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Morawska I, Cieszanowski A. Assessment of the response to systemic treatment of colorectal liver metastases on cross-sectional imaging - a systematic review. Pol J Radiol 2023; 88:e512. [PMID: 38125815 PMCID: PMC10731444 DOI: 10.5114/pjr.2023.132884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/03/2023] [Indexed: 12/23/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in the world. Nowadays many treatments are available to help control CRC, including surgery, radiation therapy, interventional radiology, and drug treatments. A multidisciplinary approach and the role of radiologists is needed to assist the surgeon in the management thanks to emerging technology and strategies. The Response Evaluation Criteria in Solid Tumours (RECIST) has been created to objectify and standardize cancer response assessment. Thus, in this article specific presumptions and practical aspects of evaluating responses according to the RECIST 1.1 are discussed. Furthermore, examples of possible response to systemic treatment of colorectal liver metastases (CRLM), including tumour necrosis, apparent diffusion coefficient (ADC) values, tumour calcification, tumour fibrosis and intratumoural fat deposition observed on cross-sectional imaging, are described. Disappearing liver metastases (DLM) presents a therapeutic dilemma. The optimal management of DLM remains controversial due to the uncertainty of residual microscopic disease and effective long-term outcomes. The article provides an overview of the CRLM phenomenon and current possible assessment methods of the response to systemic treatment.
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Affiliation(s)
- Irmina Morawska
- Department of Radiology I, The Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland
| | - Andrzej Cieszanowski
- Department of Radiology I, The Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland
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Erdoğan H, Arslan S, Durmaz MS. Hepatoselüler Karsinom ve Diğer Karaciğer Tümörlerinin Ayrımında Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Etkinliği. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.661288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Emara DMM, Mohamed FSED, Abdullah AH, Ibrahim MAH, Ibrahim ME, Hassouna EM. Is diffusion weighted imaging adding value in diagnosis of focal hepatic lesions? Experience in 50 patients. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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The role of apparent diffusion coefficient values in characterization of solid focal liver lesions: a prospective and comparative clinical study. SCIENCE CHINA-LIFE SCIENCES 2017; 60:16-22. [PMID: 28078512 DOI: 10.1007/s11427-016-0387-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/09/2016] [Indexed: 12/14/2022]
Abstract
We evaluated and compared the diagnostic accuracy (DA) of apparent diffusion coefficient (ADC) values with that of lesion-to-liver ADC ratios in the characterization of solid focal liver lesions (FLLs). This prospective study was approved by the Institutional Human Ethics Board, after waiving written informed consent. Diffusion-weighted imaging and other routine magnetic resonance imaging were performed on 142 consecutive patients with suspected liver disease. The mean ADC values and lesion-to-liver ADC ratios were compared between benign and malignant solid FLLs. Receiver operating characteristic analysis was performed. The study participants included 46 patients (28 men, 18 women; mean age, 52.5 years) with 57 solid FLLs (32 malignant and 25 benign FLLs). The mean ADC values and ADC ratios of benign solid FLLs were significantly higher than those of malignant lesions (P<0.01). The difference between the area under the receiver operating characteristic curve of the ADC values (0.699) and ADC ratios (0.752) was not significant. Our study suggests that the DA of the ADC ratio is not significantly higher than that of ADC in characterizing solid FLLs.
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Value of diffusion-weighted MRI in evaluation of solid hepatic focal lesions in patients with renal insufficiency. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Tokgoz O, Unlu E, Unal I, Serifoglu I, Oz I, Aktas E, Caglar E. Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver. Afr Health Sci 2016; 16:227-33. [PMID: 27358636 DOI: 10.4314/ahs.v16i1.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIMS To investigate the use of diffusion weighted magnetic resonance imaging (DWI) and the apparent diffusion coefficient (ADC) values in the diagnosis of hemangioma. MATERIALS AND METHODS The study population consisted of 72 patients with liver masses larger than 1 cm (72 focal lesions). DWI examination with a b value of 600 s/mm2 was carried out for all patients. After DWI examination, an ADC map was created and ADC values were measured for 72 liver masses and normal liver tissue (control group). The average ADC values of normal liver tissue and focal liver lesions, the "cut-off" ADC values, and the diagnostic sensitivity and specificity of the ADC map in diagnosing hemangioma, benign and malignant lesions were researched. RESULTS Of the 72 liver masses, 51 were benign and 21 were malignant. Benign lesions comprised 38 hemangiomas and 13 simple cysts. Malignant lesions comprised 9 hepatocellular carcinomas, and 12 metastases. The highest ADC values were measured for cysts (3.782±0.53×10(-3) mm(2)/s) and hemangiomas (2.705±0.63×10(-3) mm(2)/s). The average ADC value of hemangiomas was significantly higher than malignant lesions and the normal control group (p<0.001). The average ADC value of cysts were significantly higher when compared to hemangiomas and normal control group (p<0.001). To distinguish hemangiomas from malignant liver lesions, the "cut-off" ADC value of 1.800×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 90.9%. To distinguish hemangioma from normal liver parenchyma the "cut-off" value of 1.858×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 95.7%. To distinguish benign liver lesions from malignant liver lesions the "cut-off" value of 1.800×10(-3) mm(2)/s had a sensitivity of 96.1% and a specificity of 90.0%. CONCLUSION DWI and quantitative measurement of ADC values can be used in differential diagnosis of benign and malignant liver lesions and also in the diagnosis and differentiation of hemangiomas. When dynamic examination cannot distinguish cases with vascular metastasis and lesions from hemangioma, DWI and ADC values can be useful in the primary diagnosis and differential diagnosis. The technique does not require contrast material, so it can safely be used in patients with renal failure.
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Affiliation(s)
- Ozlem Tokgoz
- Ankara Oncology Training and Research Hospital, Department of Radiology, Ankara/Turkey
| | - Ebru Unlu
- Afyon Kocatepe University, School of Medicine, Department of Radiology, Afyon
| | - Ilker Unal
- Cukurova University, School of Medicine, Department of Biostatistics, Adana
| | - Ismail Serifoglu
- Bulent Ecevit University, School of Medicine, Department of Radiology, Zonguldak, Turkey
| | - Ilker Oz
- Bulent Ecevit University, School of Medicine, Department of Radiology, Zonguldak, Turkey
| | - Elif Aktas
- Ankara Oncology Training and Research Hospital, Department of Radiology, Ankara/Turkey
| | - Emrah Caglar
- Bulent Ecevit University, School of Medicine, Department of Radiology, Zonguldak, Turkey
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Kim H, Arnoletti PJ, Christein J, Heslin MJ, Posey JA, Pednekar A, Mark Beasley T, Morgan DE. Pancreatic adenocarcinoma: a pilot study of quantitative perfusion and diffusion-weighted breath-hold magnetic resonance imaging. ACTA ACUST UNITED AC 2016; 39:744-52. [PMID: 24549880 DOI: 10.1007/s00261-014-0107-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To confirm the feasibility of breath-hold DCE-MRI and DWI at 3T to obtain the intra-abdominal quantitative physiologic parameters, K(trans), k ep, and ADC, in patients with untreated pancreatic ductal adenocarcinomas. METHODS Diffusion-weighted single-shot echo-planar imaging (DW-SS-EPI) and dynamic contrast-enhanced (DCE) MRI were used for 16 patients with newly diagnosed biopsy-proven pancreatic ductal adenocarcinomas. K(trans), k ep, and apparent diffusion coefficient (ADC) values of pancreatic tumors, non-tumor adjacent pancreatic parenchyma (NAP), liver metastases, and normal liver tissues were quantitated and statistically compared. RESULTS Fourteen patients were able to adequately hold their breath for DCE-MRI, and 15 patients for DW-SS-EPI. Four patients had liver metastases within the 6 cm of Z axis coverage centered on the pancreatic primary tumors. K(trans) values (10(-3) min(-1)) of primary pancreatic tumors, NAP, liver metastases, and normal liver tissues were 7.3 ± 4.2 (mean ± SD), 25.8 ± 14.9, 8.1 ± 5.9, and 45.1 ± 15.6, respectively, k ep values (10(-2) min(-1)) were 3.0 ± 0.9, 7.4 ± 3.1, 5.2 ± 2.0, and 12.1 ± 2.8, respectively, and ADC values (10(-3) mm(2)/s) were 1.3 ± 0.2, 1.6 ± 0.3, 1.1 ± 0.1, and 1.3 ± 0.1, respectively. K(trans), k ep, and ADC values of primary pancreatic tumors were significantly lower than those of NAP (p < 0.05), while K(trans) and k ep values of liver metastases were significantly lower than those of normal liver tissues (p < 0.05). CONCLUSIONS 3T breath-hold quantitative physiologic MRI is a feasible technique that can be applied to a majority of patients with pancreatic adenocarcinomas.
