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Chen Q, Fang S, Yuchen Y, Li R, Deng R, Chen Y, Ma D, Lin H, Yan F. Clinical feasibility of deep learning reconstruction in liver diffusion-weighted imaging: Improvement of image quality and impact on apparent diffusion coefficient value. Eur J Radiol 2023; 168:111149. [PMID: 37862927 DOI: 10.1016/j.ejrad.2023.111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Diffusion-weighted imaging (DWI) of the liver suffers from low resolution, noise, and artifacts. This study aimed to investigate the effect of deep learning reconstruction (DLR) on image quality and apparent diffusion coefficient (ADC) quantification of liver DWI at 3 Tesla. METHOD In this prospective study, images of the liver obtained at DWI with b-values of 0 (DWI0), 50 (DWI50) and 800 s/mm2 (DWI800) from consecutive patients with liver lesions from February 2022 to February 2023 were reconstructed with and without DLR (non-DLR). Image quality was assessed qualitatively using Likert scoring system and quantitatively using signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and liver/parenchyma boundary sharpness from region-of-interest (ROI) analysis. ADC value of lesion were measured. Phantom experiment was also performed to investigate the factors that determine the effect of DLR on ADC value. Qualitative score, SNR, CNR, boundary sharpness, and apparent diffusion coefficients (ADCs) for DWI were compared using paired t-test and Wilcoxon signed rank test. P < 0.05 was considered statistically significant. RESULTS A total of 85 patients with 170 lesions were included. DLR group showed a higher qualitative score than the non-DLR group. for example, with DWI800 the score was 4.77 ± 0.52 versus 4.30 ± 0.63 (P < 0.001). DLR group also showed higher SNRs, CNRs and boundary sharpness than the non-DLR group. DLR reduced the ADC of malignant tumors (1.105[0.904, 1.340] versus 1.114[0.904, 1.320]) (P < 0.001), but there was no significant difference in the diagnostic value of malignancy for DLR and non-DLR groups (P = 57.3). The phantom study confirmed a reduction of ADC in images with low resolution, and a stronger reduction of ADC in heterogeneous structures than in homogeneous ones (P < 0.001). CONCLUSIONS DLR improved image quality of liver DWI. DLR reduced the ADC value of lesions, but did not affect the diagnostic performance of ADC in distinguishing malignant tumors on a 3.0-T MRI system.
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Affiliation(s)
- Qian Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China; Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, China
| | - Shu Fang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China
| | - Yang Yuchen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School Of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China
| | - Ruokun Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China
| | - Rong Deng
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China
| | - Yongjun Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School Of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China
| | - Di Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School Of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China
| | - Huimin Lin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, NO. 197 Ruijin Er Road, Shanghai 200025, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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2
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Pan T, Zhang D, Wu X, Li Z, Zeng H, Xu X, Zhang C, He Y, Gong Y, Wang P, Mao Q, Yao J, Lin J, Wu A, Shao G. Gold nanorods with iron oxide dual-modal bioprobes in SERS-MRI enable accurate programmed cell death ligand-1 expression detection in triple-negative breast cancer. APL Bioeng 2023; 7:026106. [PMID: 37274628 PMCID: PMC10234675 DOI: 10.1063/5.0152846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023] Open
Abstract
The efficiency of immunotherapy for triple-negative breast cancer (TNBC) is relatively low due to the difficulty in accurately detecting immune checkpoints. The detection of TNBC-related programmed cell death ligand-1 (PD-L1) expression is important to guide immunotherapy and improve treatment efficiency. Surface-enhanced Raman spectroscopy (SERS) and magnetic resonance (MR) imaging exhibit great potential for early TNBC diagnosis. SERS, an optical imaging mode, has the advantages of high detection sensitivity, good spatial resolution, and "fingerprint" spectral characteristics; however, the shallow detection penetration of SERS bioprobes limits its application in vivo. MR has the advantages of allowing deep penetration with no radiation; however, its spatial resolution needs to be improved. SERS and MR have complementary imaging features for tumor marker detection. In this study, gold nanorod and ultrasmall iron oxide nanoparticle composites were developed as dual-modal bioprobes for SERS-MRI to detect PD-L1 expression. Anti-PD-L1 (aPD-L1) was utilized to improve the targeting ability and specificity of PD-L1 expression detection. TNBC cells expressing PD-L1 were accurately detected via the SERS imaging mode in vitro, which can image at the single-cell level. In addition, bioprobe accumulation in PD-L1 expression-related tumor-bearing mice was simply and dynamically monitored and analyzed in vivo using MR and SERS. To the best of our knowledge, this is the first time a SERS-MRI dual-modal bioprobe combined with a PD-L1 antibody has been successfully used to detect PD-L1 expression in TNBC. This work paves the way for the design of high-performance bioprobe-based contrast agents for the clinical immunotherapy of TNBC.
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Affiliation(s)
| | - Dinghu Zhang
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Xiaoxia Wu
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Zihou Li
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Science (CAS) Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, CAS, Ningbo 315201, People's Republic of China
| | - Hui Zeng
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| | | | | | - Yiwei He
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Yuanchuan Gong
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| | | | - Quanliang Mao
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Science (CAS) Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, CAS, Ningbo 315201, People's Republic of China
| | | | - Jie Lin
- Authors to whom correspondence should be addressed:; ; ; and
| | - Aiguo Wu
- Authors to whom correspondence should be addressed:; ; ; and
| | - Guoliang Shao
- Authors to whom correspondence should be addressed:; ; ; and
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3
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Obara M, Kwon J, Yoneyama M, Ueda Y, Cauteren MV. Technical Advancements in Abdominal Diffusion-weighted Imaging. Magn Reson Med Sci 2023; 22:191-208. [PMID: 36928124 PMCID: PMC10086402 DOI: 10.2463/mrms.rev.2022-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Since its first observation in the 18th century, the diffusion phenomenon has been actively studied by many researchers. Diffusion-weighted imaging (DWI) is a technique to probe the diffusion of water molecules and create a MR image with contrast based on the local diffusion properties. The DWI pixel intensity is modulated by the hindrance the diffusing water molecules experience. This hindrance is caused by structures in the tissue and reflects the state of the tissue. This characteristic makes DWI a unique and effective tool to gain more insight into the tissue's pathophysiological condition. In the past decades, DWI has made dramatic technical progress, leading to greater acceptance in clinical practice. In the abdominal region, however, acquiring DWI with good quality is challenging because of several reasons, such as large imaging volume, respiratory and other types of motion, and difficulty in achieving homogeneous fat suppression. In this review, we discuss technical advancements from the past decades that help mitigate these problems common in abdominal imaging. We describe the use of scan acceleration techniques such as parallel imaging and compressed sensing to reduce image distortion in echo planar imaging. Then we compare techniques developed to mitigate issues due to respiratory motion, such as free-breathing, respiratory-triggering, and navigator-based approaches. Commonly used fat suppression techniques are also introduced, and their effectiveness is discussed. Additionally, the influence of the abovementioned techniques on image quality is demonstrated. Finally, we discuss the current and future clinical applications of abdominal DWI, such as whole-body DWI, simultaneous multiple-slice excitation, intravoxel incoherent motion, and the use of artificial intelligence. Abdominal DWI has the potential to develop further in the future, thanks to scan acceleration and image quality improvement driven by technological advancements. The accumulation of clinical proof will further drive clinical acceptance.
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Affiliation(s)
| | | | | | - Yu Ueda
- MR Clinical Science, Philips Japan Ltd
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4
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Półtorak-Szymczak G, Budlewski T, Furmanek MI, Wierzba W, Sklinda K, Walecki J, Mruk B. Radiological Imaging of Gastro-Entero-Pancreatic Neuroendocrine Tumors. The Review of Current Literature Emphasizing the Diagnostic Value of Chosen Imaging Methods. Front Oncol 2021; 11:670233. [PMID: 34211845 PMCID: PMC8239281 DOI: 10.3389/fonc.2021.670233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
Despite development of radiologic imaging, detection and follow-up of neuroendocrine neoplasms (NENs) still pose a diagnostic challenge, due to the heterogeneity of NEN, their relatively long-term growth, and small size of primary tumor. A set of information obtained by using different radiological imaging tools simplifies a choice of the most appropriate treatment method. Moreover, radiological imaging plays an important role in the assessment of metastatic lesions, especially in the liver, as well as, tumor response to treatment. This article reviews the current, broadly in use imaging modalities which are applied to the diagnosis of GEP-NETs, (the most common type of NENs) and put emphasis on the strengths and limitations of each modality.
