Monoexponential, biexponential and stretched-exponential models based diffusion weighted imaging: a comparative study in the differential diagnosis of benign and malignant breast lesions

Objective To investgate the value of various parameters obtained from monoexponential,biexponential,and stretched exponential diffusion-weighted imaging models in the differential diagnosis of breast lesions.Methods A retrospective study was performed in 54 patients with pathologically confirmed malignant tumors(n=30),benign lesions(n=34)and normal fibroglandular

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.

Differential diagnosis of pancreatic cancer by single-shot echo-planar imaging diffusion-weighted imaging

AIM: To investigate the diagnostic ability of single-shot echo-planar imaging(EPI) diffusion-weighted imaging (DWI) to differentiate between malignant and benign pancreatic lesions. METHODS: A computerized search was performed on Pub Med, MEDLINE and EMBASE up to August 2014. Nine studies(10 sets of data) with a total of 304 malignant pancreatic lesions and 188 benign pancreatic lesions were included. The characteristics of each study included the study name, year of publication, magnetic resonance modalities used, patient population, strength of field, pulse time, repetition time, echo time(TE), maximum b factor, mean age, mean body weight, fat suppression, number of benign and malignant lesions, and true positive, true negative, false positive and false negative results. All analyses were performed using Meta-Di Sc and Stata 11.0.RESULTS: The pooled sensitivity and specificity of singleshot EPI DWI were 0.83(95%CI: 0.79-0.87) and 0.77(95%CI: 0.70-0.83), respectively. The positive likelihood ratio and negative likelihood ratio were 5.09(95%CI: 2.19-11.84) and 0.23(95%CI: 0.15-0.36), respectively. The P value for the χ2 heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.89 and 0.82, respectively. Publication bias was not present(t = 0.58, P = 0.58). Meta-regression analysis indicated that fat suppression, mean age, TE, and maximum b factor were not sources of heterogeneity(all P > 0.05). CONCLUSION: Single-shot EPI DWI is useful to differentiate between malignant and benign pancreatic lesions. Lesion size ≥ 2 cm is the limit for the diagnosis of early lesions.

Diffusion-weighted magnetic resonance imaging in cancer: Reported apparent diffusion coefficients,in-vitro and invivo reproducibility

There is considerable disparity in the published apparent diffusion coefficient(ADC) values across different anatomies. Institutions are increasingly assessing repeatability and reproducibility of the derived ADC to determine its variation,which could potentially be used as an indicator in determining tumour aggressiveness or assessing tumour response. In this manuscript,a review of selected articles published to date in healthy extracranial body diffusion-weighted magnetic resonance imaging is presented,detailing reported ADC values and discussing their variation across different studies. In total 115 studies were selected including 28 for liver parenchyma,15 for kidney(renal parenchyma),14 for spleen,13 for pancreatic body,6 for gallbladder,13 for prostate,13 for uterus(endometrium,myometrium,cervix) and 13 for fibroglandular breast tissue. Median ADC values in selected studies were found to be 1.28 × 10-3 mm2/s in liver,1.94 × 10-3 mm2/s in kidney,1.60 × 10-3 mm2/s in pancreatic body,0.85 × 10-3 mm2/s in spleen,2.73 × 10-3 mm2/s in gallbladder,1.64 × 10-3 mm2/s and 1.31 × 10-3 mm2/s in prostate peripheral zone and central gland respectively(combined median value of 1.54×10-3 mm2/s),1.44 × 10-3 mm2/s in endometrium,1.53 × 10-3 mm2/s in myometrium,1.71 × 10-3 mm2/s in cervix and 1.92 × 10-3 mm2/s in breast. In addition,six phantom studies and thirteen in vivo studies were summarized to compare repeatability and reproducibility of the measured ADC. All selected phantom studies demonstrated lower intra-scanner and inter-scanner variation compared to in vivo studies. Based on the findings of this manuscript,it is recommended that protocols need to be optimised for the body part studied and that system-induced variability must be established using a standardized phantom in any clinical study. Reproducibility of the measured ADC must also be assessed in a volunteer population,as variations are far more significant in vivo compared with phantom studies.

