Improved detection of metastatic melanoma by t2weighted imaging. The rather sobering performance of wholebody mri for nstaging in malignant melanoma has to be seen in the context of major advantages that. We assessed the ability of dynamic contrast enhanced t1 mri dcemri perfusion to identify pseudoprogression in melanoma brain metastases. There is evidence from other solid organ cancers and metastases that dwi may be used as a biomarker of prognosis and treatment response. Diffusionweighted magnetic resonance imaging as a cancer. The potential of diffusionweighted magnetic resonance imaging dwmri in assessing the hypoxic fraction, ifp, and metastatic propensity of tumors was investigated in this study. Based upon this the authors conclude the superiority of ocular ultrasound in the. Diffusion mri also has been suggested as a measure of therapyinduced cytotoxic edema because viable cells act as a diffusion barrier in tissue.
Diffusion measurements reflect the effective displacement of water molecules allowed to migrate for a given time. Twenty patients who underwent complete surgical resection of their umlm n 83 were included. Wholebody mri with diffusion weighted sequences compared with 18 fdg petct, ct and superficial lymph node ultrasonography in the staging of advanced cutaneous melanoma. Reaction on ocular ultrasound versus mri in the detection. Intracranial metastatic melanoma is the third most common brain metastasis. Purpose to assess the value of wb mri including dwi compared to computed tomography ct. Ct, positron emission tomography pet, magnetic resonance imaging mri, are the cornerstone for.
The incidence of these tumors increases with age, with only 2% of tumors found in patients younger than 20 years of age 6. Metastatic lesions are isointense to mildly hypointense on t1weighted images and are hyperintense on t2weighted images or with fluid attenuation inversion recovery. Diffusion related mri parameters for assessing early treatment response of liver metastases to cytotoxic therapy in colorectal cancer jung hoon kim1,2 ijin joo1 taeyong kim3 saewon han3 yong jae kim4 jeong min lee1,2 joon koo han1,2 kim jh, joo i, kim ty, et al. Diffusionweighted magnetic resonance imaging dwmri, which measures water mobility within tissues and indirectly relates to extracellular space, has. Accurate target volume delineation is crucial for the radiotherapy of tumors. With the development of new magnetic resonance mr imaging technologies and stronger diffusion gradients, recent applications of diffusionweighted imaging in wholebody imaging have attracted considerable attention, especially in the field of oncology. Role of wholebody diffusion mr in detection of metastatic. Diffusion and perfusion weighted magnetic resonance imaging.
Although no investigators have reported diffusion findings in a series of cases of choroidal melanoma, roshdy et al 10 reported two cases of choroidal melanoma, both. Jan 25, 2016 studies have shown that in cutaneous melanoma, wholebody diffusion weighted imaging is as sensitive as conventional mri sequences in the detection of extracranial metastases. Pdf diffusion restriction of posterior uveal melanoma on. Whereas temperature modulates molecular mobility in pure water by approximately 2. Wholebody wb magnetic resonance imaging mri, including diffusionweighted imaging dwi, has been increasingly used for the detection of metastatic disease. Dwmri in assessment of the hypoxic fraction, interstitial. Targeted chemotherapeutic agents often do not result in tumor shrinkage, so new biomarkers that correlate with clinical efficacy are needed. Wholebody mri with diffusionweighted imaging in bone. When wb mri is evaluated, both dwi and conventional mri sequences must be scrutinized. Advantages of multicontrast mri examination including a diffusionweighted sequence in comparison with petct. Diffusionweighted imaging of metastatic brain tumors. Primary uveal malignant melanoma radiology reference. Wholebody mri with diffusionweighted sequences compared with 18 fdg petct, ct and superficial lymph node ultrasonography in the staging of advanced cutaneous melanoma. Evaluation of diffusionweighted mri and fdgpetct to assess.
Presurgery liver mr imaging included t2weighted, t1weighted, dw and dynamicgadoliniumenhanced mr sequences. Reaction on ocular ultrasound versus mri in the detection of. Indeed, diffusion mri has been shown to be an earlier biomarker compared to tumor volume 7, 8. The objective of our study was to use the criteria of iodized oil deposition, tumor size, and tumor enhancement to assess the utility of diffusion weighted and conventional mri in the evaluation of tumor response after tace for metastatic ocular melanoma. Principles and applications of diffusionweighted imaging in. The mean adc obtained from malignant breast lesions was statistically different from that observed with solid benign lesions t 9. Measurement of cell density and necrotic fraction in human melanoma xenografts by diffusion weighted magnetic resonance imaging. The potential of diffusion weighted magnetic resonance imaging dwmri and dynamic contrast enhanced mri dcemri in assessing microenvironmental effects of sunitinib treatment was investigated in this preclinical study. Dcemri perfusion predicts pseudoprogression in metastatic. Dec 24, 2019 it can be challenging to differentiate pseudoprogression from progression. Our results indicate that diffusion weighted and contrastenhanced mri can be used to. Utility of diffusionweighted imaging in the diagnosis of inguinal. On t2weighted images, lesions are typically isointense to hypointense to gray matter. Chemoembolization of hepatic metastases from ocular.
