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1.
Riccardo Faletti Maria Carla Cassinis Paolo Fonio Angela Grasso Giacomo Battisti Laura Bergamasco Giovanni Gandini 《European radiology》2013,23(12):3501-3508
Objective
To compare contrast-enhanced (CEMR) and diffusion-weighted (DWI) magnetic resonance imaging in diagnosing acute pyelonephritis (APN) and to assess ADC measurement reliability in differentiating among normal renal parenchyma, APN and abscesses.Methods
Eighty-eight patients (80 women, mean age 36.5 years) with clinical suspicion of APN were retrospectively reviewed. An experienced observer quantified lesions with a score ranging from 0 to 3. DWI and CEMR were compared on the basis of the assigned score, total examination number (88) and on presence (36)/absence (52) of abscesses. ADC values, calculated at the healthy parenchyma, APN and abscessed were compared to each other.Results
Agreement between CEMR and DWI was 94.3 % (83/88 patients; P?<?0.05). In the APN group, DWI was awarded the highest visibility score compared to CEMR (P?=?0.05), while in the abscess group CEMR had the highest score (P?=?0.04). The difference between ADC values of the APN-healthy parenchyma and abscess-APN groups was significant (P?<?0.05). The area under the ROC curve of ADC values of the APN-healthy and abscess-APN groups were found to be 0.94 (95 % CI; cutoff value?=?2) and 0.78 (95 % CI; cutoff value?=?1.2) respectively.Conclusions
Diffusion-weighted imaging appears reliable in the diagnosis and follow-up of acute pyelonephritis and could provide a reasonable alternative to contrast-enhanced magnetic resonance imaging.Key Points
? Acute pyelonephritis (APN) is an inflammatory process that preferentially affects young women ? Contrast-enhanced MRI is the reference investigation for the diagnosis and follow-up of APN ? Diffusion-weighted imaging can help differentiate between APN and abscesses ? This is especially useful when administration of contrast agent is contraindicated. 相似文献2.
Hyun Jeong Park Seong Hyun Kim Kyung Mi Jang Seo-youn Choi Soon Jin Lee Dongil Choi 《European radiology》2014,24(4):947-958
Objectives
To assess the added value of diffusion-weighted imaging (DWI) to conventional magnetic resonance imaging (MRI) for differentiating benign from malignant bile duct strictures.Methods
Twenty-seven patients with a benign stricture and 42 patients with a malignant stricture who had undergone gadoxetic acid-enhanced MRI with DWI were enrolled. Qualitative (signal intensity, dynamic enhancement pattern) and quantitative (wall thickness and length) analyses were performed. Two observers independently reviewed a set of conventional MRI and a combined set of conventional MRI and DWI, and receiver operating characteristic (ROC) curve analysis was assessed.Results
Benign strictures showed isointensity (18.5–70.4 %) and a similar enhancement pattern (22.2 %) to that of normal bile duct more frequently than malignant strictures (0–40.5 % and 0 %) on conventional MRI (P?<?0.05). Malignant strictures (90.5–92.9 %) showed hypervascularity on arterial and portal venous phase images more frequently than benign strictures (37.0–70.4 %) (P?<?0.01) On DWI, all malignant strictures showed hyperintensity compared with benign cases (70.4 %) (P?<?0.001). Malignant strictures were significantly thicker and longer than benign strictures (P?<?0.001). The diagnostic performance of both observers improved significantly after additional review of DWI.Conclusions
Adding DWI to conventional MRI is more helpful for differentiating benign from malignant bile duct strictures than conventional MRI alone.Key points
? Accurate diagnosis and exclusion of benign strictures of bile duct are important. ? Diffusion-weighted MRI helps to distinguish benign from malignant bile duct strictures. ? DWI plus conventional MRI provides superior diagnostic accuracy to conventional MRI alone. 相似文献3.