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Affiliation(s)
- Gabriela Półtorak-Szymczak
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Tadeusz Budlewski
- Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland.,Department of Nuclear Medicine, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Mariusz Ireneusz Furmanek
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Waldemar Wierzba
- Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland.,University of Humanities and Economics, Lodz, Poland
| | - Katarzyna Sklinda
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Jerzy Walecki
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Bartosz Mruk
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
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Adams LC, Bressem KK, Brangsch J, Reimann C, Nowak K, Brenner W, Makowski MR. Quantitative 3D Assessment of 68Ga-DOTATOC PET/MRI with Diffusion-Weighted Imaging to Assess Imaging Markers for Gastroenteropancreatic Neuroendocrine Tumors: Preliminary Results. J Nucl Med 2019; 61:1021-1027. [PMID: 31862798 DOI: 10.2967/jnumed.119.234062] [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: 07/21/2019] [Accepted: 11/13/2019] [Indexed: 01/09/2023] Open
Abstract
68Ga-DOTATOC PET/MRI combines the advantages of PET in the acquisition of metabolic-functional information with the high soft-tissue contrast of MRI. SUVs in tumors have been suggested to be a measure of somatostatin receptor expression. A challenge with receptor ligands is that the distribution volume is confined to tissues with tracer uptake, potentially limiting SUV quantification. In this study, various functional 3-dimensional SUV apparent diffusion coefficient (ADC) parameters and arterial tumor enhancement were tested for ability to characterize gastroenteropancreatic (GEP) neuroendocrine tumors (NETs). Methods: For this single-center, cross-sectional study, 22 patients with 24 histologically confirmed GEP NET lesions (15 men and 7 women; median age, 61 y; range, 43-81 y) who underwent hybrid 68Ga-DOTA PET/MRI at 3 T between January 2017 and July 2019 met the eligibility criteria. SUV, tumor-to-background ratio, total functional tumor volume, and mean and minimum ADC were measured on the basis of volumes of interest and examined with receiver-operating-characteristic analysis to determine cutoffs for differentiation between low- and intermediate-grade GEP NETs. The Spearman rank correlation coefficient was used to assess correlations between functional imaging parameters. Results: The ratio of PET-derived SUVmean and diffusion-weighted imaging-derived minimum ADC was introduced as a combined variable to predict tumor grade, outperforming single predictors. On the basis of a threshold ratio of 0.03, tumors could be classified as grade 2 with a sensitivity of 86% and a specificity of 100%. SUV and functional ADCs, as well as arterial contrast enhancement parameters, showed nonsignificant and mostly negligible correlations. Conclusion: Because receptor density and tumor cellularity appear to be independent, potentially complementary phenomena, the combined ratio of PET/MRI and SUVmean/ADCmin may be used as a novel biomarker allowing differentiation between grade 1 and grade 2 GEP NETs.
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Affiliation(s)
- Lisa C Adams
- Department of Radiology Charité, Berlin, Germany; and
| | | | | | | | - Kristin Nowak
- Department of Radiology Charité, Berlin, Germany; and
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6
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Low b-value (50-100) diffusion-weighted images detect significantly more hyperintense liver lesions in children than T2-weighted images. Pediatr Radiol 2019; 49:1299-1305. [PMID: 31292681 DOI: 10.1007/s00247-019-04455-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/16/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Low b-value (50-100 s/mm2) diffusion-weighted images (low b-value DWI) have been shown to be superior to T2-weighted fast spin echo sequence (T2-W) in detecting liver lesions in adults. There are no such studies assessing this difference in children. OBJECTIVE The purpose of the study was to compare the sensitivity of low b-value DWI images and T2-W images in detecting focal liver lesions in children. MATERIALS AND METHODS A retrospective review of liver magnetic resonance imaging (MRI) to assess focal liver lesions in 50 children (22 males, 28 females; age: 2 months to 17 years [mean: 10.9 years]) was performed. Two radiologists reviewed both low b-value DWI and T2-W sequences independently on different occasions to note lesions, the smallest lesion size and the location. A consensus reading of the entire MRI examination and a correlation with follow-up, other imaging modalities and pathology in available cases were used to determine the final number of lesions as a reference standard. The average number of lesions per patient detected by both readers on each sequence was compared with each other and with the reference standard using the signed-rank test. The smallest lesions detected by each sequence were compared using the paired t-test. RESULTS One hundred seventy hyperintense lesions were identified on consensus review to serve as the reference standard. The average number of lesions identified by both readers on low b-value DWI was 134 (79%) and on T2-W was 95 (56%). There was excellent interobserver agreement for detection of lesions on low b-value DWI (intraclass correlation coefficient [ICC]=0.96 [0.93-0.98]) and T2-W (ICC=0.85 [0.75-0.91]), with slightly better agreement on low b-value DWI. Both readers identified significantly more number of lesions on low b-value DWI compared to T2-W (Reader 1: P=0.0036, Reader 2: P=0.0001). Compared to the reference standard (mean number of lesions: 3.45), T2-W detected significantly fewer lesions (mean number of lesions: 1.91; P=0.0001) while there was no significant difference in lesion detection on low b-value DWI (mean number of lesions: 2.68; P=0.1527). Low b-value DWI and T2-W were not significantly different in identifying the smallest lesion size (Reader 1: P=0.19, Reader 2: P=0.47). CONCLUSION Low b-value DWI images are more sensitive than T2-W sequences in detecting hyperintense focal liver lesions in children.
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7
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Marion-Audibert AM, Vullierme MP, Ronot M, Mabrut JY, Sauvanet A, Zins M, Cuilleron M, Sa-Cunha A, Lévy P, Rode A. Routine MRI With DWI Sequences to Detect Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Carcinoma and Normal Liver CT: A Prospective Multicenter Study. AJR Am J Roentgenol 2018; 211:W217-W225. [PMID: 30240298 DOI: 10.2214/ajr.18.19640] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of systematic MRI with DWI for the detection of liver metastases (LM) in patients with potentially resectable pancreatic ductal carcinoma and normal liver findings at CT. SUBJECTS AND METHODS Patients with potentially resectable pancreatic ductal carcinoma and a normal liver at CT were enrolled in a prospective multicenter study between March 2011 and July 2013 and underwent preoperative MRI. The reference standard was pathologic analysis of detected hepatic lesions. RESULTS A total of 118 patients were enrolled. MRI depicted liver lesions that were not visible at CT in 16 patients. All lesions were visualized both with and without DWI. Lesions were LM in 12 (10.2%) patients and were confirmed in seven patients by preoperative biopsy, four by intraoperative frozen section, and one at 6-month follow-up evaluation after pancreatic resection. All but one liver metastatic lesion diagnosed with MRI were smaller than 10 mm. Four of 118 (3.4%) patients had a false-positive diagnosis of LM at MRI and remained LM free after a follow-up period of 24 months or longer. Three of 102 (2.9%) patients with normal MRI findings had subcapsular LM that were diagnosed intraoperatively. At follow-up, 99 of 118 (83.9%) patients were LM free after a mean of 24 months. The patient-based sensitivity of MRI for the detection of LM was 80.0% (95% CI, 51.9-95.7%); specificity, 96.1% (95% CI, 90.4-98.9%); positive predictive value, 75.0% (95% CI, 47.6-92.7%); and negative predictive value, 97.1% (95% CI, 91.6-99.4%). CONCLUSION Compared with CT, preoperative MRI improves the detection of LM in patients with potentially resectable pancreatic ductal carcinoma and may change management and the rate of unnecessary laparotomy and pancreatectomy for 10% of patients.
