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Tanabe M, Higashi M, Miyoshi K, Morooka R, Kiyoyama H, Ihara K, Kawano Y, Yamane M, Yamaguchi T, Ito K. Breath-hold diffusion-weighted MR imaging (DWI) using deep learning reconstruction: Comparison with navigator triggered DWI in patients with malignant liver tumors. Radiography (Lond) 2025; 31:275-280. [PMID: 39667265 DOI: 10.1016/j.radi.2024.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 11/27/2024] [Accepted: 11/30/2024] [Indexed: 12/14/2024]
Abstract
INTRODUCTION This study investigated the feasibility of single breath-hold (BH) diffusion-weighted MR imaging (DWI) using deep learning reconstruction (DLR) compared to navigator triggered (NT) DWI in patients with malignant liver tumors. METHODS This study included 91 patients who underwent both BH-DWI and NT-DWI with 3T MR system. Abdominal MR images were subjectively analyzed to compare visualization of liver edges, presence of ghosting artifacts, conspicuity of malignant liver tumors, and overall image quality. Then, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) values of malignant liver tumors were objectively measured using regions of interest. RESULTS Image quality except conspicuity of malignant liver tumors were significantly better in BH-DW image than in NT-DW image (p < 0.01). Regarding the conspicuity of malignant liver tumors, there was no statistically significant difference between BH-DWI and NT-DWI (p = 0.67). The conspicuity score of 1 or 2 was rendered in 19 (21 %) patients in NT-DWI group. Conversely, BH-DWI showed a score of 3 or 4 in 11 (58 %) of these 19 patients. The SNR was significantly higher in BH-DWI than in NT-DWI (29.5 ± 14.0 vs. 27.3 ± 14.7, p < 0.047). No significant difference was observed between CNR and ADC values of malignant liver tumors between BH-DWI and NT-DWI (5.67 ± 3.57 vs. 5.78 ± 3.08, p = 0.243; 997.2 ± 207.0 vs. 1021.0 ± 253.1, p = 0.547). CONCLUSION The BH-DWI using DLR is feasible for liver MRI by improving the SNR and overall image quality, and may play a complementary role to NT-DWI by improving the conspicuity of malignant liver tumor in patients with image distortion in NT-DWI. IMPLICATIONS FOR PRACTICE BH-DWI with DLR would be a preferred approach to achieving sufficient image quality in patients with an irregular triggering pattern, as an alternative to NT-DWI. A further reduction in BH duration (<15 s) should be achieved, taking into account patient tolerance.
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Affiliation(s)
- M Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - M Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - K Miyoshi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - R Morooka
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - H Kiyoyama
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - K Ihara
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Y Kawano
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - M Yamane
- Department of Radiological Technology, Yamaguchi University Hospital, Japan
| | - T Yamaguchi
- Department of Radiological Technology, Yamaguchi University Hospital, Japan
| | - K Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
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Ginocchio LA, Jaglan S, Tong A, Smereka PN, Benkert T, Chandarana H, Shanbhogue KP. Accelerated Diffusion-Weighted Magnetic Resonance Imaging of the Liver at 1.5 T With Deep Learning-Based Image Reconstruction: Impact on Image Quality and Lesion Detection. J Comput Assist Tomogr 2024; 48:853-858. [PMID: 38722777 DOI: 10.1097/rct.0000000000001622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
OBJECTIVE To perform image quality comparison between deep learning-based multiband diffusion-weighted sequence (DL-mb-DWI), accelerated multiband diffusion-weighted sequence (accelerated mb-DWI), and conventional multiband diffusion-weighted sequence (conventional mb-DWI) in patients undergoing clinical liver magnetic resonance imaging (MRI). METHODS Fifty consecutive patients who underwent clinical MRI of the liver at a 1.5-T scanner, between September 1, 2021, and January 31, 2022, were included in this study. Three radiologists independently reviewed images using a 5-point Likert scale for artifacts and image quality factors, in addition to assessing the presence of liver lesions and lesion conspicuity. RESULTS DL-mb-DWI acquisition time was 65.0 ± 2.4 seconds, significantly ( P < 0.001) shorter than conventional mb-DWI (147.5 ± 19.2 seconds) and accelerated mb-DWI (94.3 ± 1.8 seconds). DL-mb-DWI received significantly higher scores than conventional mb-DWI for conspicuity of the left lobe ( P < 0.001), sharpness of intrahepatic vessel margin ( P < 0.001), sharpness of the pancreatic contour ( P < 0.001), in-plane motion artifact ( P = 0.002), and overall image quality ( P = 0.005) by reader 2. DL-mb-DWI received significantly higher scores for conspicuity of the left lobe ( P = 0.006), sharpness of the pancreatic contour ( P = 0.020), and in-plane motion artifact ( P = 0.042) by reader 3. DL-mb-DWI received significantly higher scores for strength of fat suppression ( P = 0.004) and sharpness of the pancreatic contour ( P = 0.038) by reader 1. The remaining quality parameters did not reach statistical significance for reader 1. CONCLUSIONS Novel diffusion-weighted MRI sequence with deep learning-based image reconstruction demonstrated significantly decreased acquisition times compared with conventional and accelerated mb-DWI sequences, while maintaining or improving image quality for routine abdominal MRI. DL-mb-DWI offers a potential alternative to conventional mb-DWI in routine clinical liver MRI.
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Affiliation(s)
- Luke A Ginocchio
- From the Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Sonam Jaglan
- From the Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Angela Tong
- From the Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Paul N Smereka
- From the Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Hersh Chandarana
- From the Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Krishna P Shanbhogue
- From the Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
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Maung ST, Tanpowpong N, Satja M, Treeprasertsuk S, Chaiteerakij R. MRI for hepatocellular carcinoma and the role of abbreviated MRI for surveillance of hepatocellular carcinoma. J Gastroenterol Hepatol 2024; 39:1969-1981. [PMID: 38899804 DOI: 10.1111/jgh.16643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) constitutes the majority of liver cancers and significantly impacts global cancer mortality. While ultrasound (US) with or without alpha-fetoprotein is the mainstay for HCC surveillance, its limitations highlight the necessity for more effective surveillance tools. Therefore, this review explores evolving imaging modalities and abbreviated magnetic resonance imaging (MRI) (AMRI) protocols as promising alternatives, addressing challenges in HCC surveillance. AREAS COVERED This comprehensive review delves into the evaluation and challenges of HCC surveillance tools, focusing on non-contrast abbreviated MRI (NC-AMRI) and contrast-enhanced abbreviated MRI protocols. It covers the implementation of AMRI for HCC surveillance, patient preferences, adherence, and strategies for optimizing cost-effectiveness. Additionally, the article provides insights into prospects for HCC surveillance by summarizing meta-analyses, prospective studies, and ongoing clinical trials evaluating AMRI protocols. EXPERT OPINION The opinions underscore the transformative impact of AMRI on HCC surveillance, especially in overcoming US limitations. Promising results from NC-AMRI protocols indicate its potential for high-risk patient surveillance, though prospective studies in true surveillance settings are essential for validation. Future research should prioritize risk-stratified AMRI protocols and address cost-effectiveness for broader clinical implementation, alongside comparative analyses with US for optimal surveillance strategies.
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Affiliation(s)
- Soe Thiha Maung
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Ma Har Myaing Hospital, Yangon, Myanmar
| | - Natthaporn Tanpowpong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Minchanat Satja
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Li T, Wang J, Yang Y, Glide-Hurst CK, Wen N, Cai J. Multi-parametric MRI for radiotherapy simulation. Med Phys 2023; 50:5273-5293. [PMID: 36710376 PMCID: PMC10382603 DOI: 10.1002/mp.16256] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 09/10/2022] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) has become an important imaging modality in the field of radiotherapy (RT) in the past decade, especially with the development of various novel MRI and image-guidance techniques. In this review article, we will describe recent developments and discuss the applications of multi-parametric MRI (mpMRI) in RT simulation. In this review, mpMRI refers to a general and loose definition which includes various multi-contrast MRI techniques. Specifically, we will focus on the implementation, challenges, and future directions of mpMRI techniques for RT simulation.
