Anton Faron¹, Alois M. Sprinkart¹, Claus C. Pieper¹, Rolf Fimmers², Wolfgang Block¹, Carsten Meyer¹, Daniel Thomas¹, Ulrike Attenberger¹, and Julian A. Luetkens^1
1Radiology, University Hospital Bonn, Bonn, Germany, ²Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany

Magnetic resonance imaging (MRI) allows for body composition assessment, including determination of fat-free muscle area (FFMA). This study aimed to evaluate the prognostic value of FFMA, opportunistically measured from pre-interventional liver MRI, to predict outcome in patients receiving radioembolization (RE) for treatment of hepatocellular carcinoma (HCC). Patients with high FFMA showed significantly increased overall survival following treatment. On multivariate analysis, FFMA was an independent predictor of survival and thereby may reveal additional prognostic information in these patients. FFMA may become a promising new biomarker, since it is easy to assess from routine clinical imaging and represents a potential therapeutic target.      

Evanthia Kousi¹, Christina Messiou¹, Aisha Miah², Matthew Orton¹, Rick Haas^3,4, Khin Thway², Georgina Hopkinson¹, Shane Zaidi², Myles Smith², Elizabeth Barquin², Eleanor Moskovic², Nikolaos Fotiadis², Dirk Strauss², Andrew Hayes¹, and Maria A Schmidt^1
1The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom, ²The Royal Marsden NHS Foundation Trust, London, United Kingdom, ³The Netherlands Cancer Institute, Amsterdam, Netherlands, ⁴The Leiden University Medical Center, Leiden, Netherlands

Summary: Myxoid liposarcomas (MLS) show enhanced radiotherapy response owing to their distinctive vasculature. We explore the role of functional MRI in identifying MLS response to radiotherapy.

Methods: Ten patients with histologically-proven MLS received radiotherapy. Diffusion, T2* and vascularity estimates were assessed at pre-, during and post-radiotherapy.

Results: Baseline values and post-radiotherapy changes of [Gd], IAUGC60 and Ktrans were statistically different between responders and non-responders but not ADC. Responders demonstrated statistically significant early tumour volume and post-radiotherapy T2* reductions. 

Conclusion: Baseline vascularity estimates and their post-radiotherapy changes could predict MLS response. Early volume changes precede changes in MLS functionality.  

Gayatri Sharma¹, Abdul K Abdul K. Parchur², Jaidip M. Jagtap², brian M. Fish², Bergom Carmen ³, Michael Flister⁴, Meetha M. Medhora⁵, and Amit Joshi^1,6
1Biomedical Engineering, Medical College of Wisconsin, MILWAUKEE, WI, United States, ²Medical College of Wisconsin, MILWAUKEE, WI, United States, ³Radiation Oncology, Medical College of Wisconsin, MILWAUKEE, WI, United States, ⁴Physiology, Medical College of Wisconsin, MILWAUKEE, WI, United States, ⁵Medical College of Wisconsin, Medical College of Wisconsin, MILWAUKEE, WI, United States, ⁶Biophysics, Medical College of Wisconsin, MILWAUKEE, WI, United States

X-ray CT or MR Image-guided radiation therapy (IGRT) is routinely employed for oral cancer treatment. Enhancing tumor dose while limiting collateral damage to salivary glands is of critical importance for oral cancer patients.  Here, we demonstrate the efficacy of multifunctional Theranostic nanoparticles (TNPs) for MR image guided radiation therapy in a rat xenograft model of oral cancer. These TNPs composed of Gold (Au) core and Gd(III) shell with combined X-ray and MR contrast can enable pre-procedure radiotherapy planning via T1-MR imaging, as well as enhance radiation treatment efficacy by increasing the tumor deposited radiation dose.

Lukas Carl Lundholm¹, Mikael Montelius¹, Oscar Jalnefjord¹, Emman Shubbar¹, Eva Forssell-Aronsson¹, and Maria Ljungberg^1
1Department of Radiation Physics, Institute of Clinical Sciences, Göteborg, Sweden

Diffusion MRI methods to characterize tumour tissue could facilitate early assessment of radiotherapy response. In this study mouse models of human small intestine neuroendocrine tumours were irradiated externally, and post-treatment effects were studied over two weeks using VERDICT and kurtosis analysis of diffusion MRI measurements. Results showed multiple correlations between tumour treatment response and parameters estimated from the models, suggesting that a decrease of cell density and microstructural barriers early after treatment indicates a more substantial response. Both VERDICT and kurtosis analysis shows great potential for early assessment of treatment response to external radiation therapy in the studied tumour model.

Michal Tomaszewski¹, William Dominguez Viqueira¹, Heiko Enderling², and Robert J Gillies^1
1Cancer Physiology, H. Lee Moffitt Cancer Center, Tampa, FL, United States, ²Institute of Mathematical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, United States

Tumor response to radiotherapy (XRT) varies significantly between patients, calling for improved response quantification methods. Tumor response to fractionated XRT was quantified in a mouse model of pancreatic cancer with multiple MR sequences. Texture feature analysis of quantitative T2 maps revealed that histogram width information (Interquartile range metric) provided a more sensitive measure of XRT response than first order metrics, reflecting the structural heterogeneity increase due to necrosis, which presaged tumor volume changes. Thus, radiomic analyses of qT2 maps show significant promise for early response prediction, which will be crucial for future development of dynamic adaptive radiotherapy.

