Optimization of MR diffusion-weighted imaging acquisitions for pancreatic cancer at 3.0 T

Objectives

To investigate and optimize diffusion-weighted imaging (DWI) acquisitions for pancreatic cancer at 3.0 T.

Methods

Forty-five patients with pancreatic cancer were examined by four DWI acquisitions with b values = 0 and 600 s/mm² at 3.0 T, including breath-holding DWI (BH-DWI), respiratory-triggered DWI (TRIG-DWI), respiratory-triggered DWI with inversion–recovery technique (TRIGIR-DWI), and free-breathing DWI with inversion–recovery technique (FBIR-DWI). Artifacts, contrast ratio (CR), contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) of pancreatic cancer were statistically compared among DWI acquisitions.

Results

TRIGIR-DWI displayed the lowest artifacts and highest CR compared to other DWI acquisitions. CNRs of pancreatic cancer in TRIG-DWI and TRIGIR-DWI were statistically higher than that in FBIR-DWI and BH-DWI. Different ADCs between pancreatic cancer and noncancerous pancreatic tissues were noticed by a paired-samples T test in TRIG-DWI (p = 0.017), TRIGIR-DWI (p = 0.00001) and FBIR-DWI (p = 0.000041).

Conclusions

TRIGIR-DWI may be the optimal acquisition of DWI for pancreatic cancer at 3.0 T.     

The value of diffusion-weighted MRI to evaluate the response to radiochemotherapy for cervical cancer

Purpose

To investigate the value of apparent diffusion coefficient (ADC) to predict and monitor the therapy response for cervical cancer patients receiving concurrent radiochemotherapy, and to analyze the influence of different b-value combinations on ADC-based evaluation of treatment response.

Material and Methods

Seventy-five cervical cancer patients treated with radiochemotherapy received conventional MRI and DWI prior to therapy, after 2 weeks of therapy, after four weeks of therapy and after therapy completion. Treatment response was classified as complete response (CR, n = 35), partial response (PR, n = 22) and stable disease (SD, n = 18), which was determined according to final tumor size after 6 months of therapy completion. Dynamic changes of apparent diffusion coefficients (ADC) and tumor size in the three tumor groups were observed and compared. All the ADCs were calculated from b = 0, 600 s/mm² and b = 0, 1000 s/mm².

Results

The ADC increased percentage was higher in CR group than those in PR and SD groups after two weeks and four weeks of therapy, with significant differences in absolute ADCs between CR and PR, SD groups after therapy completion; the overall discriminatory capability for differentiation of CR and PR, SD groups was higher for high b-value combination (0, 1000 s/mm²) than for low b-value combination (0, 600 s/mm²).

Conclusion

DWI can be used as a predictive and monitoring biomarker of treatment response to radiochemotherapy in patients with cervical cancer. High b-value combination may be more reliable to evaluate the treatment response for cervical cancer.     

Gadoxetic acid-enhanced MRI compared with CT during angiography in the diagnosis of hepatocellular carcinoma

Purpose

To assess the value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) for the pre-therapeutic detection of hepatocellular carcinoma (HCC) using receiver operating characteristic (ROC) analysis with the combination of computed tomography (CT) arterial portography and CT hepatic arteriography (CTAP/CTHA).

Materials and Methods

A total of 54 consecutive patients with 87 nodular HCCs were retrospectively analyzed. All HCC nodules were confirmed pathologically. Three blinded readers independently reviewed 432 hepatic segments, including 78 segments with 87 HCCs. Each reader read two sets of images: Set 1, CTAP/CTHA; Set 2, gadoxetic acid-enhanced MRI including a gradient dual-echo sequence and diffusion-weighted imaging (DWI). The ROC method was used to analyze the results. The sensitivity, specificity, positive predictive value, negative predictive value and sensitivity according to tumor size were evaluated.

