MR Elastography in Cancer

Guo, Jing; Savic, Lynn Jeanette; Sack, Ingolf

doi:10.1097/rli.0000000000000971

Cited by 16 publications

(7 citation statements)

References 121 publications

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“…As tomoelastography is still an emerging field, there is limited data available on tumors in general (see also ref. [49]), and especially when considering tissue fluidity . Therefore, the underlying principles of tumor mechanics were approached agnostically and the data sets were analyzed from all available in vivo tomoelastography studies on solid tumors that included stiffness and fluidity maps of both tumors and respective control tissue.…”

Section: Methodsmentioning

confidence: 99%

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Changes in Tissue Fluidity Predict Tumor Aggressiveness In Vivo

Sauer¹,

Grosser

Shahryari

et al. 2023

Advanced Science

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Cancer progression is caused by genetic changes and associated with various alterations in cell properties, which also affect a tumor's mechanical state. While an increased stiffness has been well known for long for solid tumors, it has limited prognostic power. It is hypothesized that cancer progression is accompanied by tissue fluidization, where portions of the tissue can change position across different length scales. Supported by tabletop magnetic resonance elastography (MRE) on stroma mimicking collagen gels and microscopic analysis of live cells inside patient derived tumor explants, an overview is provided of how cancer associated mechanisms, including cellular unjamming, proliferation, microenvironment composition, and remodeling can alter a tissue's fluidity and stiffness. In vivo, state‐of‐the‐art multifrequency MRE can distinguish tumors from their surrounding host tissue by their rheological fingerprints. Most importantly, a meta‐analysis on the currently available clinical studies is conducted and universal trends are identified. The results and conclusions are condensed into a gedankenexperiment about how a tumor can grow and eventually metastasize into its environment from a physics perspective to deduce corresponding mechanical properties. Based on stiffness, fluidity, spatial heterogeneity, and texture of the tumor front a roadmap for a prognosis of a tumor's aggressiveness and metastatic potential is presented.

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Section: Methodsmentioning

confidence: 99%

“…As tomoelastography is still an emerging field, there is limited data available on tumors in general (see also ref. [49]), and especially [44] Control (HV°) 1.28 ± 0.14 −0.01 ± 0.09 30…”

Section: Studies Used For Classificationmentioning

confidence: 99%

Changes in Tissue Fluidity Predict Tumor Aggressiveness In Vivo

Sauer¹,

Grosser

Shahryari

et al. 2023

Advanced Science

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“…Longitudinal (over time) or local (over space) differences in tissue stiffness might add to the growing knowledge of pancreatic disease pathophysiology. Specifically, MRE research to date has mainly focused on large organs, such as the liver and brain 8 . Assessment of the pancreas with MRE remains challenging due to its small size, elongated shape, and central abdominal location.…”

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confidence: 99%

“…Specifically, MRE research to date has mainly focused on large organs, such as the liver and brain. 8 Assessment of the pancreas with MRE remains challenging due to its small size, elongated shape, and central abdominal location. Shear wave quality is paramount to obtaining reliable results regarding biomechanics, which rely on the analysis and reconstruction of the propagation of shear waves into and through the pancreas.…”

mentioning

confidence: 99%

Single Breath‐Hold MR Elastography for Fast Biomechanical Probing of Pancreatic Stiffness

van Schelt,

Gottwald,

Wassenaar

et al. 2023

Magnetic Resonance Imaging

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BackgroundPancreatic ductal adenocarcinoma (PDAC) stromal disposition is thought to influence chemotherapy efficacy and increase tissue stiffness, which could be quantified noninvasively via MR elastography (MRE). Current methods cause position‐based errors in pancreas location over time, hampering accuracy. It would be beneficial to have a single breath‐hold acquisition.PurposeTo develop and test a single breath‐hold three‐dimensional MRE technique utilizing prospective undersampling and a compressed sensing reconstruction (CS‐MRE).Study TypeProspective.PopulationA total of 30 healthy volunteers (HV) (31 ± 9 years; 33% male) and five patients with PDAC (69 ± 5 years; 80% male).Field Strength/Sequence3‐T, GRE Ristretto MRE.AssessmentFirst, optimization of multi breath‐hold MRE was done in 10 HV using four combinations of vibration frequency, number of measured wave‐phase offsets, and TE and looking at MRE quality measures in the pancreas head. Second, viscoelastic parameters delineated in the pancreas head or tumor of CS‐MRE were compared against (I) 2D and (II) 3D four breath‐hold acquisitions in HV (N = 20) and PDAC patients. Intrasession repeatability was assessed for CS‐MRE in a subgroup of healthy volunteers (N = 15).Statistical TestsTests include repeated measures analysis of variance (ANOVA), Bland–Altman analysis, and coefficients of variation (CoVs). A P‐value <.05 was considered statistically significant.ResultsOptimization of the four breath‐hold acquisitions resulted in 40 Hz vibration frequency, five wave‐phases, and echo time (TE) = 6.9 msec as the preferred method (4BH‐MRE). CS‐MRE quantitative results did not differ from 4BH‐MRE. Shear wave speed (SWS) and phase angle differed significantly between HV and PDAC patients using 4BH‐MRE or CS‐MRE. The limits of agreement for SWS were [−0.09, 0.10] m/second and the within‐subject CoV was 4.8% for CS‐MRE.Data ConclusionCS‐MRE might allow a single breath‐hold MRE acquisition with comparable SWS and phase angle as 4BH‐MRE, and it may still enable to differentiate between HV and PDAC.Level of Evidence: 2Technical Efficacy Stage: 2

