• Title/Summary/Keyword: Magnetic resonance imaging, diffusion weighted

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Diagnosis of Residual Tumors after Unplanned Excision of Soft-Tissue Sarcomas: Conventional MRI Features and Added Value of Diffusion-Weighted Imaging

  • Jin, Kiok;Lee, Min Hee;Yoon, Min A;Kim, Hwa Jung;Kim, Wanlim;Chee, Choong Geun;Chung, Hye Won;Lee, Sang Hoon;Shin, Myung Jin
    • Investigative Magnetic Resonance Imaging
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    • v.26 no.1
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    • pp.20-31
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    • 2022
  • Purpose: To assess conventional MRI features associated with residual soft-tissue sarcomas following unplanned excision (UPE), and to compare the diagnostic performance of conventional MRI only with that of MRI including diffusion-weighted imaging (DWI) for residual tumors after UPE. Materials and Methods: We included 103 consecutive patients who had received UPE of a soft-tissue sarcoma with wide excision of the tumor bed between December 2013 and December 2019 and who also underwent conventional MRI and DWI in this retrospective study. The presence of focal enhancement, soft-tissue edema, fascial enhancement, fluid collections, and hematoma on MRI including DWI was reviewed by two musculoskeletal radiologists. We used classification and regression tree (CART) analysis to identify the most significant MRI features. We compared the diagnostic performances of conventional MRI and added DWI using the McNemar test. Results: Residual tumors were present in 69 (66.9%) of 103 patients, whereas no tumors were found in 34 (33.1%) patients. CART showed focal enhancement to be the most significant predictor of residual tumors and correctly predicted residual tumors in 81.6% (84/103) and 78.6% (81/103) of patients for Reader 1 and Reader 2, respectively. Compared with conventional MRI only, the addition of DWI for Reader 1 improved specificity (32.8% vs. 56%, 33.3% vs. 63.0%, P < 0.05), decreased sensitivity (96.8% vs. 84.1%, 98.7% vs. 76.7%, P < 0.05), without a difference in diagnostic accuracy (76.7% vs. 74.8%, 72.9% vs. 71.4%) in total and in subgroups. For Reader 2, diagnostic performance was not significantly different between the sets of MRI (P > 0.05). Conclusion: After UPE of a soft-tissue sarcoma, the presence or absence of a focal enhancement was the most significant MRI finding predicting residual tumors. MRI provided good diagnostic accuracy for detecting residual tumors, and the addition of DWI to conventional MRI may increase specificity.

Diffusion-Weighted Imaging for Detecting Glufosinate Ammonium Intoxication: A Case Report (글루포시네이트 암모늄 중독 환자의 확산자기공명영상 소견: 증례 보고)

  • Hyoung Yeob Kim;Noh Hyuk Park
    • Journal of the Korean Society of Radiology
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    • v.83 no.6
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    • pp.1354-1359
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    • 2022
  • Glufosinate ammonium-containing herbicides are non-selective herbicides, used worldwide. With the increasing use of glufosinate ammonium-containing herbicides, cases of acute intoxication in suicide attempts have also increased. Herein, we report a case of a patient presenting cytotoxic edema in the posterior limbs of the bilateral internal capsules, bilateral middle cerebellar peduncles, and splenium of the corpus callosum on the brain diffusion-weighted MRI after glufosinate ammonium intoxication.

Brain Magnetic Resolution Imaging to Diagnose Bing-Neel Syndrome

  • Kim, Ho-Jung;Suh, Sang-Il;Kim, Joo-Han;Kim, Byung-Jo
    • Journal of Korean Neurosurgical Society
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    • v.46 no.6
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    • pp.588-591
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    • 2009
  • Radiologic findings of Bing-Neel syndrome, which is an extremely uncommon complication resulting from malignant lymphocyte infiltration into the central nervous system (CNS) in patients with Waldenstr$\ddot{o}$m's macroglobulinemia (WM), have been infrequently reported due to extreme rarity of the case. A 75-year-old man with WM presented at a neurology clinic with progressive gait and memory disturbances, and dysarthria of 2 months duration. Cerebrospinal fluid and serum protein electrophoresis and immunofixation electrophoresis showed IgM kappa-type monoclonal gammopathy. Brain magnetic resonance imaging revealed multifocal, hyperintense lesions on T2 weighted-images. Brain diffusion-weighted imaging (DWI) demonstrated hyperintensities in cerebral and cerebellar lesions that appeared isointense on apparent diffusion coefficient maps, which were compatible with vasogenic edema. Although histologic analysis is a confirmative study to prove direct cell infiltration into the brain, brain MRI with DWI may be a good supportive study to diagnose Bing-Neel syndrome.

