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Van AT, McTavish S, Peeters JM, Weiss K, Makowski MR, Braren RF, Karampinos DC. Motion-induced phase-corrected homodyne reconstruction for partial Fourier single-shot diffusion-weighted echo planar imaging of the liver. NMR IN BIOMEDICINE 2024; 37:e5147. [PMID: 38561247 DOI: 10.1002/nbm.5147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
Partial Fourier encoding is popular in single-shot (ss) diffusion-weighted (DW) echo planar imaging (EPI) because it enables a shorter echo time (TE) and, hence, improves the signal-to-noise-ratio. Motion during diffusion encoding causes k-space shifting and dispersion, which compromises the quality of the homodyne reconstruction. This work provides a comprehensive understanding of the artifacts in homodyne reconstruction of partial Fourier ss-DW-EPI data in the presence of motion-induced phase and proposes the motion-induced phase-corrected homodyne (mpc-hdyne) reconstruction method to ameliorate these artifacts. Simulations with different types of motion-induced phase were performed to provide an understanding of the potential artifacts that occur in the homodyne reconstruction of partial Fourier ss-DW-EPI data. To correct for the artifacts, the mpc-hdyne reconstruction is proposed. The algorithm recenters k-space, updates the partial Fourier factor according to detected global k-space shifts, and removes low-resolution nonlinear phase before the conventional homodyne reconstruction. The mpc-hdyne reconstruction is tested on both simulation and in vivo data. Motion-induced phase can cause signal overestimation, worm artifacts, and signal loss in partial Fourier ss-DW-EPI data with the conventional homodyne reconstruction. Simulation and in vivo data showed that the proposed mpc-hdyne reconstruction ameliorated artifacts, yielding higher quality DW images compared with conventional homodyne reconstruction. Based on the understanding of the artifacts in homodyne reconstruction of partial Fourier ss-DW-EPI data, the mpc-hdyne reconstruction was proposed and showed superior performance compared with the conventional homodyne reconstruction on both simulation and in vivo data.
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Affiliation(s)
- Anh T Van
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Sean McTavish
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | | | | | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Rickmer F Braren
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
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2
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Furtado FS, Mercaldo ND, Vahle T, Benkert T, Bradley WR, Ratanaprasatporn L, Seethamraju RT, Harisinghani MG, Lee S, Suarez-Weiss K, Umutlu L, Catana C, Pomykala KL, Domachevsky L, Bernstine H, Groshar D, Rosen BR, Catalano OA. Simultaneous multislice diffusion-weighted imaging versus standard diffusion-weighted imaging in whole-body PET/MRI. Eur Radiol 2023; 33:2536-2547. [PMID: 36460925 DOI: 10.1007/s00330-022-09275-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To compare standard (STD-DWI) single-shot echo-planar imaging DWI and simultaneous multislice (SMS) DWI during whole-body positron emission tomography (PET)/MRI regarding acquisition time, image quality, and lesion detection. METHODS Eighty-three adults (47 females, 57%), median age of 64 years (IQR 52-71), were prospectively enrolled from August 2018 to March 2020. Inclusion criteria were (a) abdominal or pelvic tumors and (b) PET/MRI referral from a clinician. Patients were excluded if whole-body acquisition of STD-DWI and SMS-DWI sequences was not completed. The evaluated sequences were axial STD-DWI at b-values 50-400-800 s/mm2 and the apparent diffusion coefficient (ADC), and axial SMS-DWI at b-values 50-300-800 s/mm2 and ADC, acquired with a 3-T PET/MRI scanner. Three radiologists rated each sequence's quality on a five-point scale. Lesion detection was quantified using the anatomic MRI sequences and PET as the reference standard. Regression models were constructed to quantify the association between all imaging outcomes/scores and sequence type. RESULTS The median whole-body STD-DWI acquisition time was 14.8 min (IQR 14.1-16.0) versus 7.0 min (IQR 6.7-7.2) for whole-body SMS-DWI, p < 0.001. SMS-DWI image quality scores were higher than STD-DWI in the abdomen (OR 5.31, 95% CI 2.76-10.22, p < 0.001), but lower in the cervicothoracic junction (OR 0.21, 95% CI 0.10-0.43, p < 0.001). There was no significant difference in the chest, mediastinum, pelvis, and rectum. STD-DWI detected 276/352 (78%) lesions while SMS-DWI located 296/352 (84%, OR 1.46, 95% CI 1.02-2.07, p = 0.038). CONCLUSIONS In cancer staging and restaging, SMS-DWI abbreviates acquisition while maintaining or improving the diagnostic yield in most anatomic regions. KEY POINTS • Simultaneous multislice diffusion-weighted imaging enables faster whole-body image acquisition. • Simultaneous multislice diffusion-weighted imaging maintains or improves image quality when compared to single-shot echo-planar diffusion-weighted imaging in most anatomical regions. • Simultaneous multislice diffusion-weighted imaging leads to superior lesion detection.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Nathaniel D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Thomas Vahle
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - William R Bradley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lisa Ratanaprasatporn
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Ravi Teja Seethamraju
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- MR Collaborations, Siemens Medical Solutions USA, Inc., 30 Jonathan Ln, Malden, MA, 02148, USA
| | - Mukesh G Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Susanna Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Krista Suarez-Weiss
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Lale Umutlu
- Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Ciprian Catana
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | | | - Liran Domachevsky
- Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
| | - Hanna Bernstine
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - David Groshar
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - Bruse R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
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Ding WH, Lu YF, Xu MX, Yu RS. Compare image quality of T2-weighted imaging with different phase acceleration factors. Medicine (Baltimore) 2023; 102:e33234. [PMID: 36897710 PMCID: PMC9997765 DOI: 10.1097/md.0000000000033234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Previous studies demonstrated that adjusting the phase acceleration (PA) factors could influence image quality. To improve image quality and decrease respiratory artifacts of lesions in the liver on T2-weighted image by adjusting PA factor and number of excitation (NEX). Sixty consecutive patients with hepatic lesions were enrolled in this prospective research between May 2020 and June 2020. All patients had 3.0T magnetic resonance imaging with 4 sequences (combining PA factors and NEXs, the former was 2 and 3, the latter were 1.5 and 2, respectively, with the same other scanning parameters). Two readers used 5-point quality scales to assess image quality. The signal intensity was measured by drawing regions of interest in the liver, spleen, and background on the T2-weighted imaging. Artifacts, overall image impression, and vascular conspicuity were better when the PA factor was 3 than 2. Artifacts and vascular conspicuity were better when NEX was 2 than 1.5. PA factor 3 and NEX 2 got a higher score in 5-point quality scales and less scan time than the other 3 sequences. Meanwhile, the signal-to-noise ratio of PA factor 3 and NEX 2 was best among these 4 sequences. PA factor and NEX could influence the imaging quality and lesion-to-hepatic contrast in detecting hepatic lesions on T2-weighted images. PA factor 3 and NEX 2 may have a positive effect in the clinic, especially for those with irregular respiration, as it decreased artifacts and reduced scan time.
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Affiliation(s)
- Wen-Hong Ding
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan-Fei Lu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meng-Xi Xu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Han S, Lee JM, Kim SW, Park S, Nickel MD, Yoon JH. Evaluation of HASTE T2 weighted image with reduced echo time for detecting focal liver lesions in patients at risk of developing hepatocellular carcinoma. Eur J Radiol 2022; 157:110588. [DOI: 10.1016/j.ejrad.2022.110588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/06/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
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Bode M, Zhang S, Terwolbeck MN, Molavi Tabrizi C, Yoneyama M, Kraemer NA, Kuhl CK, Barabasch A. Liver diffusion-weighted MR imaging with L1-regularized iterative sensitivity encoding reconstruction based on single-shot echo-planar imaging: initial clinical experience. Sci Rep 2022; 12:12468. [PMID: 35864273 PMCID: PMC9304342 DOI: 10.1038/s41598-022-16324-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
To investigate whether combining L1-regularized iterative sensitivity encoding (SENSE) reconstruction and single-shot echo planar imaging (EPI) is useful in hepatic DWI. Single-shot EPI-DWI with L1-regularized iterative SENSE reconstruction (L1-DWI) and conventional parallel imaging-based reconstruction (conv-DWI) in liver MRI were compared in volunteers and patients. For the patient cohort, 75 subjects (60 ± 13 years) with 349 focal liver lesions (FLL) were included. Patient groups A and B were used to reduce acquisition time or improve spatial resolution, respectively. Image parameters were rated on a 5-point scale. The number of FLLs was recorded; in case of discrepancy, the reason for non-detectability was analyzed. In volunteers, higher signal-to-noise ratio (24.4 ± 5.6 vs. 12.2 ± 2.3, p < 0.001 at b = 0; 19.3 ± 2.8 vs. 9.8 ± 1.6, p < 0.001 at b = 800) and lower standard deviation of the apparent diffusion coefficient-values (0.17 vs. 0.20 mm2/s, p < 0.05) were found on L1-DWI compared to conv-DWI. In patients, image ratings were similar for all parameters except for "conspicuity of FLLs" which was rated significantly lower on L1-DWI vs. conv-DWI (4.7 ± 0.6 vs. 4.2 ± 0.9, p < 0.05) in group A. In five patients, 11/349 FLLs were not detectable on L1-DWI, but on conv-DWI. L1-regularized iterative reconstruction of single-shot EPI DWI can accelerate image acquisition or improve spatial resolution. However, our finding that FLLs were non-detectable on L1-DWI warrants further research.
