• Korean Journal of Digital Imaging in Medicine
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• v.15 no.1
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• pp.27-31
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• 2013

Perfusion MR imaging is how to use exogenous and endogenous contrast agent. Exogenous perfusion MRI methods which are dynamic susceptibility contrast using $T2^*$ effect and dynamic contrast-enhanced using T1 weighted image after injection contrast media. An endogenous perfusion MRI method which is arterial spin labeling using arterial blood flow in body. In order to exam perfusion MRI in human, technical access are very important according to disease conditions. For instance, dynamic susceptibility contrast is used in patients with acute stroke because of short exam time, while dynamic susceptibility contrast or dynamic contrast enhancement provides the various perfusion information for patients with tumor, vascular stenosis. Arterial spin labeling is useful for children, women who are expected to be pregnant. In this regard, perfusion MR imaging is required to understanding, and the author would like to share information with clinical users

• Journal of the Korean Magnetic Resonance Society
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• v.9 no.2
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• pp.93-102
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• 2005

Purpose: To develop an advanced non-linear curve fitting (NLCF) algorithm for dynamic susceptibility contrast study of brain. Materials and Methods: The first pass effects give rise to spuriously high estimates of $K^{trans}$ in voxels with large vascular components. An explicit threshold value has been used to reject voxels. Results: By using this non-linear curve fitting algorithm, the blood perfusion and the volume estimation were accurately evaluated in T2*-weighted dynamic contrast enhanced (DCE)-MR images. From the recalculated each parameters, perfusion weighted image were outlined by using modified non-linear curve fitting algorithm. This results were improved estimation of T2*-weighted dynamic series. Conclusion: The present study demonstrated an improvement of an estimation of kinetic parameters from dynamic contrast-enhanced (DCE) T2*-weighted magnetic resonance imaging data, using contrast agents. The advanced kinetic models include the relation of volume transfer constant $K^{trans}\;(min^{-1})$ and the volume of extravascular extracellular space (EES) per unit volume of tissue $\nu_e$.

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

• Korean Journal of Radiology
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• v.22 no.7
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• pp.1021-1033
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• 2021

Objective: To assess the expression of vascular normalization genes in different molecular subtypes of breast cancer and to determine whether molecular subtypes with a higher vascular normalization gene expression can be identified using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI). Materials and Methods: This prospective study evaluated 306 female (mean age ± standard deviation, 50 ± 10 years), recruited between January 2014 and August 2017, who had de novo breast cancer larger than 1 cm in diameter (308 tumors). DCE MRI followed by IVIM DWI studies using 11 different b-values (0 to 1200 s/mm²) were performed on a 1.5T MRI system. The Tofts model and segmented biexponential IVIM analysis were used. For each tumor, the molecular subtype (according to six [I-VI] subtypes and PAM50 subtypes), expression profile of genes for vascular normalization, pericytes, and normal vascular signatures were determined using freshly frozen tissue. Statistical associations between imaging parameters and molecular subtypes were examined using logistic regression or linear regression with a significance level of p = 0.05. Results: Breast cancer subtypes III and VI and PAM50 subtypes luminal A and normal-like exhibited a higher expression of genes for vascular normalization, pericyte markers, and normal vessel function signature (p < 0.001 for all) compared to other subtypes. Subtypes III and VI and PAM50 subtypes luminal A and normal-like, versus the remaining subtypes, showed significant associations with K^trans, k_ep, v_p, and IAUGC_BN90 on DEC MRI, with relatively smaller values in the former. The subtype grouping was significantly associated with D, with relatively less restricted diffusion in subtypes III and VI and PAM50 subtypes luminal A and normal-like. Conclusion: DCE MRI and IVIM parameters may identify molecular subtypes of breast cancers with a different vascular normalization gene expression.

