1
|
Jahn M, Layer G. [Multiparametric MRI in hepatocellular carcinoma, part 2 : Diffusion-weighted imaging in the primary diagnostics and treatment monitoring]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:587-596. [PMID: 38884639 DOI: 10.1007/s00117-024-01323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/18/2024]
Abstract
In addition to morphology and tissue perfusion, diffusion-weighted imaging (DWI) is the third pillar of multiparametric diagnostics in oncology. Due to the strong correlation between the apparent diffusion coefficient (ADC) and cell count in hepatocellular carcinoma (HCC), it can be used as a surrogate marker for tumor cell quantity. Therefore, ADC effectively reflects the effects of cytoreductive treatment, such as transarterial chemoembolization (TACE) and systemic chemotherapy and becomes an important clinical marker for treatment response. The DWI should remain an integral part of a magnetic resonance imaging (MRI) protocol in primary HCC diagnostics and treatment monitoring but is of secondary clinical importance compared to contrast-enhanced MRI perfusion sequences and the use of liver-specific contrast agents. For the future, standardization of DWI sequences for better comparability of various study protocols would be desirable.
Collapse
Affiliation(s)
- Mona Jahn
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstraße 79, 67063, Ludwigshafen, Deutschland.
| | - Günter Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstraße 79, 67063, Ludwigshafen, Deutschland
| |
Collapse
|
2
|
Rata M, De Paepe KN, Orton MR, Castagnoli F, d'Arcy J, Winfield JM, Hughes J, Stemmer A, Nickel MD, Koh DM. Evaluation of simultaneous multi-slice acquisition with advanced processing for free-breathing diffusion-weighted imaging in patients with liver metastasis. Eur Radiol 2024; 34:2457-2467. [PMID: 37776361 PMCID: PMC10957610 DOI: 10.1007/s00330-023-10234-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) acquisition and advanced processing can accelerate acquisition time and improve MR image quality. This study evaluated the image quality and apparent diffusion coefficient (ADC) measurements of free-breathing DWI acquired from patients with liver metastases using a prototype SMS-DWI acquisition (with/without an advanced processing option) and conventional DWI. METHODS Four DWI schemes were compared in a pilot 5-patient cohort; three DWI schemes were further assessed in a 24-patient cohort. Two readers scored image quality of all b-value images and ADC maps across the three methods. ADC measurements were performed, for all three methods, in left and right liver parenchyma, spleen, and liver metastases. The Friedman non-parametric test (post-hoc Wilcoxon test with Bonferroni correction) was used to compare image quality scoring; t-test was used for ADC comparisons. RESULTS SMS-DWI was faster (by 24%) than conventional DWI. Both readers scored the SMS-DWI with advanced processing as having the best image quality for highest b-value images (b750) and ADC maps; Cohen's kappa inter-reader agreement was 0.6 for b750 image and 0.56 for ADC maps. The prototype SMS-DWI sequence with advanced processing allowed a better visualization of the left lobe of the liver. ADC measured in liver parenchyma, spleen, and liver metastases using the SMS-DWI with advanced processing option showed lower values than those derived from the SMS-DWI method alone (t-test, p < 0.0001; p < 0.0001; p = 0.002). CONCLUSIONS Free-breathing SMS-DWI with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. CLINICAL RELEVANCE STATEMENT Free-breathing simultaneous multi-slice- diffusion-weighted imaging (DWI) with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. KEY POINTS • Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) can accelerate acquisition time and improve image quality. • Apparent diffusion coefficients (ADC) measured in liver parenchyma, spleen, and liver metastases using the simultaneous multi-slice DWI with advanced processing were significantly lower than those derived from the simultaneous multi-slice DWI method alone. • Simultaneous multi-slice DWI sequence with inline advanced processing was faster and demonstrated better image quality in liver patients.
Collapse
Affiliation(s)
- Mihaela Rata
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - Katja N De Paepe
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew R Orton
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Francesca Castagnoli
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - James d'Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Jessica M Winfield
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Julie Hughes
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alto Stemmer
- Siemens Healthcare GmbH, MR Application Predevelopment, Erlangen, Germany
| | | | - Dow-Mu Koh
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| |
Collapse
|
3
|
Sobeh T, Inbar Y, Apter S, Soffer S, Anteby R, Kraus M, Konen E, Klang E. Diffusion-weighted MRI for predicting and assessing treatment response of liver metastases from CRC - A systematic review and meta-analysis. Eur J Radiol 2023; 163:110810. [PMID: 37075628 DOI: 10.1016/j.ejrad.2023.110810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
The evaluation of response to chemotherapy and targeted therapies in colorectal liver metastases has traditionally been based on size changes, as per the RECIST criteria. However, therapy may alter tissue composition and not only tumor size, therefore, functional imaging techniques such as diffusion-weighted magnetic resonance imaging (DWI) may offer a more comprehensive assessment of treatment response. The aim of this systematic review and meta-analysis was to evaluate the use of DWI in the prediction and assessment of response to treatment in colorectal liver metastases and to determine if there is a baseline apparent diffusion coefficient (ADC) cut-off value that can predict a favorable response. A literature search was conducted using the MEDLINE/PubMed database, and risk of bias was evaluated using the QUADAS-2 tool. The mean differences between responders and non-responders were pooled. A total of 16 studies met the inclusion criteria, and various diffusion-derived techniques and coefficients were found to have potential for predicting and assessing treatment response. However, discrepancies were noted between studies. The most consistent predictor of response was a lower baseline ADC value calculated using traditional mono-exponential methods. Non-mono-exponential techniques for calculating DWI-derived parameters were also reported. A meta-analysis of a subset of studies failed to establish a cut-off value of ADC due to heterogeneity, but revealed a pooled mean difference of -0.12 × 10-3 mm2/s between responders and non-responders. The results of this systematic review suggest that diffusion-derived techniques and coefficients may contribute to the evaluation and prediction of treatment response in colorectal liver metastases. Further controlled prospective studies are needed to confirm these findings and to guide clinical and radiological decision-making in the management of patients with CRC liver metastases.