Chien-Yi Liao¹, Cheng-Chia Lee^2,3,4, Huai-Che Yang^2,3, Wen-Yuh Chung^2,3, Hsiu-Mei Wu^3,5, Wan-Yuo Guo^3,5, Ren-Shyan Liu^1,6, and Chia-Feng Lu^1,7
1Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ²Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan, ³School of Medicine, National Yang-Ming University, Taipei, Taiwan, ⁴Brain Research Center, National Yang-Ming University, Taipei, Taiwan, ⁵Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan, ⁶Department of Nuclear Medicine and National PET/Cyclotron Center, Taipei Veterans General Hospital, Taipei, Taiwan, ⁷Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan

The development of brain metastases is a devastating consequence of disease progression of advanced non-small cell lung cancer patients. This study proposed an approach to predict the treatment outcome after gamma knife radiosurgery based on preradiosurgical MR radiomics. We suggested that imaging characteristics extracted from preradiosurgical MRIs can be potential image biomarkers for the outcome prediction.

Anne Adlung¹, Michaela A. U. Hoesl¹, Sherif Mohamed², Arne M. Ruder³, Frank A. Giordano³, Eva Neumaier Probst², and Lothar R. Schad^1
1Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany, ²Department of Neuroradiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany, ³Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

Brain metastases are the most common malignancy in the brain and can be caused by different primary tumors. The Sodium-SRS study is a prospective feasibility study to observe TSC changes in brain metastases around ablative stereotactical radiosurgery (SRS) treatment with 22 Gy single dose using GammaKnife. TSC was measured with 23Na MRI in two patients at three different time points. The prelimenary results showed feasibility to detect TSC dynamics in brain metastases treated with SRS, which warrants further evaluation.

Jia fei¹, Han dongming¹, and Wang Kaiyu^2
1The First Affiliated Hospital of Xinxiang Medical University, Xin xiang, China, ²GE Healthcare ,MR Research China, Beijing, China

This work assessed the feasibility of quantitative parameters derived from APT and IVIM in the predicting the recurrence of early stage Hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). We find that  combined quantitative parameters of APT and IVIM can be used to predict the recurrence. Therefore, APT and IVIM can be used as imaging biomarkers to predict the recurrence of early stage of HCC after TACE treatment.

Mikael Montelius¹, Lukas Lundholm¹, Oscar Jalnefjord¹, Emman Shubbar¹, Eva Forssell-Aronsson¹, and Maria Ljungberg^1
1Radiation Physics, Clinical Sciences, Gothenburg, Sweden

The diffusion coefficient (D) and T2* reflect clinically significant tumor characteristics, including cellularity and hypoxia. Methods to non-invasively assess D and T2* at diagnosis and early follow up are desired. The aim of this work was to evaluate the sensitivity of D and T2* to radiotherapy effects in a neuroendocrine tumor model, and to evaluate clustering as an objective method to facilitate D and T2* analysis. 20 mice were examined using MRI before and repeatedly for 2 weeks after tumor irradiation (8Gy) . We show that D and T2* are potential response biomarkers, and that clustering improves response prediction for T2*.

Emma L. Reeves¹, Jin Li¹, Jessica K. R. Boult¹, Barbara Blouw², David Kang², Jeffrey C. Bamber¹, Yann Jamin¹, and Simon P. Robinson^1
1Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom, ²Halozyme Therapeutics, San Diego, CA, United States

PEGPH20 has been shown to decompress blood vessels and improve tumour drug delivery. Given the sensitivity of R₂* to paramagnetic deoxyhaemoglobin and reflection of RBC content in tumour vasculature, we hypothesised that IS-MRI may provide a useful biomarker of PEGPH20 response. We performed IS-MRI before and after PEGPH20 treatment in 4T1 HAS3 and MDA-MB-231 LM2-4 orthotopic breast tumours. R₂* significantly increased following PEGPH20 treatment in 4T1 HAS3 tumours, however, R₂* was unable to detect a similar response to PEGPH20 in the relatively hypovascular MDA-MB-231 LM2-4 tumours. Another vascular biomarker may provide greater sensitivity and detect PEGPH20 response in hypovascular tumours.

Shujian Li¹, Jie Liu¹, Jinxia Zhu², Han Fei³, and Jingliang Cheng^1
1Department of Magnetic Resonance, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ²MR Collaboration, Siemens Healthcare Ltd, Beijing, China, ³MR R&D Collaboration, Siemens Healthineers, Los Angeles, CA, United States

This study determined the value of quantitative transverse relaxation time (T2) mapping as an alternative method to conventional magnetic resonance imaging (MRI) for evaluating the response to concurrent chemoradiotherapy (CCRT) in 27 patients with advanced cervical cancer (CC). Response values were calculated at three time points (before CCRT, 4 weeks after CCRT, and at the end of CCRT) and then compared. The results showed that quantitative T2 mapping can be effectively used for monitoring treatment response during and after treatment, but not for pre-treatment monitoring.

