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Improved Performance in Differentiating Benign from Malignant Sinonasal Tumors Using diffusion-weighted Combined with Dynamic Contrast-enhanced Magnetic Resonance Imaging

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Chinese Medical Journal 2015年第5期128卷 586-592页

作者： Xin-Yan Wang Fei Yan Hui Hao Jian-Xing Wu Qing-Hua Chen Jun-Fang Xian Department of Radiology Beijing Tongren Hospital Capital Medical University Beijing 100730 China Department of Radiology Beijing Tongren Hospital Capital Medical University Beijing 100730 China Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology Capital Medical University Beijing 100069 China

Background：Differentiating benign from malignant sinonsal lesions is essential for treatment planning as well as determining the patient＇s prognosis,but the differentiation is often difficult in clinical practice.The study aimed to determine whether the combination of diffusion-weighted （DW） and dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） can improve the performance in differentiating benign from malignant sinonasal tumors.Methods：This retrospective study included 197 consecutive patients with sinonasal tumors （116 malignant tumors and 81 benign tumors）.All patients underwent both DW and DCE-MRI in a 3-T magnetic resonance scanner.Two different settings ofb values （0,700 and 0,1000 s/mm^2） and two different strategies of region of interest （ROI） including whole slice （WS） and partial slice （PS） were used to calculate apparent diffusion coefficients （ADCs）.A DW parameter with WS ADCsb0.1000 and two DCE-MRI parameters （time intensity curve [TIC] and time to peak enhancement [Tpeak]） were finally combined to use in differentiating the benign from the malignant tumors in this study.Results：The mean ADCs of malignant sinonasal tumors （WS ADCsb0,1000=1.084 × 10^-3 mm^2/s） were significantly lower than those of benign tumors （WS ADCsb0,1000=1.617 × 10^-3 mm^2/s,P 〈 0.001）.The accuracy using WS ADCsb0,1000 alone was 83.7% in differentiating the benign from the malignant tumors （85.3% sensitivity,81.2% specificity,86.4% positive predictive value [PPV],and 79.5% negative predictive value [NPV]）.The accuracy using DCE with Tpeak and TIC alone was 72.1% （69.1% sensitivity,74.1% specificity,77.5% PPV,and 65.1% NPV）.Using DW-MRI parameter was superior than using DCE parameters in differentiation between benign and malignant sinonasal tumors （P 〈 0.001）.The accuracy was 87.3% （90.5% sensitivity,82.7% specificity,88.2% PPV,and 85.9% NPV） using DW-MRI combined with DCE-MRI,which was superior than that using DCE-MRI alone or using DW-MRI alone （both P 〈 0.001） in differentiating the benign from the malignant tum

关键词： diffusion-weighted Dynamic Contrast-enhanced Magnetic Resonance Imaging Nasal Cavity Neoplasm, Paranasal Sinus

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The applied research of simultaneous image acquisition of T2-weighted imaging(T2WI)and diffusion-weighted imaging(DWI)in the assessment of patients with prostate cancer

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Asian Journal of Andrology 2019年第2期21卷 177-182页

作者： Yi Liu Wei Wang Xiu-Bo Qin Hui-Hui Wang Ge Gao Xiao-Dong Zhang Xiao-Ying Wang Department of Radiology Peking University First HospitalBeijing 100034China

We aimed to evaluate the feasibility of simultaneous image acquisition of multiple instantaneous switchable scan(MISS)for prostate magnetic resonance imaging(MRI)on 3T.Fifty-three patients were scanned with MRI due to suspected prostate cancer.Twenty-eight of them got histological results.First,two readers assessed the structure delineation and image quality based on images of conventional T2-weighted imaging(T2WI)and diffusion-weighted imaging(DWI)(CTD).Second,two readers identified the index lesion together,and then,reader one evaluated the contrast of index lesion on T2WI and signal ratio on apparent diffusion coefficient map.Third,they assigned Prostate Imaging Reporting and Data System(PI-RADS)score in consensus for the index lesion.After 4 weeks,the images of MISS were reviewed by the same readers following the same process.Finally,two readers gave preference for image interpretation,respectively.Kappa coefficient,Wilcoxon signed-rank test,paired-sample t-test,Bland-Altman analysis,and receiver operating characteristic(ROC)analysis were used for statistical analysis.The acquisition time of CTD was 6 min and 10 st while the acquisition time of MISS was 4 min and 30 s.Interobserver agreements for image evaluation were k=0.65 and k=0.80 for CTD and MISS,respectively.MISS-T2WI showed better delineation for seminal vesicles than CTD-T2WI(reader 1:P<0.001,reader 2:P=0.001).The index lesion demonstrated higher contrast in MISS-T2WI(P<0.001).The FI-RADS scores based on CTD and MISS exhibited high ability in predicting clinically significant cancer(area under curve[AUC]=0.828 vs 0.854).Readers preferred to use MISS in 41.5%-47.2%of cases.MISS showed comparable performance to conventional technique with less acquisition time.

