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Abstract
CLINICAL/METHODICAL ISSUE Detection and characterization of focal liver lesions. STANDARD RADIOLOGICAL METHODS Due to its excellent soft tissue contrast, the availability of liver-specific contrast agents and the possibility of functional imaging, magnetic resonance imaging (MRI) is the method of choice for the evaluation of focal liver lesions. METHODICAL INNOVATIONS Diffusion-weighted imaging (DWI) enables generation of functional information about the microstructure of a tissue besides morphological information. PERFORMANCE In the detection of focal liver lesions DWI shows a better detection rate compared to T2w sequences and a slightly poorer detection rate compared to dynamic T1w sequences. In principle, using DWI it is possible to distinguish malignant from benign liver lesions and also to detect a therapy response at an early stage. ACHIEVEMENTS For both detection and characterization of focal liver lesions, DWI represents a promising alternative to the morphological sequences; however, a more detailed characterization with the use of further sequences should be carried out particularly for the characterization of solid benign lesions. For the assessment and prognosis of therapy response, DWI offers advantages compared to morphological sequences. PRACTICAL RECOMMENDATIONS For the detection of focal liver lesions DWI is in principle sufficient. After visual detection of a solid liver lesion a more detailed characterization should be carried out using further sequences (in particular dynamic T1w sequences). The DWI procedure should be used for the assessment and prognosis of a therapy response.
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Affiliation(s)
- P Riffel
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - S O Schoenberg
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - J Krammer
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Li R, Wu G, Wang R. Application values of 3.0T magnetic resonance diffusion weighted imaging for distinguishing liver malignant tumors and benign lesions. Oncol Lett 2018; 15:2091-2096. [PMID: 29434910 PMCID: PMC5776940 DOI: 10.3892/ol.2017.7565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 07/03/2017] [Indexed: 12/20/2022] Open
Abstract
The aim of the present study was to investigate the significance and values of 3.0T diffusion weighted imaging (DWI) to differentially diagnose benign and malignant space-occupying liver lesions. A total of 91 patients with liver space-occupying lesions (145 lesions) were admitted into Zhongnan Hospital of Wuhan University (Wuhan, China) from November 2015 to May 2016. Routine scanning, DWI and high-resolution T2-weighted imaging using spin-echo echo-planar imaging were performed on all patients, to compare the apparent diffusion coefficient (ADC) values of three regions of interest in lesions with normal liver tissue. The ADC values of malignant liver lesions compared with benign liver cysts demonstrated a statistically significant difference in low b-value (P<0.05) and there was also a significant difference between malignant lesion and hepatic cyst, hepatic hemangioma or hepatic abscess in middle b-value (P<0.05). The measured ADC value may be more conducive to identify the nature of the liver space-occupying lesions; as the ADC values of malignant liver lesion, liver cyst, and liver abscesses demonstrated a statistical significance in high b-value (P<0.05). The mean ADC values between malignant liver tumors compared with benign lesions indicated a statistically significant difference. In the present study, liver space-occupying lesions demonstrated different DWI features and ADC ranges, and 3.0T DWI may be a potential means to accurately determine the nature of lesions, identifying benign and malignant space-occupying lesions.
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Affiliation(s)
- Ruibin Li
- Department of Diagnostic Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Guangyao Wu
- Department of Diagnostic Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Rui Wang
- Department of Diagnostic Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
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Standard-b-Value Versus Low-b-Value Diffusion-Weighted Imaging in Hepatic Lesion Discrimination: A Meta-analysis. J Comput Assist Tomogr 2017; 40:498-504. [PMID: 26938696 DOI: 10.1097/rct.0000000000000377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We sought to determine the comparative diagnostic performance of standard-b-value (500-1000s/mm) versus low-b-value (≤500 s/mm) diffusion-weighted imaging (DWI) in the discrimination of hepatic lesions. METHODS A total of 1775 hepatic malignant lesions and 1120 benign hepatic lesions from 21 studies were included. RESULTS (1) The global sensitivity was 0.86 (95% confidence interval [CI], 0.847-0.879), the specificity was 0.82 (95% CI, 0.797-0.842), the positive likelihood ratio (PLR) was 6.234 (95% CI, 4.260-9.123), the negative likelihood ratio (NLR) was 0.175 (95% CI, 0.135-0.227), and diagnostic odds ratio (DOR) was 42.836 (95% CI, 24.134-76.031). The area under the curve (AUC) and Q* index were 0.93 and 0.87. Publication bias was not present (P > 0.05). (2)The sensitivity of a subgroup meta-analysis of standard-b-value DWI was 0.858 (95% CI, 0.835-0.880), the specificity was 0.836 (95% CI, 0.807-0.863), the PLR was 6.527 (95% CI, 3.857-11.046), the NLR was 0.168 (95% CI, 0.123-0.239), and the DOR was 49.716 (95% CI, 22.897-107.98). The AUC and Q* index were 0.941 and 0.88. (3)The sensitivity of a subgroup meta-analysis of low-b-value DWI was 0.87 (95% CI, 0.84-0.89), the specificity was 0.80 (95% CI, 0.76-0.83), the PLR was 6.22 (95% CI, 3.29-11.76), the NLR was 0.19 (95% CI, 0.12-0.29), and the DOR was 37.14 (95% CI, 14.80-93.18). The AUC and Q* index were 0.922 and 0.86. CONCLUSIONS Hepatic DWI is useful in differentiating between malignant and benign hepatic lesions. Standard-b-value DWI displayed an overall superior diagnostic accuracy over low-b-value DWI. Further trials needed to determine whether increasing b values beyond 1000 s/mm affects the diagnostic accuracy of hepatic lesion discrimination.
