Staging liver fibrosis with various diffusion-weighted magnetic resonance imaging models

BACKGROUND Diffusion-weighted imaging(DWI)has been developed to stage liver fibrosis.However,its diagnostic performance is inconsistent among studies.Therefore,it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort.AIM To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances.METHODS This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants.All participants underwent multi-b value DWI.The main DWI-derived parameters included Mono-apparent diffusion coefficient(ADC)from mono-exponential DWI,intravoxel incoherent motion model-derived true diffusion coefficient(IVIM-D),diffusion kurtosis imaging-derived apparent diffusivity(DKI-MD),stretched exponential model-derived distributed diffusion coefficient(SEM-DDC),fractional order calculus(FROC)model-derived diffusion coefficient(FROC-D)and FROC model-derived microstructural quantity(FROC-μ),and continuous-time random-walk(CTRW)model-derived anomalous diffusion coefficient(CTRW-D)and CTRW model-derived temporal diffusion heterogeneity index(CTRW-α).The correlations between DWI-derived parameters and fibrosis stages and the parameters’diagnostic efficacy in detecting significant fibrosis(SF)were assessed and compared.RESULTS CTRW-D(r=-0.356),CTRW-α(r=-0.297),DKI-MD(r=-0.297),FROC-D(r=-0.350),FROC-μ(r=-0.321),IVIM-D(r=-0.251),Mono-ADC(r=-0.362),and SEM-DDC(r=-0.263)were significantly correlated with fibrosis stages.The areas under the ROC curves(AUCs)of the combined index of the six models for distinguishing SF(0.697-0.747)were higher than each of the parameters alone(0.524-0.719).The DWI models’ability to detect SF was similar.The combined index of CTRW model parameters had the highest AUC(0.747).CONCLUSION The DWI models were similarly valuable in distinguishing SF in patients with liver disease.The combined index of CTRW parameters had the highest AUC.

Deep learning-based magnetic resonance imaging reconstruction for improving the image quality of reduced-field-of-view diffusionweighted imaging of the pancreas

BACKGROUND It has been reported that deep learning-based reconstruction(DLR)can reduce image noise and artifacts,thereby improving the signal-to-noise ratio and image sharpness.However,no previous studies have evaluated the efficacy of DLR in improving image quality in reduced-field-of-view(reduced-FOV)diffusionweighted imaging(DWI)[field-of-view optimized and constrained undistorted single-shot(FOCUS)]of the pancreas.We hypothesized that a combination of these techniques would improve DWI image quality without prolonging the scan time but would influence the apparent diffusion coefficient calculation.AIM To evaluate the efficacy of DLR for image quality improvement of FOCUS of the pancreas.METHODS This was a retrospective study evaluated 37 patients with pancreatic cystic lesions who underwent magnetic resonance imaging between August 2021 and October 2021.We evaluated three types of FOCUS examinations:FOCUS with DLR(FOCUS-DLR+),FOCUS without DLR(FOCUS-DLR−),and conventional FOCUS(FOCUS-conv).The three types of FOCUS and their apparent diffusion coefficient(ADC)maps were compared qualitatively and quantitatively.RESULTS FOCUS-DLR+(3.62,average score of two radiologists)showed significantly better qualitative scores for image noise than FOCUS-DLR−(2.62)and FOCUS-conv(2.88)(P<0.05).Furthermore,FOCUS-DLR+showed the highest contrast ratio and 600 s/mm^(2)(0.72±0.08 and 0.68±0.08)and FOCUS-DLR−showed the highest CR between cystic lesions and the pancreatic parenchyma for the b-values of 0 and 600 s/mm2(0.62±0.21 and 0.62±0.21)(P<0.05),respectively.FOCUS-DLR+provided significantly higher ADCs of the pancreas and lesion(1.44±0.24 and 3.00±0.66)compared to FOCUS-DLR−(1.39±0.22 and 2.86±0.61)and significantly lower ADCs compared to FOCUS-conv(1.84±0.45 and 3.32±0.70)(P<0.05),respectively.CONCLUSION This study evaluated the efficacy of DLR for image quality improvement in reduced-FOV DWI of the pancreas.DLR can significantly denoise images without prolonging the scan time or decreasing the spatial resolution.The denoising level of DWI can be controlled to make the images appear more natural to the human eye.However,this study revealed that DLR did not ameliorate pancreatic distortion.Additionally,physicians should pay attention to the interpretation of ADCs after DLR application because ADCs are significantly changed by DLR.

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.

