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Dynamic contrast-enhanced MRI in oncology: how we do it
Giuseppe Petralia1,2, Paul E Summers3, Andrea Agostini4,5
1Unità di Imaging di Precisione e Ricerca, Dipartimento di Immagini e Scienze Radiologiche, IEO, Istituto Europeo di Oncologia IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Abstract:
Magnetic resonance imaging (MRI) is particularly attractive for clinical application in perfusion imaging thanks to the absence of ionizing radiation and limited volumes of contrast agent (CA) necessary. Dynamic contrast-enhanced MRI (DCE-MRI) involves sequentially acquiring T1-weighted images through an organ of interest during the passage of a bolus administration of CA. It is a particularly flexible approach to perfusion imaging as the signal intensity time course allows not only rapid qualitative assessment, but also quantitative measures of intrinsic perfusion and permeability parameters. We examine aspects of the T1-weighted image series acquisition, CA administration, post-processing that constitute a DCE-MRI study in clinical practice, before considering some heuristics that may aid in interpreting the resulting contrast enhancement time series. While qualitative DCE-MRI has a well-established role in the diagnostic assessment of a range of tumours, and a central role in MR mammography, clinical use of quantitative DCE-MRI remains limited outside of clinical trials. The recent publication of proposals for standardized acquisition and analysis protocols for DCE-MRI by the Quantitative Imaging Biomarker Alliance may be an opportunity to consolidate and advance clinical practice.
Insights
Dynamic contrast-enhanced MRI (DCE-MRI) offers radiation-free perfusion imaging. While qualitative DCE-MRI is established for tumor diagnosis, quantitative DCE-MRI use is limited, but standardization efforts may advance clinical practice.
Area of Science:
- Medical Imaging
- Radiology
- Biophysics
Background:
- Magnetic resonance imaging (MRI) is advantageous for perfusion imaging due to its non-ionizing nature and minimal contrast agent (CA) requirements.
- Dynamic contrast-enhanced MRI (DCE-MRI) acquires sequential T1-weighted images during CA bolus passage, enabling both qualitative and quantitative perfusion and permeability assessments.
Purpose of the Study:
- To review the acquisition, CA administration, and post-processing steps in clinical DCE-MRI studies.
- To discuss heuristics for interpreting contrast enhancement time series in DCE-MRI.
- To evaluate the current clinical utility and future potential of quantitative DCE-MRI.
Main Methods:
- Examination of T1-weighted image series acquisition protocols.
- Review of contrast agent administration techniques.
- Analysis of post-processing methodologies for DCE-MRI data.
- Discussion of interpretation strategies for contrast enhancement time courses.
Main Results:
- Qualitative DCE-MRI is widely used for tumor diagnosis and MR mammography.
- Quantitative DCE-MRI applications remain largely confined to clinical trials.
- Standardization proposals by the Quantitative Imaging Biomarker Alliance may foster broader clinical adoption.
Conclusions:
- DCE-MRI is a versatile perfusion imaging technique with inherent safety advantages.
- Advancements in standardization are crucial for expanding the clinical use of quantitative DCE-MRI.
- Future integration of quantitative DCE-MRI may enhance diagnostic capabilities in various clinical settings.
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