Monitoring therapeutic responses of primary bone tumors by diffusion-weighted image: Initial results

Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging

The aim of this study is to evaluate the usefulness of diffusion-weighted (DW) magnetic resonance (MR) imaging in detecting peritoneal dissemination in cases of gynecological malignancy. We retrospectively analyzed MR images obtained from 26 consecutive patients with gynecological malignancy. Peritoneal dissemination was histologically diagnosed in 15 of the 26 patients after surgery. We obtained DW images and half-Fourier single-shot turbo-spin-echo images in the abdomen and pelvis, and then generated fusion images. Coronal maximum-intensity-projection images were reconstructed from the axial source images. Reader interpretations were compared with the laparotomy findings in the surgical records. Receiver-operating characteristic (ROC) curves were used to represent the presence of peritoneal dissemination. In addition, the sensitivity and specificity were calculated. DW imaging depicted the tumors in 14 of 15 patients with peritoneal dissemination as abnormal signal intensity. ROC analysis yielded Az values of 0.974 and 0.932 for the two reviewers. The mean sensitivity and specificity were 90 and 95.5%. DW imaging plays an important role in the diagnosis and therapeutic management of patients with gynecological malignancy.

Diffusion-weighted and diffusion tensor imaging for pediatric musculoskeletal disorders

Diffusion-weighted imaging (DWI) is a powerful tool that has recently been applied to evaluate several pediatric musculoskeletal disorders. DWI probes abnormalities of tissue structure by detecting microscopic changes in water mobility that develop when disease alters the organization of normal tissue. DWI provides tissue characterization at a cellular level beyond what is available with other imaging techniques, and can sometimes identify pathology before gross anatomic alterations manifest. These features of early detection and tissue characterization make DWI particularly appealing for probing diseases that affect the musculoskeletal system. This article focuses on the current and future applications of DWI in the musculoskeletal system, with particular attention paid to pediatric disorders. Although most of the applications are experimental, we have emphasized the current state of knowledge and the main research questions that need to be investigated.

Diffusion-weighted whole-body MR imaging with background body signal suppression: a feasibility study at 3.0 Tesla

The purpose was to provide a diffusion-weighted whole-body magnetic resonance (MR) imaging sequence with background body signal suppression (DWIBS) at 3.0 Tesla. A diffusion-weighted spin-echo echo-planar imaging sequence was combined with the following methods of fat suppression: short TI inversion recovery (STIR), spectral attenuated inversion recovery (SPAIR), and spectral presaturation by inversion recovery (SPIR). Optimized sequences were implemented on a 3.0- and a 1.5-Tesla system and evaluated in three healthy volunteers and six patients with various lesions in the neck, chest, and abdomen on the basis of reconstructed maximum intensity projection images. In one patient with metastases of malignant melanoma, DWIBS was compared with (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET). Good fat suppression for all regions and diagnostic image quality in all cases could be obtained at 3.0 Tesla with the STIR method. In comparison with 1.5 Tesla, DWIBS images at 3.0 Tesla were judged to provide a better lesion-to-bone tissue contrast. However, larger susceptibility-induced image distortions and signal intensity losses, stronger blurring artifacts, and more pronounced motion artifacts degraded the image quality at 3.0 Tesla. A good correlation was found between the metastases as depicted by DWIBS and those as visualized by FDG-PET. DWIBS is feasible at 3.0 Tesla with diagnostic image quality.

Diagnostic ability of apparent diffusion coefficients for lymphomas and carcinomas in the pharynx

We evaluated the diagnostic ability of diffusion-weighted imaging for the differentiation between lymphomas and carcinomas in the pharynx and between carcinomas with different histological types in the pharynx. T1-weighted, fat-suppressed T2-weighted, and diffusion-weighted MR imaging was performed on 14 patients with pharyngeal lymphomas, 26 patients with carcinomas of the pharynx, 5 patients with adenoidal hypertrophy, and 22 patients with normal tonsils. Apparent diffusion coefficients (ADCs) were determined by using two b factors (500 and 1,000 s/mm(2)). The ADCs of lymphomas were significantly smaller (0.454 +/- 0.075 x 10(-3) mm(2)/s) than those of carcinomas (0.863 +/- 0.238 x 10(-3) mm(2)/s). The ADCs of poorly differentiated and undifferentiated carcinomas (0.691 +/- 0.149 x 10(-3) mm(2)/s) were significantly smaller than those of moderately differentiated and well-differentiated carcinomas (0.971 +/- 0.221 x 10(-3) mm(2)/s), but were significantly larger than those of lymphomas. When an ADC smaller than 0.560 x 10(-3) mm(2)/s was used for predicting lymphomas, we obtained the highest accuracy of 96%, with 100% sensitivity and 94% specificity, 86% positive predictive value, and 100% negative predictive value. Therefore, ADC measurements effectively differentiate lymphomas from carcinomas in the pharynx and could be a useful adjunct to biopsy-based development of treatment planning.