Added value of diffusion-weighted MR imaging to T2-weighted and dynamic contrast-enhanced MR imaging in T staging of gastric cancer

Liu, Song; He, Jian; Guan, Wei; Li, Qiang; Yu, Haiping; Zhou, Zhuping; Bao, Shanshan; Zhou, Zhengyang

doi:10.1016/j.clinimag.2013.12.001

Cited by 25 publications

(39 citation statements)

References 19 publications

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“…In particular, Borrmann 4 gastric cancer exhibits a thickened wall, referred to as 'sandwich sign' (23). Our findings suggested that DWIBS/T2 may add diagnostic information to the process of T-staging (20)(21)(22)24).…”

Section: Discussionmentioning

confidence: 81%

Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Tomizawa

Shinozaki

Fugo

et al. 2016

Molecular and Clinical Oncology

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Abstract. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) yields positive results for cancer against the surrounding tissues. The combination of DWIBS and T2-weighted images (DWIBS/T2) in the diagnosis of gastrointestinal tract cancers was retrospectively analyzed in the present study. Patients were subjected to magnetic resonance imaging after cancer was diagnosed through specimens obtained via biopsy or endoscopic mucosal resection. Sixteen patients were assessed between July, 2012 and June, 2013 and the correlation between detection with DWIBS/T2 and T staging was analyzed. Regarding patients who underwent surgery, the correlation between detection with DWIBS/T2 and the diameter or depth of invasion was analyzed. All cancers that had advanced to >T2 stage were detectable by DWIBS/T2, whereas all cancers staged as T2) or invading beyond the muscularis propria. IntroductionEndoscopy is the gold standard for diagnosing cancers of the gastrointestinal tract, including the esophagus, stomach, colon and rectum (1,2). However, endoscopy is not suitable for evaluating the depth of invasion and extent of cancer, as it only allows observation of the lumen. Endoscopic ultrasonography (EUS) and contrast-enhanced computed tomography (CE-CT) are performed to assess the structure of the primary lesion, the depth of invasion into the surrounding tissues and distant metastasis (3,4). Assessing the depth of invasion may occasionally be difficult due to the weak contrast of the cancer against the surrounding tissues. Therefore, an imaging modality with a strong signal and contrast would facilitate the assessment of the depth of tumor invasion.Magnetic resonance imaging (MRI) is not as popular as CT due to blurring and low spatial resolution (5). However, MRI may be a promising method if a strong soft tissue contrast in the abdomen can be achieved. Diffusion-weighted wholebody imaging with background body signal suppression (DWIBS) images are acquired using multiple-signal averaging, pre-pulse fat suppression and heavy diffusion weighting during free breathing (6). DWIBS is based on diffusion-weighted imaging (DWI) that visualizes and assesses the random movement of water at the molecular level (Brownian motion) (7,8). An advantage of DWIBS is that it provides a strong contrast of cancerous against surrounding non-cancerous tissues, which is useful for the detection, staging and monitoring of the response to therapy (9). A major limitation of DWIBS is that anatomical analysis may be difficult at times (10,11).

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Section: Discussionmentioning

confidence: 81%

Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Tomizawa

Shinozaki

Fugo

et al. 2016

Molecular and Clinical Oncology

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“…Some studies have previously determined the ability of DW-MRI to detect, stage and assess tumor response in oncology (32,33,39,40). Liu et al .…”

Section: Discussionmentioning

confidence: 99%

“…have also reported that other variables (in addition to T and N stage) can influence patient survival in GC and have pointed out the need to investigate novel prognostic biomarkers able to reliably differentiate different prognostic groups in patients with GC (31). There is growing evidence supporting the use of DW-MRI with regard to TNM staging for GC (32,33). …”