Wholebody mri with diffusionweighted sequences for the. Diffusion and perfusion magnetic resonance imaging mri can provide functional information about brain tumors, and they are able to detect tumor volume and physiological changes beyond the lesions shown on conventional mri. The aim of our study was to compare wholebody mri magnetic resonance imaging with a multicontrast protocol including a dw diffusion weighted sequence to petct positron emission tomography using 18 fdg 18ffluorodeoxyglucose for staging advanced melanoma. Freebreathing 3d diffusion mri for highresolution hepatic. Wholebody wb magnetic resonance imaging mri, including. Airp best cases in radiologicpathologic correlation. Diffusion mri petct oncology wholebody melanoma abstract the aim of our study was to compare wholebody mri magnetic resonance imaging with a multicontrast protocol including a dw diffusion weighted sequence to petct positron emission tomography using 18 fdg 18f. Dec 20, 2012 wholebody wb magnetic resonance imaging mri, including diffusionweighted imaging dwi, has been increasingly used for the detection of metastatic disease. While nuclear medicine technology, including petct, has been at the foreground of exploration, new mr imaging techniques, specifically diffusion weighted and diffusion tensor imaging, have shown interesting applications towards. Wholebody mri including diffusionweighted imaging compared to ct for staging of malignant melanoma. Tumor staging, imaging techniques, and management rectal cancer is prone to local recurrence and systemic metastasis. Healthy cells are impermeable to fumarate, so conversion of. Quantitative multiparametric mri in uveal melanoma.
Diffusion and perfusion weighted magnetic resonance. Purpose of this study was to evaluate the feasibility and diagnostic potential of wholebody magnetic resonance imaging wbmri with diffusion. Sensitivity of different mri sequences in the early detection of. We therefore investigated dwi characteristics of cerebral metastases and their peritumoral region. Over the last several years, there has been significant advancement in the molecular characterization of intracranial diseases, particularly cerebral neoplasms. Research article open access dwmri in assessment of. Purpose to assess the value of wb mri including dwi compared to computed tomography ct for staging of malignant melanoma. In this study, we investigated noninvasive imaging protocols to monitor responses to sorafenib, a multikinase inhibitor approved for treatment of renal cell and hepatocellular carcinoma. Neuroradiology brain, mr, mrdiffusionperfusion, diagnostic procedure. Schneider1,3, georg keinrath1, olga solyanik1, jessica olivier2, wolfgang g. To compare adc values of hypervascular and hypovascular metastases and the added value of dwmri to t2weighted t2w images in their detection. In this paper, we report the clinical features and mri findings of four cases of primary vaginal melanoma, including the dwi and dynamic. Chemoembolization of hepatic metastases from ocular melanoma.
Studies have shown that in cutaneous melanoma, wholebody diffusionweighted imaging is as sensitive as conventional mri sequences in the detection of extracranial metastases. Cancer patients with primary tumors showing extensive hypoxia and highly elevated interstitial fluid pressure ifp have poor prognosis. Presurgery liver mr imaging included t2weighted, t1weighted, dw and dynamicgadoliniumenhanced mr. Diffusionweighted mri for imaging cell death after. The objective of our study was to use the criteria of iodized oil deposition, tumor size, and tumor enhancement to assess the utility of diffusionweighted and conventional mri in the evaluation of tumor response after tace for metastatic ocular melanoma. Magnetic resonance imaging identifies early effects of. However, owing to improvements in tnm staging and treatment, including a more widespread use of rectal mri and increased radiologist awareness of the key rectal cancer tnm staging features. Brain metastasis is a common and devastating consequence of metastatic malignant melanoma. On mri, sinonasal melanoma that contains melanin is usually isointense to hyperintense to gray matter on t1weighted images, although amelanotic melanoma may also appear t1 hyperintense. During the 10 years between 2007 and 2016, a total of 46 consecutive patients 19 men with a mean age sd of 59. Our results indicate that diffusionweighted and contrastenhanced mri can be used to.
