Diffusion-tensor imaging as an adjunct to dynamic contrastenhanced MRI for improved accuracy of differential diagnosis between breast ductal carcinoma in situ and invasive breast carcinoma

Objective:To determine the value of diffusion-tensor imaging（DTI） as an adjunct to dynamic contrastenhanced magnetic resonance imaging（DCE-MRI） for improved accuracy of differential diagnosis between breast ductal carcinoma in situ（DCIS） and invasive breast carcinoma（IBC）.Methods:The MRI data of 63 patients pathologically confirmed as breast cancer were analyzed.The conventional MRI analysis metrics included enhancement style,initial enhancement characteristic,maximum slope of increase,time to peak,time signal intensity curve（TIC） pattern,and signal intensity on FST2 WI.The values of apparent diffusion coefficient（ADC）,directionally-averaged mean diffusivity(D_avg),exponential attenuation（EA）,fractional anisotropy（FA）,volume ratio（VR） and relative anisotropy（RA）were calculated and compared between DCIS and IBC.Multivariate logistic regression was used to identify independent factors for distinguishing IBC and DCIS.The diagnostic performance of the diagnosis equation was evaluated using the receiver operating characteristic（ROC） curve.The diagnostic efficacies of DCEMRI,DWI and DTI were compared independendy or combined.Results:EA value,lesion enhancement style and TIC pattern were identified as independent factor for differential diagnosis of IBC and DCIS.The combination diagnosis showed higher diagnostic efficacy than a single use of DCE-MRI（P=0.02）,and the area of the curve was improved from 0.84（95%CI,0.67-0.99） to0.94（95%CI,0.85-1.00）.Conclusions:Quantitative DTI measurement as an adjunct to DCE-MRI could improve the diagnostic performance of differential diagnosis between DCIS and IBC compared to a single use of DCE-MRI.     

The application of HE4 in diagnosis of gynecological pelvic malignant tumor

OBJECTIVE To investigate the value of human epididymis gene product 4 （HE4） in differential diagnosis of gynecological pelvic tumors. METHODS The level of serum HE4 in 132 women was determined. These women were divided into three groups, i.e., 46 women with good health being classified as the normal control （NC） group, and based on clinicopathological results, the other 86 with pelvic masses being classified into groups of benign （n = 56） and malignant lesions （n = 30）, respectively. RESULTS The range of serum HE4 in the NC group was （23.5-46.0） pmol/L, with an average value of （34.1± 5.6） pmol/L; the range of serum HE4 in the benign lesion group was （30.1-58.9） pmol/L, with an average value of （39.1 ± 7.2） pmol/L; the range of serum HE4 in the group of malignancy was （31.2-1430.0） pmol/L, and the average value was （248.7 ± 364.5） pmol/L. The level of HE4 in the malignant lesion group was significantly higher than that in the other 2 groups, with a statistical difference, P 〈 0.001. The diagnostic index reached maximum （0.847） when the serum HE4 was at 51.6 pmol/L, and the sensitivity and specificity of HE4 were 86.7% and 98.0%, respectively. The area under the receiver- operator characteristic curve （ROC） was 0.935 （95% CI 0.832-1.037, P = 0.000）. The consistency checking Kappa value of HE4 in the diagnosis of pelvic malignant tumors was 0.867, P = 0.000. CONCLUSION The determination of serum HE4 is a good indicator in differential diagnosis of benign and malignant ovarian tumors.     

