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Hoffmann E, Masthoff M, Kunz WG, Seidensticker M, Bobe S, Gerwing M, Berdel WE, Schliemann C, Faber C, Wildgruber M. Multiparametric MRI for characterization of the tumour microenvironment. Nat Rev Clin Oncol 2024; 21:428-448. [PMID: 38641651 DOI: 10.1038/s41571-024-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
Our understanding of tumour biology has evolved over the past decades and cancer is now viewed as a complex ecosystem with interactions between various cellular and non-cellular components within the tumour microenvironment (TME) at multiple scales. However, morphological imaging remains the mainstay of tumour staging and assessment of response to therapy, and the characterization of the TME with non-invasive imaging has not yet entered routine clinical practice. By combining multiple MRI sequences, each providing different but complementary information about the TME, multiparametric MRI (mpMRI) enables non-invasive assessment of molecular and cellular features within the TME, including their spatial and temporal heterogeneity. With an increasing number of advanced MRI techniques bridging the gap between preclinical and clinical applications, mpMRI could ultimately guide the selection of treatment approaches, precisely tailored to each individual patient, tumour and therapeutic modality. In this Review, we describe the evolving role of mpMRI in the non-invasive characterization of the TME, outline its applications for cancer detection, staging and assessment of response to therapy, and discuss considerations and challenges for its use in future medical applications, including personalized integrated diagnostics.
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Affiliation(s)
- Emily Hoffmann
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Max Masthoff
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Bobe
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
| | | | | | - Cornelius Faber
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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Li J, Huang X, Wang L, Wang X, Li Y, Liu X, Ye N, Yang S, Nie F. Role of Contrast-Enhanced Ultrasound With the Enhancement Pattern and Qualitative Analysis for Differentiating Hypovascular Solid Renal Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:295-303. [PMID: 37996360 DOI: 10.1016/j.ultrasmedbio.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/29/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The aim of the work described here was to explore the clinical value of contrast-enhanced ultrasound (CEUS) with the enhancement pattern and qualitative analysis in distinguishing different types of hypovascular solid renal lesions. METHODS A total of 140 patients with 140 renal tumors (all diagnosed by pathology), which manifested hypo-enhancement on CEUS, were included in this study. We compared conventional ultrasound (US) and CEUS features in five common hypovascular renal tumors, including renal angiomyolipoma (RAML), clear cell renal cell carcinoma (ccRCC), renal pelvic urothelial carcinoma (RPUC), papillary renal cell carcinoma (pRCC) and chromophobe renal cell carcinoma (chRCC). The diagnostic value of conventional US and qualitative parameters of CEUS for differentiating hypovascular solid renal lesions were evaluated. RESULTS The mean age of patients with a benign renal lesion was younger than that of patients with a malignant renal lesion (p < 0.05). Echogenicity and qualitative parameters such as wash-out, perfusion defects and perilesional rim-like enhancement (PRE) in the two groups differed significantly (all p values <0.05). Benign renal lesions exhibited mainly slow wash-out, whereas malignant renal lesions exhibited predominantly fast wash-out on CEUS (p < 0.05). There were significant differences in echogenicity, such as between RAML and ccRCC, between RAML and RPUC and between RAML and pRCC (all p values <0.05). The rates of appearance of perfusion defect in ccRCC (48%, 13/27) and pRCC (53%, 10/19) were significantly higher than the rate in RAML (14%, 6/43) (p < 0.05). The rates of appearance of PRE in ccRCC (15%, 4/27), pRCC (26%, 5/19) and chRCC (24%,4/17) were significantly higher than the rate in RAML (9%, 4/43) (p < 0.05). CONCLUSION CEUS with the enhancement pattern and qualitative analysis may be helpful in distinguishing malignant from benign hypovascular renal lesions.
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Affiliation(s)
- Jing Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Xiao Huang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Lan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Xiaofeng Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Yan Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Xuehui Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Na Ye
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Shaoqing Yang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China.
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Xu Y, Wan Q, Ren X, Jiang Y, Wang F, Yao J, Wu P, Shen A, Wang P. Amide proton transfer-weighted MRI for renal tumors: Comparison with diffusion-weighted imaging. Magn Reson Imaging 2024; 106:104-109. [PMID: 38135260 DOI: 10.1016/j.mri.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To investigate the potential of amide proton transfer-weighted (APTw) MRI in identifying benign and malignant renal tumors and to evaluate whether APTw MRI can add diagnostic value to diffusion-weighted imaging (DWI). MATERIALS AND METHODS Participants with renal tumor underwent preoperative multiparametric MRI, including APTw MRI and DWI. The APTw and apparent diffusion coefficient (ADC) of malignant tumors and benign tumors were calculated independently by two radiologists and compared. The value of the mean APTw and the mean ADC for differentiating malignant and benign tumors was evaluated by receiver operating characteristic analysis. RESULTS In total, 65 participants (mean age, 59 years ±14; 41 men) were evaluated: 54 with malignant and 11 with benign renal tumors. Malignant renal tumors showed higher mean APTw values [2.03% (1.63) vs 1.00% (1.60); P < 0.01] and lower mean ADC values (1.22 × 10-3 mm2/s ± 0.37 vs 1.51 × 10-3 mm2/s ± 0.37; P < 0.05) than benign renal tumors. The area under the receiver operating characteristic curve (AUC) of APTw, ADC and the combination of them for the identification of benign and malignant renal tumors was 0.78(95% CI: 0.66, 0.87; P < 0.001),0.70(95% CI: 0.54, 0.86; P < 0.05) and 0.79 (95% CI: 0.67, 0.88; P < 0.001). The optimal cutoff value for mean APTw was 2.14% (sensitivity, 74%; specificity, 73%). There was no difference between these three parameters for differentiating malignant from benign renal tumors (P > 0.05). CONCLUSION The APTw MRI has the potential use as an imaging biomarker for renal malignant and benign tumors.
