Faculty Bibliography

OBJECTIVE: The objectives of this study were to develop a new method for free-breathing contrast-enhanced multiphase liver magnetic resonance imaging (MRI) using a combination of compressed sensing, parallel imaging, and radial k-space sampling and to demonstrate the feasibility of this method by performing image quality comparison with breath-hold cartesian T1-weighted (conventional) postcontrast acquisitions in healthy participants. MATERIALS AND METHODS: This Health Insurance Portability and Accountability Act-compliant prospective study received approval from the institutional review board. Eight participants underwent 3 separate contrast-enhanced fat-saturated T1-weighted gradient-echo MRI examinations with matching imaging parameters: conventional breath-hold examination with cartesian k-space sampling volumetric interpolate breath hold examination (BH-VIBE) and free-breathing acquisitions with interleaved angle-bisection and continuous golden-angle radial sampling schemes. Interleaved angle-bisection and golden-angle data from each 100 consecutive spokes were reconstructed using a combination of compressed sensing and parallel imaging (interleaved-angle radial sparse parallel [IARASP] and golden-angle radial sparse parallel [GRASP]) to generate multiple postcontrast phases.Arterial- and venous-phase BH-VIBE, IARASP, and GRASP reconstructions were evaluated by 2 radiologists in a blinded fashion. The readers independently assessed quality of enhancement (QE), overall image quality (IQ), and other parameters of image quality on a 5-point scale, with the highest score indicating the most desirable examination. Mixed model analysis of variance was used to compare each measure of image quality. RESULTS: Images of BH-VIBE and GRASP had significantly higher QE and IQ values compared with IARASP for both phases (P < 0.05). The differences in QE between BH-VIBE and GRASP for the arterial and venous phases were not significant (P > 0.05). Although GRASP had lower IQ score compared with BH-VIBE for the arterial (3.9 vs 4.8; P < 0.0001) and venous (4.2 vs 4.8; P = 0.005) phases, GRASP received IQ scores of 3 or more in all participants, which was consistent with acceptable or better diagnostic image quality. CONCLUSION: Contrast-enhanced multiphase liver MRI of diagnostic quality can be performed during free breathing using a combination of compressed sensing, parallel imaging, and golden-angle radial sampling.

OBJECTIVE: To evaluate the role of multiparametric magnetic resonance imaging (MRI) performed in men without a biopsy-proven diagnosis of prostate cancer using follow-up biopsy as the reference standard. MATERIALS AND METHODS: Forty-two patients without biopsy-proven cancer and who underwent MRI were included. In all patients, MRI was performed at 3T using a pelvic phased-array coil and included T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging. Thirteen had undergone no previous biopsy, and 29 had undergone at least 1 previous negative biopsy. All patients underwent prostate biopsy following MRI. Two fellowship-trained radiologists in consensus reviewed all cases and categorized each lobe as positive or negative for tumor. These interpretations were correlated with findings on post-MRI biopsy. RESULTS: Follow-up biopsy was positive in 23 lobes in 15 patients (36% of study cohort). On a per-patient basis, MRI had a sensitivity of 100%, specificity of 74%, positive predictive value (PPV) of 68%, and negative predictive value (NPV) of 100%. On a per-lobe basis, MRI had a sensitivity of 65%, specificity of 84%, PPV of 60%, and NPV of 86%. There was a nearly significant association between Gleason score and tumor detection on MRI (P = 0.072). CONCLUSIONS: In our sample, MRI had 100% sensitivity in predicting the presence of tumor on subsequent biopsy on a per-patient basis, suggesting a possible role for MRI in selecting patients with an elevated prostatic specific antigen (PSA) to undergo prostate biopsy. However, MRI had weaker specificity for prediction of a subsequent positive biopsy, as well as weaker sensitivity for tumor on a per-lobe basis, indicating that in patients with a positive MRI result, tissue sampling remains necessary for confirmation of the diagnosis as well as for treatment planning.

OBJECTIVES: Multi-parametric MRI is emerging as a promising method for prostate cancer diagnosis. prognosis and treatment planning. However, the localization of in-vivo detected lesions and pathologic sites of cancer remains a significant challenge. To overcome this limitation we have developed and tested a system for co-registration of in-vivo MRI, ex-vivo MRI and histology. MATERIALS AND METHODS: Three men diagnosed with localized prostate cancer (ages 54-72, PSA levels 5.1-7.7 ng/ml) were prospectively enrolled in this study. All patients underwent 3T multi-parametric MRI that included T2W, DCE-MRI, and DWI prior to robotic-assisted prostatectomy. Ex-vivo multi-parametric MRI was performed on fresh prostate specimen. Excised prostates were then sliced at regular intervals and photographed both before and after fixation. Slices were perpendicular to the main axis of the posterior capsule, i.e., along the direction of the rectal wall. Guided by the location of the urethra, 2D digital images were assembled into 3D models. Cancer foci, extra-capsular extensions and zonal margins were delineated by the pathologist and included in 3D histology data. A locally-developed software was applied to register in-vivo, ex-vivo and histology using an over-determined set of anatomical landmarks placed in anterior fibro-muscular stroma, central. transition and peripheral zones. The mean root square distance across corresponding control points was used to assess co-registration error. RESULTS: Two specimens were pT3a and one pT2b (negative margin) at pathology. The software successfully fused in-vivo MRI. ex-vivo MRI fresh specimen and histology using appropriate (rigid and affine) transformation models with mean square error of 1.59 mm. Coregistration accuracy was confirmed by multi-modality viewing using operator-guided variable transparency. CONCLUSION: The method enables successful co-registration of pre-operative MRI, ex-vivo MRI and pathology and it provides initial evidence of feasibility of MRI-guided surgical planning.

