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1
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Algarin YA, Pulumati A, Tan J, Zeitouni NC. Advances in non-invasive imaging for dermatofibrosarcoma protuberans: A review. Australas J Dermatol 2024; 65:610-620. [PMID: 39361531 PMCID: PMC11629142 DOI: 10.1111/ajd.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 08/09/2024] [Accepted: 09/11/2024] [Indexed: 10/05/2024]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma characterized by an asymmetric, infiltrative growth pattern and a high risk of local recurrence. This study aims to evaluate the effectiveness of various imaging modalities in the assessment and management of DFSP. Nine imaging modalities were reviewed including: Ultrasound (US), High-Frequency Doppler Ultrasound (HFUS), Computed tomography (CT), Positron emission tomography-computed tomography (PET-CT), and Magnetic Resonance Imaging (MRI), High-resolution-MRI (HR-MRI), Magnetic Resonance Spectroscopy (MRS), Optical Coherence Tomography (OCT), and Dermatoscopy. Imaging is mainly used for preoperative assessment and surgical planning, not routine diagnosis. US is effective for initial evaluations, demonstrating superior ability in detecting muscle invasion and defining tumour boundaries (sensitivity - 81.8%, specificity - 100%). MRI is valuable for preoperative evaluation, surgical planning, and monitoring DFSP recurrence. It more accurately assesses tumour depth than palpation, with a sensitivity of 67% and specificity of 100%, but was inferior when compared to US. CT is utilized in cases of suspected bone involvement or pulmonary metastasis. For advanced or recurrent DFSP, PET-CT helps manage treatment responses and imatinib therapy. Emerging technologies like MRS and OCT show potential in improving diagnostic accuracy and defining surgical margins, though more data are needed. US, MRI, and CT are the primary imaging modalities for DFSP. Emerging technologies like HR-MRI, PET-CT, MRS, and OCT hold promise for refining diagnostic and management strategies. Integrating multiple technologies could enhance management, particularly in atypical or aggressive cases. Further studies are required to refine imaging protocols and improve DFSP outcomes.
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Affiliation(s)
| | - Anika Pulumati
- University of Missouri‐Kansas City School of MedicineKansas CityMissouriUSA
| | - Jiali Tan
- Albany Medical CollegeAlbanyNew YorkUSA
| | - Nathalie C. Zeitouni
- Medical Dermatology SpecialistsUniversity of Arizona COM PhoenixPhoenixArizonaUSA
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2
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Petković Ramadža D, Kuhtić I, Žarković K, Lochmüller H, Čavka M, Kovač I, Barić I, Prutki M. Case Report: Advanced Skeletal Muscle Imaging in S-Adenosylhomocysteine Hydrolase Deficiency and Further Insight Into Muscle Pathology. Front Pediatr 2022; 10:847445. [PMID: 35463910 PMCID: PMC9026168 DOI: 10.3389/fped.2022.847445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION S-Adenosylhomocysteine hydrolase deficiency (SAHHD) is a rare inherited multisystemic disease with muscle involvement as one of the most prominent and poorly understood features. To get better insight into muscle involvement, skeletal muscles were analyzed by magnetic resonance imaging (MRI) and MR spectroscopy (MRS) in three brothers with SAHHD in the different age group. METHOD The study was based on analysis of MRI and MRS of skeletal muscles of the lower and the proximal muscle groups of the upper extremities in three SAHHD patients. RESULTS Three siblings presented in early infancy with similar signs and symptoms, including motor developmental delay. All manifested myopathy, more pronounced in the lower extremities and the proximal skeletal muscle groups, and permanently elevated creatine kinase. At the time of MRI and MRS study, the brothers were at the age of 13, 11, and 8 years, respectively. MRI revealed lipid infiltration, and the MRS curve showed an elevated muscle lipid fraction (higher peak of lipid), which increased with age, and was more prominent in the proximal skeletal muscles of the lower extremities. These results were consistent with muscle biopsy findings in two of them, while the third patient had no specific pathological changes in the examined muscle tissue. CONCLUSIONS These findings demonstrate that an accessible and non-invasive method of MRI and MRS is useful for an insight into the extent of muscle involvement, monitoring disease progression, and response to treatment in SAHHD.
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Affiliation(s)
- Danijela Petković Ramadža
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivana Kuhtić
- Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Kamelija Žarković
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Pathology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Department of Medicine, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mislav Čavka
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ida Kovač
- Department of Rehabilitation and Orthopaedic Devices, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivo Barić
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Maja Prutki
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
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Fang S, Yang Y, Xu N, Tu Y, Yin Z, Zhang Y, Liu Y, Duan Z, Liu W, Wang S. An Update in Imaging Evaluation of Histopathological Grade of Soft Tissue Sarcomas Using Structural and Quantitative Imaging and Radiomics. J Magn Reson Imaging 2021; 55:1357-1375. [PMID: 34637568 DOI: 10.1002/jmri.27954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/22/2022] Open
Abstract
Over the past two decades, considerable efforts have been made to develop non-invasive methods for determining tumor grade or surrogates for predicting the biological behavior, aiding early treatment decisions, and providing prognostic information. The development of new imaging tools, such as diffusion-weighted imaging, diffusion kurtosis imaging, perfusion imaging, and magnetic resonance spectroscopy have provided leverage in the diagnosis of soft tissue sarcomas. Artificial intelligence is a new technology used to study and simulate human thinking and abilities, which can extract and analyze advanced and quantitative image features from medical images with high throughput for an in-depth characterization of the spatial heterogeneity of tumor tissues. This article reviews the current imaging modalities used to predict the histopathological grade of soft tissue sarcomas and highlights the advantages and limitations of each modality. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Shaobo Fang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Yanyu Yang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Nan Xu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Yun Tu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenzhen Yin
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Yu Zhang
- Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yajie Liu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Zhiqing Duan
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Wenyu Liu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
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4
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Howe BM, Broski SM, Littrell LA, Pepin KM, Wenger DE. Quantitative Musculoskeletal Tumor Imaging. Semin Musculoskelet Radiol 2020; 24:428-440. [PMID: 32992370 DOI: 10.1055/s-0040-1708825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The role of quantitative magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) techniques continues to grow and evolve in the evaluation of musculoskeletal tumors. In this review we discuss the MRI quantitative techniques of volumetric measurement, chemical shift imaging, diffusion-weighted imaging, elastography, spectroscopy, and dynamic contrast enhancement. We also review quantitative PET techniques in the evaluation of musculoskeletal tumors, as well as virtual surgical planning and three-dimensional printing.
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Affiliation(s)
- B Matthew Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Kay M Pepin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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5
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Amar M, Ghasi RG, Krishna LG, Khanna G. Proton MR spectroscopy in characterization of focal bone lesions of peripheral skeleton. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0109-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of our study was to determine the value of single-voxel proton MR spectroscopy (1HMRS) in distinguishing benign from malignant focal bone lesions in the peripheral skeleton. MRI and 1HMRS was performed in 50 focal lesions (> 1 cm size) detected on radiographs of peripheral skeleton.1HMRS was performed at 1.5 T with TE of 144 ms with automatic shimming and water suppression. Qualitative analysis for a discrete choline peak at 3.2 ppm was done. Significance of the presence of choline peak on 1HMRS in distinguishing benign from malignant lesions was calculated using histopathology as a gold standard. Chi-square test was used and p value < 0.05 was considered significant.
Results
Forty-one benign and 9 malignant lesions were confirmed by histopathological results. Amongst malignant lesions, choline peak was positive in all but 1 case of low-grade lymphoma. MR spectra of 11 benign lesions showed the presence of choline peak. All 7 benign giant cell tumors (GCT) were positive for choline peak. The sensitivity, specificity, PPV, NPV of proton MR spectroscopy in differentiating benign from malignant lesions were 87.5%,71%,38.8%, and 96.4% respectively. p value was significant (< 0.05).
