Search

Purpose: Synthetic tissue equivalent (STE) materials currently used to simulate tumor and surrounding tissues for IROC‐Houston's anthropomorphic head and thorax QA phantoms cannot be visualized using magnetic resonance (MR) imaging. The purpose of this study was to characterize dual MR/CT‐visible STE materials that can be used in an end‐to‐end QA phantom for MR‐guided radiotherapy (MRgRT) modalities. Methods: Over 80 materials’ MR, CT, and dosimetric STE properties were investigated for use in MRgRT QA phantoms. The materials tested included homogeneous and heterogeneous materials to simulate soft tissue/tumor and lung tissues. Materials were scanned on a Siemens’ Magnetom Espree 1.5 T using four sequences, which showed the materials visual contrast between T1‐ and T2‐weighted images. Each material's Hounsfield number and electron density data was collected using a GE's CT Lightspeed Simulator. Dosimetric properties were examined by constructing a 10 × 10 × 20 cm3 phantom of the selected STE materials that was divided into three sections: anterior, middle, and posterior. Anterior and posterior pieces were composed of polystyrene, whereas the middle section was substituted with the selected STE materials. EBT3 film was inserted into the phantom's midline and was irradiated using an Elekta's Versa 6 MV beam with a prescription of 6 Gy at 1.5 cm and varying field size of: 10 × 10 cm2, 6 × 6 cm2, and 3 × 3 cm2. Measured film PDD curves were compared to planning system calculations and conventional STE materials’ percent depth dose (PDD) curves. Results: The majority of the tested materials showed comparable CT attenuation properties to their respective organ site; however, most of the tested materials were not visible on either T1‐ or T2‐weighted MR images. Silicone, hydrocarbon, synthetic gelatin, and liquid PVC plastic‐based materials showed good MR image contrast. In‐house lung equivalent materials made with either silicone‐ or hydrocarbon‐based materials had HUs ranging from: −978 to −117 and −667 to −593, respectively. Synthetic gelatin and PVC plastic‐based materials resembled soft tissue/tumor equivalent materials and had HUs of: −175 to −170 and −29 to 32, respectively. PDD curves of the selected MR/CT‐visible materials were comparable to IROC‐Houston's conventional phantom STE materials. The smallest field size showed the largest disagreements, where the average discrepancies between calculated and measured PDD curves were 1.8% and 5.9% for homogeneous and heterogeneous testing materials, respectively. Conclusions: Gelatin, liquid plastic, and hydrocarbon‐based materials were determined as alternative STE substitutes for MRgRT QA phantoms. [ABSTRACT FROM AUTHOR]

Brachytherapy, a radiotherapy technique for treating prostate cancer, involves the implantation of numerous radioactive seeds into the prostate. While the implanted seeds can be easily identified on a computed tomography image, distinguishing the prostate and surrounding soft tissues is not as straightforward. Magnetic resonance imaging (MRI) offers superior anatomical delineation, but the seeds appear as dark voids and are difficult to identify, thus creating a conundrum. Cobalt dichloride-N-acetyl-cysteine (C4) has previously been shown to be promising as an encapsulated contrast agent marker. We performed spin–lattice relaxation time (T1) and spin–spin relaxation time (T2) measurements of C4 solutions with varying cobalt dichloride concentrations to determine the corresponding relaxivities, r1�and r2. These relaxation parameters were investigated at different field strengths, temperatures and orientations. T1�measurements obtained at 1.5 and 3.0 T, as well as at room and body temperature, showed that r1�is field-independent and temperature-independent. Conversely, the T2�values at 3.0 T were shorter than at 1.5 T, while the T2�values at body temperature were slightly higher than at room temperature. By examining the relaxivities with the C4 vials aligned in three different planes, we found no orientation-dependence. With these relaxation characteristics, we aim to develop pulse sequences that will enhance the C4 signal against prostatic stroma. Ultimately, the use of C4 as a positive contrast agent marker will encourage the use of MRI to obtain an accurate representation of the radiation dose delivered to the prostate and surrounding normal anatomical structures. [ABSTRACT FROM AUTHOR]

Purpose: A generalised polynomial chaos (gPC) method is used to incorporate constitutive parameter uncertainties within the Pennes representation of bioheat transfer phenomena. The stochastic temperature predictions of the mathematical model are critically evaluated against MR thermometry data for planning MR-guided laser-induced thermal therapies (MRgLITT). Methods: The Pennes bioheat transfer model coupled with a diffusion theory approximation of laser tissue interaction was implemented as the underlying deterministic kernel. A probabilistic sensitivity study was used to identify parameters that provide the most variance in temperature output. Confidence intervals of the temperature predictions are compared to MR temperature imaging (MRTI) obtained during phantom and in vivo canine ( n = 4) MRgLITT experiments. The gPC predictions were quantitatively compared to MRTI data using probabilistic linear and temporal profiles as well as 2-D 60 °C isotherms. Results: Optical parameters provided the highest variance in the model output (peak standard deviation: anisotropy 3.51 °C, absorption 2.94 °C, scattering 1.84 °C, conductivity 1.43 °C, and perfusion 0.94 °C). Further, within the statistical sense considered, a non-linear model of the temperature and damage-dependent perfusion, absorption, and scattering is captured within the confidence intervals of the linear gPC method. Multivariate stochastic model predictions using parameters with the dominant sensitivities show good agreement with experimental MRTI data. Conclusions: Given parameter uncertainties and mathematical modelling approximations of the Pennes bioheat model, the statistical framework demonstrates conservative estimates of the therapeutic heating and has potential for use as a computational prediction tool for thermal therapy planning. [ABSTRACT FROM AUTHOR]

Abstract: Advances in nanotechnology for oncology will arise from an increased understanding of the interaction between nanomaterials and biological systems; refinement of multifunctional nanocomposites for applications such as simultaneous imaging and therapy (theranostics); and harnessing of the unique physicochemical properties arising from nanoscale effects which distinguish them from small-molecular-weight molecules in the detection and destruction of cancer cells with high selectivity and efficiency. The major challenges in successful clinical translation of tumor specific nanoparticle delivery include overcoming various biological barriers and demonstrating enhanced therapeutic efficacy over the current standard of care in the clinic. For many nanoparticle mediated theranostic applications, image guidance can play a crucial role not only in exploiting the cancer specific imaging capabilities of these novel particles, but in planning, targeting, monitoring and verifying treatment delivery, thus enhancing the safety and efficacy of these emerging procedures. [Copyright &y& Elsevier]

Purpose: Sub-lethal temperature elevations in the tumour incurred during laser cancer therapy can induce heat shock protein (HSP) expression leading to enhanced tumour survival and recurrence. Nanoshells utilised in combination with laser therapy can potentially enable selective heat deposition, greater thermal injury, and diminished HSP expression in the tumour. The study objective was to measure the distribution of temperature and HSP expression in prostate tumours in response to laser therapy alone or with nanoshells to determine if these combinatorial therapies can minimise HSP expression. Methods: PC3 cells were inoculated in the backs of CB17-Prkd c SCID/J mice and treated with external laser irradiation (wavelength of 810 nm, irradiance of 5 W/cm2, spot size of 5 mm, and heating duration of 3 min) alone or in combination with gold nanoshells (diameter of 55 nm and outer gold shell thickness of 10 nm) introduced into the tumour 24 h prior to laser treatment. Magnetic resonance temperature imaging was used to measure the distribution of temperature elevation in the tumours during laser treatment. Tumours were sectioned 16 h following laser treatment, stained for Hsp27 and Hsp70, imaged with a confocal microscope, and HSP expression levels were quantified as a function of depth in the tumours. Results: Maximum temperature elevations at the tumour surface were 28°C for laser treatment only and 50°C for laser heating in combination with gold nanoshells. Laser therapy alone caused significant induction of HSP expression in the first few millimeters of the tumour depth, whereas decreasing HSP expression occurred with greater tumour depth. Tumours treated with laser and nanoshells experienced substantial temperatures (73-78°C) at the tumour surface and temperatures greater than 53°C in the first few millimeters which eliminated HSP expression. Conclusion: Inclusion of nanoshells in laser therapy can provide a mechanism for enhancing heat deposition capable of eliminating HSP expression within a larger tumour region compared to laser heating alone. [ABSTRACT FROM AUTHOR]

