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Xiao Y, Li J, Zhong J, Chen D, Shi J, Jin H. Diagnostic Performance of Diffusion-Weighted Imaging for Colorectal Cancer Detection: An Updated Systematic Review and Meta-Analysis. Front Oncol 2022; 12:656095. [PMID: 35814462 PMCID: PMC9260027 DOI: 10.3389/fonc.2022.656095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Magnetic resonance imaging (MRI), which uses strong magnetic fields and radio waves (radiofrequency energy) to make images, is one of the best imaging methods for soft tissues and can clearly display unique anatomical structures. Diffusion-weighted imaging (DWI) has been developed for identifying various malignant tumors. Aim To investigate the diagnostic value of DWI-MRI quantitative analysis in colorectal cancer detection. Methods The PubMed, Cochrane Library, and Embase databases were searched from inception to May 29, 2020. Studies published in English that used DWI-MRI for diagnosing colorectal cancer were included. Case reports, letters, reviews, and studies conducted in non-humans or in-vitro experiments were excluded. The pooled diagnostic odds ratio (DOR) and hierarchical summary receiver operating characteristic (HSROC) curves were computed for DWI, and the area under the curve (AUC) and associated standard error (SE) and 95% confidence intervals (CIs) were also used. Results In total, 15 studies with 1,655 participants were finally included in this meta-analysis. There were four prospective studies and 11 retrospective studies. Eight studies focused on rectal cancer, six on colorectal cancer, and one on colonic cancer. The performance of DWI-MRI for diagnosing colorectal cancer was accurate, with pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 0.88 (95% CI = 0.85–0.91), 0.92 (95% CI = 0.91–0.94), 30.36 (95% CI = 11.05–83.43), and 0.44 (95% CI = 0.30–0.64), respectively. The DOR and HSROC curves were 121 (95% CI = 56–261) and 0.92 (λ: 4.79), respectively. Conclusion DWI showed high diagnostic accuracy for colorectal cancer detection. Further studies with large sample sizes and prospective design are needed to confirm these results.
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Affiliation(s)
- Yunfei Xiao
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiamei Zhong
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dequan Chen
- Department of Radiology, People’s Hospital of Chongqing Hechuan, Chongqing, China
| | - Jianbo Shi
- Department of Radiology, The Seventh People’s Hospital of Chongqing, Chongqing, China
| | - Hongrui Jin
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Hongrui Jin,
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Retter A, Gong F, Syer T, Singh S, Adeleke S, Punwani S. Emerging methods for prostate cancer imaging: evaluating cancer structure and metabolic alterations more clearly. Mol Oncol 2021; 15:2565-2579. [PMID: 34328279 PMCID: PMC8486595 DOI: 10.1002/1878-0261.13071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022] Open
Abstract
Imaging plays a fundamental role in all aspects of the cancer management pathway. However, conventional imaging techniques are largely reliant on morphological and size descriptors that have well-known limitations, particularly when considering targeted-therapy response monitoring. Thus, new imaging methods have been developed to characterise cancer and are now routinely implemented, such as diffusion-weighted imaging, dynamic contrast enhancement, positron emission technology (PET) and magnetic resonance spectroscopy. However, despite the improvement these techniques have enabled, limitations still remain. Novel imaging methods are now emerging, intent on further interrogating cancers. These techniques are at different stages of maturity along the biomarker pathway and aim to further evaluate the cancer microstructure (vascular, extracellular and restricted diffusion for cytometry in tumours) magnetic resonance imaging (MRI), luminal water fraction imaging] as well as the metabolic alterations associated with cancers (novel PET tracers, hyperpolarised MRI). Finally, the use of machine learning has shown powerful potential applications. By using prostate cancer as an exemplar, this Review aims to showcase these potentially potent imaging techniques and what stage we are at in their application to conventional clinical practice.
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Affiliation(s)
| | | | - Tom Syer
- UCL Centre for Medical ImagingLondonUK
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Podgórska J, Pasicz K, Zagórowicz E, Mróz A, Gołębiewski B, Kuś P, Jasieniak J, Skrzyński W, Wieszczy P, Kukołowicz P, Cieszanowski A. Intravoxel incoherent motion MRI in evaluating inflammatory activity in ulcerative colitis: a pilot study. Acta Radiol 2021; 62:439-446. [PMID: 32536258 DOI: 10.1177/0284185120931689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND A non-invasive tool for the assessment of ulcerative colitis (UC) activity is needed for treatment control. PURPOSE To determine the efficacy of intravoxel incoherent motion (IVIM) in assessing inflammatory activity in UC. MATERIAL AND METHODS In this prospective study, 20 adult patients underwent 3.0-T magnetic resonance imaging (MRI) IVIM diffusion-weighted imaging (DWI) with 10 b-values (0-900 s/mm2) 0-6 days after biopsies entailing colonoscopy. The inflammatory activity of large bowel segments was graded on endoscopy with Mayo score and on pathology with a six‑grade classification system. IVIM‑derived parameters (f, D, and D*) calculated from regions of interest placed within the bowel wall were correlated with both scores (56 and 34 bowel segments, respectively). Radiologists were blinded to endoscopy and pathology results. A T-test and Wilcoxon rank sum test was used in comparisons and receiver operating characteristic curve analysis was performed. RESULTS Statistically significant differences were found between histopathologically inactive or mild activity and moderate to severe activity in f (respectively: mean = 0.19 and mean = 0.28, P = 0.024; area under the curve [AUC] = 0.723, sensitivity 0.82, specificity 0.59, accuracy 0.67 for a 0.185 cut-off value) and D (mean = 1.34 × 10-3mm2/s and mean = 1.07 × 10-3mm2/s, P = 0.0083; AUC = 0.735, sensitivity 0.91, specificity 0.54, accuracy 0.66 for cut-off value 1.24 × 10-3mm2/s). No significant difference in D* was noted. No significant correlation between Mayo endoscopic subscore, and f, D, nor D* was found. CONCLUSION IVIM perfusion fraction correlates with UC activity and might represent emerging tool in assessment of inflammatory activity.
