We would like to thank Mr. Nachum Stern and Ms. Fanny Attar for their excellent technical assistance. H.D. holds the Fred and Andrea Fallek Chair for Breast Cancer Research.

<html>注：所有的协议获得批准由梅尔医学中心，卡法萨巴，以色列内部审查委员会和签署知情同意从所有受试者获得。 1.患者准备和定位，在MRI扫描仪<ol><li>插入静脉导管在左或右手臂为造影剂注射。 </li><li>确保患者躺在用两个乳房的乳房线圈的双边开口自由悬挂俯卧这表现在图5中。 </li><li>确保所述头部被定位在枕患者的头部和颈部的舒适性和两个臂被置于头部上方这表现在图5中。 </li><li>确保每个乳房在中央位置，下垂松弛和深深的各线圈开口内尽可能表现出如图5所示 。 </li></ol>Ë5“SRC =”/文件/ ftp_upload / 52048 / 52048fig5highres.jpg“/&gt; 图5：一个女人的乳房MRI扫描定位。注意俯卧位置和自由悬挂两个乳房的乳房线圈的双侧开口。 <ol start="5"><li>连接自动注射泵向静脉内导管。 </li></ol> 2. MRI扫描<ol><li>与MRI扫描器获得的导频图像用于定位两个乳房和确定的视角（FOV）领域，切片和切片厚度的编号，以完全覆盖两个乳房与延伸到腋窝和胸壁。 </li><li>在所有与MRI扫描器执行以下扫描序列，保持在FOV，切片数目和层厚为每种情况下的相同的值。例如，获得60以360毫米的读取和相位方向视场，切片厚度范围介于2至3毫米，这取决于乳房的大小，和相位编码方向L的轴向切片2;&gt; R 2或R &gt;&gt; L。因人而异的面内分辨率取决于用于每个序列的采集矩阵尺寸以下序列如表1所示。 </li></ol><table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td>实验参数</td><td> 2D T2加权</td><td> 2D DTI </td><td> 2D GE字段映射</td><td> 3D DCE </td></tr><tr><td>重复时间（TR）毫秒</td><td> 5500 </td><td> 10800 </td><td> 669 </td><td> 6.8 </td></tr><tr><td>回波时间（TE）毫秒</td><td> 122 </td><td> 120 </td><td> 4.92 </td><td> 2.49 </td></tr><tr><td>的TE（2） </td><td></td><td></td><td> 7.38 </td><td></td></tr><tr><td>翻转角，度</td><td></td><td></td><td> 60 </td><td> 18 </td></tr><tr><td>采集矩阵</td><td> 640×428 </td><td> 192×192 </td><td> 64×192 </TD&gt; <td> 428 X 428 </td></tr><tr><td>平均</td><td> 1 </td><td> 1 </td><td> 1 </td><td> 1 </td></tr><tr><td>串联</td><td> 4 </td><td> 1 </td><td> 1 </td><td> 1 </td></tr><tr><td>涡轮因素</td><td> 21 </td><td></td><td></td><td></td></tr><tr><td>每片列车数量</td><td> 11 </td><td></td><td></td><td></td></tr><tr><td>回波间隔，毫秒</td><td> 10 </td><td> 0.79 </td><td></td><td></td></tr><tr><td>带宽，赫兹/像素</td><td> 300 </td><td> 1860 </td><td> 1532 </td><td> 560 </td></tr><tr><td>在平面扫描分辨率</td><td> 0.56 X 0.84 </td><td> 1.9×1.9 </td><td></td><td> 0.8×0.8 </td></tr><tr><td>在平面图像分辨率</td><td> 0.56 X 0.56 </td><td> 1.9×1.9 </td><td> 1.9×1.9 </td><td> 0.8×0.8 </td></tr><tr><td>采集时间，分：秒</td><td> 4:26 </td><td> 6：09 </td><td> 1:28 </td><td> 1:06（X9） </td></tr><tr><td> ＃扩散梯度</td><td></td><td>三十</td><td></td><td></td></tr><tr><td>脂肪抑制</td><td>没有</td><td> FAT-SAT / SPAIR 1 </td><td></td><td>没有</td></tr><tr><td> b值，秒/毫米2 </td><td></td><td> 0，700 </td><td></td><td></td></tr></tbody></table> 表1：本研究中使用的序列的实验参数 1的FAT-SAT：脂肪饱和。 SPAIR：频谱衰减反转恢复。 <ol start="3"><li>与MRI扫描器的用户接口计算机定位，其包括两个乳房和腋下的区域，并且限定了匀场框。应用迭代垫补战略，以优化磁场29。 <ol><li>显示质子谱的用户界面的计算机的屏幕上，并且由围绕吨的频率调整匀场他水共振频率，然后对脂肪的共振频率。重复匀场，直到它最好分开脂肪和水的信号，并作为优化透露，在质子谱最大信号强度和形状。验证该照射频率为中心的水的共振频率。 </li></ol></li><li>使用广义自动校准部分并行采集（格拉巴）通过用户界面计算机的2D横向T2加权快速自旋回波多片序列适用于高空间分辨率不饱和脂肪，有加速因子2.修正了会弹出参数根据它们在表1中“2D T2加权”的列值在屏幕上。 </li><li>通过用户界面计算机应用的2D横向，脂肪抑制，自旋回波弥散张量成像-使用DTI两次重新调整平面回波成像序列30，使用格拉巴，与加速因子2.修正参数这将根据它们在表1中的栏“2D DTI”值弹出在屏幕上。 </li><li>通过用户接口计算机应用一个字段映射序列用于校正回波平面成像（EPI）几何扭曲，并且所描述的Jezzard和巴拉班31获得相位微分的图像。确保该序列包括采集的2D横向梯度回波（GE）的图像具有两个同相不同回波时间，并且该相位编码方向是一样的，在DTI序列（ 步骤2.5）。固定，这将根据它们在表1中的栏“2D GE字段映射”值弹出屏幕上的参数。 </li><li>通过用户接口计算机应用动态对比增强协议使用3D快速梯度回波序列，而不脂肪抑制，利用根据这三个时间点（3TP）方法32优化参数。修复参数将根据其在表1中的栏“3D DCE”值弹出在屏幕上。 <ol><li>根据在步骤2.7协议记录两个初始扫图像。 </li></ol></li><li>注入15秒第二预造影采集造影剂gadopentetatedimeglumine结束之前，在0.1毫摩尔/公斤体重的剂量，使用自动泵以2毫升/秒的速率，随后加20ml生理盐水冲洗，以2毫升/秒。 <ol><li>继续录制7序列3D数据集，根据在54，120，186，252，318，384，450秒后注射造影剂协议步骤2.7。 </li></ol></li><li>通过用户接口计算机二维横向申请T2加权脂肪抑制快速自旋回波的多片序列在使用GRAPPA高空间分辨率，以加速因子2.用实验细节类似于那些用于T2加权成像在步骤2.4中所述</s仲&gt;。 注：时间过程总结在MRI协议的步骤在图6中提供。 </li></ol><img alt="图6" src="/files/ftp_upload/52048/52048fig6highres.jpg" /> 图6：临床MRI方案的时间过程。 3.图像处理<ol><li>转移由所有的扫描序列得到的整个数据集（在步骤2.4中所述- 2.9）到远程工作站或个人计算机，并处理与专门用于分析乳腺扩散张量成像和DCE-MRI的软件程序的图像的整个数据集。 <ol><li>在这里，执行下面用C ++编写的自制软件是通过使用MATLAB 19的编程环境中验证所描述的步骤。在一般情况下，商业扫描器提供的图像处理工具，大脑可以适于乳房，但DTI实验可能没有全部由我们的自制软件应用的处理功能</li></ol></li><li>执行使用以下在图7中的流程图中的步骤的专用DTI图像处理软件的DTI数据集的图像处理。 </li></ol><img alt="图7" src="/files/ftp_upload/52048/52048fig7highres.jpg" /> 图7：参与DTI处理的步骤的流程图 。 <ol style="margin-left: 40px;"><li>使用DTI软件程序来评估乳房以外的噪声水平和在感兴趣的3至4个区域（大约为1 平方厘米）的其余组织，并找到最大噪声级。 </li><li>使用DTI软件程序来计算像素的像素，在上述的最大噪声级并在每个切片60的所有像素，六个扩散系数，D XX，D- YY，D-ZZ，D XY，D XZ，D- YZ，对称张量D中描述下面33的（ 见图8） <img alt="式（1）" fo:content-width="2in" src="/files/ftp_upload/52048/52048eq1.jpg" /> 其中D XY = D YX，D ZY = D YZ，D ZX = D XZ。 <ol><li>为了计算的张量分量使用基于所述Stejskal-坦纳方程的非线性回归拟合程序：硅，J（B）的Si =（0）EXP（-BD），其中的Si，J（b）是信号像素i相在方向j和硅一扩散梯度的强度（0）是相同的像素中的B = 0 mm 2的·s的信号的强度。该嵌合最小化的30非线性函数的平方和在每个扩散梯度方向6扩散张量可变部分由Levenberg-Marquardt算法34。这一步的修改是由自由软件cminpack执行（ <a href="http://devernay.free.fr/hacks/cminpack/index.html" target="_blank">http://devernay.free.fr/hacks/cminpack/index.html</a> ）。 </li></ol></li></ol><img alt="图8" src="/files/ftp_upload/52048/52048fig8highres.jpg" /> 图8：的计算步骤得到所述对称扩散张量示意图。 <ol start="3" style="margin-left: 40px;"><li>使用该软件的DTI通过施加主成分分析（PCA）35对角化每个像素中的对称弥散张量。 注：PCA是一种常用的方法，以减少数据的维数，并找到了相关的像素参数映射到不相关和正交轴的一个新的坐标系的线性变换。该公关ocess产量为每个像素3的特征向量（ν1，ν2，ν3），定义为椭圆形，与组织的扩散帧一致的三个正交轴，以及相应的3扩散特征值的扩散方向，布置从高低，即确定三个定向扩散系数（λ1，λ2，λ3）（ 见图9和10）。 </li></ol><img alt="图9" src="/files/ftp_upload/52048/52048fig9highres.jpg" /> 图9：的计算步骤得到的特征向量与所述组织和所述扩散帧建模到椭球重合示意图。 <img alt="图10" src="/files/ftp_upload/52048/52048fig10highres.jpg" /> 图10：Schemat的该计算在正常导管组织和癌组织中扩散的特征向量和特征值的主要处理步骤的IC绘制。 <ol start="4" style="margin-left: 40px;"><li>使用DTI软件程序来计算定义为三个特征值&lt;λ&gt; =（λ1 +λ2 +λ3）/ 3的平均每个像素的表观扩散系数（ADC）。 </li><li>使用DTI软件程序来计算为每个像素定义为差的最大绝对值各向异性指数（λ1 - λ3）。 </li><li>使用DTI软件程序来计算每个像素的分数各向异性（FA）索引，根据下列公式的范围内（在一个方向上自由扩散）在0（各向同性扩散）至1： <img alt="公式2" fo:content-width="3in" src="/files/ftp_upload/52048/52048eq2.jpg" width="300" /></li><li>使用DTI软件程序DISPLAY上的像素在整个两个乳房的矢量地图显示的主要特征向量的方向，ν1，并用三色表示ν1的主方向和覆盖它们的同一个T2加权图像的彩色编码映射每个切片的像素切片（ 图9）。使用免费软件GTK（进行这一步<a href="http://gtk.org" target="_blank">http://gtk.org</a> ）的图形。 </li><li>使用DTI软件程序来构造扩散张量成像参数图，通过像素中的每个切片在整个两个乳房的全部扩散张量的值的参数λ1，λ2，λ3，ADC的显示像素，λ1-λ3，和FA和包裹在相同切片的T2加权图像（ 图11）。 </li></ol><img alt="图11" src="/files/ftp_upload/52048/52048fig11highres.jpg" width="700" /> <str翁&gt;图11：在一个24岁的健康志愿者的乳房中央切片的参数DTI地图输出叠加同片导演的T2加权图像上。 - 红色方向指示图从左至右，绿色指示灯从前到后，绿色指示头脚方向。需要注意的是，在矢量地图的矢量被标记为白线。所有扩散系数和最大各向异性指数是在10 -3毫米2 /秒的单位。 FA是无单位的。在矢量地图的比例尺是指长度为20毫米并且是指在T 2图像中的比例尺为20毫米的长度中的所有剩余图像。 <ol start="3"><li>使用DTI软件程序来纠正，如果需要的话，几何失真通过加载如在步骤2.6中得到的相位差图。移的相位差图的范围在上方的梯度回波图像的噪声电平的所有像素的范围-π到+πrepresenting弧度的相移Δɸ（X，Y，Z）（ 图12）。 <ol><li>使用DTI软件程序来计算根据所述空间转变像素： <img alt="公式3" fo:content-width="1.5in" src="/files/ftp_upload/52048/52048eq3.jpg" width="150" /> ΔTE是两个回波之间的时间差等于2.46×10 -3毫秒和BWP是在实验中的相位带宽等于13.2赫兹/像素。根据现场的地图移位的象素，并重新计算扩散张量的参数（ 图12）。 </li></ol></li></ol><img alt="图12" src="/files/ftp_upload/52048/52048fig12highres.jpg" /> 图12：使用相位差地图几何畸变校正的实施例的图像记录从一个47岁的志愿者与浸润性小叶癌。在左侧的T2加权图像上的第一列和一个片的相位差地图与癌症在左乳房的显示方式。在第二和第三列λ1的地图校正之前被显示在第一行中和校正后λ1的地图被显示在第二行中。在λ1地图叠加相应的T2加权图像上。在第2 次的列的全方位水扩散系数（0.8-3.0）×10 -3毫米2 /秒的用于颜色编码的规模，并在第三列中的减压范围是用来为1.7×10的阈值-3毫米2 /秒，强调癌症在左乳房和正常乳腺组织之间的对比度。在T2的图像的比例尺是指在所有的图像的长度为20毫米。 <ol start="4"><li>执行使用软件，通过增强的动力学参数的象素映射提供的像素的DCE-MRI数据集的图像处理，如3TP图像处理软件17。 </li></ol>