Results

For each reader, the area under the curve was significantly higher for Set 2 than for Set 1. The mean area under the curve was also significantly greater for Set 2 than for Set 1 (area under the curve, 0.98 vs. 0.93; P = .0009). The sensitivity was significantly higher for Set 2 than for Set 1 for all three readers (P = .012, .013 and .039, respectively). The difference in the specificity, positive predictive values and negative predictive values of the two modalities for each reader was not significant (P > .05).

Conclusion

Gadoxetic acid-enhanced MRI including a gradient dual-echo sequence and DWI is recommended for the pre-therapeutic evaluation of patients with HCC.     

Diffusion-weighted magnetic resonance imaging to evaluate microvascular density after transarterial embolization ablation in a rabbit VX2 liver tumor model

Objective

To evaluate the correlation between findings from diffusion weighted imaging (DWI) and microvascular density (MVD) measurements in VX2 liver tumors after transarterial embolization ablation (TEA).

Materials and Methods

Eighteen New Zealand white rabbits were used in this study. VX2 tumor cells were implanted in livers by percutaneous puncture under computed tomography (CT) guidance. Two weeks later, all rabbits underwent conventional magnetic resonance imaging (MRI) (T1 and T2 imaging), DWI, (b = 100, 600, and 1000 s/mm²) and TEA. MRI was performed again1 week after TEA. Liver tissue was then harvested and processed for hematoxylin and eosin (H&E) staining and immunohistochemical staining for CD31to determine MVD.

Results

VX2 liver tumors were successfully established in all 18 rabbits. Optimal contrast was achieved with a b value of 600 s/mm².The maximum pre-operative apparent diffusion coefficient (ADC)_difference value was 0.28 × 10^− 3 ± 0.10 × 10^− 3 mm²/s, and was significantly different (P < 0.001) from the maximum postoperative ADC_difference value of 0.47 × 10^− 3 ± 0.10 × 10^− 3 mm²/s. However, the mean ADC value for the entire tumor was not significantly correlated with MVD (r = 0.221, P = 0.379), nor was the ADC value for the regions of viable tumor (r = − 0.044, P = 0.862). However, the maximum postoperative ADC_difference value was positively correlated with MVD(r = 0.606, F = 12.247, P = 0.003).

Conclusion

DWI is effective to evaluate the therapeutic efficacy of TEA. The maximum ADC_difference offers a promising new method to noninvasively assess tumor angiogenesis.     

Imaging features of small (≤ 3 cm) pancreatic solid tumors on gadoxetic-acid-enhanced MR imaging and diffusion-weighted imaging: an initial experience

Objective

The objective was to determine imaging features that distinguish small (≤3cm) solid pancreatic adenocarcinoma, neuroendocrine tumor (NET) and solid pseudopapillary tumor (SPT) on gadoxetic-acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighed imaging (DWI).

Materials and methods

Twenty-four adenocarcinomas, 10 NETs and 8 SPTs were retrospectively included. Two radiologists analyzed morphologic features, signal intensity of the tumors on MR images including DWI (b=800) and dynamic enhancement pattern with consensus. Tumor-to-parenchyma ratio and tumor apparent diffusion coefficients (ADCs) were quantitatively assessed.

Results

All adenocarcinomas had an ill-defined margin and irregular shape, and more frequently had pancreatic duct dilatation compared with other tumors (P<.05). All SPTs and all but one of the adenocarcinomas (95.8%) had no arterial enhancement with progressively increased enhancement, whereas seven NETs (70%) had arterial enhancement with progressively decreased enhancement (P<.01). The mean value of tumor-to-parenchyma ratio on arterial and portal phases was significantly higher for NETs, and the mean value of tumor ADCs was significantly lower for SPTs than for other tumors (P<.05).

Conclusions

Gadoxetic-acid-enhanced MRI may aid in differentiation between small adenocarcinomas, NETs and SPTs based on morphologic features with dynamic enhancement pattern in adenocarcinomas, dynamic enhancement pattern with tumor-to-parenchyma ration on arterial and portal phases in NETs, and dynamic enhancement pattern with lower ADC value in SPTs.     