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Saito K, Yoshimura N, Shirota N, Saguchi T, Sugimoto K, Tokuuye K. Distinguishing liver haemangiomas from metastatic tumours using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced diffusion-weighted imaging at 1.5T MRI. J Med Imaging Radiat Oncol 2016; 60:599-606. [DOI: 10.1111/1754-9485.12487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/23/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Kazuhiro Saito
- Department of Radiology; Tokyo Medical University; Tokyo Japan
| | | | | | - Toru Saguchi
- Department of Radiology; Tokyo Medical University; Tokyo Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Tokyo Japan
| | - Koichi Tokuuye
- Department of Radiology; Tokyo Medical University; Tokyo Japan
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Kececi I, Nural M, Aslan K, Danacı M, Kefeli M, Tosun M. Efficacy of diffusion-weighted magnetic resonance imaging in the diagnosis and staging of endometrial tumors. Diagn Interv Imaging 2016; 97:177-86. [DOI: 10.1016/j.diii.2015.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 06/15/2015] [Accepted: 06/30/2015] [Indexed: 11/25/2022]
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Chen ZG, Xu L, Zhang SW, Huang Y, Pan RH. Lesion discrimination with breath-hold hepatic diffusion-weighted imaging: A meta-analysis. World J Gastroenterol 2015; 21:1621-7. [PMID: 25663782 PMCID: PMC4316105 DOI: 10.3748/wjg.v21.i5.1621] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/23/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the diagnostic capability of breath-hold diffusion-weighted imaging (DWI) for differentiation between malignant and benign hepatic lesions.
METHODS: A total of 614 malignant liver lesions (132 hepatocellular carcinomas, 468 metastases and 14 intrahepatic cholangiocarcinomas) and 291 benign liver lesions (102 hemangiomas, 158 cysts, 24 focal nodular hyperplasia, 1 angiomyolipoma and 6 hepatic adenomas) were included from seven studies (eight sets of data).
RESULTS: The pooled sensitivity and specificity of breath-hold DWI were 0.93 [95% confidence interval (CI): 0.91-0.95] and 0.87 (95%CI: 0.83-0.91), respectively. The positive likelihood ratio and negative likelihood ratio were 7.28 (95%CI: 4.51-11.76) and 0.09 (95%CI: 0.05-0.17), respectively. The P value for χ2 heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.96 and 0.91, respectively. Publication bias was not present (t = 0.49, P = 0.64). The meta-regression analysis indicated that evaluated covariates including magnetic resonance imaging modality, echo time, mean age, maximum b factor, and number of b factors were not sources of heterogeneity (all P > 0.05).
CONCLUSION: Breath-hold DWI is useful for differentiating between malignant and benign hepatic lesions. The diffusion characteristics of benign lesions that mimic malignant ones have rarely been investigated.
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Chen J, Wu M, Liu R, Li S, Gao R, Song B. Preoperative evaluation of the histological grade of hepatocellular carcinoma with diffusion-weighted imaging: a meta-analysis. PLoS One 2015; 10:e0117661. [PMID: 25658359 PMCID: PMC4320049 DOI: 10.1371/journal.pone.0117661] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in the preoperative prediction of the histological grade of hepatocellular carcinoma (HCC). MATERIALS AND METHODS A comprehensive literature search was performed in several authoritative databases to identify relevant articles. QUADAS-2 was used to assess the quality of included studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Summary receiver operating characteristic (SROC) curves were derived and areas under the SROC curve (AUC) were computed to indicate the diagnostic accuracy. Heterogeneity test, meta-regression analysis and sensitivity analysis were performed to identify factors and studies contributed to the heterogeneity. RESULTS A total of 11 studies with 912 HCCs were included in this meta-analysis. The pooled sensitivity, specificity, PLR and NLR with corresponding 95% confidence intervals (CI) were 0.54(0.47-0.61), 0.90(0.87-0.93), 4.88(2.99-7.97) and 0.46(0.27-0.77) for the prediction of well-differentiated HCC (w-HCC), 0.84(0.78-0.89), 0.48(0.43-0.52), 2.29(1.43-3.69) and 0.30(0.22-0.41) for the prediction of poorly-differentiated HCC (p-HCC). The AUC were 0.9311 and 0.8513 in predicting w-HCC and p-HCC, respectively. Results were further evaluated according to the method of image interpretation. Significant heterogeneity was observed. CONCLUSION DWI had excellent and moderately high diagnostic accuracy for the detection of w-HCC and p-HCC, respectively. Nonetheless, further studies in larger populations and an optimized image acquisition and interpretation are required before DWI-derived parameters can be used as a useful image biomarker for the prediction of the histological grade of HCC.
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Affiliation(s)
- Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Mingpeng Wu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Rongbo Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Siyi Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Ronghui Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
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Aslan K, Danaci M, Polat AV, Aydin R, Soyucok A. Can a b value of 500 be substituted for a b value of 1000 in the characterization of focal liver lesions? ACTA ACUST UNITED AC 2014; 39:300-9. [PMID: 24441577 DOI: 10.1007/s00261-013-0066-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Comparison of two different b values in diffusion-weighted magnetic resonance imaging (DWI) for characterization of focal liver lesions. METHODS A total of 174 focal liver lesions from 100 patients were analyzed using two different b values (500 and 1000 s/mm(2)). The DWI with b values of 500 s/mm(2) (DWI500) and 1000 s/mm(2) (DWI1000) were analyzed using the Mann-Whitney test, kappa statistic, and paired t test with respect to image quality. The statistically significant differences between DWI500 and DWI1000 in the characterization of the lesions with respect to the cutoff ADC values were evaluated via χ (2) test. RESULTS DWI500 had the highest mean score in the qualitative evaluation of image quality (p < 0.0001) and the highest signal-to-noise ratio (8.7 ± 2.1; p < 0.0001). The sensitivity, specificity, and AUC for discriminating malignant from benign focal lesions on DWI500 and DWI1000 using cutoff ADC values of 1.54 × 10(-3) and 1.38 × 10(-3) s/mm(2) were 95.8%, 92.3%, 0.98, and 93.8%, 92.3%, 0.97, respectively. There was no statistically significant difference in sensitivity, specificity, and AUC values between DWI500 and DWI1000 with respect to the cutoff ADC values (p > 0.05). CONCLUSIONS The image quality of DWI500 was better than that of DWI1000, and there was no significant difference between DWI500 and DWI1000 in the characterization of the lesions with respect to the cutoff ADC values. The b value of 500 s/mm(2) can be substituted for the b value of 1000 s/mm(2) in the characterization of focal liver lesions.
