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

Objective： To 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）. Methods： Between 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. Results： Median 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-offof 1.80×10-3 mm^2/s could distinguish between stages I and Ⅱ and an ADC value of ≤1.36-10-3 mm^2/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）. Conclusions： ADC 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.

Apparent diffusion coefficient values of normal testis and variations with age

The usefulness of diffusion-weighted magnetic resonance imaging （DWI） in the evaluation of scrotal pathology has recently been reported. A standard reference of normal testicular apparent diffusion coefficient （ADC） values and their variations with age is necessary when interpreting normal testicular anatomy and pathology. We evaluated 147 normal testes using DWI, including 71 testes from 53 men aged 20-39years （group 1）, 67 testes from 42 men aged 40-69 years （group 2） and nine testes from six men older than 70years （group 3）. DWI was performed along the axial plane, using a single shot, multislice spin-echo planar diffusion pulse sequence and b-values of 0 and 900 s mm-2. The mean and standard deviation of the ADC values of normal testicular parenchyma were calculated for each age group separately. Analysis of variance （ANOVA） followed by post hoc analysis （Dunnett T3） was used for statistical purposes. The ADC values （x 10-3 mm2s-1） of normal testicular tissue were different among age groups （group 1：1.08 ± 0.13; group 2：1.15 ±0.15 and group 3：1.31± 0.22）. ANOVA revealed differences in mean ADC among age groups （F= 11.391, P〈 0.001）. Post hoc analysis showed differences between groups 1 and 2 （P= 0.008） and between groups 1 and 3 （P= 0.043）, but not between groups 2 and 3 （P= 0.197）. Our findings suggest that ADC values of normal testicular tissue increase with advancing age.

Apparent diffusion coefficient in normal and abnormal pattern of intervertebral lumbar discs: initial experience

The aim of the present study was to compare the relationship of morphologically defined non-bulging/herni-ated, bulging and herniated intervertebral lumbar discs with quantitative apparent diffusion coefficient （ADC）. Thirty-two healthy volunteers and 28 patients with back pain or sciatica were examined by MRI. All intervertebral lumbar discs from L1 to S1 were classified according to morphological abnormality and degenerated grades. The ADC values of nucleus pulposus （NP） were measured and recorded. The significant differences about mean ADC values of NP were found between non-bulging/herniated discs and bulging discs as well as herniated discs （P 0.05）, whereas there were no significant differences in ADC values between bulging and herniated discs （P 0.05）. Moreover, statistically significant relationship was found in the mean ADC values of NP between ＂non-bulging/herniated and non-degenerated discs＂ and ＂non-bulging/herniated degenerated discs＂ as well as herniated discs （P 0.05）. Linear regression analysis between ADC value and disc level revealed an inverse correlation （r = -0.18）. The ADC map of the NP is a potentially useful tool for the quantitative assessment of componential and molecular alterations accompanied with lumbar disc abnormalities.

Whole lesion histogram analysis of apparent diffusion coefficient predicts therapy response in locally advanced rectal cancer

BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC.METHODS This is a single-center,retrospective study,which included 48 patients with LARC.All patients underwent a pre-treatment magnetic resonance imaging(MRI)scan for primary tumor staging and a second restaging MRI for response evaluation.The sample was distributed as follows:18 responder patients(R)and 30 non-responders(non-R).Eight parameters derived from the whole-lesion histogram analysis(ADCmean,skewness,kurtosis,and ADC10^(th),25^(th),50^(th),75^(th),90^(th) percentiles),as well as the ADCmean from the hot spot region of interest(ROI),were calculated for each patient before and after treatment.Then all data were compared between R and non-R using the Mann-Whitney U test.Two measures of diagnostic accuracy were applied:the receiver operating characteristic curve and the diagnostic odds ratio(DOR).We also reported intra-and interobserver variability by calculating the intraclass correlation coefficient(ICC).RESULTS Post-nCRT kurtosis,as well as post-nCRT skewness,were significantly lower in R than in non-R(both P<0.001,respectively).We also found that,after treatment,R had a larger loss of both kurtosis and skewness than non-R(Δ%kurtosis and Δ skewness,P<0.001).Other parameters that demonstrated changes between groups were post-nCRT ADC10^(th),Δ%ADC10^(th),Δ%ADCmean,and ROIΔ%ADCmean.However,the best diagnostic performance was achieved byΔ%kurtosis at a threshold of 11.85%(Area under the receiver operating characteristic curve[AUC]=0.991,DOR=376),followed by post-nCRT kurtosis=0.78×10^(-3)mm^(2)/s(AUC=0.985,DOR=375.3),Δskewness=0.16(AUC=0.885,DOR=192.2)and post-nCRT skewness=1.59×10^(-3)mm^(2)/s(AUC=0.815,DOR=168.6).Finally,intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement,ensuring the implementation of histogram analysis into routine clinical practice.CONCLUSION Whole-tumor ADC histogram parameters,particularly kurtosis and skewness,are relevant biomarkers for predicting the nCRT response in LARC.Both parameters appear to be more reliable than ADCmean from one-slice ROI.

Apparent diffusion coefficient evaluation for secondary changes in the cerebellum of rats after middle cerebral artery occlusion

Supratentorial cerebral infarction can cause functional inhibition of remote regions such as the cerebellum, which may be relevant to diaschisis. This phenomenon is often analyzed using positron emission tomography and single photon emission CT. However, these methods are expensive and radioactive. Thus, the present study quantified the changes of infarction core and remote regions after unilateral middle cerebral artery occlusion using apparent diffusion coefficient values. Diffu- sion-weighted imaging showed that the area of infarction core gradually increased to involve the cerebral cortex with increasing infarction time. Diffusion weighted imaging signals were initially in- creased and then stabilized by 24 hours. With increasing infarction time, the apparent diffusion co- efficient value in the infarction core and remote bilateral cerebellum both gradually decreased, and then slightly increased 3-24 hours after infarction. Apparent diffusion coefficient values at remote regions （cerebellum） varied along with the change of supratentorial infarction core, suggesting that the phenomenon of diaschisis existed at the remote regions. Thus, apparent diffusion coefficient values and diffusion weighted imaging can be used to detect early diaschisis.

Correlation of magnetic resonance imaging quantitative parameters and apparent diffusion coefficient value with pathological breast cancer

BACKGROUND China ranks 120th worldwide for the incidence of breast cancer and 163rd for mortality.Early screening,diagnosis,and timely determination of the optimal treatment plan can help ensure clinical efficacy and prognosis.AIM To investigate the relationship between quantitative magnetic resonance imaging parameters,apparent diffusion coefficient value,pathological immunohistochemical status,and patient prognosis.METHODS A total of 108 patients with breast cancer(breast cancer group)and 110 patients with benign breast tumors(benign group)confirmed by pathological examination at our Hospital from September 2013 to August 2016 were selected.All patients had undergone preoperative magnetic resonance imaging(MRI)examinations,and the quantitative parameters of MRI and apparent diffusion coefficient(ADC)values for the two groups were compared.The MRI quantitative parameters and ADC values of patients with different estrogen receptor(ER),progesterone receptor,and human epidermal growth factor receptor-2 expression were statistically analyzed.The relationship between the quantitative parameters of MRI and ADC values and patient recurrence was analyzed using receiver operating curves.RESULTS The measured values of the quantitative parameters of MRI-Ktrans,Kep,and Ve in the breast cancer group were higher than those in the benign group;the ADC value in the breast cancer group was lower than that in the benign group,and the difference was statistically significant(P<0.05).The Ktrans,Ve,and ADC values in patients with ER-positive breast cancer were significantly lower than those in patients with negative ER expression(P<0.05).After 5 years of follow-up,22 patients with breast cancer experienced postoperative recurrence.The Kep,Ve,and ADC values of the recurrence group were significantly lower than those of the non-recurrence group,and the difference was statistically significant(P<0.05).CONCLUSION MRI quantitative parameters and ADC are related to the expression of breast cancer-related immunological receptor factors and have certain clinical value in assessing postoperative recurrence in patients.