Diffusion-weighted imaging (DWI) of the spleen in patients with liver cirrhosis and portal hypertension

Objective

The purpose of this study was to assess the influence of liver cirrhosis and portal hypertension on diffusion coefficients of the spleen.

Material and Methods

We retrospectively evaluated 50 patients with liver cirrhosis and 50 patients without any history of liver disease who underwent magnetic resonance imaging of the upper abdomen, including echo planar diffusion-weighted imaging using b values of 50, 300 and 600 mm²/s. Spleen apparent diffusion coefficient (ADC), liver ADC, muscle ADC and normalized spleen ADC (defined as the ratio of spleen ADC to muscle ADC) were compared between cirrhotic patients and patients in the control group and correlated with Child–Pugh stages. Reproducibility was assessed by measuring interclass correlation coefficient (n = 11). Additionally, in eight patients, ADC measurements were performed 1 day before and 3 days after transjugular intrahepatic portosystemic shunt (TIPSS) implantation.

Results

Compared with control subjects, patients with cirrhosis and portal hypertension had significantly higher spleen ADCs (P = .0001). There was a statistically significant correlation between Child–Pugh grade and spleen ADC (Pearson correlation coefficient, observer 1 r = 0.6, P = .0001; observer 2 r = 0.5, P = .0001). After TIPSS implantation, we observed a reduction in spleen ADC values. Spleen ADC measurements showed a high reproducibility (interclass correlation coefficient 0.75, P = .001).

Conclusion

Our data suggest that different stages of liver cirrhosis and portal hypertension correlate with ADC values of the spleen. Furthermore, ADC values of the spleen decrease after TIPSS implantation. Further studies are required to understand the potential clinical values of these observations.     

Diagnostic performance of apparent diffusion coefficient and quantitative kinetic parameters for predicting additional malignancy in patients with newly diagnosed breast cancer

Purpose

To evaluate the diagnostic performance of an apparent diffusion coefficient (ADC) and quantitative kinetic parameters in patients with newly diagnosed breast cancer.

Materials and Methods

We enrolled 169 lesions in 89 patients with breast cancer who underwent dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI). Comparisons between benign and malignant lesions were performed for lesion type (mass or nonmass-like enhancement), size (≥ 1 cm or < 1 cm), ADC, kinetic parameters and the presence of a US correlate.

Results

There were 63 benign and 106 malignant lesions. The mean size and initial peak enhancement of the benign lesions were significantly lower than those of malignant lesions (P < 0.001 for both). The ADC of the benign lesions was significantly higher than that of malignant lesions (1.42 × 10^− 3 mm²/sec vs. 1.04 × 10^− 3 mm²/sec; P < 0.001). The area under the receiver operating characteristic curve (AUC) for predicting malignancy was 0.87 for the combined parameters of size, ADC, and initial peak enhancement, which was higher than those of each parameter.

Conclusions

Combination of quantitative kinetic parameters and ADC showed higher diagnostic performance for predicting malignancy than each parameter alone for the evaluation of patients with breast cancer.     

Dual-source parallel radiofrequency transmission for magnetic resonance breast imaging at 3 T: Any added clinical value?

Purpose

To investigate the influence of dual-source parallel radiofrequency (RF) excitation on clinical breast MR images.

Methods

A 3 T MR system with both dual-source and conventional single-source RF excitations was used to examine 22 patients. Axial TSE-T₂WI with fat suppression, TSE-T₁WI without fat suppression, THRIVE (3D field echo) and DWI (SE-EPI) were obtained by using both excitation techniques. Image homogeneity, image contrast and lesion conspicuity were measured or independently scored by two radiologists and were compared by paired-sample t test or Wilcoxon test.

Results

Both excitations revealed 24 lesions. For SE sequences using dual-source mode, image homogeneity was improved (P = 0.00), scan time was reduced, and ghost artifacts on DWI were significantly reduced (P = 0.00). However, image contrast was not increased and lesion conspicuity had no significant difference between two modes, except DWI on which lesion conspicuity was significantly improved (P = 0.00), due to less ghost artifacts. For field-echo sequence, image homogeneity, acquisition time, image contrast and lesion conspicuity had no significant difference between the two modes.

