• Investigative Magnetic Resonance Imaging
• /
• v.23 no.2
• /
• pp.125-135
• /
• 2019

Purpose: The purpose of this study was to evaluate dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI), and diffusion-weighted imaging (DWI) variables, for axillary lymph node (ALN) metastasis in the early stage of breast cancer. Materials and Methods: January 2011-April 2015, 787 patients with early stage of breast cancer were retrospectively reviewed. Only cases of invasive ductal carcinoma, were included in the patient population. Among them, 240 patients who underwent 3.0-T DCE-MRI, including DWI with b value 0 and $800s/mm^2$ were enrolled. MRI variables (adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, quantitative kinetic parameters, signal enhancement ratio (SER), tumor apparent diffusion coefficient (ADC), peritumoral ADC, and peritumor-tumor ADC ratio) clinico-pathologic variables (age, T stage, multifocality, extensive intraductal carcinoma component (EIC), estrogen receptor, progesterone receptor, HER-2 status, Ki-67, molecular subtype, histologic grade, and nuclear grade) were compared between patients with axillary lymph node metastasis and those with no lymph node metastasis. Multivariate regression analysis was performed, to determine independent variables associated with ALN metastasis, and the area under the receiver operating characteristic curve (AUC), for predicting ALN metastasis was analyzed, for those variables. Results: On breast MRI, moderate or prominent ipsilateral whole-breast vascularity (moderate, odds ratio [OR] 3.45, 95% confidence interval [CI] 1.28-9.51 vs. prominent, OR = 15.59, 95% CI 2.52-96.46), SER (OR = 1.68, 95% CI 1.09-2.59), and peritumor-tumor ADC ratio (OR = 6.77, 95% CI 2.41-18.99), were independently associated with ALN metastasis. Among clinico-pathologic variables, HER-2 positivity was independently associated, with ALN metastasis (OR = 23.71, 95% CI 10.50-53.54). The AUC for combining selected MRI variables and clinico-pathologic variables, was higher than that of clinico-pathologic variables (P < 0.05). Conclusion: SER, moderate or prominent increased whole breast vascularity, and peritumor-tumor ADC ratio on breast MRI, are valuable in predicting ALN metastasis, in patients with early stage of breast cancer.

• Investigative Magnetic Resonance Imaging
• /
• v.20 no.2
• /
• pp.88-94
• /
• 2016

Purpose: Fluid-attenuated inversion recovery (FLAIR) imaging can be obtained faster with shorter repletion time (TR), but it gets noisier. We hypothesized that shorter-TR FLAIR obtained at 3 tesla (3T) with a 32-channel coil may be comparable to conventional FLAIR. The aim of this study was to compare the diagnostic value between conventional FLAIR (TR = 9000 ms, FLAIR9000) and shorter-TR FLAIR (TR = 6000 ms, FLAIR6000) at 3T in terms of diffusion-weighted imaging-FLAIR mismatch. Materials and Methods: We recruited 184 patients with acute ischemic stroke (28 patients < 4.5 hours) who had undergone 5-mm diffusion-weighted imaging (DWI) and two successive 5-mm FLAIR images (no gap; in-plane resolution, $0.9{\times}0.9mm$) at 3T with a 32-channel coil. The acquisition times for FLAIR9000 and FLAIR6000 were 108 seconds (generalized autocalibrating partially parallel acquisitions [GRAPPA] = 2) and 60 seconds (GRAPPA = 3), respectively. Two radiologists independently assessed the paired imaging sets (DWI-FLAIR9000 and DWI-FLAIR6000) for the presence of matched hyperintense lesions on each FLAIR imaging. The signal intensity ratios (area of DWI lesion to contralateral normal-appearing region) on both FLAIR imaging sets were compared. Results: DWI-FLAIR9000 mismatch was present in 39 of 184 (21.2%) patients, which was perfectly the same on FLAIR6000. Three of 145 patients (2%) with DWI-matched lesions on FLAIR9000 had discrepancy on FLAIR6000, showing no significant difference (P > 0.05). Interobserver agreement was excellent for both DWI-FLAIR9000 and DWI-FLAIR6000 (k = 0.904 and 0.883, respectively). Between the two FLAIR imaging sets, there was no significant difference of signal intensity ratio (mean, standard deviation; $1.25{\pm}0.20$; $1.24{\pm}0.20$, respectively) (P > 0.05). Conclusion: For the determination of mismatch or match between DWI and FLAIR imaging, there is no significant difference between FLAIR9000 and FLAIR6000 at 3T with a 32-channel coil.