The apparent diffusion coefficient does not reflect cytotoxic edema on the uninjured side after traumatic brain injury

After traumatic brain injury, vasogenic and cytotoxic edema appear sequentially on the involved side. Neuroimaging investigations of edema on the injured side have employed apparent diffusion coefficient measurements in diffusion tensor imaging. We investigated the changes occurring on the injured and uninjured sides using diffusion tensor imaging/apparent diffusion coefficient and histological samples in rats. We found that, on the injured side, that vasogenic edema appeared at 1 hour and intracellular edema appeared at 3 hours. Mixed edema was observed at 6 hours, worsening until 12–24 hours post-injury. Simultaneously, microglial cells proliferated at the trauma site. Apparent diffusion coefficient values increased at 1 hour, decreased at 6 hours, and increased at 12 hours. The uninjured side showed no significant pathological change at 1 hour after injury. Cytotoxic edema appeared at 3 hours, and vasogenic edema was visible at 6 hours. Cytotoxic edema persisted, but vasogenic edema tended to decrease after 12–24 hours. Despite this complex edema pattern on the uninjured side with associated pathologic changes, no significant change in apparent diffusion coefficient values was detected over the first 24 hours. Apparent diffusion coefficient values accurately detected the changes on the injured side, but did not detect the changes on the uninjured side, giving a false-negative result.

Transient elastography and diffusion-weighted magnetic resonance imaging for assessment of liver fibrosis in children with chronic hepatitis C

BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment.Noninvasive altern-atives for liver biopsy such as transient elastography(TE)and diffusion-weighted magnetic resonance imaging(DW-MRI)are critical needs.AIM To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.METHODS This prospective cross-sectional study initially recruited 100 children with CHC virus infection.Sixty-four children completed the full set of investigations including liver stiffness measurement(LSM)using TE and measurement of apparent diffusion coefficient(ADC)of the liver and spleen using DW-MRI.Liver biopsies were evaluated for fibrosis using Ishak scoring system.LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.RESULTS Most patients had moderate fibrosis(73.5%)while 26.5%had mild fibrosis.None had severe fibrosis or cirrhosis.The majority(68.8%)had mild activity,while only 7.8%had moderate activity.Ishak scores had a significant direct correlation with LSM(P=0.008)and were negatively correlated with both liver and spleen ADC but with no statistical significance(P=0.086 and P=0.145,respectively).Similarly,histopatho-logical activity correlated significantly with LSM(P=0.002)but not with liver or spleen ADC(P=0.84 and 0.98 respectively).LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages(area under the curve=0.700 and 0.747,respectively)with a better performance of liver ADC.CONCLUSION TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.

Textural differences based on apparent diffusion coefficient maps for discriminating pT3 subclasses of rectal adenocarcinoma

BACKGROUND The accuracy of discriminating pT3a from pT3b-c rectal cancer using highresolution magnetic resonance imaging(MRI)remains unsatisfactory,although texture analysis(TA)could improve such discrimination.AIM To investigate the value of TA on apparent diffusion coefficient(ADC)maps in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors.METHODS This was a case-control study of 59 patients with pT3 rectal adenocarcinoma,who underwent diffusion-weighted imaging(DWI)between October 2016 and December 2018.The inclusion criteria were:(1)Proven pT3 rectal adenocarcinoma;(2)Primary MRI including high-resolution T2-weighted image(T2WI)and DWI;and(3)Availability of pathological reports for surgical specimens.The exclusion criteria were:(1)Poor image quality;(2)Preoperative chemoradiation therapy;and(3)A different pathological type.First-order(ADC values,skewness,kurtosis,and uniformity)and second-order(energy,entropy,inertia,and correlation)texture features were derived from whole-lesion ADC maps.Receiver operating characteristic curves were used to determine the diagnostic value for pT3b-c tumors.RESULTS The final study population consisted of 59 patients(34 men and 25 women),with a median age of 66 years(range,41-85 years).Thirty patients had pT3a,24 had pT3b,and five had pT3c.Among the ADC first-order textural differences between pT3a and pT3b-c rectal adenocarcinomas,only skewness was significantly lower in the pT3a tumors than in pT3b-c tumors.Among the ADC second-order textural differences,energy and entropy were significantly different between pT3a and pT3b-c rectal adenocarcinomas.For differentiating pT3a rectal adenocarcinomas from pT3b-c tumors,the areas under the curves(AUCs)of skewness,energy,and entropy were 0.686,0.657,and 0.747,respectively.Logistic regression analysis of all three features yielded a greater AUC(0.775)in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors(69.0%sensitivity and 83.3%specificity).CONCLUSION TA features derived from ADC maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors.