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Affiliation(s)
- Joanna Podgórska
- Department of Radiology I, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarzyna Pasicz
- Medical Physics Department, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Edyta Zagórowicz
- Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Andrzej Mróz
- Department of Gastroenterology, Hepatology and Clinical Oncology, The Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Pathomorphology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Bogumił Gołębiewski
- Department of Radiology I, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Kuś
- Department of Radiology I, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jakub Jasieniak
- Department of Radiology I, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Witold Skrzyński
- Medical Physics Department, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Paulina Wieszczy
- Department of Gastroenterology, Hepatology and Clinical Oncology, The Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Paweł Kukołowicz
- Medical Physics Department, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Andrzej Cieszanowski
- Department of Radiology I, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Mainenti PP, Stanzione A, Guarino S, Romeo V, Ugga L, Romano F, Storto G, Maurea S, Brunetti A. Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging. World J Gastroenterol 2019; 25:5233-5256. [PMID: 31558870 PMCID: PMC6761241 DOI: 10.3748/wjg.v25.i35.5233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the leading causes of tumor-related deaths worldwide. Among the various tools at physicians’ disposal for the diagnostic management of the disease, tomographic imaging (e.g., CT, MRI, and hybrid PET imaging) is considered essential. The qualitative and subjective evaluation of tomographic images is the main approach used to obtain valuable clinical information, although this strategy suffers from both intrinsic and operator-dependent limitations. More recently, advanced imaging techniques have been developed with the aim of overcoming these issues. Such techniques, such as diffusion-weighted MRI and perfusion imaging, were designed for the “in vivo” evaluation of specific biological tissue features in order to describe them in terms of quantitative parameters, which could answer questions difficult to address with conventional imaging alone (e.g., questions related to tissue characterization and prognosis). Furthermore, it has been observed that a large amount of numerical and statistical information is buried inside tomographic images, resulting in their invisibility during conventional assessment. This information can be extracted and represented in terms of quantitative parameters through different processes (e.g., texture analysis). Numerous researchers have focused their work on the significance of these quantitative imaging parameters for the management of CRC patients. In this review, we aimed to focus on evidence reported in the academic literature regarding the application of parametric imaging to the diagnosis, staging and prognosis of CRC while discussing future perspectives and present limitations. While the transition from purely anatomical to quantitative tomographic imaging appears achievable for CRC diagnostics, some essential milestones, such as scanning and analysis standardization and the definition of robust cut-off values, must be achieved before quantitative tomographic imaging can be incorporated into daily clinical practice.
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Affiliation(s)
- Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples 80145, Italy
| | - Arnaldo Stanzione
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Salvatore Guarino
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Valeria Romeo
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Lorenzo Ugga
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Federica Romano
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Giovanni Storto
- IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture 85028, Italy
| | - Simone Maurea
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Arturo Brunetti
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
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Faster magnetic resonance imaging in emergency room patients with right lower quadrant pain and suspected acute appendicitis. Pol J Radiol 2018; 83:e340-e347. [PMID: 30627257 PMCID: PMC6323540 DOI: 10.5114/pjr.2018.77790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 07/23/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose Emergency Departments (ED) are becoming busier, with a resultant increase in the number of imaging referrals. The purpose of this study was to assess the diagnostic accuracy of an abbreviated two sequence magnetic resonance (MR) protocol for evaluating ED patients with right lower quadrant pain and suspected acute appendicitis, with a view to expediting patient turnaround times and imaging costs. Material and methods Fifty patients (49 females, one male; mean age 25.4 ± 5.2 years) who underwent ED MR imaging from July 2014 to March 2015 for right lower quadrant pain were retrospectively reviewed. MR abdomen/pelvis was performed on 1.5 T MR obtaining axial T1 gradient echo in/out of phase, transverse fast spin echo T2 with fat sat/motion correction, axial/coronal T2 HASTE (half-Fourier acquisition single-shot turbo spin-echo), and axial DWI (diffusion-weighted imaging) sequences. Images were reviewed by two fellowship-trained radiologists on a five-point confidence scale. Mean acquisition/interpretation times for the standard departmental protocol and the proposed abbreviated MR protocol (comprising T2 HASTE and DWI images) were calculated. Sensitivity, specificity, and diagnostic accuracy for the abbreviated protocol against the full protocol were also calculated. Results Mean scanning time for abbreviated protocol and standard protocol was calculated to be 21.1 minutes and 40.5 minutes, respectively. Mean interpretation time for abbreviated protocol for reader one and two was 4.1 ± 1.5 minutes and 4.5 ± 1.4 minutes, respectively, and for standard protocol was 8.1 ± 1.8 minutes and 7.1 ± 1.4 minutes, respectively. Sensitivity, specificity, and accuracy for the FAST protocol were calculated to be 100% each for reader one and 75%, 100%, and 94%, respectively, for reader two. Conclusions The proposed abbreviated MR protocol has comparable diagnostic accuracy in diagnosing ED patients with right lower quadrant pain, with significant reduction in imaging/interpretation times. It thus has the potential to be implemented in ED imaging with significant reduction in patient turnaround times and costs.
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Guardiola M, Buitrago S, Fernández-Esparrach G, O'Callaghan JM, Romeu J, Cuatrecasas M, Córdova H, González Ballester MÁ, Camara O. Dielectric properties of colon polyps, cancer, and normal mucosa: Ex vivo measurements from 0.5 to 20 GHz. Med Phys 2018; 45:3768-3782. [PMID: 29807391 DOI: 10.1002/mp.13016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 05/09/2018] [Accepted: 05/18/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Colorectal cancer is highly preventable by detecting and removing polyps, which are the precursors. Currently, the most accurate test is colonoscopy, but still misses 22% of polyps due to visualization limitations. In this paper, we preliminary assess the potential of microwave imaging and dielectric properties (e.g., complex permittivity) as a complementary method for detecting polyps and cancer tissue in the colon. The dielectric properties of biological tissues have been used in a wide variety of applications, including safety assessment of wireless technologies and design of medical diagnostic or therapeutic techniques (microwave imaging, hyperthermia, and ablation). The main purpose of this work is to measure the complex permittivity of different types of colon polyps, cancer, and normal mucosa in ex vivo human samples to study if the dielectric properties are appropriate for classification purposes. METHODS The complex permittivity of freshly excised healthy colon tissue, cancer, and histological samples of different types of polyps from 23 patients was characterized using an open-ended coaxial probe between 0.5 and 20 GHz. The obtained measurements were classified into five tissue groups before applying a data reduction step with a frequency dispersive single-pole Debye model. The classification was finally compared with pathological analysis of tissue samples, which is the gold standard. RESULTS The complex permittivity progressively increases as the tissue degenerates from normal to cancer. When comparing to the gold-standard histological tissue analysis, the sensitivity and specificity of the proposed method is the following: 100% and 95% for cancer diagnosis; 91% and 62% for adenomas with high-grade dysplasia; 100% and 61% for adenomas with low-grade dysplasia; and 100% and 74% for hyperplastic polyps, respectively. In addition, complex permittivity measurements were independent of the lesion shape and size, which is also an interesting property comparing to current colonoscopy techniques. CONCLUSIONS The contrast in complex permittivities between normal and abnormal colon tissues presented here for the first time demonstrate the potential of these measurements for tissue classification. It also opens the door to the development of a microwave endoscopic device to complement the outcomes of colonoscopy with functional tissue information.
