Whole-body diffusion-weighted imaging: Is it all we need for detecting metastases in melanoma patients?

Research output: Contribution to journalArticle

Abstract

Objectives: To investigate whether whole-body diffusion-weighted imaging (WB-DWI) alone is adequate for detecting metastases in melanoma patients, or if standard WB contrast-enhanced magnetic resonance imaging (WB-ceMRI) is required. Methods: Seventy-one WB-DWI studies were performed quarterly along with whole-body MRI including contrast-enhanced sequences (WB-ceMRI) in 19 patients with advanced melanoma. The reference standard was biopsy, other imaging investigations, or changes observed on follow-up. Findings of metastasis in separate WB-DWI and WB-DWI + WB-ceMRI readings were compared using κ statistics. Additionally, the distribution of findings was examined and calculated per body region (brain, neck, chest, abdomen, liver, pelvis, subcutaneous tissues, bones) and diagnostic accuracy (DA), sensitivity, specificity, negative predictive value, and positive predictive value were calculated per patient. Results: The eight examinations that were positive by the reference standard contained a total of 14 metastatic findings. With almost perfect agreement between techniques (κ = 85 %, 95 % CI 70-100 %) for detection of examinations with metastatic findings, and complete agreement in extracranial metastasis detection, 10 metastases were detected using WB-DWI and 13 using WB-DWI + WB-ceMRI. WB-DWI and WB-DWI + WB-MRI had equivalent per patient DA (79 %). Conclusions: WB-DWI without additional WB-ceMRI sequences is promising for the detection of extracranial metastases in melanoma patients, but contrast-enhanced MRI is required for evaluating the brain. Key Points: • Whole-body (WB) magnetic resonance imaging (MRI) is increasingly used for oncological disease assessment. • WB diffusion-weighted MRI detects extracranial metastases in melanoma patients. • Contrast-enhanced MRI is only required for detecting brain metastases. • WB-DWI is inferior to low-dose CT for detecting lung metastases.

Original languageEnglish
Pages (from-to)3466-3476
Number of pages11
JournalEuropean Radiology
Volume23
Issue number12
DOIs
Publication statusPublished - Dec 2013

Fingerprint

Melanoma
Magnetic Resonance Imaging
Neoplasm Metastasis
Whole Body Imaging
Brain
Body Regions
Diffusion Magnetic Resonance Imaging
Subcutaneous Tissue
Pelvis
Abdomen
Reading
Neck
Thorax
Biopsy
Bone and Bones
Sensitivity and Specificity
Lung
Liver

Keywords

  • Contrast-enhanced MRI
  • Diffusion-weighted MRI
  • Melanoma
  • Metastasis
  • Whole-body imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Whole-body diffusion-weighted imaging : Is it all we need for detecting metastases in melanoma patients? / Petralia, Giuseppe; Padhani, Anwar; Summers, Paul; Alessi, Sarah; Raimondi, Sara; Testori, Alessandro; Bellomi, Massimo.

In: European Radiology, Vol. 23, No. 12, 12.2013, p. 3466-3476.

Research output: Contribution to journalArticle

@article{27ad7ac3436b40308d61f5997e0e601a,
title = "Whole-body diffusion-weighted imaging: Is it all we need for detecting metastases in melanoma patients?",
abstract = "Objectives: To investigate whether whole-body diffusion-weighted imaging (WB-DWI) alone is adequate for detecting metastases in melanoma patients, or if standard WB contrast-enhanced magnetic resonance imaging (WB-ceMRI) is required. Methods: Seventy-one WB-DWI studies were performed quarterly along with whole-body MRI including contrast-enhanced sequences (WB-ceMRI) in 19 patients with advanced melanoma. The reference standard was biopsy, other imaging investigations, or changes observed on follow-up. Findings of metastasis in separate WB-DWI and WB-DWI + WB-ceMRI readings were compared using κ statistics. Additionally, the distribution of findings was examined and calculated per body region (brain, neck, chest, abdomen, liver, pelvis, subcutaneous tissues, bones) and diagnostic accuracy (DA), sensitivity, specificity, negative predictive value, and positive predictive value were calculated per patient. Results: The eight examinations that were positive by the reference standard contained a total of 14 metastatic findings. With almost perfect agreement between techniques (κ = 85 {\%}, 95 {\%} CI 70-100 {\%}) for detection of examinations with metastatic findings, and complete agreement in extracranial metastasis detection, 10 metastases were detected using WB-DWI and 13 using WB-DWI + WB-ceMRI. WB-DWI and WB-DWI + WB-MRI had equivalent per patient DA (79 {\%}). Conclusions: WB-DWI without additional WB-ceMRI sequences is promising for the detection of extracranial metastases in melanoma patients, but contrast-enhanced MRI is required for evaluating the brain. Key Points: • Whole-body (WB) magnetic resonance imaging (MRI) is increasingly used for oncological disease assessment. • WB diffusion-weighted MRI detects extracranial metastases in melanoma patients. • Contrast-enhanced MRI is only required for detecting brain metastases. • WB-DWI is inferior to low-dose CT for detecting lung metastases.",
keywords = "Contrast-enhanced MRI, Diffusion-weighted MRI, Melanoma, Metastasis, Whole-body imaging",
author = "Giuseppe Petralia and Anwar Padhani and Paul Summers and Sarah Alessi and Sara Raimondi and Alessandro Testori and Massimo Bellomi",
year = "2013",
month = "12",
doi = "10.1007/s00330-013-2968-x",
language = "English",
volume = "23",
pages = "3466--3476",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",
number = "12",

}

TY - JOUR

T1 - Whole-body diffusion-weighted imaging

T2 - Is it all we need for detecting metastases in melanoma patients?