Conclusion
1HMRS in focal bone lesions can help in the differentiation of malignant from benign musculoskeletal tumors. Although some benign lesions may show false-positive result, absence of choline peak is a reliable reassurance against malignancy. GCT is an exception amongst benign bone tumors as it consistently shows the presence of choline peak on 1HMRS.
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Gimber LH, Chadaz TS, Flake W, Taljanovic MS. Advanced MR Imaging of Musculoskeletal Tumors: An Overview. Semin Roentgenol 2019; 54:149-161. [PMID: 31128738 DOI: 10.1053/j.ro.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lana Hirai Gimber
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - Tyson S Chadaz
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - William Flake
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - Mihra S Taljanovic
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ
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MR Imaging of Pediatric Musculoskeletal Tumors:: Recent Advances and Clinical Applications. Magn Reson Imaging Clin N Am 2019; 27:341-371. [PMID: 30910102 DOI: 10.1016/j.mric.2019.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pediatric musculoskeletal tumors comprise approximately 10% of childhood neoplasms, and MR imaging has been used as the imaging evaluation standard for these tumors. The role of MR imaging in these cases includes identification of tumor origin, tissue characterization, and definition of tumor extent and relationship to adjacent structures as well as therapeutic response in posttreatment surveillance. Technical advances have enabled quantitative evaluation of biochemical changes in tumors. This article reviews recent updates to MR imaging of pediatric musculoskeletal tumors, focusing on advanced MR imaging techniques and providing information on the relevant physics of these techniques, clinical applications, and pitfalls.
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8
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Multiparametric MR Imaging of Soft Tissue Tumors and Pseudotumors. Magn Reson Imaging Clin N Am 2018; 26:543-558. [DOI: 10.1016/j.mric.2018.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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10
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Watts V GJ, Zoga AC, Abraham JA. Posttreatment Imaging in Orthopedic Oncology. Semin Roentgenol 2017; 52:291-300. [PMID: 28965548 DOI: 10.1053/j.ro.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- George J Watts V
- Department of Radiology, Musculoskeletal Imaging and Intervention, Thomas Jefferson University, Philadelphia, PA
| | - Adam C Zoga
- Department of Radiology, Musculoskeletal Imaging and Intervention, Thomas Jefferson University, Philadelphia, PA.
| | - John A Abraham
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Center, Thomas Jefferson University, Philadelphia, PA; Orthopaedic Oncology Surgery, Rothman Institute, Philadelphia, PA
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11
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Jones BC, Fayad LM. Musculoskeletal Tumor Imaging: Focus on Emerging Techniques. Semin Roentgenol 2017; 52:269-281. [PMID: 28965546 DOI: 10.1053/j.ro.2017.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Blake C Jones
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD; The Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; The Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
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13
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Kransdorf MJ, Murphey MD. Imaging of Soft-Tissue Musculoskeletal Masses: Fundamental Concepts. Radiographics 2017; 36:1931-1948. [PMID: 27726739 DOI: 10.1148/rg.2016160084] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiologic evaluation of musculoskeletal soft-tissue masses has changed dramatically with the continued improvements in imaging technology. The integration of advanced imaging has provided the radiologist with a wide range of assessment tools, but as with all powerful arsenals, selection and application of the appropriate imaging method can be problematic. Although the choices available for imaging evaluation of musculoskeletal masses have changed dramatically, the basic objectives of this assessment have remained constant: diagnosis and staging. The basic principles for evaluating musculoskeletal soft-tissue masses and achieving these objectives have not changed. This article addresses application of the current imaging methods to assessment of soft-tissue musculoskeletal masses, emphasizing fundamental concepts. We do not intend to provide a comprehensive review of imaging techniques, but rather to provide a useful review of the concepts needed to select the appropriate initial imaging method, magnetic resonance (MR) imaging field of view, MR imaging sequences, contrast material requirements, and rapid image acquisition techniques. We also address use of the new quantitative techniques of chemical shift and diffusion-weighted imaging. Finally, we review the current uses of computed tomography and ultrasonography. Although the choices available for imaging evaluation of musculoskeletal masses have changed dramatically within the past decade, appropriate application of the fundamental concepts of imaging will maximize the diagnostic utility of imaging examinations. ©RSNA, 2016.
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Affiliation(s)
- Mark J Kransdorf
- From the Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.J.K.); American Institute for Radiologic Pathology, Silver Spring, Md (M.D.M.); and Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M.)
| | - Mark D Murphey
- From the Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.J.K.); American Institute for Radiologic Pathology, Silver Spring, Md (M.D.M.); and Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M.)
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14
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Zhang TH, Hu CH, Chen JX, Xu ZD, Shen JK. Differentiation Diagnosis of Hypo-Intense T2 Area in Unilateral Peripheral Zone of Prostate Using Magnetic Resonance Spectroscopy (MRS): Prostate Carcinoma versus Prostatitis. Med Sci Monit 2017; 23:3837-3843. [PMID: 28790299 PMCID: PMC5565236 DOI: 10.12659/msm.903123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background To determine whether magnetic resonance spectroscopy (MRS) can be used as a reliable denominator for the differentiation of prostatitis and prostate cancer (PCa) in the peripheral zone. Material/Methods Forty-three patients with unilateral peripheral zone PCa and 35 patients with unilateral peripheral zone prostatitis were recruited for this study. Magnetic resonance imaging (MRI) and MRS were acquired on a 1.5T MR scanner. The ratios of (Cho+Cr)/Cit of hypo-intense T2 area were calculated. The mean ratios of (Cho+Cr)/Cit in hypo-intense T2 area of PCa and that of prostatitis were compared retrospectively by t-test. The citrate and choline amplitudes in the hypo-intense T2 area were compared with that in the contralateral normal peripheral zone tissue. Results The mean ratios of (Cho+Cr)/Cit in the hypo-intense T2 area of PCa was 3.0±2.48, whereas that of prostatitis was 5.2±7.08, without significant statistical difference (p=0.306). A reduction in citrate was seen in both PCa and prostatitis tissue, however, choline was elevated in PCa tissue, whereas on the contrary, choline had no significant change in cases of prostatitis. Conclusions The mean ratios of (Cho+Cr)/Cit had no specificity in differentiation of PCa and prostatitis in the peripheral zone, however, the metabolic pattern showed promise as an adjunct to conventional imaging in differentiating prostatitis from PCa in the peripheral zone.
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Affiliation(s)
- Tong-Hua Zhang
- Department of Radiology, The 1st Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Chun-Hong Hu
- Department of Radiology, The 1st Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jian-Xin Chen
- Department of Radiology, The 1st People's Hospital of Zhang Jiagang Affiliated to Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zheng-Dao Xu
- Department of Radiology, The 1st People's Hospital of Zhang Jiagang Affiliated to Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jun-Kang Shen
- Department of Radiology, The 2nd Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Kalia V, Leung DG, Sneag DB, Del Grande F, Carrino JA. Advanced MRI Techniques for Muscle Imaging. Semin Musculoskelet Radiol 2017; 21:459-469. [PMID: 28772322 DOI: 10.1055/s-0037-1604007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractAdvanced magnetic resonance imaging (MRI) techniques can evaluate a wide array of muscle pathologies including acute or chronic muscle injury, musculotendinous response to injury, intramuscular collections and soft tissue masses, and others. In recent years, MRI has played a more important role in muscle disease diagnosis and monitoring. MRI provides excellent spatial and contrast resolution and helps direct optimal sites for muscle biopsy. Whole-body MRI now helps identify signature patterns of muscular involvement in large anatomical regions with relative ease. Quantitative MRI has advanced the evaluation and disease tracking of muscle atrophy and fatty infiltration in entities such as muscular dystrophies. Multivoxel magnetic resonance spectroscopy (MRS) now allows a more thorough, complete evaluation of a muscle of interest without the inherent sampling bias of single-voxel MRS or biopsy. Diffusion MRI allows quantification of muscle inflammation and capillary perfusion as well as muscle fiber tracking.
