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Mary A Neal^1,2, Charlotte Holland^1,2, Benjamin J Pippard^1,2, Ian Forrest³, Graham Burns³, Rod Lawson⁴, Holly F Fisher⁵, John NS Matthews⁵, A John Simpson², Jim M Wild⁶, and Peter E Thelwall^1,2
1Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom, ²Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom, ³Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom, ⁴Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom, ⁵Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom, ⁶POLARIS, Imaging Sciences, Department of IICD, University of Sheffield, Sheffield, United Kingdom

Keywords: Lung, Non-Proton, fluorine, 19F, ventilation

¹⁹F-MRI is an emerging technique which holds promise for direct, quantitative imaging of pulmonary ventilation without recourse to ionising radiation or use of specialist hyperpolarised gases. We aimed to assess the sensitivity of ¹⁹F-MRI to treatment response by imaging inhaled perfluoropropane in patients with asthma and patients with COPD before and after administration of a bronchodilator, at two research sites. Significant increases in percent ventilated lung volume were measured from the ¹⁹F-MR images following bronchodilator administration in both patient groups, and a positive correlation with spirometry was measured, demonstrating good technique sensitivity and clinical validity.

Ruimeng Zhao¹, Siyao Du¹, Si Gao¹, Lizhi Xie², Jing Shi³, and Lina Zhang^1
1Department of Radiology, The First Hospital of China Medical University, Shenyang, China, ²MR Research, GE Healthcare, Beijing, China, ³Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China

Keywords: Breast, Cancer, neoadjuvant chemotherapy; pathological complete response

This study investigated the time course changes of synthetic magnetic resonance imaging (MRI) parameters (T1/T2 relaxation time [T1/T2], proton density [PD]) during neoadjuvant chemotherapy (NAC) and evaluate their value as predictors for pathological complete response (pCR) in locally advanced breast cancer. The results showed that median synthetic T1/T2/PD and tumor diameter generally decreased throughout NAC. And the Change of synthetic T1 after the first cycle of NAC may be an early predictor for NAC response in locally advanced breast cancer during whole treatment cycles. However, its predictive ability is significantly affected by histological grades.

Yanjin Qin¹, Yunfei Zhang², Yongming Dai², and Tao Ai^1
1Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, ²MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China

Keywords: Breast, Cancer

In the present study, we compared the potential of various diffusion parameters derived from five models in distinguishing breast lesions, including the mono-exponential model (Mono), intravoxel incoherent motion (IVIM) model, diffusion kurtosis imaging (DKI) model, stretched exponential model (SEM), and continuous-time random-walk (CTRW) mode. We found that diffusion-related parameters by the SEM and CTRW models are superior to ADC in discriminating breast lesions. Multiple diffusion parameters by all five diffusion models are related while the information provided is diverse.
 

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Shiyun Sun¹, Yajia Gu¹, and Chao You^1
1Fudan University Shanghai Cancer Center, Shanghai, China

Keywords: Breast, Breast, breast edema; magnetic resonance imaging (MRI); treatment response; recurrence

This study aims to develop an accurate and convenient prediction model for luminal breast cancer based on conventional MRI. First, we evaluated conventional MRI features and their changes during NAC (pre, early and post) and identified stable imaging markers that predicted multiple treatment responses and prognosis. Second, we comprehensively explored the shrinkage pattern, breast edema and changes during NAC. We found that both of them can provide added value to traditional MRI features. Finally, we constructed a combined model with multi-parameter MRI features and clinicopathological information, which showed good prediction performance in treatment response and prognosis of luminal breast cancer.