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Affiliation(s)
- Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jihong Wang
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingli Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Carri K Glide-Hurst
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Ning Wen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- The Global Institute of Future Technology, Shanghai Jiaotong University, Shanghai, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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Reginelli A, Giacobbe G, Del Canto MT, Alessandrella M, Balestrucci G, Urraro F, Russo GM, Gallo L, Danti G, Frittoli B, Stoppino L, Schettini D, Iafrate F, Cappabianca S, Laghi A, Grassi R, Brunese L, Barile A, Miele V. Peritoneal Carcinosis: What the Radiologist Needs to Know. Diagnostics (Basel) 2023; 13:diagnostics13111974. [PMID: 37296826 DOI: 10.3390/diagnostics13111974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Peritoneal carcinosis is a condition characterized by the spread of cancer cells to the peritoneum, which is the thin membrane that lines the abdominal cavity. It is a serious condition that can result from many different types of cancer, including ovarian, colon, stomach, pancreatic, and appendix cancer. The diagnosis and quantification of lesions in peritoneal carcinosis are critical in the management of patients with the condition, and imaging plays a central role in this process. Radiologists play a vital role in the multidisciplinary management of patients with peritoneal carcinosis. They need to have a thorough understanding of the pathophysiology of the condition, the underlying neoplasms, and the typical imaging findings. In addition, they need to be aware of the differential diagnoses and the advantages and disadvantages of the various imaging methods available. Imaging plays a central role in the diagnosis and quantification of lesions, and radiologists play a critical role in this process. Ultrasound, computed tomography, magnetic resonance, and PET/CT scans are used to diagnose peritoneal carcinosis. Each imaging procedure has advantages and disadvantages, and particular imaging techniques are recommended based on patient conditions. Our aim is to provide knowledge to radiologists regarding appropriate techniques, imaging findings, differential diagnoses, and treatment options. With the advent of AI in oncology, the future of precision medicine appears promising, and the interconnection between structured reporting and AI is likely to improve diagnostic accuracy and treatment outcomes for patients with peritoneal carcinosis.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131 Naples, Italy
| | - Maria Teresa Del Canto
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Marina Alessandrella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giovanni Balestrucci
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Gaetano Maria Russo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Barbara Frittoli
- Department of Radiology, Spedali Civili Hospital, 25123 Brescia, Italy
| | - Luca Stoppino
- Department of Radiology, University Hospital of Foggia, 71122 Foggia, Italy
| | - Daria Schettini
- Department of Radiology, Villa Scassi Hospital, Corso Scassi 1, 16121 Genova, Italy
| | - Franco Iafrate
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza-University of Rome, Radiology Unit-Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Roberto Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy
| | - Vittorio Miele
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, 56126 Pisa, Italy
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Ohno N, Yoshida K, Ueda Y, Makino Y, Miyati T, Gabata T, Kobayashi S. Diffusion-weighted Imaging of the Abdomen during a Single Breath-hold Using Simultaneous-multislice Echo-planar Imaging. Magn Reson Med Sci 2021; 22:253-262. [PMID: 34732598 PMCID: PMC10086397 DOI: 10.2463/mrms.mp.2021-0087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This multi-scanner study aimed to investigate the validity of single breath-hold (BH) diffusion-weighted imaging (DWI) using simultaneous-multislice (SMS) echo-planar imaging in multiple abdominal organs to enable faster acquisition and reliable quantification of apparent diffusion coefficient (ADC). METHODS SNR, geometric distortion (GD), and ADC in a phantom; the ADC in the liver, renal cortex, paraspinal muscle, spleen, and pancreas; and the signal intensity ratio of the portal vein-to-muscle (SIRPV-M) in healthy volunteers were compared between BH- and respiratory-triggered (RT) DWI with b-values of 0 and 800 s/mm2 in two different MRI scanners. RESULTS The phantom study showed that the SNR of BH-DWI was significantly lower than that of the RT-DWI (P < 0.05 for both scanners), whereas the GD and ADC of BH-DWI did not differ significantly from those of the RT-DWI (P = 0.09-0.60). In the volunteer study, the scan times were 23 seconds for BH-DWI and 184±33 seconds for RT-DWI, respectively. The ADC of the liver in BH-DWI was significantly lower than that in RT-DWI (P < 0.05 for both scanners), whereas there were no significant differences in the ADCs of the renal cortex, paraspinal muscle, spleen, or pancreas between BH-DWI and RT-DWI (P = 0.07-0.86). The SIRPV-M in BH-DWI was significantly smaller than in RT-DWI (P < 0.05 for both scanners). CONCLUSION The proposed method enables the acquisition of abdominal diffusion-weighted images in a single BH.
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Affiliation(s)
- Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | | | - Yu Ueda
- MR Clinical Science, Philips Japan, Ltd
| | - Yuki Makino
- Department of Radiological Technology, Kanazawa University Hospital
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | | | - Satoshi Kobayashi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University.,Department of Radiology, Kanazawa University Hospital.,Department of Radiological Technology, Kanazawa University Hospital
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Seeing the whole picture: Added value of MRI for extraperitoneal findings in CRS-HIPEC candidates. Eur J Surg Oncol 2021; 48:462-469. [PMID: 34563410 DOI: 10.1016/j.ejso.2021.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE In colorectal cancer (CRC) patients the selection of suitable cytoreductive surgery and hyperthermic peritoneal chemotherapy (CRS-HIPEC) candidates is based on the location and extent of peritoneal metastases (PM) and presence of extraperitoneal metastases. MRI is increasingly being used to accurately assess the extent of PM, however, the significance of extraperitoneal findings in these scans has never been evaluated before. METHODS CRC patients who had undergone an additional MRI scan after standard work-up with CT for preoperative staging between January 2016-January 2020 were selected. CT and MRI reports were reviewed for new abdominopelvic extra-peritoneal findings on MRI (MR-EPF) and MR-EPFs concerning lesions previously indicated as equivocal (uncertain benign/malignant) on CT. Reference standard were surgical results or follow-up imaging. RESULTS In 158 included patients 60 MR-EPFs (in 58/158 patients) were noted: twenty-six (43%) were new findings and thirty-four (57%) were equivocal findings on CT. Of the 34 equivocal findings 27 were 'rejected/less likely malignant' and 7 'confirmed/more likely malignant' based on MRI. In 29 patients (18%) the MR-EPFs had direct influence on treatment planning. Three patients (2%), eligible for CRS-HIPEC on CT, were deemed inoperable due to MR-EPFs. CONCLUSION MRI had an added value in more than a third of the patients due to abdominopelvic extraperitoneal findings that were undetected or indeterminate on CT and therefore influenced the treatment in a substantial part of the patients. Combined with the known accurate detection of peritoneal disease on MRI, MRI seems a logical addition to the diagnostic workup of potential CRS-HIPEC candidates.
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Granata V, Fusco R, Avallone A, Cassata A, Palaia R, Delrio P, Grassi R, Tatangelo F, Grazzini G, Izzo F, Petrillo A. Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting. PLoS One 2020; 15:e0241431. [PMID: 33211702 PMCID: PMC7676687 DOI: 10.1371/journal.pone.0241431] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background MRI is the most reliable imaging modality that allows to assess liver metastases. Our purpose is to compare the per-lesion and per-patient detection rate of gadoxetic acid-(Gd-EOB) enhanced liver MRI and fast MR protocol including Diffusion Weighted Imaging (DWI) and T2-W Fat Suppression sequence in the detection of liver metastasis in pre surgical setting. Methods One hundred and eight patients with pathologically proven liver metastases (756 liver metastases) underwent Gd-EOBMRI were enrolled in this study. Three radiologist independently graded the presence of liver lesions on a five-point confidence scale assessed only abbreviated protocol (DWI and sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) fat suppressed sequence) and after an interval of more than 2 weeks the conventional study (all acquired sequences). Per-lesion and per-patient detection rate of metastases were calculated. Weighted к values were used to evaluate inter-reader agreement of the confidence scale regarding the presence of the lesion. Results MRI detected 732 liver metastases. All lesions were identified both by conventional study as by abbreviated protocol. In terms of per-lesion detection rate of liver metastasis, all three readers had higher detection rate both with abbreviated protocol and with standard protocol with Gd-EOB (96.8% [732 of 756] vs. 96.5% [730 of 756] for reader 1; 95.8% [725 of 756] vs. 95.2% [720 of 756] for reader 2; 96.5% [730 of 756] vs. 96.5% [730 of 756] for reader 3). Inter-reader agreement of lesions detection rate between the three radiologists was excellent (k range, 0.86–0.98) both for Gd-EOB MRI and for Fast protocol (k range, 0.89–0.99). Conclusion Abbreviated protocol showed the same detection rate than conventional study in detection of liver metastases.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Roberta Fusco
- Radiology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
- * E-mail:
| | - Antonio Avallone
- Gastrointestinal Oncology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Antonino Cassata
- Gastrointestinal Oncology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Paolo Delrio
- Division of Gastrointestinal Surgical Oncology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Roberta Grassi
- Division of Radiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fabiana Tatangelo
- Division of Pathology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Giulia Grazzini
- Division of Radiology, “Azienda Ospedaliera Universitaria Careggi”, Florence, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
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Ahmed NNA, El Gaafary SM, Elia RZ, Abdulhafiz EM. Role of abbreviated MRI protocol for screening of HCC in HCV related cirrhotic patients prior to direct-acting antiviral treatment. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00199-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Luo L, Luo Q, Tang L. Diagnostic value and clinical significance of MRI and CT in detecting lymph node metastasis of early cervical cancer. Oncol Lett 2019; 19:700-706. [PMID: 31897185 PMCID: PMC6924181 DOI: 10.3892/ol.2019.11180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022] Open
Abstract
Diagnostic value and clinical significance of magnetic resonance imaging (MRI) and computed tomography (CT) in detecting lymph node metastasis of early cervical cancer were investigated. From April 2015 to April 2019, 160 patients with lymph node metastasis (stage I–II) of early cervical cancer in Jining No. 1 People's Hospital were retrospectively analyzed. All the patients underwent MRI, CT diagnosis and MRI combined with CT diagnosis before operation. Sensitivity, specificity and diagnostic accordance rate, the diagnostic value and clinical significance of MRI, CT and MRI combined with CT in the diagnosis of lymph node metastasis of early cervical cancer were compared. The sensitivity, specificity and diagnostic accordance rate of MRI in the diagnosis of lymph node metastasis of early cervical cancer in stage Ia-Ib were 75.00, 72.92 and 77.50%, respectively, which were significantly higher than those of PET/CT in the same period (P<0.05). The sensitivity, specificity and diagnostic accordance rate of MRI combined with CT in the diagnosis of early cervical cancer in stage Ia-Ib were 78.13, 87.50 and 83.75%, respectively, which were significantly higher than those of MRI or CT alone (P<0.05). However, the sensitivity, specificity and diagnostic accordance rate of MRI combined with CT in the diagnosis of lymph node metastasis of early cervical cancer in stage IIa-IIb were 91.66, 82.81 and 88.13%, respectively, which were significantly higher than those of MRI or CT alone (P<0.05). MRI is superior to CT in the diagnosis of lymph node metastasis of early cervical cancer. However, the diagnostic efficiency of combined scans of the two is far higher than that of MRI or CT alone, which has more diagnostic value. In clinic, MRI and CT should be combined to improve the diagnostic accuracy of diseases.
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Affiliation(s)
- Lan Luo
- Department of Gynaecology, Jining No. 1 People's Hospital, Jining, Shandong 272000, P.R. China
| | - Qian Luo
- Department of Radiology, Jining No. 1 People's Hospital, Jining, Shandong 272000, P.R. China
| | - Liang Tang
- Department of Oncology, Jining No. 1 People's Hospital, Jining, Shandong 272000, P.R. China
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Emara DMM, Mohamed FSED, Abdullah AH, Ibrahim MAH, Ibrahim ME, Hassouna EM. Is diffusion weighted imaging adding value in diagnosis of focal hepatic lesions? Experience in 50 patients. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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12
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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: 0.3] [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.