Kareem Wahid¹, Abdallah Mohammed¹, Lisanne Van Dijk¹, Sara Ahmed¹, Renjie He¹, Baher Elgohari¹, Yao Ding², Jihong Wang², Stephen Lai³, and Clifton Fuller^1
1Radiation Oncology, MD Anderson Cancer Center, Houston, TX, United States, ²Radiation Physics, MD Anderson Cancer Center, Houston, TX, United States, ³Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, United States

Current methodology in analyzing pathological lymph node radiotherapy response in head and neck cancer relies on qualitative visual inspection of geometrical features. A quantitative approach that takes into account dynamic changes in underlying lymph node pathology could be an important supplemental clinical tool in radiotherapy treatment planning. Herein, we investigate dynamic contrast enhanced MRI quantitative parametric maps as possible biomarker candidates for lymph node radiotherapy response by analyzing multi-timepoint images of head and neck cancer patients.

Abdallah Sherif Radwan Mohamed¹, Renjie He¹, Yao Ding¹, Jihong Wang¹, Joly Fahim¹, Baher Elgohari¹, Hesham Elhalawani¹, Jason Johnson², Jason Stafford³, Jim Bankson³, Mark Chambers⁴, Vlad Sandulache⁵, Clifton Fuller¹, and Stephen Lai^4
1Radiation Oncology, MD Anderson Cancer Center, Houston, TX, United States, ²Diagnostic imaging, MD Anderson Cancer Center, Houston, TX, United States, ³Imaging physics, MD Anderson Cancer Center, Houston, TX, United States, ⁴Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, United States, ⁵Baylor College of Medicine, Houston, TX, United States

Our aim was to characterize the quantitative DCE-MRI parameters associated with advanced mandibular osteoradionecrosis (ORN) in comparison with normal mandible. Thirty patients with advanced ORN after radiation of head and neck cancer were prospectively enrolled. Our results confirm there is a quantitatively significant higher degree of leakiness in the mandibular vasculature as measured using DCE-MRI parameters of areas affected with advanced grade of ORN versus healthy mandible. We were able to measure significant increases in quantitative parameters (3.3 fold K^trans, 3 fold v_e) compared to non-ORN mandibular bone.

Daphne A.J.J. Driessen¹, Tim Dijkema¹, Sjoert A.H. Pegge², Patrik Zámecnik², Adriana C.H. van Engen-van Grunsven³, Willem L.J. Weijs⁴, Robert P. Takes⁵, Tom W.J. Scheenen², and Johannes H.A.M. Kaanders^1
1Radiation Oncology, Radboud university medical centre, Nijmegen, Netherlands, ²Radiology and Nuclear Medicine, Radboud university medical centre, Nijmegen, Netherlands, ³Pathology, Radboud university medical centre, Nijmegen, Netherlands, ⁴Oral- and Maxillofacial Surgery and Head and Neck Surgery, Radboud university medical centre, Nijmegen, Netherlands, ⁵Otorhinolaryngology and Head and Neck Surgery, Radboud university medical centre, Nijmegen, Netherlands

Head and neck cancers have a high propensity to metastasize to the lymph nodes of the neck. Accurate knowledge of this regional nodal status is of great importance for therapy selection and prognosis. Ultrasmall superparamagnetic iron oxide (USPIO) particles (Ferumoxtran-10 / Ferrotran®) are a promising contrast agent that can be used to detect nodal metastases with MRI. This study aims to validate USPIO-MRI for the detection of nodal metastases in head and neck cancer patients with histopathology as the reference standard. The workflow and preliminary results in 5 patients are shown in this abstract.

Nicholas Senn¹, Ehab Husain², Yazan Masannat³, Sai Man Cheung¹, Bernard Siow⁴, Steven D Heys⁵, and Jiabao He^1
1Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, United Kingdom, ²Pathology department, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, ³Breast Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, ⁴Francis Crick Institute, London, United Kingdom, ⁵School of Medicine, University of Aberdeen, Aberdeen, United Kingdom

Breast cancers often present a spatially heterogenous response to treatment manifesting as diverse variations in the underlying distribution of cellularity. We hypothesised that kurtosis from diffusion q-space imaging provides a higher effect gradient to assess the amount of entropy and dispersion in breast cancer cellularity than measures of diffusion displacement. We investigated whole breast tumours excised from surgery, with imaging performed same day overnight on a clinical 3T MRI system. The entropy and dispersion obtained from kurtosis were significantly higher than that obtained from displacement measurements, yielding a higher effect gradient, and significantly correlated with the histologic cellularity.

jian jiang¹ and ailian liu^1
1The first affiliated hospital of Dalian medical university, Dalian, China

My study is to evaluate the diagnostic value of 3D MRI texture analysis based on T1WI, T2WI, DKI and contrasted-enhanced T1WI MRI sequences
 in differential diagnosis of benign and malignant presacral lesion after resection of rectal carcinoma

Ye Ju¹, Shifeng Tian¹, Ailian Liu¹, Lina Zhang¹, Lizhi Xie², Yan Guo², and Xin Li^2
1First affiliated hospital of dalian medical university, Dalian, China, ²GE Healthcare, Beijing, China

In this study, we used the whole tumor volume measurement of texture analysis based on ADC images to identify breast ductal carcinoma in situ (DCIS) and DCIS with microinvasion (DCISM), which revealed to be feasible approach for differentiating between DCIS and DCISM.