Caecilia S. Reiner Paul Stolzmann Lars Husmann Irene A. Burger Martin W. Hüllner Niklaus G. Schaefer Paul M. Schneider Gustav K. von Schulthess Patrick Veit-Haibach 《European journal of nuclear medicine and molecular imaging》2014,41(4):649-658
Purpose
To compare the accuracy of PET/MR imaging with that of FDG PET/CT and to determine the MR sequences necessary for the detection of liver metastasis using a trimodality PET/CT/MR set-up.Methods
Included in this single-centre IRB-approved study were 55 patients (22 women, age 61?±?11 years) with suspected liver metastases from gastrointestinal cancer. Imaging using a trimodality PET/CT/MR set-up (time-of-flight PET/CT and 3-T whole-body MR imager) comprised PET, low-dose CT, contrast-enhanced (CE) CT of the abdomen, and MR with T1-W/T2-W, diffusion-weighted (DWI), and dynamic CE imaging. Two readers evaluated the following image sets for liver metastasis: PET/CT (set A), PET/CECT (B), PET/MR including T1-W/T2-W (C), T1-W/T2-W with either DWI (D) or CE imaging (E), and a combination (F). The accuracy of each image set was determined by receiver-operating characteristic analysis using image set B as the standard of reference.Results
Of 120 liver lesions in 21/55 patients (38 %), 79 (66 %) were considered malignant, and 63/79 (80 %) showed abnormal FDG uptake. Accuracies were 0.937 (95 % CI 89.5 – 97.9 %) for image set A, 1.00 (95 % CI 99.9 – 100.0 %) for set C, 0.998 (95 % CI 99.4 – 100.0 %) for set D, 0.997 (95 % CI 99.3 – 100.0 %) for set E, and 0.995 (95 % CI 99.0 – 100.0 %) for set F. Differences were significant for image sets D – F (P?<?0.05) when including lesions without abnormal FDG uptake. As shown by follow-up imaging after 50 – 177 days, the use of image sets D and both sets E and F led to the detection of metastases in one and three patients, respectively, and further metastases in the contralateral lobe in two patients negative on PET/CECT (P?=?0.06).Conclusion
PET/MR imaging with T1-W/T2-W sequences results in similar diagnostic accuracy for the detection of liver metastases to PET/CECT. To significantly improve the characterization of liver lesions, we recommend the use of dynamic CE imaging sequences. PET/MR imaging has a diagnostic impact on clinical decision making. 相似文献4.
Jerome Aellen Eugenio Abela Sarah E. Buerki Raimund Kottke Elisabeth Springer Kaspar Schindler Christian Weisstanner Marwan El-Koussy Gerhard Schroth Roland Wiest Jan Gralla Rajeev K. Verma 《European radiology》2014,24(11):2980-2988
Objective
To investigate pathological findings in the susceptibility weighted imaging (SWI) of patients experiencing convulsive (CSE) or non-convulsive status epilepticus (NCSE) with focal hyperperfusion in the acute setting.Methods
Twelve patients (six with NCSE confirmed by electroencephalogram (EEG) and six patients with CSE with seizure event clinically diagnosed) underwent MRI in this acute setting (mean time between onset of symptoms and MRI was 3 h 8 min), including SWI, dynamic susceptibility contrast MR imaging (DSC) and diffusion-weighted imaging (DWI). MRI sequences were retrospectively evaluated and compared with EEG findings (10/12 patients), and clinical symptoms.Results
Twelve out of 12 (100 %) patients showed a focal parenchymal area with pseudo-narrowed cortical veins on SWI, associated with focal hyperperfused areas (increased cerebral blood flow (CBF) and mean transit time (MTT) shortening), and cortical DWI restriction in 6/12 patients (50 %). Additionally, these areas were associated with ictal or postical EEG patterns in 8/10 patients (80 %). Most frequent acute clinical findings were aphasia and/or hemiparesis in eight patients, and all of them showed pseudo-narrowed veins in those parenchymal areas responsible for these symptoms.Conclusion
In this study series with CSE and NCSE patients, SWI showed focally pseudo-narrowed cortical veins in hyperperfused and ictal parenchymal areas. Therefore, SWI might have the potential to identify an ictal region in CSE/NCSE.Key Points
? The focal ictal brain regions show hyperperfusion in DSC MR-perfusion imaging. ? SWI shows focally diminished cortical veins in hyperperfused ictal regions. ? SWI has the potential to identify a focal ictal region in CSE/NCSE. 相似文献5.
