Transatlantic teamwork on MR spectroscopy leads to glory in poster awards

A multinational research team addressing which technique works best for fast spectroscopic imaging in clinical practice struck gold in the poster hall on Wednesday afternoon.

Authors from Indianapolis; Lund, Sweden; Bonn, Germany; and New Mexico collected one of the seven prestigious Magna Cum Laude awards for their practical education exhibit.

For routine use of MR spectroscopy, scan times need to be acceptable, but the metabolic information should not be impaired, according to lead presenter Dr. Ulrike Dydak, a researcher at the School of Health Sciences at Purdue University in Indianapolis. A remaining major limitation of MRS is the lack of fast, automated, and reliable quantification of the large amount of spectra obtained within one scan. This has changed during the past two years with the development of new ultrafast MRS techniques, notably SENSE-PEPSI, 3D GRAPPA-(P)EPSI, and spiral SENSE-SI.

"MRS allows for noninvasive in vivo chemical analysis of tissue by detection and quantification of many metabolites such as neuronal, membrane, or energy markers; neurotransmitters; or lipids," Dydak said. "Today, virtually every clinical MR scanner is capable of performing MRS, which is slowly becoming routine in radiology."

MRS is used most widely in the neurosciences, but it also has applications in muscle and the prostate, breast, liver, pancreas, kidneys, uterus, and heart. Conventional MRS is slow because any spatial encoding is done by phase-encoding steps only and, compared with MRI, one additional dimension must be sampled. Furthermore, the acquisition time to sample this additional spectral dimension is inversely proportional to the spectral resolution; in other words, the shorter your sample, the worse the spectral resolution.

Another U.S.-led MR research group, headed by Dr. Thomas M. Carr III at the University of Virginia, received a Magna Cum Laude for its exhibit about emerging imaging techniques for evaluating intraductal lesions of the breast.

Intraductal lesions of the breast represent a spectrum of pathological processes and have traditionally been assessed with conventional galactography, which is invasive, uncomfortable, and often inaccurate. MRI can now be used to characterize ductal pathology.

"Emerging techniques such as MR ductography are likely to further expand the role of MR in assessing the patient with nipple discharge," Carr said.

Nipple discharge is the third most common breast complaint. It causes anxiety for patients and, in a minority of cases, the condition is pathologic and attributable to an underlying benign or malignant breast lesion. These patients present with spontaneous, unilateral nipple discharge that is bloody or serous and typically expressed from a single duct.

Papillary carcinoma, ductal carcinoma in situ, and invasive ductal carcinoma can still be causes of pathologic discharge, Carr noted. Studies have indicated that malignant lesions may be responsible in up to 15% of cases, and in some cases, nipple discharge may be the only sign of a breast malignancy. Almost all cases of pathologic nipple discharge warrant further imaging evaluation.

The other five recipients of the Magna Cum Laude were Dr. Gopinath Gnanasegaran, department of nuclear medicine and radiology, Guy's and St. Thomas' Hospital, London; Dr. Naoko Saito, Boston Medical Center; Dr. Meghan G. Lubner, University of Wisconsin Medical School in Madison; Dr. Diego F. Lemos, University of Vermont at Burlington; and Dr. Toshihiro Furuta, University of Tokyo.