Diffusion-weighted imaging or MR spectroscopy: Which to use for the assessment of the response to chemotherapy in breast cancer patients?

Background Diffusion-weighted MRI (DWI) and MR spectroscopy (MRS) both are noninvasive MR sequences that could be used as a reliable tool to assess the functional behavior of the breast cancer. The aim of the study was to assess the value of DWI and MRS in predicting the early response to neo-adjuvant chemotherapy (NAC) and absence of residual disease after treatment. Results One hundred thirty-three patients diagnosed with breast cancer and scheduled for NAC were enrolled in this study. All lesions were subjected to qualitative and quantitative analysis of DCE-MRI, DWI and MRS, where the lesions size, kinetic parameters, ADC values and MRS choline peak were recorded before the start of NAC and after completion of chemotherapy. The results of each MRI modality were correlated with the findings that were found at the pathology report of the complete surgical specimen. The sensitivity and specificity of the MR modalities to predict pathological complete remission post-NAC were 73.68% and 83.33%, respectively, using the kinetic curve pattern, 78.95% and 83.33%, respectively, using the ADC value and finally 78.95% and 91.67%, respectively, using the MRS choline peak. Similar sensitivity (89.47%) to predict pathological complete remission was presented by the ADC value and the MRS choline peak together when compared to the ADC value and dynamic curve patterns. Conclusion DWI and MRS are valuable MRI techniques and their accuracy in detecting residual disease is almost similar to that of DCE MRI. The inclusion of these sequences in the imaging protocol of NAC candidates improve monitoring of the response to treatment and allow early distinction between complete, partial and non-responders' cases in breast cancer patients.

The Value of Monomer Hydrogen Proton Magnetic Resonance Spectra in the Diagnosis of Liver Benign and Malignant Lesions

The early diagnosis and treatment of liver disease are very important in clinics. Magnetic resonance spectroscopy (MRS) provides a non-invasive 'window' on the biochemical processes in the body. This study deployed research based on application of monomer element 1HMRS in the diagnosis of benign or malignant liver lesions. Patients with different liver diseases were recruited along with healthy controls. GE Signa Twinspeed 1.5T MRI was performed on livers along with monomeric hydrogen MRS, followed by SAGE software analysis. In healthy patient's livers, both choline and lipid peaks were observed under MRS, with occasionally glutamine and glutamic acid complex (Glx) peak and glucogen and glucose complex (Glu) peak. Malignant liver lesions had significantly elevated choline peak and choline/lipid ratio compared to control or benign lesions (P < 0.05). The accuracy, sensitivity and specificity of MRI against malignant tumors were 89.4%, 86.2% and 91.1%, respectively. These figures for choline/lipid and MRI plus choline/lipid were 87.2%, 92.3% and 90.1%, and 94.1%, 89.1% and 90.4%, respectively. Our study shows that monomeric hydrogen proton MRS might be used as the diagnostic evidences for malignant liver diseases, especially for choline peak level and choline/lipid ratio. However, large cohort multi-center study is required to confirm the findings in the future.

Role of Magnetic Resonance Spectroscopy in the Evaluation of Ring Enhancing Lesions of the Brain

Introduction: The ring enhancing lesions of the brain are a challenging group of lesions with the variable possibilities of diagnosis under conventional Magnetic Resonance Imaging (MRI). Employing advanced techniques such as Magnetic Resonance Spectroscopy (MRS) could increase the success rates of the diagnosis. Aim: To assess the role of MRS in evaluating varying ring enhancing lesions of the brain. Materials and Methods: This prospective observational study involved 50 patients aged between 3-82 years who were detected with ring enhancing lesions of the brain on contrast MR studies. The patients underwent MRS evaluation. Categorical data was represented as frequency (%). The metabolite peaks of choline, lipid, lactate, N-Acetyl Aspartate (NAA), succinate and amino acids were recorded. The choline/creatine ratio was calculated and associated with the type of lesion the patients exhibited. Results: Among the 50 patients screened, the most prevalent pathologies were tuberculoma (36%) and neurocysticercosis (22%). While the patients diagnosed with tuberculoma presented with higher peak level of lipids and choline/creatine ratio of >1-2. Increased lactate, succinate, choline peak concomitant with no or insignificant lipid peak, were noted in the cases of neurocysticercosis. Primary brain tumour showed high choline peaks and elevated choline/creatine ratio (>2). Metastasis showed increased choline peak. Cerebral abscess showed increased amino acids and lactate peak. Conclusion: The diagnosis of varying ring enhancing lesions of the brain was accurately investigated by MRS. This accuracy enables delineating a treatment plan void of any dilemma.

Proton MR spectroscopy in characterization of focal bone lesions of peripheral skeleton

Background The aim of our study was to determine the value of single-voxel proton MR spectroscopy (1HMRS) in distinguishing benign from malignant focal bone lesions in the peripheral skeleton. MRI and 1HMRS was performed in 50 focal lesions (> 1 cm size) detected on radiographs of peripheral skeleton.1HMRS was performed at 1.5 T with TE of 144 ms with automatic shimming and water suppression. Qualitative analysis for a discrete choline peak at 3.2 ppm was done. Significance of the presence of choline peak on 1HMRS in distinguishing benign from malignant lesions was calculated using histopathology as a gold standard. Chi-square test was used and p value < 0.05 was considered significant. Results Forty-one benign and 9 malignant lesions were confirmed by histopathological results. Amongst malignant lesions, choline peak was positive in all but 1 case of low-grade lymphoma. MR spectra of 11 benign lesions showed the presence of choline peak. All 7 benign giant cell tumors (GCT) were positive for choline peak. The sensitivity, specificity, PPV, NPV of proton MR spectroscopy in differentiating benign from malignant lesions were 87.5%,71%,38.8%, and 96.4% respectively. p value was significant (< 0.05). Conclusion 1HMRS in focal bone lesions can help in the differentiation of malignant from benign musculoskeletal tumors. Although some benign lesions may show false-positive result, absence of choline peak is a reliable reassurance against malignancy. GCT is an exception amongst benign bone tumors as it consistently shows the presence of choline peak on 1HMRS.

