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1.
Christine Schmid-Tannwald Christoph M. Schmid-Tannwald John N. Morelli Ralph Neumann Alexander R. Haug Nathalie Jansen Konstantin Nikolaou Nicolai Schramm Maximilian F. Reiser Carsten Rist 《European journal of nuclear medicine and molecular imaging》2013,40(6):897-907
Purpose
The aim of the study was to evaluate contrast-enhanced MRI, diffusion-weighted MRI (DW MRI), and 68Ga-DOTATATE positron emission tomography (PET)/CT in the detection of intermediate to well-differentiated neuroendocrine tumors (NET) of the pancreas.Methods
Eighteen patients with pathologically proven pancreatic NET who underwent MRI including DW MRI and PET/CT within 6 weeks of each other were included in this retrospective study. Two radiologists evaluated T2-weighted (T2w), T2w?+?DW MRI, T2w?+?contrast-enhanced T1-weighted (CE T1w) MR images, and PET/CT for NET detection. The sensitivity and level of diagnostic confidence were compared among modalities using McNemar’s test and a Wilcoxon signed rank test. Apparent diffusion coefficients (ADC) of pancreatic NETs and normal pancreatic tissue were compared with Student’s t test.Results
Of the NETs, 8/23 (34.8 %) and 9/23 (39.1 %) were detected on T2w images by observers 1 and 2, respectively. Detection rates improved significantly by combining T2w images with DW MRI (observer 1: 14/23?=?61 %; observer 2: 15/23?=?65.2 %; p?<?0.05) or CE T1w images (observer 1: 14/23?=?61 %; observer 2: 15/23?=?65.2 %; p?<?0.05). Detection rates of pancreatic NET with PET/CT (both observers: 23/23?=?100 %) were statistically significantly higher than with MRI (p?<?0.05). The mean ADC value of NET (1.02?±?0.26?×?10?3?mm2/s) was statistically significantly lower than that of normal pancreatic tissue (1.48?±?0.39?×?10?3?mm2/s).Conclusion
DW MRI is a valuable adjunct to T2w imaging and comparable to CE T1w imaging in pancreatic NET detection, quantitatively differentiating between NET and normal pancreatic tissue with ADC measurements. 68Ga-DOTATATE PET/CT is more sensitive than MRI in the detection of pancreatic NET. 相似文献2.
Marcelo A. Queiroz Martin Hüllner Felix Kuhn Gerhardt Huber Christian Meerwein Spyros Kollias Gustav von Schulthess Patrick Veit-Haibach 《European journal of nuclear medicine and molecular imaging》2014,41(12):2212-2221
Objective
The purpose of this study was to analyze whether diffusion-weighted imaging (DWI) adds significant information to positron emission tomography/magnetic resonance imaging (PET/MRI) on lesion detection and characterization in head and neck cancers.Methods
Seventy patients with different head and neck cancers were enrolled in this prospective study. All patients underwent sequential contrast-enhanced (ce) PET/computed tomography (CT) and cePET/MRI using a tri-modality PET/CT-MR setup either for staging or re-staging. First, the DWI alone was evaluated, followed by the PET/MRI with conventional sequences, and in a third step, the PET/MRI with DWI was evaluated. McNemar’s test was used to evaluate differences in the accuracy of PET/MRI with and without DWI compared to the standard of reference.Results
One hundred eighty-eight (188) lesions were found, and of those, 118 (62.8 %) were malignant and 70 (37.2 %) were benign. PET/MRI without DWI had a higher accuracy in detecting malignant lesions than DWI alone (86.8 % vs. 60.6 %, p?0.001). PET/MRI combined with DWI detected 120 concurrent lesions (89 malignant and 31 benign), PET/MRI alone identified 48 additional lesions (20 malignant and 28 benign), and DWI alone detected 20 different lesions (nine malignant and 11 benign). However, lesions detected on DWI did not change overall staging. SUV maximum and mean were significantly higher in malignant lesions than in benign lesions. DWI parameters between malignant and benign lesions were not statistically different.Conclusion
The use of DWI as part of PET/MRI to evaluate head and neck cancers does not provide remarkable information. Thus, the use of DWI might not be needed in clinical PET/MRI protocols for the staging or restaging of head and neck cancers. 相似文献3.