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13
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Sui Y, Zou Z, Li F, Hao C. Application value of MRI diffuse weighted imaging combined with PET/CT in the diagnosis of stomach cancer at different stages. Oncol Lett 2019; 18:43-48. [PMID: 31289470 PMCID: PMC6540421 DOI: 10.3892/ol.2019.10286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/17/2019] [Indexed: 02/07/2023] Open
Abstract
Value of MRI diffusion-weighted imaging (MRI DWI) combined with PET/CT in the diagnosis and staging of stomach cancer (SC) was investigated. A retrospective analysis was performed on 160 patients with SC diagnosed by pathological biopsy in The Affiliated Yantai Yuhuangding Hospital of Qingdao University from March 2015 to April 2018. The values of MRI DWI, PET/CT and combined diagnosis in the diagnosis and staging of SC were compared according to the criteria of diagnosis of postoperative pathological or clinical comprehensive evaluation. The sensitivity, specificity and diagnostic coincidence rate of MRI DWI in the diagnosis of SC at stage I-II were 61.05, 64.62 and 62.50%, respectively, which were significantly lower than those of PET/CT (P<0.05). Sensitivity, specificity and diagnostic coincidence rate of MRI DWI in the diagnosis of SC at stage III-IV were lower than those of PET/CT (P<0.05). Sensitivity and diagnostic coincidence rate of MRI DWI combined with PET/CT in the diagnosis of SC at stage I-II were significantly higher than those of MRI DWI or PET/CT alone (P<0.05). Specificity and diagnostic coincidence rate of MRI DWI combined with PET/CT in the diagnosis of SC at stage III-IV were significantly higher than those of MRI DWI or PET/CT alone (P<0.05). PET/CT is superior to MRI DWI in SC staging, whereas the diagnostic efficiency of combined scan is much higher than that of PET/CT or MRI DWI alone. In order to obtain more accurate preoperative staging and to avoid diagnostic exploratory laparotomy, the combination of MRI DWI and PET/CT techniques should be used in the comprehensive analysis of the disease to improve the accuracy of clinical diagnosis.
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Affiliation(s)
- Yanbin Sui
- Department of Medical Image, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Zhenxing Zou
- Department of Medical Image, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Fangfang Li
- Department of Blood Purification, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Cuijuan Hao
- Department of Medical Image, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
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Low RN, Barone RM, Rousset P. Peritoneal MRI in patients undergoing cytoreductive surgery and HIPEC: History, clinical applications, and implementation. Eur J Surg Oncol 2019; 47:65-74. [PMID: 30852063 DOI: 10.1016/j.ejso.2019.02.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 11/26/2022] Open
Abstract
MR imaging provides considerable advantages in the evaluation of patients with peritoneal metastases. A standardized peritoneal MRI protocol, including diffusion-weighted and gadolinium-enhanced sequences, allows an efficient exploration of small peritoneal tumors that are often missed on other imaging tests. In experienced hands, a dedicated reading allows producing a quantitative and qualitative evaluation of lesional localization to better assist surgeons in the selection of candidates for curative surgery by evaluating the possibility of complete resection, and to plan the surgical procedure. Based on a close collaboration between oncologic surgeon and radiologist, MRI provides a powerful tool for accurate preoperative imaging in patients being considered for curative surgery but also in their surveillance to detect an early recurrence.
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Affiliation(s)
- Russell N Low
- Department of Radiology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA, 92123, USA.
| | - Robert M Barone
- Department of Surgical Oncology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA, 92123, USA.
| | - Pascal Rousset
- Department of Radiology, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France; Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France.
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15
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Magnetic Resonance Imaging of the Perirenal Space and Retroperitoneum. Magn Reson Imaging Clin N Am 2019; 27:77-103. [PMID: 30466914 DOI: 10.1016/j.mric.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hussein RS, Tantawy W, Abbas YA. MRI assessment of hepatocellular carcinoma after locoregional therapy. Insights Imaging 2019; 10:8. [PMID: 30694398 PMCID: PMC6352610 DOI: 10.1186/s13244-019-0690-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022] Open
Abstract
Liver cirrhosis and hepatocellular carcinoma (HCC) constitute one of the major causes of morbidity, mortality, and high health care costs worldwide. Multiple treatment options are available for HCC depending on the clinical status of the patient, size and location of the tumor, and available techniques and expertise. Locoregional treatment options are multiple. The most challenging part is how to assess the treatment response by different imaging modalities, but our scope will be assessing the response to locoregional therapy for HCC by MRI. This will be addressed by conventional MR methods using LI-RADS v2018 and by functional MR using diffusion-weighted imaging, perfusion, and highlighting the value of the novel intravoxel incoherent motion (IVIM).
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Affiliation(s)
- Rasha S Hussein
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt.
| | - Wahid Tantawy
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
| | - Yasser A Abbas
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
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Virarkar M, Viswanathan C, Iyer R, de Castro Faria S, Morani A, Carter B, Ganeshan D, Elsherif S, Bhosale PR. The Role of Positron Emission Tomography/Magnetic Resonance Imaging in Gynecological Malignancies. J Comput Assist Tomogr 2019; 43:825-834. [PMID: 31453978 DOI: 10.1097/rct.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Accurate oncological staging for early detection is of utmost importance in patient care and increasing the overall patient survival outcome. Hybrid imaging in the form of positron emission tomography (PET)/computed tomography has been successfully implemented in oncological imaging and, where available, has been used consistently in patients with gynecologic malignancies. The implementation of PET/magnetic resonance imaging (MRI) enables high-quality assessment of gynecological malignancies by combining the diagnostic advantages of metabolic information of PET along with the high-resolution anatomical and functional information from the MRI to provide precise information about staging, recurrence, and metastases. This article will review the various applications of PET/MRI in gynecological cancer.
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Affiliation(s)
- Mayur Virarkar
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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18
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Lo GC, Kambadakone A. MR Imaging of Pancreatic Neuroendocrine Tumors. Magn Reson Imaging Clin N Am 2018; 26:391-403. [DOI: 10.1016/j.mric.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Özdemir O, Metin Y, Metin NO, Küpeli A. Contribution of diffusion-weighted imaging to conventional MRI for detection of haemorrhagic infarction in ovary torsion. BMC Med Imaging 2017; 17:56. [PMID: 29166871 PMCID: PMC5700677 DOI: 10.1186/s12880-017-0232-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 11/16/2017] [Indexed: 12/04/2022] Open
Abstract
Background To assess the role of DWI in differentiation haemorrhagic ovary infarction from non-haemorrhagic one. Methods For this prospectively designed study, of 117 female patients who presented with acute lower quadrant pain and underwent MRI for suspicion of ovary torsion, results of only 29 patients (mean age, 24.7; SD, ±5.7; age range, 18–37), with surgical and pathological confirmation of adnexal torsion, were included to the study. All patients underwent DWI after conventional MRI. Quantitative and qualitative analysis of both the torsed and contralateral normal ovary were performed. Results of conventional MRI and DWI were noted. Results At operation 15 patients were found to have haemorrhagic infarction while 14 had non-haemorrhagic infarction. Of the 29 patients, 17 torsed ovaries could be salvaged in a viable state. We found statistically significant correlation of the ADC values, between haemorrhagic and non-haemorrhagic ovary infarction. The ADC values were significantly lower in patients with haemorrhagic infarction than non-haemorrhagic ones (p < 0.001). Using an ADC threshold of 1.27, the sensitivity of DWI for haemorrhagic infarction was 0.93 and specificity 0.85. Conclusion DWI may be used with a significant success for the preoperative diagnosis of haemorrhagic infarction. This may be alerting for pre-emptive surgery in avoiding serious complications and preventing irreversible structural damage of the ovary.
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Affiliation(s)
- Oğuzhan Özdemir
- Faculty of Medicine, Department of Radiology, RTEÜ, 53100, Rize, Turkey.
| | - Yavuz Metin
- Faculty of Medicine, Department of Radiology, RTEÜ, 53100, Rize, Turkey
| | | | - Ali Küpeli
- Department of Radiology, Muş State Hospital, Muş, Turkey
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Shenoy-Bhangle A, Baliyan V, Kordbacheh H, Guimaraes AR, Kambadakone A. Diffusion weighted magnetic resonance imaging of liver: Principles, clinical applications and recent updates. World J Hepatol 2017; 9:1081-1091. [PMID: 28989564 PMCID: PMC5612839 DOI: 10.4254/wjh.v9.i26.1081] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/06/2017] [Accepted: 06/06/2017] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors such as the ease of acquisition and ability to obtain functional information in the absence of intravenous contrast, especially in patients with abnormal renal function, have contributed to the growing interest in exploring clinical applications of DWI. In the liver, DWI demonstrates a gamut of clinical applications ranging from detecting focal liver lesions to monitoring response in patients undergoing serial follow-up after loco-regional and systemic therapies. DWI is also being applied in the evaluation of diffuse liver diseases such as non-alcoholic fatty liver disease, hepatic fibrosis and cirrhosis. In this review, we intend to review the basic principles, technique, current clinical applications and future trends of DW-MRI in the liver.
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Affiliation(s)
| | - Vinit Baliyan
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Hamed Kordbacheh
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | | | - Avinash Kambadakone
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States.
