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Gundogdu B, Pittman JM, Chatterjee A, Szasz T, Lee G, Giurcanu M, Medved M, Engelmann R, Guo X, Yousuf A, Antic T, Devaraj A, Fan X, Oto A, Karczmar GS. Directional and inter-acquisition variability in diffusion-weighted imaging and editing for restricted diffusion. Magn Reson Med 2022; 88:2298-2310. [PMID: 35861268 PMCID: PMC9545544 DOI: 10.1002/mrm.29385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate and quantify inter-directional and inter-acquisition variation in diffusion-weighted imaging (DWI) and emphasize signals that report restricted diffusion to enhance cancer conspicuity, while reducing the effects of local microscopic motion and magnetic field fluctuations. METHODS Ten patients with biopsy-proven prostate cancer were studied under an Institutional Review Board-approved protocol. Individual acquisitions of DWI signal intensities were reconstructed to calculate inter-acquisition distributions and their statistics, which were compared for healthy versus cancer tissue. A method was proposed to detect and filter the acquisitions affected by motion-induced signal loss. First, signals that reflect restricted diffusion were separated from the acquisitions that suffer from signal loss, likely due to microscopic motion, by imposing a cutoff value. Furthermore, corrected apparent diffusion coefficient maps were calculated by employing a weighted sum of the multiple acquisitions, instead of conventional averaging. These weights were calculated by applying a soft-max function to the set of acquisitions per-voxel, making the analysis immune to acquisitions with significant signal loss, even if the number of such acquisitions is high. RESULTS Inter-acquisition variation is much larger than the Rician noise variance, local spatial variations, and the estimates of diffusion anisotropy based on the current data, as well as the published values of anisotropy. The proposed method increases the contrast for cancers and yields a sensitivity of98 . 8 % $$ 98.8\% $$ with a false positive rate of3 . 9 % $$ 3.9\% $$ . CONCLUSION Motion-induced signal loss makes conventional signal-averaging suboptimal and can obscure signals from areas with restricted diffusion. Filtering or weighting individual acquisitions prior to image analysis can overcome this problem.
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Affiliation(s)
| | - Jay M. Pittman
- Department of RadiologyUniversity of ChicagoChicagoIllinoisUSA
| | | | - Teodora Szasz
- Research Computing CenterUniversity of ChicagoChicagoIllinoisUSA
| | - Grace Lee
- Department of RadiologyUniversity of ChicagoChicagoIllinoisUSA
| | - Mihai Giurcanu
- Department of Public Health SciencesUniversity of ChicagoIllinoisUSA
| | - Milica Medved
- Department of RadiologyUniversity of ChicagoChicagoIllinoisUSA
| | - Roger Engelmann
- Department of RadiologyUniversity of ChicagoChicagoIllinoisUSA
| | - Xiaodong Guo
- Department of RadiologyUniversity of ChicagoChicagoIllinoisUSA
| | - Ambereen Yousuf
- Department of RadiologyUniversity of ChicagoChicagoIllinoisUSA
| | - Tatjana Antic
- Department of PathologyUniversity of ChicagoChicagoIllinoisUSA
| | - Ajit Devaraj
- Philips Research North AmericaCambridgeMassachusettsUSA
| | - Xiaobing Fan
- Department of RadiologyUniversity of ChicagoChicagoIllinoisUSA
| | - Aytekin Oto
- Department of RadiologyUniversity of ChicagoChicagoIllinoisUSA
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State of the Art: Lung Cancer Staging Using Updated Imaging Modalities. Bioengineering (Basel) 2022; 9:bioengineering9100493. [PMID: 36290461 PMCID: PMC9598500 DOI: 10.3390/bioengineering9100493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Lung cancer is among the most common mortality causes worldwide. This scientific article is a comprehensive review of current knowledge regarding screening, subtyping, imaging, staging, and management of treatment response for lung cancer. The traditional imaging modality for screening and initial lung cancer diagnosis is computed tomography (CT). Recently, a dual-energy CT was proven to enhance the categorization of variable pulmonary lesions. The National Comprehensive Cancer Network (NCCN) recommends usage of fluorodeoxyglucose positron emission tomography (FDG PET) in concert with CT to properly stage lung cancer and to prevent fruitless thoracotomies. Diffusion MR is an alternative to FDG PET/CT that is radiation-free and has a comparable diagnostic performance. For response evaluation after treatment, FDG PET/CT is a potent modality which predicts survival better than CT. Updated knowledge of lung cancer genomic abnormalities and treatment regimens helps to improve the radiologists’ skills. Incorporating the radiologic experience is crucial for precise diagnosis, therapy planning, and surveillance of lung cancer.
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CT Combined with Multiparameter MRI in Differentiating Pathological Subtypes of Non-Small-Cell Lung Cancer before Surgery. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8207301. [PMID: 35655730 PMCID: PMC9129958 DOI: 10.1155/2022/8207301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 12/24/2022]
Abstract
Objective To investigate the diagnostic value of computed tomography (CT) combined with multiparametric magnetic resonance imaging (mpMRI) for preoperative differentiation of non-small-cell lung cancer (NSCLC). Methods CT and MRI imaging data were collected from all patients with squamous lung cancer and adenocarcinoma admitted to our hospital from June 2019 to December 2020 (286 cases). ROC curves were plotted to evaluate the performance of CT, mpMRI, and CT combined with mpMRI to differentiate pathological subtypes of NSCLC. Univariate and multivariate regression were used to be independent predictors of pathological subtypes of NSCLC. Results ROC curves showed that CT combined with mpMRI had the largest area under the curve, followed by mpMRI and CT successively. Univariate regression analysis showed that gender, smoking, tumor size, morphology, marginal lobulation, marginal burr, bronchial truncation sign, and vascular convergence sign were factors influencing the pathological subtype of NSCLC. Multivariate regression analysis suggested the fact that gender, tumor size, morphology, marginal lobulation, bronchial truncation, and vascular convergence sign are likely the independent predictors of NSCLC pathological subtypes. Conclusions CT combined with mpMRI can effectively distinguish NSCLC pathological subtypes, which is worthy of clinical application.