Hepatocellular carcinoma: Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?

BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS), supported by the American College of Radiology(ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma(HCC). Diffusionweighted imaging(DWI), which is described as an ancillary imaging feature of LI-RADS, can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging(MRI) for HCC.AIM To determine whether the use of DWI can improve the diagnostic efficiency of LIRADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.METHODS In this institutional review board-approved study, 245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018. Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017. The test was used to determine the agreement between the two readers with or without DWI. In addition, the sensitivity(SE), specificity(SP), accuracy(AC), positive predictive value(PPV), and negative predictive value(NPV) of LI-RADS were calculated.Youden index values were used to compare the diagnostic performance of LIRADS with or without DWI.RESULTS Almost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS(kappa value: 0.813 without DWI and 0.882 with DWI). For LR-5, the diagnostic SE, SP, and AC values were 61.2%, 92.5%, and71.4%, respectively, with or without DWI; for LR-4/5, they were 73.9%, 80%, and75.9% without DWI and 87.9%, 80%, and 85.3% with DWI; for LR-4/5/M, they were 75.8%, 58.8%, and 70.2% without DWI and 87.9%, 58.8%, and 78.4% with DWI; for LR-4/5/TIV, they were 75.8%, 75%, and 75.5% without DWI and 89.7%,75%, and 84.9% with DWI. The Youden index values of the LI-RADS classification without or with DWI were as follows: LR-4/5: 0.539 vs 0.679; LR-4/5/M: 0.346 vs 0.467; and LR-4/5/TIV: 0.508 vs 0.647.CONCLUSION LI-RADS v2017 has been successfully applied with gadoxetate-enhanced MRI for patients at high risk for HCC. The addition of DWI significantly increases the diagnostic efficiency for HCC.

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.

Diffusion-weighted imaging of biliopancreatic disorders:Correlation with conventional magnetic resonance imaging

Diffusion-weighted magnetic resonance imaging(DWI)is a well established method for the evaluation of intracranial diseases,such as acute stroke.DWI for extracranial application is more difficult due to physiological motion artifacts and the heterogeneous composition of the organs.However,thanks to the newer technical development of DWI,DWI has become increasingly used over the past few years in extracranial organs including the abdomen and pelvis.Most previous studies of DWI have been limited to the evaluation of diffuse parenchymal abnormalities and focal lesions in abdominal organs,whereas there are few studies about DWI for the evaluation of the biliopancreatic tract.Although further studies are needed to determine its performance in evaluating bile duct,gallbladder and pancreas diseases,DWI has potential in the assessment of the functional information on the biliopancreatic tract concerning the status of tissue cellularity,because increased cellularity is associated with impeded diffusion,as indicated by a reduction in the apparent diffusion coefficient.The detection of malignant lesions and their differentiation from benign tumor-like lesions in the biliopancreatic tract could be improved using DWI in conjunction with findings obtained with conventional magnetic resonance cholagiopancreatography.Additionally,DWI can be useful for the assessment of the biliopancreatic tract in patients with renal impairment because contrast-enhanced computed tomography or magnetic resonance scans should be avoided in these patients.

Updates in advanced diffusion-weighted magnetic resonance imaging techniques in the evaluation of prostate cancer

Diffusion-weighted magnetic resonance imaging(DWMRI) is considered part of the standard imaging protocol for the evaluation of patients with prostate cancer.It has been proven valuable as a functional tool for qualitative and quantitative analysis of prostate cancer beyond anatomical MRI sequences such as T2-weighted imaging. This review discusses ongoing controversies in DW-MRI acquisition, including the optimal number of b-values to be used for prostate DWI, and summarizes the current literature on the use of advanced DWMRI techniques. These include intravoxel incoherent motion imaging, which better accounts for the nonmono-exponential behavior of the apparent diffusion coefficient as a function of b-value and the influence of perfusion at low b-values. Another technique is diffusion kurtosis imaging(DKI). Metrics from DKI reflect excess kurtosis of tissues, representing its deviation from Gaussian diffusion behavior. Preliminary results suggest that DKI findings may have more value than findings from conventional DW-MRI for the assessment of prostate cancer.

Dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in the activity staging of terminal ileum Crohn's disease

BACKGROUND The activity staging of Crohn’s disease(CD)in the terminal ileum is critical in developing an accurate clinical treatment plan.The activity of terminal ileum CD is associated with the microcirculation of involved bowel walls.Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusionweighted imaging(DWI)can reflect perfusion and permeability of bowel walls by providing microcirculation information.As such,we hypothesize that DCE-MRI and DWI parameters can assess terminal ileum CD,thereby providing an opportunity to stage CD activity.AIM To evaluate the value of DCE-MRI and DWI in assessing activity of terminal ileum CD.METHODS Forty-eight patients with CD who underwent DCE-MRI and DWI were enrolled.The patients’activity was graded as remission,mild and moderate-severe.The transfer constant(Ktrans),wash-out constant(Kep),and extravascular extracellular volume fraction(Ve)were calculated from DCE-MRI and the apparent diffusion coefficient(ADC)was obtained from DWI.Magnetic Resonance Index of Activity(MaRIA)was calculated from magnetic resonance enterography.Differences in these quantitative parameters were compared between normal ileal loop(NIL)and inflamed terminal ileum(ITI)and among different activity grades.The correlations between these parameters,MaRIA,the Crohn’s Disease Activity Index(CDAI),and Crohn’s Disease Endoscopic Index of Severity(CDEIS)were examined.Receiver operating characteristic curve analyses were used to determine the diagnostic performance of these parameters in differentiating between CD activity levels.RESULTS Higher Ktrans(0.07±0.04 vs 0.01±0.01),Kep(0.24±0.11 vs 0.15±0.05)and Ve(0.27±0.07 vs 0.08±0.03),but lower ADC(1.41±0.26 vs 2.41±0.30)values were found in ITI than in NIL(all P<0.001).The Ktrans,Kep,Ve and MaRIA increased with disease activity,whereas the ADC decreased(all P<0.001).The Ktrans,Kep,Ve and MaRIA showed positive correlations with the CDAI(r=0.866 for Ktrans,0.870 for Kep,0.858 for Ve,0.890 for MaRIA,all P<0.001)and CDEIS(r=0.563 for Ktrans,0.567 for Kep,0.571 for Ve,0.842 for MaRIA,all P<0.001),while the ADC showed negative correlations with the CDAI(r=-0.857,P<0.001)and CDEIS(r=-0.536,P<0.001).The areas under the curve(AUC)for the Ktrans,Kep,Ve,ADC and MaRIA values ranged from 0.68 to 0.91 for differentiating inactive CD(CD remission)from active CD(mild to severe CD).The AUC when combining the Ktrans,Kep and Ve was 0.80,while combining DCE-MRI parameters and ADC values yielded the highest AUC of 0.95.CONCLUSION DCE-MRI and DWI parameters all serve as measures to stage CD activity.When they are combined,the assessment performance is improved and better than MaRIA.

Optimal b value of diffusion-weighted imaging on a 3.0T magnetic resonance scanner in Crohn's disease

AIM: To determine the optimal b value of diffusion-weighted imaging for detecting active inflammation in Crohn&#x02019;s disease.

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.

Magnetic resonance imaging findings of spontaneous pyomyoma in a premenopausal woman managed with myomectomy:A case report

BACKGROUND Acute fibroid complications are rare.However,failure to recognize and treat acute complications expeditiously when they occur can lead to catastrophic,even deadly,complications.Pyomyoma is a rare but potentially fatal condition resulting from infarction and infection of a fibroid through bacterial seeding and direct,hematogenous,or lymphatic dissemination.Even though the diagnosis is established through clinical and laboratory findings,imaging is an important complementary method to support the suspected diagnosis.CASE SUMMARY Herein,we report a case of a pyomyoma in a nulliparous woman previously diagnosed with uterine leiomyomatosis according to ultrasound findings.The patient had previously attended the emergency room due to hypogastric pain unresponsive to analgesics.After a week of persistent pain,she developed sepsis without any identifiable foci.Magnetic resonance imaging revealed findings compatible with uterine myomatosis with red degeneration,and a possible diagnosis of a pyomyoma was made according to the imaging findings along with the patient’s clinical features.We decided to perform myomectomy(which is an infrequently performed surgical treatment due to the procedure’s intrinsic implic-ations)due to the patient’s desire to preserve fertility.Histopathologic results revealed a uterine leiomyoma with coagulative and liquefactive necrosis,while the tissue culture showed gram-negative cocci bacteria,which were successfully treated using antibiotic therapy.The patient’s health status improved after several days.CONCLUSION The main diagnostic tools to evaluate pyomyomas are the clinical and laboratory findings as well as tissue cultures.Nonetheless,magnetic resonance imaging can help to corroborate these findings as well as to better characterize myomas with its different complications.

