Diffusion weighted imaging in the liver

Diffusion weighted magnetic resonance imaging (DWI) is an imaging technique which provides tissue contrast by the measurement of diffusion properties of water molecules within tissues. Diffusion is expressed in an apparent diffusion coefficient (ADC), which reflects the diffusion properties unique to each type of tissue. DWI has been originally used in neuroradiology. More recently, DWI has increasingly been used in addition to conventional unenhanced and enhanced magnetic resonance imaging (MRI) in other parts of the body. The reason for this delay was a number of technical problems inherent to the technique, making DWI very sensitive to artifacts, which had to be overcome. With assessment of ADC values, DWI proved to be helpful in characterization of focal liver lesions. However, DWI should always be used in conjunction to conventional MRI since there is considerable overlap between ADC values of benign and malignant lesions. DWI is useful in the detection of hepatocellular carcinoma in the cirrhotic liver and detection of liver metastases in oncological patients. In addition, DWI is a promising tool in the prediction of tumor responsiveness to chemotherapy and the follow-up of oncological patients after treatment, as DWI may be capable of detecting recurrent disease earlier than conventional imaging.This review focuses on the most common applications of DWI in the liver.

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.

PRELIMINARY APPLICATION OF WHOLE BODY DIFFUSION WEIGHTED IMAGING IN SCREENING METASTASIS

Objective To investigate the feasibility of whole body diffusion weighted imaging (WB-DWI) in screening metastasis. Methods WB-DWI was performed in 24 patients diagnosed with various types of primary tumors. The three-dimensional maximum intensity projection reconstruction and black-and-white flip technique were used to observe metastatic lesions, and the results were compared with those of bone scintigraphy. Results By WB-DWI scanning sequence at b = 800 s/mm2, all the bone lesions found by bone scintigraphy in the cohort were well identified, and other lesions of soft tissue and organs were also well demonstrated. Its screening capability was equivalent with bone scintigraphy in screening metastases in bones (P = 0.062). Conclusion WB-DWI was practicable with the parameter settings attempted in metastases screening.

FEASIBILITY OF DIAGNOSING AND STAGING LIVER FIBROSIS WITH DIFFUSION WEIGHTED IMAGING

Objective To assess the clinical feasibility of diagnosing and staging liver fibrosis by apparent diffusion coefficient (ADC). Methods Totally, 43 patients (mean age 29.3 years) with chronic hepatitis by liver biopsy and 7 healthy controls (mean age 39.9 years) underwent liver diffusion weighted imaging (DWI) with four b values: 0, 200, 500, and 1000 s/mm2 respectively. The liver fibrosis was staged according to Ishak fibrosis stage. The ADC value of liver fibrosis patients and healthy controls was compared. The correlation of ADC value and liver fibrosis staging was analyzed. Result The histological staging showed 8 stage 1 patients, 10 stage 2 patients, 6 stage 3 patients, 9 stage 4 patients, 8 stage 5 patients and 2 stage 6 patients. The mean ADC value of liver fibrosis patients was significantly lower than that of healthy controls except for stage 1 group (P < 0.05). There was a negative correlation between liver fibrosis staging and ADC value (r = -0.697 with b=500 s/mm2, P < 0.01). Receiver operating characteristic (ROC) curve of ADC value of advanced liver fibrosis (Ishak stage F3 and higher) showed that area under curve = 0.913, 0.825, and 0.794 with b = 500, 1000, and 200 s/mm2, respectively (95% confidence interval: 83.6%-99.0%, 70.7%-94.3%, 66.5%- 92.4%; P < 0.05). When b value was 500 s/mm2, the sensitivity (84%) and specificity (80%) of DWI for diagnosis of advanced liver fibrosis were the highest. Conclusion DWI is proved to be a useful clinical tool in the quantitative evaluation of liver fibrosis and in the prediction of the process of liver fibrosis with the recommendable b value (500 s/mm2).

