Dataset Information

Lymphedema evaluation using noninvasive 3T MR lymphangiography.

ABSTRACT: PURPOSE:To exploit the long 3.0T relaxation times and low flow velocity of lymphatic fluid to develop a noninvasive 3.0T lymphangiography sequence and evaluate its relevance in patients with lymphedema. MATERIALS AND METHODS:A 3.0T turbo-spin-echo (TSE) pulse train with long echo time (TEeffective ?=?600 msec; shot-duration?=?13.2 msec) and TSE-factor (TSE-factor?=?90) was developed and signal evolution simulated. The method was evaluated in healthy adults (n?=?11) and patients with unilateral breast cancer treatment-related lymphedema (BCRL; n?=?25), with a subgroup (n?=?5) of BCRL participants scanned before and after manual lymphatic drainage (MLD) therapy. Maximal lymphatic vessel cross-sectional area, signal-to-noise-ratio (SNR), and results from a five-point categorical scoring system were recorded. Nonparametric tests were applied to evaluate study parameter differences between controls and patients, as well as between affected and contralateral sides in patients (significance criteria: two-sided P < 0.05). RESULTS:Patient volunteers demonstrated larger lymphatic cross-sectional areas in the affected (arm?=?12.9?±?6.3?mm2 ; torso?=?17.2?±?15.6?mm2 ) vs. contralateral (arm?=?9.4?±?3.9?mm2 ; torso?=?9.1?±?4.6?mm2 ) side; this difference was significant both for the arm (P?=?0.014) and torso (P?=?0.025). Affected (arm: P?=?0.010; torso: P?=?0.016) but not contralateral (arm: P?=?0.42; torso: P?=?0.71) vessel areas were significantly elevated compared with control values. Lymphatic cross-sectional areas reduced following MLD on the affected side (pre-MLD: arm?=?8.8?±?1.8?mm2 ; torso?=?31.4?±?26.0?mm2 ; post-MLD: arm?=?6.6?±?1.8?mm2 ; torso?=?23.1?±?24.3?mm2 ). This change was significant in the torso (P?=?0.036). The categorical scoring was found to be less specific for detecting lateralizing disease compared to lymphatic-vessel areas. CONCLUSION:A 3.0T lymphangiography sequence is proposed, which allows for upper extremity lymph stasis to be detected in ?10 minutes without exogenous contrast agents. LEVEL OF EVIDENCE:1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1349-1360.

SUBMITTER: Crescenzi R

PROVIDER: S-EPMC5573666 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Lymphedema evaluation using noninvasive 3T MR lymphangiography.

Crescenzi Rachelle R Donahue Paula M C PMC Hartley Katherine G KG Desai Aditi A AA Scott Allison O AO Braxton Vaughn V Mahany Helen H Lants Sarah K SK Donahue Manus J MJ

Journal of magnetic resonance imaging : JMRI 20170228 5

<h4>Purpose</h4>To exploit the long 3.0T relaxation times and low flow velocity of lymphatic fluid to develop a noninvasive 3.0T lymphangiography sequence and evaluate its relevance in patients with lymphedema.<h4>Materials and methods</h4>A 3.0T turbo-spin-echo (TSE) pulse train with long echo time (TE<sub>effective</sub> = 600 msec; shot-duration = 13.2 msec) and TSE-factor (TSE-factor = 90) was developed and signal evolution simulated. The method was evaluated in healthy adults (n = 11) and ...[more]