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Tang X, Bai G, Wang H, Guo F, Yin H. Elaboration of Multiparametric MRI-Based Radiomics Signature for the Preoperative Quantitative Identification of the Histological Grade in Patients With Non-Small-Cell Lung Cancer. J Magn Reson Imaging 2022; 56:579-589. [PMID: 35040525 DOI: 10.1002/jmri.28051] [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: 09/23/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The histological grading plays an essential role in the treatment decision of lung cancer. Detected tumors are usually biopsied to confirm histologic grade. How to use MRI extracted radiomics features for accurately grading lung cancer is still challenging. PURPOSE To examine the diagnostic utility of multiparametric MRI radiomics and clinical factors for grading non-small-cell lung cancer (NSCLC). STUDY TYPE Retrospective. POPULATION A total of 148 patients (25.7% female) with postoperative pathologically confirmed NSCLC and divided into the training cohort (N = 110) and the validation cohort (N = 38). FIELD STRENGTH/SEQUENCE A 1.5 T; single-shot turbo spin-echo (TSE), T2-weighted imaging (T2WI), and integrated shimming-echo planar imaging (ISHIM-EPI) diffusion-weighted imaging (DWI). ASSESSMENT A total of 2775 radiomics features were extracted from carcinomatous regions of interest on T2WI, DWI, and the apparent diffusion coefficient (ADC) maps. The five optimal features were selected by using the Student' s t-test, the least absolute shrinkage and selection operator (LASSO) and stepwise regression. The Radscore combined with clinical factors, which selected by univariate and multivariate analyses, to develop a radiomics-clinical nomogram. Its performance was evaluated in the training cohort and the validation cohort. The potential clinical usefulness was analyzed by the receiver operating characteristic curve (ROC), area under the curve (AUC), and the Hosmer-Lemeshow test. STATISTICAL TESTS Student's t-test, univariate analyses, multivariate analyses, LASSO, ROC, AUC, and the Hosmer-Lemeshow test. P < 0.05 was considered statistically significant. RESULTS Favorable discrimination performance was obtained for five optimal features (out of the 2775 features), using the training cohorts (AUC 0.761) and validation cohorts (AUC 0.753). In addition, the radiomics-clinical nomogram significantly improved the ability to identify histological grades in the training cohort (AUC 0.814) and the validation cohort (AUC 0.767). DATA CONCLUSIONS The radiomics-clinical nomogram based on multiparametric MRI might have the potential to distinguish the histological grade of NSCLC. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Xing Tang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Guoyan Bai
- Department of Clinical Laboratory, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710032, China
| | - Hong Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Fan Guo
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
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UNLU EN, ALTINSOY HB, GÜLEÇ BALBAY E, SUNGUR MA, BORAN M, ÖNAL B. Shear Wave Ultrasound Elastography And Dıffusıon-Weıghted Magnetıc Resonance Imagıng Fındıngs Of Pleural-Based Masses Wıth Hıstopathologıc Correlatıon. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.880329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jagoda P, Fleckenstein J, Sonnhoff M, Schneider G, Ruebe C, Buecker A, Stroeder J. Diffusion-weighted MRI improves response assessment after definitive radiotherapy in patients with NSCLC. Cancer Imaging 2021; 21:15. [PMID: 33478592 PMCID: PMC7818746 DOI: 10.1186/s40644-021-00384-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/08/2021] [Indexed: 01/15/2023] Open
Abstract
Background Computed tomography (CT) is the standard procedure for follow-up of non-small-cell lung cancer (NSCLC) after radiochemotherapy. CT has difficulties differentiating between tumor, atelectasis and radiation induced lung toxicity (RILT). Diffusion-weighted imaging (DWI) may enable a more accurate detection of vital tumor tissue. The aim of this study was to determine the diagnostic value of MRI versus CT in the follow-up of NSCLC. Methods Twelve patients with NSCLC stages I-III scheduled for radiochemotherapy were enrolled in this prospective study. CT with i.v. contrast agent and non enhanced MRI were performed before and 3, 6 and 12 months after treatment. Standardized ROIs were used to determine the apparent diffusion weighted coefficient (ADC) within the tumor. Tumor size was assessed by the longest longitudinal diameter (LD) and tumor volume on DWI and CT. RILT was assessed on a 4-point-score in breath-triggered T2-TSE and CT. Results There was no significant difference regarding LD and tumor volume between MRI and CT (p ≥ 0.6221, respectively p ≥ 0.25). Evaluation of RILT showed a very high correlation between MRI and CT at 3 (r = 0.8750) and 12 months (r = 0.903). Assessment of the ADC values suggested that patients with a good tumor response have higher ADC values than non-responders. Conclusions DWI is equivalent to CT for tumor volume determination in patients with NSCLC during follow up. The extent of RILT can be reliably determined by MRI. DWI could become a beneficial method to assess tumor response more accurately. ADC values may be useful as a prognostic marker.
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Affiliation(s)
- Philippe Jagoda
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany.
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, 66421, Homburg, Saar, Germany
| | - Mathias Sonnhoff
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, 66421, Homburg, Saar, Germany
| | - Günther Schneider
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany
| | - Christian Ruebe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, 66421, Homburg, Saar, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany
| | - Jonas Stroeder
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany
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Pulmonary MRI: Applications and Use Cases. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Comparison of the diagnostic accuracy of diffusion-weighted magnetic resonance imaging and positron emission tomography/computed tomography in pulmonary nodules: a prospective study. Pol J Radiol 2020; 84:e498-e503. [PMID: 32082446 PMCID: PMC7016491 DOI: 10.5114/pjr.2019.91200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Computed tomography (CT) and positron emission tomography (PET) are the mainstay imaging methods in the evaluation and follow-up of pulmonary nodules. But they both have high radiation risk for patients. Diffusion- weighted magnetic resonance imaging (DW-MRI), on the other hand, is a radiation free imaging method that gives information about the biological structure of tissues at the molecular level by measuring random movement of water in biological tissues. In this prospective study we aimed to compare the computed tomography characteristics of the nodules in terms of malignancy and to compare the accuracy of DW-MRI and PET/CT results in those patients. Material and methods Seventy-six patients suspicious for lung cancer on thorax CT imaging were prospectively further evaluated by thorax diffusion-weighted imaging and PET/CT. Pulmonary lesion characteristics, apparent diffusion coefficient (ADC), and maximum standardised uptake values (SUVmax) were compared with histopathological results. Results There was statistically significant moderate negative correlation between PET-SUVmax and ADC values of lung lesions. ADC values below the cut-off was 97.1%, specificity was 97.6%, positive predictive value was 97.1%, and the negative predictive value was 97.6%. Conclusions DAG-MRI and PET/CT have similar success in the differentiation of benign and malignant lung lesions.
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Role of diffusion weighted MR-imaging in the evaluation of malignant mediastinal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-0132-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Background
Conducted studies showed that the ADC (apparent diffusion coefficient) values of malignant mediastinal lesions are significantly lower than those of benign lesions. Investigators determined cut-off ADC values to differentiate the two; concluding that ADC value is a promising noninvasive, imaging parameter that helps assess and characterize mediastinal tumors.
Taking this a step forward, the primary objective of our prospective study was to investigate the potential of DW-MRI (diffusion-weighted magnetic resonance imaging) to characterize malignant mediastinal lesions using their ADC values.
Thirty-three patients that underwent MRI of the chest with DWI and latter pathologically diagnosed with a malignant mediastinal lesion were included in this study. Lesions’ ADC values were measured and correlated with the histopathological results. The statistical significance of differences between measurements was tested using the one-way ANOVA (analysis of variance) test; p values equal to or less than 0.05 were considered significant.
Results
There was no statistically significant difference between the ADCmean values of the histopathological groups of lesions assessed with the overlap of their ADCmean values. The average ADCmean value of NHL (non-Hodgkin lymphoma) was evidently lower than that of HD (Hodgkin disease) with no overlap between their ADCmean values. DWI failed at characterizing one lesion in this study as a malignant tumor, namely an immature teratoma (germ-cell tumor). Again DWI could not be used to evaluate a mass, latter pathologically diagnosed as an angiosarcoma, because of its overall hemorrhagic nature showing no definite non-hemorrhagic soft tissue components. The aforementioned results did not differ considerably when minimum ADC was used instead of mean ADC.
Conclusion
There was no statistically significant difference between the ADC values of the malignant mediastinal lesions evaluated. However, regarding lymphoma subtypes, our limited sample study of lymphoma suggested a considerable difference between the ADC values of Hodgkin disease and non-Hodgkin lymphoma.
