Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT

Shin, Kyung Eun; Yi, Chin A; Kim, Tae Sung; Lee, Ho Yun; Choi, Young Soo; Kim, Hong Kwan; Kim, Young Tae

doi:10.1007/s00330-013-3054-0

Cited by 46 publications

(35 citation statements)

References 27 publications

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“…The T1 signal intensity of benign mediastinal cysts can be intermediate to hyperintense, depending on the amount of hemorrhage and proteinaceous material within the lesion (23,31). DW imaging of benign mediastinal cysts typically reveals T2 hyperintensity without diffusion restric-tion, but infected benign mediastinal cysts can show diffusion restriction (32).…”

Section: Mediastinal Cystsmentioning

confidence: 99%

Mediastinal and Pleural MR Imaging: Practical Approach for Daily Practice

et al. 2018

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Radiologists in any practice setting should be prepared to use thoracic magnetic resonance (MR) imaging for noncardiac and nonangiographic applications. This begins with understanding the sequence building blocks that can be used to design effective thoracic MR imaging protocols. In most instances, the sequences used in thoracic MR imaging are adapted from protocols used elsewhere in the body. Some modifications, including the addition of electrocardiographic gating or respiratory triggering, may be necessary for certain applications. Once protocols are in place, recognition of clinical scenarios in which thoracic MR imaging can provide value beyond other imaging modalities is essential. MR imaging is particularly beneficial in evaluating for benign features in indeterminate lesions. In lesions that are suspected to be composed of fluid, including mediastinal cysts and lesions composed of dilated lymphatics, MR imaging can confirm the presence of fluid and absence of suspicious enhancement. It can also be used to evaluate for intravoxel lipid, a finding seen in benign residual thymic tissue and thymic hyperplasia. Because of its excellent contrast resolution and potential for subtraction images, MR imaging can interrogate local treatment sites for the development of recurrent tumor on a background of post-treatment changes. In addition to characterization of lesions, thoracic MR imaging can be useful in surgical and treatment planning. By identifying nodular sites of enhancement or areas of diffusion restriction within cystic or necrotic lesions, MR imaging can be used to direct sites for biopsy. MR imaging can help evaluate for local tumor invasion with the application of "real-time" cine sequences to determine whether a lesion is adherent to an adjacent structure or surface. Finally, MR imaging is the modality of choice for imaging potential tumor thrombus. By understanding the role of MR imaging in these clinical scenarios, radiologists can increase the use of thoracic MR imaging for the benefit of improved decision making in the care of patients. RSNA, 2018.

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Section: Mediastinal Cystsmentioning

confidence: 99%

Mediastinal and Pleural MR Imaging: Practical Approach for Daily Practice

et al. 2018

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“…Quantitative assessment of a tumor is possible by calculating its apparent diffusion coefficient (ADC) value which is inversely correlated with tissue cellularity. Hence, DWI has been proposed as a cancer biomarker with the diagnostic potential to distinguish benign from malignant tumors because of the tendency of the latter to show more restricted diffusion, i.e., lower ADC values (Table 2) [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Role of diffusion weighted MR-imaging in the evaluation of malignant mediastinal lesions

Sabri

Nossair

Assal

et al. 2020

Egypt J Radiol Nucl Med

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Background: Conducted studies showed that the ADC (apparent diffusion coefficient) values of malignant mediastinal lesions are significantly lower than those of benign lesions. Investigators determined cut-off ADC values to differentiate the two; concluding that ADC value is a promising noninvasive, imaging parameter that helps assess and characterize mediastinal tumors. Taking this a step forward, the primary objective of our prospective study was to investigate the potential of DW-MRI (diffusion-weighted magnetic resonance imaging) to characterize malignant mediastinal lesions using their ADC values. Thirty-three patients that underwent MRI of the chest with DWI and latter pathologically diagnosed with a malignant mediastinal lesion were included in this study. Lesions' ADC values were measured and correlated with the histopathological results. The statistical significance of differences between measurements was tested using the one-way ANOVA (analysis of variance) test; p values equal to or less than 0.05 were considered significant. Results: There was no statistically significant difference between the ADC mean values of the histopathological groups of lesions assessed with the overlap of their ADC mean values. The average ADC mean value of NHL (non-Hodgkin lymphoma) was evidently lower than that of HD (Hodgkin disease) with no overlap between their ADC mean values. DWI failed at characterizing one lesion in this study as a malignant tumor, namely an immature teratoma (germ-cell tumor). Again DWI could not be used to evaluate a mass, latter pathologically diagnosed as an angiosarcoma, because of its overall hemorrhagic nature showing no definite non-hemorrhagic soft tissue components. The aforementioned results did not differ considerably when minimum ADC was used instead of mean ADC. Conclusion: There was no statistically significant difference between the ADC values of the malignant mediastinal lesions evaluated. However, regarding lymphoma subtypes, our limited sample study of lymphoma suggested a considerable difference between the ADC values of Hodgkin disease and non-Hodgkin lymphoma.

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“…If a lesion is large enough, regions of interest can be placed on the ADC map to determine local ADC values. Depending on the tissue being imaged, some thresholds have been proposed for distinguishing malignant from benign lesions . In order to avoid ADC underestimation, TEs should be minimized .…”

Section: Building Blocksmentioning

confidence: 99%

“…Depending on the tissue being imaged, some thresholds have been proposed for distinguishing malignant from benign lesions. 28,[48][49][50][51][52][53] In order to avoid ADC underestimation, TEs should be minimized. 5,48 It is important to recognize that when an ADC map is created using the b = 0 sec/mm 2 data, the measured ADC may be overestimated due to a substantial perfusion component from the b = 0 sec/mm 2 data.…”

Section: Functional Sequencesmentioning

confidence: 99%

Building blocks for thoracic MRI: Challenges, sequences, and protocol design

Raptis

Ludwig

Hammer

et al. 2019

Magnetic Resonance Imaging

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Thoracic MRI presents important and unique challenges. Decreased proton density in the lung in combination with respiratory and cardiac motion can degrade image quality and render poorly executed sequences uninterpretable. Despite these challenges, thoracic MRI has an important clinical role, both as a problem‐solving tool and in an increasing array of clinical indications. Advances in scanner and sequence design have also helped to drive this development, presenting the radiologist with improved techniques for thoracic MRI. Given this evolving landscape, radiologists must be familiar with what thoracic MR has to offer. The first step in developing an effective thoracic MRI practice requires the creation of efficient and malleable protocols that can answer clinical questions. To do this, radiologists must have a working knowledge of the MR sequences that are used in the thorax, many of which have been adapted from use elsewhere in the body. These sequences can be broadly divided into three categories: traditional/anatomic, functional, and cine based. Traditional/anatomic sequences allow for the depiction of anatomy and pathologic processes with the ability for characterization of signal intensity and contrast enhancement. Functional sequences, including diffusion‐weighted imaging, and high temporal resolution dynamic contrast enhancement, allow for the noninvasive measurement of tissue‐specific parameters. Cine‐based sequences can depict the motion of structures in the thorax, either with retrospective ECG gating or in real time. The purpose of this article is to review these categories, the building block sequences that comprise them, and identify basic questions that should be considered in thoracic MRI protocol design. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:682–701.

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Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT

Cited by 46 publications

References 27 publications

Mediastinal and Pleural MR Imaging: Practical Approach for Daily Practice

Mediastinal and Pleural MR Imaging: Practical Approach for Daily Practice

Role of diffusion weighted MR-imaging in the evaluation of malignant mediastinal lesions

Building blocks for thoracic MRI: Challenges, sequences, and protocol design

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