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Affiliation(s)
- Marta Guardiola
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
| | - Santiago Buitrago
- CommSensLab, Department of Signal Theory and Communications, Universitat Politècnica de Catalunya, Barcelona, 08034, Spain
| | - Glòria Fernández-Esparrach
- Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, IDIBAPS, CIBERehd, Hospital Clínic, Universitat de Barcelona, Barcelona, 08036, Spain
| | - Joan M O'Callaghan
- CommSensLab, Department of Signal Theory and Communications, Universitat Politècnica de Catalunya, Barcelona, 08034, Spain
| | - Jordi Romeu
- CommSensLab, Department of Signal Theory and Communications, Universitat Politècnica de Catalunya, Barcelona, 08034, Spain
| | - Miriam Cuatrecasas
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Banc de Tumors Biobanc Clinic-IDIBAPS, Barcelona, 08036, Spain
| | - Henry Córdova
- Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, IDIBAPS, CIBERehd, Hospital Clínic, Universitat de Barcelona, Barcelona, 08036, Spain
| | - Miguel Ángel González Ballester
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- ICREA, Barcelona, 08010, Spain
| | - Oscar Camara
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
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7
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Stanescu-Siegmund N, Nimsch Y, Wunderlich AP, Wagner M, Meier R, Juchems MS, Beer M, Schmidt SA. Quantification of inflammatory activity in patients with Crohn's disease using diffusion weighted imaging (DWI) in MR enteroclysis and MR enterography. Acta Radiol 2017; 58:264-271. [PMID: 27178031 DOI: 10.1177/0284185116648503] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Individual studies have demonstrated the potential of diffusion-weighted magnetic resonance imaging (DWI-MRI) for identifying inflamed bowel segments. However, these studies were conducted with rather small patient cohorts and in most cases by means of MR enterography only. Purpose To demonstrate the feasibility of detecting inflamed bowel segments in a large collective of patients with Crohn's disease using DWI in MR enteroclysis and MR enterography and to compare the results of both techniques, also considering clinical parameters by means of the Harvey-Bradshaw Index (HBI). Material and Methods Ninety-six patients underwent MRI enteroclysis and 35 patients MR enterography, both with additional DWI. The HBI as well as apparent diffusion coefficients (ADC) in areas of inflamed and normal bowel wall were determined. Thus resulting in 208 bowel segments that were visualized and subsequently statistically analyzed. Results There were no significant differences in ADC values in MR enteroclysis and MR enterography ( P = 0.383 in inflammation, P = 0.223 in normal wall). Areas of inflammation showed statistically highly significant lower ADC values than areas of normal bowel wall ( P < 0.001). An ADC threshold of 1.56 × 10-3 mm2/s can distinguish between normal and inflamed bowel segments with a sensitivity of 97.4% and a specificity of 99.2%. A highly significant correlation could be shown between ADC and HBI values ( P = 0.001). Conclusion DWI-MRI facilitates recognition of inflamed bowel segments in patients with Crohn's disease and the ADC values show an excellent correlation to the HBI. There were no significant differences in ADC values in MR enteroclysis and MR enterography. An ADC threshold of 1.56 × 10-3 mm2/s differentiates between normal and inflamed bowel wall.
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Affiliation(s)
- Nora Stanescu-Siegmund
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany
| | - Yessica Nimsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany
| | - Arthur P Wunderlich
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany
| | - Martin Wagner
- Department of Internal Medicine I, University Hospital of Ulm, Ulm, Germany
| | - Reinhard Meier
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany
| | - Markus S Juchems
- Department of Diagnostic and Interventional Radiology, Konstanz Hospital, Konstanz, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany
| | - Stefan A Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany
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Schmid-Tannwald C, Schmid-Tannwald CM, Morelli JN, Albert NL, Braunagel M, Trumm C, Reiser MF, Ertl-Wagner B, Rist C. The role of diffusion-weighted MRI in assessment of inflammatory bowel disease. Abdom Radiol (NY) 2016; 41:1484-94. [PMID: 27108127 DOI: 10.1007/s00261-016-0727-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the role of diffusion-weighted MRI (DW-MRI) in detecting and differentiating acute from chronic bowel inflammation in patients with Crohn's disease (CD). MATERIALS AND METHODS MR-enteroclysis examinations with DW-MRI were reviewed from 24 patients with histologically proven CD. Segments of bowel were evaluated for acute and chronic inflammation in three different reviews of the MRI images: T2w alone, T2w + DWI, and T2w + CET1w. Mean ADC values of normal bowel segments, as well as bowel segments with acute and chronic inflammation were calculated and compared. Analyses of receiver-operating characteristic (ROC) curve were performed. RESULTS Hundred and forty four bowel segments in total were reviewed. Inflammation was present in 45 segments. Acute inflammation was present in 31 segments, chronic inflammation in 14. 98 bowel segments showed no inflammatory activity. Sensitivity and specificity for differentiation between normal and inflamed bowel segments was 0.6, 0.67, and 0.80 on T2w, T2w + DWI, and T2w + CET1w datasets, respectively. Specificities for differentiation between normal and inflamed bowel segments were 0.96, 0.96, and 0.98. Sensitivities for differentiation between acute and chronically inflamed bowel segments were 0.85, 0.91, and 0.96, and specificities were 0.88, 0.89, and 1.0, respectively. The mean ADC value of normal bowel (2.18 ± 0.37 × 10(-3) mm(2)/s) was statistically significantly greater than the mean value of inflamed bowel segments (p < 0.001). The mean ADC value of acutely inflamed bowel segments was statistically significantly lower than that of chronically inflamed bowel segments (1.09 ± 0.18 × 10(-3) vs. 1.55 ± 0.21 × 10(-3) mm(2)/s) (p < 0.001). Estimated area under the ROC curve for the diagnosis of acute vs. chronic inflammation was 0.950. A threshold of ADC value of 1.41 × 10(-3) mm(2)/s was optimal for calculation of sensitivity and specificity. CONCLUSION DW-MRI improves detection and differentiation of acute vs. chronic inflammatory changes of the bowel in patients with CD compared to T2w-images alone.
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Affiliation(s)
- Christine Schmid-Tannwald
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph M Schmid-Tannwald
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - John N Morelli
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 N Caroline, Baltimore, MD, 21287, USA
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Margarita Braunagel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Trumm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Carsten Rist
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Stanley E, Moriarty HK, Cronin CG. Advanced multimodality imaging of inflammatory bowel disease in 2015: An update. World J Radiol 2016; 8:571-580. [PMID: 27358684 PMCID: PMC4919756 DOI: 10.4329/wjr.v8.i6.571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/09/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023] Open
Abstract
The diagnosis and effective management of inflammatory bowel disease (IBD) requires a combination clinical, endoscopic, histological, biological, and imaging data. While endoscopy and biopsy remains the gold standard for diagnosis of IBD, imaging plays a central role in the assessment of extra mural disease, in disease surveillance and in the assessment of response to medical treatments, which are often expensive. Imaging is also vital in the detection and diagnosis of disease related complications, both acute and chronic. In this review, we will describe, with illustrative images, the imaging features of IBD in adults, with emphasis on up-to-date imaging techniques focusing predominantly on cross sectional imaging and new magnetic resonance imaging techniques.