Xinyao Zhao¹, Qingqing Wen², Weiqiang Dou², and Junying Wang^3
1Department of Radiology, Yantaishan Hospital, Yantai , Shandong Province, China, ²GE Healthcare, MR Research China, Beijing, China, ³Shandong Province Qianfoshan Hospital, Jinan, Shandong Province, China

Keywords: Liver, Diffusion/other diffusion imaging techniques, IVIM

The accurate evaluation of tumor response after Transarterial Chemoembolization (TACE) treatment is important for tumor prognosis and subsequent treatment. In this study, we comprehensively investigated the feasibility of IVIM parameters in the TACE treatment area, peritumoral area, and hepatic parenchymal to predict tumor recurrence in hepatocellular carcinoma patients after TACE treatment. ADC and D of TACE-treated area, and D of the peritumoral area can predict the intralesional and peritumoral recurrence after TACE treatment with high accuracy, indicating that IVIM might be a useful tool in predicting the therapeutic response and the peritumoral invasion.

Ying Xu¹, Lu Li¹, Yi Yang¹, Lizhi Xie², Sicong Wang², Feng Ye¹, and Xinming Zhao^1
1Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China, ²GE Healthcare, China, Beijing, China

Keywords: Liver, Treatment, Targeted Therapy, Immunotherapy, Prognostic Prediction ·

One-hundred and sixty-six patients (55.6±10.4 years) treated with lenvatinib plus anti-PD-1 antibody were included in training cohort and 77 patients (55.4±10.7 years) treated with lenvatinib or bevacizumab plus anti-PD-1 antibody were included in validation cohort. Based on independent risk factors (Gender, intRatumoral fAt, enhancing tumor caPsule, gross growtH type and CRAFITY Score) identified by the multivariate analysis, a novel prognostic tool named GRAPH-CRAFITY Score was developed to predict OS. GRAPH-CRAFITY Score by integrating Gender, MR features and laboratory tests is an effective and user-friendly tool to predict OS of HCC patients treated with targeted therapy and immunotherapy.

Yue Zhao¹, Xiuhong Guan¹, Yongzhou Xu², Xinqing Jiang¹, and Ruimeng Yang^1
1Department of Radiology, Guangzhou First People’s Hospital, Guangzhou, China, ²Philips Healthcare, Guangzhou, China

Keywords: Liver, Cancer

The cell proliferation index, Ki-67 labeling index (LI) indicates the status of cell proliferation activity which corresponds with tumor biological behavior, treatment efficacy and prognosis. If the preoperative Ki-67 expression status in HCC can be accurately predicted noninvasively, it may provide important information for clinical decision-making. T1 mapping is useful for preoperative prediction of Ki-67 LI of HCC. The nomogram Combining T1 mapping on gadoxetic acid-enhanced MRI and clinical indicators has good predictive efficacy for preoperative prediction of Ki-67 LI, which can promote the individualized risk stratification and further treatment decision of HCC patients.

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Martin D Holland¹, Ezinwanne Onuoha², Moh’d Khushman³, Darryl Outlaw³, Mehmet Akce ³, Bassel El-Rayes ³, Grant R Williams ³, Salila Hashmi ⁴, Sushanth Reddy ⁴, J. Bart Rose ⁴, Desiree E. Morgan ⁵, Xiaoyu Jiang ⁶, Dana Cardin ⁷, Katherine Frederick-Dyer ⁶, Junzhong Xu ⁶, and Harrison D Kim^5
1Interdisciplinary Engineering, University of Alabama at Birmingham, Birmingham, AL, United States, ²Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States, ³Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, ⁴Surgery, University of Alabama at Birmingham, Birmingham, AL, United States, ⁵Radiology, University of Alabama at Birmingham, Birmingham, AL, United States, ⁶Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States, ⁷Medicine, Vanderbilt University Medical Center, Nashville, TN, United States

Keywords: Pancreas, Cancer, DCE-MRI, Pancreatic cancer, Therapy monitoring, Perfusion phantom, Quantification

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion by monitoring the dynamic change of MRI contrast agents. However, the inter/intra-scanner variability in quantitative DCE-MRI (qDCE) measurement remains a concern. We developed a point-of-care portable perfusion phantom (P4) that can be imaged with a human subject in a standard MRI scanner to detect and correct the inter/intra-scanner variability of qDCE measurement. We demonstrated that the PDAC response to chemotherapy could be accurately assessed using quantitative DCE-MRI after our P4-based error correction method approximately seven weeks after starting therapy in two clinics.