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Affiliation(s)
| | - Marie-Pierre Vullierme
- 2 Department of Medical Imaging, Beaujon University Hospital, 100 Blvd Leclerc, Clichy-la-Garenne, 92110, France
| | - Maxime Ronot
- 2 Department of Medical Imaging, Beaujon University Hospital, 100 Blvd Leclerc, Clichy-la-Garenne, 92110, France
| | - Jean-Yves Mabrut
- 3 Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France
| | - Alain Sauvanet
- 4 Department of Digestive Surgery and Liver Transplantation, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Marc Zins
- 5 Department of Medical Imaging, Saint-Joseph Hospital, Paris, France
| | - Muriel Cuilleron
- 6 Department of Medical Imaging, Nord University Hospital, Saint-Etienne, France
| | - Antonio Sa-Cunha
- 7 Department of Digestive Surgery and Liver Transplantation, University Hospital of Bordeaux, France
- 8 Present address: Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Philippe Lévy
- 9 Department of Pancreatology, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Agnès Rode
- 10 Department of Medical Imaging, Croix-Rousse University Hospital, Lyon, France
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8
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Abstract
CLINICAL/METHODICAL ISSUE Detection and characterization of focal liver lesions. STANDARD RADIOLOGICAL METHODS Due to its excellent soft tissue contrast, the availability of liver-specific contrast agents and the possibility of functional imaging, magnetic resonance imaging (MRI) is the method of choice for the evaluation of focal liver lesions. METHODICAL INNOVATIONS Diffusion-weighted imaging (DWI) enables generation of functional information about the microstructure of a tissue besides morphological information. PERFORMANCE In the detection of focal liver lesions DWI shows a better detection rate compared to T2w sequences and a slightly poorer detection rate compared to dynamic T1w sequences. In principle, using DWI it is possible to distinguish malignant from benign liver lesions and also to detect a therapy response at an early stage. ACHIEVEMENTS For both detection and characterization of focal liver lesions, DWI represents a promising alternative to the morphological sequences; however, a more detailed characterization with the use of further sequences should be carried out particularly for the characterization of solid benign lesions. For the assessment and prognosis of therapy response, DWI offers advantages compared to morphological sequences. PRACTICAL RECOMMENDATIONS For the detection of focal liver lesions DWI is in principle sufficient. After visual detection of a solid liver lesion a more detailed characterization should be carried out using further sequences (in particular dynamic T1w sequences). The DWI procedure should be used for the assessment and prognosis of a therapy response.
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Affiliation(s)
- P Riffel
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - S O Schoenberg
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - J Krammer
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Shenoy-Bhangle A, Baliyan V, Kordbacheh H, Guimaraes AR, Kambadakone A. Diffusion weighted magnetic resonance imaging of liver: Principles, clinical applications and recent updates. World J Hepatol 2017; 9:1081-1091. [PMID: 28989564 PMCID: PMC5612839 DOI: 10.4254/wjh.v9.i26.1081] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/06/2017] [Accepted: 06/07/2017] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors such as the ease of acquisition and ability to obtain functional information in the absence of intravenous contrast, especially in patients with abnormal renal function, have contributed to the growing interest in exploring clinical applications of DWI. In the liver, DWI demonstrates a gamut of clinical applications ranging from detecting focal liver lesions to monitoring response in patients undergoing serial follow-up after loco-regional and systemic therapies. DWI is also being applied in the evaluation of diffuse liver diseases such as non-alcoholic fatty liver disease, hepatic fibrosis and cirrhosis. In this review, we intend to review the basic principles, technique, current clinical applications and future trends of DW-MRI in the liver.
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Affiliation(s)
| | - Vinit Baliyan
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Hamed Kordbacheh
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | | | - Avinash Kambadakone
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
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10
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Gordic S, Thung SN, Roayaie S, Wagner M, Taouli B. Hepatic adenomatosis in liver cirrhosis. Eur J Radiol Open 2017; 4:115-117. [PMID: 28932768 PMCID: PMC5597816 DOI: 10.1016/j.ejro.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/15/2017] [Accepted: 08/29/2017] [Indexed: 01/14/2023] Open
Abstract
Hepatocellular adenoma (HCA) is a benign liver tumor most frequently occurring in women using oral contraception. HCA develops in normal or nearly normal livers and is extremely rare in cirrhosis. The authors present magnetic resonance imaging and histopathologic findings in a 57-year-old man with liver cirrhosis and hepatic adenomatosis. As the differentiation between HCA and hepatocellular carcinoma (HCC) can be difficult with imaging, we would like to highlight the importance of ancillary findings such as the presence of iron on MRI, which can be observed in HCA.
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Affiliation(s)
- Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Swan N Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sasan Roayaie
- Liver Cancer Program, Hofstra-North Shore Long Island Jewish School of Medicine, Lenox Hill Hospital, New York, NY, USA
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sorbonne Universités, UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
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11
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Taouli B, Beer AJ, Chenevert T, Collins D, Lehman C, Matos C, Padhani AR, Rosenkrantz AB, Shukla-Dave A, Sigmund E, Tanenbaum L, Thoeny H, Thomassin-Naggara I, Barbieri S, Corcuera-Solano I, Orton M, Partridge SC, Koh DM. Diffusion-weighted imaging outside the brain: Consensus statement from an ISMRM-sponsored workshop. J Magn Reson Imaging 2016; 44:521-40. [PMID: 26892827 PMCID: PMC4983499 DOI: 10.1002/jmri.25196] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/28/2016] [Accepted: 01/30/2016] [Indexed: 12/11/2022] Open
Abstract
The significant advances in magnetic resonance imaging (MRI) hardware and software, sequence design, and postprocessing methods have made diffusion-weighted imaging (DWI) an important part of body MRI protocols and have fueled extensive research on quantitative diffusion outside the brain, particularly in the oncologic setting. In this review, we summarize the most up-to-date information on DWI acquisition and clinical applications outside the brain, as discussed in an ISMRM-sponsored symposium held in April 2015. We first introduce recent advances in acquisition, processing, and quality control; then review scientific evidence in major organ systems; and finally describe future directions. J. Magn. Reson. Imaging 2016;44:521-540.
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Affiliation(s)
- Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ambros J. Beer
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Thomas Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David Collins
- CR UK Cancer Imaging Centre, Institute of Cancer Research and Department of Radiology, Royal Marsden Hospital, London, UK
| | - Constance Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Celso Matos
- Department of Radiology, Champalimaud Clinical Centre, Lisbon, Portugal
| | | | | | - Amita Shukla-Dave
- Departments of Medical Physics and Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Eric Sigmund
- Irene and Bernard Schwartz Center for Biomedical Imaging (CBI) and Center for Advanced Imaging and Innovation (CAIR), Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Lawrence Tanenbaum
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Harriet Thoeny
- Department of Diagnostic Radiology, Inselspital Bern, Bern, Switzerland
| | | | | | - Idoia Corcuera-Solano
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew Orton
- CR UK Cancer Imaging Centre, Institute of Cancer Research and Department of Radiology, Royal Marsden Hospital, London, UK
| | | | - Dow-Mu Koh
- Institute of Cancer Research and Department of Radiology, Royal Marsden Hospital, London, UK
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Hicks RM, Yee J, Ohliger MA, Weinstein S, Kao J, Ikram NS, Hope TA. Comparison of diffusion-weighted imaging and T2-weighted single shot fast spin-echo: Implications for LI-RADS characterization of hepatocellular carcinoma. Magn Reson Imaging 2016; 34:915-21. [PMID: 27108359 DOI: 10.1016/j.mri.2016.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/17/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the performance of diffusion-weighted imaging (DWI) and T2-weighted single shot fast spin-echo (SSFSE) imaging of the liver in the detection of hepatocellular carcinoma (HCC) in reference to the LI-RADS classification system. METHODS MR images of 40 patients with 68 LI-RADS grade 3-5 lesions were analyzed. Two readers independently reviewed sequences and characterized lesion signal intensity, followed by consensus evaluation. CE-MRI served as reference standard. Sensitivities were compared across sequences. Lesion-to-liver contrast-to-noise ratios (CNRs) and apparent diffusion coefficients (ADCs) were measured and compared using the Wilcoxon signed-rank test across sequences and the Mann-Whitney U or Kruskal-Wallis test between LI-RADS categories. Inter-reader variability was assessed using Cohen's kappa statistic. RESULTS Consensus sensitivities of LI-RADS 3-5 lesions using SSFSE images versus DWI were similar (0.53-0.63, p=0.089), however, the sensitivity with DWI b=700 was higher (0.63) than DWI b=0 (0.53, p=0.039). Lesion-to-liver CNRs were larger for all DWI sequences compared to SSFSE images (p<0.001 for all). ADCs of large (>2cm) LIRADS 3-5 lesions were lower than those of small lesions (1.09±0.33 vs. 1.31±0.26, p=0.02), however lesion ADCs were not different from those of adjacent hepatic parenchyma for any LI-RADS lesion. CONCLUSIONS DWI has a similar sensitivity compared to SSFSE, but intensity on DWI likely represents intrinsic T2 signal hyper-intensity rather than restricted diffusion as the ADC values were not lower than adjacent parenchyma. Therefore it may not be appropriate to consider hyper-intensity on high b-value as a separate ancillary criteria to T2 hyper-intensity in LI-RADS.