Distinctive magnetic resonance imaging features in primary central nervous system lymphoma:A case report

BACKGROUND Primary central nervous system lymphoma(PCNSL)is a rare malignant tumor originating from the lymphatic hematopoietic system.It exhibits unique imaging manifestations due to its biological characteristics.CASE SUMMARY Magnetic resonance imaging(MRI)with diffusion-weighted imaging(DWI),perfusion-weighted imaging(PWI),and magnetic resonance spectroscopy was performed.The imaging findings showed multiple space-occupying lesions with low signal on T1-weighted imaging,uniform high signal on T2-weighted imaging,and obvious enhancement on contrast-enhanced scans.DWI revealed diffusion restriction,PWI demonstrated hypoperfusion,and spectroscopy showed elevated choline peak and decreased N-acetylaspartic acid.The patient's condition significantly improved after hormone shock therapy.CONCLUSION This case highlights the distinctive imaging features of PCNSL and their importance in accurate diagnosis and management.

Diagnostic Power of Diffusion-weighted Magnetic Resonance Imaging for the Presence of Lymph Node Metastasis:A Meta-analysis

Present work was designed to quantitatively evaluate the performance of diffusion-weighted magnetic resonance imaging（DWI） in the diagnosis of the presence of metastasis in lymph nodes（LNs）. Eligible studies were identified from systematical Pub Med and EMBASE searches. Data were extracted. Meta-analyses were performed to generate pooled sensitivity and specificity on the basis of per-node, per-lesion and per-patient, respectively. Fourteen publications（2458 LNs, 404 lesions and 334 patients） were eligible. Per-node basis demonstrated the pooled sensitivity and specificity was 0.82（P〈0.0001） and 0.90（P〈0.0001）, respectively. Per-lesion basis illustrated the pooled sensitivity and specificity was 0.73（P=0.0036） and 0.85（P〈0.0001）, respectively. Per-patient basis indicated the pooled sensitivity and specificity was 0.67（P=0.0909） and 0.86（P〈0.0001）, respectively. In conclusion, DWI has rather a negative predictive value for the diagnosis of LN metastasis presence. The difference of the mean apparent diffusion coefficients between benign and malignant LNs is not yet stable. Therefore, the DWI technique has to be further improved.

The Value of Magnetic Resonance Diffusion-Weighted Imaging in Evaluating the Efficacy of Concurrent Chemoradiotherapy in Patients with Hypopharyngeal Carcinoma

Objective: To investigate the application value of magnetic resonance diffusion-weighted imaging (DWI) combined with conventional magnetic resonance imaging (MRI) in evaluating the efficacy of concurrent chemoradiotherapy for hypopharyngeal carcinoma. Methods: A total of 20 patients with hypopharyngeal carcinoma diagnosed by pathological biopsy (who only received chemoradiotherapy without surgery) were collected. Before treatment, all patients underwent conventional MRI and DWI scanning, MRI characteristics of patients were analyzed, and maximum cross-sectional area of the tumor and average apparent diffusion coefficient (ADC) value were measured. One month after treatment, MRI was performed again to measure residual tumor area and ADC value, and the tumor remission rate was calculated. The changes in tumor ADC values before and after treatment were analyzed and their correlation with tumor remission rate was analyzed. The differences in ADC values and changes between complete response patients (CR group) and incomplete response patients (non-CR group) before and after treatment were analyzed. Results: The tumor area of 20 patients with hypopharyngeal cancer was 3.48 (0.93 - 5.6) cm2 before treatment and 0.24 (0 - 0.9) cm2 after treatment. There were 15 patients (15/20, 75%) in the CR group and 5 patients (5/20, 25.0%) in the non-CR group. The remission rate was 90.3% (6.0% - 100%). The average ADC value of the tumor before treatment was negatively correlated with the tumor remission rate after treatment (r = ?0.786, ?0.813, P Conclusion: The ADC value of tumor before treatment and the change of ADC value of tumor before and after treatment have a certain significance in evaluating the early remission rate of hypopharyngeal carcinoma after chemoradiotherapy.

