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Hua C, Qiu L, Zhou L, Zhuang Y, Cai T, Xu B, Hao S, Fang X, Wang L, Jiang H. Value of multiparametric magnetic resonance imaging for evaluating chronic kidney disease and renal fibrosis. Eur Radiol 2023; 33:5211-5221. [PMID: 37148348 DOI: 10.1007/s00330-023-09674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES To identify optimized MRI markers for evaluating chronic kidney disease (CKD) and renal interstitial fibrosis (IF). MATERIALS AND METHODS This prospective study included 43 patients with CKD and 20 controls. The CKD group was divided into mild and moderate-to-severe subgroups based on pathological results. Scanned sequences included T1 mapping, R2* mapping, intravoxel incoherent motion imaging, and diffusion-weighted imaging. One-way analyses of variance were used to compare MRI parameters among groups. Correlations of MRI parameters with estimated glomerular filtration rate (eGFR) and renal IF were analyzed using age as covariates. The support vector machine (SVM) model was used to evaluate the diagnostic efficacy of multiparametric MRI. RESULTS Compared to control values, renal cortical apparent diffusion coefficient (cADC), medullary ADC (mADC), cortical pure diffusion coefficient (cDt), medullary Dt (mDt), cortical shifted apparent diffusion coefficient (csADC), and medullary sADC (msADC) values gradually decreased in the mild and moderate-to-severe groups, while cortical T1 (cT1) and medullary T1 (mT1) values gradually increased. Values of cADC, mADC, cDt, mDt, cT1, mT1, csADC, and msADC were significantly associated with eGFR and IF (p < 0.001). The SVM model indicated that multiparametric MRI combining cT1 and csADC can distinguish patients with CKD from controls with high accuracy (0.84), sensitivity (0.70), and specificity (0.92) (AUC: 0.96). Multiparametric MRI combining cT1 and cADC exhibited high accuracy (0.91), sensitivity (0.95), and specificity (0.81) for evaluating IF severity (AUC: 0.96). CONCLUSION Multiparametric MRI combining T1 mapping and diffusion imaging may be of clinical utility in non-invasive assessment of CKD and IF. CLINICAL RELEVANCE STATEMENT This study shows that multiparametric MRI combining T1 mapping and diffusion imaging may be clinically useful in the non-invasive assessment of chronic kidney disease (CKD) and interstitial fibrosis; this could provide information for risk stratification, diagnosis, treatment, and prognosis. KEY POINTS • Optimized MRI markers for evaluating chronic kidney disease and renal interstitial fibrosis were investigated. • Renal cortex/medullary T1 values increased as interstitial fibrosis increased; cortical shifted apparent diffusion coefficient (csADC) correlated significantly with eGFR and interstitial fibrosis. • Support vector machine (SVM) combining cortical T1 (cT1) and csADC/cADC effectively identifies chronic kidney disease and accurately predicts renal interstitial fibrosis.
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Affiliation(s)
- Chenchen Hua
- Diagnostic Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
- Department of Diagnostic Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Lu Qiu
- Department of Diagnostic Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Leting Zhou
- Department of Nephrology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Yi Zhuang
- Department of Diagnostic Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Ting Cai
- Department of Nephrology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Bin Xu
- Diagnostic Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Shaowei Hao
- Siemens Healthineers Digital Technology (Shanghai) CO., Ltd, Shanghai, China
| | - Xiangming Fang
- Diagnostic Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Liang Wang
- Department of Nephrology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China.
| | - Haoxiang Jiang
- Department of Diagnostic Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China.
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Roushdy MMM, Elsherif MMR, Kayed EMS, Farghaly S, Sayed AR. Does Diffusion Magnetic Resonance Imaging (DWI) has Role in Irradiated Laryngeal Carcinoma? Indian J Otolaryngol Head Neck Surg 2022; 74:6339-6346. [PMID: 36742495 PMCID: PMC9895342 DOI: 10.1007/s12070-021-03071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
DWI involves acquisition of signal of movement of water proton in cellular spaces of body (Brownian motion). It includes qualitative method either restricted or facilitated and quantitive method which is apparent diffusion coefficient value(ADC) which is related to proportion of extracellular and intracellular components of the tissue., ADC is calculated with use of at least two b value more accurate using more DWI with different b value,ADC levels is low in increased tissue cellularity, as malignancy., ADC levels is high in non-tumoral tissue alterations such as direct endoscopy oedema, radiotherapy necrosis are expected to have minimal cellularity. ADC is most accurate in the detection of malignancy versus tissue edema or radionecrosis the aim of study to assess value of ADC as regarding measuring sensitivity and specificity and accuracy to differentiate tumor recurrence from radionecrosis. This study includes 36 patients who were suspected patients of tumor recurrence after radiotherapy; it is a prospective randomized comparative clinical trial. The patients were assessed using direct laryngoscopic examination under general anaesthesia and biopsy, and diffusion weighted image on the neck (b0 and b1000), ADC map and ADC value measured al lesion and normal tissues and compared with pathology results. ADC value (mean 0.93 ± 0.30 X 10-3 mm2/s) in patients had recurrent carcinoma was significantly lower (P < .0001) than the mean ADC of normal tissue in the same patients (1.26 ± 0.134) while mean ADC of tumour recurrence (P < .0001) was lower than mean ADC value of radio necrosis (1.63 ± 0.21 × 10-3 mm2/s). MRI ADC value is a sensitive and non-invasive method in detection of a recurrent laryngeal lesion from radionecrosis.
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Affiliation(s)
| | | | - Ezzat Mohamed Saleh Kayed
- Otorhinolaryngology Department, Assiut University Hospital, Assiut University, 5thfloor main building, Assiut, Egypt
| | - Shimaa Farghaly
- Radio-diagnosis Department, Assiut University Hospital, Assiut University, First Floor Main Building, Assiut, Egypt
| | - Ahmed Ragab Sayed
- Otorhinolaryngology Department, Assiut University Hospital, Assiut University, 5thfloor main building, Assiut, Egypt
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Bruvo M, Mahmood F. Apparent diffusion coefficient measurement of the parotid gland parenchyma. Quant Imaging Med Surg 2021; 11:3812-3829. [PMID: 34341752 DOI: 10.21037/qims-20-1178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Abstract
The measurements of apparent diffusion coefficient (ADC) with diffusion weighted magnetic resonance imaging (DW-MRI) is becoming a popular diagnostic and research tool for examination of parotid glands. However, there is little agreement between the reported ADC values of the parotid gland in published literature. In this review 43 studies on ADC measurement of the parotid glands were included. The analyses indicated several possible culprits of the observed ADC discrepancies. For example, DW-MRI examinations under gustatory stimulation gives higher ADC values compared to the unstimulated parotid gland (P=0.003). The diffusion weighting factors (b-values) can either increase (b-value <200 s/mm2) or decrease ADC values (b-values >1,000 s/mm2). The timing of follow-up DW-MRI after radiotherapy (RT) indicates correlation to the found ADC values (R2 =0.39). Interestingly, the choice of regions of interest (ROI) appears not to affect the measurements of ADC (P=0.75). It can be concluded that there is a critical need for standardization of ADC measurement of the parotid glands to allow valid inter-study comparisons and eventually to reach consensus on the use of ADC as biomarker.
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Affiliation(s)
- Maja Bruvo
- Radiography, Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark.,Research Unit for Oncology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Karaman CZ, Tanyeri A, Özgür R, Öztürk VS. Parotid gland tumors: comparison of conventional and diffusion-weighted MRI findings with histopathological results. Dentomaxillofac Radiol 2020; 50:20200391. [PMID: 33237812 DOI: 10.1259/dmfr.20200391] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between pathological classification of parotid gland tumors and conventional MRI - diffusion-weighted imaging findings and also contribute the possible effect of apparent diffusion coefficient (ADC) to diagnosis. METHODS 60 patients with parotid masses diagnosed using histopathology and/or cytology were enrolled in this retrospective study. All patients were evaluated using a 1.5 T MRI. Demographic features, conventional MRI findings, and ADC values (mean, minimum, maximum, and relative) were recorded. MRI findings and ADC values were compared between benign-malignant groups and pleomorphic adenoma vs Warthin's tumor groups. RESULTS 60 tumors (48 benign, 12 malignant) were evaluated in a total of 60 patients (39 males, 21 females). The mean age was 59 (±14, 18-86) years old; the mean lesion size was 26 (±10, 11-61) mm. On the texture of conventional MRI, T2 dominantly hyperintense/with hypointensity signal was seen in 87% of pleomorphic adenomas and T2 dominantly hypointense/with hyperintesity signal was encountered in 64% of all Warthin's tumors. Seven (28%) Warthin's tumors were misdiagnosed as pleomorphic adenomas and two others (8%) as malignant tumors. The commonly used mean ADC value was 1.6 ± 0.6 × 10-3 mm2 s-1 for benign tumors, 0.8 ± 0.3 × 10-3 mm2 s-1 for malign tumors, 1 (0.9-1.8) × 10-3 mm2 s-1 for Warthin's tumors, and 1.9 ± 0.3 × 10-3 mm2 s-1 for pleomorphic adenomas. There was a statistically significant difference in ADC values between benign-malignant tumors and pleomorphic adenomas-Warthin's tumors. CONCLUSIONS Warthin's tumor may occasionally be misdiagnosed as pleomorphic adenoma and malignant tumor because of variable morphologic features. In addition to benign-malignant differentiation, the added ADC measurement may also be useful for differentiating Warthin's tumors from pleomorphic adenomas.