Collapse
Affiliation(s)
- Tamer Sobeh
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yael Inbar
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Apter
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel; Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Roi Anteby
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of General Surgery, Sheba Medical Center at Tel HaShomer, Israel
| | - Matan Kraus
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Afat S, Herrmann J, Almansour H, Benkert T, Weiland E, Hölldobler T, Nikolaou K, Gassenmaier S. Acquisition time reduction of diffusion-weighted liver imaging using deep learning image reconstruction. Diagn Interv Imaging 2023; 104:178-184. [PMID: 36787419 DOI: 10.1016/j.diii.2022.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of deep learning accelerated diffusion-weighted imaging (DWIDL) in 1.5-T liver MRI on image quality, sharpness, and diagnostic confidence. MATERIALS AND METHODS One-hundred patients who underwent liver MRI at 1.5-T including DWI with two different b-values (50 and 800 s/mm²) between February and April 2022 were retrospectively included. There were 54 men and 46 women, with a mean age of 59 ± 14 (SD) years (range: 21-88 years). The single average raw data were retrospectively processed using a deep learning (DL) image reconstruction algorithm leading to a simulated acquisition time of 1 min 28 s for DWIDL as compared to 2 min 31 s for standard DWI (DWIStd) via reduction of signal averages. All DWI datasets were reviewed by four radiologists using a Likert scale ranging from 1-4 using the following criteria: noise level, extent of artifacts, sharpness, overall image quality, and diagnostic confidence. Furthermore, quantitative assessment of noise and signal-to-noise ratio (SNR) was performed via regions of interest. RESULTS No significant differences were found regarding artifacts and overall image quality (P > 0.05). Noise measurements for the spleen, liver, and erector spinae muscles revealed significantly lower noise for DWIDL versus DWIStd (P < 0.001). SNR measurements in the above-mentioned tissues also showed significantly superior results for DWIDL versus DWIStd for b = 50 s/mm² and ADC maps (all P < 0.001). For b = 800 s/mm², significantly superior results were found for the spleen, right hemiliver, and erector spinae muscles. CONCLUSIONS DL image reconstruction of liver DWI at 1.5-T is feasible including significant reduction of acquisition time without compromised image quality.
Collapse
Affiliation(s)
- Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany.
| | - Judith Herrmann
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany
| | - Haidara Almansour
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany
| | - Thomas Benkert
- MR Applications Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, Erlangen 91052, Germany
| | - Elisabeth Weiland
- MR Applications Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, Erlangen 91052, Germany
| | - Thomas Hölldobler
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany; Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tuebingen, Germany
| | - Sebastian Gassenmaier
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
| | | | | | - Yu Ueda
- MR Clinical Science, Philips Japan Ltd
| | | |
Collapse
|
6
|
Abdulaal OM, MacMahon PJ, Rainford L, Cradock A, O’Driscoll D, Galligan M, Alshoabi SA, Alsharif W, McGee A. Evaluation of image quality of diffusion weighted readout segmentation of long variable echo-trains MR pulse sequence for lumbosacral nerve imaging at 3T. Quant Imaging Med Surg 2023; 13:196-209. [PMID: 36620175 PMCID: PMC9816736 DOI: 10.21037/qims-22-191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022]
Abstract
Background Limited magnetic resonance (MR) pulse sequences facilitate lumbosacral nerve imaging with acceptable image quality. This study aimed to evaluate the impact of parameter modification for Diffusion Weighted Image (DWI) using Readout Segmentation of Long Variable Echo-trains (RESOLVE) sequence with opportunities for improving the visibility of lumbosacral nerves and image quality. Methods Following ethical approval and acquisition of informed consent, imaging of an MR phantom and twenty healthy volunteers (n=20) was prospectively performed with 3T MRI scanner. Acquired sequences included standard two-dimensional (2D) turbo spin echo sequences and readout-segmented echo-planar imaging (EPI) DWI-RESOLVE using three different b-values b-50, b-500 and b-800 s/mm2. Signal-to-noise ratio (SNR), apparent diffusion coefficient (ADC) and nerve size were measured. Two musculoskeletal radiologists evaluated anatomical structure visualisation and image quality. Quantitative and qualitative findings for healthy volunteers were investigated for differences using Wilcoxon signed-rank and Friedman tests, respectively. Inter and intra-observer agreement was determined with κ statistics. Results Phantom images revealed higher SNR for images with low b-values with 206.1 (±10.9), 125.1 (±45.2) and 59.2 (±17.8) for DWI-RESOLVE images acquired at b50, b500 and b800, respectively. Comparable results were found for SNR, ADC and nerve size across normal right and left sided for healthy volunteer images. The SNR findings for b-50 images were higher than b-500 and b-800 images for healthy volunteer images. The qualitative findings ranked images acquired using b-50 and b-500 images significantly higher than corresponding b-800 images (P<0.05). Inter and intra-observer agreements for evaluation across all b-values ranged from 0.59 to 0.81 and 0.83 to 0.92, respectively. Conclusions The modified DWI-RESOLVE images facilitated visualization of the normal lumbosacral nerves with acceptable image quality, which support the clinical applicability of this sequence.
