Qin Li¹, Pu-Yeh Wu², and Yajia Gu^1
1Fudan University Shanghai Cancer Center, Shanghai, China, ²GE Healthcare, Beijing, China

This study quantitatively evaluated intra-tumoral heterogeneity through histogram analysis of synthetic MRI parameters, and determined correlations with prognostic factors and molecular subtypes of breast IDC. We found that IDC with high nuclear grade had higher PD10th, PDmean, PDmedian and PDmax. PDmedian was higher in IDC with HER2 positivity. T110th was higher in cancers with PR negativity. Cancers with hormone receptornegativity had higher T210th, T2mean and T2median than that with hormone receptor positivity. Overall, we demonstrated that whole-tumor histogram-based imaging features derived from synthetic MRI correlated with prognostic factors and may be considered a non-invasive approach for discriminating IDC subtypes.

Qihao Zhang¹, Michele B Drotman¹, Christine Chen¹, Thanh Nguyen¹, Pascal Spincemaille¹, and Yi Wang^2
1Weill Cornell Medical College, New York, NY, United States, ²Cornell University, New York, NY, United States

We evaluate quantitative transport mapping (QTM) based on the inversion of transport equation without any arterial input function (AIF) for automatically postprocessing dynamic contrast enhanced MRI (DCE-MRI) to differentiate malignant and benign breast tumors using biopsy pathology as reference and comparing with traditional Kety’s method and enhancement curve characteristics (ECC). Automated QTM velocity was found to be the most accurate, then ECC enhancement amplitude with manual ROI, and lastly Kety’s K^trans  with a manual AIF for differentiating malignant from benign breast tumor.

Ping N Wang¹, Julia V Velikina², Alexey A Samsonov², Lloyd Estkowski³, Ty A Cashen³, Frederick Felcz², Roberta M Strigel^1,2,4, Frank R Korosec^1,2, and James H Holmes^2
1Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States, ²Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States, ³Global MR Applications & Workflow, GE Healthcare, Madison, WI, United States, ⁴Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States

Advanced acquisition and reconstruction methods have been proposed to improve spatial and temporal resolution for prone breast DCE. However, limited work has been performed in the supine setting, which is used in most downstream clinical services including surgery and biopsy. In this work, we propose a radial acquisition combined with self-gating and MOCCO reconstruction. We assess performance of these methods using a simulated breast phantom with respiratory motion and contrast kinetics allowing evaluation of reconstruction accuracy against the assigned ground truth. Evaluation of both spatial and temporal quality was also performed in a first in-vivo patient volunteer.

Mehran Baboli¹, Pippa Storey², Terlika Pandit Sood², Justin Fogarty², Melanie Moccaldi², Alana Lewin², Linda Moy², and Sungheon Gene Kim^1
1Radiology, Weill Cornell Medicine, New York, NY, United States, ²Radiology, NYU Langone Health, New York, NY, United States

We assessed the distribution of saturated fatty acid (SFA) in the adipose tissue around malignant tumors and the whole breast of patients with benign and malignant lesions. Bilateral gradient echo spectroscopic imaging sequence was acquired simultaneously. A voxel-wise analysis in the frequency domain was then applied to measure the SFA in each breast's adipose tissues and peri-tumoral region. Our results showed that the SFA was significantly higher around the malignant tumor than on the contralateral side, while no significant changes were observed with benign lesions. The results indicate that the SFA may be closely associated with the malignancy of lesions.

Ting-ting Lin¹ and Jiang-ning Dong^2
1Radiology Department, Anhui Provincial Cancer Hospital, Hefei, China, ²Radiology department, Anhui Provincial Cancer Hospital, Hefei, China

The aim of our study was to investigate the early predictive value of IVIM-DWI in neoadjuvant chemotherapy for breast cancer. 43 cases of breast cancer confirmed by pathological puncture biopsy in our hospital were enrolled in this study. Four courses of neoadjuvant chemotherapy were used to evaluate the efficacy. The conclusion obtained via the present study is IVIM-DWI can predict the early curative effect of neoadjuvant chemotherapy for breast cancer and evaluate its effectiveness. It can assist conventional MRI to evaluate the curative effect.

