Objective To evaluate the clinical impact of whole body diffusion weighted imaging （WB-DWI） on diagnosis and staging of malignant lymphoma. Methods Thirty-one patients with suspected lymphadenopathy were enrolled. ...Objective To evaluate the clinical impact of whole body diffusion weighted imaging （WB-DWI） on diagnosis and staging of malignant lymphoma. Methods Thirty-one patients with suspected lymphadenopathy were enrolled. WB-DWI was performed by using short TI inversion recovery echo-planar imaging sequence with free breathing and built-in body coil. Axial T2- weighted imaging images of the same location were used as reference. The results of WB-DWI were compared with pathological results and other imaging modalities. The mean apparent diffusion coefficient （ADC） values of different kinds of lymph nodes were compared. Results WB-DWI was positive in all 18 cases with lymphoma, 5 cases with metastatic lymph nodes and 4 of 8 eases with benign lymphadenopathy. The mean ADC value of lymphomatous, metastatic and benign lymph nodes was （0.87 ± 0.17） × 10^3, （0.98± 0.09） × 10^3 and （1.20 ± 0.10） × 10^3 mm^2/s. There was significant difference in ADC value between benign lymph nodes and other two groups （P 〈 0.01）. The sensitivity, specificity and accuracy of WB-DWI in diagnosis of lymphoma were 100% （18/18）, 30.8% （4/13） and 71.0% （22/31）. When an ADC value of 1.08 × 10^-3 mm^2/s was used as the threshold value for differentiating malignant from benign lymph nodes, the best results were obtained with sensitivity of 87.8% and specificity of 91.3%. Sixteen of eighteen cases （88.9%） of lymphoma were accurately staged in accordance with clinical staging. Conclusions WB-DWI is a sensitive, but less specific technique for diagnosis of lymphoma. It is difficult to differentiate lymphnmatous from metastatic lymph nodes using WB-DWI. However, it is a valuable imaging modality for staging of patients with malignant lymphoma.展开更多
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 cer...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.展开更多
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 （T...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.展开更多
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...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.展开更多
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 enrolle...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.展开更多
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 patien...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.展开更多
Objective To investigate the feasibility of magnetic resonance （MR） diffusion weighted imaging （DWI） for evaluation of radiotherapeutic effects on rabbit VX2 tumor model. Methods Sixteen New Zealand white rabbits...Objective To investigate the feasibility of magnetic resonance （MR） diffusion weighted imaging （DWI） for evaluation of radiotherapeutic effects on rabbit VX2 tumor model. Methods Sixteen New Zealand white rabbits received a subcutaneous implantation of VX2 tumor cell suspension 0.5 mL （4× 10^7 ceUs/mL） in their right thighs to set up tumor model. And 2 weeks later they were randomly divided into therapy group （Group T, n = 10） and control group （Group C, n = 6）. Group T received radiotherapy at a single dose of 10 Gy. MR imaging （MRI） scan including short TI inversion recovery echo-planar imaging DWI, T1-weighted imaging （T1WI） and T2-weighted imaging （T2WI） sequences were performed 1 day prior to as well as 1 day, 2 days, 3 days and 7 days after radiotherapy. Group C received only MRI scan at the same time points without any treatment. MRI appearance on T2WI, TlWI, and DWI images was compared and tumor volume was calculated. Apparent diffusion coefficient （ADC） values of the tumor were evaluated in all cases. HE staining was used for pathological study. Results Necrosis （n = 8） and hemorrhage （n = 2） were seen gradually on T2WI and T1WI images of Group T after time point of day 2 after irradiation. In Group C, no obvious necrosis was found until day 7. There was no significant difference in tumor volume between the two groups before radiotherapy. After radiotherapy, tumors in Group T showed a gradual growth but not as obvious as Group C. There was a significant difference in tumor volume between the two groups from day 2 on （P 〈 0.05）. ADC value changed dramatically fight from the 1st day after radiotherapy in Group T [（0.99 ± 0.15） ×10^-3 mm^2/s for 1 day before radiotherapy, （1.23 ± 0.08） ×10^-3 , （1.45 ± 0.07） ×10^-3 , （1.63 ± 0.06） ×10^-3 , and （2.02 ± 0.18） ×10^-3 mm^2 for day 1, 2, 3, and 7]; and ADC value had no significant changes after radiotherapy in Group C except day 7 [（1.07±0.08） ×10^-3 mm^2 for 1 day before radiotherapy, （1.03 ± 0.04）×10^-3 , （1.05 ± 0.02）×10^-3 , （1.05 ± 0.05） ×10^-3 , and （0.95 ± 0.07） ×10^-3 mm^2 for day 1, 2, 3, and 7]. There was significant difference in ADC value between the two groups for each time point after radiotherapy （P 〈 0.01）. Pathological study showed that the number of viable tumor cells in Group T decreased 1 day after radiotherapy, and the inflammatory cell infiltration was marked and almost all viable tumor cells disappeared by day 7 after radiotherapy. Conclusions DWI is a new promising technique for monitoring radiotherapy outcomes. ADC value may give a prior clue on physiological changes of radiotherapy before routine MRI could tell.展开更多
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 ...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).展开更多
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 w...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.展开更多
