Breast Cancer: Clinical & Technical

Wednesday 14 May 2014

Eddy Solomon¹, Noam Nissan^1,2, Amir Seginer¹, Edna Furman-Haran³, Myra Shapiro-Feinberg⁴, Hadassa Degani², and Lucio Frydman^1
1Chemical Physics, Weizmann Institute of Science, Rehovot, Israel, ²Biological Regulation, Weizmann Institute of Science, Rehovot, Israel, ³Biological Services, Weizmann Institute of Science, Rehovot, Israel, ⁴Radiology, Meir Hospital, Kfar Saba, Israel

A recently proposed MRI methodology, SPatio-temporal ENcoding (SPEN), was employed to quantify apparent diffusion coefficients in breast. SPEN is highly robust in terms of overcoming B0-inhomogeneities and heterogeneous chemical shift environments, and hence could present advantages in these challenging studies. Diffusion SPEN measurements were carried out at 3T and included healthy female volunteers and patients with biopsy-confirmed breast cancer. Substantial advantages in terms of both anatomical image qualities and diffusional information vis-à-vis EPI were observed, confirming SPEN’s ability to yield reliable ADC values and reveal a reduction of ADC in cancerous tissues.

Wen Hao¹, Bin Zhao¹, Hui Liu², Marcel D. Nickel³, Elisabeth Weiland³, and Guangbin Wang^1
1Magnetic resonance imaging, Shandong medical imaging research institution, Shandong University, Jinan, ShanDong, China, ²MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China, ³MR Applications Development, Siemens AG, Healthcare Sector, Erlangen, Germany

We have investigated pharmacokinetic parameters for various bolus tracking time using CDT-VIBE sequence and drew the conclusion that a scanning time of 3 min after the injection of contrast might be adequate to yield reliable pharmacokinetic parameters and can be used for the evaluation of enhancing of breast lesions with reasonable accuracy in clinical setting.

Lenka Minarikova¹, Wolfgang Bogner¹, Olgica Zaric¹, Katja Pinker-Domenig¹, Thomas Helbich¹, Siegfried Trattnig¹, and Stephan Gruber^1
1High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

The purpose of this study was to compare bilateral breast-DWI with sub-mm-resolution (0.9mm2) at 7T with 3T (1.4mm2) in the same patients. The results suggest that breast 7T DWI can be performed with significantly higher spatial resolution than at 3T, with comparable SNR. Therefore, 7T DWI in breast cancer has the potential to improve lesion detection and/or differentiation. In addition, the high resolution of 7T DWI at b=0s/mm2 has very similar contrast as STIR and could, therefore, potentially replace additional T2-weighted MRI and save measurement time.

Jun Chen¹, Kathleen Brandt¹, Karthik Ghosh¹, Roger Grimm¹, Kevin Glaser¹, Jennifer Kugel¹, Kay Pepin¹, and Richard Ehman^1
1Mayo Clinic, Rochester, MN, United States

In conventional breast MR Elastography (MRE), the driver compresses the breasts to maintain mechanical coupling for wave transmission. This compression could introduce a significant bias into the measured stiffness of breast tissue. For the first time, this study reports strong evidence of breast compression effects in breast MRE. With 20% breast compression, glandular and adipose tissue stiffness increased by 53.8% and 103.8% respectively. Therefore, true breast tissue stiffness can be measured only when there is no compression, such as when using the noncompressive breast MRE technique utilized in this study.

Debra S Rivera¹, Jannie P Wijnen², Wybe J. M. van der Kemp², Alexander J Raaijmakers², Peter R Luijten², and Dennis WJ Klomp^2
1Neurophysics, Max Planck Institute, Leipzig, Germany, ²Univercity Medical Center Utrecht, Netherlands

Lymph node treatment response predicts 5-year survival. Insufficient monitoring methods slow drug development and breakthroughs in individualized treatment. Phospholipid metabolism indicates malignant transformation, thus preclinical drug development uses spectroscopy. Combining specialized RF hardware with 7T, we shrink voxels to clinically relevant volumes in vivo (1.2 cm isotropic). The setup is safe and compatible with existing breast coils. We present images of <1 cm nodes, and the first 31P spectra from an axilla lymph node in vivo. With signal visible just above the noise floor in a healthy volunteer, the hardware holds potential for monitoring treatment response in malignant lymph nodes.

Gene Young Cho¹, Linda Moy¹, Ana Paula Klautau Leite², Steven Baete¹, Jim Babb¹, Sungheon Kim¹, Daniel K Sodickson¹, and Eric E Sigmund^1
1Radiology - Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, Select, United States,²Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil

Advanced imaging methods such as diffusion MRI with intravoxel incoherent motion (IVIM) analysis provide quantification of imaging biomarkers that relate to physiological tumor characteristics. In this study, advanced diffusion MRI parameters (ADC and IVIM) and heterogeneity markers from histogram analysis of the whole tumor (i.e. kurtosis, skewness, deviation) are correlated with molecular prognostic factors (i.e. ER, PR, Her2/Neu, and Ki-67) in breast cancer patients. Such an analysis may provide useful metrics for breast cancer heterogeneity, which may play a useful role in diagnosis.