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Affiliation(s)
- Maike Bode
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Shuo Zhang
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.,Philips Healthcare, Hamburg, Germany
| | - Mark N Terwolbeck
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Caroline Molavi Tabrizi
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Nils A Kraemer
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Alexandra Barabasch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Laun FB, Führes T, Seuss H, Müller A, Bickelhaupt S, Stemmer A, Benkert T, Uder M, Saake M. Flow-compensated diffusion encoding in MRI for improved liver metastasis detection. PLoS One 2022; 17:e0268843. [PMID: 35617260 PMCID: PMC9135229 DOI: 10.1371/journal.pone.0268843] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/09/2022] [Indexed: 12/27/2022] Open
Abstract
Magnetic resonance (MR) diffusion-weighted imaging (DWI) is often used to detect focal liver lesions (FLLs), though DWI image quality can be limited in the left liver lobe owing to the pulsatile motion of the nearby heart. Flow-compensated (FloCo) diffusion encoding has been shown to reduce this pulsation artifact. The purpose of this prospective study was to intra-individually compare DWI of the liver acquired with conventional monopolar and FloCo diffusion encoding for assessing metastatic FLLs in non-cirrhotic patients. Forty patients with known or suspected multiple metastatic FLLs were included and measured at 1.5 T field strength with a conventional (monopolar) and a FloCo diffusion encoding EPI sequence (single refocused; b-values, 50 and 800 s/mm2). Two board-certified radiologists analyzed the DWI images independently. They issued Likert-scale ratings (1 = worst, 5 = best) for pulsation artifact severity and counted the difference of lesions visible at b = 800 s/mm² separately for small and large FLLs (i.e., < 1 cm or > 1 cm) and separately for left and right liver lobe. Differences between the two diffusion encodings were assessed with the Wilcoxon signed-rank test. Both readers found a reduction in pulsation artifact in the liver with FloCo encoding (p < 0.001 for both liver lobes). More small lesions were detected with FloCo diffusion encoding in both liver lobes (left lobe: six and seven additional lesions by readers 1 and 2, respectively; right lobe: five and seven additional lesions for readers 1 and 2, respectively). Both readers found one additional large lesion in the left liver lobe. Thus, flow-compensated diffusion encoding appears more effective than monopolar diffusion encoding for the detection of liver metastases.
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Affiliation(s)
- Frederik B. Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tobit Führes
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hannes Seuss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Radiology, Klinikum Forchheim—Fränkische Schweiz gGmbH, Forchheim, Germany
| | - Astrid Müller
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Bickelhaupt
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marc Saake
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- * E-mail:
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Gupta S, Choh NA, Bhatt MG, Wani RA, Rasool Z, Rasool SR. Diffusion-Weighted Imaging: An Exciting and Problem-Solving Tool in Patients with Hepatic Metastases. Indian J Radiol Imaging 2021; 31:86-90. [PMID: 34316115 PMCID: PMC8299484 DOI: 10.1055/s-0041-1729490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background
The diffusion-weighted imaging (DWI) is based on the random Brownian motion of water molecules that influences image contrast depending on different pathological conditions.
Objective
The purpose of this study was to evaluate the efficacy of various magnetic resonance imaging (MRI) sequences including diffusion-weighted and gadobenate-enhanced MRI in the detection and characterization of liver lesions in a patient of known primary malignancy and to compare MRI with contrast-enhanced computed tomography (CECT) and ultrasonography (USG) in the detection of liver metastases.
Methods
All patients underwent a multiphase MRI. The final diagnosis was established by histopathological examination.
Results
A total of 43 patients of known primary malignancy were enrolled. MRI gave a provisional diagnosis of liver metastases in 21 patients and benign disease in 22 patients with histopathological correlation revealing two false-negative and one false-positive result. In the detection of lesions, DWI outscored other sequences (92.9 vs. 83.5% in hepatobiliary phase vs. 55.0% in T
2
-weighted sequences) with a statistically significant difference noted only in comparison with T
2
-weighted sequences (
p
< 0.001). In 16 patients, MRI added new lesions that were not detected by CECT/USG. The sensitivity and specificity of MRI for detecting metastases were 90.9%/95.2% and 97.9%/96.8% for per-patient and per-lesion basis, respectively.
Conclusion
Multiphase MRI improved both the detection and characterization of liver metastases. Adding DWI to the routine MR sequences helped in detecting small liver metastases (<10 mm) not detected by other sequences.
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Affiliation(s)
- Savia Gupta
- Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Naseer A Choh
- Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohd Gull Bhatt
- Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rauf A Wani
- Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Zubaida Rasool
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sheikh R Rasool
- Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Structured reporting of CT or MRI for perihilar cholangiocarcinoma: usefulness for clinical planning and interdisciplinary communication. Jpn J Radiol 2020; 39:349-356. [PMID: 33175312 DOI: 10.1007/s11604-020-01068-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the content and communication between the radiologist and the clinicians for treatment planning of structured reports (SRs) and narrative reports (NRs) for reporting CT/MRI findings in patients with perihilar cholangiocarcinoma. MATERIALS AND METHOD This retrospective study included 54 patients with perihilar cholangiocarcinoma who underwent CT/MRI before ERCP or surgery. For all patients, we generated both NRs and SRs for perihilar cholangiocarcinoma and compared the number of key features between NRs and SRs. In addition, three clinicians performed a questionnaire evaluation that included three questions regarding assessment of the sufficiency of information for surgical or procedural planning, the effort required for information extraction, and the report quality rated on a Likert scale. RESULTS SRs included significantly more predefined key features (6.89 ± 0.31) than NRs (5.87 ± 0.70) (p < 0.001). SRs provided greater sufficiency of information for clinical planning than NRs (89.9% vs. 18.5% of the cases, respectively; p < 0.001). Extraction of information was easier from SRs than NRs (94.4% vs. 9.3%, respectively) (p < 0.001). SRs received a higher overall report quality rating (5.96 ± 0.19) than NRs (4.31 ± 0.77) (p < 0.001). CONCLUSIONS SRs of CT/MRI findings for hilar cholangiocarcinoma can reveal more predefined key features, provide more sufficiency of information, and yield higher satisfaction levels, in comparison with NRs.
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Riexinger A, Laun FB, Bickelhaupt S, Seuß H, Uder M, Hensel B, Saake M. On the dependence of the cardiac motion artifact on the breathing cycle in liver diffusion-weighted imaging. PLoS One 2020; 15:e0239743. [PMID: 33002028 PMCID: PMC7529231 DOI: 10.1371/journal.pone.0239743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The purpose of this study was to investigate whether the cardiac motion artifact that regularly appears in diffusion-weighted imaging of the left liver lobe might be reduced by acquiring images in inspiration, when the coupling between heart and liver might be minimal. Materials and methods 43 patients with known or suspected focal liver lesions were examined at 1.5 T with breath hold acquisition, once in inspiration and once in expiration. Data were acquired with a diffusion-weighted echo planar imaging sequence and two b-values (b50 = 50 s/mm² and b800 = 800 s/mm²). The severity of the cardiac motion artifact in the left liver lobe was rated by two experienced radiologists for both b-values with a 5 point Likert scale. Additionally, the normalized signal S(b800)/S(b50) in the left liver lobe was computed. The Wilcoxon signed-rank test was used comparing the scores of the two readers obtained in inspiration and expiration, and to compare the normalized signal in inspiration and expiration. Results The normalized signal in inspiration was slightly higher than in expiration (0.349±0.077 vs 0.336±0.058), which would indicate a slight reduction of the cardiac motion artifact, but this difference was not significant (p = 0.24). In the qualitative evaluation, the readers did not observe a significant difference for b50 (reader 1: p = 0.61; reader 2: p = 0.18). For b800, reader 1 observed a significant difference of small effect size favouring expiration (p = 0.03 with a difference of mean Likert scores of 0.27), while reader 2 observed no significant difference (p = 0.62). Conclusion Acquiring the data in inspiration does not lead to a markedly reduced cardiac motion artifact in diffusion-weighted imaging of the left liver lobe and is in this regard not to be preferred over acquiring the data in expiration.
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Affiliation(s)
- Andreas Riexinger
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- * E-mail:
| | | | | | - Hannes Seuß
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Bernhard Hensel
- Center for Medical Physics and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marc Saake
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
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de Mooij CM, Sunen I, Mitea C, Lalji UC, Vanwetswinkel S, Smidt ML, van Nijnatten TJ. Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients. Nucl Med Commun 2020; 41:995-1004. [PMID: 32769814 PMCID: PMC7497599 DOI: 10.1097/mnm.0000000000001254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To provide a systematic review regarding the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) and diffusion-weighted imaging (DWI) compared to 18F-FDG PET/computed tomography (CT) focused on nodal and distant staging in breast cancer patients. METHODS The PubMed and Embase databases were searched for relevant publications until April 2020. Two independent reviewers searched for eligible articles based on predefined in- and exclusion criteria, assessed quality and extracted data. RESULTS Eleven eligible studies were selected from 561 publications identified by the search. In seven studies, PET/CT was compared with PET/MRI, and in five, PET/CT with DWI. Significantly higher sensitivity for PET/MRI compared to PET/CT in a lesion-based analysis was reported for all lesions together (77% versus 89%) in one study, osseous metastases (69-99% versus 92-98%) in two studies and hepatic metastases (70-75% versus 80-100%) in one study. Moreover, PET/MRI revealed a significantly higher amount of osseous metastases (90 versus 141) than PET/CT. PET/CT is associated with a statistically higher specificity than PET/MRI in the lesion detection of all lesions together (98% versus 96%) and of osseous metastases (100% versus 95%), both in one study. None of the reviewed studies reported significant differences between PET/CT and DWI for any of the evaluated sites. There is a trend toward higher specificity for PET/CT. CONCLUSION In general, there is a trend toward higher sensitivity and lower specificity of PET/MRI when compared to PET/CT. Results on the diagnostic performance of DWI are conflicting. Rather than evaluating it separate, it seems to have complementary value when combined with other MR sequences.