关键词： diffusion-weighted imaging magnetic resonance imaging prostate cancer

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

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World Journal of Gastroenterology 2019年第5期25卷 622-631页

作者： Tong Zhang Zi-Xing Huang Yi Wei Han-Yu Jiang Jie Chen Xi-Jiao Liu Li-Kun Cao Ting Duan Xiao-Peng He Chun-Chao Xia Bin Song Department of Radiology Sichuan University West China Hospital

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.

关键词： Hepatocellular carcinoma Liver Imaging Reporting and Data System Magnetic resonance imaging diffusion-weighted imaging Diagnosis

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

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World Journal of Gastroenterology 2019年第27期25卷 3619-3633页

作者： Hao Yu Ya-Qi Shen Fang-Qin Tan Zi-Ling Zhou Zhen Li Dao-Yu Hu John N Morelli Department of Radiology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina St.John’s Medical Center TulsaOK 74133United States

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;C

关键词： Magnetic resonance imaging diffusion-weighted imaging Crohn’s disease Ileum Reproducibility

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Abdominal applications of diffusion-weighted magnetic resonance imaging: Where do we stand?

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World Journal of Radiology 2013年第3期5卷 68-80页

作者： Ajaykumar C Morani Khaled M Elsayes Peter S Liu William J Weadock Janio Szklaruk Jonathan Russell Dillman Asra Khan Thomas L Chenevert Hero K Hussain Department of Radiology University of Texas MD Anderson Cancer Center Department of Radiology University of Michigan

diffusion-weighted imaging (DWI) is one of the magnetic resonance imaging (MRI) sequences providing qualitative as well as quantitative information at a cellular level. It has been widely used for various applications in the central nervous system. Over the past decade, various extracranial applications of DWI have been increasingly explored, as it may detect changes even before signal alterations or morphological abnormalities become apparent on other pulse sequences. Initial results from abdominal MRI applications are promising, particularly in oncological settings and for the detection of abscesses. The purpose of this article is to describe the clinically relevant basic concepts of DWI, techniques to perform abdominal DWI, its analysis and applications in abdominal visceral MR imaging, in addition to a brief overview of whole body DWI MRI.

关键词： diffusion-weighted imaging Imaging diffusion

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

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World Journal of Radiology 2016年第1期8卷 21-49页

作者： Maysam M Jafar Arman Parsai Marc E Miquel Barts Cancer Institute Queen Mary University of London Clinical Physics Barts Health NHS Trust Radiology Barts Health NHS Trust William Harvey Research Institute Queen Mary University of London

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.

关键词： diffusion-weighted magnetic resonance imaging Apparent diffusion coefficient reproducibility Apparent diffusion coefficient Cancer imaging Extracranial organs

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diffusion-weighted imaging and variable flip angle T1 mapping: a supplement for image-guided biopsy in follow-up analysis of liver fibrosis

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Journal of Interventional Medicine 2018年第3期1卷 150-156页

作者： Peng Hu Jihong Sun Fangfang Lv Borui Pi Fangping Xu Guocan Han Xi Hu Yue Wang Ning Huang Xia Wu Xiaoming Yang Department of Radiology Sir Run Run Shaw Hospital Zhejiang University School of Medicine Department of Infectious Diseases Sir Run Run Shaw Hospital Zhejiang University School of Medicine GE Healthcare Image-Guided Bio-Molecular Interventions Research Department of Radiology University of Washington School of Medicine

Purpose To evaluate the performance of diffusion-weighted imaging(DWI) and variable flip angle(VFA) T1 mapping as a supplement to image-guided biopsy in follow-up analysis of liver fibrosis. Materials and Methods This prospective study was approved by the institution's committee on human research, and written informed consent was provided from the enrolled patients. We investigated five MRI parameters of DWI and VFA T1 mapping, collected from 11 patients who underwent serial ultrasound image-guided biopsy with follow-up MRI within 1.5 years after treatment for liver fibrosis/cirrhosis. For each patient, four consecutive MRI examinations were conducted, including baseline MRI before treatment and three follow-up MRI examinations after treatment at each 0.5-year interval. ADC values at four b values and T1 relaxation times were correlated to pathology-confirmed liver fibrosis stages, which were subsequently divided into two groups, stages F2–3 and F4. The receiver operating characteristic(ROC) analysis and repeated measurement analysis of variance were used for statistical analysis. Results Among these ADC parameters, ADC value(b = 500 s/mm^2) was the most consistent in differentiating between stage F2–3 and F4 liver fibrosis. Repeated measurement analysis showed that the intra-group and inter-group differences were 0.447 and 0.024, respectively. T1 relaxation time could not consistently differentiate between the F2–3 and F4 groups; however, it was repeatable, and the intra-group and inter-group differences were 0.410 and 0.042, respectively. Conclusion MRI-ADC value at a b value of 500 s/mm^2 can be a promising biomarker for differentiating stages F2–3 and F4 liver fibrosis. A combination of this biomarker with repeatable T1 relaxation time may function as a non-invasive tool for follow-up liver fibrosis in patients who reject repeated image-guided biopsy.

