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Whole-Body MRI including Diffusion-Weighted Imaging in Oncology
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cancer is one of the major causes of worldwide mortality. Imaging plays a vital role in the staging, follow-up, and evaluation of therapeutic response in cancer patients. Whole-body (WB) magnetic resonance imaging (MRI), as a non-ionizing imaging technique, is a promising procedure to assess tumor spreading in a single examination. New MRI technological developments now enable the application of diffusion-weighted imaging (DWI) of the entire body. DWI reflects the random motion of water molecules and provides functional information of body tissues. DWI can be quantified with the use of the apparent diffusion coefficient (ADC). The aim of this dissertation was to demonstrate the value of WB MRI including DWI in cancer patients.

WB MRI including DWI, 18F-NaF PET/CT, and bone scintigraphy was performed on 49 patients with newly diagnosed, high-risk prostate cancer, for the purpose of detecting bone metastases. WB DWI showed higher specificity, but lower sensitivity compared to 18F-NaF PET/CT. In addition, WB MRI including DWI, and CT of the chest and abdomen was performed in 23 patients with malignant melanoma. We concluded that WB MRI could not completely supplant CT for the staging of malignant melanoma, especially with respect to the detection of lesions in the chest region. In this study, WB MRI and DWI were able to detect more bone lesions compared to CT, and showed several lesions outside the CT field of view, reinforcing the advantage of whole-body examination.

WB MRI, including DWI, was performed in 71 patients with testicular cancer. This modality demonstrated its feasibility for use in the follow-up of such patients. WB MRI, including DWI, and 18F-FDG PET-CT, were carried out in 50 patients with malignant lymphoma. Both these imaging modalities proved to be promising approaches for predicting clinical outcomes and discriminating between different subtypes of lymphomas.

In conclusion, WB MRI, including DWI, is an evolving technique that is continuing to undergo technical refinement. Standardization of image acquisition and analysis will be invaluable, allowing for more accurate comparison between studies, and widespread application of this technique in clinical practice. Both WB MRI, including DWI and PET/CT, have their particular strengths and weaknesses in the evaluation of metastatic disease. DWI and PET/CT are different functional techniques, so that combinations of these techniques may provide complementary and more comprehensive information of tumor tissue. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 51 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 948
Keyword [en]
Diffusion-weighted imaging, Whole-body MRI, NaF PET/CT, FDG PE/CT, apparent diffusion coefficient
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-209777ISBN: 978-91-554-8796-6 (print)OAI: oai:DiVA.org:uu-209777DiVA: diva2:659598
Public defence
2013-12-11, Hedstrandsalen, Akademiska sjukhuset, Ing 70 bv, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2013-11-20 Created: 2013-10-25 Last updated: 2014-01-23
List of papers
1. Whole-Body Diffusion-Weighted MRI Compared With 18F-NaF PET/CT for Detection of Bone Metastases in Patients With High-Risk Prostate Carcinoma
Open this publication in new window or tab >>Whole-Body Diffusion-Weighted MRI Compared With 18F-NaF PET/CT for Detection of Bone Metastases in Patients With High-Risk Prostate Carcinoma
Show others...
2012 (English)In: American Journal of Roentgenology, ISSN 0361-803X, E-ISSN 1546-3141, Vol. 199, no 5, 1114-1120 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

The purpose of this study was to evaluate the accuracy of whole-body diffusion-weighted MRI (DWI) and 18F-NaF PET/CT for detection of bone metastases in patients with high-risk prostate cancer.

SUBJECTS AND METHODS:

Both patient- and lesion-based analyses were performed on 49 consecutive patients (median age, 67 years; age range, 57-80 years) with recently diagnosed high-risk prostate cancer. All patients underwent bone scintigraphy, whole-body MRI including DWI and 18F-NaF PET/CT before treatment. Bone scintigraphy, conventional MR images, and follow-up images were used as the standard of reference to evaluate 18F-NaF PET/CT and DWI.

RESULTS:

On patient-based analysis, five patients had skeletal metastases on reference imaging that both DWI and 18F-NaF PET/CT could verify, and 18F-NaF PET/CT and DWI showed false-positive findings in four and one patient, respectively. With lesion-based analysis, 18F-NaF PET/CT and DWI showed nine and five true-positive lesions, zero and four false-negative lesions, and seven and two false-positive lesions, respectively. Two patients with uncountable bone metastases were analyzed separately. In these patients, 18F-NaF PET/CT showed more bone metastases than did DWI.

CONCLUSION:

We believe 18F-NaF PET/CT is a sensitive modality for detection of bone metastases caused by prostate cancer. Whole-body DWI shows a higher specificity but lower sensitivity than 18F-NaF PET/CT. Future studies with a larger patient cohort along with analyses of costs and clinical availability are needed before implementation of these methods can be considered.

National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-183656 (URN)10.2214/AJR.11.8351 (DOI)000310593000047 ()23096187 (PubMedID)
Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2017-12-07Bibliographically approved
2. Whole-body MRI including diffusion-weighted imaging compared to CT for staging of malignant melanoma
Open this publication in new window or tab >>Whole-body MRI including diffusion-weighted imaging compared to CT for staging of malignant melanoma
2013 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 118, no 2, 91-97 p.Article in journal (Refereed) Published
Abstract [en]

Background. Whole-body (WB) magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), has been increasingly used for the detection of metastatic disease. Purpose. To assess the value of WB MRI including DWI compared to computed tomography (CT) for staging of malignant melanoma. A second aim was to assess the value of DWI in addition to conventional MR sequences for the detection of lesions. Material and methods. WB MRI with DWI and CT chest, abdomen, and pelvis were performed in 23 patients with histologically confirmed malignant melanoma. CT before and after the MRI examinations and the clinical follow-up was utilized as the standard of reference. Results. WB MRI and WB DWI detected 345 and 302 lesions, respectively, compared to 397 lesions with CT. The sensitivity of WB MRI and WB DWI varied considerably in different regions of the body. In the lungs, WB MRI and WB DWI showed 63% and 47% true-positive lesions, respectively. WB MRI and WB DWI detected 56 bone lesions in 12 patients compared to 42 lesions in 8 patients with CT. In addition, WB MRI and WB DWI could detect 68 lesions outside the field of view of CT in six patients. Conclusion. WB MRI is still not ready to replace CT for staging of malignant melanoma, especially in the thorax region. However, WB MRI is advantageous for detection of bone lesions and lesions outside the investigated volume of the conventional CT. When WB MRI is evaluated, both DWI and conventional MRI sequences must be scrutinized.

Keyword
DWI, malignant melanoma, whole-body MRI
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-200054 (URN)10.3109/03009734.2013.778375 (DOI)000317486000005 ()
Available from: 2013-05-23 Created: 2013-05-20 Last updated: 2017-12-06Bibliographically approved
3. Whole-Body MRI, including Diffusion-Weighted Imaging in Follow-Up of Patients with Testicular Cancer.
Open this publication in new window or tab >>Whole-Body MRI, including Diffusion-Weighted Imaging in Follow-Up of Patients with Testicular Cancer.
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-209776 (URN)
Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2014-01-23
4. The Prognostic and Diagnostic Value of Whole-Body Diffusion-Weighted MRI and 18F-FDG PET/CT in Lymphoma Patients
Open this publication in new window or tab >>The Prognostic and Diagnostic Value of Whole-Body Diffusion-Weighted MRI and 18F-FDG PET/CT in Lymphoma Patients
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-209774 (URN)
Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2014-01-23

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