Prateek Kalra1, Arunark Kolipaka, PhD1, Jeffrey R. Hawley, MD1, and Brian Raterman1
1Radiology, Ohio State University Wexner Medical Center, Columbus, OH, United States
Synopsis
Magnetic resonance
elastography (MRE) is a non-invasive technique to estimate stiffness of soft
tissues and has been applied in the breast. However, none of the earlier
studies have extensively tested MRE to induce vibrations in the breast using a
soft sternum driver at higher field strength and its repeatability of stiffness
measurements. The aim of the study is to estimate breast stiffness using MRE by
inducing vibrations using a soft sternum driver in normal volunteers at 3T and
to determine the reproducibility of stiffness measurements. Preliminary results show that the MRE-derived stiffness values are
reproducible in normal volunteers at 3T and can be further extended to detect
breast tumors in patients. Purpose
Palpation is a basic technique used to detect breast tumors, but it is subjective and qualitative. Mammography on the other hand can provide discomfort to subjects and has poor sensitivity and specificity in detecting tumors in dense breasts [1-3]. Dynamic contrast enhanced MRI has been currently used to detect cancerous tumors; however, it involves injection of contrast agent. Magnetic resonance elastography (MRE), a non-invasive technique to estimate stiffness of soft tissues and has been applied in the breast [4,5]. However, none of the earlier studies have extensively tested MRE to induce vibrations in the breast using a soft sternum driver at higher field strength and its repeatability of stiffness measurements. The aim of the study is to estimate breast stiffness using MRE by inducing vibrations using a soft sternum driver in normal volunteers at 3T and to determine the reproducibility of stiffness measurements.
Methods
All imaging was performed using
a 3T MRI scanner (Skyra, Siemens Healthcare, Germany). Written
informed consent was obtained from all volunteers (n=19, women aged: 24-63yrs).
Axial slices were obtained using a gradient echo (GRE) MRE sequence. Experimental
set up with patient lying on the breast coil face down is shown in figure 1. 60Hz vibrations were introduced through a soft sternum driver that sits on the
MRI breast coil as shown in figure 2. Imaging parameters included: FOV=320x320mm2,
matrix size=256x256, slice thickness=5mm, number of slices=5, MRE phase offsets=4.
Motion encoding gradient of 60Hz was applied separately in the x, y and z
directions to encode in-plane and through plane displacement fields. For
reproducibility study, after the first scan each volunteer was asked to step
out of scanner and repositioned for a repeat scan within 5 minutes while all
the imaging parameters remained the same as first scan. MRE images were masked to
obtain the breast and a curl processing was performed to remove longitudinal
component of motion. Additionally, directional filter was applied to remove the
reflected waves. Finally, 3D local frequency estimation was performed to obtain
weighted stiffness map using MRE-Lab (Mayo Clinic, Rochester, MN).
Results
Figure 3 displays the short-axis magnitude image (a) in one
of the volunteers, and snapshot of one of the time points of wave propagation
in three spatial directions (b-d) and the corresponding 3D weighted stiffness
map (e). Figure 4 shows mean stiffness values of two repeat scans (scan 1 and scan 2) from the center slice in all the volunteers. Mean stiffness of the
breast across all 19 normal volunteers was found to be 0.88±0.12 kPa. Figure 5
shows the correlation plot of mean stiffness between scan 1 and scan 2 demonstrating a good correlation with R2=0.82.
Discussion
Preliminary results demonstrate that MRE of the breast is
reproducible at higher field strength using a soft sternum driver. This driver
demonstrated better wave penetration without the need of contacting the breast.
Furthermore, the soft pad (i.e. sternum driver) provided no discomfort to the
subjects. Currently, more studies are further warranted for its applicability
in diagnosing breast tumors.
Conclusion
MRE can be used to estimate
the stiffness of breast tissue with good reproducibility at higher field
strength and vibrations are introduced using a soft sternum driver without any
discomfort to the subjects.
Acknowledgements
Funded by
NIH R01HL124096. References
[1] Bird, R. E., Wallace, T. W., & Yankaskas,
B. C. (1992). Analysis of cancers missed at screening mammography. Radiology, 184(3), 613-617.
[2] Harvey, Jennifer A., Laurie L. Fajardo, and Connie A. Innis.
"Previous mammograms in patients with impalpable breast carcinoma:
retrospective vs blinded interpretation. 1993 ARRS President's Award." AJR. American journal of
roentgenology 161.6 (1993):
1167-1172.
[3] Weinreb, J. C., & Newstead, G. (1995). MR
imaging of the breast. Radiology,196(3),
593-610.
[4] McKnight, Alexia L., et al. "MR elastography of breast
cancer: preliminary results." American
journal of roentgenology 178.6
(2002): 1411-1417.
[5] Sinkus, Ralph, et al. "Viscoelastic shear
properties of in vivo breast lesions measured by MR elastography." Magnetic resonance imaging 23.2 (2005): 159-165.