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Magnetic resonance colonography including diffusion-weighted imaging in children and adolescents with inflammatory bowel disease: do we really need intravenous contrast? Invest Radiol 2015; 50:32-9. [PMID: 25215934 DOI: 10.1097/rli.0000000000000092] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Magnetic resonance colonography (MRC) is a well-accepted, noninvasive imaging modality for the depiction of inflammatory bowel disease. Diffusion-weighted imaging (DWI) is very helpful to display inflammatory lesions. The aim of this retrospective study was to assess whether intravenous contrast is needed to depict inflammatory lesions in bowel magnetic resonance imaging if DWI is available. MATERIALS AND METHODS Thirty-seven patients (23 females, 14 males; mean age, 14.6 years) underwent MRC on a 1.5-T scanner (MAGNETOM Avanto; Siemens). Contrast-enhanced T1-weighted (ce-T1-w) sequences and DWI sequences in axial and coronal planes (b = 50, 500, 1000) were acquired. Two reviewers evaluated (1) DWI, (2) ce-T1-w MRC, as well as (3) DWI and ce-T1-w MRC concerning lesion conspicuity. The preferred b value was assessed. Colonoscopy was performed within 1 week, including biopsies serving as the reference standard. Sensitivities and specificities were calculated, and interobserver variability was assessed. RESULTS Mean sensitivity and specificity of the 2 readers for the depiction of inflammatory lesions were 78.4%/100% using ce-T1-w MRC, 95.2%/100% using DWI, and 93.5%/100% combining both imaging techniques compared with colonoscopy including results of the histopathological samples. In 6 patients, inflammatory lesions were only detected by DWI; in another 6 patients, DWI detected additional lesions. The κ values for the 2 readers were excellent (k = 0.92-0.96). The preferred b value with the best detectability of the lesion was b1000 in 28 of the 30 patients (93.3%) with restricted diffusion. CONCLUSIONS Diffusion-weighted imaging of the bowel identified inflammatory lesions with high accuracy and revealed lesions that were not detectable with ce-T1-w imaging alone. A b value of 1000 showed the best lesion detectability.
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Abstract
OBJECTIVE Pediatric patients with inflammatory bowel disease (IBD) commonly need repetitive imaging to assess disease activity and complications. Recently, MR enterography has become a first-line radiologic study in children with IBD because of improved image quality, excellent soft-tissue contrast resolution, and lack of ionizing radiation. The purpose of this article is to describe the use of diffusion-weighted imaging (DWI) in MR enterography and the evaluation of pediatric IBD. CONCLUSION Several contemporary publications have shown that DWI can be useful for assessing both pediatric and adult patients with IBD as an important adjunct pulse sequence. Specifically, DWI can be used to identify abnormal bowel segments, assess disease inflammatory activity, and detect and characterize a variety of extraintestinal IBD-related manifestations and complications.
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Er HÇ, Erden A, Küçük NÖ, Geçim E. Correlation of minimum apparent diffusion coefficient with maximum standardized uptake on fluorodeoxyglucose PET-CT in patients with rectal adenocarcinoma. Diagn Interv Radiol 2015; 20:105-9. [PMID: 24100063 DOI: 10.5152/dir.2013.13275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to retrospectively assess the correlation between minimum apparent diffusion coefficient (ADCmin) values obtained from diffusion-weighted magnetic resonance imaging (MRI) and maximum standardized uptake values (SUVmax) obtained from positron emission tomography-computed tomography (PET-CT) in rectal cancer. MATERIALS AND METHODS Forty-one patients with pathologically confirmed rectal adenocarcinoma were included in this study. For preoperative staging, PET-CT and pelvic MRI with diffusion-weighted imaging were performed within one week (mean time interval, 3±1 day). For ADC measurements, the region of interest (ROI) was manually drawn along the border of each hyperintense tumor on b=1000 s/mm2 images. After repeating this procedure on each consecutive tumor-containing slice to cover the entire tumoral area, ROIs were copied to ADC maps. ADCmin was determined as the lowest ADC value among all ROIs in each tumor. For SUVmax measurements, whole-body images were assessed visually on transaxial, sagittal, and coronal images. ROIs were determined from the lesions observed on each slice, and SUVmax values were calculated automatically. The mean values of ADCmin and SUVmax were compared using Spearman's test. RESULTS The mean ADCmin was 0.62±0.19×10-3 mm2/s (range, 0.368-1.227×10-3 mm2/s), the mean SUVmax was 20.07±9.3 (range, 4.3-49.5). A significant negative correlation was found between ADCmin and SUVmax (r=-0.347; P = 0.026). CONCLUSION There was a significant negative correlation between the ADCmin and SUVmax values in rectal adenocarcinomas.
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Affiliation(s)
- Hale Çolakoğlu Er
- From the Departments of Radiology (H.Ç.E., A.E. e-mail: ), Nuclear Medicine (N.Ö.K.), and General Surgery (E.G.), Ankara University School of Medicine, Ankara, Turkey
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Feng Q, Yan YQ, Zhu J, Tong JL, Xu JR. Optimal b value of diffusion-weighted imaging on a 3.0T magnetic resonance scanner in Crohn’s disease. World J Gastroenterol 2014; 20:12621-12627. [PMID: 25253967 PMCID: PMC4168100 DOI: 10.3748/wjg.v20.i35.12621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/18/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the optimal b value of diffusion-weighted imaging for detecting active inflammation in Crohn’s disease.
METHODS: Thirty-one patients clinically diagnosed with active Crohn’s disease were referred for magnetic resonance examination. All patients were scanned on a 3.0T magnetic resonance scanner using the same protocol involving four different b values (800, 1500, 2000 and 2500 s/mm2). The diagnostic effect of diffusion-weighted imaging was evaluated and compared with endoscopic findings. The diffusion-weighted image quality of four b value groups was evaluated and apparent diffusion coefficient was measured for both normal and inflammatory intestinal segments.
RESULTS: The contrast-to-noise ratio and signal-to-noise ratio were not satisfied when b value 2000 or 2500 s/mm2 was adopted (36.52 ± 14.95 vs 34.78 ± 24.83, P > 0.05; 53.58 ± 23.45 vs 47.58 ± 29.67, P > 0.05). The qualitative image quality was not enough to meet diagnostic requirement. No matter which b value was chosen, the apparent diffusion coefficient of inflammatory intestinal segments was significantly lower than that of normal intestinal segments (1.38 ± 0.28 vs 2.00 ± 0.38, P < 0.01; 1.09 ± 0.20 vs 1.50 ± 0.28, P < 0.01; 0.95 ± 0.19 vs 1.34 ± 0.28, P < 0.01; 0.88 ± 0.14 vs 1.20 ± 0.21, P < 0.01). The lesion detection rate (90.32%), diagnostic sensitivity (81.18%) and specificity (95.10%) would be appropriate when b value 1500 s/mm2 was adopted.
CONCLUSION: High b value is suitable for intestinal DW examination on a high field MR scanner.