Minimally invasive thermal therapy using high-power diode lasers is an active area of clinical research. Gold nanoshells (AuNS) can be tuned to absorb light in the range used for laser ablation and may facilitate more conformal tumor heating and sparing of normal tissue via enhanced tumor specific heating. This concept was investigated in a xenograft model of prostate cancer (PC-3) using MR temperature imaging (MRTI) in a 1.5T scanner to characterize the spatiotemporal temperature distribution resulting from nanoparticle mediated heating. Tumors with and without intravenously injected AuNS were exposed to an external laser tuned to 808 nm for 180 sec at 4 W/cm2 under real-time monitoring with proton resonance frequency shift based MRTI. Microscopy indicated that these nanoparticles (140-150 nm) accumulated passively in the tumor and remained close to the tumor microvasculature. MRTI measured a statistically significant ( p < 0.001) increase in maximum temperature in the tumor cortex (mean == 21 ± 7°C) in ++AuNS tumors versus control tumors. Analysis of the temperature maps helped demonstrate that the overall distribution of temperature within ++AuNS tumors was demonstrably higher versus control, and resulted in damage visible on histopathology. This research demonstrates that passive uptake of intravenously injected AuNS in PC-3 xenografts converts the tumor vasculature into a potent heating source for nanoparticle mediated ablation at power levels which do not generate significant damage in normal tissue. When used in conjunction with MRTI, this has implications for development and validation of more conformal delivery of therapy for interstitial laser ablations. [ABSTRACT FROM AUTHOR]

Purpose: Magnetic resonance imaging (MRI) is the optimal imaging modality for the prostate and surrounding critical organ structures. However, on MRI, the titanium radioactive seeds used for brachytherapy appear as black holes (negative contrast) and cannot be accurately localized. We sought to develop an encapsulated contrast agent marker (ECAM) with high-signal intensity on MRI to permit accurate localization of radioactive seeds with MRI during and after prostate brachytherapy. Methods and Materials: We investigated several agents with paramagnetic and superparamagnetic properties. The agents were injected into titanium, acrylic, and glass seeds, which were linked together in various combinations and imaged with MRI. The agent with the greatest T1-weighted signal was tested further in a canine prostate and agarose phantom. Studies were performed on a 1.5-T clinical MRI scanner. Results: The cobalt-chloride complex contrast (C4) agent with stoichiometry (CoCl2)0.8(C2H5NO2)0.2 had the greatest T1-weighted signal (positive contrast) with a relaxivity ratio >1 (r2/r1 = 1.21 ± 0.29). Acrylic-titanium and glass-titanium seed strands were clearly visualized with the encapsulated contrast agent marker. Conclusion: We have developed a novel ECAM that permits positive identification of the radioactive seeds used for prostate brachytherapy on MRI. Preclinical in vitro phantom studies and in vivo canine studies are needed to further optimize MRI sequencing techniques to facilitate MRI-based dosimetry. [Copyright &y& Elsevier]

Spherical nanoparticles with a gold outer shell and silica core can be tuned to absorb near-infrared light of a specific wavelength. These nanoparticles have the potential to enhance the treatment efficacy of laser-induced thermal therapy (LITT). In order to enhance both the potential efficacy and safety of such procedures, accurate methods of treatment planning are needed to predict the temperature distribution associated with treatment application. In this work, the standard diffusion approximation was used to model the laser fluence in phantoms containing different concentrations of nanoparticles, and the temperature distribution within the phantom was simulated in three-dimensions using the finite element technique. Magnetic resonance temperature imaging was used to visualize the spatiotemporal distribution of the temperature in the phantoms. In most cases, excellent correlation is demonstrated between the simulations and the experiment (<3.0% mean error observed). This has significant implications for the treatment planning of LITT treatments using gold-silica nanoshells. [ABSTRACT FROM AUTHOR]

Simple Summary: High-dose-rate (HDR) MRI-Assisted Radiosurgery (MARS) is an advanced form of brachytherapy or interventional radiotherapy involving the use of a remote after-loading system to transport an encapsulated radioisotope source to within or near a tumor with MRI precision. An HDR MARS can be used for treating both primary and recurrent prostate cancer with fewer treatment-related toxicities and comparable survival rates. Image-guided HDR brachytherapy has been linked with better local tumor control and overall survival. Magnetic resonance imaging (MRI) is more effective than computed tomography (CT) and ultrasonography in distinguishing the boundaries of a tumor versus the surrounding normal tissues. However, localizing the applicator and source is more challenging with MRI because conventional fiducial markers are not positively visualized on MRI. The aim of our study was to investigate the MRI signal intensities and characteristics of a newly developed positive-contrast MRI line marker (C4:S) for HDR MARS. We found that C4:S MRI line markers were positively visualized on both T1- and T2-weighted MRI sequences. Our findings indicate the value of C4:S line markers for HDR MARS. Magnetic resonance imaging (MRI) can facilitate accurate organ delineation and optimal dose distributions in high-dose-rate (HDR) MRI-Assisted Radiosurgery (MARS). Its use for this purpose has been limited by the lack of positive-contrast MRI markers that can clearly delineate the lumen of the HDR applicator and precisely show the path of the HDR source on T1- and T2-weighted MRI sequences. We investigated a novel MRI positive-contrast HDR brachytherapy or interventional radiotherapy line marker, C4:S, consisting of C4 (visible on T1-weighted images) complexed with saline. Longitudinal relaxation time (T1) and transverse relaxation time (T2) for C4:S were measured on a 1.5 T MRI scanner. High-density polyethylene (HDPE) tubing filled with C4:S as an HDR brachytherapy line marker was tested for visibility on T1- and T2-weighted MRI sequences in a tissue-equivalent female ultrasound training pelvis phantom. Relaxivity measurements indicated that C4:S solution had good T1-weighted contrast (relative to oil [fat] signal intensity) and good T2-weighted contrast (relative to water signal intensity) at both room temperature (relaxivity ratio > 1; r2/r1 = 1.43) and body temperature (relaxivity ratio > 1; r2/r1 = 1.38). These measurements were verified by the positive visualization of the C4:S (C4/saline 50:50) HDPE tube HDR brachytherapy line marker on both T1- and T2-weighted MRI sequences. Orientation did not affect the relaxivity of the C4:S contrast solution. C4:S encapsulated in HDPE tubing can be visualized as a positive line marker on both T1- and T2-weighted MRI sequences. MRI-guided HDR planning may be possible with these novel line markers for HDR MARS for several types of cancer. [ABSTRACT FROM AUTHOR]

To determine the feasibility of quantitative apparent diffusion coefficient (ADC) acquisition during magnetic resonance imaging-guided brachytherapy (MRgBT) using reduced field-of-view (rFOV) diffusion-weighted imaging (DWI). T2-weighted (T2w) MR and full-FOV single-shot echo planar (ssEPI) DWI were acquired in 7 patients with cervical or vaginal malignancy at baseline and prior to brachytherapy, while rFOV-DWI was acquired during MRgBT following brachytherapy applicator placement. The gross target volume (GTV) was contoured on the T2w images and registered to the ADC map. Voxels at the GTV's maximum Maurer distance comprised a central sub-volume (GTV center). Contour ADC mean and standard deviation were compared between timepoints using repeated measures ANOVA. ssEPI-DWI mean ADC increased between baseline and prebrachytherapy from 1.03 ± 0.18 10−3 mm2/s to 1.34 ± 0.28 10−3 mm2/s for the GTV (p = 0.06) and from 0.84 ± 0.13 10−3 mm2/s to 1.26 ± 0.25 10−3 mm2/s at the level of the GTV center (p = 0.03), consistent with early treatment response. rFOV-DWI during MRgBT demonstrated mean ADC values of 1.28 ± 0.14 10−3 mm2/s and 1.28 ± 0.19 10−3 mm2/s for the GTV and GTV center , respectively (p = 0.02 and p = 0.03 relative to baseline). No significant differences were observed between ssEPI-DWI and rFOV-DWI ADC measurements. Quantitative ADC measurement in the setting of MRI guided brachytherapy implant placement for cervical and vaginal cancers is feasible using rFOV-DWI, with comparable mean ADC comparable to prebrachytherapy ssEPI-DWI, and may enable MRI-guided radiotherapy targeting of low ADC, radiation resistant sub-volumes of tumor. [ABSTRACT FROM AUTHOR]

