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Liu J, Huang M, Ren Y, Xu M, Zhu J, Li Y, Cheng J. Added value of zoomed-echo-planar imaging diffusion-weighted imaging for evaluation of periampullary carcinomas. Abdom Radiol (NY) 2023; 48:3079-3090. [PMID: 37405416 PMCID: PMC10480326 DOI: 10.1007/s00261-023-03990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND To assess the image quality feasibility and diagnostic value of zoomed diffusion-weighted imaging (z-EPI DWI) using echo-planar imaging (EPI) compared with conventional DWI (c-EPI DWI) in patients with periampullary disease. METHODS Thirty-six patients with periampullary carcinomas and fifteen with benign periampullary disease were included in this study. All the subjects underwent MR cholangiopancreatography (MRCP), c-EPI DWI, and z-EPI DWI. Two radiologists independently assessed image quality of the two image sets, including overall image quality and lesion conspicuity. In addition, signal intensity and ADC measurements of DWIs in the periampullary lesions were conducted. Diagnostic accuracies of the combined image sets of MRCP and z-EPI DWI were compared with those of a combined set of MRCP and c-EPI DWI. RESULTS z-EPI DWI showed significantly better image quality scores (anatomic structure visualization, 2.94 ± 0.24; overall image quality, 2.96 ± 0.17) compared to that with c-EPI DWI (anatomic structure visualization, 2.02 ± 0.22; overall image quality, 2.04 ± 0.24) (both P < 0.01). For all the periampullary malignant lesions and small lesions (≤ 20 mm), there was better delineation of lesion conspicuity and the lesion margin, as well as diagnostic confidence with z-EPI DWI (all P < 0.05). The rate of periampullary malignancy's hyperintense signal on z-EPI DWI was increased to 91.7% (33/36) compared to c-EPI DWI (69.4% (25/36)) (P = 0.023). For all malignant lesions and small lesions, the diagnostic accuracy scores were increased using the MRCP and z-EPI DWI combined set, compared to the MRCP and c-EPI DWI combined set (P < 0.05). Diagnostic accuracy for detection and differentiation of malignant lesions from benign lesions significantly improved for the MRCP and z-EPI DWI combined set compared with MRCP and c-EPI DWI combined set (P < 0.05). There were no significant differences between c-EPI DWI and z-EPI DWI in the ADC values of periampullary malignant and benign lesions (P > 0.05). CONCLUSIONS z-EPI DWI has an advantage that could lead to remarkable image quality improvements and enhanced lesion visualization of periampullary carcinomas. z-EPI DWI was superior to c-EPI DWI for detecting, delineating, and diagnosing the lesions, particularly for small challenging lesions.
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Affiliation(s)
- Jingjing Liu
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Mengyue Huang
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanan Ren
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Man Xu
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Yinhua Li
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Obara M, Kwon J, Yoneyama M, Ueda Y, Cauteren MV. Technical Advancements in Abdominal Diffusion-weighted Imaging. Magn Reson Med Sci 2023; 22:191-208. [PMID: 36928124 PMCID: PMC10086402 DOI: 10.2463/mrms.rev.2022-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Since its first observation in the 18th century, the diffusion phenomenon has been actively studied by many researchers. Diffusion-weighted imaging (DWI) is a technique to probe the diffusion of water molecules and create a MR image with contrast based on the local diffusion properties. The DWI pixel intensity is modulated by the hindrance the diffusing water molecules experience. This hindrance is caused by structures in the tissue and reflects the state of the tissue. This characteristic makes DWI a unique and effective tool to gain more insight into the tissue's pathophysiological condition. In the past decades, DWI has made dramatic technical progress, leading to greater acceptance in clinical practice. In the abdominal region, however, acquiring DWI with good quality is challenging because of several reasons, such as large imaging volume, respiratory and other types of motion, and difficulty in achieving homogeneous fat suppression. In this review, we discuss technical advancements from the past decades that help mitigate these problems common in abdominal imaging. We describe the use of scan acceleration techniques such as parallel imaging and compressed sensing to reduce image distortion in echo planar imaging. Then we compare techniques developed to mitigate issues due to respiratory motion, such as free-breathing, respiratory-triggering, and navigator-based approaches. Commonly used fat suppression techniques are also introduced, and their effectiveness is discussed. Additionally, the influence of the abovementioned techniques on image quality is demonstrated. Finally, we discuss the current and future clinical applications of abdominal DWI, such as whole-body DWI, simultaneous multiple-slice excitation, intravoxel incoherent motion, and the use of artificial intelligence. Abdominal DWI has the potential to develop further in the future, thanks to scan acceleration and image quality improvement driven by technological advancements. The accumulation of clinical proof will further drive clinical acceptance.
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Affiliation(s)
| | | | | | - Yu Ueda
- MR Clinical Science, Philips Japan Ltd
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Yalcinoz K, Ikizceli T, Kahveci S, Karahan OI. Diffusion-weighted MRI and FLAIR sequence for differentiation of hydatid cysts and simple cysts in the liver. Eur J Radiol Open 2021; 8:100355. [PMID: 34136590 PMCID: PMC8181784 DOI: 10.1016/j.ejro.2021.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022] Open
Abstract
DWI signal characteristics are useful in differentiating between hydatid cysts and simple cysts. ADC values (b600 and b1000) can distinguish hydatid cyst and simple cyst. FLAIR sequence contributes to the differentiation of type 2 hydatid and simple cysts.
Purpose The contribution of DWI and FLAIR to the differential diagnosis of type 1, 2, and 3 hydatid cysts and simple liver cysts was investigated according to the Gharbi classification. This study is the first report using FLAIR sequence for the differential diagnosis of liver hydatid cysts in this regard. Methods A total of 82 hydatid cysts and 40 simple cysts were scanned with DWI (in b600-b1000 values) and FLAIR sequence. In 64 patients included in the study, a total of 122 cystic lesions were diagnosed histopathologically or during follow-up. FLAIR and DWI signal characteristics were evaluated, and ADC values were calculated. Results The mean ADC value of hydatid cysts on DWI (b600) was 3.07 ± 0.41 × 10−3 s/mm2, while it was 3.91 ± 0.51 × 10−3 s/mm2 for simple cysts and the difference was statistically significant (p < 0.05). On b1000 DWI, the mean ADC values of hydatid and simple cysts were 2.99 ± 0.38 × 10−3 s/mm2 and 3.43 ± 0:29 × 10−3 s/mm2, respectively (p < 0.05). The qualitative evaluation of the signal intensity on b600−1000 DWI demonstrated the difference between the simple and hydatid cyst groups (p < 0.05). Type 2 hydatid cysts alone were distinguished from type 2–3 hydatid and simple cysts by FLAIR (p < 0.05). Conclusions ADC values can distinguish between hydatid cyst and simple cyst. FLAIR contributes to the differentiation of type 2 hydatid and simple cysts.
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Affiliation(s)
- Kursad Yalcinoz
- Elbistan State Hospital, Radiology Clinic, Kahramanmaras, Turkey
| | - Turkan Ikizceli
- University of Health Sciences, Istanbul Haseki Training and Research Hospital, Department of Radiology, Adnan Adivar Street, Number: 9, 34130, Fatih, Istanbul, Turkey
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Alwalid O, Wang Y, Fan W, Han P. Value of gadoxetic acid-enhanced MR imaging and DWI in classification, characterization and confidence in diagnosis of solid focal liver lesions. Scand J Gastroenterol 2021; 56:72-80. [PMID: 33232614 DOI: 10.1080/00365521.2020.1847314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess gadoxetic acid (Gd-EOB-DTPA) and diffusion-weighted imaging (DWI) value in classification (benign vs. malignant) and characterization of solid focal liver lesions (SFLLs) and impact on confidence in diagnosis. METHODS A total of 195 lesions (46 hepatocellular carcinomas [HCCs], 45 metastases, 32 adenomas, 37 focal nodular hyperplasias [FNHs] and 35 hemangiomas) were retrospectively evaluated in 93 patients. Three imaging datasets were compared: DWI/ apparent diffusion coefficient (ADC) (set A), Gd-EOB-DTPA (set B) and combination of both (set C). Two radiologists (R) independently classified (on a five-point ordinal scale) and characterized each lesion. The accuracy in classification and characterization was compared, and the diagnostic confidence was assessed. RESULTS The classification accuracy on set A, B and C was 86.2%, 91.3% and 91.8% (R1), and 84.6%, 91.8% and 93.3% (R2); and characterization accuracy was 67.2%, 88.2% and 87.7% (R1), and 60.5%, 88.2% and 85.6% (R2). Classification by reader 1 showed no significant difference between set A and B (p=.09). For both readers, there was a significant difference between set A and C in both classification and characterization (all p < .05), but no significant difference between set B and C in neither classification nor characterization. No significant difference between the three datasets in classification and characterization of hemangiomas (all p > .05). The diagnostic confidence of the readers has increased progressively from set A to Set C (all p < .01). CONCLUSIONS DWI may suggest benignity or malignancy of solid liver lesions, while Gd-EOB-DTPA-enhanced imaging remains superior in lesions characterization and the combination of both increases the diagnostic confidence. DWI is very helpful in the diagnosis of hepatic hemangiomas.