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Winzer R, Hoberück S, Zöphel K, Kotzerke J, Brauer T, Hoffmann RT, Platzek I. Diffusion-weighted MRI for initial staging in Hodgkin`s lymphoma: comparison with FDG PET. Eur J Radiol 2019; 123:108775. [PMID: 31864143 DOI: 10.1016/j.ejrad.2019.108775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/27/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the use of diffusion-weighted MRI (DWI) for initial staging of Hodgkin`s lymphoma and compare it to FDG PET. METHODS Forty-one patients with Hodgkin`s lymphoma (14 f, 27 m, median age 39 y) were included in this retrospective study. All patients underwent FDG PET/MR for initial staging, including DWI. The Lugano classification was used to describe disease extent. A combination of follow-up imaging and histopathology served as the reference standard. Method agreement was assessed using weighted kappa (κ). The accuracy of the imaging methods was evaluated using ROC curve analysis. RESULTS Regarding the Lugano stage, DWI and FDG PET had identical results in 34/41 cases (κ = 0.77). Sensitivity and specificity for nodal involvement was 89.9% and 93.8% for DWI, and 93.8% and 86.9% for FDG PET, respectively. In regard to extranodal involvement, sensitivity and specificity were 88.5% and 99.3% for DWI and 92.3% and 92.7% for FDG PET. The accuracy of both methods for nodal (p = 0.06) and extranodal involvement (p = 0.66) did not differ significantly. CONCLUSION Despite high sensitivity and specificity, DWI in free breathing cannot be currently recommended as an alternative to FDG PET in initial staging of Hodgkin`s lymphoma due to substantial differences in regard to therapy-determining Lugano Stage.
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Affiliation(s)
- Robert Winzer
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Sebastian Hoberück
- Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden, Germany
| | - Klaus Zöphel
- Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden, Germany
| | - Jörg Kotzerke
- Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden, Germany
| | - Thomas Brauer
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany
| | - Ivan Platzek
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany
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Diffusion-Weighted Imaging Can Differentiate between Malignant and Benign Pleural Diseases. Cancers (Basel) 2019; 11:cancers11060811. [PMID: 31212757 PMCID: PMC6627409 DOI: 10.3390/cancers11060811] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022] Open
Abstract
It is not clear whether magnetic resonance imaging (MRI) is useful for the assessment of pleural diseases. The aim of this study is to determine whether diffusion-weighted magnetic resonance imaging (DWI) can differentiate malignant pleural mesothelioma (MPM) from pleural dissemination of lung cancer, empyema or pleural effusion. The DWI was calibrated with the b value of 0 and 800 s/mm2. There were 11 MPMs (8 epithelioid and 3 biphasic), 10 pleural disseminations of lung cancer, 10 empyemas, and 12 pleural effusions. The apparent diffusion coefficient (ADC) of the pleural diseases was 1.22 ± 0.25 × 10−3 mm2/s in the MPMs, 1.31 ± 0.49 × 10−3 mm2/s in the pleural disseminations, 2.01 ± 0.45 × 10−3 mm2/s in the empyemas and 3.76 ± 0.62 × 10−3 mm2/s in the pleural effusions. The ADC of the MPMs and the pleural disseminations were significantly lower than the ADC of the empyemas and the pleural effusions. Concerning the diffusion pattern of DWI, all 11 MPMs showed strong continuous diffusion, 9 of 10 pleural disseminations showed strong scattered diffusion and 1 pleural dissemination showed strong continuous diffusion, all 10 empyemas showed weak continuous diffusion, and all 12 pleural effusions showed no decreased diffusion. DWI can evaluate pleural diseases morphologically and qualitatively, and thus differentiate between malignant and benign pleural diseases.
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Shi Z, Han J, Qin J, Zhang Y. Clinical application of diffusion-weighted imaging and dynamic contrast-enhanced MRI in assessing the clinical curative effect of early ankylosing spondylitis. Medicine (Baltimore) 2019; 98:e15227. [PMID: 31096431 PMCID: PMC6531155 DOI: 10.1097/md.0000000000015227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The study aimed to demonstrate the clinical application value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing a clinical curative effect of early ankylosing spondylitis (AS).Forty-eight patients with early AS who were already treated combinations by traditional Chinese and Western medicine were involved in this study. All subjects underwent the conventional MRI, DWI, and DCE-MRI scanning of bilateral sacroiliac joints before and after treatment. The relevant data, such as the mean apparent diffusion coefficient (ADC) value, time-intensity curve of subarticular surface bone marrow, and the relationship between ADC value and enhancement factor (Fenh), enhancement slope (Senh), and time to peak (TTP), were obtained.1. The mean ADC value of the subarticular surface bone marrow of patients and after clinical treatment was (5.05 ± 1.10) × 10 and (4.34 ± 0.55) × 10 mm/s in ilium and (4.63 ± 0.79) × 10 and (3.96 ± 0.23) × 10 mm/s in sacrum, respectively. 2. In the DCE-MRI follow-up treatment imaging of 48 patients with AS (192 parts), the TIC curve type recorded was as follows: 43.75% (84/192) of type II, 56.25% (108/192) of type III, and type I curve was not seen. The number of type II curve was significantly reduced for pre treatment group (84 cases) compared with that post treatment group (124 cases). The Fenh, Senh, and TTP values were respective (113.38 ± 44.71)%, (60.94 ± 38.56)% min, (129.52 ± 42.66) s in ilium and (83.03 ± 20.39)%, (44.91 ± 15.19)% min, (123.44 ± 28.50) s in sacrum before clinical treatment. After the treatment, the Fenh, Senh, and TTP values were respective (75.90 ± 17.97)%, (33.96 ± 11.36)% min, (138.67 ± 26.60) s in ilium and (73.28 ± 15.67)%, (31.92 ± 8.15)% min, (140.19 ± 19.88) s in sacrum. The Fenh, Senh, and TTP values of semiquantitative indexes before and after clinical treatment were significantly different.DWI and DCE-MRI sequences can help evaluate the degree of active changes in AS inflammation and treatment effect in patients with early AS, and provide reliable imaging evidence.
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Affiliation(s)
- Zhaojuan Shi
- Department of Nuclear Medicine, Qilu Hospital, Shandong University, Jinan
- Department of Diagnostic Radiology, Affiliated Hospital of Taishan Medical University, Taian, Shandong, China
| | - Jiankui Han
- Department of Nuclear Medicine, Qilu Hospital, Shandong University, Jinan
| | - Jian Qin
- Department of Diagnostic Radiology, Affiliated Hospital of Taishan Medical University, Taian, Shandong, China
| | - Yue Zhang
- Department of Diagnostic Radiology, Affiliated Hospital of Taishan Medical University, Taian, Shandong, China
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Raptis CA, Ludwig DR, Hammer MM, Luna A, Broncano J, Henry TS, Bhalla S, Ackman JB. Building blocks for thoracic MRI: Challenges, sequences, and protocol design. J Magn Reson Imaging 2019; 50:682-701. [PMID: 30779459 DOI: 10.1002/jmri.26677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 12/19/2022] Open
Abstract
Thoracic MRI presents important and unique challenges. Decreased proton density in the lung in combination with respiratory and cardiac motion can degrade image quality and render poorly executed sequences uninterpretable. Despite these challenges, thoracic MRI has an important clinical role, both as a problem-solving tool and in an increasing array of clinical indications. Advances in scanner and sequence design have also helped to drive this development, presenting the radiologist with improved techniques for thoracic MRI. Given this evolving landscape, radiologists must be familiar with what thoracic MR has to offer. The first step in developing an effective thoracic MRI practice requires the creation of efficient and malleable protocols that can answer clinical questions. To do this, radiologists must have a working knowledge of the MR sequences that are used in the thorax, many of which have been adapted from use elsewhere in the body. These sequences can be broadly divided into three categories: traditional/anatomic, functional, and cine based. Traditional/anatomic sequences allow for the depiction of anatomy and pathologic processes with the ability for characterization of signal intensity and contrast enhancement. Functional sequences, including diffusion-weighted imaging, and high temporal resolution dynamic contrast enhancement, allow for the noninvasive measurement of tissue-specific parameters. Cine-based sequences can depict the motion of structures in the thorax, either with retrospective ECG gating or in real time. The purpose of this article is to review these categories, the building block sequences that comprise them, and identify basic questions that should be considered in thoracic MRI protocol design. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:682-701.