<ol>
	<li>Turnbull, L. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dynamic+contrast-enhanced+MRI+in+the+diagnosis+and+management+of+breast+cancer.">Dynamic contrast-enhanced MRI in the diagnosis and management of breast cancer.</a> NMR Biomed. 22 (1), 28-39 (2009).</li><li>Sardanelli, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+imaging+of+the+breast:+recommendations+from+the+EUSOMA+working+group.">Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group.</a> Eur J Cancer. 46 (8), 1296-1316 (2010).</li><li>Lehman, C. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+and+interpretation+time+of+computer-aided+detection+among+novice+and+experienced+breast+MRI+readers.">Accuracy and interpretation time of computer-aided detection among novice and experienced breast MRI readers.</a> AJR Am J Roentgenol. 200 (6), 683-689 (2013).</li><li>Riedl, C. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+imaging+of+the+breast+improves+detection+of+invasive+cancer,+preinvasive+cancer,+and+premalignant+lesions+during+surveillance+of+women+at+high+risk+for+breast+cancer.">Magnetic resonance imaging of the breast improves detection of invasive cancer, preinvasive cancer, and premalignant lesions during surveillance of women at high risk for breast cancer.</a> Clin Cancer Res. 13 (20), 6144-6152 (2007).</li><li>Heywang-K&#246;brunner, S. H., Hacker, A., Sedlacek, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+imaging:+the+evolution+of+breast+imaging.">Magnetic resonance imaging: the evolution of breast imaging.</a> Breast. 22 (2), 77-82 (2013).</li><li>Peters, N. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Meta-analysis+of+MR+imaging+in+the+diagnosis+of+breast+lesions.">Meta-analysis of MR imaging in the diagnosis of breast lesions.</a> Radiology. 246 (1), 116-124 (2008).</li><li>Warner, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+review:+using+magnetic+resonance+imaging+to+screen+women+at+high+risk+for+breast+cancer.">Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer.</a> Ann Intern Med. 148 (9), 671-679 (2008).</li><li>Benndorf, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breast+MRI+as+an+adjunct+to+mammography:+Does+it+really+suffer+from+low+specificity?+A+retrospective+analysis+stratified+by+mammographic+BI-RADS+classes.">Breast MRI as an adjunct to mammography: Does it really suffer from low specificity? A retrospective analysis stratified by mammographic BI-RADS classes.</a> Acta Radiol. 51 (7), 715-721 (2010).</li><li>Thomassin-Naggara, I., De Bazelaire, C., Chopier, J., Bazot, M., Marsault, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Trop+I+Diffusion-weighted+MR+imaging+of+the+breast:+advantages+and+pitfalls.">Trop I Diffusion-weighted MR imaging of the breast: advantages and pitfalls.</a> Eur J Radiol. 82 (3), 435-443 (2013).</li><li>Bogner, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion-weighted+MR+for+differentiation+of+breast+lesions+at+3.0+T:+how+does+selection+of+diffusion+protocols+affect+diagnosis.">Diffusion-weighted MR for differentiation of breast lesions at 3.0 T: how does selection of diffusion protocols affect diagnosis.</a> Radiology. 253 (2), 341-351 (2009).</li><li>Partridge, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+imaging+of+the+breast:+preliminary+clinical+findings+[abstr].">Diffusion tensor imaging of the breast: preliminary clinical findings [abstr].</a> Proceedings of the Fourteenth Meeting of the International Society for Magnetic Resonance in Medicine. , (2006).</li><li>Partridge, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+MRI:+preliminary+anisotropy+measures+and+mapping+of+breast+tumors.">Diffusion tensor MRI: preliminary anisotropy measures and mapping of breast tumors.</a> J Magn Reson Imaging. 31 (2), 339-347 (2010).</li><li>Partridge, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+magnetic+resonance+imaging+of+the+normal+breast.">Diffusion tensor magnetic resonance imaging of the normal breast.</a> Magn Reson Imaging. 28 (3), 320-328 (2010).</li><li>Baltzer, P. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+magnetic+resonance+imaging+of+the+breast:+a+pilot+study.">Diffusion tensor magnetic resonance imaging of the breast: a pilot study.</a> Eur Radiol. 21 (1), 1-10 (2011).</li><li>Wang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimization+of+the+parameters+for+diffusion+tensor+magnetic+resonance+imaging+data+acquisition+for+breast+fiber+tractography+at+1.5.">Optimization of the parameters for diffusion tensor magnetic resonance imaging data acquisition for breast fiber tractography at 1.5.</a> T. Clin Breast Cancer. 14 (1), 61-67 (2014).</li><li>Eyal, E., Degani, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Method+and+apparatus+for+ductal+tube+tracking+imaging+for+breast+cancer+and+diagnosis+and+product.">Method and apparatus for ductal tube tracking imaging for breast cancer and diagnosis and product.</a> US Patent. , (2008).</li><li>Eyal, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+MRI+method+for+breast+cancer+detection+based+on+diffusion+tensor+tracking+of+the+ductal+trees+[abstr].">Novel MRI method for breast cancer detection based on diffusion tensor tracking of the ductal trees [abstr].</a> , 362 (2010).</li><li>Furman-Haran, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breast+cancer+detection+and+diagnosis+based+on+diffusion+tensor+imaging+[abstr].">Breast cancer detection and diagnosis based on diffusion tensor imaging [abstr].</a> , 515 (2011).</li><li>Eyal, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Parametric+diffusion+tensor+imaging+of+the+breast.">Parametric diffusion tensor imaging of the breast.</a> Invest Radiol. 47 (5), 284-291 (2012).</li><li>Tagliafico, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+magnetic+resonance+imaging+of+the+normal+breast:+reproducibility+of+DTI-derived+fractional+anisotropy+and+apparent+diffusion+coefficient+at+3.0+T.">Diffusion tensor magnetic resonance imaging of the normal breast: reproducibility of DTI-derived fractional anisotropy and apparent diffusion coefficient at 3.0 T.</a> Radiol Med. 117 (6), 992-1003 (2012).</li><li>Cakir, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+the+diagnostic+performances+of+diffusion+parameters+in+diffusion+weighted+imaging+and+diffusion+tensor+imaging+of+breast+lesions.Eur.">Comparison of the diagnostic performances of diffusion parameters in diffusion weighted imaging and diffusion tensor imaging of breast lesions.Eur.</a> J Radiol. 82 (12), e801-e806 (2013).</li><li>Tsougos, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+contribution+of+diffusion+tensor+imaging+and+magnetic+resonance+spectroscopy+for+the+differentiation+of+breast+lesions+at+3T.">The contribution of diffusion tensor imaging and magnetic resonance spectroscopy for the differentiation of breast lesions at 3T.</a> Acta Radiol. 55 (1), 14-23 (2014).</li><li>Wiederer, P. a. z. a. h. r. S., Leo, C., Nanz, D., Boss, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+breast+MRI:+2D+histogram+analysis+of+diffusion+tensor+parameters+in+normal+tissue.">Quantitative breast MRI: 2D histogram analysis of diffusion tensor parameters in normal tissue.</a> Magn Reson Mater Phy. 27, 185-193 (2014).</li><li>Nissan, N., Furman-Haran, E., Shapiro-Feinberg, M., Grobgeld, D., Degani, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion-tensor+MR+imaging+of+the+breast:+hormonal+regulation.">Diffusion-tensor MR imaging of the breast: hormonal regulation.</a> Radiology. 271 (3), 672-680 (2014).</li><li>Cooper, A. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> On the Anatomy of the breast. , (1840).</li><li>Ohtake, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-assisted+complete+three-dimensional+reconstruction+of+the+mammary+ductal/lobular+systems:+implications+of+ductal+anastomoses+for+breast-conserving+surgery).">Computer-assisted complete three-dimensional reconstruction of the mammary ductal/lobular systems: implications of ductal anastomoses for breast-conserving surgery).</a> Cancer. 91 (12), 2263-2272 (2001).</li><li>Going, J. J., Moffat, D. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Escaping+from+Flatland:+clinical+and+biological+aspects+of+human+mammary+duct+anatomy+in+three+dimensions.">Escaping from Flatland: clinical and biological aspects of human mammary duct anatomy in three dimensions.</a> J Pathol. 203 (1), 538-544 (2004).</li><li>Hancu, I., Govenkar, A., Lenkinski, R. E., Lee, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=On+shimming+approaches+in+3T+breast+MRI.">On shimming approaches in 3T breast MRI.</a> Magn Reson Med. 69 (3), 862-867 (2013).</li><li>Basser, P. J., Jones, D. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion-tensor+MRI:+theory,+experimental+design+and+data+analysis+-+a+technical+review.">Diffusion-tensor MRI: theory, experimental design and data analysis - a technical review.</a> NMR Biomed. 15 (7-8), 465-467 (2002).</li><li>Reese, T. G., Heid, O., Weisskoff, R. M., Wedeen, V. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reduction+of+eddy-current-induced+distortion+in+diffusion+MRI+using+a+twice-refocused+spin+echo.">Reduction of eddy-current-induced distortion in diffusion MRI using a twice-refocused spin echo.</a> Magn Reson Med. 49 (1), 1771-1782 (2003).</li><li>Jezzard, P., Balaban, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correction+for+geometric+distortion+in+echo+planar+images+from+B0+field+variations.">Correction for geometric distortion in echo planar images from B0 field variations.</a> Magn Reson Med. 34 (1), 65-73 (1995).</li><li>Kelcz, F., Furman-Haran, E., Grobgeld, D., Degani, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+testing+of+high-spatial+resolution+parametric+contrast-enhanced+MR+imaging+of+the+breast.">Clinical testing of high-spatial resolution parametric contrast-enhanced MR imaging of the breast.</a> AJR Am J Roentgenol. 179 (6), 1485-1492 (2002).</li><li>Le Bihan, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+imaging:+concepts+and+applications.">Diffusion tensor imaging: concepts and applications.</a> J Magn Reson Imaging. 13 (4), 534-546 (2001).</li><li>Marquardt, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+Algorithm+for+Least-Squares+Estimation+of+Nonlinear+Parameter.">An Algorithm for Least-Squares Estimation of Nonlinear Parameter.</a> SIAM Journal on Applied Mathematics. 11 (2), 431-441 (1963).</li><li>Jolliffe, I. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Principal+Component+Analysis:+A+Beginner's+Guide+&#8212;+I.+Introduction+and+application.">Principal Component Analysis: A Beginner's Guide &#8212; I. Introduction and application.</a> Weather. 45 (10), 375-382 (1990).</li><li>Mayr, N. A., Staples, J. J., Robinson, R. A., Vanmetre, J. E., Hussey, D. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morphometric+studies+in+intraductal+breast+carcinoma+using+computerized+image+analysis.">Morphometric studies in intraductal breast carcinoma using computerized image analysis.</a> Cancer. 67 (11), 2805-2812 (1991).</li><li>Ramsay, D. T., Kent, J. C., Hartmann, R. A., Hartmann, P. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anatomy+of+the+lactating+human+breast+redefined+with+ultrasound+imaging.">Anatomy of the lactating human breast redefined with ultrasound imaging.</a> J Anat. 206 (6), 525-534 (2005).</li><li>Gooding, M. J., Mellor, M., Shipley, J. A., Broadbent, K. A., Goddard, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automatic+mammary+duct+detection+in+3D+ultrasound.">Automatic mammary duct detection in 3D ultrasound.</a> Med Image Comput Comput Assist Interv. 8 (1), 434-441 (2005).</li><li>Reisert, M. M., Eyal, E., Grobgeld, D., Degani, H., Hennig, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+based+reconstruction+of+the+ductal+tree+[abstr].">Diffusion tensor based reconstruction of the ductal tree [abstr].</a> , 3649 (2011).</li><li>Jezzard, P., Clare, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sources+of+distortion+in+functional+MRI+data.">Sources of distortion in functional MRI data.</a> Hum Brain Mapp. 8 (2-3), 80-85 (1999).</li><li>Jones, D. K., Cercignani, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Twenty-five+pitfalls+in+the+analysis+of+diffusion+MRI+data.">Twenty-five pitfalls in the analysis of diffusion MRI data.</a> NMR Biomed. 23 (7), 803-820 (2010).</li></ol>