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Affiliation(s)
- Hyunki Kim
- Departments of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294-0019, USA,
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Ribot EJ, Trotier AJ, Castets CR, Dallaudière B, Thiaudière E, Franconi JM, Miraux S. Free-breathing 3D diffusion MRI for high-resolution hepatic metastasis characterization in small animals. Clin Exp Metastasis 2015; 33:167-78. [DOI: 10.1007/s10585-015-9766-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
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Hennedige TP, Hallinan JTPD, Leung FP, Teo LLS, Iyer S, Wang G, Chang S, Madhavan KK, Wee A, Venkatesh SK. Comparison of magnetic resonance elastography and diffusion-weighted imaging for differentiating benign and malignant liver lesions. Eur Radiol 2015; 26:398-406. [PMID: 26032879 DOI: 10.1007/s00330-015-3835-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 04/23/2015] [Accepted: 05/07/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Comparison of magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) for differentiating malignant and benign focal liver lesions (FLLs). METHODS Seventy-nine subjects with 124 FLLs (44 benign and 80 malignant) underwent both MRE and DWI. MRE was performed with a modified gradient-echo sequence and DWI with a free breathing technique (b = 0.500). Apparent diffusion coefficient (ADC) maps and stiffness maps were generated. FLL mean stiffness and ADC values were obtained by placing regions of interest over the FLLs on stiffness and ADC maps. The accuracy of MRE and DWI for differentiation of benign and malignant FLL was compared using receiver operating curve (ROC) analysis. RESULTS There was a significant negative correlation between stiffness and ADC (r = -0.54, p < 0.0001) of FLLs. Malignant FLLs had significantly higher mean stiffness (7.9kPa vs. 3.1kPa, p < 0.001) and lower mean ADC (129 vs. 200 × 10(-3)mm(2)/s, p < 0.001) than benign FLLs. The sensitivity/specificity/positive predictive value/negative predictive value for differentiating malignant from benign FLLs with MRE (cut-off, >4.54kPa) and DWI (cut-off, <151 × 10(-3)mm(2)/s) were 96.3/95.5/97.5/93.3% (p < 0.001) and 85/81.8/88.3/75% (p < 0.001), respectively. ROC analysis showed significantly higher accuracy for MRE than DWI (0.986 vs. 0.82, p = 0.0016). CONCLUSION MRE is significantly more accurate than DWI for differentiating benign and malignant FLLs. KEY POINTS • MRE is superior to DWI for differentiating benign and malignant focal liver lesions. • Benign lesions with large fibrous components may have higher stiffness with MRE. • Cholangiocarcinomas tend to have higher stiffness than hepatocellular carcinomas. • Hepatocellular adenomas tend to have lower stiffness than focal nodular hyperplasia. • MRE is superior to conventional MRI in differentiating benign and malignant liver lesions.
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Affiliation(s)
- Tiffany P Hennedige
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore
| | | | - Fiona P Leung
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore.,South West Radiology, Liverpool, NSW, Australia
| | - Lynette Li San Teo
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore
| | - Sridhar Iyer
- Department of Surgery, National University Health System, Singapore, Singapore
| | - Gang Wang
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore.,University of Calgary, Alberta, Canada
| | - Stephen Chang
- Department of Surgery, National University Health System, Singapore, Singapore
| | | | - Aileen Wee
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA.
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Assessment of diffusion-weighted imaging for characterizing focal liver lesions. Clin Imaging 2014; 39:278-84. [PMID: 25433855 DOI: 10.1016/j.clinimag.2014.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 08/31/2014] [Accepted: 09/19/2014] [Indexed: 12/19/2022]
Abstract
In 150 patients, 153 hepatic lesions (39 metastases, 27 hemangiomas, 26 hepatocellular carcinomas, 25 cysts, 15 adenomas, 8 focal nodular hyperplasias, 5 abscesses, 4 hamartomas, and 4 cholangiocarcinomas) were evaluated during a 24-month period. Apparent diffusion coefficient (ADC) values of benign lesions (1.994×10(-3) mm(2) s(-1)) were significantly higher than ADC values of malignant lesions (1.070×10(-3) mm(2) s(-1)). Mean ADC value for solid benign lesions (1.143×10(-3) mm(2) s(-1)±0.214×10(-3) mm(2) s(-1)) was not significantly different from malignant lesions. ADC values did not allow differentiating malignant from benign solid lesions (area under the curve=0.61). ADC cutoff value threshold of 1.6×10(-3) mm(2) s(-1) yielded higher accuracy for differentiating benign from malignant lesions.
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Latif MA, Hawary GE, Badrawy AE, Alfy HE. The role of MR diffusion in differentiation of malignant and benign hepatic focal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Galea N, Cantisani V, Taouli B. Liver lesion detection and characterization: role of diffusion-weighted imaging. J Magn Reson Imaging 2014; 37:1260-76. [PMID: 23712841 DOI: 10.1002/jmri.23947] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/11/2012] [Indexed: 12/11/2022] Open
Abstract
Diffusion-weighted imaging (DWI) plays an emerging role for the assessment of focal and diffuse liver diseases. This growing interest is due to that fact that DWI is a noncontrast technique with inherent high contrast resolution, with promising results for detection and characterization of focal liver lesions. Recent advances in diffusion image quality have also added interest to this technique in the abdomen. The purpose of this review is to describe the current clinical roles of DWI for the detection and characterization of focal liver lesions, and to review pitfalls, limitations, and future directions of DWI for assessment of focal liver disease.