Zecca C Cereda C Wetzel S Tschuor S Staedler C Santini F Nadarajah N Bassetti CL Gobbi C 《Neuroradiology》2012,54(6):573-578
Introduction
Diffusion-weighted imaging (DWI) has become a reference MRI technique for the evaluation of neurological disorders. Few publications have investigated the application of DWI for inflammatory demyelinating lesions. The purpose of the study was to describe diffusion-weighted imaging characteristics of acute, spinal demyelinating lesions.Methods
Six consecutive patients (two males, four females; aged 28–64?years) with acute spinal cord demyelinating lesions were studied in a prospective case series design from June 2009 to October 2010. We performed magnetic resonance imaging studies from 2 to 14?days from symptom onset on the patients with relapsing remitting multiple sclerosis (n?=?3) or clinically isolated syndrome (n?=?3). Main outcome measures were diffusion-weighted imaging and apparent diffusion coefficient pattern (ADC) of acute spinal cord demyelinating lesions.Results
All spinal lesions showed a restricted diffusion pattern (DWI+/ADC?) with a 24% median ADC signal decrease. A good correlation between clinical presentation and lesion site was observed.Conclusion
Acute demyelinating spinal cord lesions show a uniform restricted diffusion pattern. Clinicians and neuro-radiologists should be aware that this pattern is not necessarily confirmatory for an ischaemic aetiology. 相似文献6.
Marius E. Mayerhoefer Ahmed Ba-Ssalamah Michael Weber Markus Mitterhauser Harald Eidherr Wolfgang Wadsak Markus Raderer Siegfried Trattnig Andreas Herneth Georgios Karanikas 《European radiology》2013,23(7):1978-1985
Objectives
To compare fused gadoxetate-enhanced Ga-68-DOTANOC PET/MRI and Ga-68-DOTANOC PET/DWI (diffusion-weighted imaging) for the assessment of abdominal neuroendocrine tumours (NETs).Methods
Eighteen patients with suspected or histologically proven NETs of the abdomen were enrolled in this retrospective study. All patients underwent Ga-68-DOTANOC PET/CT for a primary search, staging, or restaging, and received an additional MRI, including dynamic gadoxetate-enhanced T1-weighted sequences and DWI (b-values 50, 300 and 600). Co-registered gadoxetate-enhanced PET/MRI and PET/DWI were separately analysed for NET lesions by a nuclear medicine physician and a radiologist in consensus. Sensitivity and specificity were calculated on a per-region, per-organ and per-patient basis.Results
Eighty-seven out of 684 anatomical regions, and 23 out of 270 organs, were NET-positive in 14 out of 18 patients. Region-based sensitivities and specificities were 97.7 % and 99.7 % for gadoxetate-enhanced PET/MRI and 98.9 % and 99.7 % for PET/DWI. Organ-based sensitivities and specificities were 91.3 % and 99.6 % for gadoxetate-enhanced PET/MRI and 95.7 % and 99.6 % for PET/DWI. Finally, patient-based sensitivities and specificities were 100 % and 100 % for gadoxetate-enhanced PET/MRI and 100 % and 75 % for PET/DWI. Sensitivities and specificities of the two methods did not differ significantly.Conclusions
Gadoxetate-enhanced Ga-68-DOTANOC PET/MRI and Ga-68-DOTANOC PET/DWI are equally useful for the assessment of abdominal NETs.Key Points
? Positron emission tomography and magnetic resonance imaging can both assess neuroendocrine tumours. ? Fusion of PET/MR imaging provides helpful information. ? Gadoxetate-enhanced Ga-68-DOTANOC PET/MRI and Ga-68-DOTANOC PET/DWI assess neuroendocrine tumours equally well. ? PET/DWI is inherently simpler than gadoxetate-enhanced PET/MRI. ? Only benign hepatic lesions pose a potential diagnostic dilemma for PET/DWI. 相似文献7.