Collapse
Affiliation(s)
- Osamah M. Abdulaal
- Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madina, Saudi Arabia;,Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter J. MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland;,School of Medicine, University College Dublin, Dublin, Ireland
| | - Louise Rainford
- Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Andrea Cradock
- Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Dearbhail O’Driscoll
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marie Galligan
- Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sultan A. Alshoabi
- Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madina, Saudi Arabia
| | - Walaa Alsharif
- Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madina, Saudi Arabia
| | - Allison McGee
- Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
7
|
Fan PL, Chu J, Wang Q, Wang C. The clinical value of dual-energy computed tomography and diffusion-weighted imaging in the context of liver cancer: A narrative review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:862-868. [PMID: 35338779 DOI: 10.1002/jcu.23197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/22/2022] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
The dual-energy computed tomography (DECT) and diffusion-weighted magnetic resonance imaging (DWI-MRI) are used to diagnose liver cancer. The clinical value of these two examination methods needs to be further summarized. We collected and summarized relevant literature published from 2011 to 2021. The diagnostic performance of DECT was assessed between conventional computed tomography and DWI-MRI. DWI-MRI had a 69% sensitivity for detecting small hepatocellular carcinoma (HCC) lesions and a 60% diagnostic specificity for differentiating between types of HCC lesions. DECT had a sensitivity to small liver lesions (<1 cm) of 69%, and the diagnostic specificity for HCC and metastasis was about 60%. DWI was more sensitive (90.3% vs. 74.9%) and accurate (91.9% vs. 76.9%) in diagnosing HCC compared with conventional MRI sequencing. With the aid of contrast media, DWI-MRI had 90.0% specificity for detecting small HCCs (smaller than 1 cm). Furthermore, DWI-MRI not only provided physicians with valuable diagnostic information but also delivered histological grading information, with 78% accuracy for all benign lesions and 71% for solid lesions. DECT had relatively high sensitivity and required a lower contrast medium dose. With standardized quantitative parameters, it can be an extremely useful tool for HCC surveillance. DWI-MRI is the preferred imaging process as it produces high-contrast images for supporting an early diagnosis (high sensitivity and specificity) and provides histological information using non-ionizing radiation.
Collapse
Affiliation(s)
- Pei-Lin Fan
- Discipline of Diagnostic Radiography, University of Sydney, Sydney, Australia
| | - Jun Chu
- Discipline of Diagnostic Radiography, University of Sydney, Sydney, Australia
| | - Qing Wang
- Discipline of Diagnostic Radiography, University of Sydney, Sydney, Australia
| | - Chen Wang
- Discipline of Diagnostic Radiography, University of Sydney, Sydney, Australia
| |
Collapse
|
8
|
A Scoring System for Predicting Microvascular Invasion in Hepatocellular Carcinoma Based on Quantitative Functional MRI. J Clin Med 2022; 11:jcm11133789. [PMID: 35807074 PMCID: PMC9267530 DOI: 10.3390/jcm11133789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is a histopathological marker and risk factor for HCC recurrence. We integrated diffusion-weighted imaging (DWI) and magnetic resonance (MR) image findings of tumors into a scoring system for predicting MVI. In total, 228 HCC patients with pathologically confirmed MVI who underwent surgical resection or liver transplant between November 2012 and March 2021 were enrolled retrospectively. Patients were divided into a right liver lobe group (n = 173, 75.9%) as the model dataset and a left liver lobe group (n = 55, 24.1%) as the model validation dataset. Multivariate logistic regression identified two-segment involved tumor (Score: 1; OR: 3.14; 95% CI: 1.22 to 8.06; p = 0.017); ADCmin ≤ 0.95 × 10−3 mm2/s (Score: 2; OR: 10.88; 95% CI: 4.61 to 25.68; p = 0.000); and largest single tumor diameter ≥ 3 cm (Score: 1; OR: 5.05; 95% CI: 2.25 to 11.30; p = 0.000), as predictive factors for the scoring model. Among all patients, sensitivity was 89.66%, specificity 58.04%, positive predictive value 68.87%, and negative predictive value 84.41%. For validation of left lobe group, sensitivity was 80.64%, specificity 70.83%, positive predictive value 78.12%, and negative predictive value 73.91%. The scoring model using ADCmin, largest tumor diameter, and two-segment involved tumor provides high sensitivity and negative predictive value in MVI prediction for use in routine functional MR.
Collapse
|
9
|
Borgheresi A, De Muzio F, Agostini A, Ottaviani L, Bruno A, Granata V, Fusco R, Danti G, Flammia F, Grassi R, Grassi F, Bruno F, Palumbo P, Barile A, Miele V, Giovagnoni A. Lymph Nodes Evaluation in Rectal Cancer: Where Do We Stand and Future Perspective. J Clin Med 2022; 11:jcm11092599. [PMID: 35566723 PMCID: PMC9104021 DOI: 10.3390/jcm11092599] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/12/2022] Open
Abstract
The assessment of nodal involvement in patients with rectal cancer (RC) is fundamental in disease management. Magnetic Resonance Imaging (MRI) is routinely used for local and nodal staging of RC by using morphological criteria. The actual dimensional and morphological criteria for nodal assessment present several limitations in terms of sensitivity and specificity. For these reasons, several different techniques, such as Diffusion Weighted Imaging (DWI), Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Dynamic Contrast Enhancement (DCE) in MRI have been introduced but still not fully validated. Positron Emission Tomography (PET)/CT plays a pivotal role in the assessment of LNs; more recently PET/MRI has been introduced. The advantages and limitations of these imaging modalities will be provided in this narrative review. The second part of the review includes experimental techniques, such as iron-oxide particles (SPIO), and dual-energy CT (DECT). Radiomics analysis is an active field of research, and the evidence about LNs in RC will be discussed. The review also discusses the different recommendations between the European and North American guidelines for the evaluation of LNs in RC, from anatomical considerations to structured reporting.