Kwok Shing Chan^1,2, Sai Man Cheung¹, Nicholas Senn¹, Yazan Masannat^3,4, Ehab Husain^4,5, Steven D Heys³, and Jiabao He^1
1Institute of Medical Sciences, 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, ⁴School of Medicine, University of Aberdeen, Aberdeen, United Kingdom, ⁵Pathology 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 spectroscopic imaging demands an intolerably long acquisition time. Novel method using chemical shift-encoded imaging (CSEI) 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 CSEI in breast tumours.

Yafei Guo¹, Lin Lu¹, Meiying Cheng¹, Kaiyu Wang², Jinxia Guo², Xin Zhao¹, and Xiaoan Zhang^1
1the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ²GE Healthcare, MR Research China, Beijing, China

Accurate characterization of clinically-indeterminate breast masses before surgery is crucial for proper disease management. While DCE-MRI has emerged as a problem-solving technique, traditional DCE-MRI still lacks a certain quantitative standard because of its technical defects. In this study, DISCO, as a new dynamic contrast enhanced technique, was used to scan breast lesions, and the effectiveness of its parameters in the diagnosis and differential diagnosis of benign and malignant lesions was analyzed. 

Yurong Zheng¹, Rui Wang¹, Li Li¹, Haoyuan Li¹, Pengfei Wang¹, Tiejun Gan¹, Jing Zhang¹, and Kai Ai^2
1Department of Magnetic Resonance, LanZhou University Second Hospital, Lanzhou, China, ²Philips Healthcare, Xi’an, China

Intravoxel incoherent motion (IVIM) combined with Dynamic Contrast Enhanced MRI (DCE-MRI) are meaningful MRI techniques applied to breast cancer. This study used DCE-derived parameters (voiume translocation constant, K^trans and rate constant, K_ep) and IVIM-derived parameters (diffusion coefficient, D and perfusion fraction, f)  to perform correlation analysis with prognosis of breast cancer indexes (ER, PR, her-2, Ki-67). The preliminary results showed that there were correlations between K^trans, K_ep, D and prognostic factors of breast cancer. Our research may provide more important clinical evidence for the treatment and prognosis of breast cancer.  

Anabel M Scaranelo¹, Edna Furman-Haran², Abdullah Alabousi³, Dov Grobgeld², Vivianne Freitas¹, and Hadassa Degani^4
1Medical Imaging, University of Toronto, Toronto, ON, Canada, ²Weizmann Institute of Science, Rehovot, Israel, ³Department of Radiology, St Joseph's Healthcare. McMaster University, Hamilton, ON, Canada, ⁴DDE MRI Solutions Ltd., Tel Aviv, Israel

Response to breast neoadjuvant systemic therapy (NAST)  was longitudinaly monitored with Diffustion Tensor Imaging (DTI)  pre and post therapy and evaluated in reference to post surgery histopatholgy results.   A correlation was demonstrated between DTI residual tumor size and pathology size. Response in  the various breast cancer subtypes was revealed by increased λ 1 values  validated by a  correlation with the pathological  residual disease. DTI detected pCR in all breast subtypes with a good sensitivity and specificity

Michael Liu¹, Richard Ha¹, Terry Button², Yucheng Liu¹, Yun-Hsu Hao³, and Sachin Jambawalikar^1
1Radiology, Columbia University, New York, NY, United States, ²Stonybrook University, Stonybrook, NY, United States, ³Columbia University, New York, NY, United States

Multisite Breast Dynamic Contrast Enhanced MRI based Oncotype DX score models benefit from multiscale sampling

Jia Ying¹, Renee Cattell¹, and Chuan Huang^1,2,3
1Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States, ²Radiology, Stony Brook Medicine, Stony Brook, NY, United States, ³Psychiatry, Stony Brook Medicine, Stony Brook, NY, United States

Clinical determination of mammographic breast density (MD) is subjective and can also suffer from intra- and inter-reader variability. MR-based quantitative assessment of breast density has a few unique advantages over mammography. However, accurate whole breast segmentation is crucial. Manual whole breast segmentation is burdensome and current automated methods also suffer from weaknesses. In this work, a new whole breast segmentation strategy based on image registration is proposed. The test-retest reliability of breast density derived using different segmentation methods was quantitatively assessed. The results demonstrated this new segmentation method yields more reproducible values compared to existing methods.