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Affiliation(s)
- Kerim Aslan
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, 55139, Samsun, Turkey,
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Han X, Dong Y, Xiu JJ, Zhang J, Huang ZQ, Cai SF, Yuan XS, Liu QW. Diffusion-weighted imaging for the left hepatic lobe has higher diagnostic accuracy for malignant focal liver lesions. Asian Pac J Cancer Prev 2014; 15:6155-60. [PMID: 25124590 DOI: 10.7314/apjcp.2014.15.15.6155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was conducted to investigate whether apparent diffusion coefficient (ADC) measurements by dividing the liver into left and right hepatic lobes may be utilized to improve the accuracy of differential diagnosis of benign and malignant focal liver lesions. MATERIALS AND METHODS A total of 269 consecutive patients with 429 focal liver lesions were examined by 3-T magnetic resonance imaging that included diffusion-weighted imaging. For 58 patients with focal liver lesions of the same etiology in left and right hepatic lobes, ADCs of normal liver parenchyma and focal liver lesions were calculated and compared using the paired t-test. For all 269 patients, ADC cutoffs for focal liver lesions and diagnostic accuracy in the left hepatic lobe, right hepatic lobe and whole liver were evaluated by receiver operating characteristic curve analysis. RESULTS For the group of 58 patients, mean ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. For differentiating malignant lesions from benign lesions in all patients, the sensitivity and specificity were 92.6% and 92.0% in the left hepatic lobe, 94.4% and 94.4% in the right hepatic lobe, and 90.4% and 94.7% in the whole liver, respectively. The area under the curve of the right hepatic lobe, but not the left hepatic lobe, was higher than that of the whole liver. CONCLUSIONS ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. Optimal ADC cutoff for focal liver lesions in the right hepatic lobe, but not in the left hepatic lobe, had higher diagnostic accuracy compared with that in the whole liver.
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Affiliation(s)
- Xue Han
- Department of Radiology, Provincial Hospital, Shandong University, Jinan, China E-mail :
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Han NY, Park BJ, Sung DJ, Kim MJ, Cho SB, Lee CH, Jang YJ, Kim SY, Kim DS, Um SH, Won NH, Yang KS. Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: gadoxetic acid--enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation. Radiology 2014; 271:416-25. [PMID: 24475862 DOI: 10.1148/radiol.13131810] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To retrospectively evaluate findings of chemotherapy-induced focal hepatopathy (CIFH) on gadoxetic acid-enhanced magnetic resonance (MR) and diffusion-weighted (DW) images and to determine imaging features that are most helpful in differentiating CIFH from metastasis. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and informed consent was waived. MR images, including DW images and gadoxetic acid-enhanced images, from 12 patients (four men, eight women; age range, 25-64 years) with 15 CIFHs were reviewed independently and in consensus by two radiologists and were compared with those obtained in 20 control patients (12 men, eight women; age range, 32-84 years) with 30 hepatic metastasis who were matched for tumor size, primary organ, and chemotherapy regimen. Interobserver agreement was assessed with κ statistics, and univariate analysis was performed for comparisons. For quantitative analyses, apparent diffusion coefficients (ADCs) and lesion-to-liver contrast ratios (CRs) were measured. Histopathologic examinations were performed for CIFHs. RESULTS Histopathologic examination revealed that the development of CIFHs was attributable to accentuated manifestations of sinusoidal obstruction syndrome. Interobserver agreement was excellent (κ > 0.85). An ill-defined margin on hepatobiliary phase (HBP) images was the most discriminating independent variable in the differentiation of CIFH from metastasis (odds ratio, 16; P = .009). ADC and CR values in CIFH group were significantly higher than those in metastasis group (P < .001 and P = .041). CONCLUSION CIFH should be considered a mimicker of metastasis in patients with gastrointestinal malignancy during chemotherapy. CIFH can be differentiated from metastasis on the basis of gadoxetic acid-enhanced MR and DW imaging findings; an ill-defined margin on HBP images was especially characteristic.
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Affiliation(s)
- Na Yeon Han
- From the Departments of Radiology (H.N.Y., B.J.P., D.J.S., M.J.K., S.B.C.), Surgery (D.S.K.), Internal Medicine (S.H.U.), and Pathology (N.H.W.), College of Medicine, and Department of Biostatistics (K.S.Y.), Korea University, Anam Hospital, 126-1 5-Ka, Anam-Dong, Sungbuk-ku, Seoul 136-705, Republic of Korea; Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (C.H.L.); Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea (Y.J.J.); and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea (S.Y.K.)
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Galea N, Cantisani V, Taouli B. Liver lesion detection and characterization: role of diffusion-weighted imaging. J Magn Reson Imaging 2014; 37:1260-76. [PMID: 23712841 DOI: 10.1002/jmri.23947] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/11/2012] [Indexed: 12/11/2022] Open
Abstract
Diffusion-weighted imaging (DWI) plays an emerging role for the assessment of focal and diffuse liver diseases. This growing interest is due to that fact that DWI is a noncontrast technique with inherent high contrast resolution, with promising results for detection and characterization of focal liver lesions. Recent advances in diffusion image quality have also added interest to this technique in the abdomen. The purpose of this review is to describe the current clinical roles of DWI for the detection and characterization of focal liver lesions, and to review pitfalls, limitations, and future directions of DWI for assessment of focal liver disease.
