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      MR Scanner Systems Should Be Adequately Characterized in Diffusion-MRI of the Breast

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          Abstract

          Breast imaging represents a relatively recent and promising field of application of quantitative diffusion-MRI techniques. In view of the importance of guaranteeing and assessing its reliability in clinical as well as research settings, the aim of this study was to specifically characterize how the main MR scanner system-related factors affect quantitative measurements in diffusion-MRI of the breast. In particular, phantom acquisitions were performed on three 1.5 T MR scanner systems by different manufacturers, all equipped with a dedicated multi-channel breast coil as well as acquisition sequences for diffusion-MRI of the breast. We assessed the accuracy, inter-scan and inter-scanner reproducibility of the mean apparent diffusion coefficient measured along the main orthogonal directions (<ADC>) as well as of diffusion-tensor imaging (DTI)-derived mean diffusivity (MD) measurements. Additionally, we estimated spatial non-uniformity of <ADC> (NU <ADC>) and MD (NU MD) maps. We showed that the signal-to-noise ratio as well as overall calibration of high strength diffusion gradients system in typical acquisition sequences for diffusion-MRI of the breast varied across MR scanner systems, introducing systematic bias in the measurements of diffusion indices. While <ADC> and MD values were not appreciably different from each other, they substantially varied across MR scanner systems. The mean of the accuracies of measured <ADC> and MD was in the range [−2.3%,11.9%], and the mean of the coefficients of variation for <ADC> and MD measurements across MR scanner systems was 6.8%. The coefficient of variation for repeated measurements of both <ADC> and MD was < 1%, while NU <ADC> and NU MD values were <4%. Our results highlight that MR scanner system-related factors can substantially affect quantitative diffusion-MRI of the breast. Therefore, a specific quality control program for assessing and monitoring the performance of MR scanner systems for diffusion-MRI of the breast is highly recommended at every site, especially in multicenter and longitudinal studies.

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          Artifacts and pitfalls in diffusion MRI.

          Although over the last 20 years diffusion MRI has become an established technique with a great impact on health care and neurosciences, like any other MRI technique it remains subject to artifacts and pitfalls. In addition to common MRI artifacts, there are specific problems that one may encounter when using MRI scanner gradient hardware for diffusion MRI, especially in terms of eddy currents and sensitivity to motion. In this article we review those artifacts and pitfalls on a qualitative basis, and introduce possible strategies that have been developed to mitigate or overcome them.
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            Multi-parametric neuroimaging reproducibility: a 3-T resource study.

            Modern MRI image processing methods have yielded quantitative, morphometric, functional, and structural assessments of the human brain. These analyses typically exploit carefully optimized protocols for specific imaging targets. Algorithm investigators have several excellent public data resources to use to test, develop, and optimize their methods. Recently, there has been an increasing focus on combining MRI protocols in multi-parametric studies. Notably, these have included innovative approaches for fusing connectivity inferences with functional and/or anatomical characterizations. Yet, validation of the reproducibility of these interesting and novel methods has been severely hampered by the limited availability of appropriate multi-parametric data. We present an imaging protocol optimized to include state-of-the-art assessment of brain function, structure, micro-architecture, and quantitative parameters within a clinically feasible 60-min protocol on a 3-T MRI scanner. We present scan-rescan reproducibility of these imaging contrasts based on 21 healthy volunteers (11 M/10 F, 22-61 years old). The cortical gray matter, cortical white matter, ventricular cerebrospinal fluid, thalamus, putamen, caudate, cerebellar gray matter, cerebellar white matter, and brainstem were identified with mean volume-wise reproducibility of 3.5%. We tabulate the mean intensity, variability, and reproducibility of each contrast in a region of interest approach, which is essential for prospective study planning and retrospective power analysis considerations. Anatomy was highly consistent on structural acquisition (~1-5% variability), while variation on diffusion and several other quantitative scans was higher (~<10%). Some sequences are particularly variable in specific structures (ASL exhibited variation of 28% in the cerebral white matter) or in thin structures (quantitative T2 varied by up to 73% in the caudate) due, in large part, to variability in automated ROI placement. The richness of the joint distribution of intensities across imaging methods can be best assessed within the context of a particular analysis approach as opposed to a summary table. As such, all imaging data and analysis routines have been made publicly and freely available. This effort provides the neuroimaging community with a resource for optimization of algorithms that exploit the diversity of modern MRI modalities. Additionally, it establishes a baseline for continuing development and optimization of multi-parametric imaging protocols. Copyright © 2010 Elsevier Inc. All rights reserved.
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              Diffusion changes precede size reduction in neoadjuvant treatment of breast cancer.

              Traditionally, tumor response has been assessed via tumor size measurements during the course of a treatment. However, changes in these morphologically based measures occur relatively late in the course of a treatment. Alternative biomarkers are currently being evaluated to enable an earlier assessment of treatment to facilitate early cessation and cost savings. Diffusion-weighted imaging (DWI) has been identified by preclinical studies to be a likely alternative to tumor size measurements. In this study, 10 patients were examined prior to and after the first and second chemotherapy cycle time points. Longest diameter tumor measurements and apparent diffusion coefficients (ADCs) were recorded at each exam. An increase in the mean (normalized) ADC was noted as early as the first cycle time point. However, a reduction in the mean (normalized) longest diameter was only noted at the second cycle time point. Significant alterations from the baseline value were noted for ADC at the first (P=.005) and second cycle time points (P=.004). Longest diameter measurements only achieved a borderline significance at the second time point (P=.057). These results indicate that DWI may provide a suitable biomarker capable of providing an indication of response to treatment prior to tumor size measurements.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                28 January 2014
                : 9
                : 1
                : e86280
                Affiliations
                [1 ]Medical Physics Unit, Pisa University Hospital “Azienda Ospedaliero-Universitaria Pisana”, Pisa, Italy
                [2 ]Department of Oncology and Advanced Techniques, Medical Physics Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
                [3 ]Division of Radiology, Breast Unit, Massa Hospital, Azienda USL Massa e Carrara, Massa, Italy
                [4 ]Department of Biomedicine and Prevention, Medical Physics Section, University of Rome “Tor Vergata”, Rome, Italy
                [5 ]Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
                [6 ]Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
                [7 ]Harvard Medical School, Boston, Massachusetts, United States of America
                [8 ]Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy
                Northwestern University Feinberg School of Medicine, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: M. Giannelli RS SD. Performed the experiments: M. Giannelli RS. Analyzed the data: M. Giannelli SD. Contributed reagents/materials/analysis tools: M. Giannelli RS CI MI ACT M. Guerrisi MM NT SD. Wrote the paper: M. Giannelli NT SD. Performed image processing: SD. Performed critical revision and final approval of the manuscript: M. Giannelli RS CI MI ACT M. Guerrisi MM NT SD.

                Article
                PONE-D-13-21269
                10.1371/journal.pone.0086280
                3904912
                24489711
                b8a69d45-f1a7-4ac5-a33d-8922df070118
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 May 2013
                : 12 December 2013
                Page count
                Pages: 9
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Engineering
                Signal Processing
                Image Processing
                Medicine
                Non-Clinical Medicine
                Radiology
                Diagnostic Radiology
                Magnetic Resonance Imaging
                Medical Physics
                Physics
                Medical Physics

                Uncategorized
                Uncategorized

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