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Klug M, Strange CD, Truong MT, Kirshenboim Z, Ofek E, Konen E, Marom EM. Thymic Imaging Pitfalls and Strategies for Optimized Diagnosis. Radiographics 2024; 44:e230091. [PMID: 38602866 DOI: 10.1148/rg.230091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Thymic imaging is challenging because the imaging appearance of a variety of benign and malignant thymic conditions are similar. CT is the most commonly used modality for mediastinal imaging, while MRI and fluorine 18 fluorodeoxyglucose (FDG) PET/CT are helpful when they are tailored to the correct indication. Each of these imaging modalities has limitations and technical pitfalls that may lead to an incorrect diagnosis and mismanagement. CT may not be sufficient for the characterization of cystic thymic processes and differentiation between thymic hyperplasia and thymic tumors. MRI can be used to overcome these limitations but is subject to other potential pitfalls such as an equivocal decrease in signal intensity at chemical shift imaging, size limitations, unusual signal intensity for cysts, subtraction artifacts, pseudonodularity on T2-weighted MR images, early imaging misinterpretation, flow and spatial resolution issues hampering assessment of local invasion, and the overlap of apparent diffusion coefficients between malignant and benign thymic entities. FDG PET/CT is not routinely indicated due to some overlap in FDG uptake between thymomas and benign thymic processes. However, it is useful for staging and follow-up of aggressive tumors (eg, thymic carcinoma), particularly for detection of occult metastatic disease. Pitfalls in imaging after treatment of thymic malignancies relate to technical challenges such as postthymectomy sternotomy streak metal artifacts, differentiation of postsurgical thymic bed changes from tumor recurrence, or human error with typical "blind spots" for identification of metastatic disease. Understanding these pitfalls enables appropriate selection of imaging modalities, improves diagnostic accuracy, and guides patient treatment. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Maximiliano Klug
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Chad D Strange
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Mylene T Truong
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Zehavit Kirshenboim
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Efrat Ofek
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Eli Konen
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Edith Michelle Marom
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
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Broncano J, Steinbrecher K, Marquis KM, Raptis CA, Royuela Del Val J, Vollmer I, Bhalla S, Luna A. Diffusion-weighted Imaging of the Chest: A Primer for Radiologists. Radiographics 2023; 43:e220138. [PMID: 37347699 DOI: 10.1148/rg.220138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Diffusion-weighted imaging (DWI) is a fundamental sequence not only in neuroimaging but also in oncologic imaging and has emerging applications for MRI evaluation of the chest. DWI can be used in clinical practice to enhance lesion conspicuity, tissue characterization, and treatment response. While the spatial resolution of DWI is in the order of millimeters, changes in diffusion can be measured on the micrometer scale. As such, DWI sequences can provide important functional information to MRI evaluation of the chest but require careful optimization of acquisition parameters, notably selection of b values, application of parallel imaging, fat saturation, and motion correction techniques. Along with assessment of morphologic and other functional features, evaluation of DWI signal attenuation and apparent diffusion coefficient maps can aid in tissue characterization. DWI is a noninvasive noncontrast acquisition with an inherent quantitative nature and excellent reproducibility. The outstanding contrast-to-noise ratio provided by DWI can be used to improve detection of pulmonary, mediastinal, and pleural lesions, to identify the benign nature of complex cysts, to characterize the solid portions of cystic lesions, and to classify chest lesions as benign or malignant. DWI has several advantages over fluorine 18 (18F)-fluorodeoxyglucose PET/CT in the assessment, TNM staging, and treatment monitoring of lung cancer and other thoracic neoplasms with conventional or more recently developed therapies. © RSNA, 2023 Quiz questions for this article are available in the supplemental material. Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Jordi Broncano
- From the Cardiothoracic Imaging Unit (J.B.) and Department of Radiology (J.B., J.R.d.V.), Hospital San Juan de Dios, HT-RESSALTA, HT Médica, Avenida el Brillante No. 36, 14012 Córdoba, Spain; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.S., K.M.M., C.A.R., S.B.); Cardiothoracic Imaging Section, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain (I.V.); and MRI Section, Department of Radiology, Clínica Las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Kacie Steinbrecher
- From the Cardiothoracic Imaging Unit (J.B.) and Department of Radiology (J.B., J.R.d.V.), Hospital San Juan de Dios, HT-RESSALTA, HT Médica, Avenida el Brillante No. 36, 14012 Córdoba, Spain; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.S., K.M.M., C.A.R., S.B.); Cardiothoracic Imaging Section, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain (I.V.); and MRI Section, Department of Radiology, Clínica Las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Kaitlin M Marquis
- From the Cardiothoracic Imaging Unit (J.B.) and Department of Radiology (J.B., J.R.d.V.), Hospital San Juan de Dios, HT-RESSALTA, HT Médica, Avenida el Brillante No. 36, 14012 Córdoba, Spain; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.S., K.M.M., C.A.R., S.B.); Cardiothoracic Imaging Section, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain (I.V.); and MRI Section, Department of Radiology, Clínica Las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Constantin A Raptis
- From the Cardiothoracic Imaging Unit (J.B.) and Department of Radiology (J.B., J.R.d.V.), Hospital San Juan de Dios, HT-RESSALTA, HT Médica, Avenida el Brillante No. 36, 14012 Córdoba, Spain; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.S., K.M.M., C.A.R., S.B.); Cardiothoracic Imaging Section, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain (I.V.); and MRI Section, Department of Radiology, Clínica Las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Javier Royuela Del Val
- From the Cardiothoracic Imaging Unit (J.B.) and Department of Radiology (J.B., J.R.d.V.), Hospital San Juan de Dios, HT-RESSALTA, HT Médica, Avenida el Brillante No. 36, 14012 Córdoba, Spain; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.S., K.M.M., C.A.R., S.B.); Cardiothoracic Imaging Section, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain (I.V.); and MRI Section, Department of Radiology, Clínica Las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Ivan Vollmer
- From the Cardiothoracic Imaging Unit (J.B.) and Department of Radiology (J.B., J.R.d.V.), Hospital San Juan de Dios, HT-RESSALTA, HT Médica, Avenida el Brillante No. 36, 14012 Córdoba, Spain; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.S., K.M.M., C.A.R., S.B.); Cardiothoracic Imaging Section, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain (I.V.); and MRI Section, Department of Radiology, Clínica Las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Sanjeev Bhalla
- From the Cardiothoracic Imaging Unit (J.B.) and Department of Radiology (J.B., J.R.d.V.), Hospital San Juan de Dios, HT-RESSALTA, HT Médica, Avenida el Brillante No. 36, 14012 Córdoba, Spain; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.S., K.M.M., C.A.R., S.B.); Cardiothoracic Imaging Section, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain (I.V.); and MRI Section, Department of Radiology, Clínica Las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Antonio Luna
- From the Cardiothoracic Imaging Unit (J.B.) and Department of Radiology (J.B., J.R.d.V.), Hospital San Juan de Dios, HT-RESSALTA, HT Médica, Avenida el Brillante No. 36, 14012 Córdoba, Spain; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.S., K.M.M., C.A.R., S.B.); Cardiothoracic Imaging Section, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain (I.V.); and MRI Section, Department of Radiology, Clínica Las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
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Sabri YY, Mahmoud NMM, Abd El–Mageed MR, Onsy MMM, Mohamed SA, Onsy MMM, Khairy MA. Mediastinal lymphadenopathy in sarcoidosis: Can diffusion MRI play a role in its evaluation? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-01000-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Sarcoidosis is a multisystem disease defined by non-caseous epithelioid cell granulomas that can affect virtually all organs. Lung, mediastinal and hilar lymph node involvement is prevalent, occurring in around 90% of the patients, and is responsible for the majority of the morbidity and mortality related to the disorder. Sarcoidosis is one of the differential diagnoses of the benign mediastinal lymphadenopathy. This research aimed to detect the diagnostic value of magnetic resonance imaging (MRI) diffusion in evaluation of mediastinal lymphadenopathy in sarcoid patients.
Results
This cross study involved a total of 30 patients known to have sarcoidosis: 6 males and 24 females aged between 18 and 50 years (with a mean age 38.97 ± 8.67); all of them presented with mediastinal lymphadenopathy. For all patients, each lymph node group was evaluated for the average size and average ADC value. The mean ADC measured was (1.76 ± 0.28) × 10−3 mm2/s. Eight patients showed concurrent activity with poor response to the treatment, and they showed different ADC values with one of them showing low ADC with pattern of diffusion restriction displaying mean ADC value of 1.28 × 10−3 mm2/s.
Conclusions
Diffusion-weighted MRI is an established imaging technique that could be utilized to evaluate mediastinal lymphadenopathy in sarcoidosis as the benign counterpart of mediastinal lymphadenopathy.
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Kim JH, Choe J, Kim HK, Lee HY. MRI-Based Stepwise Approach to Anterior Mediastinal Cystic Lesions for Diagnosis and Further Management. Korean J Radiol 2023; 24:62-78. [PMID: 36606621 PMCID: PMC9830146 DOI: 10.3348/kjr.2022.0606] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/06/2022] [Accepted: 10/22/2022] [Indexed: 01/03/2023] Open
Abstract
As the majority of incidentally detected lesions in the anterior mediastinum is small nodules with soft tissue appearance, the differential diagnosis has typically included thymic neoplasm and prevascular lymph node, with benign cyst. Overestimation or misinterpretation of these lesions can lead to unnecessary surgery for ultimately benign conditions. nonsurgical anterior mediastinal lesions. The pitfalls of MRI evaluation for anterior mediastinal cystic lesions are as follows: first, we acknowledge the limitation of T2-weighted images for evaluating benign cystic lesions. Due to variable contents within benign cystic lesions, such as hemorrhage, T2 signal intensity may be variable. Second, owing to extensive necrosis and cystic changes, the T2 shine-through effect may be seen on diffusion-weighted images (DWI), and small solid portions might be missed on enhanced images. Therefore, both enhancement and DWI with apparent diffusion coefficient values should be considered. An algorithm will be suggested for the diagnostic evaluation of anterior mediastinal cystic lesions, and finally, a management strategy based on MRI features will be suggested.