Value of Apparent Diffusion Coefficient(ADC) of Diffusion eighted Magnetic Resonance Imaging in Common Renal Disease Diagnosis

Objective：To find the value of the apparent diffusion coefficient （ADC） of diffusion weighted magnetic resonance imaging of common renal diseases. Methods： There were 30 healthy subjects and 81 patients with renal lesions （56 cases of renal carcinoma, 18 lesions of 12 cases of renal angiomyolipomal and 21 lesions of 13 cases of renal cysts）. Conventional magnetic resonance imaging and diffusion weighted magnetic resonance imaging were carried out. We measured the average ADC value of the renal lesions and normal kidneys. ADC maps from different b values were generated by a statistical package. Results： The ADC values of normal kidneys with three different motion-probing gradients（b=500, 800, 1000 sec/mm^2） were 2.78 ± 0.14 × 10^-3mm^2s^-1, 2.45 ± 0.13 × 10^3mm^2s^-1, 2.13 ± 0.14 × 10^-3mm^2s^-1, respectively. The ADC values of renal cell carcinoma with three different motion-probing gradients（b=500, 800, 1000 sec/mm^2） were 1.63 ± 0.14 × 10^3mm^2s^-1, 1.31 ± 0.18 × 10^3mm^2s^-, 1.07 ± 0.15 × 10^-3mm^2s^-1, respectively. Among the renal cell carcinoma, the ADC value of clear cell type were 1.67 ± 0.09 × 10^3mm^2s^-1, 1.36 ± 0.13 × 10^3mm^2s^-1, 1.15 ± 0.14 × 10^3mm^2s^-1,respectively; the ADC values of granular cell type were 1.59±0.19 × 10^3mm^2s^-1, 1.25 ± 0.22 × 10^3mm^2s^-1, 0.97 ± 0.12 × 10^3mm^2s^-1, respectively. The ADC values of renal angiomyolipoma with three different motion-probing gradients（b=500, 800,1000 sec/mm^2） were 0.88 ± 0.08 × 10^3mm^2s^-1, 0.63 ± 0.07 × 10^3mm^2s^-1, 0.43 ± 0.04 × 10^3mm^2s^-1, respectively. The ADC values of renal cystic lesions with three different motionprobing gradients（b=500, 800, 1000 sec/mm^2） were 3.73 ± 0.18 × 10^3mm^2s^-1, 3.44 ± 0.13 × 10^3mm^2s^-1, 3.09± 0.21 × 10^3mm^2s^-1, respectively. Statistically significant differences exists between the ADC values of normal kidney, renal carcinomas, renal angiomyolipomas and renal cysts when the b value is the same. Among the different cell types of renal carcinomas, the ADC value of granular cell carcinoma is lower than that of clear cell carcinomas. Conclusion： It is of benefit in diagnosing and distinguishing between benign and malignant renal tumors to know the ADC values in diffusion weighted magnetic resonance imaging. Furthermore, these values help to know the internal structure of the tumor and the tumor typel, which is helpful to the treatment and in predicting the patient＇ s prognosis.