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Affiliation(s)
- Nicola Galea
- Sapienza University of Rome, Department of Radiological Sciences, Rome, Italy
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Sutherland T, Steele E, van Tonder F, Yap K. Solid focal liver lesion characterisation with apparent diffusion coefficient ratios. J Med Imaging Radiat Oncol 2013; 58:32-7. [DOI: 10.1111/1754-9485.12087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 05/25/2013] [Indexed: 01/18/2023]
Affiliation(s)
- Tom Sutherland
- Medical Imaging Department; St Vincents Hospital; Melbourne Victoria Australia
| | - Emma Steele
- Medical Imaging Department; St Vincents Hospital; Melbourne Victoria Australia
| | - Frans van Tonder
- Medical Imaging Department; St Vincents Hospital; Melbourne Victoria Australia
| | - Kelvin Yap
- Medical Imaging Department; St Vincents Hospital; Melbourne Victoria Australia
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Yadav RR, Boruah DK, Yadav G, Pandey R, Phadke RV. Imaging characteristics of cavernous sinus cavernous hemangiomas. Neuroradiol J 2012; 25:515-24. [PMID: 24029085 DOI: 10.1177/197140091202500503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/16/2012] [Indexed: 12/24/2022] Open
Abstract
Cavernous hemangiomas occur rarely in the cavernous sinus and are difficult to diagnose preoperatively. The imaging of these lesions resembles other benign paracavernous lesions such as schwannomas and meningiomas. Profuse intraoperative bleeding may be encountered during surgical resection of these lesions. A preoperative diagnosis is therefore important to alert the surgeon. We report on the imaging characteristics of two different histopathological types of cavernous sinus cavernous hemangiomas and the use of contrast-enhanced MRI, diffusion-weighted MRI and magnetic resonance spectroscopy in the differential diagnosis of these lesions.
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Affiliation(s)
- R R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences; Lucknow, India - -
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Characterization of focal liver lesions using quantitative techniques: comparison of apparent diffusion coefficient values and T2 relaxation times. Eur Radiol 2012; 22:2514-24. [PMID: 22699872 PMCID: PMC3472073 DOI: 10.1007/s00330-012-2519-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/18/2012] [Accepted: 05/12/2012] [Indexed: 12/21/2022]
Abstract
Objectives To compare the efficacy of two quantitative methods for discrimination between benign and malignant focal liver lesions (FLLs): apparent diffusion coefficient (ADC) values and T2 relaxation times. Methods Seventy-three patients with 215 confirmed FLLs (115 benign, 100 malignant) underwent 1.5-T MRI with respiratory-triggered single-shot SE DWI (b = 50, 400, 800) and dual-echo T2TSE (TR = 3,000 ms; TE1 = 84 ms; TE2 = 228 ms). ADC values and T2 relaxation times of FLLs were calculated. Sensitivity, specificity and accuracy of both techniques in diagnosing malignancy were assessed. Results The mean ADC value of malignant tumours (1.07 × 10−3 mm2/s) was significantly lower (P < 0.05) than that of benign lesions (1.86 × 10−3 mm2/s ); however, with the use of the optimal cut-off value of 1.25 × 10−3 mm2/s, 20 false positive (FP) and 20 false negative (FN) diagnoses of malignancy were noted, generating 79 % sensitivity, 82.6 % specificity and 80.9 % accuracy. The mean T2 relaxation time of malignant tumours (64.4 ms) was significantly lower (P < 0.05) than that of benign lesions (476.1 ms). At the threshold of 107 ms 22 FP and 1 FN diagnoses were noted; the sensitivity was 99 %, specificity 80.9 % and accuracy 89.3 %. Conclusions Quantitative analysis of T2 relaxation times yielded significantly higher sensitivity and accuracy in diagnosing malignant liver tumour than ADC values. Key Points • Diffusion-weighted magnetic resonance imaging is increasingly used for liver lesions. • But ADC values demonstrated only moderate accuracy for differentiation of liver lesions. • T2 relaxation times yielded higher accuracy in diagnosing malignant liver tumours. • Both ADC and T2 values overlapped between focal nodular hyperplasia and malignant lesions. • Nevertheless T2 liver mapping could be valuable for evaluating focal liver lesions.
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Gadoxetic acid-enhanced hepatobiliary phase MRI and high-b-value diffusion-weighted imaging to distinguish well-differentiated hepatocellular carcinomas from benign nodules in patients with chronic liver disease. AJR Am J Roentgenol 2011; 197:W868-75. [PMID: 22021534 DOI: 10.2214/ajr.10.6237] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the value of gadoxetic acid-enhanced hepatobiliary phase imaging and high-b-value diffusion-weighted imaging (DWI) for distinguishing well-differentiated hepatocellular carcinomas (HCCs) from benign hepatocellular nodules in patients with chronic liver disease using 3-T MRI. MATERIALS AND METHODS Forty-five patients with 46 well-differentiated HCCs (mean, 2.3 cm) and 21 patients with 24 benign hepatocellular nodules (five large regenerative nodules and 19 dysplastic nodules; mean, 1.8 cm) were included in this study. Diagnosis of well-differentiated HCCs and benign hepatocellular nodules was made histopathologically by percutaneous biopsy (n = 12 and n = 11, respectively) or surgical resection (n = 34 and n = 13, respectively). Gadoxetic acid-enhanced MRI was performed for all patients, and DWI (b values of 0 and 800 s/mm(2)) was performed for 31 well-differentiated HCCs and 11 benign hepatocellular nodules. Two radiologists performed a consensus review of the MRI scans for signal intensity compared with that of the surrounding liver parenchyma on hepatobiliary phase images and DWI (b value, 800 s/mm(2)) for qualitative analysis. The contrast-to-noise ratio (CNR) and relative contrast enhancement of lesions on hepatobiliary phase images and the apparent diffusion coefficient (ADC) values were assessed for quantitative analysis. RESULTS In the qualitative analysis, 39 well-differentiated HCCs (85%) and 14 benign hepatocellular nodules (58%) were hypointense on hepatobiliary phase images, and seven well-differentiated HCCs (15%) and 10 benign hepatocellular nodules (42%) were iso- or hyperintense (p = 0.04). Twenty-five well-differentiated HCCs (81%) and three benign hepatocellular nodules (27%) were hyperintense on DWI, with b value of 800 s/mm(2), and six well-differentiated HCCs (19%) and eight benign hepatocellular nodules (73%) were iso- or hypointense (p = 0.01). When lesion hypointensity on hepatobiliary phase images or hyperintensity on DWI were considered signs of HCC in cirrhotic liver, our results yielded sensitivities of 85% and 81% and specificities of 42% and 73%, respectively. In the quantitative analysis, the mean (± SD) relative contrast enhancement ratio of the well-differentiated HCCs (0.76 ± 2.30) was significantly higher than that of benign hepatocellular nodules (0.25 ± 0.97) (p = 0.02). The lesion-to-liver CNRs and the mean ADC values were not significantly different between the two groups (p > 0.05). CONCLUSION Hypointensity on gadoxetic acid-enhanced hepatobiliary phase images and hyperintensity on high-b-value DWI to surrounding liver parenchyma suggest well-differentiated HCCs rather than benign hepatocellular nodules in chronic liver disease.
