Elevated tissue sodium concentration in malignant breast lesions detected with non-invasive 23Na MRI

Abstract Background and Aims The development of sodium-23 magnetic resonance imaging (23Na MRI) allows the clinical quantification of tissue sodium. Recent studies have shown that hemodialysis (HD) patients have a tendency to retain tissue sodium due to impaired mechanisms in local tissue sodium clearance. However, the clinical significance of tissue sodium deposition in the HD patient population is unclear yet. The aim of this study was to investigate the association of tissue sodium deposition with well-established biomarkers of clinical outcomes. Method Chronic, thrice weekly HD patients underwent 23Na MRI of the leg on a non-dialysis day, during either the long or short interdialytic interval. Blood samples were also taken for the measurement of standard blood-based biomarkers. A multinuclear-capable 3.0-T MRI (GE Healthcare, Milwaukee WI) was used to acquire proton and sodium images. Maps of tissue 23Na concentration were generated using an in-house software developed within MATLAB (Mathworks, Natick, USA, R2018a). 23Na concentration maps were superimposed with the proton-anatomy images to delineate the regions of interest. Using the Horos (The Horos Project, Version 4.0.0) software, the soleus muscle was segmented (Figure, Panel A) and the sodium concentration in the region of interest was recorded for analysis. Results 28 HD patients completed both 23Na MRI and bloodwork; 7/28 (25%) patients were females; mean±SD age was 66.1±8.3 years, mean body mass index was 30.9±6.5 kg/m2, and mean HD vintage was 30.2±34.9 months. Soleus muscle sodium concentration showed a strong, negative correlation with serum albumin (Figure, Panel B; r=-0.66, p<0.0001). Furthermore, soleus muscle sodium concentration showed a minor association with plasma hemoglobin (r=-0.46, p=0.01). Conclusion Serum albumin is a recognized, powerful predictor of mortality in the hemodialysis patient population. The strong relationship between muscle sodium concentration and serum albumin levels suggests that tissue sodium deposition may be a relevant biomarker of clinical outcomes. In addition, muscle sodium deposition may be involved in the development of anemia. These findings warrant further studies investigating the consequences of sodium removal on these biomarkers.

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Tissue Sodium Concentration within White Matter Correlates with the Extent of Small Vessel Disease

Cerebrovascular Diseases ◽

10.1159/000514133 ◽

2021 ◽

pp. 1-9

Author(s):

Anne Adlung ◽

Melina Samartzi ◽

Lothar R. Schad ◽

Eva Neumaier-Probst ◽

Marc Fatar ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Small Vessel Disease ◽

Sodium Concentration ◽

Small Vessel ◽

Vessel Disease ◽

Significant Difference ◽

Tissue Sodium ◽

23Na Mri

Introduction: Sodium MRI (23Na MRI) derived biomarkers such as tissue sodium concentration (TSC) provide valuable information on cell function and brain tissue viability and has become a reliable tool for the assessment of brain tumors and ischemic stroke beyond pathoanatomical morphology. Patients with major stroke often suffer from different degrees of underlying white matter lesions (WMLs) attributed to chronic small vessel disease. This study aimed to evaluate the WM TSC in patients with an acute ischemic stroke and to correlate the TSC with the extent of small vessel disease. Furthermore, the reliability of relative TSC (rTSC) compared to absolute TSC in these patients was analyzed. Methodology: We prospectively examined 62 patients with acute ischemic stroke (73 ± 13 years) between November 2016 and August 2019 from which 18 patients were excluded and thus 44 patients were evaluated. A 3D 23Na MRI was acquired in addition to a T2-TIRM and a diffusion-weighted image. Coregistration and segmentation were performed with SPM 12 based on the T2-TIRM image. The extension of WM T2 hyperintense lesions in each patient was classified using the Fazekas scale of WMLs. The absolute TSC in the WM region was correlated to the Fazekas grades. The stroke region was manually segmented on the coregistered absolute diffusion coefficient image and absolute, and rTSC was calculated in the stroke region and compared to nonischemic WM region. Statistical significance was evaluated using the Student t-test. Results: For patients with Fazekas grade I (n = 25, age: 68.5 ± 15.1 years), mean TSC in WM was 55.57 ± 7.43 mM, and it was not statistically significant different from patients with Fazekas grade II (n = 7, age: 77.9 ± 6.4 years) with a mean TSC in WM of 53.9 ± 6.4 mM, p = 0.58. For patients with Fazekas grade III (n = 9, age: 81.4 ± 7.9 years), mean TSC in WM was 68.7 ± 10.5 mM, which is statistically significantly higher than the TSC in patients with Fazekas grade I and II (p < 0.001 and p = 0.05, respectively). There was a positive correlation between the TSC in WM and the Fazekas grade with r = 0.48 p < 0.001. The rTSC in the stroke region was statistically significant difference between low (0 and I) and high (2 and 3) Fazekas grades (p = 0.0353) whereas there was no statistically significant difference in absolute TSC in the stroke region between low (0 and I) and high (2 and 3) Fazekas grades. Conclusion: The significant difference in absolute TSC in WM in patients with severe small vessel disease; Fazekas grade 3 can lead to inaccuracies using rTSC quantification for evaluation of acute ischemic stroke using 23 Na MRI. The study, therefore, emphasizes the importance of absolute tissue sodium quantification.

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201Tl Scintigraphy in the Evaluation of Palpable and Nonpalpable Breast Lesions: Correlation with Mammography and Ultrasonography

Nuklearmedizin ◽

10.1055/s-0038-1629848 ◽

1997 ◽

Vol 36 (08) ◽

pp. 282-288 ◽

Cited By ~ 8

Author(s):

T. Atasever ◽

A. Özdemir ◽

I. Öznur ◽

N. I. Karabacak ◽

N. Gökçora ◽

...

Keyword(s):

Final Diagnosis ◽

Lower Sensitivity ◽

Breast Lesions ◽

Breast Cancers ◽

Combined Use ◽

Malignant Breast ◽

Malignant Lesions ◽

Benign Breast Lesions ◽

Palpable Breast ◽

Metastatic Sites

Summary Aim: Our goal was to determine the clinical usefulness of TI-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings. Methods: TI-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of TI-201. Visual and semiquantitative interpretation was performed. Results: Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. TI-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by TI-201 scintigraphy. The smallest mass lesion detected by TI-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. TI-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed TI-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated TI-201. TI-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by TI-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 ± 0.38 (mean ± SD) and 1.48 ± 0.32 (p >0.05), 1.87 ± 0.65 and 1.34 ± 0.20 (p<0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p>0.05). Conclusion: Overall, TI-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of TI-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

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