Comparison of whole-body diffusion-weighted MRI and PET/ CT for detection of metastases

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1 Comparison of whole-body diffusion-weighted MRI and PET/ CT for detection of metastases Poster No.: R-0021 Congress: RANZCR-AOCR 2012 Type: Scientific Exhibit Authors: T. D. Nguyen Keywords: Oncology, Abdomen, Lymph nodes, MR-Diffusion/Perfusion, Imaging sequences, Cancer DOI: /ranzcraocr2012/R-0021 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 14

2 Purpose Initial assessing the role of Whole-Body Diffusion-Weighted Magnetic Resonance Imaging (WBDW- MRI) in comparison with PET/CT for detection of metastases. Diffusion MRI is a specific Magnetic Resonance Imaging (MRI) modality that produces in vivo images of biological tissues weighted with the local microstructural characteristics of water diffusion. Whole-Body Diffusion-Weighted Magnetic Resonance Imaging (WBDWMRI) has the potential to help detect primary tumors and metastasis. Differentiating benign from malignant lesions, and determining the presence of disease recurrence. DW- MR imaging enables qualitative and quantitative assessment of tissue diffusivity (apparent diffusion coefficient) without the use of gadolinium chelates. Its high contrast resolution, lack of ionizing radiation, and the possibility of performing functional imaging sequences. With advances in hardware and coil systems. It a highly attractive technique, has potential alternative to PET/CT for detection of metastases. Page 2 of 14

3 Methods and Materials We retrospectively evaluated the cases of 43 patients (19 women, 24 men; age range, years), diagnosed primary cancer. All the patients executed whole-body diffusion weighted MRI on the Siemens Avanto 1,5T MRI, syngo TimCT, Gradient 45 mtm SR 200 T/m/sec, 16-channel body- array coils and the results were compared with PEP/CT whole-body scanning (Biograph true D w/true V 64 slice, Siemens) at the same time. DW sequence was performed in the Axial plane (4000/78; matrix, 192 x 192; field of view, x 384 mm; thick, 5mm, b factors, 0, 500, and 800 sec/mm ; 30 sections; imaging time, 2 minutes 04 seconds). Page 3 of 14

4 Results 43 cases were executed whole-body MRI and PET/CT: 40 of 43 patients had confirmed metastasis. 1 case: showed additional small vertebral body metastasis that were not seen on PET/CT. 2 case: whole-body MRI showed one additional node in liver (metastasis) that was not seen on PEP/CT. 3 case Whole-body MRI showed one intra-abdominal lymph node (benign lymph node) that was not seen on PEP/CT. 1 case PET/CT showed one pelvic peritoneal focal had increased metabolic activity, that was not seen on MRI. All the cases left showed the same results between whole-body MRI and PET/CT. Whole body Diffusion Weighted - MRI (WBDW-MRI) has sensitivities for detecting lesions higher than PET/ CT. Because most of lesions have contained water molecules very sensitive to diffusion sequences, especially in bone tissues (spine) are low-signal intensity on MRI, so the lesions of matastatic bone are showed more clearly. For example to detect metastasis of spine better than PET/CT (Figs. 1,2). WBDW-MRI can distinguish between metastasis of bone and early degenerative spine, while PET/CT can increase metabolic activities with both two cases. One patient with cancer of the nasopharynx, PET/CT showe bilateral neck lymph node (metastasis) and metastasis of the hepatic lobe VI, but not seen one node metastasis of the hepatic lobe VIII, 7mm seen on WBDWMRI (Fig. 3). Base on ADC of diffusion pulse sequences, We can measure (ROI) lesions with MRI machine software to distinguish between benign and malignant lesions. The malignant lesions have mean ADC number lower than benign lesions (Fig. 5). In Fig. 4, PET/CT showed light absorption of radioactive the abdominal peritonium, WBDW-MRI was not seen on MRI. This patient has had colon cancer and chemotherapy, we checked it six months later but we did not see the change of size, property damage, so keep following up. However, the specificity of PET/CT is higher than WBDW-MRI, because it detects benign lesions early as inflamed lymph node, hepatic hemangioma, cysts (Figs. 6, 7), in these cases we must inject contrast media to be distinguished more exactly. The number of our study about patients is little, research time is limited, however, to evaluate the effectiveness of detecting metastatis of WBDW-MRI compared with PET/CT is the first and reduce costs in the diagnosis and the treatment. Page 4 of 14