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The diagnostic value of diffusion-weighted magnetic resonance imaging in soft tissue abscesses. Eur J Radiol 2011; 77:490-4. [DOI: 10.1016/j.ejrad.2009.08.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 08/26/2009] [Accepted: 08/26/2009] [Indexed: 11/22/2022]
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Onur MR, Çiçekçi M, Kayalı A, Poyraz AK, Kocakoç E. The role of ADC measurement in differential diagnosis of focal hepatic lesions. Eur J Radiol 2011; 81:e171-6. [PMID: 21353418 DOI: 10.1016/j.ejrad.2011.01.116] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 01/05/2011] [Accepted: 01/17/2011] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate the utility of apparent diffusion coefficient (ADC) measurement in characterization of focal solid hepatic lesions and determine the role of ADC values in differentiation of solid benign and solid malignant hepatic lesions. MATERIALS AND METHODS Between June 2006 and December 2010, a total of 95 focal solid hepatic lesions in 95 consecutive patients were evaluated by abdominal MRI. Diffusion weighted MRI was performed with b 100, b 600 and b 1000 gradients with ADC measurements. Comparison of mean ADC values between solid benign (focal nodular hyperplasia and other solid benign lesions) and solid malignant lesion (hepatocellular carcinoma, metastasis, and cholangiocarcinoma) groups and between each benign and malignant lesion was done. The ROC analyses were performed in order to determine cut-off ADC values for differentiation of benign and malignant lesion groups at 3 different gradients. RESULTS Twenty-six of 95 lesions were benign and 69 were malignant. Mean ADC values of solid benign lesions at b 100, b 600 and b 1000 gradients were 2.25±0.54×10(-3), 1.97±0.64×10(-3) and 1.52±0.47×10(-3) mm2/s, respectively. Mean ADC values of solid malignant lesions at b 100, b 600 and b 1000 gradients were 1.84±0.57×10(-3), 1.37±0.38×10(-3) and 1.08±0.22×10(-3) mm2/s, respectively. The ADC values of solid benign lesions were significantly higher than solid malignant lesions at all 3 gradients (P<0.05). Differentiation of benign and malignant subtype lesions from each other in their groups did not yield as significant findings as comparing results between benign and malignant lesions. CONCLUSION Although ADC measurements were not helpful for differentiating subtypes of solid benign or solid malignant lesions, ADC measurements at 3 different gradients may be useful in differential diagnosis of benign lesions from malignant ones.
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Affiliation(s)
- Mehmet Ruhi Onur
- University of Firat, Faculty of Medicine, Department of Radiology, Turkey.
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Miller FH, Hammond N, Siddiqi AJ, Shroff S, Khatri G, Wang Y, Merrick LB, Nikolaidis P. Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 2010; 32:138-47. [PMID: 20578020 DOI: 10.1002/jmri.22235] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate apparent diffusion coefficient (ADC) values for characterization of a variety of focal liver lesions and specifically for differentiation of solid benign lesions (focal nodular hyperplasia [FNH] and adenomas) from solid malignant neoplasms (metastases and hepatocellular carcinoma [HCC]) in a large case series. MATERIALS AND METHODS A total of 542 lesions in 382 patients were evaluated. ADC values were measured in 166 hemangiomas, 112 hepatomas, 107 metastases, 95 cysts, 10 abscesses, 43 FNH, and nine adenomas. ADCs of 1.5 and 1.6 (x10(-3) mm(2)/second) were selected as threshold values to separate benign and malignant lesions. Sensitivity, specificity, positive, and negative predictive values (PPV, NPV) were calculated. Comparisons were carried out with studentized range test. RESULTS There was high interobserver agreement in ADC measurements for all lesion types. The mean ADCs for cysts was 3.40 (x10 (-3) mm(2)/second), hemangiomas 2.26, FNH 1.79, adenomas 1.49, abscesses 1.97, HCC 1.53, and metastases 1.50. The mean ADC for benign lesions was 2.50 and for malignant lesions was 1.52. Cysts were easily distinguished from other lesions. There was, however, overlap between solid benign and malignant lesions. CONCLUSION Benign lesions have higher mean ADC values than malignant lesions. However, ADC values of solid benign lesions (FNH and adenomas) are similar to malignant lesions (metastases, HCC) limiting the value of diffusion weighted imaging (DWI) for differentiating solid liver masses.
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Affiliation(s)
- Frank H Miller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Apparent Diffusion Coefficient in Invasive Ductal Breast Carcinoma: Correlation with Detailed Histologic Features and the Enhancement Ratio on Dynamic Contrast-Enhanced MR Images. JOURNAL OF ONCOLOGY 2010; 2010. [PMID: 20871661 PMCID: PMC2939440 DOI: 10.1155/2010/821048] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/15/2010] [Indexed: 12/04/2022]
Abstract
Purpose. To investigate the correlation of Apperent Diffusion Coefficient (ADC) values in invasive ductal breast carcinomas with detailed histologic features and enhancement ratios on dynamic contrast-enhanced MRI.
Methods and Materials. Dynamic MR images and diffusion-weighted images (DWIs) of invasive ductal breast carcinomas were reviewed in 25 (26 lesions) women. In each patient, DWI, T2WI, T1WI, and dynamic images were obtained. The ADC values of the 26 carcinomas were calculated with b-factors of 0 and 1000 s/mm2
using echoplanar DWI. Correlations of the ADC values were examined on dynamic MRI with enhancement ratios (early to delayed phase: E/D ratio) and detailed histologic findings for each lesion, including cellular density, the size of cancer nests, and architectural features of the stroma (broad, narrow, and delicate) between cancer nests.
Results. The mean ADC was 0.915 ± 0.151 × 10−3 mm2/sec. Cellular density was significantly correlated with ADC values (P = .0184) and E/D ratios (P = .0315). The ADC values were also significantly correlated to features of the stroma (broad to narrow, P = .0366).
Conclusion. The findings suggest that DWIs reflect the growth patterns of carcinomas, including cellular density and architectural features of the stroma, and E/D ratios may also be closely correlated to cellular density.
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Nishie A, Tajima T, Ishigami K, Ushijima Y, Okamoto D, Hirakawa M, Nishihara Y, Taketomi A, Hatakenaka M, Irie H, Yoshimitsu K, Honda H. Detection of hepatocellular carcinoma (HCC) using super paramagnetic iron oxide (SPIO)-enhanced MRI: Added value of diffusion-weighted imaging (DWI). J Magn Reson Imaging 2010; 31:373-82. [PMID: 20099351 DOI: 10.1002/jmri.22059] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate whether diffusion-weighted imaging (DWI) improves the detection of hepatocellular carcinoma (HCC) on super paramagnetic iron oxide (SPIO)-enhanced MRI. MATERIALS AND METHODS This retrospective study group consisted of 30 patients with 50 HCC nodules who underwent MRI at 1.5 Tesla. Two combined MR sequence sets were compared for detecting HCC: SPIO-enhanced MRI (axial T2-weighted fast spin-echo (FSE) and T1-/T2*-weighted fast field echo (FFE) scanned before and after administration of ferucarbotran) and SPIO-enhanced MRI + DWI (SPIO-enhanced MRI with axial DWI scanned before and after administration of ferucarbotran). Three blinded readers independently reviewed for the presence of HCC on a segment-by-segment basis using a four-point confidence scale. The performance of the two combined MR sequence sets was evaluated using receiver operating characteristic (ROC) analysis. RESULTS The average area under the ROC curve (Az) of the three readers for the SPIO-enhanced MRI + DWI set (0.870 +/- 0.046) was significantly higher that that for the SPIO-enhanced MRI set (0.820 +/- 0.055) (P = .025). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detection of HCC were 66.0%, 98.0%, 90.0%, and 91.4%, respectively, for the SPIO-enhanced MRI set, and 70.0%, 98.6%, 92.9%, and 92.4%, respectively, for the SPIO-enhanced MRI + DWI set. CONCLUSION The SPIO-enhanced MRI + DWI set outperformed the SPIO-enhanced MRI set for depicting HCC.