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“…M R elastography (MRE) can be used to noninvasively measure viscoelastic properties, assessing the stiffness of biological soft tissues in vivo. 1,2 This technique can visualize the propagation of shear waves through soft tissue, such as in the pancreas for pancreatic cancer. 1 Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer, 3 with a 5-year overall survival rate of 11%.…”

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confidence: 99%

MRElastography of the Pancreas: Bowel Preparation and Repeatability Assessment in Pancreatic Cancer Patients and Healthy Controls

Wassenaar,

van Schelt,

Schrauben

et al. 2023

Magnetic Resonance Imaging

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BackgroundPancreatic ductal adenocarcinoma (PDAC) stromal viscoelasticity can be measured using MR elastography (MRE). Bowel preparation regimens could affect MRE quality and knowledge on repeatability is crucial for clinical implementation.PurposeTo assess effects of four bowel preparation regimens on MRE quality and to evaluate repeatability and differentiate patients from healthy controls.Study TypeProspective.Population15 controls (41 ± 16 years; 47% female), 16 PDAC patients (one excluded, 66 ± 12 years; 40% female) with 15 age‐/sex‐matched controls (65 ± 11 years; 40% female). Final sample size was 25 controls and 15 PDAC.Field Strength/Sequence3‐T, spin‐echo echo‐planar‐imaging, turbo spin‐echo, and fast field echo gradient‐echo.AssessmentFour different regimens were used: fasting; scopolaminebutyl; drinking 0.5 L water; combination of 0.5 L water and scopolaminebutyl. MRE signal‐to‐noise ratio (SNR) was compared between all regimens. MRE repeatability (test–retest) and differences in shear wave speed (SWS) and phase angle (ϕ) were assessed in PDAC and controls. Regions‐of‐interest were defined for tumor, nontumorous (n = 8) tissue in PDAC, and whole pancreas in controls. Two radiologists delineated tumors twice for evaluation of intraobserver and interobserver variability.Statistical TestsRepeated measures analysis of variance, coefficients of variation (CoVs), Bland–Altman analysis, (un)paired t‐test, Mann–Whitney U‐test, and Wilcoxon signed‐rank test. P‐value<0.05 was considered statistically significant.ResultsPreparation regimens did not significantly influence MRE‐SNR. Therefore, the least burdensome preparation (fasting only) was continued. CoVs for tumor SWS were: intrasession (12.8%) and intersession (21.7%), and intraobserver (7.9%) and interobserver (10.3%) comparisons. For controls, CoVs were intrasession (4.6%) and intersession (6.4%). Average SWS for tumor, nontumor, and healthy tissue were: 1.74 ± 0.58, 1.38 ± 0.27, and 1.18 ± 0.16 m/sec (ϕ: 1.02 ± 0.17, 0.91 ± 0.07, and 0.85 ± 0.08 rad), respectively. Significant differences were found between all groups, except for ϕ between healthy–nontumor (P = 0.094).Data ConclusionThe proposed bowel preparation regimens may not influence MRE quality. MRE may be able to differentiate between healthy tissue–tumor and tumor–nontumor.Level of Evidence2Technical Efficacy Stage2

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MR Elastography in Cancer

Cited by 16 publications

References 121 publications

Changes in Tissue Fluidity Predict Tumor Aggressiveness In Vivo

Changes in Tissue Fluidity Predict Tumor Aggressiveness In Vivo

Single Breath‐Hold MR Elastography for Fast Biomechanical Probing of Pancreatic Stiffness

MRElastography of the Pancreas: Bowel Preparation and Repeatability Assessment in Pancreatic Cancer Patients and Healthy Controls

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