Collapse
Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
| | - Letizia Ottaviani
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale IRCCS di Napoli, 80131 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy
- Correspondence:
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Federica Flammia
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Roberta Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Francesca Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Abruzzo Health Unit 1, Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, 67100 L’Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
| |
Collapse
|
10
|
Mahmood KA, Rashid RJ, Fateh SM, Mohammed NA. Evaluation of the Effect of Patient Preparation Using Castor Oil on ADC Value of Focal Liver Lesion. Int J Gen Med 2021; 14:469-474. [PMID: 33623419 PMCID: PMC7896795 DOI: 10.2147/ijgm.s289661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the role of patient preparation using castor oil on the ADC value of focal liver lesion. Patients and Methods Retrospective case-control study over more than two years. Magnetic resonance imaging (MRI) scan, including diffusion-weighted imaging (DWI) of the upper abdomen performed for 87 cases and 71 controls in patients with focal hepatic hemangiomas. Cases were prepared using castor oil prior to the scan without identifiable unwanted effect, while controls did not receive any special preparation. Since liver hemangioma is a common lesion, it was selected and used as a sample. Apparent Diffusion Coefficient (ADC) values of focal liver lesion were calculated in cases and controls. Results The mean ADC value of liver hemangioma was lower in cases compared to controls; the mean ADC value was (2.21±0.39x10ˉ3mm2/s) in cases and (2.51±0.49x10ˉ3mm2/s) in controls. Left lobes were more affected by lesions; the mean ADC value of the left lobe lesions was (2.26±0.37 x10ˉ3mm2/s) and (2.86±0.43 x10ˉ3mm2/s) in cases and controls, respectively. The ADC value of lesions in the right lobe was (2.19±0.39x10ˉ3mm2/s) in cases and (2.39± 0.45x10ˉ3mm2/s) in controls. There was a significant segmental ADC variation; lesions at segments II, III, IVb, and V demonstrated illusive ADC elevation in controls. Conclusion There is erroneous elevation of lobar and segmental ADC value of liver hemangiomas in non prepared patients. This Potential source of error (peristalsis, partial volume, and paramagnetic gas effect of gastrointestinal tract) on hepatic lesions’ ADC value can be avoided by proper preparation using castor oil prior to MRI scanning.
Collapse
Affiliation(s)
- Kawa Abdulla Mahmood
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Rezheen Jamal Rashid
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Salah Mohammed Fateh
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Naser Abdullah Mohammed
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| |
Collapse
|
11
|
Association between liver diffusion-weighted imaging apparent diffusion coefficient values and other measures of liver disease in pediatric autoimmune liver disease patients. Abdom Radiol (NY) 2021; 46:197-204. [PMID: 32462385 DOI: 10.1007/s00261-020-02595-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple quantitative magnetic resonance imaging (MRI) methods have been described to noninvasively detect and characterize liver fibrosis, including diffusion-weighted imaging (DWI). PURPOSE To evaluate associations between liver MRI DWI apparent diffusion coefficient (ADC) values and clinical factors and other quantitative liver MRI metrics in pediatric patients with autoimmune liver disease (AILD). MATERIALS AND METHODS Fifty-seven research liver MRI examinations performed from January 2017 to August 2018 for pediatric AILD registry participants were evaluated. Liver DWI ADC values, liver and spleen stiffness (kPa), and iron-corrected T1 (cT1; Perspectum Diagnostics) were measured at four anatomic levels. Participant age, sex, and laboratory data (alanine aminotransferase [ALT], total bilirubin, alkaline phosphatase, gamma-glutamyl transferase [GGT]) were recorded. Spearman's rank-order correlation (rho) and multiple linear regression were used to evaluate the associations between liver ADC values and predictor variables. RESULTS Mean (SD) participant age was 14.8 (4.0) years, 45.6% (26/57) were girls. Mean liver DWI ADC value was 1.34 (0.14 × 10-3) mm2/s. Liver ADC values showed weak to moderate correlations with liver stiffness (r = - 0.42, p = 0.001), spleen stiffness (r = - 0.34; p = 0.015), whole-liver mean cT1 (r = - 0.39; p = 0.007), ALT (r = - 0.50; p = 0.0001), and GGT (r = - 0.48; p = 0.0004). Multiple linear regression showed liver stiffness (p = 0.0009) and sex (p = 0.023) to be independent predictors of liver ADC values. CONCLUSION Liver DWI ADC values are significantly associated with liver and spleen stiffnesses, liver cT1, ALT, GGT, and participant sex, with liver stiffness and sex remaining significant at multivariable regression. Liver ADC ultimately may play a role in multi-parametric prediction of chronic liver disease/fibrosis severity.
Collapse
|
12
|
Cancer Detection and Quantification of Treatment Response Using Diffusion-Weighted MRI. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
13
|
Steger GL, Salesov E, Richter H, Reusch CE, Kircher PR, Del Chicca F. Evaluation of the changes in hepatic apparent diffusion coefficient and hepatic fat fraction in healthy cats during body weight gain. Am J Vet Res 2020; 81:796-803. [PMID: 32969732 DOI: 10.2460/ajvr.81.10.796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the change in mean hepatic apparent diffusion coefficient (ADC) and hepatic fat fraction (HFF) during body weight gain in cats by use of MRI. ANIMALS 12 purpose-bred adult neutered male cats. PROCEDURES The cats underwent general health and MRI examination at time 0 (before dietary intervention) and time 1 (after 40 weeks of being fed high-energy food ad libitum). Sequences included multiple-echo gradient-recalled echo MRI and diffusion-weighted MRI with 3 b values (0, 400, and 800 s/mm2). Variables (body weight and the HFF and ADC in selected regions of interest in the liver parenchyma) were compared between time points by Wilcoxon paired-sample tests. Relationships among variables were assessed with generalized mixed-effects models. RESULTS Median body weight was 4.5 and 6.5 kg, mean ± SD HFF was 3.39 ± 0.89% and 5.37 ± 1.92%, and mean ± SD hepatic ADC was 1.21 ± 0.08 × 10-3 mm2/s and 1.01 ± 0.2 × 10-3 mm2/s at times 0 and 1, respectively. Significant differences between time points were found for body weight, HFF, and ADC. The HFF was positively associated with body weight and ADC was negatively associated with HFF. CONCLUSIONS AND CLINICAL RELEVANCE Similar to findings in people, cats had decreasing hepatic ADC as HFF increased. Protons associated with fat tissue in the liver may reduce diffusivity, resulting in a lower ADC than in liver with lower HFF. Longer studies and evaluation of cats with different nutritional states are necessary to further investigate these findings.