We integrated a brachytherapy procedural workflow within an existing diagnostic 3.0-T (3T) MRI suite. This setup facilitates intraoperative MRI guidance for optimal applicator positioning, particularly for interstitial needle placements in gynecologic cases with extensive parametrial involvement. Here we summarize the multidisciplinary collaboration, equipment, and supplies necessary to implement an intraoperative MRI-guided brachytherapy program; outline the operational workflow via process maps; and address safety precautions. We evaluate internal resource utilization associated with this progressive approach via time-driven activity-based costing methodology, comparing institutional costs to that of a traditional workflow (within a CT suite, followed by separate postprocedure MRI) over a single brachytherapy procedural episode. Resource utilization was only 15% higher for the intraoperative MRI-based workflow, attributable to use of the MRI suite and increased radiologist effort. Personnel expenses were the greatest cost drivers for either workflow, accounting for 76–77% of total resource utilization. However, use of the MRI suite allows for potential cost-shifting opportunities from other resources, such as CT, during the procedural episode. Improvements in process speed can also decrease costs: for each 10% decrease in case duration from baseline procedure time, total costs could decrease by roughly 8%. This analysis supports the feasibility of an intraoperative MRI-guided brachytherapy program within a diagnostic MRI suite and defines many of the resources required for this procedural workflow. Longer followup will define the full utility of this approach in optimizing the therapeutic ratio for gynecologic cancers, which may translate into lower costs and higher value with time, over a full cycle of care. [ABSTRACT FROM AUTHOR]

To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the utility of five different standard measurement methods for determining image uniformity for partially parallel imaging (PPI) acquisitions in terms of consistency across a variety of pulse sequences and reconstruction strategies. Methods: Images were produced with a phantom using a 12-channel head matrix coil in a 3T MRI system (TIM TRIO, Siemens Medical Solutions, Erlangen, Germany). Images produced using echo-planar, fast spin echo, gradient echo, and balanced steady state free precession pulse sequences were evaluated. Two different PPI reconstruction methods were investigated, generalized autocalibrating partially parallel acquisition algorithm (GRAPPA) and modified sensitivity-encoding (mSENSE) with acceleration factors (R) of 2, 3, and 4. Additionally images were acquired with conventional, two-dimensional Fourier imaging methods (R = 1). Five measurement methods of uniformity, recommended by the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) were considered. The methods investigated were (1) an ACR method and a (2) NEMA method for calculating the peak deviation nonuniformity, (3) a modification of a NEMA method used to produce a gray scale uniformity map, (4) determining the normalized absolute average deviation uniformity, and (5) a NEMA method that focused on 17 areas of the image to measure uniformity. Changes in uniformity as a function of reconstruction method at the same R-value were also investigated. Two-way analysis of variance (ANOVA) was used to determine whether R-value or reconstruction method had a greater influence on signal intensity uniformity measurements for partially parallel MRI. Results: Two of the methods studied had consistently negative slopes when signal intensity uniformity was plotted against R-value. The results obtained comparing mSENSE against GRAPPA found no consistent difference between GRAPPA and mSENSE with regard to signal intensity uniformity. The results of the two-way ANOVA analysis suggest that R-value and pulse sequence type produce the largest influences on uniformity and PPI reconstruction method had relatively little effect. Conclusions: Two of the methods of measuring signal intensity uniformity, described by the (NEMA) MRI standards, consistently indicated a decrease in uniformity with an increase in R-value. Other methods investigated did not demonstrate consistent results for evaluating signal uniformity in MR images obtained by partially parallel methods. However, because the spatial distribution of noise affects uniformity, it is recommended that additional uniformity quality metrics be investigated for partially parallel MR images. [ABSTRACT FROM AUTHOR]

Purpose: Dynamic susceptibility contrast (DSC)‐MRI is a perfusion imaging technique from which useful quantitative imaging biomarkers can be derived. Relative cerebral blood volume (rCBV) is such a biomarker commonly used for evaluating brain tumors. To account for the extravasation of contrast agents in tumors, post‐processing leakage correction is often applied to improve rCBV accuracy. Digital reference objects (DRO) are ideal for testing the post‐processing software, because the biophysical model used to generate the DRO can be matched to the one that the software uses. This study aims to develop DROs to validate the leakage correction of software using Weisskoff model and to examine the effect of background signal time curves that are required by the model. Methods: Three DROs were generated using the Weisskoff model, each composed of nine foreground lesion objects with combinations of different levels of rCBV and contrast leakage parameter (K2). Three types of background were implemented for these DROs: (1) a multi‐compartment brain‐like background, (2) a sphere background with a constant signal time curve, and (3) a sphere background with signal time curve identical to that of the brain‐like DRO's white matter (WM). The DROs were then analyzed with an FDA‐cleared software with and without leakage correction. Leakage correction was tested with and without brain segmentation. Results: Accuracy of leakage correction was able to be verified using the brain‐like phantom and the sphere phantom with WM background. The sphere with constant background did not perform well with leakage correction with or without brain segmentation. The DROs were able to verify that for the particular software tested, leakage correction with brain segmentation achieved the lowest error. Conclusions: DSC‐MRI DROs with biophysical model matched to that of the post‐processing software can be well used for the software's validation, provided that the background signals are also properly simulated for generating the reference time curve required by the model. Care needs to be taken to consider the interaction of the design of the DRO with the software's implementation of brain segmentation to extract the reference time curve. [ABSTRACT FROM AUTHOR]

Purpose: We aim to characterize the quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters associated with advanced mandibular osteoradionecrosis (ORN) compared with the contralateral normal mandible.Methods and Materials: Patients with a diagnosis of advanced ORN after curative-intent radiation treatment of head and neck cancer were prospectively enrolled after institutional review board approval and study-specific informed consent were obtained. Quantitative maps generated with the Tofts and extended Tofts pharmacokinetic models were used for analysis. Manual segmentation of advanced ORN 3-dimensional volume was done using anatomic sequences to create ORN volumes of interest (VOIs). Subsequently, normal mandibular VOIs were segmented on the contralateral healthy mandible of similar volume and anatomic location to create control VOIs. Finally, anatomic sequences were coregistered to DCE sequences, and contours were propagated to the respective parameter maps.Results: Thirty patients were included. The median time to ORN diagnosis after completion of IMRT was 38 months (range, 6-184 months), whereas median time to ORN progression to advanced grade after initial diagnosis was 5.6 months (range, 0-128 months). There were statistically significant higher Ktrans and Ve in ORN-VOIs compared with controls (0.23 vs 0.07 min-1, and 0.34 vs 0.15; P < .0001 for both). The average relative increase of Ktrans in ORN-VOIs was 3.2-fold higher than healthy mandibular control VOIs. Moreover, the corresponding rise of Ve in ORN-VOIs was 2.7-fold higher than in the controls. Using combined Ktrans and Ve parameters, 27 patients (90%) had at least a 200% increase of either of the studied parameters in the ORN-VOIs compared with their healthy mandible VOIs.Conclusions: Our results confirm that there is a quantitatively significant higher degree of leakiness in the mandibular vasculature as measured using DCE-MRI parameters of areas with advanced ORN versus healthy mandible. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the utility of a novel MRI-positive line marker, composed of C4:S (cobalt chloride–based contrast agent) encapsulated in high-density polyethylene tubing, in permitting dosimetry and treatment planning directly on MRI. We evaluated the clinical feasibility of the C4:S line markers in nine sequential brachytherapy procedures for gynecologic malignancies, including six tandem-and-ovoid and three interstitial cases. We then quantified the internal resource utilization of an intraoperative MRI-guided procedural episode via time-driven activity-based costing, identifying opportunities for cost-containment with use of the C4:S line markers. The C4:S line markers demonstrated the strongest positive signal visibility on 3D constructive interference in steady state (CISS)/FIESTA-C followed by T1-weighted sequences, permitting accurate delineation of the applicator lumen and thus the source path. These images may be fused along with traditional T2-weighted sequences for optimal tumor and anatomy contouring, followed by treatment planning directly on MRI. By eliminating postoperative CT for fusion and applicator registration from the procedural episode, use of the C4:S line markers could decrease workflow time and lower total delivery costs per procedure. This analysis supports the clinical utility and value contribution of the C4:S line markers, which permit accurate MRI-based dosimetry and treatment planning, thereby eliminating the need for postoperative CT for fusion and applicator registration. [ABSTRACT FROM AUTHOR]