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8.
Agostino De Pascale Giorgina Barbara Piccoli Sandro Massimo Priola Daniela Rognone Valentina Consiglio Irene Garetto Laura Rizzo Andrea Veltri 《European radiology》2013,23(11):3077-3086
Objectives
The diagnosis of acute pyelonephritis (APN) requires demonstration of parenchymal involvement. When no predisposing conditions are found, non-complicated APN is suspected and CT or MRI should be performed. Diffusion-weighted (DW) MRI might be useful, quicker and cheaper than the standard gadolinium-enhanced (GE) MRI. The aim of this study is to compare DW-MRI with GE-MRI to test its diagnostic accuracy in APN.Methods
Of 318 consecutive patients hospitalised for APN, 279 underwent MRI. Four hundred and fourteen MR studies (first test and follow-up examinations) were gathered and data were processed using Diffusion Analysis software. DW-MRI has been compared with GE-MRI for evaluating diagnostic agreement.Results
Two hundred and forty-four patients were diagnosed as having APN; 35 were negative. One hundred and sixty-three APN cases were considered non-complicated and selected for the study. Among the 414 MR examinations, comparing DW-MRI with GE-MRI, positive correlation was found in 258 cases, negative in 133. There were 14 false-negatives and 9 false-positives. DW-MRI achieved sensitivity 95.2 %, specificity 94.9 %, positive predictive value 96.9 %, negative predictive value 92.3 % and accuracy 94.6 %.Conclusions
DW-MRI is reliable for diagnosing non-complicated APN. The high diagnostic agreement between DW-MRI and GE-MRI offers new perspectives in diagnostic management, enabling diagnosis of non-complicated APN without using ionising radiation or contrast media.Key Points
? The diagnosis of acute pyelonephritis (APN) requires demonstration of renal involvement. ? Hitherto magnetic resonance imaging required gadolinium enhancement (GE-MRI) to establish this diagnosis. ? But diagnostic agreement between diffusion-weighted and GE-MRI offers new diagnostic opportunities. ? Quantification of ADC values can help diagnose and monitor APN. ? DW-MRI avoids ionising radiation and paramagnetic contrast medium administration. 相似文献9.
Objectives
To analyse diffusion-weighted MRI of acute spinal cord trauma and evaluate its diagnostic value.Methods
Conventional MRI and multishot, navigator-corrected DWI were performed in 20 patients with acute spinal cord trauma using 1.5-T MR within 72 h after the onset of trauma.Results
Twenty cases were classified into four categories according to the characteristics of DWI: (1) Oedema type: ten cases presented with variable hyperintense areas within the spinal cord. There were significant differences in the apparent diffusion coefficients (ADCs) between lesions and unaffected regions (t?=?-7.621, P?<?0.01). ADC values of lesions were markedly lower than those of normal areas. (2) Mixed type: six cases showed heterogeneously hyperintense areas due to a mixture of haemorrhage and oedema. (3) Haemorrhage type: two cases showed lesions as marked hypointensity due to intramedullary haemorrhage. (4) Compressed type (by epidural haemorrhage): one of the two cases showed an area of mild hyperintensity in the markedly compressed cord due to epidural haematoma.Conclusions
Muti-shot DWI of the spinal cord can help visualise and evaluate the injured spinal cord in the early stage, especially in distinguishing the cytotoxic oedema from vasogenic oedema. It can assist in detecting intramedullary haemorrhage and may have a potential role in the evaluation of compressed spinal cord.Key Points
? Multishot, navigator-corrected diffusion-weighted MRI is helpful when evaluating spinal cord injury (SCI). ? Four types of SCI may be classified according to the DWI characteristics. ? DWI differentiates cytotoxic from vasogenic oedema, thereby determining the centre of SCI. ? DWI can assist in detecting intramedullary haemorrhage. ? DWI can help evaluate the degree of compressed spinal cord. 相似文献10.