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Affiliation(s)
- Nicola Galea
- Sapienza University of Rome, Department of Radiological Sciences, Rome, Italy
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Girometti R, Del Pin M, Pullini S, Cereser L, Como G, Bazzocchi M, Zuiani C. Does diffusion-weighted imaging add diagnostic confidence in discriminating between benign and malignant solid focal liver lesions? Clin Imaging 2013; 38:136-41. [PMID: 24332555 DOI: 10.1016/j.clinimag.2013.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/12/2013] [Indexed: 01/16/2023]
Abstract
We investigated whether diffusion-weighted Imaging (DWI) adds diagnostic confidence in assessing focal liver lesions (FLLs). By reviewing FLLs without and with DWI at 1.5 T, two radiologists scored the confidence in diagnosing benignancy/malignancy (confidence score), and DWI usefulness (usefulness score). We showed that adding DWI significantly decreased the confidence score of the most experienced radiologist and increased his confidence in false-negative diagnoses showing atypical features on conventional magnetic resonance imaging.
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Affiliation(s)
- Rossano Girometti
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, "S.Maria della Misericordia", via Colugna n. 50 - 33100 Udine, Italy.
| | - Matteo Del Pin
- Radiology Department, "S. Maria degli Angeli" Hospital, via Montereale n. 24 - 33170, Pordenone, Italy
| | - Serena Pullini
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, "S.Maria della Misericordia", via Colugna n. 50 - 33100 Udine, Italy
| | - Lorenzo Cereser
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, "S.Maria della Misericordia", via Colugna n. 50 - 33100 Udine, Italy
| | - Giuseppe Como
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, "S.Maria della Misericordia", via Colugna n. 50 - 33100 Udine, Italy
| | - Massimo Bazzocchi
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, "S.Maria della Misericordia", via Colugna n. 50 - 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, "S.Maria della Misericordia", via Colugna n. 50 - 33100 Udine, Italy
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d'Assignies G, Fina P, Bruno O, Vullierme MP, Tubach F, Paradis V, Sauvanet A, Ruszniewski P, Vilgrain V. High sensitivity of diffusion-weighted MR imaging for the detection of liver metastases from neuroendocrine tumors: comparison with T2-weighted and dynamic gadolinium-enhanced MR imaging. Radiology 2013; 268:390-9. [PMID: 23533288 DOI: 10.1148/radiol.13121628] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the sensitivity and specificity of diffusion-weighted (DW) magnetic resonance (MR) imaging for identifying liver metastases from neuroendocrine tumor (NET) to those of T2-weighted fast spin-echo (FSE) and three-dimensional dynamic gadolinium-enhanced MR imaging, with surgical and histopathologic findings as the reference standard. MATERIALS AND METHODS This retrospective study was approved by institutional review board, and informed consent was waived. Fifty-nine patients with NETs (41 patients with 162 liver metastases, and 18 control subjects with no liver metastases) underwent MR imaging that included DW, T2-weighted FSE, and dynamic gadolinium-enhanced MR sequences. Images were retrospectively reviewed by two abdominal radiologists, independently, for the detection and characterization of liver metastases. MR findings were compared with histopathologic and intraoperative ultrasonography findings for metastasis on a lesion-by-lesion basis to determine the sensitivity of each MR sequence alone and combined. Specificity was calculated by using the control population. Interreader agreement for each MR sequence and McNemar test were also calculated. RESULTS There was excellent agreement between observers 1 and 2 for characterizing liver metastases at per-lesion analysis (κ coefficient: 0.86-1.00). DW MR was more sensitive (observer 1: sensitivity, 71.6% [116 of 162], 95% confidence interval [CI]: 64.2%, 78.0%; observer 2: sensitivity, 71.0% [115 of 162], 95% CI: 63.6%, 77.4%) than T2-weighted FSE (observer 1: sensitivity, 55.6% [90 of 162], 95% CI: 47.9%, 63.0%; observer 2: sensitivity, 55.6% [90 of 162], 95% CI: 47.9%, 63.0%) and dynamic gadolinium-enhanced MR (observer 1: sensitivity, 47.5% [77 of 162], 95% CI: 34.0%, 55.2%; observer 2: sensitivity, 48.1% [78 of 162], 95% CI: 40.6%, 55.8%) (P < .001 for both, McNemar test). The specificity of these sequences ranged from 88.9% to 100% (DW MR vs T2-weighted FSE MR: P > .99, DW MR vs dynamic gadolinium-enhanced MR: P = .61, and T2-weighted FSE MR vs dynamic gadolinium-enhanced MR: P = .61, McNemar test). CONCLUSION DW MR imaging was more sensitive for the detection and characterization of liver metastases from NETs than T2-weighted FSE and dynamic gadolinium-enhanced MR imaging and should be systematically performed.
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Affiliation(s)
- Gaspard d'Assignies
- Department of Radiology, Assistance-Publique Hôpitaux de Paris, Hôpital Beaujon, 100 bd du Général Leclerc, 92110 Clichy, France
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Zhang P, Cui Y, Li W, Ren G, Chu C, Wu X. Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T. World J Surg Oncol 2012; 10:237. [PMID: 23137333 PMCID: PMC3514117 DOI: 10.1186/1477-7819-10-237] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/18/2012] [Indexed: 01/08/2023] Open
Abstract
Background Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Our study aims to determine the usefulness of apparent diffusion coefficients (ADC) for characterizing complex solid and cystic adnexal masses. Methods One-hundred and 91 patients underwent diffusion-weighted (DW) magnetic resonance (MR) imaging of 202 ovarian masses. The mean ADC value of the solid components was measured and assessed for each ovarian mass. Differences in ADC between ovarian masses were tested using the Student’s t-test. The receiver operating characteristic (ROC) was used to assess the ability of ADC to differentiate between benign and malignant complex adnexal masses. Results Eighty-five patients were premenopausal, and 106 were postmenopausal. Seventy-four of the 202 ovarian masses were benign and 128 were malignant. There was a significant difference between the mean ADC values of benign and malignant ovarian masses (p < 0.05). However, there were no significant differences in ADC values between fibrothecomas, Brenner tumors and malignant ovarian masses. The ROC analysis indicated that a cutoff ADC value of 1.20 x10-3 mm2/s may be the optimal one for differentiating between benign and malignant tumors. Conclusions A high signal intensity within the solid component on T2WI was less frequently in benign than in malignant adnexal masses. The combination of DW imaging with ADC value measurements and T2-weighted signal characteristics of solid components is useful for differentiating between benign and malignant ovarian masses.
