51
|
Dalah E, Erickson B, Oshima K, Schott D, Hall WA, Paulson E, Tai A, Knechtges P, Li XA. Correlation of ADC With Pathological Treatment Response for Radiation Therapy of Pancreatic Cancer. Transl Oncol 2018; 11:391-398. [PMID: 29455085 PMCID: PMC5852406 DOI: 10.1016/j.tranon.2018.01.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE: To investigate the feasibility of using apparent diffusion coefficient (ADC) to assesspathological treatment response in pancreatic ductal adenocarcinoma (PDAC) following neoadjuvant chemoradiation (nCR). MATERIALS/METHODS: MRI and pathological data collected for 25patients with resectable and borderline resectable PDAC following nCR were retrospectively analyzed. Pre- and post-nCR mean ADC values in the tumors were compared using Wilcoxon matched pairs test. Correlation of pathological treatment response and ADC values was assessed using Pearson’s correlation coefficient test and receiver-operating-curve (ROC) analysis. RESULTS: The average mean and standard deviation (SD) of the ADC values for all the patients analyzed were significantly higher in post-nCR (1.667±0.161×10-3) compared with those prior to nCR (1.395±0.136×10-3 mm2/sec), (P<0.05). The mean ADC values after nCR were significantly correlated with the pathological responses (r=-0.5172); P=0.02. The area under the curve (AUC) of the ADC values for differentiating G1, G2 and G3 pathological responses, using ROC analysis, was found to be 0.6310 and P=0.03. CONCLUSION: Changes of pre- and post-treatment ADC values significantly correlated with pathological treatment response for PDAC patients treated with chemoradiation therapy, indicating that the ADC could be used to assesstreatment response for PDAC.
Collapse
Affiliation(s)
- Entesar Dalah
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medical Diagnostic Imaging, College of Health Science, University of Sharjah, UAE.
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Kiyoko Oshima
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Diane Schott
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Paul Knechtges
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
52
|
[Postoperative and posttherapeutic changes after primary bone tumors : What's important for radiologists?]. Radiologe 2017; 57:938-957. [PMID: 28986639 DOI: 10.1007/s00117-017-0304-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Posttreatment imaging of primary bone tumours represents a diagnostic challenge for radiologists. Depending on the primary bone tumour common radiological procedures, such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI), are employed. Radiography and CT are particularly useful in benign bone tumours and in matrix-forming bone tumours. MRI comes into consideration with malignant tumour recurrence and tumoral soft tissue infiltration. Bone scintigraphy is of superior importance if a primarily multifocal manifestation of bone tumour or metastasizing tumour disease is suspected. Molecular imaging (FDG-PET and hybrid imaging, using CT) are gaining increasing importance in light of monitoring neoadjuvant chemotherapy and detecting recurrent tumour appearance. The current literature shows sensitivity and specificity values for recurrent detection of up to 92% and 93%. Diagnostic accuracy is as high as 95%, thus, exceeding accuracy values for CT (67%) and MRI (86%) by far. Likewise, this is also applicable for the assessment of the neoadjuvant chemotherapy. Moreover, PET-based modalities are able to establish prognostic statements using SUV-threshold values at baseline (especially for Ewing sarcomas). Advanced imaging techniques have made a great diagnostic step forward and have proven to be relevant and reproducible with respect to both relapse detection and treatment assessment. Furthermore, it is not clear whether a higher detection rate of early tumour recurrence will inevitably lead to better outcome and survival.
Collapse
|
53
|
Liu G, Cui Z, Dai Y, Yao Q, Xu J, Wu G. Paradoxical puborectalis syndrome on diffusion-weighted imaging: a retrospective study of 72 cases. Sci Rep 2017; 7:2925. [PMID: 28592800 PMCID: PMC5462772 DOI: 10.1038/s41598-017-03127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 04/25/2017] [Indexed: 11/30/2022] Open
Abstract
This study aimed to evaluate the application value of diffusion-weighted imaging (DWI) for assessing paradoxical puborectalis syndrome (PPS) in patients with obstructive defecation syndrome (ODS). The medical records of 72 ODS patients who underwent magnetic resonance (MR)-DWI and MR-defecography were retrospectively reviewed. The differences in the apparent diffusion coefficients (ADCs) and the thickness of the right and left branches of the puborectalis muscles between the PPS(+) and PPS(−) groups were compared. In addition, the absolute within-patient differences between the right and left branches (ADC, thickness) were compared between the two groups. The absolute difference in ADCs (right branch - left branch) was significantly different between the two groups. Regardless of whether the ADC was acquired through single-ROI (0.10 ± 0.08 vs 0.23 ± 0.18, P = 0.000) or multi-ROI (0.16 ± 0.14 vs 0.27 ± 0.17, P = 0.009) analysis, the PPS(+) patients displayed a lower absolute ADC difference than did the PPS(−) patients. However, there was no statistically significant difference in the ADC value, thickness or the absolute difference in thickness between the two groups. These findings suggest that DWI may have value in quantitatively assessing the puborectalis muscle in ODS patients, whereas the value of puborectalis thickness in such aspect needs further study.
Collapse
Affiliation(s)
- Guiqin Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhe Cui
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongming Dai
- Magnetic Resonance Imaging Institute for Biomedical Research, Wayne State University, Detroit, MI, USA
| | - Qiuying Yao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Guangyu Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
54
|
Kubo T, Furuta T, Johan MP, Ochi M, Adachi N. Value of diffusion-weighted imaging for evaluating chemotherapy response in osteosarcoma: A meta-analysis. Mol Clin Oncol 2017; 7:88-92. [PMID: 28685082 DOI: 10.3892/mco.2017.1273] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/29/2017] [Indexed: 01/31/2023] Open
Abstract
The histological examination of the tumor necrosis upon surgery remains the most reliable prognostic factor for osteosarcoma. However, the detection of more early prognostic factors is desirable in order to increase the survival rates and decrease the risk rates for iatrogenic toxicity. The purpose of the current systematic review and meta-analysis was to provide an up-to-date summary of the role of diffusion-weighted imaging (DWI) for the preoperative assessment of the chemotherapy response in osteosarcoma. Articles evaluating DWI for the preoperative assessment of the chemotherapy response of osteosarcoma were systematically searched for in four electronic literature databases. The mean difference in apparent diffusion coefficient (ADC) following neoadjuvant chemotherapy between good and poor histological responders was assessed in 5 studies. The mean difference in the ADC ratio (the percentage change in ADC between post-neoadjuvant and pre-neoadjuvant chemotherapy) reported in 3 studies was also assessed. Five articles with 106 patients fulfilled all of the inclusion criteria for the meta-analysis. Significant mean differences were found between good and poor responders in the ADC in the 5 studies (P=0.03) and the ADC ratio in the 3 studies (P<0.00001). The good responders demonstrated a higher ADC and a higher ADC ratio than the poor responders. DWI performed with ADC values was useful for predicting the chemotherapeutic response of osteosarcoma. This method may have promising potential as a preoperative non-invasive modality.
Collapse
Affiliation(s)
- Tadahiko Kubo
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Taisuke Furuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Muhammad P Johan
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| |
Collapse
|
55
|
Padhani AR, Lecouvet FE, Tunariu N, Koh DM, De Keyzer F, Collins DJ, Sala E, Fanti S, Vargas HA, Petralia G, Schlemmer HP, Tombal B, de Bono J. Rationale for Modernising Imaging in Advanced Prostate Cancer. Eur Urol Focus 2017; 3:223-239. [PMID: 28753774 DOI: 10.1016/j.euf.2016.06.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/29/2016] [Accepted: 06/29/2016] [Indexed: 12/25/2022]
Abstract
CONTEXT To effectively manage patients with advanced prostate cancer (APC), it is essential to have accurate, reproducible, and validated methods for detecting and quantifying the burden of bone and soft tissue metastases and for assessing their response to therapy. Current standard of care imaging with bone and computed tomography (CT) scans have significant limitations for the assessment of bone metastases in particular. OBJECTIVE We aimed to undertake a critical comparative review of imaging methods used for diagnosis and disease monitoring of metastatic APC from the perspective of their availability and ability to assess disease presence, extent, and response of bone and soft tissue disease. EVIDENCE ACQUISITION An expert panel of radiologists, nuclear medicine physicians, and medical physicists with the greatest experience of imaging in advanced prostate cancer prepared a review of the practicalities, performance, merits, and limitations of currently available imaging methods. EVIDENCE SYNTHESIS Meta-analyses showed that positron emission tomography (PET)/CT with different radiotracers and whole-body magnetic resonance imaging (WB-MRI) are more accurate for bone lesion detection than CT and bone scans (BSs). At a patient level, the pooled sensitivities for bone disease by using choline (CH)-PET/CT, WB-MRI, and BS were 91% (95% confidence interval [CI], 83-96%), 97% (95% CI, 91-99%), and 79% (95% CI, 73-83%), respectively. The pooled specificities for bone metastases detection using CH-PET/CT, WB-MRI, and BS were 99% (95% CI, 93-100%), 95% (95% CI, 90-97%), and 82% (95% CI, 78-85%), respectively. The ability of PET/CT and WB-MRI to assess therapeutic benefits is promising but has not been comprehensively evaluated. There is variability in the cost, availability, and quality of PET/CT and WB-MRI. CONCLUSIONS Standardisation of acquisition, interpretation, and reporting of WB-MRI and PET/CT scans is required to assess the performance of these techniques in clinical trials of treatment approaches in APC. PATIENT SUMMARY PET/CT and whole-body MRI scans have the potential to improve detection and to assess response to treatment of all states of advanced prostate cancer. Consensus recommendations on quality standards, interpretation, and reporting are needed but will require validation in clinical trials of established and new treatment approaches.