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Abstract
BACKGROUND Endoscopy and imaging objectively assess Crohn's disease (CD) activity. Magnetic resonance enterography (MRE) uses no ionizing radiation, carries no significant morbidity, and is highly sensitive in revealing soft tissues inflammation. Diffusion-weighted imaging can distinguish intestinal inflammation from a lower diffusion of water molecules giving rise to a reduced apparent diffusion coefficient. The magnetic resonance index of activity score and, more recently, the Clermont score were recently developed for staging CD activity. The aim of this study was to compare the MRE scores and the Simple Endoscopic Score for CD in identifying ileal CD activity. METHODS Fifty-five patients with ileal and ileocolonic CD were consecutively enrolled between June 2012 and June 2013. All patients underwent clinical examination, biochemical tests, MRE, and colonoscopy to assess disease activity. RESULTS MRE assessed active ileal disease in 31 patients (56.3%). The Clermont score significantly correlated with the magnetic resonance index of activity score (r = 0.91; P < 0.0001) and the Simple Endoscopic Score for CD (r = 0.76; P < 0.0001). The apparent diffusion coefficient correlated with the Simple Endoscopic Score for CD (r = -0.63; P < 0.0001) especially in unoperated patients. CONCLUSIONS The Clermont score and the apparent diffusion coefficient value can stage ileal CD, avoiding the need to use contrast agents.
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Amzallag-Bellenger E, Soyer P, Barbe C, Nguyen TLF, Amara N, Hoeffel C. Diffusion-weighted imaging for the detection of mesenteric small bowel tumours with Magnetic Resonance--enterography. Eur Radiol 2014; 24:2916-26. [PMID: 25113647 DOI: 10.1007/s00330-014-3303-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 05/01/2014] [Accepted: 06/27/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To retrospectively investigate the added value of diffusion-weighted MR imaging (DWI) for detecting mesenteric small bowel tumours (MSBTs) via MR-enterography. MATERIALS AND METHODS MR-enterographies of 98 patients with suspected MSBTs were blindly analyzed by two independent readers for the presence of MSBTs. Four imaging sets including "standard" (Haste and TrueFisp), "standard + DWI," "standard + gadolinium-enhanced" and "standard + DWI + gadolinium-enhanced" were reviewed. Diagnostic performance of different readings were compared with McNemar's test. RESULTS Twenty-nine MSBTs were pathologically confirmed. For R1 (junior radiologist) sensitivity, specificity, PPV, NPV and accuracy for the detection of MSBTs via standard MRI were 52 % [95 % CI: 34 %-70 %] (15/29), 94 % [95 % CI: 89 %-100 %] (65/69), 79 % [95 % CI: 61 %-97 %] (15/19), 82 % [95 % CI: 74 %-91 %] (65/79) and 82 % [95 % CI: 74 %-89 %] (80/98), respectively. For R2 (senior radiologist) they were 76 % [95 % CI: 60 %-91 %] (22/29), 96 % [95 % CI: 91-100 %] (66/69), 88 % [95 % CI: 75 %-100 %] (22/25), 90 % [95 % CI: 84 %-97 %] (66/73) and 90 % [95 % CI: 84 %-96 %] (88/98), respectively. Adding DWI they were 72 % [95 % CI: 56 %-89 %] (21/29), 91 % [95 % CI: 85 %-98 %] (63/69), 78 % [95 % CI: 62 %-94 %] (21/27), 89 % [95 % CI: 81 %-96 %] (63/71) and 87 % [95 % CI: 80 %-94 %] (85/98) for R1 and 79 % [95 % CI: 65 %-94 %] (23/29), 97 % [95 % CI: 93 %-100 %] (67/69), 92 % [95 % CI: 81 %-100 %] (23/25), 92 % [95 % CI: 86 %-98 %] (67/73) and 92 % [95 % CI: 86 %-97 %] (90/98) for R2. Sensitivities for tumour detection were higher after adding DWI to standard MRI, although only for R1 was this significant (P = 0.03). Adding DWI to standard + gadolinium-enhanced MRI did not significantly increase MR performance. CONCLUSION DWI improves MSBT detection via MR-enterography compared to standard unenhanced MR-enterography, especially for unexperienced readers. KEY POINTS • MR-enterography is accurate for the detection of mesenteric small-bowel tumours. • Diffusion-weighted sequencing helps inexperienced readers detect small-bowel tumours with MR-enterography. • Diffusion-weighted sequencing adds value to standard MR-enterography when gadolinium is contraindicated.
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Affiliation(s)
- Elisa Amzallag-Bellenger
- Department of Radiology, Hôpital Robert Debré, Avenue du Général Koenig, 51092, Reims Cedex, France,
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Akashi M, Nakahusa Y, Yakabe T, Egashira Y, Koga Y, Sumi K, Noshiro H, Irie H, Tokunaga O, Miyazaki K. Assessment of aggressiveness of rectal cancer using 3-T MRI: correlation between the apparent diffusion coefficient as a potential imaging biomarker and histologic prognostic factors. Acta Radiol 2014; 55:524-31. [PMID: 24005562 DOI: 10.1177/0284185113503154] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) permits non-invasive assessment of tumor characteristics. PURPOSE To assess the value of DW-MRI as a potential non-invasive marker of tumor aggressiveness in rectal cancer by analyzing the relationship between tumoral apparent diffusion coefficient (ADC) values of MRI and histopathologic prognostic parameters that are not affected by preoperative chemoradiation therapy. MATERIAL AND METHODS Forty patients with rectal cancer were assessed with primary staging 3-T MRI, including DWI, before undergoing surgical therapy. In all patients, surgery was performed without neoadjuvant therapy. Mean tumor ADC was measured and compared between subgroups based on pretreatment carcinoembryonic antigen (CEA) levels, MRI parameters (e.g. postoperative local recurrence), and histopathologic parameters, including A (invasive distance: A1, T-stage; A2, mesorectal fascia [MRF] status), B (differentiation grade: B1, poorly differentiated; B2, moderately differentiated; B3, well differentiated), C (others: C1, N-stage; C2, lymphangiovascular invasion). RESULTS Mean tumor ADCs were different when comparing groups stratified by histologic differentiation grades (P=0.0192). There was no significant difference in mean ADCs when stratifying patients according to CEA levels, T-stage, N-stage, MRF status, presence of lymphangiovascular invasion, or the presence of local recurrence. CONCLUSION Significant correlations were found between mean ADC values and differentiation grade. ADC may be useful as an imaging biomarker of tumor aggressiveness, but it cannot serve as an independent biomarker of advanced rectal cancer.
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Affiliation(s)
- Michiaki Akashi
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
- Department of Pathology and Biodefense, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuji Nakahusa
- Department of Surgery, Hukuoka Red Cross Hospital, Hukouoka, Japan
| | - Tomomi Yakabe
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshiyuki Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Yasuo Koga
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kenji Sumi
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirokazu Noshiro
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Osamu Tokunaga
- Department of Pathology and Biodefense, Faculty of Medicine, Saga University, Saga, Japan
| | - Kohji Miyazaki
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Abstract
Magnetic resonance enterography in Crohn disease management has been rapidly growing in importance during recent years. Being familiar to this technique is essential for radiologists and also, to some extent, for gastroenterologists. Our aim is to study and describe the imaging findings in magnetic resonance enterography in Crohn disease to develop a comprehensive and useful review article and imaging atlas.