An Early Continuous Experimental Study on Magnetic Resonance Diffusion-weighted Image of Focal Cerebral Ischemia and Reperfusion in Rats

Summary： The chronological and spatial rules of changes during focal cerebral ischemia and reperfusion in different brain regions with magnetic resonance diffusion-weighted imaging （DWI） in a model of occlusion of middle cerebral artery （MCAO） and the development of cytotoxic edema in acute phase were explored. Fifteen healthy S-D rats with MCA occluded by thread-emboli were randomly divided into three groups. 15 min after the operation, the serial imaging was scanned on DWI for the three groups. The relative mean signal intensity （RMSI） of the frontal lobe, parietal lobe, lateral cauda-putamen, medial cauda-putamen and the volume of regions of hyperintense signal on DWI were calculated. After the last DWI scanning, T2WI was performed for the three groups. After 15 rain ischemia, the rats was presented hyperintense signals on DWI. The regions of hyperintense signal were enlarged with prolonging ischemia time. The regions of hyperintense signal were back to normal after 60 min reperfusion with a small part remaining to show hyperintense signal. The RMSIs of parietal lobe and lateral cauda-putamen were higher than that of the frontal lobe and medial cauda-putamen both in ischemia phase and recanalization phase. The three groups were normal on T2WI imaging. DWI had good sensitivity to acute cerebral ischemia, which was used to study the chronological and spatial rules of development of early cell edema in ischemia regions.

Consistency between magnetic resonance diffusion-weighted images and pathological findings in a hyperacute cerebral infarction rabbit model

BACKGROUND： Because magnetic resonance diffusion-weighted imaging is sensitive to water molecule movement, it has particular advantages for early diagnosis of cerebral infarction. However, the relationship between apparent diffusion coefficient changes with ischemia time, particularly relative apparent diffusion coefficient and tissue pathological changes remains controversial. OBJECTIVE： To explore the correlation between apparent diffusion coefficient changes and pathologic changes in hyperacute cerebral infarction. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment of neuroimaging. The study was performed at the Laboratory of Radiology Department, Longgang Central Hospital of Shenzhen from October 2007 to October 2008. MATERIALS： Magnetic resonance scanner was purchased from Philips Medical Systems, Best, the Netherlands. METHODS： A total of 42 healthy, adult, New Zealand rabbits were randomly assigned into sham-operation, ischemia 0.5-, 1-, 2-, 3-, 4-, and 6-hour groups, with six animals in each group. Local cerebral ischemia model was established by right middle cerebral artery occlusion, and cranial MRI scanning and pathologic observation were performed, respectively, at 0.5, 1,2, 3, 4, and 6 hours following ischemia. The middle cerebral artery of sham-operation group was only exposed, but not occluded. Images at the above-mentioned time points were also collected. MAIN OUTCOME MEASURES： Apparent diffusion coefficient and relative apparent diffusion coefficient values of abnormal signal on diffusion-weighted imaging were calculated and compared with pathological changes in the ischemic region. RESULTS： No abnormal diffusion-weighted imaging signals or pathological changes were observed in the sham-operation group. Abnormal signal intensity on diffusion-weighted imaging was first observed in the 0.5-hour group. Apparent diffusion coefficient and relative apparent diffusion coefficient values decreased in all middle cerebral artery occlusion rabbits and reached lowest levels at 3 hours, followed by a gradual increase. The right ischemic basal ganglia region with high signal intensity on diffusion-weighted imaging extended with increasing time of occlusion, and the pathologic outcome corresponded with MRI changes. CONCLUSION： Relative apparent diffusion coefficient values changed regularly with ischemia time and displayed good correspondence to pathological manifestations.

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.

Magnetic resonance imaging in breast cancer:A literature review and future perspectives

Early detection and diagnosis of breast cancer are essential for successful treatment. Currently mammography and ultrasound are the basic imaging techniques for the detection and localization of breast tumors. The low sensitivity and specificity of these imaging tools resulted in a demand for new imaging modalities and breast magnetic resonance imaging(MRI) has become increasingly important in the detection and delineation of breast cancer in daily practice. However, the clinical benefits of the use of pre-operative MRI in women with newly diagnosed breast cancer is still a matter of debate. The main additional diagnostic value of MRI relies on specific situations such as detecting multifocal, multicentric or contralateral disease unrecognized on conventional assessment(particularly in patients diagnosed with invasive lobular carcinoma), assessing the response to neoadjuvant chemotherapy, detection of cancer in dense breast tissue, recognition of an occult primary breast cancer in patients presenting with cancer metastasis in axillary lymph nodes, among others. Nevertheless, the development of new MRI technolo-gies such as diffusion-weighted imaging, proton spectroscopy and higher field strength 7.0 T imaging offer a new perspective in providing additional information in breast abnormalities. We conducted an expert literature review on the value of breast MRI in diagnosing and staging breast cancer, as well as the future potentials of new MRI technologies.

Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage

AIMTo describe magnetic resonance (MR) imaging features of pancreatic neuroendocrine neoplasms (PanNENs) according to their grade and tumor-nodes-metastases stage by comparing them to histopathology and to determine the accuracy of MR imaging features in predicting their biological behavior.METHODSThis study was approved by our institutional review board; requirement for informed patient consent was waived due to the retrospective nature of the study. Preoperative MR examinations of 55 PanNEN patients (29 men, 26 women; mean age of 57.6 years, range 21-83 years) performed between June 2013 and December 2015 were reviewed. Qualitative and quantitative features were compared between tumor grades and stages determined by histopathological analysis.RESULTSIll defined margins were more common in G2-3 and stage III-IV PanNENs than in G1 and low-stage tumors (P < 0.001); this feature had high specificity in the identification of G2-3 and stage III-IV tumors (90.3% and 96%, 95%CI: 73.1-97.5 and 77.7-99.8). The mean apparent diffusion coefficient value was significantly lower in G2-3 and stage III-IV lesions compared to well differentiated and low-stage tumors (1.09 × 10-3 mm2/s vs 1.45 × 10-3 mm2/s and 1.10 × 10-3 mm2/s vs 1.53 × 10-3 mm2/s, P = 0.003 and 0.001). Receiving operator characteristic analysis determined optimal cut-offs of 1.21 and 1.28 × 10-3 mm2/s for the identification of G2-3 and stage III-IV tumors, with sensitivity and specificity values of 70.8/80.7% and 64.5/64% (95%CI: 48.7-86.6/60-92.7 and 45.4-80.2/42.6-81.3).CONCLUSIONMR features of PanNENs vary according to their grade of differentiation and their stage at diagnosis and could predict the biological behavior of these tumors.

Quantitative diffusion-weighted magnetic resonance enterography in ileal Crohn’s disease: A systematic analysis of intra and interobserver reproducibility

BACKGROUND Magnetic resonance enterography(MRE) is increasingly attractive as a noninvasive and radiation-free tool for assessing Crohn’s disease(CD). Diffusionweighted imaging(DWI) is recommended as an optional MRE sequence for CD by the European Society of Gastrointestinal and Abdominal Radiology, and has shown a superb potential as a quantitative modality for bowel inflammation evaluation. However, the measurement reproducibility of quantitative DWI analysis in MRE has not been ascertained so far. To facilitate the application of quantitative diffusion-weighted MRE in the clinical routine, systematic investigations of the intra and interobserver reproducibility of DWI quantitative parameters should be performed.AIM To evaluate the intra and interobserver reproducibility of quantitative analysis for diffusion-weighted MRE(DW-MRE) in ileal CD.METHODS Forty-four subjects(21 with CD and 23 control subjects) who underwent ileocolonoscopy and DW-MRE(b = 800 s/mm2) within one week were included.Two radiologists independently measured apparent diffusion coefficients(ADC)of the terminal ileum and signal intensity ratio(SR) of the terminal ileum to ipsilateral psoas muscle on DWI images(b = 800 s/mm2). Between-and withinreader agreements were assessed using intraclass correlation coefficients(ICC),coefficients of variation(CoV), and 95% limits of agreement of Bland-Altman plots(BA-LA LoA). Diagnostic performances of ADC and SR for identifying inflamed terminal ileum from the normal were evaluated by receiver operating characteristic(ROC) curve analysis.RESULTS There were no significant differences in ADC or SR values between the two sessions or between the two radiologists either in the CD or control group(paired t-test, P > 0.05). The intra and interobserver reproducibility of ADC(ICC: 0.952-0.984;CoV: 3.73-6.28%;BA-LA LoA: ±11.27% to ±15.88%) and SR(ICC: 0.969-0.989;CoV: 3.51%-4.64%;BA-LA LoA: ±10.62% to ±15.45%) was excellent for CD.Agreement of ADC measurements was slightly less in control subjects(ICC:0.641-0.736;CoV: 10.47%-11.43%;BA-LA LoA: ± 26.59% to ± 30.83%). SR of normal terminal ileum demonstrated high intra and interobserver reproducibility(ICC: 0.944-0.974;CoV: 3.73%-6.28%;BA-LA LoA: ± 18.58% to ± 24.43%). ADC and SR of two readers had outstanding diagnostic efficiencies(area under the ROC curve: 0.923-0.988).CONCLUSION Quantitative parameters derived from DW-MRE have good to excellent intra and interobserver agreements with high diagnostic accuracy, and can serve as robust and efficient quantitative biomarkers for CD evaluation.