Average Apparent Diffusion Coefficient Research Articles

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

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

Initial experience of 3-tesla apparent diffusion coefficient values in characterizing squamous cell carcinomas of the head and neck

With the increased clinical use of 3-Tesla (3T) magnets, it becomes important to identify the potential applications of advanced magnetic resonance (MR) imaging techniques such as diffusion-weighted imaging in head and neck pathologies. To establish the 3T apparent diffusion coefficient (ADC) values for normal neck structures, and to examine the utility of ADC values in distinguishing head and neck squamous cell carcinomas (HNSCC) from normal neck anatomy. 3T diffusion-weighted imaging was performed on 10 normal volunteers and 10 patients with known HNSCC. In the volunteers, mean ADC was calculated in the parotid gland, submandibular gland, base of the tongue, pterygoid muscle, masseter muscle, paraspinal muscles, true vocal cord, thyroid gland, thyroid cartilage, cricoid cartilage, and lymph nodes. The mean tumor ADC value was calculated from the 10 patients with HNSCC and compared with the normal ADC values from various neck structures. The mean ADC value measured in the HNSCC was 1.101 (+/-0.214) x 10(-3) mm(2)/s. This was significantly lower than ADC values of paraspinal muscles, pterygoid muscle, masseter muscle, thyroid gland, and base of the tongue (P=0.0006, 0.0002, 0.0001, 0.001, and 0.002, respectively). The tumor ADC values were not significantly different from ADC values of parotid and submandibular glands (P=0.057 and 0.14, respectively). 3T ADC values show potential for distinguishing HNSCC from normal extracranial head and neck structures.

Diffusion-Weighted Imaging Improves Outcome Prediction in Pediatric Traumatic Brain Injury

Diffusion-weighted imaging (DWI) and consequent apparent diffusion coefficient (ADC) maps have been used for lesion detection and as a predictor of outcome in adults with traumatic brain injury (TBI), but few studies have been reported in children. We evaluated the role of DWI and ADC for outcome prediction after pediatric TBI (n=37 TBI; n=10 controls). Fifteen regions of interest (ROIs) were manually drawn on ADC maps that were grouped for analysis into peripheral gray matter, peripheral white matter, deep gray and white matter, and posterior fossa. All ROIs excluded areas that appeared abnormal on T2-weighted images (T2WI). Acute injury severity was measured using the Glasgow Coma Scale (GCS) score, and 6-12-month outcomes were assessed using the Pediatric Cerebral Performance Category Scale (PCPCS) score. Patients were categorized into five groups: (1) controls; (2) all TBI patients; (3) mild/moderate TBI with good outcomes; (4) severe TBI with good outcomes; and (5) severe TBI with poor outcomes. ADC values in the peripheral white matter were significantly reduced in children with severe TBI with poor outcomes (72.8+/-14.4x10(-3) mm2/sec) compared to those with severe TBI and good outcomes (82.5+/-3.8x10(-3) mm2/sec; p<0.05). We also found that the average total brain ADC value alone had the greatest ability to predict outcome and could correctly predict outcome in 84% of cases. Assessment of DWI and ADC values in pediatric TBI is useful in evaluating injury, particularly in brain regions that appear normal on conventional imaging. Early identification of children at high risk for poor outcome may assist in aggressive clinical management of pediatric TBI patients.

Central neurocytoma: proton MR spectroscopy and diffusion weighted MR imaging findings

To present proton magnetic resonance spectroscopy and diffusion-weighted imaging (DWI) findings of central neurocytoma (CN). Imaging findings of seven patients with the histopathological diagnosis of CN (five male and two female; age range, 21-28 years of age) were evaluated retrospectively. In addition to conventional magnetic resonance imaging features, we also assessed the metabolite ratios and tumor normalized apparent diffusion coefficient (NADC), which was calculated by dividing the tumor apparent diffusion coefficient (ADC) values by normal ADC. Approval from our institutional review board was obtained for this review. The tumor choline/creatine ratios were 5.17+/-2.38, while N-acetyl aspartate/choline and N-acetyl aspartate/creatine ratios were 0.33+/-0.15 and 1.84+/-1.38, respectively. On DWI, tumors had heterogeneous hyperintense appearances when compared with the contralateral parietal lobe white matter and tumor NADC values were 0.63+/-0.05. Significantly increased choline/creatine and decreased N-acetyl aspartate/choline ratios with lower NADC values in CN resemble high-grade gliomas and complicate the diagnosis. Familiarity its physiologic features would help to presurgical diagnosis of ventricular and exraventricular CNs.