关键词： image-guided biopsy,MRI T1 mapping diffusion-weighted imaging

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diffusion-weighted magnetic resonance imaging without bowel preparation for detection of ulcerative colitis

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World Journal of Gastroenterology 2015年第33期21卷 9785-9792页

作者： Li-Li Yu Hai-Shan Yang Bu-Tian Zhang Zhong-Wen Lv Fu-Rong Wang Chun-Yu Zhang Wei-Bo Chen Hui-Mao Zhang Department of Radiology The China-Japan Union Hospital of Jilin University Philips Healthcare Department of Radiology The First Hospital of Jilin University

AIM: To evaluate the accuracy of diffusion-weighted imaging(DWI) without bowel preparation,the optimal b value and the changes in apparent diffusion coefficient(ADC) in detecting ulcerative colitis(UC).METHODS: A total of 20 patients who underwent 3T magnetic resonance imaging(MRI) without bowel preparation and colonoscopy within 24 h were recruited.Biochemical indexes,including C-reactive protein(CRP),erythrocyte sedimentation rate,hemoglobin,leucocytes,platelets,serum iron and albumin,were determined.Biochemical examinations were then performed within 24 h before or after MR colonography was conducted.DWI was performed at various b values(b = 0,400,600,800,and 1000 s/mm2).Two radiologists independently and blindly reviewed conventional- and contrast-enhanced MR images,DWI and ADC maps; these radiologists also determined ADC in each intestinal segment(rectum,sigmoid,left colon,transverse colon,and right colon).Receiver operating characteristic(ROC) analysis was performed to assess the diagnostic performance of DWI hyperintensity from various b factors,ADC values and different radiological signs to detect endoscopic inflammation in the corresponding bowel segment.Optimal ADC threshold was estimated by maximizing the combination of sensitivity and specificity.MRfindings were correlated with endoscopic results and clinical markers; these findings were then estimated by ROC analysis.RESULTS: A total of 100 segments(71 with endoscopic colonic inflammation; 29 normal) were included.The proposed total magnetic resonance score(MR-score-T) was correlated with the total modified Baron score(Baron-T; r = 0.875,P 1 corresponded to endoscopic colonic inflammation with a sensitivity of 85.9%,a specificity of 82.8% and an area under the curve(AUC) of 0.929(P < 0.0001).The ac

关键词： diffusion-weighted imaging Apparent diffusion coef

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

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World Journal of Gastroenterology 2013年第33期19卷 5520-5527页

作者： Gang Cai Ye Xu Ji Zhu Wei-Lie Gu Shuai Zhang Xue-Jun Ma San-Jun Cai Zhen Zhang Department of Radiation Oncology Fudan University Shanghai Cancer Center Department of Oncology Shanghai Medical CollegeFudan University Department of Colorectal Surgery Fudan University Shanghai Cancer Center Department of Endoscopic Center Zhongshan HospitalFudan University Department of Radiology Fudan University Shanghai Cancer Cente

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.

关键词： Locally advanced rectal cancer Neoadjuvant chemoradiation diffusion-weighted magnetic resonance imaging Apparent diffusion coefficient

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

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World Journal of Gastroenterology 2014年第35期20卷 12621-12627页

作者： Qi Feng Yun-Qi Yan Jiong Zhu Jin-Lu Tong Jian-Rong Xu Department of Radiology Renji HospitalSchool of MedicineShanghai Jiao Tong University Department of Gastroenterology Renji HospitalSchool of MedicineShanghai Jiao Tong University

AIM:To determine the optimal b value of diffusionweighted imaging for detecting active inflammation in Crohn's disease.METHODS:Thirty-one patients clinically diagnosed with active Crohn’s disease were referred for magnetic resonance examination.All patients were scanned on a3.0T magnetic resonance scanner using the same protocol involving four different b values(800,1500,2000and 2500 s/mm2).The diagnostic effect of diffusionweighted imaging was evaluated and compared with endoscopic findings.The diffusion-weighted image quality of four b value groups was evaluated and apparent diffusion coefficient was measured for both nor-mal and inflammatory intestinal segments.RESULTS:The contrast-to-noise ratio and signal-tonoise ratio were not satisfied when b value 2000 or2500 s/mm2 was adopted(36.52±14.95 vs 34.78±24.83,P>0.05;53.58±23.45 vs 47.58±29.67,P>0.05).The qualitative image quality was not enough to meet diagnostic requirement.No matter which b value was chosen,the apparent diffusion coefficient of inflammatory intestinal segments was significantly lower than that of normal intestinal segments(1.38±0.28 vs 2.00±0.38,P<0.01;1.09±0.20 vs 1.50±0.28,P<0.01;0.95±0.19 vs 1.34±0.28,P<0.01;0.88±0.14 vs 1.20±0.21,P<0.01).The lesion detection rate(90.32%),diagnostic sensitivity(81.18%)and specificity(95.10%)would be appropriate when b value 1500 s/mm2 was adopted.CONCLUSION:High b value is suitable for intestinal DW examination on a high field MR scanner.

关键词： Crohn’s disease diffusion-weighted imaging b value

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