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Background: Breast cancer is the most common cancer in women worldwide. However, it remains a difficult diagnosis problem to differentiate between benign and malignant breast lesions, especially in small early breast lesions., Purpose: To assess the diagnostic value of diffusion-weighted imaging (DWI) combined with T2-weighted imaging (T2WI) for small breast cancer characterization., Material and Methods: Fifty-eight patients (65 lesions) with a lesion <2 cm in diameter underwent 3.0 Tesla breast magnetic resonance imaging (MRI) including DWI and histological analysis. Three observers with varying experience levels reviewed MRI. The probability of breast cancer in each lesion on MR images was recorded with a 5-point scale. Areas under the receiver-operating characteristic curve (AUCs) were compared by using the Z test; sensitivity and specificity were determined with the Z test after adjusting for data clustering., Results: AUC of T2WI and DWI (Observer 1, 0.95; Observer 2, 0.91; Observer 3, 0.83) was greater than that of T2WI (Observer 1, 0.80; Observer 2, 0.74; Observer 3, 0.70) for all observers (P < 0.0001 in all comparisons). Sensitivity of T2WI and DWI (Observer 1, 90%; Observer 2, 93%; and Observer 3, 86%) was greater than that of T2WI alone (Observer 1, 76%; Observer 2, 83%; Observer 3, 79%) for all observers (P < 0.0001 in all comparisons). Specificity of T2WI and DWI was greater than that of T2WI alone for observer 1 (89% vs. 72%, P < 0.01) and observer 2 (94% vs. 78%, P < 0.001)., Conclusion: DWI combined with T2WI can improve the diagnostic performance of MRI in small breast cancer characterization. It should be considered selectively in the preoperative evaluation of patients with small lesions of the breast.

Background: Gadoxetic acid is a recently developed hepatobiliary-specific contrast material used for magnetic resonance imaging (MRI) which enables highly sensitive detection of hepatocellular carcinoma (HCC)., Aim: We performed a meta-analysis of all available studies of the diagnostic performance of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for detection of HCC in patients with chronic liver disease., Methods: Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis., Results: Across 10 studies of 570 patients, Gd-EOB-MRI sensitivity was 0.91 (95 % CI 0.77, 0.97) and specificity was 0.93 (95 % CI 0.85, 0.97). Overall, LR+ was 13.6 (95 % CI 5.6, 33.2), LR- was 0.10 (95 % CI 0.04, 0.27), and DOR was 140.36 (95 % CI 28, 696). Among patients with high pre-test probabilities, MRI enabled confirmation of HCC; among patients with low pre-test probabilities, MRI enabled exclusion of HCC. Worst-case-scenario (pre-test probability, 50 %) post-test probabilities were 93 and 9 % for positive and negative MRI results, respectively. In studies in which both Gd-EOB-MRI and contrast enhanced computed tomography (CE-CT) were performed, Gd-EOB-MRI was more sensitive than CE-CT (0.93 vs. 0.78; p < 0.05). Subgroup analysis suggested average lesion size (<2 vs. >2 cm) did not affect the diagnostic accuracy of the test (p > 0.05)., Conclusions: A limited number of small studies suggest Gd-EOB-MRI has good diagnostic performance in the detection of HCC among patients with chronic liver disease. It is also confirmed to be a reliable tool for evaluation of small early-stage HCC.

Objective: This meta-analysis aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in predicting responses in patients with locally advanced rectal cancer after preoperative neoadjuvant therapy., Methods: Articles in English language relating to the accuracy of MRI for this utility were retrieved. Methodological quality was assessed by Quality Assessment of Diagnostic Accuracy Studies tool. Pooled estimation and subgroup analysis data were obtained by statistical analysis., Results: Fourteen studies involved 751 pathologically confirmed patients met the inclusion criteria. Methodological quality was relatively high. To predict histopathological response in locally advanced rectal cancer by MRI, the pooled sensitivity and specificity were 0.78 [95 % confidence intervals (CI), 0.65, 0.87] and 0.81 (95 % CI, 0.72, 0.87), respectively. Positive likelihood ratio and negative likelihood ratio were 4.1 (95 %CI, 2.9, 5.8) and 0.27 (95 % CI, 0.17, 0.43), respectively. Subgroup analysis showing that imaging was performed at 3.0 T MRI devices had higher pooled sensitivity (0.92, 95 % CI, 0.84, 1.00) than the subgroup of MRI with ≤1.5 T (0.68, 95 % CI, 0.53, 0.82) (p < 0.05).The sensitivity and specificity of T2-weighted imaging (T2WI) with diffusion-weighted imaging (DWI) were 0.92 (95 % CI, 0.81, 1.00) and 0.75 (95 % CI, 0.54, 0.95); those of T2WI alone were 0.64 (95 % CI, 0.47, 0.82) and 0.88 (95 % CI, 0.81, 0.94) (p > 0.05)., Conclusion: This meta-analysis indicates that MRI is an accurate tool in predicting pathologic response after preoperative therapy in patients with locally advanced rectal cancer. It is suggested to perform MRI by 3.0 T devices, which might be sensitive to identify responder. The addition of DWI to T2WI showed a non-significant improvement in sensitivity, which deserves further investigation.