Conclusions

Dual-source parallel RF transmission has some added value for improving breast image quality. However, its value is limited in terms of improving lesion detection and characterization.     

Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis

Purpose

The purpose of the study was to determine significant imaging features to differentiate between infiltrative hepatocellular carcinoma (HCC) and confluent fibrosis (CF) in liver cirrhosis using Gd-EOB-DTPA-enhanced 3-T magnetic resonance imaging.

Material and methods

Nineteen infiltrative HCCs and eight CFs were included. We evaluated the difference in imaging findings and apparent diffusion coefficient (ADC) between the two entities. We compared T2-weighted image (WI) and hepatobiliary phase (HBP) in terms of the clarity of the lesion outer margin.

Results

Seventeen infiltrative HCCs showed lobulated margin, while focal CFs showed either straight (n = 3) or irregular margins (n = 5) (P = .001). All infiltrative HCCs had intact or bulging contours, and all focal CFs showed capsular retraction (P = .001). Fourteen infiltrative HCCs and two focal CFs showed arterial enhancement (P = .035). The ADC of infiltrative HCCs was significantly lower than that of CFs (P = .001). Satellite nodules were noted in 10 infiltrative HCCs. In terms of outer margin clarity, infiltrative HCCs showed a more distinct margin on HBP than on T2-WI (P = .005), while these two sequences were not significantly different in focal CFs (P = 1.000).

Conclusion

HBP improved the imaging characteristics of infiltrative HCC, allowing it to be distinguished from focal CF. Infiltrative HCC showed lower ADC values than focal CF. Lobular configuration, contour bulging, enhancement pattern, associated satellite nodules and portal vein thrombosis were still found to be highly suggestive MR findings for infiltrative HCC.     

Validation of optimal DCE-MRI perfusion threshold to classify at-risk tumor imaging voxels in heterogeneous cervical cancer for outcome prediction

Purpose

To classify tumor imaging voxels at-risk for treatment failure within the heterogeneous cervical cancer using DCE MRI and determine optimal voxel's DCE threshold values at different treatment time points for early prediction of treatment failure.

Material and Method

DCE-MRI from 102 patients with stage IB2–IVB cervical cancer was obtained at 3 different treatment time points: before (MRI 1) and during treatment (MRI 2 at 2–2.5 weeks and MRI 3 at 4–5 weeks). For each tumor voxel, the plateau signal intensity (SI) was derived from its time-SI curve from the DCE MRI. The optimal SI thresholds to classify the at-risk tumor voxels was determined by the maximal area under the curve using ROC analysis when varies SI value from 1.0 to 3.0 and correlates with treatment outcome.

Results

The optimal SI thresholds for MRI 1, 2 and 3 were 2.2, 2.2 and 2.1 for significant differentiation between local recurrence/control, respectively, and 1.8, 2.1 and 2.2 for death/survival, respectively.

Conclusion

Optimal SI thresholds are clinically validated to quantify at-risk tumor voxels which vary with time. A single universal threshold (SI = 1.9) was identified for all 3 treatment time points and remained significant for the early prediction of treatment failure.     

Using intravoxel incoherent motion (IVIM) MR imaging to predict lipiodol uptake in patients with hepatocellular carcinoma following transcatheter arterial chemoembolization: A preliminary result

Purpose

To assess the usefulness of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) for predicting lipiodol uptake in patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).

Materials and methods

The institutional review board approved this study. 44 HCC patients underwent IVIM-DWI and Gd-EOB-DTPA-enhanced MRI prior to TACE. Using post-TACE CT as a reference standard, each HCC was classified into either lipiodol good uptake (LGU) or poor uptake (LPU) group. Apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion coefficient (D*), and perfusion fraction (f) in HCC were calculated. Arterial enhancement ratio (AER) and IVIM parameters were compared between those two groups using the Mann-Whitney U test.