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Affiliation(s)
- Jong Hee Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Zhu JJ, Shen J, Zhang W, Wang F, Yuan M, Xu H, Yu TF. Quantitative texture analysis based on dynamic contrast enhanced MRI for differential diagnosis between primary thymic lymphoma from thymic carcinoma. Sci Rep 2022; 12:12629. [PMID: 35871647 PMCID: PMC9309158 DOI: 10.1038/s41598-022-16393-y] [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: 04/24/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractTo evaluate the value of texture analysis based on dynamic contrast enhanced MRI (DCE-MRI) in the differential diagnosis of thymic carcinoma and thymic lymphoma. Sixty-nine patients with pathologically confirmed (thymic carcinoma, n = 32; thymic lymphoma, n = 37) were enrolled in this retrospective study. Ktrans, Kep and Ve maps were automatically generated, and texture features were extracted, including mean, median, 5th/95th percentile, skewness, kurtosis, diff-variance, diff-entropy, contrast and entropy. The differences in parameters between the two groups were compared and the diagnostic efficacy was calculated. The Ktrans-related significant features yielded an area under the curve (AUC) of 0.769 (sensitivity 90.6%, specificity 51.4%) for the differentiation between thymic carcinoma and thymic lymphoma. The Kep-related significant features yielded an AUC of 0.780 (sensitivity 87.5%, specificity 62.2%). The Ve-related significant features yielded an AUC of 0.807 (sensitivity 75.0%, specificity 78.4%). The combination of DCE-MRI textural features yielded an AUC of 0.962 (sensitivity 93.8%, specificity 89.2%). Five parameters were screened out, including age, Ktrans-entropy, Kep-entropy, Ve-entropy, and Ve-P95. The combination of these five parameters yielded the best discrimination efficiency (AUC of 0.943, 93.7% sensitivity, 81.1% specificity). Texture analysis of DCE-MRI may be helpful to distinguish thymic carcinoma from thymic lymphoma.
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Thuy TTM, Trang NTH, Vy TT, Duc VT, Nam NH, Chien PC, Nhi LHH, Minh LHN. Role of diffusion-weighted MRI in differentiation between benign and malignant anterior mediastinal masses. Front Oncol 2022; 12:985735. [PMID: 36313699 PMCID: PMC9606681 DOI: 10.3389/fonc.2022.985735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Diffusion-weighted imaging (DWI) is considered to be a useful biomarker to characterize the cellularity of lesions, yet its application in the thorax to evaluate anterior mediastinal lesions has not been well investigated. The aims of our study were to describe the magnetic resonance (MR) characteristics of anterior mediastinal masses and to assess the role of apparent diffusion coefficient (ADC) value in distinguishing benign from malignant lesions of the anterior mediastinum. We conducted a retrospective cross-sectional study including 55 patients with anterior mediastinal masses who underwent preinterventional MR scanning with the following sequences: T1 VIBE DIXON pre and post-contrast, T2 HASTE, T2 TIRM, DWI-ADC map (b values of 0 and 2000 sec/mm2). The ADC measurements were obtained by two approaches: hot-spot ROI and whole-tumor histogram analysis. The lesions were grouped by three distinct ways: benign versus malignant, group A (benign lesions and type A, AB, B1 thymoma) versus group B (type B2, B3 thymoma and other malignant lesions), lymphoma versus other malignancies. The study was composed of 55 patients, with 5 benign lesions and 50 malignant lesions. The ADCmean, ADCmedian, ADC10, ADC90 in the histogram-based approach and the hot-spot-ROI-based mean ADC of the malignant lesions were significantly lower than those of benign lesions (P values< 0.05). The hot-spot-ROI-based mean ADC had the highest value in differentiation between benign and malignant mediastinal lesions, as well as between group A and group B; the ADC cutoffs (with sensitivity, specificity) to differentiate malignant from benign lesions and group A from group B were 1.17 x 10-3 mm2/sec (80%, 80%) and 0.99 x 10-3 mm2/sec (78.4%, 88.9%), respectively. The ADC values obtained by using the hot-spot-ROI-based and the histogram-based approaches are helpful in differentiating benign and malignant anterior mediastinal masses.
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Affiliation(s)
- Tran Thi Mai Thuy
- Department of Diagnostic Imaging, University Medical Center, Ho Chi Minh City, Vietnam
- Department of Radiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Truong Hoang Trang
- Department of Diagnostic Imaging, University Medical Center, Ho Chi Minh City, Vietnam
- Department of Radiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thanh Vy
- Thoracic and Vascular Department, University Medical Center, Ho Chi Minh City, Vietnam
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vo Tan Duc
- Department of Diagnostic Imaging, University Medical Center, Ho Chi Minh City, Vietnam
- Department of Radiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Nam
- Department of Diagnostic Imaging, University Medical Center, Ho Chi Minh City, Vietnam
- Department of Radiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Phan Cong Chien
- Department of Diagnostic Imaging, University Medical Center, Ho Chi Minh City, Vietnam
| | - Le Huu Hanh Nhi
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Huu Nhat Minh
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Global Clinical Scholars Research Training Program (GCSRT), Harvard Medical School, Boston, MA, United States
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
- *Correspondence: Le Huu Nhat Minh,
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Choudhary R, Marwah V, Sengupta P, Malik V, Verma S, Pandey I, Kumar TA, Wasan A. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing mediastinal lymphadenopathy: Experience from a tertiary care centre. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Choe J, Lee SM, Ahn Y, Kim CH, Seo JB, Lee HY. Characteristics and outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI: implications for management of cystic lesions. Insights Imaging 2022; 13:136. [PMID: 35976511 PMCID: PMC9385942 DOI: 10.1186/s13244-022-01275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chest MRI is a useful diagnostic modality for the evaluation of anterior mediastinal lesions but the outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI are unclear. METHODS In this multicenter retrospective study, patients who underwent contrast-enhanced chest MRI in two tertiary centers to assess anterior mediastinal cystic lesions were included after excluding overt solid tumors and thymic hyperplasia. Anterior mediastinal cystic lesions were classified into two categories: probable (simple) cyst or indeterminate lesion (complex cyst). Size and imaging features of lesions during follow-up were evaluated and clinical outcomes were assessed. RESULTS A total of 204 patients (mean age, 59 ± 11 years; M:F = 111:93) were studied; 186 (91.2%) were classified as probable cysts and 18 (8.8%) as indeterminate lesions on MRI. Among patients with probable cysts and more than 2 years of follow-up, lesion size was unchanged in 39.6% (36/91), decreased in 16.5% (15/91), and fluctuated in 8.8% (8/91). All patients who underwent surgery were confirmed cysts. None developed mural nodules or irregular wall thickening, suspicious for malignancy during follow-up. In patients with indeterminate lesions, 16.7% (3/18) had pathologically confirmed thymoma and 44.4% (8/18) had proven cysts. Follow-up numbers and intervals after MRI in patients with probable cysts were variable among physicians and institutions in clinical practice (p < 0.05) but more than half were followed for up to 2 years in two centers. CONCLUSION Diagnosing anterior mediastinal cysts using MRI is reliable. MRI-based management of anterior mediastinal lesions may reduce the number of unnecessary follow-ups and surgeries.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea.
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Chu Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, Korea.
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CT and MRI features in 22 cases of primary malignant thymic germ cell tumours. Clin Radiol 2022; 77:390-398. [DOI: 10.1016/j.crad.2022.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
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10
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Sabri YY, Ewis NM, Zawam HEH, Khairy MA. Role of diffusion MRI in diagnosis of mediastinal lymphoma: initial assessment and response to therapy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00597-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Malignant lymphoma accounts for nearly 20% of all mediastinal neoplasms in adults and 50% in children. Hodgkin’s disease is the most common primary mediastinal lymphoma. In non-Hodgkin’s lymphoma, the two most common forms of primary mediastinal lymphoma are lymphoblastic lymphoma and diffuse large B-cell lymphoma. The aim of this study is to implement diffusion MRI in the algorithm of diagnosis of mediastinal lymphoma, differentiating Hodgkin's from non-Hodgkin's lymphoma and assessment of post therapeutic response.
Results
Using Diffusion weighted magnetic resonance imaging DWI-MRI, there were statistic significant difference between ADC values in lymph nodes and mediastinal masses in Hodgkin and non-Hodgkin lymphomas. ADC range in non-treated Hodgkin lymphoma cases was 0.774 to 1.4, while ADC range in in non-treated non-Hodgkin lymphoma was 0.476 to 0.668. In this study, there was statistically significant difference of ADC values in lymphoma cases presented by mediastinal masses with and without chemotherapy.
Conclusions
Diffusion weighted magnetic resonance imaging DWI-MRI is a promising functional technique in diagnosis of Hodgkin's and non-Hodgkin's lymphoma and assessment of response to treatment with no need for special preparation, contrast injection or radiation exposure.