Vera Froeling Florian Elgeti Martin H. Maurer Christian Scheurig-Muenkler Alexander Beck Thomas J. Kroencke Ulrich-Frank Pape Bernd Hamm Winfried Brenner Nils F. Schreiter 《Annals of nuclear medicine》2012,26(9):738-743
Purpose
To evaluate the impact of Ga-68 DOTATOC PET/CT on diagnosis and therapeutic management of patients with multiple endocrine neoplasia (MEN).Materials and methods
We did 28 Ga-68 DOTATOC PET/CT in 21 MEN patients (10 female, 11 men; mean age 41.3?years). 109 lesions detected were classified into MEN-associated lesions [i.e., neuroendocrine tumors (NET)] and non-MEN-associated lesions for PET, CT, and PET/CT. The impact of Ga-68 DOTATOC PET/CT on diagnosis and therapeutic management of patients with MEN were assessed by the records of the interdisciplinary NET tumor board including histopathological findings, clinical and radiological follow-up.Results
Ga-68 DOTATOC PET/CT had an impact on diagnosis and therapeutic management in 10/21 (47.6?%) MEN patients. For detecting NET lesions in MEN patients Ga-68 DOTATOC PET/CT reached a sensitivity/specificity of 91.7?%/93.5?%. There was a significant difference for the detection rate between Ga-68 DOTATOC PET/CT and CT alone (p?<?0.001) both using contrast-agent (p?=?0.002) or not (p?<?0.001) and also a significant difference between contrast-enhanced (CE-) CT and non-CE-CT alone (p?=?0.006).Conclusions
GA-68 DOTATOC PET/CT allows a high detection rate of NET lesions in the context of MEN-1 syndrome as well as influence therapeutic management in nearly up to half of the patients. GA-68 DOTATOC PET/CT should include a CE-CT to improve MEN-associated NET lesion detection. 相似文献4.
Stefano Severi Oriana Nanni Lisa Bodei Maddalena Sansovini Annarita Ianniello Stefania Nicoletti Emanuela Scarpi Federica Matteucci Laura Gilardi Giovanni Paganelli 《European journal of nuclear medicine and molecular imaging》2013,40(6):881-888
Purpose
The prognostic value of FDG PET for neuroendocrine tumours (NETs) has been reported. In this study we evaluated the role of FDG PET in predicting response and progression-free survival (PFS) after 177Lu-DOTATATE peptide receptor radionuclide therapy (Lu-PRRT) in patients with advanced well-differentiated grade 1/2 NETs.Methods
We retrospectively evaluated 52 patients with progressive advanced NETs overexpressing somatostatin receptors and treated with Lu-PRRT with a cumulative activity up to 27.7 GBq divided into five courses. According to WHO 2010/ENETS classification, patients were stratified into two groups: those with grade 1 tumour (Ki-67 index ≤2 %, 19 patients), and those with grade 2 tumour (Ki-67 index >3 % to <20 %, 33 patients). On the basis of the FDG PET scan, 33 patients were classified as PET-positive (PET+) and 19 as PET-negative (PET?).Results
FDG PET was positive in 57 % of patients with grade 1 NET and in 66 % of patients with grade 2 NET, and the rates of disease control (DC, i.e. complete response + partial response + stable disease) in grade 1 and grade 2 patients were 95 % and 79 %, respectively (P?=?0.232). In PET? and PET+ patients, the DC rates were 100 % and 76 % (P?=?0.020) with a PFS of 32 and 20 months, respectively (P?=?0.033). Of the PET+ patients with grade 1 NET, 91 % showed disease control, whereas about one in three PET+ patients with grade 2 NET (32 %) progressed after Lu-PRRT (DC rate 68 %).Conclusion
These results suggest that FDG PET evaluation is useful for predicting response to Lu-PRRT in patients with grade 1/2 advanced NETs. Notably, none of PET? patients had progressed at the first follow-up examination after Lu-PRRT. Grade 2 NET and PET+ (arbitrary SUV cutoff >2.5) were frequently associated with more aggressive disease. PET+ patients with grade 2 NET, 32 % of whom did not respond to Lu-PRRT monotherapy, might benefit from more intensive therapy protocols, such as the combination of chemotherapy and PRRT. 相似文献5.
Karsten Beiderwellen Michael Huebner Philipp Heusch Johannes Grueneisen Verena Ruhlmann Felix Nensa Hilmar Kuehl Lale Umutlu Sandra Rosenbaum-Krumme Thomas C. Lauenstein 《European radiology》2014,24(8):2023-2030
Objectives
To compare [18?F]FDG PET/MRI with PET/CT for the assessment of bone lesions in oncologic patients.Methods
This prospective study included 67 patients with solid tumours scheduled for PET/CT with [18?F]FDG who also underwent a whole-body PET/MRI scan. The datasets (PET/CT, PET/MRI) were rated by two readers regarding lesion conspicuity (four-point scale) and diagnostic confidence (five-point scale). Median scores were compared using the Wilcoxon test.Results
Bone metastases were present in ten patients (15 %), and benign bone lesions in 15 patients (22 %). Bone metastases were predominantly localized in the pelvis (18 lesions, 38 %) and the spine (14 lesions, 29 %). Benign bone lesions were exclusively osteosclerotic and smaller than the metastases (mean size 6 mm vs. 23 mm). While PET/CT allowed identification of 45 of 48 bone metastases (94 %), PET/MRI allowed identification of all bone metastases (100 %). Conspicuity of metastases was high for both modalities with significantly better results using PET/MRI (p?<?0.05). Diagnostic confidence in lesion detection was high for both modalities without a significant difference. In benign lesions, conspicuity and diagnostic confidence were significantly higher with PET/CT (p?<?0.05).Conclusions
[18?F]FDG PET/MRI shows high potential for the assessment of bone metastases by offering superior lesion conspicuity when compared to PET/CT. In hypersclerotic, benign bone lesions PET/CT still sets the reference.Key Points
? PET/MRI and PET/CT are of equal value for the identification of disease-positive patients ? PET/MRI offers higher lesion conspicuity as well as diagnostic confidence ? PET/MRI is an attractive new alternative for the assessment of bone metastases 相似文献6.