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.

Prediction of different stages of rectal cancer: Texture analysis based on diffusion-weighted images and apparent diffusion coefficient maps

BACKGROUND It is evident that an accurate evaluation of T and N stage rectal cancer is essential for treatment planning.It has not been extensively investigated whether texture features derived from diffusion-weighted imaging(DWI)images and apparent diffusion coefficient(ADC)maps are associated with the extent of local invasion(pathological stage T1-2 vs T3-4)and nodal involvement(pathological stage N0 vs N1-2)in rectal cancer.AIM To predict different stages of rectal cancer using texture analysis based on DWI images and ADC maps.METHODS One hundred and fifteen patients with pathologically proven rectal cancer,who underwent preoperative magnetic resonance imaging,including DWI,were enrolled,retrospectively.The ADC measurements(ADCmean,ADCmin,ADCmax)as well as texture features,including the gray level co-occurrence matrix parameters,the gray level run-length matrix parameters and wavelet parameters were calculated based on DWI(b=0 and b=1000)images and the ADC maps.Independent sample t-tests or Mann-Whitney U tests were used for statistical analysis.Multivariate logistic regression analysis was conducted to establish the models.The predictive performance was validated by receiver operating characteristic curve analysis.RESULTS Dissimilarity,sum average,information correlation and run-length nonuniformity from DWIb=0 images,gray level nonuniformity,run percentage and run-length nonuniformity from DWIb=1000 images,and dissimilarity and run percentage from ADC maps were found to be independent predictors of local invasion(stage T3-4).The area under the operating characteristic curve of the model reached 0.793 with a sensitivity of 78.57%and a specificity of 74.19%.Sum average,gray level nonuniformity and the horizontal components of symlet transform(SymletH)from DWIb=0 images,sum average,information correlation,long run low gray level emphasis and SymletH from DWIb=1000 images,and ADCmax,ADCmean and information correlation from ADC maps were identified as independent predictors of nodal involvement.The area under the operating characteristic curve of the model reached 0.802 with a sensitivity of 80.77%and a specificity of 68.25%.CONCLUSION Texture features extracted from DWI images and ADC maps are useful clues for predicting pathological T and N stages in rectal cancer.

Importance of b value in diffusion weighted imaging for the diagnosis of pancreatic cancer

AIM:To investigate the use of multi-b-value diffusionweighted imaging in diagnosing pancreatic cancer.METHODS:We retrospectively analyzed 33 cases of pancreatic cancer and 12 cases of benign pancreatic tumors at the Second Affiliated Hospital of Kunming Medical University from December 2008 to January2011.The demographic characteristics,clinical presentation,routine magnetic resonance imaging and diffusion weighted imaging(DWI)features with different b values were reviewed.Continuous data were expressed as mean±SD.Comparisons between pancreatic cancer and benign pancreatic tumors were performed using the Student’s t test.A probability of P<0.05 was considered statistically significant.RESULTS:Thirty-three patients with pancreatic cancer were identified.The mean age at diagnosis was 60±5.6 years.The male:female ratio was 21:12.Twenty cases were confirmed by surgical resection and 13 by biopsy of metastases.T1 weighted images demonstrated a pancreatic head mass in 16 patients,a pancreatic body mass in 10 cases,and a pancreatic tail mass with pancreatic atrophy in 7 cases.Eight patients had hepatic metastases,13 had invasion or envelopment of mesenteric vessels,4 had bone metastases,and 8had lymph node metastases.DWI demonstrated an irregular intense mass with unclear margins.Necrotic tissue demonstrated an uneven low signal.A b of 1100s/mm2was associated with a high intensity signal with poor anatomical delineation.A b of 700 s/mm2was associated with apparent diffusion coefficients(ADCs)that were useful in distinguishing benign and malignant pancreatic tumors(P<0.05).b values of 50,350,400,450 and 1100 s/mm2were associated with ADCs that did not differentiate the two tumors.CONCLUSION:Low b value images demonstrated superior anatomical details when compared to high b value images.Tumor tissue definition was high and contrast with the surrounding tissues was good.DWI was useful in diagnosing pancreatic cancer.