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Affiliation(s)
- Cornelis Maarten de Mooij
- Departments of Radiology and Nuclear Medicine
- Surgery
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Inés Sunen
- Departments of Radiology and Nuclear Medicine
- Department of Radiology, Miguel Servet Hospital, Zaragoza, Spain
| | - Cristina Mitea
- Departments of Radiology and Nuclear Medicine
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | | | - Marjolein L. Smidt
- Surgery
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Thiemo J.A. van Nijnatten
- Departments of Radiology and Nuclear Medicine
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
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11
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Rauh SS, Riexinger AJ, Ohlmeyer S, Hammon M, Saake M, Stemmer A, Uder M, Hensel B, Laun FB. A mixed waveform protocol for reduction of the cardiac motion artifact in black-blood diffusion-weighted imaging of the liver. Magn Reson Imaging 2020; 67:59-68. [PMID: 31923466 DOI: 10.1016/j.mri.2019.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/11/2019] [Accepted: 12/31/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Diffusion-weighted imaging (DWI) in the liver suffers from signal loss due to the cardiac motion artifact, especially in the left liver lobe. The purpose of this work was to improve the image quality of liver DWI in terms of cardiac motion artifact reduction and achievement of black-blood images in low b-value images. MATERIAL AND METHODS Ten healthy volunteers (age 20-31 years) underwent MRI examinations at 1.5 T with a prototype DWI sequence provided by the vendor. Two diffusion encodings (i.e. waveforms), monopolar and flow-compensated, and the b-values 0, 20, 50, 100, 150, 600 and 800 s/mm2 were used. Two Likert scales describing the severity of the pulsation artifact and the quality of the black-blood state were defined and evaluated by two experienced radiologists. Regions of interest (ROIs) were manually drawn in the right and left liver lobe in each slice and combined to a volume of interest (VOI). The mean and coefficient of variation were calculated for each normalized VOI-averaged signal to assess the severity of the cardiac motion artifact. The ADC was calculated using two b-values once for the monopolar data and once with mixed data, using the monopolar data for the small and the flow-compensated data for the high b-value. A Wilcoxon rank sum test was used to compare the Likert scores obtained for monopolar and flow-compensated data. RESULTS At b-values from 20 to 150 s/mm2, unlike the flow-compensated diffusion encoding, the monopolar encoding yielded black blood in all images with a negligible signal loss due to the cardiac motion artifact. At the b-values 600 and 800 s/mm2, the flow-compensated encoding resulted in a significantly reduced cardiac motion artifact, especially in the left liver lobe, and in a black-blood state. The ADC calculated with monopolar data was significantly higher in the left than in the right liver lobe. CONCLUSION It is recommendable to use the following mixed waveform protocol: Monopolar diffusion encodings at small b-values and flow-compensated diffusion encodings at high b-values.
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Affiliation(s)
- Susanne S Rauh
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Andreas J Riexinger
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sabine Ohlmeyer
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Hammon
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marc Saake
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bernhard Hensel
- Center for Medical Physics and Engineering, Friedrich-Alexander-Universität Erlangen-, Nürnberg, (FAU), Erlangen, Germany
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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12
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Low b-value (50-100) diffusion-weighted images detect significantly more hyperintense liver lesions in children than T2-weighted images. Pediatr Radiol 2019; 49:1299-1305. [PMID: 31292681 DOI: 10.1007/s00247-019-04455-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/16/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Low b-value (50-100 s/mm2) diffusion-weighted images (low b-value DWI) have been shown to be superior to T2-weighted fast spin echo sequence (T2-W) in detecting liver lesions in adults. There are no such studies assessing this difference in children. OBJECTIVE The purpose of the study was to compare the sensitivity of low b-value DWI images and T2-W images in detecting focal liver lesions in children. MATERIALS AND METHODS A retrospective review of liver magnetic resonance imaging (MRI) to assess focal liver lesions in 50 children (22 males, 28 females; age: 2 months to 17 years [mean: 10.9 years]) was performed. Two radiologists reviewed both low b-value DWI and T2-W sequences independently on different occasions to note lesions, the smallest lesion size and the location. A consensus reading of the entire MRI examination and a correlation with follow-up, other imaging modalities and pathology in available cases were used to determine the final number of lesions as a reference standard. The average number of lesions per patient detected by both readers on each sequence was compared with each other and with the reference standard using the signed-rank test. The smallest lesions detected by each sequence were compared using the paired t-test. RESULTS One hundred seventy hyperintense lesions were identified on consensus review to serve as the reference standard. The average number of lesions identified by both readers on low b-value DWI was 134 (79%) and on T2-W was 95 (56%). There was excellent interobserver agreement for detection of lesions on low b-value DWI (intraclass correlation coefficient [ICC]=0.96 [0.93-0.98]) and T2-W (ICC=0.85 [0.75-0.91]), with slightly better agreement on low b-value DWI. Both readers identified significantly more number of lesions on low b-value DWI compared to T2-W (Reader 1: P=0.0036, Reader 2: P=0.0001). Compared to the reference standard (mean number of lesions: 3.45), T2-W detected significantly fewer lesions (mean number of lesions: 1.91; P=0.0001) while there was no significant difference in lesion detection on low b-value DWI (mean number of lesions: 2.68; P=0.1527). Low b-value DWI and T2-W were not significantly different in identifying the smallest lesion size (Reader 1: P=0.19, Reader 2: P=0.47). CONCLUSION Low b-value DWI images are more sensitive than T2-W sequences in detecting hyperintense focal liver lesions in children.
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13
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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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14
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Diagnostic performance of [18F]FDG-PET/MRI for liver metastasis in patients with primary malignancy: a systematic review and meta-analysis. Eur Radiol 2019; 29:3553-3563. [DOI: 10.1007/s00330-018-5909-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/18/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022]
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15
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Marion-Audibert AM, Vullierme MP, Ronot M, Mabrut JY, Sauvanet A, Zins M, Cuilleron M, Sa-Cunha A, Lévy P, Rode A. Routine MRI With DWI Sequences to Detect Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Carcinoma and Normal Liver CT: A Prospective Multicenter Study. AJR Am J Roentgenol 2018; 211:W217-W225. [PMID: 30240298 DOI: 10.2214/ajr.18.19640] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of systematic MRI with DWI for the detection of liver metastases (LM) in patients with potentially resectable pancreatic ductal carcinoma and normal liver findings at CT. SUBJECTS AND METHODS Patients with potentially resectable pancreatic ductal carcinoma and a normal liver at CT were enrolled in a prospective multicenter study between March 2011 and July 2013 and underwent preoperative MRI. The reference standard was pathologic analysis of detected hepatic lesions. RESULTS A total of 118 patients were enrolled. MRI depicted liver lesions that were not visible at CT in 16 patients. All lesions were visualized both with and without DWI. Lesions were LM in 12 (10.2%) patients and were confirmed in seven patients by preoperative biopsy, four by intraoperative frozen section, and one at 6-month follow-up evaluation after pancreatic resection. All but one liver metastatic lesion diagnosed with MRI were smaller than 10 mm. Four of 118 (3.4%) patients had a false-positive diagnosis of LM at MRI and remained LM free after a follow-up period of 24 months or longer. Three of 102 (2.9%) patients with normal MRI findings had subcapsular LM that were diagnosed intraoperatively. At follow-up, 99 of 118 (83.9%) patients were LM free after a mean of 24 months. The patient-based sensitivity of MRI for the detection of LM was 80.0% (95% CI, 51.9-95.7%); specificity, 96.1% (95% CI, 90.4-98.9%); positive predictive value, 75.0% (95% CI, 47.6-92.7%); and negative predictive value, 97.1% (95% CI, 91.6-99.4%). CONCLUSION Compared with CT, preoperative MRI improves the detection of LM in patients with potentially resectable pancreatic ductal carcinoma and may change management and the rate of unnecessary laparotomy and pancreatectomy for 10% of patients.
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Affiliation(s)
| | - Marie-Pierre Vullierme
- 2 Department of Medical Imaging, Beaujon University Hospital, 100 Blvd Leclerc, Clichy-la-Garenne, 92110, France
| | - Maxime Ronot
- 2 Department of Medical Imaging, Beaujon University Hospital, 100 Blvd Leclerc, Clichy-la-Garenne, 92110, France
| | - Jean-Yves Mabrut
- 3 Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France
| | - Alain Sauvanet
- 4 Department of Digestive Surgery and Liver Transplantation, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Marc Zins
- 5 Department of Medical Imaging, Saint-Joseph Hospital, Paris, France
| | - Muriel Cuilleron
- 6 Department of Medical Imaging, Nord University Hospital, Saint-Etienne, France
| | - Antonio Sa-Cunha
- 7 Department of Digestive Surgery and Liver Transplantation, University Hospital of Bordeaux, France
- 8 Present address: Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Philippe Lévy
- 9 Department of Pancreatology, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Agnès Rode
- 10 Department of Medical Imaging, Croix-Rousse University Hospital, Lyon, France
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16
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Patella F, Pesapane F, Fumarola EM, Emili I, Spairani R, Angileri SA, Tresoldi S, Franceschelli G, Carrafiello G. CT-MRI LI-RADS v2017: A Comprehensive Guide for Beginners. J Clin Transl Hepatol 2018; 6:222-236. [PMID: 29951368 PMCID: PMC6018316 DOI: 10.14218/jcth.2017.00062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the second leading cause of cancer-related deceases worldwide. Early diagnosis is essential for correct management and improvement of prognosis. Proposed for the first time in 2011 and updated for the last time in 2017, the Liver Imaging-Reporting and Data System (LI-RADS) is a comprehensive system for standardized interpretation and reporting of computed tomography (CT) and magnetic resonance imaging (MRI) liver examinations, endorsed by the American College of Radiology to achieve congruence with HCC diagnostic criteria in at-risk populations. Understanding its algorithm is fundamental to correctly apply LI-RADS in clinical practice. In this pictorial review, we provide a guide for beginners, explaining LI-RADS indications, describing major and ancillary features and eventually elucidating the diagnostic algorithm with the use of some clinical examples.