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Affiliation(s)
- Ping Zhang
- Department of Obstetrics and Gynecology, Xinhua Hospital affiliated toShanghai JiaoTong University School of Medicine, Shanghai 200092, China
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Li W, Chu C, Cui Y, Zhang P, Zhu M. Diffusion-weighted MRI: a useful technique to discriminate benign versus malignant ovarian surface epithelial tumors with solid and cystic components. Abdom Radiol (NY) 2012; 37:897-903. [PMID: 22038329 DOI: 10.1007/s00261-011-9814-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate differences in apparent diffusion coefficient (ADC) values for the solid component of benign and malignant ovarian surface epithelial tumors with the goal of differentiating benign versus malignant ovarian tumors preoperatively. MATERIALS AND METHODS A total of 127 patients with 131 pelvic masses identified by ultrasound between January 2006 and January 2011 were enrolled in this study. 46 patients were diagnosed with benign tumors, and 85 patients were diagnosed with malignant pathologies. For all of the patients, routine spin-echo MRI and diffusion-weighted imaging were performed. ADC values were determined for all of the masses, and the mean ADC values for the benign and malignant tumors were analyzed using Student's t test. A P value <0.05 was considered statistically significant. RESULTS Mean ADC values associated with malignant ovarian surface epithelial tumors were significantly lower than the mean ADC values of the benign tumors. In addition, the range of ADC values associated with a 95% confidence interval did not overlap between the two groups. ROC analysis indicated that a cutoff ADC value of 1.25 × 10(-3) mm(2)/s was associated with 90.1% sensitivity and 89.9% specificity. CONCLUSION ADC values determined from 1.5 T MR DWI of benign and malignant ovarian masses were found to be significantly different.
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Affiliation(s)
- Wenhua Li
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Road, Shanghai, 200092, China.
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Accuracy of visual analysis vs. apparent diffusion coefficient quantification in differentiating solid benign and malignant focal liver lesions with diffusion-weighted imaging. Radiol Med 2012; 118:343-55. [PMID: 22986693 DOI: 10.1007/s11547-012-0873-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 12/15/2011] [Indexed: 12/24/2022]
Abstract
PURPOSE The authors compared the accuracy of diffusion-weighted imaging (DWI) visual analysis (VA) vs. apparent diffusion coefficient quantification (ADC-Q) in assessing malignancy of solid focal liver lesions (FLLs). MATERIALS AND METHODS Using a 1.5-T system, two radiologists retrospectively assessed as benign or malignant 50 solid FLLs: (a) by VA of signal intensity on DWI images at b=800 s/mm(2) and ADC map; (b) by quantifying lesion ADC. Reference standard included histology or follow-up confirmation of diagnosis by a consensus panel. Receiver operating characteristic (ROC) curve analysis was performed. RESULTS because of 20 false-negative hepatocellular carcinomas, VA showed lower accuracy than ADC-Q (52.0% VS. 68.0%). however, stratified accuracy for metastases was higher with VA (75.0 VS. 66%). ADC and signal features of malignant and benign FLLs were found to largely overlap. CONCLUSIONS VA performed worse than ADC-Q for hepatocellular carcinoma and better for metastases. Overall, the accuracy of both methods was limited because of the overlap in visual appearance and ADC values between solid benign and malignant FLLs.
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Ozaki M, Inoue Y, Miyati T, Hata H, Mizukami S, Komi S, Matsunaga K, Woodhams R. Motion artifact reduction of diffusion-weighted MRI of the liver: use of velocity-compensated diffusion gradients combined with tetrahedral gradients. J Magn Reson Imaging 2012; 37:172-8. [PMID: 22987784 DOI: 10.1002/jmri.23796] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 07/31/2012] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess the effect of motion artifact reduction on the diffusion-weighted magnetic resonance imaging (DWI-MRI) of the liver, we compared velocity-compensated DWI (VC-DWI) and VC-DWI combined with tetrahedral gradients (t-VC-DWI) to conventional DWI (c-DWI) in the assessment of apparent diffusion coefficients (ADCs) of the liver. MATERIALS AND METHODS In 12 healthy volunteers, the liver was scanned with c-DWI, VC-DWI, and t-VC-DWI sequences. The signal-to-noise ratio (SNR) and ADC of the liver parenchyma were measured and compared among sequences. RESULTS The image quality was visually better for t-VC-DWI than for the others. The SNR for t-VC-DWI was significantly higher than that for VC-DWI (P < 0.05) and comparable to that for c-DWI. ADCs in both hepatic lobes were significantly lower for t-VC-DWI than for c-DWI (P < 0.01). ADC in the left lobe was significantly lower for VC-DWI than for c-DWI (P < 0.01). Although ADC in the left lobe was significantly higher for c-DWI (P < 0.01), no significant differences in ADCs were found between the right and left lobes for VC-DWI and t-VC-DWI. CONCLUSION The use of a t-VC-DWI sequence enables us to correct ADCs of the liver for artificial elevation due to cardiac motion, with preserved SNR.
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Affiliation(s)
- Masanori Ozaki
- School of Allied Health Sciences, Kitasato University, Kanagawa, Japan.