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 me...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.展开更多
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 hyperpla...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.展开更多
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 Ze...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.展开更多
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 v...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.展开更多
文摘Objective To evaluate the clinical impact of whole body diffusion weighted imaging （WB-DWI） on diagnosis and staging of malignant lymphoma. Methods Thirty-one patients with suspected lymphadenopathy were enrolled. WB-DWI was performed by using short TI inversion recovery echo-planar imaging sequence with free breathing and built-in body coil. Axial T2- weighted imaging images of the same location were used as reference. The results of WB-DWI were compared with pathological results and other imaging modalities. The mean apparent diffusion coefficient （ADC） values of different kinds of lymph nodes were compared. Results WB-DWI was positive in all 18 cases with lymphoma, 5 cases with metastatic lymph nodes and 4 of 8 eases with benign lymphadenopathy. The mean ADC value of lymphomatous, metastatic and benign lymph nodes was （0.87 ± 0.17） × 10^3, （0.98± 0.09） × 10^3 and （1.20 ± 0.10） × 10^3 mm^2/s. There was significant difference in ADC value between benign lymph nodes and other two groups （P 〈 0.01）. The sensitivity, specificity and accuracy of WB-DWI in diagnosis of lymphoma were 100% （18/18）, 30.8% （4/13） and 71.0% （22/31）. When an ADC value of 1.08 × 10^-3 mm^2/s was used as the threshold value for differentiating malignant from benign lymph nodes, the best results were obtained with sensitivity of 87.8% and specificity of 91.3%. Sixteen of eighteen cases （88.9%） of lymphoma were accurately staged in accordance with clinical staging. Conclusions WB-DWI is a sensitive, but less specific technique for diagnosis of lymphoma. It is difficult to differentiate lymphnmatous from metastatic lymph nodes using WB-DWI. However, it is a valuable imaging modality for staging of patients with malignant lymphoma.
文摘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.
基金The National Natural Science Foundation of China, NO. 30470503The Key Program of Shanghai Science and Technology Commission, NO. 04JC14074The Foundation of Shanghai Educational commission, NO. 03J405037
文摘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.
文摘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.
文摘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.
文摘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.
文摘Objective To investigate the feasibility of magnetic resonance （MR） diffusion weighted imaging （DWI） for evaluation of radiotherapeutic effects on rabbit VX2 tumor model. Methods Sixteen New Zealand white rabbits received a subcutaneous implantation of VX2 tumor cell suspension 0.5 mL （4× 10^7 ceUs/mL） in their right thighs to set up tumor model. And 2 weeks later they were randomly divided into therapy group （Group T, n = 10） and control group （Group C, n = 6）. Group T received radiotherapy at a single dose of 10 Gy. MR imaging （MRI） scan including short TI inversion recovery echo-planar imaging DWI, T1-weighted imaging （T1WI） and T2-weighted imaging （T2WI） sequences were performed 1 day prior to as well as 1 day, 2 days, 3 days and 7 days after radiotherapy. Group C received only MRI scan at the same time points without any treatment. MRI appearance on T2WI, TlWI, and DWI images was compared and tumor volume was calculated. Apparent diffusion coefficient （ADC） values of the tumor were evaluated in all cases. HE staining was used for pathological study. Results Necrosis （n = 8） and hemorrhage （n = 2） were seen gradually on T2WI and T1WI images of Group T after time point of day 2 after irradiation. In Group C, no obvious necrosis was found until day 7. There was no significant difference in tumor volume between the two groups before radiotherapy. After radiotherapy, tumors in Group T showed a gradual growth but not as obvious as Group C. There was a significant difference in tumor volume between the two groups from day 2 on （P 〈 0.05）. ADC value changed dramatically fight from the 1st day after radiotherapy in Group T [（0.99 ± 0.15） ×10^-3 mm^2/s for 1 day before radiotherapy, （1.23 ± 0.08） ×10^-3 , （1.45 ± 0.07） ×10^-3 , （1.63 ± 0.06） ×10^-3 , and （2.02 ± 0.18） ×10^-3 mm^2 for day 1, 2, 3, and 7]; and ADC value had no significant changes after radiotherapy in Group C except day 7 [（1.07±0.08） ×10^-3 mm^2 for 1 day before radiotherapy, （1.03 ± 0.04）×10^-3 , （1.05 ± 0.02）×10^-3 , （1.05 ± 0.05） ×10^-3 , and （0.95 ± 0.07） ×10^-3 mm^2 for day 1, 2, 3, and 7]. There was significant difference in ADC value between the two groups for each time point after radiotherapy （P 〈 0.01）. Pathological study showed that the number of viable tumor cells in Group T decreased 1 day after radiotherapy, and the inflammatory cell infiltration was marked and almost all viable tumor cells disappeared by day 7 after radiotherapy. Conclusions DWI is a new promising technique for monitoring radiotherapy outcomes. ADC value may give a prior clue on physiological changes of radiotherapy before routine MRI could tell.
基金a Grant from Shanghai Scientific and Technological Commission Foundation (06411952)
文摘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).
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
