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Lee K, Jeong YJ, Choo KS, Nam SB, Kim HY, Jung YJ, Lee SJ, Joo JH, Kim JY, Kim JJ, Kim JY, Yun MS, Nam KJ. Comparison of Fused Diffusion-Weighted Imaging Using Unenhanced MRI and Abbreviated Post-Contrast-Enhanced MRI in Patients with Breast Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1563. [PMID: 37763682 PMCID: PMC10534817 DOI: 10.3390/medicina59091563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: To determine the percentage of breast cancers detectable by fused diffusion-weighted imaging (DWI) using unenhanced magnetic resonance imaging (MRI) and abbreviated post-contrast-enhanced MRI. Materials and Methods: Between October 2016 and October 2017, 194 consecutive women (mean age, 54.2 years; age range, 28-82 years) with newly diagnosed unilateral breast cancer, who underwent preoperative 3.0 T breast MRI with DWI, were evaluated. Both fused DWI and abbreviated MRI were independently reviewed by two radiologists for the detection of index cancer (which showed the most suspicious findings in both breasts), location, lesion conspicuity, lesion type, and lesion size. Moreover, the relationship between cancer detection and histopathological results of surgical specimens was evaluated. Results: Index cancer detection rates were comparable between fused DWI and abbreviated MRI (radiologist 1: 174/194 [89.7%] vs. 184/194 [94.8%], respectively, p = 0.057; radiologist 2: 174/194 [89.7%] vs. 183/194 [94.3%], respectively, p = 0.092). In both radiologists, abbreviated MRI showed a significantly higher lesion conspicuity than fused DWI (radiologist 1: 9.37 ± 2.24 vs. 8.78 ± 3.03, respectively, p < 0.001; radiologist 2: 9.16 ± 2.32 vs. 8.39 ± 2.93, respectively, p < 0.001). The κ value for the interobserver agreement of index cancer detection was 0.67 on fused DWI and 0.85 on abbreviated MRI. For lesion conspicuity, the intraclass correlation coefficients were 0.72 on fused DWI and 0.82 on abbreviated MRI. Among the histopathological factors, tumor invasiveness was associated with cancer detection on both fused DWI (p = 0.011) and abbreviated MRI (p = 0.004, radiologist 1), lymphovascular invasion on abbreviated MRI (p = 0.032, radiologist 1), and necrosis on fused DWI (p = 0.031, radiologist 2). Conclusions: Index cancer detection was comparable between fused DWI and abbreviated MRI, although abbreviated MRI showed a significantly better lesion conspicuity.
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Affiliation(s)
- Kyeyoung Lee
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (K.L.); (K.S.C.)
| | - Yeo Jin Jeong
- Department of Health Promotion Center, Pusan National University Yangsan Hospital, Yangsan-si 50612, Republic of Korea;
| | - Ki Seok Choo
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (K.L.); (K.S.C.)
| | - Su Bong Nam
- Department of Plastic and Reconstructive Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea;
| | - Hyun Yul Kim
- Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (H.Y.K.); (Y.J.J.); (S.J.L.)
| | - Youn Joo Jung
- Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (H.Y.K.); (Y.J.J.); (S.J.L.)
| | - Seung Ju Lee
- Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (H.Y.K.); (Y.J.J.); (S.J.L.)
| | - Ji Hyeon Joo
- Department of Radiation Oncology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea;
| | - Jin You Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea; (J.Y.K.); (J.J.K.)
| | - Jin Joo Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea; (J.Y.K.); (J.J.K.)
| | - Jee Yeon Kim
- Department of Pathology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea;
| | - Mi Sook Yun
- Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si 50612, Republic of Korea;
| | - Kyung Jin Nam
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (K.L.); (K.S.C.)
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Preoperative risk stratification in women with endometrial cancer: A comparison of contrast-enhanced MR imaging and diffusion-weighted MR imaging. Eur J Radiol 2022; 150:110276. [PMID: 35339860 DOI: 10.1016/j.ejrad.2022.110276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/24/2022] [Accepted: 03/20/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare CE MRI and DWI in the risk stratification of women with endometrial cancer for lymph node metastasis. METHOD Two readers independently assessed the degree of myometrial invasion on two separate occasions in a retrospective cohort of 84 women with endometrial cancers: once with CE MRI and standard anatomic sequences and another time with DWI and standard anatomic sequences. Participants were stratified according to their risk of lymph node metastasis following the European Society for Medical Oncology guidelines. The rate of lymph node metastasis was compared between the risk stratification groups obtained using CE MRI or DWI by generalized estimating equations. RESULTS In the low-risk group, the rate of lymph node metastasis was 1.9% (1/53) when using CE MRI and 1.9% (1/54) when using DWI for reader 1, and 3.8% (2/52) when using CE MRI and 1.9% (1/52) when using DWI for reader 2. The rate of lymph node metastasis in the high-risk group was 25.8% (8/31) when using CE MRI and 26.7% (8/30) when using DWI for reader 1, and 21.9% (7/32) when using CE MRI and 25.0% (8/32) when using DWI for reader 2. There was no significant difference between CE MRI and DWI in the rate of lymph node metastasis according to the risk stratification (p > .05 in both low- and high-risk groups for both readers). CONCLUSION DWI might be a comparable alternative to CE MRI in the preoperative risk stratification of women with endometrial cancer for lymph node metastasis.
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Kumasaka S, Motegi S, Kumasaka Y, Nishikata T, Otomo M, Tsushima Y. Whole-body magnetic resonance imaging (WB-MRI) with diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) in prostate cancer: Prevalence and clinical significance of incidental findings. Br J Radiol 2022; 95:20210459. [PMID: 34111963 PMCID: PMC8978253 DOI: 10.1259/bjr.20210459] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) is now recommended as a first-line staging modality in prostate cancer patients, and the widespread use of DWIBS may lead to an increased frequency of incidental findings. The aim of this study was to evaluate the prevalence and clinical significance of incidental findings on whole-body magnetic resonance imaging (WB-MRI) with DWIBS. METHODS Data from 124 patients with prostate cancer (age, 76.5 ± 5.6 years), who underwent 1.5 T WB-MRI with STIR, TSE-T2, TSE-T1, In/Out GRE, and DWIBS sequences, were retrospectively analyzed. Findings unrelated to prostate cancer were considered as incidental findings and categorized into two groups based on their clinical implications as follows: imaging follow-up or additional examinations was required (significant incidental findings) and no need to additional work-up (non-significant incidental findings). A chi-square test was performed to compare the differences in the prevalence of significant incidental findings based on age (≤75 and>75 years old). RESULTS A total of 334 incidental findings were found with 8.1% (n = 27) as significant incidental findings. Significant incidental findings were more frequent in patients over 75 years old than those of 75 years old or younger (28.6% vs 11.1%, p = 0.018). CONCLUSION Clinically significant incidental findings, which required imaging follow-up or additional examinations, were commonly observed in prostate cancer patients on WB-MRI/DWIBS. ADVANCES IN KNOWLEDGE Some incidental findings were clinically significant that may lead to changes in treatment strategy. Checking the entire organ carefully for abnormalities and reporting any incidental findings detected are important.
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Affiliation(s)
- Soma Kumasaka
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shunichi Motegi
- Department of Radiological Sciences, School of Health Sciences, International University of Health and Welfare, Otawara City, Japan
| | - Yuka Kumasaka
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | | | - Masami Otomo
- Department of Radiology, Josai Clinic, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Kurita A, Mori Y, Someya Y, Kubo S, Azuma S, Iwano K, Ikeda S, Okumura R, Yazumi S. High signal intensity on diffusion-weighted magnetic resonance images is a useful finding for detecting early-stage pancreatic cancer. Abdom Radiol (NY) 2021; 46:4817-4827. [PMID: 34223962 PMCID: PMC8435518 DOI: 10.1007/s00261-021-03199-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 02/06/2023]
Abstract
Purpose Early detection of pancreatic ductal adenocarcinoma (PDAC) may improve the prognosis. We evaluated novel imaging findings that may contribute to early detection. Methods This single-center, retrospective study enrolled 37 patients with a localized main pancreatic duct (MPD) stricture and no obvious pancreatic mass. All patients underwent endoscopic retrograde cholangiopancreatography and brush sampling with cytology and serial pancreatic juice aspiration cytologic examination via endoscopic naso-pancreatic drainage. Patients with cytology-confirmed malignancy underwent surgical resection. The remaining patients were followed by contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography. Results Twenty patients had confirmed malignancy (cancer group) and 17 did not (non-cancer group). Age, MPD stricture location, and PDAC risk factors were similar, but the sex predominance and symptom rate differed between the two groups. In the cancer group, 17 patients were diagnosed by cytology and three by clinical symptoms. CECT, MRI, and endoscopic ultrasonography (EUS) revealed no solid tumors in either group. CECT revealed no significant differences between groups. Diffusion-weighted MRI revealed significant differences in the signal intensity between groups. EUS detected indistinct and small hypoechoic areas in 70% and 41.2% of patients in the cancer and non-cancer groups, respectively. In the cancer group, 11 were diagnosed with cancer at the first indication, and nine were diagnosed at follow-up; the prognosis did not differ between these two subgroups.ss Conclusions High signal intensity in diffusion-weighted MRI may be useful for detecting early-stage PDAC and may be an indication for surgical resection even without pathologic confirmation. Clinical trial registration The study was a registered at the University Hospital Medical Information Network (UMIN000039623). Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00261-021-03199-1.