AGE-RELATED CHANGES OF BONE MARROW OF NORMAL ADULT MAN ON DIFFUSION WEIGHTED IMAGING

Objective To investigate the signal intensity and apparent diffusion coefficient (ADC) of bone marrow of normal adult man on diffusion weighted imaging (DWI). Methods Fifteen healthy volunteers and thirty-eight patients with benign prostatic hyperplasia or normal prostate were enrolled in this study, with age range 28-82 years old (mean 55.26 ± 18.05 years). All people were examined with large field DWI on a 3.0T magnetic resonance scanner, which ranges from the top of head to the lower limb. The signal-to-noise ratio (SNR) on the DWI and ADC of lumber vertebra at renal hilum level, left ilium and superior segment of left femur were measured. The measured SNR and ADC value of the above sites were compared by one way analysis of variance and their correlations with age were investigated by Pearson's correlation analysis. Results The SNR of lumber vertebra, left ilium and left femur showed no significant difference (F = 0.271, P = 0.763). The SNR of lumber vertebra (r = 0.309, P = 0.024) and left ilium (r = 0.359, P = 0.008) showed positive correlation with age, while the SNR of left femur showed no correlation with age (r = -0.163, P = 0.283). The ADC of lumber vertebra [(0.617 ± 0.177) ×10-3 mm2/s] was significantly higher than that of left ilium [(0.404 ± 0.112) ×10-3 mm2/s, P < 0.001] and left femur [(0.362 ± 0.092) ×10-3 mm2/s, P < 0.001], while the ADC of left ilium and left femur had no significant difference. The ADC of lumber vertebra, left ilium and left femur showed no correlation with age. Conclusion Understanding of age-related changes of normal adult bone marrow on DWI is very important to differentiate the normal bone marrow and abnormal lesions.

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.

PRELIMINARY STUDY OF FEASIBILITY OF WHOLE BODY DIFFUSION WEIGHTED IMAGING IN DIAGNOSIS OF METASTASIS OF TUMOR

Objective To evaluate the feasibility of whole body diffusion weighted imaging (DWI) in the diagnosis of metastatic tumor. Methods Fifty-six patients (40 males and 16 females, age ranging from 29 to 84 years with a mean age of 57 years) with a variety of primary tumors were investigated by whole body DWI combined with computed tomography (CT) and/or conventional magnetic resonance imaging (MRI) scans. Twelve patients underwent positron emission tomography. The final diagnosis was made on the basis of CT or high resolution CT result for lung lesion and MRI or CT result for skull, abdomen and other parts. All tumors were classified into four groups by their diameter: below 1.0 cm, 1.0-1.9 cm, 2.0-2.9 cm, and above 3.0 cm. The sensitivity and specificity of whole body DWI in the detection of metastatic tumor were analyzed. Results The sensitivities of whole body DWI for screening metastasis of the four groups were 38%, 75%, 97%, and 100%, respectively. Whole body DWI showed the highest sensitivity and specificity for detecting metastasis of the skeletal system. It was difficult to find metastatic tumor whose diameter was below 1.0 cm, or lymph nodes located in the pelvis with diameter below 2.0 cm. Conclusions Whole body DWI is a promising method in the diagnosis of metastastic tumors. With the perfection of scanning parameter, whole body DWI should be a new effective whole body technique for tumor detection.

Clinical Value of Whole-body Magnetic Resonance Diffusion Weighted Imaging on Detection of Malignant Metastases

Objective To evaluate the value of whole-body diffusion weighted imaging （WB-DWI） on detection of malignant metastasis. Methods Forty-six patients with malignant tumors underwent WB-DWI examinations between April 2007 and August 2007 in our hospital. Before WB-DWI examination, the primary cancers of all the patients were confirmed by pathology, and the TNM-stage was assessed with conventional magnetic resonance imaging （MRI） or computed tomography （CT）. WB-DWI was performed using short TI inversion recovery echo-planar imaging （STIR-EPI） sequence. Abnormal high signal intensities on WB-DWI were considered as metastases. The results of WB-DWI were compared with other imaging modalities. For the assessment of the diagnostic capability of WB-DWI, WB-DWI were compared with CT for demonstrating mediastinal lymph node metastases and lung metastases, and with conventional MRI for demonstrating metastases in other locations. Results WB-DWI demonstrated 143 focuses, 14 routine imaging. The number of bone metastases depicted of which were diagnosed to be benign lesions in on WB-DWI and routine imaging was 85 and 86; lymph node metastases was 17 and 18; liver metastases was 14 and 14; lung metastases was 4 and 8; and brain metastases was 6 and 8, respectively. WB-DWI failed to detect 12 metastatic lesions including 3 osteoplastic bone metastases, 4 lung metastases, 3 mediastinal lymph node metastases, and 2 brain metastases Four metastatic lesions including 2 deltopectoral lymph nodes and 2 rib metastases were detected with WB-DWI alone, all of which evolved greatly during clinical follow-up for more than 6 months. WB-DWI had higher detection rates for metastatic lesions in liver, bone, and lymph nodes than those in lung and brain （ X^2=30, P〈0.001）. Conclusions WB-DWI could detect most of metastatic lesions that were diagnosed with conventional MRI and CT. The limitations of WB-DWI might be had high false-positive rate and low efficiency in detecting mecliastinal lymph node, brain, and lung metastases.