Diffusionweighted magnetic resonance imaging dwmri is routinely included in mri examination protocols for tumor diagnosis, to differ benign from malignant lesions, to detect recurrent. This article is from upsala journal of medical sciences, volume 118. There are few case reports of mri findings in vaginal melanoma,,, and the diffusion weighted imaging dwi and dynamic contrastenhanced mri findings in vaginal melanoma have not yet been documented. Wholebody wb magnetic resonance imaging mri, including diffusion weighted imaging dwi, has been increasingly used for the detection of metastatic disease. There is evidence from other solid organ cancers and metastases that dwi may be used as a biomarker of prognosis and. With the development of new magnetic resonance mr imaging technologies and stronger diffusion gradients, recent applications of diffusion weighted imaging in wholebody imaging have attracted considerable attention, especially in the field of oncology. Malignant tumors usually show restricted diffusion, with a low apparent diffusion coefficient. The estimated annual incidence of central nervous system cns metastasis is approximately 8. Another comparative study on the same topic found wholebody mri to be at least as accurate as 18 ffdg petct for nstaging, using a combination of conventional mri sequences and diffusionweighted mri. Patients with melanoma brain metastases who underwent immunotherapy and dcemri were identified.
Figure 3 demonstrates the scatterplots of the observed adcs. Imaging of ocular melanoma metastasis the british journal. For a broad discussion about the primary tumor or brain metastasis in general, please refer to the articles. Clinical and imaging features of noncutaneous melanoma. Antiangiogenic treatment may change the tumor microenvironment and hence influence the effect of conventional therapies. Principles and applications of diffusionweighted imaging. Aug 27, 2019 in the recently published article entitled ocular ultrasound versus mri in the detection of extrascleral extension in a patient with choroidal melanoma jacobsen et al. The smaller lesion also demonstrates clear diffusion restriction due to its. Wholebody mri including diffusionweighted imaging compared.
Differentiation of clinically benign and malignant breast. Any information contained in this pdf file is automatically generated from digital material submitted. Improved detection of metastatic melanoma by t2weighted. Sep 21, 2016 accurate target volume delineation is crucial for the radiotherapy of tumors. Diffusion weighted mr imaging is routinely used at brain mr imaging examination. Diffusionweighted imaging relies on the detection of the random microscopic motion of free water molecules known as brownian movement. Malignant melanoma of the uvea is the most common primary intraocular malignancy and is predominantly seen in caucasians 5. Primary vaginal melanoma is a rare malignant tumor, accounting for only 2. Dwi, malignant melanoma, wholebody mri introduction wholebody wb magnetic resonance imaging mri with diffusionweighted imaging dwi has recently been introduced for the evaluation of multifocal metastases in oncology patients. While nuclear medicine technology, including petct, has been at the foreground of exploration, new mr imaging techniques, specifically diffusionweighted and diffusion tensor imaging, have shown interesting applications towards. Diffusionweighted imaging of ocular melanoma request pdf. Comparative study of two wholebody imaging techniques in the. It can be challenging to differentiate pseudoprogression from progression.
This noninvasive technique continues to grow in popularity as a way to study brain pathways that could never. Wb mri with dwi and ct chest, abdomen, and pelvis were performed in 23 patients with histologically confirmed malignant melanoma. In a first part, we compared the respective overall accuracy of each modality. To compare adc values of hypervascular and hypovascular metastases and the added value of dwmri to. We aimed to assess the sensitivity of diffusionweighted dw magnetic resonance mr imaging for the detection of pathologically confirmed uveal melanoma liver metastases umlm. Diffusionrelated mri parameters for assessing early. Diffusion mr imaging of the brain in patients with cancer. Diffusionweighted imaging dwi allows characterization of masses on the basis of their cellular density. A07 and r18 melanoma xenografts were used as general models of human cancer. Melanoma can produce distinctive mr findings, 2 however, because approximately half of melanoma metastases are.
Wholebody wb magnetic resonance imaging mri with diffusionweighted imaging. Melanoma is a malignant disease that arises from melanocytes and has a steadily increased incidence over the last decades. Dwi, malignant melanoma, wholebody mri introduction wholebody wb magnetic resonance imaging mri with diffusion weighted imaging dwi has recently been introduced for the evaluation of multifocal metastases in oncology patients. Mri appearance metastatic lesions are isointense to mildly hypointense on t1weighted images and are hyperintense on t2weighted images or with fluid attenuation inversion recovery. Mri findings in primary vaginal melanomaa report of four. Pdf wholebody mri including diffusionweighted imaging. Diffusionweighted mri dwi has been used in neurosurgical practice mainly to distinguish cerebral metastases from abscess and glioma. Diffusion weighted imaging relies on the detection of the random microscopic motion of free water molecules known as brownian movement.