5 Images for this section: Fig. 1: Paitient 48 years-old, wonam, breast cancer had chemotherapy and radiation therapy, PET/CT (picture a): showed D3, D12, S1 vertebral body metastasis; WBDWMRI (picture b): showed additional D3, D6, D7, D8, D10, D12-S1 vertebral body metastasis (added 4 vertebral body) Medic medical center - / Page 5 of 14

6 Fig. 2: Paitient 48 years-old, wonam, breast cancer had chemotherapy and radiation therapy, PET/CT (picture a): showed D3, D12, S1 vertebral body metastasis; WBDWMRI (picture b): showed additional D3, D6, D7, D8, D10, D12-S1 vertebral body metastasis (added 4 vertebral body) Medic medical center - / Page 6 of 14

7 Fig. 3: Patient 61 years-old man,cancer of the nasopharynx, PET/CT showe bilateral neck lymph node (metastasis) and metastasis of the hepatic lobe VI, but not seen one node metastasis of the hepatic lobe VIII, 7mm (seen on WBDW-MRI) Medic medical center - / Page 7 of 14

8 Fig. 4: Paitient 57 years-old, man, Colon cencer had therapy, WBDW-MRI showed one intra-abdominal metastasis lymph node (ADC Medic medical center - / Page 8 of 14

9 Fig. 5: Paitient 57 years-old, man, Colon cencer had therapy, WBDW-MRI showed one intra-abdominal metastasis lymph node (ADC Medic medical center - / Page 9 of 14

10 Fig. 6: Patient 64 years-old man, Colon cancer had therapy for 4 years, WBDW-MRI showed one intra-abdominal lymph node, 8mm (benign lymph node) that was not seen on PEP/CT. Medic medical center - / Page 10 of 14

11 Fig. 7: Patient 64 years-old man, Colon cancer had therapy for 4 years, WBDW-MRI showed one intra-abdominal lymph node, 8mm (benign lymph node) that was not seen on PEP/CT. Medic medical center - / Page 11 of 14

12 Conclusion Whole-body diffusion weighted MR imaging can be used for detection of metastases with high sensitivity. It can replace PET / CT in screening for cancer metastases in the future. Page 12 of 14

13 Personal Information Page 13 of 14

14 References 1 A. L. Baert, Leuven, M. F. Reiser, München, H. Hricak, New York, M. Knauth, Göttingen-MD; Diff usion-weightediff usion-weighted MR Imaging- Applications in the Body; Medical radiology 2 Bachir Taouli and Dow-Mu Koh; Diffusion-weighted MR Imaging of the Liver; Radiology January : Yoshiharu Ohno, Hisanobu Koyama, Yumiko Onishi, Daisuke Takenaka, Munenobu Nogami, Takeshi Yoshikawa, Sumiaki Matsumoto, Yoshikazu Kotani, and Kazuro Sugimura-MD ;Non-Small Cell Lung Cancer: Whole-Body MR Examination for MStage Assessment-Utility for Whole-Body Diffusion-weighted Imaging Compared with Integrated FDG PET/CT; Radiology August : ; Published online June 6, 2008, doi: /radiol Masahiro Okada, MD, Norihide Sato, MD, PhD, Kazunari Ishii, MD, PhD, Kaname Matsumura, MD, PhD, Makoto, Hosono, MD, PhD and Takamichi murakami, MD, 67 PhD. FDG PET/CT versus CT, MR Imaging, and Ga Scintigraphy in the Posttherapy Evaluation of Malignant Lymphoma. July 2010 RadioGraphics, 30, Wolfgang Luboldt, Rainer Küfer, Norbert Blumstein, Todd L. Toussaint, Alexander Kluge, Marcus D. Seemann, and Hans-Joachim Luboldt-MD ; Prostate Carcinoma: Diffusion-weighted Imaging as Potential Alternative to Conventional MR and C-Choline PET/CT for Detection of Bone Metastases Radiology December : ; Published online October 10, 2008, doi: /radiol Tejas Parikh, Stephen J. Drew, Vivian S. Lee, Samson Wong, Elizabeth M. Hecht and Bachir Taouli-MD ; Focal Liver Lesion Detection and Characterization with Diffusionweighted MR Imaging: Comparison with Standard Breath-hold T2-weighted Imaging, Radiology March : Page 14 of 14