Collapse
Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK.
| | - Frederic E Lecouvet
- Department of Radiology, Centre du Cancer and Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Frederik De Keyzer
- Department of Radiology, Medical Imaging Research Centre, University Hospitals Leuven, Leuven, Belgium
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefano Fanti
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Heinz Peter Schlemmer
- Department of Radiology, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Johann de Bono
- Drug Development Unit, Institute of Cancer Research and the Royal Marsden NHS Trust, Surrey, UK
| |
Collapse
|
56
|
Nacey NC, Geeslin MG, Miller GW, Pierce JL. Magnetic resonance imaging of the knee: An overview and update of conventional and state of the art imaging. J Magn Reson Imaging 2017; 45:1257-1275. [PMID: 28211591 DOI: 10.1002/jmri.25620] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become the preferred modality for imaging the knee to show pathology and guide patient management and treatment. The knee is one of the most frequently injured joints, and knee pain is a pervasive difficulty that can affect all age groups. Due to the diverse pathology, complex anatomy, and a myriad of injury mechanisms of the knee, the MRI knee protocol and sequences should ensure detection of both soft tissue and osseous structures in detail and with accuracy. The knowledge of knee anatomy and the normal or injured MRI appearance of these key structures are critical for precise diagnosis. Advances in MRI technology provide the imaging necessary to obtain high-resolution images to evaluate menisci, ligaments, and tendons. Furthermore, recent advances in MRI techniques allow for improved imaging in the postoperative knee and metal artifact reduction, tumor imaging, cartilage evaluation, and visualization of nerves. As treatment and operative management techniques evolve, understanding the correct application of these advancements in MRI of the knee will prove to be valuable to clinical practice. LEVEL OF EVIDENCE 5 J. MAGN. RESON. IMAGING 2017;45:1257-1275.
Collapse
Affiliation(s)
- Nicholas C Nacey
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew G Geeslin
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Grady Wilson Miller
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer L Pierce
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
57
|
De Robertis R, Cingarlini S, Tinazzi Martini P, Ortolani S, Butturini G, Landoni L, Regi P, Girelli R, Capelli P, Gobbo S, Tortora G, Scarpa A, Pederzoli P, D’Onofrio M. Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage. World J Gastroenterol 2017; 23:275-285. [PMID: 28127201 PMCID: PMC5236507 DOI: 10.3748/wjg.v23.i2.275] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/07/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe magnetic resonance (MR) imaging features of pancreatic neuroendocrine neoplasms (PanNENs) according to their grade and tumor-nodes-metastases stage by comparing them to histopathology and to determine the accuracy of MR imaging features in predicting their biological behavior.
METHODS This study was approved by our institutional review board; requirement for informed patient consent was waived due to the retrospective nature of the study. Preoperative MR examinations of 55 PanNEN patients (29 men, 26 women; mean age of 57.6 years, range 21-83 years) performed between June 2013 and December 2015 were reviewed. Qualitative and quantitative features were compared between tumor grades and stages determined by histopathological analysis.
RESULTS Ill defined margins were more common in G2-3 and stage III-IV PanNENs than in G1 and low-stage tumors (P < 0.001); this feature had high specificity in the identification of G2-3 and stage III-IV tumors (90.3% and 96%, 95%CI: 73.1-97.5 and 77.7-99.8). The mean apparent diffusion coefficient value was significantly lower in G2-3 and stage III-IV lesions compared to well differentiated and low-stage tumors (1.09 × 10-3 mm2/s vs 1.45 × 10-3 mm2/s and 1.10 × 10-3 mm2/s vs 1.53 × 10-3 mm2/s, P = 0.003 and 0.001). Receiving operator characteristic analysis determined optimal cut-offs of 1.21 and 1.28 × 10-3 mm2/s for the identification of G2-3 and stage III-IV tumors, with sensitivity and specificity values of 70.8/80.7% and 64.5/64% (95%CI: 48.7-86.6/60-92.7 and 45.4-80.2/42.6-81.3).
CONCLUSION MR features of PanNENs vary according to their grade of differentiation and their stage at diagnosis and could predict the biological behavior of these tumors.
Collapse
|
58
|
Diffusion weighted and dynamic contrast enhanced magnetic resonance imaging in assessment of malignant liver tumors after percutaneous radiofrequency ablation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
59
|
The diffusion-weighted magnetic resonance imaging (DWI) predicts the early response of esophageal squamous cell carcinoma to concurrent chemoradiotherapy. Radiother Oncol 2016; 121:246-251. [DOI: 10.1016/j.radonc.2016.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 12/16/2022]
|
60
|
Qiu B, Wang D, Yang H, Xie W, Liang Y, Cai P, Chen Z, Liu M, Fu J, Xie C, Liu H. Combined modalities of magnetic resonance imaging, endoscopy and computed tomography in the evaluation of tumor responses to definitive chemoradiotherapy in esophageal squamous cell carcinoma. Radiother Oncol 2016; 121:239-245. [DOI: 10.1016/j.radonc.2016.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 08/31/2016] [Accepted: 09/11/2016] [Indexed: 11/26/2022]
|
61
|
Reynaud O, Winters KV, Hoang DM, Wadghiri YZ, Novikov DS, Kim SG. Pulsed and oscillating gradient MRI for assessment of cell size and extracellular space (POMACE) in mouse gliomas. NMR IN BIOMEDICINE 2016; 29:1350-63. [PMID: 27448059 PMCID: PMC5035213 DOI: 10.1002/nbm.3577] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/30/2016] [Accepted: 06/07/2016] [Indexed: 05/10/2023]
Abstract
Solid tumor microstructure is related to the aggressiveness of the tumor, interstitial pressure and drug delivery pathways, which are closely associated with treatment response, metastatic spread and prognosis. In this study, we introduce a novel diffusion MRI data analysis framework, pulsed and oscillating gradient MRI for assessment of cell size and extracellular space (POMACE), and demonstrate its feasibility in a mouse tumor model. In vivo and ex vivo POMACE experiments were performed on mice bearing the GL261 murine glioma model (n = 8). Since the complete diffusion time dependence is in general non-analytical, the tumor microstructure was modeled in an appropriate time/frequency regime by impermeable spheres (radius Rcell , intracellular diffusivity Dics ) surrounded by extracellular space (ECS) (approximated by constant apparent diffusivity Decs in volume fraction ECS). POMACE parametric maps (ECS, Rcell , Dics , Decs ) were compared with conventional diffusion-weighted imaging metrics, electron microscopy (EM), alternative ECS determination based on effective medium theory (EMT), and optical microscopy performed on the same samples. It was shown that Decs can be approximated by its long time tortuosity limit in the range [1/(88 Hz)-31 ms]. ECS estimations (44 ± 7% in vivo and 54 ± 11% ex vivo) were in agreement with EMT-based ECS and literature on brain gliomas. Ex vivo, ECS maps correlated well with optical microscopy. Cell sizes (Rcell = 4.8 ± 1.3 in vivo and 4.3 ± 1.4 µm ex vivo) were consistent with EM measurements (4.7 ± 1.8 µm). In conclusion, Rcell and ECS can be quantified and mapped in vivo and ex vivo in brain tumors using the proposed POMACE method. Our experimental results support the view that POMACE provides a way to interpret the frequency or time dependence of the diffusion coefficient in tumors in terms of objective biophysical parameters of neuronal tissue, which can be used for non-invasive monitoring of preclinical cancer studies and treatment efficacy. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Olivier Reynaud
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY, USA.
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.
| | - Kerryanne Veronica Winters
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Dung Minh Hoang
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Youssef Zaim Wadghiri
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Dmitry S Novikov
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Sungheon Gene Kim
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
62
|
Diffusion-weighted imaging and the skeletal system: a literature review. Clin Radiol 2016; 71:1071-82. [PMID: 27519973 DOI: 10.1016/j.crad.2016.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/24/2016] [Accepted: 07/08/2016] [Indexed: 01/26/2023]
Abstract
Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) sequence that has a well-established role in neuroimaging, and is increasingly being utilised in other clinical contexts, including the assessment of various skeletal disorders. It utilises the variability of Brownian motion of water molecules; the differing patterns of water molecular diffusion in various biological tissues help determine the contrast obtained in DWI. Although early research on the clinical role of DWI focused mainly on the field of neuroimaging, there are now more studies demonstrating the promising role DWI has in the diagnosis and monitoring of various osseous diseases. DWI has been shown to be useful in assessing a patient's skeletal tumour burden, monitoring the post-chemotherapy response of various bony malignancies, detecting hip ischaemia in patients with Legg-Calvé-Perthes disease, as well as determining the quality of repaired articular cartilage. Despite its relative successes, DWI has several limitations, including its limited clinical value in differentiating chondrosarcomas from benign bone lesions, as well as osteoporotic vertebral compression fractures from compression fractures due to malignancy. This literature review aims to provide an overview of the recent developments in the use of DWI in imaging the skeletal system, and to clarify the role of DWI in assessing various osseous diseases.
Collapse
|
63
|
Cook GJR, Azad G, Padhani AR. Bone imaging in prostate cancer: the evolving roles of nuclear medicine and radiology. Clin Transl Imaging 2016; 4:439-447. [PMID: 27933280 PMCID: PMC5118401 DOI: 10.1007/s40336-016-0196-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/21/2016] [Indexed: 01/01/2023]
Abstract
The bone scan continues to be recommended for both the staging and therapy response assessment of skeletal metastases from prostate cancer. However, it is widely recognised that bone scans have limited sensitivity for disease detection and is both insensitive and non-specific for determining treatment response, at an early enough time point to be clinically useful. We, therefore, review the evolving roles of nuclear medicine and radiology for this application. We have reviewed the published literature reporting recent developments in imaging bone metastases in prostate cancer, and provide a balanced synopsis of the state of the art. The development of single-photon emission computed tomography combined with computed tomography has improved detection sensitivity and specificity but has not yet been shown to lead to improvements in monitoring therapy. A number of bone-specific and tumour-specific tracers for positron emission tomography/computed tomography (PET/CT) are now available for advanced prostate cancer that show promise in both clinical settings. At the same time, the development of whole-body magnetic resonance imaging (WB-MRI) that incorporates diffusion-weighted imaging also offers significant improvements for detection and therapy response assessment. There are emerging data showing comparative SPECT/CT, PET/CT, and WB-MRI test performance for disease detection, but no compelling data on the usefulness of these technologies in response assessment have yet emerged.
Collapse
Affiliation(s)
- Gary J. R. Cook
- Division of Imaging Sciences and Biomedical Engineering, Department of Cancer Imaging, Clinical PET Centre, St Thomas’ Hospital, Kings College London, London, SE1 7EH UK
| | - Gurdip Azad
- Division of Imaging Sciences and Biomedical Engineering, Department of Cancer Imaging, Clinical PET Centre, St Thomas’ Hospital, Kings College London, London, SE1 7EH UK
| | - Anwar R. Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN UK
| |
Collapse
|
64
|
Garner HW, Kransdorf MJ. Musculoskeletal Sarcoma: Update on Imaging of the Post-treatment Patient. Can Assoc Radiol J 2016; 67:12-20. [DOI: 10.1016/j.carj.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 12/30/2022] Open
Abstract
Post-treatment imaging of musculoskeletal sarcoma remains challenging, but newer imaging techniques are improving our ability to recognize both local and distant recurrence and accurately distinguish local recurrence from post-treatment change. We review recent advances in dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping and positron emission tomography/computed tomography in the post-treatment follow-up of musculoskeletal sarcoma. We also describe our multidisciplinary sarcoma team approach to patient care and the essential role of the radiologist in the clinical follow-up scheme.