Diffusion weighted imaging for the detection and evaluation of cholesteatoma

Cholesteatoma is a collection of keratinous debris and stratified squamous epithelium.It is trapped in the middle ear and can lead to bony erosion.The disease is treated surgically often followed by a second-look procedure to check for residual tissue or recurrence.Cholesteatoma has specific signal-intensity characteristics on magnetic resonance imaging with very high signal intensity on diffusion weighted imaging(DWI).Various DWI techniques exist:Echo-planar imaging(EPI)-based and non-EPI-based techniques as well as new approaches like multi-shot EPI DWI.This article summarizes all techniques,discusses the significance in detecting cholesteatoma and mentions actual studies.Further recommendations for daily clinical practise are provided.

NORMAL APPEARANCE OF LARGE FIELD DIFFUSION WEIGHTED IMAGING ON 3.0T MRI

Objective To evaluate the normal appearance of large field diffusion weighted imaging (DWI) on 3.0T magnetic resonance imaging (MRI). Methods Twenty healthy volunteers and thirty patients with benign prostate hyperplasia were included in this study. All patients were examined with large field DWI on 3.0T MRI. Normal tissue appearance was analyzed and apparent diffusion coefficient (ADC) of normal tissue with high signal intensity was measured. The ADC values of bilateral symmetrical tissue were also compared. The ADC values of intervertebral disks of healthy people younger than 50 years and exceeding 50 years were compared. Results Salivary gland, spleen, kidney, gallbladder, bladder, prostate, seminal vesicle, testis, intervertebral disk, liquid in articular cavity and lymph node showed high signal intensity on large field DWI, while lung, liver and bone showed hypo-signal intensity. The mean ADC values of partial hyperintensity tissue were as followed: parotid gland (1.088 ± 0.114) ×10-3 mm2/s, submaxillary gland (1.309 ± 0.189) ×10-3 mm2/s, kidney (1.909 ± 0.143) ×10-3 mm2/s, seminal vesicle (1.669 ± 0.168) ×10-3 mm2/s, testis (1.028 ± 0.075) ×10-3 mm2/s, spleen (0.963 ± 0.108) ×10-3 mm2/s, bladder (2.898 ± 0.267) ×10-3 mm2/s, prostate (1.448 ± 0.132) ×10-3 mm2/s, intervertebral disks (1.360 ± 0.140) ×10-3 mm2/s. No statistical significance was found between the ADC values of bilateral symmetrical tissues. The difference of ADC values of intervertebral disks of healthy people younger than 50 years [(1.372 ± 0.142) ×10-3 mm2/s] and exceeding 50 years [(1.344 ± 0.134) ×10-3 mm2/s] showed statistical significance (P = 0.040). Conclusion Understanding the high signal intensity of normal tissue on large field DWI may help to differentiate the normal tissues and abnormal ones.

EXPERIMENTAL STUDY OF INFLAMMATORY AND METASTATIC LYMPH NODES WITH DIFFUSION WEIGHTED IMAGING ON ANIMAL MODEL: COMPARISON WITH CONVENTIONAL METHODS