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Affiliation(s)
- Osamah Alwalid
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuhui Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Sriman R, Venkatesh K, Mathew C, Pankaj M, Shankar R. Validity of diffusion-weighted magnetic resonance imaging in the evaluation of acute pyelonephritis in comparison with contrast-enhanced computed tomography. Pol J Radiol 2020; 85:e137-43. [PMID: 32322320 DOI: 10.5114/pjr.2020.93669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Applications of diffusion-weighted magnetic resonance imaging outside the brain have gained increasing importance in recent years, and recent studies have shown the usage of diffusion-weighted (DW) imaging in diagnosing pyelonephritis based on renal cortical and medullary apparent diffusion coefficient (ADC) values. The aim of this study was to assess the validity of DW magnetic resonance (MR) imaging in comparison with contrast-enhanced computed tomography (CECT) in diagnosing pyelonephritis. Material and methods A cross-sectional observational study was conducted for a period of six months in a tertiary hospital in Coimbatore. All patients with clinical and laboratory diagnosis of acute pyelonephritis, who were referred for radiological imaging (CECT), were taken into the study. Out of 112 patients with a clinical and laboratorial diagnosis of acute pyelonephritis (APN), who underwent both DW MR and CECT, diagnosis of APN was made in 100 patients based on CECT, while in 12 cases the investigation (CECT) was negative. Finally, these 100 patients were included in the study. The validity of DW MR imaging in diagnosing APN was assessed by deriving sensitivity, specificity, and positive and negative predictive value in comparison with CECT findings. Results The validity report of DW MR imaging in the detection of APN showed a very high sensitivity (96-100%) and specificity (86-90%) and very low false positives (6-10%) and negatives (< 5%), and it also showed that in the areas of affected renal parenchyma ADC values were consistently lower compared to unaffected renal parenchyma. Conclusion Based on the generated hypothesis, DW MR imaging of the kidneys seems to be highly sensitive and specific for the detection of focal or diffuse infections within the kidney in comparison with CECT.
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Erdoğan H, Arslan S, Durmaz MS. Hepatoselüler Karsinom ve Diğer Karaciğer Tümörlerinin Ayrımında Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Etkinliği. Dicle Tıp Dergisi 2019. [DOI: 10.5798/dicletip.661288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pankaj Jain T, Kan WT, Edward S, Fernon H, Kansan Naider R. Evaluation of ADC ratio on liver MRI diffusion to discriminate benign versus malignant solid liver lesions. Eur J Radiol Open 2018; 5:209-214. [PMID: 30480057 PMCID: PMC6240802 DOI: 10.1016/j.ejro.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/12/2018] [Accepted: 10/21/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this project is to investigate the usefulness of the absolute liver lesion ADC value and ratio of Apparent diffusion coefficient (ADC) values of a liver lesion and liver parenchyma to discriminate between a benign and malignant lesion. METHODS Liver MRI scans performed between January 2009 and June 2015 were retrospectively analysed. Scans were performed on either a 1.5 T or 3 T MRI unit. The type of liver lesion (benign or malignant) was determined by its radiological appearance, histology result and clinical management. Lesions with undetermined diagnosis or MRI studies degraded by artifacts were excluded. Liver cysts were also excluded from the analysis. ADC value of a lesion and liver parenchyma was measured and ADCratio was calculated. The values were analysed using independent samples t-test Results:Data set contained 39 benign lesions and 36 malignant lesions. Mean ADC value for benign lesions was 1678, and the mean value for malignant lesions was 1097 with a statistically significant difference of p < 0.001. All lesions with ADC value below 955 were malignant, while all lesions with ADC value above 1880 were benign. ADC value of 1260 was identified as the best available cut-off value for differentiating benign and malignant lesions, achieving sensitivity of 92%, specificity of 80% and an overall accuracy of 89%. The mean lesion to liver ADCratio for benign lesions was 1.3467 and for malignant lesions was 0.9038 with a statistically significant difference of p < 0.001. All lesions with ADCratio measuring <0.9 were malignant while lesions with ADCratio>1.5 were benign. ADCratio of 1.1 was identified statistically as the best available cut-off value for differentiating benign from malignant lesions, with sensitivity of 82%, specificity of 86% and an overall accuracy of 92%. CONCLUSION Our dataset indicates that lesion to background liver ADCratio is superior in discriminating between benign and malignant focal lesions compared to absolute ADC values of the hepatic lesions.
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Affiliation(s)
- Tarun Pankaj Jain
- Universal Medical Imaging, 1/110 Giles street, Kingston, ACT 2604, Canada
- Medical Imaging Department, The Canberra Hospital, Garran, ACT 2606, Australia
| | - Wen Ter Kan
- Medical Imaging Department, The Canberra Hospital, Garran, ACT 2606, Australia
- Corresponding author.
| | - Sean Edward
- Medical Imaging Department, The Canberra Hospital, Garran, ACT 2606, Australia
| | - Helen Fernon
- Universal Medical Imaging, 1/110 Giles street, Kingston, ACT 2604, Canada
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Tyagi N, Cloutier M, Zakian K, Deasy JO, Hunt M, Rimner A. Diffusion-weighted MRI of the lung at 3T evaluated using echo-planar-based and single-shot turbo spin-echo-based acquisition techniques for radiotherapy applications. J Appl Clin Med Phys 2018; 20:284-292. [PMID: 30421496 PMCID: PMC6333125 DOI: 10.1002/acm2.12493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/14/2023] Open
Abstract
Purpose To compare single‐shot echo‐planar (SS‐EPI)‐based and turbo spin‐echo (SS‐TSE)‐based diffusion‐weighted imaging (DWI) in Non‐Small Cell Lung Cancer (NSCLC) patients and to characterize the distributions of apparent diffusion coefficient (ADC) values generated by the two techniques. Methods Ten NSCLC patients were enrolled in a prospective IRB‐approved study to compare and optimize DWI using EPI and TSE‐based techniques for radiotherapy planning. The imaging protocol included axial T2w, EPI‐based DWI and TSE‐based DWI on a 3 T Philips scanner. Both EPI‐based and TSE‐based DWI sequences used three b values (0, 400, and 800 s/mm2). The acquisition times for EPI‐based and TSE‐based DWI were 5 and 8 min, respectively. DW‐MR images were manually coregistered with axial T2w images, and tumor volume contoured on T2w images were mapped onto the DWI scans. A pixel‐by‐pixel fit of tumor ADC was calculated based on monoexponential signal behavior. Tumor ADC mean, standard deviation, kurtosis, and skewness were calculated and compared between EPI and TSE‐based DWI. Image distortion and ADC values between the two techniques were also quantified using fieldmap analysis and a NIST traceable ice‐water diffusion phantom, respectively. Results The mean ADC for EPI and TSE‐based DWI were 1.282 ± 0.42 × 10−3 and 1.211 ± 0.31 × 10−3 mm2/s. The average skewness and kurtosis were 0.14 ± 0.4 and 2.43 ± 0.40 for DWI‐EPI and −0.06 ± 0.69 and 2.89 ± 0.62 for DWI‐TSE. Fieldmap analysis showed a mean distortion of 13.72 ± 8.12 mm for GTV for DWI‐EPI and 0.61 ± 0.4 mm for DWI‐TSE. ADC values obtained using the diffusion phantom for the two techniques were within 0.03 × 10−3 mm2/s with respect to each other as well as the established values. Conclusions Diffusion‐weighted turbo spin‐echo shows better geometrical accuracy compared to DWI‐EPI. Mean ADC values were similar with both acquisitions but the shape of the histograms was different based on the skewness and kurtosis values. The impact of differences in respiratory technique on ADC values requires further investigation.
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Affiliation(s)
- Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Cloutier
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristen Zakian
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kanmaz L, Karavas E. The Role of Diffusion-Weighted Magnetic Resonance Imaging in the Differentiation of Head and Neck Masses. J Clin Med 2018; 7:jcm7060130. [PMID: 29844262 PMCID: PMC6025517 DOI: 10.3390/jcm7060130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/13/2018] [Accepted: 05/21/2018] [Indexed: 01/20/2023] Open
Abstract
The purpose of this study was to evaluate the value of diffusion-weighted MRI (DW-MRI) in differentiating benign and malignant head and neck masses by comparing their apparent diffusion coefficient (ADC) values. The study included 32 patients with a neck mass >1 cm in diameter who were examined with echo planar DW-MRI. Two different diffusion gradients (b values of b = 0 and b = 1000 s/mm2) were applied. DWI and ADC maps of 32 neck masses in 32 patients were obtained. Mean ADC values of benign and malignant neck lesions were measured and compared statistically. A total of 15 (46.9%) malignant masses and 17 (53.1%) benign masses were determined. Of all the neck masses, the ADC value of cystic masses was the highest and that of lymphomas was the lowest. The mean ADC values of benign and malignant neck masses were 1.57 × 10−3 mm2/s and 0.90 × 10−3 mm2/s, respectively. The difference between mean ADC values of benign and malignant neck masses was significant (p < 0.01). Diffusion-weighted MRI with ADC measurements can be useful in the differential diagnosis of neck masses.
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Affiliation(s)
- Lutfi Kanmaz
- Department of Otorhinolaryngology-Head and Neck Surgery, Pazarcık State Hospital, Kahramanmaraş 46700, Turkey.
| | - Erdal Karavas
- Department of Radiology, Faculty of Medicine, Erzincan University, Erzincan 24100, Turkey.
