Lesion Apparent Diffusion Coefficient Research Articles

The Diagnostic Value of Conventional MRI Combined With Diffusion-Weighted Imaging in Microprolactinomas.

Turbo spin-echo (TSE) diffusion-weighted imaging (DWI) sequences may reduce susceptibility artifacts and image distortion in sellar region, allowing better visualization of small pituitary lesions, and may be used to assist in the diagnosis of pituitary microadenomas. To explore the application value of conventional MRI combined with DWI sequences in the diagnosis of microprolactinomas. Prospective. Thirty-four patients in microprolactinomas with high signal on T2WI (HT2-PRL) group (34 females, 34 ± 7 years), 26 patients in microprolactinomas with equal or low signal on T2WI (ELT2-PRL) group (21 females, 34 ± 7 years), 35 patients with hyperprolactinemia (33 females, 32 ± 8 years), and 30 normal controls (25 females, 31 ± 7 years). TSE sequence at 3 T. Pituitary morphological parameters (such as length and volume), dynamic contrast-enhanced parameters (such as time to peak) and the apparent diffusion coefficients (ADCs) were measured in each group. ANOVA and Mann-Whitney U test were used to compare parameters among groups. Spearman's coefficient was used to evaluate the correlation between variables. ROC analysis was used to assess the performance of the parameters. A P-value <0.05 was considered statistically significant. The pituitary volume of patients in HT2-PRL, ELT2-PRL, and hyperprolactinemia group were 831.00 (747.60, 887.60), 923.63 ± 219.34, and 737.20 (606.40, 836.80) mm3. The pituitary maximum height in these three groups were 7.03 (6.43, 8.63), 8.03 ± 1.41, and 6.63 ± 1.28 mm, respectively. The lesion ADC value was significantly correlated with T2 relative signal intensity (the ratio of signal intensity of microprolactinoma or anterior pituitary to left temporal cortex) (r = 0.821). Compared with patients with hyperprolactinemia, the diagnostic efficacy of T2 relative signal intensity was higher in HT2-PRL group, with an AUC of 0.954, whereas the ADC value was the highest in ELT2-PRL group, with an AUC of 0.924. DWI sequences can be used to assist in the diagnosis of pituitary microadenomas. 1 TECHNICAL EFFICACY: Stage 2.

Clinical-imaging metrics for the diagnosis of prostate cancer in PI-RADS 3 lesions

ObjectiveTo explore the feasibility and efficacy of clinical-imaging metrics in the diagnosis of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in prostate imaging-reporting and data system (PI-RADS) category 3 lesions. MethodsA retrospective analysis was conducted on lesions diagnosed as PI-RADS 3. They were categorized into benign, non-csPCa and csPCa groups. Apparent diffusion coefficient (ADC), T2-weighted imaging signal intensity (T2WISI), coefficient of variation of ADC and T2WISI, prostate-specific antigen density (PSAD), ADC density (ADCD), prostate-specific antigen lesion volume density (PSAVD) and ADC lesion volume density (ADCVD) were measured and calculated. Univariate and multivariate analyses were used to identify risk factors associated with PCa and csPCa. Receiver operating characteristic curve (ROC) and decision curves were utilized to assess the efficacy and net benefit of independent risk factors. ResultsAmong 202 patients, 133 had benign prostate disease, 25 non-csPCa and 44 csPCa. Age, PSA and lesion location showed no significant differences (P > 0.05) among the groups. T2WISI and coefficient of variation of ADC (ADCcv) were independent risk factors for PCa in PI-RADS 3 lesions, yielding an area under the curve (AUC) of 0.68. ADC was an independent risk factor for csPCa in PI-RADS 3 lesions, yielding an AUC of 0.65. Decision curve analysis showed net benefit for patients at certain probability thresholds. ConclusionsT2WISI and ADCcv, along with ADC, respectively showed considerable promise in enhancing the diagnosis of PCa and csPCa in PI-RADS 3 lesions.

MRI manifestations of 40 cases with the hepatic epithelioid hemangioendothelioma classification based on the morphology and size