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Affiliation(s)
- Can Zafer Karaman
- Department of Radiology, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ahmet Tanyeri
- Department of Radiology, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey.,Department of Radiology, Yozgat City Hospital, Yozgat, Turkey
| | - Recep Özgür
- Department of Radiology, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey.,Department of Radiology, Devrek State Hospital, Zonguldak, Turkey
| | - Veli Süha Öztürk
- Department of Radiology, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey.,Department of Radiology, Salihli State Hospital, Manisa, Turkey
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Liu YJ, Lee YH, Chang HC, Chung HW, Wang CW, Juan CH, Chu YH, Lee JC, Juan CJ. Imaging quality of PROPELLER diffusion-weighted MR imaging and its diagnostic performance in distinguishing pleomorphic adenomas from Warthin tumors of the parotid gland. NMR IN BIOMEDICINE 2020; 33:e4282. [PMID: 32124504 DOI: 10.1002/nbm.4282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
The aim of this study was to evaluate the imaging quality and diagnostic performance of fast spin echo diffusion-weighted imaging with periodically rotated overlapping parallel lines with enhanced reconstruction (FSE-PROP-DWI) in distinguishing parotid pleomorphic adenoma (PMA) from Warthin tumor (WT). This retrospective study enrolled 44 parotid gland tumors from 34 patients, including 15 PMAs and 29 WTs with waived written informed consent. All participants underwent 1.5 T diffusion-weighted imaging including FSE-PROP-DWI and single-shot echo-planar diffusion-weighted imaging (SS-EP-DWI). After imaging resizing and registration among T2WI, FSE-PROP-DWI and SS-EP-DWI, imaging distortion was quantitatively analyzed by using the Dice coefficient. Signal-to-noise ratio and contrast-to-noise ratio were qualitatively evaluated. The mean apparent diffusion coefficient (ADC) of parotid gland tumors was calculated. Wilcoxon signed-rank test was used for paired comparison between FSE-PROP-DWI versus SS-EP-DWI. Mann-Whitney U test was used for independent group comparison between PMAs versus WTs. Diagnostic performance was evaluated by receiver operating characteristics curve analysis. P < 0.05 was considered statistically significant. The Dice coefficient was statistically significantly higher on FSE-PROP-DWI than SS-EP-DWI for both tumors (P < 0.005). Mean ADC was statistically significantly higher in PMAs than WTs on both FSE-PROP-DWI and SS-EP-DWI (P < 0.005). FSE-PROP-DWI and SS-EP-DWI successfully distinguished PMAs from WTs with an AUC of 0.880 and 0.945, respectively (P < 0.05). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy in diagnosing PMAs were 100%, 69.0%, 62.5%, 100% and 79.5% for FSE-PROP-DWI, and 100%, 82.8%, 75%, 100% and 88.6% for SS-EP-DWI, respectively. FSE-PROP-DWI is useful to distinguish parotid PMAs from WTs with less distortion of tumors but lower AUC than SS-EP-DWI.
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Affiliation(s)
- Yi-Jui Liu
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
| | - Yi-Hsiung Lee
- Electrical and Communication Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Hing-Chiu Chang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Hsiao-Wen Chung
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Chih-Wei Wang
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Cheng-Hsuan Juan
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
| | - Yueng-Hsiang Chu
- Department of Otolaryngology-Head & Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Jih-Chin Lee
- Department of Otolaryngology-Head & Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Chun-Jung Juan
- Department of Medical Imaging, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, Republic of China
- Department of Radiology, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
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Shi D, Qian JJ, Fan GH, Shen JK, Tian Y, Xu L. Salivary gland function in nasopharyngeal carcinoma before and late after intensity-modulated radiotherapy evaluated by dynamic diffusion-weighted MR imaging with gustatory stimulation. BMC Oral Health 2019; 19:288. [PMID: 31864328 PMCID: PMC6925496 DOI: 10.1186/s12903-019-0951-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/07/2019] [Indexed: 11/15/2022] Open
Abstract
Background Xerostomia caused by radiation-induced salivary glands injury has a considerable impact on patients’ quality of life. Nowadays, the existed different methods of evaluating xerostomia in clinical practice there are still some disadvantages and limitations. This study used diffusion-weighted magnetic resonance imaging (DW-MRI) with gustatory stimulation to assess salivary glands function after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods DW-MRI was performed in 30 NPC patients and swab method was used to calculate rest and stimulated salivary flow rates (SFR). DW sequence at rest and then repeated ten times during stimulation were obtained. Apparent diffusion coefficients (ADCs) maps of three glands were calculated. Patients before and after RT were recorded as xerostomia and non-xerostomia groups separately. Rest and stimulated ADCs, ADCs increase rates (IRs), time to maximum ADCs (Tmax), ADCs change rates (CRs), rest and stimulated SFR, SFR increase rates (IRs) and SFR change rates (CRs) before and after RT were assessed. Results The rest and stimulated ADCs of three glands after RT were higher than those before RT (p < 0.001). The rest and stimulated SFR of all salivary glands after RT were lower than those before RT (p < 0.001). A correlation existed between rest ADCs of submandibular glands and rest SFR of submandibular mixed with sublingual glands and full three glands before RT (p = 0.019, p = 0.009), stimulated ADCs and stimulated SFR in parotid glands before RT (p = 0.047). The rest ADCs of parotid glands after RT correlated to XQ scores (p = 0.037). Conclusions The salivary glands’ ADCs increased after RT both in rest and stimulated state due to the radiation injury and the ADCs correlated with SFR and XQ scores of evaluating the xerostomia in clinical practice.
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Affiliation(s)
- Dai Shi
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Jian-Jun Qian
- Department of Radiotherapy and Oncolog, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Guo-Hua Fan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Jun-Kang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Ye Tian
- Department of Radiotherapy and Oncolog, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Liang Xu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.
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Zhong X, Dale BM, Nickel MD, Kannengiesser SAR, Kiefer B, Bashir M. Improved accuracy of apparent diffusion coefficient quantification using a fully automatic noise bias compensation method: Preliminary evaluation in prostate diffusion weighted imaging. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2019; 305:22-30. [PMID: 31158792 DOI: 10.1016/j.jmr.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/11/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
Noise in diffusion magnetic resonance imaging can introduce bias in apparent diffusion coefficient (ADC) quantification. Previous studies proposed methods that are site-specific techniques as research tools with limited availability and typically require manual intervention, not completely ready to use in the clinical environment. The purpose of this study was to develop a fully automatic computational method to correct noise bias in ADC quantification and perform a preliminary evaluation in the clinical prostate diffusion weighted imaging (DWI). Using a pseudo replica approach for the noise map calculation as well as a direct mapping and a stepwise Chebychev polynomial modelling approach for the ADC fitting, a fully automatic noise-bias-compensated ADC calculation method was proposed and implemented both on the scanner and offline. The proposed method was validated in a computer simulation and a standardized diffusion phantom with ground-truth values. Two in vivo studies were performed to evaluate the proposed method in the clinical environment. The first in vivo study performed acquisitions using a clinically routine prostate DWI protocol on 29 subjects to evaluate the consistency between simulated and empirical results. In the second in vivo study, prostate ADC values of 14 subjects were compared between data acquired with external coils only and reconstructed with the proposed method vs. acquired with external combined with endorectal coils and reconstructed with the conventional method. In statistical analyses, p < 0.05 was regarded as significantly different. In the computer simulation, the proposed method showed smaller error percentage than the other methods and was significantly different (p < 2.2 × 10-16). With low signal-to-noise ratio (SNR), the conventional method underestimated ADC values compared to the ground truth values of the diffusion phantom, while the results of the proposed method were more consistent with the ground truth values. Statistical analyses showed no significant differences between measured and simulated results in the first in vivo study (p = 0.5618). Data from the second in vivo study showed that agreement between ADC measured with external coils only and combined coils was improved for the proposed method (mean bias: 0.04 × 10-3 mm2/s, 95% confidence interval (CI) = [-0.01, 0.09] × 10-3 mm2/s, p = 0.187), compared to the conventional method (mean bias: -0.12 × 10-3 mm2/s, 95% CI = [-0.17, -0.06] × 10-3 mm2/s, p < 0.0001). The proposed method compensates noise bias in low-SNR diffusion-weighted acquisitions and results show improved ADC quantification accuracy in the prostate. This method may be suitable for both clinical imaging and research utilizing ADC quantification.
