Feasibility of Velocity-Selective Arterial Spin Labeling in Breast Cancer Patients for Noncontrast-Enhanced Perfusion Imaging

Suzanne L Franklin; Nora Voormolen; Isabell K Bones; Tijmen Korteweg; Martin N J M Wasser; Henrike G Dankers; Daniele Cohen; Marijn van Stralen; Clemens Bos; Matthias J P van Osch

doi:10.1002/jmri.27781

Feasibility of Velocity-Selective Arterial Spin Labeling in Breast Cancer Patients for Noncontrast-Enhanced Perfusion Imaging

Suzanne L Franklin, Nora Voormolen, Isabell K Bones, Tijmen Korteweg, Martin N J M Wasser, Henrike G Dankers, Daniele Cohen, Marijn van Stralen, Clemens Bos, Matthias J P van Osch

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Dynamic contrast-enhanced (DCE) MRI is the most sensitive method for detection of breast cancer. However, due to high costs and retention of intravenously injected gadolinium-based contrast agent, screening with DCE-MRI is only recommended for patients who are at high risk for developing breast cancer. Thus, a noncontrast-enhanced alternative to DCE is desirable.

PURPOSE: To investigate whether velocity selective arterial spin labeling (VS-ASL) can be used to identify increased perfusion and vascularity within breast lesions compared to surrounding tissue.

STUDY TYPE: Prospective.

POPULATION: Eight breast cancer patients.

FIELD STRENGTH/SEQUENCE: A 3 T; VS-ASL with multislice single-shot gradient-echo echo-planar-imaging readout.

ASSESSMENT: VS-ASL scans were independently assessed by three radiologists, with 3-25 years of experience in breast radiology. Scans were scored on lesion visibility and artifacts, based on a 3-point Likert scale. A score of 1 corresponded to "lesions being distinguishable from background" (lesion visibility), and "no or few artifacts visible, artifacts can be distinguished from blood signal" (artifact score). A distinction was made between mass and nonmass lesions (based on BI-RADS lexicon), as assessed in the standard clinical exam.

STATISTICAL TESTS: Intra-class correlation coefficient (ICC) for interobserver agreement.

RESULTS: The ICC was 0.77 for lesion visibility and 0.84 for the artifact score. Overall, mass lesions had a mean score of 1.27 on lesion visibility and 1.53 on the artifact score. Nonmass lesions had a mean score of 2.11 on lesion visibility and 2.11 on the artifact score.

DATA CONCLUSION: We have demonstrated the technical feasibility of bilateral whole-breast perfusion imaging using VS-ASL in breast cancer patients.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

Original language	English
Pages (from-to)	1282-1291
Number of pages	10
Journal	Journal of Magnetic Resonance Imaging
Volume	54
Issue number	4
DOIs	https://doi.org/10.1002/jmri.27781
Publication status	Published - Oct 2021

Keywords

arterial spin labeling
ASL
breast cancer
DCE-MRI
noncontrast enhanced
screening

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Franklin, S. L., Voormolen, N., Bones, I. K., Korteweg, T., Wasser, M. N. J. M., Dankers, H. G., Cohen, D., van Stralen, M., Bos, C., & van Osch, M. J. P. (2021). Feasibility of Velocity-Selective Arterial Spin Labeling in Breast Cancer Patients for Noncontrast-Enhanced Perfusion Imaging. Journal of Magnetic Resonance Imaging, 54(4), 1282-1291. https://doi.org/10.1002/jmri.27781

@article{34119612b80f49a38fcf56199da11e49,

title = "Feasibility of Velocity-Selective Arterial Spin Labeling in Breast Cancer Patients for Noncontrast-Enhanced Perfusion Imaging",

