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Yucel S, Aycicek T, Ceyhan Bilgici M, Dincer OS, Tomak L. 3 Tesla MRI in diagnosis and follow up of children with pneumonia. Clin Imaging 2021; 79:213-218. [PMID: 34116298 DOI: 10.1016/j.clinimag.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the utilization of 3-Tesla (3 T) magnetic resonance imaging (MRI) in detection of pulmonary abnormalities in children with pneumonia. MATERIALS AND METHODS Forty-seven children with pneumonia prospectively underwent 3 T thoracic MRI and posteroanterior (PA) chest radiography (CR). Of these, 15 patients also underwent contrast-enhanced thorax computed tomography (CT) or high-resolution CT (HRCT). The MRI protocol included axial and coronal T2-weighted spectral presaturation with inversion recovery (SPIR) Multivane-XD and axial echo-planar diffusion-weighted imaging (EPI DWI) with respiratory gating. Kappa statistics, Cochran Q, and McNemar tests were used to investigate the results. RESULTS Agreement between CR and MRI was substantial in detecting consolidation/infiltration (k = 0.64), peribronchial thickening (k = 0.64), and bronchiectasis (k = 1); moderate in detecting cavity (k = 0.54) and pleural effusion (k = 0.44); and fair in detecting empyema (0.32) and bilateral involvement of lungs (k = 0.23). MRI was superior to CR in detecting bilateral involvement (p < 0.001), lymph node (p < 0.001), pleural effusion (p < 0.001), and empyema (p = 0.003). MRI detected all the consolidation/infiltration also detected on CT imaging. A kappa test showed moderate agreement between MRI and CT in detecting pleural effusion and ground-glass opacity (GGO), and substantial or almost perfect agreement for all other pathologies. No statistically significant difference was observed between MRI and CT for detecting pneumonia-associated pathologies by the McNemar test. CONCLUSION Thoracic 3 T MRI is an accurate and effective technique for evaluating children with pneumonia. MRI detected more pathologies than CR and had similar results to those of thorax CT.
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Affiliation(s)
- Serap Yucel
- Mus State Hospital, Department of Radiology, Mus, Turkey.
| | - Tugba Aycicek
- M.D. Prof. Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Disease, Samsun, Turkey
| | - Meltem Ceyhan Bilgici
- Ondokuz Mayıs University Faculty of Medicine, Department of Radiology, Samsun, Turkey
| | - Oguz Salih Dincer
- M.D. Prof. Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Disease, Samsun, Turkey
| | - Leman Tomak
- Ondokuz Mayis University Faculty of Medicine, Department of Biostatistics and Medical Informatics, Samsun, Turkey
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2
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Harrington SG, Johnson MK, Greer MLC, Gee MS. Pearls and Pitfalls in MR Enterography Interpretation for Pediatric Patients. Semin Ultrasound CT MR 2020; 41:462-471. [DOI: 10.1053/j.sult.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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3
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Lorza AMA, Ravi H, Philip RC, Galons JP, Trouard TP, Parra NA, Von Hoff DD, Read WL, Tibes R, Korn RL, Raghunand N. Dose-response assessment by quantitative MRI in a phase 1 clinical study of the anti-cancer vascular disrupting agent crolibulin. Sci Rep 2020; 10:14449. [PMID: 32879326 PMCID: PMC7468301 DOI: 10.1038/s41598-020-71246-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023] Open
Abstract
The vascular disrupting agent crolibulin binds to the colchicine binding site and produces anti-vascular and apoptotic effects. In a multisite phase 1 clinical study of crolibulin (NCT00423410), we measured treatment-induced changes in tumor perfusion and water diffusivity (ADC) using dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted MRI (DW-MRI), and computed correlates of crolibulin pharmacokinetics. 11 subjects with advanced solid tumors were imaged by MRI at baseline and 2–3 days post-crolibulin (13–24 mg/m2). ADC maps were computed from DW-MRI. Pre-contrast T1 maps were computed, co-registered with the DCE-MRI series, and maps of area-under-the-gadolinium-concentration-curve-at-90 s (AUC90s) and the Extended Tofts Model parameters ktrans, ve, and vp were calculated. There was a strong correlation between higher plasma drug \documentclass[12pt]{minimal}
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\begin{document}$${AUC}_{90s}>15.8$$\end{document}AUC90s>15.8 mM s, and, (2) increase in tumor fraction with \documentclass[12pt]{minimal}
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\begin{document}$${v}_{e}<0.3$$\end{document}ve<0.3. A higher plasma drug AUC was correlated with a linear combination of (1) increase in tumor fraction with \documentclass[12pt]{minimal}
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\begin{document}$${\text{ADC}} < 1.1 \times 10^{ - 3} \;{\text{mm}}^{2} /{\text{s}}$$\end{document}ADC<1.1×10-3mm2/s, and, (2) increase in tumor fraction with \documentclass[12pt]{minimal}
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\begin{document}$$v_{e}<0.3$$\end{document}ve<0.3. These findings are suggestive of cell swelling and decreased tumor perfusion 2–3 days post-treatment with crolibulin. The multivariable linear regression models reported here can inform crolibulin dosing in future clinical studies of crolibulin combined with cytotoxic or immune-oncology agents.