• Investigative Magnetic Resonance Imaging
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• v.17 no.3
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• pp.192-199
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• 2013

Purpose : To retrospectively evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging (DCE-MRI) in detecting recurrent prostate cancer after HIFU of clinically localized cancer, as compared with T2-weighted imaging (T2WI). Materials and Methods: Twenty-six patients with increased prostate-specific antigen levels after HIFU were included in this study. All MR examinations were performed using T2WI and DCE-MRI, followed by transrectal ultrasound-guided biopsy. MRI and biopsy results were correlated in six prostate sectors. Residual or recurrent cancer after HIFU was defined as local tumor progression if biopsy results showed any cancer foci. Two independent readers interpreted the MR images. Results: Of 156 prostate sectors, 51 (33%) were positive for cancer in 17 patients. For detecting local tumor progression, the sensitivity of DCE-MRI and T2WI was 80% and 57% for reader 1 (P < 0.001) versus 84% and 61% for reader 2 (P < 0.001), respectively. The specificity and overall accuracy between DCE-MRI and T2WI showed no statistical difference in both readers (P > 0.05). Interobserver agreement of DCE-MRI and T2WI was moderate and fair, respectively. Conclusion: For detecting local tumor progression of prostate cancer after HIFU, DCE-MRI was more sensitive than T2WI, with less interobserver variability.

• Korean Journal of Radiology
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• v.22 no.4
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• pp.559-567
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• 2021

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imaging-reporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

• Journal of the Korean Society of Radiology
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• v.82 no.5
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• pp.1218-1230
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• 2021

Purpose To compare the per-patient diagnostic performance of simulated abbreviated MRI (AMRI) to that of conventional MRI (CMRI) with full-sequence dynamic gadoxetic acid (GA) enhancement for early-stage hepatocellular carcinoma (HCC) screening in high-risk patients. Materials and Methods A total of 201 consecutive patients at high-risk for HCC, who underwent 3T liver MRI, were included in this retrospective study. The AMRI protocol comprised T2-weighted imaging, hepatobiliary phase imaging after GA injection, and diffusion-weighted imaging. For each patient, two AMRI and CMRI image sets were independently reviewed by two radiologists. Inter-reader agreement was assessed using Cohen's kappa value. A composite reference standard was used to determine the diagnostic performance of each image set for each reader. Results A total of 93 HCCs were detected in 79 patients. The inter-reader agreement was almost perfect for both image sets (κ = 0.839, 0.948). In AMRI, the per-patient sensitivity and negative predictive values (NPV) were 94.9% and 96.4%, respectively. In CMRI, the per-patient sensitivity and NPV were 96.2% and 97.5%, respectively. Conclusion AMRI, using only three sequences, had a comparable diagnostic performance to CMRI in screening early-stage HCC. AMRI could be an alternative HCC screening tool for high-risk HCC patients.

• Investigative Magnetic Resonance Imaging
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• v.19 no.4
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• pp.231-236
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• 2015

A 17-year-old girl presented with complaints of headache and decreasing vision of one month's duration, without any history of fever, weight loss, or any evidence of an immuno-compromised state. Her neurological examination was normal, except for papilledema. Laboratory investigations were within normal limits, except for a slightly increased Erythrocyte Sedimentation Rate (ESR). Non-contrast computerized tomography of her head revealed complex mass in left frontal lobe with a concentric, slightly hyperdense, thickened wall, and moderate perilesional edema with mass effect. Differential diagnoses considered in this case were pilocytic astrocytoma, metastasis and abscess. Magnetic resonance imaging (MRI) obtained in 3.0 Tesla (3.0T) scanner revealed a lobulated outline cystic mass in the left frontal lobe with two concentric layers of T2 hypointense wall, with T2 hyperintensity between the concentric ring. Moderate perilesional edema and mass effect were seen. Post gadolinium study showed a markedly enhancing irregular wall with some enhancing nodular solid component. No restricted diffusion was seen in this mass in diffusion weighted imaging (DWI). Magnetic resonance spectroscopy (MRS) showed increased lactate and lipid peaks in the central part of this mass, although some areas at the wall and perilesional T2 hyperintensity showed an increased choline peak without significant decrease in N-acetylaspartate (NAA) level. Arterial spin labelling (ASL) and dynamic susceptibility contrast (DSC) enhanced perfusion study showed decrease in relative cerebral blood volume at this region. These features in MRI were suggestive of brain abscess. The patient underwent craniotomy with excision of a grayish nodular lesion. Abundant acid fast bacilli (AFB) in acid fast staining, and epithelioid cell granulomas, caseation necrosis and Langhans giant cells in histopathology, were conclusive of tubercular abscess. Tubercular brain abscess is a rare manifestation that simulates malignancy and cause diagnostic dilemma. MRI along with MRS and magnetic resonance perfusion studies, are powerful tools to differentiate lesions in such equivocal cases.