Ulrich Katscher¹, Jakob Meineke¹, Shuo Zhang², and Jochen Keupp^1
1Philips Research Europe, Hamburg, Germany, ²Philips Healthcare, Hamburg, Germany

To quantify diffusion weighting and to calculate the diagnostically valuable “Apparent Diffusion Coefficient” (ADC) in MR-based “Diffusion-Weighted Imaging” (DWI), a standardized b-value is typically used. To avoid typical shortcomings of standard DWI, diffusion-weighted double-echo-steady-state (dwDESS) sequences were proposed, which don’t show geometrical distortions. Balanced bipolar dwDESS, in particular, provides high SNR and is robust against motion. However, a proper definition of the b-value equivalent to standard DWI is not yet well addressed. This study investigated an estimation for effective b-values in dwDESS based on approximation of the underlying signal model, which was verified in phantom and human measurements.  

Ping N Wang¹, Julia V Velikina², Leah C Henze Bancroft², Alexey A Samsonov², Frederick Felcz², Roberta M Strigel^1,2,3, and James H Holmes^2
1Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States, ²Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States, ³Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States

Radial acquisition with MOCCO reconstruction has been proposed for high spatial and temporal resolution breast DCE imaging. However, the performance of the method has not been evaluated across a wide range of temporal enhancement curves. In this work, we use a breast digital reference object with the ability to provide a wide range of lesion contrast kinetics using the extended Tofts model for pharmacokinetic simulation. A voxel-by-voxel quantitative analysis was applied and compared with the ground truth.  

Patrick J Bolan¹, Jessica A McKay², Mehmet Akcakaya³, An L Church⁴, Michael T Nelson⁴, Kamil Ugurbil¹, and Steen Moeller^1
1Radiology / Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States, ²Radiology, Stanford University, Palo Alto, CA, United States, ³Electrical and Computer Engineering /CMRR, University of Minnesota, Minneapolis, MN, United States, ⁴Radiology, University of Minnesota, Minneapolis, MN, United States

This study explores the use of a low-rank denoising technique (NORDIC) on breast DWI. Accuracy and repeatability were assessed by subdividing full acquisitions into shorter scans, calculating ADC with and without NORDIC, and comparing the resultant ADC maps. We found that the denoising effects were dependent on SNR – low SNR regions (e.g., background) had greater denoising efficacy than high SNR regions. These findings indicate that NORDIC may help improve assessment of small lesions, and could be used to prospectively optimize higher-resolution acquisition protocols.

James Dion Barnett¹, Marie-France Penet¹, Balaji Krishnamachary ¹, Zaver Bhujwalla¹, Flonne Wildes¹, Santosh Kumar Bharti¹, and Yelena Mironchik^1
1The Johns Hopkins University School of Medicine, Baltimore, MD, United States

Cycloxygenase-2 (COX-2) is a pathological marker of high clinical relevance. COX-2 initiates the biosynthesis of inflammatory and immunosuppressive prostanoids to promote a hostile tumor microenvironment. Solid tumors rely on vital organs such as the spleen to survive, proliferate and evade immune recognition. We modulated breast cancer COX-2 expression to investigate the metabolic effects in the spleen of immunocompetent and immunocompromised mice. High resolution 1H magnetic resonance spectroscopy (MRS) was performed to identify changes in spleen metabolites. We observed distinct, COX-2-dependent increases in various metabolites in severe combined immunodeficient (SCID) mice compared to immunocompetent BALB/c mice.

Sai Man Cheung¹, Ehab Husain^2,3, Vasiliki Mallikourti¹, Yazan Masannat^3,4, Steven D Heys⁴, and Jiabao He^1
1Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom, ²Pathology Department, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, ³School of Medicine, University of Aberdeen, Aberdeen, United Kingdom, ⁴Breast Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom

Lymphovascular invasion (LVI) is associated with increased recurrence and metastatic risk in breast cancer. LVI, with genetic mutation in metabolism of saturated and monounsaturated fatty acids, leads to the deregulation of lipid composition. Currently LVI is estimated using the pre-operative core biopsy, while definitive LVI can only be determined after surgery, precluding patients to receive timely neoadjuvant chemotherapy or hormonal treatment. Double quantum filtered correlation spectroscopy (DQF-COSY) is a method capable of accurate non-­invasive lipid composition quantification. We therefore hypothesised there is a difference in lipid composition derived from DQF-COSY between LVI status.

