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Objective To investigate the correlation between ADC value and glioma IDH-1/1p19q genotype. Methods The MRI features and molecular pathological results of 69 patients with pathologically confirmed diagnosis of WHO grade Ⅱ/Ⅲ glioma between March 2013 and December 2020 were retrospectively analyzed. The diagnostic performance of ADC values on glioma genotypes (IDH-1, 1p19q) was evaluated using the ROC curve of the subjects' working characteristics. Results The ADCmean, ADCmin, rADCmean, and rADCmin in the IDH-1 mutation group were significantly higher than those in the IDH-1 wild group (P < 0.05, P < 0.01, P < 0.05, P < 0.01). The use of the rADCmin threshold (0.979×103mm2/s) had the highest efficacy (AUC=0.770) for diagnosis of IDH-1 mutant and IDH-1 wild-type gliomas as well as sensitivity and specificity of 84.61% and 59.09%, respectively. Conclusion ADC can be used as an imaging biomarker for noninvasive prediction of IDH-1 mutant and wild-type Ⅱ /Ⅲ gliomas.
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Background: At present, the diagnosis and efficacy evaluation of acute leukemia (AL) are assessed by bone marrow aspiration, which is invasive and subject to sampling errors. Therefore, there is a pressing need to develop a noninvasive and accurate imaging method to evaluate bone marrow changes in patients with AL. This study aimed to compare the apparent diffusion coefficient (ADC) values obtained from fluid?attenuated inversion recovery diffusion?weighted imaging (FLAIR?DWI) and conventional DWI in the lumbar bone marrow of patients with AL and to investigate their performance for evaluating response to induction chemotherapy. Methods: A total of 28 patients with newly diagnosed AL and 25 patients with AL after induction chemotherapy underwent MRI scans at 1.5 Tesla using a conventional DWI and a FLAIR?DWI sequence on sagittal planes covering the lumbar bone marrow. Further, the ADC values from these two sequences, denoted as ADCCON and ADCFLAIR, were measured on multiple vertebrae. The percentage of leukemia cells in bone marrow was recorded, and bone marrow aspiration was performed on treated patients to determine complete remission (CR) and nonremission (NR). Results: ADCFLAIR [(0.453 ± 0.103) × 10?3 mm2/s] was significantly lower than ADCCON [(0.486 ± 0.096) × 10?3 mm2/s] in the 28 untreated patients (t = 3.051, P = 0.005). In the 25 treated patients, ADCFLAIR and ADCCON values [(0.566 ± 0.239) × 10?3 mm2/s] and [(0.716 ± 0.235) × 10?3 mm2/s], respectively, were higher compared with the untreated patients. The ADCCON values showed a nonsignificant difference between the CR (n = 18) and NR (n = 7) groups (t = 1.409, P = 0.305). However, the ADCFLAIR values exhibited statistically significant difference (t = 2.542, P = 0.018) between the two groups. In a receiver operator characteristic (ROC) analysis, the area under the curve (AUC) using ADCFLAIR (0.770) was larger than that of ADCCON (0.611) in distinguishing the CR and NR patients following the chemotherapy. Conclusion: Although both ADCCON and ADCFLAIR are sensitive to tissue changes induced by chemotherapy, FLAIR?DWI outperformed conventional DWI in separating AL patients with CR from NR after chemotherapy. A possible mechanism is that FLAIR?DWI suppresses signals from free water, making the ADC measurement more sensitive to structural changes in the bone marrow
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@#Introduction: Intravenous thrombolysis (IVT) is the gold standard for the treatment of patients with acute ischemic stroke (AIS) presenting within four and a half hours of onset. However, development of new thrombolytic agents and advanced imaging has led to extended time for thrombolysis based on advanced imaging. Here we describe four patients who presented in the extended hours; that benefitted from thrombolysis. Case series: We advocate magnetic resonance imaging (MRI) for AIS, that includes diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC), fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), and magnetic resonance angiography (MRA). We included four patients who were more than 18 years old, with National Institute of Health Stroke Scale (NIHSS) of six or more, presenting between four and a half to nine hours after stroke onset with no contraindications for intravenous thrombolysis. The imaging criteria used to determine eligibility for IVT is evidence of DWI-FLAIR mismatch on MRI. If FLAIR detects no signal change in the area of stroke on DWI, it is then termed DWIFLAIR mismatch, or FLAIR-negative – indicating high probability that the brain tissue is still viable, and that patients are good candidates for IVT. Conclusion: For patients with AIS who present within nine hours, DWI-FLAIR mismatch serves as an excellent surrogate marker of salvageable brain tissue, allowing a greater proportion of patients benefiting from this life-saving therapy. Our experience also shows that with careful patient selection, treatment with IVT can safely be given without an increased risk of bleeding or mortality.