Objective: To explore the MRI characteristics of the hepatic epithelioid hemangioendothelioma (HEHE) classification according to morphology and size. Methods: The clinical, pathological, and MRI imaging data of 40 cases with HEHE confirmed pathologically from December 2009 to September 2021 were retrospectively analyzed. A paired sample t-test was used for comparison between the two groups. Results: There were 40 cases (5 solitary, 24 multifocal, 9 local fusion, and 2 diffuse fusion) and 214 lesions (163 nodules, 31 masses, and 20 fusion foci). The most common features of lesions were subcapsular growth and capsular depression. The signal intensity of lesions ≤1cm was usually uniform with whole or ring enhancement. Nodules and mass-like lesions ≥1cm on a T1-weighted image had slightly reduced signal intensity or manifested as a halo sign. Target signs on a T2-weighted image were characterized by: target or centripetal enhancement; fusion-type lesions; irregular growth and hepatic capsular retraction, with ring or target-like enhancement in the early stage of fusion and patchy irregular enhancement in the late stage; blood vessels traversing or accompanied by malformed blood vessels; focal bleeding; an increasing proportion of extrahepatic metastases and abnormal liver function with the type of classified manifestation; primarily portal vein branches traversing; and reduced overall intralesional bleeding rate (17%). Lollipop signs were presented in 19 cases, with a high expression rate in mass-type lesions (42%). The fusion lesions were expressed, but the morphological manifestation was atypical. The diffusion-weighted imaging mostly showed high signal or target-like high signal. An average apparent diffusion coefficient of lesions was (1.56±0.36) ×10(-3)mm(2)/s, which was statistically significantly different compared with that of adjacent normal liver parenchyma (t=8.28, P<0.001). Conclusion: The MRI manifestations for the HEHE classification are closely related to the morphology and size of the lesions and have certain differences and characteristics that are helpful for the diagnosis of the disease when combined with clinical and laboratory examinations.

EVALUATION OF HEPATIC MASS LESIONS BY DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING

Objectives: The purpose of this study was to compare apparent diffusion coefficient (ADC) values for benign and malignant neoplastic hepatic lesions and also for suspected infective hepatic masses in which histopathology may always not be indicated. Methods: This is a cross-sectional study conducted in the department of radio diagnosis and imaging, army hospital research and referral, Delhi Cantt. All the patients coming for magnetic resonance imaging (MRI) scans for focal liver lesions detected on other imaging modalities were included. The imaging was done at the 1.5 Tesla MAGNETOM AVANTO A Tim system (Siemens Ltd.). Various parameters of the morphology of lesions in conventional MRI and parameters in diffusion-weighted MRI were evaluated. Results: A total of 75 patients were included in the study. The mean age of the subjects was 52.57±15.28 years, with a male: female sex ratio of 0.5:1. Among the 75 subjects, 20 subjects with hepatic cysts had no restrictions, and 12 patients with hemangioma were hyperintense on both diffusion-weighted imaging (DWI) and ADC. The mean differences between benign and malignant lesion ADC values. The difference was statistically significant (p&lt;0.001). In the present study, we get a cut-off for the ADC value of 1.581×10-3 mm2/s, which proved to be an optimal parameter for differentiation between benign and malignant lesions. Conclusion: DWI proved to be a very useful supplementary imaging technique in conjunction with conventional imaging sequences in the analysis of focal hepatic lesions and should be included in the imaging algorithm for such lesions.

Association of ADC of hyperintense lesions on FLAIR images with TERT promoter mutation status in glioblastoma IDH wild type.

Although mutations in telomerase reverse transcriptase (TERT) promoter (TERTp) are the most common alterations in glioblastoma (GBM), predicting TERTp mutation status by preoperative imaging is difficult. We determined whether tumour-surrounding hyperintense lesions on fluid-attenuated inversion recovery (FLAIR) were superior to those of contrast-enhanced lesions (CELs) in assessing TERTp mutation status using magnetic resonance imaging (MRI). This retrospective study included 114 consecutive patients with primary isocitrate dehydrogenase (IDH)-wild-type GBM. The apparent diffusion coefficient (ADC) and volume of CELs and FLAIR hyperintense lesions (FHLs) were determined, and the correlation between MRI features and TERTp mutation status was analyzed. In a subset of cases, FHLs were histopathologically analyzed to determine the correlation between tumor cell density and ADC. TERTp mutations were present in 77 (67.5%) patients. The minimum ADC of FHLs was significantly lower in the TERTp-mutant group than in the TERTp-wild-type group (mean, 958.9 × 10-3 and 1092.1 × 10-3 mm2/s, respectively, P < 0.01). However, other MRI features, such as CEL and FHL volumes, minimum ADC of CELs, and FHL/CEL ratio, were not significantly different between the two groups. Histopathologic analysis indicated high tumor cell density in FHLs with low ADC. The ADC of FHLs was significantly lower in IDH-wild-type GBM with TERTp mutations, suggesting that determining the ADC of FHLs on preoperative MRI might be helpful in predicting TERTp mutation status and surgical planning.

Prostate Biopsy May Not Be Indicated Early after Bacillus Calmette Guérin Treatment.