Reversible brainstem hypertensive encephalopathy (RBHE): Clinicoradiologic dissociation

We report two cases of reversible brainstem hypertensive encephalopathy (RBHE) with unusual magnetic resonance (MR) findings. Patient 1, an 85-year-old man without a history of hypertension, developed acute severe hypertension and mild consciousness disturbance as the only symptoms. Patient 2, a 46-year-old man with an untreated hypertension, presented with extremely high blood pressure and general fatigue, vertigo, and mild dysarthria as the initial manifestations. In these patients, fluid-attenuated inversion recovery (FLAIR) and T2-weighted MR images revealed diffuse hyperintensities in the brainstem. Diffusion-weighted imaging (DWI) findings were normal, and apparent diffusion coefficient (ADC) values were increased in the brainstem. The supratentorial regions were largely spared, and mildly diffuse hyperintensities were noted in the white matter. There were no accompanying changes in the occipital lobe and cerebellum. The lesions completely resolved after stabilization of blood pressure. The normal DWI findings and high ADC values were consistent with vasogenic edema due to severe hypertension. The characteristics of RBHE are a very high blood pressure, mild clinical and neurologic symptoms, rapidly improved MR findings after initial treatment with the control of hypertension, and a marked clinicoradiologic dissociation.

Sci-Sat AM(1): Imaging-01: Tumour and normal tissue T2 and ADC distributions for a mouse model at 9.4T.

Magnetic resonance (MR) measurements of relaxation times and diffusion coefficient in tissue have been demonstrated to be sensitive to biological changes induced by radiation therapy. We are currently using mouse models of human glioblastoma multiforme (GBM) to study tumour response to ionizing radiation by MRI at 9.4T. Utilizing conventional imaging techniques coupled with quantitative measurements of transverse relaxation time (T2) and apparent diffusion coefficient (ADC), we monitor changes during tumour growth and subsequent changes after single-fraction radiotherapy. In addition to tumour parameters, we have measured T2 and ADC in other structures that appear in the same transverse slices as tumour tissue. Here we report the measured distributions of T2 and ADC in tumour and in normal tissues that are likely to be encountered during MR imaging of tumour xenografts in mice, including liver, kidney, fat, skeletal muscle, spinal cord, and brain. Quantitative knowledge of these distributions in normal tissue is important in optimizing the sequences used for imaging of these tissues, and in optimizing continued measurements of T2 and ADC changes. Knowledge of parameter distributions in tumour is important because recent studies have suggested that the T2 and ADC responses after therapy may be the result of large shifts in smaller isolated pockets of tumour, rather than more moderate shifts in T2 and ADC over the whole tumour volume. These distributions provide a baseline measurement of typical distributions in advance of radiation therapy.

The Effect of Susceptibility of Gadolinium Contrast Media on Diffusion-weighted Imaging and the Apparent Diffusion Coefficient

The development of parallel magnetic resonance imaging has resulted in the frequent use of diffusion-weighted imaging (DWI) in clinical medicine, which usually involves the use of contrast medium. However, gadolinium (Gd) contrast medium may have some effect on DWI and the apparent diffusion coefficient (ADC). The present study was performed to determine whether the magnetic susceptibility of contrast medium alters the DWI signal and the value of ADC in some imaging techniques. Nonfat suppression DWI, short-time inversion recovery (STIR) combination, and chemical shift selective (CHESS) combination DWI were performed to examine 10 phantoms with gadolinium-meglumine gadopentetate (Gd-DTPA) dissolved at concentrations from 0.0005 to 0.1 mmol in physiologic saline as a contrast medium. The average pixel value and ADC of each method were determined. ADC showed no differences between before and after treatment with contrast medium for all imaging techniques with Gd considered distributed over the whole tumor. The signal intensity did not change on nonfat suppression or CHESS combination DWI, but deteriorated on STIR. ADC was not influenced by the magnetic susceptibility of contrast medium. In addition, it was suggested that the ability of tumor detection may be reduced if STIR is used as fat suppression.