Mammography combined with breast dynamic contrast-enhanced-magnetic resonance imaging for the diagnosis of early breast cancer

Objective The aim of this study was to investigate the application of mammography combined with breast dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) for the diagnosis of early breast cancer. Methods Mammography and DCE-MRI were performed for 120 patients with breast cancer(malignant, 102; benign; 18). Results The sensitivity of mammography for early diagnosis of breast cancer was 66.67%, specificity was 77.78%, and accuracy was 68.33%. The sensitivity of MRI for early diagnosis of breast cancer was 94.12%, specificity was 88.89%, and accuracy was 93.33%. However, the sensitivity of mammography combined with DCE-MRI volume imaging with enhanced water signal(VIEWS) scanning for early diagnosis of breast cancer was 97.06%, specificity was 94.44%, and accuracy was 96.67%. Conclusion Mammography combined with DCE-MRI increased the sensitivity, specificity, and accuracy of diagnosing early breast cancer.     

COMBINED IMAGING DIAGNOSIS OF PAROTID MASSES

Computed tomography (CT), ultrasonography, sialography, and 99mTc scintigraphy were applied before operation to 108 patients with parotid masses. The results of each technique and the combined study of them were compared with the pathological diagnosis. Ultrasonography was found to be a very effective diagnostic aid in determining the presence of space-occupying lesion in the parotid. CT was the best technique to provide adequately reliable informations regarding the location of the tumor and the relationship between tumor and surrounding tissues. For diagnosing the nature of tumors, ultrasonography combined with sialography was reliable. 99mTc scintigraphy was better than other techniques in diagnosis of adenolymphoma. The diagnostic accuracy of combined diagnosis (90.7%) was higher than those of ultrasonography (83%), CT (80.5%), sialography (79%), and 99mTc scintigraphy (13.9%) alone. The advantage of combined diagnosis was particularly obvious for the diagnosis of low-grade malignant tumors.     

CLINICOPATHOLOGICAL ANALYSIS OF 5785 CASES WITH RESPIRATORY SYSTEM TUMORS

Objective; To study the characteristics and tendency of incidence of patients with respiratory system tumors during the past 23 y in Tianjin. Methods： All data in our research was obtained from the surgical pathology files of Department of Pathology of the general and the Second Hospitals of Tianjin Medical University between 1981 and 2003. All data was analyzed by Spss 11.5 statistics program. The comparisons were made by u-test, P〈0.05 was considered as significant. Results： 1. The detection rate of malignant tumors is significantly higher than that of benign tumors （U=52.68, p=0.000） in respiratory system. 2. The common sites of benign tumors are nose and pharynx, but the common sites of malignant tumors are lung and larynx. 3. The incidence of benign tumors generally peaks between the ages of 40 and 50, but the incidence of malignant tumor generally peaks between the ages of 50 and 60. 4. The commonest histological type of malignant tumors is squamous cell carcinoma, but the commonest histological type of benign tumors is papilloma. 5. The detection rate of malignant lung tumors steadily increased between 1981 and 1999 and increased sharply from 1999 to 2003, but the detection rate of malignant Nasopharyngeal tumors steadily decreased from 1981 to 2003. Between 1981 and 1997, the detection rate of malignant laryngeal tumors steadily increased, followed by a decrease between 1997 and 2003. Conclusion： The detection rate of malignant respiratory system tumors especially lung cancer is gradually increasing. Therefore early prevention and treatment are critical to patients＇ prognosis.     

头颈部肿瘤99mTc-MIBI阳性显像的临床研究

Objective： To investigate the diagnostic potential value of ^99Tc-MIBI imaging in head and neck tumors. Methods： Ninety-one patients with malignant and benign head and neck lesions were subjected to ^99mTc-MIBI tomography, and 20 healthy volunteers served as control group. Results： The overall sensitivity,specificity, accuracy and positive predictive accuracy of early/delay ^99mTc-MIBI imaging in diagnosis of head and neck malignant tumors were 78.7%/72.3%, 72.1%/88.4%, 75.6%/80.0% and 75.5%/87.2% respectively. The results of ^99mTc-MIBI Imaging in diagnosis of nasopharyngeal cancer and sinonasal non-Hodgkin＇s lymphoma were more satisfactory than those in maxillary sinus cancer. In distinguishing recurrent/residual nasopharyngeal carcinoma and sinonasal non-Hodgkin＇s lymphoma, ^99mTc-MIBI scintigraphy was superior to CT/MRI. Conclusion： ^99mTc-MIBI imaging is a promising useful tool in identifying head and neck tumor, and it has a special value to evaluate the local invasion and metastasis involved.     

