Technical innovation in dynamic contrast-enhanced magnetic resonance imaging of musculoskeletal tumors: an MR angiographic sequence using a sparse k-space sampling strategy

Fayad, Laura M.; Mugera, Charles; Soldatos, Theodoros; Flammang, Aaron; Grande, Filippo Del

doi:10.1007/s00256-013-1604-9

Cited by 26 publications

(29 citation statements)

References 11 publications

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“…Third, a limited analysis of DCE-MR imaging data was performed, because we only investigated the presence of early arterial enhancement for distinguishing MPNSTs from BPNSTs; the latter technique, though not quantitative, has recently been shown to be adequate for assessing soft-tissue sarcomas. 21 Further quantitative analysis of tumor perfusion can also be performed, which may enhance the differentiation of benign and malignant tumors, but it is a cumbersome analysis that is not as easily performed clinically as the quantification of ADC maps. Finally, 1 observer (Laura M. Fayad) was directly involved in the diagnosis and management of some tumors included in this study.…”

Section: Discussionmentioning

confidence: 99%

Conventional and Functional MR Imaging of Peripheral Nerve Sheath Tumors: Initial Experience

Demehri¹,

Belzberg

Blakeley

et al. 2014

American Journal of Neuroradiology

114

109

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BACKGROUND AND PURPOSE Differentiating benign from malignant peripheral nerve sheath tumors can be very challenging using conventional MR imaging. Our aim was to test the hypothesis that conventional and functional MR imaging can accurately diagnose malignancy in patients with indeterminate peripheral nerve sheath tumors. MATERIALS AND METHODS This institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study retrospectively reviewed 61 consecutive patients with 80 indeterminate peripheral nerve sheath tumors. Of these, 31 histologically proved peripheral nerve sheath tumors imaged with conventional (unenhanced T1, fluid-sensitive, contrast-enhanced T1-weighted sequences) and functional MR imaging (DWI/apparent diffusion coefficient mapping, dynamic contrast-enhanced MR imaging) were included. Two observers independently assessed anatomic (size, morphology, signal) and functional (ADC values, early arterial enhancement by dynamic contrast-enhanced MR) features to determine interobserver agreement. The accuracy of MR imaging for differentiating malignant from benign was also determined by receiver operating characteristic analysis. RESULTS Of 31 peripheral nerve sheath tumors, there were 9 malignant (9%) and 22 benign ones (81%). With anatomic sequences, average tumor diameter (6.3 ± 1.8 versus 3.9 ± 2.3 mm, P = .009), ill-defined/infiltrative margins (77% versus 32%; P = .04), and the presence of peritumoral edema (66% versus 23%, P = .01) were different for malignant peripheral nerve sheath tumors and benign peripheral nerve sheath tumors. With functional sequences, minimum ADC (0.47 ± 0.32 × 10−3 mm2/s versus 1.08 ± 0.26 × 10−3 mm2/s; P [H11021] .0001) and the presence of early arterial enhancement (50% versus 11%; P = .03) were different for malignant peripheral nerve sheath tumors and benign peripheral nerve sheath tumors. The minimum ADC (area under receiver operating characteristic curve was 0.89; 95% confidence interval, 0.73– 0.97) and the average tumor diameter (area under the curve = 0.8; 95% CI, 0.66 – 0.94) were accurate in differentiating malignant peripheral nerve sheath tumors from benign peripheral nerve sheath tumors. With threshold values for minimum ADC ≤ 1.0 × 10−3 mm2/s and an average diameter of ≥4.2 cm, malignancy could be diagnosed with 100% sensitivity (95% CI, 66.4%–100%). CONCLUSIONS Average tumor diameter and minimum ADC values are potentially important parameters that may be used to distinguish malignant peripheral nerve sheath tumors from benign peripheral nerve sheath tumors.

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Section: Discussionmentioning

confidence: 99%

Conventional and Functional MR Imaging of Peripheral Nerve Sheath Tumors: Initial Experience

Demehri¹,

Belzberg

Blakeley

et al. 2014

American Journal of Neuroradiology

114

109

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“…A composite set of images was reconstructed with maximum intensity projection in coronal, axial, and sagittal planes. Enhancement in the volume of interest could be viewed throughout different phases, similar to techniques described in prior work (22,26). Patients were included only if they had completed all their care at the institution; had undergone postneoadjuvant therapy, preoperative conventional MR imaging (T1-weighted, T2-weighted, or T1-weighted imaging with contrast enhancement) and DWI or DCE MR imaging; and had a histologic specimen available that could be analyzed for the percentage of postsurgical necrosis, viable tumor, and granulation tissue or fibrosis.…”

Section: Advances In Knowledgementioning

confidence: 99%

“…prediction of response to treatment in soft-tissue sarcomas (20)(21)(22)(23)(24)(25)(26). We hypothesized that differences in diffusion characteristics and enhancement patterns exist among viable tumor, nonneoplastic granulation tissue, and fibrosis in soft-tissue sarcomas, and that the addition of DWI and DCE imaging to the conventional MR imaging examination may increase the accuracy of MR imaging for assessment of treatment response.…”

Section: Musculoskeletal Imaging: Multiparametric Mr Imaging Assessmementioning

confidence: 99%

Multiparametric Assessment of Treatment Response in High-Grade Soft-Tissue Sarcomas with Anatomic and Functional MR Imaging Sequences

