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Tanaka R, Fujiwara M, Sakamoto N, Suzuki H, Tachibana K, Ohtsuka K, Kishimoto K, Kamma H, Shibahara J, Kondo H. Cytomorphometric and flow cytometric analyses using liquid-based cytology materials in subtypes of lung adenocarcinoma. Diagn Cytopathol 2022; 50:394-403. [PMID: 35567786 DOI: 10.1002/dc.24978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The histological classifications of invasive lung adenocarcinoma subtypes are considered to predict patient prognosis after surgical treatment. The objectives of this study were to evaluate cytomorphological characteristics and proliferative activities among the histological predominant patterns by performing cytomorphometric and flow cytometric analyses using liquid-based cytology materials. METHODS Cytological samples fixed by liquid-based cytology preservatives from 53 surgically-resected lung adenocarcinoma specimens were obtained between August 2018 and November 2019. The Papanicolaou-stained and paired Ki-67-stained slides were analyzed for calculating nuclear morphology (nuclear area, nuclear perimeter and nuclear circularity) and Ki-67 labeling index using software. The cell proliferation index (CPIx) was calculated and cellular information including cell cycle stage of tumor cells was obtained by flow cytometry. RESULTS The 53 cases included papillary (n = 29), acinar (n = 8), lepidic (n = 5), and solid (n = 4) subtypes, and invasive mucinous adenocarcinoma (n = 7) were also included. In the lepidic pattern, nuclear area (79.6 ± 28.8 μm2 ) and perimeter (34.1 ± 6.1 μm) were relatively larger and longer than those of the other predominant patterns. The Ki-67 labeling index of the solid pattern (27.9 ± 12.5%) was highest compared with those of other predominant patterns. There were statistically significant differences in the lepidic versus solid patterns and the papillary versus solid patterns (p = .013 and p = .039, respectively). The calculated mean CPIx of the lepidic and the acinar patterns were approximately two-fold higher than those of the other predominant patterns. CONCLUSION By revealing the differences of cytomorphological characteristics, these methodologies might be used for diagnosing cytopathological materials using digital cytopathology.
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Affiliation(s)
- Ryota Tanaka
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Masachika Fujiwara
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Norihiko Sakamoto
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hitomi Suzuki
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Keisei Tachibana
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Kouki Ohtsuka
- Department of Clinical Laboratory, Kyorin University School of Medicine, Tokyo, Japan
| | - Koji Kishimoto
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroshi Kamma
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Haruhiko Kondo
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Diffusion MR: A New Diagnostic Tool for Elastofibroma Dorsi. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:103-107. [PMID: 32377143 PMCID: PMC7192251 DOI: 10.14744/semb.2018.78309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/04/2018] [Indexed: 11/21/2022]
Abstract
Elastofibroma dorsi is a benign lesion commonly presents as a palpable enlarging mass at the inferior pole of the scapula. Clinical presentation and radiological characteristics are often enough to suggest an accurate diagnosis. Increased awareness of the characteristic appearance and location of these benign lesions will increase radiologic diagnosis and decrease the need for biopsy. Ten patients were admitted with a complaint of asymptomatic or painful subcutaneous masses localized at subscapulary region. Thorax computed tomography, magnetic resonance imaging (MRI) and a new feasible technique in differential diagnosis with malignancy and probable diagnosis of elastofibroma dorsi and diffusion-weighted MRI were used for diagnosis. Surgery was applied to all patients, frozen-section biopsies of the lesions at the preoperative period, and final pathologies were all benign. Totally resection of whole lesions as en-bloc excision without any rest was performed at all patients. Postoperative and follow-up periods were uneventful. Diffusion MRI can play an important role in the future and save the patients, especially medically poor ones, from the potential risks of surgery. Necessary further examinations for probable bilaterally lesions will save the patient from the risk of a second operation.
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Chang N, Wang XH, Cui LB, Yin H, Jiang T, Chen FL, Liu LP, Zhang J. Diagnostic performance of diffusion-weighted magnetic resonance imaging in pulmonary malignant lesions: a meta-analysis. Transl Lung Cancer Res 2019; 8:738-747. [PMID: 32010553 DOI: 10.21037/tlcr.2019.10.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Overuse or misuse of positron emission tomography/computed tomography (PET/CT) should be avoided for its ionizing-radiation. Diffusion-weighted magnetic resonance imaging (DW-MRI), characterized by no radiation, may be regarded as an alternative in differentiating pulmonary nodules. We aim to estimate the diagnostic accuracy of DW-MRI in diagnosing of pulmonary lesions. Methods Relevant studies were searched through PubMed and Embase with no language restriction from inception to March 8, 2019. We selected studies reporting sensitivity and specificity of DW-MRI for differentiating pulmonary nodules. A summary estimates of sensitivity, specificity and area under curve (AUC) of receiver operating characteristic (ROC) of DW-MRI were analyzed with a random effects model. Results We included data from 37 studies, which altogether included 2,311 pulmonary lesions. The pooled sensitivity and specificity were 0.86 (95% CI, 0.82-0.89) and 0.79 (95% CI, 0.72-0.85), and AUC was 0.90 (95% CI, 0.87-0.92). Subsequent subgroup analysis showed the higher sensitivity of DW-MRI in pulmonary lesion >2 cm in comparison to lesions ≤2 cm, however, higher specificity was observed in smaller lesions. Conclusions Radiation-free DW-MRI showed a favorable balance between sensitivity and specificity in diagnosing pulmonary malignancies especially in lesion size ≤2 cm. Existing evidence indicated that DW-MRI may be considered as an independent substitute in diagnosis of lung lesions, which might help to prevent long-term side-effects from radiographic diagnosing and evaluating procedures.