Jingjun Wu¹, Ailian Liu¹, Jiazheng Wang², Liangjie Lin², Lihua Chen¹, Qingwei Song¹, Renwang Pu¹, and Bingbing Gao^1
1Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China, ²Philips Healthcare, Beijing, China

In the current study, multiple high b-value DWI-based texture analysis was applied to evaluate tumor heterogeneity in prostate cancer patients. Parameters, including MinIntensity, MedianIntensity, MeanValue, and Skewnesswere were significantly different among DWI images with different b values. Therefore, texture analysis based on DWI maps with different b values may serve as a preoperative and non-invasive method for evaluating heterogeneity of prostate cancer.

Zuohua Tang¹, Zebin Xiao¹, Peng Wang¹, and Zhongshuai Zhang^2
1Radiology, Fudan University Eye & ENT Hospital, Shanghai, China, ²MR Scientific Marketing, Siemens Healthcare, Shanghai, China

A reliable differentiation of different histological types of sinonasal malignancies is usually difficult by using conventional CT and MR imaging but plays an important role in determining the treatment strategies for the patients. This is the first study which combined DKI and IVIM to distinguish among four histological types of sinonasal malignant tumors, including squamous cell carcinomas (SCCs), olfactory neuroblastomas (ONBs), malignant melanomas (MMs), and lymphomas. Our study showed that these sinonasal malignant tumors had distinct profiles in DKI and IVIM parameters, determined by different proportions of tissue complexity, capillary perfusion, or water diffusion components within tumor.

Christine H Feng¹, Christopher C Conlin², Ana E Rodríguez-Soto², Roshan Karunamuni¹, Aaron B Simon¹, Rebecca Rakow-Penner², Michael E Hahn², Anders M Dale^2,3, and Tyler Seibert^1,4
1Radiation Medicine & Applied Sciences, UC San Diego, La Jolla, CA, United States, ²Radiology, UC San Diego, La Jolla, CA, United States, ³Neurosciences, UC San Diego, La Jolla, CA, United States, ⁴Bioengineering, UC San Diego, La Jolla, CA, United States

Prostate cancer is the second most frequent malignancy in men worldwide—novel strategies are needed to better identify patients with clinically significant disease. We developed a biexponential linear regression model using data from 36 men who underwent prostate MRI with 5 distinct b-values. We evaluated quantitative detection of clinically significant prostate cancer. The biexponential model and derivative lookup table outperformed simple ADC and kurtosis in quantitative classification of benign tissue and cancer (AUC 0.958 and 0.976 vs 0.632 and 0.409, respectively).

Madeline Carr^1,2,3, Michael Jameson^1,2,3,4, Christopher Rumley^2,4,5, Gary Liney^2,3,4, Mark Lee^3,4, Phillip Chlap^2,4, Peter Metcalfe^1,2, and Lois Holloway^1,2,3,4,6
1Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, Australia, ²Medical Physics, Ingham Institute of Applied Medical Research, Liverpool, Australia, ³Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Australia, ⁴South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia, ⁵Townsville Hospital and Health Service, Townsville, Australia, ⁶Institute of Medical Physics, University of Sydney, Camperdown, Australia

The effect of altering the input parameters into a Pharmacokinetic (PK) model on output parameter values generated was investigated. This included determining the variations induced by using individualized versus population based Arterial Input Function and haematocrit values in the model. This was completed for multiple DCE-MRI scans acquired along the course of radiotherapy treatment for 5 head and neck cancer patients.  Qualitatively, most patients had similar trendlines when comparing between each combination of parameter inputs. However quantitatively, the %difference between baseline and subsequent weeks highlighted significant impacts caused by input parameter selection; having implications for applications in treatment response monitoring.

Hongna Tan¹, Fuwen Gan², Yaping Wu³, Yusong Lin⁴, and Meiyun Wang^3
1Radiology, Department of Radiology, Henan Provincial People’s Hospital & Imaging Diagnosis of Neurological Diseases and Research Laboratory of Henan Province & People's Hospital of Zhengzhou University, Henan, China, 450003, Zhengzhou, China, ²Collaborative Innovation Center for Internet Healthcare & School of Software and Applied Technology, Zhengzhou University, Zhengzhou, Henan,China, 450052, Zhengzhou, China, ³Department of Radiology, Henan Provincial People’s Hospital & Imaging Diagnosis of Neurological Diseases and Research Laboratory of Henan Province & People's Hospital of Zhengzhou University, Henan, China, 450003, Zhengzhou, China, ⁴Collaborative Innovation Center for Internet Healthcare & School of Software, Zhengzhou University, Zhengzhou, Henan,China, 450052, Zhengzhou, China

 Currently, a noninvasive and high diagnostic sensitivity model for preoperative predicting the status of ALN is need. Our aim is to investigate the value of radiomics method based on the fat-suppressed T2 sequence for preoperative predicting axillary lymph node (ALN) metastasis in breast carcinoma.

Annemarie Knill¹, Matthew Blackledge¹, Jessica Winfield^1,2, Andra Curcean², James Larkin³, Samra Turajlic³, Dow-Mu Koh^1,2, and Christina Messiou^1,2
1Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom, ²Department of Radiology, The Royal Marsden NHS Foundation Trust, London, United Kingdom, ³Renal and Melanoma Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom

Whole body MRI, including diffusion weighted imaging, has potential to unravel complex response patterns in patients with metastatic melanoma receiving immunotherapy. To minimise the effect of noise on resultant apparent diffusion coefficient (ADC) maps, images should be acquired using optimal b-values. These values have been calculated from MRI scans of 11 patients, with 99 metastases. The optimal pair of b-values is found to be 50 and 1250 s/mm². A significant difference is reported between the distributions of the ADC values before and after treatment with immunotherapy. This provides preliminary evidence that ADC could provide a biomarker of response to immunotherapy.