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Affiliation(s)
- Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Los Angeles, CA, United States.
| | - Brian M Dale
- MR R&D Collaborations, Siemens Healthcare, Cary, NC, United States
| | - Marcel D Nickel
- MR Application Development, Siemens Healthcare GmbH, Erlangen, Germany
| | | | - Berthold Kiefer
- MR Application Development, Siemens Healthcare GmbH, Erlangen, Germany
| | - Mustafa Bashir
- Department of Radiology, Duke University Medical Center, Durham, NC, United States; Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC, United States
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Chen Z, Chen YL, Yu Q, Zhou SH, Bao YY, Shang DS, Ruan LX. Excision of tumors in the parapharyngeal space using an endoscopically assisted transoral approach: a case series and literature review. J Int Med Res 2018; 47:1103-1113. [PMID: 30526171 PMCID: PMC6421391 DOI: 10.1177/0300060518816190] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) provides important information regarding tumors in the parapharyngeal space (PPS), revealing their origin, whether they are benign or malignant, and their relationships with surrounding structures. METHODS Twelve tumors in the PPS were completely excised using an endoscopically assisted transoral approach (EATA). The MRI features were analyzed. RESULTS Ten pleomorphic adenomas confirmed on postoperative pathological examination had the parotid pedicle sign. A fat space between the tumor and parotid gland may distinguish such a tumor from a tumor arising from a minor salivary gland in the prestyloid space and a tumor arising from the deep lobe of the parotid gland. Both the jugular vein and carotid artery were displaced posteriorly in all 10 cases of pleomorphic adenomas. The principal features of the two schwannomas confirmed on postoperative pathological examination were separation of the internal carotid artery and internal jugular vein and anteromedial displacement of the internal carotid artery, suggesting that the tumors originated in the poststyloid space. In this review, 95 tumors were excised by the EATA in the English-language literature. CONCLUSIONS MRI renders differential diagnosis possible. PPS tumors may be completely excised via an EATA guided by tumor features evident on preoperative MRI.
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Affiliation(s)
- Zhe Chen
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - Ya-Lian Chen
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - Qi Yu
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - Shui-Hong Zhou
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - Yang-Yang Bao
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - De-Sheng Shang
- 2 Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ling-Xiang Ruan
- 2 Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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A comparison of conventional and diffusion-weighted magnetic resonance imaging in the diagnosis of sialadenitis and pleomorphic adenoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:451-457. [PMID: 30497909 DOI: 10.1016/j.oooo.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to compare the efficacy of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in correctly identifying the presence of disease in the major salivary glands and correctly distinguish sialadenitis from pleomorphic adenoma. STUDY DESIGN Twenty-one patients diagnosed with unilateral sialadenitis or pleomorphic adenoma were selected. The nonaffected contralateral glands were also analyzed. T1- and T2-weighted MRI and DWI were obtained using spin-echo pulse sequences with a 1.5 Tesla MRI device. The diagnostic performance of 3 observers was evaluated for detection of salivary gland alterations and differentiation between sialadenitis and pleomorphic adenoma based on evaluation of MRI in comparison with DWI. RESULTS Intra-and interobserver reliability ranged from 0.86 to 0.94. DWI demonstrated greater sensitivity and accuracy values compared with MRI for both detection of disease and differentiation of sialadenitis from pleomorphic adenoma, with specificity values that were greater than or equal to those of MRI. DWI yielded significantly higher diagnostic odds ratios compared with MRI for both identification of disease and differentiation between lesions. CONCLUSIONS DWI demonstrated better diagnostic performance in the detection of alterations in the salivary glands and in differentiating between sialadenitis and pleomorphic adenoma compared with conventional T1 and T2-weighted MRI.
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Abstract
This article reviews the role of routine and advanced diffusion imaging modules of the salivary glands. Routine and advanced diffusion imaging modules have a role in differentiation of malignant from benign salivary gland tumors, characterization of some benign salivary gland tumors, and staging of salivary gland cancer. The role of advanced diffusion modules in patients with salivary gland cancer after surgery, radiation therapy, or radioiodine therapy is discussed. Advanced diffusion imaging modules can help in diagnosis and staging of Sjögren syndrome.
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Intravoxel Incoherent Motion Diffusion-weighted MR Imaging for Early Evaluation of the Effect of Radiofrequency Ablation in Rabbit Liver VX2 Tumors. Acad Radiol 2018; 25:1128-1135. [PMID: 29478919 DOI: 10.1016/j.acra.2018.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 12/23/2022]
Abstract
RATIONALE AND OBJECTIVES This study aims to investigate the value of intravoxel incoherent motion (IVIM)-derived parameters for early evaluation of the efficiency of radiofrequency ablation (RFA) treatment for rabbit liver VX2 tumor. MATERIALS AND METHODS Eighteen rabbit liver VX2 tumor models were constructed, and computed tomography-guided RFA was performed. One day before and 7 days after RFA, 18 models underwent magnetic resonance imaging, including contrast-enhanced imaging and IVIM diffusion-weighted imaging with 16 b-factors (0-1000 s/mm2). Post-RFA liver tumors were segmented into viable tumor, inflammatory reaction, and ablation necrotic regions according to gross and histopathologic examinations. Parameters derived from IVIM were calculated. One-way analysis of variance and least significant difference test were used for comparisons among the three regions. The diagnostic performance of parameters was evaluated using receiver operating characteristic (ROC) analysis. RESULTS ADCtotal, D, and f values were significantly lower in viable tumor than in inflammatory reaction regions (all P < .05), but D* showed no significant difference between the two regions. ADCtotal values of viable tumor regions were significantly lower than that of ablation necrotic regions (P = .007), but D* values of necrotic regions were significantly lower than that of viable tumor regions (P = .045). In ROC analysis, ADC showed the highest area under the ROC curve for differentiating inflammatory reaction from viable tumor region. CONCLUSIONS ADCtotal, D, and f were valuable discriminating markers for differentiation between regions of viable tumor and inflammatory reaction in post-RFA tumor, especially ADCtotal outperformed the other two parameters with higher diagnostic performance.
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Khamis ME, Ahmed AF, Ismail EI, Bayomy MF, El-Anwar MW. The diagnostic efficacy of apparent diffusion coefficient value and Choline/Creatine ratio in differentiation between parotid gland tumors. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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JOURNAL CLUB: The Warthin Tumor Score: A Simple and Reliable Method to Distinguish Warthin Tumors From Pleomorphic Adenomas and Carcinomas. AJR Am J Roentgenol 2018; 210:1330-1337. [PMID: 29667889 DOI: 10.2214/ajr.17.18492] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this article is to propose a Warthin tumor (WT) score to distinguish WTs from other parotid tumors. MATERIALS AND METHODS The study included 78 patients with 92 histologically proven parotid tumors, including 42 WTs, 30 pleomorphic adenomas (PMAs), and 20 carcinomas. Echo-planar DW images were acquired. The WT score, which comprised the mean apparent diffusion coefficient (ADCM) and the SD of the ADC (ADCSD) of tumors, patient age, and patient sex, was used to predict WTs. The diagnostic performance of the WT score was evaluated using ROC analyses. Statistical significance was denoted by p < 0.05. RESULTS With the use of optimized criteria, including an ADCM less than or equal to 1.016 × 10-3 mm2/s (WT score, 1), an ADCSD less than or equal to 0.1171 × 10-3 mm2/s (WT score, 1), patient age older than 49 years (WT score, 1), and male sex (WT score, 1), a WT score greater than 2 had a sensitivity, specificity, positive negative value, negative predictive value, and accuracy of 85.7%, 100.0%, 100.0%, 89.3%, and 93.4%, respectively. CONCLUSION The WT score allows parotid WTs to be distinguished from PMAs and carcinomas with high accuracy.
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Luo M, Zhang L, Jiang XH, Zhang WD. Intravoxel incoherent motion: application in differentiation of hepatocellular carcinoma and focal nodular hyperplasia. Diagn Interv Radiol 2018; 23:263-271. [PMID: 28703102 DOI: 10.5152/dir.2017.16595] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to explore whether intravoxel incoherent motion (IVIM)-related parameters of hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) demonstrate differences that could be used to differentiate and improve diagnostic efficiency. METHODS A total of 27 patients, including 22 with HCC and 5 with FNH, underwent liver 3.0 T magnetic resonance imaging for routine sequences. They were concurrently examined by IVIM diffusion-weighted imaging (DWI) scanning with 11 different b values (0-800 s/mm2). IVIM-derived parameters, such as pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADCtotal), were quantified automatically by post-processing software and compared between HCC and FNH groups. A receiver operating characteristic (ROC) curve was then created to predict their diagnostic value. RESULTS D* was weak in terms of reproducibility among the other parameters. ADCtotal, D, and D* were significantly lower in the HCC group than in the FNH group, while f did not show a significant difference. ADCtotal and D had the largest area under the curve values (AUC; 0.915 and 0.897, respectively) and similarly high efficacy to differentiate the two conditions. CONCLUSION IVIM provides a new modality to differentiate the HCC and FNH. ADCtotal and D demonstrated outstanding and comparable diagnosing utility.