Joe H. Chang Daryl Lim Joon Sze Ting Lee Chee-Yan Hiew Stephen Esler Sylvia J. Gong Morikatsu Wada David Clouston Richard O’Sullivan Yin P. Goh Henri Tochon-Danguy J. Gordon Chan Damien Bolton Andrew M. Scott Vincent Khoo Ian D. Davis 《European radiology》2014,24(3):715-722
Objectives
To evaluate the accuracy of transrectal ultrasound-guided (TRUS) biopsy, diffusion-weighted (DW) magnetic resonance imaging (MRI), 11C-choline (CHOL) positron emission tomography (PET), and 18F-fluorodeoxyglucose (FDG) PET in predicting the prostatectomy Gleason risk (GR).Methods
The study included 21 patients who underwent TRUS biopsy and multi-technique imaging before radical prostatectomy. Values from five different tests (TRUS biopsy, DW MRI, CHOL PET, FDG PET, and combined DW MRI/CHOL PET) were correlated with the prostatectomy GR using Spearman’s ρ. Tests that were found to have significant correlations were used to classify patients into GR groups.Results
The following tests had significant correlations with prostatectomy GR: TRUS biopsy (ρ?=?0.617, P?=?0.003), DW MRI (ρ?=?–0.601, P?=?0.004), and combined DW MRI/CHOL PET (ρ?=?–0.623, P?=?0.003). CHOL PET alone and FDG PET only had weak correlations. The correct GR classification rates were 67 % with TRUS biopsy, 67 % with DW MRI, and 76 % with combined DW MRI/CHOL PET.Conclusions
DW MRI and combined DW MRI/CHOL PET have significant correlations and high rates of correct classification of the prostatectomy GR, the strength and accuracy of which are comparable with TRUS biopsy.Key Points
? Accurate determination of the Gleason score is essential for prostate cancer management. ? DW MRI ± CHOL PET correlated significantly with prostatectomy Gleason score. ? These correlations are similar to that between TRUS biopsy and prostatectomy. 相似文献7.
Pierre-Hugues Vivier Asmaa Sallem Marion Beurdeley Ruth P. Lim Julien Leroux Jérome Caudron Cyril Coudray Agnès Liard Isabelle Michelet Jean-Nicolas Dacher 《European radiology》2014,24(1):19-25
Objectives
To evaluate the performance of diffusion-weighted imaging (DWI) against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1-WI) in children.Methods
Thirty-nine consecutive patients (mean age 5.7 years) with suspected acute pyelonephritis underwent magnetic resonance imaging (MRI) including DWI and (the reference standard) Gd-T1-WI. Each study was read in double-blinded fashion by two radiologists. Each kidney was graded as normal or abnormal. Sensitivity and specificity of DWI were computed. Agreement between sequences and interobserver reproducibility were calculated (Cohen κ statistic and the McNemar tests).Results
Thirty-two kidneys (41 %) had hypo-enhancing areas on Gd-T1-W images. The sensitivity and specificity of DWI were 100 % (32/32) and 93.5 % (43/46). DWI demonstrated excellent agreement (κ?=?0.92,) with Gd-T1-W, with no significant difference (P?=?0.25) in detection of abnormal lesions. Interobserver reproducibility was excellent with DWI (κ?=?0.79).Conclusion
DWI enabled similar detection of abnormal areas to Gd-T1-WI and may provide an injection-free means of evaluation of acute pyelonephritis.Key points
? Diffusion weighted magnetic resonance imaging (DWI) can confirm acute pyelonepritis. ? DWI provided comparable results to gadolinium enhanced T1-W MRI in acute pyelonepritis. ? Contrast medium injection could be avoided for diagnosing acute pyelonephritis by MRI. ? MRI with T2-WI and DWI provide a fast and comprehensive diagnostic tool. 相似文献8.