Goals: To evaluate the overall diagnostic accuracy of magnetic resonance imaging (MRI) in assessing the activity of Crohn's disease (CD) in the small bowel., Background: Cross-sectional imaging techniques are playing an increasing role in the evaluation of suspected CD. Advantages of MRI include a lack of ionizing radiation, the ability to provide dynamic information regarding bowel distention and motility, improved soft-tissue contrast, and a relatively safe intravenous contrast agent profile., Study: Two reviewers searched MEDLINE, EMBASE, and other electronic databases to identify studies in which MRI imaging was evaluated for assessing the activity of CD in the small bowel from January 2001 to September 2011. Bivariate random-effects meta-analytic methods were used to estimate summary, sensitivity, specificity, and receiver operating characteristic curves., Results: MRI had a pooled sensitivity of 0.87 [95% confidence interval (CI): 0.77, 0.93] and a pooled specificity of 0.91 (95% CI: 0.81, 0.96). Overall, likelihood ratio (LR)+ was 9.5 (95% CI: 4.4, 20.6) and LR- was 0.14 (95% CI: 0.08, 0.26). In patients with high pretest probabilities, MRI enabled confirmation of active CD; in patients with low pretest probabilities, MRI enabled exclusion of active CD. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 90% and 13% for positive and negative MRI results, respectively., Conclusions: A limited number of small studies suggest that MRI has high sensitivity and specificity for diagnosis of active CD in the small bowel; MRI will likely also prove to be suitable as the primary modality for active CD imaging surveillance.

Background: To obtain diagnostic performance values of T2-weighted imaging (T2WI) and contrast-enhanced magnetic resonance imaging (CE-MRI) in the prediction of myometrial invasion in patients with endometrial cancer., Methods: Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 1995 to March 2012. Pooled estimation data were obtained by statistical analysis., Results: Eleven articles (548 patients) were included. For assessing any myometrial involvement, the pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for CE-MRI were 0.81 (95% CI, 0.72, 0.88), 0.72 (95% CI, 0.64, 0.79), 0.65 (95% CI, 0.56, 0.73) and 0.85 (95% CI, 0.78, 0.91); for T2WI, they were 0.87 (95% CI, 0.78, 0.94), 0.58 (95% CI, 0.47, 0.69), 0.64 (95% CI, 0.54, 0.73), 0.84 (95% CI, 0.73, 0.92) respectively. The pooled specificity of CE-MRI (0.72) was significantly higher than T2WI (0.58) (P < 0.05). For assessing deep myometrial involvement, there was no statistically significant difference between CE-MRI and T2WI, (P > 0.05)., Conclusions: CE-MRI has a good diagnostic performance in the prediction of any myometrial invasion and is superior to T2WI. But its PPV is somewhat suboptimal. For assessing deep myometrial involvement, its NPV appears relative high and negative findings strongly suggest an absence of deep myometrial involvement, which can guide therapeutic decision-making.

Rationale and Objectives: The aim of this study was to evaluate the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DWI) in prostate cancer., Materials and Methods: The MEDLINE, Embase, CANCERLIT, and Cochrane Library databases were searched for studies published from January 2001 to August 2011 evaluating the diagnostic performance of DWI in detecting prostate carcinoma. Sensitivities and specificities were determined across studies, and summary receiver-operating characteristic curves were constructed using hierarchical regression models., Results: Sixteen studies (18 subsets) with a total of 852 patients were included. Six studies (seven subsets) examining men with pathologically confirmed prostate cancer (260 patients) had pooled sensitivity and specificity of 0.88 (95% confidence interval [CI], 0.76-0.95) and 0.84 (95% CI, 0.76-0.90), respectively. Compared to patients at high risk for clinically relevant cancer, sensitivity was higher in low-risk patients (0.94 [95% CI, 0.89-0.97] vs 0.62 [95% CI, 0.54-0.70], P < .05), but specificity was lower (0.86 [95% CI, 0.72-0.94] vs 0.89 [95% CI, 0.83-0.93], P < .05). Ten studies (11 subsets) examining patients with suspected prostate cancer (592 patients) had pooled sensitivity and specificity of 0.76 (95% CI, 0.68-0.84) and 0.86 (95% CI, 0.79-0.91). Sensitivity was lower in high-risk patients (0.74 [95% CI, 0.57-0.87] vs 0.78 [95% CI, 0.70-0.84], P > .05), but specificity was higher (0.92 [95% CI, 0.89-0.94] vs 0.78 [95% CI, 0.70-0.84], P < .05)., Conclusions: A limited number of small studies suggest that DWI could be a rule-in test for high-risk patients. Further prospective studies including larger populations are necessary to confirm the actual value of DWI in this field., (Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.)

