Multiparametric Whole-body MRI with Diffusion-weighted Imaging and ADC Mapping for the Identification of Visceral and Osseous Metastases From Solid Tumors

Jacobs, Michael A.; Macura, Katarzyna J.; Zaheer, Atif; Antonarakis, Emmanuel S.; Stearns, Vered; Wolff, Antonio C.; Feiweier, Thorsten; Kamel, Ihab R.; Wahl, Richard L.; Pan, Li

doi:10.1016/j.acra.2018.02.010

Cited by 33 publications

(30 citation statements)

References 45 publications

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“…By using different b values trace ADC maps can be created on a pixel-by-pixel basis which gives quantitative analysis. 3 Malignant lesions with highly cellular microenvironments limit diffusion and show low ADC values due to large number of cell membranes. Conversely high ADC values are observed in less cellular benign lesions due to free diffusion of water molecules.…”

Section: Discussionmentioning

confidence: 99%

“…Short scanning time and the lack of need for intravenous contrast material are the other advantages which make it easy to be incorporated into a routine imaging protocol. 3,4 However, DWI is most often referred for intracranial pathologies. 5 Usage of DWI in the extracranial sites such as abdomen and pelvis is also encouraging and has become a routine sequence in oncologic settings.…”

Section: Discussionmentioning

confidence: 99%

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Role of diffusion-weighted MRI in differentiating benign from malignant bone tumors

2019

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Objective: To evaluate the role of diffusion-weighted MRI in differentiating benign from malignant primary bone tumors. To know the sensitivity and specificity of diffusion weighted MRI and calculating apparent diffusion coefficient (ADC) cutoff in differentiating benign from malignant primary bone tumors. Methods and materials : This is a prospective observational study of 50 patients, who were clinically or radiologically suspected with primary bone tumor and referred to the Department of Radiodiagnosis, for radiography or for MRI. These patients underwent routine MRI sequences including diffusion-weighted MRI with b-values of 0, 500 and 1000, followed by pathological examination supplemented by immunohistochemistry (wherever necessary). Hematological malignancies, recently biopsied cases and recurrent cases were excluded from the study. Results: Out of 50 patients with suspected bone tumors, 15 were benign (and tumor like lesions) and 35 were malignant primary bone tumors. The most common age group involved for both benign and malignant primary bone tumors was 11–20 years (23 cases—46%). In our study, total number of affected males were 27 (54%) and total number of affected females were 23 (46%) with M:F ratio of 1.17:1. In this study 72% lesions had appendicular bone involvement and 28% had axial bone involvement. 94.3% of malignant lesions showed restriction on diffusion-weighted imaging (DWI) and in 80 % of benign lesions restriction was absent on DWI which was statistically significant. Mean ADC levels in malignant lesions was 1.092 ± 0.497 and in benign lesions was 1.62 ± 0.596 which was statistically significant. Chondrosarcoma had highest ADC and Ewing’s sarcoma had lowest ADC values in malignant lesions. Chondroblastoma had highest ADC and Osteomyelitis had lowest ADC values in benign lesions. ADC value of 1.31 had highest sensitivity and specificity to differentiate between benign and malignant lesions. Conclusion: DWI is helpful in differentiating malignant from benign bone tumors and tumor like lesions with diffusion restriction favoring malignancy. Inspite of some overlap, ADC values of benign and malignant bone tumors are different and measurement of ADC values improves the accuracy of the diagnosis of bone tumors and tumor like lesions. Calculation of ADC may also be used as baseline reference to assess response to treatment in future or for follow up. Advances in knowledge: DWI imaging (and ADC values) has been extensively used in neuroimaging. Extension of this application to musculoskeletal–oncologic imaging is not so well studied. Apart from differentiating benign from malignant lesions which is the main focus of this study, assessment of response to treatment by ADC values may be possible in near future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of diffusion-weighted MRI in differentiating benign from malignant bone tumors

2019

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“…There are now effective lines of treatment for patients with metastatic disease, which can improve symptoms, prevent complications and prolong life [8][9][10][11][12][13]. Furthermore, oligometastatic disease (typically < 5 metastases), may be suitable for aggressive local therapy in combination with systemic treatment.…”

Section: The Approach To the Patient With Suspected Advanced Breast Cmentioning

confidence: 99%

Imaging diagnosis of metastatic breast cancer

et al. 2020

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Numerous imaging modalities may be used for the staging of women with advanced breast cancer. Although bone scintigraphy and multiplanar-CT are the most frequently used tests, others including PET, MRI and hybrid scans are also utilised, with no specific recommendations of which test should be preferentially used. We review the evidence behind the imaging modalities that characterise metastases in breast cancer and to update the evidence on comparative imaging accuracy.

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“…In literature, several studies used other diagnostic exams to verify the real presence of bone metastases, like CT, PET/CT, X-ray, or follow-up. However, no study used bone biopsy as a control [ 16 , 17 , 18 ].…”

Section: Diffusion-weighted Imaging (Dwi) Sequences In Bone Metastmentioning

confidence: 99%

Whole-Body MRI with Diffusion-Weighted Imaging in Bone Metastases: A Narrative Review

et al. 2018

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Whole body magnetic resonance imaging (MRI) with diffusion-weighted imaging (WB-MRI-DWI) is currently emerging as a diagnostic technique in the evaluation of bone metastases from breast, prostate, lung, thyroid, and melanoma tumors. The most relevant articles regarding the detection of solid tumor bone metastases with MRI have been reviewed and cited. The imaging methods currently used in the detection of bone metastases are bone scintigraphy, computed tomography (CT), and positron emission tomography (PET/CT) with 2-deoxy-2-[fluorine-18] fluoro-d-glucose (18F-FDG PET/CT). WB-MRI-DWI allows qualitative and quantitative evaluation of focal lesions through signal intensity evaluation on DWI images and the reconstruction of the apparent diffusion coefficient (ADC) map. In prostate and breast cancer, WB-MRI-DWI is useful in assessing the response of bone lesions to therapy and to detecting early non-responders, while in lung cancer the method shows a similar sensitivity to 18F-FDG PET/CT in the detection of bone metastases. In bone metastases of thyroid tumors and melanoma, the WB-MRI-DWI shows a higher sensitivity when compared to 18F-FDG PET/CT. With a standardization of the WB-MRI-DWI protocol, this method seems to play an important role in the diagnosis of bone solid tumor metastases.

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Multiparametric Whole-body MRI with Diffusion-weighted Imaging and ADC Mapping for the Identification of Visceral and Osseous Metastases From Solid Tumors

Cited by 33 publications

References 45 publications

Role of diffusion-weighted MRI in differentiating benign from malignant bone tumors

Role of diffusion-weighted MRI in differentiating benign from malignant bone tumors

Imaging diagnosis of metastatic breast cancer

Whole-Body MRI with Diffusion-Weighted Imaging in Bone Metastases: A Narrative Review

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