Functional changes of apparent diffusion coefficient during visual stimulation investigated by diffusion-weighted gradient-echo fMRI

The signal source of apparent diffusion coefficient (ADC) changes induced by neural activity is not fully understood. To examine this issue, ADC-fMRI in response to a visual stimulus was obtained in isoflurane-anesthetized cats at 9.4 T. A gradient-echo technique was used for minimizing the coupling between diffusion and background field gradients, which was experimentally confirmed. In the small b-value domain ( b = 5 and 200 s/mm 2), a functional ADC increase was detected at the middle of the visual cortex and at the cortical surface, which was caused mainly by an increase in cerebral blood volume (CBV) and inflow. With higher b-values ( b = 200 and 1000−1200 s/mm 2), a functional ADC decrease was observed in the parenchyma and also at the cortical surface. Within the parenchyma, the ADC decrease responded faster than the BOLD signal, but was not well localized to the middle of visual cortex and almost disappeared when the intravascular signal was removed with a susceptibility contrast agent, suggesting that the decrease in ADC without contrast agent was mostly of vascular origin. At the cortical surface, an average ADC decrease of 0.5% remained after injection of the contrast agent, which may have arisen from a functional reduction of the partial volume of cerebrospinal fluid. Overall, a functional ADC change of tissue origin could not be detected under our experimental conditions.

Cognitive function correlates with frontal white matter apparent diffusion coefficients in patients with leukoaraiosis

Diffusion weighted imaging (DWI) displays a high sensitivity to white matter changes, even in areas where no lesions are visible. Correlation with vascular risk factors and cognitive dysfunction seems to be feasible using this technique. We aimed to test relations between age, blood pressure and cognitive function,with lesion load and average Apparent Diffusion Coefficient (ADC) values in lesioned (LWM) and in normal appearing white matter (NAWM), in patients with age related white matter lesions (ARWML). Subjects were 29 patients (mean age 72.6 +/- 5.2 years) with different severity of ARWML on MRI and no (or mild) disability assessed by the Instrumental Activities of Daily Living Scale. Imaging lesion load was quantified in bilateral frontal, temporal, parieto-occipital, basal ganglia and infratentorial regions, using a simple visual rating scale; ADC was measured bilaterally in Regions of Interest in parieto-occipital and frontal NAWM, and in frontal periventricular LWM. Neuropsychological examination consisted of Raven Colored Progressive Matrices, Rey's Complex Figure, Digit Canceling. Symbol digit Substitution, Inverse Digit Repetition and Verbal Fluency tests. Visual scales scores and ADC were significantly higher in frontal and parieto-occipital regions. Both were significantly correlated to age and blood pressure, in frontal (visual scale scores and ADC) and parieto-occipital regions (ADC). Attention skills were negatively correlated to ADC in LWM and NAWM in frontal regions and with frontal region visual scale scores. Our findings suggest that severity of white matter ischemic changes is correlated with worse cognitive function, as well as advanced age and higher blood pressure.A higher vulnerability of frontal white matter to vascular disease seems to play an important role in executive dysfunction, mainly determined by impairment of attentional skills.DWI results suggest this could be true even for NAWM.

Diffusion-weighted MRI sequences (DW-MRI) of the kidney: normal findings, influence of hydration state and repeatability of results

This study was performed to determine the apparent diffusion coefficient (ADC) of the normal kidney using diffusion-weighted magnetic resonance imaging (DW-MRI) sequences and to analyse both the changes due to hydration state and results repeatability. Ten volunteers underwent DW-MRI imaging of the kidneys with a breath-hold single-shot spin-echo planar imaging (SE-EPI) sequence in the axial and coronal planes with b values of 300, 500, 800 s/mm(2), in different states of hydration. Urine osmolarity (OsmU) and sodium excretion (NaU) were measured at the time of each examination. ADC maps were created for all b values, and ADC values were calculated and compared between different states of hydration. In five subjects, the protocol was conducted twice to test data repeatability. ADC values were lower with higher b values (3.00 vs. 2.47 vs. 1.99 x 10(-3) mm(2)/s with b values of 300, 500, 800 s/mm(2), respectively). ADC values in different hydration states were not statistically different. Measurements were reproducible. OsmU and NaU were statistically different in the different states of hydration (p<0.01). ADC values significantly decrease with higher b values. Average ADC values in the normal kidney are reproducible. Hydration state does not significantly influence mean ADC values.

Fetal MRI: what is the future?

Fetal MRI: what is the future?