Bacillus Calmette-Guérin (BCG) treatment for non-muscle-invasive bladder cancer frequently causes an intraprostatic BCG granuloma. We investigated the optimal timing for a prostate biopsy after BCG treatment by retrospectively analyzing the cases of 22 patients with non-muscle-invasive bladder cancer who underwent a prostate biopsy after BCG treatment at our institute (2013-2017). Biopsies were indicated for a rising prostate-specific antigen (PSA) level, positive digital rectal examination findings, or the appearance of de novo low apparent diffusion coefficient lesions on MRI. The control group was comprised of 28 age- and PSA-matched patients. The relationships among the cancer detection rate and the patients' PSA levels and MRI findings were analyzed. Prostate cancer was detected by biopsy in only 13.9% (3/22) of the patients in the BCG group but in 78.5% (22/28) of the control patients (p=0.0001). The three patients in the BCG group in whom prostate cancer was detected had all undergone the biopsy > 1 year after their BCG treatment. The remaining biopsies were performed within 1 year after BCG treatment and resulted in no diagnoses of prostate cancer. We suggest that performing a prostate biopsy early after BCG treatment is not informative or useful.

Correlation between dynamic contrast-enhanced MRI characteristics and apparent diffusion coefficient with Ki-67-positive expression in non-mass enhancement of breast cancer

As a remarkably specific characteristic of breast cancer observed on magnetic resonance imaging (MRI), the association between the NME type breast cancer and prognosis, including Ki-67, necessitates comprehensive exploration. To investigate the correlation between dynamic contrast-enhanced MRI (DCE-MRI) characteristics and apparent diffusion coefficient (ADC) values with Ki-67-positive expression in NME type breast cancer. A total of 63 NME type breast cancer patients were retrospectively reviewed. Malignancies were confirmed by surgical pathology. All patients underwent DCE and diffusion-weighted imaging (DWI) before surgery. DCE-MRI characteristics, including tumor distribution, internal enhancement pattern, axillary adenopathy, and time-intensity curve types were observed. ADC values and lesion sizes were also measured. The correlation between these features and Ki-67 expression were assessed using Chi-square test, Fisher’s exact test, and Spearman rank analysis. The receiver operating characteristic curve and area under the curve (AUC) was used to evaluate the diagnostic performance of Ki-67-positive expression. Regional distribution, TIC type, and ipsilateral axillary lymph node enlargement were correlated with Ki-67-positive expression (χ2 = 0.397, 0.357, and 0.357, respectively; P < 0.01). ADC value and lesion size were positively correlated with Ki-67-positive expression (rs = 0.295, 0.392; P < 0.05). The optimal threshold values for lesion size and ADC value to assess Ki-67 expression were determined to be 5.05 (AUC = 0.759) cm and 0.403 × 10–3 s/mm2 (AUC = 0.695), respectively. The best diagnosis performance was the ADC combined with lesion size (AUC = 0.791). The ADC value, lesion size, regional distribution, and TIC type in NME type breast cancer were correlated with Ki-67-positive expression. These features will aid diagnosis and treatment of NME type breast cancer.

Evaluations of the diagnostic performance of ZOOMit diffusion-weighted imaging and conventional diffusion-weighted imaging for breast lesions.

Diffusion-weighted imaging (DWI) is valuable in the screening, diagnosis, and grading of breast lesions. However, conventional DWI (C-DWI) is prone to chemical shift and distortion. ZOOMit DWI (Z-DWI), as an advanced magnetic resonance imaging (MRI) technique, applies two spatially selective parallel excitation pulses to focus sampling in the hope of obtaining more valuable information. This study aimed to evaluate and compare the image quality and feasibility of Z-DWI with those of C-DWI in breast lesions. The study included 51 patients with breast lesions who underwent breast MRI from May 2021 to February 2022. All patients received Z-DWI and C-DWI sequences, with b values selected as 50 and 800 s/mm2 (Z-DWIb50, Z-DWIb800, C-DWIb50, and C-DWIb800). Apparent diffusion coefficient (ADC) values based on Z-DWI and C-DWI were calculated. For qualitative analysis, four image quality parameters were selected and assessed on a 4-point Likert scale (1 = poor and 4 = excellent). For quantitative analysis, ADC, relative ADC (rADC), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and tumor-to-parenchymal contrast (TPC) values were selected for comparison. Z-DWI had higher scores compared to C-DWI in terms of lesion conspicuity, anatomical details, distortion and artifacts, and overall image quality (P<0.05). Meanwhile, the agreement between the two readers was reasonably good [intraclass correlation coefficient (ICC) range, 0.360-0.881]. The SNR of Z-DWIb800 was better than that of C-DWIb800 (P<0.001). The Z-DWI ADC and rADC values of breast lesions were statistically significantly lower than those of C-DWI (mean ADC: P<0.001; rADC; P=0.005). Z-DWI sequences were shown to have superior image quality. The ADC map of Z-DWI is more conducive to the imaging evaluation of breast lesions.

Quantitative diffusion weighted imaging in patients with hepatocellular carcinoma: effects of simultaneous multi-slice acceleration and gadoxetic acid administration.