Objective To investigate the feasibility of magnetic resonance （MR） diffusion weighted imaging （DWI） in discriminating inflammatory from VX2 carcinoma metastatic lymph nodes in rabbit model. Methods Twenty New Zealand white rabbits were randomly divided into 2 groups. Complete Freund＇s adjuvant was injected into the bilateral dorsal footpads to set up ipsilateral lymphadenitis model （n = 10）, and the other 10 rabbits received a subcutaneous implantation of VX2 tumor cell suspension （1.5×10^7 cells/mL） in both thighs to set up metastatic lymph node model. MR imaging scan covering the popliteal fossa and lilac fossa including short time inversion recovery echo-planar imaging DWI （STIR-EPI-DWI）, Tl-weighted imaging （T1WI） and T2-weighted imaging （T2WI） was performed 2 weeks after injection. T2WI signal intensity （SI）, DWI SI, long/short axial ratio （LSR） and apparent diffusion coefficient （ADC） values of the lymph nodes were evaluated in all cases. Right after MR imaging scan, popliteal and iliac fossa lymph nodes were collected for hematoxylin-eosin staining. Results Totally 33 lymph nodes larger than 5 turn, including 22 inflammatory and 11 metastatic ones, were successfully isolated and taken into pathological analysis. LSR showed no significant difference between the inflammatory and malignant lymph nodes （P 〉 0.05）. Both benign and malignant lymph nodes appeared iso-intense on TlWI and hyperintense on both T2WI and DWI images with an even lower TlWI and higher T2WI SI core at the hilum. Both T2WI and DWI SI showed no significant difference between two pathological groups （P 〉 0.01） in popliteal fossa. The mean ADC value of inflammatory nodes [（1.199±0.281） ×10^-3 mm^2/s] was significantly higher than that of metastatic nodes [（0.858 ± 0.090） ×10^-3 mm^2/s, P 〈 0.01]. On ADC map, a high ADC value central area could be seen in most of the lymph nodes no matter benign or malignant. ADC value gave out the largest area under curve （AUCADC = 0.955） compared with other three indexes （AUCLsR = 0.488; AUCT2WI SI = 0.727; AUCDDWISI = 0.822） and gave the best sensitivity and specificity in lymph node differential diagnosis compared with the other three indexes. Conclusions High quality DWI image can be obtained using STIR-EPI-DWI sequence in rabbit model. DWI is a new promising technique for differentiating inflammatory from metastatic lymph nodes. Compared with routine MR sequence, DWI could provide more useful physiological and functional information for diagnosis.

1H magnetic resonance spectroscopy and diffusion weighted imaging findings of medulloblastoma in 3.0T MRI A retrospective analysis of 17 cases

1H magnetic resonance spectroscopy and diffusion weighted imaging features of the cerebellar vermis in 17 medulloblastoma patients were retrospectively analyzed, and 17 healthy volunteers were selected as controls. 1H magnetic resonance spectroscopy showed that in all 17 medulloblastoma patients, N-acetyl aspartate and creatine peaks were significantly decreased, the choline peak was significantly increased, and there was evidence of a myo-inositol peak. Further, 11 patients showed a low taurine peak at 3.4 ppm, five patients showed a lipid peak at 0.9-1.3 ppm, and three patients showed a negative lactic acid peak at 1.33 ppm. Compared with the control group, the ratios of N-acetyl aspartate/choline and N-acetyl aspartate/creatine were significantly decreased, and the ratio of choline/creatine was increased, in medulloblastoma patients. Diffusion weighted imaging displayed hyperintensity and decreased apparent diffusion coefficient in medulloblastoma patients. These findings indicate that 1H magnetic resonance spectroscopy and diffusion weighted imaging are useful for qualitative diagnosis of medulloblastoma.

Image Quality Stability of Whole-body Diffusion Weighted Imaging

Objective To assess the reproducibility of whole-body diffusion weighted imaging(WB-DWI) technique in healthy volunteers under normal breathing with background body signal suppression.Methods WB-DWI was performed on 32 healthy volunteers twice within two-week period using short TI inversion-recovery diffusion-weighted echo-planar imaging sequence and built-in body coil.The volunteers were scanned across six stations continuously covering the entire body from the head to the feet under normal breathing.The bone apparent diffusion coefficient(ADC) and exponential ADC(eADC) of regions of interest(ROIs) were measured.We analyzed correlation of the results using paired-t-test to assess the reproducibility of the WB-DWI technique.Results We were successful in collecting and analyzing data of 64 WB-DWI images.There was no significant difference in bone ADC and eADC of 824 ROIs between the paired observers and paired scans(P>0.05).Most of the images from all stations were of diagnostic quality.Conclusion The measurements of bone ADC and eADC have good reproducibility.WB-DWI technique under normal breathing with background body signal suppression is adequate.