Evaluation of Treatment Response Using Diffusion-Weighted MAI in Metastatic Spines (척추 전이암에서 확산강조 자기공명 영상을 이용한 치료반응의 평가)

  • Lee, Jang-Jin;Shin, Sei-One
    • Journal of Yeungnam Medical Science
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    • v.18 no.1
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    • pp.30-38
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    • 2001
  • Background: The purpose of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging for monitoring the response to radiation therapy in metastatic bone marrow of the spines. Materials and Methods: Twenty-one patients with metastatic bone marrow of the spines were examined with MRI. Diffusion-weighted and spin-echo MRI were performed in 10 patients before and after radiation therapy with or without systemic chemotherapy, and performed in 11 patients after radiation therapy alone. Follow up spin-echo and diffusion-weighted MRI were obtained at 1 to 6 months after radiation therapy according to patients' condition. The diffusion-weighted imaging sequence was based on reversed fast imaging with steady-state precession (PSIF). Signal intensity changes of the metastatic bone marrows before and after radiation therapy on conventional spin-echo sequence MRI and diffusion-weighted MRI were evaluated. Bone marrow contrast ratios and signal-to-noise ratios before and after radiation therapy of diffusion- weighted MRI were analyzed. Results: All metastatic bone marrow of the spinal bodies were hyperintense to normal bone marrow of the spinal bodies on pretreatment diffusion-weighted MRI and positive bone marrow contrast ratios(p<0.001), and hypointense to normal spinal bodies on posttreatment diffusion-weighted MRI and negative bone marrow contrast ratios(p<0.001). The signal to noise ratios after treatment decreased comparing with those of pretreatment. Decreased signal intensity of the metastatic bone marrows on diffusion-weighted MRI began to be observed at average more than one month after the initiation of the radiation therapy. Conclusion: These results suggest that diffusion-weighted MRI would be an excellent method for monitoring the response to therapy of metastatic bone marrow of the spinal bodies, however, must be investigated in a larger series of patients with longer follow up period.

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Delayed Cerebral Metastases from Completely Resected Cardiac Myxoma: Case Report and Review of Literature (완전히 절제된 심장 점액종의 지연된 뇌전이: 증례보고 및 문헌고찰)

  • Kim, Ah-Hyun;Lee, Jae-Wook;Lee, Mi-Kyung;Yoon, Pyeong-Ho;Kim, Min-Jung
    • Investigative Magnetic Resonance Imaging
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    • v.15 no.2
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    • pp.165-169
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    • 2011
  • Cardiac myxoma is the most common benign tumor of the heart. However, low incidence of recurrence and metastasis has been reported. A 49-year-old female patient was admitted in the hospital due to sudden onset of left side weakness. Magnetic resonance imaging (MRI) of brain showed multifocal areas of diffusion restriction on diffusion weighted images. Echocardiography was performed to evaluate the cause of embolic brain infarction and cardiac myxoma was found in the left atrium. The patient underwent complete excision of the mass. One year later, the patient was readmitted with symptoms of dysarthria. Brain MRI showed newly developed multiple hemorrhagic metastatic lesions. The patient underwent radiotherapy of the metastatic lesions. Although rare, cardiac myxoma can cause delayed metastasis. We report a rare case of delayed multiple cerebral metastases from the completely resected cardiac myxoma.