Results

Of the 51 HCCs, 37 (72.5%) were LGU group and 14 (27.5%) were LPU group. AER of HCC was significantly higher in LGU than LPU (0.99 ± 0.54 and 0.67 ± 0.45; P = .034). ADC, D, and f values were not significantly different (P = .073, .059, and .196, respectively) between these two groups. D* was significantly elevated in LGU than LPU (48.10 ± 15.33 and 26.75 ± 9.55; P = .001).

Conclusion

Both AER derived from contrast enhanced MRI and D* values derived from IVIM-DWI for HCC were significantly higher in LGU than in LPU. These parameters would be helpful for predicting the lipiodol uptake.     

Conspicuity of bone metastases on fast Dixon-based multisequence whole-body MRI: Clinical utility per sequence

Purpose

The purpose of the study was to evaluate the conspicuity of bone metastases on each of the numerous sequences produced by fast Dixon-based multisequence whole-body (WB) magnetic resonance imaging (MRI) scanning in order to determine the most clinically useful sequences overall and per anatomic region.

Materials and Methods

Twenty-seven breast cancer patients with bone metastases were prospectively studied with fast Dixon-based WB MRI including head/neck, chest, abdominal, pelvic, thigh, calf/feet and either cervical, thoracic and lumbar or cervical/thoracic and thoracic/lumbar regions. Sequences included coronal T2, axial T1 without and with intravenous gadolinium (+ C), sagittal T1 spine + C, each associated fat-only (FO) and fat-saturated (FS) sequence, axial diffusion-weighted imaging (DWI) and short tau inversion recovery (STIR). Blinded reviewers evaluated lesion conspicuity, a surrogate of clinical utility, on a five-point scale per anatomic region. Sequences were compared using analysis of variance, differences were detected with Tukey's honestly significant difference test, and the four sequences with highest mean conspicuity were compared to the remainder overall and per anatomic region.

Results

Overall, a significant lesion conspicuity difference was found (P < .0001), and lesion conspicuity was significantly higher on FS T1 + C, FO T1 + C, T1 + C sagittal and FS T1 + C axial sequences (P < .0001). Per-region results were the same in the head/neck. Other sequences overlapped with these and included the following: chest/abdomen — FO T2, DWI; pelvis — DWI, FO T2; thigh — FS T2, FO T2, FO T1 + C; calf/feet — FS T2, DWI, FO T2, STIR.

Conclusion

Overall, bone lesions were most conspicuous on FS T1 + C sagittal, FO T1 + C sagittal, T1 + C sagittal and FS T1 + C axial fast Dixon WB MRI sequences.     

Noncontrast MRI with diffusion-weighted imaging as the sole imaging modality for detecting liver malignancy in patients with high risk for hepatocellular carcinoma

Purpose

To compare the diagnostic performance of the noncontrast MRI including DWI to the standard MRI for detecting hepatic malignancies in patients with chronic liver disease.

Materials and methods

We included 135 patients with 136 histologically-confirmed hepatocellular carcinomas (HCCs), 12 cholangiocarcinomas, and 34 benign lesions (≤ 2.0 cm), and 22 patients with cirrhosis but no focal liver lesion who underwent 3.0 T liver MRI. Noncontrast MRI set (T1- and T2-weighted images and DWI) and standard MRI set (gadoxetic acid-enhanced and noncontrast MRI) were analyzed independently by three observers to detect liver malignancies using receiver operating characteristic analysis.

Results

The Az value of the noncontrast MRI (mean, 0.906) was not inferior to that of the combined MRI (mean, 0.924) for detecting malignancies by all observers (P > 0.05). For each observer, no significant difference was found in the sensitivity and specificity between the two MRI sets for detecting liver malignancies and distinguishing them from benign lesions (P > 0.05), whereas negative predictive value was higher with the combined MRI than with the noncontrast MRI (P = 0.0001). When using pooled data, the sensitivity of the combined MRI (mean 94.8%) was higher than that of the noncontrast MRI (mean, 91.7%) (P = 0.001), whereas specificity was equivalent (78.6% vs 77.5%).

