 17 adult patients (median age 55 years; 47% male) were included in the analysis. Of the 17 patients assessed, ABI was not observed on either ULF-pMR or HCT in eight patients (47%). ABI was observed in the remaining nine patients with a total of 10 events (8 ischemic, 2 hemorrhagic). Of the eight ischemic events, ULF-pMR observed all eight, while HCT only observed four events. Regarding hemorrhagic stroke, ULF-pMR observed only one of them, while HCT observed both. ULF-pMR outperformed HCT for the detection of ABI, especially ischemic injury, and may offer diagnostic advantages for ICU patients. The lack of sensitivity to hemorrhage may improve with modification of the imaging acquisition program

Detection of Acute Brain Injury in Intensive Care Unit Patients on ECMO Support Using Ultra-Low-Field Portable MRI: A Retrospective Analysis Compared to Head CT

Early detection of acute brain injury (ABI) is critical to intensive care unit (ICU) patient management and intervention to decrease major complications. Head CT (HCT) is the standard of care for the assessment of ABI in ICU patients; however, it has limited sensitivity compared to MRI. We retrospectively compared the ability of ultra-low-field portable MR (ULF-pMR) and head HCT, acquired within 24 h of each other, to detect ABI in ICU patients supported on extracorporeal membrane oxygenation (ECMO). A total of 17 adult patients (median age 55 years; 47% male) were included in the analysis. Of the 17 patients assessed, ABI was not observed on either ULF-pMR or HCT in eight patients (47%). ABI was observed in the remaining nine patients with a total of 10 events (8 ischemic, 2 hemorrhagic). Of the eight ischemic events, ULF-pMR observed all eight, while HCT only observed four events. Regarding hemorrhagic stroke, ULF-pMR observed only one of them, while HCT observed both. ULF-pMR outperformed HCT for the detection of ABI, especially ischemic injury, and may offer diagnostic advantages for ICU patients. The lack of sensitivity to hemorrhage may improve with modification of the imaging acquisition program

Quantitative Magnetization Transfer Imaging of the Breast at 3.0 T: Reproducibility in Healthy Volunteers

Key Words: quantitative MR, breast cancer, pool size ratio, test-retest Abbreviations: Magnetic resonance imaging (MRI), Dynamic contrast-enhanced MRI (DCE-MRI), extracellular matrix (ECM), magnetization transfer MRI (MT-MRI), magnetization transfer (MT), MT ratio (MTR), quantitative MT (qMT), field of view (FOV), fibroglandular (FG), volume of interest (VOI), mean PSR (mPSR), mean T2 M (mT2 M ), mPSR from the first scanning session (mPSR1), mPSR from the second scanning session (mPSR2), confidence interval (CI), echo time (TE), repetition time (TR), pool size ratio (PSR), radiofrequency (RF) Quantitative magnetization transfer magnetic resonance imaging provides a means for indirectly detecting changes in the macromolecular content of tissue noninvasively. A potential application is the diagnosis and assessment of treatment response in breast cancer; however, before quantitative magnetization transfer imaging can be reliably used in such settings, the technique's reproducibility in healthy breast tissue must be established. Thus, this study aims to establish the reproducibility of the measurement of the macromolecular-tofree water proton pool size ratio (PSR) in healthy fibroglandular (FG) breast tissue. Thirteen women with no history of breast disease were scanned twice within a single scanning session, with repositioning between scans. Eleven women had appreciable FG tissue for test-retest measurements. Mean PSR values for the FG tissue ranged from 9.5% to 16.7%. The absolute value of the difference between 2 mean PSR measurements for each volunteer ranged from 0.1% to 2.1%. The 95% confidence interval for the mean difference was Ϯ0.75%, and the repeatability value was 2.39%. These results indicate that the expected measurement variability would be Ϯ0.75% for a cohort of a similar size and would be Ϯ2.39% for an individual, suggesting that future studies of change in PSR in patients with breast cancer are feasible

Quantitative Evaluation of Temporal Regularizers in Compressed Sensing Dynamic Contrast Enhanced MRI of the Breast

Purpose. Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) is used in cancer imaging to probe tumor vascular properties. Compressed sensing (CS) theory makes it possible to recover MR images from randomly undersampled k-space data using nonlinear recovery schemes. The purpose of this paper is to quantitatively evaluate common temporal sparsity-promoting regularizers for CS DCE-MRI of the breast. Methods. We considered five ubiquitous temporal regularizers on 4.5x retrospectively undersampled Cartesian in vivo breast DCE-MRI data: Fourier transform (FT), Haar wavelet transform (WT), total variation (TV), second-order total generalized variation (TGVα2), and nuclear norm (NN). We measured the signal-to-error ratio (SER) of the reconstructed images, the error in tumor mean, and concordance correlation coefficients (CCCs) of the derived pharmacokinetic parameters Ktrans (volume transfer constant) and ve (extravascular-extracellular volume fraction) across a population of random sampling schemes. Results. NN produced the lowest image error (SER: 29.1), while TV/TGVα2 produced the most accurate Ktrans (CCC: 0.974/0.974) and ve (CCC: 0.916/0.917). WT produced the highest image error (SER: 21.8), while FT produced the least accurate Ktrans (CCC: 0.842) and ve (CCC: 0.799). Conclusion. TV/TGVα2 should be used as temporal constraints for CS DCE-MRI of the breast