作者什么都没有透露。

这项工作表明，DTI的能力，在扫描3个T在高空间分辨率（〜8毫米3），以测量在体内在两个乳房的整个fibroglandular组织水扩散张量的参数。的开发在本研究中启用的大的DTI数据集的分析的过程中，同时算法和软件的合奏查看各个扩散系数，λ1，λ2，λ3的扩散参数图，ADC和各向异性指数λ1-λ 3，和FA所有乳腺癌切片。这项工作中也强调不同扩散系数和各向异性指数的电位来检测和诊断乳腺癌。研究结果表明素扩散系数，λ1，是用于检测乳腺癌，与从正常乳腺组织区分恶性一个实质能力的主要参数。次要indepen凹痕参数，具有高灵敏度，但特异性比λ1低得多，是其作用，以确认该检测由素扩散系数的最大各向异性指数。 结果还证明的MRI来测量体内定向水扩散并量化该扩散的各向异性在整个导管/腺系统在两个乳房的能力。为了确保各向异性测量30扩散梯度方向均匀精密轮廓施加。的120毫秒，和空间分辨率的优化高回波时间的选择显示的水扩散，在管道的限制。正常导管的平均大小被报告为90微米，具有〜70％的40-100微米36的范围内。根据爱因斯坦方程平均自由水扩散位移，X =（6DT）1/2，其中D是自由水的扩散系数及吨扩散时间。在我们的实验中，x是约25微米，并且因此，所述导管的水分子的一小部分是由乳腺导管壁的限制，导致了相对低的FA值在乳房（上限值〜0.3）相比，发现该值在脑白质（≥0.5）。在爵士阿斯特利库柏研究25它显露人类乳房组织被组织成单独的波瓣，每个导管树组成。的泌乳乳房37初步超声研究已尝试，以及检测用二阶形状测量38剖导管结构。然而，没有成像方法已成功迄今揭示了整个导管系统，两个乳房在体内 。该算法用于从DTI结果获得整个3D导管树系统仍在发展，但向量映射清楚显示出的电位以显示乳腺树的详细和高度多元化解剖。最近的我基于我们的DTI数据集乳房的全3D跟踪nitial企图报道39。 在这个工作过程中技术上的限制已经注意到由于低效的脂肪抑制和EPI扭曲。脂肪抑制由脂肪饱和序列（FAT-SAT），它通常是在密集的乳房高效的实现。然而，在脂肪酸乳房光谱选择衰减反转恢复（SPAIR），这是更有效的，并到B1不均匀性较不敏感的，被施加。该EPI基于扩散的协议不得不由于梯度引起的涡流额外的限制，B 0场不均匀性和敏感性的差异40,41。这些限制通过使用对水和脂肪信号的迭代自动和手动匀场，并选择下可能回波间隔最小化。此外，几何失真的后处理校正的协议中所描述偶尔使用。总体在致密乳房具有较强的水信号，有可能克服技术上的限制的情况下;然而，有5例在本研究中具有高度的脂肪酸乳房不能因上述限制分析。 总之，已经开发了用于乳腺癌的扩散张量的MRI的协议和图像处理工具。这完全安全，快速，无创的​​方法精确剖析乳房的架构，可以方便的检测乳腺癌的诊所。素扩散系数，λ1，最大各向异性指数，λ1-λ3，发现作为两个独立的扩散参数，用于检测癌症。乳腺癌患者的临床研究表明，与这两个参数的检测效率是比得上DCE MRI杂志。因此，从基本理解癌症发展的乳房结构和及其对揭示依赖新兴此方法的量化显著的变化，以及它是一种安全，快速的方法，使其成为调查涉及各种乳腺导管增生发展方面，以及用于测试大规模前瞻性研究乳腺癌筛查的临床影响的重要工具。