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Affiliation(s)
- Ning Chang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Xiao-Hui Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Long-Biao Cui
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 710032, China
| | - Fu-Lin Chen
- College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Li-Peng Liu
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.,Division of Pediatric Blood Diseases Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Jian Zhang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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Fatihoğlu E, Biri S, Aydın S, Ergün E, Koşar PN. MRI in Evaluation of Solitary Pulmonary Nodules. Turk Thorac J 2019; 20:90-96. [PMID: 30958979 DOI: 10.5152/turkthoracj.2018.18049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study is to assess magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), T2-weighted image (T2WI), and apparent diffusion coefficient (ADC) maps' threshold values before computed tomography (CT)-guided transthorasic biopsy in solitary pulmonary nodules (SPN) by describing tumoral cell density. MATERIALS AND METHODS Patients who had SPN were prospectively evaluated with MRI (T1WI, T2WI) and DWI (b=0, b=500, b=1000).The ADC maps were created for each patient. Before the biopsy, lesion muscle ratios (LMR) at T2WI, ADC value, and lesion spinal cord ratio at each b values were noted. The measurements were correlated with the histopathological results. RESULTS A total of 53 patients were included in the study: 30.2% (n=16) were female, and 69.8% (n=37) were male. Among them, 17 lesions (32.1%) were benign, and 36 lesions (67.9%) were malignant. The age varied between 40 and 82 years, with a mean of 61.7±9.1 years. The SPN diameters were between 10 and 30 mm, and the median was 24 mm. The LSR0 and LMR values were not statistically significant in detecting malignancy. LSR500 >0.53 value can predict malignancy with 100% sensitivity and 70.6% specificity. LSR1000 >0.53 can predict malignancy with 88.9% sensitivity and 88.2% specificity. Setting the cut-off value at 0.9×10-3, the ADC values had a sensitivity of 72.2% and a specificity of 88.2% for predicting malignancy. CONCLUSION For SPN follow-up, a new following-up protocol can be safely established using DWI and ADC mapping. Using these MRI parameters might decrease unnecessary biopsy rates and complications of biopsies.
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Affiliation(s)
- Erdem Fatihoğlu
- Clinic of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Suzan Biri
- Clinic of Radiology, Koru Hospital, Ankara, Turkey
| | - Sonay Aydın
- Clinic of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Elif Ergün
- Clinic of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Pınar Nercis Koşar
- Clinic of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
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Dang S, Gao X, Ma G, Yu N, Han D, Yang Q, Tian X, Duan H. Combination of free-breathing radial 3D fat-suppressed T1-weighted gradient-echo sequence with diffusion weighted images: Potential for differentiating malignant from benign peripheral solid pulmonary masses. Magn Reson Imaging 2018; 57:271-276. [PMID: 30557591 DOI: 10.1016/j.mri.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/08/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES High resolution CT is the most commonly used radiological method for differentiating benign from malignant peripheral solid pulmonary masses, however, some of them are not easily diagnosed by morphology alone. Furthermore, due to the radiation dose, it is unsuitable for patients with disorders requiring repeated examinations over prolonged periods. The aims of this study were to evaluate whether a combination of diffusion-weighted images (DWI) and free-breathing radial 3D fat-suppressed T1-weighted gradient echo (radial volumetric interpolated breath-hold examination, radial VIBE) sequence can enable discrimination between benign from malignant peripheral solid pulmonary masses. MATERIALS AND METHODS Both chest CT scan and MR imaging with radial VIBE and DWI were obtained from 47 patients; 30 males and 17 females (mean age 64 years old; age range 48-83 years old). Benign and malignant peripheral solid pulmonary masses were conclusively identified by pathology results. Two radiologists independently reviewed all the images and record radiological features including morphological signs on radial VIBE, CT images, and ADC value. Receiver operating characteristic (ROC) was used to analyze the capability of radial VIBE as well as DWI to distinguish malignant from benign peripheral solid pulmonary masses. RESULTS In 77% of patients, malignant peripheral solid pulmonary masses were found. Morphological signs of mediastinal lymph node enlargement and lobulation were more easily found in malignant masses in both radial VIBE (mediastinal lymph node enlargement: p = 0.033, lobulation: p = 0.039) and CT (mediastinal lymph node enlargement: p = 0.004, lobulation: p = 0.012). The ADC value were also significant difference between benign and malignant groups (p = 0.001). Combined ADC value with radial VIBE was a most specific test than routine-dose CT (86.1% vs 75%, p < 0.001), but less sensitive than routine-dose CT (81.8% vs 90.9%; p < 0.001) for malignant peripheral solid pulmonary masses detection. Diagnostic accuracy was 89% for combining ADC value with radial VIBE, and 85% for routine-dose CT. CONCLUSIONS Combination of morphological signs and ADC value seems to improve differentiating malignant from benign peripheral solid pulmonary masses. Especially in patients unable to endure radiation exposure, suspend respiration, radial VIBE provides similar morphological signs displaying to those on routine-dose CT.
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Affiliation(s)
- Shan Dang
- Department of Radiology, The affiliated hospital of Shaanxi university of Chinese medicine, Xian Yang, China
| | - Xiang Gao
- Department of Clinical Lab, Nuclear Industry 215 Hospital of Shaanxi Province, Xian Yang, China
| | - Guangming Ma
- Department of Radiology, The affiliated hospital of Shaanxi university of Chinese medicine, Xian Yang, China
| | - Nan Yu
- Department of Radiology, The affiliated hospital of Shaanxi university of Chinese medicine, Xian Yang, China
| | - Dong Han
- Department of Radiology, The affiliated hospital of Shaanxi university of Chinese medicine, Xian Yang, China
| | - Qi Yang
- Department of Radiology, The affiliated hospital of Shaanxi university of Chinese medicine, Xian Yang, China
| | - Xin Tian
- Department of Radiology, The affiliated hospital of Shaanxi university of Chinese medicine, Xian Yang, China
| | - Haifeng Duan
- Department of Radiology, The affiliated hospital of Shaanxi university of Chinese medicine, Xian Yang, China.
