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Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico, 155, 00161 Rome, Italy

Prof. Dr. Leonardo Pace

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Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy

MRI and PET/MRI in Hematology and Oncology

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Dear Colleagues,

Accurate staging and precise measurement of tumor burden are essential to plan effective therapy of cancer patients. Evaluation of therapeutic changes is equally essential to modify the therapeutic strategy. FDG-PET /CT has become a cornerstone in the staging and restaging of neoplasms, in the evaluation of therapeutic efficacy during or after treatment and in the planning of radiotherapy, proving to be more sensitive than contrast-enhanced CT in the staging of lymphoma and in the diagnosis of diffuse neoplasms.

To date, MRI has been considered only an alternative method for the diagnosis and staging of various hematologic and oncologic diseases especially in younger patients, due to the absence of ionizing radiation, high soft tissue contrast and good spatial resolution. The use of advanced sequences, such as DWI, however, has further improved the diagnostic accuracy of MRI in oncology. The recently developed whole body (WB) MRI technique has significantly increased the diagnostic accuracy of MRI in onco-hematological imaging, providing an excellent total body imaging.

In myeloma only WB-MRI is now recognized as a highly sensitive test for diagnosis and staging. Instead in lymphoma, WB-DWI-MRI merely serves as an alternative technique to FDG-PET/CT, especially in pediatric patients, although its use is increasingly important in adult patients as well. Despite the high sensitivity in the diagnosis and follow up of lymphomas and non-hematologic malignancies, WB DWI MRI is not recommended in current guidelines yet.

PET/MRI is a relatively new hybrid imaging technique, recently introduced into routine clinical practice. Several comparative studies between hybrid PET/CT and PET/MRI imaging techniques recently been performed in relatively small patient populations have provided preliminary satisfactory results in favour of MRI.

The aim of this issue is to discuss the current clinical applications of the up-to-date MRI techniques in oncology and hematology as well as to propose research topics in the field of hematology and oncology.

Prof. Dr. Francesca Maccioni
Prof. Dr. Leonardo Pace
Topic Editors

Keywords

• MRI
• Whole Body MRI
• Diffusion Weighted Imaging
• PET/MRI
• Haematology
• Oncology
• Lymphoma
• Myeloma
• Radiopharmaceuticals
• CNS tumor
• Head & neck tumor
• Liver cancer
• Gynecological cancer
• Musculoskeletal tumor

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Cancers cancers	5.2	7.4	2009	18.2 Days	CHF 2900
Diagnostics diagnostics	3.6	3.6	2011	18.8 Days	CHF 2600
Hemato hemato	-	-	2020	20.1 Days	CHF 1000
Journal of Clinical Medicine jcm	3.9	5.4	2012	19.7 Days	CHF 2600
Tomography tomography	1.9	2.3	2015	23.5 Days	CHF 2400

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Published Papers (9 papers)

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Open AccessReview

Diffusion Weighted Imaging in Neuro-Oncology: Diagnosis, Post-Treatment Changes, and Advanced Sequences—An Updated Review

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Cancers 2023, 15(3), 618; https://doi.org/10.3390/cancers15030618 - 19 Jan 2023

Cited by 3 | Viewed by 2539

Abstract

DWI is an imaging technique commonly used for the assessment of acute ischemia, inflammatory disorders, and CNS neoplasia. It has several benefits since it is a quick, easily replicable sequence that is widely used on many standard scanners. In addition to its normal clinical purpose, DWI offers crucial functional and physiological information regarding brain neoplasia and the surrounding milieu. A narrative review of the literature was conducted based on the PubMed database with the purpose of investigating the potential role of DWI in the neuro-oncology field. A total of 179 articles were included in the study. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Open AccessArticle

Comparison between PSMA PET/CT and MRI for Characterizing Hepatocellular carcinoma: A Real-World Study

Veronica Chi Ken Wong

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Tomography 2023, 9(1), 130-138; https://doi.org/10.3390/tomography9010011 - 13 Jan 2023