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Accuracy of Whole-Body DWI for Metastases Screening in a Diverse Group of Malignancies: Comparison With Conventional Cross-Sectional Imaging and Nuclear Scintigraphy. AJR Am J Roentgenol 2017; 209:477-490. [PMID: 28678578 DOI: 10.2214/ajr.17.17829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study is to assess the role of whole-body (WB) DWI as a screening modality for the detection of metastases and to compare it to conventional cross-sectional imaging modalities or nuclear scintigraphy in a population with various histopathologic malignancies. SUBJECTS AND METHODS WB DWI and conventional imaging (CT, MRI, or scintigraphy) were performed for patients with known malignancies for metastatic workup, and these patients were followed up for a period of 1 year. Two radiologists assessed WB DW images separately, and conventional images were assessed by the senior radiologist. The metastatic lesions were classified into four regions: liver, lung, skeletal system, and lymph nodes. The reference standard was considered on the basis of histopathologic confirmation or clinical follow-up of the metastatic lesions. RESULTS WB DWI was slightly inferior to conventional imaging modalities for the detection of hepatic metastases (sensitivity, 86.6% vs 93.3%; specificity, 91.6% vs 95.8%; and accuracy, 89.7% vs 94.8%) and skeletal metastases (sensitivity, 81.8% vs 89.4%; specificity, 86.4% vs 94.3%; and accuracy, 85.2% vs 93.0%); however, the differences were not statistically significant (p = 0.625 for hepatic metastases and p = 0.0953 for skeletal metastases, McNemar test). WB DWI was statistically significantly inferior to conventional imaging for the detection of lymph node metastases (sensitivity, 74.0% vs 81.5%; specificity, 87.9% vs 90.1%; accuracy, 81.4% vs 86.0%; p = 0.0389). WB DWI was statistically significantly inferior to conventional imaging for the detection of pulmonary metastases (sensitivity, 33.3% vs 100.0%; specificity, 90.9% vs 100.0%; accuracy, 60.8% vs 100.0%; p = 0.045). CONCLUSION WB DWI can be used for screening hepatic and skeletal metastases, but its reliability as the sole imaging sequence for the detection of lymph nodal and pulmonary metastases is poor and, at present, it cannot replace conventional imaging modalities.
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22
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Zhang Q, Coolen BF, Versluis MJ, Strijkers GJ, Nederveen AJ. Diffusion-prepared stimulated-echo turbo spin echo (DPsti-TSE): An eddy current-insensitive sequence for three-dimensional high-resolution and undistorted diffusion-weighted imaging. NMR IN BIOMEDICINE 2017; 30:e3719. [PMID: 28295736 DOI: 10.1002/nbm.3719] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/10/2017] [Accepted: 02/04/2017] [Indexed: 06/06/2023]
Abstract
In this study, we present a new three-dimensional (3D), diffusion-prepared turbo spin echo sequence based on a stimulated-echo read-out (DPsti-TSE) enabling high-resolution and undistorted diffusion-weighted imaging (DWI). A dephasing gradient in the diffusion preparation module and rephasing gradients in the turbo spin echo module create stimulated echoes, which prevent signal loss caused by eddy currents. Near to perfect agreement of apparent diffusion coefficient (ADC) values between DPsti-TSE and diffusion-weighted echo planar imaging (DW-EPI) was demonstrated in both phantom transient signal experiments and phantom imaging experiments. High-resolution and undistorted DPsti-TSE was demonstrated in vivo in prostate and carotid vessel wall. 3D whole-prostate DWI was achieved with four b values in only 6 min. Undistorted ADC maps of the prostate peripheral zone were obtained at low and high imaging resolutions with no change in mean ADC values [(1.60 ± 0.10) × 10-3 versus (1.60 ± 0.02) × 10-3 mm2 /s]. High-resolution 3D DWI of the carotid vessel wall was achieved in 12 min, with consistent ADC values [(1.40 ± 0.23) × 10-3 mm2 /s] across different subjects, as well as slice locations through the imaging volume. This study shows that DPsti-TSE can serve as a robust 3D diffusion-weighted sequence and is an attractive alternative to the traditional two-dimensional DW-EPI approaches.
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Affiliation(s)
- Qinwei Zhang
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bram F Coolen
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
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23
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Comparison of T2-weighted imaging, diffusion-weighted imaging and contrast-enhanced T1-weighted MR imaging for evaluating perianal fistulas. Clin Imaging 2017; 44:16-21. [PMID: 28395191 DOI: 10.1016/j.clinimag.2017.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/01/2017] [Accepted: 03/29/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the lesion conspicuity and diagnostic performance of three imaging data sets (T2WI, combined T2WI and DWI [combined DWI], contrast-enhanced (CE)-T1WI) in assessing perianal fistulas. METHODS Two radiologists with 7 and 15years of experience assessed 28 fistulas from 24 patients in each image set. RESULTS The lesion conspicuity was improved for only one reader after reading the combined DWI (P=0.0039) and CE-T1WI (P=0.0215). The accuracy was stationary for fistula type (reader 1, all 93%; reader 2, all 89%) or for direction of internal opening (96% for all sets; 92% for CE-T1WI). CONCLUSION Although combined DWI and CE-T1WI might improve fistula conspicuity, they showed comparable diagnostic performance to T2WI.
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Fischerova D, Zikan M, Semeradova I, Slama J, Kocian R, Dundr P, Nemejcova K, Burgetova A, Dusek L, Cibula D. Ultrasound in preoperative assessment of pelvic and abdominal spread in patients with ovarian cancer: a prospective study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:263-274. [PMID: 27091633 DOI: 10.1002/uog.15942] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To analyze the accuracy of ultrasound in assessing pelvic and intra-abdominal spread in patients with ovarian cancer. METHODS This prospective study enrolled all consecutive patients referred to a single gynecological oncology center for suspected ovarian cancer. We analyzed only data from patients with histologically confirmed primary ovarian cancer who were evaluated following predefined preoperative ultrasound, intraoperative and pathology protocols. We evaluated the agreement of depth of infiltration of the rectosigmoid wall, tumor spread in different peritoneal compartments and presence of metastatic retroperitoneal and inguinal lymph nodes, as determined at ultrasound, with intraoperative and histopathological findings. RESULTS In total, 578 patients were enrolled between March 2008 and January 2013, of whom 394 met the study inclusion criteria and were analyzed; 74% of these suffered from advanced-stage cancer. Our results showed excellent agreement between ultrasound and histology in assessment of rectosigmoid wall infiltration (kappa value, 0.812; area under the receiver-operating characteristics curve, 0.898). The overall accuracy in evaluating different peritoneal compartments, retroperitoneal and inguinal lymph nodes and depth of rectosigmoid wall infiltration was 85.3%, 84.8%, 99.7% and 91.1%, respectively. Ultrasound showed high sensitivity only in the assessment of rectosigmoid wall infiltration (83.1%), peritoneal spread into the pelvis (81.4%) and omentum (67.3%), and inguinal metastatic lymph nodes (100%). The specificity of ultrasound in detection of all evaluated parameters was > 90%. CONCLUSION This is the largest imaging study to date on ovarian cancer staging. Ultrasound can be used as the method of choice to plan rectosigmoid wall resection and dissection of infiltrated inguinal lymph nodes. In assessing different peritoneal and retroperitoneal compartments, ultrasound was accurate and highly specific. However, similar to other modern imaging techniques, it had relatively low sensitivity, further supporting the role of comprehensive surgical staging. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Fischerova
- Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - M Zikan
- Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - I Semeradova
- Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - J Slama
- Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - R Kocian
- Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - P Dundr
- Department of Pathology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - K Nemejcova
- Department of Pathology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - A Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - L Dusek
- Institute of Biostatistics and Analysis, Masaryk University, Brno, Czech Republic
| | - D Cibula
- Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
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Peng J, Li JJ, Li J, Li HW, Xu GP, Jia RR, Zhang XN, Zhao Y. Could ADC values be a promising diagnostic criterion for differentiating malignant and benign hepatic lesions in Asian populations: A meta-analysis. Medicine (Baltimore) 2016; 95:e5470. [PMID: 27902599 PMCID: PMC5134810 DOI: 10.1097/md.0000000000005470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Liver cancer exhibits geographic and ethnic differences in its prevalence and biology, which implies that it is impractical to develop universal guidelines for all patients. Thus, a meta-analysis was conducted to identify the accuracy of apparent diffusion coefficients (ADCs) for discriminating malignant from benign liver lesions in Asians. METHODS Eligible studies published in PubMed, Ovid, and Embase/Medline were updated onto October 2014. STATA 12.0 and Meta-Disc 1.4 were used to perform this meta-analysis. RESULTS Eight studies comprising 661 benign liver lesions and 598 malignant liver lesions fulfilled all the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.88 (95% confidence interval [CI] 0.75-0.95), 0.93 (95% CI 0.86-0.97), 12.42 (95% CI 6.09-25.31), 0.13 (95% CI 0.06-0.29), and 95.58 (95% CI 35.29-258.89), respectively. Overall, the area under the summary receiver-operating characteristic curve was 0.96 (95% CI 0.94-0.98). Heterogeneity was found to originate potentially from the type of benign lesion. A subgroup analysis showed that differentiating between hemangiomas, cysts, and malignant liver lesions produced a significantly higher diagnostic accuracy than that of solid liver lesions. CONCLUSION Our meta-analysis indicated that ADC could be promising for characterizing liver lesions among Asians, indicating that the ADC value is a promising diagnostic criterion candidate. Meanwhile, the use of dual b values could be sufficient for liver lesion characterization. However, large-scale, high-quality trials should be conducted to identify specific standards, including cut-off values for further development of diffusion-weighted imaging as a routine clinical application among Asian populations.
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Anzidei M, Napoli A, Sacconi B, Boni F, Noce V, Di Martino M, Saba L, Catalano C. Magnetic resonance-guided focused ultrasound for the treatment of painful bone metastases: role of apparent diffusion coefficient (ADC) and dynamic contrast enhanced (DCE) MRI in the assessment of clinical outcome. Radiol Med 2016; 121:905-915. [PMID: 27567615 DOI: 10.1007/s11547-016-0675-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/16/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess the correlation between functional MRI, including ADC values obtained from DWI and DCE, and clinical outcome in patients with bone metastases treated with MRgFUS. METHODS AND MATERIALS Twenty-three patients with symptomatic bone metastases underwent MRgFUS treatment (ExAblate 2100 system InSightec) for pain palliation. All patients underwent clinical and imaging follow-up examinations at 1, 3 and 6 months after treatment. Visual Analog Scale (VAS) score was used to evaluate treatment efficacy in terms of pain palliation while ADC maps obtained by DWI sequences, and DCE data were used for quantitative assessment of treatment response at imaging. Spearman Correlation Coefficient Test was calculated to assess the correlation between VAS, ADC and DCE data. RESULTS All treatments were performed successfully without adverse events. On the basis of VAS score, 16 (69.6 %) patients were classified as complete clinical responders, 6 (26.1 %) as partial responders and only one (4.3 %) was classified as a non-responder. The mean VAS score decreased from 7.09 ± 1.8 at baseline to 2.65 ± 1.36 at 1 month, 1.04 ± 1.91 at 3 months and 1.09 ± 1.99 at 6 months (p < 0.001). Baseline mean ADC value of treated lesions was 1.05 ± 0.15 mm2/s, increasing along follow-up period (1.57 ± 0.27 mm2/s 1st month; 1.49 ± 0.3 mm2/s 3rd month; 1.45 ± 0.32 mm2/s 6th month, p < 0.001). Non perfused volume (NPV) was 46.4 at 1 month, 45.2 at 3 months and 43.8 at 6 months. Spearman Coefficient demonstrated a statistically significant negative correlation between VAS and ADC values (ρ = -0.684; p = 0.03), but no significant correlation between VAS and NPV (ρ = 0.02216, p = 0.9305). Among other DCE data, Ktrans significantly changed in complete responders (3 months Ktrans = 2.14/min; -ΔKt = 52.65 % p < 0.01) and was not significantly different in partial responders (3 months Ktrans 0.042/min; ΔKt = 11.39 % p > 0.01). CONCLUSION In patients with painful bone metastases treated with MRgFUS, ADC and Ktrans variation observed in the ablated lesions correlate with VAS values and may play a role as objective imaging marker of treatment response.