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Affiliation(s)
- Andres M Arias Lorza
- Department of Cancer Physiology, Moffitt Cancer Center, SRB-4, Tampa, FL, 33612, USA
| | - Harshan Ravi
- Department of Cancer Physiology, Moffitt Cancer Center, SRB-4, Tampa, FL, 33612, USA
| | - Rohit C Philip
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | | | - Theodore P Trouard
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85724, USA
| | - Nestor A Parra
- Department of Cancer Physiology, Moffitt Cancer Center, SRB-4, Tampa, FL, 33612, USA
| | - Daniel D Von Hoff
- Translational Genomics Research Institute (TGen), Phoenix, AZ, USA.,HonorHealth Clinical Research Institute, Scottsdale, AZ, USA
| | - William L Read
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Raoul Tibes
- Department of Internal Medicine II, Julius Maximilians University and Medical Center, Würzburg, Germany
| | | | - Natarajan Raghunand
- Department of Cancer Physiology, Moffitt Cancer Center, SRB-4, Tampa, FL, 33612, USA. .,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
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Strategies to Reduce the Use of Gadolinium-Based Contrast Agents for Abdominal MRI in Children. AJR Am J Roentgenol 2020; 214:1054-1064. [DOI: 10.2214/ajr.19.22232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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5
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Hirsch FW, Sorge I, Vogel-Claussen J, Roth C, Gräfe D, Päts A, Voskrebenzev A, Anders RM. The current status and further prospects for lung magnetic resonance imaging in pediatric radiology. Pediatr Radiol 2020; 50:734-749. [PMID: 31996938 PMCID: PMC7150663 DOI: 10.1007/s00247-019-04594-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/08/2019] [Accepted: 11/28/2019] [Indexed: 12/19/2022]
Abstract
Lung MRI makes it possible to replace up to 90% of CT examinations with radiation-free magnetic resonance diagnostics of the lungs without suffering any diagnostic loss. The individual radiation exposure can thus be relevantly reduced. This applies in particular to children who repeatedly require sectional imaging of the lung, e.g., in tumor surveillance or in chronic lung diseases such as cystic fibrosis. In this paper we discuss various factors that favor the establishment of lung MRI in the clinical setting. Among the many sequences proposed for lung imaging, respiration-triggered T2-W turbo spin-echo (TSE) sequences have been established as a good standard for children. Additional sequences are mostly dispensable. The most important pulmonary findings are demonstrated here in the form of a detailed pictorial essay. T1-weighted gradient echo sequences with ultrashort echo time are a new option. These sequences anticipate signal loss in the lung and deliver CT-like images with high spatial resolution. When using self-gated T1-W ultrashort echo time 3-D sequences that acquire iso-voxel geometry in the sub-millimeter range, secondary reconstructions are possible.