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Kim H, Yu JS, Kim DJ, Chung JJ, Kim JH, Kim KW. Diffusion-weighted MR imaging before and after contrast enhancement with superparamagnetic iron oxide for assessment of hepatic metastasis. Yonsei Med J 2012; 53:825-33. [PMID: 22665353 PMCID: PMC3381471 DOI: 10.3349/ymj.2012.53.4.825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The purpose of our study was to validate diffusion-weighted MRI (DWI) before and after superparamagnetic iron oxide (SPIO) injection for assessment of hepatic metastases. MATERIALS AND METHODS Eighty-six hepatic metastases (size range, 0.3-4.7 cm; mean, 1.5 cm) verified pathologically or by follow-up imaging studies in 22 consecutive patients (17 men and 5 women; 44-83 years; mean age, 60 years) during a 13-month period were enrolled. Hepatic MRI, including DWI (b-factors=50, 400, 800 s/mm²) with breath-holding technique of single-shot spin-echo echo-planar imaging (TR/TE=1000/69 ms, average=2) before and after SPIO administration, were retrospectively reviewed by two independent radiologists with a 5-point scale confidence score for each hepatic lesion on pre-contrast DWI (pre-DWI), SPIO-enhanced DWI (SPIO-DWI), and SPIO-enhanced T2*-weighted imaging (SPIO-T2*wI). RESULTS For all lesions, SPIO-T2*wI showed significantly higher confidence score in the diagnosis of hepatic metastases than pre-contrast or SPIO-DWI regardless of the size of b-factors (p<0.05) with only one exception; using b-factor=50 s/mm², the score of SPIO-T2*wI was still higher than SPIO-DWI but there was no statistical significance given by observer 1 (p=0.730). For the subcentimeter lesions (n=37), SPIO-T2*wI showed the highest score, and using b-factor= 50 or 400 s/mm² SPIO-DWI showed similar confidence scores to SPIO-T2*wI by both observers (p>0.05). Pre-DWI using b-factor=50 sec/mm² was also comparable with SPIO-T2*wI by observer 1 (p=0.060). CONCLUSION Pre-DWI has a limited value for the assessment of hepatic metastases, however, the repetition of DWI after SPIO injection using small b-factors could complement SPIO-T2*wI, especially for subcentimeter lesions.
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Affiliation(s)
- Hana Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Sik Yu
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Jung Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae-Joon Chung
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hee Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Whang Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Bonekamp S, Corona-Villalobos CP, Kamel IR. Oncologic applications of diffusion-weighted MRI in the body. J Magn Reson Imaging 2012; 35:257-79. [PMID: 22271274 DOI: 10.1002/jmri.22786] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diffusion-weighted MRI (DWI) allows the detection of malignancies in the abdomen and pelvis. Lesion detection and characterization using DWI largely depends on the increased cellularity of solid or cystic lesions compared with the surrounding tissue. This increased cellularity leads results in restricted diffusion as indicated by reduction in the apparent diffusion coefficient (ADC). Low pretreatment ADC values of several malignancies have been shown to be predictive of better outcome. DWI can assess response to systemic or regional treatment of cancer at a cellular level and will therefore detect successful treatment earlier than anatomical measures. In this review, we provide a brief technical overview of DWI, discuss quantitative image analysis approaches, and review studies which have used DWI for the purpose of detection and characterization of malignancies as well as the early prediction of treatment response.
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Affiliation(s)
- Susanne Bonekamp
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Pelvic inflammatory disease: evaluation of diagnostic accuracy with conventional MR with added diffusion-weighted imaging. ACTA ACUST UNITED AC 2012; 38:193-200. [DOI: 10.1007/s00261-012-9896-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rosenkrantz AB, Oei M, Babb JS, Niver BE, Taouli B. Diffusion-weighted imaging of the abdomen at 3.0 Tesla: image quality and apparent diffusion coefficient reproducibility compared with 1.5 Tesla. J Magn Reson Imaging 2011; 33:128-35. [PMID: 21182130 DOI: 10.1002/jmri.22395] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare single-shot echo-planar imaging (SS EPI) diffusion-weighted MRI (DWI) of abdominal organs between 1.5 Tesla (T) and 3.0T in healthy volunteers in terms of image quality, apparent diffusion coefficient (ADC) values, and ADC reproducibility. MATERIALS AND METHODS Eight healthy volunteers were prospectively imaged in this HIPAA-compliant IRB-approved study. Each subject underwent two consecutive scans at both 1.5 and 3.0T, which included breathhold and free-breathing DWI using a wide range of b-values (0 to 800 s/mm²). A blinded observer rated subjective image quality (maximum score= 8), and a separate observer placed regions of interest within the liver, renal cortices, pancreas, and spleen to measure ADC at each field strength. Paired Wilcoxon tests were used to compare abdominal DWI between 1.5T and 3.0T for specific combinations of organs, b-values, and acquisition techniques. RESULTS Subjective image quality was significantly lower at 3.0T for all comparisons (P = 0.0078- 0.0156). ADC values were similar at 1.5T and 3.0T for all assessed organs, except for lower liver ADC at 3.0T using b0-500-600 and breathhold technique. ADC reproducibility was moderate at both 1.5T and 3.0T, with no significant difference in coefficient of variation of ADC between field strengths. CONCLUSION Compared with 1.5T, SS EPI at 3.0T provided generally similar ADC values, however, with worse image quality. Further optimization of abdominal DWI at 3.0T is needed.
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Wile GE, Leyendecker JR. Magnetic resonance imaging of the liver: sequence optimization and artifacts. Magn Reson Imaging Clin N Am 2011; 18:525-47, xi. [PMID: 21094454 DOI: 10.1016/j.mric.2010.07.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The liver is one of the most challenging organs of the body to image with magnetic resonance because it is large and mobile, receives a dual blood supply, and is surrounded by organs and structures that contribute to artifacts from flow and susceptibility. Recent advances in imaging hardware, in addition to improvements in temporal resolution and development of hepatocyte-specific contrast agents, make imaging of the liver more approachable than in the past; however, it remains a complex process that requires compromise. In this article the authors discuss development and optimization of a liver imaging protocol at 1.5 T, with common variations in each element of the protocol, as well as the strengths and weaknesses associated with the relevant sequences.