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Zarghampour M, Fouladi DF, Pandey A, Ghasabeh MA, Pandey P, Varzaneh FN, Khoshpouri P, Shao N, Pan L, Grimm R, Kamel IR. Utility of volumetric contrast-enhanced and diffusion-weighted MRI in differentiating between common primary hypervascular liver tumors. J Magn Reson Imaging 2018; 48:1080-1090. [DOI: 10.1002/jmri.26032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/15/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Manijeh Zarghampour
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Daniel F. Fouladi
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Ankur Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Mounes Aliyari Ghasabeh
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Pallavi Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Farnaz Najmi Varzaneh
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Nannan Shao
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Li Pan
- Siemens Healthcare; Baltimore Maryland USA
| | | | - Ihab R. Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
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AbdelGawad EA, AbdelGawad EA, Magdi M. Reliability of ADC values in recognition of renal changes produced by extracorporeal shock wave lithotripsy (ESWL). The Egyptian Journal of Radiology and Nuclear Medicine 2018. [DOI: 10.1016/j.ejrnm.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Luo M, Song H, Liu G, Lin Y, Luo L, Zhou X, Chen B. Comparison of DWI and 18F-FDG PET/CT for assessing preoperative N-staging in gastric cancer: evidence from a meta-analysis. Oncotarget 2017; 8:84473-88. [PMID: 29137440 DOI: 10.18632/oncotarget.21055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/08/2017] [Indexed: 12/18/2022] Open
Abstract
The diagnostic values of diffusion weighted imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for N-staging of gastric cancer (GC) were identified and compared. After a systematic search to identify relevant articles, meta-analysis was used to summarize the sensitivities, specificities, and areas under curves (AUCs) for DWI and PET/CT. To better understand the diagnostic utility of DWI and PET/CT for N-staging, the performance of multi-detector computed tomography (MDCT) was used as a reference. Fifteen studies were analyzed. The pooled sensitivity, specificity, and AUC with 95% confidence intervals of DWI were 0.79 (0.73–0.85), 0.69 (0.61–0.77), and 0.81 (0.77–0.84), respectively. For PET/CT, the corresponding values were 0.52 (0.39–0.64), 0.88 (0.61–0.97), and 0.66 (0.62–0.70), respectively. Comparison of the two techniques revealed DWI had higher sensitivity and AUC, but no difference in specificity. DWI exhibited higher sensitivity but lower specificity than MDCT, and 18F-FDG PET/CT had lower sensitivity and equivalent specificity. Overall, DWI performed better than 18F-FDG PET/CT for preoperative N-staging in GC. When the efficacy of MDCT was taken as a reference, DWI represented a complementary imaging technique, while 18F-FDG PET/CT had limited utility for preoperative N-staging.
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Dijkstra H, Oudkerk M, Kappert P, Sijens PE. Assessment of the link between quantitative biexponential diffusion-weighted imaging and contrast-enhanced MRI in the liver. Magn Reson Imaging 2017; 38:47-53. [DOI: 10.1016/j.mri.2016.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 11/18/2022]
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Dijkstra H, Wolff D, van Melle JP, Bartelds B, Willems TP, Oudkerk M, Hillege H, van den Berg AP, Ebels T, Berger RMF, Sijens PE. Diminished liver microperfusion in Fontan patients: A biexponential DWI study. PLoS One 2017; 12:e0173149. [PMID: 28257439 PMCID: PMC5336266 DOI: 10.1371/journal.pone.0173149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/15/2017] [Indexed: 12/13/2022] Open
Abstract
It has been demonstrated that hepatic apparent diffusion coefficients (ADC) are decreasing in patients with a Fontan circulation. It remains however unclear whether this is a true decrease of molecular diffusion, or rather reflects decreased microperfusion due to decreased portal blood flow. The purpose of this study was therefore to differentiate diffusion and microperfusion using intravoxel incoherent motion (IVIM) modeled diffusion-weighted imaging (DWI) for different liver segments in patients with a Fontan circulation, compare to a control group, and relate with liver function, chronic hepatic congestion and hepatic disease. For that purpose, livers of 59 consecutively included patients with Fontan circulation (29 men; mean-age, 19.1 years) were examined (Oct 2012─Dec 2013) with 1.5T MRI and DWI (b = 0,50,100,250,500,750,1500,1750 s/mm2). IVIM (Dslow, Dfast, ffast) and ADC were calculated for eight liver segments, compared to a control group (19 volunteers; 10 men; mean-age, 32.9 years), and correlated to follow-up duration, clinical variables, and laboratory measurements associated with liver function. The results demonstrated that microperfusion was reduced (p<0.001) in Fontan livers compared to controls with ─38.1% for Dfast and ─32.6% for ffast. Molecular diffusion (Dslow) was similar between patients and controls, while ADC was significantly lower (─14.3%) in patients (p<0.001). ADC decreased significantly with follow-up duration after Fontan operation (r = ─0.657). Dslow showed significant inverse correlations (r = ─0.591) with follow-up duration whereas Dfast and ffast did not. From these results it was concluded that the decreasing ADC values in Fontan livers compared with controls reflect decreases in hepatic microperfusion rather than any change in molecular diffusion. However, with the time elapsed since the Fontan operation molecular diffusion and ADC decreased while microperfusion remained stable. This indicates that after Fontan operation initial blood flow effects on the liver are followed by intracellular changes preceding the formation of fibrosis and cirrhosis.
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Affiliation(s)
- Hildebrand Dijkstra
- Center for Medical Imaging—North East Netherlands, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Djoeke Wolff
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology/Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost P. van Melle
- Center for Congenital Heart Diseases, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Beatrijs Bartelds
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology/Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tineke P. Willems
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging—North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans Hillege
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Aad P. van den Berg
- Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tjark Ebels
- Center for Congenital Heart Diseases, Department of Cardiothoracic Surgery University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rolf M. F. Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology/Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul E. Sijens
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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Abstract
Objective To assess the feasibility and reliability of apparent diffusion coefficient
(ADC) measurements of normal adrenal glands. Materials and methods This was a retrospective study involving 32 healthy subjects, divided into
two groups: prepubertal (PreP, n = 12), aged from 2 months
to 12.5 years (4 males; 8 females); and postpubertal (PostP,
n = 20), aged from 11.9 to 61 years (5 males; 15
females). Diffusion-weighted magnetic resonance imaging (DW-MRI) sequences
were acquired at a 1.5 T scanner using b values of 0, 20,
500, and 1000 s/mm2. Two radiologists evaluated the images. ADC
values were measured pixel-by-pixel on DW-MRI scans, and automatic
co-registration with the ADC map was obtained. Results Mean ADC values for the right adrenal glands were 1.44 ×
10-3 mm2/s for the PreP group and 1.23 ×
10-3 mm2/s for the PostP group, whereas they were
1.58 × 10-3 mm2/s and 1.32 ×
10-3 mm2/s, respectively, for the left glands. ADC
values were higher in the PreP group than in the PostP group
(p < 0.05). Agreement between readers was almost
perfect (intraclass correlation coefficient, 0.84-0.94; p
< 0.05). Conclusion Our results demonstrate the feasibility and reliability of performing DW-MRI
measurements of normal adrenal glands. They could also support the
feasibility of ADC measurements of small structures.
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Affiliation(s)
- Sara Reis Teixeira
- MD, PhD, Attending Physician at the Centro de Ciências das Imagens e Física Médica (CCIFM), Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Paula Condé Lamparelli Elias
- MD, PhD, Endocrinology Division of the Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Andrea Farias de Melo Leite
- MD, PhD, Attending Physician at the Instituto de Medicina Integral Professor Fernando Figueira de Pernambuco (IMIP), Recife, PE, Brazil
| | - Tatiane Mendes Gonçalves de Oliveira
- MD, PhD, Attending Physician at the Centro de Ciências das Imagens e Física Médica (CCIFM), Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Valdair Francisco Muglia
- MD, PhD, Associate Professor in the Radiology Division of the Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Elias Junior
- MD, PhD, Associate Professor in the Radiology Division of the Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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16
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Talaat Ali M, Fouad Osman M, Homos MD, Mohamed Nabil D. Role of 3-T diffusion-weighted magnetic resonance imaging in differentiation between benign and malignant hepatic lesions. The Egyptian Journal of Radiology and Nuclear Medicine 2016. [DOI: 10.1016/j.ejrnm.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Düzenli K, Öztürk M, Yıldırım İO, Erdem G. The utility of diffusion-weighted imaging to assess acute renal parenchymal changes due to unilateral ureteral stone obstruction. Urolithiasis 2016; 45:401-405. [DOI: 10.1007/s00240-016-0924-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/27/2016] [Indexed: 01/19/2023]
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18
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Dijkstra H, Dorrius MD, Wielema M, Pijnappel RM, Oudkerk M, Sijens PE. Quantitative DWI implemented after DCE-MRI yields increased specificity for BI-RADS 3 and 4 breast lesions. J Magn Reson Imaging 2016; 44:1642-1649. [PMID: 27273694 DOI: 10.1002/jmri.25331] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/19/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To assess if specificity can be increased when semiautomated breast lesion analysis of quantitative diffusion-weighted imaging (DWI) is implemented after dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI) in the workup of BI-RADS 3 and 4 breast lesions larger than 1 cm. MATERIALS AND METHODS In all, 120 consecutive patients (mean-age, 48 years; age range, 23-75 years) with 139 breast lesions (≥1 cm) were examined (2010-2014) with 1.5T DCE-MRI and DWI (b = 0, 50, 200, 500, 800, 1000 s/mm2 ) and the BI-RADS classification and histopathology were obtained. For each lesion malignancy was excluded using voxelwise semiautomated breast lesion analysis based on previously defined thresholds for the apparent diffusion coefficient (ADC) and the three intravoxel incoherent motion (IVIM) parameters: molecular diffusion (Dslow ), microperfusion (Dfast ), and the fraction of Dfast (ffast ). The sensitivity (Se), specificity (Sp), and negative predictive value (NPV) based on only IVIM parameters combined in parallel (Dslow , Dfast , and ffast ), or the ADC or the BI-RADS classification by DCE-MRI were compared. Subsequently, the Se, Sp, and NPV of the combination of the BI-RADS classification by DCE-MRI followed by the IVIM parameters in parallel (or the ADC) were compared. RESULTS In all, 23 of 139 breast lesions were benign. Se and Sp of DCE-MRI was 100% and 30.4% (NPV = 100%). Se and Sp of IVIM parameters in parallel were 92.2% and 52.2% (NPV = 57.1%) and for the ADC 95.7% and 17.4%, respectively (NPV = 44.4%). In all, 26 of 139 lesions were classified as BI-RADS 3 (n = 7) or BI-RADS 4 (n = 19). DCE-MRI combined with ADC (Se = 99.1%, Sp = 34.8%) or IVIM (Se = 99.1%, Sp = 56.5%) did significantly improve (P = 0.016) Sp of DCE-MRI alone for workup of BI-RADS 3 and 4 lesions (NPV = 92.9%). CONCLUSION Quantitative DWI has a lower NPV compared to DCE-MRI for evaluation of breast lesions and may therefore not be able to replace DCE-MRI; when implemented after DCE-MRI as problem solver for BI-RADS 3 and 4 lesions, the combined specificity improves significantly. J. Magn. Reson. Imaging 2016;44:1642-1649.