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Affiliation(s)
- Michele Anzidei
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Alessandro Napoli
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Beatrice Sacconi
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.,Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Viale Regina Elena 291, Rome, Italy
| | - Fabrizio Boni
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Vincenzo Noce
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Michele Di Martino
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Cagliari, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Colagrande S, Castellani A, Nardi C, Lorini C, Calistri L, Filippone A. The role of diffusion-weighted imaging in the detection of hepatic metastases from colorectal cancer: A comparison with unenhanced and Gd-EOB-DTPA enhanced MRI. Eur J Radiol 2016; 85:1027-1034. [PMID: 27130067 DOI: 10.1016/j.ejrad.2016.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/14/2015] [Accepted: 02/08/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare the role of DWI vs. gadoxetic-acid-disodium enhanced MRI in the detection of colorectal hepatic metastases. METHODS Fifty-four patients with 115 hepatic metastases were included in this retrospective study, approved by the Ethical Board. All patients underwent intraoperative-ultrasound and surgical resection within two weeks after MRI. Images were grouped in 4 sets, which were analyzed by two radiologists in different sessions: unenhanced T1-T2w (set A), set A plus DWI (set B), set A plus gadoxetic-acid-disodium (set C), set A plus DWI plus gadoxetic-acid-disodium (set D). For each set, metastases presence/size/site was reported. Interobserver agreement and statistical significance were assessed by Cohen's kappa and Mc-Nemar's test, respectively. RESULTS Readers' agreement was always very good (k>0.80). Mean sensitivity values were 84.3/92.1/95.6/97.3% for set A/B/C/D, respectively. Mean specificity, positive predicted, negative predicted, and accuracy values strongly and progressively increased in the various set too: from 62.5% (set A) to 85.0% as for specificity, from 92.8% to 97.3% as for positive predicted value, from 41.0% to 85.1% as for negative predicted value, and from 81.1% to 95.5% as for accuracy. For each reader from set A to D, the number of false negatives progressively decreases. CONCLUSIONS For both readers, DWI improved all statistical parameters in the unenhanced examinations, as for nodules either smaller or greater than 1cm, while in the EOB-enhanced examinations DWI prevalently increased specificity/negative predictive value.
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Affiliation(s)
- 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.
| | - Alessandro Castellani
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy.
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy.
| | - Chiara Lorini
- Department of Health Science, University of Florence, viale GB Morgagni 48, Florence 50134, Italy.
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy.
| | - Antonella Filippone
- Departement of Neurosciences and Imaging, Section of Radiological Imaging, "G. d'Annunzio" University-Ospedale SS. Annunziata, Via dei Vestini, Chieti 66013, Italy.
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Lakhman Y, Nougaret S, Miccò M, Scelzo C, Vargas HA, Sosa RE, Sutton EJ, Chi DS, Hricak H, Sala E. Role of MR Imaging and FDG PET/CT in Selection and Follow-up of Patients Treated with Pelvic Exenteration for Gynecologic Malignancies. Radiographics 2016; 35:1295-313. [PMID: 26172364 DOI: 10.1148/rg.2015140313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pelvic exenteration (PE) is a radical surgical procedure used for the past 6 decades to treat locally advanced malignant diseases confined to the pelvis, particularly persistent or recurrent gynecologic cancers in the irradiated pelvis. The traditional surgical technique known as total PE consists of resection of all pelvic viscera followed by reconstruction. Depending on the tumor extent, the procedure can be tailored to remove only anterior or posterior structures, including the bladder (anterior exenteration) or rectum (posterior exenteration). Conversely, more extended pelvic resection can be performed if the pelvic sidewall is invaded by cancer. Preoperative imaging evaluation with magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is central to establishing tumor resectability and therefore patient eligibility for the procedure. These imaging modalities complement each other in diagnosis of tumor recurrence and differentiation of persistent disease from posttreatment changes. MR imaging can accurately demonstrate local tumor extent and show adjacent organ invasion. FDG PET/CT is useful in excluding nodal and distant metastases. In addition, FDG PET/CT metrics may serve as predictive biomarkers for overall and disease-free survival. This pictorial review describes different types of exenterative surgical procedures and illustrates the central role of imaging in accurate patient selection, treatment planning, and postsurgical surveillance.
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Affiliation(s)
- Yulia Lakhman
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Stephanie Nougaret
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Maura Miccò
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Chiara Scelzo
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Hebert A Vargas
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Ramon E Sosa
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Elizabeth J Sutton
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Dennis S Chi
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Hedvig Hricak
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Evis Sala
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
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Meng XF, Zhu SC, Sun SJ, Guo JC, Wang X. Diffusion weighted imaging for the differential diagnosis of benign vs. malignant ovarian neoplasms. Oncol Lett 2016; 11:3795-3802. [PMID: 27313697 DOI: 10.3892/ol.2016.4445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022] Open
Abstract
In order to assess the diagnostic accuracy of diffusion weighted imaging (DWI) in differentiating between benign and malignant ovarian neoplasms, a systemic meta-analysis was conducted. Relevant studies were retrieved from scientific literature databases, including the PubMed, Wiley, EBSCO, Ovid, Web of Science, Wanfang, China National Knowledge Infrastructure and VIP databases. Following a multi-step screening and study selection process, the relevant data was extracted for use in the present study. Statistical analyses were performed using Meta-disc software version 1.4 and STATA statistical software version 12.0. A total of 285 articles were retrieved from the database searches. Following a careful screening process, 10 case-control studies were selected for the present meta-analysis. The 10 studies investigated the efficacy of DWI in diagnosing ovarian neoplasms, and included a combined total of 1,159 subjects, of which 559 patients had malignant lesions and 600 had benign lesions. The results showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio (DOR) and area under the curve of the summary receiver operating characteristics curve of DWI for differentiating between benign and malignant ovarian neoplasms were 0.93, 0.89, 7.58, 0.10, 85.33 and 0.95, respectively. A subgroup analysis based on ethnicity revealed no significant difference between Asians and Caucasians. Another subgroup analysis by magnetic resonance imaging (MRI) type showed that the DORs for GE Healthcare Life Sciences and Siemens AG machines were 100.76 [95% confidence interval (CI), 65.28-155.53] and 30.85 (95% CI, 10.40-91.53), respectively; this indicates that the diagnostic efficiency of the GE Healthcare Life Sciences MRI is superior compared with the Siemens AG MRI. The DWI demonstrated an excellent diagnostic performance in discriminating between benign and malignant ovarian neoplasms, and predicted the surgical outcome in ovarian neoplasms.
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Affiliation(s)
- Xiang-Fu Meng
- Department of Radiology, Linyi Traditional Chinese Medicine Hospital, Linyi, Shandong 276003, P.R. China
| | - Shi-Cai Zhu
- Department of Radiology, Linyi Traditional Chinese Medicine Hospital, Linyi, Shandong 276003, P.R. China
| | - Shao-Juan Sun
- Department of Radiology, Linyi Traditional Chinese Medicine Hospital, Linyi, Shandong 276003, P.R. China
| | - Ji-Cai Guo
- Department of Respiratory Medicine, Linyi Traditional Chinese Medicine Hospital, Linyi, Shandong 276003, P.R. China
| | - Xue Wang
- Department of Ultrasound, Linyi Traditional Chinese Medicine Hospital, Linyi, Shandong 276003, P.R. China
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30
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Low RN. Preoperative and surveillance MR imaging of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy. J Gastrointest Oncol 2016; 7:58-71. [PMID: 26941984 DOI: 10.3978/j.issn.2078-6891.2015.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
MR imaging provides considerable advantages for imaging patients with peritoneal tumor. Its inherently superior contrast resolution compared to CT allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms including diffusion-weighted (DW) MRI and gadolinium-enhanced MRI provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC).
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Affiliation(s)
- Russell N Low
- Department of Radiology and Sharp and Children's MRI Center, Sharp Memorial Hospital, San Diego, CA 92123, USA
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31
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Song JS, Hwang SB, Chung GH, Jin GY. Intra-Individual, Inter-Vendor Comparison of Diffusion-Weighted MR Imaging of Upper Abdominal Organs at 3.0 Tesla with an Emphasis on the Value of Normalization with the Spleen. Korean J Radiol 2016; 17:209-17. [PMID: 26957905 PMCID: PMC4781759 DOI: 10.3348/kjr.2016.17.2.209] [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: 08/03/2015] [Accepted: 01/13/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To compare the apparent diffusion coefficient (ADC) values of upper abdominal organs with 2 different 3.0 tesla MR systems and to investigate the usefulness of normalization using the spleen. MATERIALS AND METHODS Forty-one patients were enrolled in this prospective study, of which, 35 patients (M:F, 27:8; mean age ± standard deviation, 62.3 ± 12.3 years) were finally analyzed. In addition to the routine liver MR protocol, single-shot spin-echo echo-planar diffusion-weighted imaging using b values of 0, 50, 400, and 800 s/mm(2) in 2 different MR systems was performed. ADC values of the liver, spleen, pancreas, kidney and liver lesion (if present) were measured and analyzed. ADC values of the spleen were used for normalization. The Pearson correlation, Spearman correlation, paired sample t test, Wilcoxon signed rank test and Bland-Altman method were used for statistical analysis. RESULTS For all anatomical regions and liver lesions, both non-normalized and normalized ADC values from 2 different MR systems showed significant correlations (r = 0.5196-0.8488). Non-normalized ADC values of both MR systems differed significantly in all anatomical regions and liver lesions (p < 0.001). However, the normalized ADC of all anatomical regions and liver lesions did not differ significantly (p = 0.065-0.661), with significantly lower coefficient of variance than that of non-normalized ADC (p < 0.009). CONCLUSION Normalization of the abdominal ADC values using the spleen as a reference organ reduces differences between different MR systems, and could facilitate consistent use of ADC as an imaging biomarker for multi-center or longitudinal studies.