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Affiliation(s)
- Ma Luo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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Yologlu Z, Aydin H, Alp NA, Aribas BK, Kizilgoz V, Arda K. Diffusion weighted magnetic resonance imaging in the diagnosis of parotid masses. Preliminary results. Saudi Med J 2017; 37:1412-1416. [PMID: 27874161 PMCID: PMC5303784 DOI: 10.15537/smj.2016.12.16288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To demonstrate the diagnostic potentials of MRI, diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) mapping in the detection of parotid masses correlated to the histopathological results. Methods Study design was retrospective. Fifteen patients with parotid gland masses were included as the study group and contralateral normal parotis glands of same patients were taken as the control group. Patients with bilateral parotid gland tumors were excluded, 7 right-sided and 8 left-sided parotid masses were included in the research. The study took place at the Department of Radiology, Ankara, Turkey, between May 2012 and September 2014. Results Apparent diffusion coefficient measurements of 15 parotis tumors in 1000 and 750 sec/mm2b-values with comparison to the contralateral normal gland parenchyma were demonstrated. Neurofibromas was predicted as the highest, and lipomas as the lowest ADC values. Pleomorphic adenomas, Warthin’s tumor, and normal parotid parenchyma indicate significant statistical differences from each other on the basis of mean ADC values (p<0.05). Conclusion The DWI and ADC mapping of parotis gland could aid in the differential diagnosis of benign and malignant masses.
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Affiliation(s)
- Zeynel Yologlu
- Radiology Department, Dr. Abdurrahman Yurtaslan Onkoloji Research Hospital, Afyonkarahisar State Hospital, Ankara, Turkey. E-mail.
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Comparison of intravoxel incoherent motion diffusion-weighted imaging between turbo spin-echo and echo-planar imaging of the head and neck. Eur Radiol 2017; 28:316-324. [DOI: 10.1007/s00330-017-4990-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/25/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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Schakel T, Hoogduin JM, Terhaard CHJ, Philippens MEP. Technical Note: Diffusion-weighted MRI with minimal distortion in head-and-neck radiotherapy using a turbo spin echo acquisition method. Med Phys 2017; 44:4188-4193. [PMID: 28543364 DOI: 10.1002/mp.12363] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Diffusion-weighted (DW) MRI, showing high contrast between tumor and background tissue, is a promising technique in radiotherapy for tumor delineation. However, its use for head-and-neck patients is hampered by poor geometric accuracy in conventional echo planar imaging (EPI) DW-MRI. An alternative turbo spin echo sequence, DW-SPLICE, is implemented and demonstrated in patients. METHODS The DW-SPLICE sequence was implemented on a 3.0 T system and evaluated in 10 patients. The patients were scanned in treatment position, using a customized head support and immobilization mask. Image distortions were quantified at the gross tumor volume (GTV) using field map analysis. The apparent diffusion coefficient (ADC) was evaluated using an ice water phantom. RESULTS The DW images acquired by DW-SPLICE showed no image distortions. Field map analysis at the gross tumor volumes resulted in a median distortion of 0.2 mm for DW-SPLICE, whereas for the conventional method this was 7.2 mm. ADC values, measured using an ice water phantom were in accordance with literature values. CONCLUSIONS The implementation of DW-SPLICE allows for diffusion-weighted imaging of patients in treatment position with excellent geometrical accuracy. The images can be used to facilitate target volume delineation in RT treatment planning.
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Affiliation(s)
- Tim Schakel
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Johannes M Hoogduin
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marielle E P Philippens
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Tao X, Yang G, Wang P, Wu Y, Zhu W, Shi H, Gong X, Gao W, Yu Q. The value of combining conventional, diffusion-weighted and dynamic contrast-enhanced MR imaging for the diagnosis of parotid gland tumours. Dentomaxillofac Radiol 2017; 46:20160434. [PMID: 28299943 DOI: 10.1259/dmfr.20160434] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the value of combining conventional MRI, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE)-MRI in diagnosing solid neoplasms in the parotid gland. METHODS A total of 148 subjects (101 subjects with benign and 47 subjects with malignant tumours) were evaluated with conventional MRI, DWI and DCE-MRI prior to surgery and pathologic verification. The items observed with conventional MRI included the shape, capsule and signal intensity of parotid masses. The apparent diffusion coefficient (ADC) was calculated from DWI that was obtained with a b-factor of 0 and 1000 s mm-2. A time-intensity curve (TIC) was obtained from DCE-MRI. RESULTS There were significant differences (p < 0.01) in the shape, capsule, ADC and TIC between benign and malignant parotid tumours. Irregular neoplasms without a capsule, ADC <1.12 × 10-3 mm2 s-1 and a plateau enhancement pattern were valuable parameters for predicting malignant neoplasms. A combination of all of these parameters yielded sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value of 85.1%, 94.1%, 91.2%, 87.0% and 93.1%, respectively. CONCLUSIONS A combined analysis using conventional MRI, DWI and DCE-MRI is helpful in distinguishing benign from malignant tumours in the parotid gland.
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Affiliation(s)
- Xiaofeng Tao
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gongxin Yang
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pingzhong Wang
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingwei Wu
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjing Zhu
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huimin Shi
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Gong
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiqing Gao
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Yu
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Diffusion-weighted magnetic resonance imaging for evaluation of salivary gland function in head and neck cancer patients treated with intensity-modulated radiotherapy. Radiother Oncol 2017; 122:178-184. [DOI: 10.1016/j.radonc.2016.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/30/2016] [Accepted: 07/05/2016] [Indexed: 12/17/2022]
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Terra GTC, Oliveira JXD, Hernandez A, Lourenço SV, Arita ES, Cortes ARG. Diffusion-weighted MRI for differentiation between sialadenitis and pleomorphic adenoma. Dentomaxillofac Radiol 2016; 46:20160257. [PMID: 27845594 DOI: 10.1259/dmfr.20160257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare apparent diffusion coefficient (ADC) values from diffusion-weighted MRI (DWI) among normal salivary glands, cases with sialadenitis and cases with pleomorphic adenoma of major salivary glands. METHODS 22 patients (totalling 44 major salivary glands) diagnosed with either unilateral sialadenitis (on either parotid or submandibular gland) or parotid gland pleomorphic adenoma were selected. Contralateral non-affected glands (normal) were also analyzed. DW images were achieved using a spin-echo pulse sequence with a 1.5-T MRI device. Mean ADC values were compared among the three groups analyzed (contralateral normal glands, sialadenitis and pleomorphic adenoma). RESULTS The mean ADC values were significantly higher in cases of parotid sialadenitis (p = 0.001), but not in cases of submandibular sialadenitis (p = 0.466), as compared with the contralateral non-affected glands. Cases of pleomorphic adenoma presented the highest ADC values of the study. In addition, one-way ANOVA test revealed a significant difference among the three groups of parotid glands analyzed. CONCLUSIONS Within the limitations of this study, the present results suggest that DWI allows for differentiation between parotid sialadenitis and pleomorphic adenoma.
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Affiliation(s)
- Guilherme T C Terra
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Jefferson X D Oliveira
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Adalsa Hernandez
- 2 Department of Oral Radiology, Clinica Felix Boada, Caracas, Venezuela
| | - Silvia V Lourenço
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Emiko S Arita
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Arthur R G Cortes
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Ding C, Xing X, Guo Q, Liu D, Guo Y, Cui H. Diffusion-weighted MRI findings in Sjögren's syndrome: a preliminary study. Acta Radiol 2016; 57:691-700. [PMID: 26339039 DOI: 10.1177/0284185115603245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 08/02/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parotid glands diffusion-weighted imaging (DWI) in Sjögren's syndrome patients have provided conflicting results currently. PURPOSE To determine if parotid gland DWI using a small region of interest (ROI) can provide diagnosis and assess therapeutic efficacy in Sjögren's syndrome. MATERIAL AND METHODS Twenty-three women with Sjögren's syndrome, five with dry mouth who did not meet diagnostic criteria for Sjögren's syndrome, and 11 healthy volunteers (controls) were evaluated with DWI. All participants received routine T1-weighted (T1W) imaging and T2-weighted (T2W) fat-suppressed imaging, and DWI. The SI ratios (SIRs) and ADC ratios (ADCRs) for parotid gland/spinal cord were then calculated. Approximately 8-10 round ROIs measuring approximately 5 mm(2) were placed on each lobe of the parotid gland, and the signal intensity (SI) was measured while avoiding fat, ducts, and blood vessels. A ROI encompassing the entire lobe of the parotid gland was also used to measure SI. RESULTS Using 5 mm(2) ROIs significantly higher DWI SIRs were noted in participants with Sjögren's syndrome compared with either participants with dry mouth without Sjögren's syndrome or healthy volunteers (all, P <0.001). The difference was not related to the presence of fat. No differences were noted when the larger ROI was used. In addition, parotid gland from untreated Sjögren's participants showed significantly higher SIRs compared with those from treated participants (P = 0.015). CONCLUSION A small ROI DWI can provide morphological and functional information on the parotid gland in Sjögren's syndrome patients, and can aid in the diagnosis and evaluation of therapeutic efficacy.
