CEST MRI quantification procedures for breast cancer treatment‐related lymphedema therapy evaluation

Crescenzi, Rachelle; Donahue, Paula M. C.; Mahany, Helen B.; Lants, Sarah K; Donahue, Manus J.

doi:10.1002/mrm.28031

Cited by 16 publications

(26 citation statements)

References 42 publications

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“…The three studies included in this review investigated the use of MRI to quantify therapeutic response to MLD, a common component of the complex decongestive therapy that mobilizes lymph stasis from superficial tissue to deep lymphatic circulation [13]. The effectiveness of MLD remains controversial because detection of changes in lymphedema tissue is difficult with conventional examinations, such as volumetric measurement [8].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, we searched only the PubMed/ MEDLINE and Scopus databases. We also acknowledge that the studies included in this review measured the characteristics of healthy volunteers, which was not described in this study because our analysis was focused on their patients who underwent therapy [8,12,13]. However, this systematic review provides information on the use of MRI to evaluate therapy for BCRL, which is an important topic because of both lymphedema prevalence and debate about the efficacy of lymphedema therapies [14].…”

Section: Discussionmentioning

confidence: 99%

“…However, this study was limited by the small number of patients and because MRI was performed immediately after MLD, and therefore, only immediate changes promoted by MLD were assessed [8]. In 2019, Crescenzi et al [13] proposed 3.0-T MRI to quantify the effect of MLD by differences of chemical exchange saturation transfer (CEST) contrast, using correction procedures for B0 and B1 heterogeneity and T1 relaxation time. Twelve patients with BCRL were enrolled and evaluated with MRI before and after MLD.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…In 2019, Crescenzi et al [ 13 ] proposed 3.0-T MRI to quantify the effect of MLD by differences of chemical exchange saturation transfer (CEST) contrast, using correction procedures for B0 and B1 heterogeneity and T 1 relaxation time. Twelve patients with BCRL were enrolled and evaluated with MRI before and after MLD.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

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Use of magnetic resonance imaging for evaluation of therapeutic response in breast cancer-related lymphedema: A systematic review

et al. 2020

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Breast cancer treatment-related lymphedema (BCRL) is a common comorbidity in breast cancer survivors. Although magnetic resonance imaging (MRI) is widely used to evaluate therapeutic response of patients with various medical conditions, it is not routinely used to evaluate lymphedema patients. We conducted a systematic review of the literature to identify studies on the use of MRI to evaluate therapy for BCRL. We hypothesized that MRI could provide information otherwise not possible through other examinations. On October 21, 2019, we conducted a systematic review on the PubMed/MEDLINE and Scopus databases, without time frame or language limitations, to identify studies on the use of MRI to evaluate therapy for BCRL. We excluded studies that investigated other applications of MRI, such as lymphedema diagnosis and surgical planning. Of 63 potential articles identified with the search, three case series fulfilled the eligibility criteria. In total, 53 patients with BCRL were included and quantitatively evaluated with MRI before and after manual lymphatic drainage. Authors used MRI or MR lymphagiography to investigate factors such as lymphatic vessel cross-sectional area, tissue water relaxation time (T<sub>2</sub>), and chemical exchange saturation transfer. The only study that compared MRI measurement with standard examinations reported that MRI added information to the therapy evaluation. MRI seems to be a promising tool for quantitative measurement of therapeutic response in patients with BCRL. However, the identified studies focused on only manual lymphatic drainage and were limited by the small numbers of patients. More studies are necessary to shed light on the topic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

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Use of magnetic resonance imaging for evaluation of therapeutic response in breast cancer-related lymphedema: A systematic review

et al. 2020

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“…Donahue et al [ 47 ] found APT signals (both standard asymmetry and Lorentzian asymmetry) had no significant difference between the right and left arms of healthy controls but values increased in the patient’s arm that was affected by lymphedema. Crescenzi et al [ 43 ] found that the proton transfer ratio (PTR, defined as 1–Z’, where Z’ is the Z-spectra after B 1 correction) APT significantly correlated with T 1 and BMI (body-mass-index) in controls, and the lymphedema stage in breast cancer treatment-related lymphedema (BCRL) participants. The post-therapy PTR of APT significantly increased in the affected arm of BCRL participants, consistent with the treatment effects that were from mobilized lymphatic fluid.…”