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Affiliation(s)
- Akihiro Nishie
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan.
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Gulani V, Willatt JM, Blaimer M, Hussain HK, Duerk JL, Griswold MA. Effect of contrast media on single-shot echo planar imaging: implications for abdominal diffusion imaging. J Magn Reson Imaging 2010; 30:1203-8. [PMID: 19856456 DOI: 10.1002/jmri.21945] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The goal of this study was to determine the effect of contrast media on the signal behavior of single-shot echo planar imaging (ssEPI) used for abdominal diffusion imaging. MATERIALS AND METHODS The signal of an ssEPI spin echo sequence in a water phantom with varying concentrations of gadolinium was modeled with Bloch equations and the predicted behavior validated on a phantom at 1.5T. Six volunteers were given gadolinium contrast and signal intensity (SI) time courses for regions of interest (ROIs) in the liver, pancreas, spleen, renal cortex, and medulla were analyzed. Student's t-test was used to compare precontrast SI to 0, 1, 4, 5, 10, and 13 minutes following contrast. RESULTS The results show that following contrast ssEPI SI goes through a nadir, recovering differently for each organ. Maximal contrast-related signal losses relative to precontrast signal are 20%, 20%, 53%, and 67% for the liver, pancreas, renal cortex, and medulla, respectively. The SIs remain statistically below the precontrast values for 5, 4, and 1 minute for the pancreas, liver, and spleen, and for all times measured for the renal cortex and medulla. CONCLUSION Abdominal diffusion imaging should be performed prior to contrast due to adverse effects on the signal in ssEPI.
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Affiliation(s)
- Vikas Gulani
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106-8062, USA.
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Coenegrachts K. Magnetic resonance imaging of the liver: New imaging strategies for evaluating focal liver lesions. World J Radiol 2009; 1:72-85. [PMID: 21160723 PMCID: PMC2999307 DOI: 10.4329/wjr.v1.i1.72] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 11/12/2009] [Accepted: 11/16/2009] [Indexed: 02/06/2023] Open
Abstract
The early detection of focal liver lesions, particularly those which are malignant, is of utmost importance. The resection of liver metastases of some malignancies (including colorectal cancer) has been shown to improve the survival of patients. Exact knowledge of the number, size, and regional distribution of liver metastases is essential to determine their resectability. Almost all focal liver lesions larger than 10 mm are demonstrated with current imaging techniques but the detection of smaller focal liver lesions is still relatively poor. One of the advantages of magnetic resonance imaging (MRI) of the liver is better soft tissue contrast (compared to other radiologic modalities), which allows better detection and characterization of the focal liver lesions in question. Developments in MRI hardware and software and the availability of novel MRI contrast agents have further improved the diagnostic yield of MRI in lesion detection and characterization. Although the primary modalities for liver imaging are ultrasound and computed tomography, recent studies have suggested that MRI is the most sensitive method for detecting small liver metastatic lesions, and MRI is now considered the pre-operative standard method for diagnosis. Two recent developments in MRI sequences for the upper abdomen comprise unenhanced diffusion-weighted imaging (DWI), and keyhole-based dynamic contrast-enhanced (DCE) MRI (4D THRIVE). DWI allows improved detection (b = 10 s/mm2) of small (< 10 mm) focal liver lesions in particular, and is useful as a road map sequence. Also, using higher b-values, the calculation of the apparent diffusion coefficient value, true diffusion coefficient, D, and the perfusion fraction, f, has been used for the characterization of focal liver lesions. DCE 4D THRIVE enables MRI of the liver with high temporal and spatial resolution and full liver coverage. 4D THRIVE improves evaluation of focal liver lesions, providing multiple arterial and venous phases, and allows the calculation of perfusion parameters using pharmacokinetic models. 4D THRIVE has potential benefits in terms of detection, characterization and staging of focal liver lesions and in monitoring therapy.
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Sijens PE. Parametric exploration of the liver by magnetic resonance methods. Eur Radiol 2009; 19:2594-607. [PMID: 19504103 PMCID: PMC2762052 DOI: 10.1007/s00330-009-1470-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 04/24/2009] [Accepted: 04/30/2009] [Indexed: 12/16/2022]
Abstract
MRI, as a completely noninvasive technique, can provide quantitative assessment of perfusion, diffusion, viscoelasticity and metabolism, yielding diverse information about liver function. Furthermore, pathological accumulations of iron and lipids can be quantified. Perfusion MRI with various contrast agents is commonly used for the detection and characterization of focal liver disease and the quantification of blood flow parameters. An extended new application is the evaluation of the therapeutic effect of antiangiogenic drugs on liver tumours. Novel, but already widespread, is a histologically validated relaxometry method using five gradient echo sequences for quantifying liver iron content elevation, a measure of inflammation, liver disease and cancer. Because of the high perfusion fraction in the liver, the apparent diffusion coefficients strongly depend on the gradient factors used in diffusion-weighted MRI. While complicating analysis, this offers the opportunity to study perfusion without contrast injection. Another novel method, MR elastography, has already been established as the only technique able to stage fibrosis or diagnose mild disease. Liver fat content is accurately determined with multivoxel MR spectroscopy (MRS) or by faster MRI methods that are, despite their widespread use, prone to systematic error. Focal liver disease characterisation will be of great benefit once multivoxel methods with fat suppression are implemented in proton MRS, in particular on high-field MR systems providing gains in signal-to-noise ratio and spectral resolution.
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Affiliation(s)
- Paul E Sijens
- Radiology, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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Sandrasegaran K, Akisik FM, Lin C, Tahir B, Rajan J, Aisen AM. The value of diffusion-weighted imaging in characterizing focal liver masses. Acad Radiol 2009; 16:1208-14. [PMID: 19608435 DOI: 10.1016/j.acra.2009.05.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 05/01/2009] [Accepted: 05/03/2009] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if focal liver masses could be differentiated as benign or malignant on the basis of diffusion-weighted imaging (DWI). METHODS AND MATERIALS A total of 104 patients with focal liver masses were scanned using 1.5 T magnetic resonance imaging (MRI). DWI was performed with b values of 0, 50, and 400 s/mm(2). Of these, 76 patients had lesions larger than 2 cm diameter, radiologic or pathologic characterization of the lesion, and diagnostic quality DWI. The apparent diffusion coefficient (ADC) of the largest liver lesion was measured. The liver masses were diagnosed on histology or had characteristic computed tomography/MRI findings and follow up of more than 6 months. The analyzed lesions were hemangioma (n = 17), cysts (n = 5), hepatocellular cancer (HCC) (n = 41), adenoma (n = 3), focal nodular hyperplasia (FNH) (n = 6), and metastases (n = 4). RESULTS The mean (standard deviation) ADC values (10(-5) mm(2)/second) of hemangiomas, cysts, FNH, and HCC were 156.8 (54.1), 190.2 (43.0), 130.1 (81.9), and 107.6 (32.7). The ADC of cysts and hemangiomas were significantly higher than that of other lesions (P = .0003, t-test). There was no significant difference between ADC values of solid, benign liver lesions (FNH, adenoma) and malignant lesions (HCC, metastases) (P = .62). CONCLUSION Solid liver lesions have a lower ADC than cysts and hemangiomas. However, there is no significant difference in ADC between solid benign and malignant lesions. DWI appears to have only minimal additional value over currently used MRI sequences in characterizing liver masses.