Collapse
|
65
|
Bhojwani N, Szpakowski P, Partovi S, Maurer MH, Grosse U, von Tengg-Kobligk H, Zipp-Partovi L, Fergus N, Kosmas C, Nikolaou K, Robbin MR. Diffusion-weighted imaging in musculoskeletal radiology-clinical applications and future directions. Quant Imaging Med Surg 2015; 5:740-53. [PMID: 26682143 DOI: 10.3978/j.issn.2223-4292.2015.07.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diffusion-weighted imaging (DWI) is an established diagnostic tool with regards to the central nervous system (CNS) and research into its application in the musculoskeletal system has been growing. It has been shown that DWI has utility in differentiating vertebral compression fractures from malignant ones, assessing partial and complete tears of the anterior cruciate ligament (ACL), monitoring tumor response to therapy, and characterization of soft-tissue and bone tumors. DWI is however less useful in differentiating malignant vs. infectious processes. As of yet, no definitive qualitative or quantitative properties have been established due to reasons ranging from variability in acquisition protocols to overlapping imaging characteristics. Even with these limitations, DWI can still provide clinically useful information, increasing diagnostic accuracy and improving patient management when magnetic resonance imaging (MRI) findings are inconclusive. The purpose of this article is to summarize recent research into DWI applications in the musculoskeletal system.
Collapse
Affiliation(s)
- Nicholas Bhojwani
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Peter Szpakowski
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Sasan Partovi
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Martin H Maurer
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Ulrich Grosse
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Hendrik von Tengg-Kobligk
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Lisa Zipp-Partovi
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Nathan Fergus
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Christos Kosmas
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Konstantin Nikolaou
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Mark R Robbin
- 1 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; 2 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA ; 3 Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Freiburgstrasse, Bern 3010, Switzerland ; 4 Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany ; 5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| |
Collapse
|
66
|
Subhawong TK, Jacobs MA, Fayad LM. Diffusion-weighted MR imaging for characterizing musculoskeletal lesions. Radiographics 2015; 34:1163-77. [PMID: 25208274 DOI: 10.1148/rg.345140190] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diffusion-weighted (DW) imaging is a functional magnetic resonance (MR) imaging technique that can readily be incorporated into a routine non-contrast material-enhanced MR imaging protocol with little additional scanning time. DW imaging is based on changes in the Brownian motion of water molecules caused by tissue microstructure. The apparent diffusion coefficient (ADC) is a quantitative measure of Brownian movement: Low ADC values typically reflect highly cellular microenvironments in which diffusion is restricted by the presence of cell membranes, whereas acellular regions allow free diffusion and result in elevated ADC values. Thus, with ADC mapping, one may derive useful quantitative information regarding the cellularity of a musculoskeletal lesion using a nonenhanced technique. The role of localized DW imaging in differentiating malignant from benign osseous and soft-tissue lesions is still evolving; when carefully applied, however, this modality has proved helpful in a subset of tumor types, such as nonmyxoid soft-tissue tumors. Studies of the use of DW imaging in assessing the treatment response of both osseous and soft-tissue tumors have shown that higher ADC values correlate with better response to cytotoxic therapy. Successful application of DW imaging in the evaluation of musculoskeletal lesions requires familiarity with potential diagnostic pitfalls that stem from technical artifacts and confounding factors unrelated to lesion cellularity. Further investigation is needed to evaluate the impact of DW imaging-ADC mapping on management and outcome in patients with musculoskeletal lesions.
Collapse
Affiliation(s)
- Ty K Subhawong
- From the Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136 (T.K.S.); and Sidney Kimmel Comprehensive Cancer Center (M.A.J., L.M.F.), Russell H. Morgan Department of Radiology and Radiological Science (M.A.J., L.M.F.), and Department of Orthopaedic Surgery (L.M.F.), Johns Hopkins Medical Institutions, Baltimore, Md
| | | | | |
Collapse
|
67
|
Liu LP, Cui LB, Zhang XX, Cao J, Chang N, Tang X, Qi S, Zhang XL, Yin H, Zhang J. Diagnostic Performance of Diffusion-weighted Magnetic Resonance Imaging in Bone Malignancy: Evidence From a Meta-Analysis. Medicine (Baltimore) 2015; 94:e1998. [PMID: 26559290 PMCID: PMC4912284 DOI: 10.1097/md.0000000000001998] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Current state-of-the-art nuclear medicine imaging methods (such as PET/CT or bone scintigraphy) may have insufficient sensitivity for predicting bone tumor, and substantial exposure to ionizing radiation is associated with the risk of secondary cancer development. Diffusion-weighted MRI (DW-MRI) is radiation free and requires no intravenous contrast media, and hence is more suitable for population groups that are vulnerable to ionizing radiation and/or impaired renal functions. This meta-analysis was conducted to investigate whether whole-body DW-MRI is a viable means in differentiating bone malignancy. Medline and Embase databases were searched from their inception to May 2015 without language restriction for studies evaluating DW-MRI for detection of bone lesions. Methodological quality was assessed by the quality assessment of diagnostic studies (QUADAS-2) instrument. Sensitivities, specificities, diagnostic odds ratio (DOR), and areas under the curve (AUC) were used as measures of the diagnostic accuracy. We combined the effects by using the random-effects mode. Potential threshold effects and publication bias were investigated. We included data from 32 studies with 1507 patients. The pooled sensitivity, specificity, and AUC were 0.95 (95% CI, 0.90-0.97), 0.92 (95% CI, 0.88-0.95), and 0.98 on a per-patient basis, and they were 0.91 (95% CI, 0.87-0.94), 0.94 (95% CI, 0.90-0.96), and 0.97 on a per-lesion basis. In subgroup analysis, there is no statistical significance found in the sensitivity and specificity of using DWI only and DWI combined with other morphological or functional imaging sequence in both basis (P > 0.05). A b value of 750 to 1000 s/mm enables higher AUC and DOR for whole-body imaging purpose when compared with other values in both basis either (P < 0.01). The ROC space did not show a curvilinear trend of points and a threshold effect was not observed. According to the Deek's plots, there was no publication bias on both basis. Our results support the use of DWI as an effective means for distinguishing malignant bone lesions; however, various imaging parameters need to be standardized prior to its broad use in clinical practice.
Collapse
Affiliation(s)
- Li-Peng Liu
- From the Department of Respiratory Medicine (L-PL, X-XZ, JC, NC, JZ); Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China (L-BC, XT, SQ, HY); and Department of Radiology, University of California, San Francisco, California (X-LZ)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
68
|
Barnes SL, Sorace AG, Loveless ME, Whisenant JG, Yankeelov TE. Correlation of tumor characteristics derived from DCE-MRI and DW-MRI with histology in murine models of breast cancer. NMR IN BIOMEDICINE 2015; 28:1345-56. [PMID: 26332194 PMCID: PMC4573954 DOI: 10.1002/nbm.3377] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 05/04/2023]
Abstract
The purpose of this work was to determine the relationship between the apparent diffusion coefficient (ADC, from diffusion-weighted (DW) MRI), the extravascular, extracellular volume fraction (ve , from dynamic contrast-enhanced (DCE) MRI), and histological measurement of the extracellular space fraction. Athymic nude mice were injected with either human epidermal growth factor receptor 2 positive (HER2+) BT474 (n = 15) or triple negative MDA-MB-231 (n = 20) breast cancer cells, treated with either Herceptin (n = 8), Abraxane (low dose n = 7, high dose n = 6), or saline (n = 7 for each cell line), and imaged using DW- and DCE-MRI before, during, and after treatment. After the final imaging acquisition, the tissue was resected and evaluated by histological analysis. H&E-stained central slices were scanned using a digital brightfield microscope and evaluated with thresholding techniques to calculate the extracellular space. For both BT474 and MDA-MB-231, the median ADC of the central slice exhibited a significantly positive correlation with the corresponding central slice extracellular space as measured by H&E (p = 0.03, p < 0.01, respectively). Median ve calculated from the central slice showed differing results between the two cell lines. For BT474, a significant correlation between ve and extracellular space was calculated (p = 0.02), while MDA-MB-231 tumors did not demonstrate a significant correlation (p = 0.64). Additionally, there was no correlation discovered between ADC and ve with either whole tumor analysis or central slice analysis (p > 0.05). While ADC correlates well with the histologically determined fraction of extracellular space, these data add to the growing body of literature that suggests that ve derived from DCE-MRI is not a reliable biomarker of extracellular space for a range of physiological conditions.
Collapse
Affiliation(s)
- Stephanie L. Barnes
- Vanderbilt Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Anna G. Sorace
- Vanderbilt Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Mary E. Loveless
- Vanderbilt Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Jennifer G. Whisenant
- Vanderbilt Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Thomas E. Yankeelov
- Vanderbilt Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA
| |
Collapse
|
69
|
Bonaffini PA, Ippolito D, Casiraghi A, Besostri V, Franzesi CT, Sironi S. Apparent diffusion coefficient maps integrated in whole-body MRI examination for the evaluation of tumor response to chemotherapy in patients with multiple myeloma. Acad Radiol 2015; 22:1163-71. [PMID: 26182979 DOI: 10.1016/j.acra.2015.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the diagnostic value of apparent diffusion coefficient (ADC) maps in the assessment of response to chemotherapy in patients with multiple myeloma (MM). MATERIALS AND METHODS Fourteen patients (seven women) with MM underwent whole-body magnetic resonance imaging (WB-MRI) study on a 1.5T scanner, before and after chemotherapy. DWI with background body signal suppression (DWIBS) sequences (b values: 0, 500, and 1000 mm(2)/sec) were qualitatively analyzed, along with T1 turbo spine echo and short tau inversion recovery T2-weighted images, to evaluate bone lesions. On ADC maps, regions of interest were manually drawn along contours of lesions. The ADC values percentage variation (ΔADC) before (MR1) and after (MR2) chemotherapy were calculated and compared between responders (11 of 14) and nonresponders (3 of 14). The percentage of plasma cells by the means of the bone marrow aspirate was evaluated as parameter for response to chemotherapy. RESULTS Twenty-four lesions, hyperintense on DWIBS as compared to normal bone marrow, were evaluated. In responder group, the mean ADC values were 0.63 ± 0.24 × 10(-3) mm(2)/s on MR1 and 1.04 ± 0.46 × 10(-3) mm(2)/s on MR2; partial or complete signal intensity decrease during follow-up on DWIBS was found along with a reduction of plasma cells infiltration in the bone marrow. The mean ADC values for nonresponders were 0.61 ± 0.05 × 10(-3) mm(2)/s on MR1 and 0.69 ± 0.09 × 10(-3) mm(2)/s on MR2. The mean variation of ΔADC in responders (Δ = 66%) was significantly different (P < .05) than in nonresponders (Δ = 15%). CONCLUSIONS WB-MRI with DWIBS sequences, by evaluating posttreatment changes of ADC values, might represent a complementary diagnostic tool in the assessment of response to chemotherapy in MM patients.
