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Breast cancer imaging with glucosamine CEST (chemical exchange saturation transfer) MRI: first human experience

  • Molecular Imaging
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study aims to evaluate the feasibility of imaging breast cancer with glucosamine (GlcN) chemical exchange saturation transfer (CEST) MRI technique to distinguish between tumor and surrounding tissue, compared to the conventional MRI method.

Methods

Twelve patients with newly diagnosed breast tumors (median age, 53 years) were recruited in this prospective IRB-approved study, between August 2019 and March 2020. Informed consent was obtained from all patients. All MRI measurements were performed on a 3-T clinical MRI scanner. For CEST imaging, a fat-suppressed 3D RF-spoiled gradient echo sequence with saturation pulse train was applied. CEST signals were quantified in the tumor and in the surrounding tissue based on magnetization transfer ratio asymmetry (MTRasym) and a multi-Gaussian fitting.

Results

GlcN CEST MRI revealed higher signal intensities in the tumor tissue compared to the surrounding breast tissue (MTRasym effect of 8.12 ± 4.09%, N = 12, p = 2.2 E−03) with the incremental increase due to GlcN uptake of 3.41 ± 0.79% (N = 12, p = 2.2 E−03), which is in line with tumor location as demonstrated by T1W and T2W MRI. GlcN CEST spectra comprise distinct peaks corresponding to proton exchange between free water and hydroxyl and amide/amine groups, and relayed nuclear Overhauser enhancement (NOE) from aliphatic groups, all yielded larger CEST integrals in the tumor tissue after GlcN uptake by an averaged factor of 2.2 ± 1.2 (p = 3.38 E−03), 1.4 ± 0.4 (p =9.88 E−03), and 1.6 ± 0.6 (p = 2.09 E−02), respectively.

Conclusion

The results of this initial feasibility study indicate the potential of GlcN CEST MRI to diagnose breast cancer in a clinical setup.

Key Points

• GlcN CEST MRI method is demonstrated for its the ability to differentiate between breast tumor lesions and the surrounding tissue, based on the differential accumulation of the GlcN in the tumors.

• GlcN CEST imaging may be used to identify metabolic active malignant breast tumors without using a Gd contrast agent.

• The GlcN CEST MRI method may be considered for use in a clinical setup for breast cancer detection and should be tested as a complementary method to conventional clinical MRI methods.

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Abbreviations

CEST:

Chemical exchange saturation transfer

Gd:

Gadolinium

GlcN:

Glucosamine

MRI:

Magnetic resonance imaging

MT:

Magnetization transfer

MTRasym:

Magnetization transfer ratio asymmetry

NOE:

Nuclear Overhauser enhancement

ROI:

Region of interest

T1W:

T1-weighted

T2W:

T2-weighted

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Acknowledgements

We are indebted to the patients who participated in this research and we gratefully acknowledge Dr. Ilana Haas and Dr. Ravit Agassi for assisting in their recruitment.

Funding

The authors gratefully acknowledge the support of this research by the Earlier.org - Friends For an Earlier Breast Cancer Test foundation and the Israel Science Foundation.

Author information

Author notes

  1. Michal Rivlin and Debbie Anaby contributed equally to this work.

Authors and Affiliations

  1. School of Chemistry, Tel-Aviv University, Levanon St., 6997801, Tel Aviv, Israel

    Michal Rivlin & Gil Navon

  2. Department of Radiology, Sheba Medical Center, Sheba Tel Ha’shomer, Emek Ha Ella 1 St, 5265601, Ramat-Gan, Israel

    Debbie Anaby & Noam Nissan

  3. The Sackler School of Medicine, Tel-Aviv University, Levanon St., 6997801, Tel Aviv, Israel

    Debbie Anaby, Noam Nissan & Miri Sklair-Levy

  4. Departmnet of Neuroradiology, University Clinic Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany

    Moritz Zaiss

  5. Department of Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany

    Anagha Deshmane

  6. Meirav High Risk Clinic, Department of Diagnostic Imaging, Sheba Medical Center, Emek Ha Ella 1 St, 5265601, Ramat Gan, Israel

    Miri Sklair-Levy

Authors
  1. Michal Rivlin
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  2. Debbie Anaby
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  3. Noam Nissan
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  4. Moritz Zaiss
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  5. Anagha Deshmane
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  6. Gil Navon
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  7. Miri Sklair-Levy
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Corresponding author

Correspondence to Gil Navon.

Ethics declarations

Ethics approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Guarantor

The scientific guarantor of this publication is Prof. Gil Navon.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Rivlin, M., Anaby, D., Nissan, N. et al. Breast cancer imaging with glucosamine CEST (chemical exchange saturation transfer) MRI: first human experience. Eur Radiol 32, 7365–7373 (2022). https://doi.org/10.1007/s00330-022-08772-w

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  • DOI: https://doi.org/10.1007/s00330-022-08772-w

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