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11.
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12.
Valeria Panebianco Flavio Barchetti Alessandro Sciarra Daniela Musio Valerio Forte Vincenzo Gentile Vincenzo Tombolini Carlo Catalano 《European radiology》2013,23(6):1745-1752
Objectives
To validate the role of 3-T diffusion-weighted imaging (DWI) in the detection of local prostate cancer recurrence after radical prostatectomy (RP).Methods
T2-weighted imaging, DWI and dynamic contrast-enhanced MRI (DCE-MRI) were performed with a 3-T magnet in 262 patients after RP. Twenty out of 262 patients evaluated were excluded. MRI results were validated by prostate-specific antigen (PSA) reduction after external beam radiotherapy in group A (126 patients, local recurrence size range 4–8 mm) and by transrectal ultrasound biopsy in group B (116 patients, local recurrence size range 9–15 mm).Results
In group A combined T2-weighted and DCE-MRI (T2+DCE) shows 98 % sensitivity, 94 % specificity and 93 % accuracy in identifying local recurrence; combined T2-weighted and DWI with a b value of 3,000 s/mm2 (T2+DW3) displays 97 % sensitivity, 95 % specificity and 92 % accuracy, while with a b value of 1,000 s/mm2 (T2+DW1) affords 93 % sensitivity, 89 % specificity and 88 % accuracy. In group B T2+DCE shows 100 % sensitivity, 97 % specificity and 91 % accuracy in detecting local cancer recurrence; T2+DW3 displays 98 % sensitivity, 96 % specificity and 89 % accuracy; T2+DW1 has 94 % sensitivity, 92 % specificity and 86 % accuracy.Conclusion
DCE-MRI is the most reliable technique in detecting local prostate cancer recurrence after RP, though DWI can be proposed as a reliable alternative.Key Points
? Diffusion-weighted magnetic resonance imaging (DWI-MRI) is being increasingly used in oncology. ? PSA analysis does not distinguish prostate cancer recurrence from distant metastasis. ? DWI-MR can diagnose local prostate cancer recurrence after radical prostatectomy. ? DWI-MR is almost comparable to DCE-MRI in detecting local recurrence. 相似文献13.
Objectives
To determine the added value of diffusion-weighted imaging (DWI) to standard magnetic resonance imaging (MRI) to differentiate malignant from benign soft tissue tumours at 3.0 T.Methods
3.0 T MR images including DWI in 63 patients who underwent surgery for soft tissue tumours were retrospectively analyzed. Two readers independently interpreted MRI for the presence of malignancy in two steps: standard MRI alone, standard MRI and DWI with qualitative and quantitative analysis combined.Results
There were 34 malignant and 29 non-malignant soft tissue tumours. In qualitative analysis, hyperintensity relative to skeletal muscle was more frequent in malignant than benign tumours on DWI (P=0.003). In quantitative analysis, ADCs of malignant tumours were significantly lower than those of non-malignant tumours (P≤0.002): 759±385 vs. 1188±423 μm2/sec minimum ADC value, 941±440 vs. 1310±440 μm2/sec average ADC value. The mean sensitivity, specificity and accuracy of both readers were 96 %, 72 %, and 85 % on standard MRI alone and 97 %, 90 %, and 94 % on standard MRI with DWI.Conclusions
The addition of DWI to standard MRI improves the diagnostic accuracy for differentiation of malignant from benign soft tissue tumours at 3.0 T.Key Points
? DWI has added value for differentiating malignant from benign soft tissue tumours. ? Addition of DWI to standard MRI at 3.0 T improves the diagnostic accuracy. ? Measurements of both ADC min within solid portion and ADC av are helpful.14.