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Affiliation(s)
- Franz Wolfgang Hirsch
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany.
| | - Ina Sorge
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625, Hannover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Centre for Lung Research, 30625, Hannover, Germany
| | - Christian Roth
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Daniel Gräfe
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Anne Päts
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625, Hannover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Centre for Lung Research, 30625, Hannover, Germany
| | - Rebecca Marie Anders
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
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Schutter R, Lantinga VA, Borra RJH, Moers C. MRI for diagnosis of post-renal transplant complications: current state-of-the-art and future perspectives. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:49-61. [PMID: 31879853 DOI: 10.1007/s10334-019-00813-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/27/2019] [Accepted: 11/30/2019] [Indexed: 02/07/2023]
Abstract
Kidney transplantation has developed into a widespread procedure to treat end stage renal failure, with transplantation results improving over the years. Postoperative complications have decreased over the past decades, but are still an important cause of morbidity and mortality. Early accurate diagnosis and treatment is the key to prevent renal allograft impairment or even graft loss. Ideally, a diagnostic tool should be able to detect post-transplant renal dysfunction, differentiate between the different causes and monitor renal function during and after therapeutic interventions. Non-invasive imaging modalities for diagnostic purposes show promising results. Magnetic resonance imaging (MRI) techniques have a number of advantages, such as the lack of ionizing radiation and the possibility to obtain relevant tissue information without contrast, reducing the risk of contrast-induced nephrotoxicity. However, most techniques still lack the specificity to distinguish different types of parenchymal diseases. Despite some promising outcomes, MRI is still barely used in the post-transplantation diagnostic process. The aim of this review is to survey the current literature on the relevance and clinical applicability of diagnostic MRI modalities for the detection of various types of complications after kidney transplantation.
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Affiliation(s)
- Rianne Schutter
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| | - Veerle A Lantinga
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ronald J H Borra
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Cyril Moers
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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7
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Lee MH, Eutsler EP, Sheybani EF, Khanna G. Rapid non-contrast magnetic resonance imaging for post appendectomy intra-abdominal abscess in children. Pediatr Radiol 2017; 47:935-941. [PMID: 28424822 DOI: 10.1007/s00247-017-3860-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/06/2017] [Accepted: 04/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute appendicitis, especially if perforated at presentation, is often complicated by postoperative abscess formation. The detection of a postoperative abscess relies primarily on imaging. This has traditionally been done with contrast-enhanced computed tomography. Non-contrast magnetic resonance imaging (MRI) has the potential to accurately detect intra-abdominal abscesses, especially with the use of diffusion-weighted imaging (DWI). OBJECTIVE To evaluate our single-center experience with a rapid non-contrast MRI protocol evaluating post-appendectomy abscesses in children with persistent postsurgical symptoms. MATERIALS AND METHODS In this retrospective, institutional review board-approved study, all patients underwent a clinically indicated non-contrast 1.5- or 3-Tesla abdomen/pelvis MRI consisting of single-shot fast spin echo, inversion recovery and DWI sequences. All MRI studies were reviewed by two blinded pediatric radiologists to identify the presence of a drainable fluid collection. Each fluid collection was further characterized as accessible or not accessible for percutaneous or transrectal drainage. Imaging findings were compared to clinical outcome. RESULTS Seven of the 15 patients had a clinically significant fluid collection, and 5 of these patients were treated with percutaneous drain placement or exploratory laparotomy. The other patients had a phlegmon or a clinically insignificant fluid collection and were discharged home within 48 h. CONCLUSION Rapid non-contrast MRI utilizing fluid-sensitive and DWI sequences can be used to identify drainable fluid collections in post-appendectomy patients. This protocol can be used to triage patients between conservative management vs. abscess drainage without oral/intravenous contrast or exposure to ionizing radiation.
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Affiliation(s)
- Megan H Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd., Box 8131, St. Louis, MO, 63110, USA.