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Affiliation(s)
- Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
- *Correspondence to: Filippo Pesapane, Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, Milan 20122, Italy. Tel: +39-13012751123; Fax: +39-2-50323393; E-mail:
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Emili
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Riccardo Spairani
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Silvia Tresoldi
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Giuseppe Franceschelli
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
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17
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Koh FHX, Tan KK, Teo LLS, Ang BWL, Thian YL. Prospective comparison between magnetic resonance imaging and computed tomography in colorectal cancer staging. ANZ J Surg 2018; 88:E498-E502. [PMID: 28803449 DOI: 10.1111/ans.14138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/20/2017] [Accepted: 06/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diffusion-weighted (DW) imaging is a functional magnetic resonance imaging (MRI) technique that detects lesions with high cellularity, such as malignant tumours. This prospective study was performed to compare the accuracy of DW-MRI with multidetector computed tomography (MDCT) in staging of colorectal cancer. METHODS Thirty patients with histologically proven colorectal cancer were prospectively recruited. Each patient underwent both MDCT and DW-MRI of the abdomen-pelvis for primary staging. Images were evaluated for nodal and distant metastases. The reference standard was histopathological findings for nodal involvement and surveillance imaging for suspected hepatic metastases. RESULTS The primary cancers were located in the rectum (n = 16, 53.3%), sigmoid colon (n = 9, 30%) and right colon (n = 5, 16.6%). For nodal metastases, the sensitivity and specificity of DW-MRI were 84.6% (95% confidence interval (CI): 54.6-98.1%) and 20.0% (95% CI: 2.5-55.6%) compared with 84.6% (95% CI: 54.6-98.1%) and 40.0% (95% CI: 12.2-73.8%) for MDCT. For liver metastases, the sensitivity and specificity for DW-MRI were 100.0% (95% CI: 63.1-100.0%) and 100% (95% CI: 84.6-100%) compared with 87.5% (95% CI: 47.4-99.7%) and 95.5% (95% CI: 77.2-99.9%) for MDCT. DW imaging altered the clinical management in three (10.0%) patients by detecting missed hepatic metastases in two patients and accurately diagnosing another patient with a hepatic cyst, mistaken for metastasis on MDCT. CONCLUSION DW-MRI is more accurate for detecting hepatic metastases in colorectal cancer compared with MDCT.
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Affiliation(s)
- Frederick H X Koh
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lynette L S Teo
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore
| | - Bertrand W L Ang
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore
| | - Yee-Liang Thian
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore
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18
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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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19
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Gordic S, Thung SN, Roayaie S, Wagner M, Taouli B. Hepatic adenomatosis in liver cirrhosis. Eur J Radiol Open 2017; 4:115-117. [PMID: 28932768 PMCID: PMC5597816 DOI: 10.1016/j.ejro.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/15/2017] [Accepted: 08/29/2017] [Indexed: 01/14/2023] Open
Abstract
Hepatocellular adenoma (HCA) is a benign liver tumor most frequently occurring in women using oral contraception. HCA develops in normal or nearly normal livers and is extremely rare in cirrhosis. The authors present magnetic resonance imaging and histopathologic findings in a 57-year-old man with liver cirrhosis and hepatic adenomatosis. As the differentiation between HCA and hepatocellular carcinoma (HCC) can be difficult with imaging, we would like to highlight the importance of ancillary findings such as the presence of iron on MRI, which can be observed in HCA.
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Affiliation(s)
- Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Swan N Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sasan Roayaie
- Liver Cancer Program, Hofstra-North Shore Long Island Jewish School of Medicine, Lenox Hill Hospital, New York, NY, USA
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sorbonne Universités, UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
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20
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Talaat Ali M, Fouad Osman M, Homos MD, Mohamed Nabil D. Role of 3-T diffusion-weighted magnetic resonance imaging in differentiation between benign and malignant hepatic lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Saito K, Tajima Y, Harada TL. Diffusion-weighted imaging of the liver: Current applications. World J Radiol 2016; 8:857-867. [PMID: 27928467 PMCID: PMC5120245 DOI: 10.4329/wjr.v8.i11.857] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/10/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI) of the liver can be performed using most commercially available machines and is currently accepted in routine sequence. This sequence has some potential as an imaging biomarker for fibrosis, tumor detection/characterization, and following/predicting therapy. To improve reliability including accuracy and reproducibility, researchers have validated this new technique in terms of image acquisition, data sampling, and analysis. The added value of DWI in contrast-enhanced magnetic resonance imaging was established in the detection of malignant liver lesions. However, some limitations remain in terms of lesion characterization and fibrosis detection. Furthermore, the methodologies of image acquisition and data analysis have been inconsistent. Therefore, researchers should make every effort to not only improve accuracy and reproducibility but also standardize imaging parameters.
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22
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Fraum TJ, Owen JW, Fowler KJ. Beyond Histologic Staging: Emerging Imaging Strategies in Colorectal Cancer with Special Focus on Magnetic Resonance Imaging. Clin Colon Rectal Surg 2016; 29:205-15. [PMID: 27582645 DOI: 10.1055/s-0036-1584288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Imaging plays an increasingly important role in the staging and management of colorectal cancer. In recent years, magnetic resonance imaging (MRI) has supplanted transrectal ultrasound as the preferred modality for the locoregional staging of rectal cancer. Furthermore, the advent of both diffusion-weighted imaging and hepatobiliary contrast agents has significantly enhanced the ability of MRI to detect colorectal liver metastases. In clinical practice, MRI routinely provides prognostic information, helps to guide surgical strategy, and determines the need for neoadjuvant therapies related to both the primary tumor and metastatic disease. Expanding on these roles for MRI, positron emission tomography (PET)/MRI is the newest clinical hybrid imaging modality and combines the metabolic information of PET with the high soft tissue contrast of MRI. The addition of PET/MRI to the clinical staging armamentarium has the potential to provide comprehensive state-of-the-art colorectal cancer staging in a single examination.
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Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Joseph W Owen
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
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23
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Lavelle L, O'Neill A, McMahon C, Cantwell C, Heffernan E, Malone D, Daly L, Skehan S. Is diffusion-weighted MRI sufficient for follow-up of neuroendocrine tumour liver metastases? Clin Radiol 2016; 71:863-8. [DOI: 10.1016/j.crad.2016.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 05/21/2016] [Accepted: 05/23/2016] [Indexed: 02/07/2023]
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Özdemir O, Metin Y, Metin NO, Küpeli A, Kalcan S, Taşçı F. Contribution of diffusion-weighted MR imaging in follow-up of inflammatory appendiceal mass: Preliminary results and review of the literature. Eur J Radiol Open 2016; 3:207-15. [PMID: 27570803 PMCID: PMC4990663 DOI: 10.1016/j.ejro.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 12/29/2022] Open
Abstract
Objective We aimed to search the contribution of diffusion-weighted imaging (DWI) in follow-up of patients with acute appendicitis associated inflammatory appendiceal mass (IAM). DWI was used as a monitoring imaging method to assess the response of medical treatment. Materials and methods 19 patients (mean age, 37+–13.1; age range, 19–69; M/F: 10/9), presented with clinical, laboratory and computed tomography (CT) findings suggestive of IAM were enrolled prospectively in this study. CT and DWI images were evaluated by two radiologists in consensus. b values 0, 500 and 1000 s/mm2 were used, and DWI images were analysed both qualitatively and quantitatively. Laboratory parameters were C-reactive protein value and white blood cell count. During follow-up changes in the diameter of IMA and laboratory parameters were correlated with ADC values. Conservative treatment with interval appendectomy and a total conservative approach without surgery were the treatment options during follow-up. Results We found statistically significant correlation between the ADC values, maximum IAM diameter and laboratory parameters. During follow-up five surgical procedures were performed: one patient underwent surgery for cecal adenocarcinoma and four underwent interval appendectomy. One patient developed acute relapse of IAM at the sixth month of follow-up. Conclusion DWI may be used with a significant success for follow-up of patients with IAM. As a monitoring imaging method, DWI may also aid in determining of most appropriate timing for interval appendectomy as well as may help in diagnosing alternative diagnoses (e.g. malignancy and inflammatory bowel disease) that can mimic IAM.