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Ohno Y, Yui M, Koyama H, Yoshikawa T, Seki S, Ueno Y, Miyazaki M, Ouyang C, Sugimura K. Chemical Exchange Saturation Transfer MR Imaging: Preliminary Results for Differentiation of Malignant and Benign Thoracic Lesions. Radiology 2016; 279:578-89. [DOI: 10.1148/radiol.2015151161] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Inan N, Arslan A, Donmez M, Sarisoy HT. Diagnostic Accuracy of Dynamic Contrast Enhanced Magnetic Resonance Imaging in Characterizing Lung Masses. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e23026. [PMID: 27703654 PMCID: PMC5040099 DOI: 10.5812/iranjradiol.23026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/02/2014] [Accepted: 12/14/2014] [Indexed: 11/19/2022]
Abstract
Background Imaging plays a critical role not only in the detection, but also in the characterization of lung masses as benign or malignant. Objectives To determine the diagnostic accuracy of dynamic magnetic resonance imaging (MRI) in the differential diagnosis of benign and malignant lung masses. Patients and Methods Ninety-four masses were included in this prospective study. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, followed by a T1-weighted FFE sequence in the late phase (5th minutes). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained and the maximum relative enhancement, wash-in rate, and time-to-peak enhancement of masses in both groups were calculated. Results The early phase contrast enhancement patterns were homogeneous in 78.2% of the benign masses, while heterogeneous in 74.4% of the malignant tumors. On the late phase images, 70.8% of the benign masses showed homogeneous enhancement, while most of the malignant masses showed heterogeneous enhancement (82.4%). During the first pass, the maximum relative enhancement and wash-in rate values of malignant masses were significantly higher than those of the benign masses (P = 0.03 and 0.04, respectively). The cutoff value at 15% yielded a sensitivity of 85.4%, specificity of 61.2%, and positive predictive value of 68.7% for the maximum relative enhancement. Conclusion Contrast enhancement patterns and SI-time curve analysis of MRI are helpful in the differential diagnosis of benign and malignant lung masses.
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Affiliation(s)
- Nagihan Inan
- Department of Radiology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
- Corresponding author: Nagihan Inan, Department of Radiology, School of Medicine, University of Kocaeli, Kocaeli, Turkey. Tel: +90-2623037242, Fax: +90-2623038003, E-mail:
| | - Arzu Arslan
- Department of Radiology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Muhammed Donmez
- Department of Radiology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Hasan Tahsin Sarisoy
- Department of Radiology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
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Ciet P, Serra G, Andrinopoulou ER, Bertolo S, Ros M, Catalano C, Colagrande S, Tiddens HAWM, Morana G. Diffusion weighted imaging in cystic fibrosis disease: beyond morphological imaging. Eur Radiol 2016; 26:3830-3839. [PMID: 26873494 DOI: 10.1007/s00330-016-4248-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/22/2015] [Accepted: 01/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the feasibility of diffusion-weighted imaging (DWI) to assess inflammatory lung changes in patients with Cystic Fibrosis (CF) METHODS: CF patients referred for their annual check-up had spirometry, chest-CT and MRI on the same day. MRI was performed in a 1.5 T scanner with BLADE and EPI-DWI sequences (b = 0-600 s/mm2). End-inspiratory and end-expiratory scans were acquired in multi-row scanners. DWI was scored with an established semi-quantitative scoring system. DWI score was correlated to CT sub-scores for bronchiectasis (CF-CTBE), mucus (CF-CTmucus), total score (CF-CTtotal-score), FEV1, and BMI. T-test was used to assess differences between patients with and without DWI-hotspots. RESULTS Thirty-three CF patients were enrolled (mean 21 years, range 6-51, 19 female). 4 % (SD 2.6, range 1.5-12.9) of total CF-CT alterations presented DWI-hotspots. DWI-hotspots coincided with mucus plugging (60 %), consolidation (30 %) and bronchiectasis (10 %). DWItotal-score correlated (all p < 0.0001) positively to CF-CTBE (r = 0.757), CF-CTmucus (r = 0.759) and CF-CTtotal-score (r = 0.79); and negatively to FEV1 (r = 0.688). FEV1 was significantly higher (p < 0.0001) in patients without DWI-hotspots. CONCLUSIONS DWI-hotspots strongly correlated with radiological and clinical parameters of lung disease severity. Future validation studies are needed to establish the exact nature of DWI-hotspots in CF patients. KEY POINTS • DWI hotspots only partly overlapped structural abnormalities on morphological imaging • DWI strongly correlated with radiological and clinical indicators of CF-disease severity • Patients with more DWI hotspots had lower lung function values • Mucus score best predicted the presence of DWI-hotspots with restricted diffusion.
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Affiliation(s)
- Pierluigi Ciet
- Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands.,Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Goffredo Serra
- Department of Radiology, University of Rome "Sapienza", Rome, Italy
| | | | - Silvia Bertolo
- Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Mirco Ros
- Department of Pediatrics, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Catalano
- Department of Radiology, University of Rome "Sapienza", Rome, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi., Largo Brambilla 3, Florence, 50134, Italy
| | - Harm A W M Tiddens
- Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy.