Section: Introductionmentioning

confidence: 99%

Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer

Giganti

Ambrosi

Chiari

et al. 2017

Chinese Journal of Cancer Research

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ObjectiveTo investigate the role of apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) when applied to the 7th TNM classification in the staging and prognosis of gastric cancer (GC).MethodsBetween October 2009 and May 2014, a total of 89 patients with non-metastatic, biopsy proven GC underwent 1.5T DW-MRI, and then treated with radical surgery. Tumor ADC was measured retrospectively and compared with final histology following the 7th TNM staging (local invasion, nodal involvement and according to the different groups — stage I, II and III). Kaplan-Meier curves were also generated. The follow-up period is updated to May 2016.ResultsMedian follow-up period was 33 months and 45/89 (51%) deaths from GC were observed. ADC was significantly different both for local invasion and nodal involvement (P<0.001). Considering final histology as the reference standard, a preoperative ADC cut-off of 1.80×10–3 mm2/s could distinguish between stages I and II and an ADC value of ≤1.36×10–3 mm2/s was associated with stage III (P<0.001). Kaplan-Meier curves demonstrated that the survival rates for the three prognostic groups were significantly different according to final histology and ADC cut-offs (P<0.001). ConclusionsADC is different according to local invasion, nodal involvement and the 7th TNM stage groups for GC, representing a potential, additional prognostic biomarker. The addition of DW-MRI could aid in the staging and risk stratification of GC.

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“…CT with ionized radiation requires the injection of iodine contrast medium. 9 EUS is an invasive technique requiring sedation 1 and is highly operator dependent. 10 PET highly depends upon the standardized uptake value and the pathological subtype of the cancer.…”

Section: Advances In Knowledgementioning

confidence: 99%

“…We compared the pooled T (T3-4 vs T1-2) performance characteristics of MRI with DWI 9,22,24,25 to those without DWI 23,[26][27][28][29][30] to determine whether DWI could have helped preoperative staging performances (Table 4). However, we found that the summary results for T staging of GC (Table 4) showed no statistically significant difference between MRI with DWI and without DWI in sensitivity (p 5 0.279) and specificity (p 5 0.283).…”

Section: Subgroup Analysesmentioning

confidence: 99%

The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

Huang¹,

Xie²,

Guo³

et al. 2015

BJR

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Objective: To perform a meta-analysis and literature review regarding the diagnostic accuracy of MRI for pre-operative tumour depth invasion (T) and regional lymph node invasion (N) staging of gastric carcinoma (GC). Methods: Articles were identified through systematic search of Medline, PubMed, Cochrane Library, Web of Science, Springerlink and several Chinese databases. The study quality was assessed by the quality assessment for studies of diagnostic accuracy. 2 reviewers independently extracted and assessed the data from 11 eligible studies. A meta-analysis was then carried out. Subgroup and sensitivity analyses were also performed. Results: 11 studies (439 patients) were finally included in the current review. Among these studies, the significant evidence of heterogeneity was only discovered for Subgroup analyses showed that diffusion-weighted imaging was more helpful for T staging. Conclusion:The present systematic review suggests that MRI has a good diagnostic accuracy for pre-operative T staging of GC and should be widely used in clinical work. However, the ability for N staging is relatively poor on MRI. Advances in knowledge:In the pre-operative staging of GC, MRI was a useful tool and may enhance accuracy for the T staging of advanced GC.Gastric carcinoma (GC) is the fourth most common cancer and the second leading cause of cancer-related death with a 5-year survival rate of ,20% around the world. 1 The disease is more common in Asian countries, especially China, Japan and Republic of Korea.2,3 Accurate assessment of local tumour depth invasion (T) and regional lymph node invasion (N) plays an essential role in predicting prognosis and determining the most appropriate treatment planning. 4,5The pre-operative staging of GC has been based on a multimodality approach, such as endoscopic ultrasonography (EUS), CT, MRI and positron emission tomography (PET).6,7 EUS and CT have been widely used for GC staging in previous years.8 Of course, different imaging modalities have themselves relative merits. CT with ionized radiation requires the injection of iodine contrast medium.9 EUS is an invasive technique requiring sedation 1 and is highly operator dependent.10 PET highly depends upon the standardized uptake value and the pathological subtype of the cancer. 11MRI is a powerful imaging method with high soft-tissue contrast, with technical versatility for sequence selection and modification, and without ionizing radiation. However, it was unsuitable for the staging of GC owing to its long acquisition time and susceptibility to motion artefacts in previous years. With technology improved and shorter imaging time, these limitations have recently been partially overcome. 12Recently, there has been much research using MRI to assess pre-operative staging of GC. Nevertheless, the number of patients in each study has been insufficient, and the results varied among the articles. Also, the limited imaging field of view of MRI in a single session makes it difficult to stage the distant metastasis (M). 13Therefore, the o...

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Added value of diffusion-weighted MR imaging to T2-weighted and dynamic contrast-enhanced MR imaging in T staging of gastric cancer

Cited by 25 publications

References 19 publications

Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer

The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

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