Diffusion-weighted MRI in cervical cancer

The purpose was to investigate the potential value of apparent diffusion coefficient (ADC) measurement with MRI in the assessment of cervix cancer. Diffusion-weighted MRI was performed in 47 patients with cervical carcinoma undergoing chemoradiation therapy and 26 normal controls on a 1.5-T system with a b-value of 600 s/mm(2). FIGO stage, tumor volume, nodal status, interstitial fluid pressure (IFP) and oxygen measurements were recorded. Response was defined as no visible tumor 3-6 months following completion of therapy. The average median ADC (mADC) of cervical carcinomas (1.09+/-0.20 x 10(-3) mm(2)/s) was significantly lower than normal cervix (2.09+/-0.46 x 10(-3) mm(2)/s) (P<0.001). There was no correlation between mADC, nodal status, tumor volume, IFP or oxygen measurements. mADC was significantly lower in FIGO stages T1b/T2a (0.986 x 10(-3) mm(2)/s) compared to T2b (1.21 x 10(-3) mm(2)/s) and T3/T4 (1.10 x 10(-3) mm(2)/s) (P<0.001). In patients with squamous carcinomas the 90th percentile of ADC values was lower in responders than non-responders (P<0.05). Median ADC in cervix carcinoma is significantly lower compared to normal cervix. ADC may have predictive value in squamous tumors, but further long-term study will determine the ultimate clinical utility.

Vertical distribution of [formula omitted] transport parameters in Boom Clay in the Mol-1 borehole (Mol, Belgium)

An important question for the performance assessment of a potential geological waste disposal site for radioactive waste in Boom Clay is: Can the Boom Clay be considered as a homogeneous clay layer from the point of view of its migration properties? Therefore, the hydraulic conductivity and the transport parameters of tritiated water (HTO) and two critical radionuclides ( 129I − and H 14 CO 3 - ) in Boom Clay and the upper lying sands of Eigenbilzen or Voort have been determined by pulse injection experiments on cores taken from different depths in the Mol-1 borehole (Belgium). The results for HTO and iodide have been reported previously and the present paper completes this study with H 14 CO 3 - . In the range from 191 m to 281 m depth (Below Drilling Table), the Boom Clay Formation can be considered as homogeneous with respect to the hydraulic conductivity and the transport parameters of H 14 CO 3 - . The value of the vertical hydraulic conductivity is around 2.5–3 × 10 −12 m/s. The average apparent diffusion coefficient D app of H 14 CO 3 - in the direction perpendicular to the bedding plane is (6 ± 3) × 10 −11 m 2/s. The product ηR of the diffusion accessible porosity η and the retardation factor R of H 14 CO 3 - is 0.26 ± 0.03, lying between the value of iodide ( ηR = 0.16) and of HTO ( ηR = 0.37). Due to anion exclusion, iodide has a lower porosity than HTO. Because of the lower ηR value of an anion as iodide, a slight sorption of H 14 CO 3 - cannot be excluded ( R ⩽ 0.26/0.16 ≈ 1.6).

High b-value diffusion-weighted MR imaging of normal brain at 3 T

Introduction The purpose of this study was to determine the normative apparent diffusion coefficient (ADC) values at 3 T using high b-value (3000 s/mm 2) diffusion-weighted images (DWI) and compare the signal characteristics of the high b value with standard b-value (1000 s/mm 2) DWI. Methods Institutional review board approval was obtained for this prospective study which included 20 volunteers (10 M, 10 F, mean age: 38.7 ± 14.9) without any known clinical disease or radiological findings. All brain examinations were performed with 3 T MR by using similar parameters of b1000 and b3000 DWI sequences. DWI and ADC maps were obtained. Signal intensity, noise, signal to noise ratio (SNR), contrast to noise (CNR), contrast ratio (CR), and ADC values of bilateral posterior limb of internal capsule, frontal white matter, parietal gray matter, pons, thalamus, splenium of corpus callosum were measured on b1000 and b3000 DW images. Results In all anatomic locations, MR signal intensity, SNR and ADC values of b3000 images were significantly lower than MR signal intensity, SNR and ADC values of b1000 images ( p < 0.001). The CNR and CR values at the posterior limb of internal capsule and pons were significantly increased on b3000 images ( p < 0.001) and decreased in the other regions measured. Conclusion The ADC values calculated from standard b-value DWI were significantly higher than those calculated from high b-value DWI. These results agree with the previous studies. In the regions where CNR values increase with high b value, b3000 DWI images may provide additional clinical information.