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Abstract
PET/MRI is a hybrid imaging modality that is gaining clinical interest with the first Food and Drug Administration-approved simultaneous imaging system recently added to the clinical armamentarium. Several advanced PET/MRI applications, such as high-resolution anatomic imaging, diffusion-weighted imaging, motion correction, and cardiac imaging, show great potential for clinical use. The purpose of this article is to highlight several advanced PET/MRI applications through case examples and review of the current literature.
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Karaman A, Durur-Subasi I, Alper F, Araz O, Subasi M, Demirci E, Albayrak M, Polat G, Akgun M, Karabulut N. Correlation of diffusion MRI with the Ki-67 index in non-small cell lung cancer. Radiol Oncol 2015; 49:250-5. [PMID: 26401130 PMCID: PMC4577221 DOI: 10.1515/raon-2015-0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/09/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The primary objective of the study was to evaluate the association between the minimum apparent diffusion coefficient (ADCmin) and Ki-67, an index for cellular proliferation, in non-small cell lung cancers. Also, we aimed to assess whether ADCmin values differ between tumour subtypes and tissue sampling method. METHODS The patients who had diffusion weighted magnetic resonance imaging (DW-MRI) were enrolled retrospectively. The correlation between ADCmin and the Ki-67 index was evaluated. RESULTS Ninety three patients, with a mean age 65 ± 11 years, with histopathologically proven adenocarcinoma and squamous cell carcinoma of the lungs and had technically successful DW-MRI were included in the study. The numbers of tumour subtypes were 47 for adenocarcinoma and 46 for squamous cell carcinoma. There was a good negative correlation between ADCmin values and the Ki-67 proliferation index (r = -0.837, p < 0.001). The mean ADCmin value was higher and the mean Ki-67 index was lower in adenocarcinomas compared to squamous cell carcinoma (p < 0.0001). There was no statistical difference between tissue sampling methods. CONCLUSIONS Because ADCmin shows a good but negative correlation with Ki-67 index, it provides an opportunity to evaluate tumours and their aggressiveness and may be helpful in the differentiation of subtypes non-invasively.
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Affiliation(s)
- Adem Karaman
- Department of Radiology, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Irmak Durur-Subasi
- Department of Radiology, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Fatih Alper
- Department of Radiology, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Omer Araz
- Department of Pulmonary Diseases, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Mahmut Subasi
- Department of Thoracic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Elif Demirci
- Department of Pathology, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Mevlut Albayrak
- Department of Pathology, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Gökhan Polat
- Department of Radiology, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Metin Akgun
- Department of Pulmonary Diseases, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Nevzat Karabulut
- Department of Radiology, Pamukkale University, Medical Faculty, Denizli, Turkey
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Liu H, Liu Y, Yu T, Ye N, Wang Q. Evaluation of apparent diffusion coefficient associated with pathological grade of lung carcinoma, before therapy. J Magn Reson Imaging 2014; 42:595-601. [PMID: 25537656 DOI: 10.1002/jmri.24823] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/20/2014] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To investigate the feasibility and utility of apparent diffusion coefficient (ADC) in predicting the tumor cellular density and grades of lung cancers. MATERIALS AND METHODS Forty-one consecutive patients (26 men and 15 women; mean age, 59.9 years) with histologically proven lung cancers were enrolled in the study and underwent MR examination. ADC values and tumor cellular density of different histological grades were analyzed. The relationship of the ADC with tumor cellular density and grades were also evaluated. RESULTS The ADC values of lung cancer in grade III was significantly lower than those in grade I and grade II (P = 0.008 and 0.011, respectively). The cellular density in grade III was significantly higher than other two grades (P = 0.029 and 0.022, respectively). ADC value of lung cancer correlated negatively with grades and tumor cellular density (P = 0.001 and P = 0.001, respectively). According to the ROC analysis, the cutoff value of ADC was 1.175 × 10(-3) mm(2) /s with the optimal sensitivity (88.2%) and specificity (62.5%), respectively. CONCLUSION ADC measurement of lung cancer was a helpful method to evaluate the pathological grade and tumor cellular density. The quantitative analysis of ADC in conjunction with conventional MR findings could provide more valuable information for the assessment of pulmonary tumor. J
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Affiliation(s)
- Haidong Liu
- Department of Radiology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Ying Liu
- Department of Radiology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Tielian Yu
- Department of Radiology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Ning Ye
- Department of Radiology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Qing Wang
- Department of Radiology, General Hospital of Tianjin Medical University, Tianjin, China
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Koyama H, Ohno Y, Seki S, Nishio M, Yoshikawa T, Matsumoto S, Maniwa Y, Itoh T, Nishimura Y, Sugimura K. Value of diffusion-weighted MR imaging using various parameters for assessment and characterization of solitary pulmonary nodules. Eur J Radiol 2014; 84:509-515. [PMID: 25554007 DOI: 10.1016/j.ejrad.2014.11.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/07/2014] [Accepted: 11/12/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the appropriate parameters and evaluation method for characterizing solitary pulmonary nodules (SPNs) using quantitative parameters of diffusion-weighted imaging (DWI). METHODS Thirty-two subjects with 36 SPNs underwent DWI with seven different b values (0, 50, 100, 150, 300, 500, and 1000s/mm(2)). Five quantitative parameters were obtained from the region of interest drawn over each SPN: apparent diffusion coefficients (ADCs), true diffusion coefficients (DCs), and perfusion fractions (PFs), and signal-intensity ratios between lesion and spinal cord from DWI (b values: 1000 [LSR1000] and 500 [LSR500)]). All quantitative parameters and the diagnostic capabilities were statistically compared. RESULTS SPNs were diagnosed as follow: malignant (n=27) and benign (n=9). Parameter comparisons for malignant and benign showed both LSRs differed significantly (p<0.05). Applying feasible threshold values showed LSR500 specificity (88.9% [8/9]) and accuracy (77.8% [28/36]) were significantly higher than ADC, DC, and PF specificity and accuracy (p<0.05). LSR1000 accuracy (72.2% [26/36]) was significantly higher than DC accuracy, and its specificity (88.9% [8/9]) was significantly higher than ADC, DC, and PF specificities (p<0.05). CONCLUSIONS For quantitative differentiation of SPNs, LSR evaluation was more useful and practical than ADC, DC, and PF, and choice of b values showed little impact for the differentiation.