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Objective To evaluate the effect of neoadjuvant androgen deprivation therapy (ADT) for prostate cancer on diffusion weighted imaging base on the pathological results after radical prostatectomy.Methods Medical records of 33 patients diagnosed with prostate cancer and treated with neoadjuvant androgen deprivation therapy and radical prostatectomy between January 2016 and September 2019 at Peking University First Hospital were retrospectively reviewed.Average age of patients was 67.7 (49-81) years old.All of the patients underwent prostate MRI examination before and after neoadjuvant ADT.Results Mean prostate volume after neoadjuvant ADT is 28.5 (6.25-113.76) em3,which decreased significantly by therapy (Z =-4.458,P ＜ 0.05).Apparent diffusion coefficient (ADC) values increased significantly in tumor (1.070 ± 0.325) vs.(0.828 ± 0.291) × 10-3 mm2/s (P ＜ 0.001) and decreased in benign prostatic tissue (P ＜ 0.05).Relative changes in ADC differed significantly between low-median level ISUP group and high level ISUP group (0.315 ± 0.173) vs.(0.164 ± 0.224) × 10-3 mm2/s (P ＜ 0.05),as well as obvious reaction group and focal reaction group(0.278 ± 0.21) vs.(0.094 ± 0.119) × 10-3 mm2/s (P ＜ 0.05).Conclusions There were significant,quantitative measurable changes of ADC value in prostate cancer after neoadjuvant ADT.DWI can be used to assess the efficacy of neoadjuvant ADT for prostate cancer as well as predicting pathological features.
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Objective To explore the value of diffusion kurtosis imaging (DKI) in predicting radiotherapy sensitivity of esophageal cancer from the animal model level.Methods BALB/c nude mice were subcutaneously injected with Eca-109 cell lines to form xenograft tumors.The tumors received a single dose of 15 Gy (6 MV X-rays) in the experimental group or had no any treatment as control.The volume of transplanted tumor,the change of ADC,MK and MD values,and the tumor cell density and necrosis ratio of these two groups were observed at the corresponding time points.Results The growth of xenograft volume in the experimental group was suppressed and it was significantly smaller than that in the control group (t=3.206-6.149,P＜0.05) at the 7th day after radiotherapy.From the 3rd day after radiotherapy,the ADC and MD values of the experimental group were significantly higher than those of the control group,and the MK values was lower than those in the control group (tADC =-11.018--2.049,tMD =-6.609--2.052,tMK =2.492-9.323,P＜0.05).Meanwhile,the tumor cell density of the control group was higher than that of the experimental group,and the proportion of necrosis in the experimental group was higher than that in the control group (tdensity =-8.387--2.239,t is =2.980-17.430,P＜0.05).Conclusions A single large dose radiation could inhibit the growth of xenograft.ADC,MK,MD values changed at the early stage prior to morphological changes of tumor in consistent with the change of cell density and necrosis ratio.DKI has the potential value in predicting radiotherapy sensitivity of esophageal carcinoma.
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Objective To discuss the MRI findings of hepatic epithelioid hemangioendothelioma (EHE).Methods MRI and clinical data of 8 EHE patients confirmed by pathology in PLA General Hospital were retrospectively analyzed.Results 8 patients included 3 male and 5 female.1 patient had single lesion and 7 patients had multiple lesions.A total of 162 lesions were detected and most of the lesions were in the peripheral liver.For T1WI,100 lesions (61.7％) showed slightly low signal,and 62 lesions (38.3％) showed lower signal intensity in the center of the lesion and appeared as "target sign".For T2WI,the center of 29 lesions (17.9％) showed two-loop "target sign",66 lesions (40.7％) showed three-loop "target sign",and 67 lesions (41.4％) showed slightly homogeneous higher signal.For DWI,116 lesions (71.6％) showed halo-like high signal and 46 lesions (28.4％) showed uniform high signal.For dynamic enhancement,the lesions showed slightly enhancement in the arterial phase,and persistent enhancement in portal venous phase,the center of 122 lesions (about 75.3％) showed enhancement and 40 lesions (24.7％) showed no enhancement in delayed phase.1 patient with hepatobiliary specific contrast was enhanced in hepatobiliary phase.“Hepatic capsule depression” was observed in 30 lesions.7 lesions appeared as “lollipop sign”,and were enveloped in 16 lesions.Conclusion MRI,DWI and dynamic contrastenhanced scanning of EHE in liver are characteristic,which is helpful for qualitative diagnosis before surgery.