Chondroblastoma in the long bone diaphysis: a report of two cases with literature review

To investigate the clinical characteristics of chondroblastoma with an emphasis on lesions located in the long bone diaphysis,we reviewed the clinical data of 7 patients with histologically proven chondroblastoma treated in Tianjin Medical University Cancer Hospital and Fudan University Cancer Hospital between January 1995 and May 2009.There were two rare cases of chondroblastoma in the long bone diaphysis.One patient with a lesion in the tibial diaphysis underwent intralesional curettage and bone grafting,and the postoperative bone function was measured as excellent according to the Enneking scoring system.The patient was still alive upon follow-up at 60 months.The other patient with a lesion in the humeral diaphysis underwent resection,and the postoperative bone function was excellent at 48 months,at which there was no evidence of recurrence or metastasis.Thus,except for the distinctive site of the long bone diaphysis,which made diagnosis difficult,the patients’ ages,symptoms,X-ray and CT images,treatment,and prognosis were in accordance with typical lesions in the epiphysis and metaphysis.The diagnosis of chondroblastoma in the long bone diaphysis significantly depends on histopathologic characteristics.     

Study of Benign and Malignant Intraductal Lesions of the Breast by Fiberoptic Ductoscopy

OBJECTIVE To observe and subtype the appearance of intraductal papilloma (lesions) and of infiltrating ductal carcinoma or early infiltrating ductal carcinoma using a fiberoptic ductoscope (FDS) examination, and to discuss the differentiation and diagnosis of benign and malignant tumors by FDS.METHODS The characteristics of FDS images and diagnostic data for 229patients with intraductal papilloma (lesions) and 50 patients with ductal carcinoma, who were confirmed by surgical pathology from October 1998 to December 2003, were analyzed retrospectively.RESULTS The appearance of the lesions observed by FDS were grouped into 4 types: a monothelia (type Ⅰ), polythelia (type Ⅱ), superficies (type Ⅲ)and a mixture (type Ⅳ). Intraductal papillomas (lesions) were more commonly seen in type Ⅰ and Ⅱ, and intraductal carcinomas or early infiltrating ductal carcinomas were more commonly seen in type Ⅲ and Ⅳ;there was a statistically significant difference in the distribution of the ductoscopic types, except in type Ⅱ, between the two types of lesions, P＜0.001. The focal detection rate by FDS for intraductal papilloma and papillomatosis was 99.6% (228/229) and for breast cancer was 96.0% (48/50). The diagnostic accuracy was 97.8% (224/229) and 82.0% (41/50),respectively.CONCLUSION FDS can be a guide for the treament of benign and malignant intraductal tumors, with early discovery and accurate diagnosis.     

Application of Real-time Ultrasound Elastography in Diagnosing Benign and Malignant Thyroid Solid Nodules

Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nature of these nodules,and to assess the clinical value of elasticity scores(ES) and strain ratio(SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules(99 benign ones and 32 malignant ones) in 120 patients(78 females and 41 males).Three radiologists evaluated the nodules based on a four-degree elasticity scoring system.The nodules were classified according to the ES as soft(ES 1-2) or hard(ES 3-4).The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78%and 80%,respectively.SR values > 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87%and a specificity of 92%.The SR of the benign lesions was 1.64±1.37,which was significantly different from that of malignant lesions,which was 4.96±2.13(P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones.Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules.It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.     