• Investigative Magnetic Resonance Imaging
• /
• v.25 no.4
• /
• pp.323-331
• /
• 2021

Purpose: To investigate the diagnostic criteria of T1-weighted imaging (T1W) and time-of-flight (TOF) imaging for detecting intraplaque hemorrhage (IPH) of a vertebrobasilar artery (VBA) compared with simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging. Materials and Methods: Eighty-seven patients with VBA atherosclerosis who underwent high resolution MR imaging for evaluation of VBA plaque were reviewed. The presence and location of VBA plaque and IPH on SNAP were determined. The signal intensity (SI) of the VBA plaque on T1W and TOF imaging was manually measured and the SI ratio against adjacent muscles was calculated. The receiver-operating characteristic (ROC) curve was used to compare the diagnostic accuracy for detecting VBA IPH. Results: Of 87 patients, 67 had IPH and 20 had no IPH on SNAP. The SI ratio between VBA IPH and temporalis muscle on T1W was significantly higher than that in the no-IPH group (235.9 ± 16.8 vs. 120.0 ± 5.1, P < 0.001). The SI ratio between IPH and temporalis muscle on TOF was also significantly higher than that in the no-IPH group (236.8 ± 13.3 vs. 112.8 ± 7.4, P < 0.001). Diagnostic efficacies of SI ratios on TOF and TIW were excellent (AUC: 0.976 on TOF and 0.964 on T1W; cutoff value: 136.7% for TOF imaging and 135.1% for T1W imaging). Conclusion: Compared with SNAP, cutoff levels of the SI ratio between VBA plaque and temporalis muscle on T1W and TOF imaging for detecting IPH were approximately 1.35 times.

• Journal of Korean Neurosurgical Society
• /
• v.43 no.6
• /
• pp.275-280
• /
• 2008

Objective : In order to assess the incidence of thromboembolic events and their clinical presentations, the present study prospectively examined routine brain magnetic resonance images (MRI) taken within 48 hours after a coil embolization of cerebral aneurysms. Methods : From January 2006 to January 2008, 163 cases of coil embolization of cerebral aneurysm were performed along with routine brain MRI, including diffusion-weighted magnetic resonance (DW-MR) imaging, within 48 hours after the embolization of the aneurysm to detect the silent thromboembolic events regardless of any neurological changes. If any neurological changes were observed, an immediate brain MRI follow-up was performed. High-signal-intensity lesions in the DW-MR images were considered as acute thromboembolic events and the number and locations of the lesions were also recorded. Results : Among the 163 coil embolization cases, 98(60.1%) showed high-signal intensities in the DW-MR imaging follow-up, 66 cases (67.0%) involved the eloquent area and only 6cases (6.0%) showed focal neurological symptoms correlated to the DW-MR findings. The incidence of DW-MR lesions was higher in older patients (${\geq}60$ yrs) when compared to younger patients (<60 yrs) (p=0.002, odd's ratio=1.043). The older patients also showed a higher incidence of abnormal DW-MR signals in aneurysm-unrelated lesions (p=0.0003, odd's ratio=5.078). Conclusion : The incidence of symptomatic thromboembolic attacks after coil embolization of the cerebral aneurysm was found to be lower than that reported in previous studies. While DW-MR imaging revealed a higher number of thromboembolic events, most of these were clinically silent and transient and showed favorable clinical outcomes. However, the incidence of DW-MR abnormalities was higher in older patients, along with unpredictable thromboembolic events on DW-MR images. Thus, in order to provide adequate and timely treatment and to minimize neurological sequelae, a routine DW-MR follow-up after coil embolization of cerebral aneurysms might be helpful, especially in older patients.