Diffusion-Weighted MR Imaging of Intracerebral Hemorrhage

  • Bo Kiung Kang;Dong Gyu Na;Jae Wook Ryoo;Hong Sik Byun;Hong Gee Roh;Yong Seon Pyeun
    • Korean Journal of Radiology
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    • v.2 no.4
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    • pp.183-191
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    • 2001
  • Objective: To document the signal characteristics of intracerebral hemorrhage (ICH) at evolving stages on diffusion-weighted images (DWI) by comparison with conventional MR images. Materials and Methods: In our retrospective study, 38 patients with ICH underwent a set of imaging sequences that included DWI, T1-and T2-weighted imaging, and fluid-attenuated inversion recovery (FLAIR). In 33 and 10 patients, respectively, conventional and echo-planar T2* gradient-echo images were also obtained. According to the time interval between symptom onset and initial MRI, five stages were categorized: hyperacute (n=6); acute (n=7); early subacute (n=7); late subacute (n=10); and chronic (n=8). We investigated the signal intensity and apparent diffusion coefficient (ADC) of ICH and compared the signal intensities of hematomas at DWI and on conventional MR images. Results: DWI showed that hematomas were hyperintense at the hyperacute and late subacute stages, and hypointense at the acute, early subacute and chronic stages. Invariably, focal hypointensity was observed within a hyperacute hematoma. At the hyperacute, acute and early subacute stages, hyperintense rims that corresponded with edema surrounding the hematoma were present. The mean ADC ratio was 0.73 at the hyperacute stage, 0.72 at the acute stage, 0.70 at the early subacute stage, 0.72 at the late subacute stage, and 2.56 at the chronic stage. Conclusion: DWI showed that the signal intensity of an ICH may be related to both its ADC value and the magnetic susceptibility effect. In patients with acute stroke, an understanding of the characteristic features of ICH seen at DWI can be helpful in both the characterization of intracranial hemorrhagic lesions and the differentiation of hemorrhage from ischemia.

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Diffusion-Weighted MR Imaging of Various Intracranial Diseases : Clinical Utility (다양한 두개강내 질환의 확산강조 자기공명영상 : 임상적 유용성)

  • 김영준
    • Investigative Magnetic Resonance Imaging
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    • v.2 no.1
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    • pp.104-112
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    • 1998
  • Purpose : To evaluate the clinical utility of diffusion-weighted imaging by analyzing the signal intersity of lesions in patients with various intracranial diseases. Materials and Methods : difusion-weighted MR imaging was prospectively perormed in randomly selected 70 patients with various intracranial idseases. They consisted of 20 patients with acute infarct, 21 patients with chronic infarct of small vessel disease, 14 patients with primary intracranial tumor, three patients with brain metastasis, five patient with brain abscess, five patients with brain abscess, five patients with cerebral hemorrhage, one patient with neurocysticercosis, and one patient with epidermoid cyst. the diffusion-weighted images were obtained immediately after routine T2-weighted imaging on a 1.5T MR unit using single shot spin echo EPI technique with 6500 ms TR, 107ms TE, $128{\times}128$ matrix, 1 number of excitation, $24{\times}24$ field of view, 5-7 mm slice thickness, 2-3 mm inter-slice gap. The diffusion-gradients (b value of ($1000s{\;}/{\;}textrm{mm}^2$)) were applied along three directions(x, y, z). On visual inspection of diffusion-weighted images, the signal intersity of lesions was arbitrarily graded as one of 5 grades. In quantitative assessment, we measured the signal intensity of all the lesions and the contralateral corresponding normal area using round region of interest(ROI), and then calculated the signal intensity ratio of the lesion to the normal brain parenchyma. Results : On visual inspection, markedly hyperintense signals were seen in all cases of acute infarct, brain abscess, epidermoid cyst, and neurocysticercosis in degenerating stage. In all cases of cerebral hematoma, the very high signal internsity was intermingled with low signal intensity. focal very high signal intersity was also seen in a solid portion of the tumor in a patient. the mean signal intensity ratios of all those lesions to the normal brain parenchyma were above 2.5. Gliosis, solid component of brain tumor, brain metastasis, and vasogenic dedma appeared isointense to the normal brain parenchyma in 71%, 64%, 100%, and 67%, respectively ; the mean signal intensity ratios of those lesions to the normal brain parenchyma ranged 1.15 to 1.28 and there was no significant difference among these(p>0.1). Cystic cerebromalacia and necrotic or cystic portions in tumor were markedly or slightly hypointense, and the mean signal intensity ratios were 0.45 and 0.42, respectively. Conclusion : Very high signal intensity of acute infarct, brain abscess, epidermoid cyst, and cystic neurocysticercosis in degenerating stage on diffusion-weighted images may be helpful in differentiating from other diseases that are hypointense or isointense to the normal brain parenchyma. It may be especially useful differentiation of brain abscess from brain tumor with necrotic or cystic portion.