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Affiliation(s)
- Hildebrand Dijkstra
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Monique D Dorrius
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Mirjam Wielema
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Ruud M Pijnappel
- University of Utrecht, University Medical Center Utrecht, Department of Radiology, Utrecht, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands
| | - Paul E Sijens
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
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19
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Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P. Diffusion-weighted MRI in Crohn's disease: Current status and recommendations. J Magn Reson Imaging 2016; 44:1381-1396. [PMID: 27249184 DOI: 10.1002/jmri.25325] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/12/2016] [Indexed: 12/19/2022] Open
Abstract
Over the past years, technological improvements and refinements in magnetic resonance imaging (MRI) hardware have made high-quality diffusion-weighted imaging (DWI) routinely possible for the bowel. DWI is promising for the detection and characterization of lesions in Crohn's disease (CD) and has been advocated as an alternative to intravenous gadolinium-based contrast agents. Furthermore, quantification using the apparent diffusion coefficient may have value as a biomarker of CD activity and has shown promise. In this article we critically review the literature pertaining to the value of DWI in CD for detection, characterization, and quantification of disease activity and complications. Although the body of supportive evidence is growing, it is clear that well-designed, multicenter studies are required before the role of DWI in clinical practice can be fully established. J. Magn. Reson. Imaging 2016;44:1381-1396.
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Affiliation(s)
- Anthony Dohan
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, Podium Level 2, University College Hospital, London, UK
| | | | - Maximilien Barret
- Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Allez
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Magaly Zappa
- Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | | | - Xavier Dray
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Reinhold
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
| | - Philippe Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
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20
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Hicks RM, Yee J, Ohliger MA, Weinstein S, Kao J, Ikram NS, Hope TA. Comparison of diffusion-weighted imaging and T2-weighted single shot fast spin-echo: Implications for LI-RADS characterization of hepatocellular carcinoma. Magn Reson Imaging 2016; 34:915-21. [PMID: 27108359 DOI: 10.1016/j.mri.2016.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/17/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the performance of diffusion-weighted imaging (DWI) and T2-weighted single shot fast spin-echo (SSFSE) imaging of the liver in the detection of hepatocellular carcinoma (HCC) in reference to the LI-RADS classification system. METHODS MR images of 40 patients with 68 LI-RADS grade 3-5 lesions were analyzed. Two readers independently reviewed sequences and characterized lesion signal intensity, followed by consensus evaluation. CE-MRI served as reference standard. Sensitivities were compared across sequences. Lesion-to-liver contrast-to-noise ratios (CNRs) and apparent diffusion coefficients (ADCs) were measured and compared using the Wilcoxon signed-rank test across sequences and the Mann-Whitney U or Kruskal-Wallis test between LI-RADS categories. Inter-reader variability was assessed using Cohen's kappa statistic. RESULTS Consensus sensitivities of LI-RADS 3-5 lesions using SSFSE images versus DWI were similar (0.53-0.63, p=0.089), however, the sensitivity with DWI b=700 was higher (0.63) than DWI b=0 (0.53, p=0.039). Lesion-to-liver CNRs were larger for all DWI sequences compared to SSFSE images (p<0.001 for all). ADCs of large (>2cm) LIRADS 3-5 lesions were lower than those of small lesions (1.09±0.33 vs. 1.31±0.26, p=0.02), however lesion ADCs were not different from those of adjacent hepatic parenchyma for any LI-RADS lesion. CONCLUSIONS DWI has a similar sensitivity compared to SSFSE, but intensity on DWI likely represents intrinsic T2 signal hyper-intensity rather than restricted diffusion as the ADC values were not lower than adjacent parenchyma. Therefore it may not be appropriate to consider hyper-intensity on high b-value as a separate ancillary criteria to T2 hyper-intensity in LI-RADS.
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Affiliation(s)
- Robert M Hicks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Judy Yee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Stefanie Weinstein
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey Kao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Nabia S Ikram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA.
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Metin MR, Aydın H, Çetin H, Özmen E, Kayaçetin S. The efficacy of diffusion weighted imaging and apparent diffusion coefficients mapping for liver metastasis of colonic adenocarcinomas. Saudi Med J 2016; 37:379-85. [PMID: 27052280 PMCID: PMC4852015 DOI: 10.15537/smj.2016.4.14921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives: To establish retrospectively the relation between the histopathologic grade of colorectal liver metastasis and apparent diffusion coefficient (ADC) values of hepatic metastases of colorectal adenocarcinomas. Methods: The diagnoses of liver metastases were confirmed with biopsy, surgery, and follow-up imaging findings. Twenty-six patients with 94 liver metastasis were included in the study. Of 94 masses, 59 were poorly-differentiated adenocarcinoma, 18 were moderately-differentiated adenocarcinoma, and 17 were well-differentiated regarding the diameters, ADC values, and ratio index (RI) values. Kolmogorov-smirnov normality test, Kruskal-wallis analysis of variance, Mann-Whitney U test with Bonferroni correction, Spearman correlation analysis, and receiver operating characteristics curve methods were applied to evaluate the statistical relations. Results: There was a statistically significant difference in terms of ADC values and RI between poorly-differentiated adenocarcinoma and moderately-differentiated adenocarcinoma plus well-differentiated adenocarcinomas. Poorly-differentiated adenocarcinomas have the lowest ADC values and highest RI values among other groups. Conclusion: Use of ADC values alone can be executed for the diagnosis of focal hepatic masses and also can aid in the differentiation of benign and malignant hepatic lesions.
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Affiliation(s)
- Melike R Metin
- Radiology Department, Education and Research Hospital, Ankara, Turkey. E-mail.
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jafar MM, Parsai A, Miquel ME. Diffusion-weighted magnetic resonance imaging in cancer: Reported apparent diffusion coefficients, in-vitro and in-vivo reproducibility. World J Radiol 2016; 8:21-49. [PMID: 26834942 PMCID: PMC4731347 DOI: 10.4329/wjr.v8.i1.21] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/10/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
There is considerable disparity in the published apparent diffusion coefficient (ADC) values across different anatomies. Institutions are increasingly assessing repeatability and reproducibility of the derived ADC to determine its variation, which could potentially be used as an indicator in determining tumour aggressiveness or assessing tumour response. In this manuscript, a review of selected articles published to date in healthy extra-cranial body diffusion-weighted magnetic resonance imaging is presented, detailing reported ADC values and discussing their variation across different studies. In total 115 studies were selected including 28 for liver parenchyma, 15 for kidney (renal parenchyma), 14 for spleen, 13 for pancreatic body, 6 for gallbladder, 13 for prostate, 13 for uterus (endometrium, myometrium, cervix) and 13 for fibroglandular breast tissue. Median ADC values in selected studies were found to be 1.28 × 10-3 mm2/s in liver, 1.94 × 10-3 mm2/s in kidney, 1.60 × 10-3 mm2/s in pancreatic body, 0.85 × 10-3 mm2/s in spleen, 2.73 × 10-3 mm2/s in gallbladder, 1.64 × 10-3 mm2/s and 1.31 × 10-3 mm2/s in prostate peripheral zone and central gland respectively (combined median value of 1.54×10-3 mm2/s), 1.44 × 10-3 mm2/s in endometrium, 1.53 × 10-3 mm2/s in myometrium, 1.71 × 10-3 mm2/s in cervix and 1.92 × 10-3 mm2/s in breast. In addition, six phantom studies and thirteen in vivo studies were summarized to compare repeatability and reproducibility of the measured ADC. All selected phantom studies demonstrated lower intra-scanner and inter-scanner variation compared to in vivo studies. Based on the findings of this manuscript, it is recommended that protocols need to be optimised for the body part studied and that system-induced variability must be established using a standardized phantom in any clinical study. Reproducibility of the measured ADC must also be assessed in a volunteer population, as variations are far more significant in vivo compared with phantom studies.