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Hu YC, Yan WQ, Yan LF, Xiao G, Han Y, Liu CX, Wang SZ, Li GF, Wang SM, Yang G, Duan SJ, Li B, Wang W, Cui GB. Differentiating thymoma, thymic carcinoma and lymphoma based on collagen fibre patterns with T2- and diffusion-weighted magnetic resonance imaging. Eur Radiol 2021; 32:194-204. [PMID: 34215941 DOI: 10.1007/s00330-021-08143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The amount and distribution of intratumoural collagen fibre vary among different thymic tumours, which can be clearly detected with T2- and diffusion-weighted MR images. To explore the incidences of collagen fibre patterns (CFPs) among thymomas, thymic carcinomas and lymphomas on imaging, and to evaluate the efficacy and reproducibility of CFPs in differential diagnosis of thymic tumours. MATERIALS AND METHODS Three hundred and ninety-eight patients with pathologically diagnosed thymoma, thymic carcinoma and lymphoma who underwent T2- and diffusion-weighted MR imaging were retrospectively enrolled. CFPs were classified into four categories: septum sign, patchy pattern, mixed pattern and no septum sign. The incidences of CFPs were compared among different thymic tumours, and the efficacy and reproducibility in differentiating the defined tumour types were analysed. RESULTS There were significant differences in CFPs among thymomas, thymic squamous cell carcinomas (TSCCs), other thymic carcinomas and neuroendocrine tumours (OTC&NTs) and thymic lymphomas. Septum signs were found in 209 (86%) thymomas, which differed between thymomas and any other thymic neoplasms (all p < 0.005). The patchy, mixed patterns and no septum sign were mainly seen in TSCCs (80.3%), OTC&NTs (78.9%) and thymic lymphomas (56.9%), respectively. The consistency of different CFP evaluation between two readers was either good or excellent. CFPs achieved high efficacy in identifying the thymic tumours. CONCLUSION The CFPs based on T2- and diffusion-weighted MR imaging were of great value in the differential diagnosis of thymic tumours. KEY POINTS • Significant differences are found in intratumoural collagen fibre patterns among thymomas, thymic squamous cell carcinomas, other thymic carcinomas and neuroendocrine tumours and thymic lymphomas. • The septum sign, patchy pattern, mixed pattern and no septum sign are mainly seen in thymomas (86%), thymic squamous cell carcinomas (80.3%), other thymic carcinomas and neuroendocrine tumours (79%) and thymic lymphomas (57%), respectively. • The collagen fibre patterns have high efficacy and reproducibility in differentiating thymomas, thymic squamous cell carcinomas and thymic lymphomas.
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Affiliation(s)
- Yu-Chuan Hu
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China.,Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Wei-Qiang Yan
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Lin-Feng Yan
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China.,Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Gang Xiao
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China.,Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Yu Han
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China.,Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Chen-Xi Liu
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China.,Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Sheng-Zhong Wang
- Faculty of Medical Technology, Shaanxi University of Traditional Chinese Medicine, Xianyang, 712046, Shaanxi, People's Republic of China
| | - Gang-Feng Li
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China.,Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Shu-Mei Wang
- Department of Pathology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Guang Yang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Shi-Jun Duan
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Bo Li
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Wen Wang
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China. .,Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, 710038, Shaanxi, People's Republic of China.
| | - Guang-Bin Cui
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China. .,Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, 710038, Shaanxi, People's Republic of China.
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12
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Heeger AP, Ackman JB. Added Value of Magnetic Resonance Imaging for the Evaluation of Mediastinal Lesions. Radiol Clin North Am 2021; 59:251-277. [PMID: 33551086 DOI: 10.1016/j.rcl.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The high soft tissue contrast and tissue characterization properties of magnetic resonance imaging allow further characterization of indeterminate mediastinal lesions on chest radiography and computed tomography, increasing diagnostic specificity, preventing unnecessary intervention, and guiding intervention or surgery when needed. The combination of its higher soft tissue contrast and ability to image dynamically during free breathing, without ionizing radiation exposure, allows more thorough and readily appreciable assessment of a lesion's invasiveness and assessment of phrenic nerve involvement, with significant implications for prognostic clinical staging and surgical management.
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Affiliation(s)
- Allen P Heeger
- Department of Radiology, Division of Thoracic Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Founders House 202, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeanne B Ackman
- Department of Radiology, Division of Thoracic Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Founders House 202, 55 Fruit Street, Boston, MA 02114, USA.
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13
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Diffusion MR: A New Diagnostic Tool for Elastofibroma Dorsi. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:103-107. [PMID: 32377143 PMCID: PMC7192251 DOI: 10.14744/semb.2018.78309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/04/2018] [Indexed: 11/21/2022]
Abstract
Elastofibroma dorsi is a benign lesion commonly presents as a palpable enlarging mass at the inferior pole of the scapula. Clinical presentation and radiological characteristics are often enough to suggest an accurate diagnosis. Increased awareness of the characteristic appearance and location of these benign lesions will increase radiologic diagnosis and decrease the need for biopsy. Ten patients were admitted with a complaint of asymptomatic or painful subcutaneous masses localized at subscapulary region. Thorax computed tomography, magnetic resonance imaging (MRI) and a new feasible technique in differential diagnosis with malignancy and probable diagnosis of elastofibroma dorsi and diffusion-weighted MRI were used for diagnosis. Surgery was applied to all patients, frozen-section biopsies of the lesions at the preoperative period, and final pathologies were all benign. Totally resection of whole lesions as en-bloc excision without any rest was performed at all patients. Postoperative and follow-up periods were uneventful. Diffusion MRI can play an important role in the future and save the patients, especially medically poor ones, from the potential risks of surgery. Necessary further examinations for probable bilaterally lesions will save the patient from the risk of a second operation.
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14
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Role of diffusion weighted MR-imaging in the evaluation of malignant mediastinal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-0132-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Background
Conducted studies showed that the ADC (apparent diffusion coefficient) values of malignant mediastinal lesions are significantly lower than those of benign lesions. Investigators determined cut-off ADC values to differentiate the two; concluding that ADC value is a promising noninvasive, imaging parameter that helps assess and characterize mediastinal tumors.
Taking this a step forward, the primary objective of our prospective study was to investigate the potential of DW-MRI (diffusion-weighted magnetic resonance imaging) to characterize malignant mediastinal lesions using their ADC values.
Thirty-three patients that underwent MRI of the chest with DWI and latter pathologically diagnosed with a malignant mediastinal lesion were included in this study. Lesions’ ADC values were measured and correlated with the histopathological results. The statistical significance of differences between measurements was tested using the one-way ANOVA (analysis of variance) test; p values equal to or less than 0.05 were considered significant.
Results
There was no statistically significant difference between the ADCmean values of the histopathological groups of lesions assessed with the overlap of their ADCmean values. The average ADCmean value of NHL (non-Hodgkin lymphoma) was evidently lower than that of HD (Hodgkin disease) with no overlap between their ADCmean values. DWI failed at characterizing one lesion in this study as a malignant tumor, namely an immature teratoma (germ-cell tumor). Again DWI could not be used to evaluate a mass, latter pathologically diagnosed as an angiosarcoma, because of its overall hemorrhagic nature showing no definite non-hemorrhagic soft tissue components. The aforementioned results did not differ considerably when minimum ADC was used instead of mean ADC.
Conclusion
There was no statistically significant difference between the ADC values of the malignant mediastinal lesions evaluated. However, regarding lymphoma subtypes, our limited sample study of lymphoma suggested a considerable difference between the ADC values of Hodgkin disease and non-Hodgkin lymphoma.
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15
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Tuan PA, Vien MV, Dong HV, Sibell D, Giang BV. The Value of CT and MRI for Determining Thymoma in Patients With Myasthenia Gravis. Cancer Control 2019; 26:1073274819865281. [PMID: 31331197 PMCID: PMC6651671 DOI: 10.1177/1073274819865281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of the study was to evaluate the usefulness of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating thymoma from nonthymoma abnormalities in patients with myasthenia gravis (MG). A cross-sectional study of 53 patients with MG, who had undergone surgical thymectomy, was conducted at 103 Hospital (Hanoi, Vietnam) and Cho Ray Hospital (Ho Chi Minh City, Vietnam) during August 2014 and January 2017. The CT and MRI images of patients with MG were qualitatively and quantitatively (radiodensity and chemical shift ratio [CSR]) analyzed to determine and compare their ability to distinguish thymoma from nonthymoma abnormalities. Logistic regression was used to identify the association between imaging parameters (eg, CSR) and the thymoma status. The receiver operating curve (ROC) analysis was used to determine the differentiating ability of CSR and radiodensity. As results, of the 53 patients with MG, 33 were with thymoma and 20 were with nonthymoma abnormalities. At qualitative assessment, MRI had significantly higher accuracy than did CT in differentiating thymoma from nonthymoma abnormalities (94.3% vs 83%). At quantitative assessment, both the radiodensity and CSR were significantly higher for thymoma compared with nonthymoma groups (P < .001). The ROC analysis showed that CSR had significantly higher sensitivity (Se) and specificity (Sp) than radiodensity in discriminating between the 2 groups (CSR: Se 100%, Sp 95% vs radiodensity: Se 90.9%, Sp 70%). When combining both qualitative and quantitative parameters, MRI had even higher accuracy than did CT in thymoma diagnosis (P = .031). In conclusion, chemical shift MRI was more accurate than CT for differentiating thymoma from nonthymoma in patients with MG.
