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DW-MRI of the urogenital tract: applications in oncology.

Petralia G, Thoeny HC - Cancer Imaging (2010)

Bottom Line: Promising results were also published for the detection of prostate cancer.DW-MRI may improve the performance of conventional T2-weighted and contrast-enhanced MRI in the preoperative work-up of bladder cancer, as it may help in distinguishing superficial from muscle invasive bladder cancer, which is critical for patient management.Another challenging application of DW-MRI in the urogenital tract is the detection of pelvic lymph node metastases.

View Article: PubMed Central - PubMed

Affiliation: Institute of Diagnostic, Pediatric and Interventional Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse 10, Bern, Switzerland.

ABSTRACT
Diffusion-weighted magnetic resonance imaging (DW-MRI) appears to hold promise as a non-invasive imaging modality in the detection of early microstructural and functional changes of different organs. DW-MRI is an imaging technique with a high sensitivity for the detection of a large variety of diseases in the urogenital tract. In kidneys, DW-MRI has shown promise for the characterization of solid lesions. Also in focal T1 hyperintense lesions DW-MRI was able to differentiate hemorrhagic cysts from tumours according to the lower apparent diffusion coefficient (ADC) values reported for renal cell carcinomas. Promising results were also published for the detection of prostate cancer. DW-MRI applied in addition to conventional T2-weighted imaging has been found to improve tumour detection. On a 3 T magnetic resonance unit ADC values were reported to be lower for tumours compared with the normal-appearing peripheral zone. The combined approach of T2-weighted imaging and DW-MRI also showed promising results for the detection of recurrent tumour in patients after radiation therapy. DW-MRI may improve the performance of conventional T2-weighted and contrast-enhanced MRI in the preoperative work-up of bladder cancer, as it may help in distinguishing superficial from muscle invasive bladder cancer, which is critical for patient management. Another challenging application of DW-MRI in the urogenital tract is the detection of pelvic lymph node metastases. As the ADC is generally reduced in malignant tumours and increased under inflammatory conditions, reduced ADC values were expected in patients with lymph node metastases.

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MRI (at 3 T) of a 50-year-old patient with 2 lymph node metastases from prostate carcinoma in the right external iliac chain. (A) On the DW-MR image at a b value of 1000 s/mm2 the lymph node metastases show high signal intensity (arrows). (B) On the corresponding ADC map the lymph node metastases reveal impeded diffusion, represented by colour shades of dark grey.
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Figure 6: MRI (at 3 T) of a 50-year-old patient with 2 lymph node metastases from prostate carcinoma in the right external iliac chain. (A) On the DW-MR image at a b value of 1000 s/mm2 the lymph node metastases show high signal intensity (arrows). (B) On the corresponding ADC map the lymph node metastases reveal impeded diffusion, represented by colour shades of dark grey.

Mentions: DW-MRI may have a role in the assessment of malignant lymph nodes from urogenital tumours, because malignant nodes are in theory expected to show impeded diffusion, resulting in low ADC values, as most primary malignant tumours show impeded diffusion caused by high cellularity (Fig. 6). There is one study including 29 patients that investigated the potential contribution of ADC values in the differentiation between benign and malignant lymph nodes in patients with prostate cancer, showing significant differences in the mean ADC for b values of 50, 300, and 600 s/mm2 between malignant (1.07 ± 0.23 × 10−3 mm2/s) and benign (1.54 ± 0.25 × 10−3 mm2/s) lymph nodes[67]. However, definitive data are not yet available and the potential of DW-MRI for lymph node assessment in normal-sized nodes is still being investigated.Figure 6


DW-MRI of the urogenital tract: applications in oncology.

Petralia G, Thoeny HC - Cancer Imaging (2010)

MRI (at 3 T) of a 50-year-old patient with 2 lymph node metastases from prostate carcinoma in the right external iliac chain. (A) On the DW-MR image at a b value of 1000 s/mm2 the lymph node metastases show high signal intensity (arrows). (B) On the corresponding ADC map the lymph node metastases reveal impeded diffusion, represented by colour shades of dark grey.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2967148&req=5

Figure 6: MRI (at 3 T) of a 50-year-old patient with 2 lymph node metastases from prostate carcinoma in the right external iliac chain. (A) On the DW-MR image at a b value of 1000 s/mm2 the lymph node metastases show high signal intensity (arrows). (B) On the corresponding ADC map the lymph node metastases reveal impeded diffusion, represented by colour shades of dark grey.
Mentions: DW-MRI may have a role in the assessment of malignant lymph nodes from urogenital tumours, because malignant nodes are in theory expected to show impeded diffusion, resulting in low ADC values, as most primary malignant tumours show impeded diffusion caused by high cellularity (Fig. 6). There is one study including 29 patients that investigated the potential contribution of ADC values in the differentiation between benign and malignant lymph nodes in patients with prostate cancer, showing significant differences in the mean ADC for b values of 50, 300, and 600 s/mm2 between malignant (1.07 ± 0.23 × 10−3 mm2/s) and benign (1.54 ± 0.25 × 10−3 mm2/s) lymph nodes[67]. However, definitive data are not yet available and the potential of DW-MRI for lymph node assessment in normal-sized nodes is still being investigated.Figure 6

Bottom Line: Promising results were also published for the detection of prostate cancer.DW-MRI may improve the performance of conventional T2-weighted and contrast-enhanced MRI in the preoperative work-up of bladder cancer, as it may help in distinguishing superficial from muscle invasive bladder cancer, which is critical for patient management.Another challenging application of DW-MRI in the urogenital tract is the detection of pelvic lymph node metastases.

View Article: PubMed Central - PubMed

Affiliation: Institute of Diagnostic, Pediatric and Interventional Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse 10, Bern, Switzerland.

ABSTRACT
Diffusion-weighted magnetic resonance imaging (DW-MRI) appears to hold promise as a non-invasive imaging modality in the detection of early microstructural and functional changes of different organs. DW-MRI is an imaging technique with a high sensitivity for the detection of a large variety of diseases in the urogenital tract. In kidneys, DW-MRI has shown promise for the characterization of solid lesions. Also in focal T1 hyperintense lesions DW-MRI was able to differentiate hemorrhagic cysts from tumours according to the lower apparent diffusion coefficient (ADC) values reported for renal cell carcinomas. Promising results were also published for the detection of prostate cancer. DW-MRI applied in addition to conventional T2-weighted imaging has been found to improve tumour detection. On a 3 T magnetic resonance unit ADC values were reported to be lower for tumours compared with the normal-appearing peripheral zone. The combined approach of T2-weighted imaging and DW-MRI also showed promising results for the detection of recurrent tumour in patients after radiation therapy. DW-MRI may improve the performance of conventional T2-weighted and contrast-enhanced MRI in the preoperative work-up of bladder cancer, as it may help in distinguishing superficial from muscle invasive bladder cancer, which is critical for patient management. Another challenging application of DW-MRI in the urogenital tract is the detection of pelvic lymph node metastases. As the ADC is generally reduced in malignant tumours and increased under inflammatory conditions, reduced ADC values were expected in patients with lymph node metastases.

Show MeSH
Related in: MedlinePlus