To investigate whether simultaneous multi-slice (SMS) acceleration and gadoxetic acid administration affect the quantitative apparent diffusion coefficient (ADC) and signal-to-noise ratio (SNR) measurement of DWI in patients with HCC. This prospective study initially enrolled 208 patients with clinically suspected HCC. Free breathing SMS-DWI and conventional DWI (CON-DWI) were performed before and after gadoxetic acid administration. Lesion conspicuity, ADCs and SNRs of the HCC lesion and normal liver parenchyma were independently measured by two radiologists. The paired t test or Wilcoxon signed rank test was used to evaluate the differences of lesion conspicuity, ADCs and SNRs between SMS-DWI and CON-DWI, as well as those before and after gadoxetic acid administration. A total of 102 HCC patients (90 men and 12 women; mean age, 54.6 ± 11.7 years) were finally included for analysis. SMS-DWI and CON-DWI demonstrated comparable lesion conspicuity (P = 0.081-0.566). For the influence of SMS acceleration, the SNRs of liver parenchyma on enhanced SMS-DWI were significantly higher than enhanced CON-DWI (P = 0.015). For the influence of gadoxetic acid administration, the mean ADCs were significantly higher on enhanced SMS-DWI than unenhanced SMS-DWI (HCC, P = 0.013; liver parenchyma, P = 0.032). Quantitative ADC measurements of HCC and liver parenchyma were not affected by SMS acceleration, and SMS-DWI can provide higher SNR than CON-DWI. However, the ADC measurements can be affected by gadoxetic acid administration on SMS-DWI, so it is recommended to perform SMS-DWI before gadoxetic acid administration.

Comparison of image quality and quantitative parameters in intravoxel incoherent motion imaging at 3-T based on turbo spin-echo and echo-planar imaging in patients with oral cancer.

To compare the image quality, apparent diffusion coefficient (ADC), and intravoxel incoherent motion- (IVIM) derived parameters of IVIM imaging based on turbo spin-echo (TSE) and echo-planar imaging (EPI) of patients with oral cancer and to assess the equivalence of the ADC and IVIM-derived parameters. Thirty patients with oral cancer underwent TSE-IVIM and EPI-IVIM imaging using a 3.0-T system. The distortion ratio (DR), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), qualitative evaluations of image quality, ADC, pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were compared between the two sequences. The consistency of the quantitative parameters in oral cancer between the TSE and EPI sequences was evaluated using a Bland-Altman analysis. TSE-IVIM had a significantly smaller DR than EPI-IVIM (P < 0.001). The CNR of EPI-IVIM on most of the anatomical sites was significantly higher than that of TSE-IVIM (P < 0.05), while the SNR was not significantly different (P > 0.05). TSE-IVIM had significantly higher image quality, less distortion and artifacts, and lower image contrast compared with EPI-IVIM (P < 0.05). The lesion-edge sharpness and diagnostic confidence of EPI-IVIM were lower than that of TSE-IVIM, although no significant differences existed (P > 0.05). The ADC and D of TSE-IVIM had better reproducibility (intraclass correlation coefficient > 0.9). Although no significant difference existed for the ADC and IVIM-derived parameters of lesions between the two sequences (P > 0.05), wide limits of agreement were found in the Bland-Altman plots. TSE-IVIM could be used as an alternative technique to EPI-IVIM for patients with oral cancer because of its better image quality. Furthermore, TSE-IVIM can provide more accurate quantitative parameters. However, the quantitative parameters derived from the two IVIM techniques cannot be used as equivalent parameters for patients with oral cancer.

The outstanding diagnostic value of DKI in multimodal magnetic resonance imaging for benign and malignant breast tumors: A diagnostic accuracy study.

To explore the value of applying different magnetic resonance imaging MRI sequences in the differential diagnosis of benign and malignant breast tumors. Routine breast magnetic resonance scans (T1-weighted image, T1WI; T2-weighted image, T2WI), dynamically enhanced scans, diffusion-weighted Imaging, and diffusion kurtosis imaging (DKI) scans were performed on 63 female patients with breast-occupying lesions. The benign and malignant lesions were confirmed by biopsy, excision-histopathology reports. There are 70 lesions, of which 46 are benign and 24 are malignant. Analyze the primary conditions, such as the shape, size, and boundary of the lesion, and determine the apparent diffusion coefficient (ADC), mean kurtosis (MK), and mean diffusion (MD) values. The receiver operating characteristic curve was used to evaluate the value and difference in differentiating benign and malignant lesions. In this study, the results of the 2 testers both showed that the MK of malignant lesions was significantly higher than that of benign lesions (P < .001), and the MD of benign lesions was higher than that of malignant lesions (P < .05). The ADC of benign lesions was higher than that of malignant lesions (P < .05). For MK, the area under the curve of the 2 testers was 0.855/0.869, respectively. When the best cutoff value of MK for tester 1 was 0.515, the sensitivity and specificity of MK for diagnosing malignant tumors were 83.3%/87.0%, respectively. For the 2 testers MD, and ADC, the area under the curve was < 0.5, and the diagnostic value was low. The MK value obtained by DKI has a specific value in the differential diagnosis of benign and malignant breast lesions. DKI is helpful in the identification of benign and malignant breast tumors. The diagnostic value is outstanding, and its importance to the changes in the microstructure of the organization needs to be further explored.

