Diagnosis of liver metastases: Can diffusion-weighted imaging (DWI) be used as a stand alone sequence?

Kenis, Christoph; Deckers, F.; Foer, Bert De; Mieghem, François Van; Laere, Steven Van; Pouillon, Marc

doi:10.1016/j.ejrad.2011.02.019

Cited by 45 publications

(23 citation statements)

References 24 publications

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“…In a recent study by Kenis et al [13] , DWI was used in the staging of oncological disease in patients with impaired renal function; in this study, MR showed a significant additional capability in the detection of metastases when considering DWI and gadolinium MRI together [13] . Kenis et al [13] analyzed three image sets: unenhanced T1 and T2 acquisitions/gadolinium-enhanced T1, DWI and a combination set; all observers reported high sensitivity values using the combination set of images; as a consequence, diagnostic accuracy increased significantly when DWI was added to Gd-MRI.…”

Section: Discussionmentioning

confidence: 99%

“…In view of its capability to detect FLLs, DWI has been widely introduced in liver imaging, and many studies have recently emphasized its additional values in liver imaging in order to detect malignant FLLs [13][14][15] . In this regard, a routine MRI protocol should ideally use all posroutine MRI protocol should ideally use all possible strategies, including many un-enhanced scans: in and out-of-phase T1-weighted sequences, T2-weighted FSE sequences -even with spatial fat saturation or different echo-time, white-blood sequences for morphologic assessment of liver anatomy such as steady-state sequences, and SSFSE sequences to emphasize T2-content; dynamic multiphase gadolinium-enhanced acquisitions are necessary to subsequently evaluate FLLs and to study their behavior in the arterial, portal and late phases.…”

Section: Discussionmentioning

confidence: 99%

“…Parallel techniques reduce artifacts, such as "blurring" or magnetic susceptibility artifacts, increasing the signal-to-noise ratio (SNR) [10,11] ; moreover, respiratory-triggered sequences offer a better possibility of SNR compared to breath-hold techniques [12] . Many studies have recently started to compare DWI to T1-weighted acquisition in the detection and characterization of liver lesions [13][14][15] . In diffusion imaging of the liver, the first difficulty concerns the choice of the appropriate b-value, which means the degree of weighting in diffusion.…”

Section: Introductionmentioning

confidence: 99%

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Diffusion-weighted MRI in a liver protocol: Its role in focal lesion detection

Palmucci

Mauro²,

Messina³

et al. 2012

WJR

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AIM:To evaluate the role of diffusion-weighted imaging (�WI) in the detection of focal liver lesions (FLLs), using a conventional magnetic resonance imaging (MRI) protocol. METHODS:Fifty-two patients (22 males, average age 55.6 years, range: 25-82 years), studied using a 1.5 Tesla magnetic resonance scanner, were retrospectively analyzed; detection of FLLs was evaluated by considering the number of lesions observed with the following sequences: (1) respiratory-triggered diffusion-weighted single-shot echo-planar (�W SS-EP) sequences; (2) fat-suppressed fast spin-echo (fs-FSE) T2 weighted sequences; (3) steady-state free precession (SSFP) images; and (4) dynamic triphasic gadolinium-enhanced images, acquired with three-dimensional fast spoiled gradient-echo (3� FSPGR). Two radiologists independently reviewed the images: they were blinded to their respective reports. �W SS-EP sequences were compared to fs-FSE, SSFP and dynamic gadolinium-enhanced acquisitions using a t -test. Pairs were compared for the detection of: (1) all FLLs; (2) benign FLLs; (3) malignant FLLs; (4) metastases; and (5) hepatocellular carcinoma (HCC). RESULTS:Interobserver agreement was very good (weighted k = 0.926, CI = 0.880-0.971); on the consensus reading, 277 FLLs were detected. In the comparison with fs-FSE, DW SS-EP sequences had a significantly higher score in the detection of all FLLs, benign FLLs, malignant FLLs and metastases; no statistical difference was observed in the detection of hepatocellular carcinoma (HCCs). In the comparison with SSFP sequences, DW SS-EP had significantly higher scores (P < 0.05) in the detection of all lesions, benign lesions, malignant lesions, metastases and HCC. All FLLs were better detected by dynamic 3� FSGR enhanced acquisition, with P = 0.0023 for reader 1 and P = 0.0086 for reader 2 in the comparison with �W SS-EP sequences; with reference to benign FLLs, �W SS-EP showed lower values than 3� FSPGR enhanced acquisition (P < 0.05). No statistical differences were observed in the detection of malignant lesions and metastases; considering HCCs, a very slight difference was reported by reader 1 (P = 0.049), whereas no difference was found by reader 2 (P = 0.06). CONCLUSION:In lesion detection, �WI had higher scores than T2 sequences; considering malignant FLLs, no statistical difference was observed between �WI and dynamic gadolinium images.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diffusion-weighted MRI in a liver protocol: Its role in focal lesion detection