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Tsushima Y, Takahashi-Taketomi A, Endo K. Magnetic resonance (MR) differential diagnosis of breast tumors using apparent diffusion coefficient (ADC) on 1.5-T. J Magn Reson Imaging 2009; 30:249-55. [DOI: 10.1002/jmri.21854] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Ogura A, Hayakawa K, Miyati T, Maeda F. Imaging parameter effects in apparent diffusion coefficient determination of magnetic resonance imaging. Eur J Radiol 2009; 77:185-8. [PMID: 19646836 DOI: 10.1016/j.ejrad.2009.06.031] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 06/22/2009] [Accepted: 06/25/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE Although an apparent diffusion coefficient (ADC) value is often used for differential diagnosis of tumours, it varies with scanning parameters. The present study was performed to investigate the influence of imaging parameters, i.e., b value, repetition time (TR) and echo time (TE), on ADC value. METHODS The phantoms were scanned using diffusion weighted imaging (DWI) with changing b values (b=0-3000 s/mm(2)), TR and TE to determine the influence on ADC. Moreover, ADC of the brain in normal volunteers was determined with varying b values (b=0-1000 s/mm(2)). RESULTS Diffusion decay curves were obtained by biexponential fitting in all phantoms. The points where fast and slow components of the biexponential decay crossed were called turning points. The b values of turning points that crossed from the biexponential curve were different in each phantom. The b values of turning points depended on ADC of fast diffusion component. When ADC is calculated using two b values of front and back for the turning point, the ADC value may be different. Therefore, it was necessary to perform calculations by b value until the turning point to obtain the ADC value of the fast component. In addition, b≥100 was recommended to avoid the influence of perfusion by blood. Furthermore, the choice of long TR and short TE was effective for accurate measurement of ADC. CONCLUSION It is important to determine the turning point for measuring ADC.
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Affiliation(s)
- Akio Ogura
- Department of Radiology, Kyoto City Hospital, Nakagyo-ku, Kyoto, Japan.
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Hepatic metastases: use of diffusion-weighted echo-planar imaging. ACTA ACUST UNITED AC 2009; 35:454-61. [DOI: 10.1007/s00261-009-9541-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 04/30/2009] [Indexed: 12/15/2022]
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Vandecaveye V, De Keyzer F, Verslype C, Op de Beeck K, Komuta M, Topal B, Roebben I, Bielen D, Roskams T, Nevens F, Dymarkowski S. Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma. Eur Radiol 2009; 19:2456-66. [PMID: 19440718 DOI: 10.1007/s00330-009-1431-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 03/02/2009] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to evaluate the accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating HCC from benign cirrhotic lesions compared with conventional dynamic contrast-enhanced MRI. Fifty-five patients with cirrhosis underwent conventional and DW-MRI at 1.5 Tesla. Signal intensity ratios (SI(ratio)) of solid liver lesions to adjacent hepatic parenchyma were measured for b0, b100, b600 and b1000, and the apparent diffusion coefficients (ADC) were calculated. In 27 patients, imaging results were compared to histopathology, and in 28 patients, to imaging follow-up. Based on predetermined thresholds, sensitivity and specificity of DW-MRI and conventional MRI were compared. SI(ratio) was significantly different between malignant and benign lesions at all b-values (P < 0.0001). No significant difference in ADC was seen (P = 0.47). For detection of malignant lesions, DW-MRI with b600-SI(ratio) yielded a sensitivity of 95.2% compared to 80.6% for conventional MRI (P = 0.023) and a specificity of 82.7% compared to 65.4% (P = 0.064). The improved accuracy was most beneficial for differentiating malignant lesions smaller than 2 cm. DW-MRI with b600-SI(ratio) improved the detection of small HCC and the differentiation of pseudotumoral lesions compared with conventional MRI.
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Affiliation(s)
- Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, B-3000, Leuven, Belgium.
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Respiratory-Triggered Versus Breath-Hold Diffusion-Weighted MRI of Liver Lesions: Comparison of Image Quality and Apparent Diffusion Coefficient Values. AJR Am J Roentgenol 2009; 192:915-22. [DOI: 10.2214/ajr.08.1260] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tsushima Y, Takahashi-Taketomi A, Endo K. Diagnostic utility of diffusion-weighted MR imaging and apparent diffusion coefficient value for the diagnosis of adrenal tumors. J Magn Reson Imaging 2009; 29:112-7. [PMID: 19097108 DOI: 10.1002/jmri.21616] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To determine the utility of diffusion-weighted MR imaging (DWI) for the diagnosis of adrenal tumors. MATERIALS AND METHODS Forty-two patients (24 men and 18 women; age, 61.5 +/- 12.7 years old; range, 34-86 years) with 43 adrenal tumors (11 functioning cortical adenomas, 20 nonfunctioning cortical adenomas, 7 metastatic tumors, and 5 pheochromocytomas) were retrospectively investigated. DWIs were obtained by single-shot spin-echo type echo-planar imaging sequence (1.5 Tesla [T]; TR = 8000 ms, TE = 72, b-factor = 0 and 1000 s/mm(2)), and apparent diffusion coefficient (ADC) value was calculated. Chemical shift images were obtained by gradient echo sequence (TR = 161, TE = 2.38 [out-of-phase, OP] and 4.76 [in-phase, IP], FA = 60), and the signal intensity index (SII; [IP-OP]/IP *100%) was calculated. RESULTS There was no difference in ADC values between adenomas (1.09 +/- 0.29*10(-3) mm(2)/s; range, 0.52-1.64) and metastatic tumors (0.85 +/- 0.26*10(-3); 0.51-1.23; p = 0.14). Pheochromocytomas showed the higher mean ADC value (1.59 +/- 0.34*10(-3); 1.04-1.96) compared with those of adenomas or metastatic tumors (P < 0.05 and P < 0.005, respectively). The mean SII of adenomas (62.1 +/- 17.9%; 14.5-88.4) was significantly higher than those of pheochromocytomas (4.0 +/- 10.0%; -19.6-3.3; P < 0.005) or metastatic tumors (-1.5 +/- 11.7%; -18.3-8.2; P < 0.01). There was no correlation between ADC values and SII. CONCLUSION Although pheochromocytomas showed higher ADC values, we did not find that ADC value had diagnostic utility for differentiating adenomas and metastatic tumors.
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Affiliation(s)
- Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Hospital, Gunma, Japan.
