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This study investigated whether in vivo CEST may discriminate LNs with versus without metastatic involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>3T MRI was performed in patients with breast cancer before clinically\u2010indicated mastectomy or lumpectomy with LN removal, after which LN metastasic involvement was determined using histological evaluation. Non\u2010contrast anatomical imaging, as well as B<jats:sub>0<\/jats:sub> and B<jats:sub>1<\/jats:sub> field maps, were acquired in sequence with three\u2010point CEST\u2010Dixon (3D turbo\u2010gradient\u2010echo; factor\u2009=\u200925; TR\/TE1\/\u0394TE\u2009=\u2009851\/1.35\/1.1\u2009ms; spatial\u2010resolution\u2009=\u20092.5\u2009\u00d7\u20092.5\u2009\u00d7\u20096\u2009mm; slices\u2009=\u200910; four sinc\u2010gauss pulses with duty\u2010cycle\u2009=\u20090.5, total saturation duration\u2009=\u2009701.7\u2009ms; B<jats:sub>1<\/jats:sub>\u2009=\u20091.5\u2009\u03bcT; saturation offsets\u2009=\u2009\u22125.5 to +5.5\u2009ppm; stepsize\u2009=\u20090.2\u2009ppm; scan duration\u2009=\u20096\u2009min 30\u2009s). The mean z\u2010spectrum from LNs with (<jats:italic>n<\/jats:italic>\u2009=\u200920) versus without (<jats:italic>n<\/jats:italic>\u2009=\u200922) metastatic involvement were analyzed and a Wilcoxon rank\u2010sum test (significance: <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) was applied to evaluate differences in B<jats:sub>0,<\/jats:sub> B<jats:sub>1<\/jats:sub>, and magnetization transfer ratio (MTR) in differing spectral regions of known proton exchange (nuclear Overhauser effect [NOE], amide, amine, and hydroxyl) between cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No difference in axillary B<jats:sub>1<\/jats:sub> (<jats:italic>p<\/jats:italic>\u2009=\u20090.634) or B<jats:sub>0<\/jats:sub> (<jats:italic>p<\/jats:italic>\u2009=\u20090.689) was observed between cohorts. Elevated MTR was observed for the NOE (\u22121.7\u2009ppm; MTR\u2009=\u20090.285\u2009\u00b1\u20090.075 vs. 0.248\u2009\u00b1\u20090.039; <jats:italic>p<\/jats:italic>\u2009=\u20090.048), amine (+2.5\u2009ppm; MTR\u2009=\u20090.284\u2009\u00b1\u20090.067 vs. 0.234\u2009\u00b1\u20090.31; <jats:italic>p<\/jats:italic>\u2009=\u20090.005), and hydroxyl (+1\u2009ppm; MTR\u2009=\u20090.394\u2009\u00b1\u20090.075 vs. 0.329\u2009\u00b1\u20090.055; <jats:italic>p<\/jats:italic>\u2009=\u20090.002) protons in LNs from participants with versus without metastatic involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Findings are consistent with a unique metastatic LN microenvironment detectable by CEST\u2010Dixon and suggest that CEST MRI may have potential for mapping LN metastasis non\u2010invasively in vivo.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mrm.29858","type":"journal-article","created":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T03:57:08Z","timestamp":1694231828000},"page":"670-680","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["In vivo lymph node <scp>CEST\u2010Dixon MRI<\/scp> in breast cancer patients with metastatic lymph node involvement"],"prefix":"10.1002","volume":"91","author":[{"given":"Manus J.","family":"Donahue","sequence":"first","affiliation":[{"name":"Department of Neurology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula M. 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Sky","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Neurology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Garza","sequence":"additional","affiliation":[{"name":"Department of Neurology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Department of Radiology and Radiological Sciences Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niral J.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Cooper","sequence":"additional","affiliation":[{"name":"Nashville Breast Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill B.","family":"De Vis","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingrid","family":"Meszoely","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology and Endocrine Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1008-4570","authenticated-orcid":false,"given":"Rachelle","family":"Crescenzi","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Sciences Vanderbilt University 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