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Affiliation(s)
- Geoffrey E Wile
- Body Imaging Section, Department of Radiology, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA.
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Stang A, Keles H, Hentschke S, Seydewitz C, Keuchel M, Pohland C, Dahlke J, Weilert H, Wessling J, Malzfeldt E. Real-time ultrasonography-computed tomography fusion imaging for staging of hepatic metastatic involvement in patients with colorectal cancer: initial results from comparison to US seeing separate CT images and to multidetector-row CT alone. Invest Radiol 2011; 45:491-501. [PMID: 20458251 DOI: 10.1097/rli.0b013e3181ddd3da] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To prospectively evaluate the role of real-time ultrasonography (US)-computed tomography (CT) fusion imaging (US-CT) in comparison with US seeing separate CT images (US + CT) and multidetector-row CT (MDCT) for the correct staging of hepatic metastatic involvement in patients with colorectal cancer. METHODS Sixty-four patients with newly diagnosed colorectal cancer and who were referred for abdominopelvic staging before primary tumor resection underwent same-day MDCT, US + CT, and US-CT. Examinations were evaluated on-site by 2 investigators in consensus. Investigators recorded the size and location of detected lesions on segmental liver maps, classified them as being benign, malignant, or indeterminate, and finally assessed the M stage of the liver as being M0, M1, or Mx (indeterminate). All patients underwent surgical exploration including intraoperative US. Reference standard diagnosis was based on findings at surgery, intraoperative US, histopathology, and MDCT follow-up imaging. Differences among investigated modalities were analyzed using McNemar's test. RESULTS The reference standard verified 109 (45 < or = 1 cm) hepatic lesions in 25 patients, including 65 (25 < or = 1 cm) metastases in 16 patients (M1). Regarding the 45 < or = 1 cm liver lesions, rates for detection were significantly higher (P < 0.05) for MDCT (80%, 36/45) and US-CT (77.8%, 35/45) than for US + CT (64.4%, 29/45); the rate for correct classification by US-CT (71.1%, 32/45) was significantly higher than for US + CT (48.9%, 22/45) and MDCT (31.1%, 14/45) (all P < 0.05). On patient-based analysis, specificity of MDCT (85.4%, 41/48) was significantly lower (P < 0.05) than for US-CT (97.9%, 47/48) and US + CT (93.7%, 45/48); the positive predictive value of MDCT (63.1%, 12/19) was not significantly different (P = 0.27) compared with US + CT (82.3%, 14/17) but significantly lower (P < 0.05) than for US-CT (93.7%, 15/16). In 13 patients (59 lesions) with only benign (stage M0) or coexistent benign and malignant lesions (stage M1), indeterminate lesion ratings and indeterminate liver stagings (Mx) occurred both significantly lower (P < 0.05) with US-CT (3.4%, 2/59; and 0%, 0/13) than with US + CT (11.9%, 7/59; and 23.1%, 3/13) or with MDCT (30.5%, 18/59; and 53.8%, 7/13). CONCLUSIONS Based on these initial diagnostic experiences, complementary US-CT fusion imaging of small CT-indeterminate liver lesions may have value in staging patients with colorectal cancer, focusing on patients who were likely to harbor only benign or coexisting benign and malignant liver lesions and in whom change of M staging would change the clinical management.
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Affiliation(s)
- Axel Stang
- Department of Oncology, Asklepios Hospital Altona, Hamburg, Germany.
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Kenis C, Deckers F, De Foer B, Van Mieghem F, Van Laere S, Pouillon M. Diagnosis of liver metastases: can diffusion-weighted imaging (DWI) be used as a stand alone sequence? Eur J Radiol 2011; 81:1016-23. [PMID: 21377305 DOI: 10.1016/j.ejrad.2011.02.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 02/04/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate if diffusion-weighted MRI (DWI) can replace gadolinium-enhanced MRI (Gd-MRI) for diagnosing liver metastases. The diagnostic accuracy of both techniques alone and in combination are compared. MATERIALS AND METHODS Sixty-eight patients with histologically proven primary extrahepatic tumors were included in this retrospective study. Lesions included 62 metastases and 130 benign lesions. Three image sets (unenhanced T1 and T2/gadolinium enhanced T1 (Gd-MRI), DWI and combination of both) were reviewed independently by 3 observers. The areas under the receiver operating characteristic curves (A(z)), sensitivity and specificity for the 3 image sets were compared. The standard of reference was either histopathology or multi-modality and clinical follow-up. RESULTS Pooled data showed higher diagnostic accuracy for the combined set (A(z)=0.93) compared to Gd-MRI (p=0.001) and DWI (p<0.0001). No difference was found between the performance of Gd-MRI and DWI (p=0.09). Sensitivity for the combined set was higher than Gd-MRI (p=0.0003) and DWI (p=0.0034). Specificity for DWI was lower than Gd-MRI (p<0.0001) and the combined set (p<0.0001). CONCLUSION The diagnostic performance of DWI is equal to that of Gd-MRI. DWI alone can be used in patients where gadolinium contrast administration is not allowed. Combination of Gd-MRI and DWI significantly increases diagnostic accuracy.
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Affiliation(s)
- Christoph Kenis
- Department of Radiology, GZA Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk, Belgium.