Utility of diffusion-weighted imaging in the diagnosis of inguinal lymph node metastasis with malignant melanoma

Malignant melanoma is a malignancy of pigmentproducing cells(melanocytes) located predominantly in the skin. Nodal metastases are an adverse prognostic factor compromising long term patient survival. Therefore, accurate detection of regional nodal metastases is required for optimization of treatment. Computed tomography(CT) and magnetic resonance imaging(MRI) remain the primary imaging modalities for regional staging of malignant melanoma. However, both modalities rely on size-related and morphological criteria to differentiate between benign and malignant lymph nodes, decreasing the sensitivity for detection of small metastases. Surgery is the primary mode of therapy for localized cutaneous melanoma. Patients should be followed up for metastases after surgical removal. We report here a case of inguinal lymph node enlargement with a genital vesicular lesion with a history of surgery for malignant melanoma on her thigh two years ago. CT and diffusion weighted-MRI(DW-MRI) were applied for the lymph node identification. DW-MRI revealed malignant lymph nodes due to malignant melanoma metastases correlation with pathological findings.

Apparent diffusion coefficient-based histogram analysis differentiates histological subtypes of periampullary adenocarcinoma

BACKGROUND For periampullary adenocarcinoma,the histological subtype is a better prognostic predictor than the site of tumor origin.Intestinal-type periampullary adenocarcinoma(IPAC)is reported to have a better prognosis than the pancreatobiliary-type periampullary adenocarcinoma(PPAC).However,the classification of histological subtypes is difficult to determine before surgery.Apparent diffusion coefficient(ADC)histogram analysis is a noninvasive,nonenhanced method with high reproducibility that could help differentiate the two subtypes.AIM To investigate whether volumetric ADC histogram analysis is helpful for distinguishing IPAC from PPAC.METHODS Between January 2015 and October 2018,476 consecutive patients who were suspected of having a periampullary tumor and underwent magnetic resonance imaging(MRI)were reviewed in this retrospective study.Only patients who underwent MRI at 3.0 T with different diffusion-weighted images(b-values=800 and 1000 s/mm^2)and who were confirmed with a periampullary adenocarcinoma were further analyzed.Then,the mean,5th,10th,25th,50th,75th,90th,and 95th percentiles of ADC values and ADCmin,ADCmax,kurtosis,skewness,and entropy were obtained from the volumetric histogram analysis.Comparisons were made by an independent Student's t-test or Mann-Whitney U test.Multiple-class receiver operating characteristic curve analysis was performed to determine and compare the diagnostic value of each significant parameter.RESULTS In total,40 patients with histopathologically confirmed IPAC(n=17)or PPAC(n=23)were enrolled.The mean,5th,25th,50th,75th,90th,and 95th percentiles and ADCmax derived from ADC1000 were significantly lower in the PPAC group than in the IPAC group(P<0.05).However,values derived from ADC800 showed no significant difference between the two groups.The 75th percentile of ADC1000 values achieved the highest area under the curve(AUC)for differentiating IPAC from PPAC(AUC=0.781;sensitivity,91%;specificity,59%;cut-off value,1.50×10^-3 mm^2/s).CONCLUSION Volumetric ADC histogram analysis at a b-value of 1000 s/mm2 might be helpful for differentiating the histological subtypes of periampullary adenocarcinoma before surgery.

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).