Automated acute ischemic stroke lesion delineation based on apparent diffusion coefficient thresholds.

Automated lesion segmentation is increasingly used in acute ischemic stroke magnetic resonance imaging (MRI). We explored in detail the performance of apparent diffusion coefficient (ADC) thresholding for delineating baseline diffusion-weighted imaging (DWI) lesions. Retrospective, exploratory analysis of the prospective observational single-center 1000Plus study from September 2008 to June 2013 (clinicaltrials.org; NCT00715533). We built a fully automated lesion segmentation algorithm using a fixed ADC threshold (≤620 × 10-6 mm2/s) to delineate the baseline DWI lesion and analyzed its performance compared to manual assessments. Diagnostic capabilities of best possible ADC thresholds were investigated using receiver operating characteristic curves. Influential patient factors on ADC thresholding techniques' performance were studied by conducting multiple linear regression. 108 acute ischemic stroke patients were selected for analysis. The median Dice coefficient for the algorithm was 0.43 (IQR 0.20-0.64). Mean ADC values in the DWI lesion (β = -0.68, p < 0.001) and DWI lesion volumes (β = 0.29, p < 0.001) predicted performance. Optimal individual ADC thresholds differed between subjects with a median of ≤691 × 10-6 mm2/s (IQR ≤660-750 × 10-6 mm2/s). Mean ADC values in the DWI lesion (β = -0.96, p < 0.001) and mean ADC values in the brain parenchyma (β = 0.24, p < 0.001) were associated with the performance of individual thresholds. The performance of ADC thresholds for delineating acute stroke lesions varies substantially between patients. It is influenced by factors such as lesion size as well as lesion and parenchymal ADC values. Considering the inherent noisiness of ADC maps, ADC threshold-based automated delineation of very small lesions is not reliable.

Correlation of Quantitative Diffusion-Weighted MR Parameters and SUVmax from 18-FDG PET-CT in Lung Cancer: A Prospective Observational Study

Abstract Background Diffusion-weighted magnetic resonance imaging (DW-MRI) sequences report the cellularity in tissues and 18-fluorodeoxyglucose (18-FDG) positron emission tomography–computed tomography (PET-CT) provides information on glucose metabolism in cells, associated to tumor aggressiveness. The aim of this study was to assess the correlation between quantitative diffusion-weighted magnetic resonance parameters and maximum standardized uptake value (SUVmax) using 18-FDG PET-CT in lung cancer and metastatic lymph nodes. Methods Histologically proven 29 patients of lung cancers were subjected to 18-FDG PET-CT and DW-MRI (parameters: repetition time/time to echo [TR/TE] = 4,000/76 ms; b-values = 0, 400, and 800 s/mm2) between June 2018 and June 2019. SUVmax was calculated on the PET-CT images representing region of interest (ROI) in the tumor. The apparent diffusion coefficient (ADC) values were quantified by placing an ROI over the tumor at a high b-value of 800 mm2/s. Statistical analyses for correlation between SUVmax and ADC were done using Pearson's correlation coefficient (r). Results Significant negative correlation was observed between analyses of ADC and SUVmax for primary lesions of all nonsmall-cell lung cancers (NSCLCs; p &lt; 0.05) and its histological subtype adenocarcinoma (p &lt; 0.05) but not squamous cell carcinomas (p = 0.35). Significant negative correlation was also observed for metastatic lymph nodes of adenocarcinoma (p &lt; 0.05) but not for metastatic lymph nodes of all NSCLCs (p = 0.05) or squamous cell carcinomas (p = 0.55). Conclusions Diffusion-weighted imaging (DWI) with ADC may represent a new prognostic marker due to a significant negative correlation between ADC determined by DWI and SUVmax by PET-CT in NSCLCs. Furthermore, DWI-MRI of the thorax can be added to routine 18-FDG PET-CT for staging and response assessment in lung cancer in prospects.

Longitudinal monitoring of Apparent Diffusion Coefficient (ADC) in patients with prostate cancer undergoing MR-guided radiotherapy on an MR-Linac at 1.5 T: a prospective feasibility study.