乳腺癌是全世界妇女癌症中最常见的原因。早期发现乳癌具有改善生活的乳腺癌患者的质量和存活的关键作用。目前的标准的乳腺癌的方法检测是基于X射线乳腺摄影和超声波扫描。灵敏度和它们的技术，特别是用于检测病变致密乳房特异性不足，刺激了其他技术，包括乳房磁共振成像（MRI）的发展。动态对比增强（DCE）MRI已经被确立为一个强大的工具，乳腺癌1,2的检测和诊断，经常容易通过计算机辅助诊断装置3。目前，它被用于特殊情况，如高风险患者4，但不能用于常规筛选，因为成本高的推测，需要使用一个注射造影剂，缺乏标准化第二变量特异性鉴别恶性病变，从低/中值5,6使用乳腺X线摄影联合和DCE-MRI 7,8获得高价值良性的。最近，扩散加权成像，将所得的表观扩散系数（ADC）地图被评价为一种补充方法为DCE-MRI和它表明ADC值可以帮助癌症，良性病变和正常乳腺组织9,10区分。此外，乳腺扩散张量成像（DTI）的研究，在3个T 16-24的1.5T的11-15场强，并开始在健康志愿者和患者的乳腺病变。大多数研究报告ADC和分数各向异性（FA）值11,12,14,15,20-23，发现这两个参数是重复性与ADC值比FA 13,20更具可重复性。这些研究的结果表明，恶性病变表现出低ADC值作为​​补偿ARED正常组织及良性病变，但是，矛盾的结果报告中的值和FA 11,12,14,20-23的诊断能力。在一组3个T-DTI研究的3张量特征向量在乳房组织帧的值被报告为好，其结果是在主要特征向量的向量图，固有值的参数图，ADC，FA呈现和最大各向异性指数16-19,24。在这些研究中的主要扩散特征值与最大各向异性被示出，作为癌的副病灶的检测和诊断中最敏感的独立参数乳房由fibroglandular组织和脂肪组织。所述fibroglandular组织被进一步由许多裂片，它们在尺寸和形状高度可变的。每个叶组织包括乳腺功能树和相关的小叶形成腺体组织，和周围的结缔组织音响纤维状组织。大多数乳腺恶性肿瘤开始由上皮细胞中的导管或小叶， 原位癌 ，其通过渗入周围组织变成浸润癌显影的异常增殖。因此，导管/小叶结构是恶性乳腺癌转化研究的必要区域。 乳腺导管树的结构特点采用注射彩色蜡以乳房切除标本25管道首次调查体外于1840年由阿斯特利爵士库珀。近日，全乳腺导管树木计算机得出跟踪已使用乳房切除标本26,27少数人的乳房来实现的。这里介绍的工作表明， 在体内扩散张量成像获得的参数提供了不同的乳腺组织显微结构特征相关的信息，从而也非侵入性乳 ​​腺癌的检测。 在p潜在的乳腺癌扩散张量成像原理物质环境的基于MRI的能力来衡量和量化各向异性水扩散受限的环境中28。在一般情况下，水的扩散的均质溶液是免费的，各向同性的，但是，如果水的运动被停止，因为限制由不可渗透壁的扩散变得各向异性与自由平行于壁的快速扩散，并垂直于壁较慢受限扩散（ 图1）。水扩散在组织中是复杂的，并取决于分子内的结构和生理功能和细胞外室包括细胞的大小，细胞的密度，细胞外曲折和水交换通过膜，以及对血管和淋巴管网络的存在（ 图2）。 <img alt="图1" src="/files/ftp_upload/52048/52048fig1highres.jpg" /> 图1：自由和限制扩散水分子自由扩散（左）和限制扩散通过不可渗透壁（右）的示意图。 <img alt="图2" src="/files/ftp_upload/52048/52048fig2highres.jpg" /> 图2：在一个组织复杂扩散水扩散的示出了在细胞外和细胞内区室和这两个隔室之间的水交换（箭头）的水分子运动在蜂窝系统中示意图。 由于乳房的特定建筑特色的水分子中的乳腺导管和小叶扩散提出限制，并且各向异性运动的一个具体的实例中：在平行于所述导管的壁和小叶扩散接近于自由扩散，但在垂直的方向的壁是由壁限定，两个组成层的细胞和基底膜。因此在导管/腺体系统的扩散是比较快的和各向异性。另一方面，在周围的管道中的结缔组织的纤维组织的扩散速度快，各向同性的高水含量和低的细胞密度在这个组织中（ 图3和4）的结果。在恶性肿瘤的情况下，该导管和小叶癌细胞堵塞增加了水的运动的曲折和限制，导致的扩散系数的降低在所有方向上，并在各向异性运动（ 图3和4）。 <img alt="图3" src="/files/ftp_upload/52048/52048fig3highres.jpg" /> 图3：扩散乳房小叶切过小叶，一个小叶内的水扩散示意图。左图：水限制了小叶“墙壁展示快速扩散平行扩散到墙壁和弥散受限垂直于墙壁。右：扩散小叶癌细胞。在细胞外室中的扩散是高度受阻，但在所有的方向相似的，因此，几乎各向同性。 <img alt="图4" src="/files/ftp_upload/52048/52048fig4highres.jpg" /> 图4：水扩散的导管系统树左：注射用彩色蜡乳腺导管，可见其辐射方向，它们之间的衍生物25。中间：一个正常的导管树与矢量指示导管（黑色箭头）内的扩散示意图和结缔组织（绿色箭头）。右：一个导管树与癌细胞的两个基因座（紫色）示意图。红色箭头显示出在癌症的扩散。 本文详细介绍了弥散张量扫描方法和公关ocessing算法和启用检测乳腺恶性肿瘤的DTI数据集的软件分析。所有的癌症是由乳腺活检和/或手术标本组织病理学的研究结果证实。我们还描述了T2加权扫描协议获得乳房的解剖特点，以及该服务作为评价的DTI检测灵敏度的参考方法DCE扫描协议。 <a href="https://www.jove.com/files/ftp_upload/52048/52048fig4large.jpg" target="_blank">请点击此处查看该图的放大版本。</a>

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			<td height="41" rowspan="2" style="height:41px;width:364px;">Magnetol-Gadopentetatedimeglumine</td>
			<td rowspan="2" style="width:180px;">Soreq, Yavne, Israel</td>
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			<td height="41" rowspan="2" style="height:41px;width:364px;">3 Tesla MRI scanner,&#160; MAGNETON Trio&#160;&#160;</td>
			<td rowspan="2" style="width:180px;">Siemens, Erlangn, Germany</td>
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			<td style="width:180px;">In-Vivo, Orlando FA</td>
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			<td style="width:355px;">7.channel</td>
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			<td height="41" rowspan="2" style="height:41px;">Automated pump, Spectris Solaris MR Injector&#160;&#160;</td>
			<td rowspan="2" style="width:180px;">Medrad, Indianola , PA&#160;&#160;&#160;&#160;&#160;&#160;&#160;</td>
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			<td rowspan="3" style="width:180px;">Home-built</td>
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			<td rowspan="3" style="width:355px;">Property of Yeda Research and Development Co.&#160; Ltd http://www.yedarnd.com/ContactUs.asp&#160;</td>
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			<td height="43" style="height:43px;width:364px;">3TP Image processing software</td>
			<td style="width:180px;">Home-built</td>
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			<td style="width:355px;">Property of Yeda Research and Development Co.&#160; Ltd http://www.yedarnd.com/ContactUs.asp&#160;</td>
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tracking the mammary architectural features and detecting breast cancer with magnetic resonance diffusion tensor imaging

Breast cancer is the most common cause of cancer among women worldwide. Early detection of breast cancer has a critical role in improving the quality of life and survival of breast cancer patients. In this paper a new approach for the detection of breast cancer is described, based on tracking the mammary architectural elements using diffusion tensor imaging (DTI). 
The paper focuses on the scanning protocols and image processing algorithms and software that were designed to fit the diffusion properties of the mammary fibroglandular tissue and its changes during malignant transformation. The final output yields pixel by pixel vector maps that track the architecture of the entire mammary ductal glandular trees and parametric maps of the diffusion tensor coefficients and anisotropy indices. 
The efficiency of the method to detect breast cancer was tested by scanning women volunteers including 68 patients with breast cancer confirmed by histopathology findings. Regions with cancer cells exhibited a marked reduction in the diffusion coefficients and in the maximal anisotropy index as compared to the normal breast tissue, providing an intrinsic contrast for delineating the boundaries of malignant growth. Overall, the sensitivity of the DTI parameters to detect breast cancer was found to be high, particularly in dense breasts, and comparable to the current standard breast MRI method that requires injection of a contrast agent. Thus, this method offers a completely non-invasive, safe and sensitive tool for breast cancer detection.