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Affiliation(s)
| | | | | | - David Sibell
- 3 Oregon Health & Science University, Portland, OR, USA
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16
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Raptis CA, Ludwig DR, Hammer MM, Luna A, Broncano J, Henry TS, Bhalla S, Ackman JB. Building blocks for thoracic MRI: Challenges, sequences, and protocol design. J Magn Reson Imaging 2019; 50:682-701. [PMID: 30779459 DOI: 10.1002/jmri.26677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 12/19/2022] Open
Abstract
Thoracic MRI presents important and unique challenges. Decreased proton density in the lung in combination with respiratory and cardiac motion can degrade image quality and render poorly executed sequences uninterpretable. Despite these challenges, thoracic MRI has an important clinical role, both as a problem-solving tool and in an increasing array of clinical indications. Advances in scanner and sequence design have also helped to drive this development, presenting the radiologist with improved techniques for thoracic MRI. Given this evolving landscape, radiologists must be familiar with what thoracic MR has to offer. The first step in developing an effective thoracic MRI practice requires the creation of efficient and malleable protocols that can answer clinical questions. To do this, radiologists must have a working knowledge of the MR sequences that are used in the thorax, many of which have been adapted from use elsewhere in the body. These sequences can be broadly divided into three categories: traditional/anatomic, functional, and cine based. Traditional/anatomic sequences allow for the depiction of anatomy and pathologic processes with the ability for characterization of signal intensity and contrast enhancement. Functional sequences, including diffusion-weighted imaging, and high temporal resolution dynamic contrast enhancement, allow for the noninvasive measurement of tissue-specific parameters. Cine-based sequences can depict the motion of structures in the thorax, either with retrospective ECG gating or in real time. The purpose of this article is to review these categories, the building block sequences that comprise them, and identify basic questions that should be considered in thoracic MRI protocol design. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:682-701.
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Affiliation(s)
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
| | - Mark M Hammer
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio Luna
- Health Time, Clinica Las Nieves, Jaen, Spain.,University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jordi Broncano
- Health Time, Hospital de la Cruz Roja and San Juan de Dios, Cordoba, Spain
| | - Travis S Henry
- University of California-San Francisco, San Francisco, California, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
| | - Jeanne B Ackman
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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Role of diffusion-weighted magnetic resonance imaging in the differentiation of benign and malignant pulmonary lesions. Pol J Radiol 2018; 83:e569-e578. [PMID: 30800195 PMCID: PMC6384403 DOI: 10.5114/pjr.2018.81281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/23/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the role of magnetic resonance (MRI) diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurement of solid and cystic pulmonary masses in differentiating benign from malignant lesions. Material and methods The study included 41 patients with pulmonary masses, who underwent conventional MRI and DWI (b value 0, 500, and 1000 s/mm²) examinations with 1.5-T MRI. The diffusion signal and the mean ADC values of the solid and cystic lesions were obtained. Statistical analyses were performed with the Mann-Whitney U test (z), Pearson’s chi-square test, and receiver operating characteristic (ROC) analysis. Results Thirty-three lesions were malignant, and eight lesions were benign. The malignant masses showed significantly higher signal intensity on DWI than benign masses (p = 0.006), and the mean ADC value of malignant solid lesions was significantly lower than that of benign lesions (p = 0.02). By ROC analysis, an ADC cut-off value of 1.4 × 10–3 mm2/s was considered the threshold value, and the sensitivity and specificity were 93.8% and 75%, respectively. There was no significant difference between the ADC value of the cystic parts inside the benign and the malignant lesions. Conclusions Diffusion-weighted MRI and measurement of ADC value can significantly differentiate between solid benign and malignant pulmonary masses.
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18
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El-Nahas MA, Sadek AG, Gwely NN, Elrakhawy MM, Al-Naghy EAEAA. MR diffusion imaging and ADC measurement in solid and cystic mediastinal masses for differentiating benign from malignant lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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19
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Yan WQ, Xin YK, Jing Y, Li GF, Wang SM, Rong WC, Xiao G, Lei XB, Li B, Hu YC, Cui GB. Iodine Quantification Using Dual-Energy Computed Tomography for Differentiating Thymic Tumors. J Comput Assist Tomogr 2018; 42:873-880. [PMID: 30339550 PMCID: PMC6250292 DOI: 10.1097/rct.0000000000000800] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 12/27/2022]
Abstract
The aim of the study was to explore the efficacy of iodine quantification with dual-energy computed tomography (DECT) in differentiating thymoma, thymic carcinoma, and thymic lymphoma. MATERIALS AND METHODS Fifty-seven patients with pathologically confirmed low-risk thymoma (n = 16), high-risk thymoma (n = 15), thymic carcinoma (n = 14), and thymic lymphoma (n = 12) underwent chest contrast-enhanced DECT scan were enrolled in this study. Tumor DECT parameters including iodine-related Hounsfield unit (IHU), iodine concentration (IC), mixed HU (MHU), and iodine ratio in dual phase, slope of energy spectral HU curve (λ), and virtual noncontrast (VNC) were compared for differences among 4 groups by one-way analysis of variance. Receiver operating characteristic curve was used to determine the efficacy for differentiating the low-risk thymoma from other thymic tumor by defined parameters. RESULTS According to quantitative analysis, dual-phase IHU, IC, and MHU values in patients with low-risk thymoma were significantly increased compared with patients with high-risk thymoma, thymic carcinoma, and thymic lymphoma (P < 0.05/4).The venous phase IHU value yielded the highest performance with area under the curve of 0.893, 75.0% sensitivity, and 89.7% specificity for differentiating the low-risk thymomas from high-risk thymomas or thymic carcinoma at the cutoff value of 34.3 HU. When differentiating low-risk thymomas from thymic lymphoma, the venous phase IC value obtained the highest diagnostic efficacy with the area under the curve of 0.969, and sensitivity, specificity, and cutoff value were 87.5%, 100.0%, and 1.25 mg/mL, respectively. CONCLUSIONS Iodine quantification with DECT may be useful for differentiating the low-risk thymomas from other thymic tumors.
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Affiliation(s)
- Wei-Qiang Yan
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Yong-Kang Xin
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Yong Jing
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Gang-Feng Li
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Shu-Mei Wang
- Department of Pathology, Tangdu Hospital, the Military Medical University of PLA Airforce (Fourth Military Medical University), Shaanxi, PR China
| | - Wei-Cheng Rong
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Gang Xiao
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Xue-Bin Lei
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Bo Li
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Yu-Chuan Hu
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
| | - Guang-Bin Cui
- From the Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, and
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20
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A Thymic Hyperplasia Case without Suppressing on Chemical Shift Magnetic Resonance Imaging. Case Rep Radiol 2018; 2018:7305619. [PMID: 29862111 PMCID: PMC5971343 DOI: 10.1155/2018/7305619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/26/2018] [Accepted: 04/01/2018] [Indexed: 01/25/2023] Open
Abstract
A 22-year-old woman with myasthenia gravis (MG) presented with ptosis and mild muscle weakness symptoms for one year. Computed tomography (CT) presented a diffuse bilobulate enlargement gland with a high density of soft tissue. Magnetic resonance imaging (MRI) showed the gland with no suppression on the opposed-phase chemical shift. After the thymic tumor diagnosis, she underwent thoracoscopic surgery for tumor resection. The postoperative histopathological finding was thymic lymphoid hyperplasia. This case suggests chemical shift MRI is not enough in distinguishing, and supplementary examination is essential to avoid unnecessary thymic biopsy and surgery.
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Zhang W, Zhou Y, Xu XQ, Kong LY, Xu H, Yu TF, Shi HB, Feng Q. A Whole-Tumor Histogram Analysis of Apparent Diffusion Coefficient Maps for Differentiating Thymic Carcinoma from Lymphoma. Korean J Radiol 2018. [PMID: 29520195 PMCID: PMC5840066 DOI: 10.3348/kjr.2018.19.2.358] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the performance of a whole-tumor histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating thymic carcinoma from lymphoma, and compare it with that of a commonly used hot-spot region-of-interest (ROI)-based ADC measurement. Materials and Methods Diffusion weighted imaging data of 15 patients with thymic carcinoma and 13 patients with lymphoma were retrospectively collected and processed with a mono-exponential model. ADC measurements were performed by using a histogram-based and hot-spot-ROI-based approach. In the histogram-based approach, the following parameters were generated: mean ADC (ADCmean), median ADC (ADCmedian), 10th and 90th percentile of ADC (ADC10 and ADC90), kurtosis, and skewness. The difference in ADCs between thymic carcinoma and lymphoma was compared using a t test. Receiver operating characteristic analyses were conducted to determine and compare the differentiating performance of ADCs. Results Lymphoma demonstrated significantly lower ADCmean, ADCmedian, ADC10, ADC90, and hot-spot-ROI-based mean ADC than those found in thymic carcinoma (all p values < 0.05). There were no differences found in the kurtosis (p = 0.412) and skewness (p = 0.273). The ADC10 demonstrated optimal differentiating performance (cut-off value, 0.403 × 10-3 mm2/s; area under the receiver operating characteristic curve [AUC], 0.977; sensitivity, 92.3%; specificity, 93.3%), followed by the ADCmean, ADCmedian, ADC90, and hot-spot-ROI-based mean ADC. The AUC of ADC10 was significantly higher than that of the hot spot ROI based ADC (0.977 vs. 0.797, p = 0.036). Conclusion Compared with the commonly used hot spot ROI based ADC measurement, a histogram analysis of ADC maps can improve the differentiating performance between thymic carcinoma and lymphoma.