| | - Eric P Eutsler
- Pediatric Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Geetika Khanna
- Pediatric Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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8
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Bekiesińska-Figatowska M, Romaniuk-Doroszewska A, Szkudlińska-Pawlak S, Duczkowska A, Mądzik J, Szopa-Krupińska M, Maciejewski TM. Diagnostic Imaging of Pregnant Women - The Role of Magnetic Resonance Imaging. Pol J Radiol 2017; 82:220-226. [PMID: 28507642 PMCID: PMC5406112 DOI: 10.12659/pjr.900071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Presentation of magnetic resonance imaging (MRI) findings in pregnant women in the Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland. MATERIAL/METHODS Forty-three symptomatic pregnant women underwent MRI between 9 and 33 weeks of gestation (mean of 23 weeks). Moreover, we included 2 pregnant women who underwent fetal MRI and had incidental abnormalities. RESULTS In 9 cases, we excluded the suspected brain abnormalities. In 4 cases, we found unremarkable changes in the brain without clinical significance. One patient was diagnosed with multiple sclerosis, one with cortical dysplasia, one with pineal hemorrhage and one with a brain tumor. On abdominal MRI, 2 patients had normal findings, one patient had colon cancer with a hepatic metastasis, one patient had a hepatic angioma, one patient had an extraadrenal pheochromocytoma, one patient had an abscess in the iliopsoas muscle, 9 patients had myomas, two patients had ovarian simple cysts, two endometrial cysts, three dermoid cysts, one patient had sacrococcygeal teratoma, one patient had a cystadenofibroma (partial borderline tumor), one patient had an androgenic ovarian tumor and two patients had hyperreactio luteinalis. One patient was diagnosed with transient osteoporosis of the hip and one with a stress fracture of the sacral bone. CONCLUSIONS Magnetic resonance imaging is the best imaging modality for pregnant women. Although ultrasonography is the method of choice, doubtful cases as well as structures that cannot be examined with ultrasonography can be non-invasively evaluated with MRI.
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Affiliation(s)
| | | | | | | | - Jarosław Mądzik
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
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9
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Durur-Subasi I, Durur-Karakaya A, Karaman A, Seker M, Demirci E, Alper F. Is the necrosis/wall ADC ratio useful for the differentiation of benign and malignant breast lesions? Br J Radiol 2017; 90:20160803. [PMID: 28339285 DOI: 10.1259/bjr.20160803] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether the necrosis/wall apparent diffusion coefficient (ADC) ratio is useful for the malignant-benign differentiation of necrotic breast lesions. METHODS Breast MRI was performed using a 3-T system. In this retrospective study, calculation of the necrosis/wall ADC ratio was based on ADC values measured from the necrosis and from the wall of malignant and benign breast lesions by diffusion-weighted imaging (DWI). By synchronizing post-contrast T1 weighted images, the separate parts of wall and necrosis were maintained. All the diagnoses were pathologically confirmed. Statistical analyses were conducted using an independent sample t-test and receiver operating characteristic analysis. The intraclass and interclass correlations were evaluated. RESULTS A total of 66 female patients were enrolled, 38 of whom had necrotic breast carcinomas and 28 of whom had breast abscesses. The ADC values were obtained from both the wall and necrosis. The mean necrosis/wall ADC ratio (± standard deviation) was 1.61 ± 0.51 in carcinomas, and it was 0.65 ± 0.33 in abscesses. The area under the curve values for necrosis ADC, wall ADC and the necrosis/wall ADC ratio were 0.680, 0.068 and 0.942, respectively. A wall/necrosis ADC ratio cut-off value of 1.18 demonstrated a sensitivity of 97%, specificity of 93%, a positive-predictive value of 95%, a negative-predictive value of 96% and an accuracy of 95% in determining the malignant nature of necrotic breast lesions. There was a good intra- and interclass reliability for the ADC values of both necrosis and wall. CONCLUSION The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating breast carcinomas from abscesses using DWI. Advances in knowledge: ADC values of the necrosis obtained by DWI are valuable for malignant-benign differentiation in necrotic breast lesions. The necrosis/wall ADC ratio appears to be a reliable and promising tool in the breast imaging field.
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Affiliation(s)
- Irmak Durur-Subasi
- 1 Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Afak Durur-Karakaya
- 2 Department of Radiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Adem Karaman
- 3 Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Mehmet Seker
- 2 Department of Radiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Elif Demirci
- 4 Department of Pathology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Fatih Alper
- 3 Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Diffusion-weighted imaging in pediatric body magnetic resonance imaging. Pediatr Radiol 2016; 46:847-57. [PMID: 27229502 DOI: 10.1007/s00247-016-3573-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/06/2016] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
Abstract
Diffusion-weighted MRI is being increasingly used in pediatric body imaging. Its role is still emerging. It is used for detection of tumors and abscesses, differentiation of benign and malignant tumors, and detection of inflamed bowel segments in inflammatory bowel disease in children. It holds great promise in the assessment of therapy response in body tumors, with apparent diffusion coefficient (ADC) value as a potential biomarker. Significant overlap of ADC values of benign and malignant processes and less reproducibility of ADC measurements are hampering its widespread use in clinical practice. With standardization of the technique, diffusion-weighted imaging (DWI) is likely to be used more frequently in clinical practice. We discuss the principles and technique of DWI, selection of b value, qualitative and quantitative assessment, and current status of DWI in evaluation of disease processes in the pediatric body.