该方法是通过扫描正常志愿者在不同的激素阶段开始测试，并显示出图11展示了使用我们的年轻健康志愿者与fibroglandular组织的相对高的分数的中央片的软件中得到的参数和向量地图，可以清楚地看到在T2加权图像上（所有的灰色地带是fibroglandular组织及明亮区域的脂肪）。素扩散系数λ1的方向显示在地图上的矢量V1与像素指向乳头的大部分。正如预期的扩散张量系数λ从1下降的值λ2λ3。使用使平均扩散ADC的计算这三个扩散系数，分数各向异性（FA）和最大各向异性，λ1 - λ3。在FA和地图λ1的通知- λ <sub&gt; 3的高一致性这两个指标值的空间分布。 在绝经后妇女的乳房通常密度较低，如图中的示例图13为一个63岁的正常志愿者。扩散系数是低的中老年人志愿者但各向异性指数是导管和小叶，从而下部直径可能是因为较高，较高的限制强加于在方向上的扩散垂直于导管的壁。另一示例演示张量的导管的尺寸的灵敏度示于图14泌乳志愿者的例子中由于牛奶脂肪球内的水基流体，它包含溶解的碳水化合物和蛋白质聚集体与矿物质胶体，牛奶的粘度比通常的水液中的管道，并且因此更高的，泌乳乳房的水扩散系数是升奥尔比绝经前妇女24。此外，乳头附近的管道大和限制在垂直于管的方向上，比在非泌乳乳房下，并因此在各向异性指数较低为好。然而，在哺乳期乳腺小叶-posterior地区各向异性仍较高。 患者恶性肿瘤的扩散张量参数的主要变化是展示在一个显著减少三个扩散系数。在λ1的改变中发现，以提供最高的对比度噪声比19。该研究纳入68例确诊的病理其中包括33例确诊为浸润性导管癌（IDC），19导管原位癌 （DCIS），13浸润性小叶癌（ILC）和3个与其他恶性肿瘤。几位患者的多焦点或多中心的乳腺癌。在癌症的大小瓦里编从3到95毫米，10至30mm14毫米和四分位数范围。在所有这些患者的DCE和DTI的检出率是相当的。然而，5个案件呈增强在DCE和病理证实为癌症并没有因脂肪乳房的技术问题，主要涉及领域和不均匀性脂肪抑制不足造成的扭曲和文物列入DTI分析。 图15，16和17展示了两个主要的扩散参数的典型参数映射λ1和λ1 - λ3，其用于检测乳房恶性肿瘤。该图所示，除了T2加权图像，DCE分析使用3TP颜色编码方法的结果。如在引言说明恶性细胞的存在下，在导管或小叶及其周围阻碍扩散在细胞外隔室显著减少吨他扩散系数。此外，由于导管的结构的各向异性消失的癌细胞扩散在所有方向在一个混乱的方式，没有明显的方向。该FA是不乳腺癌检测的适当参数，因为该参数的平均扩散的正常化导致的FA的高值癌症类似于在正常组织19。然而，最大各向异性确实提供用于检测癌症的装置（ 图15-17）。然而，由于结缔组织的纤维组织也接近各向同性并表现出极大的各向异性值低，这个参数比扩散系数λ1不太具体，并作为辅助参数λ1。 图17也表明DTI的表征应对新辅助化疗的能力。在本实施例中，患者完全回答了在治疗（4个周期的广告riamycin + Cycloxane - ，其次是4个周期紫杉醇）。事实上，对治疗的反应引起扩散系数的值，以典型的正常乳腺组织中的显著增加，暗示修复结缔组织的存在，并取代了癌细胞。类似的结果，在4的回应治疗的其他患者。 <img alt="图13" src="/files/ftp_upload/52048/52048fig13highres.jpg" /> 图13：一个63岁的健康志愿者的中心乳腺切片参数DTI地图输出叠加同片导演的T2加权图像上。 - 红色方向指示图从左至右，绿色指示灯从前到后，绿色指示头脚方向。请注意，载体被标记为白线。所有的扩散系数和最大各向异性指数是在1×10 -3毫米2 /秒的单位。 FA是无单位的。在矢量地图参考比例尺器以一个长度为20毫米，并在T 2图像中的比例尺是指在所有剩余图像的长度为20毫米。 <img alt="图14" src="/files/ftp_upload/52048/52048fig14highres.jpg" /> 图14：一个40岁的志愿者哺乳期覆盖同一片迪尔的T2加权图像上的中心乳腺切片参数DTI地图输出 。 - 红色方向指示图从左至右，绿色指示灯从前到后，绿色指示头脚方向。所有的扩散系数和最大各向异性指数是在1×10 -3毫米2 /秒的单位。 FA是无单位的。注意在方向图和矢量图，大多数象素被朝向乳头对齐。还要注意的相对于图7和10名健康志愿者的值较低的扩散系数。在矢量地图的比例尺是指为20mm和长度在T2的图像比例尺是指在所有剩余图像的长度为20毫米。 <img alt="图15" src="/files/ftp_upload/52048/52048fig15highres.jpg" /> 图15：λ1和λ1参数映射- λ3在一个38岁的患者的多焦点浸润性导管癌 。在第1次的原始的DTI参数都带有1.7×10 -3毫米2 /秒的阈值为λ1和0.6 平方毫米/秒，λ1-λ3（高于阈值的所有值都染成紫色）。在第2 次原料，值高于该阈值不着色，显示出底层的T2加权图象。该图还包含在左侧一个的T2加权图像上的1列和一个DCE参数图，由3TP方法作为DTI参数图中得到的相同切片的，。在T2的图像的比例尺是指为20mm的长度iN所有图像。注意，该DCE的图像的面内的空间分辨率比DTI的约两倍高，然而，有一个在3TP和λ1参数图的位置和尺寸的高视觉一致性。 <img alt="图16" src="/files/ftp_upload/52048/52048fig16highres.jpg" /> 图16：λ1和λ1-λ3在一个60岁的患者，低级DCIS图中还包括在所述留下的T2加权图像和一个DCE参数图上的1列的参数映射 ，由所获得的3TP方法同片的DTI参数图的。在T2的图像的比例尺是指在所有的图像的长度为20毫米。注意DTI来检测癌症的高脂肪丰胸的能力。 <img alt="图17" src="/files/ftp_upload/52048/52048fig17highres.jpg" /> 图17：λ1和λ1参数映射- λ3在一个39岁的患者，其中包含之前和新辅助化疗后浸润性小叶癌患者被扫描两次，治疗前一次和手术前一次，4个周期后Adryamicin为+。紫杉醇Cycloxan和4个周期。注意增加λ1和λ1-λ3在回应治疗癌症的地区。治疗前获得的第1次的原始节目的图像和第2 次的原始节目的图像的大致相同的区域的1行中，在手术前获得。治疗前癌区域表现出1-λ3值低于其阈值λ1和λ，以及治疗后这两个参数，以增加值高于其阈值。该图还包含在左边的T2加权图像的1列;在第二栏木ltiple图像投影-MIP，减去了2分钟后对比图像预对比度的图像获得的;在第3列中的DCE参数图的3TP方法获得。在T2的图像的比例尺是指20毫米的长度中的所有图像

Watch this Scientific Journal Video about Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging at JoVE.com

Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging

We describe how to obtain parametric and vector maps of the diffusion tensor of the breast using magnetic resonance imaging. The protocol and final output following imaging processing are tailored for tracking breast architectural features and detecting breast malignancy.

跟踪乳腺建筑特色与检测乳腺癌的磁共振扩散张量成像

Breast cancer is the most common cause of cancer among women worldwide. Early detection of breast cancer has a critical role in improving the quality of ...

tracking-mammary-architectural-features-detecting-breast-cancer-with

Research

JoVE Journal

Medicine

22.1K 次观看.  Weizmann Institute of Science. We describe how to obtain parametric and vector maps of the diffusion tensor of the breast using magnetic resonance imaging. The protocol and final output following imaging processing are tailored for tracking breast architectural features and detecting breast malignancy. 

视频: Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging

Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking

Purpose: An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that strain is a more sensitive and earlier marker for contractile dysfunction than the frequently used parameter EF. Current technologies for CMR are time consuming and difficult to implement in clinical practice. Feature tracking is a technology that can lead to more automization and robustness of quantitative analysis of medical images with less time consumption than comparable methods.
Methods: An automatic or manual input in a single phase serves as an initialization from which the system starts to track the displacement of individual patterns representing anatomical structures over time. The specialty of this method is that the images do not need to be manipulated in any way beforehand like e.g. tagging of CMR images.
Results: The method is very well suited for tracking muscular tissue and with this allowing quantitative elaboration of myocardium and also blood flow.
Conclusions: This new method offers a robust and time saving procedure to quantify myocardial tissue and blood with displacement, velocity and deformation parameters on regular sequences of CMR imaging. It therefore can be implemented in clinical practice.

An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that strain is a more sensitive and earlier marker for contractile dysfunction than the frequently used parameter EF.

磁共振衍生的心肌劳损评估使用特征跟踪

Purpose: An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that ...