Meta-analysis of Quantitative Diffusion-weighted MR Imaging in Differentiating Benign and Malignant Pancreatic Masses

There have been numerous studies done to explore the diagnostic performance of quanti- tative diffusion-weighted （DW） MR imaging to differentiate between benign and malignant pancre- atic masses. However, the results have been inconsistent. We performed a meta-analysis to investigate whether DW-MR imaging can differentiate between these two diseases. Databases including MEDLINE, EMBASE and Cochrane Library were utilized to find relevant articles published between January 2001 and January 2014. A Stata version 12.0 and a Meta-Disc version 1.4 were used to de- scribe primary results. Twelve studies with 594 patients, which fulfilled the inclusion criteria, were enrolled for the analysis. The pooled sensitivity and specificity of DW imaging was 0.91 （95% CI： 0.84, 0.95） and 0.86 （95% CI： 0.76, 0.93） respectively. The area under the curve of the summary re- ceiver operating characteristic was 0.95 （95% CI： 0.93, 0.96）. The results indicated that DW imaging might be a valuable tool for differentiating benign and malignant pancreatic masses.

Differentiation between Benign and Malignant Breast Lesions Using ADC on Diffusion-Weighted Imaging at 3.0 T

Aim: To investigate the diagnostic efficiency of apparent diffusion coefficient value (ADC) in differentiating benign from malignant breast lesions at 3.0 T diffusion-weighted imaging with different pair of b value. Methods: Total 110 patients with 107 lesions (44 benign and 63 malignant) were selected for our study with five different b-values 0, 400, 800, 1200 and 1600 s/mm2. ADC values were calculated using different pairs of b values. The cut-off ADC values and diagnostic efficiency were evaluated by receiver operating characteristic analysis. Comparison of Mean ADC value for breast lesions was determined by using independent sample t test. ROC curves were used for diagnostic efficiency of ADC using different pairs of b values. Results: With increase of b value, mean ADC value decreases. The mean ADC values for benign were 1.73 × 10-3 mm2/s for b 0 and 400, 1.57 × 10-3 mm2/s for b 0 and 800, 1.43 × 10-3 mm2/s for b 0 and 1200 and 1.30 × 10-3 mm2/s for b 0 and 1600 s/mm2. The mean ADC values for the malignant breast lesion were 1.21 × 10-3 mm2/s for b 0 and 400, 1.06 × 10-3 mm2/s for b 0 and 800, 0.94 × 10-3 mm2/s for b 0 and 1200 and 0.86 × 10-3 mm2/s for b 0 and 1600 s/mm2. ADC diagnostic efficiency for benign and malignant lesion for all the pair of b value combination was significant (p > 0.05). The sensitivity, specificity, PPV, NPV and accuracy were 80.95%, 90.9%, 92.72%, 76.92%, 85.04% for b 0 and 400;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 800;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 1200;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 1600 s/mm2 respectively. Conclusion: DWI is effective in differentiating benign and malignant breast lesion at 3.0 Tesla using ADC with higher b value combination.

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.

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.

Diffusion-weighted magnetic resonance imaging for predicting the response of rectal cancer to neoadjuvant concurrent chemoradiation

AIM:To evaluate the clinical value of diffusion-weighted magnetic resonance imaging(DW-MRI)in predicting the response of rectal cancer to neoadjuvant chemoradiation.METHODS:This prospective study was approved by our institutional review board,and informed consent was obtained from each patient.Fifteen patients(median age 56 years)with locally advanced rectal cancer were treated in our hospital from June 2006 to December 2007.All patients were stageⅢB-C according to the results of MRI and endorectal ultrasound examinations.All patients underwent pelvic irradiation with 45 Gy/25 fx per 35 days.The concurrent chemotherapy regimen consisted of capecitabine 625mg/m2,bid(Monday-Friday),and oxaliplatin 50 mg/m2,weekly.The patients underwent surgery 5-8 wk after the completion of neoadjuvant therapy.T downstaging was defined as the downstaging of the tumor from cT3to ypT0-2 or from cT4 to ypT0-3.Good regression was defined as TRG 3-4,and poor regression was defined as TRG 0-2.Diffusion-weighted magnetic resonance images were obtained prior to and weekly during the course of neoadjuvant chemoradiation,and the apparent diffusion coefficient(ADC)values were calculated from the acquired tumor images.RESULTS:Comparison with the mean pretreatment tumor ADC revealed an increase in the mean tumor ADC during the course of neoadjuvant chemoradiation,especially at the 2ndweek(P=0.004).We found a strong negative correlation between the mean pretreatment tumor ADC and tumor regression after neoadjuvant chemoradiation(P=0.021).In the T downstage and tumor regression groups,we found a significant increase in the mean ADC at the 2ndweek of neoadjuvant therapy(P=0.011;0.004).CONCLUSION:DW-MRI might be a valuable clinical tool to help predict or assess the response of rectal cancer to neoadjuvant chemoradiation at an early timepoint.