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Affiliation(s)
- Vivek Kalia
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Doris G Leung
- The Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Filippo Del Grande
- Servizio si Radiologia del Sottoceneri, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
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Patni RS, Boruah DK, Sanyal S, Gogoi BB, Patni M, Khandelia R, Gogoi N. Characterisation of musculoskeletal tumours by multivoxel proton MR spectroscopy. Skeletal Radiol 2017; 46:483-495. [PMID: 28188338 DOI: 10.1007/s00256-017-2573-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/26/2016] [Accepted: 01/10/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the role of multi-voxel proton MR spectroscopy in differentiating benign and malignant musculoskeletal tumours in a more objective way and to correlate the MRS data parameters with histopathology. METHODS AND MATERIALS A hospital-based prospective study was carried out comprising 42 patients who underwent MRI examinations from 1 July 2013 to 30 June 2014. After routine sequences, single-slice multi-voxel proton MR spectroscopy was included at TE-135 using the PRESS sequence. The voxel with the maximum choline/Cr ratio was used for analysis of data in 32 patients. The strength of association between the MR spectroscopy findings and the nature of tumour and histopathological grading were assessed. RESULTS Of the 42 patients, the MR spectra were not of diagnostic quality in 10. In the remaining 32 patients, 12 (37.5%) had benign and 20 (62.5%) malignant tumours. The mean choline/Cr ratio was 6.97 ± 5.95 (SD) for benign tumours and 25.39 ± 17.72 (SD) for malignant tumours. In our study statistical significance was noted between the choline/Cr ratio and the histological nature of musculoskeletal tumours (p = 0.002) assessed by unpaired t-test. The choline/Cr ratio and histological grading were also found to be significant (p = 0.001) when assessed by one-way ANOVA test. CONCLUSIONS Multi-voxel MR spectroscopy showed a higher choline/Cr ratio in malignant musculoskeletal tumours than in benign ones (p = 0.002). The choline/Cr ratio and histological grading of musculoskeletal tumours also showed statistical significance (p = 0.001).
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Affiliation(s)
- Ruchi S Patni
- Department of Radio-diagnosis, Assam Medical College, Dibrugarh, Assam, India
| | - Deb K Boruah
- Department of Radio-diagnosis, Assam Medical College, Dibrugarh, Assam, India.
- M-Lane, RCC-4, Assam Medical College Campus, Dibrugarh, Assam, 786002, India.
| | | | - Bidyut B Gogoi
- Department of Pathology, NEIGHRMS, Shillong, Meghalaya, India
| | - Maninder Patni
- Department of Anesthesiology, Geetanjali Medical College, Udaipur, Rajasthan, India
| | - Rosy Khandelia
- Department of Pathology, Assam Medical College, Dibrugarh, Assam, India
| | - Nripen Gogoi
- Department of Radio-diagnosis, Assam Medical College, Dibrugarh, Assam, India
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Nacey NC, Geeslin MG, Miller GW, Pierce JL. Magnetic resonance imaging of the knee: An overview and update of conventional and state of the art imaging. J Magn Reson Imaging 2017; 45:1257-1275. [PMID: 28211591 DOI: 10.1002/jmri.25620] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become the preferred modality for imaging the knee to show pathology and guide patient management and treatment. The knee is one of the most frequently injured joints, and knee pain is a pervasive difficulty that can affect all age groups. Due to the diverse pathology, complex anatomy, and a myriad of injury mechanisms of the knee, the MRI knee protocol and sequences should ensure detection of both soft tissue and osseous structures in detail and with accuracy. The knowledge of knee anatomy and the normal or injured MRI appearance of these key structures are critical for precise diagnosis. Advances in MRI technology provide the imaging necessary to obtain high-resolution images to evaluate menisci, ligaments, and tendons. Furthermore, recent advances in MRI techniques allow for improved imaging in the postoperative knee and metal artifact reduction, tumor imaging, cartilage evaluation, and visualization of nerves. As treatment and operative management techniques evolve, understanding the correct application of these advancements in MRI of the knee will prove to be valuable to clinical practice. LEVEL OF EVIDENCE 5 J. MAGN. RESON. IMAGING 2017;45:1257-1275.
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Affiliation(s)
- Nicholas C Nacey
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew G Geeslin
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Grady Wilson Miller
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer L Pierce
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
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Abstract
Magnetic resonance spectroscopy (MRS) is a noninvasive functional technique to evaluate the biochemical behavior of human tissues. This property has been widely used in assessment and therapy monitoring of brain tumors. MRS studies can be implemented outside the brain, with successful and promising results in the evaluation of prostate and breast cancer, although still with limited reproducibility. As a result of technical improvements, malignancies of the musculoskeletal system and abdominopelvic organs can benefit from the molecular information that MRS provides. The technical challenges and main applications in oncology of (1)H MRS in a clinical setting are the focus of this review.
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19
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Current utilities of imaging in grading musculoskeletal soft tissue sarcomas. Eur J Radiol 2016; 85:1336-44. [DOI: 10.1016/j.ejrad.2016.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 12/21/2022]
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20
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Jin W, Woo DC, Jahng GH. In vivo H1 MR spectroscopy using 3 Tesla to investigate the metabolic profiles of joint fluids in different types of knee diseases. J Appl Clin Med Phys 2016; 17:561-572. [PMID: 27074491 PMCID: PMC5874966 DOI: 10.1120/jacmp.v17i2.6144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/13/2015] [Accepted: 12/10/2015] [Indexed: 12/03/2022] Open
Abstract
In vivo proton (H1) magnetic resonance spectroscopy (MRS) has not yet been systematically used to study joint fluids in human knees. The objective of this study, therefore, was to assess the ability of proton MRS to identify the apparent heterogeneous characteristics of metabolic spectra in the joint fluid regions in human knees using a high‐field MRI system. Eighty‐four patients with effusion lesions who were referred for routine knee MR imaging underwent proton MRS with point‐resolved, single‐voxel MR spectroscopy using a clinical 3.0 Tesla MRI system. Thirty‐eight patients were confirmed to have the following: degenerative osteoarthritis, 21 patients (Group 1); traumatic diseases, 12 patients (Group 2); infectious diseases, 4 patients and an inflammatory disease, 1 patient (Group 3). Spectroscopy data were analyzed using the public jMRUI freeware software to obtain lipid metabolites. Nonparametric statistical comparisons were performed to investigate any differences in metabolites among the three disease groups. The major metabolites were vinylic CH=CH lipids around 5.1−5.5 ppm, CH2 lipids around 1.1−1.5 ppm, and CH3 lipids around 0.7−1.0 ppm. Each patient had either a CH=CH lipid peak, CH2 and CH3 lipid peaks, or all three peaks. There were no significant differences among the three groups for the CH3 (p=0.9019), CH2 (p=0.6406), and CH=CH lipids (p=0.5467) and water (p=0.2853); none of the metabolites could differentiate between any of the three types of diseases. The CH2 lipids in the 38 patients who had confirmed fluid characteristics were significantly correlated with CH3 lipids (rho=0.835, p<0.0001). The ratio of CH3 to CH2 was highest in the degenerative disease. In both the degenerative and traumatic diseases, metabolite peaks of the vinylic CH=CH lipids around 5.1−5.5 ppm and of the sum of the CH2 and CH3 lipids around 0.7−1.5 ppm were observed, but in the infectious disease, only a metabolite peak of the sum of the CH2 and CH3 lipids was detected. Although none of the metabolites could statistically significantly differentiate between the three types of diseases, the different lipid metabolite peaks and their ratios in the three disease groups may give us a hint at the different mechanisms of joint fluids in the infectious, degenerative, and traumatic diseases. PACS number(s): 87.61.Ff, 33.25.+k, 87.14.Cc
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Affiliation(s)
- Wook Jin
- Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University.