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Affiliation(s)
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
| | - Mark M Hammer
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio Luna
- Health Time, Clinica Las Nieves, Jaen, Spain.,University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jordi Broncano
- Health Time, Hospital de la Cruz Roja and San Juan de Dios, Cordoba, Spain
| | - Travis S Henry
- University of California-San Francisco, San Francisco, California, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
| | - Jeanne B Ackman
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Romei C, Turturici L, Tavanti L, Miedema J, Fiorini S, Marletta M, Wielopolski P, Tiddens H, Falaschi F, Ciet P. The use of chest magnetic resonance imaging in interstitial lung disease: a systematic review. Eur Respir Rev 2018; 27:27/150/180062. [PMID: 30567932 DOI: 10.1183/16000617.0062-2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/23/2018] [Indexed: 01/09/2023] Open
Abstract
Thin-slices multi-detector computed tomography (MDCT) plays a key role in the differential diagnosis of interstitial lung disease (ILD). However, thin-slices MDCT has a limited ability to detect active inflammation, which is an important target of newly developed ILD drug therapy. Magnetic resonance imaging (MRI), thanks to its multi-parameter capability, provides better tissue characterisation than thin-slices MDCT.Our aim was to summarise the current status of MRI applications in ILD and to propose an ILD-MRI protocol. A systematic literature search was conducted for relevant studies on chest MRI in patients with ILD.We retrieved 1246 papers of which 55 original papers were selected for the review. We identified 24 studies comparing image quality of thin-slices MDCT and MRI using several MRI sequences. These studies described new MRI sequences to assess ILD parenchymal abnormalities, such as honeycombing, reticulation and ground-glass opacity. Thin-slices MDCT remains superior to MRI for morphological imaging. However, recent studies with ultra-short echo-time MRI showed image quality comparable to thin-slices MDCT. Several studies demonstrated the added value of chest MRI by using functional imaging, especially to detect and quantify inflammatory changes.We concluded that chest MRI could play a role in ILD patients to differentiate inflammatory and fibrotic changes and to assess efficacy of new ILD drugs.
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Affiliation(s)
- Chiara Romei
- 2nd Radiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Laura Turturici
- Radiology, Azienda USL Toscana nord ovest Sede di Viareggio, Viareggio, Italy
| | - Laura Tavanti
- Dept of Surgical, Medical, Molecular Pathology and Critical Care, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Jelle Miedema
- Dept of Respiratory Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sara Fiorini
- 1st Radiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Massimo Marletta
- 1st Radiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Piotr Wielopolski
- Dept of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harm Tiddens
- Dept of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Pediatric Pulmonology and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fabio Falaschi
- 2nd Radiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Pierluigi Ciet
- Dept of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Pediatric Pulmonology and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Basso Dias A, Zanon M, Altmayer S, Sartori Pacini G, Henz Concatto N, Watte G, Garcez A, Mohammed TL, Verma N, Medeiros T, Marchiori E, Irion K, Hochhegger B. Fluorine 18-FDG PET/CT and Diffusion-weighted MRI for Malignant versus Benign Pulmonary Lesions: A Meta-Analysis. Radiology 2018; 290:525-534. [PMID: 30480492 DOI: 10.1148/radiol.2018181159] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To perform a meta-analysis of the literature to compare the diagnostic performance of fluorine 18 fluorodeoxyglucose PET/CT and diffusion-weighted (DW) MRI in the differentiation of malignant and benign pulmonary nodules and masses. Materials and Methods Published English-language studies on the diagnostic accuracy of PET/CT and/or DW MRI in the characterization of pulmonary lesions were searched in relevant databases through December 2017. The primary focus was on studies in which joint DW MRI and PET/CT were performed in the entire study population, to reduce interstudy heterogeneity. For DW MRI, lesion-to-spinal cord signal intensity ratio and apparent diffusion coefficient were evaluated; for PET/CT, maximum standard uptake value was evaluated. The pooled sensitivities, specificities, diagnostic odds ratios, and areas under the receiver operating characteristic curve (AUCs) for PET/CT and DW MRI were determined along with 95% confidence intervals (CIs). Results Thirty-seven studies met the inclusion criteria, with a total of 4224 participants and 4463 lesions (3090 malignant lesions [69.2%]). In the primary analysis of joint DW MRI and PET/CT studies (n = 6), DW MRI had a pooled sensitivity and specificity of 83% (95% CI: 75%, 89%) and 91% (95% CI: 80%, 96%), respectively, compared with 78% (95% CI: 70%, 84%) (P = .01 vs DW MRI) and 81% (95% CI: 72%, 88%) (P = .056 vs DW MRI) for PET/CT. DW MRI yielded an AUC of 0.93 (95% CI: 0.90, 0.95), versus 0.86 (95% CI: 0.83, 0.89) for PET/CT (P = .001). The diagnostic odds ratio of DW MRI (50 [95% CI: 19, 132]) was superior to that of PET/CT (15 [95% CI: 7, 32]) (P = .006). Conclusion The diagnostic performance of diffusion-weighted MRI is comparable or superior to that of fluorine 18 fluorodeoxyglucose PET/CT in the differentiation of malignant and benign pulmonary lesions. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Schiebler in this issue.
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Affiliation(s)
- Adriano Basso Dias
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Matheus Zanon
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Stephan Altmayer
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Gabriel Sartori Pacini
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Natália Henz Concatto
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Guilherme Watte
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Anderson Garcez
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Tan-Lucien Mohammed
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Nupur Verma
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Tássia Medeiros
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Edson Marchiori
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Klaus Irion
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
| | - Bruno Hochhegger
- From the Medical Imaging Research Laboratory, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av Independência 75, Porto Alegre, Brazil 90020160 (A.B.D., M.Z., S.A., G.S.P., G.W., B.H.); Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (A.B.D., M.Z., S.A., G.S.P., B.H.); Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (N.H.C.); Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil (A.G.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (T.L.M., N.V.); Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil (T.M., B.H.); Department of Radiology, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil (E.M.); and Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust-Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Manchester, England (K.I.)
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Raptis CA, McWilliams SR, Ratkowski KL, Broncano J, Green DB, Bhalla S. Mediastinal and Pleural MR Imaging: Practical Approach for Daily Practice. Radiographics 2018; 38:37-55. [PMID: 29320326 DOI: 10.1148/rg.2018170091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Radiologists in any practice setting should be prepared to use thoracic magnetic resonance (MR) imaging for noncardiac and nonangiographic applications. This begins with understanding the sequence building blocks that can be used to design effective thoracic MR imaging protocols. In most instances, the sequences used in thoracic MR imaging are adapted from protocols used elsewhere in the body. Some modifications, including the addition of electrocardiographic gating or respiratory triggering, may be necessary for certain applications. Once protocols are in place, recognition of clinical scenarios in which thoracic MR imaging can provide value beyond other imaging modalities is essential. MR imaging is particularly beneficial in evaluating for benign features in indeterminate lesions. In lesions that are suspected to be composed of fluid, including mediastinal cysts and lesions composed of dilated lymphatics, MR imaging can confirm the presence of fluid and absence of suspicious enhancement. It can also be used to evaluate for intravoxel lipid, a finding seen in benign residual thymic tissue and thymic hyperplasia. Because of its excellent contrast resolution and potential for subtraction images, MR imaging can interrogate local treatment sites for the development of recurrent tumor on a background of post-treatment changes. In addition to characterization of lesions, thoracic MR imaging can be useful in surgical and treatment planning. By identifying nodular sites of enhancement or areas of diffusion restriction within cystic or necrotic lesions, MR imaging can be used to direct sites for biopsy. MR imaging can help evaluate for local tumor invasion with the application of "real-time" cine sequences to determine whether a lesion is adherent to an adjacent structure or surface. Finally, MR imaging is the modality of choice for imaging potential tumor thrombus. By understanding the role of MR imaging in these clinical scenarios, radiologists can increase the use of thoracic MR imaging for the benefit of improved decision making in the care of patients. ©RSNA, 2018.