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Affiliation(s)
- Hisanobu Koyama
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yoshiharu Ohno
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichiro Seki
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mizuho Nishio
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Yoshikawa
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sumiaki Matsumoto
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimasa Maniwa
- Department of General Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuro Sugimura
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Li B, Li Q, Chen C, Guan Y, Liu S. A systematic review and meta-analysis of the accuracy of diffusion-weighted MRI in the detection of malignant pulmonary nodules and masses. Acad Radiol 2014; 21:21-9. [PMID: 24331261 DOI: 10.1016/j.acra.2013.09.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/29/2013] [Accepted: 09/30/2013] [Indexed: 12/31/2022]
Abstract
RATIONALE AND OBJECTIVES To perform a meta-analysis to assess the diagnostic performance of the diffusion-weighted magnetic resonance imaging (DWI) technique in discrimination of benign and malignant pulmonary nodules or masses. MATERIALS AND METHODS Data sources were studies published in PubMed, MEDLINE, EMBASE, Cochrane Library, and China National Knowledge Infrastructure databases from January 2001 to May 2013. Studies evaluating the diagnostic accuracy of DWI for benign/malignant discrimination of pulmonary nodules in English or Chinese language were considered for inclusion. Methodological quality was assessed by the quality assessment of diagnostic studies instrument. Sensitivities, specificities, predictive values, diagnostic odds ratios (DORs), and areas under the receiver operating characteristic curve (AUCs) were calculated. Potential threshold effect, heterogeneity, and publication bias were investigated. We also evaluated the clinical utility of DWI in diagnosis of lung lesions. RESULTS Seventeen studies comprising 855 malignant and 322 benign lesions were included in this meta-analysis. There was no significant threshold effect. Summary receiver operating characteristic curve showed that AUC was 0.909 (95% confidence interval [CI], 0.862-0.931). Pooled weighted estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were 0.828 (95% CI, 0.801-0.853), 0.801 (95% CI, 0.753-0.843), 4.01 (95% CI, 2.78-5.80), and 0.20 (95% CI, 0.15-0.27), respectively. Heterogeneity was found to have stemmed primarily from study design (retrospective or prospective study). Subgroup analysis showed that diagnostic performance (sensitivity, 0.88; 95% CI, 0.82-0.92 and specificity, 0.89; 95% CI, 0.79-0.96) of retrospectively designed studies was significantly higher than that of prospectively designed studies. The Deeks' funnel plot indicated the absence of publication bias. CONCLUSIONS With respect to the accuracy and DOR, DWI is useful for differentiation between malignant and benign pulmonary nodules or masses. Diagnostic test accuracy is not the be-all and end-all of diagnostic testing. Concerning PLR and NLR, DWI may not help to alter posttest probability compared to pretest probability to sufficiently alter physician's decision making. Future analyses should be conducted in large-scale, high-quality trials to evaluate its clinical value and establish standards of DWI measurement, analysis, and cutoff values of diagnosis.
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Affiliation(s)
- Bin Li
- Department of Radiology, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China
| | - Qiong Li
- Department of Radiology, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China
| | - Cong Chen
- Radiation Treatment Center, 100 Hospital of PLA, Suzhou, Jiangsu Province, China
| | - Yu Guan
- Department of Radiology, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China
| | - Shiyuan Liu
- Department of Radiology, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China.
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Characterisation of solitary pulmonary lesions combining visual perfusion and quantitative diffusion MR imaging. Eur Radiol 2013; 24:531-41. [PMID: 24173597 DOI: 10.1007/s00330-013-3053-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/14/2013] [Accepted: 10/08/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of dynamic contrast-enhanced (DCE) magnetic resonance (MR) and diffusion-weighted imaging (DWI) sequences for defining benignity or malignancy of solitary pulmonary lesions (SPL). METHODS First, 54 consecutive patients with SPL, clinically staged (CT and PET or integrated PET-CT) as N0M0, were included in this prospective study. An additional 3-Tesla MR examination including DCE and DWI was performed 1 day before the surgical procedure. Histopathology of the surgical specimen served as the standard of reference. Subsequently, this functional method of SPL characterisation was validated with a second cohort of 54 patients. RESULTS In the feasibility group, 11 benign and 43 malignant SPL were included. Using the combination of conventional MR sequences with visual interpretation of DCE-MR curves resulted in a sensitivity, specificity and accuracy of 100%, 55% and 91%, respectively. These results can be improved by DWI (with a cut-off value of 1.52 × 10(-3) mm(2)/s for ADChigh) leading to a sensitivity, specificity and accuracy of 98%, 82% and 94%, respectively. In the validation group these results were confirmed. CONCLUSION Visual DCE-MR-based curve interpretation can be used for initial differentiation of benign from malignant SPL, while additional quantitative DWI-based interpretation can further improve the specificity. KEY POINTS • Magnetic resonance imaging is increasingly being used to help differentiate lung lesions. • Solitary pulmonary lesions (SPL) are accurately characterised by combining DCE-MRI and DWI. • Visual DCE-MRI assessment facilitates the diagnostic throughput in patients with SPL. • DWI provides additional information in inconclusive DCE-MRI (type B pattern).