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Ogawa M, Urano M, Takaishi T, Kan H, Arai N, Takahashi H, Hara M, Saito M, Shibamoto Y. T-staging of rectal cancer: Utility of single-shot turbo spin-echo diffusion-weighted imaging with T2-weighted images and fusion images. PLoS One 2021; 16:e0249433. [PMID: 33882087 PMCID: PMC8059798 DOI: 10.1371/journal.pone.0249433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/17/2021] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of turbo spin-echo (TSE) DWI with fusion images in the T-staging compared with T2-weighted imaging (T2WI) alone and conventional echo-planner imaging (EPI) DWI. METHODS In this prospective study, 4-mm-thick axial EPI-DWI, TSE-DWI, and T2WI were performed with the same slice locations for 20 patients with rectal cancer. Fusion images of DWI and T2WI were created for both EPI-DWI and TSE-DWI. Ten readers independently diagnosed the T-stages and scored the degree of confidence referring to T2WI alone and then to DWI, T2WI, and fusion images (DWI+T2WI) for each EPI-DWI and TSE-DWI. Visual score assessments of image quality were performed for each DWI. RESULTS Inter-observer agreement of T-staging for 10 readers was slight on T2WI alone but fair on EPI-DWI+T2WI and excellent on TSE-DWI+T2WI images. No readers gave higher confidence scores for T2WI compared to EPI/TSE-DWI+T2WI and for EPI-DWI+T2WI compared to TSE-DWI+T2WI. In seven pathologically-proven cases, poor, poor to slight, and fair to perfect agreements with the pathological T-stage were observed with T2WI alone, EPI-DWI+T2WI, and TSE-DWI+T2WI, respectively. All readers gave higher scores regarding image distortion and lower scores regarding image noise for TSE-DWI compared to EPI-DWI. For DWI utility, higher scores were assigned for TSE-DWI compared to EPI-DWI in 7 readers and there were no significant differences in the other 3 readers. CONCLUSION TSE-DWI images might be more appropriate for image fusion with T2WI and rectal cancer T-staging compared with EPI-DWI and T2WI alone.
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Affiliation(s)
- Masaki Ogawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Misugi Urano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taku Takaishi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirohito Kan
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Arai
- Department of Radiological Technology, Suzuka University of Medical Science, Suzuka, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masayasu Hara
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Miki Saito
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Colvin SD, Cason DE, Galgano SJ, Triche BL, Gordetsky J, Rais-Bahrami S, Porter KK. Fusion of high B-value diffusion-weighted and T2-weighted MR images increases sensitivity for identification of extraprostatic disease in prostate cancer. Clin Imaging 2020; 68:202-209. [PMID: 32892105 DOI: 10.1016/j.clinimag.2020.08.022] [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: 05/09/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate whether fusion of high b-value diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) increases radiologists' ability to detect pathologic features responsible for upstaging in prostate cancer patients prior to radical prostatectomy (RP). BASIC PROCEDURES This was a retrospective study including 103 patients who underwent RP and a prostate MRI performed at 3T. High b-value DWI and T2WI were fused and interpreted by three radiologists with different degrees of experience. Prior to and after fusion, readers answered questionnaires about cancer presence, extraprostatic extension (EPE), seminal vesicle (SV) invasion, lymph node (LN) involvement, and reader confidence. Pathology reports served as the reference standard. MAIN FINDINGS High b-value DWI-T2WI fusion increased sensitivity for detection of EPE from 65.6% to 77.4% (p < 0.05), SV invasion from 40.5% to 48.8% (p < 0.05), and LN metastasis by 23.8% to 44.4% (p < 0.05). Readers' confidence significantly improved with the use of fusion imaging. Across all readers, confidence of cancer detection increased by 12.5% (p < 0.05), EPE by 14.7% (p < 0.05), SV invasion by 8.1% (p < 0.05), and LN metastasis by 2.5% (p < 0.05) using Wilcoxon signed rank test. PRINCIPAL CONCLUSIONS Fusion overlay of high b-value DWI and T2WI increases sensitivity for detection of extraprostatic disease resulting in upstaging at the time of RP.
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Affiliation(s)
- Stephanie D Colvin
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Daniel E Cason
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Benjamin L Triche
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Soroush Rais-Bahrami
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
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Gharibvand MM, Ahmadzadeh A, Asadi F, Fazelinejad Z. The diagnostic precision of apparent diffusion coefficient (ADC) in grading of malignant endometrial lesions compared with histopathological findings. J Family Med Prim Care 2019; 8:3372-3378. [PMID: 31742171 PMCID: PMC6857380 DOI: 10.4103/jfmpc.jfmpc_142_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/12/2019] [Accepted: 09/17/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The present study aimed to extract apparent diffusion coefficient (ADC) values from the diffusion-weighted imaging (DWI) sequence of endometrial lesions and compare them with tissue specimen results in order to determine the precision of ADC values in grading of malignant endometrial lesions. METHODS The present prospective study was conducted on 22 patients complaining of abnormal vaginal bleeding or evidence for endometrial thickening or masses detected using the ultrasound. Sampling was performed for pathological examination. MRI T2W+DWI+T1W+Post Contrast T1W were performed for patients. The statistical analysis was performed in SPSS 20 and MedCalc. RESULTS In this study, although the mean ADC value was lower in patients with endometrial cancer than those with benign endometrial lesions, the difference was not significant (0.86 ± 0.2 mm2/sec versus 1.33 ± 0.53 mm2/sec; P = 0.13). Using the cutoff point of 0.53, the sensitivity and specificity of ADC value for differentiating benign and malignant lesions, respectively, equaled 90.91 and 9.09, with an equal positive and negative predictive value of 50%. In patients with endometrioid adenocarcinoma, mean ADC value was 0.93 ± 0.15 in FIGO Grade I, and 0.76 ± 0.165 in FIGO Grade II. Based on the statistical test, no significant difference existed between the two groups in terms of ADC values. CONCLUSION Results indicate that the use of a DWI sequence (ADC values) can prevent invasive measures in the diagnosis of benign endometrial lesions and the identification of malignant lesions with a high precision in many patients having accompanying diseases or other cases for which invasive measures cannot be used. Also, there is no significant difference in the mean ADC values between G1 and G2 of endometrioid carcinoma.
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Affiliation(s)
- Mohammad M. Gharibvand
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Azar Ahmadzadeh
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Fariba Asadi
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran,Address for correspondence: Dr. Fariba Asadi, Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran. E-mail:
| | - Zahra Fazelinejad
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
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Rezk M, Nasr I, Ali I, Abdelhamed H. Comparative Study between 18F FDG-PET/CT and Whole Body MRI DWIBS in Assessment of Recurrent Breast Cancer (Prospective, Comparative, Cross-sectional Study Design). Indian J Nucl Med 2019; 34:1-9. [PMID: 30713370 PMCID: PMC6352640 DOI: 10.4103/ijnm.ijnm_121_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: This study aims to assess the diagnostic performance of 18F-fluorodeoxyglucose-positron emission tomography/computerized tomography (18FDG-PET/CT) compared to whole body (WB) magnetic resonance diffusion-weighted imaging (DWI) with background body signal suppression (MR/DWIBS) in lesions detection in patients with recurrent breast cancer. Materials and Methods: Twenty-three female patients with suspected breast cancer recurrence by clinical, laboratory, or conventional imaging underwent both 18FDG-PET/CT and WB MR/DWIBS. WB 18FDG-PET/CT was performed using the standard technique. WB MR/DWIBS acquired sequences were WB DWI with short tau inversion recovery (STIR), coronal T1, and coronal STIR. Both 18FDG-PET/CT and WB-magnetic resonance imaging/DWIBS were independently interpreted using visual qualitative and quantitative analysis. Pathological findings and combined clinical/radiological follow-up data were used as a reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for both techniques. Results: PET/CT demonstrated higher specificity and sensitivity indices than MR/DWIBS in the detection of the nodal and distant lesions, while the latter displayed higher sensitivity in the detection of local breast lesions. The overall sensitivity, specificity, NPV, PPV, and accuracy of PET/CT were 84.8%, 86.3%, 90.4%, 78.7%, and 85.4% versus 82.1%, 78.0%, 85.2%, 74.0%, and 80.5% for MR/DWIBS. A high degree of agreement existed between PET/CT and MR-DWIBS. Conclusion: 18FDG-PET/CT is more sensitive and has superiority in the assessment of nodal and distant lesions than DWIBS that has a potential superior role in the assessment of local breast lesions. DWIBS has a promising and helpful complementary tool for 18FDG-PET/CT in the evaluation of patients with proven malignancies.