• Investigative Magnetic Resonance Imaging
• /
• v.20 no.3
• /
• pp.167-174
• /
• 2016

Purpose: To identify magnetic resonance imaging (MRI) findings of leukemic infiltration of optic nerve and optic neuritis in leukemic patients with emphasis of clinical findings as reference standard to differentiate them. Materials and Methods: MRI and clinical findings of 7 patients diagnosed as leukemic infiltration of optic nerve (n = 5) and optic neuritis (n = 2) in our institution between July 2006 and August 2015were reviewed retrospectively. In particular, MR imaging findings involved perineural enhancement and thickening of optic nerve and its degree, signal intensity, laterality (unilateral/bilateral), intraconal fat infiltration and its degree, and associated central nervous system abnormalities. Results: Of 5 cases of leukemic infiltration of optic nerve, 4 cases showed positive cerebrospinal fluid (CSF) study for leukemia relapse and 1 case was positive on bone marrow (BM) biopsy only. Moreover, of 5 leukemic infiltration of optic nerve, 2 cases showed the most specific MR findings for leukemic central nervous system involvement including 1 prominent leptomeningeal enhancement and 1 chloroma. However, other MR imaging findings of the patients with leukemic infiltration or optic neuritis such as thickening and perineural enhancement of optic nerves are overlapped. Conclusion: Enhancement and thickening of optic nerve were overlapped MR findings in leukemic infiltration of optic nerve and optic neuritis. Our findings suggest that enhancing optic nerve thickening with associated central nervous system MR abnormality favors the diagnosis of leukemic infiltration of optic nerve, especially in patients with history of acute lymphoblastic leukemia. However, CSF and BM study were required for differentiation between leukemic infiltration of optic nerve and optic neuritis.

• Investigative Magnetic Resonance Imaging
• /
• v.10 no.1
• /
• pp.26-31
• /
• 2006

Purpose : To evaluate the effect of global scaling analysis on brain activation for sensory and motor functional MR imaging study. Materials and methods : Four normal subjects without abnormal neurological history were included. Arm extension-flexion movement was used for motor function and 1KHz pure tone stimulation was used for auditory function. Functional magnetic resonance imaging was performed at 3T MRI (GE, Milwaukee, USA) using BOLD-EPI technique and SPM2 was employed for data analysis. On data analysis, the brain activation images were obtained with and without global scaling by fixing other parameters such as motion correction and realignment. Results : The difference in brain activation between no scaling and global scaling was not large in case of right upper extremity movement (p<0.000001). For auditory test, brain activation with global scaling showed larger activation than that of without global scaling (p<0.05). Conclusion : A caution must be taken into account when analyzing functional imaging data with global scaling especially for functional study of small local BOLD signal change.

• Investigative Magnetic Resonance Imaging
• /
• v.23 no.4
• /
• pp.351-360
• /
• 2019

Purpose: To investigate noninvasive biomarkers for predicting treatment response in patients with locally advanced HCC who underwent concurrent chemoradiotherapy (CCRTx). Materials and Methods: Thirty patients (55.5 ± 10.2 years old, M:F = 24:6) who underwent CCRTx due to advanced HCC were enrolled. Contrast-enhanced US (CEUS) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) were obtained before and immediately after CCRTx. The third CEUS was obtained at one month after CCRTx was completed. Response was assessed at three months after CCRTx based on RECIST 1.1. Quantitative imaging biomarkers measured with CEUS and MRI were compared between groups. A cutoff value was calculated with ROC analysis. Overall survival (OS) was compared by the Breslow method. Results: Twenty-five patients were categorized into the non-progression group and five patients were categorized into the progression group. Peak enhancement of the first CEUS before CCRTx (PE1) was significantly lower in the non-progression group (median, 18.6%; IQR, 20.9%) than that in the progression group (median, 59.1%; IQR, 13.5%; P = 0.002). There was no significant difference in other quantitative biomarkers between the two groups. On ROC analysis, with a cutoff value of 42.6% in PE1, the non-progression group was diagnosed with a sensitivity of 90.9% and a specificity of 100%. OS was also significantly longer in patients with PE1 < 42.6% (P = 0.014). Conclusion: Early treatment response and OS could be predicted by PE on CEUS before CCRTx in patients with HCC.