Annalisa Macera Chiara Lario Massimo Petracchini Teresa Gallo Daniele Regge Irene Floriani Dario Ribero Lorenzo Capussotti Stefano Cirillo 《European radiology》2013,23(3):739-747
Objectives
To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy.Methods
Thirty-two consecutive patients with a total of 166 liver lesions were retrospectively enrolled. Of the lesions, 144 (86.8 %) were metastatic at pathology. Three image sets (1, Gd-EOB-DTPA; 2, DWI; 3, combined Gd-EOB-DTPA and DWI) were independently reviewed by two observers. Statistical analysis was performed on a per-lesion basis.Results
Evaluation of image set 1 correctly identified 127/166 lesions (accuracy 76.5 %; 95 % CI 69.3–82.7) and 106/144 metastases (sensitivity 73.6 %, 95 % CI 65.6–80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3–72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9–68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4–93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1–95.1). Differences were statistically significant (P?<?0.001). Notably, similar results were obtained analysing only small lesions (<1 cm).Conclusions
The combination of DWI with Gd-EOB-DTPA-enhanced MRI imaging significantly increases the diagnostic accuracy and sensitivity in patients with colorectal liver metastases treated with preoperative chemotherapy, and it is particularly effective in the detection of small lesions.Key Points
? Accurate detection of colorectal liver metastases is essential to determine resectability. ? Almost 80 % of patients are candidates for neoadjuvant chemotherapic treatment at diagnosis. After chemotherapy, metastases usually decrease, and drug-induced liver steatosis may be present. ? The sensitivity of imaging is significantly inferior to that in chemotherapy-naïve patients. ? DWI combined with Gd-EOB-DTPA increases sensitivity in detecting small metastases after chemotherapy. 相似文献9.
Kim YN Yi CA Lee KS Kwon OJ Lee HY Kim BT Choi JY Kim SW Chung MP Han J Kim TS Chung MJ Shim YM 《European radiology》2012,22(7):1537-1546
Objectives
To determine the positive reading criteria for malignant nodes when interpreting combined MRI and PET/CT images for preoperative nodal staging in non-small-cell lung cancer (NSCLC).Methods
Forty-nine patients with biopsy-proven NSCLC underwent both PET/CT and thoracic MRI [diffusion weighted imaging (DWI)]. Each nodal station was evaluated for the presence of metastasis by applying either inclusive (positive if either one read positive) or exclusive (positive if both read positive) criteria in the combined interpretation of PET/CT and MRI. Nodal stage was confirmed pathologically. The combined diagnostic accuracy of PET/CT and MRI was determined on per-nodal station and per-patient bases and compared with that of PET/CT alone.Results
In 49 patients, 39 (19%) of 206 nodal stations harboured malignant cells. Out of 206 nodal stations, 186 (90%) had concordant readings, while the rest (10%) had discordant readings. Inclusive criteria of combined PET/CT and MRI helped increase sensitivity for detecting nodal metastasis (69%) compared with PET/CT alone (46%; P?=?0.003), while specificity was not significantly decreased.Conclusion
Inclusive criteria in combined MRI and PET/CT readings help improve significantly the sensitivity for detecting nodal metastasis compared with PET/CT alone and may decrease unnecessary open thoracotomy. Key Points ? Combined interpretation of MRI and PET/CT enhances the detection of nodal metastasis. ? Inclusive criteria of combined MRI/PET/CT improved the sensitivity for detecting nodal metastasis. ? Combined interpretation of MRI and PET/CT may reduce unnecessary open thoracotomies. 相似文献10.
Kazuhiro Kitajima Yuko Suenaga Yoshiko Ueno Tomonori Kanda Tetsuo Maeda Natsuko Makihara Yasuhiko Ebina Hideto Yamada Satoru Takahashi Kazuro Sugimura 《Annals of nuclear medicine》2014,28(1):25-32
Background
To evaluate the diagnostic value of retrospective image fusion from pelvic magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (PET) in detecting intra-pelvic recurrence of gynecological tumor.Methods
Thirty patients with a suspicion of recurrence of gynecological malignancy underwent inline contrast-enhanced PET/computed tomography (CT) and pelvic contrast-enhanced MRI for restaging. Diagnostic performance about the local recurrence, pelvic lymph node and bone metastasis and peritoneal lesion of PET/low-dose non-enhanced CT (PET/ldCT), PET/full-dose contrast-enhanced CT (PET/ceCT), contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) were evaluated by two experienced readers. Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. McNemar test was employed for statistical analysis.Results
Documented positive locally recurrent disease, pelvic lymph node and bone metastases, and peritoneal dissemination were present in 53.3, 26.7, 10.0, and 16.7 %, respectively. Patient-based sensitivity for detecting local recurrence, pelvic lymph node and bone metastasis and peritoneal lesion were 87.5, 87.5, 100 and 80.0 %, respectively, for fused PET/MRI, 87.5, 62.5, 66.7 and 60.0 %, respectively, for contrast-enhanced MRI, 62.5, 87.5, 66.7 and 80.0 %, respectively, for PET/ceCT, and 50.0, 87.5, 66.7 and 60.0 %, respectively, for PET/ldCT. The sensitivity of diagnosing local recurrence by fused PET/MRI was significantly better than that of PET/ldCT (p = 0.041). The patient-based sensitivity, specificity and accuracy for the detection of intra-pelvic recurrence/metastasis were 91.3, 100 and 93.3 % for fused PET/MRI, 82.6, 100 and 86.7 % for contrast-enhanced MRI, 82.6, 100 and 86.7 % for PET/ceCT and 78.3, 85.7 and 80.0 % for PET/ldCT.Conclusion
Fused PET/MRI combines the individual advantages of MRI and PET, and is a valuable technique for assessment of intra-pelvic recurrence of gynecological cancers. 相似文献11.