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Affiliation(s)
- Mahmoud Rezk
- Department of Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ibrahim Nasr
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ismail Ali
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Heba Abdelhamed
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Abdelsalam EM, EL Adalany MA, Fouda MEA. Value of diffusion weighted magnetic resonance imaging in grading of urinary bladder carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Andrade-Campos M, Valero E, Roca M, Giraldo P. The utility of magnetic resonance imaging for bone involvement in Gaucher disease. Assessing more than bone crises. Blood Cells Mol Dis 2018; 68:126-134. [DOI: 10.1016/j.bcmd.2016.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022]
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Guo Y, Wang P, Wang P, Gao W, Li F, Yang X, Ni H, Shen W, Guo Z. Myometrial invasion and overall staging of endometrial carcinoma: assessment using fusion of T2-weighted magnetic resonance imaging and diffusion-weighted magnetic resonance imaging. Onco Targets Ther 2017; 10:5937-5943. [PMID: 29290687 PMCID: PMC5735992 DOI: 10.2147/ott.s145763] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background The age of onset of endometrial carcinoma has been decreasing in recent years. In endometrial carcinoma, it is important to accurately assess invasion depth and preoperative staging. Fusion of T2-weighted magnetic resonance imaging (T2WI) and diffusion-weighted magnetic resonance imaging (DWI) may contribute to the improvement of anatomical localization of lesions. Materials and methods In our study, a total of 58 endometrial carcinoma cases were included. Based on the revised 2009 International Federation of Gynecology and Obstetrics staging system, a fusion of T2WI and DWI was utilized for the evaluation of invasion depth and determination of the overall stage. Postoperative pathologic assessment was considered as the reference standard. The consistency of T2WI image staging and pathologic staging, and the consistency of fused T2WI and DWI and pathologic staging were all analyzed using Kappa statistics. Results Compared with the T2WI group, a significantly higher diagnostic accuracy was observed for myometrial invasion with fusion of T2WI and DWI (77.6% for T2WI; 94.8% for T2WI-DWI). For the identification of deep invasion, we calculated values for diagnostic sensitivity (69.2% for T2WI; 92.3% for T2WI-DWI), specificity (80% for T2WI; 95.6% for T2WI-DWI), positive predictive value (50% for T2WI; 85.7% for T2WI-DWI), and negative predictive value (90% for T2WI; 97.7% for T2WI-DWI). In summary, T2WI-DWI fusion exhibits higher diagnostic accuracy with respect to staging relative to T2WI only (81.0% for T2WI; 94.8% for T2WI-DWI). Conclusion Fused T2WI-DWI may represent a noninvasive, lower cost approach for the effective assessment of myometrial invasion and staging of endometrial carcinoma.
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Affiliation(s)
- Yu Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin.,Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Ping Wang
- Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Penghui Wang
- Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Wei Gao
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Fenge Li
- Department of Gynecology, Tianjin First Center Hospital, Tianjin, People's Republic of China
| | - Xueling Yang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Hongyan Ni
- Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Wen Shen
- Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin
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Morone M, Bali MA, Tunariu N, Messiou C, Blackledge M, Grazioli L, Koh DM. Whole-Body MRI: Current Applications in Oncology. AJR Am J Roentgenol 2017; 209:W336-W349. [PMID: 28981354 DOI: 10.2214/ajr.17.17984] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to review current image acquisition and interpretation for whole-body MRI, clinical applications, and the emerging roles in oncologic imaging, especially in the assessment of bone marrow diseases. CONCLUSION Whole-body MRI is an emerging technique used for early diagnosis, staging, and assessment of therapeutic response in oncology. The improved accessibility and advances in technology, including widely available sequences (Dixon and DWI), have accelerated its deployment and acceptance in clinical practice.
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Affiliation(s)
- Mario Morone
- 1 Prima Radiologia Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia, BS 25123, Italy
| | | | - Nina Tunariu
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Christina Messiou
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Luigi Grazioli
- 1 Prima Radiologia Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia, BS 25123, Italy
| | - Dow-Mu Koh
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
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Kim SH, Shin HJ, Shin KC, Chae EY, Choi WJ, Cha JH, Kim HH. Diagnostic Performance of Fused Diffusion-Weighted Imaging Using T1-Weighted Imaging for Axillary Nodal Staging in Patients With Early Breast Cancer. Clin Breast Cancer 2017; 17:154-163. [DOI: 10.1016/j.clbc.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/12/2016] [Indexed: 01/17/2023]
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An YY, Kim SH, Kang BJ. Differentiation of malignant and benign breast lesions: Added value of the qualitative analysis of breast lesions on diffusion-weighted imaging (DWI) using readout-segmented echo-planar imaging at 3.0 T. PLoS One 2017; 12:e0174681. [PMID: 28358833 PMCID: PMC5373600 DOI: 10.1371/journal.pone.0174681] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/12/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To determine the added value of qualitative analysis as an adjunct to quantitative analysis for the discrimination of benign and malignant lesions in patients with breast cancer using diffusion-weighted imaging (DWI) with readout-segmented echo-planar imaging (rs-EPI). Methods A total of 99 patients with 144 lesions were reviewed from our prospectively collected database. DWI data were obtained using rs-EPI acquired at 3.0 T. The diagnostic performances of DWI in the qualitative, quantitative, and combination analyses were compared with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Additionally, the effect of lesion size on the diagnostic performance of the DWI combination analysis was evaluated. Results The strongest indicators of malignancy on DWI were a heterogeneous pattern (P = 0.005) and an apparent diffusion coefficient (ADC) value <1.0 × 10–3 mm2/sec (P = 0.002). The area under the curve (AUC) values for the qualitative analysis, quantitative analysis, and combination analysis on DWI were 0.732 (95% CI, 0.651–0.803), 0.780 (95% CI, 0.703–0.846), and 0.826 (95% CI, 0.754–0.885), respectively (P<0.0001). The AUC for the combination analysis on DWI was superior to that for DCE-MRI alone (0.651, P = 0.003) but inferior to that for DCE-MRI plus the ADC value (0.883, P = 0.03). For the DWI combination analysis, the sensitivity was significantly lower in the size ≤1 cm group than in the size >1 cm group (80% vs. 95.6%, P = 0.034). Conclusions Qualitative analysis of tumor morphology was diagnostically applicable on DWI using rs-EPI. This qualitative analysis adds value to quantitative analyses for lesion characterization in patients with breast cancer.
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Affiliation(s)
- Yeong Yi An
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
- * E-mail:
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Teixeira SR, Elias PCL, Leite AFDM, de Oliveira TMG, Muglia VF, Elias Junior J. Apparent diffusion coefficient of normal adrenal glands. Radiol Bras 2017; 49:363-368. [PMID: 28057963 PMCID: PMC5210033 DOI: 10.1590/0100-3984.2015.0045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective To assess the feasibility and reliability of apparent diffusion coefficient
(ADC) measurements of normal adrenal glands. Materials and methods This was a retrospective study involving 32 healthy subjects, divided into
two groups: prepubertal (PreP, n = 12), aged from 2 months
to 12.5 years (4 males; 8 females); and postpubertal (PostP,
n = 20), aged from 11.9 to 61 years (5 males; 15
females). Diffusion-weighted magnetic resonance imaging (DW-MRI) sequences
were acquired at a 1.5 T scanner using b values of 0, 20,
500, and 1000 s/mm2. Two radiologists evaluated the images. ADC
values were measured pixel-by-pixel on DW-MRI scans, and automatic
co-registration with the ADC map was obtained. Results Mean ADC values for the right adrenal glands were 1.44 ×
10-3 mm2/s for the PreP group and 1.23 ×
10-3 mm2/s for the PostP group, whereas they were
1.58 × 10-3 mm2/s and 1.32 ×
10-3 mm2/s, respectively, for the left glands. ADC
values were higher in the PreP group than in the PostP group
(p < 0.05). Agreement between readers was almost
perfect (intraclass correlation coefficient, 0.84-0.94; p
< 0.05). Conclusion Our results demonstrate the feasibility and reliability of performing DW-MRI
measurements of normal adrenal glands. They could also support the
feasibility of ADC measurements of small structures.
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Affiliation(s)
- Sara Reis Teixeira
- MD, PhD, Attending Physician at the Centro de Ciências das Imagens e Física Médica (CCIFM), Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Paula Condé Lamparelli Elias
- MD, PhD, Endocrinology Division of the Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Andrea Farias de Melo Leite
- MD, PhD, Attending Physician at the Instituto de Medicina Integral Professor Fernando Figueira de Pernambuco (IMIP), Recife, PE, Brazil
| | - Tatiane Mendes Gonçalves de Oliveira
- MD, PhD, Attending Physician at the Centro de Ciências das Imagens e Física Médica (CCIFM), Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Valdair Francisco Muglia
- MD, PhD, Associate Professor in the Radiology Division of the Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Elias Junior
- MD, PhD, Associate Professor in the Radiology Division of the Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Shin HJ, Chae EY, Choi WJ, Ha SM, Park JY, Shin KC, Cha JH, Kim HH. Diagnostic Performance of Fused Diffusion-Weighted Imaging Using Unenhanced or Postcontrast T1-Weighted MR Imaging in Patients With Breast Cancer. Medicine (Baltimore) 2016; 95:e3502. [PMID: 27124054 PMCID: PMC4998717 DOI: 10.1097/md.0000000000003502] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To evaluate the diagnostic performance of fused diffusion-weighted imaging (DWI) using either unenhanced (UFMR) or early postcontrast T1-weighted imaging (PCFMR) to detect and characterize breast lesions in patients with breast cancer.This retrospective observational study was approved by institutional review board in our hospital and informed consents were waived. We retrospectively selected 87 consecutive patients who underwent preoperative breast magnetic resonance imaging, including DWI and definitive surgery. Both UFMR and PCFMR were reviewed by 5 radiologists for detection, lesion size, Breast Imaging Reporting and Data System final assessment, the probability of malignancy, lesion conspicuity, and apparent diffusion coefficients.A total of 129 lesions were identified by at least 2 readers on UFMR or PCFMR. Of 645 potentially detected lesions, there were 528 (82%) with UFMR and 554 (86%) with PCFMR. Malignant lesions or index cancers showed significantly higher detection rates than benign or additional lesions on both UFMR and PCFMR (P < 0.05). Area under the characteristic curves (AUCs) for predicting malignancy ranged 0.927 to 0.986 for UFMR, and 0.936 to 0.993 for PCFMR, which was not significantly different. Lesion conspicuity was significantly higher on PCFMR than UFMR (8.59 ± 1.67 vs 9.19 ± 1.36, respectively; P < 0.05) across 5 readers. Mean intraclass correlation coefficients for lesion size on UFMR and PCFMR were 0.89 and 0.92, respectively.Detection rates of index malignant lesions were similar for UFMR and PCFMR. Interobserver agreement for final assessments was reliable across 5 readers. Diagnostic accuracy for predicting malignancy with UFMR versus PCFMR was similar, although lesion conspicuity was significantly greater with the latter.
