Li Cheng, Liu Zhen-sheng, Du Xian-mao, He Ling, Chen Jian, Wang Wei, Sun Fei, Du Fang, Luo Zhi-gang, Xue Zhen-long, Zhao Yi, Zhou Chang-wu
Department of Radiology, Yangzhou No. 1 People's Hospital, Southeast University, Jiangsu 225001, China.
Chin Med Sci J. 2009 Jun;24(2):112-6. doi: 10.1016/s1001-9294(09)60072-9.
To evaluate the value of whole-body diffusion weighted imaging (WB-DWI) on detection of malignant metastasis.
Forty-six patients with malignant tumors underwent WB-DWI examinations between April 2007 and August 2007 in our hospital. Before WB-DWI examination, the primary cancers of all the patients were confirmed by pathology, and the TNM-stage was assessed with conventional magnetic resonance imaging (MRI) or computed tomography (CT). WB-DWI was performed using short TI inversion recovery echo-planar imaging (STIR-EPI) sequence. Abnormal high signal intensities on WB-DWI were considered as metastases. The results of WB-DWI were compared with other imaging modalities. For the assessment of the diagnostic capability of WB-DWI, WB-DWI were compared with CT for demonstrating mediastinal lymph node metastases and lung metastases, and with conventional MRI for demonstrating metastases in other locations.
WB-DWI demonstrated 143 focuses, 14 of which were diagnosed to be benign lesions in routine imaging. The number of bone metastases depicted on WB-DWI and routine imaging was 85 and 86; lymph node metastases was 17 and 18; liver metastases was 14 and 14; lung metastases was 4 and 8; and brain metastases was 6 and 8, respectively. WB-DWI failed to detect 12 metastatic lesions including 3 osteoplastic bone metastases, 4 lung metastases, 3 mediastinal lymph node metastases, and 2 brain metastases. Four metastatic lesions including 2 deltopectoral lymph nodes and 2 rib metastases were detected with WB-DWI alone, all of which evolved greatly during clinical follow-up for more than 6 months. WB-DWI had higher detection rates for metastatic lesions in liver, bone, and lymph nodes than those in lung and brain (chi2=30, P<0.001).
WB-DWI could detect most of metastatic lesions that were diagnosed with conventional MRI and CT. The limitations of WB-DWI might be had high false-positive rate and low efficiency in detecting mediastinal lymph node, brain, and lung metastases.
评估全身弥散加权成像（WB-DWI）在检测恶性肿瘤转移方面的价值。
2007年4月至2007年8月期间，我院对46例恶性肿瘤患者进行了WB-DWI检查。在WB-DWI检查前，所有患者的原发性癌症均经病理确诊，并采用传统磁共振成像（MRI）或计算机断层扫描（CT）评估TNM分期。使用短TI反转恢复回波平面成像（STIR-EPI）序列进行WB-DWI检查。WB-DWI上的异常高信号强度被视为转移灶。将WB-DWI的结果与其他成像方式进行比较。为评估WB-DWI的诊断能力，将WB-DWI与CT用于显示纵隔淋巴结转移和肺转移进行比较，与传统MRI用于显示其他部位转移进行比较。
WB-DWI显示143个病灶，其中14个在常规成像中被诊断为良性病变。WB-DWI和常规成像显示的骨转移灶数量分别为85个和86个；淋巴结转移灶分别为17个和18个；肝转移灶分别为14个和14个；肺转移灶分别为4个和8个；脑转移灶分别为6个和8个。WB-DWI未能检测到12个转移病灶，包括3个成骨性骨转移、4个肺转移、3个纵隔淋巴结转移和2个脑转移。仅通过WB-DWI检测到4个转移病灶，包括2个三角肌胸大肌间淋巴结和2个肋骨转移，所有这些病灶在超过6个月的临床随访期间均有显著变化。WB-DWI对肝、骨和淋巴结转移灶的检测率高于肺和脑转移灶（χ2=30，P<0.001）。
WB-DWI能够检测出大多数通过传统MRI和CT诊断出的转移病灶。WB-DWI的局限性可能在于检测纵隔淋巴结、脑和肺转移时假阳性率高且效率低。