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The Principles of Diffusion MR

  • 장용민
    • Proceedings of the KSMRM Conference
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    • 2003.10a
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    • pp.49-53
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    • 2003
  • 확산텐서영상(Diffusion Tensor Imaging)의 개념은 1980년대 중반 확산강조영상(Diffusion Weighted Imaging)의 개념이 도입되면서 거의 동시에 도입되었지만 MR 장비의 기계적 한계등으로 인해 최근에야 임상적으로 사용되기 시작했다. 확산텐서영상(DTI)과 확산강조영상(DWI)의 방법론적인 차이점은 단순히 확산강조영상의 경우 세 개의 다른방향 (X-, Y-, Z-축)으로 확산측정용 경사자장을 가하는 반면 확산텐서영상의 경우 이보다 많은 방향 (최소한 6 방향)으로 확산측정용 경사자장을 가한다는 점이다. 이러한 차이로부터 금방 알 수 있는 점은 확산강조영상은 확산텐서영상의 일부라는 점이다. 즉, 확산텐서영상의 경우 더 많은 방향으로 확산측정용 경사자장을 가했으므로 더 많은 정보를 획득할 수 있고 이중 세 개의 방향 (주로 X,Y,Z)에 대한 정보만을 이용하게 되면 확산강조영상이다. 이러한 이유로 확산텐서영상을 획득하면 확산강조영상에서 얻게 되는 방향별 확산강조영상, 등방성(isotropic) 확산강조영상, ADC (Apparent Diffusion Coefficient) map등도 기본적으로 얻게 되므로 추가로 확산강조영상을 획득할 필요가 없다. 본 강의에서는 이러한 확산(텐서)영상의 물리적 원리를 복잡한 수학적 설명보다는 개념 위주로 설명해 보고자 한다.

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Clinical Manifestations and Imaging Characteristics of Gliomatosis Cerebri with Pathological Confirmation

  • Zhang, Chun-Pu;Li, Hua-Qing;Zhang, Wei-Tao;Liu, Ming-Hui;Pan, Wen-Jing
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.11
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    • pp.4487-4491
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    • 2014
  • Objective: To explore the clinical manifestations and imaging characteristics of gliomatosis cerebri to raise the awareness and improve its diagnostic accuracy for patients. Materials and Methods: Clinical data, imaging characteristics and pathological examination of 12 patients with GC from Jan., 2008 to Jan., 2012 were analyzed retrospectively. Results: Patients with GC were clinically manifested with headache, vomiting, repeated seizures, fatigue and unstable walking, most of whom had more than 2 lesions involving in parietal lobe, followed by temporal lobe, frontal lobe, periventricular white matter and corpus callosum. Magnetic resonance imaging (MRI) showed diffuse distribution, T1-weighted images (T1WI) with equal and low signals and T2-weighted images (T2WI) with bilateral symmetrical high diffuse signals. There was no reinforcement by enhancement scanning and signals were different in diffusion-weighted images (DWI). The higher the tumor staging, the stronger the signals. Pathological examination showed neuroastrocytoma in which tumor tissues were manifested by infiltrative growth in blood vessels and around neurons. Conclusions: In clinical diagnosis of GC, much attention should be paid to the diffuse distribution of imaging characteristics, incomplete matching between clinical and imaging characteristics and confirmation by combining with histopathological examination.

Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

  • Joseba Salguero;Enrique Gomez-Gomez;Jose Valero-Rosa;Julia Carrasco-Valiente;Juan Mesa;Cristina Martin;Juan Pablo Campos-Hernandez;Juan Manuel Rubio;Daniel Lopez;Maria Jose Requena
    • Korean Journal of Radiology
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    • v.22 no.4
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    • pp.559-567
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    • 2021
  • Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imaging-reporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.