abstract = "BACKGROUND: Dynamic contrast-enhanced (DCE) MRI is the most sensitive method for detection of breast cancer. However, due to high costs and retention of intravenously injected gadolinium-based contrast agent, screening with DCE-MRI is only recommended for patients who are at high risk for developing breast cancer. Thus, a noncontrast-enhanced alternative to DCE is desirable.PURPOSE: To investigate whether velocity selective arterial spin labeling (VS-ASL) can be used to identify increased perfusion and vascularity within breast lesions compared to surrounding tissue.STUDY TYPE: Prospective.POPULATION: Eight breast cancer patients.FIELD STRENGTH/SEQUENCE: A 3 T; VS-ASL with multislice single-shot gradient-echo echo-planar-imaging readout.ASSESSMENT: VS-ASL scans were independently assessed by three radiologists, with 3-25 years of experience in breast radiology. Scans were scored on lesion visibility and artifacts, based on a 3-point Likert scale. A score of 1 corresponded to {"}lesions being distinguishable from background{"} (lesion visibility), and {"}no or few artifacts visible, artifacts can be distinguished from blood signal{"} (artifact score). A distinction was made between mass and nonmass lesions (based on BI-RADS lexicon), as assessed in the standard clinical exam.STATISTICAL TESTS: Intra-class correlation coefficient (ICC) for interobserver agreement.RESULTS: The ICC was 0.77 for lesion visibility and 0.84 for the artifact score. Overall, mass lesions had a mean score of 1.27 on lesion visibility and 1.53 on the artifact score. Nonmass lesions had a mean score of 2.11 on lesion visibility and 2.11 on the artifact score.DATA CONCLUSION: We have demonstrated the technical feasibility of bilateral whole-breast perfusion imaging using VS-ASL in breast cancer patients.EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.",

keywords = "arterial spin labeling, ASL, breast cancer, DCE-MRI, noncontrast enhanced, screening",

author = "Franklin, {Suzanne L} and Nora Voormolen and Bones, {Isabell K} and Tijmen Korteweg and Wasser, {Martin N J M} and Dankers, {Henrike G} and Daniele Cohen and {van Stralen}, Marijn and Clemens Bos and {van Osch}, {Matthias J P}",

note = "Funding Information: The authors thank MeVis Medical Solutions AG (Bremen, Germany) for providing MeVisLab medical image processing and visualization environment, which was used for image analysis. The authors thank E. M. M. Krol‐Warmerdam, J. van Leeuwen‐Bϋttner, and G.M.C. Ranke for their valuable help in recruitments of patients. This work is part of the research program Drag and Drop ASL with project number 14951, which is (partly) financed by the Netherlands Organization for Scientific Research (NWO). Funding Information: The authors thank MeVis Medical Solutions AG (Bremen, Germany) for providing MeVisLab medical image processing and visualization environment, which was used for image analysis. The authors thank E. M. M. Krol-Warmerdam, J. van Leeuwen-Bϋttner, and G.M.C. Ranke for their valuable help in recruitments of patients. This work is part of the research program Drag and Drop ASL with project number 14951, which is (partly) financed by the Netherlands Organization for Scientific Research (NWO). Publisher Copyright: {\textcopyright} 2021 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC. on behalf of International Society for Magnetic Resonance in Medicine.",

year = "2021",

month = oct,

doi = "10.1002/jmri.27781",

language = "English",

volume = "54",

pages = "1282--1291",

journal = "Journal of Magnetic Resonance Imaging",

issn = "1053-1807",

publisher = "John Wiley & Sons Inc.",

number = "4",

}

TY - JOUR

T1 - Feasibility of Velocity-Selective Arterial Spin Labeling in Breast Cancer Patients for Noncontrast-Enhanced Perfusion Imaging

AU - Franklin, Suzanne L

AU - Voormolen, Nora

AU - Bones, Isabell K

AU - Korteweg, Tijmen

AU - Wasser, Martin N J M

AU - Dankers, Henrike G

AU - Cohen, Daniele

AU - van Stralen, Marijn

AU - Bos, Clemens

AU - van Osch, Matthias J P

N1 - Funding Information: The authors thank MeVis Medical Solutions AG (Bremen, Germany) for providing MeVisLab medical image processing and visualization environment, which was used for image analysis. The authors thank E. M. M. Krol‐Warmerdam, J. van Leeuwen‐Bϋttner, and G.M.C. Ranke for their valuable help in recruitments of patients. This work is part of the research program Drag and Drop ASL with project number 14951, which is (partly) financed by the Netherlands Organization for Scientific Research (NWO). Funding Information: The authors thank MeVis Medical Solutions AG (Bremen, Germany) for providing MeVisLab medical image processing and visualization environment, which was used for image analysis. The authors thank E. M. M. Krol-Warmerdam, J. van Leeuwen-Bϋttner, and G.M.C. Ranke for their valuable help in recruitments of patients. This work is part of the research program Drag and Drop ASL with project number 14951, which is (partly) financed by the Netherlands Organization for Scientific Research (NWO). Publisher Copyright: © 2021 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC. on behalf of International Society for Magnetic Resonance in Medicine.