• Investigative Magnetic Resonance Imaging
• /
• v.23 no.3
• /
• pp.241-250
• /
• 2019

Purpose: The purpose of this study was to determine the relation between quantitative magnetic resonance imaging biomarkers, and clinical performances in chronic phase of carbon monoxide intoxication. Materials and Methods: Eighteen magnetic resonance scans and cognitive evaluations were performed, on patients with carbon monoxide intoxication in chronic phase. Apparent diffusion coefficient (ADC) ratios of affected versus unaffected centrum semiovale, and corpus callosum were obtained. Signal intensity (SI) ratios between affected centrum semiovale, and normal pons in T2-FLAIR (fluid-attenuated inversion recovery) images were obtained. The Mini-Mental State Exam, and clinical outcome scores were assessed. Correlation coefficients were calculated, between MRI and clinical markers. Patients were further classified into poor-outcome and good-outcome groups based on clinical performance, and imaging parameters were compared. T2-SI ratio of centrum semiovale was compared, with that of 18 sex-matched and age-matched controls. Results: T2-SI ratio of centrum semiovale was significantly higher in the poor-outcome group, than that in the good-outcome group and was strongly inversely correlated, with results from the Mini-Mental State Exam. ADC ratios of centrum semiovale were significantly lower in the poor outcome group than in the good outcome group, and were moderately correlated with the Mini-Mental State Exam score. Conclusion: A higher T2-SI and a lower ratio of ADC values in the centrum semiovale, may indicate presence of more severe white matter injury and clinical impairment. T2-SI ratio and ADC values in the centrum semiovale, are useful quantitative imaging biomarkers for correlation with clinical performance in individuals with carbon monoxide intoxication.

• Kosin Medical Journal
• /
• v.33 no.3
• /
• pp.297-306
• /
• 2018

Objectives: Identification of axillary metastases in breast cancer is important for staging disease and planning treatment, but current techniques are associated with a number of adverse events. This report evaluates the diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) techniques for identification of axillary metastases in breast cancer patients. Methods: We performed a meta-analysis of previous studies that compared SPIO enhanced MRI with histological diagnosis after surgery or biopsy. We searched PubMed, Ovid, Springer Link, and Cochrane library to identify studies reporting data for SPIO enhanced MRI for detection of axillary lymph node metastases in breast cancer until December 2013. The following keywords were used: "magnetic resonance imaging AND axilla" and "superparamagnetic iron oxide AND axilla". Eligible studies were those that compared SPIO enhanced MRI with histological diagnosis. Sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analyses were done. Study quality and heterogeneity were also assessed. Results: There were 7 publications that met the criteria for inclusion in our meta-analysis. SROC curve analysis for per patient data showed an overall sensitivity of 0.83 (95% Confidence interval (CI): 0.75-0.89) and overall specificity of 0.97 (95% CI: 0.94-0.98). Overall weighted area under the curve was 0.9563. Conclusions: SPIO enhanced MRI showed a trend toward high diagnostic accuracy in detection of lymph node metastases for breast cancer. So, when the breast cancer patients has axillary metastases histologically, SPIO enhanced MRI may be effective diagnostic imaging modality for axillary metastases.

• Investigative Magnetic Resonance Imaging
• /
• v.21 no.4
• /
• pp.223-232
• /
• 2017

Purpose: To report the use of multiband accelerated echo-planar imaging (EPI) for resting-state functional MRI (rs-fMRI) to achieve rapid high temporal resolution at 3T compared to conventional EPI. Materials and Methods: rs-fMRI data were acquired from 20 healthy right-handed volunteers by using three methods: conventional single-band gradient-echo EPI acquisition (Data 1), multiband gradient-echo EPI acquisition with 240 volumes (Data 2) and 480 volumes (Data 3). Temporal signal-to-noise ratio (tSNR) maps were obtained by dividing the mean of the time course of each voxel by its temporal standard deviation. The resting-state sensorimotor network (SMN) and default mode network (DMN) were estimated using independent component analysis (ICA) and a seed-based method. One-way analysis of variance (ANOVA) was performed between the tSNR map, SMN, and DMN from the three data sets for between-group analysis. P < 0.05 with a family-wise error (FWE) correction for multiple comparisons was considered statistically significant. Results: One-way ANOVA and post-hoc two-sample t-tests showed that the tSNR was higher in Data 1 than Data 2 and 3 in white matter structures such as the striatum and medial and superior longitudinal fasciculus. One-way ANOVA revealed no differences in SMN or DMN across the three data sets. Conclusion: Within the adapted metrics estimated under specific imaging conditions employed in this study, multiband accelerated EPI, which substantially reduced scan times, provides the same quality image of functional connectivity as rs-fMRI by using conventional EPI at 3T. Under employed imaging conditions, this technique shows strong potential for clinical acceptance and translation of rs-fMRI protocols with potential advantages in spatial and/or temporal resolution. However, further study is warranted to evaluate whether the current findings can be generalized in diverse settings.