Advanced MRI Techniques in the Evaluation of Complex Cystic Breast Lesions

Objective The purpose of this research work was to evaluate complex cystic breast lesions by advanced MRI techniques and correlating imaging with histologic findings. Methods and Materials In a cross-sectional design from September 2013 to August 2015, 50 patients having sonographically detected complex cystic lesions of the breast were included in the study. Morphological characteristics were assessed. Dynamic contrast-enhanced MRI along with diffusion-weighted imaging and MR spectroscopy were used to further classify lesions into benign and malignant categories. All the findings were correlated with histopathology. Results Of the 50 complex cystic lesions, 32 proved to be benign and 18 were malignant on histopathology. MRI features of heterogeneous enhancement on CE-MRI (13/18), Type III kinetic curve (13/18), reduced apparent diffusion coefficient (18/18), and tall choline peak (17/18) were strong predictors of malignancy. Thirteen of the 18 lesions showed a combination of Type III curve, reduced apparent diffusion coefficient value, and tall choline peak. Conclusions Advanced MRI techniques like dynamic imaging, diffusion-weighted sequences, and MR spectroscopy provide a high level of diagnostic confidence in the characterization of complex cystic breast lesion, thus allowing early diagnosis and significantly reducing patient morbidity and mortality. From our study, lesions showing heterogeneous contrast enhancement, Type III kinetic curve, diffusion restriction, and tall choline peak were significantly associated with malignant complex cystic lesions of the breast.

Resveratrol Is Active against Leishmania amazonensis:In VitroEffect of Its Association with Amphotericin B

ABSTRACTResveratrol is a polyphenol found in black grapes and red wine and has many biological activities. In this study, we evaluated the effect of resveratrol alone and in association with amphotericin B (AMB) againstLeishmania amazonensis. Our results demonstrate that resveratrol possesses both antipromastigote and antiamastigote effects, with 50% inhibitory concentrations (IC50s) of 27 and 42 μM, respectively. The association of resveratrol with AMB showed synergy forL. amazonensisamastigotes, as demonstrated by the mean sums of fractional inhibitory index concentration (mean ΣFIC) of 0.483, although for promastigotes, this association was indifferent. Treatment with resveratrol increased the percentage of promastigotes in the sub-G0/G1phase of the cell cycle, reduced the mitochondrial potential, and showed an elevated choline peak and CH2-to-CH3ratio in the nuclear magnetic resonance (NMR) spectroscopy analysis; all these features indicate parasite death. Resveratrol also decreased the activity of the enzyme arginase in uninfected and infected macrophages with and without stimulation with interleukin-4 (IL-4), also implicating arginase inhibition in parasite death. The anti-Leishmaniaeffect of resveratrol and its potential synergistic association with AMB indicate that these compounds should be subjected to further studies of drug association therapyin vivo.

The key role of correlation between MR spectroscopy choline peak and calcium sensing receptor for breast cancer: Diagnosis by a 3T MR scanner.

e22132 Background: The Ca2+-sensing receptor (CaSR) regulates the Ca2+ signaling and its expression is present in both normal and malignant breast tissues. Recently, we demonstrated in a pre-clinical setting the CaSR expression in breast cancer mouse model by manganese enhanced MRI (Baio G et al. Eur Rad 2011). Alteration in choline phospholipid metabolism as detected by MRI, is a common feature of breast and many other cancer cells or tumors. Since CaSR-ChoK signaling plays an important role in breast cancer, we compared the MRS (MR spectroscopy) choline peak by a 3T MR scanner between calcium sensing receptor positive and negative breast cancers. Methods: Breast MRI of 16 consecutive patients with breast lesions were performed by a 3T MR and MRS findings were defined as positive by the visual inspection for the presence or the absence of choline peak. MRS imaging were compared with histologic findings and the pattern of CaSR by immunohistochemistry. The immunohistochemical results were qualitatively classified according to intensity and pattern of the staining, using a 6-point scale to score the intensity of the CaSR expression (0, absent; 5, intense, widespread expression). Results: A choline peak was present in 10 of 15 malignant lesions and the CaSR expression was between 3 to 5 score at immunohistochemestry analysis (p<.0006). In 4 of 15 malignant lesions the choline peak was absent or not consistent at the visual analysis with a CaSR patterns of 1-2. In one benign lesion (papillary hyperplasia), the choline peak was consistent and the CaSR pattern was with score 3. Conclusions: In this study we evaluated if MRS presence or absence of choline peak well correlated with CaSR positive and negative breast cancers. We observed a choline peak with an high level expression of CaSR (score 3-5) in 67% of the breast lesions, while in 27% of the lesions the choline peak was absent with a low CaSR expression (score 1-2). These preliminary results support the hypothesis that CaSR represents an important role in the production of choline in breast cancer, determining an increase of his production when CaSR is expressed at high level and implicating and absence of choline peak when CaSR is not expressed.