Zehua Zhang¹, Caixia Fu², Robert Grimm³, and Zhengrong Zhou^1
1Shanghai Cancer Center, Shanghai, China, ²MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China, ³MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany

Keywords: Pancreas, Diffusion/other diffusion imaging techniques

This study firstly compared diffusion kurtosis imaging (DKI) and traditional diffusion weighted imaging (DWI) in evaluating first-line chemotherapy in unresectable pancreatic cancer. The result demonstrated that higher efficacy was shown in DKI derived parameters than DWI by the ROC curve analysis. DKI has potential to become a new non-invasive tool for clinical efficacy evaluation and help clinicians select individualized treatment.

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Danny Lee^1,2, Seungjong Oh^1,2, Min-Sig Hwang^1,2, Daniel Pavord¹, Jason Sohn^1,2, Athanasios Colonias¹, Mark Trombetta¹, Alexander Kirichenko^1,2, and Paul Renz^1
1Allegheny Health Network, Pittsburgh, PA, United States, ²Drexel University College of Medicine, Philadelphia, PA, United States

Keywords: Cancer, Pancreas, MR-guided pancreas SBRT on MR-Linac

Ablative SBRT to pancreatic cancers on MRI-Linac is a novel and rapidly evolving technology allowing real-time visualization of tumor and nearby organs-at-risk (OAR). Reliable identification of pancreas tumors on MR-Linac has direct impact on radiotherapy planning and outcome. A novel workflow was clinically implemented for pancreas stereotactic body radiotherapy on Elekta Unity MR-Linac. Compared to T2W images, pancreas tumors on T1W images, were superiorly visible for accurate delineation during the entire treatment course. This study is the first to determine the impact of an optimized MR sequence for pancreas tumors and OARs during multi-fractionate MR-guided radiotherapy on 1.5T Elekta MR-Linac.

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Katrinus Keijnemans¹, Pim Borman¹, Bas Raaymakers¹, and Martin Fast^1
1Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands

Keywords: Lung, Radiotherapy, 4D-MRI, Respiratory navigator

Accurate characterization of internal anatomical motion is essential for correctly guiding free-breathing radiotherapy treatments on the MR-linacs. Respiratory-correlated 4D-MRI can potentially provide this crucial information during each treatment session. We acquired a 1D respiratory navigator (1D-RNAV) interleaved with simultaneous multi-slice (SMS) images, yielding a concurrent 2D navigator (2D-RNAV). Respiratory-correlated 4D-MRIs were obtained with the 1D and 2D internal navigator surrogate signals, and the amount of missing anatomical data was quantified. Using the 1D-RNAV signal yielded fewer missing data in respiratory-correlated 4D-MRIs. Improving breathing regularity using biofeedback did not substantially influence the choice of navigator.

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Aritrick Chatterjee^1,2, Xiaobing Fan¹, Aytekin Oto¹, and Gregory Karczmar^1
1University of Chicago, CHICAGO, IL, United States, ²Sanford J. Grossman Center of Excellence in Prostate Imaging and Image Guided Therapy, Chicago, IL, United States

Keywords: Prostate, Cancer

This study introduces a new quantitative mapping technique referred to as “Four Quadrant Vector Mapping” of HM-MRI data, where each image voxel is represented as a vector within a 2D plot with components ‘∆T2/∆b’ and ‘∆ADC/∆TE’ with associated spatial coordinates and quadrant, distance and angle. Measured metrics provides effective cancer markers, with cancers associated with high PQ4, lower PQ2, and higher vector angle, and lower amplitude. Quadrant mapping parameters show promise for determining cancer aggressiveness as they are moderately correlated with Gleason score. Four quadrant mapping could be combined with the compartmental analysis of HM-MRI data to increase diagnostic accuracy.