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Regini F, Gourtsoyianni S, Cardoso De Melo R, Charles-Edwards GD, Griffin N, Parikh J, Rottenberg G, Leslie M, Gaya A, Goh V. Rectal tumour volume (GTV) delineation using T2-weighted and diffusion-weighted MRI: Implications for radiotherapy planning. Eur J Radiol 2014; 83:768-72. [PMID: 24646719 DOI: 10.1016/j.ejrad.2014.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare the rectal tumour gross target volume (GTV) delineated on T2 weighted (T2W MRI) and diffusion weighted MRI (DWI) images by two different observers and to assess if agreement is improved by DWI. MATERIAL AND METHODS 27 consecutive patients (15 male, range 27.1-88.8 years, mean 66.9 years) underwent 1.5T MRI prior to chemoradiation (45Gy in 25 fractions; oral capecitabine 850mg/m(2)), including axial T2W MRI (TR=6600ms, TE=90ms) and DWI (TR=3000ms, TE=77ms, b=0, 100, 800s/mm(2)). 3D tumour volume (cm(3)) was measured by volume of interest (VOI) analysis by two independent readers for the T2W MRI and b800 DWI axial images, and the T2W MRI and DWI volumes compared using Mann-Whitney test. Observer agreement was assessed using Bland-Altman statistics. Significance was at 5%. RESULTS Artefacts precluded DWI analysis in 1 patient. In the remaining 26 patients evaluated, median (range) T2W MRI MRI and DWI (b=800s/mm(2)) 3D GTVin cm(3) were 33.97 (4.44-199.8) and 31.38 (2.43-228), respectively, for Reader One and 43.78 (7.57-267.7) and 42.45 (3.68-251) for Reader Two. T2W MRI GTVs were slightly larger but not statistically different from DWI volumes: p=0.52 Reader One; p=0.92 Reader Two. Interobserver mean difference (95% limits of agreement) for T2W MRI and DWI GTVs were -9.84 (-54.96 to +35.28) cm(3) and -14.79 (-54.01 to +24.43) cm(3) respectively. CONCLUSION Smaller DWI volumes may result from better tumour conspicuity but overall observer agreement is not improved by DWI.
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Affiliation(s)
- F Regini
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Experimental and Clinical Biomedical Sciences - Radiodiagnostic Unit 2 - University of Florence- Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
| | - S Gourtsoyianni
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK.
| | - R Cardoso De Melo
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - G D Charles-Edwards
- Division of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK; Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - N Griffin
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK.
| | - J Parikh
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - G Rottenberg
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - M Leslie
- Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - A Gaya
- Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - V Goh
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK.
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Yacoub JH, Oto A. New Magnetic Resonance Imaging Modalities for Crohn Disease. Magn Reson Imaging Clin N Am 2014; 22:35-50. [DOI: 10.1016/j.mric.2013.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kinner S, Blex S, Maderwald S, Forsting M, Gerken G, Lauenstein TC. Addition of diffusion-weighted imaging can improve diagnostic confidence in bowel MRI. Clin Radiol 2013; 69:372-7. [PMID: 24360512 DOI: 10.1016/j.crad.2013.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 09/04/2013] [Accepted: 09/30/2013] [Indexed: 01/08/2023]
Abstract
AIM To evaluate whether the addition of diffusion-weighted imaging (DWI) in bowel abdominal magnetic resonance imaging (MRI) can improve diagnostic confidence. MATERIALS AND METHODS One hundred and eleven consecutive patients with suspected or known inflammatory bowel disease (n = 59), tumour disease (n = 31), unspecific abdominal pain (n = 16), and suspected graft-versus-host disease (n = 5) underwent bowel MRI using a 1.5 T MRI machine. In addition to T2-weighted (T2W) and contrast-enhanced T1-weighted (CE-T1W) data, axial and coronal DWI sequences were collected (b = 50, 500, 1000). Diagnostic confidence for lesion detection with and without DWI was evaluated using a four-point Likert scale [1 = certainly no lesion(s), 2 = probably no lesion(s), 3 = probably lesion(s), 4 = certainly lesion(s)]. RESULTS In 11 of 111 patients (10%), the diagnostic confidence was improved by DWI. In seven patients, readers changed their diagnosis from "probable" to "certain presence of lesions". In another four patients, lesions were diagnosed based on DWI, which were not delineated on CE-T1W and T2W imaging. CONCLUSION DWI of the bowel can provide additional information to the reader and, therefore, improve diagnostic confidence. Hence, additional DWI should be integrated into a standard bowel MRI protocol.
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Affiliation(s)
- S Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - S Blex
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - S Maderwald
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - G Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - T C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Value of DW-MRI ADC quantification of colonic wall lesions in differentiation of inflammatory bowel disease and colorectal carcinoma. Jpn J Radiol 2013; 32:6-13. [PMID: 24178154 DOI: 10.1007/s11604-013-0260-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 10/20/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of our study was to assess the efficiency of diffusion-weighted magnetic resonance imaging (DW-MRI) and the quantification of apparent diffusion coefficient (ADC) values in differentiating colorectal carcinoma from colonic inflammatory bowel disease (IBD) in cases with isolated colonic wall lesions and uncertain clinical and radiologic diagnostic criteria. METHODS The study comprised 58 patients with segmental or focal isolated colonic wall thickening. All lacked satisfactory clinical-radiological findings for etiology determination. The mean ADC values of the thickened colonic walls were retrospectively compared with final histopathologic diagnoses. Receiver operating characteristic (ROC) curve analysis was used to determine the ADC cutoff value for differentiation. RESULTS Mean ADC value in the colorectal carcinoma group was significantly lower than that in the IBD group: n = 27, 1.02 ± 0.26 × 10(-3) mm(2)/s; and n = 31, 1.53 ± 0.19 × 10(-3) mm(2)/s, respectively (P < 0.001). Cutoff ADC value for differentiating colorectal carcinoma from IBD was calculated as 1.39 × 10(-3) mm(2)/s, with 83.9 % sensitivity and 85.2 % specificity. CONCLUSION ADC measurement of the involved colonic wall segments with DW-MRI has the potential to differentiate isolated colonic IBD from colorectal carcinoma in cases in which clinical-radiologic findings are insufficient for a definitive diagnosis.