• Journal of Yeungnam Medical Science
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• v.22 no.1
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• pp.43-51
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• 2005

Background: To examine the ultrasonographic and magnetic resonance (MRI) imaging findings of a cervical mass type cervical pregnancy. Materials and Methods: The ultrasonographic and MRI findings of 5 patients pathologically confirmed as having a cervical pregnancy were analyzed retrospectively. On ultrasonography, the size and echo pattern of the uterine cervix, the shape and echo pattern of the lesion, the degree and the pattern of blood flow on the color Doppler study and the spectral Doppler pattern were analyzed. The shape, signal intensity, and degree and pattern of enhancement of the lesion were evaluated on MRI. Results: The uterine cervix was enlarged and the size of the lesion was 6.1 to 7.1 (average, 6.5) cm. The endocervical canal was irregularly dilated and showed heterogeneous echogenicity in all 5 cases. Four of the 5 lesions were heterogeneously hyper- or mixed echoic and remaining one was relatively homogeneous echogenic. Doppler ultrasonography revealed an increased vascularity of the peritrophoblastic flow pattern. In all 4 cases where MRI performed, the lesion was irregular in shape and the margin was not sharply demarcated. The T2-weighed image showed that the lesions were mixed signal intensity. Three of the 4 lesions contained high signal intensity nodular portions and a low signal intensity rim was observed along the margin of the nodular portions. The T1-weighted image revealed multiple signal voids along the periphery of the lesions and high signal intensity portions as a result of hemorrhage were noted. The dynamic enhanced study showed that the high signal intensity portions on the T2-weighted image were strongly enhanced similar to the vessels on the early phase and the contrast enhancement gradually decreased with time. Conclusion: A cervical mass type cervical pregnancy can be correctly diagnosed using the patient's clinical symptom, the elevation in the serum ${\beta}$-HCG level, and characteristic ultrasonographic and MRI findings.

• Journal of Yeungnam Medical Science
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• v.26 no.1
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• pp.30-37
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• 2009

Purpose : To radiologically differentiate renal oncocytoma from other renal solid tumors, we analyzed and characterized, retrogradely, radiologic findings of renal oncocytomas. Materials and Methods : Radiologic findings of pathologically proven renal oncocytoma were analyzed in 9 patients. CT was performed in all patients, ultrasonography in 4 patients and MRI in 3 patients.(51) Results : On ultrasonography, the echogenicity of the mass was slightly more hyperechoic than normal renal parenchyma in all 4 cases. Two cases were homogeneous and the remaining two cases were relatively homogeneous. On CT, all 8 cases showed iso-density to slightly low density compared to normal renal parenchyma and 5 cases were homogeneous but the central portion of the mass was of a slightly lower density than the peripheral portion in 3 cases. All six cases had an arterial phase scan and were heterogeneously enhanced. An irregular, lower-enhancing portion was found in the central portion of the mass. Segmental inversion of contrast enhancement was found in 5 of 6 cases that had a dynamic enhancement study. On MR T1-weighted imaging, the mass was of iso-signal intensity to normal renal parenchyma and the central portion of the mass had a slightly hypo-signal intensity than the peripheral portion. On T2-weighted imaging, 2 cases were heterogeneous; the peripheral portion was of low signal intensity and central portion was of higher signal intensity than normal renal parenchyma. One case was relatively homogeneous and showed a slightly lower signal intensity than that of normal parenchyma, except for a central small portion showing high signal intensity. For 2 cases that had a dynamic study, a segmental inversion of contrast enhancement was noted. Conclusion : Renal oncocytoma is seen as a well-marginated solid mass lesion. On enhanced scans it is heterogeneously enhanced and segmental inversion of contrast enhancement may be seen. The possibility of oncocytoma can be suggested in cases showing these radiologic findings.