Michelle W Tong¹, Maren M. Sjaastad Andreassen², Ana Rodríguez-Soto¹, Christopher C Conlin¹, Tyler Seibert³, Michael Hahn¹, Rebecca Rakow-Penner¹, and Anders M Dale^1
1Radiology, University of California, San Diego, La Jolla, CA, United States, ²Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway, ³Radiation Oncology, University of California, San Diego, La Jolla, CA, United States

MRI is commonly used to evaluate breast cancer response to neoadjuvant chemotherapy. Image registration algorithms aid diagnostic accuracy by correcting changes in patient position across visits. A novel technique, Fast Longitudinal Image REgistration (FLIRE), was evaluated by comparison to a standard algorithm optimized for breast tissue, DRAMMS. Breast images acquired over the course of neoadjuvant treatment were registered to baseline images. FLIRE runtime was 5 minutes (~20× faster).  With this fast processing time, FLIRE performed within 2.5-10.2% of optimized DRAMMS in similarity measures. Overall accuracy and computation speed for FLIRE with default arguments demonstrates promise for clinical time-sensitive applications. 

Yuko Someya¹, Mami Iima^1,2, Hirohiko Imai³, Hiroyoshi Isoda¹, Masako Kataoka¹, Denis Le Bihan^4,5,6, and Yuji Nakamoto^1
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan, ²Department of Clinical Innovative medicine, Institute for advancement of clinical and translational science, Kyoto University Hospital, Kyoto, Japan, ³Department of Systems science, Graduate School of Informatics, Kyoto University, Kyoto, Japan, ⁴NeuroSpin/Joliot, CEA-Saclay Center, Paris-Saclay University, Gif-sur-Yvette, France, ⁵Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan, ⁶National Institute for Physiological Sciences, Okazaki, Japan

We investigated the time-dependency of IVIM /non-Gaussian diffusion parameters in vivo and post-mortem using breast xenograft models (MDA-MB-231). f_IVIM, perfusion-related fraction, dropped abruptly post-mortem, though not reaching 0 completely, suggesting imperfect modeling. f_IVIM, estimated from the pseudo-diffusion model, was independent of the diffusion time. The significant decrease of sADC and ADC₀ values and the increase in K values observed between short and long diffusion times, as well as after sacrification are in accordance with an increase in diffusion hindrance, as more water molecules hit many boundaries, such as cell membranes. However, different mechanisms may be at stake.

Ioannis Papadopoulos¹, Ivan Dimitrov², Jochen Keupp³, Durga Udayakumar^1,4, Stephen Seiler¹, Sunati Sahoo⁵, Yin Xi¹, Emily Knippa¹, Robert Lenkinski^1,4, Ananth Madhuranthakam^1,4, Shu Zhang⁶, and Elena Vinogradov^1,4
1Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States, ²Philips Healthcare, Gainesville, FL, United States, ³Philips Research, Hamburg, Germany, ⁴Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, United States, ⁵Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States, ⁶Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States

CEST-mDixon imaging utilizing hydroxyl and amine pools could aid breast tumor diagnosis, as shown in previous preliminary studies. In the current study, CEST-mDixon is evaluated in a breast cancer patient cohort using improved saturation and acquisition parameters. The results agree with previous findings demonstrating moderate linear correlation of CEST effects at 1 ppm and 2 ppm with Ki-67. In addition, we observe a linear correlation with the percentage of cells positive for nuclear expression of the progesterone receptor (PR), the first such observation reported. Overall, the study confirms the potential for CEST-mDixon for characterizing breast tumor aggressiveness non-invasively.

Milica Medved¹, Ulrich Katscher², Hiroyuki Abe¹, and Gregory S Karczmar^1
1Department of Radiology, The University of Chicago, Chicago, IL, United States, ²Philips Research, Hamburg, Germany

Current breast MRI protocols are heavily reliant on dynamic contrast-enhanced MRI (DCEMRI), but this practice is not ideal, due to recently reported findings of long-term gadolinium deposition in several tissues.  We demonstrate feasibility of EPT analysis as applied to HiSS MRI data, which could simplify the process of lesion delineation relative to the current method and may thus improve the diagnostic accuracy of non-contrast breast MRI.  Linearly extrapolated phase, to TE = 0 ms, from complex multi-TE gradient echo images obtained using HiSS MRI was used for this purpose.