Collapse
Affiliation(s)
- Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy; Department of Health Sciences, Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy.
| | - Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| | - Alessandra Casiraghi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| | - Valeria Besostri
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| | - Cammillo Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| |
Collapse
|
70
|
Amit P, Malhotra A, Kumar R, Kumar L, Patro DK, Elangovan S. Evaluation of static and dynamic MRI for assessing response of bone sarcomas to preoperative chemotherapy: Correlation with histological necrosis. Indian J Radiol Imaging 2015; 25:269-75. [PMID: 26288521 PMCID: PMC4531451 DOI: 10.4103/0971-3026.161452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Preoperative chemotherapy plays a key role in management of bone sarcomas. Postoperative evaluation of histological necrosis has been the gold standard method of assessing response to preoperative chemotherapy. This study was done to evaluate the efficacy of static and dynamic magnetic resonance imaging (MRI) for assessing response preoperatively. MATERIALS AND METHODS Our study included 14 patients (12 osteosarcomas and 2 malignant fibrous histiocytomas) with mean age of 21.8 years, treated with preoperative chemotherapy followed by surgery. They were evaluated with static and dynamic MRI twice, before starting chemotherapy and again prior to surgery. Change in tumor volume and slope of signal intensity - time curve were calculated and correlated with percentage of histological necrosis using Pearson correlation test. RESULTS The change in dynamic MRI slope was significant (P = 0.001). Also, ≥60% reduction in slope of the curve proved to be an indicator of good histological response [positive predictive value (PPV) =80%]. Change in tumor volume failed to show significant correlation (P = 0.071). Although it showed high negative predictive value (NPV = 85.7%), PPV was too low (PPV = 57.14%). CONCLUSIONS Dynamic MRI correctly predicts histological necrosis after administration of preoperative chemotherapy to bone sarcomas. Hence, it can be used as a preoperative indicator of response to neoadjuvant chemotherapy. On the other hand, volumetric assessment by static MRI is not an effective predictor of histological necrosis. This study proves the superiority of dynamic contrast-enhanced study over volumetric study by MRI.
Collapse
Affiliation(s)
- Priyadarshi Amit
- Department of Orthopaedics, Max Super Speciality Hospital, New Delhi, India
| | - Atul Malhotra
- Department of Orthopaedics, Sport Injury Centre, Safdarjung Hospital, New Delhi, India
| | - Rahul Kumar
- Department of Orthopaedics, Sport Injury Centre, Safdarjung Hospital, New Delhi, India
| | - Lokesh Kumar
- Department of Radiodiagnosis, Sport Injury Centre, Safdarjung Hospital, New Delhi, India
| | - Dilip Kumar Patro
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Sundar Elangovan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| |
Collapse
|
71
|
Diffusion MRI with Semi-Automated Segmentation Can Serve as a Restricted Predictive Biomarker of the Therapeutic Response of Liver Metastasis. Magn Reson Imaging 2015; 33:1267-1273. [PMID: 26284600 DOI: 10.1016/j.mri.2015.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/13/2015] [Accepted: 08/08/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the value of semi-automated segmentation applied to diffusion MRI for predicting the therapeutic response of liver metastasis. METHODS Conventional diffusion weighted magnetic resonance imaging (MRI) was performed using b-values of 0, 150, 300 and 450s/mm(2) at baseline and days 4, 11 and 39 following initiation of a new chemotherapy regimen in a pilot study with 18 women with 37 liver metastases from primary breast cancer. A semi-automated segmentation approach was used to identify liver metastases. Linear regression analysis was used to assess the relationship between baseline values of the apparent diffusion coefficient (ADC) and change in tumor size by day 39. RESULTS A semi-automated segmentation scheme was critical for obtaining the most reliable ADC measurements. A statistically significant relationship between baseline ADC values and change in tumor size at day 39 was observed for minimally treated patients with metastatic liver lesions measuring 2-5cm in size (p=0.002), but not for heavily treated patients with the same tumor size range (p=0.29), or for tumors of smaller or larger sizes. ROC analysis identified a baseline threshold ADC value of 1.33μm(2)/ms as 75% sensitive and 83% specific for identifying non-responding metastases in minimally treated patients with 2-5cm liver lesions. CONCLUSION Quantitative imaging can substantially benefit from a semi-automated segmentation scheme. Quantitative diffusion MRI results can be predictive of therapeutic outcome in selected patients with liver metastases, but not for all liver metastases, and therefore should be considered to be a restricted biomarker.
Collapse
|
72
|
Reynaud O, Winters KV, Hoang DM, Wadghiri YZ, Novikov DS, Kim SG. Surface-to-volume ratio mapping of tumor microstructure using oscillating gradient diffusion weighted imaging. Magn Reson Med 2015. [PMID: 26207354 DOI: 10.1002/mrm.25865] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To disentangle the free diffusivity (D0 ) and cellular membrane restrictions, by means of their surface-to-volume ratio (S/V), using the frequency-dependence of the diffusion coefficient D(ω), measured in brain tumors in the short diffusion-time regime using oscillating gradients (OGSE). METHODS In vivo and ex vivo OGSE experiments were performed on mice bearing the GL261 murine glioma model (n = 10) to identify the relevant time/frequency (t/ω) domain where D(ω) linearly decreases with ω(-1/2) . Parametric maps (S/V, D0 ) are compared with conventional DWI metrics. The impact of frequency range and temperature (20°C versus 37°C) on S/V and D0 is investigated ex vivo. RESULTS The validity of the short diffusion-time regime is demonstrated in vivo and ex vivo. Ex vivo measurements confirm that the purely geometric restrictions embodied in S/V are independent from temperature and frequency range, while the temperature dependence of the free diffusivity D0 is similar to that of pure water. CONCLUSION Our results suggest that D(ω) in the short diffusion-time regime can be used to uncouple the purely geometric restriction effect, such as S/V, from the intrinsic medium diffusivity properties, and provides a nonempirical and objective way to interpret frequency/time-dependent diffusion changes in tumors in terms of objective biophysical tissue parameters. Magn Reson Med 76:237-247, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Olivier Reynaud
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, New York, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Kerryanne Veronica Winters
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, New York, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Dung Minh Hoang
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, New York, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Youssef Zaim Wadghiri
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, New York, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Dmitry S Novikov
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, New York, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Sungheon Gene Kim
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, New York, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| |
Collapse
|
73
|
Abstract
Multiple nonmorphologic magnetic resonance sequences are available in musculoskeletal imaging that can provide additional information to better characterize and diagnose musculoskeletal disorders and diseases. These sequences include blood-oxygen-level-dependent (BOLD), arterial spin labeling (ASL), diffusion-weighted imaging (DWI), and diffusion-tensor imaging (DTI). BOLD and ASL provide different methods to evaluate skeletal muscle microperfusion. The BOLD signal reflects the ratio between oxyhemoglobin and deoxyhemoglobin. ASL uses selective tagging of inflowing blood spins in a specific region for calculating local perfusion. DWI and DTI provide information about the structural integrity of soft tissue including muscles and fibers as well as pathologies.
Collapse
|
74
|
Woolf DK, Padhani AR, Makris A. Assessing response to treatment of bone metastases from breast cancer: what should be the standard of care? Ann Oncol 2015; 26:1048-1057. [PMID: 25471332 DOI: 10.1093/annonc/mdu558] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/13/2014] [Indexed: 01/09/2023] Open
Abstract
Bone is the most common site for breast cancer metastases, occurring in up to 70% of those with metastatic disease. In order to effectively manage these patients, it is essential to have consistent, reproducible and validated methods of assessing response to therapy. We present current clinical practice of imaging response assessment of bone metastases. We also review the biology of bone metastases and measures of response assessment including clinical assessment, tumour markers and imaging techniques; bone scans (BSs), computed tomography (CT), positron emission tomography, magnetic resonance imaging (MRI) and whole-body diffusion-weighted MRI (WB DW-MRI). The current standard of care of BSs and CT has significant limitations and are not routinely recommended for the purpose of response assessment in the bones. WB DW-MRI has the potential to address this unmet need and should be evaluated in clinical trials.
Collapse
Affiliation(s)
- D K Woolf
- Breast Cancer Research Unit, Mount Vernon Cancer Centre, Northwood.
| | - A R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - A Makris
- Breast Cancer Research Unit, Mount Vernon Cancer Centre, Northwood
| |
Collapse
|
75
|
Chen Y, Ren W, Zheng D, Zhong J, Liu X, Yue Q, Liu M, Xiao Y, Chen W, Chan Q, Pan J. Diffusion kurtosis imaging predicts neoadjuvant chemotherapy responses within 4 days in advanced nasopharyngeal carcinoma patients. J Magn Reson Imaging 2015; 42:1354-61. [PMID: 25873208 DOI: 10.1002/jmri.24910] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To explore the clinical value of diffusion kurtosis imaging (DKI) and monoexponential diffusion-weighted imaging (DWI) for predicting early response to neoadjuvant chemotherapy (NAC) in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS Fifty-nine patients with stage III-IVb NPC underwent four 3.0T MR scans: prior to, and on the 4th, 21st, 42nd days after NAC initiation. The parameters of DKI (corrected diffusion coefficient, D; excess diffusion kurtosis coefficient, K) and monoexponential DWI (apparent diffusion coefficient, ADC) were obtained at the first three scans. Statistical methods included Student's t-test or Mann-Whitney U-test, receiver operating characteristic (ROC) curve analyses and paired X(2) test. RESULTS D(pre) in responders group (RG) was significantly lower than nonresponders group (NRG) (1.029 ± 0.033 vs. 1.184 ± 0.055, ×10(-3) mm(2) /s, P = 0.020). ADC(day4) and ΔD(day4) were the most useful parameters of the two diffusional models to distinguish RG from NRG, respectively (area under the curve, 0.761 vs. 0.895). ΔD(day4) was more sensitive than ADC(day4) to predict treatment response to NAC (P = 0.006). CONCLUSION Both DKI and monoexponential DWI showed potential to predict treatment response to NAC prior to morphological change. DKI may be superior to monoexponential DWI for predicting early response to NAC in patients with locally advanced NPC.