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Ye J, Kumar BS, Li XB, Li HM, Zhou YW, Liu LQ. Clinical applications of diffusion-weighted magnetic resonance imaging in diagnosis of renal lesions - a systematic review. Clin Physiol Funct Imaging 2015; 37:459-473. [PMID: 26648310 DOI: 10.1111/cpf.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/21/2015] [Indexed: 01/07/2023]
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is an established technique to detect the changes of the diffusion of water in biological tissues and reflect the pathophysiological process on the molecular level. It is a promising non-invasive imaging modality in detection of microstructural and functional changes in pathologies of kidney. To systematically review the research advancement of the DW-MRI in diagnosis of renal lesions, a systematic literature search was performed up to 8 October 2014 using the MEDLINE/PubMed and Embase databases for articles reporting on DW-MRI in diagnosis of renal lesions. Only articles with full data about DW-MRI application with potential implication in solving usually encountered clinical challenges about renal lesions were finally examined. The clinical application of DW-MRI allows a better understanding of some pathologic conditions of the kidney including renal insufficiency, renal artery stenosis, ureteral obstruction, foetal kidney disease, hydronephrosis and pyonephrosis. In addition, DW-MRI can also provide clinicians with the information of function evaluation of renal allograft and curative effect assessment of renal tumour. In summary, performance of renal DW-MRI, presuming that measurements are high quality, will further boost this modality, particularly for early detection of diffusion renal conditions, as well as more accurate characterization of renal lesions.
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Affiliation(s)
- Jing Ye
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | | | - Xiao-Bo Li
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hong-Mei Li
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Ying-Wen Zhou
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Li-Qin Liu
- Department of Oncology, Northern Jiangsu People's Hospital, Yangzhou, China
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Koken D, Cagli B, Tuncel SA, Sengul E, Yilmaz E, Unlu ME. Efficacy of diffusion-weighted MRI in the differentiation of all liver hydatid cyst types. J Med Imaging Radiat Oncol 2015; 60:59-65. [DOI: 10.1111/1754-9485.12417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Deniz Koken
- Department of Radiology; Trakya University School of Medicine; Edirne Turkey
| | - Bekir Cagli
- Department of Radiology; Trakya University School of Medicine; Edirne Turkey
| | | | - Ersin Sengul
- Department of Radiology; Trakya University School of Medicine; Edirne Turkey
| | - Erdem Yilmaz
- Department of Radiology; Trakya University School of Medicine; Edirne Turkey
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Dijkstra H, Dorrius MD, Wielema M, Jaspers K, Pijnappel RM, Oudkerk M, Sijens PE. Semi-automated quantitative intravoxel incoherent motion analysis and its implementation in breast diffusion-weighted imaging. J Magn Reson Imaging 2015; 43:1122-31. [PMID: 26558851 DOI: 10.1002/jmri.25086] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/15/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To optimize and validate intravoxel incoherent motion (IVIM) modeled diffusion-weighted imaging (DWI) compared with the apparent diffusion coefficient (ADC) for semi-automated analysis of breast lesions using a multi-reader setup. MATERIALS AND METHODS Patients (n = 176) with breast lesions (≥1 cm) and known pathology were prospectively examined (1.5 Tesla) with DWI (b = 0, 50, 200, 500, 800, 1000 s/mm(2) ) between November 2008 and July 2014 and grouped into a training and test set. Three independent readers applied a semi-automated procedure for setting regions-of-interest for each lesion and recorded ADC and IVIM parameters: molecular diffusion (Dslow ), microperfusion (Dfast ), and the fraction of Dfast (ffast ). In the training set (24 lesions, 12 benign), a semi-automated method was optimized to yield maximum true negatives (TN) with minimal false negatives (FN): only the optimal fraction (Fo) of voxels in the lesions was used and optimal thresholds were determined. The optimal Fo and thresholds were then applied to a consecutive test set (139 lesions, 23 benign) to obtain specificity and sensitivity. RESULTS In the training set, optimal thresholds were 1.44 × 10(-3) mm(2) /s (Dslow ), 18.55 × 10(-3) mm(2) /s (Dfast ), 0.247 (ffast ) and 2.00 × 10(-3) mm(2) /s (ADC) with Fo set to 0.61, 0.85, 1.0, and 1.0, respectively, this resulted in TN = 5 (IVIM) and TN = 1 (ADC), with FN = 0. In the test set, sensitivity and specificity among the readers were 90.5-93.1% and 43.5-52.2%, respectively, for IVIM, and 94.8-95.7% and 13.0-21.7% for ADC (P ≤ 0.0034) without inter-reader differences (P = 1.000). CONCLUSION The presented semi-automated method for breast lesion evaluation is reader independent and yields significantly higher specificity for IVIM compared with the ADC.
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Affiliation(s)
- Hildebrand Dijkstra
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Monique D Dorrius
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Mirjam Wielema
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Karolien Jaspers
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Ruud M Pijnappel
- University of Utrecht, University Medical Center Utrecht, Department of Radiology, Utrecht, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands
| | - Paul E Sijens
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
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Sonmezgoz F, Kalaycı TO, Karakeci A, Karasu Ş. Renal Apparent Diffusion Coefficient Values in Patients with Obstructive Uropathy and High Values of Creatinine. J Belg Soc Radiol 2015; 99:82-6. [PMID: 30039074 DOI: 10.5334/jbr-btr.854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Diffusion weighted magnetic resonance imaging (DW-MRI) of the kidneys provides noninvasive information on renal function in healthy volunteers, and it is feasible in severely ill patients. It may provide information on the degree of kidney dysfunction. The purpose of this study is to evaluate apparent diffusion coefficient (ADC) values using DW-MRI in patients with obstructive uropathy and elevated serum creatinine levels. Methods: Fifty patients with high serum creatinine levels and diagnoses of chronic urinary obstruction detected by ultrasonography were included in this study. DW-MRIs were obtained from 50 patients with hydronephrotic kidneys and 26 healthy volunteers using a 1.5T whole-body MR scanner. Results: ADC measurements of renal parenchyma in hydronephrotic kidneys were significantly lower compared to normal kidneys (p < 001). Conclusion: The measurement of ADC values has potential value in the evaluation of the functional status of hydronephrotic kidneys.
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Kokabi N, Camacho JC, Xing M, Qiu D, Kitajima H, Mittal PK, Kim HS. Apparent diffusion coefficient quantification as an early imaging biomarker of response and predictor of survival following yttrium-90 radioembolization for unresectable infiltrative hepatocellular carcinoma with portal vein thrombosis. ACTA ACUST UNITED AC. 2014;39:969-978. [PMID: 24740759 DOI: 10.1007/s00261-014-0127-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate early diffusion-weighted imaging (DWI) at 30-days post-yttrium-90 (Y-90) radioembolization as a predictor of treatment response and survival in unresectable infiltrative hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT). MATERIALS AND METHODS In a prospective study, 18 consecutive patients with unresectable infiltrative HCC and PVT underwent Y-90 therapy. MR imaging was obtained pre Y-90, and at 1 and 3 months post-therapy with DWI fat-suppressed tri-directional diffusion gradient (b = 50, 400, 800 s/mm(2)). Response was evaluated using target mRECIST and EASL. Relative change in apparent diffusion coefficient (ADC) value of tumors was evaluated. Statistical analysis using receiver operator characteristic curves was performed. Paired t test and Pearson correlation coefficient (r) were used to assess intra- and inter-observer variability. Survival analysis was performed using Kaplan-Meier estimation and log-rank test. RESULTS Mean ADC values of all HCC's at baseline and at 30-days post-Y90 therapy was 0.86 × 10(-3) and 1.17×10(-3) mm(2)/s, respectively (p < 0.001). Tumors with objective response by mRECIST had significantly increased ADC value when compared to "non-responders" (1.27 vs. 1.05×10(-3) mm(2)/s, p = 0.002). A >30% increase in ADC value at 30-days was found to be at least 90% sensitive in predicting response at 90 days. A >30% increase in ADC value at 30-days predicted significantly prolonged survival. CONCLUSION A 30% increase in ADC value at 30-days measured post Y90 is a reproducible early imaging response biomarker predicting tumor response and prolonged survival following Y-90 therapy in infiltrative HCC with PVT.