Teik Hin Tan Boon Nang Lee Siti Zarina Amir Hassan 《Nuclear Medicine and Molecular Imaging》2014,48(3):212-215
Purpose
In neuroendocrine liver metastases of unknown primary, a multimodality approach is usually adopted and consists of transabdominal ultrasound, endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine techniques, endoscopy and exploratory surgery. The purpose of the study is to evaluate the diagnostic value of 68Ga-DOTATATE positron emission tomography (PET)/CT as part of a multimodality approach in neuroendocrine liver metastases of unknown primary.Materials and Methods
Six patients (M:F?=?5:1, age range 28–56 years) with immunohistochemically proven neuroendocrine liver metastases but inconclusive initial CT work-up were retrospectively analysed. Clinical finding, histopathology, comparative imaging and follow-up were used to validate the results when ethically justified.Results
68Ga-DOTATATE PET/CT identified the primary tumour in five out of six (83.3 %) patients: pancreas (n?=?4) and stomach (n?=?1). Out of three patients with indeterminate primary on initial CT, two patients were confirmed by 68Ga-DOTATATE PET/CT. Absence of uptake in indeterminate primary of one patient was later confirmed negative by histopathology. In another three patients with undetected primary on initial CT, primary site was demonstrated in all patients with unsuspected metastases in two patients on 68Ga-DOTATATE PET/ CT. No further work-up was done to confirm the primary in patients with distant metastases. Change of management was observed in three out of six (50 %) patients.Conclusion
Our small study indicates that 68Ga-DOTATATE PET/CT is a promising diagnostic option in the multimodality approach to neuroendocrine liver metastases of unknown primary origin. 相似文献12.
Luc A. Heijnen Doenja M. J. Lambregts Dipanjali Mondal Milou H. Martens Robert G. Riedl Geerard L. Beets Regina G. H. Beets-Tan 《European radiology》2013,23(12):3354-3360
Objectives
To evaluate the performance of diffusion-weighted MRI (DWI) for the detection of lymph nodes and for differentiating between benign and metastatic nodes during primary rectal cancer staging.Methods
Twenty-one patients underwent 1.5-T MRI followed by surgery (± preoperative 5?×?5 Gy). Imaging consisted of T2-weighted MRI, DWI (b0, 500, 1000), and 3DT1-weighted MRI with 1-mm isotropic voxels. The latter was used for accurate detection and per lesion histological validation of nodes. Two independent readers analysed the signal intensity on DWI and measured the mean apparent diffusion coefficient (ADC) for each node (ADCnode) and the ADC of each node relative to the mean tumour ADC (ADCrel).Results
DWI detected 6 % more nodes than T2W-MRI. The signal on DWI was not accurate for the differentiation of metastatic nodes (AUC 0.45–0.50). Interobserver reproducibility for the nodal ADC measurements was excellent (ICC 0.93). Mean ADCnode was higher for benign than for malignant nodes (1.15?±?0.24 vs. 1.04?±?0.22 *10-3 mm2/s), though not statistically significant (P?=?0.10). Area under the ROC curve/sensitivity/specificity for the assessment of metastatic nodes were 0.64/67 %/60 % for ADCnode and 0.67/75 %/61 % for ADCrel.Conclusions
DWI can facilitate lymph node detection, but alone it is not reliable for differentiating between benign and malignant lymph nodes.Key Points
? Diffusion-weighted (DW) magnetic resonance imaging (MRI) offers new information in rectal cancer. ? DW MRI demonstrates more lymph nodes than standard T2-weighted MRI. ? Visual DWI assessment does not discriminate between benign and metastatic nodes. ? Apparent diffusion coefficients do not discriminate between benign and metastatic nodes. 相似文献13.