Hybrid MRI linear accelerators (MR-Linac) might enable individualized online adaptation of radiotherapy using quantitative MRI sequences as diffusion-weighted imaging (DWI). The purpose of this study was to investigate the dynamics of lesion apparent diffusion coefficient (ADC) in patients with prostate cancer undergoing MR-guided radiation therapy (MRgRT) on a 1.5T MR-Linac. The ADC values at a diagnostic 3T MRI scanner were used as the reference standard. In this prospective single-center study, patients with biopsy-confirmed prostate cancer who underwent both an MRI exam at a 3T scanner (MRI3T) and an exam at a 1.5T MR-Linac (MRL) at baseline and during radiotherapy were included. Lesion ADC values were measured by a radiologist and a radiation oncologist on the slice with the largest lesion. ADC values were compared before vs. during radiotherapy (during the second week) on both systems via paired t-tests. Furthermore, Pearson correlation coefficient and inter-reader agreement were computed. A total of nine male patients aged 67 ± 6 years [range 60 - 67 years] were included. In seven patients, the cancerous lesion was in the peripheral zone, and in two patients the lesion was in the transition zone. Inter-reader reliability regarding lesion ADC measurement was excellent with an intraclass correlation coefficient of (ICC) > 0.90 both at baseline and during radiotherapy. Thus, the results of the first reader will be reported. In both systems, there was a statistically significant elevation of lesion ADC during radiotherapy (mean MRL-ADC at baseline was 0.97 ± 0.18 × 10-3 mm2/s vs. mean MRL-ADC during radiotherapy 1.38 ± 0.3 × 10-3 mm2/s, yielding a mean lesion ADC elevation of 0.41 ± 0.20 × 10-3 mm2/s, p < 0.001). Mean MRI3T-ADC at baseline was 0.78 ± 0.165 × 10-3 mm2/s vs. mean MRI3T-ADC during radiotherapy 0.99 ± 0.175 × 10-3 mm2/s, yielding a mean lesion ADC elevation of 0.21 ± 0.96 × 10-3 mm2/s p < 0.001). The absolute ADC values from MRL were consistently significantly higher than those from MRI3T at baseline and during radiotherapy (p < = 0.001). However, there was a strong positive correlation between MRL-ADC and MRI3T-ADC at baseline (r = 0.798, p = 0.01) and during radiotherapy (r = 0.863, p = 0.003). Lesion ADC as measured on MRL increased significantly during radiotherapy and ADC measurements of lesions on both systems showed similar dynamics. This indicates that lesion ADC as measured on the MRL may be used as a biomarker for evaluation of treatment response. In contrast, absolute ADC values as calculated by the algorithm of the manufacturer of the MRL showed systematic deviations from values obtained on a diagnostic 3T MRI system. These preliminary findings are promising but need large-scale validation. Once validated, lesion ADC on MRL might be used for real-time assessment of tumor response in patients with prostate cancer undergoing MR-guided radiation therapy.

Diffusion kurtosis imaging and diffusion weighted imaging comparison in diagnosis of early hypoxic–ischemic brain edema

BackgroundHypoxic–ischemic encephalopathy (HIE) refers to cerebral hypoxic–ischemic injury caused by asphyxia during perinatal period, which is one of the important causes of neonatal death and sequelae. Early and accurate diagnosis of HIE is of great significance for the prognostic evaluation of patients. The purpose of this study is to explore the efficacy of diffusion-kurtosis imaging (DKI) and diffusion-weighted imaging (DWI) in the diagnosis of early HIE.MethodsTwenty Yorkshire newborn piglets (3–5 days) were randomly divided into control group and experimental group. DWI and DKI scanning were performed at timepoints of 3, 6, 9, 12, 16, and 24 h after hypoxic–ischemic exposure. At each timepoint, the parameter values obtained by each group scan were measured, and the lesion area of the apparent diffusion coefficient (ADC) map and mean diffusion coefficient (MDC) map were measured. (For better interpretation of this study, we replaced the description of MD with MDC). Then, we completely removed the brain for pathological examination, and observed the state of cells and mitochondria in the ADC/MDC matching area (the actual area of the lesion), and the mismatch area (the area around the lesion).ResultsIn the experimental group, the ADC and MDC values decreased with time, but the MDC decreased more significantly and the change rate was higher. Both MDC and ADC values changed rapidly from 3 to 12 h and slowly from 12 to 24 h. The MDC and ADC images showed obvious lesions at 3 h for the first time. At this time, the area of ADC lesions was larger than that of MDC. As the lesions developed, the area of ADC maps was always larger than that of the MDC maps within 24 h. By observing the microstructure of the tissues by light microscopy, we found that the ADC and MDC matching area in the experimental group showed swelling of neurons, infiltration of inflammatory cells, and local necrotic lesions. Consistent with the observation under light microscope, pathological changes were observed in the matching ADC and MDC regions under electron microscopy as well, including collapse of mitochondrial membrane, fracture of partial mitochondrial ridge, and emergence of autophagosomes. In the mismatching region, the above pathological changes were not observed in the corresponding region of the ADC map.ConclusionsDKI’s characteristic parameter MDC is better than ADC (parameter of DWI) to reflect the real area of the lesion. Therefore, DKI is superior to DWI in diagnosing early HIE.