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Affiliation(s)
- Robert M Hicks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Judy Yee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Stefanie Weinstein
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey Kao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Nabia S Ikram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA.
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Diffusion-Weighted Imaging with Two Different b-Values in Detection of Solid Focal Liver Lesions. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8128207. [PMID: 27019851 PMCID: PMC4785245 DOI: 10.1155/2016/8128207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 01/14/2023]
Abstract
One hundred and eighty-two consecutive patients with suspected liver disease were recruited to receive diffusion-weighted imaging (DWI) with two different b-values, in comparison with T2-weighted imaging (T2WI). The detection rate of three MR sequences in solid focal liver lesions (FLLs) and subgroup analyses were performed. Our prospective study found that DWI600 was equivalent to DWI100 and T2WI for the detection of solid FLLs overall but was significantly more accurate in the detection of malignant solid FLLs and lesions larger than 10 mm.
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Hedderich DM, Weiss K, Maintz D, Persigehl T. [Modern magnetic resonance imaging of the liver]. Radiologe 2015; 55:1045-56. [PMID: 26628259 DOI: 10.1007/s00117-015-0031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Magnetic resonance imaging (MRI) of the liver has become an essential tool in the radiological diagnostics of both focal and diffuse diseases of the liver and is subject to constant change due to technological progress. Recently, important improvements could be achieved by innovations regarding MR hardware, sequences and postprocessing methods. The diagnostic spectrum of MRI could be broadened particularly due to new examination sequences, while at the same time scanning time could be shortened and image quality has been improved. The aim of this article is to explain both the technological background and the clinical application of recent MR sequence developments and to present the scope of a modern MRI protocol for the liver.
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Affiliation(s)
- D M Hedderich
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - K Weiss
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Philips Healthcare Deutschland, Hamburg, Deutschland
| | - D Maintz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - T Persigehl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Bouchaibi SE, Coenegrachts K, Bali MA, Absil J, Metens T, Matos C. Focal liver lesions detection: Comparison of respiratory-triggering, triggering and tracking navigator and tracking-only navigator in diffusion-weighted imaging. Eur J Radiol 2015; 84:1857-65. [PMID: 26119802 DOI: 10.1016/j.ejrad.2015.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/14/2015] [Accepted: 06/16/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare low b value (10s/mm(2)) spin-echo echo-planar (SE-EP) diffusion-weighted imaging (DWI) acquired with respiratory-triggering (RT), triggering and tracking navigator (TT), tracking only navigator (TRON) techniques for image quality and focal liver lesions (FLL) detection in non-cirrhotic patients. MATERIAL AND METHODS This bi-centric study was approved by the institutional review boards; informed consent was obtained. Eighty-three patients were prospectively included and SE-EP-DWI with RT, TT and TRON techniques were performed. DWI sequences were randomized and independently analyzed by two readers. The qualitative evaluation was based on a 3-point score for axial artifacts (motion, ghost, susceptibility artifacts and distortion) and stair-step artifacts. Sensitivity of FLL detection was calculated for all lesions together and after lesion size stratification (≤ 10 mm, >10-20mm and >20mm). The standard of reference consisted of a retrospective reading of the conventional MRI, the three DWI sequences and by follow-up (12 months): a total of 409 FLL were detected. Data between sequences was compared with non-parametric tests. Cohen's kappa coefficient was used for inter-observer agreement. RESULTS Image quality was comparable for RT and TT. TRON showed statistically significantly more axial artifacts for the two readers (p<0.05). Stair-step artifacts were not statistically significantly different between DWI sequences. Overall sensitivities for RT, TT, TRON were 85%, 86%, 82% and 86%, 89% 83%, respectively, for readers 1 and 2. The inter-observer agreement was very good. CONCLUSION Image quality was better for RT and TT compared to TRON. Overall sensitivities for FLL detection were comparable between techniques and readers.
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Affiliation(s)
- Said El Bouchaibi
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium
| | - Kenneth Coenegrachts
- Department of Radiology AZ Sint-Jan Brugge - Oostende AV, Campus Brugge, Ruddershove 10, B-8000 Brugge, Belgium
| | - Maria Antonietta Bali
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium
| | - Julie Absil
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium
| | - Thierry Metens
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium.
| | - Celso Matos
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium
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Elbarbary AA, Saleh Elahwal HM, Elashwah ME. Role of Diffusion Weighted Magnetic Resonance Imaging in evaluation of hepatic focal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Wagner M, Ronot M, Doblas S, Giraudeau C, Van Beers B, Belghiti J, Paradis V, Vilgrain V. Assessment of the residual tumour of colorectal liver metastases after chemotherapy: diffusion-weighted MR magnetic resonance imaging in the peripheral and entire tumour. Eur Radiol 2015; 26:206-15. [DOI: 10.1007/s00330-015-3800-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 04/07/2015] [Accepted: 04/13/2015] [Indexed: 12/13/2022]
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Kircher A, Bongartz G, Merkle EM, Zech CJ. [Rational imaging of hepatocellular carcinoma. The challenge of multimodal diagnostic criteria]. Radiologe 2015; 54:664-72. [PMID: 25047522 DOI: 10.1007/s00117-014-2652-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CLINICAL/METHODICAL ISSUE Both computed tomography (CT) and magnetic resonance imaging (MRI) constitute the gold standard in radiological imaging of hepatocellular carcinoma (HCC). In cases of typical contrast behavior each modality as a single dynamic technique allows the diagnosis of HCC. There is still a challenge in detection of small HCCs < 2 cm, in differentiating HCC and high-grade dysplasia from other benign liver lesions as well as the evaluation of hypovascular liver lesions in the cirrhotic liver. PERFORMANCE Nowadays, both modalities achieve high detection rates of 90-100 % for lesions > 2 cm. Regarding lesions between 1 and 2 cm there is a higher sensitivity for MRI ranging between 80 and 90 % compared to 60-75 % with CT. Besides the multimodal diagnostic criteria, MRI provides significant benefits with the use of hepatobiliary contrast. Especially in combination with diffusion- weighted imaging (DWI) increased sensitivity and diagnostic accuracy compared to CT has been described for lesions sized < 2 cm. Regarding the differentiation from other hepatic nodules in the cirrhotic liver there is strong evidence that the coexistence of arterial enhancement and hypointensity on hepatobiliary imaging is specific for HCC. Moreover, hypointensity on hepatobiliary imaging is associated with a high positive predictive value (PPV) of up to 100 % for the presence of high-grade dysplasia and HCC. ACHIEVEMENTS The use of MRI including hepatobiliary imaging and DWI has to be regarded as the best non-invasive imaging modality for the detection of HCC and for the characterization of nodules in patients with liver cirrhosis. In comparison to CT there are benefits regarding detection of small lesions < 2 cm and evaluation of hypovascular liver lesions in the context of the hepatocarcinogenesis including prognostic values of premalignant lesions. PRACTICAL RECOMMENDATIONS Both MRI and CT provide a high diagnostic performance in evaluation of HCC in liver cirrhosis. With MRI there are considerable advantages regarding the detection rate and specificity. For daily clinical routine, CT offers a fast, reliable and easy available modality with benefits for patients in reduced general state of health and restricted compliance.