Diagnostic value of diffusion-weighted magnetic resonance imaging (DWI) compared to FDG PET/CT for whole-body breast cancer staging 总被引:1,自引:0,他引:1
Till-Alexander Heusner Sherko Kuemmel Angela Koeninger Monia E. Hamami Steffen Hahn Anton Quinsten Andreas Bockisch Michael Forsting Thomas Lauenstein Gerald Antoch Alexander Stahl 《European journal of nuclear medicine and molecular imaging》2010,37(6):1077-1086
Purpose
The aim of the study was to prospectively compare the diagnostic value of whole-body diffusion-weighted imaging (DWI) and FDG PET/CT for breast cancer (BC) staging.Methods
Twenty BC patients underwent whole-body FDG PET/CT and 1.5-T DWI. Lesions with qualitatively elevated signal intensity on DW images (b?=?800 s/mm2) were rated as suspicious for tumour and mapped to individual lesions and different compartments (overall 552 lesions). The apparent diffusion coefficient (ADC) value was determined for quantitative evaluation. Histopathology, MRI findings, bone scan findings, concordant findings between FDG PET/CT and DWI, CT follow-up scans and plausibility served as the standards of reference defining malignancy.Results
According to the standards of reference, breasts harboured malignancy in 11, regional lymph nodes in 4, M1 lymph nodes in 3, bone in 7, lung in 2, liver in 3 and other tissues in 3 patients. On a compartment basis, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for the detection of malignancies were 94, 99, 98, 97 and 98% for FDG PET/CT and 91, 72, 76, 50 and 96% for DWI, respectively. Of the lesions seen on DWI only, 348 (82%) turned out to be false-positive compared to 23 (11%) on FDG PET/CT. The average lesion ADC was 820?±?300 with true-positive lesions having 929?±?252 vs 713?±?305 in false-positive lesions (p?<?0.0001).Conclusion
Based on these initial data DWI seems to be a sensitive but unspecific modality for the detection of locoregional or metastatic BC disease. There was no possibility to quantitatively distinguish lesions using ADC. DWI alone may not be recommended as a whole-body staging alternative to FDG PET(/CT). Further studies are necessary addressing the question of whether full-body MRI including DWI may become an alternative to FDG PET/CT for whole-body breast cancer staging. 相似文献14.
Claudio Spick Katja Pinker-Domenig Margaretha Rudas Thomas H. Helbich Pascal A. Baltzer 《European radiology》2014,24(6):1204-1210
Objective
To assess if the application of diffusion-weighted imaging (DWI) obviates unnecessary MR-guided biopsies in suspicious breast lesions visible only on contrast-enhanced MRI (CE-MRI).Methods
This institutional review board (IRB)-approved, retrospective, single-centre study included 101 patients (mean age, 49.5; SD 13.9 years) who underwent additional DWI at 1.5 T prior to MRI-guided biopsy of 104 lesions classified as suspicious for malignancy and visible on CE-MRI only. An experienced radiologist, blinded to histopathologic and follow-up results, measured apparent diffusion coefficient (ADC) values obtained from DWI. Diagnostic accuracy was investigated using receiver operating characteristics (ROC) analysis.Results
Histopathology revealed 20 malignant and 84 benign lesions. Lesions were masses in 61 (15 malignant, 24.6 %) and non-masses in 43 cases (five malignant, 11.6 %). Mean ADC values were 1.53?±?0.38?×?10?3 mm2/s in benign lesions and 1.06?±?0.27?×?10?3 mm2/s in malignant lesions. ROC analysis revealed exclusively benign lesions if ADC values were greater than 1.58?×?10?3 mm2/s. As a consequence, 29 false-positive biopsies (34.5 %) could have been avoided without any false-negative findings. Both in mass and in non-mass lesions, rule-in and rule-out criteria were identified using flexible ADC thresholds based on ROC analysis.Conclusion
Additional application of DWI in breast lesions visible only on MRI can avoid false-positive, MR-guided biopsies. Thus, DWI should be an integral part of breast MRI protocols.Key Points
? DWI measurements are a fast and helpful technique for improved breast lesion diagnosis ? DWI application in breast lesions visible only on MRI obviates false-positive, MR-guided biopsies ? Flexible ADC thresholds provide rule-in and rule-out criteria for breast lesion malignancy 相似文献15.