Role of the texture features of images in the diagnosis of solitary pulmonary nodules in different sizes

Objective： To explore the role of the texture features of images in the diagnosis of solitary pulmonary nodules （SPNs） in different sizes. Materials and methods： A total of 379 patients with pathologically confirmed SPNs were enrolled in this study. They were divided into three groups based on the SPN sizes： ≤10, 11-20, and 〉20 mm. Their texture features were segmented and extracted. The differences in the image features between benign and malignant SPNs were compared. The SPNs in these three groups were determined and analyzed with the texture features of images. Results： These 379 SPNs were successfully segmented using the 2D Otsu threshold method and the self-adaptive threshold segmentation method. The texture features of these SPNs were obtained using the method of grey level co-occurrence matrix （GLCM）. Of these 379 patients, 120 had benign SPNs and 259 had malignant SPNs. The entropy, contrast, energy, homogeneity, and correlation were 3.5597±0.6470, 0.5384±0.2561, 0.1921±0.1256, 0.8281±0.0604, and 0.8748±0.0740 in the benign SPNs and 3.8007±0.6235, 0.6088±0.2961, 0.1673±0.1070, 0.7980±0.0555, and 0.8550±0.0869 in the malignant SPNs （all P〈0.05）. The sensitivity, specificity, and accuracy of the texture features of images were 83.3%, 90.0%, and 86.8%, respectively, for SPNs sized 〈10 mm, and were 86.6%, 88.2%, and 87.1%, respectively, for SPNs sized 11-20 mm and 94.7%, 91.8%, and 93.9%, respectively, for SPNs sized 〉20 mm. Conclusions： The entropy and contrast of malignant pulmonary nodules have been demonstrated to be higher in comparison to those of benign pulmonary nodules, while the energy, homogeneity correlation of malignant pulmonary nodules are lower than those of benign pulmonary nodules. The texture features of images can reflect the tissue features and have high sensitivity, specificity, and accuracy in differentiating SPNs. The sensitivity and accuracy increase for larger SPNs.     

Optimization of apparent diffusion coefficient measured by diffusion-weighted MRI for diagnosis of breast lesions presenting as mass and non-mass-like enhancement

The purpose of this study was to investigate the diagnostic value of the apparent diffusion coefficient (ADC), measured by diffusion-weighted magnetic resonance imaging (MRI), for the diagnosis of breast lesions presenting as mass and non-mass-like enhancement (NMLE). The breast MRI studies of 174 patients were reviewed retrospectively. A total of 188 histologically confirmed lesions were analyzed and classified into 127 mass enhancement (86 malignant and 41 benign) and 61 NMLE (42 malignant and 19 benign). The ADC values were measured using a spin-echo echo-planner-imaging (SE-EPI) sequence with b?=?1,000 s/mm². Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. The mean ADC was 0.99?±?0.22?×?10^?3?mm²/s for invasive cancer, 1.23?±?0.33?×?10^?3?mm²/s for ductal carcinoma in situ (DCIS), and 1.52?±?0.35?×?10^?3?mm²/s for benign adenosis. The mean ADC of all NMLE lesions was 1.44?±?0.41?×?10^?3?mm²/s, which is higher than the mean ADC of all mass lesions, 1.12?±?0.33?×?10^?3?mm²/s. In the ROC analysis, the optimal cutoff ADC value for differentiating benign from malignant lesions was 1.05?×?10^?3?mm²/s for mass lesions and 1.35?×?10^?3?mm²/s for NMLE. In conclusion, ADC values can be used for the diagnosis of invasive and DCIS as well as benign tumors. The NMLE lesions tend to have higher ADC values than mass lesions; therefore, the morphological appearance of a lesion needs to be considered when using the ADC value for diagnosis.     