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Affiliation(s)
- Oğuzhan Özdemir
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Radiology, 53100, Rize, Turkey
| | - Yavuz Metin
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Radiology, 53100, Rize, Turkey
| | - Nurgül Orhan Metin
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Radiology, 53100, Rize, Turkey
| | - Ali Küpeli
- Muş State Hospital, Department of Radiology, 49000, Muş, Turkey
| | - Süleyman Kalcan
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of General Surgery, 53100, Rize, Turkey
| | - Filiz Taşçı
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Radiology, 53100, Rize, Turkey
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Nakamura Y, Higaki T, Akiyama Y, Fukumoto W, Kajiwara K, Kaichi Y, Honda Y, Komoto D, Tatsugami F, Iida M, Ohmoto T, Date S, Awai K. Diffusion-weighted MR imaging of non-complicated hepatic cysts: Value of 3T computed diffusion-weighted imaging. Eur J Radiol Open 2016; 3:138-44. [PMID: 27489867 PMCID: PMC4959945 DOI: 10.1016/j.ejro.2016.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate the utility of computed 3T diffusion-weighted imaging (c-DWI) for the diagnosis of non-complicated hepatic cysts with a focus on the T2 shine-through effect. Materials and methods In 50 patients with non-complicated hepatic cysts we acquired one set of DWIs (b-value 0 and 1000 s/mm2) at 1.5T, and two sets at 3T (b-value 0 and 1000 s/mm2, TE 70 ms; b-value 0 and 600 s/mm2, TE 60 ms). We defined the original DWIs acquired with b = 1000 s/mm2 at 1.5T and 3T as “o-1.5T-1000” and “o-3T-1000”. c-DWIs were calculated with 3T DWI at b-values of 0 and 600 s/mm2. c-DWI with b = 1000 and 1500 s/mm2 were defined as “c-1000” and “c-1500”. Radiologists evaluated the signal intensity (SI) of the cysts using a 3-point score where 1 = not visible, 2 = discernible, and 3 = clearly visible. They calculated the contrast ratio (CR) between the cysts and the surrounding liver parenchyma on each DWIs and recorded the apparent diffusion coefficient (ADC) with a b-value = 0 and 1000 s/mm2 on 1.5T- and 3T DWIs. Results Compared with o-1.5T-1000 DWI, the visual scores of all but the c-1500 DWIs were higher (p = 0.07 for c-1500- and p < 0.01 for the other DWIs). The CR at b = 1000 s/mm2 was higher on o-3T-1000- than on o-1.5T-1000- (p < 0.01) but not higher than on c-1500 DWIs (p = 0.96). The CR at b = 0 s/mm2 on 3T images with TE 70 ms was higher than on 1.5T images (p < 0.01). The ADC value was higher for 3T- than 1.5T images (p < 0.01). Conclusions Non-complicated hepatic cysts showed higher SI on o-3T-1000- than o-1.5T-1000 DWIs due to the T2-shine through effect. This high SI was suppressed on c-1500 DWIs.
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Key Words
- ADC, apparent diffusion coefficient
- CR, contrast ratio
- Computed diffusion-weighted imaging
- DWI, diffusion-weighted imaging
- Diffusion-weighted imaging
- Field strength
- HCC, hepatocellular carcinoma
- MRI, magnetic resonance imaging
- Non-complicated hepatic cysts
- SI, signal intensity
- SNR, signal-to-noise ratio
- T1-WI, T1-weighted MRI
- T2 shine-through effect
- T2-WI, T2-weighted MRI
- c-DWI, computed diffusion-weighted imaging
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Affiliation(s)
- Yuko Nakamura
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Toru Higaki
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Yuji Akiyama
- Department of Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Wataru Fukumoto
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Kenji Kajiwara
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Yoko Kaichi
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Yukiko Honda
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Daisuke Komoto
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | | | - Makoto Iida
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | | | - Shuji Date
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
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Kawahara S, Isoda H, Fujimoto K, Shimizu H, Furuta A, Arizono S, Ohno T, Yamashita R, Ono A, Togashi K. Additional benefit of computed diffusion-weighted imaging for detection of hepatic metastases at 1.5T. Clin Imaging 2016; 40:481-5. [DOI: 10.1016/j.clinimag.2015.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 12/27/2022]
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Diffusion-Weighted Imaging with Two Different b-Values in Detection of Solid Focal Liver Lesions. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8128207. [PMID: 27019851 PMCID: PMC4785245 DOI: 10.1155/2016/8128207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 01/14/2023]
Abstract
One hundred and eighty-two consecutive patients with suspected liver disease were recruited to receive diffusion-weighted imaging (DWI) with two different b-values, in comparison with T2-weighted imaging (T2WI). The detection rate of three MR sequences in solid focal liver lesions (FLLs) and subgroup analyses were performed. Our prospective study found that DWI600 was equivalent to DWI100 and T2WI for the detection of solid FLLs overall but was significantly more accurate in the detection of malignant solid FLLs and lesions larger than 10 mm.
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Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aubé C, Chatellier G. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol 2016; 26:4595-4615. [PMID: 26883327 DOI: 10.1007/s00330-016-4250-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases. METHODS A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates. RESULTS Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm. CONCLUSIONS In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis. KEY POINTS • DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases • DW-MRI and gadoxetic acid-enhanced MRI is the best combination • Same results are observed in colorectal liver metastases • Same results are observed in liver metastases smaller than 1 cm • Same results are observed when histopathology alone is the reference standard.
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Affiliation(s)
- Valérie Vilgrain
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. .,University Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Maxime Esvan
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Maxime Ronot
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Aurore Caumont-Prim
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Christophe Aubé
- Department of Radiology, CHU d'Angers, Angers, France.,Laboratoire HIFIH, LUNAM, Université d'Angers, Angers, France
| | - Gilles Chatellier
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 75006, Paris, France
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Jahic E, Sofic A, Selimovic AH. DWI/ADC in Differentiation of Benign from Malignant Focal Liver Lesion. Acta Inform Med 2016; 24:244-247. [PMID: 27708485 PMCID: PMC5037977 DOI: 10.5455/aim.2016.24.244-247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/24/2016] [Indexed: 12/11/2022] Open
Abstract
Material and methods: The study was of prospective-retrospective character. It was carried out at the AKH in Vienna (Austria), where 100 patients with focal liver lesions were included in the study. All patients underwent the routine MR sequences on appliances 1,5 and 3T (Siemens, Germany): T1, T2, HASTE, VIBE, and a DWI with three b values (b 50, b 300 b 600 s / mm2) and ADC map with ROI (regions of interest). The numerical value of ADC map was calculated, where n = 100 liver lesions, by two independent radiologists. Results: On the basis of matching the PH finding statistically we get DWI accuracy of 96.8% for the assessment of liver lesions. The average numerical value of ADC in benign hepatic lesions (FNH, Hemangiomas) in our study amounted to 1.88 (1.326 to 2.48) x103 mm2 /s, while the value of malignant liver lesions (HCC, CCC, CRCLM) were significantly lower and amounted to 1.15 (1.024 to 1.343) x10-3 mm2 /s (Figure 2). Differences between the mean ADC of benign and malignant lesions showed a statistically significant difference with p <0.0005. In our research, we get cut-off for the ADC value of 1,341x10-3 mm2 /s, which proved to be the optimal parameter for differentiation between benign and malignant lesions. Conclusion: Measuring ADC values with DWI as an additional MRI tool can help in oncological practice by distinguishing normal liver parenchyma from focal lesions, and in differentiating benign from malignant liver lesions, particularly in cases where administration of contrast is not possible.
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Affiliation(s)
- Elma Jahic
- Clinic of Radiology, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Amela Sofic
- Clinic of Radiology, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Azra Husic Selimovic
- Institute of Gastroenterology, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
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Gao Y, Erokwu BO, DeSantis DA, Croniger CM, Schur RM, Lu L, Mariappuram J, Dell KM, Flask CA. Initial evaluation of hepatic T1 relaxation time as an imaging marker of liver disease associated with autosomal recessive polycystic kidney disease (ARPKD). NMR IN BIOMEDICINE 2016; 29:84-9. [PMID: 26608869 PMCID: PMC4707433 DOI: 10.1002/nbm.3442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 05/08/2023]
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a potentially lethal multi-organ disease affecting both the kidneys and the liver. Unfortunately, there are currently no non-invasive methods to monitor liver disease progression in ARPKD patients, limiting the study of potential therapeutic interventions. Herein, we perform an initial investigation of T1 relaxation time as a potential imaging biomarker to quantitatively assess the two primary pathologic hallmarks of ARPKD liver disease: biliary dilatation and periportal fibrosis in the PCK rat model of ARPKD. T1 relaxation time results were obtained for five PCK rats at 3 months of age using a Look-Locker acquisition on a Bruker BioSpec 7.0 T MRI scanner. Six three-month-old Sprague-Dawley (SD) rats were also scanned as controls. All animals were euthanized after the three-month scans for histological and biochemical assessments of bile duct dilatation and hepatic fibrosis for comparison. PCK rats exhibited significantly increased liver T1 values (mean ± standard deviation = 935 ± 39 ms) compared with age-matched SD control rats (847 ± 26 ms, p = 0.01). One PCK rat exhibited severe cholangitis (mean T1 = 1413 ms), which occurs periodically in ARPKD patients. The observed increase in the in vivo liver T1 relaxation time correlated significantly with three histological and biochemical indicators of biliary dilatation and fibrosis: bile duct area percent (R = 0.85, p = 0.002), periportal fibrosis area percent (R = 0.82, p = 0.004), and hydroxyproline content (R = 0.76, p = 0.01). These results suggest that hepatic T1 relaxation time may provide a sensitive and non-invasive imaging biomarker to monitor ARPKD liver disease.