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The study was taken to assess the feasibility of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-values for magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine fibroid and adenomyoma. The contrast-enhanced T1-weighted image (cT1WI) as well as DWIs and ADC maps of different b-values (i.e. 200, 600 and 800 s/mm2) were obtained from nine fibroid and five adenomyoma patients, immediately after, and 12 months after MRgFUS treatment. The image contrast score, non-perfused volume (NPV) and NPV ratio obtained were compared to determine the feasibility of DWI and ADC mapping for MRgFUS treatment outcome evaluation. Our finding showed thatimmediately after MRgFUS treatment, the DWI acquired using 200 s/mm2 b-value gave the highest image contrast score among all other b-values. The NPV calculated from DWI of 200 s/mm2 showed the best correlation (R2 = 0.938) with post-contrast NPV. At 12 months follow-up, there was no specific b-value considered as significantly superior to others in terms of image contrast. However, the NPVs and NPV ratios obtained from all DWIs and ADC maps of different b-values were in good agreement with the post-contrast NPV and NPV ratio. We observed that the DWI, particularly obtained with a low b-value (i.e. 200 s/mm2), is feasible for delineation and quantitative volumetric evaluation of the ablated region immediately after the MRgFUS treatment. At 12 months follow-up, both DWIs and ADC maps are feasible for NPV and NPV ratio calculation.
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Objective To investigate the value of DWI imaging combined with T2WI imaging and CT image fusion technology and explore the role of DWI imaging in the determination of target areas in radiotherapy for advanced esophageal cancer.Methods Twenty-three patients with locally advanced esophageal cancer were included in this study.All the patients were fixed by a heat plastic device.Each patient was examined by CT,T2WI and DWI scan in the same position as the radiotherapy treatment.Images obtained from the three sequences were transmitted to the Eclipse 11.0 treatment planning system.All images were registered at Eclipse workstation as to normalized mutual information registration.The target areas were delineated by the clinical radiation physicians in the CT imaging,and CT and DWI fusion images.The target areas of the two kinds of image were evaluated using fusion function and statistical function of the treatment planning system.Results Target parameters differed significantly between CT base and CT/MRI fusion base.The results of the target volume outline closer by CT and MRI fusion image base in the three groups of clinicians.Conclusion The target volume between the groups is closer by using CT and DWI fusion image.DWI image has a good assisting effect in determining the target area of locally advanced esophageal cancer.
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Objective:To compare and analyze the value of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) of 1.5T magnetic resonance (MR) in differential diagnosis for localized prostate cancer, chronic inflammatory response and benign hyperplasia.Methods: 80 patients with localized prostate cancer were enrolled in the research. The signal to noise ratio (SNR) of DWI, ADC value and semi-quantitative classification of DWI on lesions were measured, and the diagnostic efficiencies of them were compared by using ROC curve.Results: In the 80 patients with localized prostate cancer patients, there were 52 malignant lesions and 43 benign lesions in peripheral band, and there were 31 malignant lesions and 46 benign lesions in central gland. The ADC values of prostate cancer in peripheral band and central gland were 0.91±0.12 and 0.86±0.15, respectively, and they were significantly lower than that of normal tissue (1.68±0.23 and 1.28±0.31) and benign lesions (1.24±0.21 and 1.12±0.16). The semi-quantitative classifications of DWI for benign lesions were significantly higher than that for malignant lesions in peripheral band and central gland, respectively (x2=20.88,x2=12.14;P<0.05). For the diagnostic efficiency of ADC, the sensitivities of benign and malignant lesions in peripheral band and malignant gland were 91.3% and 79.1%, respectively, and the specificities of them were 89.6% and 70.2%. And they was significant higher than the corresponding sensitivities (71.2% and 51.3%)and specificities (78.4% and 65.8%) of DWI imaging.Conclusion: Both of DWI and ADC of 1.5T magnetic resonance are the important indexes in differential diagnosis for prostate cancer, chronic inflammatory response and benign hyperplasia, while ADC value is better than DWI image in the clinical efficiency.
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Chronic expanding organizing hematoma (CEH) occasionally mimics a soft tissue tumor on MRI, which becomes more problematic in patients with a history of surgical resection for musculoskeletal malignancy. Herein, we present a case of CEH which we were able to differentiate from recurrent tumor through MRI follow-up, including diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) imaging. A 66-year-old male visited our institution under suspicion of recurrent leiomyosarcoma of the thigh, 19 months after surgery and radiation therapy. Due to inconclusive results, three US-guided biopsies and 6 MRI examinations were performed over 2 years. In the end, we could diagnose a CEH using conventional and functional MRI techniques, and it was histopathologically confirmed after surgical resection. A CEH may occur remotely after an initiating event, and it may persist and expand over several years. Functional MR sequences, in addition to conventional sequences, are helpful in differentiating CEH from malignant neoplasms.