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Affiliation(s)
- Ji Soo Song
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
| | - Seung Bae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
| | - Gyung Ho Chung
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
| | - Gong Yong Jin
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
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32
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Bagade S, Fowler KJ, Schwarz JK, Grigsby PW, Dehdashti F. PET/MRI Evaluation of Gynecologic Malignancies and Prostate Cancer. Semin Nucl Med 2016; 45:293-303. [PMID: 26050657 DOI: 10.1053/j.semnuclmed.2015.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PET combined with cross-sectional anatomical imaging is an essential part of workup for most malignancies, in which CT or MRI provides anatomical context to the functional information from PET. Hybrid imaging with PET/CT has been extensively researched and implemented clinically in the evaluation and management of patients with gynecologic malignancies. Lately, integrated PET/MR scanners have become available. This new technology is fast gaining a role in clinical applications in the fields of oncology, neurology, and cardiology. MRI provides excellent soft tissue contrast especially in the pelvis and has been proven very useful for imaging prostate and female genital pathologies. The ability of PET to provide accurate functional imaging data with high sensitivity combined with the strength of MRI to provide accurate depiction of anatomy with high contrast and spatial resolution renders combined PET/MRI a desirable method for evaluation of gynecologic malignancies and other pelvic cancers such as prostate cancer. The goal of this article is to provide an overview of the published literature using PET/MRI in gynecologic and prostate cancers.
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Affiliation(s)
- Swapnil Bagade
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Kathryn J Fowler
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Julie K Schwarz
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO; Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Perry W Grigsby
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO; Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Farrokh Dehdashti
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO.
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33
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Hedderich DM, Weiss K, Maintz D, Persigehl T. [Modern magnetic resonance imaging of the liver]. Radiologe 2015; 55:1045-56. [PMID: 26628259 DOI: 10.1007/s00117-015-0031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Magnetic resonance imaging (MRI) of the liver has become an essential tool in the radiological diagnostics of both focal and diffuse diseases of the liver and is subject to constant change due to technological progress. Recently, important improvements could be achieved by innovations regarding MR hardware, sequences and postprocessing methods. The diagnostic spectrum of MRI could be broadened particularly due to new examination sequences, while at the same time scanning time could be shortened and image quality has been improved. The aim of this article is to explain both the technological background and the clinical application of recent MR sequence developments and to present the scope of a modern MRI protocol for the liver.
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Affiliation(s)
- D M Hedderich
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - K Weiss
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Philips Healthcare Deutschland, Hamburg, Deutschland
| | - D Maintz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - T Persigehl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Klenk C, Gawande R, Tran VT, Leung JT, Chi K, Owen D, Luna-Fineman S, Sakamoto KM, McMillan A, Quon A, Daldrup-Link HE. Progressing Toward a Cohesive Pediatric 18F-FDG PET/MR Protocol: Is Administration of Gadolinium Chelates Necessary? J Nucl Med 2015; 57:70-7. [PMID: 26471690 DOI: 10.2967/jnumed.115.161646] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/10/2015] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED With the increasing availability of integrated PET/MR scanners, the utility and need for MR contrast agents for combined scans is questioned. The purpose of our study was to evaluate whether administration of gadolinium chelates is necessary for evaluation of pediatric tumors on (18)F-FDG PET/MR images. METHODS First, in 119 pediatric patients with primary and secondary tumors, we used 14 diagnostic criteria to compare the accuracy of several MR sequences: unenhanced T2-weighted fast spin-echo imaging; unenhanced diffusion-weighted imaging; and-before and after gadolinium chelate contrast enhancement-T1-weighted 3-dimensional spoiled gradient echo LAVA (liver acquisition with volume acquisition) imaging. Next, in a subset of 36 patients who had undergone (18)F-FDG PET within 3 wk of MRI, we fused the PET images with the unenhanced T2-weighted MR images (unenhanced (18)F-FDG PET/MRI) and the enhanced T1-weighted MR images (enhanced (18)F-FDG PET/MRI). Using the McNemar test, we compared the accuracy of the two types of fused images using the 14 diagnostic criteria. We also evaluated the concordance between (18)F-FDG avidity and gadolinium chelate enhancement. The standard of reference was histopathologic results, surgical notes, and follow-up imaging. RESULTS There was no significant difference in diagnostic accuracy between the unenhanced and enhanced MR images. Accordingly, there was no significant difference in diagnostic accuracy between the unenhanced and enhanced (18)F-FDG PET/MR images. (18)F-FDG avidity and gadolinium chelate enhancement were concordant in 30 of the 36 patients and 106 of their 123 tumors. CONCLUSION Gadolinium chelate administration is not necessary for accurate diagnostic characterization of most solid pediatric malignancies on (18)F-FDG PET/MR images, with the possible exception of focal liver lesions.
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Affiliation(s)
- Christopher Klenk
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
| | - Rakhee Gawande
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
| | - Vy Thao Tran
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
| | - Jennifer Trinh Leung
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
| | - Kevin Chi
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
| | - Daniel Owen
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
| | - Sandra Luna-Fineman
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Kathleen M Sakamoto
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Alex McMillan
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
| | - Andy Quon
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, and Lucile Packard Children's Hospital, Stanford University, Stanford, California; and
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Zhao YL, Guo QQ, Yang GR, Wang QD. Early changes in apparent diffusion coefficient as an indicator of response to sorafenib in hepatocellular carcinoma. J Zhejiang Univ Sci B 2015; 15:713-9. [PMID: 25091989 DOI: 10.1631/jzus.b1400010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The relationship between apparent diffusion coefficient (ADC) and chemotherapy has been established. However, whether ADC could be considered as a measure for monitoring response to sorafenib in hepatocellular carcinoma (HCC) has not been demonstrated. This study was to investigate the ADC changes of advanced HCC under sorafenib treatment. METHODS Athymic mice with HepG2 xenografts were allocated to two groups: control and sorafenib (40 mg/kg, bid). T2 and diffusion images were acquired at each time point (0, 10, 14, and 18 d post-therapy). Tumor volume and changes in ADC were calculated. RESULTS Tumor volumes on Days 10, 14, and 18 after treatment showed significant decreases in the sorafenib-treated group compared with the control. Pretreatment ADC values were not significantly different between the control and treated groups. A slow increase in ADC in the peripheral zone of tumors appeared in the treated group, which was significantly higher compared with the control group on Days 10, 14, and 18. In the central part of tumors on Day 10 after treatment, an increase in ADC appeared in the treated and control groups, the ADC of the control group being significantly lower compared with the treated tumors. From Day 10 to Day 14, the ADC map showed a progressive decrease in the central region of tumors in the treated and control groups. However, this change is more significant in the treated groups. CONCLUSIONS Early changes in mean ADC correlated with sorafenib treatment in HCC, which are promising indicators for predicting sorafenib response in this carcinoma.
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Affiliation(s)
- Yi-lei Zhao
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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Hameeduddin A, Sahdev A. Diffusion-weighted imaging and dynamic contrast-enhanced MRI in assessing response and recurrent disease in gynaecological malignancies. Cancer Imaging 2015; 15:3. [PMID: 25889065 PMCID: PMC4432943 DOI: 10.1186/s40644-015-0037-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 01/22/2015] [Indexed: 12/19/2022] Open
Abstract
Magnetic resonance imaging (MRI) has an established role in imaging pelvic gynaecological malignancies. It is routinely used in staging endometrial and cervical cancer, characterizing adnexal masses, selecting optimal treatment, monitoring treatment and detecting recurrent disease. MRI has also been shown to have an excellent performance and an evolving role in surveillance of patients after chemoradiotherapy in cervical cancer, post-trachelectomy, detecting early recurrence and planning exenterative surgery in isolated central recurrences in both cervical and endometrial cancer and in young patients on surveillance for medically managed endometrial cancer. However, conventional MRI still has limitations when the morphological appearance of early recurrent or residual disease overlaps with normal pelvic anatomy or treatment effects in the pelvis. In particular, after chemoradiotherapy for cervical cancer, distinguishing between radiotherapy changes and residual or early recurrent disease within the cervix or the vaginal vault can be challenging on conventional MRI alone. Therefore, there is an emerging need for functional imaging to overcome these limitations. The purpose of this paper is to discuss the emerging functional MRI techniques and their applications in predicting treatment response, detecting residual disease and early recurrent disease to optimize the treatment options available using diffusion-weighted imaging and dynamic contrast enhancement particularly in cervical and endometrial cancer.
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Affiliation(s)
- Ayshea Hameeduddin
- Imaging Department, St. Bartholomew's Hospital, Barts Health, West Smithfield, London, UK.
| | - Anju Sahdev
- Imaging Department, St. Bartholomew's Hospital, Barts Health, West Smithfield, London, UK.