Value of apparent diffusion coefficient measurement for discrimination of focal benign and malignant hepatic masses

The purpose of our study was to investigate the value of diffusion‐weighted magnetic resonance imaging (DW‐MRI) to discriminate benign and malignant focal lesions of the liver using parallel imaging technique. A total of 77 patients and 65 healthy controls were enrolled in the study. DW‐MRI was performed with b‐factors of 0, 500 and 1000 s/mm², and the apparent diffusion coefficients (ADC) values of the normal liver and the lesions were calculated. The mean ADC value of the focal liver lesions were as follows: simple cysts (3.16 ± 0.18 × 10^?3 mm²/s), hydatid cysts (2.58 ± 0.53 × 10^?3 mm²/s), hemangiomas (1.97 ± 0.49 × 10^?3 mm²/s), metastases (1.14 ± 0.41 × 10^?3 mm²/s) and hepatocellular carcinomas (HCC) (1.15 ± 0.36 × 10^?3 mm²/s). The mean ADC values of all the disease groups were statistically significant when compared with the mean ADC value of the normal liver (1.56 ± 0.14 × 10^?3 mm²/s), (P < 0.01). There were also statistically significant differences among the ADC values of hemangiomas and HCC metastases (P < 0.01), and simple and hydatid cysts (P < 0.008). However, there was no statistically significant difference between HCC and metastases. The present study showed that ADC measurement has the potential to differentiate benign and malignant focal hepatic lesions. We propose to add DW sequence in the MR protocol for the detection and quantitative discrimination of hepatic pathologies.     

Diffusion-weighted imaging (b value = 1500 s/mm2) is useful to decrease false-positive breast cancer cases due to fibrocystic changes

Background

We aimed to evaluate the application of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging (DWI) (b value = 1500 s/mm²) in the breast imaging reporting and data system (BI-RADS).

Methods

For 104 cases of breast lesions with definitive histology diagnosis (45 benign cases, 59 malignant cases) in which breast magnetic resonance imaging was performed, ADC values were compared between benign and malignant cases, between ductal carcinoma in situ (DCIS) and fibrocystic changes, and between DCIS and ductal hyperplasia (one type of fibrocystic change). Diagnostic accuracy was compared for a total of 101 images and for 34 images including only nine DCIS and 25 fibrocystic changes between BI-RADS alone (with categories 4a, 4b, and 5 defined as malignancies) and BI-RADS plus ADC.

Results

There were significant differences in mean ADC values between malignant and benign cases (p < 0.0001) and between DCIS and fibrocystic changes (p < 0.002), but not between DCIS and ductal hyperplasia. Positive predictive values were significantly greater for BI-RADS plus ADC than for BI-RADS alone in all cases (70.5% for BI-RADS alone, 81.3% for BI-RADS plus ADC) and in cases of DCIS versus fibrocystic changes (40.9% for BI-RADS alone, 64.3% for BI-RADS plus ADC), resulting in a significant improvement in diagnostic accuracy with the addition of ADC.

Conclusion

Adding ADC values calculated from DWI (b value = 1500 s/mm²) to BI-RADS is a useful way to improve differential diagnostic accuracy for malignant tumors and benign lesions, especially for DCIS versus fibrocystic changes, except in cases of ductal hyperplasia.     

Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging

Background

The aim of the study was to evaluate the role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of lung lesions.

Patients and methods.

Sixty-seven patients with lung lesions (48 malignant, 19 benign) were included in this prospective study. Signal intensities (SIs) were measured in diffusion-weighted MR images that were obtained with b=0, 500 and 1000 s/mm² values. Apparent diffusion coefficient (ADC) maps were calculated by using images with b=0 and 1000 s/mm² values. The statistical significance was determined using the Student-t test.

Results

The SIs of malignant lesions were significantly higher than those of benign lesions (p<0.004 for b=0 s/mm² and p<0.000 for the other b values). Using b=500 s/mm², SI≥391 indicated a malignant lesion with a sensitivity of 95%, specificity of 73% and positive predictive value of 87%. Using b=1000 s/mm², SI≥277 indicated a malignant lesion with a sensitivity of 93%, specificity of 69% and positive predictive value of 85%. There was no significant difference between malignant and benign lesions regarding ADC values (p=0.675). There was no significant difference in SIs or ADC values between small cell carcinoma and non-small cell carcinoma. When comparing undifferentiated with well- partially differentiated cancers, SIs were higher with all b values, but the difference was statistically significant only with b=1000 s/mm² (p<0.04).