Collapse
Affiliation(s)
- Yunbin Chen
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China.,Department of Radiology, First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Wang Ren
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China
| | - Dechun Zheng
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China.,Department of Radiology, First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Jing Zhong
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China
| | - Xiangyi Liu
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China
| | - Qiuyuan Yue
- Department of Radiology, First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Meng Liu
- Department of Radiology, First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Youping Xiao
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China
| | - Weibo Chen
- Philips Healthcare, Shanghai, People's Republic of China
| | - Queenie Chan
- Philips Healthcare, Hong Kong, People's Republic of China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China
| |
Collapse
|
76
|
Diffusion-weighted imaging and dynamic contrast-enhanced MRI of experimental breast cancer bone metastases – A correlation study with histology. Eur J Radiol 2015; 84:623-30. [DOI: 10.1016/j.ejrad.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022]
|
77
|
Toledano-Massiah S, Luciani A, Itti E, Zerbib P, Vignaud A, Belhadj K, Baranes L, Haioun C, Lin C, Rahmouni A. Whole-Body Diffusion-weighted Imaging in Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma. Radiographics 2015; 35:747-64. [PMID: 25815803 DOI: 10.1148/rg.2015140145] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Whole-body imaging, in particular molecular imaging with fluorine 18 ((18)F)-fluorodeoxyglucose (FDG) positron emission tomography (PET), is essential to management of lymphoma. The assessment of disease extent provided by use of whole-body imaging is mandatory for planning appropriate treatment and determining patient prognosis. Assessment of treatment response allows clinicians to tailor the treatment strategy during therapy if necessary and to document complete remission at the end of treatment. Because of rapid technical developments, such as echo-planar sequences, parallel imaging, multichannel phased-array surface coils, respiratory gating, and moving examination tables, whole-body diffusion-weighted (DW) magnetic resonance (MR) imaging that reflects cell density is now feasible in routine clinical practice. Whole-body DW MR imaging allows anatomic assessment as well as functional and quantitative evaluation of tumor sites by calculation of the apparent diffusion coefficient (ADC). Because of their high cellularity and high nucleus-to-cytoplasm ratio, lymphomatous lesions have low ADC values and appear hypointense on ADC maps. As a result, whole-body DW MR imaging with ADC mapping has become a promising tool for lymphoma staging and treatment response assessment. The authors review their 4 years of experience with 1.5-T and 3-T whole-body DW MR imaging used with (18)F-FDG PET/computed tomography at baseline, interim, and end of treatment in patients with Hodgkin lymphoma and diffuse large B-cell lymphoma and discuss the spectrum of imaging findings and potential pitfalls, limitations, and challenges associated with whole-body DW MR imaging in these patients.
Collapse
Affiliation(s)
- Sarah Toledano-Massiah
- From the Department of Medical Imaging (S.T.M., A.L., P.Z., L.B., A.R.), Department of Nuclear Medicine (E.I., L.B.), and Lymphoproliferative Unit (K.B., C.H.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France; Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.L., E.I., L.B., C.H., A.R.); Neurospin, CEA, Saclay, France (A.V.); and Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Gueishan, Taiwan (C.L.)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Bufi E, Belli P, Costantini M, Cipriani A, Di Matteo M, Bonatesta A, Franceschini G, Terribile D, Mulé A, Nardone L, Bonomo L. Role of the Apparent Diffusion Coefficient in the Prediction of Response to Neoadjuvant Chemotherapy in Patients With Locally Advanced Breast Cancer. Clin Breast Cancer 2015; 15:370-80. [PMID: 25891905 DOI: 10.1016/j.clbc.2015.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/29/2015] [Accepted: 02/17/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND We evaluated the diagnostic performance of the baseline diffusion weighted imaging (DWI) and the apparent diffusion coefficient (ADC) in the prediction of a complete pathologic response (pCR) to neoadjuvant chemotherapy (NAC) in patients with breast cancer stratified according to the tumor phenotype. PATIENTS AND METHODS We retrospectively studied 225 patients with stage II, III, and IV breast cancer who had undergone contrast-enhanced magnetic resonance imaging (MRI) and DWI before and after NAC, followed by breast surgery. RESULTS The tumor phenotypes were luminal (n = 143; 63.6%), triple-negative (TN) (n = 37; 16.4%), human epidermal growth factor receptor 2 (HER2)-enriched (n = 17; 7.6%), and hybrid (hormone receptor-positive/HER2(+); n = 28; 12.4%). After NAC, a pCR was observed in 39 patients (17.3%). No statistically significant difference was observed in the mean ADC value between a pCR and no pCR in the general population (1.132 ± 0.191 × 10(-3) mm(2)/s vs. 1.092 ± 0.189 × 10(-3) mm(2)/s, respectively; P = .23). The optimal ADC cutoff value in the general population was 0.975 × 10(-3) mm(2)/s (receiver operating characteristic [ROC] area under the curve [AUC], 0.587 for the prediction of a pCR). After splitting the population into subgroups according to tumor phenotype, we observed a significant or nearly significant difference in the mean ADC value among the responders versus the nonresponders in the TN (P = .06) and HER2(+) subgroups (P = .05). No meaningful difference was seen in the luminal and hybrid subgroups (P = .59 and P = .53, respectively). In contrast, in the TN and HER2(+) subgroups (cutoff value, 0.995 × 10(-3) mm(2)/s and 0.971 × 10(-3) mm(2)/s, respectively), we observed adequate ROC AUCs (0.766 and 0.813, respectively). CONCLUSION The pretreatment ADC value is not capable of predicting the pCR in the overall population of patients with locally advanced breast cancer. Nonetheless, an ameliorated diagnostic performance was observed in specific phenotype subgroups (ie, TN and HER2(+) tumors).
Collapse
Affiliation(s)
- Enida Bufi
- Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy.
| | - Paolo Belli
- Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Melania Costantini
- Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Antonio Cipriani
- Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Marialuisa Di Matteo
- Department of Pathology, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Angelo Bonatesta
- Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Gianluca Franceschini
- Department of Surgery, Breast Unit, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Daniela Terribile
- Department of Surgery, Breast Unit, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Antonino Mulé
- Department of Pathology, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Luigia Nardone
- Department of Radiotherapy, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy
| |
Collapse
|
79
|
Nomori H, Cong Y, Sugimura H, Kato Y. Comparing diffusion-weighted imaging and positron emission tomography for pulmonary nodules measuring from 1 to 3 cm in size. Surg Today 2015; 45:1535-41. [DOI: 10.1007/s00595-015-1117-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/17/2014] [Indexed: 11/28/2022]
|
80
|
Messina C, Christie D, Zucca E, Gospodarowicz M, Ferreri AJM. Primary and secondary bone lymphomas. Cancer Treat Rev 2015; 41:235-46. [PMID: 25698636 DOI: 10.1016/j.ctrv.2015.02.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/20/2015] [Accepted: 02/01/2015] [Indexed: 12/24/2022]
Abstract
Recent studies have contributed to the enhancement of clinical and molecular knowledge on bone lymphomas, a group of rare malignancies with particular characteristics. Nevertheless, several questions remain unanswered and the level of evidence supporting some diagnostic and therapeutic decisions remains low. Currently, three different forms of bone lymphomas can be distinguished: the primary bone lymphoma, consisting of a single bone lesion with or without regional lymphadenopathies; the polyostotic lymphoma, consisting of multifocal disease exclusively involving the skeleton; and the disseminated lymphoma with secondary infiltration of the skeleton. The first two forms exhibit a good prognosis, requiring treatments similar to those commonly used for nodal lymphomas of the same category, but several issues regarding the role of surgery and local control of the disease, the sequence of treatment, radiation volumes and doses, management of pathological fractures and prevention of late sequelae deserve particular attention. Due to its rarity, prospective trials exclusively focused on bone lymphomas appear unrealistic, thus, critical revision of our own experience and analyses of large cumulative series as well as molecular studies on archival cases remain valid alternatives to improve our knowledge on this obscure lymphoproliferative malignancy. The present review is based on the analysis of the largest available database of bone lymphomas established under the sponsorship of the International Extranodal Lymphoma Study Group (IELSG) as well as on the critical revision of related literature. We provide recommendations for diagnosis, staging, treatment, and response assessment of these patients in everyday practice as well as for the management of special conditions like pathological fractures, indolent forms and central nervous system prophylaxis.
Collapse
Affiliation(s)
- Carlo Messina
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy
| | - David Christie
- Genesiscare and Bond University, Inland Dr., Tugun, QLD, Australia
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mary Gospodarowicz
- Department of Radiation Oncology, Princess Margaret Hospital, Ontario Cancer Institute, Toronto, ON, Canada
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
81
|
Nomori H, Cong Y, Abe M, Sugimura H, Kato Y. Diffusion-weighted magnetic resonance imaging in preoperative assessment of non-small cell lung cancer. J Thorac Cardiovasc Surg 2015; 149:991-6. [PMID: 25686657 DOI: 10.1016/j.jtcvs.2015.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 12/30/2014] [Accepted: 01/10/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DWI) frequently shows heterogeneity of signal intensity (SI) in non-small cell lung cancer (NSCLC). The purpose of our study was to examine the association of SI and DWI patterns with histology, tumor invasiveness, lymph node metastasis, and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) uptake in NSCLC. METHODS One hundred forty-five patients with NSCLC underwent preoperative DWI and FDG-PET. DWI patterns were visually classified as homogenous (HOM) (n = 81) or heterogeneous (HET) (n = 64). The former was further classified as faint (faint-HOM) (n = 27) or dark (dark-HOM) (n = 54) according to a cutoff value of SI. Associations of SI and DWI patterns with tumor histology, lymphatic or vascular invasion, pleural invasion, lymph node metastasis, and FDG uptake were evaluated. RESULTS All faint-HOM tumors were well-differentiated adenocarcinoma, whereas dark-HOM and HET tumors were less-differentiated adenocarcinoma or non adenocarcinoma. Although the dark areas in HET tumors showed a dense aggregation of tumor cells, their faint areas showed abundant fibrovascular stroma or necrosis, or a well-differentiated part of adenocarcinoma. Tumor size and the frequencies of lymphatic or vascular invasion, pleural invasion, and nodal metastasis were highest in HET tumors, followed by dark-HOM and faint-HOM (P = .1-P < .001) tumors. Sixty-five tumors having at least 1 of the invasions or metastasis showed significantly higher SI than the 81 tumors without (P < .001). HET tumors had the highest FDG uptake, followed by dark-HOM and faint-HOM tumors; differences between the groups were significant (P < .01 to P < .001). CONCLUSIONS The SI and heterogeneity of DWI reflect the histologic heterogeneity, tumor aggressiveness, and FDG-PET uptake in NSCLC.