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Affiliation(s)
- A Kircher
- Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
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Diffusion-weighted MRI for uveal melanoma liver metastasis detection. Eur Radiol 2015; 25:2263-73. [DOI: 10.1007/s00330-015-3662-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/11/2014] [Accepted: 02/11/2015] [Indexed: 01/16/2023]
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Barral M, Taouli B, Guiu B, Koh DM, Luciani A, Manfredi R, Vilgrain V, Hoeffel C, Kanematsu M, Soyer P. Diffusion-weighted MR Imaging of the Pancreas: Current Status and Recommendations. Radiology 2015; 274:45-63. [DOI: 10.1148/radiol.14130778] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Low b-value (black blood) respiratory-triggered fat-suppressed single-shot spin-echo echo-planar imaging (EPI) of the liver: Comparison of image quality at 1.5 and 3 T. Clin Radiol 2014; 69:1136-41. [DOI: 10.1016/j.crad.2014.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/17/2014] [Accepted: 06/21/2014] [Indexed: 01/27/2023]
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Lewis S, Dyvorne H, Cui Y, Taouli B. Diffusion-weighted imaging of the liver: techniques and applications. Magn Reson Imaging Clin N Am 2014; 22:373-95. [PMID: 25086935 PMCID: PMC4121599 DOI: 10.1016/j.mric.2014.04.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diffusion-weighted imaging (DWI) is a technique that assesses the cellularity, tortuosity of the extracellular/extravascular space, and cell membrane density based on differences in water proton mobility in tissues. The strength of the diffusion weighting is reflected by the b value. DWI using several b values enables the quantification of the apparent diffusion coefficient. DWI is increasingly used in liver imaging for multiple reasons: it can add useful qualitative and quantitative information to conventional imaging sequences; it is acquired relatively quickly; it is easily incorporated into existing clinical protocols; and it is a noncontrast technique.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Hadrien Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Yong Cui
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA.
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Yuan Z, Li WT, Ye XD, Peng WJ, Xiao XS. Utility of diffusion-weighted imaging to assess hepatocellular carcinoma viability following transarterial chemoembolization. Oncol Lett 2014; 8:831-836. [PMID: 25013505 PMCID: PMC4081130 DOI: 10.3892/ol.2014.2228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/07/2014] [Indexed: 12/23/2022] Open
Abstract
The purpose of the present study was to evaluate whether diffusion-weighted imaging (DWI) can be used to assess hepatocellular carcinoma (HCC) viability following transarterial chemoembolization (TACE). A total of 41 consecutive patients were treated according to chemoembolization protocols. The follow-up was performed between six and eight weeks post-chemoembolization by multidetector computed tomography [or enhanced magnetic resonance imaging (MRI)] and DW-MRI on the same day. The presence of any residual tumor and the extent of tumor necrosis were evaluated according to the European Association for the Study of the Liver. The apparent diffusion coefficient (ADC) values of the entire area of the treated mass and the vital and necrotic tumor tissues were recorded. Correlation coefficients were also calculated to compare the percentage of necrosis with ADC values. The mean ADC values of the necrotic and vital tumor tissues were 2.22±0.31×10-3 mm2/sec and 1.42±0.25×10-3 mm2/sec, respectively (Mann-Whitney U test, P<0.001). The results from the receiver operating characteristic analysis showed that the threshold ADC value was 1.84×10-3 mm2/sec with 92.3% sensitivity and 100% specificity for identifying the necrotic tumor tissues. A significant linear regression correlation was identified between the ADC value of the entire area of the treated mass and the extent of tumor necrosis (r=0.58; P<0.001). In conclusion, DWI can be used to assess HCC viability following TACE.
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Affiliation(s)
- Zheng Yuan
- Department of Radiology, Shanghai People's Liberation Army No. 85 Hospital, Shanghai 200052, P.R. China ; Department of Radiology, Fudan University, Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Wen-Tao Li
- Department of Radiology, Fudan University, Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Xiao-Dan Ye
- Department of Radiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, P.R. China
| | - Wei-Jun Peng
- Department of Radiology, Fudan University, Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Xiang-Sheng Xiao
- Department of Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, P.R. China
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Jhaveri K. Image quality versus outcomes. J Magn Reson Imaging 2014; 41:866-9. [PMID: 24677391 DOI: 10.1002/jmri.24622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/04/2014] [Indexed: 12/31/2022] Open
Affiliation(s)
- Kartik Jhaveri
- University Health Network, Mt. Sinai and Womens' College Hospital, Toronto, ON, Canada
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Galea N, Cantisani V, Taouli B. Liver lesion detection and characterization: role of diffusion-weighted imaging. J Magn Reson Imaging 2014; 37:1260-76. [PMID: 23712841 DOI: 10.1002/jmri.23947] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/11/2012] [Indexed: 12/11/2022] Open
Abstract
Diffusion-weighted imaging (DWI) plays an emerging role for the assessment of focal and diffuse liver diseases. This growing interest is due to that fact that DWI is a noncontrast technique with inherent high contrast resolution, with promising results for detection and characterization of focal liver lesions. Recent advances in diffusion image quality have also added interest to this technique in the abdomen. The purpose of this review is to describe the current clinical roles of DWI for the detection and characterization of focal liver lesions, and to review pitfalls, limitations, and future directions of DWI for assessment of focal liver disease.
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Affiliation(s)
- Nicola Galea
- Sapienza University of Rome, Department of Radiological Sciences, Rome, Italy
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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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Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is now widely used as a standard imaging sequence for evaluation of the liver. The technique is easy to implement across different MRI platforms, and results in enhanced disease detection and characterization. With careful implementation, the quantitative apparent diffusion coefficient derived shows good measurement reproducibility, which can be applied for tissue characterization, the assessment of tumour response and disease prognostication. There is now a body of evidence that highlights the relative strengths and limitations of the technique for the assessment of liver diseases. The potential for more sophisticated analysis of DW-MRI data is currently being widely investigated.
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Affiliation(s)
- N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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d'Assignies G, Fina P, Bruno O, Vullierme MP, Tubach F, Paradis V, Sauvanet A, Ruszniewski P, Vilgrain V. High sensitivity of diffusion-weighted MR imaging for the detection of liver metastases from neuroendocrine tumors: comparison with T2-weighted and dynamic gadolinium-enhanced MR imaging. Radiology 2013; 268:390-9. [PMID: 23533288 DOI: 10.1148/radiol.13121628] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the sensitivity and specificity of diffusion-weighted (DW) magnetic resonance (MR) imaging for identifying liver metastases from neuroendocrine tumor (NET) to those of T2-weighted fast spin-echo (FSE) and three-dimensional dynamic gadolinium-enhanced MR imaging, with surgical and histopathologic findings as the reference standard. MATERIALS AND METHODS This retrospective study was approved by institutional review board, and informed consent was waived. Fifty-nine patients with NETs (41 patients with 162 liver metastases, and 18 control subjects with no liver metastases) underwent MR imaging that included DW, T2-weighted FSE, and dynamic gadolinium-enhanced MR sequences. Images were retrospectively reviewed by two abdominal radiologists, independently, for the detection and characterization of liver metastases. MR findings were compared with histopathologic and intraoperative ultrasonography findings for metastasis on a lesion-by-lesion basis to determine the sensitivity of each MR sequence alone and combined. Specificity was calculated by using the control population. Interreader agreement for each MR sequence and McNemar test were also calculated. RESULTS There was excellent agreement between observers 1 and 2 for characterizing liver metastases at per-lesion analysis (κ coefficient: 0.86-1.00). DW MR was more sensitive (observer 1: sensitivity, 71.6% [116 of 162], 95% confidence interval [CI]: 64.2%, 78.0%; observer 2: sensitivity, 71.0% [115 of 162], 95% CI: 63.6%, 77.4%) than T2-weighted FSE (observer 1: sensitivity, 55.6% [90 of 162], 95% CI: 47.9%, 63.0%; observer 2: sensitivity, 55.6% [90 of 162], 95% CI: 47.9%, 63.0%) and dynamic gadolinium-enhanced MR (observer 1: sensitivity, 47.5% [77 of 162], 95% CI: 34.0%, 55.2%; observer 2: sensitivity, 48.1% [78 of 162], 95% CI: 40.6%, 55.8%) (P < .001 for both, McNemar test). The specificity of these sequences ranged from 88.9% to 100% (DW MR vs T2-weighted FSE MR: P > .99, DW MR vs dynamic gadolinium-enhanced MR: P = .61, and T2-weighted FSE MR vs dynamic gadolinium-enhanced MR: P = .61, McNemar test). CONCLUSION DW MR imaging was more sensitive for the detection and characterization of liver metastases from NETs than T2-weighted FSE and dynamic gadolinium-enhanced MR imaging and should be systematically performed.