Conclusions

Diffusion-weighteted MR trace image SI is useful for the differentiation of malignant versus benign lung lesions.     

全身弥散加权成像在恶性肿瘤骨转移诊断中的应用

 目的　探讨全身弥散加权成像（WB-DWI）在恶性肿瘤骨转移诊断中的应用价值。方法　对118例恶性肿瘤患者行WB-DWI检查,并于扫描后1周内对可疑骨转移部位行常规磁共振成像（MRI）／CT检查。对资料进行统计学分析,比较单独应用WB-DWI、MRI／CT及二者联合应用（WB-DWI＋MRI／CT）对恶性肿瘤骨转移的诊断价值。分别测定骨转移组及良性骨病变组的表观弥散系数（ADC）值,探讨其在良恶性病变诊断中的价值。结果　受试工作者曲线（ROC）分析结果显示,WB-DWI＋MRI／CT诊断骨转移瘤的ROC曲线下面积、特异度、正确诊断指数及阳性预测值最高（0.999、100.0 %、97.4 %、100.0 %）,诊断效果最好;骨转移组平均ADC值[（0.71±0.15）×10-3 mm2／s]明显低于良性骨病变组[（1.50±0.23）×10-3 mm2／s],差异具有统计学意义（F＝261.587,P＜0.001）。结论　WB-DWI是常规MRI／CT的有益补充,结合ADC值测定,在恶性肿瘤骨转移诊断与鉴别诊断方面具有一定价值。     

Study of the Reduced Field-of-View Diffusion-Weighted Imaging of the Breast

BackgroundThis study aimed to compare the imaging quality, apparent diffusion coefficient (ADC) values, and application values between reduced field-of-view diffusion-weighted imaging (rFOV DWI) and single-shot echo-planar–imaging diffusion-weighted imaging (SS-EPI DWI) of breast tissue.Patients and MethodsFor 87 cases (75 with normal breast tissue, 12 with mammary cancer), breasts were scanned with SS-EPI DWI and rFOV DWI (b values, 800 s/mm²). Image quality and ADC values of breast tissue images were compared between SS-EPI DWI and rFOV DWI.ResultsThe average image quality score for the 87 cases was 4.73 in rFOV DWI and 3.62 in SS-EPI DWI. The difference was statistically significant (P < .01). The resolution of rFOV DWI was 2.25 mm × 1.23 mm, which was higher than the resolution of SS-EPI DWI (2.25 mm × 2.25 mm). The mean ADC value of 75 cases with normal breast tissue was 1.696 × 10^-3 mm²/s by rFOV DWI and 1.832 × 10^-3 mm²/s by SS-EPI DWI, and the difference was statistically significant (P < .01). The mean ADC value for the 12 cases with breast cancer was 1.065 × 10^-3 mm²/s by rFOV DWI and 1.192 × 10^-3 mm²/s by SS-EPI DWI, which was a statistically significant difference (P < .05).ConclusionrFOV DWI presented images with higher resolution and less distortion than SS-EPI DWI, and this difference may be helpful in disease diagnosis.     