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Quartuccio N, Byun BH, Alongi P, Caobelli F, Kong CB, Lim SM, Cistaro A. Assessment of response to treatment in paediatric bone sarcomas by means of PET imaging. Clin Transl Imaging 2016; 4:41-55. [DOI: 10.1007/s40336-015-0160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ahlawat S, Fayad LM. De Novo Assessment of Pediatric Musculoskeletal Soft Tissue Tumors: Beyond Anatomic Imaging. Pediatrics 2015; 136:e194-202. [PMID: 26122807 DOI: 10.1542/peds.2014-2316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Noebauer-Huhmann IM, Amann G, Krssak M, Panotopoulos J, Szomolanyi P, Weber M, Czerny C, Breitenseher M, Grabner G, Bogner W, Nemec S, Dominkus M, Funovics P, Windhager R, Trattnig S. Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results. Eur Radiol 2015; 25:2041-8. [DOI: 10.1007/s00330-014-3576-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 12/04/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
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Deshmukh S, Subhawong T, Carrino JA, Fayad L. Role of MR spectroscopy in musculoskeletal imaging. Indian J Radiol Imaging 2014; 24:210-6. [PMID: 25114383 PMCID: PMC4126135 DOI: 10.4103/0971-3026.137024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is an imaging approach that allows for the noninvasive molecular characterization of a region of interest. By detecting signals of water, lipids, and other metabolites, MRS can provide metabolic information for lesion characterization and assessment of treatment response. Although MRS has been routinely used in the brain, clinical applications within the musculoskeletal system have only more recently emerged. The aim of this article is to review the technical considerations for performing MRS in the musculoskeletal system, focusing on proton MRS, and to discuss its potential roles in musculoskeletal tumor imaging and the assessment of muscle physiology and disease.
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Affiliation(s)
- Swati Deshmukh
- Department of Radiology, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, Maryland, USA
| | - Ty Subhawong
- Department of Radiology, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, Maryland, USA
| | - John A Carrino
- Department of Radiology, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, Maryland, USA
| | - Laura Fayad
- Department of Radiology, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, Maryland, USA
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Warrington CD, Feeney DA, Ober CP, Jessen CR, Steward SM, Armién AG, Fletcher TF. Relative metabolite concentrations and ratios determined by use of 3-T region-specific proton magnetic resonance spectroscopy of the brain of healthy Beagles. Am J Vet Res 2014; 74:1291-303. [PMID: 24066913 DOI: 10.2460/ajvr.74.10.1291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine relative concentrations of selected major brain tissue metabolites and their ratios and lobar variations by use of 3-T proton (hydrogen 1 [(1)H]) magnetic resonance spectroscopy (MRS) of the brain of healthy dogs. ANIMALS 10 healthy Beagles. PROCEDURES 3-T (1)H MRS at echo times of 144 and 35 milliseconds was performed on 5 transverse slices and 1 sagittal slice of representative brain lobe regions. Intravoxel parenchyma was classified as white matter, gray matter, or mixed (gray and white) and analyzed for relative concentrations (in arbitrary units) of N-acetylaspartate (NAA), choline, and creatine (ie, height at position of peak on MRS graph) as well as their ratios (NAA-to-choline, NAA-to-creatine, and choline-to-creatine ratios). Peak heights for metabolites were compared between echo times. Peak heights for metabolites and their ratios were correlated and evaluated among matter types. Yield was calculated as interpretable voxels divided by available lobar voxels. RESULTS Reference ranges of the metabolite concentration ratios were determined at an echo time of 35 milliseconds (NAA-to-choline ratio, 1.055 to 2.224; NAA-to-creatine ratio, 1.103 to 2.161; choline-to-creatine ratio, 0.759 to 1.332) and 144 milliseconds (NAA-to-choline ratio, 0.687 to 1.788; NAA-to-creatine ratio, 0.984 to 2.044; choline-to-creatine ratio, 0.828 to 1.853). Metabolite concentration ratios were greater in white matter than in gray matter. Voxel yields ranged from 43% for the temporal lobe to 100% for the thalamus. CONCLUSIONS AND CLINICAL RELEVANCE Metabolite concentrations and concentration ratios determined with 3-T (1)H MRS were not identical to those in humans and were determined for clinical and research investigations of canine brain disease.
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Affiliation(s)
- Christopher D Warrington
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108
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Teixeira PAG, Hossu G, Kauffmann F, Sewonu A, Constans JM, Blum A, Felblinger J. Influence of calcium on choline measurements by 1H MR spectroscopy of thigh muscles. Eur Radiol 2014; 24:1309-19. [PMID: 24633428 DOI: 10.1007/s00330-014-3131-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/05/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the effects of calcium on the choline peak measurements with 1H MR spectroscopy. MATERIAL AND METHODS The thigh muscles of two cadaveric specimens were prospectively evaluated on a 3 T MR unit before and after the injection of calcium carbonate (up to 0.4322 g). The choline peaks of 147 spectra from 10 different anatomic locations were quantitatively evaluated. The influence of the calcium concentration and its disposition with respect to the main magnetic field were considered. B0 phase maps were used to evaluate field inhomogeneities. RESULTS The presence of calcium led to a 43 % underestimation of the choline peak and the choline concentration (p = 0.0002 and 0.0036). The mean choline concentrations before and after CaCO3 injection were 3.53 ± 1.72 mmol/l and 1.58 ± 0.63 mmol/l. The influence of calcium carbonate on the choline peak estimations was proportional to the calcium concentration. There was a significant position-dependent difference in the estimation of the choline peak amplitude (p < 0.0154). Calcium injection led to a measurable increase in field inhomogeneities. CONCLUSION There was a significant underestimation of the choline peak amplitude and concentration in the presence of calcium, which might cause misinterpretations of MR spectra. KEY POINTS The presence of calcium led to significant underestimation of choline measurements. The influence of calcium is dependent on its concentration and distribution. Quantitative MR spectroscopy of calcified tumours should be interpreted with caution.
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1H Magnetic resonance spectroscopy findings in idiopathic inflammatory myopathies at 3 T: feasibility and first results. Invest Radiol 2014; 48:509-16. [PMID: 23563194 DOI: 10.1097/rli.0b013e3182823562] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the feasibility and potential use of quantitative proton magnetic resonance spectroscopy (MRS) for determining metabolite concentrations in patients with suspected inflammatory myopathies. MATERIALS AND METHODS In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective study, 35 patients with a suspected inflammatory myopathy and 6 age-matched healthy volunteers underwent magnetic resonance imaging (MRI) (T1-weighted and short tau inversion recovery [STIR] sequences) and single-voxel MRS (point-resolved spectroscopy; repetition time/echo time, 2000/135 milliseconds; voxel size, 2.0 × 2.0 × 4.0 cm) at 3 T. The voxel was placed in a thigh muscle and targeted to one with abnormal STIR signal when possible. Absolute trimethylamine, creatine (Cr), and bulk lipid concentrations in each voxel were determined using the phantom replacement method. The MRS results of patients and healthy subjects were compared using the Wilcoxon rank sum test. RESULTS Twenty-one patients were diagnosed with an active idiopathic inflammatory myopathy (IIM). In 20 of these patients, MRI showed increased intramuscular STIR signal; however, the muscle where the voxel was placed was normal in 9 patients. Patients with an IIM demonstrated higher mean intramuscular Cr concentration compared with controls (62.1 vs 35.3 IU; P = 0.01), but there were no differences in the mean trimethylamine or lipid concentrations. In IIM patients with no intravoxel signal abnormality (9/21), the mean Cr concentration was still higher than that in healthy subjects (63.2 vs 35.3 IU; P = 0.001). CONCLUSIONS Quantitative 3-T MRS is feasible and may supplement the role of conventional MRI in the evaluation of patients with inflammatory myopathies, especially where MRI shows no obvious muscle abnormalities.