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Kilickesmez O, Bayramoglu S, Inci E, Cimilli T. Value of apparent diffusion coefficient measurement for discrimination of focal benign and malignant hepatic masses. J Med Imaging Radiat Oncol 2009; 53:50-5. [DOI: 10.1111/j.1754-9485.2009.02036.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Receiver operating characteristic analysis of diffusion-weighted magnetic resonance imaging in differentiating hepatic hemangioma from other hypervascular liver lesions. J Comput Assist Tomogr 2008; 32:750-6. [PMID: 18830105 DOI: 10.1097/rct.0b013e31816a6823] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the role of diffusion-weighted imaging in differentiating between hepatic hemangiomas, both typical and atypical, and other hypervascular liver lesions. METHODS Retrospective review of 182 hypervascular liver lesions in 117 patients was performed. Diffusion and contrast-enhanced magnetic resonance imaging were performed using a 1.5-T unit. Imaging protocol consisted of T2-weighted fast spin-echo images, breath-hold diffusion-weighted echo-planar images, and breath-hold unenhanced and contrast-enhanced T1-weighted 3-dimensional fat-suppressed spoiled gradient-echo images in the arterial phase (20 seconds) and portal venous phase (60 seconds). Signal intensity changes and apparent diffusion coefficient (ADC) values were evaluated for all lesions. Unpaired t test was used to compare the mean ADC values for different lesions, and statistical significance was set at P < 0.01. Receiver operating characteristic analysis was used to determine the accuracy of diffusion-weighted imaging in differentiating hemangiomas from other hypervascular liver lesions. RESULTS Lesions included typical and atypical hemangioma (n = 38), hepatocellular carcinoma (HCC; n = 58), focal nodular hyperplasia (FNH; n = 22), and neuroendocrine tumor metastasis (NET; n = 64) with a mean tumor size of 5.3 cm. Mean ADC value for hemangioma, HCC, FNH, and NET was 2.29 x 10(-3), 1.55 x 10(-3), 1.65 x 10(-3), and 1.43 x 10(-3) mm2/s, respectively. There was a statistically significant difference in the ADC value of hemangioma compared with that of FNH (P < 0.001), HCC (P < 0.001), and NET (P < 0.001), respectively. The area under the receiver operating characteristic curve was 0.91. CONCLUSIONS Diffusion-weighted magnetic resonance imaging and ADC maps can provide rapid quantifiable information to differentiate typical and atypical hemangiomas from other hypervascular liver lesions.
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Ogura A, Hayakawa K, Miyati T, Maeda F. The effect of susceptibility of gadolinium contrast media on diffusion-weighted imaging and the apparent diffusion coefficient. Acad Radiol 2008; 15:867-72. [PMID: 18572122 DOI: 10.1016/j.acra.2007.12.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Revised: 12/26/2007] [Accepted: 12/26/2007] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES The development of parallel magnetic resonance imaging has resulted in the frequent use of diffusion-weighted imaging (DWI) in clinical medicine, which usually involves the use of contrast medium. However, gadolinium (Gd) contrast medium may have some effect on DWI and the apparent diffusion coefficient (ADC). The present study was performed to determine whether the magnetic susceptibility of contrast medium alters the DWI signal and the value of ADC in some imaging techniques. MATERIALS AND METHODS Nonfat suppression DWI, short-time inversion recovery (STIR) combination, and chemical shift selective (CHESS) combination DWI were performed to examine 10 phantoms with gadolinium-meglumine gadopentetate (Gd-DTPA) dissolved at concentrations from 0.0005 to 0.1 mmol in physiologic saline as a contrast medium. The average pixel value and ADC of each method were determined. RESULTS ADC showed no differences between before and after treatment with contrast medium for all imaging techniques with Gd considered distributed over the whole tumor. The signal intensity did not change on nonfat suppression or CHESS combination DWI, but deteriorated on STIR. CONCLUSIONS ADC was not influenced by the magnetic susceptibility of contrast medium. In addition, it was suggested that the ability of tumor detection may be reduced if STIR is used as fat suppression.
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Tumor response after yttrium-90 radioembolization for hepatocellular carcinoma: comparison of diffusion-weighted functional MR imaging with anatomic MR imaging. J Vasc Interv Radiol 2008; 19:1180-6. [PMID: 18656011 DOI: 10.1016/j.jvir.2008.05.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 04/09/2008] [Accepted: 05/02/2008] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Anatomic magnetic resonance (MR) imaging assessment of hepatocellular carcinoma (HCC) response to yttrium-90 ((90)Y) radioembolization may require 3 months before therapeutic effectiveness can be determined. The relationship between anatomic MR and diffusion-weighted imaging (DWI) changes after (90)Y therapy is unclear. The present study tested the hypothesis that apparent diffusion coefficient (ADC) values on DWI at 1 month precede anatomic tumor size change at 3 months after (90)Y radioembolization. MATERIALS AND METHODS In this prospective study, 20 patients with HCC (16 men) enrolled between April 2005 and July 2006 underwent lobar (90)Y therapy with mean doses of 141 Gy (right lobe) and 98 Gy (left lobe). Anatomic 1.5-T MR imaging (gadolinium-enhanced T1-weighted gradient-recalled echo) and DWI (single-shot spin-echo echo-planar imaging; b value of 0, 500 sec/mm(2)) were performed at baseline (0-3 weeks before (90)Y therapy) and at 1 and 3 months after (90)Y therapy. Tumor size and ADC values were measured and compared, and the percentage change in ADC was compared to the change in tumor size (minimum >5% change in size), with use of a paired t test (alpha = .05). RESULTS Yttrium-90 therapy was successfully delivered in all patients. The mean baseline ADC of 1.64 x 10(-3) mm(2)/sec +/- 0.30 significantly increased to 1.81 x 10(-3) mm(2)/sec +/- 0.37 at 1 month (P = .02), and to 1.82 x 10(-3) mm(2)/sec +/- 0.23 at 3 months (P = .02). The mean baseline tumor size of 83.0 cm(2) +/- 63.7 did not change statistically at 1 month (84.1 cm(2) +/- 62.1; P = .75) or 3 months (74.0 cm(2) +/- 57.0; P = .10). The overall mean ADC percentage change at 1 month of 10.5% +/- 23.1% preceded an overall mean tumor size percentage change at 3 months of -18.5% +/- 31.5% (P = .03). CONCLUSIONS HCC tumor response assessed with DWI at 1 month preceded anatomic size changes at 3 months after (90)Y therapy. DWI may assist in early determination of the response or failure of (90)Y therapy for HCC.
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Yoshida S, Masuda H, Ishii C, Saito K, Kawakami S, Kihara K. Initial experience of functional imaging of upper urinary tract neoplasm by diffusion-weighted magnetic resonance imaging. Int J Urol 2007; 15:140-3. [DOI: 10.1111/j.1442-2042.2007.01950.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Shimizu T, Murata S, Mekata E, Miyake T, Abe H, Kurumi Y, Endo Y, Kushima R, Tani T. Clinical potential of an antitumor drug sensitivity test and diffusion-weighted MRI in a patient with a recurrent solid pseudopapillary tumor of the pancreas. J Gastroenterol 2007; 42:918-22. [PMID: 18008037 DOI: 10.1007/s00535-007-2105-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 08/12/2007] [Indexed: 02/04/2023]
Abstract
A solid pseudopapillary tumor (SPT) of the pancreas is a rare type of pancreatic neoplasm found predominantly in young women. SPTs typically behave as though benign; however, in some cases they also have malignant potential. We encountered a rare case of a recurrent SPT that developed 4 years after the initial surgery in an elderly male patient. Abdominal computed tomography (CT) revealed that the 61-year-old patient had four intra-abdominal masses, suggesting a recurrence of SPT. The patient had a history of distal pancreatectomy due to SPT in the pancreatic tail 4 years previously. These tumors showed positive signals on diffusion-weighted magnetic resonance imaging (MRI), and were treated successfully by aggressive surgical resection. Microscopic diagnosis was compatible with recurrent tumors of SPT. A chemosensitivity test, the collagen gel droplet-embedded culture drug sensitivity test (CD-DST), showed that the resected tumors were sensitive to several antitumor drugs. We suggest that the CD-DST may be used to indicate promising antitumor agents for treating SPTs with malignant tendencies. In addition, a diffusion-weighted MRI can be useful for accurately visualizing SPTs of the pancreas.