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Affiliation(s)
- Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Yue Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Ling-Yan Kong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hai Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Tong-Fu Yu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Qing Feng
- Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University, Nanjing 211166, China
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Yasaka K, Akai H, Abe O, Ohtomo K, Kiryu S. Quantitative computed tomography texture analyses for anterior mediastinal masses: Differentiation between solid masses and cysts. Eur J Radiol 2018; 100:85-91. [PMID: 29496084 DOI: 10.1016/j.ejrad.2018.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/22/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate whether solid anterior mediastinal masses could be differentiated from cysts using quantitative computed tomography (CT) texture analyses in unenhanced CT (UECT) or contrast enhanced CT (CECT). MATERIALS AND METHODS This clinical retrospective study included 76 UECT images (40 men and 36 women, 28 cystic (mean diameter, 29.5 mm) and 48 solid (mean diameter, 48.2 mm)) and 84 CECT images (45 men and 39 women, 26 cystic (mean diameter, 31.4 mm) and 58 solid (mean diameter, 51.4 mm)) of anterior mediastinal masses, which were diagnosed histopathologically or using imaging criteria. Polygonal regions of interest were placed on these masses. CT histogram analyses for images of masses with or without filtration (Laplacian of Gaussian filters with various spatial scaling factors) were performed. DeLong's test was performed to compare areas under the curve (AUC) with receiver operating characteristic analyses. RESULTS From logistic regression analyses with a stepwise procedure, a combination of the mean in unfiltered images (mean0; i.e., CT attenuation) and mean in filtered images featuring coarse texture for UECT (AUC = 0.869) and the combination of mean0 and entropy in filtered images featuring fine texture for CECT (AUC = 0.997) were found to predict better the internal characteristics of anterior mediastinal masses. In UECT and CECT, diagnostic performance using these combinations tended to be high compared to mean0 alone (AUC = 0.780 [p = 0.033] and AUC = 0.983 [p = 0.130], respectively). CONCLUSION Solid anterior mediastinal masses can be differentiated from cysts using quantitative CT texture analyses with moderate and high diagnostic performance in UECT and CECT, respectively.
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Affiliation(s)
- Koichiro Yasaka
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Hiroyuki Akai
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeru Kiryu
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan; Department of Radiology, Graduate School of Medical Sciences, International University of Health and Welfare, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
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Kong LY, Zhang W, Zhou Y, Xu H, Shi HB, Feng Q, Xu XQ, Yu TF. Histogram analysis of apparent diffusion coefficient maps for assessing thymic epithelial tumours: correlation with world health organization classification and clinical staging. Br J Radiol 2018; 91:20170580. [PMID: 29260882 DOI: 10.1259/bjr.20170580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the value of apparent diffusion coefficients (ADCs) histogram analysis for assessing World Health Organization (WHO) pathological classification and Masaoka clinical stages of thymic epithelial tumours. METHODS 37 patients with histologically confirmed thymic epithelial tumours were enrolled. ADC measurements were performed using hot-spot ROI (ADCHS-ROI) and histogram-based approach. ADC histogram parameters included mean ADC (ADCmean), median ADC (ADCmedian), 10 and 90 percentile of ADC (ADC10 and ADC90), kurtosis and skewness. One-way ANOVA, independent-sample t-test, and receiver operating characteristic were used for statistical analyses. RESULTS There were significant differences in ADCmean, ADCmedian, ADC10, ADC90 and ADCHS-ROI among low-risk thymoma (type A, AB, B1; n = 14), high-risk thymoma (type B2, B3; n = 9) and thymic carcinoma (type C, n = 14) groups (all p-values <0.05), while no significant difference in skewness (p = 0.181) and kurtosis (p = 0.088). ADC10 showed best differentiating ability (cut-off value, ≤0.689 × 10-3 mm2 s-1; AUC, 0.957; sensitivity, 95.65%; specificity, 92.86%) for discriminating low-risk thymoma from high-risk thymoma and thymic carcinoma. Advanced Masaoka stages (Stage III and IV; n = 24) tumours showed significant lower ADC parameters and higher kurtosis than early Masaoka stage (Stage I and II; n = 13) tumours (all p-values <0.05), while no significant difference on skewness (p = 0.063). ADC10 showed best differentiating ability (cut-off value, ≤0.689 × 10-3 mm2 s-1; AUC, 0.913; sensitivity, 91.30%; specificity, 85.71%) for discriminating advanced and early Masaoka stage epithelial tumours. CONCLUSION ADC histogram analysis may assist in assessing the WHO pathological classification and Masaoka clinical stages of thymic epithelial tumours. Advances in knowledge: 1. ADC histogram analysis could help to assess WHO pathological classification of thymic epithelial tumours. 2. ADC histogram analysis could help to evaluate Masaoka clinical stages of thymic epithelial tumours. 3. ADC10 might be a promising imaging biomarker for assessing and characterizing thymic epithelial tumours.
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Affiliation(s)
- Ling-Yan Kong
- 1 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Wei Zhang
- 1 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Yue Zhou
- 2 Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Hai Xu
- 1 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Hai-Bin Shi
- 1 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Qing Feng
- 3 Department of Nutrition and Food Hygiene,School of Public Health, Nanjing Medical University , School of Public Health, Nanjing Medical University , Nanjing , China
| | - Xiao-Quan Xu
- 1 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Tong-Fu Yu
- 1 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
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Is there any role for diffusion weighted magnetic resonance imaging before transthoracic CT guided biopsy? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Priola AM, Priola SM, Gned D, Giraudo MT, Veltri A. Nonsuppressing normal thymus on chemical-shift MR imaging and anterior mediastinal lymphoma: differentiation with diffusion-weighted MR imaging by using the apparent diffusion coefficient. Eur Radiol 2017; 28:1427-1437. [PMID: 29143106 DOI: 10.1007/s00330-017-5142-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/14/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To prospectively evaluate usefulness of the apparent diffusion coefficient (ADC) in differentiating anterior mediastinal lymphoma from nonsuppressing normal thymus on chemical-shift MR, and to look at the relationship between patient age and ADC. METHODS Seventy-three young subjects (25 men, 48 women; age range, 9-29 years), who underwent chemical-shift MR and diffusion-weighted MR were divided into a normal thymus group (group A, 40 subjects), and a lymphoma group (group B, 33 patients). For group A, all subjects had normal thymus with no suppression on opposed-phase chemical-shift MR. Two readers measured the signal intensity index (SII) and ADC. Differences in SII and ADC between groups were tested using t-test. ADC was correlated with age using Pearson correlation coefficient. RESULTS Mean SII±standard deviation was 2.7±1.8% for group A and 2.2±2.4% for group B, with no significant difference between groups (P=.270). Mean ADC was 2.48±0.38x10-3mm2/s for group A and 1.24±0.23x10-3mm2/s for group B. A significant difference between groups was found (P<.001), with no overlap in range. Lastly, significant correlation was found between age and ADC (r=0.935, P<.001) in group A. CONCLUSIONS ADC of diffusion-weighted MR is a noninvasive and accurate parameter for differentiating lymphoma from nonsuppressing thymus on chemical-shift MR in young subjects. KEY POINTS • SII cannot differentiate mediastinal lymphoma from nonsuppressing normal thymus at visual assessment • ADC is useful for distinguishing nonsuppressing normal thymus from mediastinal lymphoma • ADC is more accurate than transverse-diameter and surface-area in this discrimination • ADC of normal thymus is age dependent and increases with increasing age.
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Affiliation(s)
- Adriano Massimiliano Priola
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy.
| | - Sandro Massimo Priola
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Dario Gned
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Maria Teresa Giraudo
- Department of Mathematics, "Giuseppe Peano", University of Torino, Via Carlo Alberto 10, 10123, Torino, Italy
| | - Andrea Veltri
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
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Sabri YY, Farid Kolta MF, Khairy MA. MR diffusion imaging in mediastinal masses the differentiation between benign and malignant lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shimamoto A, Ashizawa K, Kido Y, Hayashi H, Nagayasu T, Kawakami A, Mukae H, Hayashi T, Ohtsubo M, Shigematsu K, Nakazono T, Yabuuchi H, Uetani M. CT and MRI findings of thymic carcinoid. Br J Radiol 2017; 90:20150341. [PMID: 28106503 DOI: 10.1259/bjr.20150341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the CT and MRI findings of thymic carcinoid and to compare these findings with previously published findings of thymoma. METHODS 11 cases of pathologically proven thymic carcinoid were reviewed retrospectively. Three patients had typical carcinoid, and eight patients had atypical carcinoid. The characteristics of the tumours and related thoracic abnormalities were assessed in each case on CT and/or MRI by two chest radiologists. The final decisions on the findings were reached by consensus. RESULTS Thymic carcinoids were more likely to have a large mass (ranging from 18 to 105 mm), irregular contours (n = 8), heterogeneous intensity on T2 weighted images (n = 6; eight patients underwent MRI), heterogeneous enhancement (n = 9) and local invasion (n = 7). A necrotic or cystic component was identified in seven patients (one typical carcinoid and six atypical carcinoids). Lymphadenopathy was seen in four patients. Septum, capsule, haemorrhage and calcification were seen in three patients, two patients, two patients and one patient, respectively, with atypical carcinoid. CONCLUSION Thymic carcinoids tend to have a high prevalence of large masses, irregular contours, heterogeneous intensity on T2 weighted images, heterogeneous enhancement and local invasion on CT and/or MRI. A necrotic or cystic component is often seen in atypical carcinoid. Advances in knowledge: Radiologic features of thymic carcinoid mimic those of high-risk thymomas and/or thymic carcinomas.