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Foti PV, Ognibene N, Spadola S, Caltabiano R, Farina R, Palmucci S, Milone P, Ettorre GC. Non-neoplastic diseases of the fallopian tube: MR imaging with emphasis on diffusion-weighted imaging. Insights Imaging 2016; 7:311-27. [PMID: 26992404 PMCID: PMC4877350 DOI: 10.1007/s13244-016-0484-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/26/2016] [Accepted: 03/03/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE We illustrate the magnetic resonance imaging (MRI) features of non-neoplastic tubaric conditions. BACKGROUND A variety of pathologic non-neoplastic conditions may affect the fallopian tubes. Knowledge of their imaging appearance is important for correct diagnosis. With recent advances in MRI, along with conventional MR sequences, diffusion-weighted imaging (DWI) sequences are available and may improve lesion characterization by discriminating the nature of the content of the dilated tube. Tubal fluid with low signal intensity on T1-weighted images, high signal intensity on T2-weighted images and no restricted diffusion on DWI is indicative of hydrosalpinx. Content with high signal intensity on T1-weighted images and restricted diffusion on DWI is suggestive of hematosalpinx associated with endometriosis or tubal pregnancy. A dilated tube with variable or heterogeneous signal intensity content on conventional MR sequences and restricted diffusion on DWI may suggest a pyosalpinx or tubo-ovarian abscess. We describe morphological characteristics, MR signal intensity features, enhancement behaviour and possible differential diagnosis of each lesion. CONCLUSION MRI is the method of choice to study adnexal pelvic masses. Qualitative and quantitative functional imaging with DWI can be of help in characterization of tubaric diseases, provided that findings are interpreted in conjunction with those obtained with conventional MRI sequences. TEACHING POINTS • Nondilated fallopian tubes are not usually seen on MR images. • MRI is the method of choice to characterize and localize utero-adnexal masses. • MRI allows characterization of lesions through evaluation of the fluid content's signal intensity. • DWI in conjunction with conventional MRI sequences may improve tissue characterization. • Pelvic inflammatory disease is the most common tubal pathology.
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Affiliation(s)
- Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Noemi Ognibene
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Saveria Spadola
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Renato Farina
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Pietro Milone
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Carlo Ettorre
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Wang T, Li W, Wu X, Yin B, Chu C, Ding M, Cui Y. Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values. PLoS One 2016; 11:e0149318. [PMID: 26894926 PMCID: PMC4760735 DOI: 10.1371/journal.pone.0149318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/29/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the added value of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values compared to MRI, for characterizing the tubo-ovarian abscesses (TOA) mimicking ovarian malignancy. Materials and Methods Patients with TOA (or ovarian abscess alone; n = 34) or ovarian malignancy (n = 35) who underwent DWI and MRI were retrospectively reviewed. The signal intensity of cystic and solid component of TOAs and ovarian malignant tumors on DWI and the corresponding ADC values were evaluated, as well as clinical characteristics, morphological features, MRI findings were comparatively analyzed. Receiver operating characteristic (ROC) curve analysis based on logistic regression was applied to identify different imaging characteristics between the two patient groups and assess the predictive value of combination diagnosis with area under the curve (AUC) analysis. Results The mean ADC value of the cystic component in TOA was significantly lower than in malignant tumors (1.04 ± 0 .41 × 10−3 mm2/s vs. 2.42 ± 0.38 × 10−3 mm2/s; p < 0.001). The mean ADC value of the enhanced solid component in 26 TOAs was 1.43 ± 0.16×10−3mm2/s, and 46.2% (12 TOAs; pseudotumor areas) showed significantly higher signal intensity on DW-MRI than in ovarian malignancy (mean ADC value 1.44 ± 0.20×10−3 mm2/s vs.1.18 ± 0.36 × 10−3 mm2/s; p = 0.043). The combination diagnosis of ADC value and dilated tubal structure achieved the best AUC of 0.996. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI vs. DWI with ADC values for predicting TOA were 47.1%, 91.4%, 84.2%, 64%, and 69.6% vs. 100%, 97.1%, 97.1%, 100%, and 98.6%, respectively. Conclusions DW-MRI is superior to MRI in the assessment of TOA mimicking ovarian malignancy, and the ADC values aid in discriminating the pseudotumor area of TOA from the solid portion of ovarian malignancy.
