title: Clinical value of whole-body magnetic resonance diffusion weighted imaging on detection of malignant metastases.
abstract: OBJECTIVE
  To evaluate the value of whole-body diffusion weighted imaging (WB-DWI) on detection of malignant metastasis.
  
  
  METHODS
  Forty-six patients with malignant tumors underwent WB-DWI examinations between April 2007 and August 2007 in our hospital. Before WB-DWI examination, the primary cancers of all the patients were confirmed by pathology, and the TNM-stage was assessed with conventional magnetic resonance imaging (MRI) or computed tomography (CT). WB-DWI was performed using short TI inversion recovery echo-planar imaging (STIR-EPI) sequence. Abnormal high signal intensities on WB-DWI were considered as metastases. The results of WB-DWI were compared with other imaging modalities. For the assessment of the diagnostic capability of WB-DWI, WB-DWI were compared with CT for demonstrating mediastinal lymph node metastases and lung metastases, and with conventional MRI for demonstrating metastases in other locations.
  
  
  RESULTS
  WB-DWI demonstrated 143 focuses, 14 of which were diagnosed to be benign lesions in routine imaging. The number of bone metastases depicted on WB-DWI and routine imaging was 85 and 86; lymph node metastases was 17 and 18; liver metastases was 14 and 14; lung metastases was 4 and 8; and brain metastases was 6 and 8, respectively. WB-DWI failed to detect 12 metastatic lesions including 3 osteoplastic bone metastases, 4 lung metastases, 3 mediastinal lymph node metastases, and 2 brain metastases. Four metastatic lesions including 2 deltopectoral lymph nodes and 2 rib metastases were detected with WB-DWI alone, all of which evolved greatly during clinical follow-up for more than 6 months. WB-DWI had higher detection rates for metastatic lesions in liver, bone, and lymph nodes than those in lung and brain (chi2=30, P<0.001).
  
  
  CONCLUSIONS
  WB-DWI could detect most of metastatic lesions that were diagnosed with conventional MRI and CT. The limitations of WB-DWI might be had high false-positive rate and low efficiency in detecting mediastinal lymph node, brain, and lung metastases.
authors.affiliation: Department of Radiology, Yangzhou No. 1 People's Hospital, Southeast University, Jiangsu 225001, China. cjr.licheng@vip.163.com
authors.forename: Cheng
authors.initials: C
authors.lastname: Li
authors.forename: Zhen-sheng
authors.initials: ZS
authors.lastname: Liu
authors.forename: Xian-mao
authors.initials: XM
authors.lastname: Du
authors.forename: Ling
authors.initials: L
authors.lastname: He
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Fei
authors.initials: F
authors.lastname: Sun
authors.forename: Fang
authors.initials: F
authors.lastname: Du
authors.forename: Zhi-gang
authors.initials: ZG
authors.lastname: Luo
authors.forename: Zhen-long
authors.initials: ZL
authors.lastname: Xue
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhao
authors.forename: Chang-wu
authors.initials: CW
authors.lastname: Zhou
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000556:secondary; D001932:Brain Neoplasms / Q000556:secondary; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000473:pathology; D009369:Neoplasms / Q000175:diagnosis / Q000473:pathology; D051598:Whole Body Imaging / Q000379:methods*