Junjia Luo¹, Shuangfeng Dai², Zebin Luo³, Wubiao Chen³, Xiaodong Chen³, and Wenxuan Luo^3
1Guangdong Medical University, Zhanjiang, China, ²Huiying Medical Technology Co., Ltd., Beijing, China, ³Affiliated Hospital of Guangdong Medical University, Zhanjiang, China

Radiomics, as it refers to the extraction and analysis of large number of advanced quantitative radiological features from medical images using high throughput methods, it provides a new evaluation method for detection of the suspicious lesion of cancer. The present study explores the value of radiomics based on the mulitparameter magnetic resonance imaging (mpMRI) for diagnosis of the benign and malignant prostatic diseases.

Chen Chen¹ and Cuiping Ren^1
1the First Affiliated Hospital of Zhengzhou University, ZhengZhou, China

To determine if histograms of ADC can be used to differentiate orbital lymphoma,pleomorphic adenoma(PA) and adenoid cystic carcinoma(ACC)

yuxi ge¹ and weiqiang dou^2
1Wuxi Fourth People's Hospital, wuxi, China, ²GE Healthcare, MR Research, Beijing, China

T2-mapping, as a quantitative and accurate measurement that can be used as a noninvasive biological marker to predict the pathological classification of rectal cancer, may be beneficial to making an individualized treatment strategy before operation of rectal cancer.

Osamu Tanaka¹, Takuya Taniguchi¹, Kousei Ono¹, and Masayuki Matsuo^2
1Radiation Oncology, Asahi University Hospital, Gifu, Japan, ²Radiation Oncology, Gifu University Hospital, Gifu, Japan

Gold markers showed little effect on the quality of DWI. Therefore, despite using iron-containing markers and the size of marker < 0.5 mm being available, MRI, particularly DWI, may be used during follow-up imaging.

Prateek Kalra¹, Ashonti Harper¹, Jeffrey Hawley ¹, Brian Raterman¹, and Arunark Kolipaka^1
1Radiology, Ohio State University Wexner Medical Center, Columbus, OH, United States

Dynamic contrast-enhanced MRI kinetic parameters have been investigated to assess the response to neoadjuvant chemotherapy (NAC). However, those studies have predictive value only after one or two cycles of NAC treatment and involves injection of contrast agent. Moreover, breast tumor sample is graded clinically using biopsy and is invasive. Aim of this study is to evaluate any correlation between MRE stiffness and clinical grading in breast carcinoma and if MRE can predict the response to NAC. Preliminary results show moderate correlation between MRE-derived stiffness and clinical grading in breast carcinoma patients. 

Junqi Sun¹, Shenglan Chen², Jie Ding^2,3, Feifei Shan¹, Yi Kang¹, Xiaoting Tang¹, and Chuan Huang^2,4,5
1Yuebei People’s Hospital, Shaoguan, China, ²Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States, ³Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, ⁴Radiology, Stony Brook Medicine, Stony Brook, NY, United States, ⁵Psychiatry, Stony Brook Medicine, Stony Brook, NY, United States

Nomograms are widely adopted as prognostic tools for clinical practice. In this study, we developed and temporally validated a radiomics nomogram to predict early response to neoadjuvant chemotherapy among patients with nasopharyngeal carcinoma using pretreatment MRI.

Archana Vadiraj Malagi¹, Devasenathipathy Kandasamy², Kedar Khare³, Deepam Pushpam⁴, Rakesh Kumar⁵, Sameer Bakhshi⁴, and Amit Mehndiratta^1,6
1Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India, ²Department of Radiodiagnosis, All India Institute of Medical Sciences Delhi, New Delhi, India, ³Indian Institute of Technology Delhi, New Delhi, India, ⁴Department of Medical Oncology, Dr. B.R. Ambedkar Institute-Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences Delhi, New Delhi, India, ⁵Department of Nuclear Medicine, All India Institute of Medical Sciences Delhi, New Delhi, India, ⁶Department of Biomedical Engineering, All India Institute of Medical Sciences Delhi, New Delhi, India

PET/CT plays an important role in assessment of treatment response in Hodgkin lymphoma (HL). This study goal was to evaluate the role of IVIM and DKI parameters role in interim assessment of HL. ADC, D(BE+TV), Dk and f showed reduction in interim which was in accordance with changes of SUVmax and SUVmean whereas D* and k showed increase against treatment response. In future, IVIM and DKI can have the potential in accurate assessment of interim monitoring in HL.