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Efficiency of apparent diffusion coefficients in differentiation of colorectal tumor recurrences and posttherapeutical soft-tissue changes. Eur J Radiol 2013; 82:1702-9. [DOI: 10.1016/j.ejrad.2013.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 05/13/2013] [Accepted: 05/15/2013] [Indexed: 11/22/2022]
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Attariwala R, Picker W. Whole body MRI: improved lesion detection and characterization with diffusion weighted techniques. J Magn Reson Imaging 2013; 38:253-68. [PMID: 23960006 PMCID: PMC3795449 DOI: 10.1002/jmri.24285] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 05/24/2013] [Indexed: 12/21/2022] Open
Abstract
Diffusion-weighted imaging (DWI) is an established functional imaging technique that interrogates the delicate balance of water movement at the cellular level. Technological advances enable this technique to be applied to whole-body MRI. Theory, b-value selection, common artifacts and target to background for optimized viewing will be reviewed for applications in the neck, chest, abdomen, and pelvis. Whole-body imaging with DWI allows novel applications of MRI to aid in evaluation of conditions such as multiple myeloma, lymphoma, and skeletal metastases, while the quantitative nature of this technique permits evaluation of response to therapy. Persisting signal at high b-values from restricted hypercellular tissue and viscous fluid also permits applications of DWI beyond oncologic imaging. DWI, when used in conjunction with routine imaging, can assist in detecting hemorrhagic degradation products, infection/abscess, and inflammation in colitis, while aiding with discrimination of free fluid and empyema, while limiting the need for intravenous contrast. DWI in conjunction with routine anatomic images provides a platform to improve lesion detection and characterization with findings rivaling other combined anatomic and functional imaging techniques, with the added benefit of no ionizing radiation.
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Schmid-Tannwald C, Oto A, Reiser MF, Zech CJ. Diffusion-weighted MRI of the abdomen: current value in clinical routine. J Magn Reson Imaging 2013; 37:35-47. [PMID: 23255414 DOI: 10.1002/jmri.23643] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 02/17/2012] [Indexed: 02/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) provides high tissue contrast without ionizing radiation exposure and unenhanced images are often diagnostic. Therefore, MRI is especially an attractive tool for patients with allergies for gadolinium-based contrast agents or renal failure. Technical advantages have led to the increasing use of diffusion-weighted (DW) MRI in abdominal imaging, which provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. This review article presents the current status of noncontrast MRI with the focus of DW-MRI. Technical background and clinical applications are explained and discussed.
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New frontiers of MRI in Crohn's disease: motility imaging, diffusion-weighted imaging, perfusion MRI, MR spectroscopy, molecular imaging, and hybrid imaging (PET/MRI). ACTA ACUST UNITED AC 2013; 37:974-82. [PMID: 22743838 DOI: 10.1007/s00261-012-9890-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article reviews the latest diagnostic advances in the evaluation of the CD, including functional studies on intestinal motility and molecular characterization of the inflammatory process at the level of the involved bowel. Molecular changes related to inflammation of the intestinal wall may be evaluated by different MRI techniques, including diffusion-weighted imaging, perfusion weighted imaging, in vivo spectroscopy, molecular imaging, and fusion imaging (PET-MRI).
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Öistämö E, Hjern F, Blomqvist L, Von Heijne A, Abraham-Nordling M. Cancer and diverticulitis of the sigmoid colon. Differentiation with computed tomography versus magnetic resonance imaging: preliminary experiences. Acta Radiol 2013; 54:237-41. [PMID: 23319717 DOI: 10.1258/ar.2012.120543] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Both colon cancer and diverticular disease are common in the Western world. A challenge when patients present with clinical findings is that both diseases can present with symptoms that may mimic the other. PURPOSE To determine whether magnetic resonance imaging (MRI) could be helpful to differentiate between diverticulitis and cancer of the sigmoid colon compared to the differentiation offered by evaluation of multidetector computed tomography (CT) in a clinical situation. MATERIAL AND METHODS Thirty patients were consecutively included. Fifteen patients were under work-up for a recently diagnosed sigmoid cancer and 15 patients had recently been treated in hospital due to first-time acute sigmoid diverticulitis. All patients underwent CT, T2- weighted MRI and diffusion-weighted MRI. Anonymized examinations were retrospectively presented in random order to one experienced radiologist. RESULTS With contrast-enhanced CT, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 66.7% (10/15) and 93.3% (14/15), respectively. Using T2-weighted and diffusion-weighted MR images, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 100% (14/14) and 100% (14/14), respectively. CONCLUSION MRI provides information that may contribute to improve the differentiation between sigmoid cancer and diverticulitis that is offered by CT. These encouraging results need to be confirmed in a larger study.
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Affiliation(s)
- Emma Öistämö
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm
| | - Fredrik Hjern
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm
| | - Lennart Blomqvist
- Department of Diagnostic Radiology, Department of Molecular Medicine and Surgery Karolinska University Hospital Solna and Karolinska Institutet, Stockholm
| | - Anders Von Heijne
- Department of Clinical Sciences, Division of Radiology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mirna Abraham-Nordling
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm
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Monguzzi L, Ippolito D, Bernasconi DP, Trattenero C, Galimberti S, Sironi S. Locally advanced rectal cancer: value of ADC mapping in prediction of tumor response to radiochemotherapy. Eur J Radiol 2013; 82:234-40. [PMID: 23122748 DOI: 10.1016/j.ejrad.2012.09.027] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/27/2012] [Accepted: 09/29/2012] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of quantitative apparent diffusion coefficient (ADC) measurements, in the assessment of the therapeutic response to chemo-radiation therapy (CRT) in patients with locally advanced rectal cancer, by analyzing post CRT values of ADC, in relation to tumor regression grade (TRG) obtained by histopathologic evaluation of the rectal specimen. METHODS This prospective study was approved by an Institutional Review Board, and informed consent was obtained from all patients. Thirty-one patients with locally advanced rectal cancer underwent pre and post CRT MR imaging at 1.5T. ADC values were measured in regions of interest (ROIs) drawn independently by two radiologists, blinded to the pathology results, on three slices of the pre and post CRT DW-MR image sets with the corresponding T2 weighted images (T2WI) available for anatomic reference. The two readers' measurements were compared for differences in ADC values, inter-observer variability (measured as the intraclass correlation coefficient; ICC) and the ADC distributions of responders vs non-responders. The diagnostic performance of ADC in the prediction of the response to CRT was evaluated by calculating the area under the ROC curve (AUC) and the optimal cut-off values. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed. RESULTS The two readers showed an overall strong agreement in measuring ADC values. For both readers, no differences in ADC pre-treatment measurements were observed between responders and non-responders. For reader 1, the post-CRT ADC and the ΔADC presented the higher AUC (0.823 and 0.803, respectively), while Δ%ADC provided the lower AUC value (0.682). The optimal cutoff point was 1.294 s/mm(2) for post-CRT measures (sensitivity=86.4%, specificity=66.7%, PPV=86.4%, NPV=66.7%), 0.500 for ΔADC (sensitivity=81.8%, specificity=66.7%, PPV=85.7%, NPV=60.0%) and 59.3% for Δ%ADC (sensitivity=63.4%, specificity=66.7, PPV=82.4%, NPV=42.9%). Similar results were observed for reader 2, with better performance obtained with the ADC post-CRT (AUC of 0.833) and an optimal cut off of 1.277 × 10(-3)s/mm(2). CONCLUSION Post-CRT ADC measurements are reliable and reproducible and may be used as a non-invasive tool to evaluate response to therapy as post-CRT ADC values and ΔADC presented good diagnostic performance to select responder patients.