Multishot Diffusion-Weighted MRI of the Breasts in the Supine vs. Prone Position.

Diffusion-weighted imaging (DWI) may allow for breast cancer screening MRI without a contrast injection. Multishot methods improve prone DWI of the breasts but face different challenges in the supine position. To establish a multishot DWI (msDWI) protocol for supine breast MRI and to evaluate the performance of supine vs. prone msDWI. Prospective. Protocol optimization: 10 healthy women (ages 22-56), supine vs. prone: 24 healthy women (ages 22-62) and five women (ages 29-61) with breast tumors. 3-T, protocol optimization msDWI: free-breathing (FB) 2-shots, FB 4-shots, respiratory-triggered (RT) 2-shots, RT 4-shots, supine vs. prone: RT 4-shot msDWI, T2-weighted fast-spin echo. Protocol optimization and supine vs. prone: three observers performed an image quality assessment of sharpness, aliasing, distortion (vs. T2), perceived SNR, and overall image quality (scale of 1-5). Apparent diffusion coefficients (ADCs) in fibroglandular tissue (FGT) and breast tumors were measured. Effect of study variables on dichotomized ratings (4/5 vs. 1/2/3) and FGT ADCs were assessed with mixed-effects logistic regression. Interobserver agreement utilized Gwet's agreement coefficient (AC). Lesion ADCs were assessed by Bland-Altman analysis and concordance correlation (ρc ). P value <0.05 was considered statistically significant. Protocol optimization: 4-shots significantly improved sharpness and distortion; RT significantly improved sharpness, aliasing, perceived SNR, and overall image quality. FGT ADCs were not significantly different between shots (P=0.812), FB vs. RT (P=0.591), or side (P=0.574). Supine vs. prone: supine images were rated significantly higher for sharpness, aliasing, and overall image quality. FGT ADCs were significantly higher supine; lesion ADCs were highly correlated (ρc =0.92). Based on image quality, supine msDWI outperformed prone msDWI. Lesion ADCs were highly correlated between the two positions, while FGT ADCs were higher in the supine position. 2. Stage 1.

S-PI-RADS and PI-RRADS for Biparametric MRI in the Detection of Prostate Cancer and Post-treatment Local Recurrence.

The application of biparametric magnetic resonance imaging (bpMRI) [T2-weighted (T2W) and diffusion weighted imaging (DWI)/apparent diffusion coefficient (ADC)] using dedicated structured methods, such as Simplified Prostate Imaging Reporting and Data System (S-PI-RADS) for the detection, categorization, and management of prostate cancer (PCa) is reported. Also, Prostate Imaging Reporting for Local Recurrence and Data System (PI-RRADS) for the detection and assessment of the probability of local recurrence after radiotherapy (RT) or radical prostatectomy (RP) in patients with biochemical recurrence (BCR) is proposed. Both S-PI-RADS and PI-RRADS assign to DWI/ADC a main role for the above purpose. S-PI-RADS identifies four categories and, on the basis of the qualitative and quantitative analysis of the restricted diffusion on ADC map and lesion volume, distinguishes two categories of lesions: category 3 (moderately homogeneous hypointense on ADC map) and category 4 (markedly homogeneous or inhomogeneous hypointense on ADC map). Ιn category 3, two subcategories (3a: volume <0.5 cm3 and 3b: volume ≥0.5 cm3) suggesting clinical management. PI-RRADS distinguishes four assessment categories and suggests the stratification of the probability (ranging from very low for category 1 to very high for category 4) of local disease recurrence. In clinical practice, S-PI-RADS and PI-RRADS, based on bpMRI represent a potential valid approach that may facilitates the detection and management of PCa and for detecting local recurrence after treatment improving communication with other professionals.

Comparison Between Amide Proton Transfer Magnetic Resonance Imaging Using 3-Dimensional Acquisition and Diffusion-Weighted Imaging for Characterization of Prostate Cancer: A Preliminary Study.