Difference Analysis of MRI Apparent Diffusion Coefficient and R_(2)^(*)Value Between Small Hepatocellular Carcinoma and Cirrhosis Nodules

Objective:To investigate the differences of apparent diffusion coefficient and transverse relaxation rate(R_(2)^(*))in magnetic resonance imaging(MRI)between micro hepatocellular carcinoma and nodules of cirrhosis.Method:The clinical data of 68 patients with micro hepatocellular carcinoma(76 lesions)and 45 patients with nodular cirrhosis(48 lesions)were retrospectively analyzed.Diffusion weighted imaging and R_(2)^(*)imaging were performed on all patients.The differences of apparent diffusion coefficient and R_(2)^(*)values in patients with micro hepatocellular carcinoma and nodular cirrhosis were compared.Receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic efficacy of apparent diffusion coefficient values and R_(2)^(*)values for microhepatocellular carcinoma.Result:Compared with nodules of cirrhosis,the mean apparent diffusion coefficient and R_(2)^(*)value of micro-hepatocellular carcinoma were significantly decreased(P<0.05).The diagnosis threshold of apparent diffusion coefficient is at 1.35×10^(-3)mm^(2)/s,and the sensitivity for the diagnosis of micro-hepatocellular carcinoma was 80.88%,and the specificity was 91.11%,and the corresponding area under the ROC curve was 0.88;The diagnostic threshold for R_(2)^(*)value was at 53.96 Hz,and the sensitivity for the diagnosis of small hepatocellular carcinoma was 91.18%,and the specificity was 77.78%,and the corresponding area under the ROC curve was 0.84.Conclusion:MRI apparent diffusion coefficient value and R_(2)^(*)value can be used to differentiate and diagnose micro hepatocellular carcinoma and nodules of cirrhosis,in which the apparent diffusion coefficient of nodules of cirrhosis was less than 1.35×10^(-3)mm^(2)/s,R_(2)^(*)values were lower than 53.96 Hz may indicate the occurrence of nodular canceration.

Quantitative magnetic resonance imaging in prostate cancer:A review of current technology

Prostate cancer(PCa)imaging forms an important part of PCa clinical management.Magnetic resonance imaging is the modality of choice for prostate imaging.Most of the current imaging assessment is qualitative i.e.,based on visual inspection and thus subjected to inter-observer disagreement.Quantitative imaging is better than qualitative assessment as it is more objective,and standardized,thus improving interobserver agreement.Apart from detecting PCa,few quantitative parameters may have potential to predict disease aggressiveness,and thus can be used for prognosis and deciding the course of management.There are various magnetic resonance imaging-based quantitative parameters and few of them are already part of PIRADS v.2.1.However,there are many other parameters that are under study and need further validation by rigorous multicenter studies before recommending them for routine clinical practice.This review intends to discuss the existing quantitative methods,recent developments,and novel techniques in detail.

Role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of focal hepatic lesions

AIM： To evaluate the utility of diffusion-weighted imaging （DWl） in screening and differential diagnosis of benign and malignant focal hepatic lesions. METHODS： Magnetic resonance imaging （MRI） examinations were performed using the Signa Excite Xl Twin Speed 1.5T system （GE Healthcare, Milwaukee, Wl, USA）. Seventy patients who had undergone MRI of the liver [29 hepatocellular carcinomas （HCC）, four cholangiocarcinomas, 34 metastatic liver cancers, 10 hemangiomas, and eight cysts] between April 2004 and August 2008 were retrospectively evaluated. Visualization of lesions, relative contrast ratio （RCR）, and apparent diffusion coefficient （ADC） were compared between benign and malignant lesions on DWl. Su- perparamagnetic iron oxide （SPIO） was administered to 59 patients, and RCR was compared pre- and postadministration.RESULTS： DWI showed higher contrast between malignant lesions （especially in multiple small metastatic cancers） and surrounding liver parenchyma than did contrast-enhanced computed tomography. ADCs （mean±SD × 10^-3 mm2/s） were significantly lower （P 〈 0.05） in malignant lesions （HCC： 1.31 ± 0.28 and liver metastasis： 1.11 ± 0.22） and were significantly higher in benign lesions （hemangioma： 1.84 ± 0.37 and cyst： 2.61 ± 0.45） than in the surrounding hepatic tissues. RCR between malignant lesions and surrounding he- patic tissues significantly improved after SPIO administration, but RCRs in benign lesions were not improved.CONCLUSION： DWI is a simple and sensitive method for screening focal hepatic lesions and is useful for differential diagnosis.