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Affiliation(s)
- Constantine A Raptis
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Sebastian R McWilliams
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Kristy L Ratkowski
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Jordi Broncano
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Daniel B Green
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
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SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer. RADIOLOGIA 2018; 60:332-346. [PMID: 29807678 DOI: 10.1016/j.rx.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 12/11/2022]
Abstract
Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.
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Luna A, Martín Noguerol T, Mata LA. Bases de la imagen funcional II: técnicas emergentes de resonancia magnética y nuevos métodos de análisis. RADIOLOGIA 2018. [DOI: 10.1016/j.rx.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer. Clin Transl Oncol 2017; 20:837-852. [PMID: 29256154 PMCID: PMC5996017 DOI: 10.1007/s12094-017-1795-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 12/17/2022]
Abstract
Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision-making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.
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Concatto NH, Watte G, Marchiori E, Irion K, Felicetti JC, Camargo JJ, Hochhegger B. Reply to Letter to the Editor re: Magnetic resonance imaging of pulmonary nodules: accuracy in a granulomatous disease-endemic region. Eur Radiol 2017; 27:4017-4018. [DOI: 10.1007/s00330-017-4799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/08/2017] [Indexed: 11/28/2022]
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Ciet P, Bertolo S, Ros M, Andrinopoulou ER, Tavano V, Lucca F, Feiweier T, Krestin GP, Tiddens HAWM, Morana G. Detection and monitoring of lung inflammation in cystic fibrosis during respiratory tract exacerbation using diffusion-weighted magnetic resonance imaging. Eur Respir J 2017; 50:50/1/1601437. [PMID: 28729470 DOI: 10.1183/13993003.01437-2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 04/10/2017] [Indexed: 01/15/2023]
Abstract
The aim was to investigate whether diffusion-weighted magnetic resonance imaging (DWI) detects and monitors inflammatory and lung function changes during respiratory tract exacerbations (RTE) treatment in patients with cystic fibrosis (CF).29 patients with RTE underwent DWI pre- and post-antibiotic treatment. A control group of 27 stable patients, matched for age and sex, underwent DWI with the same time gap as those undergoing RTE treatment. Clinical status and lung function were assessed at each DWI time point. The CF-MRI scoring system was used to assess structural lung changes in both CF groups.Significant reduction in the DWI score over the course of antibiotic treatment (p<0.0001) was observed in patients with RTE, but not in the control group. DWI score had a strong inverse correlation with clinical status (r=-0.504, p<0.0001) and lung function (r=-0.635, p<0.0001) in patients with RTE. Interestingly, there were persistent significant differences in the CF-MRI score between the RTE and control group at both baseline and follow-up (p<0.001), while the differences in DWI score were only observed at baseline (p<0.001).DWI is a promising imaging method for noninvasive detection of pulmonary inflammation during RTE, and may be used to monitor treatment efficacy of anti-inflammatory treatment.
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Affiliation(s)
- Pierluigi Ciet
- Dept of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Dept of Pediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, the Netherlands.,Dept of Radiology, Ca'Foncello Regional Hospital, Treviso, Italy
| | - Silvia Bertolo
- Dept of Radiology, Ca'Foncello Regional Hospital, Treviso, Italy
| | - Mirco Ros
- Dept of Pediatrics, Ca'Foncello Regional Hospital, Treviso, Italy
| | | | - Valentina Tavano
- Dept of Radiology, Ca'Foncello Regional Hospital, Treviso, Italy
| | - Francesca Lucca
- Dept of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Gabriel P Krestin
- Dept of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Harm A W M Tiddens
- Dept of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Dept of Pediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Giovanni Morana
- Dept of Radiology, Ca'Foncello Regional Hospital, Treviso, Italy
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Karaman A, Durur-Subasi I, Alper F, Durur-Karakaya A, Subasi M, Akgun M. Is it better to include necrosis in apparent diffusion coefficient (ADC) measurements? The necrosis/wall ADC ratio to differentiate malignant and benign necrotic lung lesions: Preliminary results. J Magn Reson Imaging 2017; 46:1001-1006. [PMID: 28152254 DOI: 10.1002/jmri.25649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine whether the use of necrosis/wall apparent diffusion coefficient (ADC) ratios in the differentiation of necrotic lung lesions is more reliable than measuring the wall alone. MATERIALS AND METHODS In this retrospective study, a total of 76 patients (54 males and 22 females, 71% vs. 29%, with a mean age of 53 ± 18 years, range, 18-84) were enrolled, 33 of whom had lung carcinoma and 43 had a benign necrotic lung lesion. A 3T scanner was used. The calculation of the necrosis/wall ADC ratio was based on ADC values measured from necrosis and the wall of the lesions by diffusion-weighted imaging (DWI). Statistical analyses were performed with the independent samples t-test and receiver operating characteristic analysis. Intraobserver and interobserver reliability were calculated for ADC values of wall and necrosis. RESULTS The mean necrosis/wall ADC ratio was 1.67 ± 0.23 for malignant lesions and 0.75 ± 0.19 for benign lung lesions (P < 0.001). To estimate malignancy the area under the curve (AUC) values for necrosis ADC, wall ADC, and the necrosis/wall ADC ratio were 0.720, 0.073, and 0.997, respectively. A wall/necrosis ADC ratio cutoff value of 1.12 demonstrated a 100% sensitivity and 98% specificity in the estimation of malignancy. Positive predictive value was 100%, and negative predictive value 98% and diagnostic accuracy 99%. There was a good intraobserver and interobserver reliability for wall and necrosis. CONCLUSION The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating lung carcinoma from benign necrotic lung lesions than measuring the wall alone. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1001-1006.
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Affiliation(s)
- Adem Karaman
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Irmak Durur-Subasi
- Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey
| | - Fatih Alper
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Afak Durur-Karakaya
- Istanbul Medipol University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Mahmut Subasi
- Turkiye Yuksek Ihtısas Training and Research Hospital, Clinic of Thoracic Surgery and Lung Transplantation, Ankara, Turkey
| | - Metin Akgun
- Ataturk University, Faculty of Medicine, Department of Chest Diseases, Erzurum, Turkey
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Pessôa FMC, de Melo ASA, Souza AS, de Souza LS, Hochhegger B, Zanetti G, Marchiori E. Applications of Magnetic Resonance Imaging of the Thorax in Pleural Diseases: A State-of-the-Art Review. Lung 2016; 194:501-9. [DOI: 10.1007/s00408-016-9909-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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Eutsler EP, Khanna G. Whole-body magnetic resonance imaging in children: technique and clinical applications. Pediatr Radiol 2016; 46:858-72. [PMID: 27229503 DOI: 10.1007/s00247-016-3586-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/20/2016] [Accepted: 02/11/2016] [Indexed: 11/28/2022]
Abstract
Whole-body MR imaging is being increasingly used in children to evaluate the extent of various oncologic and non-oncologic entities. The lack of exposure to ionizing radiation, excellent soft-tissue contrast (even without the use of contrast agents), and functional imaging capabilities make it especially suitable for screening and surveillance in the pediatric population. Technical developments such as moving table platforms, multi-channel/multi-element surface coils, and parallel imaging allow imaging of the entire body with multiple sequences in a reasonable 30- to 40-min time frame, which has facilitated its acceptance in routine clinical practice. The initial investigations in whole-body MR imaging were primarily focused on oncologic applications such as tumor screening and staging. The exquisite sensitivity of fluid-sensitive MR sequences to many different types of pathology has led to new applications of whole-body MR imaging in evaluation of multifocal rheumatologic conditions. Availability of blood pool contrast agents has allowed whole-body MR angiographic imaging of vascular malformations, vasculitides and vasculopathies. Whole-body MRI is being applied for delineating the extent and distribution of systemic and multifocal diseases, establishing diagnoses, assessing treatment response, and surveillance imaging. This article reviews the technique and clinical applications of whole-body MR imaging in children.