Cs + ADC in rat brain decreases markedly at death

Spectroscopic resolution of intracellular and extracellular compartments can be used to probe the kinetic environment of those spaces and the compartment-specific changes that occur following injury. This is important for understanding the biophysical mechanisms that underlie the remarkable diffusion-weighted MRI contrast of injured central nervous system (CNS) tissue. Cesium-133 is a physiologic analog of potassium that is actively taken up by cells and resides primarily in the intracellular space. The (133)Cs(+) signal can, thus, be exploited to probe the kinetic environment of the intracellular space. Two principal (133)Cs(+) resonances were observed at 11.74 T. These resonances arise separately from (133)Cs(+) in brain and temporalis muscle. The apparent diffusion coefficient (ADC) of Cs(+) in brain decreased from 1.0 +/- 0.2 microm(2)/ms in healthy tissue to 0.24 +/- 0.04 microm(2)/ms following global ischemia (average ADC +/- average uncertainty), while there was no significant change in the ADC of Cs(+) in temporalis muscle after injury. This finding underscores the tissue-specific nature of the decrease in ADC that accompanies brain injury. Further, as the Cs(+) ADC should reflect water ADC in the intracellular space, these results strongly support the hypothesis that the decrease in water ADC associated with CNS injury arises largely from kinetic changes taking place in the intracellular space.

Contribution of Diffusion-Weighted Imaging in the Evaluation of Diffuse White Matter Ischemic Lesions in Fetuses: Correlations with Fetopathologic Findings

The sensitivity of fetal MR imaging is poor with regard to the evaluation of diffuse ischemic white matter (WM) abnormalities. Our purpose was to evaluate the contribution of diffusion-weighted imaging (DWI) in the analysis of microstructural changes in WM and to correlate neuroimaging with neurofetopathologic findings. We included fetuses with MR imaging, DWI, and a fetopathologic examination. In a region of interest defined by MR imaging, where T1 and T2 intensities were abnormal, the apparent diffusion coefficient (ADC) was measured and immunohistochemical analysis was performed. In fetuses with no WM abnormality in signal intensity, region of interest was defined at random. Histologic reading was performed with a complete blinding of the MR imaging results and ADC values. Three degrees of histologic appearance were defined with regard to vasogenic edema, astrogliosis, microgliosis, neuronal and oligodendrocytic abnormalities, and proliferation or congestion of vessels and were compared with a chi(2) test in groups A (normal ADC) and B (increased ADC) fetuses. We included 12 fetuses in group A and 9 in group B, ranging from 29 to 38 weeks of gestation. All group B fetuses and 1 group A fetus demonstrated WM abnormalities in signal intensity. WM edema and astrogliosis were more common in group B than in group A (7/9 vs 2/12 and 8/9 vs 4/12, respectively). No significant difference was observed between both groups with regard to the other parameters. This study showed a strong correlation between increased ADCs and 1) WM abnormalities in signal intensity on MR imaging, and 2) vasogenic edema with astrogliosis of the cerebral parenchyma.

Diffusion-weighted MR imaging of the normal fetal lung

To quantify apparent diffusion coefficient (ADC) changes in fetuses with normal lungs and to determine whether ADC can be used in the assessment of fetal lung development. In 53 pregnancies (20-37th weeks of gestation), we measured ADC on diffusion-weighted imaging (DWI) in the apical, middle, and basal thirds of the right lung. ADCs were correlated with gestational age. Differences between the ADCs were assessed. Fetal lung volumes were measured on T2-weighted sequences and correlated with ADCs and with age. ADCs were 2.13 +/- 0.44 microm(2)/ms (mean +/- SD) in the apex, 1.99 +/- 0.42 microm(2)/ms (mean +/- SD) in the middle third, and 1.91 +/- 0.41 microm(2)/ms (mean +/- SD) in the lung base. Neither the individual ADC values nor average ADC values showed a significant correlation with gestational age or with lung volumes. Average ADCs decreased significantly from the lung apex toward the base. Individual ADCs showed little absolute change and heterogeneity. Lung volumes increased significantly during gestation. We have not been able to identify a pattern of changes in the ADC values that correlate with lung maturation. Furthermore, the individual, gravity-related ADC changes are subject to substantial variability and show nonuniform behavior. ADC can therefore not be used as an indicator of lung maturity.