Conclusion

Noncontrast MRI including DWI showed reasonable performance compared to the combined gadoxetic acid-enhanced and noncontrast MRI set for detecting HCC and cholangiocarcinoma and differentiating them from benign lesions in patients with chronic liver disease.     

Evaluation of ADC measurements among solid pancreatic masses by respiratory-triggered diffusion-weighted MR imaging with inversion-recovery fat-suppression technique at 3.0 T

Purpose

The objective of this paper was to investigate the value of apparent diffusion coefficients (ADCs) for differential diagnosis among solid pancreatic masses using respiratory triggered diffusion-weighted MR imaging with inversion-recovery fat-suppression technique (RT-IR-DWI) at 3.0 T.

Materials and Methods

20 normal volunteers and 72 patients (Pancreatic ductal adenocarcinoma [PDCA, n = 30], mass-forming pancreatitis [MFP, n = 15], solid pseudopapillary neoplasm [SPN, n = 12], and pancreatic neuroendocrine tumor[PNET, n = 15]) underwent RT-IR-DWI (b values: 0 and 600 s/mm²) at 3.0 T. Results were correlated with histopathologic data and follow-up imaging. ADC values among different types of pancreatic tissue were statistically analyzed and compared.

Results

Statistical difference was noticed in ADC values among normal pancreas, MFP, PDCA, SPN and PNET by ANOVA (p < .001). Normal pancreas had the highest ADC value, then followed by PNET, PDCA, MFP and SPN. There was noticeable statistical difference in ADC values among PDCA, MFP and normal pancreas by Least Significant Difference (LSD) (p < .001). ADC of SPN was statistically lower than that of PNET (p = 0.1800 × 10^− 4), PDCA (p = 0.0300 × 10^− 4) and normal pancreas (p = 0.0007 × 10^− 4). ADC of PNET was statistically lower than that of normal pancreas (p = 0.0360) and higher than that of MFP (p = 9.3000 × 10^− 4).

Conclusions

ADC measurements using RT-IR-DWI at 3.0 T may aid to disclose the histopathological pattern of normal pancreas and solid pancreatic masses, which may be helpful in characterizing solid pancreatic lesions.     

Intra-voxel incoherent motion MRI in rodent model of diethylnitrosamine-induced liver fibrosis

Rationale and Objectives

To compare the apparent diffusion coefficient (ADC) and the perfusion fraction measured by intra-voxel incoherent motion (IVIM) Magnetic Resonance Imaging (MRI) with liver fibrosis degrees in a rodent model.

Materials and Methods

All experiments received approval from our institutional animal care and use committee. Liver fibrosis was induced in 13 rats by oral gavage with diethylnitrosamine; 4 untreated rats with normal livers were used as controls. Diffusion Weighted MRI was performed and 8 gradient factors (0, 50, 100, 150, 200, 300, 400 and 500 s/mm²) were acquired. The values of ADC, true diffusion coefficient D and perfusion fraction f were measured based on Li Bihan’s method. The percentage of liver fibrosis was assessed via quantitative analysis of Masson trichrome staining using an average of 30 fields per section. The MRI measurements were compared to the histological fibrotic grade to evaluate the correlation between them.

Results

ADC contained the contribution of diffusion and perfusion. The ADC and f values decreased significantly with the increasing fibrosis level (correlation coefficient: ADC: ρ = − 0.781, p < 0.001; f: ρ = − 0.720, p = 0.001); but D was poorly correlated with fibrosis level (ρ = − 0.502, p = 0.040).

Conclusion

The hepatic ADC and the perfusion fraction f were significantly correlated with the liver fibrosis level; however, D was not. This might suggest that hepatic perfusion is altered during the progression of hepatic fibrosis.     

Comparison of accuracy of intravoxel incoherent motion and apparent diffusion coefficient techniques for predicting malignancy of head and neck tumors using half-Fourier single-shot turbo spin-echo diffusion-weighted imaging

Purpose

To evaluate the use of the intravoxel incoherent motion (IVIM) technique in half-Fourier single-shot turbo spin-echo (HASTE) diffusion-weighted imaging (DWI), and to compare its accuracy to that of apparent diffusion coefficient (ADC) to predict malignancy in head and neck tumors.

