Alibek Sedat, Cavallaro Alexander, Aplas Alexander, Uder Michael, Staatz Gundula
Radiology Institute, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
Acad Radiol. 2009 Jul;16(7):866-71. doi: 10.1016/j.acra.2009.01.004. Epub 2009 Apr 25.
To assess the value of diffusion weighted imaging (DWI) magnetic resonance imaging (MRI) in pediatric and adolescent tumor patients with focus on detection and delineation of malignant tumors of the central nervous system, chest, abdomen, and musculoskeletal system.
Twenty-nine pediatric and adolescent patients (17 males, 12 females, age, 2 months-20 years, mean age: 8.9 years) with clinically suspected malignant tumors were examined with use of a 1.5-T MR scanner with open bore design without sedation or general anesthesia. DWI images were acquired with a single-shot echo planar imaging (EPI) sequence in free breathing with b-values of 0, 500, and 1000 mm/s(2). Images were assessed by two readers in consensus. Artifacts in DWI were graded as not relevant, acceptable, or nondiagnostic. DWI/apparent diffusion coefficient maps were correlated with T1-weighted post-contrast images, and the detectability and correct delineation of the tumors were graded using a three grade scale.
Free-breathing DWI was successfully performed in all patients. In 27 patients, no relevant artifacts were observed; acceptable artifacts were seen in two patients. In all patients, malignancies were detected both on DWI and T1-weighted gadolinium images. Detection and delineation of tumors were possible in all cases with both sequences; T1-weighted gadolinium imaging was superior to DWI in only three patients. Additionally, small diffusion restricted lymph nodes were detected in three patients.
DWI is reliable for the accurate detection and delineation of malignant pediatric and adolescent tumors.
评估扩散加权成像（DWI）磁共振成像（MRI）在儿童和青少年肿瘤患者中的价值，重点在于检测和描绘中枢神经系统、胸部、腹部及肌肉骨骼系统的恶性肿瘤。
29例临床怀疑患有恶性肿瘤的儿童和青少年患者（男17例，女12例，年龄2个月至20岁，平均年龄8.9岁），使用具有开放式孔径设计的1.5-T MR扫描仪进行检查，无需镇静或全身麻醉。采用单次激发回波平面成像（EPI）序列在自由呼吸状态下采集DWI图像，b值分别为0、500和1000 mm/s²。由两位阅片者共同评估图像。将DWI中的伪影分为无关、可接受或无法诊断。将DWI/表观扩散系数图与T1加权增强后图像进行对比，并使用三级评分量表对肿瘤的可检测性和正确描绘进行分级。
所有患者均成功完成自由呼吸状态下的DWI检查。27例患者未观察到相关伪影；2例患者出现可接受的伪影。所有患者在DWI和T1加权钆剂图像上均检测到恶性肿瘤。两种序列在所有病例中均能检测和描绘肿瘤；仅3例患者中T1加权钆剂成像优于DWI。此外，3例患者检测到小的扩散受限淋巴结。
DWI对于准确检测和描绘儿童和青少年恶性肿瘤是可靠的。