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Fayad LM, Wang X, Blakeley JO, Durand DJ, Jacobs MA, Demehri S, Subhawong TK, Soldatos T, Barker PB. Characterization of peripheral nerve sheath tumors with 3T proton MR spectroscopy. AJNR Am J Neuroradiol 2013; 35:1035-41. [PMID: 24287094 DOI: 10.3174/ajnr.a3778] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE The characterization of peripheral nerve sheath tumors is challenging. The purpose here was to investigate the diagnostic value of quantitative proton MR spectroscopy at 3T for the characterization of peripheral nerve sheath tumors as benign or malignant, compared with PET. MATERIALS AND METHODS Twenty participants with 24 peripheral nerve sheath tumors underwent MR spectroscopy by use of a point-resolved sequence (TE, 135 ms). Six voxels were placed in 4 histologically proven malignant peripheral nerve sheath tumors and 22 voxels in 20 benign peripheral nerve sheath tumors (9 histologically proven, 11 with documented stability). The presence or absence of a trimethylamine signal was evaluated, the trimethylamine concentration estimated by use of phantom replacement methodology, and the trimethylamine fraction relative to Cr measured. MR spectroscopy results for benign and malignant peripheral nerve sheath tumors were compared by use of a Mann-Whitney test, and concordance or discordance with PET findings was recorded. RESULTS In all malignant tumors and in 9 of 18 benign peripheral nerve sheath tumors, a trimethylamine peak was detected, offering the presence of trimethylamine as a sensitive (100%), but not specific (50%), marker of malignant disease. Trimethylamine concentrations (2.2 ± 2.8 vs 6.6 ± 5.8 institutional units; P < .049) and the trimethylamine fraction (27 ± 42 vs 88 ± 22%; P < .012) were lower in benign than malignant peripheral nerve sheath tumors. A trimethylamine fraction threshold of 50% resulted in 100% sensitivity (95% CI, 58.0%-100%) and 72.2% (95% CI, 59.5%-75%) specificity for distinguishing benign from malignant disease. MR spectroscopy and PET results were concordant in 12 of 16 cases, (2 false-positive results for MR spectroscopy and PET each). CONCLUSIONS Quantitative measurement of trimethylamine concentration by use of MR spectroscopy is feasible in peripheral nerve sheath tumors and shows promise as a method for the differentiation of benign and malignant lesions. Trimethylamine presence within a peripheral nerve sheath tumor is a sensitive marker of malignant disease, but quantitative measurement of trimethylamine content is required to improve specificity.
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Affiliation(s)
- L M Fayad
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)Orthopedic Surgery (L.M.F.)Oncology (L.M.F., M.A.J.), The Johns Hopkins Hospital Comprehensive Neurofibromatosis Center
| | - X Wang
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)
| | - J O Blakeley
- Department of Neurology (J.O.B.), The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D J Durand
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)
| | - M A Jacobs
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)Oncology (L.M.F., M.A.J.), The Johns Hopkins Hospital Comprehensive Neurofibromatosis Center
| | - S Demehri
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)
| | - T K Subhawong
- Department of Radiology (T.K.S.), University of Miami Miller School of Medicine, Miami, Florida
| | - T Soldatos
- Research Unit of Radiology and Medical Imaging (T.S.), National and Capodestrian University of Athens, Evgenidion Hospital, Athens, Greece
| | - P B Barker
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)
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Mazzetti S, Bracco C, Regge D, Caivano R, Russo F, Stasi M. Choline-containing compounds quantification by 1H NMR spectroscopy using external reference and noise measurements. Phys Med 2013; 29:677-83. [DOI: 10.1016/j.ejmp.2012.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/22/2012] [Accepted: 07/01/2012] [Indexed: 11/26/2022] Open
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Thawait GK, Subhawong TK, Tatizawa Shiga NY, Fayad LM. "Cystic"-appearing soft tissue masses: what is the role of anatomic, functional, and metabolic MR imaging techniques in their characterization? J Magn Reson Imaging 2013; 39:504-11. [PMID: 24532375 DOI: 10.1002/jmri.24314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 06/21/2013] [Indexed: 11/05/2022] Open
Abstract
Although conventional MR imaging with contrast-enhanced T1-weighted sequences is of paramount importance for evaluating soft tissue masses, noncontrast MR sequences have emerged that facilitate their characterization. In this article, the utility and pitfalls of conventional MR imaging with T1-weighted, fluid-sensitive, and contrast-enhanced sequences will be discussed, along with that of functional (diffusion weighted imaging) and metabolic (proton MR spectroscopy) non-contrast-enhanced techniques for the purpose of soft tissue mass characterization. In particular, we discuss the application of these techniques to differentiating neoplastic or inflammatory masses that have high fluid content from benign cysts, as this distinction is a common pitfall of conventional sequences.
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Affiliation(s)
- Gaurav K Thawait
- Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, Maryland, USA
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Xu L, Liu B, Huang Y, Liu X, Zhang SW, Xin XG, Zheng JZ. 3.0 T proton magnetic resonance spectroscopy of the liver: Quantification of choline. World J Gastroenterol 2013; 19:1472-1477. [PMID: 23539666 PMCID: PMC3602508 DOI: 10.3748/wjg.v19.i9.1472] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/17/2013] [Accepted: 02/08/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the normal hepatic magnetic resonance spectroscopy findings choline/lipid2 (Cho/Lip2) associated with age and body mass index (BMI).
METHODS: A total of 58 single-voxel proton spectra of the liver were acquired at 3.0 T using the eight-channel phased array abdominal coil as the receiver coil. Consecutive stacks of breath-hold spectra were acquired using the point resolved spectroscopy technique at a short echo time of 30 ms and a repetition time of 1500 ms. The spectra were processed with the SAGE software package. Areas and heights for metabolite resonance were obtained. Student’s t test for unpaired data was used for comparisons of shimming, Cho/Lip2, and lipid content.
RESULTS: There were significant negative correlations between the Cho/Lip2 peak height ratios and BMI (r = -0.615) and age (r = -0.398) (all P < 0.01). Compared with the high-BMI group, the low-BMI group was younger (39.1 ± 13.0 years vs 47.6 ± 8.5 years, t = -2.954, P = 0.005); had better water suppression (93.4% ± 1.4% vs 85.6% ± 11.6%, t = 2.741, P = 0.014); had higher Cho/Lip2 peak heights ratio (0.2 ± 0.14 vs 0.05 ± 0.04, t = 6.033, P < 0.000); and had lower lipid content (0.03 ± 0.08 vs 0.29 ± 0.31, t = -3.309, P = 0.004). Compared with the older group, the younger group had better shimming effects (17.1 ± 3.6 Hz vs 22.0 ± 6.8 Hz, t = -2.919, P = 0.008); higher Cho/Lip2 peak heights ratios (0.03 ± 0.05 vs 0.09 ± 0.12, t = 2.4, P = 0.020); and lower lipid content (0.05 ± 0.11 vs 0.23 ± 0.32, t = -2.337, P = 0.031). Compared with the low-choline peak group, the high-choline peak group had lower lipid content (0.005 ± 0.002 vs 0.13 ± 0.23, t = -3.796, P < 0.000); lower BMI (19.6 ± 2.4 vs 23.9 ± 3.0, t = -4.410, P < 0.000); and younger age (34.7 ± 10.0 years vs 43.2 ± 12.5 years, t = -2.088, P = 0.041).