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Sujeet Kumar Mewar¹, Sanjay Sharma², Ekta Dhamijia³, Sanjay Thulkar³, S. Datta Gupta⁴, Sridhar Panaiyadiyan⁵, Naranamangalam R. Jagannathan⁶, Rajeev Kumar⁵, and Virendra Kumar ^1
1Department of N.M.R., All India Institute of Medical Sciences, New Delhi, India, ²Department of Radio-diagnosis , RPC, All India Institute of Medical Sciences, New Delhi, India, ³Department of Radio-diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, India, ⁴Department of Pathology, All India Institute of Medical Sciences, New Delhi, India, ⁵Department of Urology, All India Institute of Medical Sciences, New Delhi, India, ⁶Department of Radiology, Present address. Chettinad Academy of Research and Education, Kelambakkam., Tamil Nadu, India

Keywords: Prostate, MR-Guided Interventions

The present study demonstrated the comparison of detection rate of PCa between the three groups of patients recruited based on PSA > 4 ng/ml and abnormal DRE. The PCa detection rate of mpMRI-Inbore biopsy (Group I) was found 50 % while for mpMRI-TRUS guided biopsy (Group II) 26 %. The combined detection rate of techniques with and without mpMRI was also calculated and found 44 %, for mpMRI-Inbore biopsy and mpMRI-TRUS guided biopsy, while 34.5 %, in TRUS guided biopsy (Group III). Study shows that there is a significant advantage of mpMRI Inbore biopsy compared to TRUS guided prostate biopsy.  

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Aiming Lu¹, Guruprasad Krishnamoorthy^1,2, Jacinta G Browne¹, Scott M Thompson¹, Daniel A Adamo¹, and David A Woodrum^1
1Mayo Clinic, Rochester, MN, United States, ²Philips Healthcare, Rochester, MN, United States

Keywords: Pelvis, Artifacts, intervention

MRI-guided cryoablation is a widely used minimal invasive treatment that uses extreme cold to destroy localized diseased tissues. The cryoneedles used are expected to introduce little metal artifacts by themselves in the MRI images. However, severe artifacts along the cryoneedle shaft are sometimes observed during MRI guided cryoablations in practice, which can not only complicate the cryoablation procedures, but also potentially cause complications and negatively affect treatment outcome.  This work demonstrated that the artifacts are likely due to coupling of the cryoneedles and the RF coils, and can be minimized by proper positioning of the cryoneedles, RF coils and patients.

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Fang Wang¹, Xinghua Xu¹, Guangtai Wu¹, Lingyu Chang¹, Dumin Li¹, Weiqiang Dou², Dmytro Pylypenko², Dexin Yu¹, and Qing Wang^1
1Qilu Hospital of Shandong University, Jinan, China, ²GE Healthcare, MR Research China, Beijing, China

Keywords: Urogenital, Bladder

This study aimed to determine the feasibility of intravoxel-incoherent-motion(IVIM) and diffusion-kurtosis-imaging (DKI) parameters in differentiating tumor stages and grades of bladder cancers preoperatively. The IVIM-related parameter (true-diffusion-coefficient) and DKI-related parameters (mean-diffusivity; mean-kurtosis) were significantly higher in non–muscle-invasive than muscle-invasive bladder cancers, and in low-grade than high-grade ones (all p <0.05). Robust diagnostic efficacies were separately confirmed with high AUCs for IVIM and DKI in staging and grading bladder cancers, and the optimal efficacy was obtained with combined IVIM and DKI models. Therefore, combined IVIM and DKI might be considered effective in differentiating the stages and grades of bladder cancers.

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Qiaoyu Xu¹, Hongliang Sun², Yanyan Xu², Juan Wang², and Tongyin Zhang^2
1Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China, ²China-Japan Friendship Hospital, Beijing, China

Keywords: Pelvis, Cancer

This study aimed to investigate the usefulness of diffusion-weighted imaging (DWI) derived apparent diffusion coefficient (ADC) values and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) derived semi-quantitative parameters in distinguishing TD from MLN before surgical resection in RC patients. TD has some specific morphological features, including relatively larger size, lower short- to long-axis ratio, irregular shape and ill-defined border on T2-weighted MR images in rectal cancer. The combination of ADC values and parameters of DCE-MRI can help to improve the diagnostic efficiency of TD in rectal cancer.