Objectives
To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) as a single non-invasive method in detecting prostate cancer (PCa) and to deduce its clinical utility.Methods
A systematic literature search was performed to identify relevant original studies. Quality of included studies was assessed by QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). Data were extracted to calculate sensitivity and specificity as well as running the test of heterogeneity and threshold effect. The summary receiver operating characteristic (SROC) curve was drawn and area under SROC curve (AUC) served as a determination of the diagnostic performance of DWI for the detection of PCa.Results
A total of 21 studies were included, with 27 subsets of data available for analysis. The pooled sensitivity and specificity with corresponding 95 % confidence interval (CI) were 0.62 (95 % CI 0.61–0.64) and 0.90 (95 % CI 0.89–0.90), respectively. Pooled positive likelihood ratio and negative likelihood ratio were 5.83 (95 % CI 4.61–7.37) and 0.30 (95 % CI 0.23–0.39), respectively. The AUC was 0.8991. Significant heterogeneity was observed. There was no notable publication bias.Conclusions
DWI is an informative MRI modality in detecting PCa and shows moderately high diagnostic accuracy. General clinical application was limited because of the absence of standardized DW-MRI techniques.Key points
? DWI provides incremental information for the detection and evaluation of PCa ? DWI has moderately high diagnostic accuracy in detecting PCa ? Patient condition, imaging protocols and study design positively influence diagnostic performance ? General clinical application requires optimization of image acquisition and interpretation 相似文献15.
Pei-Qiang Cai Yao-Pan Wu Xin An Xue Qiu Ling-Heng Kong Guo-Chen Liu Chuan-Miao Xie Zhi-Zhong Pan Pei-Hong Wu Pei-Rong Ding 《European radiology》2014,24(11):2962-2970
Purpose
To determine diagnostic performance of simple measurements on diffusion-weighted MR imaging (DWI) for assessment of complete tumour response (CR) after neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC) by signal intensity (SI) and apparent diffusion coefficient (ADC) measurements.Materials and methods
Sixty-five patients with LARC who underwent neoadjuvant CRT and subsequent surgery were included. Patients underwent pre-CRT and post-CRT 3.0 T MRI. Regions of interest of the highest brightness SI were included in the tumour volume on post-CRT DWI to calculate the SIlesion, rSI, ADClesion and rADC; diagnostic performance was compared by using the receiver operating characteristic (ROC) curves. In order to validate the accuracy and reproducibility of the current strategy, the same procedure was reproduced in 80 patients with LARC at 1.5 T MRI.Results
Areas under the ROC curve for identification of a CR, based on SIlesion, rSI, ADClesion, and rADC, respectively, were 0.86, 0.94, 0.66, and 0.71 at 3.0 T MRI, and 0.92, 0.91, 0.64, and 0.61 at 1.5 T MRI.Conclusion
Post-CRT DWI SIlesion and rSI provided high diagnostic performance in assessing CR and were significantly more accurate than ADClesion, and rADC at 3.0 T MRI and 1.5 T MRI.Key Points
? Signal intensity (SI lesion ) and rSI are accurate for assessment of complete response. ? rSI seems to be superior to SI lesion at 3.0 T MRI. ? ADC or rADC measurements are not accurate for assessment of complete response. 相似文献16.
Chressen Catharina Much Björn Phillip Schoennagel Jin Yamamura Ralph Buchert Hendrik Kooijman Anne-Kathrin Schätzle Gerhard Adam Ulrike Wedegaertner 《European radiology》2013,23(7):1766-1772
Objective
To assess changes in diffusion properties in the fetal lung after cortisone administration with diffusion-weighted imaging (DWI) in fetal sheep.Methods
DWI was performed on 11 pregnant sheep with singleton pregnancies on a 1.5-T MRI scanner. Four animals received cortisone injections before baseline imaging. Seven animals served as controls. Apparent diffusion coefficient (ADC) was measured on DWI in the fetal lungs by two independent readers. The Pearson test was used to correlate ADC and gestational age. A t-test was performed to compare differences in ADC values at the baseline and follow-up images within and between groups. Inter-rater reliability was calculated.Results
In the cortisone group, ADC values increased about 10 % between the baseline and follow-up images (P?=?0.039). Comparing the cortisone and control groups, ADC values of the baseline images did not differ; whereas in the follow-up imaging, ADC values were significantly higher in the cortisone group (P?=?0.024). Lung ADC values did not correlate with gestational age (P?=?0.970). Inter-rater reliability was high (0.970, P?=?0.000).Conclusion
In this experimental model, MR-DWI can detect cortisone-induced changes in diffusion properties of the fetal lung.Key Points
? Corticosteroids are frequently administered antenatally to prevent fetal lung immaturity at birth ? DWI can detect changes in the fetal lung after corticosteroid administration ? Changes can be detected as early as 5 days after treatment ? Fetal MRI may offer a non-invasive method of monitoring lung maturation 相似文献17.