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Affiliation(s)
- Gaspard d'Assignies
- Department of Radiology, Assistance-Publique Hôpitaux de Paris, Hôpital Beaujon, 100 bd du Général Leclerc, 92110 Clichy, France
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Mayerhoefer ME, Ba-Ssalamah A, Weber M, Mitterhauser M, Eidherr H, Wadsak W, Raderer M, Trattnig S, Herneth A, Karanikas G. Gadoxetate-enhanced versus diffusion-weighted MRI for fused Ga-68-DOTANOC PET/MRI in patients with neuroendocrine tumours of the upper abdomen. Eur Radiol 2013; 23:1978-85. [DOI: 10.1007/s00330-013-2785-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/24/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
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Wagner M, Maggiori L, Ronot M, Paradis V, Vilgrain V, Panis Y, Van Beers BE. Diffusion-weighted and T2-weighted MR imaging for colorectal liver metastases detection in a rat model at 7 T: a comparative study using histological examination as reference. Eur Radiol 2013; 23:2156-64. [DOI: 10.1007/s00330-013-2789-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/31/2012] [Accepted: 01/20/2013] [Indexed: 01/03/2023]
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de Souza DAT, Parente DB, de Araújo ALE, Mortelé KJ. Modern imaging evaluation of the liver: emerging MR imaging techniques and indications. Magn Reson Imaging Clin N Am 2013; 21:337-63. [PMID: 23642557 DOI: 10.1016/j.mric.2013.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Modern MR imaging evaluation of the liver allows for a comprehensive morphologic and functional assessment of the liver parenchyma, hepatic vessels, and biliary tree, thus aiding in the diagnosis of both focal and diffuse liver diseases.
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Henninger B, Petersen J, Jaschke W. [Radiological diagnosis of primary hepatic malignancy]. Wien Med Wochenschr 2013; 163:113-22. [PMID: 23392810 DOI: 10.1007/s10354-013-0179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 11/26/2022]
Abstract
Modern radiology offers countless opportunities both in the detection but also in the characterization of primary liver malignancies. Ultrasound remains usually the first exploratory overview study whereat using ultrasound contrast agent for a further characterization of liver lesions improves this technique considerably. Advanced cross-sectional imaging methods can, in most cases, already provide an exact diagnosis. Thus, the CT is already considered a standard technique for liver imaging and magnetic resonance imaging has gained in recent years due to liver-specific contrast agents and faster sequences a central role in liver imaging. The following article provides an overview of these various radiological procedures and describes the different primary liver malignancies and their imaging characteristics.
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Affiliation(s)
- Benjamin Henninger
- Department Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich.
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Wu LM, Xu JR, Lu Q, Hua J, Chen J, Hu J. A pooled analysis of diffusion-weighted imaging in the diagnosis of hepatocellular carcinoma in chronic liver diseases. J Gastroenterol Hepatol 2013. [PMID: 23190006 DOI: 10.1111/jgh.12054] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The purpose of this study was to perform a meta-analysis of all available studies of the diagnostic performance of diffusion-weighted imaging (DWI) in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease. METHODS Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis. RESULTS Across the nine studies (476 patients), DWI sensitivity was 81% (95%CI: 67%-90%), and specificity was 89% (95% CI: 76%-95%). Overall, positive likelihood ratio was 7.11 (95%CI: 3.50, 14.48), negative likelihood ratio was 0.21 (95%CI: 0.12-0.37), and the diagnostic odds ratio (DOR) was 33.48 (95%CI: 16.67-67.25). The area under the curve of the summary receiver operator characteristic (ROC) was 0.92 (95% CI:0.89-0.94). In studies in which both DWI and conventional contrast-enhanced magnetic resonance imaging (CE-MRI) were performed, the comparison of DWI performance with that of conventional CE-MRI suggested no major differences against these two methods (P > 0.05). DWI combined CE-MRI had higher pooled sensitivity than DWI alone (93% vs 73%) (P < 0.05). CONCLUSION DWI has good diagnostic performance in the detection of HCC in patients with chronic liver disease and equivalent to conventional CE-MRI. Combination of CE-MRI and DWI can improve the diagnostic accuracy of MRI. Further larger prospective studies are still needed to establish its value for detecting HCC in patients with chronic liver disease.
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Affiliation(s)
- Lian-Ming Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Vallejo Desviat P, Martínez De Vega V, Recio Rodríguez M, Jiménez De La Peña M, Carrascoso Arranz J. Difusión en resonancia magnética en el estudio de lesiones hepáticas. Cir Esp 2013; 91:9-16. [DOI: 10.1016/j.ciresp.2011.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 09/12/2011] [Accepted: 10/03/2011] [Indexed: 01/18/2023]
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Culverwell AD, Sheridan MB, Guthrie JA, Scarsbrook AF. Diffusion-weighted MRI of the liver-Interpretative pearls and pitfalls. Clin Radiol 2012; 68:406-14. [PMID: 22981728 DOI: 10.1016/j.crad.2012.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/23/2012] [Accepted: 08/03/2012] [Indexed: 12/11/2022]
Abstract
Diffusion-weighted magnetic resonance imaging (DW MRI) is an established technique in neuroradiology and more recently has emerged as a useful adjunct to various oncological applications of MRI. It has an expanding role in the evaluation of liver lesions, offers higher detection rates for small lesions, and can increase confidence in differentiating between benign and malignant lesions. Other applications include assessment of tumour response to therapy, differentiating tumour from bland thrombus, and assessment of liver fibrosis. DW sequences can be performed on most modern MRI machines with relative ease, in a short time period and without the need for contrast medium. DW MRI can be of value in the detection and characterization of hepatic lesions but there are pitfalls, which can potentially cause interpretative difficulty. This article will review the rationale for DW MRI in liver imaging, demonstrate the clinical utility of the technique in a spectrum of hepatic diseases, and illustrate key interpretative pearls and pitfalls.
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Affiliation(s)
- A D Culverwell
- Department of Clinical Radiology, St James's University Hospital, Beckett Street, Leeds, UK
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Park MS, Kim S, Patel J, Hajdu CH, Do RKG, Mannelli L, Babb JS, Taouli B. Hepatocellular carcinoma: detection with diffusion-weighted versus contrast-enhanced magnetic resonance imaging in pretransplant patients. Hepatology 2012; 56:140-8. [PMID: 22370974 DOI: 10.1002/hep.25681] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 02/16/2012] [Indexed: 12/13/2022]
Abstract
UNLABELLED This study evaluates the performance of diffusion-weighted magnetic resonance imaging (DWI) for the detection of hepatocellular carcinoma (HCC) in pre-liver transplantation patients, compared and combined with contrast-enhanced T1-weighted imaging (CET1WI), using liver explant as the standard of reference. We included 52 patients with cirrhosis (40 men, 12 women; mean age, 56 years) who underwent DWI and CET1WI within 90 days of liver transplantation. Magnetic resonance images were analyzed for HCC detection in three separate sessions by two independent observers: DWI images (DW-set), CET1WI (CE-set), and all images together (All-set). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), per-patient accuracy, and per-lesion PPV were calculated for each image set. A total of 72 HCCs were present in 33 patients at explant (mean size, 1.5 cm [range, 0.3-6.2 cm]). Per-patient sensitivity and NPV of CE-set were significantly higher than those of DW-set when using pooled data between observers (P = 0.02 and 0.03, respectively), whereas specificity, PPV, and accuracy were equivalent. Per-lesion sensitivity was significantly higher for CE-set versus DW-set (59.0% versus 43.8%; P = 0.008, pooled data from two observers). When stratified by lesion size, the difference was significant only for lesions with a size between 1 and 2 cm (42.0% for DW-set versus 74.0% for CE-set; P = 0.001). The addition of DWI to CET1WI improved sensitivity for the more experienced observer. CONCLUSION DWI is outperformed by CET1WI for detection of HCC, but represents a reasonable alternative to CET1WI for detection of HCC with a size above 2 cm. The addition of DWI to CET1WI slightly increases the detection rate.