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Focal eosinophilic infiltration of the liver: gadoxetic acid-enhanced magnetic resonance imaging and diffusion-weighted imaging. J Comput Assist Tomogr 2011; 35:81-5. [PMID: 21160434 DOI: 10.1097/rct.0b013e3181f39f30] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Using gadoxetic acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI), the purpose of this study was to evaluate findings of focal hepatic eosinophilic infiltration. METHODS This retrospective study included 8 patients with 7 histologically confirmed focal eosinophilic infiltration (FEI) of the liver. One case was considered as FEI by using clinical findings and follow-up imaging. Gadoxetic acid-enhanced MRI and DWI were reviewed by 2 radiologists. We evaluated the signal intensity of focal lesions on T1-weighted, T2-weighted, and DW images and the pattern of enhancement in arterial, portal, equilibrium, and hepatobiliary phases of the gadoxetic acid-enhanced MRI. Apparent diffusion coefficient (ADC) value for focal eosinophilic infiltration was also calculated. RESULTS On T2-weighted images, 7 (88%) of 8 cases (7/8 lesions) showed mixed hyperintensity with irregular margins. Six (75%) of the 8 cases showed rim enhancement in the arterial phase. Most cases (5/8 lesions [63%]) showed isointensity or hypointensity in the portal and equilibrium phases. In the hepatobiliary phase, all cases (8/8) showed mixed hypointensity with irregular margins and nonspherical shapes. All cases showed hyperintensity in both low and high b-value ranges on DWI. The ADCs for 6 cases showed less than 1.05 × 10(-3) mm2/s (0.74 × 10(-3) to 1.03 × 10(-3) mm2/s). CONCLUSIONS Focal eosinophilic infiltration showed mixed hypointensity, irregular margins, and nonspherical shapes with excellent lesion-to-liver contrast in the hepatobiliary phase of the gadoxetic acid-enhanced MRI. Diffusion-weighted imaging and ADCs may not be helpful for characterizing these benign hepatic lesions.
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Xia D, Jing J, Shen H, Wu J. Value of diffusion-weighted magnetic resonance images for discrimination of focal benign and malignant hepatic lesions: a meta-analysis. J Magn Reson Imaging 2010; 32:130-7. [PMID: 20578019 DOI: 10.1002/jmri.22211] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the ability of DW-MRI in differentiating malignant hepatic tumors from benign lesions. MATERIALS AND METHODS Meta-analysis of 14 diagnostic studies was used. A systematic search in Medline, Embase, Web of Science (from January, 1966, to October, 2009), and Cochrane Controlled Clinical Trials Register Database (through third Quarter 2009) was used with screening of the literature. RESULTS A meta-analysis of all 95 published studies was performed. Fourteen studies fulfilled the inclusion criteria (804 patients with 1665 hepatic lesions). The global sensitivity was 0.91 (95% confidence interval [CI], 0.86-0.94), the specificity was 0.93 (95% CI, 0.86-0.97), the positive likelihood ratio (PLR) was 13.10 (95% CI, 6.30-27.26), the negative likelihood ratio (NLR) was 0.10 (95% CI, 0.06-0.15), and the diagnostic odds ratio (DOR) was 133.76 (95% CI, 49.77-359.45). The area under the curve of the summary receiver operator characteristic (SROC) was 0.96 (95% CI 0.94-0.98). CONCLUSION Diffusion-weighted magnetic resonance imaging is potential technically feasible to differentiate malignant from benign focal liver lesions. Apparent diffusion coefficient measurements can be useful in providing rapid quantifiable information.
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Affiliation(s)
- Dong Xia
- Department of Radiology, Lin-an People's Hospital, Hangzhou, Zhejiang Province, China
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Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 2010; 34:506-12. [PMID: 20657216 DOI: 10.1097/rct.0b013e3181da3671] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the diagnostic value of diffusion-weighted magnetic resonance imaging (DWI) for the characterization of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) in cirrhotic liver, compared with contrast material-enhanced magnetic resonance imaging (CE-MRI). METHODS A total of 54 patients with 40 HCC and 19 DN lesions were included in our study, and all lesions were histopathologically confirmed. All lesions were evaluated with CE-MRI, and breath-hold DWI was performed with b = 500 s/mm. The signal intensity (SI) of the lesions were classified as low, iso-, slightly high, and strongly high SI compared with that of the surrounding liver parenchyma on DWI for qualitative assessment. Apparent diffusion coefficients (ADCs) and lesion-to-liver ADC ratio of HCCs and DNs were measured and compared by using the Mann-Whitney U test. The lesions were characterized with the use of CE-MRI criteria and DWI, respectively. Receiver operating characteristic analysis was performed to assess the diagnostic value of DWI, CE-MRI, and these techniques combined in the differentiation of HCCs from DNs. RESULTS In the qualitative analysis, among 40 HCCs, 39 (97.5%) had slightly high or strongly high SI on DWI, and 1 (2.5%) had low SI; only 4 (21.5%) of 19 DNs had slightly high SI, and 15 (78.95%) had iso-SI or low SI. The mean (SD) ADC and ADC ratio for HCCs (1.28 x 10 [0.25] mm/s and 0.88 [0.15], respectively) were significantly lower (P < 0.01 and P < 0.001, respectively) than those for DNs (1.53 x 10 [0.33] mm/s and 1.00 [0.08], respectively). The area, Az, under the receiver operating characteristic curve for the SI feature, the ADC ratio, and the ADCs based on the diagnosis of HCC versus DN were 0.88, 0.81, and 0.68, respectively. When the slightly high SI of lesion with a cutoff ADC ratio less than 0.92 was applied as a criterion, the Az, the sensitivity, the specificity, and the accuracy of DWI for the diagnosis of HCC versus DN were 0.81, 67.50%, 94.74%, and 76.27%, respectively. The corresponding Az, sensitivity, specificity, and accuracy of CE-MRI were 0.70, 82.50%, 57.89%, and 74.58%, respectively. Combined DWI plus CE-MRI had 0.91 Az, 97.50% sensitivity, and 93.22% accuracy, which increased significantly compared with those of CE-MRI alone. CONCLUSIONS Diffusion-weighted MRI can provide additional information to differentiate HCC from DN. Combined with CE-MRI, DWI allows improved characterization of HCC versus DN in cirrhotic liver.
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Improved Detection of Hepatic Metastases From Pancreatic Cancer Using Periodically Rotated Overlapping Parallel Lines With Enhanced Reconstruction (PROPELLER) Technique After SPIO Administration. Invest Radiol 2010; 45:158-64. [DOI: 10.1097/rli.0b013e3181d32139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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