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Affiliation(s)
- Ying Gao
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Bernadette O. Erokwu
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - David A. DeSantis
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Colleen M. Croniger
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Rebecca M. Schur
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Lan Lu
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jose Mariappuram
- CWRU Center for the Study of Kidney Disease and Biology, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Katherine M. Dell
- CWRU Center for the Study of Kidney Disease and Biology, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, United States of America
- Cleveland Clinic Children’s, Cleveland, Ohio, United States of America
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Chris A. Flask
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, United States of America
- Corresponding author: Chris A. Flask, PhD, Associate Professor of Radiology, 11100 Euclid Ave / Bolwell B115, Cleveland, OH 44106, 216-844-4963,
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Multiparametric Gd-EOB-DTPA magnetic resonance in diagnosis of HCC: dynamic study, hepatobiliary phase, and diffusion-weighted imaging compared to histology after orthotopic liver transplantation. ACTA ACUST UNITED AC 2015; 40:46-55. [PMID: 24965896 DOI: 10.1007/s00261-014-0180-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate Gd-EOB-DTPA-enhanced magnetic resonance (MR) performance during dynamic (DYN) phases, hepatobiliary (HB) phase and diffusion-weighted imaging (DWI) compared with pathological findings in patients undergoing orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) associated with different conditions, such as stage of chronic liver disease, histological grading, nodule size, and occurrence of previous treatments. METHODS Retrospective analysis of 64 nodules reported as HCC at pathological analysis on 28 explanted livers, examined about 3 months before OLT using a 1.5 T device and 16 channels array after intravenous GD-EOB-DTPA injection. Lesions features and hepatic functional values were recorded for each patient. Two radiologists performed in consensus the analysis of nodules on DYN, HB, and DWI. MR findings were compared with those of pathological anatomy. Diagnostic indicators were calculated for each technique. RESULTS DYN and HB showed no statistically significant difference in sensitivity (88% and 98%, respectively), diagnostic accuracy (90.6% and 99.9%), and specificity (both 100%), for all Child-Pugh scores, gradings, sizes, and presence or absence of previous treatments. DWI had a statistically significant lower sensitivity compared to DYN (p = 0.001) and HB (p < 0.0001); its sensitivity was significantly inferior for Child-Pugh Class B nodules than for Child-Pugh Class A ones (p = 0.00005). DWI sensitivity presented a significant increase (p = 0.03) with grading and presence of previous treatments (p = 0.0006). ADC values showed no statistically significant changes with Child-Pugh score, grading and nodules size; statistically significant increase was instead found for treated vs. untreated nodules (p = 0.016). CONCLUSIONS In a multiparametric HCC MRI assessment, DYN and HB play the leading role, with DWI faring acceptably well for Child-Pugh Class A nodules and treated ones.
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Bouchaibi SE, Coenegrachts K, Bali MA, Absil J, Metens T, Matos C. Focal liver lesions detection: Comparison of respiratory-triggering, triggering and tracking navigator and tracking-only navigator in diffusion-weighted imaging. Eur J Radiol 2015; 84:1857-65. [PMID: 26119802 DOI: 10.1016/j.ejrad.2015.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/14/2015] [Accepted: 06/16/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare low b value (10s/mm(2)) spin-echo echo-planar (SE-EP) diffusion-weighted imaging (DWI) acquired with respiratory-triggering (RT), triggering and tracking navigator (TT), tracking only navigator (TRON) techniques for image quality and focal liver lesions (FLL) detection in non-cirrhotic patients. MATERIAL AND METHODS This bi-centric study was approved by the institutional review boards; informed consent was obtained. Eighty-three patients were prospectively included and SE-EP-DWI with RT, TT and TRON techniques were performed. DWI sequences were randomized and independently analyzed by two readers. The qualitative evaluation was based on a 3-point score for axial artifacts (motion, ghost, susceptibility artifacts and distortion) and stair-step artifacts. Sensitivity of FLL detection was calculated for all lesions together and after lesion size stratification (≤ 10 mm, >10-20mm and >20mm). The standard of reference consisted of a retrospective reading of the conventional MRI, the three DWI sequences and by follow-up (12 months): a total of 409 FLL were detected. Data between sequences was compared with non-parametric tests. Cohen's kappa coefficient was used for inter-observer agreement. RESULTS Image quality was comparable for RT and TT. TRON showed statistically significantly more axial artifacts for the two readers (p<0.05). Stair-step artifacts were not statistically significantly different between DWI sequences. Overall sensitivities for RT, TT, TRON were 85%, 86%, 82% and 86%, 89% 83%, respectively, for readers 1 and 2. The inter-observer agreement was very good. CONCLUSION Image quality was better for RT and TT compared to TRON. Overall sensitivities for FLL detection were comparable between techniques and readers.
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Affiliation(s)
- Said El Bouchaibi
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium
| | - Kenneth Coenegrachts
- Department of Radiology AZ Sint-Jan Brugge - Oostende AV, Campus Brugge, Ruddershove 10, B-8000 Brugge, Belgium
| | - Maria Antonietta Bali
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium
| | - Julie Absil
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium
| | - Thierry Metens
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium.
| | - Celso Matos
- Department of Radiology, Clinics of MRI, Hôpital Erasme Université Libre de Bruxelles, 808 Route de Lennik B, 1070 Bruxelles, Belgium
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Apparent diffusion coefficient quantification as an early imaging biomarker of response and predictor of survival following yttrium-90 radioembolization for unresectable infiltrative hepatocellular carcinoma with portal vein thrombosis. ACTA ACUST UNITED AC 2015; 39:969-78. [PMID: 24740759 DOI: 10.1007/s00261-014-0127-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate early diffusion-weighted imaging (DWI) at 30-days post-yttrium-90 (Y-90) radioembolization as a predictor of treatment response and survival in unresectable infiltrative hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT). MATERIALS AND METHODS In a prospective study, 18 consecutive patients with unresectable infiltrative HCC and PVT underwent Y-90 therapy. MR imaging was obtained pre Y-90, and at 1 and 3 months post-therapy with DWI fat-suppressed tri-directional diffusion gradient (b = 50, 400, 800 s/mm(2)). Response was evaluated using target mRECIST and EASL. Relative change in apparent diffusion coefficient (ADC) value of tumors was evaluated. Statistical analysis using receiver operator characteristic curves was performed. Paired t test and Pearson correlation coefficient (r) were used to assess intra- and inter-observer variability. Survival analysis was performed using Kaplan-Meier estimation and log-rank test. RESULTS Mean ADC values of all HCC's at baseline and at 30-days post-Y90 therapy was 0.86 × 10(-3) and 1.17×10(-3) mm(2)/s, respectively (p < 0.001). Tumors with objective response by mRECIST had significantly increased ADC value when compared to "non-responders" (1.27 vs. 1.05×10(-3) mm(2)/s, p = 0.002). A >30% increase in ADC value at 30-days was found to be at least 90% sensitive in predicting response at 90 days. A >30% increase in ADC value at 30-days predicted significantly prolonged survival. CONCLUSION A 30% increase in ADC value at 30-days measured post Y90 is a reproducible early imaging response biomarker predicting tumor response and prolonged survival following Y-90 therapy in infiltrative HCC with PVT.
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Wagner M, Ronot M, Doblas S, Giraudeau C, Van Beers B, Belghiti J, Paradis V, Vilgrain V. Assessment of the residual tumour of colorectal liver metastases after chemotherapy: diffusion-weighted MR magnetic resonance imaging in the peripheral and entire tumour. Eur Radiol 2015; 26:206-15. [DOI: 10.1007/s00330-015-3800-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 04/07/2015] [Accepted: 04/13/2015] [Indexed: 12/13/2022]
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Toledano-Massiah S, Luciani A, Itti E, Zerbib P, Vignaud A, Belhadj K, Baranes L, Haioun C, Lin C, Rahmouni A. Whole-Body Diffusion-weighted Imaging in Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma. Radiographics 2015; 35:747-64. [PMID: 25815803 DOI: 10.1148/rg.2015140145] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Whole-body imaging, in particular molecular imaging with fluorine 18 ((18)F)-fluorodeoxyglucose (FDG) positron emission tomography (PET), is essential to management of lymphoma. The assessment of disease extent provided by use of whole-body imaging is mandatory for planning appropriate treatment and determining patient prognosis. Assessment of treatment response allows clinicians to tailor the treatment strategy during therapy if necessary and to document complete remission at the end of treatment. Because of rapid technical developments, such as echo-planar sequences, parallel imaging, multichannel phased-array surface coils, respiratory gating, and moving examination tables, whole-body diffusion-weighted (DW) magnetic resonance (MR) imaging that reflects cell density is now feasible in routine clinical practice. Whole-body DW MR imaging allows anatomic assessment as well as functional and quantitative evaluation of tumor sites by calculation of the apparent diffusion coefficient (ADC). Because of their high cellularity and high nucleus-to-cytoplasm ratio, lymphomatous lesions have low ADC values and appear hypointense on ADC maps. As a result, whole-body DW MR imaging with ADC mapping has become a promising tool for lymphoma staging and treatment response assessment. The authors review their 4 years of experience with 1.5-T and 3-T whole-body DW MR imaging used with (18)F-FDG PET/computed tomography at baseline, interim, and end of treatment in patients with Hodgkin lymphoma and diffuse large B-cell lymphoma and discuss the spectrum of imaging findings and potential pitfalls, limitations, and challenges associated with whole-body DW MR imaging in these patients.
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Affiliation(s)
- Sarah Toledano-Massiah
- From the Department of Medical Imaging (S.T.M., A.L., P.Z., L.B., A.R.), Department of Nuclear Medicine (E.I., L.B.), and Lymphoproliferative Unit (K.B., C.H.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France; Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.L., E.I., L.B., C.H., A.R.); Neurospin, CEA, Saclay, France (A.V.); and Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Gueishan, Taiwan (C.L.)