Cited by 1 | Viewed by 2234

Abstract

Prostate specific membrane antigen (PSMA) is expressed by hepatocellular carcinoma (HCC). PSMA PET/CT has potential as an imaging agent for the detection of HCC including early diagnosis and monitoring for recurrence following surgical resection. This study aims to compare PSMA PET to standard surveillance imaging in the detection of HCC. Patients with suspected or treated HCC were prospectively recruited from a tertiary hospital outpatient clinic. In addition to routine surveillance imaging as recommended by the multidisciplinary team, a PSMA PET/CT was performed. Imaging and clinical characteristics were compared over a follow-up period of up to 12 months. In a cohort of 19 patients with known HCC or suspected recurrent HCC, PSMA PET/CT had similar efficacy to MRI for the detection of HCC, with a sensitivity of 91% and a specificity of 70% and sensitivity of 87% and a specificity of 73% for PSMA PET/CT and MRI, respectively. PSMA PET/CT had a higher negative predictive value of 90%. In this relatively large single centre study, PSMA is shown to have promising equivalence in performance and its role should be further evaluated in multi-centre prospective trials. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Open AccessArticle

Microenvironmental Factors in Oral Cavity Squamous Cell Carcinoma Undergoing Surgery: Correlation with Diffusion Kurtosis Imaging and Dynamic Contrast-Enhanced MRI

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Cancers 2023, 15(1), 15; https://doi.org/10.3390/cancers15010015 - 20 Dec 2022

Viewed by 959

Abstract

Background: In this prospective study, we hypothesized that magnetic resonance imaging (MRI) may represent not only the tumor but also the microenvironment, reflecting the heterogeneity and microstructural complexity of neoplasms. We investigated the correlation between both diffusion kurtosis imaging (DKI) and dynamic contrast-enhanced (DCE)-MRI with the pathological factors in oral cavity squamous cell carcinomas (OSCCs). Methods: A total of 37 patients with newly diagnosed OSCCs underwent an MR examination on a 3T system. The diffusion coefficient (D), the kurtosis parameter (K), the transfer constants K^trans and K_ep and the volume of extravascular extracellular space v_e were quantified. A histogram-based approach was proposed to investigate the associations between the imaging and the pathological factors based on the histology and immunochemistry. Results: Significant differences in the DCE-MRI and DKI parameters were found in relation to the inflammatory infiltrate, tumor grading, keratinization and desmoplastic reaction. Relevant relationships emerged between tumor-infiltrating lymphocytes (TILs) and DKI, with lower D and higher K values being associated with increased TILs. Conclusion: Although a further investigation is needed, these findings provide a more comprehensive biological characterization of OSCCs and may contribute to a better understanding of DKI-derived parameters, whose biophysical meaning is still not well-defined. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Open AccessArticle

Preoperative Multiparametric Quantitative Magnetic Resonance Imaging Correlates with Prognosis and Recurrence Patterns in Pancreatic Ductal Adenocarcinoma

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Cancers 2022, 14(17), 4243; https://doi.org/10.3390/cancers14174243 - 31 Aug 2022

Viewed by 1159

Abstract

Magnetic resonance imaging (MRI) has been shown to be associated with prognosis in some tumors; however, the correlation in pancreatic ductal adenocarcinoma (PDAC) remains inconclusive. In this retrospective study, we ultimately included 136 patients and analyzed quantitative MRI parameters that are associated with prognosis and recurrence patterns in PDAC using survival analysis and competing risks models; all the patients have been operated on with histopathology and immunohistochemical staining for further evaluation. In intravoxel incoherent motion diffusion-weighted imaging (DWI), we found that pure-diffusion coefficient D value was an independent risk factor for overall survival (OS) (HR: 1.696, 95% CI: 1.003–2.869, p = 0.049) and recurrence-free survival (RFS) (HR: 2.066, 95% CI: 1.252–3.409, p = 0.005). A low D value (≤1.08 × 10⁻³ mm²/s) was significantly associated with a higher risk of local recurrence (SHR: 5.905, 95% CI: 2.107–16.458, p = 0.001). Subgroup analysis revealed that patients with high D and f values had significantly better outcomes with adjuvant chemotherapy. Distant recurrence patients in the high-D value group who received chemotherapy may significantly improve their OS and RFS. It was found that preoperative multiparametric quantitative MRI correlates with prognosis and recurrence patterns in PDAC. Diffusion coefficient D value can be used as a noninvasive biomarker for predicting prognosis and recurrence patterns in PDAC. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Open AccessArticle