科研

医学

Probing the Brain in Autism Using fMRI and Diffusion Tensor Imaging

Newly emerging theories suggest that the brain does not function as a cohesive unit in autism, and this discordance is reflected in the behavioral symptoms displayed by individuals with autism. While structural neuroimaging findings have provided some insights into brain abnormalities in autism, the consistency of such findings is questionable. Functional neuroimaging, on the other hand, has been more fruitful in this regard because autism is a disorder of dynamic processing and allows examination of communication between cortical networks, which appears to be where the underlying problem occurs in autism. Functional connectivity is defined as the temporal correlation of spatially separate neurological events1. Findings from a number of recent fMRI studies have supported the idea that there is weaker coordination between different parts of the brain that should be working together to accomplish complex social or language problems2,3,4,5,6. One of the mysteries of autism is the coexistence of deficits in several domains along with relatively intact, sometimes enhanced, abilities. Such complex manifestation of autism calls for a global and comprehensive examination of the disorder at the neural level. A compelling recent account of the brain functioning in autism, the cortical underconnectivity theory,2,7 provides an integrating framework for the neurobiological bases of autism. The cortical underconnectivity theory of autism suggests that any language, social, or psychological function that is dependent on the integration of multiple brain regions is susceptible to disruption as the processing demand increases. In autism, the underfunctioning of integrative circuitry in the brain may cause widespread underconnectivity. In other words, people with autism may interpret information in a piecemeal fashion at the expense of the whole. Since cortical underconnectivity among brain regions, especially the frontal cortex and more posterior areas 3,6, has now been relatively well established, we can begin to further understand brain connectivity as a critical component of autism symptomatology.
A logical next step in this direction is to examine the anatomical connections that may mediate the functional connections mentioned above. Diffusion Tensor Imaging (DTI) is a relatively novel neuroimaging technique that helps probe the diffusion of water in the brain to infer the integrity of white matter fibers. In this technique, water diffusion in the brain is examined in several directions using diffusion gradients. While functional connectivity provides information about the synchronization of brain activation across different brain areas during a task or during rest, DTI helps in understanding the underlying axonal organization which may facilitate the cross-talk among brain areas. This paper will describe these techniques as valuable tools in understanding the brain in autism and the challenges involved in this line of research.

Neuroimaging techniques, such as functional MRI and Diffusion Tensor Imaging have become increasingly useful in characterizing the cognitive and neural deficits in autism. An examination of brain connectivity in autism at a network level along with adaptations for scanning children with developmental disabilities is presented.

探讨孤独症的脑功能磁共振成像和弥散张量成像

Newly emerging theories suggest that the brain does not function as a cohesive unit in autism, and this discordance is reflected in the behavioral ...

Multi-modal Imaging of Angiogenesis in a Nude Rat Model of Breast Cancer Bone Metastasis Using Magnetic Resonance Imaging, Volumetric Computed Tomography and Ultrasound

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell proliferation in the bone marrow cavity as well as for interaction of tumor and bone cells resulting in local bone destruction. Our aim was to develop a model of experimental bone metastasis that allows in vivo assessment of angiogenesis in skeletal lesions using non-invasive imaging techniques.
For this purpose, we injected 105 MDA-MB-231 human breast cancer cells into the superficial epigastric artery, which precludes the growth of metastases in body areas other than the respective hind leg1. Following 25-30 days after tumor cell inoculation, site-specific bone metastases develop, restricted to the distal femur, proximal tibia and proximal fibula1. Morphological and functional aspects of angiogenesis can be investigated longitudinally in bone metastases using magnetic resonance imaging (MRI), volumetric computed tomography (VCT) and ultrasound (US).
MRI displays morphologic information on the soft tissue part of bone metastases that is initially confined to the bone marrow cavity and subsequently exceeds cortical bone while progressing. Using dynamic contrast-enhanced MRI (DCE-MRI) functional data including regional blood volume, perfusion and vessel permeability can be obtained and quantified2-4. Bone destruction is captured in high resolution using morphological VCT imaging. Complementary to MRI findings, osteolytic lesions can be located adjacent to sites of intramedullary tumor growth. After contrast agent application, VCT angiography reveals the macrovessel architecture in bone metastases in high resolution, and DCE-VCT enables insight in the microcirculation of these lesions5,6. US is applicable to assess morphological and functional features from skeletal lesions due to local osteolysis of cortical bone. Using B-mode and Doppler techniques, structure and perfusion of the soft tissue metastases can be evaluated, respectively. DCE-US allows for real-time imaging of vascularization in bone metastases after injection of microbubbles7.
In conclusion, in a model of site-specific breast cancer bone metastases multi-modal imaging techniques including MRI, VCT and US offer complementary information on morphology and functional parameters of angiogenesis in these skeletal lesions.

In the pathogenesis of bone metastasis, angiogenesis is a crucial process and therefore represents a target for imaging and therapy. Here, we present a rat model of site-specific breast cancer bone metastasis and describe strategies to non-invasively image angiogenesis in vivo using magnetic resonance imaging, volumetric computed tomography and ultrasound.

利用磁共振成像，容积电脑断层扫描及超音波的裸鼠乳腺癌骨转移大鼠模型血管生成的多模态成像

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell ...

Time-lapse Imaging of Primary Preneoplastic Mammary Epithelial Cells Derived from Genetically Engineered Mouse Models of Breast Cancer

Time-lapse imaging can be used to compare behavior of cultured primary preneoplastic mammary epithelial cells derived from different genetically engineered mouse models of breast cancer. For example, time between cell divisions (cell lifetimes), apoptotic cell numbers, evolution of morphological changes, and mechanism of colony formation can be quantified and compared in cells carrying specific genetic lesions. Primary mammary epithelial cell cultures are generated from mammary glands without palpable tumor. Glands are carefully resected with clear separation from adjacent muscle, lymph nodes are removed, and single-cell suspensions of enriched mammary epithelial cells are generated by mincing mammary tissue followed by enzymatic dissociation and filtration. Single-cell suspensions are plated and placed directly under a microscope within an incubator chamber for live-cell imaging. Sixteen 650 &mu;m x 700 &mu;m fields in a 4x4 configuration from each well of a 6-well plate are imaged every 15 min for 5 days. Time-lapse images are examined directly to measure cellular behaviors that can include mechanism and frequency of cell colony formation within the first 24 hr of plating the cells (aggregation versus cell proliferation), incidence of apoptosis, and phasing of morphological changes. Single-cell tracking is used to generate cell fate maps for measurement of individual cell lifetimes and investigation of cell division patterns. Quantitative data are statistically analyzed to assess for significant differences in behavior correlated with specific genetic lesions.

Time-lapse imaging is used to assess behavior of primary preneoplastic mammary epithelial cells derived from genetically engineered mouse models of breast cancer risk to determine if there are correlations between specific behavioral parameters and distinct genetic lesions.

延时成像的主要癌前乳腺上皮细胞来源于遗传工程小鼠乳腺癌模型

Time-lapse  imaging can be used to compare behavior of cultured primary preneoplastic  mammary epithelial cells derived from different genetically ...

Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases

Diffusion tensor imaging (DTI) techniques provide information on the microstructural processes of the cerebral white matter (WM) in vivo. The present applications are designed to investigate differences of WM involvement patterns in different brain diseases, especially neurodegenerative disorders, by use of different DTI analyses in comparison with matched controls. 	
DTI data analysis is performed in a variate fashion, i.e. voxelwise comparison of regional diffusion direction-based metrics such as fractional anisotropy (FA), together with fiber tracking (FT) accompanied by tractwise fractional anisotropy statistics (TFAS) at the group level in order to identify differences in FA along WM structures, aiming at the definition of regional patterns of WM alterations at the group level. Transformation into a stereotaxic standard space is a prerequisite for group studies and requires thorough data processing to preserve directional inter-dependencies. The present applications show optimized technical approaches for this preservation of quantitative and directional information during spatial normalization in data analyses at the group level. On this basis, FT techniques can be applied to group averaged data in order to quantify metrics information as defined by FT. Additionally, application of DTI methods, i.e. differences in FA-maps after stereotaxic alignment, in a longitudinal analysis at an individual subject basis reveal information about the progression of neurological disorders. Further quality improvement of DTI based results can be obtained during preprocessing by application of a controlled elimination of gradient directions with high noise levels.	
In summary, DTI is used to define a distinct WM pathoanatomy of different brain diseases by the combination of whole brain-based and tract-based DTI analysis.