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Affiliation(s)
- Tingting Wang
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Wenhua Li
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
- * E-mail:
| | - Xiangru Wu
- Department of Pathology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Bing Yin
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Caiting Chu
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Ming Ding
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Yanfen Cui
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
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Ayyala RS, Anupindi SA, Taylor GA, Gee MS, Bellah RD, Chauvin NA. Imaging of Splenic Infections (and Their Mimickers) in Children. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-015-0129-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE Pediatric patients with inflammatory bowel disease (IBD) commonly need repetitive imaging to assess disease activity and complications. Recently, MR enterography has become a first-line radiologic study in children with IBD because of improved image quality, excellent soft-tissue contrast resolution, and lack of ionizing radiation. The purpose of this article is to describe the use of diffusion-weighted imaging (DWI) in MR enterography and the evaluation of pediatric IBD. CONCLUSION Several contemporary publications have shown that DWI can be useful for assessing both pediatric and adult patients with IBD as an important adjunct pulse sequence. Specifically, DWI can be used to identify abnormal bowel segments, assess disease inflammatory activity, and detect and characterize a variety of extraintestinal IBD-related manifestations and complications.
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Caivano R, Villonio A, D' Antuono F, Gioioso M, Rabasco P, Iannelli G, Zandolino A, Lotumolo A, Dinardo G, Macarini L, Guglielmi G, Cammarota A. Diffusion weighted imaging and apparent diffusion coefficient in 3 tesla magnetic resonance imaging of breast lesions. Cancer Invest 2015; 33:159-64. [PMID: 25831024 DOI: 10.3109/07357907.2015.1019674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the utility of diffusion-weighted-imaging (DWI) and apparent-diffusion-coefficient (ADC) in a 3T magnetic-resonance-imaging (MRI) study of breast cancer. In particular, the study aims to classify ADC-values according to histology either for benign or malignant lesions. METHODS 110 Breast MRI with MRI-DWI sequences and quantitative evaluation of the ADC were retrospectively reviewed. Results obtained with MRI-DWI and with biopsy were analyzed and ADC values were compared to histological results. RESULTS MRI showed a 95.5% sensitivity and a 83.7% specificity. The mean ADC values of benign and malignant lesions were 2.06 ± 0.19 and 1.03 ± 0.07 mm(2)/s, respectively (p < .05). CONCLUSIONS DWI and ADC-values could help distinguishing malignant and benign breast masses.
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Chavhan GB, Alsabban Z, Babyn PS. Diffusion-weighted imaging in pediatric body MR imaging: principles, technique, and emerging applications. Radiographics 2015; 34:E73-88. [PMID: 24819803 DOI: 10.1148/rg.343135047] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Diffusion-weighted (DW) imaging is an emerging technique in body imaging that provides indirect information about the microenvironment of tissues and lesions and helps detect, characterize, and follow up abnormalities. Two main challenges in the application of DW imaging to body imaging are the decreased signal-to-noise ratio of body tissues compared with neuronal tissues due to their shorter T2 relaxation time, and image degradation related to physiologic motion (eg, respiratory motion). Use of smaller b values and newer motion compensation techniques allow the evaluation of anatomic structures with DW imaging. DW imaging can be performed as a breath-hold sequence or a free-breathing sequence with or without respiratory triggering. Depending on the mobility of water molecules in their microenvironment, different normal tissues have different signals at DW imaging. Some normal tissues (eg, lymph nodes, spleen, ovarian and testicular parenchyma) are diffusion restricted, whereas others (eg, gallbladder, corpora cavernosa, endometrium, cartilage) show T2 shine-through. Epiphyses that contain fatty marrow and bone cortex appear dark on both DW images and apparent diffusion coefficient maps. Current and emerging applications of DW imaging in pediatric body imaging include tumor detection and characterization, assessment of therapy response and monitoring of tumors, noninvasive detection and grading of liver fibrosis and cirrhosis, detection of abscesses, and evaluation of inflammatory bowel disease.