In all patients with melanoma and prostate cancer lymph node and soft tissue metastasis with increased 18fdg11choline uptake could also be characterized by restriction of water diffusion and visualized by high bvalue mrimaging compare figure. Whole body wb magnetic resonance imaging mri with diffusionweighted imaging. Also diffuse muscle infiltration in the case of nonhodgkin lymphoma was visualized by mr. It usually occurs in older women, with an average age at diagnosis of 68 years age range. Note the light circular areas throughout the liver seen mostly on the left side of the screen. Research article open access 18ffdgpetct and diffusionweighted mri for monitoring a braf and cdk 46 inhibitor combination therapy in a murine model of human melanoma ralf s. Diffusion weighted imaging dwi allows characterization of masses on the basis of their cellular density. In bone metastases of thyroid tumors and melanoma, the wbmridwi shows a higher sensitivity when compared to 18ffdg petct. A regionofinterest analysis of diffusion weighted images with b values of 0 and smm was performed to calculate the apparent diffusion coefficient adc of the ocular melanoma and the. Dwmri revealed malignant lymph nodes due to malignant melanoma metastases correlation with pathological findings.
Diffusion mri remains the most comprehensive reference for understanding this rapidly evolving and powerful technology and is an essential handbook for designing, analyzing, and interpreting diffusion mr experiments diffusion imaging provides a unique window on human brain anatomy. We aimed to assess the sensitivity of diffusion weighted dw magnetic resonance mr imaging for the detection of pathologically confirmed uveal melanoma liver metastases umlm. A regionofinterest analysis of diffusionweighted images with b values of 0 and smm2 was performed to calculate the apparent diffusion coefficient adc of. Monitoring chemotherapeutic response by hyperpolarized c. It has enormous potential, but at this stage, it is more of a research option than a clinical reality. Melanoma metastases were either hypointense on t2weighted images, hyperintense on t1weighted images, or both in 71% 85120 of melanoma lesions, compared with 19% of lung lesions p melanoma lesions but in only 2% of lung. Diffusionweighted mri characteristics of the cerebral. Sensitivity of different mri sequences in the early detection.
A regionofinterest analysis of diffusionweighted images with b values of 0 and smm was performed to calculate the apparent diffusion coefficient adc of the ocular melanoma and the. Aug 03, 2014 diffusion weighted mri dwi has been used in neurosurgical practice mainly to distinguish cerebral metastases from abscess and glioma. In the recently published article entitled ocular ultrasound versus mri in the detection of extrascleral extension in a patient with choroidal melanoma jacobsen et al. Whole body magnetic resonance imaging mri with diffusion weighted imaging wbmridwi is currently emerging as a diagnostic technique in the evaluation of bone metastases from breast, prostate, lung, thyroid, and melanoma tumors. On mri, melanomas are classically hyperintense on t1weighted images. Pdf diffusion restriction of posterior uveal melanoma on mr. Whole body magnetic resonance imaging mri with diffusionweighted imaging wbmridwi is currently emerging as a diagnostic technique in the evaluation of bone metastases from breast, prostate, lung, thyroid, and melanoma tumors. Evaluation of diffusionweighted mri and fdgpetct to. Any information contained in this pdf file is automatically generated from digital material. Compared with skin melanoma, the prognosis of vaginal melanoma is worse, and the 5year overall survival rate is 5.
We hypothesized that ocular melanoma has a marked diffusion restriction as. Research paper freebreathing 3d diffusion mri for highresolution hepatic metastasis characterization in small animals emeline j. Diffusionweighted magnetic resonance imaging dwmri is. Skeletal scintigraphy is the standard procedure for visualizing bone metastases, 5070% of distant metstases. A07 and r18 melanoma xenografts were used as general models of. Human brafv600mutant melanoma a375 xenograftbearing balbc nude mice n21 were imaged by 18ffdgpetct and dwmri before day 0 and after day 7 a 1week braf and cdk 46 inhibitor combination. This upper abdominal mri scan shows multiple tumors in the liver which have spread metastasized from a malignant melanoma in an arm or leg.
For these reasons, we assessed sorafenib responses using hyperpolarized cfumarate, diffusion weighted mri dw mri in a xenograft model of human breast cancer in which daily administration of. Methods medical records of all melanoma patients referred to our center. Article the basics of diffusion and perfusion imaging in. Diffusionweighted mri for uveal melanoma liver metastasis. Wholebody mri including diffusionweighted imaging compared to. Heimer1, andrei todica2, heidrun hirnereppeneder1, moritz j. Intracranial metastatic melanoma radiology reference. Diffusion mri allows obtaining functional information on tumors, including the physiological states cell proliferationdensity 1, 2, apoptosis 3, necrosis 4, the stagesgrades 5, 6 and responses to treatments. Notably those with lung cancer, breast cancer, and melanoma 39%, 17%, and 11%, respectively largely account for patients with brain metastases. Our purpose was to show the feasibility and potential value of a multiparametric mp mri protocol employing state of the art diffusion and perfusionweighted imaging techniques.
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