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Aged , Humans , Male , Biopsy , Follow-Up Studies , Hematoma , Leiomyosarcoma , Magnetic Resonance Imaging , ThighABSTRACT
PURPOSE: To investigate whether quantitative parameters derived from Diffusion-weighted magnetic resonance imaging (DW-MRI) correlate with those of Dynamic contrast-enhanced MRI (DCE-MRI). MATERIALS AND METHODS: Thirteen patients with pathologically or clinically proven bony metastasis who had undergone MRI prior to treatment were included. The voxel size was 1.367 x 1.367 x 5 mm. A dominant tumor was selected and the apparent diffusion coefficient (ADC) value and DCE-MRI parameters were obtained by matching voxels. DCE-MRI data were analyzed yielding estimates of K(trans) (volume transfer constant) and ve. (extravascular extracellular volume fraction). Statistical analysis of ADC, K(trans), and ve value was conducted using Pearson correlation analyses. RESULTS: Fifteen lesions in pelvic bones were evaluated. Of these, 11 showed a statistically significant correlation (P < 0.05) between ADC and K(trans). The ADC and K(trans) were inversely related in 7 lesions and positively related in 4 lesions. This did not depend on the primary cancer or site of metastasis. The ADC and ve of 9 lesions correlated significantly. Of these, 4 lesions were inversely related and 5 lesions were positively related. CONCLUSION: Unlike our theoretic hypothesis, there was no consistent correlation between ADC values and K(trans) or between ADC values and ve in metastatic bone tumors.
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Humans , Diffusion , Magnetic Resonance Imaging , Neoplasm Metastasis , Pelvic BonesABSTRACT
PURPOSE: Purpose of this study was to determine if quantitative measures of CT attenuation and ADC values in combination with conventional imaging features can differentiate primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM). MATERIALS AND METHODS: Twenty-six patients with histologically-proven GBM (14 men and 12 women; median age, 50 years; age range, 22 - 73 years) and 14 patients with PCNSL (11 men and 3 women; median age, 61 years; age range, 41 - 74 years) were enrolled. Maximum CT attenuation, minimum ADC, and lesion to normal parenchyma minimum ADC ratios were measured in solid tumor regions. Conventional imaging features were evaluated for the following: ill-defined margin, homogeneous enhancement pattern, degree of necrosis, extent of tumor involvement and multiplicity. The Mann-Whitney test was used to compare maximum CT attenuation and minimum ADC values for PCNSL and GBM. Fisher's exact test was used to evaluate relationships between pathologic diagnoses and imaging features. RESULTS: The CT attenuations were similar for PCNSL and GBM (37.84 +/- 6.90 HU versus 37.00 +/- 5.54 HU, p = 0.68), but minimum ADC and minimum ADC ratio were significant lower in PCNSL than in GBM (595.01 +/- 228.28 10(-6) mm2/s versus 736.52 +/- 162.05 10(-6) mm2/s; p = 0.028, 0.87 +/- 0.26 versus 1.14 +/- 0.29; p = 0.007). PCNSL showed greater homogeneous enhancement and smaller necrotic areas than GBM (p = 0.003 and p < 0.001, respectively) and was more likely to have multiple tumors than GBM (p = 0.039). When necrotic PCNSL (n = 4) and necrotic GBM (n = 24) were compared, minimum ADC and minimum ADC ratios were also significantly lower in PCNSL, but CT attenuation were not. CONCLUSION: Although CT attenuation does not provide valuable information, minimum ADC and minimum ADC ratio and some imaging features can aid the differentiation of PCNSL and GBM.