Collapse
|
14
|
Improved Liver Diffusion-Weighted Imaging at 3 T Using Respiratory Triggering in Combination With Simultaneous Multislice Acceleration. Invest Radiol 2020; 54:744-751. [PMID: 31335634 DOI: 10.1097/rli.0000000000000594] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study was to retrospectively compare optimized respiratory-triggered diffusion-weighted imaging with simultaneous multislice acceleration (SMS-RT-DWI) of the liver with a standard free-breathing echo-planar DWI (s-DWI) protocol at 3 T with respect to the imaging artifacts inherent to DWI. MATERIALS AND METHODS Fifty-two patients who underwent a magnetic resonance imaging study of the liver were included in this retrospective study. Examinations were performed on a 3 T whole-body magnetic resonance system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). In all patients, both s-DWI and SMS-RT-DWI of the liver were obtained. Images were qualitatively evaluated by 2 independent radiologists with regard to overall image quality, liver edge sharpness, sequence-related artifacts, and overall scan preference. For quantitative evaluation, signal-to-noise ratio was measured from signal-to-noise ratio maps. The mean apparent diffusion coefficient (ADC) was measured in each liver quadrant. The Wilcoxon rank-sum test was used for analysis of the qualitative parameters and the paired Student t test for quantitative parameters. RESULTS Overall image quality, liver edge sharpness, and sequence-related artifacts of SMS-RT-DWI received significantly better ratings compared with s-DWI (P < 0.05 for all). For 90.4% of the examinations, both readers overall preferred SMS-RT-DWI to s-DWI. Acquisition time for SMS-RT-DWI was 34% faster than s-DWI. Signal-to-noise ratio values were significantly higher for s-DWI at b50 but did not statistically differ at b800, and they were more homogenous for SMS-RT-DWI, with a significantly lower standard deviation at b50. Mean ADC values decreased from the left to right hepatic lobe as well as from cranial to caudal for s-DWI. With SMS-RT-DWI, mean ADC values were homogeneous throughout the liver. CONCLUSIONS Optimized, multislice, respiratory-triggered DWI of the liver at 3 T substantially improves image quality with a reduced scan acquisition time compared with s-DWI.
Collapse
|
15
|
Grudzinski IP, Ruzycka M, Cieszanowski A, Szeszkowski W, Badurek I, Malkowska A, Bamburowicz-Klimkowska M. MRI-based preclinical discovery of DILI: A lesson from paracetamol-induced hepatotoxicity. Regul Toxicol Pharmacol 2019; 108:104478. [PMID: 31539568 DOI: 10.1016/j.yrtph.2019.104478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
Abstract
Worldwide, drug-induced liver injury (DILI) is a major cause of hepatic failure. It is also the leading cause of withdrawal, cautionary labeling, and restricted usage of licensed drugs; therefore, European Medicines Agency (EMA) and United States Food and Drug Administration (FDA) warn that the existing methods of assessing DILI are insufficient and that some of the translational biomarkers of hepatotoxicity must be relooked. Magnetic resonance imaging (MRI) seems to be a proper tool in elucidating the effects of DILI in both preclinical and clinical studies, providing excellent visualization of the morphology of the liver parenchyma. Therefore, herein, we propose preclinical MRI assessment of liver injury in experimental paracetamol-treated rats. Quantitative MRI clearly provides evidence of adverse effects in the liver tissue caused by a single overdose of paracetamol (1 g kg-1 and 1.5 g kg-1 b.w.). The results of the MRI were confirmed by the histopathological examination (H&E) of the rat liver specimen, however the adverse effects were not disclosed due to standard aminotransferase assays (ALT/AST) in rat blood serum. The results of our analysis demonstrate the successful application of MRI in the examination of paracetamol-induced hepatotoxicity in rats; it has a potential to serve as the early diagnostic tool for the prediction of DILI in preclinical evaluation.
Collapse
Affiliation(s)
- Ireneusz P Grudzinski
- Department of Applied Toxicology, Medical University of Warsaw, Banacha 1 Str., 02-097, Warsaw, Poland.
| | - Monika Ruzycka
- Department of Applied Toxicology, Medical University of Warsaw, Banacha 1 Str., 02-097, Warsaw, Poland
| | - Andrzej Cieszanowski
- Department of Radiology I, Maria Sklodowska - Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 Str., 02-781, Warsaw, Poland
| | - Wojciech Szeszkowski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A Str., 02-097, Warsaw, Poland
| | - Iwona Badurek
- Department of Pathology, Medical University of Warsaw, Center for Biostructure Research, Chalubinskiego 5 Str., 02-004, Warsaw, Poland
| | - Anna Malkowska
- Department of Applied Toxicology, Medical University of Warsaw, Banacha 1 Str., 02-097, Warsaw, Poland
| | | |
Collapse
|
16
|
Diffusion Kurtosis MR Imaging versus Conventional Diffusion-Weighted Imaging for Distinguishing Hepatocellular Carcinoma from Benign Hepatic Nodules. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:2030147. [PMID: 31396023 PMCID: PMC6664697 DOI: 10.1155/2019/2030147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/09/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022]
Abstract
Objectives To assess the efficacy of diffusion kurtosis imaging (DKI) and compare DKI-derived parameters with conventional diffusion-weighted imaging (DWI) for distinguishing hepatocellular carcinoma (HCC) from benign hepatic nodules including focal nodular hyperplasia (FNH), hemangioma, and hepatocellular adenoma (HCA). Materials and Methods 151 patients with 182 hepatic nodules (114 HCCs and 68 benign nodules including 33 FNHs, 29 hemangiomas, and 6 HCAs) were analyzed. Preoperative MRI examinations including DKI (b values: 0, 200, 500, 800, 1500, and 2000 sec/mm2) were performed, and kurtosis (K), diffusivity (D), and apparent diffusion coefficient (ADC) were calculated. The efficacy of DKI-derived parameters K, D, and ADC for distinguishing HCC from these benign nodules was analyzed. Results ROC (receiver operating characteristic curve) analysis showed the optimal cutoff values of ADC, D, and K for identification of these benign nodules, and HCCs were 1.295 (area under the curve (AUC): 0.826; sensitivity 80.6%; specificity 70.8%), 1.787 (AUC: 0.770; sensitivity 83.6%; specificity 59.6%), and 1.002 (AUC: 0.761; sensitivity 65.5%; specificity 79.0%), respectively. Statistically significant differences were found in ADC, D, and K values between groups of HCC-FNH and HCC-hemangioma (P < 0.05). There were significant differences in K and ADC values between groups of FNH-hemangioma and HCA-hemangioma (P < 0.05), respectively. Using logistic regression analysis, a regression equation was obtained: Logit(P)=−1.982X1+1.385X3+1.948(X1: ADC; X3: K), and odds ratios (OR) were 0.138 (95% confidence interval (CI): 0.052, 0.367), and 8.996 (95% CI: 0.970, 16.460), respectively. Conclusion Both ADC value and DKI-derived parameters K and D values have demonstrated a higher preoperative efficacy in distinguishing HCC from FNH, hemangioma, and HCA. No evidence was shown to suggest D or K value was superior to the ADC value.