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Affiliation(s)
- Hee Jung Shin
- From the Department of Radiology and Research Institute of Radiology, Biomedical Imaging Infrastructure, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea
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Tang MY, Zhang XM, Chen TW, Huang XH. Various diffusion magnetic resonance imaging techniques for pancreatic cancer. World J Radiol 2015; 7:424-37. [PMID: 26753059 PMCID: PMC4697117 DOI: 10.4329/wjr.v7.i12.424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/15/2015] [Accepted: 11/13/2015] [Indexed: 02/07/2023] Open
Abstract
Pancreatic cancer is one of the most common malignant tumors and remains a treatment-refractory cancer with a poor prognosis. Currently, the diagnosis of pancreatic neoplasm depends mainly on imaging and which methods are conducive to detecting small lesions. Compared to the other techniques, magnetic resonance imaging (MRI) has irreplaceable advantages and can provide valuable information unattainable with other noninvasive or minimally invasive imaging techniques. Advances in MR hardware and pulse sequence design have particularly improved the quality and robustness of MRI of the pancreas. Diffusion MR imaging serves as one of the common functional MRI techniques and is the only technique that can be used to reflect the diffusion movement of water molecules in vivo. It is generally known that diffusion properties depend on the characterization of intrinsic features of tissue microdynamics and microstructure. With the improvement of the diffusion models, diffusion MR imaging techniques are increasingly varied, from the simplest and most commonly used technique to the more complex. In this review, the various diffusion MRI techniques for pancreatic cancer are discussed, including conventional diffusion weighted imaging (DWI), multi-b DWI based on intra-voxel incoherent motion theory, diffusion tensor imaging and diffusion kurtosis imaging. The principles, main parameters, advantages and limitations of these techniques, as well as future directions for pancreatic diffusion imaging are also discussed.
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Sherif MF. The value of diffusion weighted MR imaging in T staging and correlation with histologic grading in urinary bladder cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Regacini R, Puchnick A, Shigueoka DC, Iared W, Lederman HM. Whole-body diffusion-weighted magnetic resonance imaging versus FDG-PET/CT for initial lymphoma staging: systematic review on diagnostic test accuracy studies. SAO PAULO MED J 2015; 133:141-50. [PMID: 25789779 PMCID: PMC10496634 DOI: 10.1590/1516-3180.2014.8312810] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 01/31/2014] [Accepted: 10/28/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Positron emission tomography with [18]F-fluoro-2-deoxyglucose (FDG-PET/CT) has been advocated as the method of choice for lymphoma staging, since it enables whole-body analysis with high sensitivity for detection of affected areas and because it combines capacities for anatomical and functional assessment. With technological advances, magnetic resonance imaging (MRI) has emerged as an alternative to FDG-PET/CT. This systematic review with meta-analysis aimed to compare whole-body diffusion-weighted MRI (WB-MRI) with FDG-PET/CT for lymphoma staging. DESIGN AND SETTING Systematic review on diagnostic test accuracy studies conducted at a public university. METHODS The Medline, Scopus, Embase and Lilacs databases were searched for studies published up to September 2013 that compared WB-MRI and FDG-PET/CT for lymphoma staging. The reference lists of included studies were checked for any relevant additional citations. RESULTS Six studies that evaluated the initial lymphoma staging in 116 patients were included. WB-MRI and FDG-PET/CT agreed in 90.5% of the cases (κ = 0.871; P < 0.0001). In most of the studies, when there was disagreement between the methods, WB-MRI overstaged in relation to FDG-PET/CT. The sensitivity of WB-MRI and FDG-PET/CT, in comparison with the clinical-radiological standard, ranged from 59 to 100% and from 63 to 100% respectively. CONCLUSION WB-MRI is a highly sensitive method for initial lymphoma staging. It has excellent agreement with FDG-PET/CT and is a great alternative for managing lymphoma patients, without using ionizing radiation or an intravenous contrast agent.
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Affiliation(s)
- Rodrigo Regacini
- MD, MSc. Radiologist, Discipline of Pediatric Radiology, Department of Diagnostic Imaging, Universidade Federal de São Paulo-Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.
| | - Andrea Puchnick
- BSc. Professor and Coordinator of Educational and Research Support, Department of Diagnostic Imaging, Universidade Federal de São Paulo-Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.
| | - David Carlos Shigueoka
- MD, PhD. Adjunct Professor, Department of Diagnostic Imaging, Universidade Federal de São Paulo-Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.
| | - Wagner Iared
- MD, PhD. Assistant Research Radiologist, Department of Diagnostic Imaging, Universidade Federal de São Paulo-Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil
| | - Henrique Manoel Lederman
- MD, PhD. Full Professor and Head of the Discipline of Pediatric Radiology, Department of Diagnostic Imaging, Universidade Federal de São Paulo-Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.
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Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis. Cancer Imaging 2014; 14:32. [PMID: 25608571 PMCID: PMC4331837 DOI: 10.1186/s40644-014-0032-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 10/21/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The objective of this study was to perform a systematic review and a meta-analysis in order to estimate the diagnostic accuracy of diffusion weighted imaging (DWI) in the preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma. METHODS Studies evaluating DWI for the detection of deep myometrial invasion in patients with endometrial carcinoma were systematically searched for in the MEDLINE, EMBASE, and Cochrane Library from January 1995 to January 2014. Methodologic quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies tool. Bivariate random-effects meta-analytic methods were used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and receiver operating characteristic (ROC) curves. The study also evaluated the clinical utility of DWI in preoperative assessment of deep myometrial invasion. RESULTS Seven studies enrolling a total of 320 individuals met the study inclusion criteria. The summary area under the ROC curve was 0.91. There was no evidence of publication bias (P = 0.90, bias coefficient analysis). Sensitivity and specificity of DWI for detection of deep myometrial invasion across all studies were 0.90 and 0.89, respectively. Positive and negative likelihood ratios with DWI were 8 and 0.11 respectively. In patients with high pre-test probabilities, DWI enabled confirmation of deep myometrial invasion; in patients with low pre-test probabilities, DWI enabled exclusion of deep myometrial invasion. The worst case scenario (pre-test probability, 50%) post-test probabilities were 89% and 10% for positive and negative DWI results, respectively. CONCLUSION DWI has high sensitivity and specificity for detecting deep myometrial invasion and more importantly can reliably rule out deep myometrial invasion. Therefore, it would be worthwhile to add a DWI sequence to the standard MRI protocols in preoperative evaluation of endometrial cancer in order to detect deep myometrial invasion, which along with other poor prognostic factors like age, tumor grade, and LVSI would be useful in stratifying high risk groups thereby helping in the tailoring of surgical approach in patient with low risk of endometrial carcinoma.
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Zhao Q, Liu L, Wang Q, Liang Z, Shi G. Preoperative diagnosis and staging of rectal cancer using diffusion-weighted and water imaging combined with dynamic contrast-enhanced scanning. Oncol Lett 2014; 8:2734-2740. [PMID: 25360178 PMCID: PMC4214399 DOI: 10.3892/ol.2014.2590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 03/20/2014] [Indexed: 01/24/2023] Open
Abstract
The aim of the present study was to evaluate the value of diffusion-weighted imaging (DWI) and water imaging combined with dynamic contrast-enhanced scanning for the preoperative diagnosis and staging of rectal cancer. In total, 72 patients with pathologically confirmed rectal cancer were selected for examination using magnetic resonance imaging (MRI) with phased-array coils, DWI, water imaging and dynamic contrast-enhanced scanning. The patients were divided into two groups, experimental (simple enhanced scanning plus diffusion combined with water imaging) and control (simple enhanced scanning), for the pathological observations. The sensitivity, specificity and accuracy for the T staging of the carcinomas using scan enhancement with DWI and the evaluation of cancer using water imaging were 98.5% (65/66), 66.7% (4/6) and 95.8% (69/72), respectively, and the accuracy for N staging was 89%. Whereas, the sensitivity, specificity and accuracy for the T staging of the carcinomas using simple scan enhancement were 85.7% (42/49), 78.3% (18/23) and 83.3% (60/72), respectively, and the accuracy for N staging was 61%. Therefore, the combination of multiple MRI techniques may be of high value for the early diagnosis and exact staging of rectal cancer.
