APPLICATION OF WHOLE BODY DIFFUSION WEIGHTED MR IMAGING FOR DIAGNOSIS AND STAGING OF MALIGNANT LYMPHOMA

Objective To evaluate the clinical impact of whole body diffusion weighted imaging （WB-DWI） on diagnosis and staging of malignant lymphoma. Methods Thirty-one patients with suspected lymphadenopathy were enrolled. WB-DWI was performed by using short TI inversion recovery echo-planar imaging sequence with free breathing and built-in body coil. Axial T2- weighted imaging images of the same location were used as reference. The results of WB-DWI were compared with pathological results and other imaging modalities. The mean apparent diffusion coefficient （ADC） values of different kinds of lymph nodes were compared. Results WB-DWI was positive in all 18 cases with lymphoma, 5 cases with metastatic lymph nodes and 4 of 8 eases with benign lymphadenopathy. The mean ADC value of lymphomatous, metastatic and benign lymph nodes was （0.87 ± 0.17） × 10^3, （0.98± 0.09） × 10^3 and （1.20 ± 0.10） × 10^3 mm^2/s. There was significant difference in ADC value between benign lymph nodes and other two groups （P 〈 0.01）. The sensitivity, specificity and accuracy of WB-DWI in diagnosis of lymphoma were 100% （18/18）, 30.8% （4/13） and 71.0% （22/31）. When an ADC value of 1.08 × 10^-3 mm^2/s was used as the threshold value for differentiating malignant from benign lymph nodes, the best results were obtained with sensitivity of 87.8% and specificity of 91.3%. Sixteen of eighteen cases （88.9%） of lymphoma were accurately staged in accordance with clinical staging. Conclusions WB-DWI is a sensitive, but less specific technique for diagnosis of lymphoma. It is difficult to differentiate lymphnmatous from metastatic lymph nodes using WB-DWI. However, it is a valuable imaging modality for staging of patients with malignant lymphoma.

FEASIBILITY OF WHOLE BODY DIFFUSION WEIGHTED IMAGING IN DETECTING BONE METASTASIS ON 3.0T MR SCANNER

Objective To evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison. Methods Forty-five patients with malignancy history were enrolled in our study. All the patients received the whole body DWI and bone scintigraphy scan within 1 week. The magnetic resonance (MR) examination was performed on 3.0T MR scanner using embedded body coil. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of the other imaging modality. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two techniques for detecting bone metastasis were analyzed. Results A total of 181 metastatic lesions in 77 regions of 34 patients were detected by whole body DWI, and 167 metastatic lesions in 76 regions of 31 patients were identified by bone scintigraphy. The patient-based sensitivity and PPV of whole body DWI and bone scintigraphy were similar (89.5% vs. 81.6%, 97.1% vs. 91.2%), whereas, the patient-based specificity and NPV of whole body DWI were obviously higher than those of bone scintigraphy (85.7% vs. 57.1%, 60.0% vs. 36.4%). Ten regions negative in scintigraphy but positive in whole body DWI, mainly located in spine, pelvis, and femur; nine regions only detected by scintigraphy, mainly located in skull, sternum, clavicle, and scapula. The region-based sensitivity and specificity of whole body DWI were slightly higher than those of bone scintigraphy (89.5% vs. 88.4%, 95.6% vs. 87.6%). Conclusion Whole body DWI reveals excellent concordance with bone scintigraphy regarding detection of bone metastasis, and the two techniques are complementary for each other.