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Humans , Male , Central Nervous System , Diffusion , Glioblastoma , Lymphoma , NecrosisABSTRACT
ObjectiveTo evaluate the value of MRI diffusion weighted imaging in localization of prostate cancer with whole-mount step section pathology.MethodsWe treated 36 patients using laparoscopic radical prostatectomy from Oct. 2009 to Jun. 2010. Patients who did not have an MRI/DWI examination or a surgical history of prostate and previous hormonal therapy were excluded, leaving 19 patients in our study. We analyzed the MRI and DWI collected before radical prostetectomy surgey and the post-surgery step section pathology made by the whole mount technique. The prostatic gland was divided into six sections. Two doctors read the MRI/DWI without knowing the patients' information and scored, using a 5 point scale, for each section. The tissue was graded according to the following scale: 1-definitely no cancer, 2-probably no cancer, 3-possible cancer, 4-probable cancer and 5-definite cancer. When the average score ≥4 the region was assumed to be the prostate cancer region by MRI or MRI/DWI.ResultsIn 19 patients with 114 regions, there were 48 (42％) prostate cancer regions approved by whole-mount step section pathologically.The number of prostate cancer regions was 15 (39％), 21 (55％) and 12 (32％) in base, mid and apex parts respectively. The sensitivity and specificity of the MRI was 62.5％ and 69.7％. When considering DWI, the specificity and sensitivity was elevated to 79.1％ and 83.3％. As for the apex and mid parts, the sensitivities of MRI were a little bit low (46.7％ and 66.7％ ). But the sensitivities of localization of prostate cancer for the apex and mid of prostate were elevate to 73.3％ and 85.7％ respectively when DWI was also used.ConclusionsWith whole-mount step-section pathology, the combination of MRI and DWI can improve the sensitivity of MRI for localized diagnosis in prostate cancer, especially in apex and mid parts of the prostate.
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We report herein a patient with aphasic status epilepticus (ASE) who underwent serial brain magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), perfusion imaging (PI), and magnetic resonance angiography (MRA) in the peri-ictal phase. The initial DWI revealed a high signal intensity in the left medial temporal area and PI demonstrated hyperperfusion in the left temporoparietal area. MRA revealed an increased flow signal in the ipsilateral intracranial arteries. PI signal changes had normalized by the follow-up MRI. The DWI, PI, MRA, and clinical manifestation of ASE are described herein.
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Humans , Arteries , Brain , Follow-Up Studies , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Perfusion , Perfusion Imaging , Status EpilepticusABSTRACT
@#ObjectiveTo explore the effect of Yinaotongluo Capsule on diffuse weighting image and enenery metabolism of ischemia-reperfuing rat.MethodsMagnetic resonance diffusion-weighted imaging(DWI) and 1H and magnetic resonance spectroscopy(MRS) were performed in different brain regions in focal cerebral ischemic-reperfusion injury model rats. ResultsYinaotongluo Capsule could significantly reduce the area and the intensity of infarction of rats by DWI 3 h and 5 d after treatment compared with the model group.The result of 1H MRS examination demonstrated Lac peak was lower and NAA peak higher than that of the model group. ConclusionYinaotongluo Capsule can effectually improve enenery metabolism during cerebral ischemia and reperfuing, so that to reduce the neuronal dysfunction and death in infarcts at the late stage.
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Objective To study the applied value of MR DWI and ADC value of in the hepatic lesions.Methods 36 cases ofhepatocellular carcinoma,15 cases of metastases,33 cases of hepatic cavemous hemangioma and 12 cases of cyst were examined by DWI andconventional MRI,then the ADC values were measured.Results The average ADC values of hepatic lesions were as follows:cyst was(2.90?0.68)?10~(-3)mm~2/s,hemangioma was(2.01?0.53)?10~(-3)mm~2/s,metastases was(1.57?0.42)?10~(-3)mm~2/s,hepatocellular carcinoma was(1.20?0.32)?10~(-3)mm~2/s.The ADC values of benign lesions were higher than those of malignant(P
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BACKGROUND: The management of vertiginous patients is a great challenge to emergency physicians. We evaluated the diagnostic value of a diffusion-weighted image(DWI) in differentiating central vertigo from the peripheral vertigo in patients who presented no neurological symptoms other than risk factors for stroke. METHODS: From March 2000 to February 2001, we retrospectively analyzed the cases of 68 patients who visited the emergency department with symptoms of isolated vertigo and who had risk factors for stroke. DWIs, computed tomograms(CT), and medical records were reviewed, and the final diagnose, the DWIs and the CT readings, the risk factors for stroke, and the time it took waiting for a DWI or CT scan were analyzed. RESULTS: Of the 68 patients, 21(30.8%) had central vertigo: 15 vertebrobasilar transient ischemic attacks(VB-TIA), 4 brain stem infarctions, 1 cerebellar infarction, and 1 cerebellopeduncular infarction. The DWI showed a 28.6% sensitivity, a 97.9% specificity, and an 85.7% positive predictive value in diagnosing central vertigo. It also had a 100% sensitivity in detecting infarctions. CONCLUSION: A DWI had a comparable sensitivity to MRI in detecting central vertigo and small, but potentially, lethal infarctions in our patient population. We recommend clinical application of DWI in the emergency department evaluation of isolated vertigo patients with risk factors for stroke.