Prognostic Value of Hybrid PET/MR Imaging in Patients with Differentiated Thyroid Cancer

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Cancers 2022, 14(12), 2958; https://doi.org/10.3390/cancers14122958 - 15 Jun 2022

Cited by 1 | Viewed by 1391

Abstract

Background: Hybrid positron emission tomography (PET)/magnetic resonance (MR) is an emerging imaging modality with great potential to provide complementary data acquired at the same time, under the same physiological conditions. The aim of this study was to evaluate the prognostic value of hybrid ¹⁸F-fluorodeoxyglucose (FDG) PET/MR in patients with differentiated thyroid cancer (DTC) who underwent total thyroidectomy and radioactive iodine therapy for suspicion of disease relapse. Methods: Between November 2015 and February 2017, 55 patients underwent hybrid ¹⁸F-FDG PET/MR. Assessment of positive MR was made considering all sequences in terms of malignancy based on the morphological T2-weighted features and the presence of restricted diffusivity on diffusion-weighted imaging images and both needed to be positive on the same lesion. Both foci with abnormal ¹⁸F-FDG uptake, which corresponded to tissue abnormalities on the MR, and tracer accumulation, which did not correspond to normal morphological structures, were considered positive. Results: During follow-up (mean 42 ± 27 months), 29 patients (53%) had disease recurrence. In the Cox univariate regression analysis age, serum Tg level ≥ 2 ng/mL, positive short tau inversion recovery (STIR), and positive PET were significant predictors of DTC recurrence. Kaplan–Meier survival analyses showed that patients with Tg ≥ 2 ng/mL had poorer outcomes compared to those with serum Tg level < 2 ng/mL (p < 0.05). Similarly, patients with positive STIR and positive PET had a worst outcome compared to those with negative STIR (p < 0.05) and negative PET (p < 0.005). Survival analysis performed in the subgroup of 36 subjects with Tg level ≥ 2 ng/mL revealed that patients with positive PET had a worst outcome compared to those with negative PET (p < 0.05). Conclusions: Age, serum Tg level ≥ 2 ng/mL, positive STIR, and positive ¹⁸F-FDG PET were significant predictors of DTC recurrence. However, the serum Tg level was the only independent predictor of DTC. Hybrid PET/MR imaging may have the potential to improve the information content of one modality with the other and would offer new opportunities in patients with DTC. Thus, further studies in a larger patient population are needed to understand the additional value of ¹⁸F-FDG PET/MR in patients with DTC. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Open AccessArticle

Added Value of Viscoelasticity for MRI-Based Prediction of Ki-67 Expression of Hepatocellular Carcinoma Using a Deep Learning Combined Radiomics (DLCR) Model

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Cancers 2022, 14(11), 2575; https://doi.org/10.3390/cancers14112575 - 24 May 2022

Cited by 9 | Viewed by 1692

Abstract

This study aimed to explore the added value of viscoelasticity measured by magnetic resonance elastography (MRE) in the prediction of Ki-67 expression in hepatocellular carcinoma (HCC) using a deep learning combined radiomics (DLCR) model. This retrospective study included 108 histopathology-proven HCC patients (93 males; age, 59.6 ± 11.0 years) who underwent preoperative MRI and MR elastography. They were divided into training (n = 87; 61.0 ± 9.8 years) and testing (n = 21; 60.6 ± 10.1 years) cohorts. An independent validation cohort including 43 patients (60.1 ± 11.3 years) was included for testing. A DLCR model was proposed to predict the expression of Ki-67 with cMRI, including T2W, DW, and dynamic contrast enhancement (DCE) images as inputs. The images of the shear wave speed (c-map) and phase angle (φ-map) derived from MRE were also fed into the DLCR model. The Ki-67 expression was classified into low and high groups with a threshold of 20%. Both c and φ values were ranked within the top six features for Ki-67 prediction with random forest selection, which revealed the value of MRE-based viscosity for the assessment of tumor proliferation status in HCC. When comparing the six CNN models, Xception showed the best performance for classifying the Ki-67 expression, with an AUC of 0.80 ± 0.03 (CI: 0.79–0.81) and accuracy of 0.77 ± 0.04 (CI: 0.76–0.78) when cMRI were fed into the model. The model with all modalities (MRE, AFP, and cMRI) as inputs achieved the highest AUC of 0.90 ± 0.03 (CI: 0.89–0.91) in the validation cohort. The same finding was observed in the independent testing cohort, with an AUC of 0.83 ± 0.03 (CI: 0.82–0.84). The shear wave speed and phase angle improved the performance of the DLCR model significantly for Ki-67 prediction, suggesting that MRE-based c and φ-maps can serve as important parameters to assess the tumor proliferation status in HCC. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Open AccessArticle