Annemieke S. Littooij Thomas C. Kwee Ignasi Barber Claudio Granata Malou A. Vermoolen Goya Enríquez József Zsíros Shui Yen Soh Bart de Keizer Frederik J. A. Beek Monique G. Hobbelink Marc B. Bierings Jaap Stoker Rutger A.J. Nievelstein 《European radiology》2014,24(5):1153-1165
Objective
To compare whole-body MRI, including diffusion-weighted imaging (whole-body MRI-DWI), with FDG-PET/CT for staging newly diagnosed paediatric lymphoma.Methods
A total of 36 children with newly diagnosed lymphoma prospectively underwent both whole-body MRI-DWI and FDG-PET/CT. Whole-body MRI-DWI was successfully performed in 33 patients (mean age 13.9 years). Whole-body MRI-DWI was independently evaluated by two blinded observers. After consensus reading, an unblinded expert panel evaluated the discrepant findings between whole-body MRI-DWI and FDG-PET/CT and used bone marrow biopsy, other imaging data and clinical information to derive an FDG-PET/CT-based reference standard.Results
Interobserver agreement of whole-body MRI-DWI was good [all nodal sites together (κ = 0.79); all extranodal sites together (κ = 0.69)]. There was very good agreement between the consensus whole-body MRI-DWI- and FDG-PET/CT-based reference standard for nodal (κ = 0.91) and extranodal (κ = 0.94) staging. The sensitivity and specificity of consensus whole-body MRI-DWI were 93 % and 98 % for nodal staging and 89 % and 100 % for extranodal staging, respectively. Following removal of MRI reader errors, the disease stage according to whole-body MRI-DWI agreed with the reference standard in 28 of 33 patients.Conclusions
Our results indicate that whole-body MRI-DWI is feasible for staging paediatric lymphoma and could potentially serve as a good radiation-free alternative to FDG-PET/CT.Keypoints
? Accurate staging is important for treatment planning and assessing prognosis ? Whole-body MRI-DWI could be a good radiation-free alternative to FDG-PET/CT ? Interobserver agreement of whole-body MRI-DWI is good ? Agreement between whole-body MRI and the FDG-PET/CT reference standard is good ? Most discrepancies were caused by suboptimal accuracy of size measurements on MRI 相似文献16.
Doenja M. J. Lambregts Max J. Lahaye Luc A. Heijnen Milou H. Martens Monique Maas Geerard L. Beets Regina G. H. Beets-Tan 《European radiology》2016,26(7):2118-2125
Objectives
To assess the value of MRI and diffusion-weighted imaging (DWI) for diagnosing local tumour regrowth during follow-up of organ preservation treatment after chemoradiotherapy for rectal cancer.Methods
Seventy-two patients underwent organ preservation treatment (chemoradiotherapy + transanal endoscopic microsurgery or “wait-and-see”) and were followed with MRI including DWI (1.5 T) every 3 -months during the first year and 6 months during following years. Two readers scored each MRI for local regrowth using a confidence level, first on standard MRI, then on standard MRI+DWI. Histology and clinical follow-up were the standard reference. Receiver operating characteristic curves were constructed and areas under the curve (AUC) and corresponding accuracy figures calculated on a per-scan basis.Results
Four hundred and forty MRIs were assessed. Twelve patients developed local regrowth. AUC/sensitivity/specificity for standard MRI were 0.95/58 %/98 % (R1) and 0.96/58 % /100 % (R2). For standard MRI+DWI, these numbers were 0.86/75 %/97 % (R1) and 0.98/75 %/100 % (R2). After adding DWI, the number of equivocal scores decreased from 22 to 7 (R1) and from 40 to 20 (R2).Conclusions
Although there was no overall improvement in diagnostic performance in terms of AUC, adding DWI improved the sensitivity of MRI for diagnosing local tumour regrowth and lowered the rate of equivocal MRIs.Key Points
? DWI improves sensitivity for detecting local tumour regrowth after organ preservation treatment. ? In particular, DWI can aid in detecting small local recurrence. ? DWI reduces the number of equivocal scores.17.
Yoshiko Ueno Satoru Takahashi Kazuhiro Kitajima Tokunori Kimura Ikuo Aoki Fumi Kawakami Hideaki Miyake Yoshiharu Ohno Kazuro Sugimura 《European radiology》2013,23(12):3509-3516
Objective
To assess the efficacy of computed diffusion-weighted images (cDWIs) of b?=?2000 s/mm2 (cDWI2000) generated from DWIs of b?=?0 and 1000 for prostate cancer (PCa) diagnosis in comparison with that of measured original DWIs of b?=?1000 (mDWI1000) and b?=?2000(mDWI2000) using 3-T MRI.Methods
Eighty patients who underwent a preoperative MRI examination, including T2WI and DWI (b?=?0, 1000, 2000 s/mm2), were enrolled in this study. Four combinations of images, protocol A (T2WI alone), B (T2WI + mDWI1000), C (T2WI + mDWI2000) and D (T2WI + cDWI2000), were assessed for their diagnostic capability. Areas under the receiver operating characteristic curve (Az) and diagnostic performance were evaluated, as well as contrast ratios (CR) between cancerous and non-cancerous lesions for each DWI.Results
The highest CR was obtained with cDWI2000 (0.29?±?0.16). Sensitivity, specificity, accuracy, and Az of the protocols were: A: 66.3 %, 59.4 %, 63.0 %, 0.67; B: 82.6 %, 62.0 %, 72.5 %, 0.80; C: 84.1 %, 66.5 %, 75.5 %, 0.86; D: 83.2 %, 70.0 %, 76.6 %, and 0.84, respectively The specificities and accuracies of protocol C and D were significantly higher than those of protocol B (P?<?0.05).Conclusion
cDWI2000 appears to be more effective than mDWI1000, and at least as effective as mDWI2000 for PCa diagnosis.Key Points
? Computed diffusion-weighted MRI with over b1000s/mm 2 is useful for prostate cancer detection. ? Computed DWI produces any b-value images with two different b-value images. ? DWI with computed b2000s/mm 2 is as valuable as DWI with measured b2000 s/mm 2 . 相似文献18.