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Affiliation(s)
- Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowa, Otsu 520-2192, Japan
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Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 2007; 18:477-85. [PMID: 17960390 DOI: 10.1007/s00330-007-0785-9] [Citation(s) in RCA: 293] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 08/04/2007] [Accepted: 09/11/2007] [Indexed: 02/08/2023]
Abstract
The aim of this study was to determine apparent diffusion coefficients (ADCs) of focal liver lesions on the basis of a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging sequence (DW-SS-EPI) and to evaluate whether ADC measurements can be used to characterize lesions. One hundred and two patients with focal liver lesions [11 hepatocellular carcinomas (HCC), 82 metastases, 4 focal nodular hyperplasias (FNH), 56 hemangiomas and 51 cysts; mean size, 16.6 mm; range 5-92 mm] were examined on a 1.5-T system using respiratory triggered DW-SS-EPI (b-values: 50, 300, 600 s/mm2). Results were correlated with histopathologic data and follow-up imaging. The ADCs of different lesion types were compared, and lesion discrimination using optimal thresholds for ADCs was evaluated. Mean ADCs (x10(-3)mm2/s) were 1.24 and 1.04 for normal and cirrhotic liver parenchyma and 1.05, 1.22, 1.40, 1.92 and 3.02 for HCCs, metastases, FNHs, hemangiomas and cysts, respectively. Mean ADCs differed significantly for all lesion types except for comparison of metastases with HCCs and FNHs. Overall, 88% of lesions were correctly classified as benign or malignant using a threshold value of 1.63 x 10(-3)mm2/s. Measurements of the ADCs of focal liver lesions on the basis of a respiratory triggered DW-SS-EPI sequence may constitute a useful supplementary method for lesion characterization.
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Coenegrachts K, Delanote J, Ter Beek L, Haspeslagh M, Bipat S, Stoker J, Steyaert L, Rigauts H. Evaluation of true diffusion, perfusion factor, and apparent diffusion coefficient in non-necrotic liver metastases and uncomplicated liver hemangiomas using black-blood echo planar imaging. Eur J Radiol 2007; 69:131-8. [PMID: 17950553 DOI: 10.1016/j.ejrad.2007.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 07/24/2007] [Accepted: 09/12/2007] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the added value of true diffusion (D), perfusion factor (f) and apparent diffusion coefficient at low b-values (ADC(low)) for differentiation between liver metastases and hemangiomas based on respiratory-triggered high-resolution Black-Blood Single-Shot SpinEcho Echo Planar Imaging (BB SS SE-EPI). MATERIALS AND METHODS Twenty-five patients suspected for malignant colorectal liver lesions were included in this study. A total of 106 lesions were examined. Different b-value images were compared for lesion conspicuity, image quality and artifacts using rank order statistic (RIDIT) and Student's t-test. D, f, and ADC(low) values were calculated. Pearson correlation coefficient is used for comparison of interobserver variability. RESULTS Best lesion conspicuity (p<0.05) was achieved with BB SS SE-EPI (b=0 and 10s/mm(2)); best image quality (p<0.05) with b=10s/mm(2). Image artifacts were lowest (p<0.05) with b=0s/mm(2). Over the whole sample, D in metastases (D(met)) was significantly (p<0.05) lower than D in hemangiomas (D(hem)); f and ADC(low) of metastases (f(met), respectively, ADC(lowmet)) were significantly (p<0.05) higher than f and ADC(low) of hemangiomas (f(hem), respectively, ADC(lowhem)). All Pearson correlations were statistically significant at a 0.01 level. CONCLUSIONS This preliminary study shows the potential of BB SS SE-EPI as a useful technique to aid in differentiating between liver metastasis and hemangioma. The calculation of D, f and ADC(low) provides useful additional information for differentiating metastases from hemangiomas.
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Coenegrachts K, Delanote J, Ter Beek L, Haspeslagh M, Bipat S, Stoker J, Van Kerkhove F, Steyaert L, Rigauts H, Casselman JW. Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques. Br J Radiol 2007; 80:524-31. [PMID: 17510250 DOI: 10.1259/bjr/33156643] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to compare diffusion-weighted respiratory-triggered single-shot spin echo echoplanar imaging (SS SE-EPI) sequence using four b-values (b = 0, b = 20, b = 300, b = 800 s mm(-2)) and single-shot T2 weighted turbo spin echo (T2W SS TSE) in patients with focal liver lesions, with special interest in small (<10 mm) lesions. Twenty-four patients underwent routine MRI. The five sequences were compared qualitatively for image quality, lesion conspicuity and artefacts. Quantitative analysis was performed for lesion identification and lesion-to-liver contrast-to-noise ratio (CNR). Subgroup analyses were performed for different types of lesions with different sizes. Sequences were compared by rank order statistic (RIDIT) and Kruskal-Wallis test. The best image quality (p<0.05) was achieved with T2W TSE and the best lesion conspicuity (p<0.05) with T2W TSE for biliary cysts and SE-EPI diffusion-weighted imaging (DWI) (b = 20 s mm(-2)) for haemangiomas and metastases. Image artefacts were lowest (p<0.05) with T2W TSE. T2W TSE was found to be the best protocol (p<0.05) for the identification of biliary cysts and SE-EPI DWI (b = 20 s mm(-2)) for haemangiomas and metastases. The lesion-to-liver CNRs were highest on T2W TSE for biliary cysts and on SE-EPI diffusion-weighted imaging (DWI) for haemangiomas and metastases (p<0.05). This study shows the potential of SS SE-EPI DWI (especially with a b-value of 20 s mm(-2)) as a promising technique for detecting small (<10 mm) focal liver lesions.
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Hamer OW, Schlottmann K, Sirlin CB, Feuerbach S. Technology Insight: advances in liver imaging. ACTA ACUST UNITED AC 2007; 4:215-28. [PMID: 17404589 DOI: 10.1038/ncpgasthep0766] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 01/26/2007] [Indexed: 12/23/2022]
Abstract
The role of diagnostic imaging in the assessment of liver disease continues to gain in importance. The classic techniques used for liver imaging are ultrasonography, CT and MRI. In the past decade, there have been significant advances in all three techniques. In this article, we discuss the advances in ultrasonography, CT and MRI that have improved assessment of focal and diffuse liver disease, including the development of hardware, software, processing algorithms and procedural innovations.
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Affiliation(s)
- Okka W Hamer
- University Hospital of Regensburg, Department of Radiology, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
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