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Amini B, Huang SY, Tsai J, Benveniste MF, Robledo HH, Lee EY. Primary lung and large airway neoplasms in children: current imaging evaluation with multidetector computed tomography. Radiol Clin North Am 2013; 51:637-57. [PMID: 23830790 DOI: 10.1016/j.rcl.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Multidetector computed tomography (MDCT) offers an important noninvasive imaging modality for confirmation and further characterization of primary lung and large airway neoplasms encountered in pediatric patients. Children represent a unique challenge in imaging, not only because of unique patient factors (eg, inability to follow instructions, motion, need for sedation) but because of the technical factors that must be optimized to reduce radiation dose. This article reviews an MDCT imaging algorithm, up-to-date imaging techniques, and clinical applications of MDCT for evaluating benign and malignant primary neoplasms of lung and large airway in infants and children.
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Affiliation(s)
- Behrang Amini
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Tanaka R, Nakazato Y, Horikoshi H, Tsuchida S, Yoshida T, Nakazato Y, Tachibana K, Kondo H, Goya T. Diffusion-weighted imaging and positron emission tomography in various cytological subtypes of primary lung adenocarcinoma. Clin Imaging 2013; 37:876-83. [DOI: 10.1016/j.clinimag.2013.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 05/12/2013] [Accepted: 06/04/2013] [Indexed: 11/25/2022]
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18
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Nakatani Y, Petersen I, Roggli V, Thunnissen E, Tsao M. Diagnosis of lung adenocarcinoma in resected specimens: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2013; 137:685-705. [PMID: 22913371 DOI: 10.5858/arpa.2012-0264-ra] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new lung adenocarcinoma classification has been published by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. This new classification is needed to provide uniform terminology and diagnostic criteria, most especially for bronchioloalveolar carcinoma. It was developed by an international core panel of experts representing all 3 societies with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons.This summary focuses on the aspects of this classification that address resection specimens. The terms bronchioloalveolar carcinoma and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced, such as adenocarcinoma in situ and minimally invasive adenocarcinoma for small solitary adenocarcinomas with either pure lepidic growth (adenocarcinoma in situ) and predominant lepidic growth with invasion of 5 mm or less (minimally invasive adenocarcinoma), to define the condition of patients who will have 100% or near 100% disease-specific survival, respectively, if they undergo complete lesion resection. Adenocarcinoma in situ and minimally invasive adenocarcinoma are usually nonmucinous, but rarely may be mucinous. Invasive adenocarcinomas are now classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous bronchioloalveolar carcinoma), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous bronchioloalveolar carcinoma), colloid, fetal, and enteric adenocarcinoma.It is possible that this classification may impact the next revision of the TNM staging classification, with adjustment of the size T factor according to only the invasive component pathologically in adenocarcinomas with lepidic areas.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Abstract
This review provides an overview of the current status of the published data on diffusion magnetic resonance (MR) imaging of chest tumors. Diffusion MR imaging is a non-invasive imaging technique that measures the differences in water mobility in different tissue microstructures and quantifies them based on the apparent diffusion coefficient. Diffusion MR imaging has been used for the characterization, grading and staging of lung cancer as well as for differentiating central tumors from post-obstructive consolidation. In addition, this technique helps in differentiating malignant from benign pulmonary and mediastinal tumors as well as in the characterization of pleural mesothelioma and effusion. Diffusion MR imaging can be incorporated into routine morphological MR imaging to improve radiologist confidence in image interpretation and to provide functional assessments of chest tumors during the same examination. Diffusion MR imaging could be used in the future as a functional imaging technique for tumors of the chest.
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Affiliation(s)
- A A K Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt.
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20
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Can diffusion-weighted imaging be used as a reliable sequence in the detection of malignant pulmonary nodules and masses? Magn Reson Imaging 2012; 31:235-46. [PMID: 22902469 DOI: 10.1016/j.mri.2012.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/13/2012] [Accepted: 07/18/2012] [Indexed: 12/14/2022]
Abstract
Recent developments in diffusion-weighted magnetic resonance imaging (DWI) make it possible to image malignant tumors to provide tissue contrast based on difference with the diffusion of water molecules among tissues, which can be measured by the apparent diffusion coefficient (ADC) value. We aimed to assess the diagnostic accuracy of DWI for benign/malignant discrimination of pulmonary nodules/masses with a meta-analysis. The MEDLINE, EMBASE, Cancerlit and Cochrane Library database, from January 2001 to August 2011, were searched for studies evaluating the diagnostic accuracy of DWI for benign/malignant discrimination of pulmonary nodules. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LRP and LRN), and constructed summary receiver operating characteristic SROC) curves. Across 10 studies (545 patients), there was no evidence of publication bias (P=.22, bias=-19.19). DWI had a pooled sensitivity of 0.84 (95% CI, 0.76-0.90) and a pooled specificity of 0.84 (95% CI, 0.64-0.94). Overall, LRP was 5.3 (95% CI, 2.1-13.0) and LRN was 0.19 (95% CI, 0.12-0.30). In patients with high pretest probabilities, DWI enabled confirmation of malignant pulmonary lesion; in patients with low pretest probabilities, DWI enabled exclusion of malignant pulmonary lesion. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 84% and 16% for positive and negative DWI results, respectively. Diffusion-weighted magnetic resonance imaging can be used to differentiate malignant from benign pulmonary lesions. High-quality prospective studies regarding DWI in the evaluation of pulmonary nodules are still needed to be conducted.