Sai Man Cheung¹, Kwok Shing Chan², Nicholas Senn¹, Yazan Masannat³, Ehab Husain⁴, Steven Heys³, and Jiabao He^1
1Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, United Kingdom, ²Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands, ³Breast Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, ⁴Pathology Department, Aberdeen Royal Infirmary, Aberdeen, United Kingdom

Lipid composition in breast has a major role in breast cancer prevention, with deregulation of lipid metabolism identified in BRCA1/2 genetic mutation carriers. Neoplastic tubule formation can infiltrate adipose tissue in peri-tumoural region, with low tubular differentiation indicating a poorer prognosis. Lipid composition measurement through biochemical extraction is invasive, while conventional chemical shift imaging demands an intolerably long acquisition time. Recent development in gradient-echo (GRE) based imaging allows lipid composition mapping of the whole breast in a clinically acceptable timeframe. We set out to examine the relationship between peri-tumoural lipid composition and tubule formation using GRE-based imaging in breast tumours.

Nan Zhang¹, Qingwei Song¹, Lina Zhang¹, Ailian Liu¹, Yu Song¹, and Lizhi Xie^2
1The First Affiliated Hospital of Dalian Medical University, Dalian, China, ²GE Healthcare, MR Research China, Beijing, China

Intravoxel incoherent motion (IVIM) imaging provides quantitative measurement of ADCslow for cellularity and ADC_fast and ffast for vascularity. The parameters derived from IVIM can distinguish lesions of different aggressive pathological subtypes of Stage T1 breast carcinomas^[1]. This study concerned clinical features, perfusion as well as diffusion parameters using IVIM imaging and then compared these parameters from conventional MR images on the classification of  Stage T1 HER2-positive and HER2-negative breast carcinoma lesions .

Fan WenWen¹, Fan WenWen¹, Ou Yang Han², Zhao XinMing², Zhang HongMei², and Xie LiZhi^3
1Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, BeiJing, China, ²National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, BeiJing, China, ³MR Research, GE Healthcare, BeiJing, China

The aim of this study was to evaluate the technical characteristics and diagnostic efficiency of Digital Breast Tomosynthesis (DBT) compared to conventional MRI approach and full-field digital mammography (FFDM) in screening breast cancer (BC) patients. Briefly, 253 female patients who underwent Digital Mammary Gland 3D Tomosynthesis, MR scan and FFDM were enrolled in this study. Briefly, the DBT, FFDM and MRI showed a sensitivity of 90.9%, 85.6% and 94.1%; specificity of 89.7%, 80.7% and 83.3%; and coincidence rate of 89.3%, 83.4% and 89.7%, respectively, and the difference was statistically significant (p＜0.001).

Caitlin M Tressler¹, Kanchan Sonkar¹, Vinay Ayyappan¹, Menglin Cheng¹, and Kristine Glunde^1
1Johns Hopkins University, Baltimore, MD, United States

Magnetic resonance spectroscopy (MRS) of breast cancer patients has shown a significant decrease in total choline (tCho) signal in patients responding to chemotherapy.1-4 Despite the clinical development of tCho as an imaging biomarker for response to chemotherapy, little is known about the molecular mechanism driving this observed change. We examined six chemotherapy agents in two triple negative breast cancer (TNBC) cell lines by high resolution (HR) 1H MRS to determine the impact of chemotherapy treatment on choline metabolites. Furthermore, we have begun to probe the impact of these chemotherapy agents on important genes in choline metabolism using quantitative real-time PCR.

Yuhong Qu¹, Haitao Zhu¹, Kun Cao¹, Xiaoting Li¹, and Ying-shi Sun^1
1Beijing cancer hospital, Beijing, China

This study established a deep learning model to predict PCR status after neoadjuvant therapy by combining pre-NAC and post-NAC MRI data.The area under the receiver operating characteristic (ROC) curve (AUC) of the models are 0.968 for post-NAC and 0.970 for the combined data.

Carolina Rossi Saccarelli^1,2, Peter Gibbs³, Almir G V Bitencourt¹, Isaac Daimiel¹, Roberto Lo Gullo¹, Sunitha B Thakur³, Elizabeth A Morris¹, and Katja Pinker ^1
1breast radiology, MSKCC, New York, NY, United States, ²breast radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil, ³MSKCC, New York, NY, United States

In this study, we hypothesized that the specific genomic profiles of invasive lobular carcinoma (ILC) can be captured with radiomics analysis and machine learning (ML) from standardized dynamic contrast-enhanced breast MRI. Three-dimensional tumor segmentation of the first post-contrast T1-weighted sequence was conducted and included the entire mass and non-mass enhancement lesions, unifocal and multifocal/multicentric lesions. This supervised ML model produced an accuracy of 76.6%, sensitivity of 72.7%, specificity of 80.6%, PPV of 79.1% and NPV of 74.5%. Our preliminary results indicate that radiomics analysis coupled with supervised ML allows a non-invasive differentiation between ILC and invasive ductal carcinoma.