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Affiliation(s)
- Changwei Ding
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Xiaofei Xing
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Dongwu Liu
- Departments of Rheumatology and Immunology, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, PR China
| | - Yun Guo
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Huadong Cui
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
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Differentiating locally recurrent rectal cancer from scar tissue: Value of diffusion-weighted MRI. Eur J Radiol 2016; 85:1265-70. [PMID: 27235873 DOI: 10.1016/j.ejrad.2016.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/30/2016] [Accepted: 04/13/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine a cut-off apparent diffusion coefficient (ADC) value distinguishing local recurrence from scar tissue in patients with rectal cancer treated with complete surgical tumour removal. METHODS 72 patients were retrospectively included. Patients underwent 1.5T MRI including multiplanar T2-weighted turbo-spin-echo sequences (TSE) and axial single-shot epi-diffusion-weighted sequences (EPSE). Two independent observers measured mean tumour and scar tissue ADCs by manually drawing regions of interest (ROIs). The t-test and ROC analysis were used for comparison and determining an optimal discrimination threshold. As reference standard histopathological results were used in 23 patients (32%) and clinical follow-up in 49 patients (68%). RESULTS Recurrent rectal cancer was found in 30 patients (4 female, 26 male, median age 63.13 years) and treatment related changes such as scar tissue in 42 patients (11 female, 31 male, median age 63.67 years). The mean ADC value of tumour recurrence was 1.02×10(-3)mm(2)/s (0.63-1.44×10(-3)mm(2)/s) and of scar tissue 1.77×10(-3)mm(2)/s (1.11-2.41×10(-3)mm(2)/s) showing a statistically significant difference (p<0.001). The cut-off ADC value was 1.34×10(-3)mm(2)/s with a sensitivity, specificity, and accuracy of 93%, 91%, and 92% respectively. CONCLUSIONS Diffusion weighted MRI allows for the differentiation of tumour recurrence from scar tissue after surgical resection of rectal cancer.
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Das A, Bhalla AS, Sharma R, Kumar A, Sharma M, Gamanagatti S, Thakar A, Sharma S. Benign neck masses showing restricted diffusion: Is there a histological basis for discordant behavior? World J Radiol 2016; 8:174-182. [PMID: 26981226 PMCID: PMC4770179 DOI: 10.4329/wjr.v8.i2.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/27/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Diffusion weighted imaging (DWI) evolved as a complementary tool to morphologic imaging by offering additional functional information about lesions. Although the technique utilizes movement of water molecules to characterize biological tissues in terms of their cellularity, there are other factors related to the histological constitution of lesions which can have a significant bearing on DWI. Benign lesions with atypical histology including presence of lymphoid stroma, inherently increased cellularity or abundant extracellular collagen can impede movement of water molecules similar to malignant tissues and thereby, show restricted diffusion. Knowledge of these atypical entities while interpreting DWI in clinical practice can avoid potential misdiagnosis. This review aims to present an imaging spectrum of such benign neck masses which, owing to their distinct histology, can show discordant behavior on DWI.
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Kikuchi M, Koyasu S, Shinohara S, Imai Y, Hino M, Naito Y. Preoperative Diagnostic Strategy for Parotid Gland Tumors Using Diffusion-Weighted MRI and Technetium-99m Pertechnetate Scintigraphy: A Prospective Study. PLoS One 2016; 11:e0148973. [PMID: 26849569 PMCID: PMC4744013 DOI: 10.1371/journal.pone.0148973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/26/2016] [Indexed: 11/29/2022] Open
Abstract
Objective Fine needle aspiration cytology (FNAC) for diagnosis of a parotid gland tumor is widely used but its sensitivity is low and non-diagnostic rate is relatively high. In contrast, core needle biopsy (CNB) has a higher sensitivity and lower rate of sampling errors but has a higher risk of injury to adjacent organs such as facial nerve than FNAC. Screening of patients with parotid gland tumors to identify cases of pleomorphic adenoma (PA) and Warthin tumor (WT) may allow CNB to be confined to patients without PA and WT. We established an algorithm for preoperative diagnosis and management of parotid gland tumor using diffusion-weighted MRI and 99mTc pertechnetate scintigraphy. This algorithm was developed with the goal of maximal reduction of the number of patients in whom CNB is required. The purpose of the study is to validate our algorithm prospectively. Methods A prospective study was conducted in 71 cases who were newly diagnosed with parotid gland tumor and 53 cases were enrolled in the study. In the algorithm, PA (high apparent diffusion coefficient (ADC) mean≥1.5×10−3 mm2/s) and non-PA (low ADCmean<1.5×10−3 mm2/s) cases are first distinguished based on the ADCmean on diffusion-weighed MRI. Second, among suspected non-PA cases, WT and non-WT are distinguished using technetium-99m pertechnetate scintigraphy. CNB is then performed only in probable non-PA and non-WT cases. Results Although CNB was only required in 40% (21/53) of all cases, we made a preoperative histopathological diagnosis with an accuracy of 87% (46/53) and we correctly diagnosed whether a tumor was benign or malignant with an accuracy of 96% (51/53). Preoperative surgical planning had to be changed during surgery in only one case (2%) Conclusions Our algorithm is valuable in terms of clinical practice with highly potential for preoperative diagnosis and with less risk of CNB procedure.
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Affiliation(s)
- Masahiro Kikuchi
- Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- * E-mail:
| | - Sho Koyasu
- Department of Radiology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Shogo Shinohara
- Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yukihiro Imai
- Department of Clinical Pathology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Megumu Hino
- Department of Radiology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yasushi Naito
- Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Şerifoğlu İ, Oz İİ, Damar M, Tokgöz Ö, Yazgan Ö, Erdem Z. Diffusion-weighted imaging in the head and neck region: usefulness of apparent diffusion coefficient values for characterization of lesions. Diagn Interv Radiol 2016; 21:208-14. [PMID: 25910284 DOI: 10.5152/dir.2014.14279] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to evaluate the role of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging for head and neck lesion characterization in daily routine, in comparison with histopathological results. METHODS Ninety consecutive patients who underwent magnetic resonance imaging (MRI) at a university hospital for diagnosis of neck lesions were included in this prospective study. Diffusion-weighted echo-planar MRI was performed on a 1.5 T unit with b factor of 0 and 1000 s/mm2 and ADC maps were generated. ADC values were measured for benign and malignant whole lesions seen in daily practice. RESULTS The median ADC value of the malignant tumors and benign lesions were 0.72×10-3 mm2/s, (range, 0.39-1.51×10-3 mm2/s) and 1.17×10-3 mm2/s, (range, 0.52-2.38×10-3 mm2/s), respectively, with a significant difference between them (P < 0.001). A cutoff ADC value of 0.98×10-3 mm2/s was used to distinguish between benign and malignant lesions, yielding 85.3% sensitivity and 78.6% specificity. The median ADC value of lymphomas (0.44×10-3 mm2/s; range, 0.39-0.58×10-3 mm2/s) was significantly smaller (P < 0.001) than that of squamous cell carcinomas (median ADC value 0.72×10-3 mm2/s; range, 0.65-1.06×10-3 mm2/s). There was no significant difference between median ADC values of inflammatory (1.13×10-3 mm2/s; range, 0.85-2.38×10-3 mm2/s) and noninflammatory benign lesions (1.26×10-3 mm2/s; range, 0.52-2.33×10-3 mm2/s). CONCLUSION Diffusion-weighted imaging and the ADC values can be used to differentiate and characterize benign and malignant head and neck lesions.
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Affiliation(s)
- İsmail Şerifoğlu
- Department of Radiology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey.
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Yuan M, Zhang YD, Zhu C, Yu TF, Shi HB, Shi ZF, Li H, Wu JF. Comparison of intravoxel incoherent motion diffusion-weighted MR imaging with dynamic contrast-enhanced MRI for differentiating lung cancer from benign solitary pulmonary lesions. J Magn Reson Imaging 2015; 43:669-79. [PMID: 26340144 DOI: 10.1002/jmri.25018] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To compare intravoxel incoherent motion (IVIM) and pharmacokinetic analysis dynamic contrast-enhanced MR imaging (DCE-MRI) in distinguishing lung cancer (LC) from benign solitary pulmonary lesions (SPL). METHODS This prospective study was approved by the institutional review board, and written informed consent was obtained. Eighty-one consecutive patients considered for SPL underwent DW-IVIM and DCE-3T MRI. ADC, D, D*, and f were calculated with mono- and bi-exponential models. K(trans) , kep , ve , and vp were calculated with the modified Tofts model. Receiver operating characteristic (ROC) analysis was constructed to determine the diagnostic performance of IVIM and DCE-MRI in discriminating LC from benignity. RESULTS There were 29 patients with a total of 48 benign SPL and 52 LCs: 4 small cell carcinomas (SCLC), 19 squamous cell carcinomas (SCC), and 29 adenocarcinomas (Adeno-Ca). Both Adeno-Ca (ADC: 1.19 ± 0.23 × 10(-3) mm(2) /s; D:1.12 ± 0.35 × 10(-3) mm(2) /s; ve :0.27 ± 0.13; K(trans) :0.24 ± 0.09 min(-1) ; kep :0.90 ± 0.45 min(-1) ) and SCC (1.13± 0.28 × 10(-3) mm(2) /s; 1.02 ± 0.32 10(-3) mm(2) /s; 0.32 ± 0.14; 0.26 ± 0.08 min(-1) ; 0.90 ± 0.48 min(-1) ) had significantly lower ADC, D, ve and larger K(trans) , kep than benignity (1.37 ± 0.38 × 10(-3) mm(2) /s; 1.34 ± 0.45 × 10(-3) mm(2) /s; 0.42 ± 0.19; 0.19 ± 0.08 min(-1) ; 0.53 ± 0.26 min(-1) ). D (72.2%) had significantly higher accuracy (72.2%) and higher sensitivity (91.3%) than other imaging indices (accuracy: 55.5-68.0%; sensitivity: 41.3-78.3%; all P < 0.01) except for accuracy in kep (70.8%; P > 0.05) in discriminating LC from benignity. K(trans) exhibited significantly higher specificity (84.6%) than the other indices (38.5-73.1%; P < 0.01). These results can be improved by combined D and K(trans) , leading to a sensitivity, specificity and accuracy of 94.2%, 92%, and 93.5%, respectively. CONCLUSION IVIM-derived D and DCE-derived K(trans) are two promising parameters for differentiating LC from benignity.
