Abdominal diffusion-MRI

Diffusie-MRI van het Abdomen Erik Ranschaert Sectiedag Abdominale Radiologie 08-05-09 Met dank aan Dr. Filip Deckers AZ St. Augustinus, Antwerpen

Inleiding ,[object Object],[object Object],[object Object],[object Object]

Inleiding ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Inleiding Spectral Fatsat S Fatsat + IR prepulse

Inleiding ,[object Object],[object Object],[object Object]

DWI basisprincipes A = lage B = matige C = sterke diffusiviteit Willekeurige diffusie (= Brownse bewegingen) van watermoleculen

DWI basisprincipes ,[object Object],[object Object],[object Object],[object Object],[object Object]

DWI basisprincipes ,[object Object],[object Object],[object Object],[object Object]

DWI basisprincipes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DWI basisprincipes ,[object Object],[object Object]

DWI basisprincipes Benigne Maligne b 0 b 500 ADC map

Voorbeeld: kyste geen T2 shine through meer 

Oncologische toepassingsgebieden ,[object Object],[object Object],[object Object]

Pancreas ► Pancreascarcinoom

DWI lever: karakterisatie ,[object Object],[object Object],(*) M Bruegel et al., Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique, Eur Radiol 2007, Vol 18:3;1432-1084

ADC map bij b=500 Lever ADC = 1.5*10 -3 mm 2 /s

Toegevoegde waarde DWI? ,[object Object],Parik et al., Radiology 2008;246(3):812

Toegevoegde waarde DWI? Dank aan Dr. F. Deckers

Enkele voorbeelden ,[object Object],[object Object],[object Object],[object Object],[object Object]

MRI leverprotocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Voorbeeld 1 PET-CT: FDG stapeling in pancreas: ontsteking vs. maligne? lever casus 8

Voorbeeld 1 Voorkeur: pancreasCA B=0 B=400 B=150 B=10 DWI: focale diffusierestrictie in pancreaskop

Voorbeeld 1 MDCT lever: stadi ëring CT arteriële fase CT arteriële fase

MRI Primovist + DWI DWI B=150 Primovist Biliaire fase Breen et al., Eur. Radiol. 2004:14;2249-2260 ,[object Object],[object Object],[object Object],2x

MRI rectum + DWI T3 T3 T3N1 T3N1

MRI rectum tumor nauwelijks zichtbaar op T 1 ↓ DWI fusie T 1 + DWI

DWI rectum ,[object Object],[object Object],[object Object],[object Object],[object Object],(* )Preoperative T and N staging of colorectal cancer with fusion imaging between diffusion-weighted imaging and 3D fat suppressed contrast-enhanced T1-weighted imaging (FDWI) - H. Horikoshi, T. Akiyoshi, N. Oya, A. Okayama; Ota JP, e-Poster: C-436

Preoperative T and N staging of colorectal cancer with fusion imaging between diffusion-weighted imaging and 3D fat suppressed contrast-enhanced T1-weighted imaging (FDWI) - H. Horikoshi, T. Akiyoshi, N. Oya, A. Okayama; Ota JP, e-Poster: C-436

Levermetastasen CRC MRI nov ’07 8 metastasen, 6 cysten PET-CT dec ’07 6 metastasen Resovist laat T2W DWI b50 PET-CT

Resovist laat T2W DWI b50 PET-CT

DWI voor CRC stadiëring ,[object Object],[object Object],* Rummeny et al, Detection and characterization of liver lesions in patients with colorectal cancer with diffusion weighted MR imaging, Journal of Clinical Oncology, 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition), Vol 26, No 15S (May 20 Supplement), 2008: 4071 * Bruegel et al, Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique, Eur Radiol, Vol 18, Number 3 / March, 2008 * Eiber et Al, ECR09 B-132 SS 301a

CRC Levermetastasen ,[object Object],[object Object],[object Object],[object Object],Nasu K et al., Radiology 2006; 239:122 Onishi H et al., Radiology 2006;239:31 Ward J et al, Radiology 2005;235:170 K Coenegrachts, Eur Radiol, 2009 Feb;19(2):370-9

Rectum Planning van Intensity Modulated Radiotherapy met dank aan Dr. F. Deckers

Diffusie-MRI nieren ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acute pyelonefritis B=0 B=500 B=1000 Kim et al.

Diffusie-MRI nieren ,[object Object],[object Object],[object Object],[object Object]

DWI blaastumoren ,[object Object],[object Object],[object Object]

Zhang et al, Radiol 2008 ,[object Object],[object Object],[object Object]

Nieren: voorbeeld ► Renal Cell Carcinoma

Huidige beperkingen DWI nieren ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prostaat ,[object Object],[object Object],[object Object],[object Object],[object Object],Apparent diffusion coefficient values in peripheral and transition zones of the prostate: comparison between normal and malignant prostatic tissues and correlation with histologic grade.Tamada T, et al. J Magn Reson Imaging. 2008 Sep;28(3):720-6.

Prostaat met dank aan Dr. F. Deckers

Vroege respons op chemotherapie Chemotherapie veroorzaakt celdood

Respons op chemotherapie ,[object Object],[object Object],[object Object],[object Object],[object Object],Kwantificering bij FU therapie met dank aan Dr. F. Deckers

Respons op chemotherapie ,[object Object],met dank aan Dr. F. Deckers

Respons op chemotherapie met dank aan Dr. F. Deckers

“ DWI can be used for the detection of malignant or benign tumors; however, it may be difficult to differentiate between benign and malignant lesions by ADC measurements” Oncologie - total body screening ,[object Object],Met dank aan Th. Kwee

“ DWI is a feasible clinical technique, improving the assessment of metastatic spread in routine magnetic resonance imaging examinations ” Oncologie - total body screening ,[object Object],Met dank aan Th. Kwee

“ Whole-body MRI with DWI can be used for M-stage assessment in NSCLC patients with accuracy as good as that of FDG-PET/CT ” Oncologie - total body screening ,[object Object],Met dank aan Th. Kwee

“ Diffusion-weighted imaging appears to be equal, if not superior, to STIR and T1-weighted sequences and equally as effective as (11)C-choline PET/CT in detection of bone metastases in these patients ” Oncologie - total body screening ,[object Object],Met dank aan Th. Kwee

“ The whole-body DWIBS protocol provided a fast whole-body examination with high specificity and NPV ” Oncologie - total body screening ,[object Object],Met dank aan Th. Kwee

Limitaties en beperkingen DWI ,[object Object],[object Object],[object Object],[object Object],Met dank aan Th. Kwee

Conclusie ,[object Object],[object Object],[object Object],[object Object],[object Object]

Dank voor uw aandacht ! e. [email_address] . nl

Abdominal diffusion-MRI

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