Roberto Lo Gullo¹, Isaac Daimiel ¹, Carolina Saccarelli¹, Almir Bitencourt¹, Peter Gibbs², michael James Fox², Sunitha B. Thakur^2,3, Danny F. Martinez¹, Elisabeth A. Mossir¹, and Katja Pinker^1
1Radiology, Breast imaging, Memorial Sloan Kettering Cancer Center, New York, NY, United States, ²Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States, ³medical physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States

The purpose of our study was to investigate whether radiomics features extracted from MRI of BRCA-positive patients with breast masses smaller than 1 cm coupled with machine learning can differentiate benign from malignant lesions using model-free parameter maps.  We included 96 patients with 116 lesions assessed by two readers according to the BI-RADS lexicon. Radiomics features were calculated and included in a machine learning model, along with clinical factors, to discriminate between malignant and benign lesions. The machine learning model, combining two clinical and three radiomics features, achieved higher diagnostic accuracy (81.5%) compared to morphological assessment alone (53.4%)
 

Almir Bitencourt^1,2, Peter Gibbs³, Carolina Rossi Saccarelli³, Isaac Daimiel³, Roberto Lo Gullo³, Michael Fox³, Sunitha Thakur³, Katja Pinker³, Elizabeth A Morris³, Monica Morrow⁴, and Maxime Jochelson^3
1Breast Radiology, MSKCC, New York, NY, United States, ²Department of Imaging, A.C. Camargo Cancer Center, Sao Paulo, Brazil, ³MSKCC, New York, NY, United States, ⁴Breast Surgery, MSKCC, New York, NY, United States

In this study, we used magnetic resonance (MR)-based clinical and radiomic features to assess tumor heterogeneity in 311 HER2 overexpressing breast cancer patients receiving neoadjuvant chemotherapy (NAC), and correlated these findings with tumor heterogeneity and pathologic response. Tumor heterogeneity was evaluated based on the HER2 expression (IHC vs. FISH) . Pathologic complete response (pCR) was defined as no residual invasive carcinoma in the breast or axillary lymph nodes (ypT0/isN0). Radiomics analysis and machine learning with MRI were able to assess tumor heterogeneity and predict pCR after neoadjuvant chemotherapy in these patients, with a diagnostic accuracy of 97.4% and 85.2%, respectively.

Qinglin Wang ¹, Ning Mao¹, Haizhu Xie¹, Fengjie Liu¹, and Jingjing Cui^2
1Yantai Yuhuangding Hospital, Yantai, China, ²Huiying Medical Technology Co., Beijing, China

The expression level of Ki-67 has an important reference value for the diagnosis, treatment and prognosis evaluation of breast cancer. To explore the feasibility of diffusion-weighted imaging for prediction of Ki-67 expression. In this study, the expression of Ki-67 in breast cancer was differentiated by semi-automatic extraction of the image parameters of diffusion-weighted(DWI) before treatment. The results of this study show that Ki-67-negative and Ki-67-positive breast cancer have different imaging characterization values in DWI images. The imaging of DWI is feasible in identifying the two, which is helpful to predict the expression level of Ki-67 in breast cancer before operation.

Angeline Nemeth¹, Pierre Chaudet², Benjamin Leporq¹, Pierre-Etienne Heudel³, Olivier Tredan³, Isabelle Treilleux⁴, Frank Pilleul², Agnès Coulon², and Olivier Beuf^1
1Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Lyon, France, ²Department of Radiology, Centre Léon Bérard, Lyon, France, ³Department of Medical Oncology, Centre Léon Bérard, Lyon, France, ⁴Department of Pathology, Centre Léon Bérard, Lyon, France

A total of 76 patients were enrolled in this retrospective monocentric study. All patients had a non-metastatic triple negative breast cancer and underwent a pre-therapeutic MRI protocol (T1-weighted, T2-weigthed, diffusion-weighted and dynamic-contrast-enhanced imaging) before a neoadjuvant chemotherapy. Results of radiomic analyses based on multiple contrast images and using 3 classifiers (support vector machine, Random forest and multilayer perceptron) were leading to a relative interest of using a combination of features extracted from DCE-MRI, T1W and T2W in the aim to predict responders and non-responders.

Maureen Groot Koerkamp¹, Jeanine Vasmel¹, Stefano Mandija^1,2, Marielle Philippens¹, Ramona Charaghvandi³, Maaike Moman⁴, Wouter Veldhuis⁴, Celien Vreuls⁵, Paul van Diest⁵, Arjen Witkamp⁶, Ronald Koelemij⁷, Annemiek Doeksen⁷, Thijs van Dalen⁸, Elsken van der Wall⁹, Helena Verkooijen¹⁰, Jan Lagendijk¹, Bram van Asselen¹, Desiree van den Bongard¹, and Anette Houweling^1
1Radiotherapy, UMC Utrecht, Utrecht, Netherlands, ²Computational Imaging Group for MR diagnostic & therapy, UMC Utrecht, Utrecht, Netherlands, ³Radiotherapy, Radboudumc, Nijmegen, Netherlands, ⁴Radiology, UMC Utrecht, Utrecht, Netherlands, ⁵Pathology, UMC Utrecht, Utrecht, Netherlands, ⁶Surgical Oncology, UMC Utrecht, Utrecht, Netherlands, ⁷Surgery, St. Antonius, Utrecht, Netherlands, ⁸Surgery, Diakonessenhuis, Utrecht, Netherlands, ⁹Medical Oncology, UMC Utrecht, Utrecht, Netherlands, ¹⁰Epidemiology, UMC Utrecht, Utrecht, Netherlands

Radiologist assessment and quantitative dynamic contrast-enhanced (DCE) MRI analysis were used to determine if changes in these parameters could predict pathologic complete response to single ablative dose neoadjuvant partial breast irradiation. 3.0T DCE MRI scans in prone position were obtained pre-radiotherapy (RT), and 1 week, 2, 4, 6, and, if applicable, 8 months post-RT. Quantitative analysis showed an increase of relative enhancement 1 week after RT followed by a decrease at later time points which indicates acute tissue response and tumor regression, respectively. Both radiologist assessment (n=36) and quantitative analysis (n=27) could not predict pathologic response.