MR DIFFUSION WEIGHTED IMAGING FOR EVALUATION OF RADIOTHERAPEUTIC EFFECTS ON RABBIT VX2 TUMOR MODEL

Objective To investigate the feasibility of magnetic resonance （MR） diffusion weighted imaging （DWI） for evaluation of radiotherapeutic effects on rabbit VX2 tumor model. Methods Sixteen New Zealand white rabbits received a subcutaneous implantation of VX2 tumor cell suspension 0.5 mL （4× 10^7 ceUs/mL） in their right thighs to set up tumor model. And 2 weeks later they were randomly divided into therapy group （Group T, n = 10） and control group （Group C, n = 6）. Group T received radiotherapy at a single dose of 10 Gy. MR imaging （MRI） scan including short TI inversion recovery echo-planar imaging DWI, T1-weighted imaging （T1WI） and T2-weighted imaging （T2WI） sequences were performed 1 day prior to as well as 1 day, 2 days, 3 days and 7 days after radiotherapy. Group C received only MRI scan at the same time points without any treatment. MRI appearance on T2WI, TlWI, and DWI images was compared and tumor volume was calculated. Apparent diffusion coefficient （ADC） values of the tumor were evaluated in all cases. HE staining was used for pathological study. Results Necrosis （n = 8） and hemorrhage （n = 2） were seen gradually on T2WI and T1WI images of Group T after time point of day 2 after irradiation. In Group C, no obvious necrosis was found until day 7. There was no significant difference in tumor volume between the two groups before radiotherapy. After radiotherapy, tumors in Group T showed a gradual growth but not as obvious as Group C. There was a significant difference in tumor volume between the two groups from day 2 on （P 〈 0.05）. ADC value changed dramatically fight from the 1st day after radiotherapy in Group T [（0.99 ± 0.15） ×10^-3 mm^2/s for 1 day before radiotherapy, （1.23 ± 0.08） ×10^-3 , （1.45 ± 0.07） ×10^-3 , （1.63 ± 0.06） ×10^-3 , and （2.02 ± 0.18） ×10^-3 mm^2 for day 1, 2, 3, and 7]; and ADC value had no significant changes after radiotherapy in Group C except day 7 [（1.07±0.08） ×10^-3 mm^2 for 1 day before radiotherapy, （1.03 ± 0.04）×10^-3 , （1.05 ± 0.02）×10^-3 , （1.05 ± 0.05） ×10^-3 , and （0.95 ± 0.07） ×10^-3 mm^2 for day 1, 2, 3, and 7]. There was significant difference in ADC value between the two groups for each time point after radiotherapy （P 〈 0.01）. Pathological study showed that the number of viable tumor cells in Group T decreased 1 day after radiotherapy, and the inflammatory cell infiltration was marked and almost all viable tumor cells disappeared by day 7 after radiotherapy. Conclusions DWI is a new promising technique for monitoring radiotherapy outcomes. ADC value may give a prior clue on physiological changes of radiotherapy before routine MRI could tell.

WHOLE BODY DIFFUSION WEIGHTED IMAGING:A NEW ERA OF ONCOLOGICAL RADIOLOGY

Cancer has become the leading cause of mortality in the urban area of China. Whole body diffusion weigntea imaging （WB-DWI）, also known as virtual positron emission tomography, has gradually become accepted as an image tool in tumor localization, characterization, staging and monitoring response to therapy or tumor recurrence. Our article aimed to summarize the limited initial clinical use of WB-DWI in the referred area, and to analyze the most potential advantage of WB-DWI in therapeutic monitoring and tumor staging. WB-DWI as a highly sensitive, completely non-invasive, well-tolerated and low price technique has a promising furture in tumor assessment. Profound clinical study is necessary for its further application improvement.

DIAGNOSTIC VALUE OF WHOLE BODY DIFFUSION WEIGHTED IMAGING FOR SCREENING PRIMARY TUMORS OF PATIENTS WITH METASTASES

Objective To evaluate the values of whole body diffusion weighted imaging （DWI） in screenmg pnmary unknown tumor in patients with metastases. Methods Totally, 34 patients with metastases of primary unknown tumors were scanned with whole body DWI, and conventional magnetic resonance （MR） imaging was performed if suspected lesions were detected. All the metastases including 27 cases of osseous metastases, 2 brain metastases, 2 liver metastases, 1 pulmonary multiple metastasis, 1 neck metastasis and 1 malignant ascites, were diagnosed by computed tomography, single photon emission computed tomography, or MR imaging. For the proven primary tumors diagnosed by biopsy or pathology of surgical specimens, apparent diffusion coefficient （ADC） values of the primary and metastatic lesions were measured respectively. The sensitivity and specificity of this technique for screening primary tumors were cvaluated. Results We found 24 cases with suspected primary lesions, in which 23 lesions were proved to be primary tumors, and 1 was proved to be benign lesion. And no definite primary lesion was found in 10 cases on whole body DWI, but in which 1 case was diagnosed with primary tumor by biopsy later, and the other 9 cases remained unknown within follow-up of over halfa year. The difference was not significant in ADC values between primary and metastatic lesions （P〉0.05）. The sensitivity and specificity of whole body DWI for searching primary tumors was 95.8% and 90.0%, respectively. Conclusion Combined with conventional MR scanning, whole body DWI can help to search primary lesions of patients with metastases.