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18.
Hasan Cece Mahmut Abuhandan Alpay Cakmak Sema Yildiz Mustafa Calik Ekrem Karakas Omer Karakas 《Japanese journal of radiology》2013,31(3):179-185
Purpose
The aim of the study is to evaluate neonatal bilirubin encephalopathy in the acute period by the DWI.Materials and methods
Thirty newborn babies with hyperbilirubinemia at the gestational age of 38–40 weeks, diagnosed with acute neonatal bilirubin encephalopathy as a result of clinical findings were included in the study, and a further 24 newborn babies, whose ages, weights and gestational ages were equalized, were regarded as a control group. DWI was performed on both patient and control groups.Results
When DWI apparent diffusion coefficients (ADC) of both neonatal bilirubin encephalopathy patients and the control group were compared, ACD values of neonatal bilirubin encephalopathy patients were found to be statistically significantly highly compared to that of the control group (p < 0.001). There was a significant correlation between bilirubin values and DWI findings (r = 0.41, p < 0.05).Conclusion
The ADC measurement could be a promising parameter in detecting neonatal bilirubin encephalopathy. 相似文献19.
Donnerstag F Ding X Pape L Bültmann E Lücke T Zajaczek J Hoy L Das AM Lanfermann H Ehrich J Hartmann H 《European radiology》2012,22(3):506-513
Objectives
Diffusion-weighted imaging (DWI) in children with diarrhoea associated haemolytic uraemic syndrome (D+HUS) and cerebral involvement was evaluated retrospectively.Methods
DWI within 24?h of onset of neurological symptoms. The apparent diffusion coefficient (ADC) was measured in grey/white matter and correlated with clinical and laboratory findings.Results
DWI was abnormal in all. Abnormal ADC was detected in the supratentorial white matter (6/12) and cortex (1/12), the basal ganglia (5/12), the thalami (4/12), and the cerebellum (1/12). ADC was reduced in 5/12, increased in 4/12, and both in 3/12. Mean serum sodium was lower in patients with DWI abnormalities affecting the white matter (6/12), than in those with basal ganglia/thalamic involvement (6/12). Neurological outcome was normal in 4/11 and abnormal in 7/11, and 1 patient died, outcome did not correlate to either localisation or type of DWI abnormality.Conclusions
In D+HUS with neurological symptoms, early DWI may reveal abnormal ADC not only in the basal ganglia/thalami, but also in the white matter/cortex. Besides thrombotic microangiopathy, toxic effects of shiga toxin, azotaemia and hyponatraemia / hypoosmolality may be involved in cerebral involvement in children with D+HUS. Findings on early MRI seem not to predict clinical course or outcome.Key Points
? DWI MR imaging may detect early CNS involvement in haemolytic uraemic syndrome ? Different pathogenetical mechanisms may contribute to the CNS disease in HUS ? Early MRI findings do not seem to allow prediction of clinical outcome 相似文献20.
Letterio Salvatore Politi Claudia Godi Gabriella Cammarata Alessandro Ambrosi Antonella Iadanza Roberto Lanzi Andrea Falini Stefania Bianchi Marzoli 《European radiology》2014,24(5):1118-1126