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Affiliation(s)
- Qili Zhao
- Department of Magnetic Resonance and Computed Tomography, The People's Hospital of Langfang City, Langfang, Hebei 065000, P.R. China
| | - Lijian Liu
- Department of Magnetic Resonance and Computed Tomography, The People's Hospital of Langfang City, Langfang, Hebei 065000, P.R. China
| | - Qiuyan Wang
- Department of Magnetic Resonance and Computed Tomography, The People's Hospital of Langfang City, Langfang, Hebei 065000, P.R. China
| | - Zexia Liang
- Department of Magnetic Resonance and Computed Tomography, The People's Hospital of Langfang City, Langfang, Hebei 065000, P.R. China
| | - Gaofeng Shi
- Department of Magnetic Resonance and Computed Tomography, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050019, P.R. China
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Tsuji K, Kishi S, Tsuchida T, Yamauchi T, Ikegaya S, Urasaki Y, Fujiwara Y, Ueda T, Okazawa H, Kimura H. Evaluation of staging and early response to chemotherapy with whole-body diffusion-weighted MRI in malignant lymphoma patients: A comparison with FDG-PET/CT. J Magn Reson Imaging 2014; 41:1601-7. [DOI: 10.1002/jmri.24714] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/13/2014] [Accepted: 07/15/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kazunobu Tsuji
- Department of Radiology; University of Fukui Hospital; Fukui Japan
| | - Shinji Kishi
- Department of Hematology; University of Fukui Hospital; Fukui Japan
| | - Tatsuro Tsuchida
- Department of Radiology; University of Fukui Hospital; Fukui Japan
| | | | - Satoshi Ikegaya
- Department of Hematology; University of Fukui Hospital; Fukui Japan
| | | | | | - Takanori Ueda
- Department of Hematology; University of Fukui Hospital; Fukui Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center; University of Fukui; Fukui Japan
| | - Hirohiko Kimura
- Department of Radiology; University of Fukui Hospital; Fukui Japan
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Lewis S, Dyvorne H, Cui Y, Taouli B. Diffusion-weighted imaging of the liver: techniques and applications. Magn Reson Imaging Clin N Am 2014; 22:373-95. [PMID: 25086935 PMCID: PMC4121599 DOI: 10.1016/j.mric.2014.04.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diffusion-weighted imaging (DWI) is a technique that assesses the cellularity, tortuosity of the extracellular/extravascular space, and cell membrane density based on differences in water proton mobility in tissues. The strength of the diffusion weighting is reflected by the b value. DWI using several b values enables the quantification of the apparent diffusion coefficient. DWI is increasingly used in liver imaging for multiple reasons: it can add useful qualitative and quantitative information to conventional imaging sequences; it is acquired relatively quickly; it is easily incorporated into existing clinical protocols; and it is a noncontrast technique.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Hadrien Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Yong Cui
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA.
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Canale S, Vilcot L, Ammari S, Lemery M, Bidault F, Balleyguier C, Caramella C, Dromain C. Whole body MRI in paediatric oncology. Diagn Interv Imaging 2014; 95:541-50. [DOI: 10.1016/j.diii.2013.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tamura T, Murakami S, Naito K, Yamada T, Fujimoto T, Kikkawa T. Investigation of the optimal b-value to detect breast tumors with diffusion weighted imaging by 1.5-T MRI. Cancer Imaging 2014; 14:11. [PMID: 25608450 PMCID: PMC4331817 DOI: 10.1186/1470-7330-14-11] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/21/2022] Open
Abstract
Background Previous studies have reported that the signal attenuation of diffusion-weighted magnetic resonance imaging (DWI) for normal breast tissue and tumor were well fitted by a monoexponential and a biexponential function, respectively. The aim of this study was to investigate the optimal b-value to detect breast tumors from DWI signal attenuations. Methods Sixty-four subjects with breast cancer underwent DWI using six b-values up to 3500 s/mm2. The signal attenuations of normal breast and tumor were fitted by mono- and biexponential functions, respectively. The maximum contrast b-values were estimated and compared in terms of frequency. Results In almost all cases, the contrast increased with a b-value from 0 to approximately 1500 s/mm2. For b > 1500 s/mm2, the contrast decreased. The highest contrast b-value in the range of 0 to 2500 s/mm2 most frequently was b = 1500 and the next most frequent was 1400 s/mm2. Comparing sensitivity and specificity between b = 700 and b = 1400 s/mm2, b =1400 s/mm2 was slightly superior. Conclusion Based on these results, DWI with a b-value of approximately 1400-1500 s/mm2 is recommended for optimizing breast tumor detectability.
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Kuang F, Yan Z, Wang J, Rao Z. The value of diffusion-weighted MRI to evaluate the response to radiochemotherapy for cervical cancer. Magn Reson Imaging 2013; 32:342-9. [PMID: 24512795 DOI: 10.1016/j.mri.2013.12.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/28/2013] [Accepted: 12/01/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the value of apparent diffusion coefficient (ADC) to predict and monitor the therapy response for cervical cancer patients receiving concurrent radiochemotherapy, and to analyze the influence of different b-value combinations on ADC-based evaluation of treatment response. MATERIAL AND METHODS Seventy-five cervical cancer patients treated with radiochemotherapy received conventional MRI and DWI prior to therapy, after 2 weeks of therapy, after four weeks of therapy and after therapy completion. Treatment response was classified as complete response (CR, n=35), partial response (PR, n=22) and stable disease (SD, n=18), which was determined according to final tumor size after 6 months of therapy completion. Dynamic changes of apparent diffusion coefficients (ADC) and tumor size in the three tumor groups were observed and compared. All the ADCs were calculated from b=0, 600s/mm(2) and b=0, 1000s/mm(2). RESULTS The ADC increased percentage was higher in CR group than those in PR and SD groups after two weeks and four weeks of therapy, with significant differences in absolute ADCs between CR and PR, SD groups after therapy completion; the overall discriminatory capability for differentiation of CR and PR, SD groups was higher for high b-value combination (0, 1000s/mm(2)) than for low b-value combination (0, 600s/mm(2)). CONCLUSION DWI can be used as a predictive and monitoring biomarker of treatment response to radiochemotherapy in patients with cervical cancer. High b-value combination may be more reliable to evaluate the treatment response for cervical cancer.
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Affiliation(s)
- Fei Kuang
- Department of Medical Imaging, The 174th Hospital of Chinese PLA, No 96, Wen Yuan Road, Xiamen, Fujian Province 361003, China.
| | - Ziping Yan
- Department of Medical Imaging, The 174th Hospital of Chinese PLA, No 96, Wen Yuan Road, Xiamen, Fujian Province 361003, China
| | - Jian Wang
- Department of Medical Imaging, The 174th Hospital of Chinese PLA, No 96, Wen Yuan Road, Xiamen, Fujian Province 361003, China
| | - Ziyuan Rao
- Department of Medical Imaging, The 174th Hospital of Chinese PLA, No 96, Wen Yuan Road, Xiamen, Fujian Province 361003, China
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Gawande RS, Gonzalez G, Messing S, Khurana A, Daldrup-Link HE. Role of diffusion-weighted imaging in differentiating benign and malignant pediatric abdominal tumors. Pediatr Radiol 2013; 43:836-45. [PMID: 23666206 DOI: 10.1007/s00247-013-2626-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 11/09/2012] [Accepted: 11/27/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Solid malignant tumors are more highly cellular than benign lesions and hence have a restricted diffusion of water molecules. OBJECTIVE To evaluate whether diffusion-weighted MR imaging (DWI) can differentiate between benign and malignant pediatric abdominal tumors. MATERIALS AND METHODS We retrospectively analyzed DWI scans of 68 consecutive children with 39 benign and 34 malignant abdominal masses. To calculate the apparent diffusion coefficient (ADC) maps and ADC values, we used 1.5-T sequences at TR/TE/b-value of 5,250-7,500/54-64/b = 0, 500 and 3-T sequences at 3,500-4,000/66-73/b = 0, 500, 800. ADC values were compared between benign and malignant and between data derived at 1.5 tesla (T) and at 3 tesla magnetic field strength, using the Mann-Whitney-Wilcoxon test, ANOVA and a receiver operating curve (ROC) analysis. RESULTS There was no significant difference in ADC values obtained at 1.5 T and 3 T (P = 0.962). Mean ADC values (× 10(-3) mm(2)/s) were 1.07 for solid malignant tumors, 1.6 for solid benign tumors, 2.9 for necrotic portions of malignant tumors and 3.1 for cystic benign lesions. The differences between malignant and benign solid tumors were statistically significant (P = 0.000025). ROC analysis revealed an optimal cut-off ADC value for differentiating malignant and benign solid tumors as 1.29 with excellent inter-observer reliability (alpha score 0.88). CONCLUSION DWI scans and ADC values can contribute to distinguishing between benign and malignant pediatric abdominal tumors.
