Determining the Dynamic Contrast - Enhanced Magnetic Resonance Imaging (DCE- MRI) in Diagnosis of Pulmonary Nodules

Objective: The aim of this study is to evaluate the role of dynamic contrast _ enhanced magnetic resonance imaging (DCE-MRI) in diagnosis of pulmonary nodules. Patients and methods: The study was a cross-sectional study that was conducted on 30 patients with lung nodules referred to Radio diagnosis and imaging department from chest and oncology departments. By performing repeated CT within 30 days, we identified malignant nodules. The CT was repeated at 3 and 6 months which showed that the malignant pulmonary nodules increased in size and number. Results: The maximum enhancement curve was a significant discriminator. At cut-off value of ≥ 375, the maximum enhancement curve yielded a sensitivity of 92.6% and specificity of 96% (figure 3). In contrary, the ADC value had poor diagnostic accuracy in differentiating between malignant and benign cases. Conclusion: Dynamic contrast-enhanced MRI is valuable for diagnosis of pulmonary nodules and discrimination of benign from malignant ones.

Dynamic contrast enhanced-MRI and diffusion-weighted image as predictors of lymphovascular invasion in node-negative invasive breast cancer

Background Lymphovascular invasion (LVI) is an important risk factor for prognosis of breast cancer and an unfavorable prognostic factor in node-negative invasive breast cancer patients. The purpose of this study was to evaluate the association between LVI and pre-operative features of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in node-negative invasive breast cancer. Methods Data were collected retrospectively from 132 cases who had undergone pre-operative MRI and had invasive breast carcinoma confirmed on the last surgical pathology report. MRI and DWI data were analyzed for the size of tumor, mass shape, margin, internal enhancement pattern, kinetic enhancement curve, high intratumoral T2-weighted signal intensity, peritumoral edema, DWI rim sign, and apparent diffusion coefficient (ADC) values. We calculated the relationship between presence of LVI and various prognostic factors and MRI features. Results Pathologic tumor size, mass margin, internal enhancement pattern, kinetic enhancement curve, DWI rim sign, and the difference between maximum and minimum ADC were significantly correlated with LVI (p < 0.05). Conclusions We suggest that DCE-MRI with DWI would assist in predicting LVI status in node-negative invasive breast cancer patients.

Feasibility of a multiparametric MRI protocol for imaging biomarkers associated with neoadjuvant radiotherapy for soft tissue sarcoma

Objectives: Soft tissue sarcoma (STS) is a rare malignancy with a 5 year overall survival rate of 55%. Neoadjuvant radiotherapy is commonly used in preparation for surgery, but methods to assess early response are lacking despite pathological response at surgery being predictive of overall survival, local recurrence and distant metastasis. Multiparametric MR imaging (mpMRI) is used to assess response in a variety of tumours but lacks a robust, standardised method. The overall aim of this study was to develop a feasible imaging protocol to identify imaging biomarkers for further investigation. Methods: Fifteen patients with biopsy-confirmed STS suitable for preoperative radiotherapy and radical surgery were imaged throughout treatment. The mpMRI protocol included anatomical, diffusion weighted and dynamic contrast-enhanced imaging, giving estimates of apparent diffusion coefficient (ADC) and the area under the enhancement curve at 60 s (iAUC60). Histological analysis of resected tumours included detection of CD31, Ki67, HIF and calculation of a hypoxia score. Results: There was a significant reduction in T1 at visit 2 and in ADC at visit 3. Significant associations were found between hypoxia and pre-treatment iAUC60, pre-treatment ADC and mid-treatment iAUC60. There was also statistically significant association between mid-treatment ADC and Ki67. Conclusions: This work showed that mpMRI throughout treatment is feasible in patients with STS having neoadjuvant radiotherapy. The relationships between imaging parameters, tissue biomarkers and clinical outcomes warrant further investigation. Advances in knowledge : mpMRI based biomarkers have good correlation with STS tumour biology and are potentially of use for evaluation of radiotherapy response.

Invasive breast carcinoma with MRI kinetic curve type 1

Breast cancer is the most common cancer in women and is the most significant cause of morbidity and mortality in women cancer patients. Increased awareness of people followed by periodic screening, appropriate supporting examinations, and imaging modalities according to the patient's condition could improve prognosis. We report a case report of a 55-year-old woman with a complaint of a lump in the right breast. Ultrasound examination and mammography showed a single solid lesion in the superior quadrant of the right breast corresponding to Breast Imaging-Reporting and Data System (BI-RADS) 4c. Magnetic Resonance Imaging (MRI) examination revealed a single lesion with enhancement curve type 1 according to bi-rads 4b. Results of the biopsy were grade 2 breast carcinoma without any lymph node metastases. The use of a single modality cannot be used as a benchmark in determining the best diagnosis and therapy. The kinetic feature/enhancement curve of Dynamic Contrast-Enhanced MRI (DCE-MRI) cannot be used as the main guide for determining the diagnosis. The morphology of the lesion either from ultrasound, mammography, or MRI should also be considered in determining the diagnosis and treatment plan

Enhancing Mass on MRI

The ACR BI-RADS Atlas defines a “mass” on MRI as a space-occupying lesion with convex borders. Masses are characterized by their morphology and their internal enhancement characteristics. Mass morphology descriptor categories include shape (oval, round, irregular), margins (circumscribed, irregular, spiculated), and internal enhancement (homogeneous, heterogeneous, rim enhancement, dark internal septations). Suspicious morphology descriptors of MRI masses include irregular shape, irregular or spiculated margins, and heterogeneous internal enhancement. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for an enhancing mass on MRI. Topics discussed include characteristics of benign and malignant masses, classic benign masses, and enhancement curve assessment.