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Hocaoglu E, Aksoy S, Akarsu C, Kones O, Inci E, Alis H. Evaluation of diffusion-weighted MR imaging in the diagnosis of mild acute pancreatitis. Clin Imaging 2015; 39:463-7. [DOI: 10.1016/j.clinimag.2014.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/28/2014] [Accepted: 10/01/2014] [Indexed: 01/15/2023]
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Pasoglou V, Michoux N, Tombal B, Jamar F, Lecouvet FE. wbMRI to detect bone metastases: critical review on diagnostic accuracy and comparison to other imaging modalities. Clin Transl Imaging 2015; 3:141-57. [DOI: 10.1007/s40336-015-0120-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Hefeda MM, Abo Dewan KA, Dawoud MA. Apparent diffusion coefficient of renal parenchyma and color Doppler ultrasound of intrarenal arteries in patients with cirrhosis related renal dysfunction. The Egyptian Journal of Radiology and Nuclear Medicine 2014. [DOI: 10.1016/j.ejrnm.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Parsai A, Zerizer I, Roche O, Gkoutzios P, Miquel ME. Assessment of diffusion-weighted imaging for characterizing focal liver lesions. Clin Imaging. 2015;39:278-284. [PMID: 25433855 DOI: 10.1016/j.clinimag.2014.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Pazahr S, Nanz D, Rossi C, Chuck N, Stenger I, Wurnig MC, Schick F, Boss A. Magnetic resonance imaging of the liver: apparent diffusion coefficients from multiexponential analysis of b values greater than 50 s/mm2 do not respond to caloric intake despite increased portal-venous blood flow. Invest Radiol. 2014;49:138-146. [PMID: 24169068 DOI: 10.1097/rli.0000000000000005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to measure potential changes of the apparent diffusion coefficient (ADC) in diffusion-weighted imaging of the liver before and after caloric challenge in correlation to the induced changes in portal vein flow. MATERIALS AND METHODS The study was approved by the local ethics committee. Each of 10 healthy volunteers underwent 4 measurements in a 1.5-T whole-body magnetic resonance scanner on 2 different days: a first scan after fasting for at least 8 hours and a second scan 30 minutes after intake of a standardized caloric either a protein- or carbohydrate-rich meal. Diffusion-weighted spin-echo echo-planar magnetic resonance images were acquired at b values of 0, 50, 150, 250, 500, 750, and 1000 s/mm. In addition, portal vein flow was quantified with 2-dimensional phase-contrast imaging (velocity encoding parallel to flow direction, 60 cm/s). Mean ADC values for regions of interest in 3 different slices were measured from b50 to b250 and from b500 to b1000 images. RESULTS Carbohydrate- and protein-rich food intake both resulted in a substantial increase in the portal vein flow (fasting state, 638.6 ± 202.3 mL/min; after protein intake, 1322 ± 266.8; after carbohydrate intake, 1767 ± 421.6). The signal decay with increasingly strong diffusion weighting (b values from 0 to 1000 s/mm2) exhibited a triexponential characteristic, implying fast, intermediate, and slow-moving water-molecule proton-spin ensembles in the liver parenchyma. Mean ADC for high b values (b500-b1000) after fasting was 0.93 ± 0.09 × 10 mm/s; that after protein intake, 0.93 ± 0.11 × 10; and that after carbohydrate intake, 0.93 ± 0.08 × 10. For intermediate b values (b50-b250), the signal-decay constants were 1.27 ± 0.14 × 10 mm/s, 1.28 ± 0.15 × 10, and 1.31 ± 0.09 × 10, respectively. There was no statistically significant difference between fasting and caloric challenge. CONCLUSIONS The postprandial increase in portal vein flow is not accompanied by a change of liver parenchymal ADC values. In clinical diffusion imaging, patients may be scanned without prescan food-intake preparations. To minimize interference of perfusion effects, liver-tissue molecular water diffusion should be quantified using high b values (≥500 s/mm) only.
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Adler D, Schmidt CM, Al-Haddad M, Barthel JS, Ljung BM, Merchant NB, Romagnuolo J, Shaaban AM, Simeone D, Pitman MB, Layfield LJ. Clinical evaluation, imaging studies, indications for cytologic study and preprocedural requirements for duct brushing studies and pancreatic fine-needle aspiration: The Papanicolaou Society of Cytopathology Guidelines. Cytojournal 2014; 11:1. [PMID: 25191515 PMCID: PMC4153337 DOI: 10.4103/1742-6413.133326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 12/19/2022] Open
Abstract
The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing and postbiopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed.
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Affiliation(s)
- Douglas Adler
- Address: Division of Gastroenterology, Department of Internal Medicine at the University of Utah School of Medicine, Indianapolis, Indiana
| | - C Max Schmidt
- Department of Surgery and Biochemistry/Molecular Biology, Indiana University, School of Medicine, Indianapolis, Indiana
| | - Mohammad Al-Haddad
- Department of Medicine, Division of Gastroenterology, Indiana University, Indianapolis, Indiana
| | | | - Britt-Marie Ljung
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, California
| | - Nipun B Merchant
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joseph Romagnuolo
- Department of Medicine, Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina
| | - Akram M Shaaban
- Department of Radiology, University of Utah, School of Medicine, Salt Lake City, Utah
| | - Diane Simeone
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri
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Riffel P, Michaely HJ, Morelli JN, Pfeuffer J, Attenberger UI, Schoenberg SO, Haneder S. Zoomed EPI-DWI of the pancreas using two-dimensional spatially-selective radiofrequency excitation pulses. PLoS One 2014; 9:e89468. [PMID: 24594702 PMCID: PMC3940598 DOI: 10.1371/journal.pone.0089468] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/20/2014] [Indexed: 12/20/2022] Open
Abstract
Background Implementation of DWI in the abdomen is challenging due to artifacts, particularly those arising from differences in tissue susceptibility. Two-dimensional, spatially-selective radiofrequency (RF) excitation pulses for single-shot echo-planar imaging (EPI) combined with a reduction in the FOV in the phase-encoding direction (i.e. zooming) leads to a decreased number of k-space acquisition lines, significantly shortening the EPI echo train and potentially susceptibility artifacts. Purpose To assess the feasibility and image quality of a zoomed diffusion-weighted EPI (z-EPI) sequence in MR imaging of the pancreas. The approach is compared to conventional single-shot EPI (c-EPI). Material and Methods 23 patients who had undergone an MRI study of the abdomen were included in this retrospective study. Examinations were performed on a 3T whole-body MR system (Magnetom Skyra, Siemens) equipped with a two-channel fully dynamic parallel transmit array (TimTX TrueShape, Siemens). The acquired sequences consisted of a conventional EPI DWI of the abdomen and a zoomed EPI DWI of the pancreas. For z-EPI, the standard sinc excitation was replaced with a two-dimensional spatially-selective RF pulse using an echo-planar transmit trajectory. Images were evaluated with regard to image blur, respiratory motion artifacts, diagnostic confidence, delineation of the pancreas, and overall scan preference. Additionally ADC values of the pancreatic head, body, and tail were calculated and compared between sequences. Results The pancreas was better delineated in every case (23/23) with z-EPI versus c-EPI. In every case (23/23), both readers preferred z-EPI overall to c-EPI. With z-EPI there was statistically significantly less image blur (p<0.0001) and respiratory motion artifact compared to c-EPI (p<0.0001). Diagnostic confidence was statistically significantly better with z-EPI (p<0.0001). No statistically significant differences in calculated ADC values were observed between the two sequences. Conclusion Zoomed diffusion-weighted EPI leads to substantial image quality improvements with reduction of susceptibility artifacts in pancreatic DWI.
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Affiliation(s)
- Philipp Riffel
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
- * E-mail:
| | - Henrik J. Michaely
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
| | - John N. Morelli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Josef Pfeuffer
- Siemens Healthcare Sector, Application Development, Erlangen, Germany
| | - Ulrike I. Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
| | - Stefan Haneder
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Adler D, Max Schmidt C, Al-Haddad M, Barthel JS, Ljung BM, Merchant NB, Romagnuolo J, Shaaban AM, Simeone D, Bishop Pitman M, Field A, Layfield LJ. Clinical evaluation, imaging studies, indications for cytologic study, and preprocedural requirements for duct brushing studies and pancreatic FNA: the Papanicolaou Society of Cytopathology recommendations for pancreatic and biliary cytology. Diagn Cytopathol 2014; 42:325-32. [PMID: 24554480 DOI: 10.1002/dc.23095] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/08/2014] [Indexed: 12/21/2022]
Abstract
The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing, and post-biopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings, and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed.
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Affiliation(s)
- Douglas Adler
- Department of Medicine, Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah
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Dijkstra H, Handayani A, Kappert P, Oudkerk M, Sijens PE. Clinical implications of non-steatotic hepatic fat fractions on quantitative diffusion-weighted imaging of the liver. PLoS One 2014; 9:e87926. [PMID: 24505333 PMCID: PMC3913701 DOI: 10.1371/journal.pone.0087926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/01/2014] [Indexed: 01/27/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is an important diagnostic tool in the assessment of focal liver lesions and diffuse liver diseases such as cirrhosis and fibrosis. Quantitative DWI parameters such as molecular diffusion, microperfusion and their fractions, are known to be affected when hepatic fat fractions (HFF) are higher than 5.5% (steatosis). However, less is known about the effect on DWI for HFF in the normal non-steatotic range below 5.5%, which can be found in a large part of the population. The aim of this study was therefore to evaluate the diagnostic implications of non-steatotic HFF on quantitative DWI parameters in eight liver segments. For this purpose, eleven healthy volunteers (2 men, mean-age 31.0) were prospectively examined with DWI and three series of in-/out-of-phase dual-echo spoiled gradient-recalled MRI sequences to obtain the HFF and T2*. DWI data were analyzed using the intravoxel incoherent motion (IVIM) model. Four circular regions (ø22.3 mm) were drawn in each of eight liver segments and averaged. Measurements were divided in group 1 (HFF≤2.75%), group 2 (2.75< HFF ≤5.5%) and group 3 (HFF>5.5%). DWI parameters and T2* were compared between the three groups and between the segments. It was observed that the molecular diffusion (0.85, 0.72 and 0.49 ×10−3 mm2/s) and T2* (32.2, 27.2 and 21.0 ms) differed significantly between the three groups of increasing HFF (2.18, 3.50 and 19.91%). Microperfusion and its fraction remained similar for different HFF. Correlations with HFF were observed for the molecular diffusion (r = −0.514, p<0.001) and T2* (−0.714, p<0.001). Similar results were obtained for the majority of individual liver segments. It was concluded that fat significantly decreases molecular diffusion in the liver, also in absence of steatosis (HFF≤5.5%). Also, it was confirmed that fat influences T2*. Determination of HFF prior to quantitative DWI is therefore crucial.