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Affiliation(s)
- Aya Shimamoto
- 1 Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuto Ashizawa
- 2 Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuo Kido
- 3 Department of Radiology, Sasebo City General Hospital, Sasebo, Japan
| | - Hideyuki Hayashi
- 1 Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- 4 Department of First Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- 5 Department of First Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- 6 Department of Second Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomayoshi Hayashi
- 7 Department of Pathology, Nagasaki Prefecture Shimabara Hospital, Nagasaki, Japan
| | - Mayumi Ohtsubo
- 8 Department of Radiology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kazuto Shigematsu
- 9 Department of Pathology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takahiko Nakazono
- 10 Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Hidetake Yabuuchi
- 11 Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Uetani
- 1 Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Diffusion-weighted Magnetic Resonance Imaging in the Differential Diagnosis of Benign and Metastatic Malignant Pleural Thickening. J Thorac Imaging 2016; 31:37-42. [PMID: 26502346 DOI: 10.1097/rti.0000000000000190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Imaging plays a critical role not only in detection but also in characterization of pleural thickening as benign or malignant. The aim of the study was to investigate the value of diffusion-weighted (DW) imaging in the differential diagnosis of benign and metastatic malignant pleural thickening. MATERIALS AND METHODS Thirty-four patients with 64 pleural foci of nodular thickening (47 metastatic malignant and 17 benign) were included in this prospective study. DW imaging was performed using a breath-hold single-shot spin-echo echo-planar sequence. Two different apparent diffusion coefficient (ADC1,2) maps were obtained with different b factors (ADC1 reconstructed from b factors of 0 and 650 mm/s and ADC2 reconstructed from b factors of 0 and 1000 mm/s), and ADCs were calculated. Quantitatively, ADCs were compared between the groups, and the optimal cutoff value was found by using receiver operating characteristic curve analysis. RESULTS Quantitatively, differences in signal intensities on DW trace images with b factors of 650 and 1000 mm/s were not statistically significant. The ADC1 and ADC2 of the metastatic malignant thickening were significantly lower than those of benign ones [mean ADC1 was 1.37±0.65×10 mm/s for metastatic malignant thickening and 2.11±0.69×10 mm/s for benign thickening (P=0.045); ADC2 was 1.06±0.56×10 mm/s for metastatic malignant thickening and 1.56±0.71×10 mm/s for benign thickening (P=0.038)]. However, because of the ADC overlap between malignant and benign disease, a sufficiently discriminative cutoff value could not be defined by the receiver operating characteristic curve analysis. CONCLUSION Despite fair sensitivity and specificity, DW imaging may serve as a complementary tool that improves the differential diagnosis of pleural thickening.
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Priola AM, Priola SM, Gned D, Piacibello E, Sardo D, Parvis G, Torti D, Ardissone F, Veltri A. Diffusion-weighted quantitative MRI to diagnose benign conditions from malignancies of the anterior mediastinum: Improvement of diagnostic accuracy by comparing perfusion-free to perfusion-sensitive measurements of the apparent diffusion coefficient. J Magn Reson Imaging 2016; 44:758-769. [DOI: 10.1002/jmri.25203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | - Sandro Massimo Priola
- Department of Diagnostic Imaging; San Luigi Gonzaga University Hospital; Orbassano (Torino) Italy
| | - Dario Gned
- Department of Diagnostic Imaging; San Luigi Gonzaga University Hospital; Orbassano (Torino) Italy
| | - Edoardo Piacibello
- Department of Diagnostic Imaging; San Luigi Gonzaga University Hospital; Orbassano (Torino) Italy
| | - Diego Sardo
- Department of Diagnostic Imaging; San Luigi Gonzaga University Hospital; Orbassano (Torino) Italy
| | - Guido Parvis
- Department of Internal Medicine and Hematology; San Luigi Gonzaga University Hospital; Orbassano (Torino) Italy
| | - Davide Torti
- Department of Internal Medicine and Hematology; San Luigi Gonzaga University Hospital; Orbassano (Torino) Italy
| | - Francesco Ardissone
- Department of Thoracic Surgery; San Luigi Gonzaga University Hospital; Orbassano (Torino) Italy
| | - Andrea Veltri
- Department of Diagnostic Imaging; San Luigi Gonzaga University Hospital; Orbassano (Torino) Italy
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Apparent diffusion coefficient measurements in diffusion-weighted magnetic resonance imaging of the anterior mediastinum: inter-observer reproducibility of five different methods of region-of-interest positioning. Eur Radiol 2016; 27:1386-1394. [DOI: 10.1007/s00330-016-4527-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/23/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022]
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Lee G, I H, Kim SJ, Pak K, Cho JS, Jeong YJ, Lee CH, Chang S. Initial Experience of 18F-FDG PET/MRI in Thymic Epithelial Tumors: Morphologic, Functional, and Metabolic Biomarkers. Clin Nucl Med 2016; 41:8-14. [PMID: 26284773 DOI: 10.1097/rlu.0000000000000946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to investigate the value of morphologic, functional, and metabolic biomarkers acquired concurrently at PET/MRI in patients with thymic epithelial tumors. PATIENTS AND METHODS During 1 year, 9 patients with suspected thymic epithelial tumors at contrast-enhanced chest CT were prospectively enrolled and underwent preoperative 18F-FDG PET/MRI. Two chest radiologists prospectively reviewed the CT and MRI scans of PET/MRI in consensus, and 2 nuclear physicians reviewed the PET images. Visual assessment of the tumor morphology, functional biomarkers such as apparent diffusion coefficient from diffusion-weighted images, and metabolic biomarkers (including SUVmax, metabolic tumor volume, total lesion glycolysis, and heterogeneity index) were recorded. All patients underwent operation, and their pathologic reports served as the reference standard. RESULTS Thymic epithelial tumors were demonstrated in all 9 patients at pathologic examination. Tumor contour (P = 0.012) and shape (P = 0.033) had an association with the World Health Organization subtype, and the presence of septum (P = 0.048) on MRI scans had an association with the Masaoka stage. In terms of functional and metabolic biomarkers, SUVmax (ρ = 0.683, P = 0.042) and SUV/apparent diffusion coefficient (ρ = 0.703, P = 0.035) correlated with the Masaoka stage. Metabolic tumor volume (P = 0.024), heterogeneity index (P = 0.024), and total lesion glycolysis (P = 0.048) were useful for classification between low- and high-risk thymic epithelial tumors. CONCLUSIONS Although limited by the small number of patients enrolled, morphologic, functional, and metabolic biomarkers derived from PET/MRI scans were useful for the stratification of thymic epithelial tumors.
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Affiliation(s)
- Geewon Lee
- From the *Department of Radiology, †Biomedical Research Institute, Departments of ‡Thoracic and Cardiovascular Surgery, §Nuclear Medicine, and ∥Pathology, Pusan National University Hospital, Busan, South Korea; and ¶Department of Radiology, University of Colorado School of Medicine, Aurora, CO
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Usuda K, Maeda S, Motono N, Ueno M, Tanaka M, Machida Y, Matoba M, Watanabe N, Tonami H, Ueda Y, Sagawa M. Diffusion Weighted Imaging Can Distinguish Benign from Malignant Mediastinal Tumors and Mass Lesions: Comparison with Positron Emission Tomography. Asian Pac J Cancer Prev 2016; 16:6469-75. [PMID: 26434861 DOI: 10.7314/apjcp.2015.16.15.6469] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DWI) makes it possible to detect malignant tumors based on the diffusion of water molecules. It is uncertain whether DWI is more useful than positron emission tomography-computed tomography (PET-CT) for distinguishing benign from malignant mediastinal tumors and mass lesions. MATERIALS AND METHODS Sixteen malignant mediastinal tumors (thymomas 7, thymic cancers 3, malignant lymphomas 3, malignant germ cell tumors 2, and thymic carcinoid 1) and 12 benign mediastinal tumors or mass lesions were assessed in this study. DWI and PET-CT were performed before biopsy or surgery. RESULTS The apparent diffusion coefficient (ADC) value (1.51±0.46x10(-3) mm2/sec) of malignant mediastinal tumors was significantly lower than that (2.96±0.86x10(-3) mm2/sec) of benign mediastinal tumors and mass lesions (P<0.0001). Maximum standardized uptake value (SUVmax) (11.30±11.22) of malignant mediastinal tumors was significantly higher than that (2.53±3.92) of benign mediastinal tumors and mass lesions (P=0.0159). Using the optimal cutoff value (OCV) 2.21x10(-3) mm2/sec for ADC and 2.93 for SUVmax, the sensitivity (100%) by DWI was not significantly higher than that (93.8%) by PET-CT for malignant mediastinal tumors. The specificity (83.3%) by DWI was not significantly higher than that (66.7%) for benign mediastinal tumors and mass lesions. The accuracy (92.9%) by DWI was not significantly higher than that (82.1%) by PET-CT for mediastinal tumors and mass lesions. CONCLUSIONS There was no significant difference between diagnostic capability of DWI and that of PET-CT for distinguishing mediastinal tumors and mass lesions. DWI is useful in distinguishing benign from malignant mediastinal tumors and mass lesions.