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Affiliation(s)
- Mi-Suk Park
- Departments of Radiology, New York University Langone Medical Center, New York, NY, USA
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Diagnostic accuracy and sensitivity of diffusion-weighted and of gadoxetic acid-enhanced 3-T MR imaging alone or in combination in the detection of small liver metastasis (≤ 1.5 cm in diameter). Invest Radiol 2012; 47:159-66. [PMID: 22330426 DOI: 10.1097/rli.0b013e31823a1495] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the diagnostic accuracy and sensitivity of combined gadoxetic acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) with each imaging approach alone for detecting small hepatic metastases (≤ 1.5 cm). MATERIALS AND METHODS Institutional review board approved this retrospective study and waived informed patient consent. Eighty-six patients with 179 liver metastases underwent liver MRI including unenhanced and gadoxetic acid-enhanced imaging and DWI at 3.0 T. Three image sets including unenhanced images-gadoxetic acid set (early dynamic and hepatocyte phase), DWI set, and the combined set-were analyzed independently and in consensus by 2 observers for detecting liver metastases using receiver operating characteristic analysis. RESULTS There was a tendency toward an increased diagnostic accuracy for the combined set (mean, 0.965) compared with that for each image set alone (mean, 0.911 for gadoxetic acid set; 0.926 for DWI set). The combined set showed better sensitivity (mean, 97.47%/95.0%: values on per-lesion/per-patient basis) than each imaging set alone (mean, 90.7%/83.7% for gadoxetic acid set; 91.6%/83.0% for DWI set) (P < 0.05) on both per-lesion basis and per-patient basis. All image sets showed similar positive predictive values. CONCLUSIONS The combination of gadoxetic acid-enhanced MRI and DWI yielded better diagnostic accuracy and sensitivity in the detection of small liver metastasis than each magnetic resonance scan sequence alone.
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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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Kim DJ, Yu JS, Kim JH, Chung JJ, Kim KW. Small hypervascular hepatocellular carcinomas: value of diffusion-weighted imaging compared with "washout" appearance on dynamic MRI. Br J Radiol 2012; 85:e879-86. [PMID: 22573299 DOI: 10.1259/bjr/23975164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the value of diffusion-weighted MRI (DWI) with the venous "washout" appearance during dynamic MRI for the assessment of small arterial hypervascular lesions in cirrhotic liver. METHODS After exclusion of benign hypervascular lesions, including haemangiomas and subcapsular non-tumorous arterioportal shunts, indicated by typical imaging features, a total of 109 small arterial hypervascular lesions (0.5-3.0 cm in the longest diameter) in 65 patients with cirrhosis who underwent gadopentetate dimeglumine-enhanced dynamic MRI and DWI (b=50, 400, 800 s mm(-2)) at 1.5 T during a 16-month period were retrospectively analysed to determine the presence of venous washout during dynamic imaging or sustained hyperintensity upon increasing the b factor size on DWI. RESULTS Among the 99 hypervascular hepatocellular carcinomas (HCCs), sustained hyperintensity on DWI (92/99, 93%) was more prevalent than the washout appearance (72/99, 72%) on dynamic MRI (p<0.001). Depending on the lesion size, subcentimetre-sized HCCs had a significantly lower prevalence of venous washout (13/30, 43%) than the sustained hyperintensity on DWI (27/30, 90%) (p=0.001). In all 10 hypervascular benign conditions, there was no venous washout on dynamic MRI and no sustained hyperintensity on DWI. Sensitivity and specificity for diagnosis of hypervascular HCCs were 92.9% and 100% in DWI and 72% and 100% in dynamic MRI, respectively. CONCLUSION Compared with the venous washout during dynamic imaging, DWI provides more reliable information in the MRI assessment of small hypervascular HCCs, distinguishing them from atypical hypervascular benign or pseudolesions. DWI could complement the early diagnosis of small hypervascular HCCs that do not display venous washout during dynamic imaging.
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Affiliation(s)
- D J Kim
- Department of Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
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Bastati-Huber N, Prosch H, Baroud S, Magnaldi S, Schima W, Ba-Ssalamah A. [New developments in MRI of the liver]. Radiologe 2012; 51:680-7. [PMID: 21809147 DOI: 10.1007/s00117-010-2126-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Radiology has gained an exceptional position in medicine because a correct diagnosis is the most crucial issue in determining an accurate and personalized therapeutic strategy. This has a direct influence not only on the individual patient but also on the socio-economic aspects of healthcare services in terms of shortening the time interval to establish a diagnosis and to avoid risk-associated invasive diagnostic methods or long-term, cost-intensive follow-up. Magnetic resonance imaging (MRI) is an excellent example of this which due to continuous technological developments and emerging techniques allows a non-invasive diagnosis of the different hepatic diseases. In this article, we illustrate the direct correlation between the recent technical advances in MRI, such as 3.0 T, diffusion-weighted imaging, perfusion imaging, spectroscopy, texture analysis and MR elastography and obtaining a confident non-invasive diagnosis of focal and diffuse liver diseases.
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Affiliation(s)
- N Bastati-Huber
- Universitätsklinik für Radiodiagnostik, AKH, Medizinische Universität Wien, Wien, Österreich.
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Taouli B. Diffusion-weighted MR Imaging for Liver Lesion Characterization: A Critical Look. Radiology 2012; 262:378-80. [DOI: 10.1148/radiol.11112417] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Haradome H, Grazioli L, Morone M, Gambarini S, Kwee TC, Takahara T, Colagrande S. T2-weighted and diffusion-weighted MRI for discriminating benign from malignant focal liver lesions: diagnostic abilities of single versus combined interpretations. J Magn Reson Imaging 2012; 35:1388-96. [PMID: 22246647 DOI: 10.1002/jmri.23573] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 12/07/2011] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To compare the diagnostic accuracies of diffusion-weighted imaging (DWI), T2-weighted imaging (T2WI), and the combination of both sequences in discriminating benign from malignant focal liver lesions (FLLs). MATERIALS AND METHODS In all, 166 patients with 269 FLLs (153 benign and 116 malignant) were retrospectively evaluated. Two abdominal readers visually assessed the DWI, T2WI, and the combined (DWI+T2WI) image sets in an independent and blinded manner. The diagnostic abilities of each image set in discriminating the benign from the malignant FLLs set were compared using a binary logistic regression model. Pathologic results, consensus reading, and follow-up imaging were used as the reference standard. RESULTS The overall characterization accuracy in all lesions of the combined set (80.3%) was significantly higher than those of the T2WI set (68.8%) and DWI set (73.2%) (combined vs. T2WI, P < 0.001; combined vs. DWI, P = 0.001), while there was no significant difference between the T2WI and DWI sets (P = 0.058). All image sets were more accurate in the characterization of malignant FLLs than of benign FLLs (P < 0.001). CONCLUSION T2WI and DWI are complementary in discriminating benign from malignant FLLs; their combination improves diagnostic confidence.
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Affiliation(s)
- Hiroki Haradome
- Department of Radiology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.