Collapse
|
17
|
Intra-individual comparison of conventional and simultaneous multislice-accelerated diffusion-weighted imaging in upper abdominal solid organs: value of ADC normalization using the spleen as a reference organ. Abdom Radiol (NY) 2019; 44:1808-1815. [PMID: 30737546 DOI: 10.1007/s00261-019-01924-5] [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: 02/07/2023]
Abstract
PURPOSE To compare the apparent diffusion coefficient (ADC) value of conventional diffusion-weighted imaging (cDWI) to simultaneous multislice-accelerated DWI (sDWI) and to evaluate the possibility of ADC normalization using the spleen as a reference organ. METHODS We retrospectively evaluated 92 patients (68 men, 24 women; mean age 60.0 years) who underwent liver magnetic resonance imaging (MRI) including both cDWI and sDWI. sDWI was obtained with an acceleration factor of 2. ADC values were measured from the right liver lobe, left liver lobe, spleen, pancreas, right kidney, and left kidney. ADC values of the spleen were used for normalization. Paired sample t test, Pearson's correlation coefficient, and Bland-Altman method were used for statistical analysis. RESULTS ADC values of cDWI were significantly lower than sDWI in all six anatomic regions (p < 0.001). The mean difference in ADC value between cDWI and sDWI ranged from 0.048 to 0.125 × 10-3 mm2/s. ADC values from cDWI and sDWI showed a moderate to very high positive correlation (p < 0.001). After ADC normalization using the spleen as a reference organ, there was no significant difference between normalized ADC of cDWI and sDWI in all 5 anatomic regions (p = 0.11 - 0.74). CONCLUSIONS Normalization of ADC using the spleen could be useful for comparing upper abdominal organs acquired with either cDWI or sDWI in longitudinal and follow-up studies.
Collapse
|
18
|
Shukla-Dave A, Obuchowski NA, Chenevert TL, Jambawalikar S, Schwartz LH, Malyarenko D, Huang W, Noworolski SM, Young RJ, Shiroishi MS, Kim H, Coolens C, Laue H, Chung C, Rosen M, Boss M, Jackson EF. Quantitative imaging biomarkers alliance (QIBA) recommendations for improved precision of DWI and DCE-MRI derived biomarkers in multicenter oncology trials. J Magn Reson Imaging 2018; 49:e101-e121. [PMID: 30451345 DOI: 10.1002/jmri.26518] [Citation(s) in RCA: 222] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/14/2022] Open
Abstract
Physiological properties of tumors can be measured both in vivo and noninvasively by diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging. Although these techniques have been used for more than two decades to study tumor diffusion, perfusion, and/or permeability, the methods and studies on how to reduce measurement error and bias in the derived imaging metrics is still lacking in the literature. This is of paramount importance because the objective is to translate these quantitative imaging biomarkers (QIBs) into clinical trials, and ultimately in clinical practice. Standardization of the image acquisition using appropriate phantoms is the first step from a technical performance standpoint. The next step is to assess whether the imaging metrics have clinical value and meet the requirements for being a QIB as defined by the Radiological Society of North America's Quantitative Imaging Biomarkers Alliance (QIBA). The goal and mission of QIBA and the National Cancer Institute Quantitative Imaging Network (QIN) initiatives are to provide technical performance standards (QIBA profiles) and QIN tools for producing reliable QIBs for use in the clinical imaging community. Some of QIBA's development of quantitative diffusion-weighted imaging and dynamic contrast-enhanced QIB profiles has been hampered by the lack of literature for repeatability and reproducibility of the derived QIBs. The available research on this topic is scant and is not in sync with improvements or upgrades in MRI technology over the years. This review focuses on the need for QIBs in oncology applications and emphasizes the importance of the assessment of their reproducibility and repeatability. Level of Evidence: 5 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;49:e101-e121.
