Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Emergency Imaging of At-Risk Patients: General Principles

Introduction Emergency departments (EDs) comprise a major source of medical care for patients in the United States, accounting for approximately 47.7% of the total number of medical care contacts. In 2018, there were over 143 million ED visits, of which over 123 million ended in release. Patients seek care in the ED for a variety of reasons, including having limited access to other appropriate health care…

Diffusion-Weighted Imaging (DWI) for Breast Lesion Characterization: The Olea Medical Perspective and the Utilization of Olea Sphere Software

The Importance of Postprocessing and Data Analysis for Breast Diffusion Weighted Imaging The role of magnetic resonance imaging (MRI) in breast cancer diagnosis and management is evolving as a supplemental screening tool for high-risk populations. Nowadays, a myriad of magnetic resonance (MR) sequences is applicable to breast imaging, with common protocol consisting in T1-weighted contrast-enhanced and T2-weighted imaging. Dynamic contrast-enhanced (DCE) MRI is highly sensitive, improving…

Breast DWI Techniques and Processing: The Philips Perspective

Data Acquisition Essential Elements of Calibration (B 0 And B 1 ) Most breast diffusion scans are performed with fat suppression and an echo-planar imaging (EPI) readout. Both these elements have optimal performance with uniform B 0 (magnet) and B 1 (radiofrequency) fields. Homogeneity of these fields heavily depends on the patient body habitus and positioning of the breasts with respect to the magnet and the…

Routine and Advanced Breast DWI Techniques and Processing: The Siemens Healthineers Per spective

As discussed in detail in earlier chapters of this book, diffusion-weighted imaging (DWI) is a powerful tool in the multiparametric assessment of breast lesions with magnetic reconace imaging (MRI) and can provide decisive information for initial detection and classification of lesions, for treatment selection, and for monitoring the efficacy of treatments and follow-up. Whereas dynamic contrast-enhanced MRI studies allow to study tissue vascularity and provide high…

Multiplatform Standardization of Breast DWI Protocols: Quality Control and Test Objects

Overview of Breast Diffusion-Weighted Imaging Standardization Efforts Given the rapid advances in diffusion-weighted imaging (DWI) technology and the multiple parameters influencing quality of breast DWI acquisition and analysis, harmonization of breast DWI protocols necessitates coherent standardization efforts by physicians, researchers, and MR vendors. These standardization efforts will likely include trade-offs between practicality and diagnostic yield. Rationale and Need for Standardization for Clinical Translation Clinical translation of…

Clinical Interpretation of Diffusion MRI, ROI Assessment, Common Errors, Pitfalls and Artifacts, Challenges in Acquisition

Diffusion-weighted imaging (DWI) is an magnetic resonance imaging (MRI) technique where the mobility of water molecules diffusing in tissue contributes to the image contrast. Sensitivity to diffusion is achieved by adding a pair of symmetrical diffusion sensitizing gradients to a spin-echo sequence. The amount of diffusion weighting is determined by the b value, which is controlled by the strength and timings of the gradients. In a…

High-Resolution Diffusion-Weighted Breast MRI Acquisition

Diffusion-weighted imaging (DWI) is a promising approach for breast magnetic resonance imaging (MRI), both as a way to complement or to replace contrast-enhanced MRI. DWI measures diffusive motion, which is quantified by diffusivity, D , often measured in mm 2 Assuming a Gaussian diffusion model, the measured parameter is called the apparent diffusion coefficient (ADC). DWI uses diffusion gradients to selectively attenuate the signal of…

Diffusion-Weighted Whole Body Imaging With Background Body Signal Suppression (DWIBS)

Basic Concept of Diffusion-Weighted Whole Body Imaging With Background Body Signal Suppression (DWIBS) Since the 1990s, diffusion-weighted imaging (DWI) has revolutionized the diagnosis of acute cerebral infarction, making it possible for patients to receive thrombolytic agents in emergency situations and escape death or severe chronic invalidity. This life-saving potential prompted manufacturers to rapidly incorporate diffusion magnetic resonance imaging (MRI) into their commercial products. On the other…

Artificial Intelligence—Enhanced Breast MRI and DWI: Current Status and Future Applications