Objective
To investigate the efficacy of positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) for early response evaluation of cervical cancer patients undergoing concurrent chemoradiotherapy (CCRT).Methods
Fifty-two patients were prospectively enrolled in the study. The pathologic findings were squamous cell carcinoma in 47 patients and adenocarcinoma in 5 patients. All patients underwent PET/CT and MRI scans before, during and within 1 month after completion of CCRT. The percent change in tumor volume during and after CCRT based on PET/CT and MRI images was compared.Results
There were significant differences (p < 0.001) between the initial tumor volume and tumor volume during and after CCRT as measured by both PET/CT and MRI. During CCRT, the percent volume reduction based on PET/CT images was significantly greater than the percent volume reduction calculated from MRI images (p = 0.024). However, after the completion of CCRT, no significant differences were found in volume reduction as calculated based on PET/CT versus MRI images (p = 0.289). The percent volume reduction of adenocarcinomas was significantly smaller than that of squamous cell carcinomas based on both PET/CT (p = 0.041) and MRI images (p < 0.001).Conclusions
Significant decreases in tumor volume were observed during and after CCRT in patients with cervical cancer. Tumor volume reduction on PET/CT images was greater than that on MRI images during CCRT. We suggest that early PET/CT as well as MRI scans could be taken during CCRT to evaluate tumor response and allow personalized treatment of cervical cancer. 相似文献19.
Kenneth E. Pengel Bas B. Koolen Claudette E. Loo Wouter V. Vogel Jelle Wesseling Esther H. Lips Emiel J. Th. Rutgers Renato A. Valdés Olmos Marie Jeanne T. F. D. Vrancken Peeters Sjoerd Rodenhuis Kenneth G. A. Gilhuijs 《European journal of nuclear medicine and molecular imaging》2014,41(8):1515-1524
Purpose
To explore the potential complementary value of PET/CT and dynamic contrast-enhanced MRI in predicting pathological response to neoadjuvant chemotherapy (NAC) of breast cancer and the dependency on breast cancer subtype.Methods
We performed 18F-FDG PET/CT and MRI examinations before and during NAC. The imaging features evaluated on both examinations included baseline and changes in 18F-FDG maximum standardized uptake value (SUVmax) on PET/CT, and tumour morphology and contrast uptake kinetics on MRI. The outcome measure was a (near) pathological complete response ((near-)pCR) after surgery. Receiver operating characteristic curves with area under the curve (AUC) were used to evaluate the relationships between patient, tumour and imaging characteristics and tumour responses.Results
Of 93 patients, 43 achieved a (near-)pCR. The responses varied among the different breast cancer subtypes. On univariate analysis the following variables were significantly associated with (near-)pCR: age (p?=?0.033), breast cancer subtype (p?<?0.001), relative change in SUVmax on PET/CT (p?<?0.001) and relative change in largest tumour diameter on MRI (p?<?0.001). The AUC for the relative reduction in SUVmax on PET/CT was 0.78 (95 % CI 0.68–0.88), and for the relative reduction in tumour diameter at late enhancement on MRI was 0.79 (95 % CI 0.70–0.89). The AUC increased to 0.90 (95 % CI 0.83–0.96) in the final multivariate model with PET/CT, MRI and breast cancer subtype combined (p?=?0.012).Conclusion
PET/CT and MRI showed comparable value for monitoring response during NAC. Combined use of PET/CT and MRI had complementary potential. Research with more patients is required to further elucidate the dependency on breast cancer subtype. 相似文献20.
Kolb A Wehrl HF Hofmann M Judenhofer MS Eriksson L Ladebeck R Lichy MP Byars L Michel C Schlemmer HP Schmand M Claussen CD Sossi V Pichler BJ 《European radiology》2012,22(8):1776-1788