CONCLUSION: Lipid accumulation could result from the increased fat in the body depending on age and BMI. Lipid can mask the resonance signal of choline.
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Drapé JL. Advances in magnetic resonance imaging of musculoskeletal tumours. Orthop Traumatol Surg Res 2013; 99:S115-23. [PMID: 23380432 DOI: 10.1016/j.otsr.2012.12.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2012] [Indexed: 02/02/2023]
Abstract
Functional magnetic resonance imaging (MRI) improves tissue characterisation and staging of bone and soft-tissue tumours compared to the information usually supplied by structural imaging. Perfusion MRI, diffusion MRI, and in-phase/opposed-phase MRI can be performed in everyday practice. Nuclear magnetic resonance (NMR) spectroscopic imaging is a challenging technique that is available only in specialised centres. Tumour characterisation can benefit from perfusion MRI with dynamic gadolinium injection and enhancement time-intensity curve analysis or from diffusion MRI. Highly cellular malignant tumours restrict diffusion and consequently decrease the apparent diffusion coefficient (ADC). With some tumours, tissue heterogeneity or the presence of a myxoid component can hinder this evaluation. Chronic hematoma can be distinguished from haemorrhagic sarcoma. Perfusion and diffusion MRI contribute to the evaluation of tumour spread, in particular by differentiating oedema from tumour tissue. Another advantage of perfusion MRI and ADC mapping is the early identification of good responders to chemotherapy. The use of NMR spectroscopy remains limited. Evaluation of the choline peak can help to differentiate benign and malignant tumours. All available functional MRI techniques have limitations and leave some overlap between benign and malignant tumours. Functional MRI can be used only as an adjunctive imaging modality to complement morphological imaging.
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Affiliation(s)
- J-L Drapé
- Service de Radiologie B, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Centre, 27 rue du Faubourg-Saint-Jacques, Paris, France.
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Fayad LM, Jacobs MA, Wang X, Carrino JA, Bluemke DA. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology 2013; 265:340-56. [PMID: 23093707 DOI: 10.1148/radiol.12111740] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although the function of magnetic resonance (MR) imaging in the evaluation of musculoskeletal tumors has traditionally been to help identify the extent of disease prior to treatment, its role continues to evolve as new techniques emerge. Conventional pulse sequences remain heavily used and useful, but with the advent of chemical shift imaging, diffusion-weighted imaging, perfusion imaging and MR spectroscopy, additional quantitative metrics have become available that may help expand the role of MR imaging to include detection, characterization, and reliable assessment of treatment response. This review discusses a multiparametric approach to the evaluation of musculoskeletal tumors, with a focus on the utility and potential added value of various pulse sequences in helping establish a diagnosis, assess pretreatment extent, and evaluate a tumor in the posttreatment setting for recurrence and treatment response.
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Affiliation(s)
- Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Wolfe St, Baltimore, MD 21287, USA.
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Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine (Phila Pa 1976) 2012; 37:E736-44. [PMID: 22210011 DOI: 10.1097/brs.0b013e3182458cac] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study is a research synthesis of the published literature evaluating the performance of magnetic resonance imaging (MRI) for differentiation of malignant from benign vertebral compression fractures (VCFs). OBJECTIVE Perform a systematic review and meta-analysis to summarize and combine the published data on MRI for discriminating malignant from benign VCFs. SUMMARY OF BACKGROUND DATA The differentiation between benign and malignant VCFs in the spine is a challenging problem confronting spine practitioners. METHODS MEDLINE, EMBASE, and other databases were searched by 2 independent reviewers to identify studies that reported the performance of MRI for discriminating malignant from benign VCF. Included studies were assessed for described MRI features and study quality. The sensitivity, specificity, and diagnostic odds ratio (OR) of each feature were pooled with a random-effects model weighted by the inverse of the variance of each individual estimate. RESULTS A total of 31 studies with 1685 subjects met the selection criteria. All the studies focused on describing specific features rather than overall diagnostic performance. Signal intensity ratio on opposed phase (chemical shift) imaging 0.8 or more (OR = 164), apparent diffusion coefficient on echo planar diffusion-weighted images 1.5 × 10(-3) mm2/s or less with b value 500 s/mm2 (OR = 130), presence of other noncharacteristic vertebral lesions (OR = 55), presence of paraspinal mass (OR = 33), involvement of posterior element (OR = 28), involvement of pedicle (OR = 24), complete replacement of normal bone marrow in VCF (OR = 19), presence of epidural mass (OR = 13), and diffuse convexity of posterior vertebral border (OR = 10) were associated with malignant VCFs, whereas coexisting healed benign VCF (OR = 0.006), presence of "fluid sign" (OR = 0.08), presence of focal posterior vertebral border convexity/retropulsion (OR = 0.08), and band-like shape of abnormal signal (OR = 0.07) were associated with benign VCFs. CONCLUSION Several specific MRI features using signal intensity characteristics, morphological characteristics, quantitative techniques, and findings at other levels can be useful for distinguishing benign from malignant VCFs and can serve as inputs for a prediction model. Observer performance reliability has not been adequately assessed.
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Girish G, Finlay K, Morag Y, Brandon C, Jacobson J, Jamadar D. Imaging review of skeletal tumors of the pelvis--part I: benign tumors of the pelvis. ScientificWorldJournal 2012; 2012:290930. [PMID: 22666102 PMCID: PMC3362015 DOI: 10.1100/2012/290930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 01/12/2012] [Indexed: 12/22/2022] Open
Abstract
The osseous pelvis is a well-recognized site of origin of numerous primary and secondary musculoskeletal tumors. The radiologic evaluation of a pelvic lesion often begins with the plain film and proceeds to computed tomography (CT), or magnetic resonance imaging (MRI) and possibly biopsy. Each of these modalities, with inherent advantages and disadvantages, has a role in the workup of pelvic osseous masses. Clinical history and imaging characteristics can significantly narrow the broad differential diagnosis for osseous pelvic lesions. The purpose of this review is to familiarize the radiologist with the presentation and appearance of some of the common benign neoplasms of the osseous pelvis and share our experience and approach in diagnosing these lesions.
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Affiliation(s)
- Gandikota Girish
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, TC-2910, Ann Arbor, MI 48109-0326, USA.
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Proton MR spectroscopy in metabolic assessment of musculoskeletal lesions. AJR Am J Roentgenol 2012; 198:162-72. [PMID: 22194493 DOI: 10.2214/ajr.11.6505] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purposes of this review are to describe the principles and method of MR spectroscopy, summarize current published data on musculoskeletal lesions, and report additional cases that have been analyzed with recently developed quantitative methods. CONCLUSION Proton MR spectroscopy can be used to identify key tissue metabolites and may serve as a useful adjunct to radiographic evaluation of musculoskeletal lesions. A pooled analysis of 122 musculoskeletal tumors revealed that a discrete choline peak has a sensitivity of 88% and specificity of 68% in the detection of malignancy. Modest improvements in diagnostic accuracy in 22 of 122 cases when absolute choline quantification was used encourage the pursuit of development of choline quantification methods.