Collapse
Affiliation(s)
- Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dariya Malyarenko
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Wei Huang
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Susan M Noworolski
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark S Shiroishi
- Division of Neuroradiology, Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Harrison Kim
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine Coolens
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Boss
- Applied Physics Division, National Institute of Standards and Technology, Boulder, Colorado, USA
| | - Edward F Jackson
- Departments of Medical Physics, Radiology, and Human Oncology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| |
Collapse
|
19
|
McNamara MM, Thomas JV, Alexander LF, Little MD, Bolus DN, Li YE, Morgan DE. Diffusion-weighted MRI as a screening tool for hepatocellular carcinoma in cirrhotic livers: correlation with explant data-a pilot study. Abdom Radiol (NY) 2018; 43:2686-2692. [PMID: 29500648 DOI: 10.1007/s00261-018-1535-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the sensitivity and specificity of diffusion-weighted liver MRI alone with complete, multiphasic gadoteridol-enhanced MRI for the detection of hepatocellular carcinoma in cirrhotic patients before liver transplant. MATERIALS AND METHODS This single institution retrospective study was performed after IRB approval and was HIPAA compliant. MRI scans of 37 patients who underwent liver transplant were evaluated and findings correlated with liver explant (36) or biopsy (1). All MRI scans were obtained within six months of explant. MRI from 17 patients with liver lesions by report at imaging subsequently proven to be HCC at pathology and 20 controls without liver lesions by imaging and pathology were reviewed in random order on the radiology PACS by three independent readers blinded to the MRI reports and pathology reports in two separate sittings. First, only the diffusion-weighted images (DWI) were interpreted. Second, the complete multiphasic MRI exam with DWI was reviewed. A consensus read was obtained by two separate radiologists who had access to the patients' explant data in order to map lesions. Reader-specific and pooled classification was assessed using sensitivity, specificity, positive predictive value, and negative predictive values and corresponding 95% confidence intervals (CI) for both DWI and complete MRI examination readings compared to pathology. McNemar's test and Kappa coefficient were used to assess differences (agreement) in DWI and complete examination readings. RESULTS A total of 37 patients have been studied (25M 12F age range 21-70). Averaged results of the three independent readers demonstrated a sensitivity of 78% (95% CI 65-89%) and specificity of 88% (95% CI 77-95%) for DWI alone for detection of liver lesions, with a positive predictive value of 85% (95% CI 72-94%) and a negative predictive value of 83% (95% CI 71-91%). Review of the complete MRI exam showed a sensitivity of 90% (95% CI 76-97%) and a specificity of 82% (95% CI 66-92%) with a positive predictive value of 83% (95% CI 69-93%) and a negative predictive value of 89% (95% CI 74-97%). McNemar's agreement test revealed no significant difference between the DWI and complete multiphasic interpretations (p = 0.3458), with simple Kappa coefficient of 0.6716 (95% CI 0.5332-0.8110). Lesions identified on DWI ranged in size from 1.5 to 5 cm. Detection of lesions was decreased in the presence of artifact from motion, large ascites, and technical issues. CONCLUSION Diffusion-weighted MRI has NPV and PPV comparable to complete multiphasic MRI examination for liver lesion detection in cirrhotic patients and may have a role in screening.
Collapse
Affiliation(s)
- M M McNamara
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - J V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L F Alexander
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - M D Little
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D N Bolus
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yufeng E Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
20
|
Diffusion-weighted imaging in hemorrhagic abdominal and pelvic lesions: restricted diffusion can mimic malignancy. Abdom Radiol (NY) 2018; 43:1772-1784. [PMID: 29110051 DOI: 10.1007/s00261-017-1366-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diffusion-weighted imaging (DWI) is an increasingly utilized sequence in the assessment of abdominal and pelvic lesions. Benign lesions containing hemorrhagic products, with conglomerates of tightly packed blood cells or fibers, can have restricted water diffusion on DWI and apparent diffusion coefficient maps. Such lesions can have restricted diffusion erroneously attributed to malignancy. This review illustrates benign hemorrhagic lesions displaying restricted diffusion, with histopathologic correlation in relevant cases.
Collapse
|
21
|
Taron J, Johannink J, Bitzer M, Nikolaou K, Notohamiprodjo M, Hoffmann R. Added value of diffusion-weighted imaging in hepatic tumors and its impact on patient management. Cancer Imaging 2018. [PMID: 29514710 PMCID: PMC5842618 DOI: 10.1186/s40644-018-0140-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background To investigate the added diagnostic value of diffusion-weighted imaging (DWI) of the liver and its impact on therapy decisions in patients with hepatic malignancy. Methods Interdisciplinary gastrointestinal tumorboard cases concerning patients with hepatic malignancies discussed between 11/2015 and 06/2016 were included in this retrospective, single-center study. Two radiologists independently reviewed the respective liver MR-examination first without, then with DWI. The readers were blinded regarding number, position and size of hepatic malignancies. Cases in which DWI revealed additional findings concerning the hepatic tumor status as compared to conventional sequences alone were presented to experienced members of the interdisciplinary tumor board. In this retrospective setting changes in treatment decisions based on these additional findings in the DWI sequences were recorded. Results A total of 87 patients were included. DWI revealed additional findings in 12 patients (13,8%). These new findings had a direct effect on the therapy in 8 patients (9,2%): In 6 patients (6,9%) the surgical/interventional treatment was adapted (n = 5: extended resection, n = 1: with transarterial chemoembolization of a single hepatocellular carcinoma only detectable in DWI); 2 patients (2,3%) received systemic therapy (n = 1: neo-adjuvant, n = 1: palliative) based on the additional findings in DWI. In 4 patients (4.6%) additional DWI findings did not affect the therapeutic decision. Conclusions DWI is a relevant diagnostic tool in oncologic imaging of the liver. By providing further information regarding tumor load in hepatic malignancies it can lead to a significant change in treatment.
Collapse
Affiliation(s)
- Jana Taron
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Jonas Johannink
- Department of Visceral Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Michael Bitzer
- Department of Internal Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| |
Collapse
|
22
|
The role of apparent diffusion coefficient values in characterization of solid focal liver lesions: a prospective and comparative clinical study. SCIENCE CHINA-LIFE SCIENCES 2017; 60:16-22. [PMID: 28078512 DOI: 10.1007/s11427-016-0387-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/09/2016] [Indexed: 12/14/2022]
Abstract
We evaluated and compared the diagnostic accuracy (DA) of apparent diffusion coefficient (ADC) values with that of lesion-to-liver ADC ratios in the characterization of solid focal liver lesions (FLLs). This prospective study was approved by the Institutional Human Ethics Board, after waiving written informed consent. Diffusion-weighted imaging and other routine magnetic resonance imaging were performed on 142 consecutive patients with suspected liver disease. The mean ADC values and lesion-to-liver ADC ratios were compared between benign and malignant solid FLLs. Receiver operating characteristic analysis was performed. The study participants included 46 patients (28 men, 18 women; mean age, 52.5 years) with 57 solid FLLs (32 malignant and 25 benign FLLs). The mean ADC values and ADC ratios of benign solid FLLs were significantly higher than those of malignant lesions (P<0.01). The difference between the area under the receiver operating characteristic curve of the ADC values (0.699) and ADC ratios (0.752) was not significant. Our study suggests that the DA of the ADC ratio is not significantly higher than that of ADC in characterizing solid FLLs.