Xixi Zhao¹, Wentao Hu², Honglei Hu¹, Chuyao Chen¹, Yongming Dai², and Yikai Xu^1
1Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China, ²MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China

Keywords: Digestive, Cancer

Different treatment strategies should be applied to locally advanced rectal cancer (LARC) patients achieving different response after neoadjuvant chemoradiotherapy (nCRT). The purpose of this study was to determine the diagnostic performance of diffusion-relaxation correlation spectroscopic imaging (DR-CSI) in discriminating the pathological complete response (pCR) to nCRT in LARC. Compared to non-pCR group, pCR group showed significantly decreased average DR-CSI VD. ROC curve analysis indicated that the VD has better diagnostic performance in distinguishing pCR from non-pCR patients than traditional ADC and T2 value.

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Lijuan Wan¹, Hongmei Zhang¹, Yumeng Zhu², Yueluan Jiang³, and Guang Yang^4
1National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ²Beijing No.4 High School International Campus, Beijing, China, ³MR Scientific Marketing, Siemens Healthineers Ltd., Beijing, China, ⁴Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China

Keywords: Pelvis, Cancer, Tumor microenvironment

Tumor-stroma ratio (TSR) can reflect the relationship between tumor cells and tumor microenvironment. Evaluation of the TSR timely and accurately is important because of its role in predicting prognosis and making individualized treatment plans. Diffusion parameters obtained from multiple mathematical models of DWI can reflect microscopic characteristics of tumors. Multi b-value DWI with the advanced zoomed DWI technology can provide a higher-spatial-resolution with less artifacts. This study aimed to investigate the value of zoomed multi b-value DWI for predicting TSR in rectal cancer. The results suggested that distributed diffusion coefficient (DDC) is a promising indicator to identify high TSR group.

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Anubhav Datta^1,2, Damien J. McHugh^1,3, Michael J. Dubec^1,3, David L. Buckley^3,4, Ross Little¹, Michael Berks¹, Susan Cheung¹, Catharine West¹, Ananya Choudhury^1,5, Peter Hoskin^1,5,6, and James P. B. O'Connor^1,2,7
1Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom, ²Clinical Radiology, The Christie NHS Foundation Trust, Manchester, United Kingdom, ³Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom, ⁴School of Medicine, University of Leeds, Leeds, United Kingdom, ⁵Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, ⁶Clinical Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom, ⁷Division of Radiotherapy and Imaging, Institute of Cancer Research, London, London, United Kingdom

Keywords: Uterus, Cancer

There is a need for robust imaging biomarkers which can be used to assess early tumour response to therapy. Intra-voxel incoherent motion (IVIM) can provide information about tumour microstructure and microvasculature, but requires technical and biological validation. This work evaluates IVIM repeatability in the uterine cervix of healthy volunteers, assesses the sensitivity of IVIM parameters to therapy in patients with uterine cervical cancer, and evaluates model suitability through a model comparison framework.

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Cheng Zhang¹, Yujiao Zhao², Cong You¹, Zhiwei Shen³, and Wen Shen^2
1The First Central Clinical College of Tianjin Medical University, Tianjin, China, ²Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China, ³Philips healthcare, Beijing, China

Keywords: Pelvis, Pelvis, Static-Dynamic MR; pelvic organs prolapse; levator ani muscle; pelvic floor reconstruction surgery; recurrent risk

As high as 54% is the anatomical recurrence rate following hysterectomy with anterior and posterior vaginal wall restoration for pelvic organ prolapse (POP). The levator ani muscle (LAM) is the primary pelvic floor support system. Using static and dynamic MRI, we investigated the association between the morphology and function of LAM and the postoperative recurrence of POP. Risk factors for the recurrence of POP included the thickness and injury of the LAM at rest, the H line, the M line, and the size of the levator hiatus at rest and strain, as well as the variation of the levator hiatus during the Valsalva maneuver.