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Koh DM, Collins DJ, Wallace T, Chau I, Riddell AM. Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases. Br J Radiol 2011; 85:980-9. [PMID: 22167501 DOI: 10.1259/bjr/91771639] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To compare the diagnostic accuracy of gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, diffusion-weighted MRI (DW-MRI) and a combination of both techniques for the detection of colorectal hepatic metastases. METHODS 72 patients with suspected colorectal liver metastases underwent Gd-EOB-DTPA MRI and DW-MRI. Images were retrospectively reviewed with unenhanced T(1) and T(2) weighted images as Gd-EOB-DTPA image set, DW-MRI image set and combined image set by two independent radiologists. Each lesion detected was scored for size, location and likelihood of metastasis, and compared with surgery and follow-up imaging. Diagnostic accuracy was compared using receiver operating characteristics and interobserver agreement by kappa statistics. RESULTS 417 lesions (310 metastases, 107 benign) were found in 72 patients. For both readers, diagnostic accuracy using the combined image set was higher [area under the curve (Az)=0.96, 0.97] than Gd-EOB-DTPA image set (Az=0.86, 0.89) or DW-MRI image set (Az=0.93, 0.92). Using combined image set improved identification of liver metastases compared with Gd-EOB-DTPA image set (p<0.001) or DW-MRI image set (p<0.001). There was very good interobserver agreement for lesion classification (κ=0.81-0.88). CONCLUSIONS Combining DW-MRI with Gd-EOB-DTPA-enhanced T(1) weighted MRI significantly improved the detection of colorectal liver metastases.
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Affiliation(s)
- D-M Koh
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, UK.
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Takahara T, Kwee TC, Sadahiro S, Yamashita T, Toyoguchi Y, Yoshizako T, Horie T, Luijten PR, Imai Y. Low b-value diffusion-weighted imaging for diagnosing strangulated small bowel obstruction: a feasibility study. J Magn Reson Imaging 2011; 34:1117-24. [PMID: 21928383 DOI: 10.1002/jmri.22735] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 07/15/2011] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess the feasibility of low b-value diffusion-weighted imaging (DWI) for diagnosing strangulated small bowel obstruction (SBO). MATERIALS AND METHODS Five volunteers and 14 patients with SBO underwent DWI at b-values of 0 and 50 s/mm(2). Apparent diffusion coefficients (ADCs) and signal preservation ratios (SPRs) were measured in the distal jejunum in the volunteers before and after butylscopolamine administration, and in the (strangulated) closed loop, near the obstructive site, and far from the obstructive site in the patients. Low b-value diffusion-weighted images in the patients were quantitatively evaluated for diagnosing strangulation. RESULTS In the volunteers, mean ADC (10(-3) mm(2)/s) and SPR (%) before butylscopolamine administration (18.3 ± 5.9 and 41.4 ± 11.5) were significantly different (P < 0.05) from those after butylscopolamine administration (6.4 ± 3.6 and 73.7 ± 12.9). In the patients, mean ADCs and SPRs among the strangulated closed loop (3.8 ± 2.2 and 83.3 ± 9.3), near the obstructive site (12.1 ± 6.9 and 57.3 ± 18.5), and far from the obstructive site (26.8 ± 10.7 and 29.9 ± 16.4) were significantly different (P < 0.05). Areas under the receiver operating characteristic curve for the diagnosis of strangulation varied between 0.937 and 1.000. CONCLUSION Low b-value DWI is a feasible technique to distinguish the strangulated closed loop from nonstrangulated loops in SBO, and show promise for diagnosing strangulated SBO.
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Affiliation(s)
- Taro Takahara
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Hypervascular hepatocellular carcinoma in the cirrhotic liver: diffusion-weighted imaging versus superparamagnetic iron oxide-enhanced MRI. Magn Reson Imaging 2011; 29:1235-43. [PMID: 21907517 DOI: 10.1016/j.mri.2011.07.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/25/2011] [Accepted: 07/29/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of the study was to validate diffusion-weighted imaging (DWI) in the assessment of hypervascular hepatocellular carcinoma (HCC) compared with superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the cirrhotic liver. MATERIAL AND METHODS Forty-six consecutive patients with 106 hypervascular focal lesions in the cirrhotic liver who underwent DWI using three b factors and gadopentetate dimeglumine-enhanced dynamic MRI followed by SPIO-enhanced MRI were enrolled. Two independent radiologists evaluated two separated image sets (SPIO set, dynamic MRI and SPIO-enhanced T2*-weighted images; DWI set, DWI and dynamic MRI) and assigned confidence levels for diagnosis of HCC using a five-point scale for each lesion. Area under the receiver operating characteristic curve (A(z)) was calculated for each image set. RESULTS The A(z) value of the DWI set was larger than the SPIO set by both readers (reader 1, 0.936 vs. 0.900, P=.050; reader 2, 0.938 vs. 0.905, P=.110). For the sensitivity (reader 1, 93.1% vs. 86.2%, P=.146; reader 2, 95.4% vs. 88.5%, P=.070) and specificity (reader 1, 89.5% vs. 73.7%, P=.250; reader 2, 79.0% vs. 73.7%, P=1.000) of HCC diagnosis, DWI sets were superior to SPIO sets without statistically significant differences. CONCLUSION For assessment of hypervascular HCC, DWI in combination with dynamic MRI provides comparable or slightly better information compared with the combination of dynamic and SPIO-enhanced MRI.
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Whole-body diffusion-weighted magnetic resonance imaging: Current evidence in oncology and potential role in colorectal cancer staging. Eur J Cancer 2011; 47:2107-16. [DOI: 10.1016/j.ejca.2011.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/11/2011] [Accepted: 05/10/2011] [Indexed: 01/11/2023]
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Chiaradia M, Baranes L, Pigneur F, Djabbari M, Zegai B, Brugières P, Zerbib P, Decaens T, Deux JF, Kobeiter H, Rahmouni A, Luciani A. Liver magnetic resonance diffusion weighted imaging: 2011 update. Clin Res Hepatol Gastroenterol 2011; 35:539-48. [PMID: 21700529 DOI: 10.1016/j.clinre.2011.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 02/04/2023]
Abstract
Diffusion-Weighted-Imaging (DWI) assesses proton motion on a cellular scale. Owing to recent instrumentation developments, diffusion sequences are now routinely used for liver imaging. This review will go through the physical principles that underlie this technique, and then highlight up-to-date liver applications including quantification of liver fibrosis, focal lesions detection and characterization, and therapy response monitoring.
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Affiliation(s)
- Mélanie Chiaradia
- Imagerie medicale, AP-HP, groupe Henri-Mondor Albert-Chenevier, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Creteil, France
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Detection, classification, and characterization of focal liver lesions: Value of diffusion-weighted MR imaging, gadoxetic acid-enhanced MR imaging and the combination of both methods. ACTA ACUST UNITED AC 2011; 37:74-82. [DOI: 10.1007/s00261-011-9758-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Bittencourt LK, Matos C, Coutinho AC. Diffusion-weighted magnetic resonance imaging in the upper abdomen: technical issues and clinical applications. Magn Reson Imaging Clin N Am 2011; 19:111-31. [PMID: 21129638 DOI: 10.1016/j.mric.2010.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent technological achievements have enabled the transposition of diffusion-weighted imaging (DWI) with good diagnostic quality into other body regions, especially the abdomen and pelvis. Many emerging and established applications are now being evaluated on the upper abdomen, the liver being the most studied organ. This article discusses imaging strategies for DWI on the upper abdomen, describes the clinical protocol, and reviews the most common clinical applications of DWI on solid abdominal organs.
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Affiliation(s)
- Leonardo K Bittencourt
- Clínica de Diagnóstico por Imagem, Carlos Bittencourt Diagnóstico por Imagem and Department of Radiology, Rio de Janeiro Federal University (UFRJ), Av. Das Américas, 4666, Centro Medico, Sala 325, Rio de Janeiro 22649-900, Brazil.
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Abstract
Liver metastases are the most frequently encountered malignant liver lesions in the Western countries. Accurate diagnosis of liver metastases is essential for appropriate management of these patients. Multiple imaging modalities, including ultrasound, CT, positron emission tomography, and MRI, are available for the evaluation of patients with suspected or known liver metastases. Contrast-enhanced MRI has a high accuracy for detection and characterization of liver lesions. Additionally, diffusion-weighted MRI (DWI) has been gaining increasing attention. It is a noncontrast technique that is easy to perform, could be incorporated in routine clinical protocols, and has the potential to provide tissue characterization. This article discusses the basic principles of DWI and discusses its emerging role in the detection of liver metastases in patients with extrahepatic malignancies.
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Affiliation(s)
- Hersh Chandarana
- Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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