Thermoembolization presents a unique treatment alternative for patients diagnosed with hepatocellular carcinoma. The approach delivers a reagent that undergoes an exothermic chemical reaction and combines the benefits of embolic as well as thermal- and chemical-ablative therapy modalities. The target tissue and vascular bed are subjected to simultaneous hyperthermia, ischemia, and chemical denaturation in a single procedure. To guide optimal delivery, we developed a mathematical model for understanding the competing diffusive and convective effects observed in thermoembolization delivery protocols. A mixture theory formulation was used to mathematically model thermoembolization as chemically reacting transport of an electrophile, dichloroacetyl chloride (DCACl), within porous living tissue. Mass and energy transport of each relevant constituent are considered. Specifically, DCACl is injected into the vessels and exothermically reacts with water in the blood or tissue to form dichloroacetic acid and hydrochloric acid. Neutralization reactions are assumed instantaneous in this approach. We validated the mathematical model predictions of temperature using MR thermometry of the thermoembolization procedure performed in ex vivo kidney. Mathematical modeling predictions of tissue death were highly dependent on the vascular geometry, injection pressure, and intrinsic amount of exothermic energy released from the chemical species, and were able to recapitulate the temperature distributions observed in MR thermometry. These efforts present a first step toward formalizing a mathematical model for thermoembolization and are promising for providing insight for delivery protocol optimization. While our approach captured the observed experimental temperature measurements, larger-scale experimental validation is needed to prioritize additional model complexity and fidelity. [ABSTRACT FROM AUTHOR]

Radiomics studies require many patients in order to power them, thus patients are often combined from different institutions and using different imaging protocols. Various studies have shown that imaging protocols affect radiomics feature values. We examined whether using data from cohorts with controlled imaging protocols improved patient outcome models. We retrospectively reviewed 726 CT and 686 PET images from head and neck cancer patients, who were divided into training or independent testing cohorts. For each patient, radiomics features with different preprocessing were calculated and two clinical variables—HPV status and tumor volume—were also included. A Cox proportional hazards model was built on the training data by using bootstrapped Lasso regression to predict overall survival. The effect of controlled imaging protocols on model performance was evaluated by subsetting the original training and independent testing cohorts to include only patients whose images were obtained using the same imaging protocol and vendor. Tumor volume, HPV status, and two radiomics covariates were selected for the CT model, resulting in an AUC of 0.72. However, volume alone produced a higher AUC, whereas adding radiomics features reduced the AUC. HPV status and one radiomics feature were selected as covariates for the PET model, resulting in an AUC of 0.59, but neither covariate was significantly associated with survival. Limiting the training and independent testing to patients with the same imaging protocol reduced the AUC for CT patients to 0.55, and no covariates were selected for PET patients. Radiomics features were not consistently associated with survival in CT or PET images of head and neck patients, even within patients with the same imaging protocol. [ABSTRACT FROM AUTHOR]

Radiomics studies require large patient cohorts, which often include patients imaged using different imaging protocols. We aimed to determine the impact of variability in imaging protocol parameters and interscanner variability using a phantom that produced feature values similar to those of patients. Positron emission tomography (PET) scans of a Hoffman brain phantom were acquired on GE Discovery 710, Siemens mCT, and Philips Vereos scanners. A standard-protocol scan was acquired on each machine, and then each parameter that could be changed was altered individually. The phantom was contoured with 10 regions of interest (ROIs). Values for 45 features with 2 different preprocessing techniques were extracted for each image. To determine the impact of each parameter on the reliability of each radiomics feature, the intraclass correlation coefficient (ICC) was calculated with the ROIs as the subjects and the parameter values as the raters. For interscanner comparisons, we compared the standard deviation of each radiomics feature value from the standard-protocol images to the standard deviation of the same radiomics feature from PET scans of 224 patients with non-small cell lung cancer. When the pixel size was resampled prior to feature extraction, all features had good reliability (ICC > 0.75) for the field of view and matrix size. The time per bed position had excellent reliability (ICC > 0.9) on all features. When the filter cutoff was restricted to values below 6 mm, all features had good reliability. Similarly, when subsets and iterations were restricted to reasonable values used in clinics, almost all features had good reliability. The average ratio of the standard deviation of features on the phantom scans to that of the NSCLC patient scans was 0.73 using fixed-bin-width preprocessing and 0.92 using 64-level preprocessing. Most radiomics feature values had at least good reliability when imaging protocol parameters were within clinically used ranges. However, interscanner variability was about equal to interpatient variability; therefore, caution must be used when combining patients scanned on equipment from different vendors in radiomics data sets. [ABSTRACT FROM AUTHOR]

Highlights • Head and neck patients are often affected by streak and beam hardening artifacts, impacting their inclusion in studies. • Streak artifacts impact the majority of radiomics features' values. • Contours of structures can abut bone without affecting most radiomics features' values if needed. • Most features were robust with up to 50% of the original tumor volume removed. • More patients' head and neck CTs can be used in radiomics studies by simply removing slices affected by streak artifacts. Abstract Radiomics studies have demonstrated the potential use of quantitative image features to improve prognostic stratification of patients with head and neck cancer. Imaging protocol parameters that can affect radiomics feature values have been investigated, but the effects of artifacts caused by intrinsic patient factors have not. Two such artifacts that are common in patients with head and neck cancer are streak artifacts caused by dental fillings and beam-hardening artifacts caused by bone. The purpose of this study was to test the impact of these artifacts and if needed, methods for compensating for these artifacts in head and neck radiomics studies. The robustness of feature values was tested by removing slices of the gross tumor volume (GTV) on computed tomography images from 30 patients with head and neck cancer; these images did not have streak artifacts or had artifacts far from the GTV. The range of each feature value over a percentage of the GTV was compared to the inter-patient variability at full volume. To determine the effects of beam-hardening artifacts, we scanned a phantom with 5 cartridges of different materials encased in polystyrene buildup. A cylindrical hole through the cartridges contained either a rod of polylactic acid to simulate water or a rod of polyvinyl chloride to simulate bone. A region of interest was drawn in each cartridge flush with the rod. Most features were robust with up to 50% of the original GTV removed. Most feature values did not significantly differ when measured with the polylactic acid rod or the polyvinyl chloride rod. Of those that did, the size of the difference did not exceed the inter-patient standard deviation in most cases. We conclude that simply removing slices affected by streak artifacts can enable these scans to be included in radiomics studies and that contours of structures can abut bone without being affected by beam hardening if needed. [ABSTRACT FROM AUTHOR]