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Affiliation(s)
- Mei Yuan
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chan Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tong-Fu Yu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhao-Fei Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang-Fen Wu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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Ryoo I, Kim JH, Choi SH, Sohn CH, Kim SC. Squamous Cell Carcinoma of the Head and Neck: Comparison of Diffusion-weighted MRI at b-values of 1,000 and 2,000 s/mm(2) to Predict Response to Induction Chemotherapy. Magn Reson Med Sci 2015; 14:337-45. [PMID: 26104081 DOI: 10.2463/mrms.2015-0003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Recent publications have reported contradictory results of pretreatment diffusion-weighted magnetic resonance imaging (DWI) for the prediction of chemoradiotherapeutic response in primary squamous cell carcinomas of the head and neck (HNSCC). Therefore, we evaluated the diagnostic performance of DWI obtained with both standard (b = 0 and 1,000 s/mm²) and high (b = 0 and 2,000 s/mm²) b-values for predicting response to induction chemotherapy in HNSCCs. METHODS For 25 patients with primary HNSCC who underwent DWI with both standard and high b-values prior to treatment, we calculated corresponding apparent diffusion coefficient (ADC) maps. Regions of interest containing the tumor were drawn on every section of ADC maps and summated to make volume-based data of the entire tumor. Histogram parameters (mean ADC, kurtosis, and skewness) were correlated with treatment response using unpaired Student t test. Univariate and multivariate analysis of the ADC parameters, patient age, sex, whole tumor volume, and T stage were also performed to predict tumor response to induction chemotherapy. RESULTS Response to induction chemotherapy was good in 13 of the 25 patients and poor in 12. The mean ADC values of good responders at standard b-value (ADC1000), 1.23 ± 0.34 (× 10⁻³ mm²/s), and high b-value (ADC2000), 0.62 ± 0.14 (× 10⁻³ mm²/s), were lower than those of poor responders (ADC1000, 1.32 ± 0.28 [× 10⁻³ mm²/s]; ADC2000, 0.76 ± 0.15 [× 10⁻³ mm²/s]), but significant difference was achieved only at the ADC2000 map (P = 0.02). In addition, mean tumor volume prior to treatment of good responders was smaller than that of poor responders. However, at multiple logistic regression analysis, only the mean ADC2000 value remained as a significant predictor of response to induction chemotherapy. CONCLUSION DWI with high b-values (b = 0 and 2,000 s/mm²) as an assessment of ADC values may help predict tumor response to neoadjuvant chemotherapy for primary HNSCCs.
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Affiliation(s)
- Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital
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Liu YJ, Lee YH, Chang HC, Huang TY, Chiu HC, Wang CW, Chiou TW, Hsu K, Juan CJ, Huang GS, Hsu HH. A potential risk of overestimating apparent diffusion coefficient in parotid glands. PLoS One 2015; 10:e0124118. [PMID: 25922948 PMCID: PMC4414616 DOI: 10.1371/journal.pone.0124118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 03/10/2015] [Indexed: 12/18/2022] Open
Abstract
Objectives To investigate transient signal loss on diffusion weighted images (DWI) and overestimation of apparent diffusion coefficient (ADC) in parotid glands using single shot echoplanar DWI (EPDWI). Materials and Methods This study enrolled 6 healthy subjects and 7 patients receiving radiotherapy. All participants received dynamic EPDWI with a total of 8 repetitions. Imaging quality of DWI was evaluated. Probability of severe overestimation of ADC (soADC), defined by an ADC ratio more than 1.2, was calculated. Error on T2WI, DWI, and ADC was computed. Statistical analysis included paired Student t testing and Mann-Whitney U test. A P value less than 0.05 was considered statistically significant. Results Transient signal loss was visually detected on some excitations of DWI but not on T2WI or mean DWI. soADC occurred randomly among 8 excitations and 3 directions of diffusion encoding gradients. Probability of soADC was significantly higher in radiotherapy group (42.86%) than in healthy group (24.39%). The mean error percentage decreased as the number of excitations increased on all images, and, it was smallest on T2WI, followed by DWI and ADC in an increasing order. Conclusions Transient signal loss on DWI was successfully detected by dynamic EPDWI. The signal loss on DWI and overestimation of ADC could be partially remedied by increasing the number of excitations.
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Affiliation(s)
- Yi-Jui Liu
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
| | - Yi-Hsiung Lee
- Ph.D. program in Electrical and Communication Engineering in Feng Chia University, Taichung, Taiwan, Republic of China
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Hing-Chiu Chang
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, United States of America
- Applied Science Laboratory, GE Healthcare, Taipei, Taiwan
| | - Teng-Yi Huang
- Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
| | - Hui-Chu Chiu
- Ph.D. program of Technology Management, Chung Hua University, Hsinchu, Taiwan, Republic of China
| | - Chih-Wei Wang
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Ta-Wei Chiou
- Department of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Kang Hsu
- Department of Dentistry, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Jung Juan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- * E-mail:
| | - Guo-Shu Huang
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Hsian-He Hsu
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
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Role of diffusion-weighted magnetic resonance imaging in the differentiation of parotid gland tumors. Oral Radiol 2015. [DOI: 10.1007/s11282-015-0203-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Value of apparent diffusion coefficient and magnetic resonance spectroscopy in the identification of various pathological subtypes of parotid gland tumors. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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31
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Koyasu S, Iima M, Umeoka S, Morisawa N, Porter DA, Ito J, Le Bihan D, Togashi K. The clinical utility of reduced-distortion readout-segmented echo-planar imaging in the head and neck region: initial experience. Eur Radiol 2014; 24:3088-96. [DOI: 10.1007/s00330-014-3369-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/14/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
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Chen X, Xian J, Wang X, Wang Y, Zhang Z, Guo J, Li J. Role of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted imaging in correcting distortion and evaluating head and neck masses using 3 T MRI. Clin Radiol 2014; 69:403-9. [DOI: 10.1016/j.crad.2013.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/25/2013] [Accepted: 11/07/2013] [Indexed: 01/18/2023]
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De Cocker LJ, D’Arco F, De Beule T, Tousseyn T, Blockmans D, Hermans R. IgG4-related systemic disease affecting the parotid and submandibular glands: magnetic resonance imaging features of IgG4-related chronic sclerosing sialadenitis and concomitant lymphadenitis. Clin Imaging 2014; 38:195-8. [DOI: 10.1016/j.clinimag.2013.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 10/28/2013] [Accepted: 11/04/2013] [Indexed: 10/26/2022]
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Baliyan V, Das CJ, Sharma S, Gupta AK. Diffusion-weighted imaging in urinary tract lesions. Clin Radiol 2014; 69:773-82. [PMID: 24581968 DOI: 10.1016/j.crad.2014.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/09/2014] [Accepted: 01/14/2014] [Indexed: 12/16/2022]
Abstract
Diffusion-weighted imaging (DWI) utilizes the signal contrast provided by the regional differences in the Brownian motion of water molecules, which is a direct reflection of the cellular micro-environment. DWI emerged as a revolutionary magnetic resonance imaging (MRI) technique in the field of stroke imaging. As far as body imaging is concerned, DWI has come a long way from being an experimental technique to an essential element of almost all abdominal MRI examinations. This progress has been made possible by technical advancements in MRI systems, as well as a better understanding of MRI physics. DWI is quick to perform and has the potential to provide crucial information about the disease process without adding much to the total imaging time. This article provides a brief review of the basic principles of DWI with insights to the information that DWI provides in the evaluation of various diseases of the urinary tract at both 1.5 and 3 T. DWI is helpful for differentiation of various histopathological subtypes of renal cell carcinoma (RCC). Prediction of histopathological grade of RCC is also becoming possible solely based on DWI. Assessment of response to chemotherapeutic agents is possible based on the change in the ADC (apparent diffusion coefficient) value. DWI performed with high b-values increases the confidence in diagnosing prostatic carcinoma. This article highlights the emerging role of DWI in the evaluation of urinary tract lesions.
