The Effectiveness of Whole Body Diffusion Weighted Magnetic Resonance Imaging in Staging Patients with Malignancy, A Single-Center Retrospective Study
DOI:
https://doi.org/10.58600/eurjther2949Keywords:
malignancy, PET-CT, MRIAbstract
Objective: This study aimed to evaluate the effectiveness of whole-body diffusion-weighted imaging with background body signal suppression (DWIBS) compared to positron emission tomography-computed tomography (PET-CT) in identifying primary cancerous lesions and metastatic spread.
Methods: A retrospective evaluation was carried out on patients diagnosed with various malignant tumors who underwent both DWIBS and PET-CT on the same day between December 2017 and January 2019. Demographic data, pathological findings, and distribution of lesions were analyzed. To ensure an inter-disciplinary framework, all DWIBS and PET-CT datasets were reviewed independently by a blinded radiologist and a nuclear medicine specialist, respectively, with a joint consensus read performed for discordant findings. Lesions were recorded according to location, and SUVmax and ADC values were compared. PET-CT served as the reference standard. Statistical correlations and comparisons were performed using appropriate non-parametric tests.
Results: Thirty patients (21 males, 9 females; age range, 33–76 years; mean age, 60.27±13.32 years) were included in the study. All primary tumors were detected by both imaging modalities. No significant measurement differences were found between DWIBS and PET-CT regarding primary lesion size. Across visceral organs, lymphatic regions, and skeletal structures, DWIBS demonstrated comparable performance to PET-CT except in the mediastinum, where PET-CT proved superior. While SUV and ADC values tended to show an inverse relationship, statistical significance was observed only in axillary lymph node metastases.
Conclusion: DWIBS showed high diagnostic compatibility with PET-CT in staging various malignancies. However, due to the heterogeneous patient group and limited cohort size, these results should be interpreted as a hypothesis-generating tool. While not a direct replacement for the gold standard, DWIBS serves as a promising, radiation-free complementary tool in oncological imaging.
References
[1] Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros B, Znaor A, Ervik M, Bray F (2019) Estimating the global cancer incidence and mortality: GLOBOCAN sources and methods. Int J Cancer. 144(8):1941-1953. https://doi.org/10.1002/ijc.31937
[2] Kwee TC, Takahara T, Ochiai R, Nievelstein RA, Luijten PR (2008) Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol. 18(9):1937-1952. https://doi.org/10.1007/s00330-008-0968-z
[3] Von Schulthess GK, Steinert HC, Hany TF (2006) Integrated PET/CT: current applications and future directions. Radiology. 238(2):405-422. https://doi.org/10.1148/radiol.2382041977
[4] Hargaden G, O’Connell M, Kavanagh E, Powell T, Ward R, Eustace S (2003) Current concepts in whole-body imaging using turbo short tau inversion recovery MR imaging. AJR Am J Roentgenol. 180(1):247-252. https://doi.org/10.2214/ajr.180.1.1800247
[5] Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high-resolution 3D display. Radiat Med. 22(4):275-282. https://doi.org/10.1007/BF02490801
[6] Kwee TC, Takahara T, Ochiai R, Nievelstein RA, Hoh DM, Ohno Y, Nakanishi K, Alavi A (2010) Complementary roles of whole-body diffusion-weighted MRI and 18F-FDG PET/CT. J Nucl Med. 51(10):1549-1558. https://doi.org/10.2967/jnumed.109.073908
[7] Uto T, Takahara Y, Nakamura Y, Naito T, Hashimoto D, Inui N, Enomoto N, Nasu S, Takahara T, Sakahara H (2009) Higher sensitivity and specificity for diffusion-weighted imaging of malignant lung lesions without ADC quantification. Radiology. 252(1):247-254. https://doi.org/10.1148/radiol.2521081195
[8] Hodolic M (2011) Role of [18F]-choline PET/CT in the evaluation of patients with prostate carcinoma. Radiol Oncol. 45(1):17-21. https://doi.org/10.2478/v10019-010-0051-x