Evaluation of Temozolomide Treatment for Glioblastoma Using Amide Proton Transfer Imaging and Diffusion MRI

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Cancers 2022, 14(8), 1907; https://doi.org/10.3390/cancers14081907 - 10 Apr 2022

Cited by 2 | Viewed by 1879

Abstract

This study aimed to evaluate tumor changes due to chemotherapy with temozolomide (TMZ) in terms of quantitative values measured by APT imaging and NODDI. We performed TMZ treatment (administered orally by gavage to the TMZ-40 mg and TMZ-60 mg groups) on 7-week-old male Wistar rats with rat glioma C6 implanted in the right brain. T₂WI, APT imaging, diffusion tensor imaging (DTI), and NODDI were performed on days 7 and 14 after implantation using 7T-MRI, and the calculated quantitative values were statistically compared. Then, HE staining was performed on brain tissue at day 7 and day 14 for each group to compare the results with the MR images. TMZ treatment inhibited tumor growth and necrotic area formation. The necrotic areas observed upon hematoxylin and eosin (HE) staining were consistent with the MTR low-signal areas observed upon APT imaging. The intracellular volume fraction (ICVF) map of the NODDI could best show the microstructure of the tumor, and its value could significantly highlight the difference in treatment effects at different TMZ doses. APT imaging and NODDI can be used to detect the microstructural changes caused by TMZ-induced tumor growth inhibition. The ICVF may be useful as a parameter for determining the effect of TMZ. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Open AccessArticle

MRI Evaluation of Complete and Near-Complete Response after Neoadjuvant Therapy in Patients with Locally Advanced Rectal Cancer

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Diagnostics 2022, 12(4), 921; https://doi.org/10.3390/diagnostics12040921 - 07 Apr 2022

Cited by 2 | Viewed by 2003

Abstract

Purpose To evaluate MRI performance in restaging locally advanced rectal cancers (LARC) after neoadjuvant chemoradiotherapy (nCRT) and interobserver agreement in identifying complete response (CR) and near-complete response (nCR). Methods 40 patients with CR and nCR on restaging MRI, surgery and/or endoscopy were enrolled. Two radiologists independently scored the restaging MRI and reported the presence of split scar sign (SSS) and MRI tumor regression grade (mrTRG). Diagnostic accuracy and ROC curves were calculated for single and combined sequences, with inter-reader agreement. Results Diagnostic performance was good for detecting CR and weaker for nCR. T2WI had the highest AUCs among individual sequences. There was a significant positive correlation between SSS and CR, with high Sp (89.5%/73.7%) and PPV (90%/79.2%) for both Readers. Similar accuracy rates were observed for the combination of sequences, with AUCs of 0.828–0.847 for CR and 0.690–0.762 for nCR. Interobserver agreement was strong for SSS, moderate for T2WI, weak for the combination of sequences. Conclusions Restaging MRI had good diagnostic performance in identifying CR and nCR. SSS had high Sp and PPV in diagnosing CR, with a strong level of interobserver agreement. T2WI with DWI was the optimal combination of sequences for selecting good responders. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Open AccessReview

The Utility of Conventional Amino Acid PET Radiotracers in the Evaluation of Glioma Recurrence also in Comparison with MRI

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Diagnostics 2022, 12(4), 844; https://doi.org/10.3390/diagnostics12040844 - 29 Mar 2022

