Diffusion magnetic resonance imaging of chest tumors

Our plain-English summary of Diffusion magnetic resonance imaging of chest tumors, by A.A. Razek (Cancer Imaging, 2012).

The study

• Author: A.A. Razek
• Journal: Cancer Imaging
• Published: 2012;12(3):452-63
• Type of article: Review
• Cited by: 66 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This review provides an overview of the current status of the published data on diffusion magnetic resonance (MR) imaging of chest tumors. Diffusion MR imaging is a non-invasive imaging technique that measures the differences in water mobility in different tissue microstructures and quantifies them based on the apparent diffusion coefficient. Diffusion MR imaging has been used for the characterization, grading and staging of lung cancer as well as for differentiating central tumors from post-obstructive consolidation. In addition, this technique helps in differentiating malignant from benign pulmonary and mediastinal tumors as well as in the characterization of pleural mesothelioma and effusion. Diffusion MR imaging can be incorporated into routine morphological MR imaging to improve radiologist confidence in image interpretation and to provide functional assessments of chest tumors during the same examination. Diffusion MR imaging could be used in the future as a functional imaging technique for tumors of the chest.

In plain English

This article was a review of published research on diffusion magnetic resonance imaging (diffusion MRI) of chest tumors. Diffusion MRI is a scanning method that measures how freely water moves in tissue, expressed as the apparent diffusion coefficient (ADC). The review studied no patients of its own and did not discuss asbestos exposure. Most of it covered lung cancer. One cited 2011 study (Tondo et al.) reported 91% accuracy, 90% sensitivity and 100% specificity for telling malignant from benign lesions. For pleural mesothelioma, the author described one preliminary study (Gill et al.). In it, ADC values of epithelioid mesothelioma were significantly higher than those of sarcomatoid mesothelioma, and biphasic and sarcomatoid types did not differ significantly. Other cited studies reported that ADC values of transudate and exudate pleural effusions differed significantly, and one called diffusion MRI promising for distinguishing malignant from benign pleural disease. The author concluded that diffusion MRI complements routine chest MRI. The author noted that ADC values depend on scanner settings, vary widely and overlap between benign and malignant tumors, and that standardization is needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review of published studies on diffusion MR imaging of chest tumors
• Who was studied: Published studies (as summarized in the article's tables) on diffusion MRI of lung cancer, mediastinal masses and lymph nodes, pleural mesothelioma and pleural effusion; no patients were studied by the author for this review
• Exposure: No asbestos or other exposure was studied; the subject was an imaging technique (diffusion MRI and ADC measurement)
• Main results:
  • Overall, across the cited studies of pulmonary lesions, the author stated that diffusion MRI and FDG-PET performed similarly in characterizing lesions, with diffusion MRI tending to give fewer false-positive results, mainly from benign inflammatory lesions
  • A cited 2011 study (Tondo et al.) used an ADC threshold to separate malignant from benign lung lesions with 91% diagnostic accuracy, 90% sensitivity and 100% specificity
  • In adults with mediastinal tumors, a cited study (reference 41) reported that a cut-off ADC value indicated a malignant lesion with a sensitivity of 95% and specificity of 87%
  • In a cited preliminary study of pleural mesothelioma (Gill et al.), ADC values of epithelioid mesothelioma were statistically significantly greater (p less than 0.05) than those of sarcomatoid mesothelioma
  • In the same preliminary mesothelioma study, there was no significant difference between the ADC values of biphasic and sarcomatoid mesothelioma
  • Cited studies reported that the ADC value of transudate pleural fluid differed significantly from that of exudate (P = 0.01, printed in garbled form); no classification performance is given for this comparison, and the individual ADC values are unreadable in the text
  • A cited study described diffusion MRI as a promising tool for differentiating malignant pleural disease from benign lesions, with high accuracy, and adding dynamic contrast-enhanced MRI seemed to further improve sensitivity
• The authors' conclusion: The author concluded that diffusion MRI offers functional imaging that complements routine anatomic chest MRI. Its potential value lies in the detection, characterization, grading and staging of lung cancer, and it has been used for mediastinal and pleural tumors. The author added that further development, standardization and research would make it more suitable for clinical use.
• Limitations the authors state:
  • The ADC is a relative measure, not an absolute one, because it depends on the b value and the MR acquisition method used
  • ADC values vary widely within the same cancer subtype, with broad overlap between benign and malignant tumors
  • Results from the cited studies are hard to compare because they used different sequences and assessment methods
  • The optimal b values for diffusion MRI of the chest have not yet been determined

Topics

Medical terms in this study, explained in our Lexicon: Staging, Lung Cancer, Consolidation, Pleural Mesothelioma.

Related studies

• Malignant pleural mesothelioma: visual assessment by using pleural pointillism at diffusion-weighted MR imaging — J. Coolen, F. De Keyzer, et al. (2015)
• The Use of Chest Magnetic Resonance Imaging in Malignant Pleural Mesothelioma Diagnosis — F. Volpi, C.A. D'Amore, et al. (2022)
• Malignant pleural mesothelioma with heterologous osteoblastic elements: computed tomography, magnetic resonance, and positron emission tomography imaging characteristics of a rare tumor — R.A. Salgado, R. Corthouts, et al. (2005)
• Diffusion-weighted MRI of malignant pleural mesothelioma: preliminary assessment of apparent diffusion coefficient in histologic subtypes — R.R. Gill, S. Umeoka, et al. (2010)
• The use of magnetic resonance imaging in malignant mesothelioma — J. Entwisle (2004)
• Asbestos-related pleural disease: value of dedicated magnetic resonance imaging techniques — M.A. Weber, M. Bock, et al. (2004)

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