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Diffusion-weighted MRI for uveal melanoma liver metastasis detection. Eur Radiol 2015; 25:2263-73. [DOI: 10.1007/s00330-015-3662-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/11/2014] [Accepted: 02/11/2015] [Indexed: 01/16/2023]
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Zendel A, Lahat E, Dreznik Y, Zakai BB, Eshkenazy R, Ariche A. "Vanishing liver metastases"-A real challenge for liver surgeons. Hepatobiliary Surg Nutr 2014; 3:295-302. [PMID: 25392841 DOI: 10.3978/j.issn.2304-3881.2014.09.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/16/2014] [Indexed: 12/21/2022]
Abstract
Expanded surgical intervention in colorectal liver metastasis (LM) and improved chemotherapy led to increasing problem of disappearing liver metastases (DLM). Treatment of those continues to evolve and poses a real challenge for HPB surgeons. This review discusses a clinical approach to DLM, emphasizing crucial steps in clinical algorithm. Particular issues such as imaging, intraoperative detection and surgical techniques are addressed. A step-by-step algorithm is suggested.
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Affiliation(s)
- Alex Zendel
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eylon Lahat
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Dreznik
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Bar Zakai
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rony Eshkenazy
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Ariche
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Low b-value (black blood) respiratory-triggered fat-suppressed single-shot spin-echo echo-planar imaging (EPI) of the liver: Comparison of image quality at 1.5 and 3 T. Clin Radiol 2014; 69:1136-41. [DOI: 10.1016/j.crad.2014.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/17/2014] [Accepted: 06/21/2014] [Indexed: 01/27/2023]
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Wei C, Tan J, Xu L, Juan L, Zhang SW, Wang L, Wang Q. Differential diagnosis between hepatic metastases and benign focal lesions using DWI with parallel acquisition technique: a meta-analysis. Tumour Biol 2014; 36:983-90. [PMID: 25318600 DOI: 10.1007/s13277-014-2663-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023] Open
Abstract
We aim to investigate the diagnostic capability of diffusion-weighted imaging using parallel acquisition technique for the differentiation between hepatic metastases and benign focal lesions with a meta-analysis. The meta-analysis included a total of 858 hepatic metastases and 440 benign liver lesions from nine studies. The pooled sensitivity and specificity of diffusion-weighted imaging (DWI) were 0.87 (95% CI, 0.84-0.89) and 0.90 (95% CI, 0.87-0.93), respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 8.50 (95% CI, 4.97-14.52) and 0.17 (95% CI, 0.11-0.26), respectively. The P value for χ (2) heterogeneity for all pooled estimates was <0.05. From the fitted summary receiver operating characteristics (SROC), the area under the curve (AUC) and Q* index were 0.95 and 0.88, respectively. Publication bias is not present (t = -0.76, P = 0.471). The meta-regression analysis indicated that evaluated covariates included patient number, patient population, mean age, maximum of b factor, number of cysts, number of hemangiomas, and field were not sources of heterogeneity (all P value >0.05). Diffusion-weighted imaging was useful for differentiation between hepatic metastases and benign focal lesions. The diffusion characteristics of the benign hepatocellular lesions, including cases of focal nodular hyperplasia (FNH) and adenoma, have rarely been reported and need further studies. The diagnostic capability of DWI with parallel acquisition technique for differentiation between metastases and benign hepatic focal lesions might be overestimated.
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Affiliation(s)
- Chenggang Wei
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong Province, People's Republic of China
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Lewis S, Dyvorne H, Cui Y, Taouli B. Diffusion-weighted imaging of the liver: techniques and applications. Magn Reson Imaging Clin N Am 2014; 22:373-95. [PMID: 25086935 PMCID: PMC4121599 DOI: 10.1016/j.mric.2014.04.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diffusion-weighted imaging (DWI) is a technique that assesses the cellularity, tortuosity of the extracellular/extravascular space, and cell membrane density based on differences in water proton mobility in tissues. The strength of the diffusion weighting is reflected by the b value. DWI using several b values enables the quantification of the apparent diffusion coefficient. DWI is increasingly used in liver imaging for multiple reasons: it can add useful qualitative and quantitative information to conventional imaging sequences; it is acquired relatively quickly; it is easily incorporated into existing clinical protocols; and it is a noncontrast technique.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Hadrien Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Yong Cui
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA.
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Is DWI/ADC a useful tool in the characterization of focal hepatic lesions suspected of malignancy? PLoS One 2014; 9:e101944. [PMID: 25025151 PMCID: PMC4099077 DOI: 10.1371/journal.pone.0101944] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/12/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Apparent diffusion coefficient (ADC) values calculated through magnetic resonance imaging have been proposed as a useful tool to distinguish benign from malignant liver lesions. Most studies however included simple cysts in their analysis. Liver cysts are easy to diagnose, have very high ADC values and their inclusion facilitates differentiation in the ADC values between benign and malignant liver lesions groups. We prospectively evaluated the ability of ADC values to differentiate metastatic liver lesions from all benign or only solid benign liver lesions. MATERIAL AND METHODS Sixty-seven adult cancer patients with 188 liver lesions were evaluated. Lesions were categorized as metastatic or benign throughout imaging and clinical evaluation. One hundred and five (105) metastatic lesions and 83 benign lesions including hemangiomas (37), cysts (42), adenomas (2) and focal nodular hyperplasias (2) were evaluated. ADC values were calculated for each lesion utilizing two b values (0 and 600 sec/mm2). RESULTS The average ADC value for cysts was 2.4×10(-3) mm2/sec (CI: 2.1-2.6), for solid benign lesions was 1.4×10(-3) mm2/sec (CI: 1.1-1.7) and for metastases was 1.0×10(-3) mm2/sec (CI: 0.8-1.3). There was a difference between the ADC values of metastases and benign solid lesions (p<0.0001). With the ADC value of 1.5×10(-3) mm2/sec as a cut off it is possible to distinguish metastatic from benign liver lesions, including cysts, with an accuracy of 78%. But to distinguish metastatic from benign solid liver lesions the best ADC cut off value was 1.2×10(-3) mm2/sec and the accuracy drops to 71%. CONCLUSIONS ADC values proved to be helpful in the distinction between metastasis and benign solid hepatic lesions. But the exclusion of cysts in the analysis point out to a lower cut off value and lower accuracy than previously reported.
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Furuta A, Isoda H, Yamashita R, Ohno T, Kawahara S, Shimizu H, Shibata T, Togashi K. Comparison of monopolar and bipolar diffusion weighted imaging sequences for detection of small hepatic metastases. Eur J Radiol 2014; 83:1626-30. [PMID: 24998079 DOI: 10.1016/j.ejrad.2014.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/01/2014] [Accepted: 06/02/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare monopolar (MP) and bipolar (BP) diffusion weighted imaging (DWI) in detecting small liver metastases. MATERIALS AND METHODS Eighty-eight patients underwent 3-T MRI. The signal-to-noise ratios (SNR) of the liver parenchyma and lesions, the lesion-to-liver contrast-to-noise ratios (CNR), and the detection sensitivities were compared. The lesion distortion was scored (LDS) from 4 (no distortion) to 1 (excessive distortion), dichotomised as no-distortion and distortion, and the association between detected lesions for each reader in the MP or BP DWI group and the dichotomised lesion distortion degree was assessed. RESULT Forty-six hepatic metastases were confirmed. The CNR with BP images showed significantly higher values than with MP (P=0.017). The detection sensitivities of the three readers were higher in the BP sequence than in MP, and one reader detected significantly more hepatic lesions with BP images (P=0.04). LDS was significantly improved with BP sequence (P=0.002). In the no-distortion group, excluding the MP DWI assessments of one reader, detection sensitivities were significantly higher than in the distortion group (P<0.001 and P=0.002, respectively). CONCLUSION Reduced lesion distortion improves the detection of small liver metastases, and BP is more sensitive in detecting small liver metastases than MP DWI.
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Affiliation(s)
- Akihiro Furuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Rikiya Yamashita
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tsuyoshi Ohno
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Seiya Kawahara
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hironori Shimizu
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Toshiya Shibata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Schmid-Tannwald C, Thomas S, Ivancevic MK, Dahi F, Rist C, Sethi I, Oto A. Diffusion-weighted MRI of metastatic liver lesions: is there a difference between hypervascular and hypovascular metastases? Acta Radiol 2014; 55:515-23. [PMID: 23986455 DOI: 10.1177/0284185113501493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Different perfusion characteristics and histopathologic features of liver metastasis may potentially lead to different diffusion-weighted magnetic resonance imaging (DW-MRI) characteristics which can affect the performance of DW-MRI in their diagnosis. PURPOSE To compare ADC values of hypervascular and hypovascular metastases and the added value of DW-MRI to T2-weighted (T2-w) images in their detection. MATERIAL AND METHODS In this retrospective study, 46 patients (21 with hypervascular, 25 with hypovascular liver metastases) who had undergone abdominal MRI were included. Two independent observers first reviewed T2-w images only and then T2-w+DW-MR images and recorded number of metastases in each session. Lesion detection rate was compared using McNemar test. ADC of metastases in each patient was measured and compared between hypo- and hypervascular lesions using t-test. RESULTS A total of 153 hypervascular and 187 hypovascular metastases were detected at consensus review. Two observers detected significantly more hypervascular metastases on T2-w+DW-MR image review session compared to T2-w image only review session (reader 1: 148 [96.7%] vs. 129 [84.3%], P=0.002; reader 2: 125 [81.9%] vs. 113 [73.8%], P=0.004). Detection rate of hypovascular metastases was similar between two sessions for both observers (reader 1: 180 [96.2%] vs. 184 [98.4%]; reader 2: 176 [94.1%] vs. 180 [96.2%], P>0.05). The mean ADC value of hypervascular metastases was significantly lower than mean ADC value of hypovascular metastases (1.23+/-0.31 × 10(-3)mm(2)/s vs. 1.49+/-0.19 × 10(-3)mm(2)/s) (P=0.001). CONCLUSION Liver metastases are not a homogenous group of lesions with uniform DW-MRI features. Hypervascular metastases demonstrate significantly lower ADC values compared to hypovascular metastases. DW-MRI improved detection of hypervascular metastases compared to T2-w images alone and is a useful adjunct to T2-w images for their detection.
