In vivo lymph node CEST-Dixon MRI in breast cancer patients with metastatic lymph node involvement

Manus J Donahue; Paula M C Donahue; R Sky Jones; Maria Garza; Chelsea Lee; Niral J Patel; Andrea Cooper; Jill B De Vis; Ingrid Meszoely; Rachelle Crescenzi

doi:10.1002/mrm.29858

In vivo lymph node CEST-Dixon MRI in breast cancer patients with metastatic lymph node involvement

Magn Reson Med. 2024 Feb;91(2):670-680. doi: 10.1002/mrm.29858. Epub 2023 Sep 8.

Authors

Manus J Donahue^{1

2}, Paula M C Donahue^{3

4}, R Sky Jones¹, Maria Garza^{1

5}, Chelsea Lee⁶, Niral J Patel⁶, Andrea Cooper⁷, Jill B De Vis⁸, Ingrid Meszoely⁹, Rachelle Crescenzi^{5

10}

Affiliations

¹ Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵ Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Department of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁷ Nashville Breast Center, Nashville, Tennessee, USA.
⁸ Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁹ Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁰ Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.

PMID: 37684712
DOI: 10.1002/mrm.29858

Abstract

Purpose: Axillary lymph nodes (LNs) often present a reservoir for metastatic breast cancer, yet metastatic LN involvement cannot be discerned definitively using diagnostic imaging. This study investigated whether in vivo CEST may discriminate LNs with versus without metastatic involvement.

Methods: 3T MRI was performed in patients with breast cancer before clinically-indicated mastectomy or lumpectomy with LN removal, after which LN metastasic involvement was determined using histological evaluation. Non-contrast anatomical imaging, as well as B₀ and B₁ field maps, were acquired in sequence with three-point CEST-Dixon (3D turbo-gradient-echo; factor = 25; TR/TE1/ΔTE = 851/1.35/1.1 ms; spatial-resolution = 2.5 × 2.5 × 6 mm; slices = 10; four sinc-gauss pulses with duty-cycle = 0.5, total saturation duration = 701.7 ms; B₁ = 1.5 μT; saturation offsets = -5.5 to +5.5 ppm; stepsize = 0.2 ppm; scan duration = 6 min 30 s). The mean z-spectrum from LNs with (n = 20) versus without (n = 22) metastatic involvement were analyzed and a Wilcoxon rank-sum test (significance: p < 0.05) was applied to evaluate differences in B_0, B₁ , and magnetization transfer ratio (MTR) in differing spectral regions of known proton exchange (nuclear Overhauser effect [NOE], amide, amine, and hydroxyl) between cohorts.

Results: No difference in axillary B₁ (p = 0.634) or B₀ (p = 0.689) was observed between cohorts. Elevated MTR was observed for the NOE (-1.7 ppm; MTR = 0.285 ± 0.075 vs. 0.248 ± 0.039; p = 0.048), amine (+2.5 ppm; MTR = 0.284 ± 0.067 vs. 0.234 ± 0.31; p = 0.005), and hydroxyl (+1 ppm; MTR = 0.394 ± 0.075 vs. 0.329 ± 0.055; p = 0.002) protons in LNs from participants with versus without metastatic involvement.

Conclusions: Findings are consistent with a unique metastatic LN microenvironment detectable by CEST-Dixon and suggest that CEST MRI may have potential for mapping LN metastasis non-invasively in vivo.

Keywords: CEST; Dixon; MRI; breast cancer; lymph node; lymphedema; metastasis.

MeSH terms

Amines
Breast / diagnostic imaging
Breast Neoplasms* / diagnostic imaging
Female
Humans
Lymphoma*
Magnetic Resonance Imaging / methods
Mastectomy
Protons
Tumor Microenvironment

Substances

Protons
Amines

Grants and funding

R01 NR015079/NR/NINR NIH HHS/United States