OBJECTIVE: The purpose of this study was to monitor iron clearance from the liver by means of T2 and T2* mapping after administration of an ultrasmall superparamagnetic iron oxide (USPIO) agent. MATERIALS AND METHODS: The study was performed using ferumoxytol (Feraheme), a USPIO agent that has been approved by the US Food and Drug Administration for the treatment of iron deficiency anemia in adult patients with chronic kidney disease. Six healthy human participants without anemia or preexisting iron overload were prospectively included. The cohort comprised 4 men and 2 postmenopausal women, aged 22 to 57 years. T2 and T2* mapping of the liver were performed at 1.5 T using multiple spin echo and multiple gradient echo sequences, respectively. After baseline imaging, ferumoxytol was injected intravenously at a dose of 5 mg Fe/kg body weight. Imaging was repeated at 3 days, 1 month, and every 2 months thereafter for up to 11 months or until liver T2* had recovered to 24 milliseconds, the threshold used to define iron deposition. For each examination, maps of the relaxation rates R2 (= 1/T2) and R2* (= 1/T2*) were generated by fitting the signal intensity data as a function of echo time to a monoexponential decay. RESULTS: No adverse reactions to ferumoxytol injection occurred. The magnetic resonance (MR) responses to ferumoxytol varied widely among the participants. Liver R2* increased from a mean value of 35.6 s (range, 28.7-40.9 s) at baseline to a mean value of 241 s (range, 161-417 s) 3 days after administration. Liver R2 increased from 19.4 s (range, 16.6-23.8 s) at baseline to 45.3 s (range, 34.4-58.5 s) at 3 days. There was also a large variation in iron clearance times. In 1 participant, MR relaxation rates had recovered to baseline by 3 months, whereas, in 3 participants, liver R2* remained elevated at 11 months (R2* > 55 s, ie, T2* < 18 milliseconds). In these 3 participants, liver R2 also remained marginally higher at 11 months than corresponding baseline values. CONCLUSIONS: Iron deposition in the liver after a 5 mg Fe/kg dose of ferumoxytol may alter signal contrast on MR images for several months after administration. This is an important consideration in the use of USPIO agents for diagnostic purposes.

Purpose: To compare histogram analysis of voxel-based whole-lesion (WL) enhancement to qualitative assessment and region-of-interest (ROI)-based enhancement analysis in discriminating the renal cell cancer (RCC) subtype clear cell RCC (ccRCC) from papillary RCC (pRCC). Materials and Methods: In this institutional review board-approved, HIPAA-compliant retrospective study, 73 patients underwent magnetic resonance (MR) imaging prior to surgery for RCC between January 2007 and January 2010. Three-dimensional fat-suppressed T1-weighted gradient-echo corticomedullary phase acquisitions, obtained before and after contrast agent administration, were transferred to a workstation at which automated registration followed by semiautomated segmentation of the RCC was performed. Percent enhancement was computed on a per-voxel basis: (SI(post) - SI(pre))/SI(pre) .100, where SI(pre) and SI(post) indicate signal intensity before and after contrast enhancement, respectively. The WL quantitative parameters of mean, median, and third quartile enhancement and histogram distribution parameters kurtosis and skewness were computed for each lesion. WL enhancement parameters were compared with ROI-based analysis and qualitative assessment with regards to diagnostic accuracy and interreader agreement in differentiating ccRCC from pRCC. Results: There were 19 pRCCs and 55 ccRCCs at pathologic examination. ccRCC had significantly higher WL mean, median, and third quartile enhancement compared with pRCC and hade significantly lower kurtosis and skewness (all P < .001). Third quartile enhancement had the highest accuracy (94.6%; area under the curve, 0.980) in discriminating ccRCC from pRCC, which was significantly higher than the accuracy of qualitative assessment (86.0%; P = .04) but not significantly higher than that of ROI enhancement (89.2%; P = .52). WL enhancement parameters had higher interreader agreement (kappa = 0.91-1.0) compared with ROI enhancement or qualitative assessment (kappa = 0.83 and 0.7, respectively) in discriminating ccRCC from pRCC. Conclusion: WL enhancement histogram analysis is feasible and can potentially be used to differentiate ccRCC from pRCC with high accuracy. (c) RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111281/-/DC1.

AIM: To assess impact of haemorrhage and delay after biopsy on prostate tumour detection using multi-parametric (MP) magnetic resonance imaging (MRI) assessment. MATERIALS AND METHODS: Forty-four patients underwent prostate MRI at 1.5 T using a pelvic phased-array coil, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging, before prostatectomy. Three radiologists independently reviewed images during four sessions [T2WI, DWI, DCE, and all parameters combined (MP-MRI)] to assess for tumour in each sextant. In a separate session, readers reviewed T1WI to score the extent of haemorrhage per sextant. Accuracy was assessed using logistic regression for correlated data. RESULTS: There was no significant difference in accuracy between readers for any session (p >/= 0.166), and results were averaged across the three readers for remaining comparisons. Accuracy was significantly greater for MP-MRI than for any parameter alone (p