PMID: 28245075

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Project description:Background Dynamic contrast material-enhanced MR lymphangiography has recently emerged as a technique to image the lymphatic anatomy and identify lymphatic flow abnormalities; however, a method to quantify lymphatic flow in health and disease is needed. Purpose To develop a method to quantify thoracic lymphatic flow patterns using dynamic contrast-enhanced MR lymphangiography. Materials and Methods The following patients with dynamic contrast-enhanced MR lymphangiography images collected in 2015 and 2016 were retrospectively identified: group A, neonates with chylothorax; group B, children with heart failure complicated by plastic bronchitis; and group C, adults with lymphatic plastic bronchitis and without heart failure. An automated image segmentation method was developed for segmenting the contrast-enhanced lymphatic flow in spatiotemporal domains from the dynamic contrast-enhanced MR lymphangiography images. The lymphatic flow rates were quantified for individual patients on the basis of their spatiotemporal dynamic contrast-enhanced MR lymphangiography segmentation results, and the flow rates were compared among the three patient groups by using Wilcoxon rank sum tests. Results Twenty-two patients were evaluated: seven neonates (mean age, 49 days ± 71 [standard deviation]; three boys, four girls), 10 children (mean age, 8 years ± 3; seven boys, three girls), and five adults (mean age, 46 years ± 10; three men, two women). The proposed method was used to obtain lymphatic flow segmentation results with Dice scores of 0.80, 0.82, and 0.83 for patients from groups A, B, and C, respectively. The mean flow rates for groups A, B, and C were 1.8 mL/min ± 1.4, 4.0 mL/min ± 1.8, and 12.5 mL/min ± 3.8, respectively. The flow rate differed significantly between groups A and B (P = .002), groups A and C (P = .01), and groups B and C (P = .01). Conclusion An automatic spatiotemporal segmentation method was used to determine thoracic lymphatic flow rates in individual patients based on their dynamic contrast-enhanced MR lymphangiographic images. © RSNA, 2020 Online supplemental material is available for this article.

Project description:To extend a commonly used noninvasive arterial spin labeling magnetic resonance (MR) imaging method for measuring blood flow to evaluate lymphatic flow.All volunteers (n = 12) provided informed consent in accordance with institutional review board and HIPAA regulations. Quantitative relaxation time (T1 and T2) measurements were made in extracted human lymphatic fluid at 3.0 T. Guided by these parameters, an arterial spin labeling MR imaging approach was adapted to measure lymphatic flow (flow-alternating inversion-recovery lymphatic water labeling, 3 × 3 × 5 mm) in healthy subjects (n = 6; mean age, 30 years ± 1 [standard deviation]; recruitment duration, 2 months). Lymphatic flow velocity was quantified by performing spin labeling measurements as a function of postlabeling delay time and by measuring time to peak signal intensity in axillary lymph nodes. Clinical feasibility was evaluated in patients with stage II lymphedema (three women; age range, 43-64 years) and in control subjects with unilateral cuff-induced lymphatic stenosis (one woman, two men; age range, 31-35 years).Mean T1 and T2 relaxation times of lymphatic fluid at 3.0 T were 3100 msec ± 160 (range, 2930-3210 msec; median, 3200 msec) and 610 msec ± 12 (range, 598-618 msec; median, 610 msec), respectively. Healthy lymphatic flow (afferent vessel to axillary node) velocity was 0.61 cm/min ± 0.13 (n = 6). A reduction (P < .005) in lymphatic flow velocity in the affected arms of patients and the affected arms of healthy subjects with manipulated cuff-induced flow reduction was observed. The ratio of unaffected to affected axilla lymphatic velocity (1.24 ± 0.18) was significantly (P < .005) higher than the left-to-right ratio in healthy subjects (0.91 ± 0.18).This work provides a foundation for clinical investigations whereby lymphedema etiogenesis and therapies may be interrogated without exogenous agents and with clinically available imaging equipment. Online supplemental material is available for this article.