Collapse
|
23
|
Scan time minimization in hepatic diffusion-weighted imaging: evaluation of the simultaneous multislice acceleration technique with different acceleration factors and gradient preparation schemes. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:739-49. [DOI: 10.1007/s10334-016-0553-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 01/21/2023]
|
24
|
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.
Collapse
|
25
|
Taron J, Martirosian P, Erb M, Kuestner T, Schwenzer NF, Schmidt H, Honndorf VS, Weiβ J, Notohamiprodjo M, Nikolaou K, Schraml C. Simultaneous multislice diffusion-weighted MRI of the liver: Analysis of different breathing schemes in comparison to standard sequences. J Magn Reson Imaging 2016; 44:865-79. [PMID: 26919580 DOI: 10.1002/jmri.25204] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To systematically evaluate image characteristics of simultaneous-multislice (SMS)-accelerated diffusion-weighted imaging (DWI) of the liver using different breathing schemes in comparison to standard sequences. MATERIALS AND METHODS DWI of the liver was performed in 10 healthy volunteers and 12 patients at 1.5T using an SMS-accelerated echo planar imaging sequence performed with respiratory-triggering and free breathing (SMS-RT, SMS-FB). Standard DWI sequences served as reference (STD-RT, STD-FB). Reduction of scan time by SMS-acceleration was measured. Image characteristics of SMS-DWI and STD-DWI with both breathing schemes were analyzed quantitatively (apparent diffusion coefficient [ADC], signal-to-noise ratio [SNR]) and qualitatively (5-point Likert scale, 5 = excellent). Qualitative and quantitative parameters were compared using Friedman test and Dunn-Bonferroni post-hoc method with P-values < 0.05 considered statistically significant. RESULTS SMS-DWI provided diagnostic image quality in volunteers and patients both with RT and FB with a reduction of scan time of 70% (0:56 vs. 3:20 min in FB). Overall image quality did not significantly differ between FB and RT acquisition in both STD and SMS sequences (median STD-RT 5.0, STD-FB 4.5, SMS-RT: 4.75; SMS-FB: 4.5; P = 0.294). SNR in the right hepatic lobe was comparable between the four tested sequences. ADC values were significantly lower in SMS-DWI compared to STD-DWI irrespective of the breathing scheme (1.2 ± 0.2 × 10(-3) mm(2) /s vs. 1.0 ± 0.2 × 10(-3) mm(2) /s; P < 0.001). CONCLUSION SMS-acceleration provides considerable scan time reduction for hepatic DWI with equivalent image quality compared to the STD technique both using RT and FB. Discrepancies in ADC between STD-DWI and SMS-DWI need to be considered when transferring the SMS technique to clinical routine reading. J. MAGN. RESON. IMAGING 2016;44:865-879.
Collapse
Affiliation(s)
- Jana Taron
- Diagnostic and Interventional Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Michael Erb
- Department of Biomedical Magnetic Resonance, University Hospital of Tuebingen, Tuebingen, Germany
| | - Thomas Kuestner
- Institute of Signal Processing and System Theory, University of Stuttgart, Stuttgart, Germany
| | - Nina F Schwenzer
- Diagnostic and Interventional Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Holger Schmidt
- Diagnostic and Interventional Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Valerie S Honndorf
- Diagnostic and Interventional Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Jakob Weiβ
- Diagnostic and Interventional Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Mike Notohamiprodjo
- Diagnostic and Interventional Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Konstantin Nikolaou
- Diagnostic and Interventional Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Christina Schraml
- Diagnostic and Interventional Radiology, University Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany.
| |
Collapse
|
26
|
Jahic E, Sofic A, Selimovic AH. DWI/ADC in Differentiation of Benign from Malignant Focal Liver Lesion. Acta Inform Med 2016; 24:244-247. [PMID: 27708485 PMCID: PMC5037977 DOI: 10.5455/aim.2016.24.244-247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/24/2016] [Indexed: 12/11/2022] Open
Abstract
Material and methods: The study was of prospective-retrospective character. It was carried out at the AKH in Vienna (Austria), where 100 patients with focal liver lesions were included in the study. All patients underwent the routine MR sequences on appliances 1,5 and 3T (Siemens, Germany): T1, T2, HASTE, VIBE, and a DWI with three b values (b 50, b 300 b 600 s / mm2) and ADC map with ROI (regions of interest). The numerical value of ADC map was calculated, where n = 100 liver lesions, by two independent radiologists. Results: On the basis of matching the PH finding statistically we get DWI accuracy of 96.8% for the assessment of liver lesions. The average numerical value of ADC in benign hepatic lesions (FNH, Hemangiomas) in our study amounted to 1.88 (1.326 to 2.48) x103 mm2 /s, while the value of malignant liver lesions (HCC, CCC, CRCLM) were significantly lower and amounted to 1.15 (1.024 to 1.343) x10-3 mm2 /s (Figure 2). Differences between the mean ADC of benign and malignant lesions showed a statistically significant difference with p <0.0005. In our research, we get cut-off for the ADC value of 1,341x10-3 mm2 /s, which proved to be the optimal parameter for differentiation between benign and malignant lesions. Conclusion: Measuring ADC values with DWI as an additional MRI tool can help in oncological practice by distinguishing normal liver parenchyma from focal lesions, and in differentiating benign from malignant liver lesions, particularly in cases where administration of contrast is not possible.
Collapse
Affiliation(s)
- Elma Jahic
- Clinic of Radiology, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Amela Sofic
- Clinic of Radiology, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Azra Husic Selimovic
- Institute of Gastroenterology, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
27
|
Simultaneous Multislice Accelerated Free-Breathing Diffusion-Weighted Imaging of the Liver at 3T. ACTA ACUST UNITED AC 2015; 40:2323-30. [DOI: 10.1007/s00261-015-0447-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
28
|
Kim MJ. Recent development of diagnostic imaging of hepatocellular carcinoma. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.11.948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Myeong-Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University Severance Hospital, Seoul, Korea
| |
Collapse
|