Diffusion tensor imaging (DTI) basically serves as an MRI-based tool to identify in vivo the microstructure of the brain and pathological processes due to neurological disorders within the cerebral white matter. DTI-based analyses allow for application to brain diseases both at the group level and in single subject data.

磁共振扩散张量成像在神经退行性疾病的分析

Diffusion tensor imaging (DTI) techniques provide information on the microstructural processes of the cerebral white matter (WM) in vivo. The present ...

Dynamic Contrast Enhanced Magnetic Resonance Imaging of an Orthotopic Pancreatic Cancer Mouse Model

Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has been limitedly used for orthotopic pancreatic tumor xenografts due to severe respiratory motion artifact in the abdominal area. Orthotopic tumor models offer advantages over subcutaneous ones, because those can reflect the primary tumor microenvironment affecting blood supply, neovascularization, and tumor cell invasion. We have recently established a protocol of DCE-MRI of orthotopic pancreatic tumor xenografts in mouse models by securing tumors with an orthogonally bent plastic board to prevent motion transfer from the chest region during imaging. The pressure by this board was localized on the abdominal area, and has not resulted in respiratory difficulty of the animals. This article demonstrates the detailed procedure of orthotopic pancreatic tumor modeling using small animals and DCE-MRI of the tumor xenografts. Quantification method of pharmacokinetic parameters in DCE-MRI is also introduced. The procedure described in this article will assist investigators to apply DCE-MRI for orthotopic gastrointestinal cancer mouse models.

The goal of this protocol is to apply dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) for orthotopic pancreatic tumor xenografts in mice. DCE-MRI is a non-invasive method to analyze microvasculature in a target tissue, and useful to assess vascular response in a tumor following a novel therapy.

原位胰腺癌小鼠模型的动态对比增强磁共振成像

Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has been limitedly used for orthotopic pancreatic tumor xenografts due to severe ...

Simultaneous PET/MRI Imaging During Mouse Cerebral Hypoxia-ischemia

Dynamic changes in tissue water diffusion and glucose metabolism occur during and after hypoxia in cerebral hypoxia-ischemia reflecting a bioenergetics disturbance in affected cells. Diffusion weighted magnetic resonance imaging (MRI) identifies regions that are damaged, potentially irreversibly, by hypoxia-ischemia. Alterations in glucose utilization in the affected tissue may be detectable by positron emission tomography (PET) imaging of 2-deoxy-2-(18F)fluoro-&#7429;-glucose ([18F]FDG) uptake. Due to the rapid and variable nature of injury in this animal model, acquisition of both modes of data must be performed simultaneously in order to meaningfully correlate PET and MRI data. In addition, inter-animal variability in the hypoxic-ischemic injury due to vascular differences limits the ability to analyze multi-modal data and observe changes to a group-wise approach if data is not acquired simultaneously in individual subjects. The method presented here allows one to acquire both diffusion-weighted MRI and [18F]FDG uptake data in the same animal before, during, and after the hypoxic challenge in order to interrogate immediate physiological changes.

The method presented here uses simultaneous positron emission tomography and magnetic resonance imaging. In the cerebral hypoxia-ischemia model, dynamic changes in diffusion and glucose metabolism occur during and after injury. The evolving and irreproducible damage in this model necessitates simultaneous acquisition if meaningful multi-modal imaging data are to be acquired.

同时PET / MRI成像在小鼠脑缺氧缺血

Dynamic changes in tissue water diffusion and glucose metabolism occur during and after hypoxia in cerebral hypoxia-ischemia reflecting a bioenergetics ...

Cardiac Magnetic Resonance Imaging at 7 Tesla

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher magnetic field strengths and potentially provides improved signal contrast and spatial resolution. While promising results have been achieved, ultra-high field CMR is challenging due to energy deposition constraints and physical phenomena such as transmission field non-uniformities and magnetic field inhomogeneities. In addition, the magneto-hydrodynamic effect renders the synchronization of the data acquisition with the cardiac motion difficult. The challenges are currently addressed by explorations into novel magnetic resonance technology. If all impediments can be overcome, ultra-high field CMR may generate new opportunities for functional CMR, myocardial tissue characterization, microstructure imaging or metabolic imaging. Recognizing this potential, we show that multi-channel radio frequency (RF) coil technology tailored for CMR at 7 Tesla together with higher order B0 shimming and a backup signal for cardiac triggering facilitates high fidelity functional CMR. With the proposed setup, cardiac chamber quantification can be accomplished in examination times similar to those achieved at lower field strengths. To share this experience and to support the dissemination of this expertise, this work describes our setup and protocol tailored for functional CMR at 7 Tesla.

The sensitivity gain inherent to ultrahigh field magnetic resonance holds promise for high spatial resolution imaging of the heart. Here, we describe a protocol customized for functional cardiovascular magnetic resonance (CMR) at 7 Tesla using an advanced multi-channel radio-frequency coil, magnetic field shimming and a triggering concept.

7号特斯拉的心脏磁共振成像

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher ...

Phase Contrast Magnetic Resonance Imaging in the Rat Common Carotid Artery

Phase contrast magnetic resonance imaging (PC-MRI) is a noninvasive approach that can quantify flow-related parameters such as blood flow. Previous studies have shown that abnormal blood flow may be associated with systemic vascular risk. Thus, PC-MRI can facilitate the translation of data obtained from animal models of cardiovascular diseases to pertinent clinical investigations. In this report, we describe the procedure for measuring blood flow in the common carotid artery (CCA) of rats using cine-gated PC-MRI and discuss relevant analysis methods. This procedure can be performed in a live, anesthetized animal and does not require euthanasia after the procedure. The proposed scanning parameters yield repeatable measurements for blood flow, indicating excellent reproducibility of the results. The PC-MRI procedure described in this article can be used for pharmacological testing, pathophysiological assessment, and cerebral hemodynamics evaluation.

The overall goal of this procedure is to measure the blood flow in the rat common carotid artery by using noninvasive phase contrast magnetic resonance imaging.

大鼠颈总动脉的相位对比磁共振成像

Phase contrast magnetic resonance imaging (PC-MRI) is a noninvasive approach that can quantify flow-related parameters such as blood flow. Previous ...

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse

Here we present a protocol to examine the levator ani hiatus in males and females with pelvic organ prolapse, during the Valsalva maneuver and while evacuating acoustic gel, using a horizontally oriented 1.5 T magnetic resonance (MR) scanner. On midsagittal images, the vertical distance of pelvic organs is measured in millimeters relative to the hymen plane (female) and to the lower border of the symphysis pubis (male), preceded by - (above) or + ( below) signs. On axial images, the levator ani area is calculated in square centimeters with a free-hand tracing method from three key images, passing through the midsymphysis (level I), tangential to the lower border of the symphysis (level II), and at the maximal anterior rectal wall bulging (level III). Areas at rest and strained are compared to find evidence of a percentage of increase. The purpose is to provide objective evidence of the maximal extent of pelvic organs descent and hiatus enlargement without the interference of foreign objects or the examiner&#39;s proximity, so as to overcome the limitations of pelvic examination and transperineal sonography (i.e., subjectivity and sex-related limitations [female only]).

Here we present a protocol to standardize the measurement of the levator ani hiatus size&#160;by magnetic resonance imaging. The purpose is to extract biomechanical inferences from image analysis by comparing resting and straining values in patients of both sexes with pelvic prolapse, using consistent anatomical bony landmarks.

男性和女性盆腔器官脱垂的磁共振成像对左旋的定量研究

Here we present a protocol to examine the levator ani hiatus in males and females with pelvic organ prolapse, during the Valsalva maneuver and while ...