Collapse
Affiliation(s)
- Hiroaki Nomori
- Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan.
| | - Yue Cong
- Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan
| | - Masaru Abe
- Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Sugimura
- Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan
| | - Yoshiaki Kato
- Department of Diagnostic Radiology, Kameda Medical Center, Chiba, Japan
| |
Collapse
|
82
|
Silva FD, Pinheiro L, Cristofano C, de Oliveira Schiavon JL, Lederman HM. Magnetic Resonance Imaging in Pediatric Bone Tumors. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0077-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
83
|
Cuneo KC, Chenevert TL, Ben-Josef E, Feng MU, Greenson JK, Hussain HK, Simeone DM, Schipper MJ, Anderson MA, Zalupski MM, Al-Hawary M, Galban CJ, Rehemtulla A, Feng FY, Lawrence TS, Ross BD. A pilot study of diffusion-weighted MRI in patients undergoing neoadjuvant chemoradiation for pancreatic cancer. Transl Oncol 2014; 7:644-9. [PMID: 25389460 PMCID: PMC4225651 DOI: 10.1016/j.tranon.2014.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 12/16/2022] Open
Abstract
PURPOSE: In the current study we examined the ability of diffusion MRI (dMRI) to predict pathologic response in pancreatic cancer patients receiving neoadjuvant chemoradiation. METHODS: We performed a prospective pilot study of dMRI in patients with resectable pancreatic cancer. Patients underwent dMRI prior to neoadjuvant chemoradiation. Surgical specimens were graded according to the percent tumor cell destruction. Apparent diffusion coefficient (ADC) maps were used to generate whole-tumor derived ADC histogram distributions and mean ADC values. The primary objective of the study was to correlate ADC parameters with pathologic and CT response. RESULTS: Ten of the 12 patients enrolled on the study completed chemoradiation and had surgery. Three were found to be unresectable at the time of surgery and no specimen was obtained. Out of the 7 patients who underwent pancreaticoduodenectomy, 3 had a grade III histopathologic response (> 90% tumor cell destruction), 2 had a grade IIB response (51% to 90% tumor cell destruction), 1 had a grade IIA response (11% to 50% tumor cell destruction), and 1 had a grade I response (> 90% viable tumor). Median survival for patients with a grade III response, grade I-II response, and unresectable disease were 25.6, 18.7, and 6.1 months, respectively. There was a significant correlation between pre-treatment mean tumor ADC values and the amount of tumor cell destruction after chemoradiation with a Pearson correlation coefficient of 0.94 (P = .001). Mean pre-treatment ADC was 161 × 10− 5 mm2/s (n = 3) in responding patients (> 90% tumor cell destruction) compared to 125 × 10− 5 mm2/s (n = 4) in non-responding patients (> 10% viable tumor). CT imaging showed no significant change in tumor size in responders or non-responders. CONCLUSIONS: dMRI may be useful to predict response to chemoradiation in pancreatic cancer. In our study, tumors with a low ADC mean value at baseline responded poorly to standard chemoradiation and would be candidates for intensified therapy.
Collapse
Affiliation(s)
- Kyle C Cuneo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI ; Department of Radiation Oncology, Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI
| | | | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Mary U Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Joel K Greenson
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Hero K Hussain
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Diane M Simeone
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Michelle A Anderson
- Department of Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI
| | - Mark M Zalupski
- Department of Medicine-Oncology, University of Michigan, Ann Arbor, MI
| | | | - Craig J Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI ; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
| | | | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Brian D Ross
- Department of Radiology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
84
|
Insights into quantitative diffusion-weighted MRI for musculoskeletal tumor imaging. AJR Am J Roentgenol 2014; 203:560-72. [PMID: 25148158 DOI: 10.2214/ajr.13.12165] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purposes of this article are to discuss the technical considerations for performing quantitative diffusion-weighted MRI (DWI) with apparent diffusion coefficient (ADC) mapping, examine the role of DWI in whole-body MRI, and review how DWI with ADC mapping can serve as an adjunct to information gleaned from conventional MRI in the radiologic evaluation of musculoskeletal lesions. CONCLUSION The primary role of whole-body DWI is in tumor detection; localized DWI is helpful in differentiating malignant bone and soft-tissue lesions. After treatment, an increase in tumor ADC values correlates with response to cytotoxic therapy. The use of DWI in the evaluation of musculoskeletal lesions requires knowledge of potential diagnostic pitfalls that stem from technical challenges and confounding biochemical factors that influence ADC maps but are unrelated to lesion cellularity.
Collapse
|
85
|
Nascimento D, Suchard G, Hatem M, de Abreu A. The role of magnetic resonance imaging in the evaluation of bone tumours and tumour-like lesions. Insights Imaging 2014; 5:419-40. [PMID: 25005774 PMCID: PMC4141345 DOI: 10.1007/s13244-014-0339-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 05/11/2014] [Accepted: 05/20/2014] [Indexed: 01/21/2023] Open
Abstract
UNLABELLED Bone tumours and tumour-like lesions are frequently encountered by radiologists. Although radiographs are the primary screening technique, magnetic resonance imaging (MRI) can help narrow the differential or make a specific diagnosis when a lesion is indeterminate or shows signs of aggressiveness. MRI can extend the diagnostic evaluation by demonstrating several tissue components. Even when a specific diagnosis cannot be made, the differential diagnosis can be narrowed. MRI is superior to the other imaging modalities in detecting bone marrow lesions and tumoral tissue (faint lytic/sclerotic bone lesions can be difficult to visualise using only radiographs). Contrast-enhanced MRI can reveal the most vascularised parts of the tumour and MRI guidance makes it possible to avoid biopsing necrotic areas. MRI is very helpful in local staging and surgical planning by assessing the degree of intramedullary extension and invasion of the adjacent physeal plates, joints, muscle compartments and neurovascular bundles. It can be used in assessing response to neoadjuvant therapy and further restaging. The post-therapeutic follow-up should also be done using MRI. Despite the high quality of MRI, there are a few pitfalls and limitations of which one should be aware. Applications of MRI in bone tumours will probably continue to grow as new sequences are further studied. TEACHING POINTS • When a lesion is indeterminate or shows signs of aggressiveness, MRI is indicated. • When MRI does not lead to a diagnosis, biopsy is indicated. • MRI is superior to the other imaging modalities in detecting bone marrow lesions. • MRI is very helpful in local staging and surgical planning. • MRI is used in assessing the response to neoadjuvant therapy, restaging and post-therapeutic follow-up.
Collapse
Affiliation(s)
- Duarte Nascimento
- Serviço de Imagiologia do Serviço de Saúde da Região Autónoma da Madeira, Avenida Luís de Camões, nº 57, 9004-514 Funchal, Portugal
| | - Guilherme Suchard
- Serviço de Radiologia do Hospital Mãe de Deus, Rua José de Alencar, 286, Menino Deus, Porto Alegre, RS, 90880-480 Brazil
| | - Maruan Hatem
- Serviço de Radiologia do Hospital Mãe de Deus, Rua José de Alencar, 286, Menino Deus, Porto Alegre, RS, 90880-480 Brazil
| | - Armando de Abreu
- Serviço de Radiologia do Hospital Mãe de Deus, Rua José de Alencar, 286, Menino Deus, Porto Alegre, RS, 90880-480 Brazil
| |
Collapse
|
86
|
Kotb SZ, Sultan AA, Elhawary GM, Taman SE. Value of diffusion weighted MRI in differentiating benign from malignant bony tumors and tumor like lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
87
|
Baunin C, Sanmartin-Viron D, Accadbled F, Sans N, Vial J, Labarre D, Domenech C, Sales de Gauzy J. Prognosis value of early diffusion MRI in Legg Perthes Calvé disease. Orthop Traumatol Surg Res 2014; 100:317-21. [PMID: 24725906 DOI: 10.1016/j.otsr.2013.12.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/29/2013] [Accepted: 12/13/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate diffusion MRI of the proximal femoral epiphysis and metaphysis as a prognosis factor in Legg Calvé Perthes (LCP) disease. METHODS Thirty-one children (mean age 5.5 years, range 2.5-10.5) with unilateral LCP were included in a prospective, consecutive series. Radiographs were analysed and classified as per Herring criteriae. Mean follow-up was 19 months (range 6-30). Forty-nine MRI scans were performed at either the condensation or fragmentation stage. Apparent Diffusion Coefficient (ADC) of both the femoral epiphysis and metaphysis were measured bilaterally and ADC ratio were calculated, then compared to the Herring group. RESULTS Sixteen hips were rated Herring A or B, 3 Herring B-C and 12 Herring C. ADC was increased in affected hips compared to unaffected sides, both at the femoral epiphysis (P<0.001) and metaphysis (P<0.0001). ADC ratio of the femoral metaphysis was positively correlated to Herring classification: if superior to 1.63, it was associated with a bad prognosis (Herring B-C or C) (P=0.0017, sensitivity=89%, specificity=58%). Interobserver reliability of ADC measurement was excellent. The 1.63 threshold could be determined as early as the condensation stage. CONCLUSIONS Diffusion presents several advantages including being non radiating and non invasive. It does not need contrast medium administration and it can be performed without anaesthesia. The origin of the increased ADC remains unknown. Basically, it reflects molecular changes (true diffusion) but it is also influenced by the vascular supply (pseudo-diffusion). ADC ratio could provide an early prognosis before Herring classification is applicable. LEVEL OF EVIDENCE Level III. Prospective uncontrolled study.