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.

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.

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.

Histogram analysis of apparent diffusion coefficient predicts response to radiofrequency ablation in hepatocellular carcinoma

Objective: The aim of this study was to predict tumor progression in patients with hepatocellular carcinoma(HCC) treated with radiofrequency ablation(RFA) using histogram analysis of apparent diffusion coefficients(ADC).Methods: Breath-hold diffusion weighted imaging(DWI) was performed in 64 patients(33 progressive and 31 stable) with biopsy-proven HCC prior to RFA. All patients had pre-treatment magnetic resonance imaging(MRI)and follow-up computed tomography(CT) or MRI. The ADC values(ADC_(10), ADC_(30_, ADC_(median) and ADC_(max))were obtained from the histogram's 10 th, 30 th, 50 th and 100 th percentiles. The ratios of ADC_(10), ADC_(30_,ADCmedian and ADCmax to the mean non-lesion area-ADC(RADC_(10), RADC_(30_, RADC_(median), and RADC_(max)) were calculated. The two patient groups were compared. Key predictive factors for survival were determined using the univariate and multivariate analysis of the Cox model. The Kaplan-Meier survival analysis was performed, and pairs of survival curves based on the key factors were compared using the log-rank test.Results: The ADC_(30_, ADCmedian, ADCmax, RADC_(30_, RADC_(median), and RADC_(max) were significantly larger in the progressive group than in the stable group(P<0.05). The median progression-free survival(PFS) was 22.9 months for all patients. The mean PFS for the stable and progressive groups were 47.7±1.3 and 9.8±1.3 months,respectively. Univariate analysis indicated that RADC_(10), RADC_(30_, and RADC_(median) were significantly correlated with the PFS [hazard ratio(HR)=31.02, 43.84, and 44.29, respectively, P<0.05 for all]. Multivariate analysis showed that RADCmedian was the only independent predictor of tumor progression(P=0.04). And the cutoff value of RADC_(median) was 0.71.Conclusions: Pre-RFA ADC histogram analysis might serve as a useful biomarker for predicting tumor progression and survival in patients with HCC treated with RFA.

Diffusion-weighted magnetic resonance imaging reflects activation of signal transducer and activator of transcription 3 during focal cerebral ischemia/reperfusion

Signal transducer and activator of transcription（STAT）is a unique protein family that binds to DNA,coupled with tyrosine phosphorylation signaling pathways,acting as a transcriptional regulator to mediate a variety of biological effects.Cerebral ischemia and reperfusion can activate STATs signaling pathway,but no studies have confirmed whether STAT activation can be verified by diffusion-weighted magnetic resonance imaging（DWI）in rats after cerebral ischemia/reperfusion.Here,we established a rat model of focal cerebral ischemia injury using the modified Longa method.DWI revealed hyperintensity in parts of the left hemisphere before reperfusion and a low apparent diffusion coefficient.STAT3 protein expression showed no significant change after reperfusion,but phosphorylated STAT3 expression began to increase after 30 minutes of reperfusion and peaked at 24 hours.Pearson correlation analysis showed that STAT3 activation was correlated positively with the relative apparent diffusion coefficient and negatively with the DWI abnormal signal area.These results indicate that DWI is a reliable representation of the infarct area and reflects STAT phosphorylation in rat brain following focal cerebral ischemia/reperfusion.