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Affiliation(s)
- Eric P Eutsler
- Mallinckrodt Institute of Radiology, Campus Box 8131, 510 S. Kingshighway, St. Louis, MO, 63110, USA.,Washington University School of Medicine, St. Louis, MO, USA
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Campus Box 8131, 510 S. Kingshighway, St. Louis, MO, 63110, USA. .,Washington University School of Medicine, St. Louis, MO, USA.
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Ciet P, Serra G, Andrinopoulou ER, Bertolo S, Ros M, Catalano C, Colagrande S, Tiddens HAWM, Morana G. Diffusion weighted imaging in cystic fibrosis disease: beyond morphological imaging. Eur Radiol 2016; 26:3830-3839. [PMID: 26873494 DOI: 10.1007/s00330-016-4248-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/22/2015] [Accepted: 01/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the feasibility of diffusion-weighted imaging (DWI) to assess inflammatory lung changes in patients with Cystic Fibrosis (CF) METHODS: CF patients referred for their annual check-up had spirometry, chest-CT and MRI on the same day. MRI was performed in a 1.5 T scanner with BLADE and EPI-DWI sequences (b = 0-600 s/mm2). End-inspiratory and end-expiratory scans were acquired in multi-row scanners. DWI was scored with an established semi-quantitative scoring system. DWI score was correlated to CT sub-scores for bronchiectasis (CF-CTBE), mucus (CF-CTmucus), total score (CF-CTtotal-score), FEV1, and BMI. T-test was used to assess differences between patients with and without DWI-hotspots. RESULTS Thirty-three CF patients were enrolled (mean 21 years, range 6-51, 19 female). 4 % (SD 2.6, range 1.5-12.9) of total CF-CT alterations presented DWI-hotspots. DWI-hotspots coincided with mucus plugging (60 %), consolidation (30 %) and bronchiectasis (10 %). DWItotal-score correlated (all p < 0.0001) positively to CF-CTBE (r = 0.757), CF-CTmucus (r = 0.759) and CF-CTtotal-score (r = 0.79); and negatively to FEV1 (r = 0.688). FEV1 was significantly higher (p < 0.0001) in patients without DWI-hotspots. CONCLUSIONS DWI-hotspots strongly correlated with radiological and clinical parameters of lung disease severity. Future validation studies are needed to establish the exact nature of DWI-hotspots in CF patients. KEY POINTS • DWI hotspots only partly overlapped structural abnormalities on morphological imaging • DWI strongly correlated with radiological and clinical indicators of CF-disease severity • Patients with more DWI hotspots had lower lung function values • Mucus score best predicted the presence of DWI-hotspots with restricted diffusion.
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Affiliation(s)
- Pierluigi Ciet
- Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands.,Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Goffredo Serra
- Department of Radiology, University of Rome "Sapienza", Rome, Italy
| | | | - Silvia Bertolo
- Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Mirco Ros
- Department of Pediatrics, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Catalano
- Department of Radiology, University of Rome "Sapienza", Rome, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi., Largo Brambilla 3, Florence, 50134, Italy
| | - Harm A W M Tiddens
- Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy.
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Priola AM, Gned D, Veltri A, Priola SM. Chemical shift and diffusion-weighted magnetic resonance imaging of the anterior mediastinum in oncology: Current clinical applications in qualitative and quantitative assessment. Crit Rev Oncol Hematol 2016; 98:335-57. [DOI: 10.1016/j.critrevonc.2015.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 10/04/2015] [Accepted: 11/19/2015] [Indexed: 12/15/2022] Open
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Broncano J, Luna A, Sánchez-González J, Alvarez-Kindelan A, Bhalla S. Functional MR Imaging in Chest Malignancies. Magn Reson Imaging Clin N Am 2016; 24:135-155. [DOI: 10.1016/j.mric.2015.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lu NH, Hung CM, Liu KY, Chen TB, Huang YH. Diagnosed chest lesion on diffusion-weighted magnetic resonance images using apparent diffusion coefficients. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:133-143. [PMID: 26890904 DOI: 10.3233/xst-160535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE A novel diagnostic method using the standard deviation (SD) value of apparent diffusion coefficient (ADC) by diffusion-weighted (DWI) magnetic resonance imaging (MRI) is applied for differential diagnosis of primary chest cancers, metastatic tumors and benign tumors. MATERIALS AND METHODS This retrospective study enrolled 27 patients (20 males, 7 female; age, 15-85; mean age, 68) who had thoracic mass lesions in the last three years and underwent an MRI chest examination at our institution. In total, 29 mass lesions were analyzed using SD of ADC and DWI. Lesions were divided into five groups: Primary lung cancers (N = 10); esophageal cancers (N = 5); metastatic tumors (N = 8); benign tumors (N = 3); and inflammatory lesions (N = 3). Quantitative assessment of MRI parameters of mass lesions was performed. The ADC value was acquired based on the average of the entire tumor area. The error-plot, t-test and the area under receiver operating characteristic (AUC) were applied for statistical analysis. RESULTS The SD of ADC value (mean±SD) was (4.867±1.359)×10-4 mm2/sec in primary lung cancers, and (3.598±0.350)×10-4 mm2/sec in metastatic tumors. The SD of ADC values of primary lung cancers and metastatic tumors (P < 0.05) were significantly different and the AUC was 0.800 (P < 0.05). The means of SD of ADC values was 4.532±1.406×10-4 mm2/sec and 2.973±0.364×10-4 mm2/sec for malignant tumors (including primary lung cancers, esophageal cancers) and benign tumors with respectively. The mean of SD of ADC values between malignant chest tumors and benign chest tumors was shown significant difference (P < 0.01). The values of AUC was 0.967 between malignant chest tumors and benign chest tumors (P < 0.05). The ADC values for primary lung cancers, metastatic tumors and benign tumors were not significantly difference (P > 0.05). CONCLUSIONS The mean of SD of ADC value by DWI can be used for differential diagnosis of chest lesions.