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Gönen M. Mixtures of receiver operating characteristic curves. Acad Radiol 2013; 20:831-7. [PMID: 23643788 DOI: 10.1016/j.acra.2013.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Receiver operating characteristic (ROC) curves are ubiquitous in the analysis of imaging metrics as markers of both diagnosis and prognosis. While empirical estimation of ROC curves remains the most popular method, there are several reasons to consider smooth estimates based on a parametric model. MATERIALS AND METHODS A mixture model is considered for modeling the distribution of the marker in the diseased population motivated by the biological observation that there is more heterogeneity in the diseased population than there is in the normal one. It is shown that this model results in an analytically tractable ROC curve which is itself a mixture of ROC curves. RESULTS The use of creatine kinase-BB isoenzyme in diagnosis of severe head trauma is used as an example. ROC curves are fit using the direct binormal method, ROCKIT software, and the Box-Cox transformation as well as the proposed mixture model. The mixture model generates an ROC curve that is much closer to the empirical one than the other methods considered. CONCLUSIONS Mixtures of ROC curves can be helpful in fitting smooth ROC curves in datasets where the diseased population has higher variability than can be explained by a single distribution.
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Affiliation(s)
- Mithat Gönen
- Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, 1275 York Ave, Box 44 New York, NY 10065, USA.
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Liu Y, Yang Y, Zhang C. A concise review of magnetic resonance molecular imaging of tumor angiogenesis by targeting integrin αvβ3 with magnetic probes. Int J Nanomedicine 2013; 8:1083-93. [PMID: 23515638 PMCID: PMC3600999 DOI: 10.2147/ijn.s39880] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Angiogenesis is an essential step for the growth and spread of malignant tumors. Accurate detection and quantification of tumor angiogenesis is important for early diagnosis of cancers as well as post therapy assessment of antiangiogenic drugs. The cell adhesion molecule integrin αvβ3 is a specific marker of angiogenesis, which is highly expressed on activated and proliferating endothelial cells, but generally not on quiescent endothelial cells. Therefore, in recent years, many different approaches have been developed for imaging αvβ3 expression, for the detection and characterization of tumor angiogenesis. The present review provides an overview of the current status of magnetic resonance molecular imaging of integrin αvβ3, including the new development of high sensitive contrast agents and strategies for improving the specificity of targeting probes and the biological effects of imaging probes on αvβ3 positive cells.
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Affiliation(s)
- Yajie Liu
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Hirsch FW, Sattler B, Sorge I, Kurch L, Viehweger A, Ritter L, Werner P, Jochimsen T, Barthel H, Bierbach U, Till H, Sabri O, Kluge R. PET/MR in children. Initial clinical experience in paediatric oncology using an integrated PET/MR scanner. Pediatr Radiol 2013; 43:860-75. [PMID: 23306377 PMCID: PMC3691480 DOI: 10.1007/s00247-012-2570-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/04/2012] [Accepted: 10/06/2012] [Indexed: 01/04/2023]
Abstract
Use of PET/MR in children has not previously been reported, to the best of our knowledge. Children with systemic malignancies may benefit from the reduced radiation exposure offered by PET/MR. We report our initial experience with PET/MR hybrid imaging and our current established sequence protocol after 21 PET/MR studies in 15 children with multifocal malignant diseases. The effective dose of a PET/MR scan was only about 20% that of the equivalent PET/CT examination. Simultaneous acquisition of PET and MR data combines the advantages of the two previously separate modalities. Furthermore, the technique also enables whole-body diffusion-weighted imaging (DWI) and statements to be made about the biological cellularity and nuclear/cytoplasmic ratio of tumours. Combined PET/MR saves time and resources. One disadvantage of PET/MR is that in order to have an effect, a significantly longer examination time is needed than with PET/CT. In our initial experience, PET/MR has turned out to be an unexpectedly stable and reliable hybrid imaging modality, which generates a complementary diagnostic study of great additional value.
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Affiliation(s)
- Franz Wolfgang Hirsch
- Department of Paediatric Radiology, University of Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
| | - Bernhard Sattler
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Ina Sorge
- Department of Paediatric Radiology, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Adrian Viehweger
- Department of Paediatric Radiology, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Lutz Ritter
- Department of Paediatric Radiology, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Peter Werner
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Thies Jochimsen
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Uta Bierbach
- Department of Paediatric Oncology, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Holger Till
- Department of Paediatric Surgery, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
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Kuang F, Chen Z, Zhong Q, Fu L, Ma M. Apparent diffusion coefficients of normal uterus in premenopausal women with 3 T MRI. Clin Radiol 2012; 68:455-60. [PMID: 23211507 DOI: 10.1016/j.crad.2012.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 09/17/2012] [Accepted: 09/19/2012] [Indexed: 11/19/2022]
Abstract
AIM To investigate the apparent diffusion coefficient (ADC) values of the normal uterine cervical zonal structures (cervical epithelium, the junctional zone, and myometrium) during different phases of the menstrual cycle among premenopausal women in different age groups. MATERIALS AND METHODS Seventy healthy women, who were divided into three age groups (group A, 24 women in their twenties; group B, 23 women in their thirties; group C, 23 women in their forties), underwent 3 T magnetic resonance imaging (MRI) with T2-weighted and diffusion-weighted imaging (DWI) during the mid-proliferative and the mid-secretory phases. RESULTS The ADC values of each cervical zonal structure were significantly different from one another (p < 0.001). The ADC values of the epithelium and junctional zones were both lower during the mid-secretory phase than those during the mid-proliferative phase in each age group (p < 0.05). There were no significant differences in the ADC values of any of the cervical zones among the three age groups for a given phase (p > 0.05). CONCLUSION ADC values of normal cervical epithelium and the junctional zone change with different phases of the menstrual cycle, which should be taken into consideration when early cervical disease is detected, when monitoring treatment response, and differentiating early tumour recurrence.
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Affiliation(s)
- F Kuang
- Department of Radiology, The 174th Hospital of Chinese PLA, No. 96, Wen Yuan Road, Xiamen, China
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Song J, Zhang C, Liu Q, Yu T, Jiang X, Xia Q, Zhang Y, Sequeiros RB. Utility of chemical shift and diffusion-weighted imaging in characterization of hyperattenuating adrenal lesions at 3.0T. Eur J Radiol 2012; 81:2137-43. [DOI: 10.1016/j.ejrad.2011.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 12/27/2022]
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Role of combined DWIBS/3D-CE-T1w whole-body MRI in tumor staging: Comparison with PET-CT. Eur J Radiol 2012; 81:1917-25. [DOI: 10.1016/j.ejrad.2011.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/07/2011] [Accepted: 08/08/2011] [Indexed: 11/17/2022]
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Fukukura Y, Takumi K, Kamimura K, Shindo T, Kumagae Y, Tateyama A, Nakajo M. Pancreatic Adenocarcinoma: Variability of Diffusion-weighted MR Imaging Findings. Radiology 2012; 263:732-40. [DOI: 10.1148/radiol.12111222] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Wu LM, Hu JN, Hua J, Liu MJ, Chen J, Xu JR. Diagnostic value of diffusion-weighted magnetic resonance imaging compared with fluorodeoxyglucose positron emission tomography/computed tomography for pancreatic malignancy: a meta-analysis using a hierarchical regression model. J Gastroenterol Hepatol 2012; 27:1027-35. [PMID: 22414092 DOI: 10.1111/j.1440-1746.2012.07112.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM To obtain diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of pancreatic malignancy. METHODS We performed a meta-analysis of all available studies of the diagnostic performance of DWI and PET/CT for pancreatic malignancy. MEDLINE, EMBASE, Cochrane library and some other databases were searched for initial studies. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves (SROC) using hierarchical regression models. RESULTS Across 16 studies with 804 patients, PET/CT sensitivity was 0.87 (95% confidence interval [CI], 0.82, 0.81) and specificity was 0.83 (95% CI, 0.71, 0.91). Overall, LR+ was 5.84 (95% CI, 4.59, 7.42) and LR- was 0.24 (95% CI, 0.17, 0.33). DWI sensitivity was 0.85 (95% CI, 0.74, 0.92) and specificity was 0.91 (95% CI, 0.71, 0.98). LR+ was 9.53 (95% CI, 2.41, 37.65) and LR- was 0.17 (95% CI, 0.09, 0.32). In subgroup analysis, the sensitivity of enhanced versus unenhanced PET/CT in the detection of pancreatic cancer was 0.91 (95% CI, 0.86, 0.96) versus 0.84 (95% CI, 0.78, 0.90) (P > 0.05), the specificity 0.88 (95% CI, 0.73, 1.00) versus 0.81 (95% CI, 0.69, 0.94) (P > 0.05). CONCLUSION Positron emission tomography/computed tomography (PET/CT) was highly sensitive and DWI was a highly specific modality in diagnosing patients with pancreatic malignancy. PET/CT and DWI could play different roles in diagnosing pancreatic carcinoma. Enhanced PET/CT seems to be superior to unenhanced PET/CT. Further larger prospective studies are needed to establish its value for diagnosis in pancreatic cancer.