Purpose: Magnetic resonance imaging (MRI) provides noninvasive evaluation of patient's anatomy without using ionizing radiation. Due to this and the high soft‐tissue contrast, MRI use has increased and has potential for use in longitudinal studies where changes in patients’ anatomy or tumors at different time points are compared. Deformable image registration can be useful for these studies. Here, we describe two datasets that can be used to evaluate the registration accuracy of systems for MR images, as it cannot be assumed to be the same as that measured on CT images. Acquisition and validation methods: Two sets of images were created to test registration accuracy. (a) A porcine phantom was created by placing ten 0.35‐mm gold markers into porcine meat. The porcine phantom was immobilized in a plastic container with movable dividers. T1‐weighted, T2‐weighted, and CT images were acquired with the porcine phantom compressed in four different ways. The markers were not visible on the MR images, due to the selected voxel size, so they did not interfere with the measured registration accuracy, while the markers were visible on the CT images and were used to identify the known deformation between positions. (b) Synthetic images were created using 28 head and neck squamous cell carcinoma patients who had MR scans pre‐, mid‐, and postradiotherapy treatment. An inter‐ and intrapatient variation model was created using these patient scans. Four synthetic pretreatment images were created using the interpatient model, and four synthetic post‐treatment images were created for each of the pretreatment images using the intrapatient model. Data format and usage notes: The T1‐weighted, T2‐weighted, and CT scans of the porcine phantom in the four positions are provided. Four T1‐weighted synthetic pretreatment images each with four synthetic post‐treatment images, and four T2‐weighted synthetic pretreatment images each with four synthetic post‐treatment images are provided. Additionally, the applied deformation vector fields to generate the synthetic post‐treatment images are provided. The data are available on TCIA under the collection MRI‐DIR. Potential applications: The proposed database provides two sets of images (one acquired and one computer generated) for use in evaluating deformable image registration accuracy. T1‐ and T2‐weighted images are available for each technique as the different image contrast in the two types of images may impact the registration accuracy. [ABSTRACT FROM AUTHOR]

Post-treatment imaging is the principal method for evaluating thermal lesions following image-guided thermal ablation procedures. While real-time temperature feedback using magnetic resonance temperature imaging (MRTI) is a complementary tool that can be used to optimise lesion size throughout the procedure, a thermal dose model is needed to convert temperature-time histories to estimates of thermal damage. However, existing models rely on empirical parameters derived from laboratory experiments that are not direct indicators of post-treatment radiologic appearance. In this work, we investigate a technique that uses perioperative MR data to find novel thermal dose model parameters that are tailored to the appearance of the thermal lesion on post-treatment contrast-enhanced imaging. Perioperative MR data were analysed for five patients receiving magnetic resonance-guided laser-induced thermal therapy (MRgLITT) for brain metastases. The characteristic enhancing ring was manually segmented on post-treatment T1-weighted imaging and registered into the MRTI geometry. Post-treatment appearance was modelled using a coupled Arrhenius-logistic model and non-linear optimisation techniques were used to find the maximum-likelihood kinetic parameters and dose thresholds that characterise the inner and outer boundary of the enhancing ring. The parameter values and thresholds were consistent with previous investigations, while the average difference between the predicted and segmented boundaries was on the order of one pixel (1 mm). The areas predicted using the optimised model parameters were also within 1 mm of those predicted by clinically utilised dose models. This technique makes clinically acquired data available for investigating new thermal dose model parameters driven by clinically relevant endpoints. [ABSTRACT FROM AUTHOR]

Purpose:Neurosurgical laser ablation is experiencing a renaissance. Computational tools for ablation planning aim to further improve the intervention. Here, global optimisation and inverse problems are demonstrated to train a model that predicts maximum laser ablation extent. Methods:A closed-form steady state model is trained on and then subsequently compared toN = 20 retrospective clinical MR thermometry datasets. Dice similarity coefficient (DSC) is calculated to provide a measure of region overlap between the 57 °C isotherms of the thermometry data and the model-predicted ablation regions; 57 °C is a tissue death surrogate at thermal steady state. A global optimisation scheme samples the dominant model parameter sensitivities, blood perfusion (ω) and optical parameter (μeff) values, throughout a parameter space totalling 11 440 value-pairs. This represents a lookup table ofμeff–ωpairs with the corresponding DSC value for each patient dataset. Theμeff–ωpair with the maximum DSC calibrates the model parameters, maximising predictive value for each patient. Finally, leave-one-out cross-validation with global optimisation information trains the model on the entire clinical dataset, and compares against the model naïvely using literature values forωandμeff. Results:When using naïve literature values, the model’s mean DSC is 0.67 whereas the calibrated model produces 0.82 during cross-validation, an improvement of 0.15 in overlap with the patient data. The 95% confidence interval of the mean difference is 0.083–0.23 (p < 0.001). Conclusions:During cross-validation, the calibrated model is superior to the naïve model as measured by DSC, with +22% mean prediction accuracy. Calibration empowers a relatively simple model to become more predictive. [ABSTRACT FROM PUBLISHER]

Purpose During magnetic resonance ( MR)-guided thermal therapies, water proton resonance frequency shift ( PRFS)-based MR temperature imaging can quantitatively monitor tissue temperature changes. It is widely known that the PRFS technique is easily perturbed by tissue motion, tissue susceptibility changes, magnetic field drift, and modality-dependent applicator-induced artifacts. Here, a referenceless Gaussian process modeling ( GPM)-based estimation of the PRFS is investigated as a methodology to mitigate unwanted background field changes. The GPM offers a complementary trade-off between data fitting and smoothing and allows prior information to be used. The end result being the GPM provides a full probabilistic prediction and an estimate of the uncertainty. Methods GPM was employed to estimate the covariance between the spatial position and MR phase measurements. The mean and variance provided by the statistical model extrapolated background phase values from nonheated neighboring voxels used to train the model. MR phase predictions in the heating ROI are computed using the spatial coordinates as the test input. The method is demonstrated in ex vivo rabbit liver tissue during focused ultrasound heating with manually introduced perturbations (n = 6) and in vivo during laser-induced interstitial thermal therapy to treat the human brain (n = 1) and liver (n = 1). Results Temperature maps estimated using the GPM referenceless method demonstrated a RMS error of <0.8°C with artifact-induced reference-based MR thermometry during ex vivo heating using focused ultrasound. Nonheated surrounding areas were <0.5°C from the artifact-free MR measurements. The GPM referenceless MR temperature values and thermally damaged regions were within the 95% confidence interval during in vivo laser ablations. Conclusions A new approach to estimation for referenceless PRFS temperature imaging is introduced that allows for an accurate probabilistic extrapolation of the background phase. The technique demonstrated reliable temperature estimates in the presence of the background phase changes and was demonstrated useful in the in vivo brain and liver ablation scenarios presented. [ABSTRACT FROM AUTHOR]

Purpose: For postimplant dosimetric assessment, computed tomography (CT) is commonly used to identify prostate brachytherapy seeds, at the expense of accurate anatomical contouring. Magnetic resonance imaging (MRI) is superior to CT for anatomical delineation, but identification of the negative-contrast seeds is challenging. Positive-contrast MRI markers were proposed to replace spacers to assist seed localization on MRI images. Visualization of these markers under varying scan parameters was investigated. Methods: To simulate a clinical scenario, a prostate phantom was implanted with 66 markers and 86 seeds, and imaged on a 3.0T MRI scanner using a 3D fast radiofrequency-spoiled gradient recalled echo acquisition with various combinations of scan parameters. Scan parameters, including flip angle, number of excitations, bandwidth, field-of-view, slice thickness, and encoding steps were systematically varied to study their effects on signal, noise, scan time, image resolution, and artifacts. Results: The effects of pulse sequence parameter selection on the marker signal strength and image noise were characterized. The authors also examined the tradeoff between signal-to-noise ratio, scan time, and image artifacts, such as the wraparound artifact, susceptibility artifact, chemical shift artifact, and partial volume averaging artifact. Given reasonable scan time and managable artifacts, the authors recommended scan parameter combinations that can provide robust visualization of the MRI markers. Conclusions: The recommended MRI pulse sequence protocol allows for consistent visualization of the markers to assist seed localization, potentially enabling MRI-only prostate postimplant dosimetry. [ABSTRACT FROM AUTHOR]