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Affiliation(s)
- Nan-Han Lu
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung City, Taiwan
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung City, Taiwan
| | - Chao-Ming Hung
- Department of General Sugary, E-DA Hospital, I-Shou University, Kaohsiung City, Taiwan
- The School of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Ying Liu
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung City, Taiwan
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung City, Taiwan
- Department of Information Engineering, I-Shou University, Kaohsiung City, Taiwan
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung City, Taiwan
| | - Yung-Hui Huang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung City, Taiwan
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Magnetic resonance imaging of pulmonary nodules: accuracy in a granulomatous disease-endemic region. Eur Radiol 2015; 26:2915-20. [PMID: 26638164 DOI: 10.1007/s00330-015-4125-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/13/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To estimate the diagnostic accuracy of signal intensity of the lesion-to-spinal cord ratio (LSR) and apparent diffusion coefficient (ADC) in diffusion-weighted (DW) magnetic resonance imaging of pulmonary nodules suspicious for lung cancer in granulomatous lung disease-endemic regions. METHODS Forty-nine patients with indeterminate solitary pulmonary nodules detected by chest computed tomography and histopathologically confirmed diagnoses were included in the study. DW images were analysed semiquantitatively by focusing regions of interest on the lesion and spinal cord at the same level (for LSR calculation). ADCs were estimated from ratios of the two image signal intensities. Ratios of T1 and T2 signal intensity between nodules and muscle were calculated for comparison. RESULTS Mean ADCs ± standard deviations for lung cancer and benign lesions were 0.9 ± 0.2 and 1.3 ± 0.2 × 10(-3) mm(2)/s, respectively. Mean LSRs were 1.4 ± 0.3 for lung cancer and 1 ± 0.1 for benign lesions. ADCs and LSRs differed significantly between malignant and benign lesions (P < 0.001). Mean T2 signal intensity ratios also differed significantly between benign and malignant lesions (0.8 ± 0.2 vs. 1.6 ± 0.2; P < 0.05). CONCLUSIONS DWI can help to differentiate malignant from benign lesions according to ADC and the LSR with good accuracy. KEY POINTS • DW imaging can help differentiate malignant from benign pulmonary nodules. • ADC and LSR signal intensities had only small overlap between malignant and benign pulmonary nodules. • Mean T2 signal intensity ratios differed significantly between benign and malignant lesions.
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Sivrioglu AK, Kafadar C. Differentiation between hepatic hemangioma and metastases on diffusion-weighted MRI. Clin Imaging 2015; 40:183. [PMID: 26508280 DOI: 10.1016/j.clinimag.2015.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 09/21/2015] [Accepted: 09/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Cahit Kafadar
- Department of Radiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
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Milito C, Pulvirenti F, Serra G, Valente M, Pesce AM, Granata G, Catalano C, Fraioli F, Quinti I. Lung magnetic resonance imaging with diffusion weighted imaging provides regional structural as well as functional information without radiation exposure in primary antibody deficiencies. J Clin Immunol 2015; 35:491-500. [PMID: 26067227 PMCID: PMC4502290 DOI: 10.1007/s10875-015-0172-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/25/2015] [Indexed: 12/26/2022]
Abstract
Purpose Primary antibody deficiency patients suffer from infectious and non-infectious pulmonary complications leading over time to chronic lung disease. The complexity of this pulmonary involvement poses significant challenge in differential diagnosis in patients with long life disease and increased radio sensitivity. We planned to verify the utility of chest Magnetic Resolution Imaging with Diffusion-Weighted Imaging as a radiation free technique. Methods Prospective evaluation of 18 patients with Common Variable Immunodeficiency and X-linked Agammaglobulinemia. On the same day, patients underwent Magnetic Resonance Imaging with Diffusion Weighted Imaging sequences, High Resolution Computerized Tomography and Pulmonary Function Tests, including diffusing capacity factor for carbon monoxide. Images were scored using a modified version of the Bhalla scoring system. Results Magnetic Resonance Imaging was non-inferior to High Resolution Computerized Tomography in the capacity to identify bronchial and parenchymal abnormalities. HRCT had a higher capacity to identify peripheral airways abnormalities, defined as an involvement of bronchial generation up to the fifth and distal (scores 2–3). Bronchial scores negatively related to pulmonary function tests. One third of consolidations and nodules had Diffusion Weighted Imaging restrictions associated with systemic granulomatous disease and systemic lymphadenopathy. Lung Magnetic Resolution Imaging detected an improvement of bronchial and parenchymal abnormalities, in recently diagnosed patients soon after starting Ig replacement. Conclusions Magnetic Resonance Imaging with Diffusion Weighted Imaging was a reliable technique to detect lung alterations in patients with Primary Antibody Deficiencies. Electronic supplementary material The online version of this article (doi:10.1007/s10875-015-0172-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome, Italy
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Coolen J, De Keyzer F, Nafteux P, De Wever W, Dooms C, Vansteenkiste J, Derweduwen A, Roebben I, Verbeken E, De Leyn P, Van Raemdonck D, Nackaerts K, Dymarkowski S, Verschakelen J. Malignant Pleural Mesothelioma: Visual Assessment by Using Pleural Pointillism at Diffusion-weighted MR Imaging. Radiology 2015; 274:576-84. [DOI: 10.1148/radiol.14132111] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Liu Z, Araki T, Okajima Y, Albert M, Hatabu H. Pulmonary hyperpolarized noble gas MRI: Recent advances and perspectives in clinical application. Eur J Radiol 2014; 83:1282-1291. [DOI: 10.1016/j.ejrad.2014.04.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/21/2014] [Accepted: 04/19/2014] [Indexed: 12/01/2022]
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Abdel Razek AAK, Khairy M, Nada N. Diffusion-weighted MR imaging in thymic epithelial tumors: correlation with World Health Organization classification and clinical staging. Radiology 2014; 273:268-75. [PMID: 24877982 DOI: 10.1148/radiol.14131643] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess thymic epithelial tumors with diffusion-weighted magnetic resonance (MR) imaging. MATERIALS AND METHODS Informed consent from patients and institutional review board approval were obtained. Prospective study was conducted on 30 consecutive patients (21 men and nine women; age range, 35-71 years) with thymic epithelial tumors. They underwent true fast imaging with steady-state precession and single-shot echo-planar diffusion-weighted MR imaging of the mediastinum with b values of 0, 400, and 800 sec/mm(2). Apparent diffusion coefficient (ADC) of the thymic epithelial tumors was calculated by the same observer at two settings and was correlated with World Health Organization classification and clinical staging. RESULTS There was significant difference in longest diameter (P = .001) and necrotic part of the tumor (P = .014) between low-risk thymoma, high-risk thymoma, and thymic carcinoma. Mean ADC value of both readings of thymic epithelial tumors (n = 30) was 1.24 × 10(-3) mm(2)/sec and 1.22 × 10(-3) mm(2)/sec, with good intraobserver agreement (κ = 0.732). There was significant difference in both readings (P = .01 and .20) of low-risk thymoma (1.30 × 10(-3) mm(2)/sec and 1.29 × 10(-3) mm(2)/sec), high-risk thymoma (1.16 × 10(-3) mm(2)/sec and 1.14 × 10(-3) mm(2)/sec), and thymic carcinoma (1.18 × 10(-3) mm(2)/sec and 1.06 × 10(-3) mm(2)/sec). Cutoff ADC values of both readings used to differentiate low-risk thymoma from high-risk thymoma and thymic carcinoma were 1.25 and 1.22 × 10(-3) mm(2)/sec with area under the curve of 0.804 and 0.851, respectively. There was significant difference in both readings of ADC value of early (stage I, II) and advanced stages (stage III, IV) of thymic epithelial tumors (P = .006 and .005, respectively). CONCLUSION ADC value is a noninvasive, reliable, and reproducible imaging parameter that may help to assess and characterize thymic epithelial tumors.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- From the Departments of Diagnostic Radiology (A.A.K.A.R.), Chest (M.K.), and Pathology (N.N.), Mansoura Faculty of Medicine, Mansoura, Egypt 13351