Diffusion-weighted imaging evaluation of subtle cerebral microstructural changes in intrauterine fetal hydrocephalus

Hydrocephalus is an important etiological factor in neurological decline. With the advent of fetal ultrasound, fetal hydrocephalus is now more frequently detected than in the past. Ultrasonography (USG) provides information on general morphology, but microstructural changes that may play a prognostic role are beyond the resolution of that technique. These changes may theoretically be revealed by diffusion-weighted magnetic resonance imaging (DW-MRI). In this study, our preliminary findings of DW-MRI on the hydrocephalic fetuses are presented. Twelve fetuses with fetal USG diagnosis of hydrocephalus were investigated using a 1.5-T MR scanner. In addition to conventional techniques, DWI was performed. It was obtained using a single-shot echo-planar imaging sequence (TR/TE: 4393/81 ms; slice thickness: 5 mm; interslice gap: 1 mm; FOV: 230 mm; matrix size: 128x256; b values: 0 and 1000 s/mm2). Apparent diffusion coefficient (ADC) values were measured in the white matter of the periventricular frontal and occipital lobes, basal ganglia, thalamus, centrum semiovale and cerebrospinal fluid in the lateral ventricle. These values were compared with the normal prenatal ADC values from a radiological study published in the literature. All fetuses had moderate or severe bilateral supratentorial ventricular dilatation that was compatible with hydrocephalus. On conventional T1- and T2-weighted imaging, cerebral parenchyma had normal signal pattern and ADC values were significantly lower than those reported for fetuses with normal brain. These values were lower in hydrocephalic fetuses with statistical significance (P<.05-.01). DWI is a sensitive technique to investigate cerebral microstructure. The reduction in cerebral blood flow and alterations in cerebral energy metabolism in cases with hydrocephalus have been shown before. Changes in cerebral blood flow and energy metabolism, as a consequence of cerebral compression, may occur in hydrocephalus. Elevated ventricular pressure may cause cerebral ischemia. The anaerobic glycolysis seen in the hydrocephalic brain tissue by increasing the lactate concentration and intracellular fluid flux may be the reason for the reduced ADC values in hydrocephalic fetuses. However, long-term prospective trials on the correlation of ADC values and neurological outcome are necessary to exploit the full benefit of that novel technique.

Usefulness of combined fractional anisotropy and apparent diffusion coefficient values for detection of involvement in multiple system atrophy

Objective: To determine whether apparent diffusion coefficient (ADC) values and fractional anisotropy (FA) values can detect early pathological involvement in multiple system atrophy (MSA), and be used to differentiate MSA-P...

Combined Use of Diffusion-Weighted MRI and 1H MR Spectroscopy to Increase Accuracy in Prostate Cancer Detection

The objective of our study was to establish the sensitivity and specificity for prostate cancer detection using a combined 1H MR spectroscopy and diffusion-weighted MRI approach. Forty-two men (mean age +/- SD, 69.3 +/- 4.7 years) with prostate cancer were studied using endorectal T2-weighted imaging, 2D chemical shift imaging (CSI), and isotropic apparent diffusion coefficient (ADC) maps. Regions of interest (ROIs) were drawn around the entire gland, central gland, and peripheral zone tumor, diagnostically defined as low signal intensity on T2-weighted images within a sextant that was biopsy-positive for tumor. Lack of susceptibility artifact on a gradient-echo B0 map through the slice selected for CSI and no high signal intensity on external array T1-weighted images confirmed the absence of significant hemorrhage after biopsy. CSI voxels were classified as nonmalignant or as tumor (ROI included > or = 30% or > or = 70% tumor). Choline-citrate (Cho/Cit) ratios and average ADCs were calculated for every voxel. A plot of Cho/Cit ratios versus ADCs yielded a line of best separation of tumor voxels from nonmalignant voxels. Receiver operating characteristic (ROC) curves were plotted for Cho/Cit ratios alone, ADCs alone, and a combination of the two. The Cho/Cit ratios were significantly higher (p < 0.001) and the ADCs were significantly lower (p < 0.006) in tumor-containing voxels than in non-tumor-containing voxels. When voxels containing 30% or more tumor were considered positive, the area under the ROC curves using combined MR spectroscopy and ADC (0.81) was similar to that of Cho/Cit alone (0.79) and better than ADC alone (0.66). When voxels containing 70% or more tumor were considered positive and cutoffs to achieve a 90%-or-greater sensitivity chosen, a combination of Cho/Cit and ADC achieved a significant improvement in specificity compared with Cho/Cit alone (p < 0.0001) or ADC alone (p < 0.0001). When voxels containing > or = 70% tumor are considered positive, the combined use of MR spectroscopy and diffusion-weighted MRI increases the specificity for prostate cancer detection while retaining the sensitivity compared with MR spectroscopy alone or diffusion-weighted MRI alone.