[9] Poeppel TD, Krause BJ, Heusner TA, Boy C, Bockisch A, Antoch G (2009) PET/CT is used for staging and follow-up of patients with malignancies. Eur J Radiol. 70(3):382-392. https://doi.org/10.1016/j.ejrad.2009.03.051
[10] Boellaard R, Delgado Bolton R, Jacene HA, Schwaiger M, Weber WA, Oyen WJ, Kraeber-Bodéré F, Bennett EG, Mottaghy FM, Heinisch F, Krause BJ, Chiti A (2015) FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 42(2):328-354. https://doi.org/10.1007/s00259-014-2961-x
[11] Kwee TC, Sabat J, Al-Tubaikh JA, Vermoolen MA, Bierings RG, de Klerk JM, Fijnheer R, Nievelstein RA (2015) Whole-body diffusion-weighted magnetic resonance imaging versus oncologic positron emission tomography-computed tomography. Diagn Interv Radiol. 21(4):343-353. https://doi.org/10.5152/dir.2015.14321
[12] Ciliberto M, Maggi F, Treglia G, Padovano F, Calandriello L, Giordano A, Rubini G (2013) Comparison between whole-body MRI and FDG PET/CT in oncology: a systematic review. Radiol Oncol. 47(3):206-218. https://doi.org/10.2478/raon-2013-0043
[13] Plathow C, Walz M, Lichy M, Aschoff P, Pfannenberg C, Bock H, Duffner F, Claussen CD (2008) Cost considerations for whole-body MRI and PET/CT. Radiologe. 48(4):384-396. https://doi.org/10.1007/s00117-007-1547-z
[14] Cafagna D, Rubini G, Iuele F, Maggialetti N, Notaristefano A, Pinto D, Stabile Ianora AA (2012) MR-DWIBS vs FDG-PET/CT in malignant tumors. Radiol Med. 117(2):293-311. https://doi.org/10.1007/s11547-011-0708-3
[15] Stecco A, Romano G, Negru M, Volpe D, Saponaro A, Costantino S, Carriero A (2009) Whole-body DWI versus PET-CT in staging lung cancer. Radiol Med. 114(1):1-17. https://doi.org/10.1007/s11547-008-0348-4
[16] Fischer MA, Nanz D, Hany T, Reiner CS, Stolzmann P, Donati OF, Breitenstein S, Alkadhi H (2011) Whole-body MRI/DWI fusion vs PET-CT. Eur Radiol. 21(7):1246-1255. https://doi.org/10.1007/s00330-010-1929-x
[17] Laurent V, Trausch G, Bruot O, Olivier P, Felblinger J, Regent D (2010) Melanoma metastasis imaging: comparison of whole-body MRI versus PET-CT. Eur J Radiol. 75(3):376-383. https://doi.org/10.1016/j.ejrad.2009.04.059
[18] Squillaci E, Manenti G, Mancino S, Ciccio C, Calabria F, Danieli R, Simonetti G (2008) Staging colon cancer: whole-body MRI vs. PET-CT. Abdom Imaging. 33(6):676-688. https://doi.org/10.1007/s00261-007-934-x
[19] van Ufford HM, Kwee TC, Beek FJ, van Leeuwen MS, Takahara T, Fijnheer R, Nievelstein RA (2011) Newly diagnosed lymphoma: whole-body MRI versus PET/CT. AJR Am J Roentgenol. 196(3):662-669. https://doi.org/10.2214/AJR.10.4343
[20] Nakamatsu S, Matsusue E, Miyoshi H, Kakite S, Kaminou T, Ogawa T (2012) ADC vs SUV in metastatic neck lymph nodes. Clin Imaging. 36(2):90-97. https://doi.org/10.1016/j.clinimag.2011.06.002
[21] Choi BB, Kim SH, Kang BJ, Lee JH, Song BJ, Jeong SH, Yim HW (2012) Diffusion-weighted imaging and FDG PET/CT in patients with invasive ductal carcinoma of the breast: prediction of prognostic factors. World J Surg Oncol. 10(1):126-134. https://doi.org/10.1186/1477-7819-10-126
[22] Krüger S, Buck AK, Mottaghy FM, Hasenkamp E, Pauls S, Schumann C, Wibmer T, Reske SN, Hombach V (2009) Detection of bone metastases: scintigraphy vs PET/CT. Eur J Nucl Med Mol Imaging. 36(11):1807-1812. https://doi.org/10.1007/s00259-009-1181-2
[23] Ak I, Sivrikoz MC, Entok E, Vardarali E (2010) Comparison of bone scintigraphy and 18F-FDG PET/CT for the detection of bone metastases in non-small cell lung cancer. Eur J Cardiothorac Surg. 37(4):792-796. https://doi.org/10.1016/j.ejcts.2009.11.011
[24] Takenaka D, Ohno Y, Matsumoto K, Aoyama N, Onishi Y, Koyama H, Nogami M, Sugimura K (2009) Detection of bone metastasis in non-small cell lung cancer patients: comparison of whole-body diffusion-weighted imaging (DWIBS), whole-body STIR imaging, and STIR-short-TI inversion recovery MRI with 18F-FDG PET/CT. J Magn Reson Imaging 30(1):288-298. https://doi.org/10.1002/jmri.21838
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