PY - 2021/10

Y1 - 2021/10

N2 - BACKGROUND: Dynamic contrast-enhanced (DCE) MRI is the most sensitive method for detection of breast cancer. However, due to high costs and retention of intravenously injected gadolinium-based contrast agent, screening with DCE-MRI is only recommended for patients who are at high risk for developing breast cancer. Thus, a noncontrast-enhanced alternative to DCE is desirable.PURPOSE: To investigate whether velocity selective arterial spin labeling (VS-ASL) can be used to identify increased perfusion and vascularity within breast lesions compared to surrounding tissue.STUDY TYPE: Prospective.POPULATION: Eight breast cancer patients.FIELD STRENGTH/SEQUENCE: A 3 T; VS-ASL with multislice single-shot gradient-echo echo-planar-imaging readout.ASSESSMENT: VS-ASL scans were independently assessed by three radiologists, with 3-25 years of experience in breast radiology. Scans were scored on lesion visibility and artifacts, based on a 3-point Likert scale. A score of 1 corresponded to "lesions being distinguishable from background" (lesion visibility), and "no or few artifacts visible, artifacts can be distinguished from blood signal" (artifact score). A distinction was made between mass and nonmass lesions (based on BI-RADS lexicon), as assessed in the standard clinical exam.STATISTICAL TESTS: Intra-class correlation coefficient (ICC) for interobserver agreement.RESULTS: The ICC was 0.77 for lesion visibility and 0.84 for the artifact score. Overall, mass lesions had a mean score of 1.27 on lesion visibility and 1.53 on the artifact score. Nonmass lesions had a mean score of 2.11 on lesion visibility and 2.11 on the artifact score.DATA CONCLUSION: We have demonstrated the technical feasibility of bilateral whole-breast perfusion imaging using VS-ASL in breast cancer patients.EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

AB - BACKGROUND: Dynamic contrast-enhanced (DCE) MRI is the most sensitive method for detection of breast cancer. However, due to high costs and retention of intravenously injected gadolinium-based contrast agent, screening with DCE-MRI is only recommended for patients who are at high risk for developing breast cancer. Thus, a noncontrast-enhanced alternative to DCE is desirable.PURPOSE: To investigate whether velocity selective arterial spin labeling (VS-ASL) can be used to identify increased perfusion and vascularity within breast lesions compared to surrounding tissue.STUDY TYPE: Prospective.POPULATION: Eight breast cancer patients.FIELD STRENGTH/SEQUENCE: A 3 T; VS-ASL with multislice single-shot gradient-echo echo-planar-imaging readout.ASSESSMENT: VS-ASL scans were independently assessed by three radiologists, with 3-25 years of experience in breast radiology. Scans were scored on lesion visibility and artifacts, based on a 3-point Likert scale. A score of 1 corresponded to "lesions being distinguishable from background" (lesion visibility), and "no or few artifacts visible, artifacts can be distinguished from blood signal" (artifact score). A distinction was made between mass and nonmass lesions (based on BI-RADS lexicon), as assessed in the standard clinical exam.STATISTICAL TESTS: Intra-class correlation coefficient (ICC) for interobserver agreement.RESULTS: The ICC was 0.77 for lesion visibility and 0.84 for the artifact score. Overall, mass lesions had a mean score of 1.27 on lesion visibility and 1.53 on the artifact score. Nonmass lesions had a mean score of 2.11 on lesion visibility and 2.11 on the artifact score.DATA CONCLUSION: We have demonstrated the technical feasibility of bilateral whole-breast perfusion imaging using VS-ASL in breast cancer patients.EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

KW - arterial spin labeling

KW - ASL

KW - breast cancer

KW - DCE-MRI

KW - noncontrast enhanced

KW - screening

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U2 - 10.1002/jmri.27781

DO - 10.1002/jmri.27781

M3 - Article

C2 - 34121250

SN - 1053-1807

VL - 54

SP - 1282

EP - 1291

JO - Journal of Magnetic Resonance Imaging

JF - Journal of Magnetic Resonance Imaging

IS - 4

ER -

Feasibility of Velocity-Selective Arterial Spin Labeling in Breast Cancer Patients for Noncontrast-Enhanced Perfusion Imaging

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