The value of diffusion-weighted magnetic resonance imaging (DW MRI) in differentiating benign and malignant liver lesions [Ocena przydatnos̈ci obrazowania dyfuzji metodą rezonansu magnetycznego w diagnostyce różnicowej lagodnych i zlos̈liwych zmian ogniskowych w wątrobie]
Rembak-Szynkiewicz J.,Zaklad Radiologii i Diagnostyki |
Bobek-Billewicz B.,Zaklad Radiologii i Diagnostyki |
Jarzab M.,III Klinika Radioterapii i Chemioterapii |
Jurkowski M.,University of Warmia and Mazury |
And 3 more authors.
Nowotwory | Year: 2014
Introduction: Despite the use of multiple diagnostic imaging techniques, a non-invasive differential diagnosis of focal lesions in the liver is still a challenging task. It is even more significant, considering the risk of complications related to liver biopsy. On the other hand, the availability of non-invasive radiological and diagnostic imaging methods has resulted in the increased detectability of incidental hepatic lesions. Therefore, further investigation of newer and more effective methods of differentiating benign from malignant hepatic lesions is extremely useful. The aim of the study was to assess the diagnostic value of Diffusion-Weighted Magnetic Resonance Imaging (DW MRI) in differentiating benign from malignant focal lesions in the liver.Material and methods: Fifty one patients with hepatic lesions detected by magnetic resonance (MR) examination were enrolled in the study. Each lesion was then verified histopathologically, cytologically, or by observation. Ninety five (71 malignant and 24 benign) hepatic focal lesions were analysed. Apart from a standard MR liver examination, an echo planar imaging spin echo diffusion weighted sequence was performed, with a slice thickness of 5 or 6 mm. The maximal b-value was 1000 s/mm2 and the minimal 0 s/mm2. In the study, the following were assessed: the presence of restricted diffusion, an absolute ADC (apparent diffusion coefficient) value, the decrease of signal intensity in DW MRI with an increase in the b-value.Results: Confirming or ruling out the restricted diffusion is usually the frst effective step in differentiating benign from malignant hepatic lesions, as indicated in the study results. In the material analysed, the diffusion restriction occurred statistically significantly more frequently in malignant (87.3 %) compared to benign lesions (12.5%), (p < 0.0001). Using the diffusion restriction as a criterion for malignancy, 87.4% lesions were correctly classified (62 malignant and 21 benign lesions). In the material analysed, the mean minADC value in malignant lesions (0.92 × 10-3 mm2/s) was statistically significantly lower compared to benign lesions (1.48 × 10-3 mm2/s) (p < 0.0001). In clinical practice, it is important to determine the ADC reference values for benign and malignant lesions. The boundary ADC value differentiating benign from malignant lesions estimated when using the ROC curve was 1.04 × 10-3 mm2/s. Considering lesions with an ADC value > 1.04 × 10-3 mm2/s to be benign and lesions with ADC value ≤ 1.04 × 10-3 mm2/s to be malignant, 75.8% lesions were correctly classified.Conclusions: The results obtained indicate that restricted diffusion, as a marker for malignant lesions, has the highest value in DW MRI in differentiating benign from malignant lesions in the liver. © Polskie Towarzystwo Onkologiczne.
Nowicka E.,III Klinika Radioterapii i Chemioterapii |
Tarnawski R.,III Klinika Radioterapii i Chemioterapii
Nowotwory | Year: 2014
Epidemiological data indicate that 6% of women are diagnosed with breast cancer with distant metastases at initial presentation. The survival for these patients is poor and the treatment is palliative. Therapy is based on systemic chemotherapy, hormonal therapy and immunotherapy. Local treatment is mainly recommended to prevent or relief symptoms but it is traditionally considered to have no impact on survival. The poor prognosis and palliative idea of therapy do not justify aggressive local treatment. Several studies indicate that local treatment of the primary tumour by both surgery and radiotherapy may improve survival for metastatic breast cancer patients. Hence maybe it is now time to reconsider the role of local therapies for this group of patients. The main objective of this review is to highlight current knowledge of local therapy of the primary tumour for breast cancer patients with synchronous distant meta-stases. We try to assess clinical practice in the local therapy of the primary tumour in metastatic breast cancer patients.