Alexandra Besser¹, Ana Rodriguez-Soto¹, Helen Park², Andrew Park², Grace Ahn Sora², Haydee Ojeda-Fournier¹, and Rebecca Rakow-Penner^2
1Radiology, University of California, San Diego, La Jolla, CA, United States, ²University of California, San Diego, La Jolla, CA, United States

 For patients with non-metastatic or locally advanced breast cancer, MRI imaging is used to follow response to neoadjuvant chemotherapy (NAC) and determine treatment plan. However, MRI radiological complete response is not always concordant with pathological complete response. In a cohort of patients imaged at our institution with non-metastatic/locally advanced breast cancer, we report that 24% of post-NAC final MRI imaging is discordant with the final pathology report. We also show that many of these MRI false negatives demonstrate residual intermediate to high grade DCIS and contain microcalcifications.

Benjamin Charles Musall¹, Abeer H Abdelhafez², Hagar S Mahmoud², Ken-Pin Hwang¹, Jong Bum Son¹, Mark D Pagel³, Lumarie Santiago⁴, Gary J Whitman⁴, Huong Le-Petross⁴, Tanya W Moseley⁴, Rosalind P Candelaria⁴, Thorunn Helgason⁵, Elizabeth E Ravenberg⁶, Jennifer K Litton⁶, Stacy L Moulder⁶, Wei T Yang⁴, Jingfei Ma¹, Gaiane M Rauch², and Beatriz E Adrada^4
1Imaging Physics, MD Anderson Cancer Center, Houston, TX, United States, ²Abdominal Imaging, MD Anderson Cancer Center, Houston, TX, United States, ³Cancer Systems Imaging, MD Anderson Cancer Center, Houston, TX, United States, ⁴Breast Imaging, MD Anderson Cancer Center, Houston, TX, United States, ⁵Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston, TX, United States, ⁶Breast Medical Oncology, MD Anderson Cancer Center, Houston, TX, United States

Diffusion fractional anisotropy and ADC were compared between tumors, peritumoral edema, and fibroglandular tissue in triple negative breast cancer. Fractional anisotropy in the peritumoral edema of triple negative breast cancer did not correlate strongly with ADC and may offer additional characterization of peritumoral edema.

Isaac Damiel¹, Daniel Topgaard^2,3, Karin Bryske², Sunitha Thakur¹, and Katja Pinker-Domenig^1
1Memorial Sloan Kettering Cancer Center, New York, NY, United States, ²Random Walk Imaging, Lund, Sweden, ³Lund University, Lund, Sweden

Diffusion tensor distribution (DTD) imaging was applied in a pilot study to investigate the potential for breast tumor grading in a clinical setting. The method relies on advanced gradient waveforms to encode the signal with information about cell densities, shapes, and orientations, and quantify tissue composition as a probability distribution in a space with dimensions analogous to the cellular ones. Five patients with ductal carcinoma underwent a <4 min DTD protocol giving voxel-resolved distributions and parameter maps with microstructural information not accessible with conventional methods, thereby encouraging future studies with larger patient groups and comparison with current gold standards.

Pauline Huang¹, Renee Cattell¹, Meghan Moriarty¹, Kwan Chen¹, Lev Bangiyev¹, Cliff Bernstein¹, Jules Cohen¹, Lea Baer¹, Dinko Franceschi¹, Haifang Li¹, and Tim Duong^1
1Radiology, Renaissance School of Medicine, Stony Brook, NY, United States

In breast cancer, lymph node status is highly related to prognosis. We evaluated the use of MRI of axillary lymph nodes (aLNs) to detect metastasis in pre-chemo breast cancer with PET as reference standard. For 4 readers scoring on T1-weighted DCE and T2-weighted MRI, the AUC, sensitivity, specificity and accuracy ranged from 0.73-0.85, 64%-83%, 54-91%, and 67-79%, respectively. Readers showed significant agreement (Spearman’s Rho 0.35-0.65). Though improvement is needed, this approach presents a less invasive method of assessing all aLNs and avoiding their unnecessary removal.

Nicholas Senn¹, Yazan Masannat², Ehab Husain³, Bernard Siow⁴, Steven D Heys⁵, and Jiabao He^1
1Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, United Kingdom, ²Breast Unit, Aberdeen Royal infirmary, Aberdeen, United Kingdom, ³Pathology department, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, ⁴Francis Crick Institute, London, United Kingdom, ⁵School of Medicine, University of Aberdeen, Aberdeen, United Kingdom

q-Space imaging (QSI) was compared against conventional DWI and non-Gaussian diffusion models of diffusion kurtosis imaging (DKI) and stretched-exponential model (SEM) to evaluate the skewness in histogram distribution of diffusion displacement and diffusivity for profiling breast tumour cellularity. We investigated whole breast tumours excised from surgery, with imaging performed same day overnight on a clinical 3T MRI system. We found QSI to yield a higher effect gradient to assess cellularity in breast cancer compared with conventional diffusion-weighted imaging methods. The skewness obtained from QSI further showed fidelity with the skewness of cellularity obtained from histology.