Patients and methods

HASTE DW images of 33 patients with head and neck tumors (10 benign and 23 malignant) were evaluated. Using the IVIM technique, parameters (D, true diffusion coefficient; f, perfusion fraction; D*, pseudodiffusion coefficient) were calculated for each tumor. ADC values were measured over a range of b values from 0 to 1000 s/mm². IVIM parameters and ADC values in benign and malignant tumors were compared using Student's t test, receiver operating characteristics (ROC) analysis, and multivariate logistic regression modeling.

Results

Mean ADC and D values of malignant tumors were significantly lower than those of benign tumors (P < 0.05). Mean D* values of malignant tumors were significantly higher than those of benign tumors (P < 0.05). There was no significant difference in mean f values between malignant and benign tumors (P > 0.05). The technique of combining D and D* was the best for predicting malignancy; accuracy for this model was higher than that for ADC.

Conclusions

The IVIM technique may be applied in HASTE DWI as a diagnostic tool to predict malignancy in head and neck masses. The use of D and D* in combination increases the diagnostic accuracy in comparison with ADC.     

Semiquantitative perfusion combined with diffusion-weighted MR imaging in pre-operative evaluation of endometrial carcinoma: Results in a group of 57 patients

Purpose

To evaluate the semiquantitative DCE and quantitative DWI parameters in endometrial cancer, in order to assess the presence of neoplastic tissue and normal myometrium and to ascertain a potential relationship with tumor grade.

Methods and materials

A total of 57 patients with biopsy-proven endometrial adenocarcinoma who underwent MR imaging examination for staging purposes were retrospectively evaluated. Imaging protocol included multiplanar T₁- and T₂-weighted TSE, DCE T₁-weighted (THRIVE; 0, 30, 90 and 120 seconds after intravenous injection of gadolinium) and DWIBS sequences (b values = 0 and 1000 mm²/s). Color perfusion and ADC maps were automatically generated on dedicated software. Relative enhancement (RE, %), maximum enhancement (ME, %), maximum relative enhancement (MRE, %), time to peak (TTP, s) and mean apparent diffusion coefficient (ADC) were calculated by manually drawing a region of interest (ROI) both on the neoplastic tissue and the normal myometrium. Histopathology was used as reference standard.

Results

Histopathological analysis confirmed the presence of endometrial carcinoma in all patients. Neoplastic tissue demonstrated significantly lower (P < 0.001) values of RE (%) 63.92 ± 35.68; ME (%) 864.91 ± 429.54 and MRE (%) 75.97 ± 38.26 as compared to normal myometrium (RE (%) 151.43 ± 55.99; ME (%) 1800.73 ± 721.32; MRE (%) 158.28 ± 54.05). TTP was significantly higher (P < 0.05) in tumor lesion (385.51 ± 1630.27 vs 195.44 ± 78.69). Mean ADC value of neoplastic tissue (775.09 ± ?220.73 × 10^− 3 mm²/s) was significantly lower (P < 0.05) than in myometrium (1602.37 ± 378.54 × 10^− 3 mm²/s). The analysis of perfusion and diffusion parameters classified according to tumor grades, showed a statistically significant difference only for RE (P = 0.043) and ME (P = 0.007).

Conclusions

Perfusion parameters and mean ADC differ significantly between endometrial cancer and normal myometrium, potentially reflecting the different microscopical features of cellularity and vascularity; however a significant relationship with tumor grade was not found in our series.     

RF-related heating assessment of extracranial neurosurgical implants at 7 T

Purpose

The purpose was to evaluate radiofrequency (RF)-related heating of commonly used extracranial neurosurgical implants in 7-T magnetic resonance imaging (MRI).