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Wang CK, Li CW, Hsieh TJ, Lin CJ, Chien SH, Tsai KB, Chang KC, Tsai HM. In vivo 1H MRS for musculoskeletal lesion characterization: which factors affect diagnostic accuracy? NMR IN BIOMEDICINE 2012; 25:359-368. [PMID: 21793078 DOI: 10.1002/nbm.1758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 05/27/2011] [Accepted: 05/31/2011] [Indexed: 05/31/2023]
Abstract
In vivo (1)H MRS is a noninvasive imaging technique for the identification of malignancy. Musculoskeletal lesions vary in their composition, causing field inhomogeneity and magnetic susceptibility effects which may be technical and diagnostic challenges for MRS. This study investigated the factors that affect diagnostic accuracy in the use of MRS for the characterization of musculoskeletal neoplasms. During a 7-year period, 210 consecutive patients with musculoskeletal lesions larger than 1.5 cm in diameter were examined. MRS of a single-voxel point-resolved spectroscopy sequence with TE = 135 ms was undertaken using a 1.5-T scanner. Lesions with a choline signal-to-noise ratio larger than 3.0 were considered to be malignant tumors. The diagnostic accuracy was calculated for all lesions and for subgroups on the basis of lesion type (bone and soft tissue), lesion composition (mixed and solid nonsclerotic), lesion size (≤4, >4-10 and >10 cm), MR scanner (MR scanner 1 and 2) and selected voxel size (≤3, >3-8 and >8 cm(3)). Multivariate logistic regressions were performed to estimate the associations between each factor and diagnostic accuracy. The diagnostic accuracy was 73.3% for all lesions. The accuracy was 54.4% for mixed lesions and 80.4% for solid nonsclerotic lesions (p < 0.001). The diagnostic accuracy was lower for larger lesions [86.8% for lesions of ≤4 cm, 71.6% for lesions of >4-10 cm (p = 0.04) and 63.6% for lesions of >10 cm (p = 0.007)]. There was no difference in diagnostic accuracy for bone versus soft-tissue lesions or as a function of MR scanner or voxel size. By the use of multivariate logistic regression, a solid nonsclerotic lesion was 3.15 times (95% confidence interval, 1.59-6.27) more likely than a mixed lesion to have a diagnosis (p = 0.001). MRS can be used to characterize musculoskeletal lesions, particularly solid nonsclerotic lesions.
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Affiliation(s)
- Chien-Kuo Wang
- Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan.
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Zhang J, Cheng K, Ding Y, Liang W, Ding Y, Vanel D, Cheng X. Study of single voxel 1H MR spectroscopy of bone tumors: differentiation of benign from malignant tumors. Eur J Radiol 2011; 82:2124-8. [PMID: 22169357 DOI: 10.1016/j.ejrad.2011.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the clinical application of single voxel (1)H MRS in the discrimination of benign and malignant bone tumors. MATERIALS AND METHODS Eighty-three patients (64 male, 19 female), presenting with a bone tumor, were examined on a 1.5 T MRI scanner. Using pathological results as a gold standard, there were 34 benign and 49 malignant tumors. After plain MRI scans, a 3D fast SPGR sequence was used for dynamic contrast-enhanced scanning. Dynamic images were transferred to the workstation, where the region of maximal enhancement was identified for prescription of the (1)H MRS sequence. Single-voxel (1)H MRS was then performed with the probe-p sequence, TR/TE = 1500/110 ms, VOI ranging from 14.4 mm × 7.3mm × 20.2mm to 27.9 mm × 25.5 mm × 20.1 mm, automatic shimming and water suppression, 15 min post-contrast. For control purposes, the 3rd lumbar spine vertebral body of six patients having lumbar disc herniation (LDH) without systemic disease was examined with (1)H MRS of normal bone marrow. The static contrast enhancement scan was used for these LDH patients. Conversion of raw MR signal to an MR spectrum was performed using SAGE 7. Cho/Lip (choline/lipids) peak height ratios were calculated. ROC curve analysis was used to determine the cut-off of Cho/Lip ratio for discrimination. RESULTS For malignant tumors, one resonance at 3.30-3.19 ppm attributed to choline and another at 1.14-1.55 ppm attributed to lipid were detected. With normal bone marrow and most benign tumors, no choline signal was detected. Choline was only found in six benign lesions. With a threshold for Cho/Lip peak height ratio of 0.2, the area under ROC curve was 0.819. The corresponding sensitivity and specificity of (1)H MRS were 76% and 88%. CONCLUSIONS Single voxel (1)H MRS can help in discriminating benign and malignant bone tumors.
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Affiliation(s)
- Jing Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
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Russo F, Mazzetti S, Grignani G, De Rosa G, Aglietta M, Anselmetti GC, Stasi M, Regge D. In vivo characterisation of soft tissue tumours by 1.5-T proton MR spectroscopy. Eur Radiol 2011; 22:1131-9. [DOI: 10.1007/s00330-011-2350-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 10/07/2011] [Accepted: 10/15/2011] [Indexed: 12/25/2022]
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Costa FM, Canella C, Gasparetto E. Advanced Magnetic Resonance Imaging Techniques in the Evaluation of Musculoskeletal Tumors. Radiol Clin North Am 2011; 49:1325-58, vii-viii. [DOI: 10.1016/j.rcl.2011.07.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Wang X, Jacobs MA, Fayad L. Therapeutic response in musculoskeletal soft tissue sarcomas: evaluation by MRI. NMR IN BIOMEDICINE 2011; 24:750-63. [PMID: 21793077 PMCID: PMC3150732 DOI: 10.1002/nbm.1731] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This article provides a literature review of the use of MRI in monitoring the treatment response of soft tissue sarcomas. The basic classification and physiology of soft tissue tumors are introduced. Then, the major treatment options for soft tissue sarcomas are summarized with brief coverage of possible responses and grading systems. Four major branches of MRI techniques are covered, including conventional T(1) - and T(2) -weighted imaging, contrast-enhanced MRI, MR diffusion and perfusion imaging, and MRS, with a focus on the tumor microenvironment. Although this literature survey focuses on recent clinical developments using these MRI techniques, research venues in preclinical studies, as well as in potential applications other than soft tissue sarcomas, are also included when comparable and/or mutually supporting. Examples from other less-discussed MRI modalities are also briefly covered, not only to complement, but also to expand, the scope and depth of information for various kinds of lesions.
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Affiliation(s)
- Xin Wang
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
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Abrantes AM, Rio J, Tavares LC, Carvalho RA, Botelho MF. Magnetic resonance spectroscopy in cancer diagnostics. Oncol Rev 2010. [DOI: 10.1007/s12156-010-0050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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A feasibility study of quantitative molecular characterization of musculoskeletal lesions by proton MR spectroscopy at 3 T. AJR Am J Roentgenol 2010; 195:W69-75. [PMID: 20566784 DOI: 10.2214/ajr.09.3718] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The purpose of this study is to establish the feasibility and potential value of measuring the concentration of choline-containing compounds by proton MR spectroscopy (MRS) in musculoskeletal lesions at 3 T. SUBJECTS AND METHODS Thirty-three subjects with 34 musculoskeletal lesions (four histologically proven malignant, 13 histologically proven benign or proven benign by follow-up analysis, and 17 posttreatment fibrosis with documented stability for 6-36 months) underwent single-voxel 3-T MRS studies. In each case, both water-suppressed and water-unsuppressed scans were obtained. The quality of the scans was recorded as excellent, adequate, or nondiagnostic, and the choline concentration was measured using water as the internal reference. The choline concentrations of benign and malignant lesions were compared using the Mann-Whitney test. RESULTS Spectral quality was excellent in 26 cases, adequate in four cases, and nondiagnostic in four cases. For malignant lesions (three sarcomas), the choline concentrations were 1.5, 2.9, and 3.8 mmol/kg, respectively. For five benign lesions (two neurofibromas, two schwannomas, and one enchondroma), the choline concentrations were 0.11, 0.28, 0.13, 0.8, and 1.2 mmol/kg, respectively. For seven benign lesions (two hematomas, two bone cysts, one lipoma, one giant cell tumor, and one pigmented villonodular synovitis), the spectra showed negligible choline content. For three posttreatment fibrosis cases, the choline concentration range was 0.2-0.4 mmol/kg. For the remaining 12 posttreatment fibrosis cases, the spectra showed negligible choline content. Average choline concentrations were different for malignant and benign lesions (2.7 vs 0.5 mmol/kg; p = 0.01). CONCLUSION The measurement of choline concentration within musculoskeletal lesions by MRS is feasible using an internal water-referencing method at 3 T and has potential for characterizing lesions for malignancy.