Palmucci

Mauro²,

Messina³

et al. 2012

WJR

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“…DWI alone can be used in patients where gadolinium contrast administration is not allowed. Combination of Gd-MRI and DWI significantly increases diagnostic accuracy (20).…”

Section: Validated Indication Of Mri In Lung Cancer Stagingmentioning

confidence: 99%

Contribution of MRI in lung cancer staging

Khalil

Bouhela

Carette

2013

Journal of the Belgian Society of Radiology

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“…The comparison of CT and DWI performed by Fukukura et al [49] , instead, reported that only CT findings might be associated with the clinical behavior of PDACs. Some studies focused on the application of DWI to the detection and characterization of liver metastases from PDAC and reported high sensitivity and specificity using DWI alone [50] or DWI plus other sequences [51][52][53] : imaging features derived from conventional MR sequences should be always taken into account because of the possible presence of DWI false-positives.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Robertis¹,

Martini²,

Demozzi³

et al. 2015

WJG

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Diffusion-weighted imaging (DWI), dynamic contrastenhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for posttreatment assessment, even at an early stage. or altered cellular membranes will present diffusion restriction, which is depicted as signal hyperintensity areas on high b-value DW images and hypointensity on the apparent diffusion coefficient (ADC) maps; ADC measurement can also quantify water molecules' diffusion. As dedifferentiation or therapies may induce microscopic changes in neoplastic tissues that could modify water molecules' diffusion, DWI can distinguish between different degrees of malignancy and can be also proposed for post-treatment monitoring. Moreover, DWI can be performed in a single session with DCE-MRI, thus providing a comprehensive "one-step" morphological and functional evaluation of hepatobilio-pancreatic tumors.Perfusion imaging techniques evaluate changes in signal intensity (DCE-MRI) or density (pCT) after contrast medium injection, being therefore able to assess microvascularization through the evaluation of the dynamics of contrast medium distribution from vessels to the neoplastic tissue. Perfusion parameters are therefore theoretically good candidates for the evaluation of microscopic vascular differences between lesions with different pathological grade and for the assessment of treatment response, especially after chemoembolization or during treatments with antiangiogenic drugs.This editorial analyzes up-to-date literature data regarding the application of functional imaging techniques, apart from molecular imaging, to hepatic and pancreatic tumors, with particular emphasis on correlations to pathological features, prognostic stratification and therapeutic response assessment. FUNCTIONAL IMAGING TECHNIQUES: TECHNICAL BASESIn 1965 Stejskal and Tanne...

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Diagnosis of liver metastases: Can diffusion-weighted imaging (DWI) be used as a stand alone sequence?

Cited by 45 publications

References 24 publications

Diffusion-weighted MRI in a liver protocol: Its role in focal lesion detection

Diffusion-weighted MRI in a liver protocol: Its role in focal lesion detection

Contribution of MRI in lung cancer staging

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

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