Project description:BACKGROUND:The quality of carotid wall MRI can benefit substantially from a dedicated RF coil that is tailored towards the human neck geometry and optimized for image signal-to-noise ratio (SNR), parallel imaging performance and RF penetration depth and coverage. In last decades, several of such dedicated carotid coils were introduced. However, a comparison of the more successful designs is still lacking. OBJECTIVE:To perform a head-to-head comparison over four dedicated MR carotid surface coils with 4, 6, 8 and 30 coil elements, respectively. MATERIAL AND METHODS:Ten volunteers were scanned on a 3T scanner. For each subject, multiple black-blood carotid vessel wall images were measured using the four coils with different parallel imaging settings. The performance of the coils was evaluated and compared in terms of image coverage, penetration depth and noise correlations between elements. Vessel wall of a common carotid section was delineated manually. Subsequently, images were assessed based on vessel wall morphology and image quality parameters. The morphological parameters consisted of the vessel wall area, thickness, and normalized wall index (wall area/total vessel area). Image quality parameters consisted of vessel wall SNR, wall-lumen contrast-to-noise ratio (CNR), the vessel g-factor, and CNRindex ((wall-lumen signal) / (wall+lumen signal)). Repeated measures analysis of variance (rmANOVA) was applied for each parameter for the averaged 10 slices for all volunteers to assess effect of coil and SENSE factor. If the rmANOVA was significant, post-hoc comparisons were conducted. RESULTS:No significant coil effect were found for vessel wall morphological parameters. SENSE acceleration affected some morphological parameters for 6- and 8-channel coils, but had no effect on the 30-channel coil. The 30-channel coil achieved high acceleration factors (10x) with significantly lower vessel g-factor values (ps ≤ 0.01), but lower vessel wall SNR and CNR values (ps ≤ 0.01). CONCLUSION:All four coils were capable of high-quality carotid MRI. The 30-channel coil is recommended when rapid image acquisition acceleration is required for 3D measurements, whereas 6- and 8-channel coils demonstrated the highest SNR performance.

Project description:The characterization of peripheral nerve sheath tumors is challenging. The purpose here was to investigate the diagnostic value of quantitative proton MR spectroscopy at 3T for the characterization of peripheral nerve sheath tumors as benign or malignant, compared with PET.Twenty participants with 24 peripheral nerve sheath tumors underwent MR spectroscopy by use of a point-resolved sequence (TE, 135 ms). Six voxels were placed in 4 histologically proven malignant peripheral nerve sheath tumors and 22 voxels in 20 benign peripheral nerve sheath tumors (9 histologically proven, 11 with documented stability). The presence or absence of a trimethylamine signal was evaluated, the trimethylamine concentration estimated by use of phantom replacement methodology, and the trimethylamine fraction relative to Cr measured. MR spectroscopy results for benign and malignant peripheral nerve sheath tumors were compared by use of a Mann-Whitney test, and concordance or discordance with PET findings was recorded.In all malignant tumors and in 9 of 18 benign peripheral nerve sheath tumors, a trimethylamine peak was detected, offering the presence of trimethylamine as a sensitive (100%), but not specific (50%), marker of malignant disease. Trimethylamine concentrations (2.2 ± 2.8 vs 6.6 ± 5.8 institutional units; P < .049) and the trimethylamine fraction (27 ± 42 vs 88 ± 22%; P < .012) were lower in benign than malignant peripheral nerve sheath tumors. A trimethylamine fraction threshold of 50% resulted in 100% sensitivity (95% CI, 58.0%-100%) and 72.2% (95% CI, 59.5%-75%) specificity for distinguishing benign from malignant disease. MR spectroscopy and PET results were concordant in 12 of 16 cases, (2 false-positive results for MR spectroscopy and PET each).Quantitative measurement of trimethylamine concentration by use of MR spectroscopy is feasible in peripheral nerve sheath tumors and shows promise as a method for the differentiation of benign and malignant lesions. Trimethylamine presence within a peripheral nerve sheath tumor is a sensitive marker of malignant disease, but quantitative measurement of trimethylamine content is required to improve specificity.

Dataset Information

Lymphedema evaluation using noninvasive 3T MR lymphangiography.

Publications

Lymphedema evaluation using noninvasive 3T MR lymphangiography.

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