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Affiliation(s)
- Govind B Chavhan
- From the Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8 (G.B.C., Z.A.); and Department of Medical Imaging, Royal University Hospital, Saskatoon, Canada (P.S.B.)
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Zidan DZ, Elghazaly HA. Can unenhanced multiparametric MRI substitute gadolinium-enhanced MRI in the characterization of vertebral marrow infiltrative lesions? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Diagnostic Value of Diffusion-Weighted Magnetic Resonance Imaging in Pelvic Abscesses. J Comput Assist Tomogr 2013; 37:971-9. [DOI: 10.1097/rct.0b013e31828bea16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Neubauer H, Evangelista L, Morbach H, Girschick H, Prelog M, Köstler H, Hahn D, Beer M. Diffusion-weighted MRI of bone marrow oedema, soft tissue oedema and synovitis in paediatric patients: feasibility and initial experience. Pediatr Rheumatol Online J 2012; 10:20. [PMID: 22849717 PMCID: PMC3508844 DOI: 10.1186/1546-0096-10-20] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/22/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND MRI has become the mainstay of diagnostic imaging in paediatric rheumatology for lesion detection, differential diagnosis and therapy surveillance. MR imaging of synovitis, in particular, is indispensable for early diagnosis and follow-up in arthritis patients. We used diffusion-weighted MRI (DWI) as a new imaging modality in comparison to standard MRI sequences to study bone marrow oedema, soft-tissue oedema and synovitis in paediatric patients. METHODS A total of 52 patients (mean age 11 ± 5 years) with bone marrow oedema (n = 31), soft-tissue oedema (n = 20) and synovitis (n = 15) were examined with transversal diffusion-weighted single-shot echoplanar imaging in addition to standard MR sequences (T2W TIRM, T1W pre- and post-contrast). Diffusion-weighted images were used for lesion detection and apparent diffusion coefficient (ADC, unit × 10-3 mm2/s) values were measured with ROI technique on ADC maps. RESULTS In 50 of 52 patients, DWI delineated the lesion of interest corresponding to pathological signal increase on standard sequences. Mean ADC was 1.60 ± 0.14 (range 1.38 - 1.99) in osseous lesions, 1.72 ± 0.31 (range 1.43 - 2.56) in soft tissue oedema and 2.82 ± 0.24 (range 2.47 - 3.18) for joint effusion (ANOVA p < 0.001). No significant difference in mean ADC was seen for inflammatory vs. non-inflammatory lesions. Relative signal intensity of oedema was similar for DWI and T2W TIRM. DWI visualised synovial restricted diffusion with a mean ADC of 2.12 ± 0.45 in 12 of 15 patients with synovitis. CONCLUSIONS Diffusion-weighted MRI reliably visualises osseous and soft tissue oedema, as compared to standard sequences. DWI of synovitis is feasible in large joints and presents a novel approach to contrast-free imaging of synovitis. Whole-body DWI for chronic non-bacterial osteomyelitis should be evaluated in future studies.
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Affiliation(s)
- Henning Neubauer
- Institute of Radiology, Department of Paediatric Radiology, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080, Wuerzburg, Germany.
| | - Laura Evangelista
- Institute of Radiology, Department of Paediatric Radiology, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080, Wuerzburg, Germany
| | - Henner Morbach
- Department of Paediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080, Wuerzburg, Germany
| | - Hermann Girschick
- Department of Paediatrics, Klinikum am Friedrichshain, Landsberger Allee 49, 10249, Berlin, Germany
| | - Martina Prelog
- Department of Paediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080, Wuerzburg, Germany
| | - Herbert Köstler
- Institute of Radiology, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Dietbert Hahn
- Institute of Radiology, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Meinrad Beer
- Institute of Radiology, Department of Paediatric Radiology, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080, Wuerzburg, Germany
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