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Affiliation(s)
- V Baliyan
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - C J Das
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - S Sharma
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A K Gupta
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Fruehwald-Pallamar J, Czerny C, Holzer-Fruehwald L, Nemec SF, Mueller-Mang C, Weber M, Mayerhoefer ME. Texture-based and diffusion-weighted discrimination of parotid gland lesions on MR images at 3.0 Tesla. NMR IN BIOMEDICINE 2013; 26:1372-1379. [PMID: 23703801 DOI: 10.1002/nbm.2962] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate whether texture-based analysis of standard MRI sequences and diffusion-weighted imaging can help in the discrimination of parotid gland masses. The MR images of 38 patients with a biopsy- or surgery-proven parotid gland mass were retrospectively analyzed. All patients were examined on the same 3.0 Tesla MR unit, with one standard protocol. The ADC (apparent diffusion coefficient) values of the tumors were measured with three regions of interest (ROIs) covering the entire tumor. Texture-based analysis was performed with the texture analysis software MaZda (version 4.7), with ROI measurements covering the entire tumor in three slices. COC (co-occurrence matrix), RUN (run-length matrix), GRA (gradient), ARM (auto-regressive model), and WAV (wavelet transform) features were calculated for all ROIs. Three subsets of 10 texture features each were used for a linear discriminant analysis (LDA) in combination with k nearest neighbor classification (k-NN). Using histology as a standard of reference, benign tumors, including subtypes, and malignant tumors were compared with regard to ADC and texture-based values, with a one-way analysis of variance with post-hoc t-tests. Significant differences were found in the mean ADC values between Warthin tumors and pleomorphic adenomas, as well as between Warthin tumors and benign lesions. Contrast-enhanced T1-weighted images contained the most relevant textural information for the discrimination between benign and malignant parotid masses, and also for the discrimination between pleomorphic adenomas and Warthin tumors. STIR images contained the least relevant texture features, particularly for the discrimination between pleomorphic adenomas and Warthin tumors. Texture analysis proved to differentiate benign from malignant lesions, as well as pleomorphic adenomas from Warthin tumors, based on standard T(1w) sequences (without and with contrast). Of all benign parotid masses, Warthin tumors had significantly lower ADC values than the other entities.
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Affiliation(s)
- Julia Fruehwald-Pallamar
- Medical University of Vienna, Department of Radiology, Subdivision of Neuroradiology and Musculoskeletal Radiology, Vienna, Austria
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Zhang Y, Ou D, Gu Y, He X, Peng W, Mao J, Yue L, Shen X. Diffusion-weighted MR imaging of salivary glands with gustatory stimulation: comparison before and after radiotherapy. Acta Radiol 2013; 54:928-33. [PMID: 23821773 DOI: 10.1177/0284185113491089] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Xerostomia is the most prominent complication in patients with head and neck carcinoma after radiotherapy (RT). Diffusion-weighted magnetic resonance imaging (DWI) with gustatory stimulation may contribute to the evaluation of salivary gland function. PURPOSE To investigate the value of DWI for quantifying physiological changes of the parotid gland during gustatory stimulation in patients before and after RT. MATERIAL AND METHODS Magnetic resonance imaging (MRI) was performed in 28 consecutive patients with nasopharyngeal carcinoma before and after RT and clinical xerostomia was also assessed. A DWI sequence was performed once at rest and continually repeated seven times during stimulation with ascorbic acid. Apparent diffusion coefficient (ADC) maps for parotid glands at different time points and the range of increase with stimulation were calculated. Paired two-tailed Student t tests were used to compare the ADC values before and after stimulation, and before and after RT. RESULTS Before RT, the ADC showed an initial increase (P < 0.001) and then fluctuated during stimulation. After RT, as the clinical xerostomia changed from Grade 0 to Grade 2, the mean ADC at rest increased compared with the pre-RT value (P < 0.001). A similar response to stimulation was observed, but the range of increase between the maximum ADC during stimulation and the baseline value at rest was higher post-RT than pre-RT (P = 0.022). The minimum ADC during stimulation was higher than the baseline value post-RT (P = 0.028), but there was no difference pre-RT (P = 0.603). CONCLUSION DWI combined with gustatory stimulation seems to display the physiological changes of the parotid gland following RT and may be a potential tool for non-invasively assessing salivary gland function.
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Affiliation(s)
- Yunyan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Dan Ou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Jian Mao
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Lei Yue
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Xigang Shen
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
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Chiaradia M, Baranes L, Van Nhieu JT, Vignaud A, Laurent A, Decaens T, Charles-Nelson A, Brugières P, Katsahian S, Djabbari M, Deux JF, Sobhani I, Karoui M, Rahmouni A, Luciani A. Intravoxel incoherent motion (IVIM) MR imaging of colorectal liver metastases: are we only looking at tumor necrosis? J Magn Reson Imaging 2013; 39:317-25. [PMID: 23723012 DOI: 10.1002/jmri.24172] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 03/15/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine if intra-voxel incoherent motion diffusion-weighted imaging (IVIM-DWI) parameters, including free molecular-based (D) and perfusion-related (D*, f) diffusion parameters, correlate with the degree of tumor necrosis and viable tumor in colo-rectal cancer (CRC) metastasis. MATERIALS AND METHODS Fifteen patients referred for resection of liver metastases from CRC were retrospectively included in this Institutional Review Board approved study. An IVIM-DWI sequence was performed on a 1.5 Tesla MR imaging system, with 10 b factors (0, 10, 20, 30, 50, 80, 100, 200, 400 and 800 s/mm(2) ). Mean D, D*, f and apparent diffusion coefficient (ADC) values were determined in metastases with a longest diameter above 10 mm. Correlations between the diffusion parameters and the degree of liver tumor necrosis and viable tissue were determined (Spearman). RESULTS Correlation between diffusion parameters and histopathological findings was performed in 35 hepatic metastases with a diameter of more than 10 mm (mean size of 17.9 mm; range, 1-68 mm). Both D (r = 0.36; P = 0.035) and ADC (r = 0.4; P = 0.02) correlated with the degree of tumor necrosis but not with viable tumor. CONCLUSION ADC variation observed in CRC metastases following systemic chemotherapy reflects a specific increase in free-molecular diffusion (D), in itself correlated to the degree of metastasis necrosis.
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Affiliation(s)
- Melanie Chiaradia
- AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, Creteil, France; Universite Paris Est Creteil, Creteil, France
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Age-related relaxo-volumetric quantitative magnetic resonance imaging of the major salivary glands. J Comput Assist Tomogr 2013; 37:272-8. [PMID: 23493218 DOI: 10.1097/rct.0b013e31827b4729] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study age-related characteristics of T1 and T2 relaxation times and volume of the major salivary glands. METHODS Thirty-five subjects (0.5-87 years old) with normal salivary glands were imaged with mixed turbo spin-echo pulse sequences at 1.5-T magnetic resonance units. Bilateral parotid, submandibular, and sublingual glands were segmented manually. Histograms for each salivary gland were generated and modeled with Gaussian functions for every parameter. RESULTS Seventy parotid glands, 52 submandibular glands, and 50 sublingual glands were segmented and the histograms were analyzed. The parotid gland exhibited shorter-peak T1s and longer-peak T2s relative to the submandibular and sublingual glands. The peak T2s for all glands showed a minimum value between 2 and 4 years of age and increased monotonically thereafter. From birth to early adulthood, all glands increased in size logarithmically. CONCLUSION Age-related relaxo-volumetric changes of the major salivary glands show clear T2 and volumetric age-related patterns for all glands.
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Lee MC, Tsai HY, Chuang KS, Liu CK, Chen MK. Prediction of nodal metastasis in head and neck cancer using a 3T MRI ADC map. AJNR Am J Neuroradiol 2013; 34:864-9. [PMID: 22997167 DOI: 10.3174/ajnr.a3281] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The detection of cervical nodal metastases is important for the prognosis and treatment of head and neck tumors. The purpose of this study was to assess the ability of ADC values at 3T to distinguish malignant from benign lymph nodes. MATERIALS AND METHODS From July 2009 to June 2010, twenty-two patients (21 men and 1 woman; mean age, 49.8±9.5 years; age range, 28-66 years) scheduled for surgical treatment of biopsy-proved head and neck cancer were prospectively and consecutively enrolled in this study. All patients were scanned on a 3T imaging unit (Verio) by using a 12-channel head coil combined with a 4-channel neck coil. Histologic findings were the reference standard for the diagnosis of lymph node metastasis. RESULTS The ADC values derived from the signal intensity averaged across images obtained with b-values of 0 and 800 s/mm2 were 1.086±0.222×10(-3) mm2/s for benign lymph nodes and 0.705±0.118×10(-3) mm2/s for malignant lymph nodes (P<.0001). When an ADC value of 0.851×10(-3) mm2/s was used as a threshold value for differentiating benign from malignant lymph nodes, the best results were obtained with an accuracy of 91.0%, sensitivity of 91.3%, and specificity of 91.1%. CONCLUSIONS The ADC value is a sensitive and specific parameter that can help to differentiate malignant from benign lymph nodes.