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Bonekamp S, Corona-Villalobos CP, Kamel IR. Oncologic applications of diffusion-weighted MRI in the body. J Magn Reson Imaging 2012; 35:257-79. [PMID: 22271274 DOI: 10.1002/jmri.22786] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diffusion-weighted MRI (DWI) allows the detection of malignancies in the abdomen and pelvis. Lesion detection and characterization using DWI largely depends on the increased cellularity of solid or cystic lesions compared with the surrounding tissue. This increased cellularity leads results in restricted diffusion as indicated by reduction in the apparent diffusion coefficient (ADC). Low pretreatment ADC values of several malignancies have been shown to be predictive of better outcome. DWI can assess response to systemic or regional treatment of cancer at a cellular level and will therefore detect successful treatment earlier than anatomical measures. In this review, we provide a brief technical overview of DWI, discuss quantitative image analysis approaches, and review studies which have used DWI for the purpose of detection and characterization of malignancies as well as the early prediction of treatment response.
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Affiliation(s)
- Susanne Bonekamp
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Motoshima S, Irie H, Nakazono T, Kamura T, Kudo S. Diffusion-weighted MR imaging in gynecologic cancers. J Gynecol Oncol 2011; 22:275-87. [PMID: 22247805 PMCID: PMC3254847 DOI: 10.3802/jgo.2011.22.4.275] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/06/2011] [Accepted: 11/16/2011] [Indexed: 12/15/2022] Open
Abstract
Diffusion-weighted imaging (DWI) reflects changes in proton mobility caused by pathological alterations of tissue cellularity, cellular membrane integrity, extracellular space perfusion, and fluid viscosity. Functional imaging is becoming increasingly important in the evaluation of cancer patients because of the limitations of morphologic imaging. DWI is being applied to the detection and characterization of tumors and the evaluation of treatment response in patients with cancer. The advantages of DWI include its cost-effectiveness and brevity of execution, its complete noninvasiveness, its lack of ionizing radiation, and the fact that it does not require injection of contrast material, thus enabling its use in patients with renal dysfunction. In this article, we describe the clinical application of DWI to gynecological disorders and its diagnostic efficacy therein.
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Coutinho AC, Krishnaraj A, Pires CE, Bittencourt LK, Guimarães AR. Pelvic Applications of Diffusion Magnetic Resonance Images. Magn Reson Imaging Clin N Am 2011; 19:133-57. [DOI: 10.1016/j.mric.2010.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Inci E, Kilickesmez O, Hocaoglu E, Aydin S, Bayramoglu S, Cimilli T. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol 2010; 21:768-75. [PMID: 20924585 DOI: 10.1007/s00330-010-1981-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 08/16/2010] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the value of diffusion-weighted MRI (DWI) in the diagnosis of acute appendicitis. METHODS 119 patients with acute appendicitis and 50 controls were enrolled in this prospective study. DWI was obtained with b factors 0, 500 and 1000 s/mm² and were assessed with a visual scoring system by two radiologists followed by quantitative evaluation of the DW images and ADC maps. RESULTS Histopathology revealed appendicitis in 79/92 patients (78%) who had undergone surgery. On visual evaluation, except for one patient with histopathologically proven appendicitis all inflamed appendixes were hyperintense on DWI (98.7%). Quantitative evaluation with DW signal intensities and ADC values revealed a significant difference with normal and inflamed appendixes (p < 0.001). The best discriminative parameter was signal intensity (b 500). With a cut-off value of 56 for the signal intensity the ratio had a sensitivity of 99% and a specificity of 97%. The cut-off ADC value at 1.66 mm²/s had a sensitivity of 97% and a specificity of 99%. CONCLUSION DWI is a valuable technique for the diagnosis of acute appendicitis with both qualitative and quantitative evaluation. DWI increases the conspicuity of the inflamed appendix. We recommend using DWI to diagnose acute appendicitis.
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Affiliation(s)
- Ercan Inci
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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Punwani S. Diffusion weighted imaging of female pelvic cancers: concepts and clinical applications. Eur J Radiol 2010; 78:21-9. [PMID: 20801592 DOI: 10.1016/j.ejrad.2010.07.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 07/30/2010] [Indexed: 12/23/2022]
Abstract
Early applications of diffusion weighted magnetic resonance imaging (DWI) were limited to neuroimaging, concentrating either on stroke or brain tumours. With recent advances in MRI hardware and software DWI is now increasingly being investigated for cancer assessment throughout the body. Clinical applications of DWI relating to female pelvic cancers have largely concentrated on detection, localisation and staging of disease. More recently investigators have started to evaluate the ability of DWI for determining tumour histology and even predicting the outcome of chemoradiation treatment. This article reviews the physical concepts of MR diffusion weighting, illustrates the biophysical basis of diffusion contrast and reports the clinical applications of DWI for cervical, endometrial, ovarian, rectal and bladder tumours.
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Affiliation(s)
- Shonit Punwani
- Department of Academic Radiology, 2nd Floor Podium, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom.
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Cao XC, Wang Y, Zhao X, Sun HR. MRI for diagnosis and evaluation of inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2010; 18:2247-2252. [DOI: 10.11569/wcjd.v18.i21.2247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a non-invasive and ionizing radiation-free cross-sectional imaging technique, magnetic resonance imaging (MRI) has shown a bright future in following up patients with inflammatory bowel disease (IBD), especially child and young adult patients. The application of new techniques in MRI makes it possible to obtain MRI images that are richer in information and to evaluate the activity of IBD more objectively and quantitatively. This improvement is of great significance for clinical decision-making and evaluation of drug efficacy in IBD patients.
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Herrmann KA, Paspulati RM, Lauenstein T, Reiser MF. Benefits and challenges in bowel MR imaging at 3.0 T. Top Magn Reson Imaging 2010; 21:165-175. [PMID: 21847036 DOI: 10.1097/rmr.0b013e31822a3294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Abdominal imaging at 3.0 T has shown to be challenging because of a number of artifacts and effects related to the physics at higher field strength. For bowel imaging at 3.0 T, artifacts due to magnetic field inhomogeneities, standing waves, increased susceptibility, and greater chemical shift effects are of particular concern because they are likely to affect the assessment of relevant structures and counterbalance the benefits of higher signal-to-noise ratio. Regarding small- and large-bowel magnetic resonance imaging, the benefits of higher field strengths translate mainly in better contrast-to-noise ratio of contrast-enhanced T1-weighted gradient echo and T2-weighted imaging, whereas steady-state free precession sequences seem to suffer from serious degradation of image quality. The present article summarizes the technical challenges in bowel imaging at 3.0 T, provides an overview of performance compared with 1.5 T in small- and large-bowel diseases including the rectum, and revises the current literature.
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Affiliation(s)
- Karin A Herrmann
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, University Hospitals Munich, Munich, Germany.
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