Assessing Bladder Radiotherapy Response With Quantitative Diffusion-Weighted Magnetic Resonance Imaging Analysis

AimsRadiotherapy with radiosensitisation offers opportunity for cure with organ preservation in muscle-invasive bladder cancer (MIBC). Treatment response assessment and follow-up are reliant on regular endoscopic evaluation of the retained bladder. In this study we aim to determine the role of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) analysis to assess bladder radiotherapy response.Materials and methodsPatients with T2-T4aN0-3M0 MIBC suitable for radical radiotherapy were recruited prospectively to an ethics approved protocol. Following transurethral resection of the bladder tumour and prior to any treatment, magnetic resonance imaging including DWI was performed on a 1.5T system using b values of 0, 100, 150, 250, 500, 750 s/mm². DWI was repeated 3 months after completing radiotherapy. Cystoscopy and tumour site biopsy were undertaken following this. The response was dichotomised into response (<T2) or poor response (≥T2). Tumour region of interest was delineated on b750 s/mm² image and transferred to the ADC map to calculate per pixel ADC values for all b values (ADC_all) and high b values (ADC_b100). ADC mean, percentiles, skew, kurtosis and their change (ΔADC and %ΔADC) were determined. Threshold predictive of response with highest specificity was ascertained using receiver operating characteristic analysis.ResultsThirty-four patients were evaluated. Response was associated with a significant increase in ΔADC mean compared with poor response at ΔADC_all (0.57 × 10^?3 mm²/s versus –0.01 × 10^?3 mm²/s; P < 0.0001) and ΔADC_b100 (0.58 × 10^?3 mm²/s versus –0.10 x 10^?3 mm²/s; P = 0.007). A 48.50% increase in %ΔADC_all mean was seen in response compared with a 1.37% decrease in poor response (P < 0.0001). This corresponded to a %ΔADC_b100 mean increase of 50.34% in response versus a 7.36% decrease for poor response (P < 0.0001). Significant area under the curve (AUC) values predictive of radiotherapy response were identified at ΔADC and %ΔADC for ADC_all and ADC_b100 mean, 10th, 25th, 50th, 75th and 90th percentiles (AUC >0.9, P < 0.01). ΔADC_all mean of 0.16 × 10^?3 mm²/s and ΔADC_b100 mean 0.12 × 10^?3 mm²/s predicted radiotherapy response with sensitivity/specificity/positive predictive value/negative predictive value of 92.9%/100.0%/100.0%/75.0% and 89.3%/100.0%/100.0%/66.7%, respectively.ConclusionsQuantitative DWI analysis can successfully provide non-invasive assessment of bladder radiotherapy response. Multicentre validation is required before prospective testing to inform MIBC radiotherapy follow-up schedules and decision making.     

Prognostic role for diffusion-weighted imaging of pediatric optic pathway glioma

Optic pathway glioma (OPG) has an unpredictable course, with poor correlation between conventional imaging features and tumor progression. We investigated whether diffusion-weighted MRI (DWI) predicts the clinical behavior of these tumors. Twelve children with OPG (median age 2.7 years; range 0.4–6.2 years) were followed for a median 4.4 years with DWI. Progression-free survival (time to requiring therapy) was compared between tumors stratified by apparent diffusion coefficient (ADC) from initial pre-treatment scans. Tumors with baseline ADC greater than 1,400 × 10^?6 mm²/s required treatment earlier than those with lower ADC (log-rank p = 0.002). In some cases, ADC increased leading up to treatment, and declined following treatment with surgery, chemotherapy, or radiation. Baseline ADC was higher in tumors that eventually required treatment (1,562 ± 192 × 10^?6 mm²/s), compared with those conservatively managed (1,123 ± 114 × 10^?6 mm²/s) (Kruskal–Wallis test p = 0.013). Higher ADC predicted earlier tumor progression in this cohort and in some cases declined after therapy. Evaluation of OPG with DWI may therefore be useful for predicting tumor behavior and assessing treatment response.     