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Affiliation(s)
- Yun Xu
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Qingxuan Wan
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Xihui Ren
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Yutao Jiang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Fang Wang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Jing Yao
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Peng Wu
- Philips Healthcare, Shanghai 200072, China
| | - Aijun Shen
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China.
| | - Peijun Wang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China.
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Qin J, Xie S, Yu Y, Yang J, Zhao Y, Qiu C, Li X, Zhang C, Hu Z, Tong D, Zhu J, Kuehn B, Shen W. Evaluation of Kidney Injury Using Arterial Spin Labeling and Blood Oxygen Level-Dependent MRI: An Experimental Study in Rats With Carbon Tetrachloride-Induced Liver Cirrhosis. J Magn Reson Imaging 2024. [PMID: 38299767 DOI: 10.1002/jmri.29265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Serum creatinine (Scr) may be not suited to timely and accurately reflect kidney injury related to chronic liver disease. Currently, the ability of arterial spin labeling (ASL) and blood oxygen level-dependent (BOLD) sequences to evaluate renal blood flow (RBF) and blood oxygen in chronic liver disease remains to be verified. PURPOSE To investigate the value of ASL and BOLD imaging in evaluating hemodynamics and oxygenation changes during kidney injury in an animal model of chronic liver disease. STUDY TYPE Prospective. ANIMAL MODEL Chronic liver disease model was established by subcutaneous injection of carbon tetrachloride. Forty-three male Sprague-Dawley rats (8 weeks) were divided into a pathological group (0, 2, 4, 6, 8, 12 weeks, each group: N = 6) and a continuous-scanning group (N = 7). FIELD STRENGTH/SEQUENCE 3-T, ASL, BOLD, and T2W. ASSESSMENT Regions of interest in the cortex (CO), outer stripe of the outer medulla (OSOM), and inner stripe of the outer medulla (ISOM) are manually delineated. The RBF and T2* values at each time point (0, 2, 4, 6, 8, 12 weeks) are measured and compared. Hematoxylin-eosin score (HE Score, damage area scoring method), alpha-smooth muscle actin (α-SMA), hypoxia-inducible factor-1alpha (HIF-1α), peritubular capillar (PTC) density, Scr, and neutrophil gelatinase-associated lipocalin were harvested. STATISTICAL TESTS Analysis of variance, Spearman correlation analysis, Kruskal-Wallis tests, and receiver operating characteristic analysis with the area under the curve (AUC). A P-value <0.05 was considered statistically significant. RESULTS Renal RBF and T2* values of CO, OSOM, and ISOM were significantly different from baseline. Both RBF and T2* were significantly correlated with HE Score, α-SMA, HIF-1α, and PTC density (|r| = 0.406-0.853). RBF demonstrated superior diagnostic capability in identifying severe kidney injury in this model of chronic liver disease (AUC = 0.964). DATA CONCLUSION Imaging by ASL and BOLD may detect renal hemodynamics and oxygenation changes related to chronic liver disease early. EVIDENCE LEVEL 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jiaming Qin
- The School of Medicine, Nankai University, Tianjin, China
| | - Shuangshuang Xie
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Yongquan Yu
- Department of Radiology, Weihai Central Hospital, Weihai, Shandong, China
| | - Jiaqi Yang
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Yumeng Zhao
- The School of Medicine, Nankai University, Tianjin, China
| | - Caixin Qiu
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Xiaotian Li
- The School of Medicine, Nankai University, Tianjin, China
| | - Cheng Zhang
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Zhandong Hu
- Department of Pathology, Tianjin First Central Hospital, Tianjin, China
| | - Dan Tong
- Department of Pathology, Tianjin First Central Hospital, Tianjin, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers, Beijing, China
| | - Bernd Kuehn
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
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Stabinska J, Wittsack HJ, Lerman LO, Ljimani A, Sigmund EE. Probing Renal Microstructure and Function with Advanced Diffusion MRI: Concepts, Applications, Challenges, and Future Directions. J Magn Reson Imaging 2023:10.1002/jmri.29127. [PMID: 37991093 PMCID: PMC11117411 DOI: 10.1002/jmri.29127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
Diffusion measurements in the kidney are affected not only by renal microstructure but also by physiological processes (i.e., glomerular filtration, water reabsorption, and urine formation). Because of the superposition of passive tissue diffusion, blood perfusion, and tubular pre-urine flow, the limitations of the monoexponential apparent diffusion coefficient (ADC) model in assessing pathophysiological changes in renal tissue are becoming apparent and motivate the development of more advanced diffusion-weighted imaging (DWI) variants. These approaches take advantage of the fact that the length scale probed in DWI measurements can be adjusted by experimental parameters, including diffusion-weighting, diffusion gradient directions and diffusion time. This forms the basis by which advanced DWI models can be used to capture not only passive diffusion effects, but also microcirculation, compartmentalization, tissue anisotropy. In this review, we provide a comprehensive overview of the recent advancements in the field of renal DWI. Following a short introduction on renal structure and physiology, we present the key methodological approaches for the acquisition and analysis of renal DWI data, including intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), non-Gaussian diffusion, and hybrid IVIM-DTI. We then briefly summarize the applications of these methods in chronic kidney disease and renal allograft dysfunction. Finally, we discuss the challenges and potential avenues for further development of renal DWI. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Eric E. Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging Center for Advanced Imaging Innovation and Research (CAI2R), New York University Langone Health, New York City, New York, USA
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