Section: Applicationsmentioning

confidence: 99%

A Brief History and Future Prospects of CEST MRI in Clinical Non-Brain Tumor Imaging

Gao

Zou

et al. 2021

IJMS

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Chemical exchange saturation transfer (CEST) MRI is a promising molecular imaging tool which allows the specific detection of metabolites that contain exchangeable amide, amine, and hydroxyl protons. Decades of development have progressed CEST imaging from an initial concept to a clinical imaging tool that is used to assess tumor metabolism. The first translation efforts involved brain imaging, but this has now progressed to imaging other body tissues. In this review, we summarize studies using CEST MRI to image a range of tumor types, including breast cancer, pelvic tumors, digestive tumors, and lung cancer. Approximately two thirds of the published studies involved breast or pelvic tumors which are sites that are less affected by body motion. Most studies conclude that CEST shows good potential for the differentiation of malignant from benign lesions with a number of reports now extending to compare different histological classifications along with the effects of anti-cancer treatments. Despite CEST being a unique ‘label-free’ approach with a higher sensitivity than MR spectroscopy, there are still some obstacles for implementing its clinical use. Future research is now focused on overcoming these challenges. Vigorous ongoing development and further clinical trials are expected to see CEST technology become more widely implemented as a mainstream imaging technology.

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In vivo lymph node CEST‐Dixon MRI in breast cancer patients with metastatic lymph node involvement

Donahue,

Jones

et al. 2023

Magnetic Resonance in Med

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PurposeAxillary lymph nodes (LNs) often present a reservoir for metastatic breast cancer, yet metastatic LN involvement cannot be discerned definitively using diagnostic imaging. This study investigated whether in vivo CEST may discriminate LNs with versus without metastatic involvement.Methods3T MRI was performed in patients with breast cancer before clinically‐indicated mastectomy or lumpectomy with LN removal, after which LN metastasic involvement was determined using histological evaluation. Non‐contrast anatomical imaging, as well as B0 and B1 field maps, were acquired in sequence with three‐point CEST‐Dixon (3D turbo‐gradient‐echo; factor = 25; TR/TE1/ΔTE = 851/1.35/1.1 ms; spatial‐resolution = 2.5 × 2.5 × 6 mm; slices = 10; four sinc‐gauss pulses with duty‐cycle = 0.5, total saturation duration = 701.7 ms; B1 = 1.5 μT; saturation offsets = −5.5 to +5.5 ppm; stepsize = 0.2 ppm; scan duration = 6 min 30 s). The mean z‐spectrum from LNs with (n = 20) versus without (n = 22) metastatic involvement were analyzed and a Wilcoxon rank‐sum test (significance: p < 0.05) was applied to evaluate differences in B0, B1, and magnetization transfer ratio (MTR) in differing spectral regions of known proton exchange (nuclear Overhauser effect [NOE], amide, amine, and hydroxyl) between cohorts.ResultsNo difference in axillary B1 (p = 0.634) or B0 (p = 0.689) was observed between cohorts. Elevated MTR was observed for the NOE (−1.7 ppm; MTR = 0.285 ± 0.075 vs. 0.248 ± 0.039; p = 0.048), amine (+2.5 ppm; MTR = 0.284 ± 0.067 vs. 0.234 ± 0.31; p = 0.005), and hydroxyl (+1 ppm; MTR = 0.394 ± 0.075 vs. 0.329 ± 0.055; p = 0.002) protons in LNs from participants with versus without metastatic involvement.ConclusionsFindings are consistent with a unique metastatic LN microenvironment detectable by CEST‐Dixon and suggest that CEST MRI may have potential for mapping LN metastasis non‐invasively in vivo.

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CEST MRI quantification procedures for breast cancer treatment‐related lymphedema therapy evaluation

Cited by 16 publications

References 42 publications

Use of magnetic resonance imaging for evaluation of therapeutic response in breast cancer-related lymphedema: A systematic review

Use of magnetic resonance imaging for evaluation of therapeutic response in breast cancer-related lymphedema: A systematic review

A Brief History and Future Prospects of CEST MRI in Clinical Non-Brain Tumor Imaging

In vivo lymph node CEST‐Dixon MRI in breast cancer patients with metastatic lymph node involvement

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