Intravoxel Incoherent Motion (IVIM) Diffusion Weighted Imaging (DWI) in the Periferic Prostate Cancer Detection and Stratification

The aim of this study was to compare the Intravoxel Incoherent Motion (IVIM) parameters between healthy Peripheral Zone (PZ), Benign Prostatic Hyperplasia (BPH) and Prostate Cancer (PCa) and compare them to assess whether there was correlation with Gleason Score (GS) grading system. Thirty-one patients with suspect of PCa underwent 1.5T Multi-Parametric Magnetic Resonance Imaging (MP-MRI) with endorectal coil with a protocol including T2WI, DWI using 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, 1000 s/mm²) and DCE. Monoexponential and IVIM model fits were used to calculate both apparent diffusion coefficient (ADC) and the following IVIM parameters: molecular diffusion coefficient (D), perfusion-related diffusion coefficient (D*) and perfusion fraction (f). The ADC and D values were significantly lower in the PCa (0.70 ± 0.16 × 10^?3 mm²/s and 0.88 ± 0.31 × 10^?3 mm²/s) compared to those found in the PZ (1.22 ± 0.20 × 10^?3 mm²/s and 1.78 ± 0.34 × 10^?3 mm²/s) and in the BPH (1.53 ± 0.23 × 10^?3 mm²/s and 1.11 ± 0.28 × 10^?3 mm²/s). The D* parameter was significantly increased in the PCa (5.35 ± 5.12 × 10^?3 mm²/s) compare to the healthy PZ (3.02 ± 2.86 × 10^?3 mm²/s), instead there was not significantly difference in the PCa compare to the BPH (5.61 ± 6.77 × 10^?3 mm²/s). The f was statistically lower in the PCa (9.01 ± 5.20%) compared to PZ (10.57 ± 9.30%), but not significantly different between PCa and BPH (9.29 ± 7.29%). The specificity, sensitivity and accuracy of T2WI associated with DWI and IVIM were higher (100, 98 and 99%, respectively) than for T2WI/DWI and IVIM alone (89, 92 and 90%, respectively). Only for ADC was found a statistical difference between low- and intermediate-/high-grade tumors. Adding IVIM to the MP-MRI could increase the diagnostic performance to detect clinically relevant PCa. ADC values have been found to have a rule to discriminate PCa reliably from normal areas and differed significantly in low- and intermediate-/high-grade PCa. In contrast, IVIM parameters were unable to distinguish between the different GS.     

Diffusion-weighted imaging and loco-regional N staging of patients with colorectal liver metastases

IntroductionDiffusion-weighted MRI (DWI) contributes to N staging of rectal cancers and diagnosis of colorectal liver metastases (CLM). About 15% of CLM patients have loco-regional lymph node (LN) metastases that impact prognosis and treatment strategy. This retrospective study is the first one to evaluate quantitative ADC measurement as a tool to identify metastatic LNs in patients with liver metastases from colorectal cancer.MethodsAll consecutive patients undergoing surgery for CLM between 2008 and 2015 were considered. Inclusion criteria were: intraoperative retrieval of at least one LN; LN ≥ 5 mm; DWI performed ≤2 months before surgery. The ADC and ADC_ratio (ADC_LN/ADC_CLM) were computed by two radiologists for all the LNs.ResultsAmong 555 patients operated for CLM, 32 met the inclusion criteria. Fifty-six LNs were analyzed and 28 were metastatic. ADC and ADC_ratio in metastatic LNs were lower than in benign LNs (ADC = 1.37 vs. 1.83 × 10⁻³ mm²/s, p < 0.001; ADC_ratio = 1.26 vs. 1.73, p < 0.001). The optimal cut-off value for ADC was 1.48 x 10^-3 mm²/s (AUC = 0.85, p < 0.001, sensitivity/specificity/accuracy 79%/93%/86% in per LN-analysis and 94%/86%/91% in per-patient analysis). The optimal cut-off for ADC_ratio was 1.15 (AUC = 0.80, p < 0.001, sensitivity/specificity/accuracy 69%/93%/81% and 76%,93%/84%). Excellent inter- and intra-operators’ agreements were observed.ConclusionIn patients with CLM, ADC values < 1.48 x 10^-3 mm²/s can be postulated as a cut-off to distinguish metastatic LNs.