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Onur MR, Akyol M, Poyraz AK, Kocakoc E, Ogur E. Diagnosis of Peritoneal Metastases with Abdominal Malignancies: Role of ADC Measurement on Diffusion Weighted MRI. Eurasian J Med 2015; 44:163-8. [PMID: 25610233 DOI: 10.5152/eajm.2012.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/04/2012] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The purpose of our study was to evaluate the utility of the apparent diffusion coefficient (ADC) value measurement in the diagnosis of peritoneal metastases on diffusion weighted magnetic resonance imaging. MATERIALS AND METHODS Diffusion weighted imaging with conventional magnetic resonance imaging sequences was performed on twenty consecutive oncology patients (group I) with peritoneal metastases. The ADC values of the metastases, the peritoneal fat around the metastases (group I) and the peritoneal fat in patients with no malignancy (group II) at b(0-100), b(0-600), and (b 0-1000) s/mm(2) gradients were measured and compared. RESULTS The apparent diffusion coefficient values of three gradients in peritoneal metastases (2.27±0.4; 1.67±0.7 and 1.09±0.4×10(-3) mm(2)/s at b 100, 600 and 1000 gradients, respectively) were significantly lower than the ADC values of the peritoneal fat around metastases (3.07±0.4; 2.07±0.4; 1.33±0.3×10(-3) mm(2)/s at b 100, 600 and 1000 gradients, respectively) (p<0.05). There was no significant difference between the ADC values of peritoneal fat in the patients of group I and group II at the 3 diffusion gradients (p>0.05). CONCLUSION The measurement of ADC values may be used as a complementary diagnostic method in differentiating peritoneal metastases from peritoneal fat on Diffusion Weighted MRI (DWMRI DWMRI).
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Affiliation(s)
- Mehmet Ruhi Onur
- Department of Radiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Muammer Akyol
- Department of Radiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Ahmet Kursad Poyraz
- Department of Radiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Ercan Kocakoc
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkin Ogur
- Department of Radiology, Faculty of Medicine, Firat University, Elazig, Turkey
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Jalli R, Jafari SH, Sefidbakht S, Kazemi K. Comparison of the Accuracy of DWI and Ultrasonography in Screening Hepatocellular Carcinoma in Patients With Chronic Liver Disease. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e12708. [PMID: 25785178 PMCID: PMC4347758 DOI: 10.5812/iranjradiol.12708] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/25/2013] [Accepted: 08/18/2013] [Indexed: 02/06/2023]
Abstract
Background: Hepatocellular carcinoma (HCC) is a neoplasm usually arising in a cirrhotic liver by a multistep carcinogenesis process. Early detection of HCC and accurate assessment of tumor burden are crucial to successful treatment planning and long-term survival. Objectives: In this study, we compared the accuracy of diffusion weighted imaging (DWI) combined with limited sequence magnetic resonance imaging (MRI) set as a potentially quick and practical MR candidate with ultrasonography (US) for screening of HCC in patients with cirrhosis. Patients and Methods: Of 96 patients with cirrhosis, 30 who had concomitant HCC proved by pathology were selected. MRI, DWI, and US of the liver were performed for the patients. Sensitivity, specificity, and accuracy of DWI alone, limited sequences MRI alone, a combination of them, and US were calculated for the detection of HCC in these patients and then comparison between these modalities was performed. Results: Combination of limited sequences MRI and DWI had the highest accuracy (94.79%) followed by DWI alone followed by limited sequence MRI alone. The least accuracy was for US (78.12%) with a statistically significant difference. Conclusion: Due to the significant improvement in the treatment of early stage of HCC compared to the previous decade, we suggest a fast, non-invasive, more accurate, but more expensive method (HASTE, OP/IP T1W sequences MRI combined with DWI) rather than US for the screening of HCC in liver cirrhosis.
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Affiliation(s)
- Reza Jalli
- Colorectal Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hamed Jafari
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author: Seyed Hamed Jafari, Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-917-3138381, Fax: +98-711-6302442, E-mail:
| | - Sepideh Sefidbakht
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kourosh Kazemi
- Department of General Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Kim HJ, Lee SS, Byun JH, Kim JC, Yu CS, Park SH, Kim AY, Ha HK. Incremental value of liver MR imaging in patients with potentially curable colorectal hepatic metastasis detected at CT: a prospective comparison of diffusion-weighted imaging, gadoxetic acid-enhanced MR imaging, and a combination of both MR techniques. Radiology 2014; 274:712-22. [PMID: 25286324 DOI: 10.1148/radiol.14140390] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To prospectively compare diagnostic performance of diffusion-weighted (DW) imaging, gadoxetic acid-enhanced magnetic resonance (MR) imaging, both techniques combined (combined MR imaging), and computed tomography (CT) for detecting colorectal hepatic metastases and evaluate incremental value of MR for patients with potentially curable colorectal hepatic metastases detected with CT. MATERIALS AND METHODS In this institutional review board-approved prospective study, with informed consent, 51 patients (39 men, 12 women; mean age, 62 years) with potentially resectable hepatic metastases detected with CT underwent liver MR, including DW imaging and gadoxetic acid-enhanced MR. Two independent readers reviewed DW, gadoxetic acid-enhanced, combined MR, and CT image sets to detect hepatic metastases. The figure-of-merit (FOM) value representing overall diagnostic performance, sensitivity, and positive predictive value (PPV) for each image set were analyzed by using free-response receiver operating characteristic analysis and generalized estimating equations. RESULTS There were 104 hepatic metastases in 47 patients. The pooled FOM values, sensitivities, and PPVs of combined MR (FOM value, 0.93; sensitivity, 98%; and PPV, 88%) and gadoxetic acid-enhanced MR (FOM value, 0.92; sensitivity, 95%; and PPV, 90%) were significantly higher than those of CT (FOM value, 0.82; sensitivity, 85%; and PPV, 73%) (P < .006). The pooled FOM value and sensitivity of combined MR (FOM value, 0.92; sensitivity, 95%) was also significantly higher than that of DW imaging (FOM value, 0.82; sensitivity, 79%) for metastases (≤1-cm diameter) (P ≤ .003). DW imaging showed significantly higher pooled sensitivity (79%) and PPV (60%) than CT (sensitivity, 50%; PPV, 33%) for the metastases (≤1-cm diameter) (P ≤ .004). In 47 patients with hepatic metastases, combined MR depicted more metastases than CT in 10 and 14 patients, respectively, according to both readers. CONCLUSION Gadoxetic acid-enhanced MR and combined MR are more accurate than CT in detecting colorectal hepatic metastases, have an incremental value when added to CT alone for detecting additional metastases, and can be routinely performed in patients with potentially curable hepatic metastases detected with CT.
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Affiliation(s)
- Hye Jin Kim
- From the Department of Radiology and Research Institute of Radiology (H.J.K., S.S.L., J.H.B., S.H.P., A.Y.K., H.K.H.) and Department of Surgery (J.C.K., C.S.Y.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songa-Gu, Seoul 138-736, Korea
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Cieszanowski A, Maj E, Kulisiewicz P, Grudzinski IP, Jakoniuk-Glodala K, Chlipala-Nitek I, Kaczynski B, Rowinski O. Non-contrast-enhanced whole-body magnetic resonance imaging in the general population: the incidence of abnormal findings in patients 50 years old and younger compared to older subjects. PLoS One 2014; 9:e107840. [PMID: 25259581 PMCID: PMC4178037 DOI: 10.1371/journal.pone.0107840] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/22/2014] [Indexed: 12/29/2022] Open
Abstract
Purpose To assess and compare the incidence of abnormal findings detected during non-contrast-enhanced whole-body magnetic resonance imaging (WB-MRI) in the general population in two age groups: (1) 50 years old and younger; and (2) over 50 years old. Materials and Methods The analysis included 666 non-contrast-enhanced WB-MRIs performed on a 1.5-T scanner between December 2009 and June 2013 in a private hospital in 451 patients 50 years old and younger and 215 patients over 50 years old. The following images were obtained: T2-STIR (whole body-coronal plane), T2-STIR (whole spine-sagittal), T2-TSE with fat-saturation (neck and trunk-axial), T2-FLAIR (head-axial), 3D T1-GRE (thorax-coronal, axial), T2-TSE (abdomen-axial), chemical shift (abdomen-axial). Detected abnormalities were classified as: insignificant (type I), potentially significant, requiring medical attention (type II), significant, requiring treatment (type III). Results There were 3375 incidental findings depicted in 659 (98.9%) subjects: 2997 type I lesions (88.8%), 363 type II lesions (10.8%) and 15 type III lesions (0.4%), including malignant or possibly malignant lesions in seven subjects. The most differences in the prevalence of abnormalities on WB-MRI between patients 50 years old and younger and over 50 years old concerned: brain infarction (22.2%, 45.0% respectively), thyroid cysts/nodules (8.7%, 18.8%), pulmonary nodules (5.0%, 16.2%), significant degenerative disease of the spine (23.3%, 44.5%), extra-spinal degenerative disease (22.4%, 61.1%), hepatic steatosis (15.8%, 24.9%), liver cysts/hemangiomas (24%, 34.5%), renal cysts (16.9%, 40.6%), prostate enlargement (5.1% of males, 34.2% of males), uterine fibroids (16.3% of females, 37.9% of females). Conclusions Incidental findings were detected in almost all of the subjects. WB-MRI demonstrated that the prevalence of the vast majority of abnormalities increases with age.
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Affiliation(s)
- Andrzej Cieszanowski
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
- Diagnostic Center, Medicover Hospital, Warsaw, Poland
| | - Edyta Maj
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
- Diagnostic Center, Medicover Hospital, Warsaw, Poland
- * E-mail:
| | - Piotr Kulisiewicz
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
- Diagnostic Center, Medicover Hospital, Warsaw, Poland
| | - Ireneusz P. Grudzinski
- Department of Toxicology, Medical University of Warsaw, Faculty of Pharmacy, Warsaw, Poland
| | | | - Irena Chlipala-Nitek
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Kaczynski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowinski
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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Hu Z, Yang W, Liu H, Wang K, Bao C, Song T, Wang J, Tian J. From PET/CT to PET/MRI: advances in instrumentation and clinical applications. Mol Pharm 2014; 11:3798-809. [PMID: 25058336 DOI: 10.1021/mp500321h] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Multimodality imaging of positron emission tomography/computed tomography (PET/CT) provides both metabolic information and the anatomic structure, which is significantly superior to either PET or CT alone and has greatly improved its clinical applications. Because of the higher soft-tissue contrast of magnetic resonance imaging (MRI) and no extra ionizing radiation, PET/MRI imaging is the hottest topic currently. PET/MRI is swiftly making its way into clinical practice. However, it has many technical difficulties to overcome, such as photomultiplier tubes, which cannot work properly in a magnetic field, and the inability to provide density information on the object for attenuation correction. This paper introduces the technique process of PET/MRI and summarizes its clinical applications, including imaging in oncology, neurology, and cardiology.