Collapse
Affiliation(s)
- C Baunin
- Department of Paediatric Imaging, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France
| | - D Sanmartin-Viron
- Department of Paediatric Imaging, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France
| | - F Accadbled
- Department of Paediatric Orthopaedic Surgery, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France.
| | - N Sans
- Department of Paediatric Imaging, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France
| | - J Vial
- Department of Paediatric Imaging, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France
| | - D Labarre
- Department of Paediatric Imaging, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France
| | - C Domenech
- Department of Paediatric Imaging, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France
| | - J Sales de Gauzy
- Department of Paediatric Orthopaedic Surgery, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France
| |
Collapse
|
88
|
Wang L, Han C, Zhu S, Shi G, Wang Q, Tian H, Kong J, Zhang A. Investigation of using diffusion-weighted magnetic resonance imaging to evaluate the therapeutic effect of esophageal carcinoma treatment. Oncol Res Treat 2014; 37:112-6. [PMID: 24685914 DOI: 10.1159/000360210] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022]
Abstract
AIM To explore the associations of diffusion-weighted magnetic resonance imaging (DWI) measurements with the therapeutic effect (TE) on and survival of esophageal carcinoma patients treated with chemoradiotherapy (CRT). METHODS From March 2010 to December 2011, 77 patients were prospectively enrolled into a cohort study. DWI was performed at the beginning and 1-3 months after CRT. The immediate post-CRT TE was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST). The associations between the disappearance status of hyperintense expression (HE) in DWI and the apparent diffusion coefficient (ADC) of DWI with the complete response (CR) as TE and survival were analyzed. RESULTS 3 patients were excluded due to the absence of HE in DWI. Analysis of the remaining 74 patients indicated that their ADC values were significantly improved from 1.64 ± 0.48 to 2.65 ± 0.58 mm2/s from pre-CRT to post-CRT (p = 0.000). Both univariate and multivariate Cox model analyses showed that high post-CRT ADC values and the disappearance status of HE associated significantly with the TE (CR rate) and survival. CONCLUSIONS DWI examination could afford useful markers to predict the treatment response as well as the survival of patients with esophageal squamous cell carcinoma. The non-disappearance of HE in DWI and low ADC values after CRT were risk factors.
Collapse
Affiliation(s)
- Lan Wang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | | | | | | | | | | | | | | |
Collapse
|
89
|
Mungai F, Pasquinelli F, Mazzoni LN, Virgili G, Ragozzino A, Quaia E, Morana G, Giovagnoni A, Grazioli L, Colagrande S. Diffusion-weighted magnetic resonance imaging in the prediction and assessment of chemotherapy outcome in liver metastases. Radiol Med 2014; 119:625-33. [PMID: 24408046 DOI: 10.1007/s11547-013-0379-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/25/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE This study assessed the capability of magnetic resonance (MR) diffusion-weighted imaging (DwI) with measurement of apparent diffusion coefficient (ADC) in both predicting and evaluating the response to chemotherapy (CHT) of liver metastases by itself and along with preliminary dimensional assessment. METHODS AND MATERIALS Patients affected by liver metastases from cancers of the digestive tract and breast were prospectively enrolled and underwent computed tomography and MR-DwI before CHT (time 0) and 20-25 days after the beginning of the second cycle (time 3). Moreover, MR-DwI was performed 10-15 (time 1) and 20-25 days (time 2) after the beginning of the first cycle. Maximum diameter and mean ADC value (×10(-3) mm(2)/s) of metastases were evaluated. Lesions were classified as progressive disease (PD), stable disease (SD) or partial response (PR) according to dimensional changes between time 0 and time 3, following RECIST 1.1 indications. Clinically, PD lesions were defined as nonresponding (NR), and SD and PR lesions as responding (R). Analysis of variance and ROC analyses were performed (significance at p < 0.05). RESULTS Eighty-six metastases (33 patients) were classified as follows: 15 PD, 39 SD and 32 PR without significant differences in mean ADC values among the groups before CHT and at all corresponding times. The mean ADC values of SD and PR groups at times 1 (respectively 1.66 ± 0.36 and 1.59 ± 0.23), 2 (1.72 ± 0.42 and 1.68 ± 0.37) and 3 (1.86 ± 0.44 and 1.73 ± 0.39) were significantly higher than the corresponding values at time 0 (1.50 ± 0.30 and 1.39 ± 0.33). An accurate cutoff value of ADC increase or diameter decrease for the early identification of R or NR lesions was not found. CONCLUSION The pretreatment ADC value of a liver metastasis does not seem useful in predicting the CHT outcome. A trend towards early ADC increase, alone or occurring with dimensional decrease, may be a good indicator of a responding lesion.
Collapse
Affiliation(s)
- Francesco Mungai
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
90
|
Pekcevik Y, Kahya MO, Kaya A. Diffusion-weighted Magnetic Resonance Imaging in the Diagnosis of Bone Tumors: Preliminary Results. J Clin Imaging Sci 2013; 3:63. [PMID: 24605258 PMCID: PMC3935268 DOI: 10.4103/2156-7514.124094] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 11/18/2022] Open
Abstract
Objective: The study aims to determine whether apparent diffusion coefficient (ADC) can help differentiate benign and malignant bone tumors. Materials and Methods: From January 2012 to February 2013, we prospectively included 26 patients. Of these 15 patients were male and 11 were female; ranging in age from 8 to 76 years (mean age, 34.5 years). Diffusion-weighted magnetic resonance (MR) imaging was obtained with a single-shot echo-planar imaging sequence using a 1.5T MR scanner. We grouped malignant lesions as primary, secondary, and primary tumor with chondroid matrix. The minimum ADC was measured in the tumors and mean minimum ADC values were selected for statistical analysis. ADC values were compared between malignant and benign tumors using the Mann-Whitney U-test and receiver operating curve analysis were done to determine optimal cut-off values. Results: The mean ADC values from the area with lowest ADC values of benign and malignant tumors were 1.99 ± 0.57 × 10−3 mm2/s and 1.02 ± 1.0 × 10−3 mm2/s, respectively. The mean minimum ADC values of benign and malignant tumors were statistically different (P = 0.029). With cut-off value of 1.37 (10−3 mm2/s), sensitivity was 77.8% and specificity was 82.4%, for distinguishing benign and malignant lesion. Benign and secondary malignant tumors showed statistically significant difference (P = 0.002). There was some overlap in ADC values between benign and malignant tumors. The mean minimum ADC values of benign and malignant chondroid tumors were high. Giant cell tumor, non-ossifying fibroma and fibrous dysplasia showed lower ADC values. Conclusion: Although there is some overlap, ADC values of benign and malignant bone tumors seem to be different. Further studies with larger patient groups are needed to find an optimal cut-off ADC value.
Collapse
Affiliation(s)
- Yeliz Pekcevik
- Department of Radiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Onur Kahya
- Department of Radiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ahmet Kaya
- Department of Orthopaedic Surgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
91
|
Inoue C, Fujii S, Kaneda S, Fukunaga T, Kaminou T, Kigawa J, Harada T, Ogawa T. Correlation of apparent diffusion coefficient value with prognostic parameters of endometrioid carcinoma. J Magn Reson Imaging 2013; 41:213-9. [DOI: 10.1002/jmri.24534] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/14/2013] [Indexed: 01/05/2023] Open
Affiliation(s)
- Chie Inoue
- Division of Radiology; Department of Pathophysiological and Therapeutic Science; Faculty of Medicine, Tottori University; Yonago Japan
| | - Shinya Fujii
- Division of Radiology; Department of Pathophysiological and Therapeutic Science; Faculty of Medicine, Tottori University; Yonago Japan
| | - Sachi Kaneda
- Division of Radiology; Department of Pathophysiological and Therapeutic Science; Faculty of Medicine, Tottori University; Yonago Japan
| | - Takeru Fukunaga
- Division of Radiology; Department of Pathophysiological and Therapeutic Science; Faculty of Medicine, Tottori University; Yonago Japan
| | - Toshio Kaminou
- Division of Radiology; Department of Pathophysiological and Therapeutic Science; Faculty of Medicine, Tottori University; Yonago Japan
| | - Junzo Kigawa
- Division of Reproductive-Perinatal Medicine and Gynecological Oncology Department of Surgery; Faculty of Medicine, Tottori University; Yonago Japan
| | - Tasuku Harada
- Division of Reproductive-Perinatal Medicine and Gynecological Oncology Department of Surgery; Faculty of Medicine, Tottori University; Yonago Japan
| | - Toshihide Ogawa
- Division of Radiology; Department of Pathophysiological and Therapeutic Science; Faculty of Medicine, Tottori University; Yonago Japan
| |
Collapse
|
92
|
Wang CS, Du LJ, Si MJ, Yin QH, Chen L, Shu M, Yuan F, Fei XC, Ding XY. Noninvasive assessment of response to neoadjuvant chemotherapy in osteosarcoma of long bones with diffusion-weighted imaging: an initial in vivo study. PLoS One 2013; 8:e72679. [PMID: 23991141 PMCID: PMC3753340 DOI: 10.1371/journal.pone.0072679] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 07/15/2013] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The purpose of our study is to investigate whether diffusion-weighted imaging (DWI) is useful for monitoring the therapeutic response after neoadjuvant chemotherapy in osteosarcoma of long bones. MATERIALS AND METHODS Conventional magnetic resonance imaging (MRI) and DWI were obtained from 35 patients with histologically proven osteosarcomas. MR examinations were performed in all patients before and after 4 courses of preoperative neoadjuvant chemotherapy. Apparent diffusion coefficients (ADC) were measured. The degree of tumor necrosis was assessed macroscopically and histologically by two experienced pathologists after operation. Student's t test was performed for testing changes in ADC value. Pearson's correlation coefficient was used to estimate the correlation between necrosis rate and post- neoadjuvant chemotherapy ADC values. P<0.05 was considered to denote a significant difference. RESULTS The difference of the whole osteosarcoma between pre- neoadjuvant chemotherapy ADC value (1.24±0.17×10(-3) mm(2)/s) and post- (1.93±0.39×10(-3) mm(2)/s) was significant difference (P<0.01). Regarding in patients with good response, the post- neoadjuvant chemotherapy values were significantly higher than the pre- neoadjuvant chemotherapy values (P<0.01). The post- neoadjuvant chemotherapy ADC value in patients with good response was higher than that of poor response (t = 8.995, P<0.01). The differences in post- neoadjuvant chemotherapy ADC between viable (1.03±0.17×10(-3) mm(2)/s) and necrotic (2.38±0.25×10(-3) mm(2)/s) tumor was highly significant (t = 23.905, P<0.01). A positive correlation between necrosis rates and the whole tumor ADC values (r = 0.769, P<0.01) was noted, but necrosis rates were not correlated with the ADC values of necrotic (r = -0.191, P = 0.272) and viable tumor areas (r = 0.292, P = 0.089). CONCLUSIONS DWI can identify residual viable tumor tissues and tumor necrosis induced by neoadjuvant chemotherapy in osteosarcoma. The ADC value can directly reflect the degree of tumor necrosis, and it is useful to evaluate the preoperative neoadjuvant chemotherapy response in patients with osteosarcoma.