Value of whole body diffusion weighted imaging in diagnostic and therapeutic evaluation of malignant lymphoma

Objective:The aim was to evaluate the role of whole body diffusion weighted imaging(WB-DWI) of magnetic resonance in the diagnosis and efficacy evaluation of malignant lymphoma.Methods:The clinical manifestation of whole body diffusion weighted imaging of 47 patients with malignant lymphoma being pathologically proved were carried on by retrospective analysis and to compare with 10 healthy volunteers.There were 8 cases of Hodgkin's lymphoma(HD) patients,of which WB-DWI examination of 5 cases were carried out before and after treatment and 3 cases were done after treatment.There were 39 cases of non-Hodgkin's lymphoma(NHL) patients,of which WB-DWI examination in 19 cases were acted before treatment,11 cases were done before and after treatment and 9 cases done after treatment.In apparent diffusion coefficient(ADC) diagram the ADC values of lymph nodes in patients with malignant lymphoma and healthy volunteers were measured respectively,among 16 patients the ADC values of parts of lymph node being consistent with the initial inspection were determined again and compared the values before and after,and compared with healthy volunteers.Results:Whole body magnetic resonance diffusion weighted imaging(MR-DWI) showed more sensitive to lymphoma,and 372 lymph nodes greater than 1 cm were detected with MR-DWI.Before treatment,mean ADC value of 35 patients with malignant lymphoma was(0.86 ± 0.21) × 10-3 mm2/s,of which an average ADC values of 28 cases after treatment was(1.22 ± 0.31) × 10-3 mm2/s,before and after treatment difference of the average ADC values of patients was statistically significant(P < 0.05);the average ADC value of cervical lymph nodes of 10 healthy volunteers(1.29 ± 0.12) × 10-3 mm2/s and of 30 patients with malignant lymphoma before treatment was statistically significant(P < 0.05),and to compare with 28 patients after treatment difference of the ADC values was not statistically significant(P > 0.05).Conclusion:WB-DWI and ADC values being measured in the clinical diagnosis of malignant lymphoma,staging and evaluation of efficacy of monitoring is a fast and effective technology,with some clinical value.

Value of MRI diffusion weighted imaging in localization of prostate cancer with whole-mount step section pathology

Objective To evaluate the value of MRI diffusion weighted imaging in localization of prostate cancer with whole-mount step section pathology. Methods We treated 36 patients using laparoscopic radical prostatectomy from Oct. 2009 to Jun. 2010. Patients who did not have an MRL /DWI examination or a surgical history of pros-

Diffusion weighted magnetic resonance imaging of liver: Principles, clinical applications and recent updates

Diffusion-weighted imaging(DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors such as the ease of acquisition and ability to obtain functional information in the absence of intravenous contrast, especially in patients with abnormal renal function, have contributed to the growing interest in exploring clinical applications of DWI. In the liver, DWI demonstrates a gamut of clinical applications ranging from detecting focal liver lesions to monitoring response in patients undergoing serial follow-up after loco-regional and systemic therapies. DWI is also being applied in the evaluation of diffuse liver diseases such as non-alcoholic fatty liver disease, hepatic fibrosis and cirrhosis. In this review, we intend to review the basic principles, technique, current clinical applications and future trends of DW-MRI in the liver.

CLINICAL APPLICATION OF BODY DIFFUSION WEIGHTED MR IMAGING IN THE DIAGNOSIS AND PREOPERATIVE N STAGING OF CERVICAL CANCER

Objective To evaluate the clinical impact of body diffusion weighted imaging (DWI) on the diagnosis and preoperative N staging of cervical cancer. Methods Twenty-four patients (mean age 37.9 years old) with proved cervical cancer by cervical biopsy and 24 female patients with other suspected pelvic abnormalities received preoperative body DWI scan. Results of body DWI were compared with pathological findings. The apparent diffusion coefficient (ADC) values of normal cervix and different pathological types of cervical cancer were compared. ADC value of normal or inflammatory lymph nodes was also compared with that of metastatic ones. Student's t test was used for statistical analysis. Results There were 5 adenocarcinomas and 19 epitheliomas showed with biopsy results, and DWI showed 21 cervical lesions out of them (87.5%). ADC values of the normal cervix (n = 24), epithelioma (n = 19), and adenocar- cinoma (n = 5) were (1.73 ± 0.31) ×10-3, (0.88 ± 0.22) ×10-3, and (1.08 ± 0.12) ×10-3 mm2/s, respectively. Statistical analysis showed significant difference in ADC value between normal cervical tissue and either tumor tissues (both P < 0.01). In patients had lymphadenectomy (n = 24), totally 67 lymph nodes including 16 metastatic lymph nodes were pathologically analyzed, and DWI showed 66 (98.5%) out of them. ADC values of normal/inflammatory and metastatic lymph nodes were (1.07 ± 0.16) ×10-3 and (0.77 ± 0.13) ×10-3 mm2/s (P < 0.01). Receiver operating characteristic (ROC) curve of ADC value of metastatic lymph node showed that area under curve was 0.961. Conclusions ADC value in cervical carcinoma is lower than that in normal cervix, and ADC may have predictive value in subtype discrimination. ADC value may improve the preoperative characterization of lymph node metastasis. And at least abdominal and pelvic DWI scan is suggested for N staging evaluation in such patients.