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Affiliation(s)
- Zhenhua Hu
- Institute of Automation, Chinese Academy of Sciences , Beijing 100190, China
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Fischerova D, Burgetova A. Imaging techniques for the evaluation of ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2014; 28:697-720. [DOI: 10.1016/j.bpobgyn.2014.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/13/2014] [Accepted: 04/18/2014] [Indexed: 12/15/2022]
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Chen ML, Zhang XY, Qi LP, Shi QL, Chen B, Sun YS. Diffusion-weighted images (DWI) without ADC values in assessment of small focal nodules in cirrhotic liver. Chin J Cancer Res 2014; 26:38-47. [PMID: 24653625 DOI: 10.3978/j.issn.1000-9604.2014.01.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/04/2013] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess if diffusion-weighted magnetic resonance (MR) imaging without apparent diffusion coefficient (ADC) values provides added diagnostic value in combination with conventional MR imaging in the detection and characterization of small nodules in cirrhotic liver. METHODS Two observers retrospectively and independently analyzed 86 nodules (≤3 cm) certified pathologically in 33 patients with liver cirrhosis, including 48 hepatocellular carcinoma (HCC) nodules, 13 high-grade dysplastic nodules (HDN), 10 low-grade dysplastic nodules (LDNs) and 15 other benign nodules. All these focal nodules were evaluated with conventional MR images (T1-weighted, T2-weighted and dynamic gadolinium-enhanced images) and breath-hold diffusion-weighted images (DWI) (b=500 s/mm(2)). The nodules were classified by using a scale of 1-3 (1, not seen; 3, well seen) on DWI for qualitative assessment. These small nodules were characterized by two radiologists. ADC values weren't measured. The diagnostic performance of the combined DWI-conventional images and the conventional images alone was evaluated using receiver operating characteristic (ROC) curves. The area under the curves (Az), sensitivity and specificity values for characterizing different small nodules were also calculated. RESULTS Among 48 HCC nodules, 33 (68.8%) were graded as 3 (well seen), 6 (12.5%) were graded as 2 (partially obscured), and 9 weren't seen on DWI. Among 13 HDNs, there were 3 (23.1%) and 4 (30.8%) graded as 3 and 2 respectively. Five (50%) of 10 benign nodules were partially obscured and slightly hyperintense. For 86 nodules, the average diagnostic accuracy of combined DWI-conventional images was 82.56%, which was increased significantly compared with conventional MR images with 76.17%. For HCC and HDN, the diagnostic accuracy of combined DWI-conventional images increased from 78.69% to 86.07%. CONCLUSIONS Diffusion-weighted MR imaging does provide added diagnostic value in the detection and characterization of HDN and HCC, and it may not be helpful for LDN and regenerative nodule (RN) in cirrhotic liver.
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Affiliation(s)
- Mai-Lin Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Li-Ping Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Qing-Lei Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Bin Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Galea N, Cantisani V, Taouli B. Liver lesion detection and characterization: role of diffusion-weighted imaging. J Magn Reson Imaging 2014; 37:1260-76. [PMID: 23712841 DOI: 10.1002/jmri.23947] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/11/2012] [Indexed: 12/11/2022] Open
Abstract
Diffusion-weighted imaging (DWI) plays an emerging role for the assessment of focal and diffuse liver diseases. This growing interest is due to that fact that DWI is a noncontrast technique with inherent high contrast resolution, with promising results for detection and characterization of focal liver lesions. Recent advances in diffusion image quality have also added interest to this technique in the abdomen. The purpose of this review is to describe the current clinical roles of DWI for the detection and characterization of focal liver lesions, and to review pitfalls, limitations, and future directions of DWI for assessment of focal liver disease.
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Affiliation(s)
- Nicola Galea
- Sapienza University of Rome, Department of Radiological Sciences, Rome, Italy
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Kinner S, Blex S, Maderwald S, Forsting M, Gerken G, Lauenstein TC. Addition of diffusion-weighted imaging can improve diagnostic confidence in bowel MRI. Clin Radiol 2013; 69:372-7. [PMID: 24360512 DOI: 10.1016/j.crad.2013.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 09/04/2013] [Accepted: 09/30/2013] [Indexed: 01/08/2023]
Abstract
AIM To evaluate whether the addition of diffusion-weighted imaging (DWI) in bowel abdominal magnetic resonance imaging (MRI) can improve diagnostic confidence. MATERIALS AND METHODS One hundred and eleven consecutive patients with suspected or known inflammatory bowel disease (n = 59), tumour disease (n = 31), unspecific abdominal pain (n = 16), and suspected graft-versus-host disease (n = 5) underwent bowel MRI using a 1.5 T MRI machine. In addition to T2-weighted (T2W) and contrast-enhanced T1-weighted (CE-T1W) data, axial and coronal DWI sequences were collected (b = 50, 500, 1000). Diagnostic confidence for lesion detection with and without DWI was evaluated using a four-point Likert scale [1 = certainly no lesion(s), 2 = probably no lesion(s), 3 = probably lesion(s), 4 = certainly lesion(s)]. RESULTS In 11 of 111 patients (10%), the diagnostic confidence was improved by DWI. In seven patients, readers changed their diagnosis from "probable" to "certain presence of lesions". In another four patients, lesions were diagnosed based on DWI, which were not delineated on CE-T1W and T2W imaging. CONCLUSION DWI of the bowel can provide additional information to the reader and, therefore, improve diagnostic confidence. Hence, additional DWI should be integrated into a standard bowel MRI protocol.
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Affiliation(s)
- S Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - S Blex
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - S Maderwald
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - G Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - T C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Badawy ME, Hamesa M, Elaggan A, Nooman AE, Gabr M. Can diffusion weighted MRI differentiate between benign and malignant hepatic focal lesions? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Torigian DA, Zaidi H, Kwee TC, Saboury B, Udupa JK, Cho ZH, Alavi A. PET/MR imaging: technical aspects and potential clinical applications. Radiology 2013; 267:26-44. [PMID: 23525716 DOI: 10.1148/radiol.13121038] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED Instruments that combine positron emission tomography (PET) and magnetic resonance (MR) imaging have recently been assembled for use in humans, and may have diagnostic performance superior to that of PET/computed tomography (CT) for particular clinical and research applications. MR imaging has major strengths compared with CT, including superior soft-tissue contrast resolution, multiplanar image acquisition, and functional imaging capability through specialized techniques such as diffusion-tensor imaging, diffusion-weighted (DW) imaging, functional MR imaging, MR elastography, MR spectroscopy, perfusion-weighted imaging, MR imaging with very short echo times, and the availability of some targeted MR imaging contrast agents. Furthermore, the lack of ionizing radiation from MR imaging is highly appealing, particularly when pediatric, young adult, or pregnant patients are to be imaged, and the safety profile of MR imaging contrast agents compares very favorably with iodinated CT contrast agents. MR imaging also can be used to guide PET image reconstruction, partial volume correction, and motion compensation for more accurate disease quantification and can improve anatomic localization of sites of radiotracer uptake, improve diagnostic performance, and provide for comprehensive regional and global structural, functional, and molecular assessment of various clinical disorders. In this review, we discuss the historical development, software-based registration, instrumentation and design, quantification issues, potential clinical applications, potential clinical roles of image segmentation and global disease assessment, and challenges related to PET/MR imaging. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121038/-/DC1.
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Affiliation(s)
- Drew A Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104-4283, USA.
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Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 2013; 266:717-40. [PMID: 23431227 DOI: 10.1148/radiol.12120315] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many treatment options are available to patients with endometrial, cervical, or ovarian cancer. Magnetic resonance (MR) imaging plays an important role in the patient journey from the initial evaluation of the extent of the disease to appropriate treatment selection and follow-up. The purpose of this review is to highlight the added role of MR imaging in the treatment stratification and overall care of patients with endometrial, cervical, or ovarian cancer. Several MR imaging techniques used in evaluation of patients with gynecologic malignancies are described, including both anatomic MR imaging sequences (T1- and T2-weighted sequences) and pulse sequences that characterize tissue on the basis of physiologic features (diffusion-weighted MR imaging), dynamic contrast agent-enhanced MR imaging, and MR spectroscopy. MR imaging findings corresponding to the 2009 revised International Federation of Gynecology and Obstetrics staging of gynecologic malignancies are also described in detail, highlighting possible pearls and pitfalls of staging. With the growing role of the radiologist as a core member of the multidisciplinary treatment planning team, it is crucial for imagers to recognize that MR imaging has become central in tailoring treatment options and therapy in patients with gynecologic malignancies.
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Affiliation(s)
- Evis Sala
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, England, UK.
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49
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Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is now widely used as a standard imaging sequence for evaluation of the liver. The technique is easy to implement across different MRI platforms, and results in enhanced disease detection and characterization. With careful implementation, the quantitative apparent diffusion coefficient derived shows good measurement reproducibility, which can be applied for tissue characterization, the assessment of tumour response and disease prognostication. There is now a body of evidence that highlights the relative strengths and limitations of the technique for the assessment of liver diseases. The potential for more sophisticated analysis of DW-MRI data is currently being widely investigated.
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Affiliation(s)
- N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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50
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Abstract
OBJECTIVE Functional MR techniques report on a variety of biologic features of tumors: dynamic contrast-enhanced, diffusion-weighted, and intrinsic susceptibility-weighted MRI and MR spectroscopy reflect, at a simplistic level, vascularity, cellularity, hypoxic status, and metabolism, respectively. This article reviews the evidence for each of the functional MR readouts to determine these clinical end points and thus influence the management of ovarian, endometrial, and cervical cancer. CONCLUSION These techniques may be implemented in gynecologic malignancies to detect, characterize, and stage tumors as well as potentially to predict the outcome and measure response to treatment.
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