Eric Edward Sigmund¹, Linda Moy¹, Jin Ah Kim¹, Sungheon Kim¹, Akshat Pujara¹, Alana Amarosa¹, Komal Jhaveri², James Babb¹, Christian Geppert³, Christopher Glielmi³, Gene Young Cho¹, Thorsten Feiweier⁴, Kimberly Jackson¹, and Amy Melsaether^1
1Radiology, NYU Langone Medical Center, New York, NY, United States, ²Oncology, NYU Langone Medical Center, New York, NY, United States,³Siemens Medical Solutions, New York, NY, United States, ⁴Healthcare Sector, Siemens AG, Erlangen, Germany

Histogram analysis of intravoxel incoherent motion (IVIM)-MRI and FDG-PET parameters in breast cancer patients Diffusion-weighted MRI, particularly its vascular-sensitive variant intravoxel incoherent motion (IVIM), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are powerful individual probes of aggressiveness in breast cancer, with potential synergies on the simultaneous MR/PET platform. To investigate their complementarity, we studied the relationships between metrics from full lesion histogram analysis (mean, maximum, minimum, standard deviation, skewness, and kurtosis) of their respective parametric maps, as well as with clinical tumor markers. A cohort of 14 breast cancer patients with a dedicated breast coil were included. Results confirm canonical malignancy trends such the inverse relation between minimum ADC and maximum SUV (r=0.5), relations between markers’ heterogeneity metrics. Multiple regression models suggest combinations of mean, extremal, and variance metrics improve correlation with tumor markers, suggesting potential for imaging surrogates to tumor profile evaluation.

Dania Daye¹, Brad Keller¹, Ahmed Ashraf¹, Sarah Gavenonis¹, Carolyn Mies², Mark Rosen¹, Michael Feldman², and Despina Kontos^1
1Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States, ²Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Emerging studies suggest that imaging features could complement standard pathologic variables in cancer prognostic assessment. However, studies on the role of DCE-MRI in improving breast cancer prognostication are still limited. The goal of this study was to investigate the complementary value of morphologic breast DCE-MRI tumor characteristics as prognostic markers for breast cancer recurrence risk assessment. DCE-MRI images were retrospectively analyzed from 57 women with breast cancer. Oncotype DX score was used as a surrogate for cancer recurrence. Our results suggest that DCE-MRI could complement histopathologic factors in predicting breast cancer recurrence risk and could potentially improve breast cancer prognostication.

Limiao Jiang¹, Bo Zhang², Dennis Lai-Hong Cheong², Soo Chin Lee³, and Thian C Ng^1,2
1Department of Diagnostic Radiology, National University of Singapore, Singapore, Singapore, ²Clinical Imaging Research Center, A*STAR & National University of Singapore, Singapore, ³Department of Haematology-Oncology, National University Health System, Singapore

DTI can be used to probe tissue microstructure in vivo. We used DTI to study vasculature alteration including “normalization” for enhancing the drug(s) delivery to breast carcinoma cells in 35 patients pre-treated with low dose Sunitinib. It showed that patients pre-treated with anti-angiogenic agent had a more significant increase in ADC compared to sole chemotherapy group. This implies that Sunitinib may have enhanced the chemotherapy effectiveness. The pre-treatment ADC values and the relative changes in tumor volume after chemotherapy were also highly correlated, suggesting that the breast carcinoma with lower pre-treatment ADCs are likely going to respond better to chemotherapy.

Sunitha Thakur¹, Soledad Milans², Sujata Patil³, and Elizabeth Morris^3
1Memorial Sloan-Kettering Cancer Center, New York, NY, United States, ²Memorial Sloan-Kettering Cancer Center, New York, United States, ³Memorial Sloan-Kettering Cancer Center, NY, United States

DWI has demonstrated potential in discriminating malignant from benign lesions. In this work we explored if DWI can improve PPV of contrast-enhanced MRI at 3.0 T. ADC values are significantly lower in malignant lesions compared to benign lesions yielding 86% sensitivity, 73% specificity, 86% PPV and 73% NPV with the optimal ADC threshold of 1.3x10^-3 mm²/s derived from ROC analysis. Higher mean ADC values were observed in DCIS lesions compared to invasive lesions, and low-risk benign compared with high risk benign lesions. DWI of lesion assessment improves the PPV of breast malignancy and can be used as an adjunct to MRI (PPV=34%) to avoid unnecessary benign biopsies.