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Affiliation(s)
- M-C Lee
- Biomedical Engineering and Environmental Sciences Department, National Tsing Hua University, Hsinchu, Taiwan
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Yang X, Tridandapani S, Beitler JJ, Yu DS, Yoshida EJ, Curran WJ, Liu T. Ultrasound GLCM texture analysis of radiation-induced parotid-gland injury in head-and-neck cancer radiotherapy: an in vivo study of late toxicity. Med Phys 2012; 39:5732-9. [PMID: 22957638 DOI: 10.1118/1.4747526] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Xerostomia (dry mouth), secondary to irradiation of the parotid glands, is one of the most common side effects of head-and-neck cancer radiotherapy. Diagnostic tools able to accurately and efficiently measure parotid gland injury have yet to be introduced into the clinic. This study's purpose is to investigate sonographic textural features as potential imaging signatures for quantitative assessment of parotid-gland injury after head-and-neck radiotherapy. METHODS The authors have investigated a series of sonographic features obtained from the gray level co-occurrence matrix (GLCM) - a second order statistical method of texture analysis. These GLCM textural features were selected based on empirical observations that the normal parotid gland exhibits homogeneous echotexture, whereas the postradiotherapy parotid gland often exhibits heterogeneous echotexture. We employed eight sonographic features: (1) angular second moment (ASM), (2) inverse differential moment (IDM), (3) contrast, (4) variance, (5) correlation, (6) entropy, (7) cluster shade, and (8) cluster prominence. Altogether, sonographic properties of the parotid glands were quantified by their degrees of homogeneity (ASM and IDM), heterogeneity (contrast and variance), smoothness (correlation), randomness (entropy), and symmetry (cluster shade and prominence). The sonographic features were tested in a pilot study of 12 postradiotherapy patients and 7 healthy volunteers. The mean follow-up time for the postradiotherapy patients was 17.2 months (range: 12.1-23.9 months) and the mean radiation dose to the parotid glands was 32.3 Gy (range: 11.0-63.4 Gy). Each participant underwent one ultrasound study in which longitudinal (vertical) ultrasound scans were performed on the bilateral parotids - a total of 24 postirradiation and 14 normal parotid glands were examined. The 14 normal parotid glands served as the control group. A radiologist contoured the parotid glands on the B-mode images and the sonographic features were computed from the contoured region-of-interest. RESULTS The authors observed significant differences (p < 0.05) in all sonographic features between the normal and postradiotherapy parotid glands. The sonographic findings were consistent with the clinical observations of the ultrasound images: normal parotid glands exhibited homogeneous texture, while the postradiotherapy parotid glands exhibited heterogeneous echotexture (e.g., hyperechoic lines and spots), which likely represents fibrosis. CONCLUSIONS The authors have demonstrated the feasibility of ultrasonic texture evaluation of parotid glands; and the sonographic features may serve as imaging signatures to assess radiation-induced parotid injury.
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Affiliation(s)
- Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
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Sakamoto J, Sasaki Y, Otonari-Yamamoto M, Sano T. Comparison of various methods for quantification of apparent diffusion coefficient of head and neck lesions with HASTE diffusion-weighted MR imaging. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:266-76. [DOI: 10.1016/j.oooo.2012.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/07/2012] [Accepted: 03/12/2012] [Indexed: 01/29/2023]
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Role of diffusion-weighted imaging with ADC mapping and in vivo 1H-MR spectroscopy in thyroid nodules. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2012.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Extracranial applications of diffusion-weighted (DW) magnetic resonance (MR) imaging are gaining increasing importance, including in head and neck radiology. The main indications for performing DW imaging in this relatively small but challenging region of the body are tissue characterization, nodal staging, therapy monitoring, and early detection of treatment failure by differentiating recurrence from posttherapeutic changes. Lower apparent diffusion coefficients (ADCs) have been reported in the head and neck region of adults and children for most malignant lesions, as compared with ADCs of benign lesions. For nodal staging, DW imaging has shown promise in helping detect lymph node metastases, even in small (subcentimeter) nodes with lower ADCs, as compared with normal or reactive nodes. Follow-up of early response to treatment is reflected in an ADC increase in the primary tumor and nodal metastases; whereas nonresponding lesions tend to reveal only a slight increase or even a decrease in ADC during follow-up. Optimization and standardization of DW imaging technical parameters, comparison of DW images with morphologic images, and increasing experience, however, are prerequisites for successful application of this challenging technique in the evaluation of various head and neck pathologic conditions.
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Affiliation(s)
- Harriet C Thoeny
- Department of Radiology, Neuroradiology and Nuclear Medicine, Inselspital, Freiburgstrasse 10, University of Bern, Bern CH-3010, Switzerland.
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Diffusion-weighted imaging of the head and neck with HASTE: influence of imaging parameters on image quality. Oral Radiol 2012. [DOI: 10.1007/s11282-012-0091-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Intravoxel incoherent motion in body diffusion-weighted MRI: reality and challenges. AJR Am J Roentgenol 2011; 196:1351-61. [PMID: 21606299 DOI: 10.2214/ajr.10.5515] [Citation(s) in RCA: 413] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Diffusion-weighted MRI is increasingly applied in the body. It has been recognized for some time, on the basis of scientific experiments and studies in the brain, that the calculation of apparent diffusion coefficient by simple monoexponential relationship between MRI signal and b value does not fully account for tissue behavior. However, appreciation of this fact in body diffusion MRI is relatively new, because technologic advancements have only recently enabled high-quality body diffusion-weighted images to be acquired using multiple b values. There is now increasing interest in the radiologic community to apply more sophisticated analytic approaches, such as those based on the principles of intravoxel incoherent motion, which allows quantitative parameters that reflect tissue microcapillary perfusion and tissue diffusivity to be derived. CONCLUSION In this review, we discuss the principles of intravoxel incoherent motion as applied to body diffusion-weighted MRI. The evidence for the technique in measuring tissue perfusion is presented and the emerging clinical utility surveyed. The requisites and challenges of quantitative evaluation beyond simple monoexponential relationships are highlighted.
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Kato H, Kanematsu M, Toida M, Kawaguchi T, Shibata T, Kajita K, Hoshi H. Salivary gland function evaluated by diffusion-weighted MR imaging with gustatory stimulation: Preliminary results. J Magn Reson Imaging 2011; 34:904-9. [DOI: 10.1002/jmri.22729] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 06/30/2011] [Indexed: 11/06/2022] Open
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Feasibility of diffusion weighted MR imaging in differentiating recurrent laryngeal carcinoma from radionecrosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Tondo F, Saponaro A, Stecco A, Lombardi M, Casadio C, Carriero A. Role of diffusion-weighted imaging in the differential diagnosis of benign and malignant lesions of the chest-mediastinum. Radiol Med 2011; 116:720-33. [PMID: 21293944 DOI: 10.1007/s11547-011-0629-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 07/12/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE We retrospectively evaluated the role of diffusion-weighted imaging (DWI) with fat and background signal suppression in the differential diagnosis of benign and malignant lesions of the chest-mediastinum by calculating the mean apparent diffusion coefficient (ADC) values. MATERIALS AND METHODS Thirty-four patients with lung nodules/mediastinal masses underwent magnetic resonance (MR) imaging of the chest with conventional and DWI sequences. All patients had been previously studied with computed tomography (CT). After magnetic resonance (MR) imaging the patients underwent transthoracic CT-guided biopsy or mediastinoscopy. After the histopathological diagnosis had been obtained, the lesions were retrospectively divided into five groups: adenocarcinomas (n=16), squamous cell carcinomas (n=12), chronic pneumonias (n=2), malignant mediastinal tumours (n=2) and typical carcinoids (n=2). We compared ADC values in the different lesion groups using the Mann-Whitney U test. RESULTS There were statistically significant differences (p<0.05) between ADC values of benign and malignant lesions. Using an ADC value of 1.25×10⁻³ mm²/s as a threshold, we were able to differentiate malignant from benign lesions with 91% diagnostic accuracy, 90% sensitivity, 100% specificity, 100% positive predictive value and 57% negative predictive value. CONCLUSIONS Short-tau inversion-recovery echo-planar imaging (STIR-EPI) sequences applied to the chest-mediastinum provided potentially useful images for the differential diagnosis of benign and malignant lesions.
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Affiliation(s)
- F Tondo
- SCDU Radiologia, Università del Piemonte Orientale A. Avogadro, C.so Mazzini 18, 28100, Novara, Italy.
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Chawla S, Kim S, Wang S, Poptani H. Diffusion-weighted imaging in head and neck cancers. Future Oncol 2009; 5:959-75. [PMID: 19792966 DOI: 10.2217/fon.09.77] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This article reviews the utility of diffusion-weighted imaging (DWI) in the diagnosis, prognosis and monitoring of treatment response in tumors arising in the head and neck region. The apparent diffusion coefficient (ADC) value, determined from DWI, can help in cancer staging and detection of subcentimeter nodal metastasis. The ADC value also discriminates carcinomas from lymphomas, benign lesions from malignant tumors and tumor necrosis from abscesses. Low pretreatment ADC values typically predict a favorable response to chemoradiation therapy. These promising reports indicate the potential of DWI as a potential biomarker for diagnosis and monitoring of treatment response in head and neck cancers. In view of the overlapping ADC values between different salivary gland tumors, care should be taken when interpreting these results and other imaging parameters should be considered for a better diagnosis. Susceptibility and motion-induced artifacts may sometimes degrade DWI image quality; however, novel techniques are being developed to overcome these drawbacks.
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Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Juan CJ, Chang HC, Hsueh CJ, Liu HS, Huang YC, Chung HW, Chen CY, Kao HW, Huang GS. Salivary Glands: Echo-Planar versus PROPELLER Diffusion-weighted MR Imaging for Assessment of ADCs. Radiology 2009; 253:144-52. [PMID: 19789257 DOI: 10.1148/radiol.2531082228] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chun-Jung Juan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
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