Diffusion tensor imaging assesses white matter injury in neonates with hypoxic-ischemic encephalopathy

With improvements in care of at-risk neonates, more and more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. Computed tomography, ultrasound, and conventional magnetic resonance imaging are helpful to diagnose brain injury, but cannot quantify white matter damage. In this study, ten full-term infants without brain injury and twenty-two full-term neonates with hypoxic-ischemic encephalopathy （14 moderate cases and 8 severe cases） underwent diffusion tensor imaging to assess its feasibility in evaluating white matter damage in this condition. Results demonstrated that fractional anisotropy, voxel volume, and number of fiber bundles were different in some brain areas between infants with brain injury and those without brain injury. The correlation between fractional anisotropy values and neonatal behavioral neurological assessment scores was closest in the posterior limbs of the internal capsule. We conclude that diffusion tensor imaging can quantify white matter injury in neonates with hypoxic-ischemic encephalopathy.

Evaluation of diffusion weighted imaging of magnetic resonance imaging in small focal hepatic lesions:a quantitative study in 56 cases

Diffusion-weighted imaging (DWI) as a new technique of magnetic resonance imaging (MRI) is used to detect focal hepatic lesions. This study was designed to evaluate the significance of DWI to differentiate focal hepatic lesions less than 3 cm in diameter by the quantitation of apparent diffusion coefficient (ADC) values. METHODS:DWI using 1.5T MRI scanner unit was performed with a spin-echo single-shot echo planar imaging (EPI) in 56 cases of small focal hepatic lesions, including hepatocellular carcinoma (11), hepatic metastatic tumor (15 ), hepatic cavernous hemangioma (14), and hepatic cyst (16).The ADC values of these lesions were calculated respectively. The ratios of the ADC values of lesion/liver in hepatocellular carcinomas and hepatic metastatic tumors were also estimated. RESULTS:The mean ADC values (mm2/s) were (0.93±0.06) ×10-3 in hepatocellular carcinomas, (1.09±0.18)×10-3 in hepatic metastatic tumors,(1.95±0.38)×10-3 in hepatic cavernous hemangiomas, and (3.18±0.33) ×10-3 in hepatic cysts. The ratios of ADC values of lesion/liver were 0.90±0.06 and 1.15±0.14 in hepatocellular carcinoma and hepatic metastatic tumors respectively, which were significantly different (P<0.05). CONCLUSION:The measurement of ADC values and the ratios of ADC values of lesion/liver are helpful in MR diagnosis and differentiation of focal hepatic lesions.

Characteristics and pathological mechanism on magnetic resonance diffusion-weighted imaging after chemoembolization in rabbit liver VX-2 tumor model