A major challenge of targeted molecular imaging and drug delivery in cancer is establishing a functional combination of ligand-directed cargo with a triggered release system. Here we develop a hydrogelbased nanotechnology platform that integrates tumor targeting, photon-to-heat conversion, and triggered drug delivery within a single nanostructure to enable multimodal imaging and controlled release of therapeutic cargo. In proof-of-concept experiments, we showa broad range of ligand peptide-based applications with phage particles, heat-sensitive liposomes, or mesoporous silica nanoparticles that self-assemble into a hydrogel for tumor-targeted drug delivery. Because nanoparticles pack densely within the nanocarrier, their surface plasmon resonance shifts to near-infrared, thereby enabling a laser-mediated photothermal mechanism of cargo release. We demonstrate both noninvasive imaging and targeted drug delivery in preclinical mouse models of breast and prostate cancer. Finally, we applied mathematical modeling to predict and confirm tumor targeting and drug delivery. These results are meaningful steps toward the design and initial translation of an enabling nanotechnology platform with potential for broad clinical application.s [ABSTRACT FROM AUTHOR]

A new method is developed to measure the magnetic susceptibilities and radii of small cylinder-like objects at arbitrary orientations accurately. This method for most biological substances only requires a standard gradient echo sequence with one or two echo times, depending on the orientation of an object relative to the main magnetic field. For objects oriented at the magic angle, however, this method is not applicable. As a byproduct of this method, the cross-sectional area as well as signals inside and outside the object can be determined. The uncertainty of each measurement is estimated from the error propagation method. Partial volume, dephasing, and phase aliasing effects are naturally included in the equations of this method. A number of simulations, phantom, and pilot in-vivo human studies are carried out to validate the theory. When the maximal phase value at the boundary of a given cylindrical object is larger than 3 radians, and the phase inside the object is more than 1 radian, the susceptibility can be accurately quantified within 15%. The radius of the object can be determined to subpixel accuracy. This is the case when the signal-to-noise ratio inside the object is about 6:1 or higher and the radius of the object is about one pixel or larger. These conditions are realistic when considering medullary and pial veins for example. [ABSTRACT FROM AUTHOR]

Purpose: Optically activated nanoparticle-mediated heating for thermal therapy applications is an area of intense research. The ability to characterise the spatio-temporal heating potential of these particles for use in modelling under various exposure conditions can aid in the exploration of new approaches for therapy as well as more quantitative prospective approaches to treatment planning. The purpose of this research was to investigate an inverse solution to the heat equation using magnetic resonance temperature imaging (MRTI) feedback, for providing optical characterisation of two types of nanoparticles (gold-silica nanoshells and gold nanorods). Methods: The optical absorption of homogeneous nanoparticle-agar mixtures was measured during exposure to an 808 nm laser using real-time MRTI. A coupled finite element solution of heat transfer was registered with the data and used to solve the inverse problem. The L2 norm of the difference between the temperature increase in the model and MRTI was minimised using a pattern search algorithm by varying the absorption coefficient of the mixture. Results: Absorption fractions were within 10% of literature values for similar nanoparticles. Comparison of temporal and spatial profiles demonstrated good qualitative agreement between the model and the MRTI. The weighted root mean square error was <1.5 σMRTI and the average Dice similarity coefficient for ΔT = 5 °C isotherms was >0.9 over the measured time interval. Conclusion: This research demonstrates the feasibility of using an indirect method for making minimally invasive estimates of nanoparticle absorption that might be expanded to analyse a variety of geometries and particles of interest. [ABSTRACT FROM AUTHOR]

Doxorubicin-loaded hollow gold nanoshells (Dox@PEG-HAuNS) increase the efficacy of photothermal ablation (PTA) not only by mediating efficient PTA but also through chemotherapy, and therefore have potential utility for local anticancer therapy. However, in vivo real-time monitoring of Dox release and temperature achieved during the laser ablation technique has not been previously demonstrated before. In this study, we used fluorescence optical imaging to map the release of Dox from Dox@PEG-HAuNS and photoacoustic imaging to monitor the tumor temperature achieved during near-infrared laser-induced photothermal heating in vitro and in vivo. In vitro, treatment with a 3-W laser was sufficient to initiate the release of Dox from Dox@PEG-HAuNS (1:3:1 wt/wt, 1.32×1012 particles/mL). Laser powers of 3 and 6W achieved ablative temperatures of more than 50°C. In 4T1 tumor-bearing nude mice that received intratumoral or intravenous injections of Dox@PEG-HAuNS, fluorescence optical imaging (emission wavelength=600nm, excitation wavelength=500nm) revealed that the fluorescence intensity in surface laser-treated tumors 24h after treatment was significantly higher than that in untreated tumors (p=0.015 for intratumoral, p=0.008 for intravenous). Similar results were obtained using an interstitial laser to irradiate tumors following the intravenous injection of Dox@PEG-HAuNS (p=0.002 at t=24h). Photoacoustic imaging (acquisition wavelength=800nm) revealed that laser treatment caused a substantial increase in tumor temperature, from 37°C to ablative temperatures of more than 50°C. Ex vivo analysis revealed that the fluorescence intensity of laser-treated tumors was twice as high as that of untreated tumors (p=0.009). Histological analysis confirmed that intratumoral injection of Dox@PEG-HAuNS and laser treatment caused significantly more tumor necrosis compared to tumors that were not treated with laser (p<0.001). On the basis of these findings, we conclude that fluorescence optical imaging and photoacoustic imaging are promising approaches to assessing Dox release and monitoring temperature, respectively, after Dox@PEG-HAuNS-mediated thermal ablation therapy. [ABSTRACT FROM AUTHOR]

Abstract: Hyperthermia, which is heating of tumors above 43°C for about 30min, has been known to modulate vascular permeability for enhanced chemotherapy. However, it is not clear whether a similar effect exists when temperature at tumor sites is elevated above 43°C, such as temperature achieved in laser-induced photothermal ablation (PTA) therapy. Also, the effect of timing of chemotherapeutic drug administration following heating in the efficiency of drug delivery is not established. In this study, we investigated the impact of near infrared (NIR) laser irradiated anti-EGFR monoclonal antibody C225-conjugated hollow gold nanospheres (C225-HAuNS) on vascular permeability and subsequent tumor uptake of a water-soluble polymer using combined MRI, ultrasound and optical imaging approaches. Magnetic temperature imaging showed a maximum temperature of 65.2±0.10°C in A431 tumor xenograft of mice treated with C225-HAuNS plus laser and 47.0±0.33°C in tumors of mice treated with saline plus laser at 4W/cm2 for 3min (control) at 2mm from the light incident surface. Dynamic contrast enhanced (DCE) MRI demonstrated greater than 2-fold increase of DTPA-Gd in the initial area under the curve (IAUC90) in mice injected with C225-HAuNS and exposed to NIR laser compared with control mice at 3min after laser treatment. Similarly, Power Doppler (PD) ultrasound revealed a 4- to 6-fold increase in percentage vascularization in mice treated with C225-HAuNS plus NIR laser compared to control mice and confirmed increased vascular perfusion immediately after laser treatment. Twenty-four hours later, the blood perfusion was shut down. On optical imaging, tumor uptake of PG-Gd-NIR813, which is the model polymeric drug used, was significantly higher (p-value<0.05) in mice injected with PG-Gd-NIR813 at 5min after laser treatment than in mice injected with PG-Gd-NIR813 at 24h after laser treatment and the saline-treated mice. In conclusion, laser irradiation of tumors after intravenous injection of C255-HAuNS induces a thermally mediated modulation of the vascular perfusion, which enhances the delivery of polymeric drugs to the tumors at the time phototherapy is initiated. [Copyright &y& Elsevier]

Advancements in nanotechnology have made it possible to create multifunctional nanostructures that can be used simultaneously to image and treat cancers. For example, hollow gold nanospheres (HAuNS) have been shown to generate intense photoacoustic signals and induce efficient photothermal ablation (PTA) therapy. In this study, we used photoacoustic tomography, a hybrid imaging modality, to assess the intravenous delivery of HAuNS targeted to integrins that are overexpressed in both glioma and angiogenic blood vessels in a mouse model of glioma. Mice were then treated with near-infrared laser, which elevated tumor temperature by 20.7°C. We found that PTA treatment significantly prolonged the survival of tumor-bearing mice. Taken together, these results show the feasibility of using a single nanostructure for image-guided local tumor PTA therapy with photoacoustic molecular imaging. [ABSTRACT FROM AUTHOR]