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Affiliation(s)
- Christine Schmid-Tannwald
- The University of Chicago, Department of Radiology, Chicago, IL, USA
- Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich, Germany
| | - Stephen Thomas
- The University of Chicago, Department of Radiology, Chicago, IL, USA
| | - Marko K Ivancevic
- The University of Chicago, Department of Radiology, Chicago, IL, USA
- Philips Healthcare, MR Clinical Science, Cleveland, OH, USA
| | - Farid Dahi
- The University of Chicago, Department of Radiology, Chicago, IL, USA
| | - Carsten Rist
- Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich, Germany
| | - Ila Sethi
- The University of Chicago, Department of Radiology, Chicago, IL, USA
| | - Aytekin Oto
- The University of Chicago, Department of Radiology, Chicago, IL, USA
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Kaya B, Koc Z. Diffusion-weighted MRI and optimal b-value for characterization of liver lesions. Acta Radiol 2014; 55:532-42. [PMID: 23982322 DOI: 10.1177/0284185113502017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is commonly used to distinguish between benign and malignant liver lesions. However, different b-values are recommended. PURPOSE To determine the most suitable b-value in DWI for differentiation of benign and malignant liver lesions. MATERIAL AND METHODS A total of 124 lesions in 89 consecutive patients (43 men, 46 women; age, mean ± standard deviation, 58 ± 14 years) with a pathological or radiological diagnosis of malignant or benign focal liver lesions after magnetic resonance imaging (MRI) were included in this study. Routine abdominal MRI and DWI were performed using seven b-values (0, 50, 200, 400, 600, 800, 1000 s/mm(2)). Lesions were analyzed for benignity/malignity using apparent diffusion coefficient (ADC) values with 10 b-value combinations and by measuring the lesion/normal parenchyma ADC ratio. RESULTS Mean ADC values were significantly different between malignant and benign lesions for all b-value combinations (P=0.000). The best b-value combination was 0 and 800 (Az=0.935). Using lower b-values such as 0 and 50 together with higher b-values ≥ 600 s/mm(2) was beneficial (Az=0.928 and 0.927). Mean ADC values were approximately 13% (1-15%) higher in total when b=0 and b=50 s/mm(2) were included in multiple b-value combinations. CONCLUSION In DWI, we recommend the use of b-values of 0 and 800 s/mm(2) as two b-values, or b=0, 50, 600, 800, and 1000 s/mm(2) as multiple b-values for distinguishing between benign and malignant liver lesions. Mean ADC value is 13% higher in total by additional use of b=0 and b=50 s/mm(2) in multiple b-value combinations.
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Affiliation(s)
- Bilal Kaya
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
- Present address: Radiology, Siirt Government Hospital, Ministry of Health, Siirt, Turkey
| | - Zafer Koc
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
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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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46
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Koc Z, Erbay G. Optimalbvalue in diffusion-weighted imaging for differentiation of abdominal lesions. J Magn Reson Imaging 2013; 40:559-66. [DOI: 10.1002/jmri.24403] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 08/19/2013] [Indexed: 01/20/2023] Open
Affiliation(s)
- Zafer Koc
- Faculty of Medicine; Department of Radiology; Baskent University; Ankara Turkey
| | - Gurcan Erbay
- Faculty of Medicine; Department of Radiology; Baskent University; Ankara Turkey
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47
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Schmid-Tannwald C, Oto A, Reiser MF, Zech CJ. Diffusion-weighted MRI of the abdomen: current value in clinical routine. J Magn Reson Imaging 2013; 37:35-47. [PMID: 23255414 DOI: 10.1002/jmri.23643] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 02/17/2012] [Indexed: 02/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) provides high tissue contrast without ionizing radiation exposure and unenhanced images are often diagnostic. Therefore, MRI is especially an attractive tool for patients with allergies for gadolinium-based contrast agents or renal failure. Technical advantages have led to the increasing use of diffusion-weighted (DW) MRI in abdominal imaging, which provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. This review article presents the current status of noncontrast MRI with the focus of DW-MRI. Technical background and clinical applications are explained and discussed.
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Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is now widely used as a standard imaging sequence for evaluation of the liver. The technique is easy to implement across different MRI platforms, and results in enhanced disease detection and characterization. With careful implementation, the quantitative apparent diffusion coefficient derived shows good measurement reproducibility, which can be applied for tissue characterization, the assessment of tumour response and disease prognostication. There is now a body of evidence that highlights the relative strengths and limitations of the technique for the assessment of liver diseases. The potential for more sophisticated analysis of DW-MRI data is currently being widely investigated.
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Affiliation(s)
- N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Schmid-Tannwald C, Jiang Y, Dahi F, Rist C, Sethi I, Oto A. Diffusion-weighted MR imaging of focal liver lesions in the left and right lobes: is there a difference in ADC values? Acad Radiol 2013; 20:440-5. [PMID: 23498984 DOI: 10.1016/j.acra.2012.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 10/27/2012] [Accepted: 10/27/2012] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES To determine possible differences between the left and right hepatic lobes in apparent diffusion coefficient (ADC) values of benign and malignant focal liver lesions (FLLs) and normal liver parenchyma. MATERIALS AND METHODS Thirty-six patients (16 males, 20 females; mean age 56.8 years) with FLLs of the same etiology in both the left and right hepatic lobes (13 patients with 26 benign FLLs and 23 patients with 46 malignant FLLs) who underwent 1.5T magnetic resonance imaging (MRI) including diffusion-weighted MRI (b values: 0 and 800 seconds/mm) with respiratory gating and without cardiac gating were included in this Health Insurance Portability and Accountability Act-compliant and institutional review board-approved study. ADC values of normal liver parenchyma and FLLs in each hepatic lobe were calculated and compared by using Student's t-test and Wilcoxon signed-rank test, respectively. RESULTS The mean ADC values of normal liver parenchyma, benign FLLs, and malignant FLLs were significantly higher (P < .001, P = .003, and P = .005, respectively) in the left hepatic lobe (1.74 × 10(-3), 1.81 × 10(-3), and 1.48 × 10(-3) mm²/second, respectively) than in the right hepatic lobe (1.48 × 10(-3), 1.54 × 10(-3), and 1.24 × 10(-3) mm²/second, respectively). CONCLUSION ADC values of benign and malignant FLLs calculated from noncardiac-gated DW-MRI are significantly higher in the left hepatic lobe compared with the right hepatic lobe. This may be a limitation for characterization of FLLs based on ADC measurements.
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d'Assignies G, Fina P, Bruno O, Vullierme MP, Tubach F, Paradis V, Sauvanet A, Ruszniewski P, Vilgrain V. High sensitivity of diffusion-weighted MR imaging for the detection of liver metastases from neuroendocrine tumors: comparison with T2-weighted and dynamic gadolinium-enhanced MR imaging. Radiology 2013; 268:390-9. [PMID: 23533288 DOI: 10.1148/radiol.13121628] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the sensitivity and specificity of diffusion-weighted (DW) magnetic resonance (MR) imaging for identifying liver metastases from neuroendocrine tumor (NET) to those of T2-weighted fast spin-echo (FSE) and three-dimensional dynamic gadolinium-enhanced MR imaging, with surgical and histopathologic findings as the reference standard. MATERIALS AND METHODS This retrospective study was approved by institutional review board, and informed consent was waived. Fifty-nine patients with NETs (41 patients with 162 liver metastases, and 18 control subjects with no liver metastases) underwent MR imaging that included DW, T2-weighted FSE, and dynamic gadolinium-enhanced MR sequences. Images were retrospectively reviewed by two abdominal radiologists, independently, for the detection and characterization of liver metastases. MR findings were compared with histopathologic and intraoperative ultrasonography findings for metastasis on a lesion-by-lesion basis to determine the sensitivity of each MR sequence alone and combined. Specificity was calculated by using the control population. Interreader agreement for each MR sequence and McNemar test were also calculated. RESULTS There was excellent agreement between observers 1 and 2 for characterizing liver metastases at per-lesion analysis (κ coefficient: 0.86-1.00). DW MR was more sensitive (observer 1: sensitivity, 71.6% [116 of 162], 95% confidence interval [CI]: 64.2%, 78.0%; observer 2: sensitivity, 71.0% [115 of 162], 95% CI: 63.6%, 77.4%) than T2-weighted FSE (observer 1: sensitivity, 55.6% [90 of 162], 95% CI: 47.9%, 63.0%; observer 2: sensitivity, 55.6% [90 of 162], 95% CI: 47.9%, 63.0%) and dynamic gadolinium-enhanced MR (observer 1: sensitivity, 47.5% [77 of 162], 95% CI: 34.0%, 55.2%; observer 2: sensitivity, 48.1% [78 of 162], 95% CI: 40.6%, 55.8%) (P < .001 for both, McNemar test). The specificity of these sequences ranged from 88.9% to 100% (DW MR vs T2-weighted FSE MR: P > .99, DW MR vs dynamic gadolinium-enhanced MR: P = .61, and T2-weighted FSE MR vs dynamic gadolinium-enhanced MR: P = .61, McNemar test). CONCLUSION DW MR imaging was more sensitive for the detection and characterization of liver metastases from NETs than T2-weighted FSE and dynamic gadolinium-enhanced MR imaging and should be systematically performed.
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Affiliation(s)
- Gaspard d'Assignies
- Department of Radiology, Assistance-Publique Hôpitaux de Paris, Hôpital Beaujon, 100 bd du Général Leclerc, 92110 Clichy, France
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