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Affiliation(s)
- Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Daigaku, Uchinada, Ishikawa, Japan E-mail :
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Priola AM, Priola SM. Re: Anterior mediastinal solid tumours in adults: characterisation using dynamic contrast-enhanced MRI, diffusion-weighted MRI, and FDG-PET/CT. Clin Radiol 2016; 71:713-5. [PMID: 27177854 DOI: 10.1016/j.crad.2016.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 02/10/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
Affiliation(s)
- A M Priola
- San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy.
| | - S M Priola
- San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy
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Ohno Y, Yui M, Koyama H, Yoshikawa T, Seki S, Ueno Y, Miyazaki M, Ouyang C, Sugimura K. Chemical Exchange Saturation Transfer MR Imaging: Preliminary Results for Differentiation of Malignant and Benign Thoracic Lesions. Radiology 2016; 279:578-89. [DOI: 10.1148/radiol.2015151161] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Comparison of CT and chemical-shift MRI for differentiating thymoma from non-thymomatous conditions in myasthenia gravis: value of qualitative and quantitative assessment. Clin Radiol 2016; 71:e157-69. [DOI: 10.1016/j.crad.2015.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/03/2015] [Accepted: 12/14/2015] [Indexed: 11/22/2022]
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Diffusion weighted MRI of mediastinal masses: Can measurement of ADC value help in the differentiation between benign and malignant lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Priola AM, Gned D, Veltri A, Priola SM. Chemical shift and diffusion-weighted magnetic resonance imaging of the anterior mediastinum in oncology: Current clinical applications in qualitative and quantitative assessment. Crit Rev Oncol Hematol 2016; 98:335-57. [DOI: 10.1016/j.critrevonc.2015.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 10/04/2015] [Accepted: 11/19/2015] [Indexed: 12/15/2022] Open
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Ye J, Kumar BS, Li XB, Li HM, Zhou YW, Liu LQ. Clinical applications of diffusion-weighted magnetic resonance imaging in diagnosis of renal lesions - a systematic review. Clin Physiol Funct Imaging 2015; 37:459-473. [PMID: 26648310 DOI: 10.1111/cpf.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/21/2015] [Indexed: 01/07/2023]
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is an established technique to detect the changes of the diffusion of water in biological tissues and reflect the pathophysiological process on the molecular level. It is a promising non-invasive imaging modality in detection of microstructural and functional changes in pathologies of kidney. To systematically review the research advancement of the DW-MRI in diagnosis of renal lesions, a systematic literature search was performed up to 8 October 2014 using the MEDLINE/PubMed and Embase databases for articles reporting on DW-MRI in diagnosis of renal lesions. Only articles with full data about DW-MRI application with potential implication in solving usually encountered clinical challenges about renal lesions were finally examined. The clinical application of DW-MRI allows a better understanding of some pathologic conditions of the kidney including renal insufficiency, renal artery stenosis, ureteral obstruction, foetal kidney disease, hydronephrosis and pyonephrosis. In addition, DW-MRI can also provide clinicians with the information of function evaluation of renal allograft and curative effect assessment of renal tumour. In summary, performance of renal DW-MRI, presuming that measurements are high quality, will further boost this modality, particularly for early detection of diffusion renal conditions, as well as more accurate characterization of renal lesions.
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Affiliation(s)
- Jing Ye
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | | | - Xiao-Bo Li
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hong-Mei Li
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Ying-Wen Zhou
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Li-Qin Liu
- Department of Oncology, Northern Jiangsu People's Hospital, Yangzhou, China
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Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival. Eur Radiol 2015; 26:2126-38. [DOI: 10.1007/s00330-015-4031-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/15/2015] [Indexed: 01/22/2023]
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Yabuuchi H, Matsuo Y, Abe K, Baba S, Sunami S, Kamitani T, Yonezawa M, Yamasaki Y, Kawanami S, Nagao M, Okamoto T, Nakamura K, Yamamoto H, Sasaki M, Honda H. Anterior mediastinal solid tumours in adults: characterisation using dynamic contrast-enhanced MRI, diffusion-weighted MRI, and FDG-PET/CT. Clin Radiol 2015; 70:1289-98. [PMID: 26272529 DOI: 10.1016/j.crad.2015.07.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 01/12/2023]
Abstract
AIM To find significant parameters to characterise anterior mediastinal solid tumours in adults using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted MRI (DWI), and combined 2-[(18)F]-fluoro-2-deoxy-d-glucose positron-emission tomography/computed tomography (FDG-PET/CT). MATERIALS AND METHODS Forty-eight histologically confirmed anterior mediastinal solid tumours in 48 patients (24 men, 24 women; age range 21-83 years, mean 50.7 years) were examined. The parameters analysed were maximal diameter, presence of capsule/septa on T2-weighted images, time-signal intensity curves (TICs), apparent diffusion coefficient (ADC), and maximum standardised uptake value (SUVmax). Also examined was whether any differences between histological types could be seen in these parameters. In a validation study, 42 anterior mediastinal solid tumours in 42 patients were examined consecutively. RESULTS The washout pattern on TIC was seen only in thymic epithelial tumours (20/32). SUVmax of lymphoma (mean, 17.9), malignant germ cell tumours (14.2), and thymic carcinomas (15.6) were significantly higher than that of thymomas (6.1). The mean maximal diameter of thymic epithelial tumours was significantly smaller than that of lymphomas (p<0.01) and malignant germ cell tumours (p<0.05). The validation study also yielded high accuracy (38/42, 91%) in differentiation among the anterior mediastinal solid tumours. CONCLUSION The SUVmax, TIC pattern on DCE-MRI, and maximal diameter might be useful to differentiate anterior mediastinal solid tumours in adults.
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Affiliation(s)
- H Yabuuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Y Matsuo
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - K Abe
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - S Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - S Sunami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - T Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - M Yonezawa
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Y Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - S Kawanami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - M Nagao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - T Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - K Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - H Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - M Sasaki
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - H Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Abdel Razek AAK, Gaballa G, Elashry R, Elkhamary S. Diffusion-weighted MR imaging of mediastinal lymphadenopathy in children. Jpn J Radiol 2015; 33:449-54. [PMID: 26067466 DOI: 10.1007/s11604-015-0434-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 05/02/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess mediastinal lymphadenopathy in children with diffusion-weighted MR imaging. MATERIALS AND METHODS Retrospective analysis of 29 consecutive children (18 boys and 11 girls aged 2-15 years) with mediastinal lymphadenopathy. They underwent single-shot echo planar diffusion-weighted MR imaging of the mediastinum with b factors of 0, 300, and 600 s/mm(2). The ADC value of the mediastinal lymph nodes was calculated and correlated with biopsy results; statistical analysis was also performed. RESULTS The mean ADC value for malignant mediastinal lymphadenopathy (n = 20) (0.99 ± 0.18 × 10(-3) mm(2)/s) was significantly lower (P = 0.001) than that for benign lymphadenopathy (n = 9) (1.35 ± 0.26 × 10(-3) mm(2)/s). There was significant difference between ADC values for non-Hodgkin lymphoma and metastatic nodes (P = 0.04). For differentiating malignant from benign mediastinal lymphadenopathy, the best result was obtained when an ADC value of 1.22 × 10(-3) mm(2)/s was used as a threshold value; area under the curve was 0.861, accuracy 93.1 %, sensitivity 100 %, specificity of 77.8 %, positive predictive value 90.9 %, and negative predictive value of 100 %. CONCLUSION Diffusion-weighted MR imaging is a promising non-invasive imaging modality that can be used for differentiation of malignant from benign mediastinal lymphadenopathy in children.
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Chemical-Shift and Diffusion-Weighted Magnetic Resonance Imaging of Thymus in Myasthenia Gravis. Invest Radiol 2015; 50:228-38. [DOI: 10.1097/rli.0000000000000120] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Priola AM, Gned D, Marci V, Veltri A, Priola SM. Diffusion-weighted MRI in a case of nonsuppressing rebound thymic hyperplasia on chemical-shift MRI. Jpn J Radiol 2015; 33:158-63. [DOI: 10.1007/s11604-014-0388-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/22/2014] [Indexed: 11/29/2022]
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Guimarães MD, Hochhegger B, Benveniste MFK, Odisio BC, Gross JL, Zurstrassen CE, Tyng CC, Bitencourt AGV, Marchiori E. Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging. Clinics (Sao Paulo) 2014; 69:787-91. [PMID: 25518038 PMCID: PMC4255081 DOI: 10.6061/clinics/2014(11)13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/17/2014] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To evaluate the preliminary results obtained using diffusion-weighted magnetic resonance imaging and the apparent diffusion coefficient for planning computed tomography-guided biopsies of selected mediastinal lesions. METHODS Eight patients with mediastinal lesions suspicious for malignancy were referred for computed tomography-guided biopsy. Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient measurement were performed to assist in biopsy planning with diffusion/computed tomography fused images. We selected mediastinal lesions that could provide discordant diagnoses depending on the biopsy site, including large heterogeneous masses, lesions associated with lung atelectasis or consolidation, lesions involving large mediastinal vessels and lesions for which the results of biopsy using other methods and histopathological examination were divergent from the clinical and radiological suspicion. RESULTS In all cases, the biopsy needle was successfully directed to areas of higher signal intensity on diffusion-weighted sequences and the lowest apparent diffusion coefficient within the lesion (mean, 0.8 [range, 0.6-1.1]×10-3 mm2/s), suggesting high cellularity. All biopsies provided adequate material for specific histopathological diagnoses of four lymphomas, two sarcomas and two thymomas. CONCLUSION Functional imaging tools, such as diffusion-weighted imaging and the apparent diffusion coefficient, are promising for implementation in noninvasive and imaging-guided procedures. However, additional studies are needed to confirm that mediastinal biopsy can be improved with these techniques.