This study aimed to compare diagnostic performance for tumor detection and for assessment of tumor aggressiveness in prostate cancer (PC) between amide proton transfer magnetic resonance imaging (MRI) with 3-dimensional acquisition (3DAPT) and diffusion-weighted imaging. The subjects were 23 patients with 27 pathologically proven PCs who underwent 3T multiparametric MRI. With reference to the pathology findings, 2 readers in consensus identified the location of PC on multiparametric MRI and measured APT signal intensity (APT SI [%]) and mean apparent diffusion coefficient (ADC) of the benign region and each PC lesion. The mean ADC showed a significant difference between benign regions and PC lesions (0.74 ± 0.15 vs 1.37 ± 0.21, P < 0.001), whereas APT SI did not ( P = 0.091). Lesion APT SI was significantly higher and lesion ADC was significantly lower in PCs with Gleason group (GG) ≥3 than in PCs with GG ≤2 (3.37 ± 1.30 vs 1.78 ± 0.67, P < 0.001, and 0.71 ± 0.18 vs 0.79 ± 0.10, P = 0.038, respectively). The APT SI was significantly higher in GG3 than in GG1, in GG3 than in GG2, and in GG4 than in GG2 ( P = 0.009, P = 0.001, and P = 0.006, respectively). The area under the curve for separating tumor lesions and benign regions was 0.601 for 3DAPT and 0.983 for ADC ( P < 0.001). The area under the curve for separating tumors with GG ≤2 from tumors with GG ≥3 was 0.912 for 3DAPT and 0.734 for ADC ( P = 0.172). In patients with PC, it might be preferable to use ADC to discriminate benign from malignant tissue and use APT SI for assessment of tumor aggressiveness.

Comparison of apparent diffusion coefficient and relative apparent diffusion coefficient values for differential diagnosis of breast lesions

Objectives: The purpose the study was to evaluate the role of diffusion weighted magnetic resonance imaging (DW-MRI) in diagnosis of benign and malignant breast lesions, to calculate a cut-off apparent diffusion coefficient (ADC) value and to explore use of relative ADC (r ADC) for improving sensitivity and specificity of MRI in diagnosis of breast cancer. Methods: This retrospective study based on a cohort of patients who underwent dynamic contrast enhanced (DCE)-MRI having suspicious breast mass by ultrasonography and mammography to whom DWI sequence was added to the routine diagnostic MRI. ADC and r ADC (lesion/normal breast tissue) values of breast masses were calculated. The threshold ADC values used to differentiate benign and malignant lesions were determined using receiver operating characteristic analysis, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Results: Malignant masses had significantly lower ADC (mean: 1.03 ± 0.36 × 10-3 mm2/s) and r ADC (mean: 0.66 ± 0.22 × 10-3 mm2/s) values than those of benign masses with ADC (mean: 1.50 ± 0.56 × 10−3 mm2/s) and r ADC (mean: 0.97 ± 0.31 × 10-3 mm2/s) values, respectively (p = 0.001 for both). The best cut-off value for the lesion ADC was 1.09 × 10-3 mm2/s with a sensitivity of 72.73%, and specificity of 79.17%. The best cut-off value for r ADC was 0.83 with sensitivity of 78.79% and specificity of 70.83%. Conclusions: DWI has high diagnostic value with high sensitivity and specificity differentiating benign and malignant breast lesions. ADC and r ADC values can improve the diagnostic accuracy of differentiating benign and malignant breast lesions.

Role of diffusion-weighted MRI in differentiation between benign and malignant anterior mediastinal masses.

Diffusion-weighted imaging (DWI) is considered to be a useful biomarker to characterize the cellularity of lesions, yet its application in the thorax to evaluate anterior mediastinal lesions has not been well investigated. The aims of our study were to describe the magnetic resonance (MR) characteristics of anterior mediastinal masses and to assess the role of apparent diffusion coefficient (ADC) value in distinguishing benign from malignant lesions of the anterior mediastinum. We conducted a retrospective cross-sectional study including 55 patients with anterior mediastinal masses who underwent preinterventional MR scanning with the following sequences: T1 VIBE DIXON pre and post-contrast, T2 HASTE, T2 TIRM, DWI-ADC map (b values of 0 and 2000 sec/mm2). The ADC measurements were obtained by two approaches: hot-spot ROI and whole-tumor histogram analysis. The lesions were grouped by three distinct ways: benign versus malignant, group A (benign lesions and type A, AB, B1 thymoma) versus group B (type B2, B3 thymoma and other malignant lesions), lymphoma versus other malignancies. The study was composed of 55 patients, with 5 benign lesions and 50 malignant lesions. The ADCmean, ADCmedian, ADC10, ADC90 in the histogram-based approach and the hot-spot-ROI-based mean ADC of the malignant lesions were significantly lower than those of benign lesions (P values< 0.05). The hot-spot-ROI-based mean ADC had the highest value in differentiation between benign and malignant mediastinal lesions, as well as between group A and group B; the ADC cutoffs (with sensitivity, specificity) to differentiate malignant from benign lesions and group A from group B were 1.17 x 10-3 mm2/sec (80%, 80%) and 0.99 x 10-3 mm2/sec (78.4%, 88.9%), respectively. The ADC values obtained by using the hot-spot-ROI-based and the histogram-based approaches are helpful in differentiating benign and malignant anterior mediastinal masses.