Shutter-speed dynamic contrast-enhanced MRI: Is it fit for purpose?

PURPOSE: To test the ability of shutter-speed dynamic contrast-enhanced (DCE) MRI to estimate water exchange (WX) using simulations and assess its performance in clinical case studies of malignant and benign breast tumors.
METHODS: Data were simulated using a 1-compartment tracer kinetic (TK) model combined with a 2-pool WX model (2PX) and with a 2-compartment TK model. Typical DCE-MRI acquisition parameters were used with both WX-sensitive (8°) and -insensitive (25°) flip angles. Clinical data were obtained from patients with malignant and benign breast tumors. Data were fitted using a 2-compartment TK model and a 1-compartment TK model combined with 4 WX models: fast exchange limit (FXL), no exchange, 2PX, and shutter-speed.
RESULTS: Fits to the 1-compartment simulated data were excellent, but estimates of WX obtained using the 2PX and shutter-speed models were poor. One-compartment TK model fits to the clinical malignant tumor data were bad, except for the shutter-speed model. However, that overestimated TK parameters compared to the best-fit 2-compartment TK model, which predicted a significant blood volume and leaky capillaries (1 tracer compartment is insufficient, 2 are necessary). All models produced excellent fits to the clinical benign tumor data with little variation between parameter estimates (1 tracer compartment is sufficient).
CONCLUSION: The 2PX and shutter-speed models were unable to estimate WX from the DCE-MRI data. A good fit to malignant tumor data using the shutter-speed model was not explained by WX, but the choice of an inappropriate TK model leading to distorted parameter estimates.