Abstract: We have developed a novel MRI marker for prostate brachytherapy. The purpose of this study was to evaluate the changes in anisotropy when cobalt chloride complex contrast agent encapsulated contrast agent markers (C4-ECAM) were placed adjacent to an iodine-125 (I-125) titanium seed, and to verify that the C4-ECAMs were visible on magnetic resonance imaging (MRI) after radiation exposure. Two C4-ECAMs were verified to be MRI visible in a phantom before radiation exposure. The C4-ECAMs were then attached to each end of a 12.7-U (10-mCi) I-125 titanium seed in a polymer tube. Anisotropy was measured and analyzed with the seed alone and with attached C4-ECAMs by suspending thermoluminescent dosimeters in a water phantom in 2 circles surrounding the radioactive source with radius of 1 or 2 cm. A T1-weighted MRI evaluation of C4-ECAMs was then performed after exposure to the amount of radiation typically delivered during 1 month of prostate brachytherapy. Measured values of the anisotropy function F(r, θ) for the I-125 seed with and without the C4-ECAMs were mutually statistically indistinguishable (standard error of the mean <4.2%) and agreed well with published TG-43 values for the bare seed. As expected, the anisotropy function ϕan(r) for the 2 datasets (with and without C4-ECAMs) derived from the measured F(r, θ) did not exhibit statistically measurable difference. Both datasets showed agreement with the published TG-43 ϕan(r) for the bare seed. The C4-ECAMs were well visualized by MRI after 1 month of radiation exposure. There were no changes in anisotropy when the C4-ECAMs were placed next to an I-125 radioactive seed, and the C4-ECAMs were visualized after radiation exposure. [Copyright &y& Elsevier]

Objective: To evaluate the effect of half-dose intravenous gadolinium contrast on the enhancement of bone and soft tissue tumors.Materials and Methods: This study is HIPAA compliant and informed consent was waived by the institutional review board. An institutional database search was performed over a 1-year period for patients with full- and half-dose MR examinations performed for musculoskeletal oncologic indications. Examination pairs that were identical with regard to field strength and presence or absence of fat saturation were included, resulting in 29 paired examinations. When multiple, the lesion that was best delineated and enhanced well on the first examination in the pair was chosen, yielding 17 bone and 12 soft tissue. Five musculoskeletal radiologists blinded to dosages were asked to assess for a difference in enhancement when comparing the lesion on both examinations and to rate the degree of difference on a three-point scale. They were also asked to identify the examination on which the lesion enhanced less (tallied as low dose). Results were analyzed with the exact binomial test.Results: The readers perceived an enhancement difference in 41% (59/145) of studies (p = 0.03) and the majority were rated as "mild" (66%, 39/59). The readers did not accurately identify the low-dose examinations (54% correctly identified, 32/59, p = 0.60).Conclusions: Half-dose gadolinium enhancement of lesions could not be accurately distinguished from full-dose enhancement upon review of the same lesion imaged at both concentrations. [ABSTRACT FROM AUTHOR]

Purpose: Minimally invasive thermal ablative therapies as alternatives to conventional surgical management of solid tumors and other pathologies is increasing owing to the potential benefits of performing these procedures in an outpatient setting with reduced complications and comorbidity. Magnetic resonance temperature imaging (MRTI) measurement allows existing thermal dose models to use the spatiotemporal temperature history to estimate the thermal damage to tissue. However, the various thermal dose models presented in the literature employ different parameters and thresholds, affecting the reliability of thermal dosimetry. In this study, the authors quantitatively compared three thermal dose models (Arrhenius rate process, CEM43, and threshold temperature) using the dice similarity coefficient (DSC). Methods: The DSC was used to compare the spatial overlap between the region of thermal damage as predicted by the models for in vivo normal canine brain during thermal therapy to the region of thermal damage as revealed by contrast-enhanced T1-weighted images acquired immediately after therapy (<20 min). The outer edge of the hyperintense rim of the ablation region was used as the surrogate marker for the limits of thermal coagulation. The DSC was also used to investigate the impact of varying the thresholds on each models' ability to predict the zone of thermal necrosis. Results: At previously reported thresholds, the authors found that all three models showed good agreement (defined as DSC>0.7) with post-treatment imaging. All three models examined across the range of commonly applied thresholds consistently showed highly accurate spatial overlap, low variability, and little dependence on temperature uncertainty. DSC values corresponding to cited thresholds were not significantly different from peak DSC values. Conclusions: Thus, the authors conclude that the all three thermal dose models can be used as a reliable surrogate for postcontrast tissue damage verification imaging in rapid ablation procedures and can also be used to enhance the capability of MRTI to control thermal therapy in real time. [ABSTRACT FROM AUTHOR]

Purpose: Focused ultrasound surgery (FUS) is a highly precise noninvasive procedure to ablate pathogenic tissue. FUS therapy is often combined with magnetic resonance (MR) imaging as MR imaging offers excellent target identification and allows for continuous monitoring of FUS induced temperature changes. As the dimensions of the ultrasound (US) focus are typically much smaller than the targeted volume, multiple sonications and focus repositioning are interleaved to scan the focus over the target volume. Focal scanning can be achieved electronically by using phased-array US transducers or mechanically by using dedicated mechanical actuators. In this study, the authors propose and evaluate the precision of a combined robotic FUS setup to overcome some of the limitations of the existing MRgFUS systems. Such systems are typically integrated into the patient table of the MR scanner and thus only provide an application of the US wave within a limited spatial range from below the patient. Methods: The fully MR-compatible robotic assistance system InnoMotion™ (InnoMedic GmbH, Herxheim, Germany) was originally designed for MR-guided interventions with needles. It offers five pneumatically driven degrees of freedom and can be moved over a wide range within the bore of the magnet. In this work, the robotic system was combined with a fixed-focus US transducer (frequency: 1.7 MHz; focal length: 68 mm, and numerical aperture: 0.44) that was integrated into a dedicated, in-house developed treatment unit for FUS application. A series of MR-guided focal scanning procedures was performed in a polyacrylamide-egg white gel phantom to assess the positioning accuracy of the combined FUS setup. In animal experiments with a 3-month-old domestic pig, the system’s potential and suitability for MRgFUS was tested. Results: In phantom experiments, a total targeting precision of about 3 mm was found, which is comparable to that of the existing MRgFUS systems. Focus positioning could be performed within a few seconds. During in vivo experiments, a defined pattern of single thermal lesions and a therapeutically relevant confluent thermal lesion could be created. The creation of local tissue necrosis by coagulation was confirmed by post-FUS MR imaging and histological examinations on the treated tissue sample. During all sonications in phantom and in vivo, reliable MR imaging and online MR thermometry could be performed without compromises due to operation of the combined robotic FUS setup. Conclusions: Compared to the existing MRgFUS systems, the combined robotic FUS approach offers a wide range of spatial flexibility so that highly flexible application of the US wave would be possible, for example, to avoid risk structures within the US field. The setup might help to realize new ways of patient access in MRgFUS therapy. The setup is compatible with any closed-bore MR system and does not require an especially designed patient table. [ABSTRACT FROM AUTHOR]

Summary: Bone is the most common site of distant metastases from breast carcinoma. The presence of bone metastases affects a patient''s prognosis, quality of life, and the planning of their treatment. We discuss recent innovations in bone imaging and present algorithms, based on the strengths and weaknesses of each technique, to facilitate the most successful and cost-effective choice of imaging studies for the detection of osseous metastases. Skeletal scintigraphy (bone scan) is very sensitive in the detection of osseous metastases and is recommended as the first imaging study in patients who are asymptomatic. Radiographs are recommended for the assessment of abnormal radionuclide uptake or the risk of pathological fracture and as initial imaging studies in patients with bone pain. MRI or PET–CT can be considered for cases of abnormal radionuclide uptake that are not addressed by radiography. Osseous metastases can lead to emergent situations, such as spinal-cord compression or impending fracture of a weight-bearing bone, and imaging guidelines are essential for early detection and initiation of appropriate therapy. The imaging method used in non-emergent situations, such as assessment of the ribs, sternum, pelvis, hips, and joints, should be guided by the strengths and limitations of each technique. [Copyright &y& Elsevier]