Differential diagnosis of metastasis from non-metastatic lymph nodes in cervical cancers： pilot study of diffusion weighted imaging with background suppression at 3T magnetic resonance

Background Diffusion weighted imaging with background suppression （DWIBS） is potentially useful in detecting metastatic lymph nodes. This study aimed to evaluate the efficacy of DWIBS at 3T magnetic resonance （MR） for diagnosing metastatic lymph nodes in cervical cancer.Methods This retrospective study included 25 patients with cervical cancer who underwent MR examination and were treated by hysterectomy and lymphadenectomy. The metastatic and non-metastatic lymph nodes were histologically proven by operation. Apparent diffusion coefficient （ADC） values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of all the identifiable lymph nodes were measured and compared.Results Twenty-five primary tumor lesions, 17 metastatic lymph nodes and 140 non-metastatic lymph nodes were pathologically confirmed in 25 cases with cervical cancer. The difference of ADC values between primary tumor lesions,metastatic and non-metastatic lymph nodes were statistically significant （F=7.93, P=0.001）. There was no statistically significant difference between primary tumor lesions of cervical cancer and metastatic lymph nodes （t=-0.75, P=-0.456）,and the difference between primary tumor lesions and non-metastatic lymph nodes was statistically significant （t =4.68, P〈0.001）. The ADC values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of metastatic and non-metastatic lymph nodes were （0.86±0.36）×10-3 mm2/s vs. （1.12±0.34）×10-3 mm2/s, （1.51±0.41） cm vs.（1.19±0.36） cm, （1.16±0.35） cm vs. （0.77±0.22） cm, 0.78±0.17 vs. 0.68±0.19 respectively, and statistically significant difference existed between two groups.Conclusions DWIBS at 3T MR has the distinct advantages in detecting pelvic lymph nodes of cervical cancer.Quantitative measurement of ADC values could reflect the degree of restriction of diffusion of metastatic and non-metastatic lymph nodes. The combination of size and ADC value would be useful in the accurate diagnosis of metastatic lymph nodes.

In vivo evaluation of renal function using diffusion weighted imaging and diffusion tensor imaging in type 2 diabetics with normoalbuminuria versus microalbuminuria

This work aims to estimate the value of diffusion weighted imaging （DWI） and diffusion tensor imaging （DTI） in detecting early-stage kidney injury in type 2 diabetic patients with normoalbuminuria （NAU） versus microalbuminuria （MAU） prospectively. A total of 30 T2DM patients with normal kidney function were recruited and assigned to the NAU group （n = 14） or MAU group （n = 16） according to 8 h overnight urinary albuminuria excretion rate （AER） results. A contemporary cohort of health check-up recipients were included as controls （n = 12）. DWI and DTI scans were performed on bilateral kidney using SE single-shot EPI, and apparent diffusion coefficient （ADC） and fractional anisotropy （FA） of the renal parenchyma was determined from ADC and FA maps of the three groups. ADC and FA values were compared among the three groups. According to DWI with a b value of 400 s/mm^2, the MAU and NAU groups showed significantly lowered mean ADC values compared with the healthy controls （P 〈 0.01）. The mean ADC in the MAU group [（2.22± 0.07） × 10^-3 mm^2/s] was slightly lower than that of the NAU group [（2.31 ± 0.22） × 10^- 3 mm^2/s], but this difference was not statistically significant （P 〉 0.05）. The FAvalue in the MAU group was higher than that in the control group （0.45 ± 0.07 vs. 0.3±0.03, P = 0.004） but did not differ from that in the NAU group （0.42 ± 0.03） （P 〉 0.05）. ADC and FA values may be more sensitive than urine AER in reflecting early-stage kidney injury and, hence, may facilitate earlier detection and quantitative evaluation of kidney injury in T2DM patients. Combined evaluation of ADC and FA values may provide a better quantitative approach for identifying diabetic nephropathy at early disease stages.

Three-Tesla magnetic resonance elastography for hepatic fibrosis:Comparison with diffusion-weighted imaging and gadoxetic acid-enhanced magnetic resonance imaging

AIM: To evaluate the feasibility of 3-Tesla magnetic resonance elastography (MRE) for hepatic fibrosis and to compare that with diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance (MR) imaging.