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Affiliation(s)
- Hildebrand Dijkstra
- Center for Medical Imaging - North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Astri Handayani
- Center for Medical Imaging - North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Kappert
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging - North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul E. Sijens
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Ozkurt H, Keskiner F, Karatag O, Alkim C, Erturk SM, Basak M. Diffusion Weighted MRI for Hepatic Fibrosis: Impact of b-Value. Iran J Radiol 2014; 11:e3555. [PMID: 24693297 PMCID: PMC3955853 DOI: 10.5812/iranjradiol.3555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 04/28/2013] [Accepted: 07/17/2013] [Indexed: 12/13/2022]
Abstract
Background Hepatic fibrosis is a typical complication of chronic liver diseases resulting in cirrhosis that remains a major public health problem worldwide. Liver biopsy is currently the gold standard for diagnosing and staging hepatic fibrosis. Percutaneous liver biopsy; however, is an invasive procedure with risks of complications. Therefore, there is need for alternative non-invasive techniques to assess liver fibrosis and chronic liver diseases. In recent years, MRI techniques, including diffusion weighted imaging (DWI), have been developed for in vivo quantification of liver fibrosis. Objectives The purpose of this study is to evaluate the utility of diffusion weighted MRI in the diagnosis and quantification of the degree of hepatic fibrosis and to investigate the influence of b-value. Patients and Methods Twenty-four patients (13 males, 11 females), with a mean age of 46 years (36-73 years) diagnosed as chronic hepatitis and histopathologically proven liver fibrosis and 22 other patients (8 males, 14 females) with no clinical or biochemical findings of liver disease, with a mean age of 51.2 years (32-75 years) were included in the study. All patients with chronic hepatitis underwent percutaneous liver biopsy by an experienced hepatologist without sonographic guidance. The Knodell histology activity index (HAI) for grading of necroinflammatory changes and Metavir scoring system for staging of the liver fibrosis were used to record the severity of the disease. All patients were examined with a 1.5 Tesla MRI system and the patients underwent diffusion weighted imaging (DWI) with a routine hepatic MRI protocol. Different b-values including 250, 500, 750, and 1000 sec/mm 2 were used to calculate apparent diffusion coefficients. Results We detected decreased apparent diffusion coefficient values in patients with hepatic fibrosis compared to patients without chronic hepatitis and there was a trend toward decrease in hepatic apparent diffusion coefficient values with an increasing degree of fibrosis. Conclusions Our findings suggest that hepatic apparent diffusion coefficient measurement with a b-value of 750 sec/mm 2 or greater is useful in accurate quantification of liver fibrosis and necroinflammation.
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Affiliation(s)
- Huseyin Ozkurt
- Department of Radiology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
- Corresponding author: Huseyin Ozkurt, Department of Radiology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey. Tel: +90-5325958625, Fax: +90-2122965467, E-mail:
| | - Firat Keskiner
- Department of Radiology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ozan Karatag
- Department of Radiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Sukru Mehmet Erturk
- Department of Radiology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Muzaffer Basak
- Department of Radiology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
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Bozgeyik Z, Onur MR, Poyraz AK. The role of diffusion weighted magnetic resonance imaging in oncologic settings. Quant Imaging Med Surg 2013; 3:269-78. [PMID: 24273745 DOI: 10.3978/j.issn.2223-4292.2013.10.07] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 10/20/2013] [Indexed: 12/17/2022]
Abstract
There is growing interest in the applications of diffusion-weighted-imaging (DWI) in oncologic area for last ten years. DWI has important advantages as do not require contrast medium, very quick technique and it provides qualitative and quantitative information that can be helpful for tumor assessment. In this article, we present oncologic applications of DWI in the parts of the body. DWI has been applied to the evaluation of central nervous system (CNS) pathologies. Some technologic advances lead to using of DWI in the extracranial sites such as abdomen and pelvis. As well as tumor detection and characterization, DWI has been widely used for predicting and monitoring response to therapy. One of the most prominent contributions of DWI is differentiation of between malignant and benign tumoral process. Apparent-diffusion-coefficient (ADC) value is quantitative parameter of DWI which reflects diffusion movements of water molecules in various tissues. Most of the studies suggested that malignant tumors had lower ADC values than benign ones. DWI may be a routine sequence in oncologic settings and it provides much useful information about tumoral tissue. We think it can be added to conventional magnetic resonance imaging (MRI) sequences.
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Lista F, Andrés G, Cáceres F, Ramón de Fata F, Rodríguez-Barbero J, Angulo J. Evaluation of risk of muscle invasion, perivesical and/or lymph node affectation by diffusion-weighted magnetic nuclear resonance in the patient who is a candidate for radical cystectomy. Actas Urol Esp 2013; 37:419-24. [PMID: 23773823 DOI: 10.1016/j.acuro.2013.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Preoperative staging of bladder cancer using imaging methods has serious limitations. The accuracy of the abdominal diffusion-weighted magnetic resonance (DW-MRI) to predict residual muscle invasion, perivesical and/or lymph node affectation in the cystectomy specimen is evaluated. MATERIAL AND METHODS A prospective study was performed on 20 patients with high grade muscle invasive bladder cancer who received transurethral resection of the bladder (TURB) in a period of <1 month. The DW-MRI was performed before the radical cystectomy and the radiologist predicted muscle invasion, extravesical affectation and lymph node affectation, being blind to the histopathological study. Sensitivity (S), specificity (sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Ac) of the test were analyzed. The medians of the apparent diffusion coefficient (ADC) value (Mann-Whitney) were compared and the ROC curves study for DW-MRI and ADC was carried out. RESULTS Distribution by categories was: pT0 1(5%), pT1 6(30%), pT2 2(10%), pT3 8(40%) and pT4 3(15%). There was agreement in the T-pT assignment in 17(85%). In 7(35%) there was lymph node affectation (pN1-2). Consistency of the DW-MRI for muscle affectation was k=.89 (CI .67-1; S=1.0, Sp=,86, PPV=.93, NPV=1.0, Ac=.95), for perivesical fat affectation k=.6 (CI .25-.95; S=.8, Sp=.8, PPV=.8, NPV=.8, Ac=.8) and for lymph node affectation k=.89 (CI .67-1; S=.86, Sp=1.0, PPV=1.0, NPV=.93, Ac=.95). Mean value of ADC was greater in G2 tumors (OMS1987) compared to G3 (p=.08). Evaluation of DW-MRI imaging and ADC numerical value showed equivalent areas under the curve for muscle (.93 and .9; Z=.7), fat (.8 and .91; Z=.31) and lymph node (.93 and .97; Z=.36) affectation, respectively. CONCLUSIONS DW-MRI allows for good pre-operative evaluation of the patient who is a candidate for cystectomy, especially for the prediction of muscle (<pT2 vs ≥pT2) and/or lymph node (N0 vs N1-2) affectation. Both are key points to choice the therapeutic attitude after the bladder TURB. Furthermore, the ADC coefficient also predicts tumor differentiation grade.