Collapse
Affiliation(s)
- Cheng-Sheng Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Radiology, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Lian-Jun Du
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming-Jue Si
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi-Hua Yin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Shu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Yuan
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Chun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Yi Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
| |
Collapse
|
93
|
Byun BH, Kong CB, Lim I, Choi CW, Song WS, Cho WH, Jeon DG, Koh JS, Lee SY, Lim SM. Combination of 18F-FDG PET/CT and Diffusion-Weighted MR Imaging as a Predictor of Histologic Response to Neoadjuvant Chemotherapy: Preliminary Results in Osteosarcoma. J Nucl Med 2013; 54:1053-9. [DOI: 10.2967/jnumed.112.115964] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
94
|
De Paepe K, Bevernage C, De Keyzer F, Wolter P, Gheysens O, Janssens A, Oyen R, Verhoef G, Vandecaveye V. Whole-body diffusion-weighted magnetic resonance imaging at 3 Tesla for early assessment of treatment response in non-Hodgkin lymphoma: a pilot study. Cancer Imaging 2013; 13:53-62. [PMID: 23466737 PMCID: PMC3589948 DOI: 10.1102/1470-7330.2013.0006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective: To evaluate 3 Tesla (T) whole-body diffusion-weighted magnetic resonance imaging (WB DWI) for early treatment assessment in aggressive non-Hodgkin lymphoma (NHL). Methods: Fourteen patients with NHL treated with standard chemotherapy underwent 3-T WB DWI before and 2 and 4 weeks during treatment, using b-values of 0–1000 s/mm2 from which the apparent diffusion coefficient (ADC) was calculated. Patient follow-up (average 20.3 months, range 15–23 months) was the reference standard. Volume and ADC changes between baseline and 2 weeks (Vratio2w, ADCratio2w) and 4 weeks (Vratio4w, ADCratio4w) of responding and non-responding lesions (lymph node and organ lesions) were compared using Mann–Whitney U tests. The per patient values of VratioN and ADCratioN to predict progression-free survival were determined with a log-rank test. Results: Eight patients showed complete remission and 6 showed tumour progression. The ADCratio2w and ADCratio4w differed significantly in lesions showing tumour progression versus complete remission (ADCratio2w = 4 ± 21% versus 119 ± 68%; ADCratio4w = 18 ± 61% versus 155 ± 78%; both P < 0.0001); the Vratio2w and Vratio4w did not (P > 0.05). Per body region, the ADCratio2w showed a negative predictive value of 100% and positive predictive value of 86%. Per patient, the ADCratio2w and ADCratio4w correlated significantly with progression-free survival (P < 0.05). Conclusion: 3-T WB DWI with ADC quantification may enable early treatment assessment of aggressive NHL.
Collapse
Affiliation(s)
- Katja De Paepe
- Department of Radiology, University Hospitals Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
95
|
Fayad LM, Jacobs MA, Wang X, Carrino JA, Bluemke DA. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology 2013; 265:340-56. [PMID: 23093707 DOI: 10.1148/radiol.12111740] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although the function of magnetic resonance (MR) imaging in the evaluation of musculoskeletal tumors has traditionally been to help identify the extent of disease prior to treatment, its role continues to evolve as new techniques emerge. Conventional pulse sequences remain heavily used and useful, but with the advent of chemical shift imaging, diffusion-weighted imaging, perfusion imaging and MR spectroscopy, additional quantitative metrics have become available that may help expand the role of MR imaging to include detection, characterization, and reliable assessment of treatment response. This review discusses a multiparametric approach to the evaluation of musculoskeletal tumors, with a focus on the utility and potential added value of various pulse sequences in helping establish a diagnosis, assess pretreatment extent, and evaluate a tumor in the posttreatment setting for recurrence and treatment response.
Collapse
Affiliation(s)
- Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Wolfe St, Baltimore, MD 21287, USA.
| | | | | | | | | |
Collapse
|
96
|
Bernsen MR, Ruggiero A, van Straten M, Kotek G, Haeck JC, Wielopolski PA, Krestin GP. Computed tomography and magnetic resonance imaging. Recent Results Cancer Res 2013. [PMID: 23179877 DOI: 10.1007/978-3-642-10853-2_1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Imaging in Oncology is rapidly moving from the detection and size measurement of a lesion to the quantitative assessment of metabolic processes and cellular and molecular interactions. Increasing insights into cancer as a complex disease with involvement of the tumor stroma in tumor pathobiological processes have made it clear that for successful control of cancer, treatment strategies should not only be directed at the tumor cells but also targeted at the tumor microenvironment. This requires understanding of the complex molecular and cellular interactions in cancer tissue. Recent developments in imaging technology have increased the possibility to image various pathobiological processes in cancer development and response to treatment. For computed tomography (CT) and magnetic resonance imaging (MRI) various improvements in hardware, software, and imaging probes have lifted these modalities from classical anatomical imaging techniques to techniques suitable to image and quantify various physiological processes and molecular and cellular interactions. Next to a more general overview of possible imaging targets in oncology this chapter provides an overview of the various developments in CT and MRI technology and some specific applications.
Collapse
Affiliation(s)
- Monique R Bernsen
- Department of Radiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
97
|
Diffusion MRI of the neck of the femur in Legg-Calve-Perthes disease: A preliminary study. Diagn Interv Imaging 2013. [DOI: 10.1016/j.diii.2012.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
98
|
Neubauer H, Evangelista L, Hassold N, Winkler B, Schlegel PG, Köstler H, Hahn D, Beer M. Diffusion-weighted MRI for detection and differentiation of musculoskeletal tumorous and tumor-like lesions in pediatric patients. World J Pediatr 2012; 8:342-9. [PMID: 23151862 DOI: 10.1007/s12519-012-0379-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND MRI is the diagnostic mainstay for detection and differentiation of musculoskeletal tumors. However, a projection regarding the biological dignity of lesions based on standard MRI sequences remains difficult and uncertain. This study was undertaken to analyse whether diffusion-weighted MRI (DWI) can distinguish between benign and malignant musculoskeletal tumorous and tumor-like lesions in pediatric patients. METHODS MR examinations of 44 consecutive pediatric patients (26 girls, mean age 11±6 years) including standard sequences and DWI (b=50/800 s/mm(2)) at 1.5 or 3 Tesla were retrospectively evaluated. The study group contained 10 patients with non-treated malignant tumors and 34 patients with benign lesions. Size, relative signal intensity and apparent diffusion coefficient (ADC, unit ×10(-3) mm(2)/s) were determined in one lesion per patient. RESULTS Mean ADC was 0.78±0.45×10(-3) mm(2)/s in patients with malignant tumors and 1.71±0.75 ×10(-3) mm(2)/s in patients with benign lesions (P<0.001). Relative operating characteristics (ROC) analysis showed a sensitivity of 90% and a specificity of 91% for malignancy, based on an ADC cut-off value of ≤1.03. On logistic regression, mean ADC and lesion size accounted for 62% of variability in benign vs. malignant tumors. For malignant tumors, the signal intensity ratio was higher on DWI than on T1w post-contrast images (P<0.002). Two cases of local tumor recurrence were diagnosed by DWI only. CONCLUSIONS DWI shows promising results for determination of biological dignity in musculoskeletal tumors. Mean ADC ≤1.03×10(-3) mm(2)/s is a strong indicator of malignancy at the first diagnosis. The use of DWI for early diagnosis of tumor recurrence in comparison with standard MRI sequences should be evaluated in prospective studies.
Collapse
Affiliation(s)
- Henning Neubauer
- Department of Pediatric Radiology, Institute of Radiology, University of Wuerzburg, Josef-Schneider-Straße 2, Wuerzburg, 97080, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
99
|
Thawait SK, Thawait GK, Frassica FJ, Andreisek G, Carrino JA, Chhabra A. A systematic approach to magnetic resonance imaging evaluation of epiphyseal lesions. Magn Reson Imaging 2012; 31:418-31. [PMID: 23102949 DOI: 10.1016/j.mri.2012.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 08/19/2012] [Accepted: 08/30/2012] [Indexed: 12/14/2022]
Abstract
Magnetic Resonance Imaging (MRI) is the preferred modality of choice to image epiphyseal lesions. It provides excellent soft tissue resolution and extent of disease. A wide spectrum of tumor and tumor like lesions can involve the epiphysis. Early and accurate diagnosis as well as appropriate management of epiphyseal lesions is critical as these conditions may lead to disabling complications such as, limb length discrepancy, angular or joint surface deformities and secondary osteoarthritis. In this article, we discuss the role of conventional sequences, such as T1W, fluid sensitive T2W and intravenous (IV) Gadolinium enhanced sequences as well as the additional value of problem solving MRI sequences such as, chemical shift and diffusion weighted imaging. Based on the imaging findings on various MRI sequences and lesion characteristics, a systematic approach directed to the diagnoses of epiphyseal lesions is presented and discussed. MRI features of clinically and biopsy proven examples of the epiphyseal lesions, such as osteomyelitis, intra-osseous abscess, infiltrative malignancy, metastases, transient osteoporosis, subchondral insufficiency fracture, avascular necrosis, osteochondral fracture, osteochondritis dissecans, eosinophilic granuloma and geode are demonstrated. Using this systematic approach, the reader will be able to better characterize epiphyseal lesions with a potential to positively affect patient management.
Collapse
Affiliation(s)
- Shrey K Thawait
- Department of Radiology, Yale University-Bridgeport hospital, Bridgeport, CT 06610, USA.
| | | | | | | | | | | |
Collapse
|
100
|
Abstract
The efficiency of an oncological treatment regimen is often assessed by morphological criteria such as tumour size evaluated by cross-sectional imaging, or by laboratory measurements of plasma biomarkers. Because these types of measures typically allow for assessment of treatment response several weeks or even months after the start of therapy, earlier response assessment that provides insight into tumour function is needed. This is particularly urgent for the evaluation of newer targeted therapies and for fractionated therapies that are delivered over a period of weeks to allow for a change of treatment in non-responding patients. Diffusion-weighted MRI (DW-MRI) is a non-invasive imaging tool that does not involve radiation or contrast media, and is sensitive to tissue microstructure and function on a cellular level. DW-MRI parameters have shown sensitivity to treatment response in a growing number of tumour types and organ sites, with additional potential as predictive parameters for treatment outcome. A brief overview of DW-MRI principles is provided here, followed by a review of recent literature in which DW-MRI has been used to monitor and predict tumour response to various therapeutic regimens.
Collapse
Affiliation(s)
- Lauren J Bains
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Switzerland
| | | | | |
Collapse
|