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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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22
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Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging. Radiol Oncol 2012; 46:106-13. [PMID: 23077446 PMCID: PMC3472932 DOI: 10.2478/v10019-012-0021-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 01/08/2012] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to evaluate the role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of lung lesions. Patients and methods. Sixty-seven patients with lung lesions (48 malignant, 19 benign) were included in this prospective study. Signal intensities (SIs) were measured in diffusion-weighted MR images that were obtained with b=0, 500 and 1000 s/mm2 values. Apparent diffusion coefficient (ADC) maps were calculated by using images with b=0 and 1000 s/mm2 values. The statistical significance was determined using the Student-t test. Results The SIs of malignant lesions were significantly higher than those of benign lesions (p<0.004 for b=0 s/mm2 and p<0.000 for the other b values). Using b=500 s/mm2, SI≥391 indicated a malignant lesion with a sensitivity of 95%, specificity of 73% and positive predictive value of 87%. Using b=1000 s/mm2, SI≥277 indicated a malignant lesion with a sensitivity of 93%, specificity of 69% and positive predictive value of 85%. There was no significant difference between malignant and benign lesions regarding ADC values (p=0.675). There was no significant difference in SIs or ADC values between small cell carcinoma and non-small cell carcinoma. When comparing undifferentiated with well- partially differentiated cancers, SIs were higher with all b values, but the difference was statistically significant only with b=1000 s/mm2 (p<0.04). Conclusions Diffusion-weighteted MR trace image SI is useful for the differentiation of malignant versus benign lung lesions.
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Tanaka R, Horikoshi H, Yoshida T, Nakazato Y, Seki E, Goya T. Diffusion-weighted magnetic resonance imaging in differentiating the invasiveness of small lung adenocarcinoma. Acta Radiol 2011; 52:750-5. [PMID: 21565888 DOI: 10.1258/ar.2011.110108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) with several sequences may provide a valuable additional modality for evaluating the grade of invasiveness lesions. Diffusion-weighted magnetic resonance imaging (DWI) represents the biological characteristics of tissues. PURPOSE To retrospectively evaluate the usefulness of DWI for evaluating the invasiveness of small lung adenocarcinomas. MATERIAL AND METHODS From May 2005 to June 2008, 46 patients with lung adenocarcinomas measuring 2 cm or less across the greatest dimension underwent a preoperative MRI study followed by surgery at the Gunma Prefectural Cancer Center. Fourteen of the tumors were bronchioloalveolar carcinomas (so-called Noguchi's type A+B group), 26 were adenocarcinomas with mixed subtypes (type C group) and six were other histological subtypes of adenocarcinomas (type D+E+F group). The mean signal intensities of a lesion (DWI) and the spinal cord (SC) were analyzed in the region of interests (ROIs), and the mean DWI/SC ratio was then calculated with the value of DWI divided by the value of SC. RESULTS The calculated mean DWI/SC ratio for the lesions were as follows: 0.448±0.261 (mean±standard deviation [SD]) for type A+B group, 0.963±0.465 for type C group, and 0.816±0.291 for type D+E+F group. The mean DWI/SC ratio of type A+B group was significantly lower than that for the type C (P = 0.0005) or type D+E+F groups (P = 0.0117). CONCLUSION DWI may thus provide useful supplementary information before determining the surgical strategy, including a limited resection.
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Affiliation(s)
- Ryota Tanaka
- Department of Surgery, Kyorin University School of Medicine, Tokyo
- Department of Thoracic Surgery
| | | | - Tsutomu Yoshida
- Department of Surgery, Kyorin University School of Medicine, Tokyo
| | - Yoshimasa Nakazato
- Department of Thoracic Surgery
- Department of Pathology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Erina Seki
- Department of Surgery, Kyorin University School of Medicine, Tokyo
| | - Tomoyuki Goya
- Department of Surgery, Kyorin University School of Medicine, Tokyo
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Liang X, Congxin W, Yi Z, Jinwen H, Chuanfu L. Whole-body diffusion-weighted MR imaging with fat suppression by using STIR: Clinical utility for detection of primary malignancies in patients initially presented with metastasis. Eur J Radiol 2011; 79:359-62. [DOI: 10.1016/j.ejrad.2010.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 02/17/2010] [Indexed: 10/19/2022]
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Pauls S, Breining T, Muche R, Schmidt SA, Wunderlich A, Krüger S, Brambs HJ, Feuerlein S. The role of dynamic, contrast-enhanced MRI in differentiating lung tumor subtypes. Clin Imaging 2011; 35:259-65. [DOI: 10.1016/j.clinimag.2010.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 05/21/2010] [Indexed: 10/28/2022]
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Malignant versus benign mediastinal lesions: quantitative assessment with diffusion weighted MR imaging. Eur Radiol 2011; 21:2255-60. [DOI: 10.1007/s00330-011-2180-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 05/03/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
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Luna A, Sánchez-Gonzalez J, Caro P. Diffusion-weighted imaging of the chest. Magn Reson Imaging Clin N Am 2011; 19:69-94. [PMID: 21129636 DOI: 10.1016/j.mric.2010.09.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diffusion-weighted imaging (DWI) is feasible in the chest with currently available MR imaging scanners, although it is technically demanding. Although there is scarce clinical experience, the use of DWI has shown promising results in the characterization of pulmonary nodules, in lung cancer characterization and staging, and in the evaluation of mediastinal and pleural pathology. Ongoing research opens a door to noninvasive evaluation of heart fibers by means of diffusion-tensor imaging. Another area under investigation is the use of DWI of hyperpolarized gases as an early biomarker of pulmonary disease.