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Klenk C, Gawande R, Uslu L, Khurana A, Qiu D, Quon A, Donig J, Rosenberg J, Luna-Fineman S, Moseley M, Daldrup-Link HE. Ionising radiation-free whole-body MRI versus (18)F-fluorodeoxyglucose PET/CT scans for children and young adults with cancer: a prospective, non-randomised, single-centre study. Lancet Oncol 2014; 15:275-85. [PMID: 24559803 DOI: 10.1016/s1470-2045(14)70021-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Imaging tests are essential for staging of children with cancer. However, CT and radiotracer-based imaging procedures are associated with substantial exposure to ionising radiation and risk of secondary cancer development later in life. Our aim was to create a highly effective, clinically feasible, ionising radiation-free staging method based on whole-body diffusion-weighted MRI and the iron supplement ferumoxytol, used off-label as a contrast agent. METHODS We compared whole-body diffusion-weighted MRI with standard clinical (18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT scans in children and young adults with malignant lymphomas and sarcomas. Whole-body diffusion-weighted magnetic resonance images were generated by coregistration of colour-encoded ferumoxytol-enhanced whole-body diffusion-weighted MRI scans for tumour detection with ferumoxytol-enhanced T1-weighted MRI scans for anatomical orientation, similar to the concept of integrated (18)F-FDG PET/CT scans. Tumour staging results were compared using Cohen's κ statistics. Histopathology and follow-up imaging served as the standard of reference. Data was assessed in the per-protocol population. This study is registered with ClinicalTrials.gov, number NCT01542879. FINDINGS 22 of 23 recruited patients were analysed because one patient discontinued before completion of the whole-body scan. Mean exposure to ionising radiation was 12·5 mSv (SD 4·1) for (18)F-FDG PET/CT compared with zero for whole-body diffusion-weighted MRI. (18)F-FDG PET/CT detected 163 of 174 malignant lesions at 1325 anatomical regions and whole-body diffusion-weighted MRI detected 158. Comparing (18)F-FDG PET/CT to whole-body diffusion-weighted MRI, sensitivities were 93·7% (95% CI 89·0-96·8) versus 90·8% (85·5-94·7); specificities 97·7% (95% CI 96·7-98·5) versus 99·5% (98·9-99·8); and diagnostic accuracies 97·2% (93·6-99·4) versus 98·3% (97·4-99·2). Tumour staging results showed very good agreement between both imaging modalities with a κ of 0·93 (0·81-1·00). No adverse events after administration of ferumoxytol were recorded. INTERPRETATION Ferumoxytol-enhanced whole-body diffusion-weighted MRI could be an alternative to (18)F-FDG PET/CT for staging of children and young adults with cancer that is free of ionising radiation. This new imaging test might help to prevent long-term side-effects from radiographic staging procedures. FUNDING Thrasher Research Fund and Clinical Health Research Institute at Stanford University.
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Affiliation(s)
- Christopher Klenk
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Rakhee Gawande
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Lebriz Uslu
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Aman Khurana
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Deqiang Qiu
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Andrew Quon
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Jessica Donig
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Jarrett Rosenberg
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | | | - Michael Moseley
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA.
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Fernández-Jiménez R, Fernández-Friera L, Sánchez-González J, Ibáñez B. Animal Models of Tissue Characterization of Area at Risk, Edema and Fibrosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9259-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
This review provides an overview of the current status of the published data on diffusion magnetic resonance (MR) imaging of chest tumors. Diffusion MR imaging is a non-invasive imaging technique that measures the differences in water mobility in different tissue microstructures and quantifies them based on the apparent diffusion coefficient. Diffusion MR imaging has been used for the characterization, grading and staging of lung cancer as well as for differentiating central tumors from post-obstructive consolidation. In addition, this technique helps in differentiating malignant from benign pulmonary and mediastinal tumors as well as in the characterization of pleural mesothelioma and effusion. Diffusion MR imaging can be incorporated into routine morphological MR imaging to improve radiologist confidence in image interpretation and to provide functional assessments of chest tumors during the same examination. Diffusion MR imaging could be used in the future as a functional imaging technique for tumors of the chest.
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Affiliation(s)
- A A K Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt.
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Coolen J, De Keyzer F, Nafteux P, De Wever W, Dooms C, Vansteenkiste J, Roebben I, Verbeken E, De Leyn P, Van Raemdonck D, Nackaerts K, Dymarkowski S, Verschakelen J. Malignant Pleural Disease: Diagnosis by Using Diffusion-weighted and Dynamic Contrast-enhanced MR Imaging—Initial Experience. Radiology 2012; 263:884-92. [DOI: 10.1148/radiol.12110872] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shan F, Zhang Z, Xing W, Qiu J, Yang S, Wang J, Jiang Y, Chen G. Differentiation between malignant and benign solitary pulmonary nodules: use of volume first-pass perfusion and combined with routine computed tomography. Eur J Radiol 2012; 81:3598-605. [PMID: 22608062 DOI: 10.1016/j.ejrad.2012.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/02/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the capability of first-pass volume perfusion computed tomography (PCT) for differentiation of solitary pulmonary nodules (SPNs) and to compare that of combination of PCT and routine CT with CT alone for the differentiation. MATERIALS AND METHODS Our institutional review board approved this study and informed consent was obtained. With nine excluded, 65 consecutive patients having a SPN with histopathologic proof or follow-up underwent a 30s PCT using the deconvolution model were evaluated. Kruskal-Wallis tests and receiver operating characteristics (ROC) analysis were underwent. Four radiologists assessed nodules independently and retrospectively. Diagnostic capability was compared for CT alone and PCT plus CT. ROC analysis, McNemar test, and weighted kappa statistics were performed. RESULTS Significant differences were found in parameters between malignant and benign nodules (p<0.0001 for blood flow, blood volume, and permeability surface area product), SPNs were more likely to be malignant by using threshold values of more than 55 ml/100 g/min, 2.5 ml/100 g, and 10 ml/100 g/min, respectively. PCT plus CT was significantly better in overall sensitivity (93%, p=0.004) and accuracy (94%, p=0.003) compared to CT alone, not specificity (96%). Area under the curve for ROC analyses of PCT plus CT was significantly larger than that of CT alone (p=0.018). Mean weighted kappa for PCT plus CT was 0.715, that for CT alone was 0.447. CONCLUSION Volume first-pass PCT can distinguish SPNs. Using PCT plus routine CT may be more sensitive and accurate for differentiating malignant from benign nodules than CT alone and allows more confidence and constancy.
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Affiliation(s)
- Fei Shan
- Department of Radiology, Third Affiliated Hospital of Suzhou University, 185, Juqian Road, Changzhou, Zip Code: 213003, PR China.
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Abdel Razek AAK, Soliman N, Elashery R. Apparent diffusion coefficient values of mediastinal masses in children. Eur J Radiol 2011; 81:1311-4. [PMID: 21439745 DOI: 10.1016/j.ejrad.2011.03.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 02/27/2011] [Accepted: 03/01/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Compare apparent diffusion coefficient (ADC) values between benign and malignant mass lesions in a cohort of children referred for imaging of a mediastinal mass. MATERIAL AND METHODS Prospective study including 24 consecutive children (11 boys, 13 girls aged 5 months to 16 years). All underwent echo planar diffusion weighted MR imaging of the mediastinum with b-factors of 0 and 600 s/mm(2). Apparent diffusion coefficient (ADC) values were calculated and correlated with the surgical finding or biopsy. RESULTS The mean ADC value of malignant mediastinal tumors was 0.91 (S.D., 0.17) × 10(-3) mm(2)/s and of benign lesions 1.8 (S.D., 0.33) × 10(-3) mm(2)/s. There was significant different in the ADC value between malignant tumors and benign mediastinal tumors (P<0.001). Selection of 1.2 × 10(-3) mm(2)/s as a threshold value for differentiating malignant from benign mediastinal masses has an accuracy of 93%, sensitivity of 92%, specificity of 94%, positive predictive value of 94%, negative predictive value of 92% and area under the curve of 0.962. CONCLUSION Apparent diffusion coefficient value is a promising non-invasive parameter for assessment of mediastinal mass in children.
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