AIM: To investigate dynamic characteristics and pathological mechanism of signal in rabbit VX-2 tumor model on diffusion-weighted imaging (DWI) after chemoembolization. METHODS: Forty New Zealand rabbits were included in the study and forty-seven rabbit VX-2 tumor models were raised by implanting directly and intrahepatically after abdominal cavity opened. Forty VX-2 tumor models from them were divided into four groups. DWI was performed periodically and respectively for each group after chemoembolization. All VX-2 tumor samples of each group were studied by pathology. The distinction of VX-2 tumors on DWI was assessed by their apparent diffusion coefficient (ADC) values. The statistical significance between different time groups, different area groups or different b-value groups was calculated by using SPSS12.0 software. RESULTS: Under b-value of 100 s/mm2, ADC values were lowest at 16 h after chemoembolization in area of VX-2 tumor periphery, central, and normal liver parenchyma around tumor, but turned to increase with further elongation of chemoembolization treatment. The distinction of ADC between different time groups was significant respectively (F = 7.325, P < 0.001; F = 2.496, P < 0.048; F = 6.856, P < 0.001). Cellular edema in the area of VX-2 tumor periphery or normal liver parenchyma around tumor, increased quickly in sixteen h after chemoembolization but, from the 16th h to the 48th h, cellular edema in the area of normal liver parenchyma around tumor decreased gradually and that in the area of VX-2 tumor periphery decreased lightly at, and then increased continually. After chemoembolization, Cellular necrosis in the area of VX-2 tumor periphery was more significantly high than that before chemoembolization. The areas of dead cells in VX-2 tumors manifested low signal and high ADC value, while the areas of viable cells manifested high signal and low ADC value. CONCLUSION: DWI is able to detect and differentiate tumor necrotic areas from viable cellular areas before and after chemoembolization. ADC of normal liver parenchyma and VX-2 tumor are influenced by intracellular edema, tissue cellular death and microcirculation disturbance after chemoembolization.

Acute pancreatitis successfully diagnosed by diffusion-weighted imaging: A case report

Diffusion-weighted imaging (DWI) is an established diagnostic method of acute stroke. The latest advances in magnetic resonance imaging (MRI) technology have greatly expanded the utility of DWI in the examination of various organs. Recent studies have revealed the usefulness of DWI for imaging of the liver, kidney, ovary, and breast. We report a patient with acute pancreatitis detected by DWI and discussed the efficacy of DWI in diagnosing acute pancreatitis. A 50-year old man presented with a primary complaint of abdominal pain. We performed both DWI and computed tomography (CT) for this patient. The signal intensity in a series of DWI was measured and the apparent diffusion coefficient (ADC) values were calculated to differentiate inflammation from normal tissue. Two experienced radiologists evaluated the grade of acute pancreatitis by comparing the CT findings. Initially, the pancreas and multiple ascites around the pancreas produced a bright signal and ADC values were reduced on DWI. As the inflammation decreased, the bright signal faded to an iso-signal and the ADC values returned to their normal level. There was no difference in the abilities of DWI and CT images to detect acute pancreatitis. However, our case indicates that DWI can evaluate the manifestations of acute pancreatitis using no enhancement material andhas the potential to replace CT as a primary diagnostic strategy for acute pancreatitis.

Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization

AIM: To investigate whether intra-procedural diffusion- weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during trans- catheter arterial chemoembolization (TACE). METHODS: Sixteen patients (15 male), aged 59 ±11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Ana- tomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm2) were performed on a 1.5-T unit. Tumor enhancement and apparent diffusion coefficient (ADC, mm2/s) values were assessed immediately before and at 1 and 3 mo after TACE. We calculated the percent change (PC) in ADC values at all time points. We compared follow-up ADC values to baseline values using a paired t test (α = 0.05). RESULTS: The intra-procedural sensitivity, specificity, and positive and negative predictive values (%) for detecting a complete or partial 1-mo tumor response using ADC PC thresholds of ±5%, ±10%, and ±15% were 77, 67, 91, and 40; 54, 67, 88, and 25; and 46, 100, 100, and 30, respectively. There was no clear predictive value for the 3-mo follow-up. Compared to baseline, the immediate post-procedure and 1-mo mean ADC values both increased; the latter obtaining statistical significance (1.48 ± 0.29 mm2/s vs 1.65 ± 0.35 × 10-3 mm2/s, P < 0.014). CONCLUSION: Intra-procedural ADC changes of > 15% predicted 1-mo anatomical HCC response with the greatest accuracy, and can provide valuable feedback at the time of TACE.