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Schmidt H, Brendle C, Schraml C, Martirosian P, Bezrukov I, Hetzel J, Müller M, Sauter A, Claussen CD, Pfannenberg C, Schwenzer NF. Correlation of Simultaneously Acquired Diffusion-Weighted Imaging and 2-Deoxy-[18F] fluoro-2-D-glucose Positron Emission Tomography of Pulmonary Lesions in a Dedicated Whole-Body Magnetic Resonance/Positron Emission Tomography System. Invest Radiol 2013; 48:247-55. [DOI: 10.1097/rli.0b013e31828d56a1] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Yoon JH, Lee JM, Yu MH, Kiefer B, Han JK, Choi BI. Evaluation of hepatic focal lesions using diffusion-weighted MR imaging: comparison of apparent diffusion coefficient and intravoxel incoherent motion-derived parameters. J Magn Reson Imaging 2013; 39:276-85. [PMID: 23633178 DOI: 10.1002/jmri.24158] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/06/2013] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To determine whether parameters obtained from intravoxel incoherent motion (IVIM)-diffusion-weighted imaging (DWI) using multiple b-values can improve characterization of common focal liver lesions (FLLs), compared with the apparent diffusion coefficient (ADCtotal ). MATERIALS AND METHODS Our Institutional Review Board approved this retrospective study and informed consent was waived. In all, 142 patients with 169 FLLs underwent liver magnetic resonance imaging (MRI) including IVIM-DWI with multiple b factors at 3.0T. ADCtotal and IVIM-DWI-derived parameters including true diffusion (Dt ), pseudodiffusion (Dp ), and perfusion fraction (f) were calculated for each lesion and compared using dedicated software. RESULTS Dt and ADCtotal were significantly lower in malignancies (0.95 ± 0.21, 1.14 ± 0.24, (×10(-3) mm(2) /sec)) than in benign FLLs (1.61 ± 0.34, 1.72 ± 0.37, (×10(-3) mm(2) /sec)). In the differential diagnosis of malignancies from benign lesions, Dt (Az value: 0.971) showed better diagnostic performance than ADCtotal (Az: 0.933) (P < 0.0005). Dt (Az: 0.961) also showed better diagnostic performance than ADCtotal (Az: 0.919) in differentiating hypervascular malignancies from benign hypervascular FLLs (P < 0.0005). In addition, Dp and f were significantly higher in hypervascular FLLs (35.74 ± 20.08 (×10(-3) mm(2) /sec), 28.14 ± 11.82 (%)) than hypovascular FLLs (21.87 ± 13.8 (×10(-3) mm(2) /sec), 12.2 ± 5.92 (%)) (P < 0.0001). CONCLUSION Dt provided better diagnostic performance than ADCtotal in differentiating benign from malignant lesions. Dp and f were significant parameters for diagnosing hypervascular FLLs.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Buisson A, Joubert A, Montoriol PF, Da Ines D, Hordonneau C, Pereira B, Garcier JM, Bommelaer G, Petitcolin V. Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease. Aliment Pharmacol Ther 2013; 37:537-45. [PMID: 23289713 DOI: 10.1111/apt.12201] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 11/29/2012] [Accepted: 12/12/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Whether diffusion-weighted imaging (DWI)-MRI is of value in detecting and assessing inflammation of ileal Crohn's disease (CD) remains poorly investigated. AIM To compare DWI-MR enterography (MRE) with conventional MRE in estimating inflammation in small bowel CD, to determine an apparent diffusion coefficient (ADC) threshold to differentiate active from non-active lesions and to assess inter-observer agreement. METHODS Thirty-one CD patients from the Clermont-Ferrand IBD unit with ileal involvement were consecutively and prospectively included between April and June 2011. All patients underwent DWI-MRI to detect the digestive segment with the most severe lesions, which was then used to calculate the ADC. Qualitative and quantitative results were compared with conventional MRE including MaRIA (Magnetic Resonance Index of Activity) score calculation and independent activity predictors (wall thickening, oedema, ulcers). Each examination was interpreted independently by two radiologists blinded for clinical assessment. RESULTS Seventeen patients (54.8%) had active CD as defined by the MaRIA score ≥7. DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE (P = 0.001). Qualitative analysis of DW sequences determined sensitivity, specificity, positive predictive value and negative predictive value as 100%, 92.9%, 94.4% and 100% respectively. Quantitative analysis using a cut-off of 1.6 × 10(-3) mm(2)/s for ADC yielded sensitivity and specificity values of, respectively, 82.4% and 100%. Inter-observer agreement was high with regard to DWI hyperintensity (κ = 0.69, accuracy rate = 85.7%) and ADC (correlation = 0.74, P < 0.001, and concordance = 0.71, P < 0.001). CONCLUSION DWI-MR enterography is a well-tolerated, non-time-consuming and accurate tool for detecting and assessing inflammation in small bowel Crohn's disease.
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Affiliation(s)
- A Buisson
- Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Auvergne University, France.
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Nam SJ, Park KY, Yu JS, Chung JJ, Kim JH, Kim KW. Hepatic cavernous hemangiomas: relationship between speed of intratumoral enhancement during dynamic MRI and apparent diffusion coefficient on diffusion-weighted imaging. Korean J Radiol 2012; 13:728-35. [PMID: 23118571 PMCID: PMC3484293 DOI: 10.3348/kjr.2012.13.6.728] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/08/2012] [Indexed: 02/06/2023] Open
Abstract
Objective To investigate the relationships between the apparent diffusion coefficients (ADCs) on diffusion-weighted imaging (DWI) and the speed of contrast-enhancement in hepatic hemangiomas. Materials and Methods Sixty-nine hepatic hemangiomas (≥ 1 cm) were evaluated with DWI, by using multiple b values (b = 50, 400, 800 s/mm2), followed by a gadolinium-enhanced dynamic MRI. The lesions were classified into three groups, according to the speed of contrast-enhancement on the portal phase. ADCs were measured on the ADC map automatically, and were calculated by using the two different b values (mADC50-400 with b values = 50 and 400; mADC400-800 with b values = 400 and 800 s/mm2). Results The mean ADCs (× 10-3 mm2/s) were significantly higher in the rapid group (1.9 ± 0.44) than in the intermediate (1.7 ± 0.35, p = 0.046) or the slow groups (1.4 ± 0.34, p = 0.002). There were significant differences between the rapid and the slow groups in mADC50-400 (2.12 vs. 1.48; p = 0.008) and mADC400-800 (1.68 vs. 1.22, p = 0.010), and between the rapid and the intermediate groups in mADC50-400 (2.12 vs. 1.79, p = 0.049). Comparing mADC50-400 with mADC400-800, there was a significant difference only in the rapid group (p = 0.001). Conclusion Higher ADCs of rapidly-enhancing hemangiomas may be related to richer intralesional vascular perfusion. Also, the restricted diffusion may be attributed to the difference of structural characteristics of hemangioma.
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Affiliation(s)
- Se Jin Nam
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 135-720, Korea
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Filipe JP, Curvo-Semedo L, Casalta-Lopes J, Marques MC, Caseiro-Alves F. Diffusion-weighted imaging of the liver: usefulness of ADC values in the differential diagnosis of focal lesions and effect of ROI methods on ADC measurements. MAGMA. 2013;26:303-312. [PMID: 23053714 DOI: 10.1007/s10334-012-0348-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 09/13/2012] [Accepted: 09/19/2012] [Indexed: 12/13/2022]
Abstract
OBJECT By measuring the apparent diffusion coefficient (ADC) of liver parenchyma and focal hepatic lesions (FHL) we proposed to investigate the utility of ADC in the differential diagnosis of hepatic disease and to determine the influence of region of interest (ROI) characteristics in those measurements. MATERIALS AND METHODS Ninety-three patients with at least one supracentimetric FHL, or parenchymal abnormality, were retrospectively evaluated. Diagnosis was based on histopathologic data or, alternatively, on a combination of consensus between imaging methods and 24 months of follow-up. Ninety lesions were evaluated with respiratory-triggered diffusion-weighted imaging (b values: 50 and 700 s/mm(2)): 14 hepatocellular carcinomas, 18 metastases, 10 focal nodular hyperplasias, four adenomas, 30 hemangiomas and 14 cysts. ADC of hepatic parenchyma was measured by placing ROIs in four different segments, and in FHLs by using three circular 1 cm(2) ROIs and one ROI encompassing the full lesion. Data was statistically analyzed (p < 0.05 considered significant), and a receiver operating characteristic curve was assessed to evaluate the accuracy for the diagnosis of malignancy. RESULTS Our measurements showed that parenchyma ADC was significantly higher in segment II and that ADCs of malignant lesions were significantly lower than those of benign lesions (p < 0.001). There was significant overlap between benign solid lesions and malignant lesions and the area under the curve for malignancy was 0.939 (sensitivity 89.7 %, specificity 90.6 %), using a cutoff of 1.43 × 10(-3) mm(2)/s. No significant difference was found between ROIs of different characteristics. CONCLUSION ADC measurements can help to characterize FHLs and differentiate normal from pathological parenchyma. Any ROI above 1 cm(2) can provide accurate ADC measurements in homogenous lesions.
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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] [What about the content of this article? (0)] [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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Miquel ME, Scott AD, Macdougall ND, Boubertakh R, Bharwani N, Rockall AG. In vitro and in vivo repeatability of abdominal diffusion-weighted MRI. Br J Radiol 2012; 85:1507-12. [PMID: 22674704 DOI: 10.1259/bjr/32269440] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To study the in vitro and in vivo (abdomen) variability of apparent diffusion coefficient (ADC) measurements at 1.5 T using a free-breathing multislice diffusion-weighted (DW) MRI sequence. METHODS DW MRI images were obtained using a multislice spin-echo echo-planar imaging sequence with b-values=0, 100, 200, 500, 750 and 1000 s mm(-2). A flood-field phantom was imaged at regular intervals over 100 days, and 10 times on the same day on 2 occasions. 10 healthy volunteers were imaged on two separate occasions. Mono-exponential ADC maps were fitted excluding b=0. Paired analysis was carried out on the liver, spleen, kidney and gallbladder using multiple regions of interest (ROIs) and volumes of interest (VOIs). RESULTS The in vitro coefficient of variation was 1.3% over 100 days, and 0.5% and 1.0% for both the daily experiments. In vivo, there was no statistical difference in the group mean ADC value between visits for any organ. Using ROIs, the coefficient of reproducibility was 20.0% for the kidney, 21.0% for the gallbladder, 24.7% for the liver and 28.0% for the spleen. For VOIs, values fall to 7.7%, 6.4%, 8.6% and 9.6%, respectively. CONCLUSION Good in vitro repeatability of ADC measurements provided a sound basis for in vivo measurement. In vivo variability is higher and when considering single measurements in the abdomen as a whole, only changes in ADC value greater than 23.1% would be statistically significant using a two-dimensional ROI. This value is substantially lower (7.9%) if large three-dimensional VOIs are considered.
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Affiliation(s)
- M E Miquel
- Clinical Physics, Barts Health NHS Trust, London, UK.
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Inci E, Hocaoglu E, Aydin S, Cimilli T. Diffusion-weighted magnetic resonance imaging in evaluation of primary solid and cystic renal masses using the Bosniak classification. Eur J Radiol 2012; 81:815-20. [DOI: 10.1016/j.ejrad.2011.02.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 02/02/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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Sakamoto J, Sasaki Y, Otonari-yamamoto M, Nishikawa K, Sano T. Diffusion-weighted imaging of the head and neck with HASTE: influence of imaging parameters on image quality. Oral Radiol 2012; 28:87-94. [DOI: 10.1007/s11282-012-0091-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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