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Quantification of muscle choline concentrations by proton MR spectroscopy at 3 T: technical feasibility. AJR Am J Roentgenol 2010; 194:W73-9. [PMID: 20028894 DOI: 10.2214/ajr.09.3125] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The quantification of choline in musculoskeletal tissues has several potential uses, including characterizing malignancy, but has not been previously achievable. We present a method of measuring the absolute concentration of choline by proton MR spectroscopy (MRS) in skeletal muscle at 3 T. MATERIALS AND METHODS At 3 T, choline measurements were performed in phantoms and healthy volunteers using proton MRS (point-resolved spectroscopy sequence [PRESS]; TR/TE, 2,000/135). In vitro choline concentrations were measured in three phantom solutions (10, 5, 1.25 mmol). Choline T1 and T2 relaxation times were measured in the muscles of five healthy subjects. In vivo choline concentrations were measured using water as an internal reference and average T1 and T2 relaxation times in 20 muscle locations (quadriceps, hamstring, adductor) of seven healthy subjects (four men, three women). Descriptive statistics are reported. RESULTS In vitro, the average measured choline concentrations of the 10-, 5-, and 1.25-mmol solutions were 9.91, 5.03, and 1.22 mmol, respectively. In vivo, the average T1 and T2 relaxation times of choline were 1,372+/-57 (SD) and 134+/-11 milliseconds, respectively. The average choline concentrations in the quadriceps and hamstring muscles were 10.0+/-0.4 (SD) and 8.0+/-2.9 mmol/kg. Interindividual variation existed in the choline concentrations (quadriceps range, 6.7-13 mmol/kg), but there was little variation by patient sex. CONCLUSION In the musculoskeletal system, the measurement of choline concentration by proton MRS at 3 T is feasible using water as an internal reference. These data provide a quantitative basis for future investigations of metabolite concentrations in normal and diseased musculoskeletal tissues.
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Lee CW, Lee JH, Kim DH, Min HS, Park BK, Cho HS, Kang HG, Suh JS, Ehara S. Proton magnetic resonance spectroscopy of musculoskeletal lesions at 3 T with metabolite quantification. Clin Imaging 2010; 34:47-52. [DOI: 10.1016/j.clinimag.2009.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 03/10/2009] [Indexed: 11/26/2022]
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Humphries PD, Zerizer I. Imaging 'the lost tribe': a review of adolescent cancer imaging. Part 1. Cancer Imaging 2009; 9:70-81. [PMID: 19933020 PMCID: PMC2792084 DOI: 10.1102/1470-7330.2009.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although a small proportion of all cancer registrations, malignancy in adolescence and young adulthood remains the most common natural cause of death in this age group. Advances in the management and outcomes of childhood cancer have not been matched within the adolescent population, with increasing incidence and poorer survival seen amongst teenagers with cancer compared with other populations. There have been increasing moves towards specific adolescent oncology centres, with the aim of centralising expertise, however, ‘adolescent imaging’ does not exist as a speciality in the same way that paediatric imaging does, with responsibility for imaging adolescent patients sometimes falling to paediatric radiologists and sometimes to ‘adult’ radiologists, usually with a specific interest in a tumour type or body system. In this article, imaging of the more common malignancies, encountered in adolescent patients is reviewed. Complications of treatment are reviewed in another article to give an overview of adolescent oncology imaging practice.
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Affiliation(s)
- P D Humphries
- University College London Hospital NHS Trust, 235 Euston Road, London NW1, UK.
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Costa FM, Vianna EM, Domingues RC, Setti M, Meohas W, Rezende JF, Domingues RC, Gasparetto EL. Espectroscopia de prótons e perfusão por ressonância magnética na avaliação dos tumores do sistema musculoesquelético. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000400006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a espectroscopia de prótons e o estudo dinâmico do contraste por ressonância magnética na diferenciação dos tumores musculoesqueléticos benignos e malignos. MATERIAIS E MÉTODOS: Foram estudados 55 pacientes com tumores musculoesqueléticos (27 malignos e 28 benignos). Os exames foram realizados em aparelho de ressonância magnética de 1.5 T com protocolo convencional e espectroscopia de prótons com TE de 135 ms. O estudo dinâmico do contraste foi adquirido pela sequência T1 gradiente-eco após a administração intravenosa de gadolínio. Curvas de intensidade de sinal versus tempo e valores de slope foram calculados. A análise estatística foi realizada pelo teste de Levene, seguido pelo teste t de Student, além dos testes qui-quadrado de Pearson e exato de Fischer. RESULTADOS: A sensibilidade, especificidade e acurácia da espectroscopia de prótons foram, respectivamente, de 87,5%, 92,3% e 90,9% (p < 0,0001). Além disso, houve significativa diferença entre o valor quantitativo da curva entre as lesões benignas (média de 27,5% por minuto) e malignas (média de 110,9% por minuto) (p < 0,0001). CONCLUSÃO: Os estudos quantitativo e qualitativo da análise dinâmica do contraste por ressonância magnética associados à presença do pico de colina são úteis na diferenciação dos tumores musculoesqueléticos em benignos e malignos.
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Affiliation(s)
| | | | | | - Marcela Setti
- Clínica de Diagnóstico Por Imagem, Brasil; Clínica de Diagnóstico Multi-Imagem, Brasil
| | | | | | | | - Emerson Leandro Gasparetto
- Clínica de Diagnóstico Por Imagem, Brasil; Clínica de Diagnóstico Multi-Imagem, Brasil; Universidade Federal do Rio de Janeiro
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Abstract
OBJECTIVE The proton MR spectroscopic finding of elevated choline has been reported to be useful in the differentiation of malignant from benign musculoskeletal tumors. This study was designed to evaluate the MR spectroscopy features of giant cell tumor (GCT) of the bone, primarily to determine whether the presence of choline is a frequent occurrence in these tumors and whether MR spectroscopy features can be correlated with clinical, radiologic, and histopathologic findings. SUBJECTS AND METHODS MRI, dynamic contrast-enhanced MRI, and proton MR spectroscopy were performed in 33 patients with bone tumors on a 1.5-T MR scanner. Of these, 12 patients who had GCT of the bone form the subject material for this study. Dynamic contrast-enhanced MRI and single-voxel proton MR spectroscopy were performed after preliminary evaluation with radiography. Patients were divided into two groups, those with elevated choline levels and those without a choline peak on MR spectroscopy. The clinical and radiologic features, including the Campanacci stage and dynamic MRI findings, were compared in these two groups. Core biopsy was performed in all patients, and in 10 of 12 patients, histopathologic evaluation of the postoperative resected specimen was also performed. RESULTS Although all 12 tumors were benign on histopathology, four had elevated choline levels. Of these, three (75%) had an aggressive radiographic appearance (Campanacci stage 3). As opposed to this, only three of the eight (37.5%) tumors without a choline peak had an aggressive radiographic appearance. Except for a single case, all tumors showed early enhancement and washout of contrast material on dynamic MRI. CONCLUSION The results of this study indicate that GCT of bone may show raised choline levels on proton MR spectroscopy. This finding is not an indicator of malignancy in these tumors.
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