Synopsis

Keywords: Contrast mechanisms: Elastography, Image acquisition: Quantification, Cross-organ: Tissue characterisation

A common task in diagnostic imaging is to assess the response of disease to therapy. MRI is inherently quantitative, providing access to many powerful biomarkers for characterizing tissue. Yet, few quantitative imaging techniques have been widely adopted in clinical practice, other than simply obtaining and recording measurements of the spatial dimensions of focal lesions (such as RECIST criteria). This presentation will review emerging evidence for several applications of MR elastography as a quantitative biomarker in cancer management. Lessons learned in gaining clinical adoption of MRE as an accepted surrogate for treatment response in chronic liver disease will be described.

A common task in diagnostic imaging is to assess the response of focal and diffuse disease processes to therapy. MRI is inherently a quantitative technology, providing access to many powerful biomarkers for characterizing tissue. Yet, few quantitative imaging techniques have been widely adopted in clinical practice, other than simply obtaining and recording measurements of the spatial dimensions of focal lesions (such as RECIST criteria).

For centuries, physicians have used a physical examination technique known as palpation as important diagnostic tool. Many cancers of the breast, thyroid, and prostate are still first detected by simple touch. Magnetic resonance elastography (MRE) is a technology for imaging the mechanical properties of tissue. The most common MRE-based biomarker currently in clinical use is a measurement of the magnitude of the complex shear modulus, a quantity that corresponds closely to the “stiffness” of tissue assessed with palpation. MRE provides access to other unique biomarkers, such as the metrics of the viscous properties of tissue, interstitial pressure, and microscopic mechanical heterogeneity, with relevance to noninvasively characterizing pathologic processes such as malignancy, inflammation, and fibrosis.

Extensive published evidence has established MRE as an accurate noninvasive quantitative method for detecting and staging liver fibrosis and for assessing treatment response or disease progression. Barely a decade after becoming available, MRE is now widely deployed and used for assessing chronic liver disease quantitively at more than 2500 locations globally. MRE has shown promise for several unique applications in cancer, however the potential value of MRE methods in assessing response to treatment of malignancies is largely unexplored to date.

After briefly assessing emerging evidence for several applications of MRE as a quantitative biomarker in cancer management, this presentation will review the lessons learned in the deployment of MRE as a quantitative tool that has been widely adopted for managing liver disease. The presentation will examine the surprisingly complex and difficult process in gaining clinical adoption of a quantitative MRI biomarker as an accepted surrogate for treatment response.

Acknowledgements

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References

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