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Affiliation(s)
| | - Bruno Hochhegger
- Department of Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Bruno Calazans Odisio
- Department of Diagnostic and Interventional Radiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | | | - Chiang Cheng Tyng
- Department of Imaging, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro, Petrópolis, RJ, Brazil
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Mesmann C, Sigovan M, Berner LP, Abergel A, Tronc F, Berthezène Y, Douek P, Boussel L. Evaluation of image quality of DWIBS versus DWI sequences in thoracic MRI at 3T. Magn Reson Imaging 2014; 32:1237-41. [PMID: 25159472 DOI: 10.1016/j.mri.2014.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 01/12/2014] [Accepted: 08/12/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare diffusion weighted imaging with background suppression (DWIBS) sequence with classic spectral diffusion sequence (DWI) with and without respiratory gating in mediastinal lymph node analysis at 3T. MATERIALS AND METHODS 26 patients scheduled for mediastinoscopic lymph node analysis, prospectively undergone a thoracic 3T MRI with DWIBS (FatSat=STIR; TR/TE=6674.1/44.7ms; IR=260 ms) and DWI sequences (FatSat=SPIR; TR/TE=1291/59.6 ms) (b=0-400-800 s/mm2) with and without (free breathing) respiratory gating. Images at b=800 were analyzed by two radiologists. They performed qualitative analysis of fat-sat homogeneity and motion artifacts, rated from 0 to 4, and quantitative evaluation by studying signal to background (STB) of lymph nodes. RESULTS Quality of fat suppression was significantly higher for DWIBS than for DWI both for free-breathing (score 3.48±0.65 vs. 1.76±0.96, p<0.0001) and respiratory-gated scans (3.17±0.77 vs. 1.72±0.73, p=0.0001). Similarly, artifacts were reduced with DWIBS (3.16±0.47 vs. 1.76±0.59, p<0.0001; 3.0±0.73 vs. 2.04±0.53, p=0.0001). Quantitative analysis showed higher STB with DWIBS (3.26±1.83 vs. 0.98±0.44, p<0.0001; 3.56±, 2.09 vs. 0.92±0.59, p<0.0001). Gating did not improve image quality and STB on DWIBS (p>0.05). CONCLUSION In thoracic MRI, ungated DWIBS sequence improves fat-sat homogeneity, reduces motion artifacts and increases STB of lymph nodes. Respiratory gating does not improve DWIBS image quality.
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Affiliation(s)
- Caroline Mesmann
- Department of Radiology, Centre hospitalier de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
| | - Monica Sigovan
- Department of Radiology, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Lise-Prune Berner
- Department of Radiology, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Adva Abergel
- Department of Radiology, Centre hospitalier de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Tronc
- Department of Thoracic Surgery, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Y Berthezène
- Department of Radiology, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, France
| | - P Douek
- Department of Radiology, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, France
| | - Loic Boussel
- Department of Radiology, Centre hospitalier de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, France
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Abdel Razek AAK, Khairy M, Nada N. Diffusion-weighted MR imaging in thymic epithelial tumors: correlation with World Health Organization classification and clinical staging. Radiology 2014; 273:268-75. [PMID: 24877982 DOI: 10.1148/radiol.14131643] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess thymic epithelial tumors with diffusion-weighted magnetic resonance (MR) imaging. MATERIALS AND METHODS Informed consent from patients and institutional review board approval were obtained. Prospective study was conducted on 30 consecutive patients (21 men and nine women; age range, 35-71 years) with thymic epithelial tumors. They underwent true fast imaging with steady-state precession and single-shot echo-planar diffusion-weighted MR imaging of the mediastinum with b values of 0, 400, and 800 sec/mm(2). Apparent diffusion coefficient (ADC) of the thymic epithelial tumors was calculated by the same observer at two settings and was correlated with World Health Organization classification and clinical staging. RESULTS There was significant difference in longest diameter (P = .001) and necrotic part of the tumor (P = .014) between low-risk thymoma, high-risk thymoma, and thymic carcinoma. Mean ADC value of both readings of thymic epithelial tumors (n = 30) was 1.24 × 10(-3) mm(2)/sec and 1.22 × 10(-3) mm(2)/sec, with good intraobserver agreement (κ = 0.732). There was significant difference in both readings (P = .01 and .20) of low-risk thymoma (1.30 × 10(-3) mm(2)/sec and 1.29 × 10(-3) mm(2)/sec), high-risk thymoma (1.16 × 10(-3) mm(2)/sec and 1.14 × 10(-3) mm(2)/sec), and thymic carcinoma (1.18 × 10(-3) mm(2)/sec and 1.06 × 10(-3) mm(2)/sec). Cutoff ADC values of both readings used to differentiate low-risk thymoma from high-risk thymoma and thymic carcinoma were 1.25 and 1.22 × 10(-3) mm(2)/sec with area under the curve of 0.804 and 0.851, respectively. There was significant difference in both readings of ADC value of early (stage I, II) and advanced stages (stage III, IV) of thymic epithelial tumors (P = .006 and .005, respectively). CONCLUSION ADC value is a noninvasive, reliable, and reproducible imaging parameter that may help to assess and characterize thymic epithelial tumors.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- From the Departments of Diagnostic Radiology (A.A.K.A.R.), Chest (M.K.), and Pathology (N.N.), Mansoura Faculty of Medicine, Mansoura, Egypt 13351
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Diffusion-weighted MR imaging vs. multi-detector row CT: Direct comparison of capability for assessment of management needs for anterior mediastinal solitary tumors. Eur J Radiol 2014; 83:835-42. [PMID: 24636535 DOI: 10.1016/j.ejrad.2014.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/27/2013] [Accepted: 01/03/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate and compare the capability of diffusion-weighted MR imaging (DWI) and CT for assessment of management needs for anterior mediastinal solitary tumors. MATERIALS AND METHODS Thirty-five patients with pathologically confirmed anterior mediastinal tumors were enrolled. The tumors were divided into two groups according to need for management: tumors not needing further intervention or treatment (group A; thymoma type A, AB and B1) and tumors needing further intervention and treatment (group B; other thymoma types and malignancies). The apparent diffusion coefficient (ADC) of each tumor was measured, and probabilities of malignancy and need for further intervention and treatment were visually assessed on CT. The differences in ADCs between group A and B and between malignancies and thymomas in group B were evaluated with the Mann-Whitney's U-test. Feasible threshold values for differentiation of group B from group A and distinguishing malignancies from thymomas assessed as group B were determined by the ROC-based positive test, and McNemar's test was used for comparing diagnostic capabilities of DWI with those of CT. RESULTS ADCs for the two groups were significantly different (p<0.001). Application of the threshold value for differentiation of group B from A showed no significant difference (p>0.05). Application of the feasible threshold value for distinguishing malignant from thymomas assessed as group B showed that specificity (76.9%) and accuracy (85.2%) of DWI were significantly better than those of visual score (p<0.05). CONCLUSION DWI has useful potential for the assessment of management needs for anterior mediastinum solitary tumors as well as CT.
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Shin KE, Yi CA, Kim TS, Lee HY, Choi YS, Kim HK, Kim J. Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT. Eur Radiol 2013; 24:677-84. [DOI: 10.1007/s00330-013-3054-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/29/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
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Lee SH, Hur J, Kim YJ, Lee HJ, Hong YJ, Choi BW. Additional value of dual-energy CT to differentiate between benign and malignant mediastinal tumors: an initial experience. Eur J Radiol 2013; 82:2043-9. [PMID: 23820175 DOI: 10.1016/j.ejrad.2013.05.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/22/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the feasibility of dual-energy computed tomography (DECT) in differentiating malignant from benign mediastinal tumors. MATERIALS AND METHODS We prospectively enrolled 25 patients (14 males; mean age: 56.7 years) who had suspected mediastinal tumors on chest radiography or non-contrast chest computed tomography (CT). All patients underwent a two-phase DECT using gemstone spectral imaging (GSI) mode (GE HD750). For the quantitative analysis, two investigators measured the following parameters of the tumors in the early and the delayed phases: CT attenuation value in Hounsfield units (HU) and iodine concentration (mg/ml). Pathological results were used for a final diagnosis. Statistical analyses were performed using the Fisher's exact test and the Mann-Whitney t-test. RESULTS 10 patients (40%) had benign pathology, while 15 (60%) had malignant pathology. The iodine concentration measurements were significantly different between benign and malignant tumors both in the early phase (1.38 mg/ml vs. 2.41 mg/ml, p=0.001) and in the delayed phase (1.52 mg/ml vs. 2.84 mg/ml, p=0.001), while mean attenuation values were not significantly different in both phases (57.8 HU vs. 69.1 HU, p=0.067 and 67.4 HU vs. 78.4 HU, p=0.086, respectively). CONCLUSIONS Dual-energy CT using a quantitative analytic methodology can be used to differentiate between benign and malignant mediastinal tumors.
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Affiliation(s)
- Seung Hyun Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Republic of Korea.
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Gümüstas S, Akça A, Inan N, Akgül AG, Liman ST. Characterization of malignant thrombus in an invasive thymoma with intravascular growth. J Radiol Case Rep 2013; 7:17-23. [PMID: 23705036 DOI: 10.3941/jrcr.v7i2.1115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report an unusual case of an invasive thymoma with a thrombus in the right atrium and describe the radiological findings consistent with the malignant nature of the thrombus. The thrombus showed significant enhancement on computerized tomography images similar to the tumoral mass. On magnetic resonance imaging, both the tumor and the thrombus have heterogeneously high signal intensities on T2-weighted images. On diffusion-weighted images they both exhibit high signal intensity and low apparent diffusion coefficient (ADC) values which support the malignant nature of the thrombus and the mass.
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Affiliation(s)
- Sevtap Gümüstas
- Department of Radiology. Kocaeli University School of Medicine, Kocaeli, Turkey
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