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Affiliation(s)
- Antonio Luna
- MR Unit, SERCOSA, Health Time Group, Clinica las Nieves, Carmelo Torres 2, 23007 Jaén, Spain.
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Henzler T, Schmid-Bindert G, Schoenberg SO, Fink C. Diffusion and perfusion MRI of the lung and mediastinum. Eur J Radiol 2011; 76:329-36. [PMID: 20627435 DOI: 10.1016/j.ejrad.2010.05.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 05/05/2010] [Indexed: 11/29/2022]
Abstract
With ongoing technical improvements such as multichannel MRI, systems with powerful gradients as well as the development of innovative pulse sequence techniques implementing parallel imaging, MRI has now entered the stage of a radiation-free alternative to computed tomography (CT) for chest imaging in clinical practice. Whereas in the past MRI of the lung was focused on morphological aspects, current MRI techniques also enable functional imaging of the lung allowing for a comprehensive assessment of lung disease in a single MRI exam. Perfusion imaging can be used for the visualization of regional pulmonary perfusion in patients with different lung diseases such as lung cancer, chronic obstructive lung disease, pulmonary embolism or for the prediction of postoperative lung function in lung cancer patients. Over the past years diffusion-weighted MR imaging (DW-MRI) of the thorax has become feasible with a significant reduction of the acquisition time, thus minimizing artifacts from respiratory and cardiac motion. In chest imaging, DW-MRI has been mainly suggested for the characterization of lung cancer, lymph nodes and pulmonary metastases. In this review article recent MR perfusion and diffusion techniques of the lung and mediastinum as well as their clinical applications are reviewed.
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Affiliation(s)
- Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Germany.
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JHM, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6:244-85. [PMID: 21252716 PMCID: PMC4513953 DOI: 10.1097/jto.0b013e318206a221] [Citation(s) in RCA: 3397] [Impact Index Per Article: 261.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. METHODS An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤ 5 mm invasion (MIA) to define patients who, if they undergo complete resection, will have 100% or near 100% disease-specific survival, respectively. AIS and MIA are usually nonmucinous but rarely may be mucinous. Invasive adenocarcinomas are classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous BAC), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous BAC), colloid, fetal, and enteric adenocarcinoma. This classification provides guidance for small biopsies and cytology specimens, as approximately 70% of lung cancers are diagnosed in such samples. Non-small cell lung carcinomas (NSCLCs), in patients with advanced-stage disease, are to be classified into more specific types such as adenocarcinoma or squamous cell carcinoma, whenever possible for several reasons: (1) adenocarcinoma or NSCLC not otherwise specified should be tested for epidermal growth factor receptor (EGFR) mutations as the presence of these mutations is predictive of responsiveness to EGFR tyrosine kinase inhibitors, (2) adenocarcinoma histology is a strong predictor for improved outcome with pemetrexed therapy compared with squamous cell carcinoma, and (3) potential life-threatening hemorrhage may occur in patients with squamous cell carcinoma who receive bevacizumab. If the tumor cannot be classified based on light microscopy alone, special studies such as immunohistochemistry and/or mucin stains should be applied to classify the tumor further. Use of the term NSCLC not otherwise specified should be minimized. CONCLUSIONS This new classification strategy is based on a multidisciplinary approach to diagnosis of lung adenocarcinoma that incorporates clinical, molecular, radiologic, and surgical issues, but it is primarily based on histology. This classification is intended to support clinical practice, and research investigation and clinical trials. As EGFR mutation is a validated predictive marker for response and progression-free survival with EGFR tyrosine kinase inhibitors in advanced lung adenocarcinoma, we recommend that patients with advanced adenocarcinomas be tested for EGFR mutation. This has implications for strategic management of tissue, particularly for small biopsies and cytology samples, to maximize high-quality tissue available for molecular studies. Potential impact for tumor, node, and metastasis staging include adjustment of the size T factor according to only the invasive component (1) pathologically in invasive tumors with lepidic areas or (2) radiologically by measuring the solid component of part-solid nodules.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Usefulness of diffusion-weighted MR imaging in the evaluation of pulmonary lesions. Eur Radiol 2009; 20:807-15. [PMID: 19862533 DOI: 10.1007/s00330-009-1629-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 08/16/2009] [Accepted: 08/20/2009] [Indexed: 12/20/2022]
Abstract
PURPOSE The role of diffusion-weighted MR imaging (DWI) in the differential diagnosis of pulmonary malignant tumours and solid benign lesions was investigated. METHODS Sixty-two patients with 66 lesions underwent conventional MRI and DWI (diffusion factor of 0 and 500 s/mm(2)) examinations with 1.5-T MRI. The signal intensity of DWI images was observed and the apparent diffusion coefficient (ADC) values of the lesions were measured. Statistical analyses were performed with the independent samples t test, Pearson's chi-square test and receiver operating characteristic (ROC) analysis. RESULTS The signal intensities of pulmonary malignant tumours and solid benign lesions were not significantly different, but the ADC value of benign lesions was statistically higher than that of malignant tumours (p = 0.001). By ROC analysis, the optimal threshold of ADC was 1.400 x 10(-3) mm(2)/s and the sensitivity and specificity were 83.3% and 74.1%, respectively. There were statistical differences between small cell carcinoma (SCLC) and non-small cell carcinoma (NSCLC) as well; the former was lower than the latter (p = 0.007). CONCLUSION Our data indicate that quantitative analysis of ADC values may help diagnose or distinguish pulmonary lesions, and it also provides a promising method for characterising the pulmonary masses.
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