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Affiliation(s)
- Lian-Ming Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Apparent diffusion coefficients of normal uterus in premenopausal women with 3.0-T magnetic resonance imaging. J Comput Assist Tomogr 2012; 36:54-9. [PMID: 22261770 DOI: 10.1097/rct.0b013e3182418885] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the apparent diffusion coefficients (ADCs) of the normal uterine zonal structures (myometrium, endometrium, and junctional zone) during different phases of the menstrual cycle among premenopausal women with different age groups. MATERIALS AND METHODS Magnetic resonance (MR) images of 67 healthy women were obtained during the midproliferative and midsecretory phases. They were further divided into 3 age groups: group A (age range, 20-29 years); group B (age range, 30-39 years), and group C (mean age, 44.62 years; age range, 40-49 years). All the women underwent 3.0-T MR scanning twice. The ADC values were compared among each uterine zonal structure and 3 age groups and were calculated between the midproliferative and midsecretory phase. RESULTS The ADC values among each uterine zonal structures were significantly different from one another (P < 0.001). The ADC values for endometrium in women in their 30s were higher than those in their 20s and in their 30s during the midproliferative and midsecretory phases (P < 0.05), and the ADC values for endometrium in each age groups were lower during the midproliferative phase than those during the midsecretory phase (P < 0.05), but there were no statistical differences in the myometrium and the junctional zone between the 2 phases or among age groups (P > 0.05). CONCLUSION These preliminary results suggested that the zone, age, and phase of the menstrual cycle in premenopausal women should be considered when interpreting the ADC values of uterine structures (especially for endometrium).
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Brenner R, Metens T, Bali M, Demetter P, Matos C. Pancreatic neuroendocrine tumor: added value of fusion of T2-weighted imaging and high b-value diffusion-weighted imaging for tumor detection. Eur J Radiol 2012; 81:e746-9. [PMID: 22386133 DOI: 10.1016/j.ejrad.2012.01.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To investigate the added value of fusion of high b-value diffusion-weighted images (DWI) and T2-weighted (T2) MR images for the detection of pancreatic neuroendocrine tumors (PNT). METHODS 18 patients with 18 histologically proven PNT were included. Two radiologists independently and retrospectively reviewed four randomized images sets (T2+T1, DWI, T2+DWI, and DWI+T2 fusion). Lesion detection confidence level was assessed using a three grade score (no lesion; uncertain lesion and certain lesion); lesion size and signal intensity were recorded. Apparent diffusion coefficients (ADC) of tumor and adjacent pancreas were measured. RESULTS Readers 1 and 2 respectively detected 14/18 and 16/18 lesions on T2+T1, 13/18 and 12/18 on DWI, 16/18 and 15/18 on T2+DWI and 17/18 and 16/18 on DWI+T2 fusion. Lesion median size was 16 mm (range: 7 mm-40 mm), 22% were hyperfunctioning (all insulinomas) and 72% were low-grade (Rindi 1). All tumors except one (with cystic component) showed lower ADC than adjacent pancreatic parenchyma. Fusion imaging had significantly better detection score by both authors (p<0.005) and provided the higher inter-reader agreement (kappa 0.7). DWI alone had the worst score for both readers. CONCLUSIONS Fusion images improve the detection of PNT, especially in patients with small isointense lesions on conventional MR sequences.
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Affiliation(s)
- Renata Brenner
- Hôpital Erasme - Université Libre de Bruxelles Medical Imaging Department, MRI Division, Route de Lennik 808, 1070 Brussels, Belgium.
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Value of diffusion-weighted imaging for the discrimination of pancreatic lesions: a meta-analysis. Eur J Gastroenterol Hepatol 2012; 24:134-42. [PMID: 22241215 DOI: 10.1097/meg.0b013e32834eff37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to explore the role of diffusion-weighted imaging (DWI) in the discrimination of pancreatic lesions through meta-analysis. METHODS The MEDLINE, EMBASE, Cancerlit, and Cochrane Library databases, from January 2001 to August 2011, were searched for studies evaluating the diagnostic performance of DWI in the discrimination of pancreatic lesions. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves. RESULTS A total of 11 studies with 586 patients, who fulfilled all of the inclusion criteria, were considered for the analysis. No publication bias was found. The pooled sensitivity of DWI was 0.86 [95% (confidence interval (CI), 0.78, 0.91] and the pooled specificity was 0.91 (95% CI, 0.81, 0.96). Overall, LR+ was 9.8 (95% CI, 4.1, 23.3) and LR- was 0.15 (95% CI, 0.09, 0.26). The area under the curve of the summary receiver operating characteristic was 0.94 (95% CI, 0.91-0.96). In subgroup analysis, prospectively designed studies had the highest pooled sensitivity (0.87, 95% CI 0.75, 0.94) and specificity (0.96, 95% CI 0.91, 0.99) (P<0.05). Study sensitivity was not correlated with the prevalence of pancreatic lesions (R=0.1076, P=0.3247). CONCLUSION A limited number of small studies suggest that DWI is a potentially technically feasible measure to differentiate malignant from benign pancreatic lesions. However, it is still controversial and is limited in that it can only distinguish certain lesions. High-quality prospective studies on DWI for the discrimination of pancreatic lesions still need to be conducted.
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Tamura T, Usui S, Murakami S, Arihiro K, Fujimoto T, Yamada T, Naito K, Akiyama M. Comparisons of multi b-value DWI signal analysis with pathological specimen of breast cancer. Magn Reson Med 2011; 68:890-7. [PMID: 22161802 DOI: 10.1002/mrm.23277] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/29/2011] [Accepted: 10/09/2011] [Indexed: 01/23/2023]
Abstract
Previous studies have reported that the signal attenuation of diffusion weighted magnetic resonance imaging for tumor tissues displays a non-monoexponential biexponential decay, and the apparent diffusion coefficients (ADCs) can be divided into a fast and slow diffusion component by using a simple biexponential decay model. The purpose of this study is to examine the non-monoexponential character of the diffusion weighted magnetic resonance imaging signal attenuations of breast cancers, estimate the fast and slow diffusion components, and compare them with the extra- and intracellular component information obtained from the pathological specimens. Twenty-two subjects having breast cancers underwent diffusion weighted magnetic resonance imaging using six b-values up to 3500 s/mm(2) and the signal attenuations were analyzed using the biexponential function. The derived slow component fraction correlated with the cellular fraction and the ADCs converged to 0.2-0.3 × 10(-3) mm(2) /s for the higher cellular fractions. The ADCs of the fast component ranged from 1.3 to 3.9 × 10(-3) mm(2) /s and showed no correlation with the extracellular components. This result suggests that the main reason for the decreasing ADC of a breast tumor is the decreasing fraction of the fast component and the increasing fraction of the slow component having a low ADC rather than the decreasing ADC of the fast component by the restricted water diffusion in the reduced extracellular spaces.
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Affiliation(s)
- Takayuki Tamura
- Department of Radiology, Hiroshima Atomic Bomb Casualty Council, Health Management & Promotion Center, Hiroshima, Japan.
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Rosenkrantz AB, Mannelli L, Kong X, Niver BE, Berkman DS, Babb JS, Melamed J, Taneja SS. Prostate cancer: utility of fusion of T2-weighted and high b-value diffusion-weighted images for peripheral zone tumor detection and localization. J Magn Reson Imaging 2011; 34:95-100. [PMID: 21698707 DOI: 10.1002/jmri.22598] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To retrospectively assess the utility of fusion of T2-weighted images (T2WI) and high b-value diffusion-weighted images (DWI) for prostate cancer detection and localization. MATERIALS AND METHODS In this IRB-approved HIPAA-compliant study, 42 patients with prostate cancer underwent MRI including multiplanar T2WI and axial DWI before prostatectomy. Two independent radiologists first assessed multiplanar T2WI and axial DWI(b-1000) images and recorded whether tumor was present in each sextant. Axial T2WI was then fused with axial DWI(b-1000) images, and the radiologists re-evaluated each sextant for tumor. Accuracy was compared using generalized estimating equations based on a binary logistic regression model. RESULTS The accuracy, sensitivity, specificity, PPV, and NPV for tumor detection on a sextant-basis using separate and fused image sets was 65.1%, 50.8%, 78.0%, 67.8%, and 63.6% and 71.0%, 60.8%, 80.3%, 73.7%, and 69.3%, respectively, for reader 1, and 54.0%, 42.5%, 64.4%, 52.0%, and 55.2%, and 61.1%, 56.7%, 65.2%, 59.6%, and 62.3%, respectively, for reader 2. The improvements in accuracy, sensitivity, and NPV using fused images were statistically significant for both readers, as was the improvement in PPV for reader 2 (P ranging from <0.0001 to 0.041). With either separate or fused images, there was greater sensitivity for tumors of higher grade or larger size (P ranging from <0.001 to 0.099). CONCLUSION Fusion of T2WI and high b-value DWI resulted in significant improvements in sensitivity and accuracy for tumor detection on a sextant-basis, with similar specificity.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Medical Center, TCH-HW202, New York, New York 10016, USA.