Background Personalized medicine is yielding increasingly precise treatment and prevention strategies for groups of individuals based on their genetic makeup, environment, and lifestyle, as enabled by approaches including genomics, transcriptomics, proteomics, metabolomics, and so forth. In oncology, the goal of using such approaches is to increasingly harness individual-level information versus population-level or traditional clinical information (e.g., tumor stage, age, gender) to select the most successful cancer…

Diffusion Tensor Imaging (DTI) of the Breast

Diffusion tensor imaging (DTI) is a widely applied quantitative magnetic resonance imaging (MRI) approach to characterize tissue microstructure throughout the body. In addition to quantifying the amount of water diffusion hindrance by tissue, DTI also captures the orientational bias (anisotropy) caused by a microstructural environment with a preferred direction. Although the initial application of DTI largely occurred in the axonal nerve bundles of the brain, a…

IVIM and Non-Gaussian DWI of the Breast

Intravoxel Incoherent Motion and Non-Gaussian Diffusion-Weighted Imaging: Introduction The role of breast magnetic resonance imaging (MRI) has expanded into many clinical applications, including differentiation between benign and malignant breast lesions, preoperative staging, evaluation of high-risk patients, and implant assessment. For breast diffusion-weighted imaging (DWI), as described in the previous chapters, apparent diffusion coefficient (ADC) has been well investigated for differentiating malignant and benign breast tumors, although…

DWI and Breast Physiology Status

The normal breast tissue undergoes marked alterations in size, shape, and function in response to the onset of puberty, pregnancy, lactation, and menopause. Both endogenous (early menarche, older age at first pregnancy, and nulliparity) and exogenous (use of hormonal replacement therapy) hormonal exposures are associated with these physiological states and were identified as risk factors for developing breast cancer. Therefore recognizing the unique imaging manifestations in…

Diffusion MRI as a Stand-Alone Unenhanced Approach for Breast Imaging and Screening

List of Abbreviations ADC apparent diffusion coefficient BI-RADS Breast Imaging Reporting and Data System BPS background parenchymal signal DCE dynamic contrast-enhanced DCIS ductal carcinoma in situ DWIST Diffusion-Weighted Magnetic Resonance Imaging Screening Trial DW MRI diffusion-weighted MRI EPI echo-planar imaging MIP maximum intensity projection Although dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is highly sensitive and endorsed by multinational organizations as a supplemental screening tool for…

Disease and Treatment Monitoring

Preoperative, or neoadjuvant chemotherapy (NAC), in which systemic therapy is administered before surgery, is used to downstage primary breast cancers while reducing the risk of recurrence. NAC often results in complete eradication of tumor at the time of surgery (pathological complete response [pCR]), and it is well established that pCR confers excellent survival outcomes. The US Food and Drug Administration (FDA) now accepts pCR as an…

Biomarkers, Prognosis, and Prediction Factors

Breast cancer is a heterogeneous group of neoplasms originating from the epithelial cells lining the milk ducts. This heterogeneity has been observed in histology for a long time and formed the backbone of the traditional pathology-driven classification of breast cancer. Multiple studies have shown that this heterogeneity in the histopathologic features of breast cancer was associated with clinical outcomes. More recently, the pathology-driven classification has been…

Overview of Breast DWI: Diagnosis of Suspicious Lesions Using DWI in Combination With Standard MRI

The Need for Reducing Unnecessary Biopsies in Breast MRI Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the breast—referred to as standard breast MRI throughout this chapter—is considered the most sensitive test for diagnosis of malignant breast lesions. Standard breast MRI relies on highlighting tumor vasculature by means of intravenously applied gadolinium (Gd)-based contrast media. Because (biologically active) cancers require nutrients, a complex cascade of cytokines…

Conventional Breast Imaging

Before the development of mammography, the detection of abnormalities in the breast was largely based on visual inspection and palpation. This has dramatically changed in the last half of the 20th century. The successive development of mammography, ultrasound, and breast magnetic resonance imaging (MRI) has made imaging of the breast indispensable. Moreover, the development of image-guided needle biopsy has virtually obviated the need for surgery of…

General Principles and Challenges of Diffusion MRI

The concept of diffusion magnetic resonance imaging (MRI) emerged in the mid-1980s, together with the first images of water molecular diffusion in the human brain, as a way to probe tissue structure. Since then, diffusion MRI has become a pillar of modern clinical imaging. Diffusion MRI is both a method and a powerful concept, because diffusing water molecules provide unique information on the tissue microscopic architecture.…