AU - Petralia, Giuseppe

AU - Padhani, Anwar

AU - Summers, Paul

AU - Alessi, Sarah

AU - Raimondi, Sara

AU - Testori, Alessandro

AU - Bellomi, Massimo

PY - 2013/12

Y1 - 2013/12

N2 - Objectives: To investigate whether whole-body diffusion-weighted imaging (WB-DWI) alone is adequate for detecting metastases in melanoma patients, or if standard WB contrast-enhanced magnetic resonance imaging (WB-ceMRI) is required. Methods: Seventy-one WB-DWI studies were performed quarterly along with whole-body MRI including contrast-enhanced sequences (WB-ceMRI) in 19 patients with advanced melanoma. The reference standard was biopsy, other imaging investigations, or changes observed on follow-up. Findings of metastasis in separate WB-DWI and WB-DWI + WB-ceMRI readings were compared using κ statistics. Additionally, the distribution of findings was examined and calculated per body region (brain, neck, chest, abdomen, liver, pelvis, subcutaneous tissues, bones) and diagnostic accuracy (DA), sensitivity, specificity, negative predictive value, and positive predictive value were calculated per patient. Results: The eight examinations that were positive by the reference standard contained a total of 14 metastatic findings. With almost perfect agreement between techniques (κ = 85 %, 95 % CI 70-100 %) for detection of examinations with metastatic findings, and complete agreement in extracranial metastasis detection, 10 metastases were detected using WB-DWI and 13 using WB-DWI + WB-ceMRI. WB-DWI and WB-DWI + WB-MRI had equivalent per patient DA (79 %). Conclusions: WB-DWI without additional WB-ceMRI sequences is promising for the detection of extracranial metastases in melanoma patients, but contrast-enhanced MRI is required for evaluating the brain. Key Points: • Whole-body (WB) magnetic resonance imaging (MRI) is increasingly used for oncological disease assessment. • WB diffusion-weighted MRI detects extracranial metastases in melanoma patients. • Contrast-enhanced MRI is only required for detecting brain metastases. • WB-DWI is inferior to low-dose CT for detecting lung metastases.

AB - Objectives: To investigate whether whole-body diffusion-weighted imaging (WB-DWI) alone is adequate for detecting metastases in melanoma patients, or if standard WB contrast-enhanced magnetic resonance imaging (WB-ceMRI) is required. Methods: Seventy-one WB-DWI studies were performed quarterly along with whole-body MRI including contrast-enhanced sequences (WB-ceMRI) in 19 patients with advanced melanoma. The reference standard was biopsy, other imaging investigations, or changes observed on follow-up. Findings of metastasis in separate WB-DWI and WB-DWI + WB-ceMRI readings were compared using κ statistics. Additionally, the distribution of findings was examined and calculated per body region (brain, neck, chest, abdomen, liver, pelvis, subcutaneous tissues, bones) and diagnostic accuracy (DA), sensitivity, specificity, negative predictive value, and positive predictive value were calculated per patient. Results: The eight examinations that were positive by the reference standard contained a total of 14 metastatic findings. With almost perfect agreement between techniques (κ = 85 %, 95 % CI 70-100 %) for detection of examinations with metastatic findings, and complete agreement in extracranial metastasis detection, 10 metastases were detected using WB-DWI and 13 using WB-DWI + WB-ceMRI. WB-DWI and WB-DWI + WB-MRI had equivalent per patient DA (79 %). Conclusions: WB-DWI without additional WB-ceMRI sequences is promising for the detection of extracranial metastases in melanoma patients, but contrast-enhanced MRI is required for evaluating the brain. Key Points: • Whole-body (WB) magnetic resonance imaging (MRI) is increasingly used for oncological disease assessment. • WB diffusion-weighted MRI detects extracranial metastases in melanoma patients. • Contrast-enhanced MRI is only required for detecting brain metastases. • WB-DWI is inferior to low-dose CT for detecting lung metastases.

KW - Contrast-enhanced MRI

KW - Diffusion-weighted MRI

KW - Melanoma

KW - Metastasis

KW - Whole-body imaging

UR - http://www.scopus.com/inward/record.url?scp=84890563789&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890563789&partnerID=8YFLogxK

U2 - 10.1007/s00330-013-2968-x

DO - 10.1007/s00330-013-2968-x

M3 - Article

C2 - 23884300

AN - SCOPUS:84890563789

VL - 23

SP - 3466

EP - 3476

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 12

ER -