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Levy A, Medjhoul A, Caramella C, Zareski E, Berges O, Chargari C, Boulet B, Bidault F, Dromain C, Balleyguier C. Interest of diffusion-weighted echo-planar MR imaging and apparent diffusion coefficient mapping in gynecological malignancies: a review. J Magn Reson Imaging 2011; 33:1020-7. [PMID: 21509857 DOI: 10.1002/jmri.22546] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Magnetic resonance imaging (MRI) remains the standard modality for the local staging of gynecological malignancies but it has several limitations, particularly for lymph node staging or evaluating peritoneal carcinomatosis. Consequently, there has been a growing interest in functional imaging modalities. Based on molecular diffusion, diffusion-weighted imaging (DWI) is a unique, noninvasive modality that provides excellent tissue contrast and was shown to improve the radiological diagnosis of malignant tumors. Using quantitative apparent diffusion coefficient (ADC) measurement of DWI provides a new tool for better distinguishing malignant tissues from benign tumors. The aim of the present review is to report on the results of DWI for the assessment of patients with gynecological malignancies. An analysis of the literature suggests that DWI studies would improve the diagnosis of cervical and endometrial tumors. It may also improve the assessment of tumor extension in patients with peritoneal carcinomatosis from gynecological malignancies. However, since the signal intensity of some cancers can range from high intensity to low intensity, a degree of uncertainty was demonstrated due to the proximity of the normal uterine myometrium and ovaries. Interestingly, there is also evidence that ADC might improve the follow-up and monitoring of patients who receive anticancer therapies, including chemotherapy or radiation therapy.
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Affiliation(s)
- Antonin Levy
- Université Paris XI, Department of Radiology, Gustave Roussy Institute, Villejuif, France
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Takahara T, Kwee TC, Sadahiro S, Yamashita T, Toyoguchi Y, Yoshizako T, Horie T, Luijten PR, Imai Y. Low b-value diffusion-weighted imaging for diagnosing strangulated small bowel obstruction: a feasibility study. J Magn Reson Imaging 2011; 34:1117-24. [PMID: 21928383 DOI: 10.1002/jmri.22735] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 07/15/2011] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess the feasibility of low b-value diffusion-weighted imaging (DWI) for diagnosing strangulated small bowel obstruction (SBO). MATERIALS AND METHODS Five volunteers and 14 patients with SBO underwent DWI at b-values of 0 and 50 s/mm(2). Apparent diffusion coefficients (ADCs) and signal preservation ratios (SPRs) were measured in the distal jejunum in the volunteers before and after butylscopolamine administration, and in the (strangulated) closed loop, near the obstructive site, and far from the obstructive site in the patients. Low b-value diffusion-weighted images in the patients were quantitatively evaluated for diagnosing strangulation. RESULTS In the volunteers, mean ADC (10(-3) mm(2)/s) and SPR (%) before butylscopolamine administration (18.3 ± 5.9 and 41.4 ± 11.5) were significantly different (P < 0.05) from those after butylscopolamine administration (6.4 ± 3.6 and 73.7 ± 12.9). In the patients, mean ADCs and SPRs among the strangulated closed loop (3.8 ± 2.2 and 83.3 ± 9.3), near the obstructive site (12.1 ± 6.9 and 57.3 ± 18.5), and far from the obstructive site (26.8 ± 10.7 and 29.9 ± 16.4) were significantly different (P < 0.05). Areas under the receiver operating characteristic curve for the diagnosis of strangulation varied between 0.937 and 1.000. CONCLUSION Low b-value DWI is a feasible technique to distinguish the strangulated closed loop from nonstrangulated loops in SBO, and show promise for diagnosing strangulated SBO.
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Affiliation(s)
- Taro Takahara
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Whole-body diffusion-weighted magnetic resonance imaging: Current evidence in oncology and potential role in colorectal cancer staging. Eur J Cancer 2011; 47:2107-16. [DOI: 10.1016/j.ejca.2011.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/11/2011] [Accepted: 05/10/2011] [Indexed: 01/11/2023]
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Whole-Body Diffusion-Weighted Imaging: The Added Value to Whole-Body MRI at Initial Diagnosis of Lymphoma. AJR Am J Roentgenol 2011; 197:W384-91. [DOI: 10.2214/ajr.10.5692] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kobayashi H, Longmire MR, Ogawa M, Choyke PL. Rational chemical design of the next generation of molecular imaging probes based on physics and biology: mixing modalities, colors and signals. Chem Soc Rev 2011; 40:4626-48. [PMID: 21607237 PMCID: PMC3417232 DOI: 10.1039/c1cs15077d] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In recent years, numerous in vivo molecular imaging probes have been developed. As a consequence, much has been published on the design and synthesis of molecular imaging probes focusing on each modality, each type of material, or each target disease. More recently, second generation molecular imaging probes with unique, multi-functional, or multiplexed characteristics have been designed. This critical review focuses on (i) molecular imaging using combinations of modalities and signals that employ the full range of the electromagnetic spectra, (ii) optimized chemical design of molecular imaging probes for in vivo kinetics based on biology and physiology across a range of physical sizes, (iii) practical examples of second generation molecular imaging probes designed to extract complementary data from targets using multiple modalities, color, and comprehensive signals (277 references).
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Affiliation(s)
- Hisataka Kobayashi
- Molecular Imaging Program, National Cancer Institute/NIH, Bldg. 10, Room B3B69, MSC 1088, 10 Center Dr Bethesda, Maryland 20892-1088, USA.
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Matos C, Serrao E, Bali MA. Magnetic resonance imaging of biliary tumors. Magn Reson Imaging Clin N Am 2011; 18:477-96, x. [PMID: 21094451 DOI: 10.1016/j.mric.2010.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article presents current magnetic resonance imaging techniques for the diagnosis of biliary tumors. It emphasizes the need for a comprehensive protocol, combining imaging sequences of the liver parenchyma and soft tissues with magnetic resonance cholangiopancreatography and magnetic resonance angiography to detect and stage biliary malignancies. Imaging characteristics that may indicate a specific diagnosis are discussed. The potential role of diffusion-weighted imaging in diagnosing the cause of biliary obstruction and detecting unsuspected nodal disease and peritoneal seeding is emphasized and illustrated.
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Affiliation(s)
- Celso Matos
- MR Imaging Division, Department of Radiology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Belgium.
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Abdulqadhr G, Molin D, Åström G, Suurküla M, Johansson L, Hagberg H, Ahlström H. Whole-body diffusion-weighted imaging compared with FDG-PET/CT in staging of lymphoma patients. Acta Radiol 2011; 52:173-80. [PMID: 21498346 DOI: 10.1258/ar.2010.100246] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has become increasingly valuable in lymph node imaging, yet the clinical utility of this technique in the staging of lymphoma has not been established. PURPOSE To compare whole-body DWI with FDG-PET/CT in the staging of lymphoma patients. MATERIAL AND METHODS Thirty-one patients, eight with Hodgkin lymphoma (HL) and 23 with non-Hodgkin's lymphoma (18 aggressive and five indolent) underwent both whole-body DWI, whole-body MRI (T1W and T2W-STIR) and FDG-PET/CT. Lesions on whole-body DWI were only considered positive if they correlated with lesions on T1W and T2W-STIR images. The staging given by each technique was compared, according to the Ann Arbor staging system. Differences in staging were solved using biopsy results, and clinical and CT follow-ups as standard of reference. RESULTS The staging was the same for DWI and FDG-PET/CT in 28 (90.3%) patients and different in three (9.7%). Of the 28 patients with the same staging, 11 had stage IV in both techniques and 17 had stages 0-III. No HL or aggressive non-Hodgkin's lymphoma patients had different staging. Three indolent small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) lymphoma had higher staging with DWI when compared with FDG-PET/CT. One small subcutaneous breast lymphoma was not seen but all other extranodal sites were detected by both techniques. CONCLUSION Whole-body DWI is a promising technique for staging of both (aggressive and indolent) non-Hodgkin's lymphoma and HL.
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Affiliation(s)
| | | | | | - Madis Suurküla
- Department of Nuclear Medicine, Uppsala University Hospital, Uppsala, Sweden
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Kalkmann J, Lauenstein T, Stattaus J. Ganzkörperdiffusionsbildgebung in der Onkologie. Radiologe 2011; 51:215-9. [DOI: 10.1007/s00117-010-2062-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer. Eur Radiol 2011; 21:1250-8. [PMID: 21240647 PMCID: PMC3088810 DOI: 10.1007/s00330-010-2052-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 11/22/2010] [Accepted: 11/25/2010] [Indexed: 12/30/2022]
Abstract
Objectives To evaluate the accuracy of standard MRI, diffusion-weighted MRI (DWI) and fusion images for the diagnosis of locally recurrent rectal cancer in patients with a clinical suspicion of recurrence. Methods Forty-two patients with a clinical suspicion of recurrence underwent 1.5-T MRI consisting of standard T2-weighted FSE (3 planes) and an axial DWI (b0,500,1000). Two readers (R1,R2) independently scored the likelihood of recurrence; [1] on standard MRI, [2] on standard MRI+DWI, and [3] on T2-weighted+DWI fusion images. Results 19/42 patients had a local recurrence. R1 achieved an area under the ROC-curve (AUC) of 0.99, sensitivity 100% and specificity 83% on standard MRI versus 0.98, 100% and 91% after addition of DWI (p = 0.78). For R2 these figures were 0.87, 84% and 74% on standard MRI and 0.91, 89% and 83% with DWI (p = 0.09). Fusion images did not significantly improve the performance. Interobserver agreement was κ0.69 for standard MRI, κ0.82 for standard MRI+DWI and κ0.84 for the fusion images. Conclusions MRI is accurate for the diagnosis of locally recurrent rectal cancer in patients with a clinical suspicion of recurrence. Addition of DWI does not significantly improve its performance. However, with DWI specificity and interobserver agreement increase. Fusion images do not improve accuracy.
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