Cited by 8 | Viewed by 2541

Abstract

Aim: In this comprehensive review we present an update on the most relevant studies evaluating the utility of amino acid PET radiotracers for the evaluation of glioma recurrence as compared to magnetic resonance imaging (MRI). Methods: A literature search extended until June 2020 on the PubMed/MEDLINE literature database was conducted using the terms “high-grade glioma”, “glioblastoma”, “brain tumors”, “positron emission tomography”, “PET”, “amino acid PET”, “[¹¹C]methyl-l-methionine”, “[¹⁸F]fluoroethyl-tyrosine”, “[¹⁸F]fluoro-l-dihydroxy-phenylalanine”, “MET”, “FET”, “DOPA”, “magnetic resonance imaging”, “MRI”, “advanced MRI”, “magnetic resonance spectroscopy”, “perfusion-weighted imaging”, “diffusion-weighted imaging”, “MRS”, “PWI”, “DWI”, “hybrid PET/MR”, “glioma recurrence”, “pseudoprogression”, “PSP”, “treatment-related change”, and “radiation necrosis” alone and in combination. Only original articles edited in English and about humans with at least 10 patients were included. Results: Forty-four articles were finally selected. Conventional amino acid PET tracers were demonstrated to be reliable diagnostic techniques in differentiating tumor recurrence thanks to their high uptake from tumor tissue and low background in normal grey matter, giving additional and early information to standard modalities. Among them, MET–PET seems to present the highest diagnostic value but its use is limited to on-site cyclotron facilities. [¹⁸F]labelled amino acids, such as FDOPA and FET, were developed to provide a more suitable PET tracer for routine clinical applications, and demonstrated similar diagnostic performance. When compared to the gold standard MRI, amino acid PET provides complementary and comparable information to standard modalities and seems to represent an essential tool in the differentiation between tumor recurrence and other entities such as pseudoprogression, radiation necrosis, and pseudoresponse. Conclusions: Despite the introduction of new advanced imaging techniques, the diagnosis of glioma recurrence remains challenging. In this scenario, the growing knowledge about imaging techniques and analysis, such as the combined PET/MRI and the application of artificial intelligence (AI) and machine learning (ML), could represent promising tools to face this difficult and debated clinical issue. Full article

(This article belongs to the Topic MRI and PET/MRI in Hematology and Oncology)

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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: FDG-PET/MRI in Differentiate Thyroid Cancer
Authors: Michele Klain¹; Carmela Nappi¹; Emanuele Nicolai²; Rosj Galicchio³; Valeria Romeo¹; Cavaliere Carlo²; Leandra Piscopo¹; Teresa Pellegrino³; Fabio Volpe¹; Giovanni Storto³; Marco Salvatore²; Alberto Cuocolo¹; Leonardo Pace⁴
Affiliation: 1 Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli;
2 IRCCS-SDN, Napoli;
3 Medicina Nucleare, IRCCS-CROB, Rionero in Vulture
4 Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitan
Abstract: We investigated the prognostic power of PET/MRI in differentiated thyroid cancer. All patients included in the study underwent FDG-PET/MRI within follow-up after radionuclide iodine-131 therapy to detect recurrence. PET and MRI variables were considered either separate or combined. Survival analysis was performed by univariate Cox proportional hazard regression analysis and event-free survival curves were obtained by Kaplan-Meier method and compared with the log-rank test. Our results showed that among all variables included in the analysis, including those derived from imaging as well as the clinical and haematological ones, serum thyroglobulin and positive FDG-PET/MR are predictors of thyroid cancer recurrence.

Title: PSMA PET/MR vs PET/CT: impact on lesion detection, interpretation and clinical management
Authors: Bendik Skarre Abrahamsen; Mattijs Elschot
Affiliation: Department of Circulation and Medical Imaging, NTNU—Norwegian University of Science and Technology, 7030 Trondheim, Norway
Abstract: Not available

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Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Cancers cancers	5.2	7.4	2009	18.2 Days	CHF 2900
Diagnostics diagnostics	3.6	3.6	2011	18.8 Days	CHF 2600
Hemato hemato	-	-	2020	20.1 Days	CHF 1000
Journal of Clinical Medicine jcm	3.9	5.4	2012	19.7 Days	CHF 2600
Tomography tomography	1.9	2.3	2015	23.5 Days	CHF 2400

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