Laser induced thermal therapy combined with the wavelength dependent optical absorption and heating power of gold-coated silica nanoshells can achieve therapeutic heating localized to a tumor volume. Accurate modeling of the spatiotemperal thermal distribution associated with this heating is essential for accurate thermal therapy treatment planning. The optical diffusion approximation (ODA), used in numerous applications of laser fluence in biology, is compared to the delta P1 optical approximation in phantoms containing different concentrations of nanoshells for several laser powers. Results are compared with temperature maps generated by magnetic resonance temperature imaging techniques and show that the delta P1 approximation is more effective than ODA at modeling the thermal distribution. The discrepancy between the two is especially prominent in phantoms with higher nanoshell concentrations where ODA was shown to give unsatisfactory results. [ABSTRACT FROM AUTHOR]

The authors investigated the performance of the iterative Steiglitz–McBride (SM) algorithm on an autoregressive moving average (ARMA) model of signals from a fast, sparsely sampled, multiecho, chemical shift imaging (CSI) acquisition using simulation, phantom, ex vivo, and in vivo experiments with a focus on its potential usage in magnetic resonance (MR)-guided interventions. The ARMA signal model facilitated a rapid calculation of the chemical shift, apparent spin-spin relaxation time (T2*), and complex amplitudes of a multipeak system from a limited number of echoes (≤16). Numerical simulations of one- and two-peak systems were used to assess the accuracy and uncertainty in the calculated spectral parameters as a function of acquisition and tissue parameters. The measured uncertainties from simulation were compared to the theoretical Cramer–Rao lower bound (CRLB) for the acquisition. Measurements made in phantoms were used to validate the T2* estimates and to validate uncertainty estimates made from the CRLB. We demonstrated application to real-time MR-guided interventions ex vivo by using the technique to monitor a percutaneous ethanol injection into a bovine liver and in vivo to monitor a laser-induced thermal therapy treatment in a canine brain. Simulation results showed that the chemical shift and amplitude uncertainties reached their respective CRLB at a signal-to-noise ratio (SNR)≥5 for echo train lengths (ETLs)≥4 using a fixed echo spacing of 3.3 ms. T2* estimates from the signal model possessed higher uncertainties but reached the CRLB at larger SNRs and/or ETLs. Highly accurate estimates for the chemical shift (<0.01 ppm) and amplitude (<1.0%) were obtained with ≥4 echoes and for T2* (<1.0%) with ≥7 echoes. We conclude that, over a reasonable range of SNR, the SM algorithm is a robust estimator of spectral parameters from fast CSI acquisitions that acquire ≤16 echoes for one- and two-peak systems. Preliminary ex vivo and in vivo experiments corroborated the results from simulation experiments and further indicate the potential of this technique for MR-guided interventional procedures with high spatiotemporal resolution ∼1.6×1.6×4 mm3 in ≤5 s. [ABSTRACT FROM AUTHOR]

A fast chemical shift imaging (CSI) technique based on a multiple gradient-recalled acquisition using a small number of echoes with intentional aliasing of the reference lipid peak is studied to determine its feasibility for temperature monitoring. Simulations were implemented to find parameters where the lipid and water peaks can be measured using a Fourier-based peak fitting approach as well as using an innovative autoregressive moving average technique. A phantom consisting of 50% mayonnaise/50% lemon juice was calibrated to temperature and compared to literature values. A porcine kidney was treated ex vivo with an external laser and imaged with the CSI technique with comparisons to temperature readings from a fluoroptic monitoring system and complex phase difference (CPD) calculations. To demonstrate the technique in vivo, a Balb/c mouse with a CT26 xenograft in the subcutaneous lower back was treated using gold-coated, silica-core nanoshells heated with an 808 nm interstitial laser. Compared to standard CPD techniques using a two-dimensional fast spoiled gradient recalled echo, this technique maintains spatiotemporal resolution, has high signal-to-noise ratio and accuracy over a wide range of T2* tissue values, can separate water and lipid signals, and additionally can use the lipid peak, when present, as an internal reference. [ABSTRACT FROM AUTHOR]

Objectives: Complete and reliable infiltration of the entire prostate is important to improve the efficacy of intraprostatic gene therapy, as well as drug delivery. We sought to evaluate the optimal injection scheme and feasibility of magnetic resonance imaging (MRI) using a surrogate solution to assess the distribution of injectate in an orthotopic canine model. Methods: Twelve dogs were anesthetized, and laparotomy was performed. Four dogs in each group were injected with a 1:10 dilution of 1% methylene blue and gadolinium-diethylenetriamine pentaacetic acid using 3, 10, and 20-core injection schemes. The dogs subsequently underwent MRI and then were killed. The prostates were harvested, sectioned, and photographed for methylene blue distribution. The cross-sectional area of the stained pathology and MRI slides was calculated, and correlation studies were performed. Statistical analysis was performed using the paired t test and Pearson’s correlation test. Results: The gadolinium distribution reflected the methylene blue distribution, with a Pearson’s correlation coefficient of 0.97 (P <0.001). The fractional volume distribution in the 3, 10, and 20-core injection schemes was 10.2%, 28.5%, and 30.1%, respectively. The volume of distribution was significantly greater for the 10-core (P = 0.0024) and 20-core (P = 0.0025) injection schemes than for the 3-core scheme. However, no significant difference was found between the 10 and 20-core schemes (P = 0.52). Conclusions: MRI using gadolinium-diethylenetriamine pentaacetic acid is an excellent modality to evaluate the effective volume distribution of injectate in an in vivo orthotopic prostate model. The 10-core injection scheme seemed to be as good as the 20-core scheme in achieving adequate distribution of injectate within the prostate. [Copyright &y& Elsevier]

Abstract: A fast spin echo two-point Dixon (fast 2PD) technique was developed for efficient T2-weighted imaging with uniform water and fat separation. The technique acquires two interleaved fast spin echo images with water and fat in-phase and 180° out-of-phase, respectively, and generates automatically separate water and fat images for each slice. The image reconstruction algorithm uses an improved and robust region-growing scheme for phase correction and achieves consistency in water and fat identification between different slices by exploiting the intrinsic correlation between the complex images from two neighboring slices. To further lower the acquisition time to that of a regular fast spin echo acquisition with a single signal average, we combined the fast 2PD technique with sensitivity encoding (SENSE). Phantom experiments show that the fast 2PD and SENSE are complementary in scan efficiency and signal-to-noise ratio (SNR). In vivo data from scanning of clinical patients demonstrate that T2-weighted imaging with uniform and consistent fat separation, including breath-hold abdominal examinations, can be readily performed with the fast 2PD technique or its combination with SENSE. [Copyright &y& Elsevier]

Radiomics has shown promise in improving models for predicting patient outcomes. However, to maximize the information gain of the radiomics features, especially in larger patient cohorts, the variability in radiomics features owing to differences between scanners and scanning protocols must be accounted for. To this aim, the imaging variability of radiomics feature values was evaluated on 100 computed tomography scanners at 35 clinics by imaging a radiomics phantom using a controlled protocol and the commonly used chest and head protocols of the local clinic. We used a linear mixed-effects model to determine the degree to which the manufacturer and individual scanners contribute to the overall variability. Using a controlled protocol reduced the overall variability by 57% and 52% compared to the local chest and head protocols respectively. The controlled protocol also reduced the relative contribution of the manufacturer to the total variability. For almost all variabilities (manufacturer, scanner, and residual with different preprocesssing), the controlled protocol scans had a significantly smaller variability than the local protocol scans did. For most radiomics features, the imaging variability was small relative to the inter-patient feature variability in non-small cell lung cancer and head and neck squamous cell carcinoma patient cohorts. From this study, we conclude that using controlled scans can reduce the variability in radiomics features, and our results demonstrate the importance of using controlled protocols in prospective radiomics studies. [ABSTRACT FROM AUTHOR]