Effect of b value on monitoring therapeutic response by diffusion-weighted imaging

AIM： To explore the diffusion gradient b-factor that optimizes both apparent diffusion coefficient （ADC） measurement and contrast-to-noise （CNR） for assessing tumor response to transarterial chemoembolization （TACE） in a rabbit model. METHODS： Twelve New Zealand white rabbits bearing VX2 tumors in the liver were treated with TACE. Diffusion-weighted imaging （DWI） with various b values was performed using the same protocol before and 3 d after treatment with TACE. ADC values and CNR of each tumor pre- and post-treatment with different b factors were analyzed. Correlation between ADC values and extent of necrosis in histological specimens was analyzed by a Pearson＇s correlation test.RESULTS： The quality of diffusion-weighted images diminished as the b value increased. A substantial decrease in the mean lesion-to-liver CNR was observed on both pre- and post-treatment DW images, the largest difference in CNR pre- and post-treatment was manifested at a b value of 1000 s/mm^2 （P = 0.036 ）. The effect of therapy on diffusion early after treatment was shown by a significant increase in ADCs （P = 0.007）, especially with large b factors （≥ 600 s/mm^2）. The mean percentage of necrotic cells present within the tumor was 76.3%-97.5%. A significant positive correlation was found between ADC values and the extent of necrosis with all b values except for b200, a higher relative coefficient between ADC values and percentage of necrosis was found on DWI with bl000 and b2000 （P = 0.002 and 0.006, respectively）. CONCLUSION： An increasing b value of up to 600 s/mm^2 would increase ADC contrast pre- and post-treatment, but decrease image quality. Taking into account both CNR and ADC measurement, diffusion-weighted imaging obtained with a b value of 1000 s/mm^2 is recommended for monitoring early hepatic tumor response to TACE.

Characteristics of liver on magnetic resonance diffusion-weighted imaging:Dynamic and image pathological investigation in rabbit liver VX-2 tumor model

AIM： To investigate dynamical and image pathological characteristics of the liver on magnetic resonance （MR） diffusion-weighted imaging （DWI） in the rabbit VX-2 tumor model. METHODS： Forty New Zealand rabbits were included in the study and VX-2 tumor piece was implanted intrahepatically. Fifteen animals received two intrahepatic implantations while 25 had one intrahepatical implantation. DWI, T1- and T2-weighted of magnetic resonance imaging （MRI） were carried out on the 7th and the 14th d after implantation and DWI was conducted, respectively on the 21th d. Ten VX-2 tumor samples were studied pathologically. RESULTS： The rate of lump detected by DWI, TlWI and T2WI was 78.7%, 10.7% and 53.5% （X^2 =32.61, P 〈 0.001） on the 7th d after implantation and 95.8%, 54.3% and 82.9% （X^2 = 21.50, P 〈 0.001） on the 14th d. The signal of most VX-2 tumors on DWI was uniform and it was equal diffusion coefficient （ADC）. did not decrease on the 7th on the map of apparent The signal of VX tumors d after implantation, most of them slowly growing during the week following implantation without significant cell dying within the tumor. VX-2 tumors grew increasingly within 14 d after implantation but the signal of most VX-2 tumors on DWI or on the map of ADC was uniform or uneven and ADC of VX tumors decreased obscurely or slightly because tumor necrosis was still not obvious. On the 21th d after implantation, the signal of most VX-2 tumors on DWI or on the map of ADC was uneven because tumor necrosis was evident and ADC of VX-2 tumor necrotic areas decreased. The areas of viable cells in VX-2 tumors manifested a high signal on DWI and a low signal on the map of ADC. The areas of dead cells or necrosis in VX-2 tumors manifested low signals on DWI and low, equal or high signals on the map of ADC but they manifested high signals on DWI and on the map of ADC at the same time when the areas of necrotic tumor became liquefied or cystic. The border of tumors on DWI appeared gradually distinct and internal signals of tumor became progressively uneven. CONCLUSION： The manifestations of viable, necrotic and liquefied or cystic areas in VX-2 tumors on DWI are typical and DWI is of significant and potential values in clinical application in both the early detection and diagnosis of liver tumors.