Soldatos¹,

Ahlawat²,

Montgomery³

et al. 2016

Radiology

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).q RSNA, 2015 Purpose:To determine the added value of quantitative diffusionweighted and dynamic contrast material-enhanced imaging to conventional magnetic resonance (MR) imaging for assessment of the response of soft-tissue sarcomas to neoadjuvant therapy. Materials and Methods:MR imaging examinations in 23 patients with soft-tissue sarcomas who had undergone neoadjuvant therapy were reviewed by two readers during three sessions: conventional imaging (T1-weighted, fluid-sensitive, static postcontrast T1-weighted), conventional with diffusion-weighted imaging, and conventional with diffusion-weighted and dynamic contrast-enhanced imaging. For each session, readers recorded imaging features and determined treatment response. Interobserver agreement was assessed and receiver operating characteristic analysis was performed to evaluate the accuracy of each session for determining response by using results of the histologic analysis as the reference standard. Good response was defined as less than or equal to 5% residual viable tumor. Results:Of the 23 sarcomas, four (17.4%) showed good histologic response (three of four with .95% granulation tissue and ,5% necrosis, one of four with 95% necrosis and ,5% viable tumor) and 19 (82.6%) showed poor response (viable tumor range, 10%-100%). Interobserver agreement was substantial or excellent for imaging features in all sequences (k = 0.789-1.000). Receiver operating characteristic analysis showed an increase in diagnostic performance with the addition of diffusion-weighted and dynamic contrast-enhanced MR imaging for prediction of response compared with that for conventional imaging alone (areas under the curve, 0.500, 0.676, 0. Conclusion:Adding functional sequences to the conventional MR imaging protocol increases the sensitivity of MR imaging for determining treatment response in soft-tissue sarcomas.q RSNA, 2015

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“…37 Once cystic, lipomatous, and vascular lesions have been ruled out, it is estimated that the ability of MRI to accurately characterize lesions is low, often ,50%. [38][39][40][41] Patterns of contrast enhancement in benign and malignant lesions overlap, 38 and with DCE-MRI malignant lesions typically demonstrate rapid early arterial enhancement and higher slopes of enhancement compared with benign lesions, 15,[17][18][19] but this pattern is not entirely specific (Fig 3). Finally, MRS is an emerging technique that has recently been applied to the characterization of musculoskeletal tumors.…”

Section: Figurementioning

confidence: 99%

“…14 Contrast material is usually injected intravenously at a rate of 2 to 5 mL/second, and imaging takes place with a temporal resolution of 3 to 10 seconds 15 carried out for as short as 2 minutes or as long as 5 to 7 minutes. The temporal resolution chosen for this pulse sequence depends on the need for spatial resolution and field-ofview coverage.…”

Section: Perfusion/dce-mrimentioning

confidence: 99%

De Novo Assessment of Pediatric Musculoskeletal Soft Tissue Tumors: Beyond Anatomic Imaging

Ahlawat

Fayad

2015

Pediatrics

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MRI plays a central role in the assessment of pediatric musculoskeletal soft tissue tumors. Although these neoplasms may initially be evaluated on other modalities, such as sonography, MRI is essential for accurately determining the extent of disease. Traditionally, MRI has been performed with sequences that provide excellent anatomic detail, with T1-weighted, fluid-sensitive, and static postcontrast T1-weighted sequences. However, with the introduction of noncontrast sequences such as diffusion-weighted imaging and magnetic resonance spectroscopy to the arsenal of available MRI techniques, functional and metabolic features of a neoplasm can now be examined noninvasively. These more recent MRI methods offer information for lesion characterization, the assessment of treatment response, and the distinction of postoperative scar from recurrence. Dynamic contrast-enhanced perfusion imaging is another useful functional technique that can be acquired before conventional static postcontrast imaging, without requiring additional contrast material. This review presents recent advances in MRI methodology that enable a comprehensive clinical assessment of musculoskeletal tumors in the pediatric population. The roles and challenges of combining anatomic, functional, and metabolic MRI sequences will be discussed as they relate to newly discovered soft tissue tumors in children.A principal role for MRI in the evaluation of pediatric musculoskeletal tumors is the determination of extent of disease for appropriate preoperative planning. Diffusion-weighted imaging (DWI), dynamic contrast-enhanced perfusion imaging (DCE-MRI), and magnetic resonance spectroscopy (MRS) have expanded the role of MRI to include lesion characterization, treatment response, and the detection of postsurgical recurrence. In this review, conventional (anatomic sequences) and advanced (functional and metabolic sequences) imaging will be discussed, with an emphasis on how these sequences are used in the clinical setting of newly discovered (de novo) pediatric soft tissue tumors. The assessment of treatment response and postsurgical recurrence is beyond the scope of this article. CHALLENGES IN THE PEDIATRIC PATIENTPediatric imaging presents unique challenges that are not encountered in the adult setting. The need for sedation in young children requires that a comprehensive protocol also be succinct. A complete tumor protocol that includes anatomic, functional, and metabolic sequences has been previously described. 1 The examination requires 60 minutes, with 15 minutes of this time allotted to MRS if desired (see Table 1).Additional challenges encountered in pediatric patients include their small size with resultant decreased signal and inherently low scan resolution.

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Technical innovation in dynamic contrast-enhanced magnetic resonance imaging of musculoskeletal tumors: an MR angiographic sequence using a sparse k-space sampling strategy

Cited by 26 publications

References 11 publications

Conventional and Functional MR Imaging of Peripheral Nerve Sheath Tumors: Initial Experience

Conventional and Functional MR Imaging of Peripheral Nerve Sheath Tumors: Initial Experience

Multiparametric Assessment of Treatment Response in High-Grade Soft-Tissue Sarcomas with Anatomic and Functional MR Imaging Sequences

De Novo Assessment of Pediatric Musculoskeletal Soft Tissue Tumors: Beyond Anatomic Imaging

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