Materials and methods

Experiments were performed using a 7-T MR system equipped with a transmit/receive RF head coil. Four commonly used titanium neurosurgical implants were studied using a test procedure adapted from the American Society for Testing and Materials Standard F2182-11a. Implants (n = 4) were tested with an MRI turbo spin echo pulse sequence designed to achieve maximum RF exposure [specific absorption rate (SAR) level = 9.9 W/kg], which was further validated by performing calorimetry. Maximum temperature increases near each implant's surface were measured using fiberoptic temperature probes in a gelled-saline-filled phantom that mimicked the conductive properties of soft tissue. Measurement results were compared to literature data for patient safety.

Results

The highest achievable phantom averaged SAR was determined by calorimetry to be 2.0 ± 0.1 W/kg due to the highly conservative SAR estimation model used by this 7-T MR system. The maximum temperature increase at this SAR level was below 1.0 °C for all extracranial neurosurgical implants that underwent testing.

Conclusion

The findings indicated that RF-related heating under the conditions used in this investigation is not a significant safety concern for patients with the particular extracranial neurosurgical implants evaluated in this study.     

Focal nodular hyperplasia of the liver: diffusion and perfusion MRI characteristics

Purpose

To present diffusion and perfusion magnetic resonance imaging (MRI) characteristics of focal nodular hyperplasia (FNH) of the liver.

Materials and Methods

Thirty-five patients with 52 FNHs (21 were pathologically-confirmed) underwent MRI at 1.5-T device. MR diffusion [diffusion-weighted imaging (DWI)] was performed using a free-breathing single-shot, spin-echo, echo-planar sequence with b gradient factor value of 500 s/mm². MR perfusion [perfusion-weighted imaging (PWI)] consisted of a 3D free-breathing LAVA sequence repeated up to 5 minutes after injection of 7 mL Gd-BOPTA (MultiHance, Bracco, Italy) and 20 mL saline flush at a flow rate of 4 mL/s. Apparent diffusion coefficient (ADC) and time-signal intensity curve (TSIC) were obtained for both normal liver and each FNH by two reviewers in conference; maximum enhancement (ME) percentage, time to peak enhancement (TTP), and maximal slope (MS) were also calculated.

Results

On DWI mean ADC value was 1.624×10^− 3 mm²/s for normal liver and 1.629×10^− 3 mm²/s for FNH. ADC value for each FNH and the normal liver was not statistically different (P= .936). On PWI, TSIC-Type 1 (quick and marked enhancement and quick decay followed by slowly decaying) was observed in all 52 FNHs, and TSIC-Type 2 (fast enhancement followed by slowly decaying plateau) in all normal livers. The mean ME, TTP and MS values were significantly different for FNH and normal liver (P= .005).

Conclusion

FNHs of the liver showed typical diffusion and perfusion MRI characteristics in all cases. On the ADC map, we could get similar value between the FNHs and the background parenchyma. On the perfusion imaging, FNHs showed a different pattern distinguished from the background liver.     

Cervical spondylosis: Evaluation of microstructural changes in spinal cord white matter and gray matter by diffusional kurtosis imaging

Introduction

We investigated microstructural changes in the spinal cord, separately for white matter and gray matter, in patients with cervical spondylosis by using diffusional kurtosis imaging (DKI).

Methods

We studied 13 consecutive patients with cervical myelopathy (15 affected sides and 11 unaffected sides). After conventional magnetic resonance (MR) imaging, DKI data were acquired by using a 3 T MR imaging scanner. Values for fractional anisotropy (FA), apparent diffusion coefficient (ADC), and mean diffusional kurtosis (MK) were calculated and compared between unaffected and affected spinal cords, separately for white matter and gray matter.

Results

Tract-specific analysis of white matter in the lateral funiculus showed no statistical differences between the affected and unaffected sides. In gray matter, only MK was significantly lower in the affected spinal cords than in unaffected spinal cords (0.60 ± 0.18 vs. 0.73 ± 0.13, P = 0.0005, Wilcoxon’s signed rank test).

Conclusions

MK values in the spinal cord may reflect microstructural changes and gray matter damage and can potentially provide more information beyond that obtained with conventional diffusion metrics.