Clinical evidence regarding the value of MRI for therapy responses assessment in breast cancer is increasing. The objective of this study is to compare the diagnostic capability of diffusion-weighted MR imaging (DW-MRI) and contrast-enhanced MR imaging (CE-MRI) to evaluate and predict pathological response in breast cancer patients receiving neoadjuvant chemotherapy (NAC). We performed a meta-analysis of all available studies of the diagnostic performance of DW-MRI or CE-MRI to evaluate and predict pathological response to NAC in patients with breast cancer. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), diagnostic odds ratio (DOR) and constructed summary receiver operating characteristic curves using hierarchical regression models. Methodological quality was assessed by QUADAS tool. Thirty-four studies met the inclusion criteria and involved 1,932 pathologically confirmed patients in total. Methodological quality was relatively high. DW-MRI sensitivity was 0.93 (95 % CI 0.82-0.97) and specificity was 0.82 (95 % CI 0.70-0.90). Overall LR+ was 5.09 (95 % CI 3.09-8.38), LR- was 0.09 (95 % CI 0.04-0.22), and DOR was 55.59 (95 % CI 21.80-141.80). CE-MRI sensitivity was 0.68 (95 % CI 0.57-0.77) and specificity was 0.91 (95 % CI 0.87-0.94). Overall LR+ was 7.48 (95 % CI 5.29-10.57), LR- was 0.36 (95 % CI 0.27-0.48), and DOR was 20.98 (95 % CI 13.24-33.24). Our study confirms that DW-MRI is a high sensitive and CE-MRI is a high specific modality in predicting pathological response to NAC in breast cancer patients. The combined use of DW-MRI and CE-MRI has the potential to improve the diagnostic performance in monitoring NAC. Further large prospective studies are warranted to assess the actual value of this combination in breast cancer preoperative treatment screening.

Background and Purpose: Evaluation of bone marrow infiltration is an essential step in the staging of lymphoma. The accuracy of (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG PET), combined (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography ((18)F-FDG-PET/CT) and magnetic resonance imaging (MRI) in diagnosing bone marrow involvement of lymphoma has never been systematically assessed, and the present systematic review was aimed at this issue., Methods: MEDLINE, EMBASE, Cochrane library and some other databases, from January 1995 to July 2010, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of (18)F-FDG PET, PET/CT and MRI for patients with bone marrow involvement of lymphoma were collected. We extracted data to calculate sensitivity, specificity, SROC curves and AUC and to test for heterogeneity. The statistic software called "Meta-Disc 1.4" was used for data analysis., Result: In 32 included studies, PET/CT had the highest pooled sensitivity, 91.6% (95%CI: 85.1, 95.9) and highest pooled specificity, 90.3% (95%CI: 85.9, 93.7). PET/CT also had the highest pooled DOR, 68.89 (95%CI: 15.88, 298.92). The AUC of PET, PET/CT, and MRI were 0.9430, 0.9505 and 0.8764. There was heterogeneity among studies and no evidence of publication bias., Conclusion: PET/CT was a highly sensitive and specific modality in diagnosing patients with bone marrow involvement in lymphoma. Compared with MRI and PET alone, PET/CT can play important roles in the staging of lymphoma., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To assess the overall diagnostic accuracy of whole-body magnetic resonance imaging (WB-MRI) in detecting bone metastases with a meta-analysis., Materials and Methods: The MEDLINE, EMBASE, Cancerlit, and Cochrane Library databases were searched from January 1995 to September 2010 for studies evaluating the accuracy of WB-MRI in detecting bone metastases. Histopathologic analysis and/or close clinical and imaging follow-up for at least 6 months was assessed. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristics., Results: A total of 11 studies with 495 patients who fulfilled all of the inclusion criteria were considered for the analysis. No publication bias was found. WB-MRI had a pooled sensitivity of 0.899 (95% confidence interval [CI], 0.845-0.939) and a pooled specificity of 0.918 (95% CI, 0.882-0.946). The subgroup without diffusion-weighted imaging (DWI) positive results had higher pooled specificity 0.961 (95% CI, 0.922-0.984) than the subgroup with DWI (P < 0.05)., Conclusion: WB-MRI was an accurate, cost-effective tool in detecting bone metastases. WB-MRI without DWI may improve the specificity of detecting bone metastases. DWI seems to be a sensitive but rather unspecific modality for the detection of bone metastatic disease. High-quality prospective studies regarding WB-MRI in detecting bone metastases still need to be conducted., (Copyright © 2011 Wiley-Liss, Inc.)

Objective: To compare several sequences of MRI and arthroscopy for detecting the ankle articular cartilage lesions and to evaluate the clinical outcome of special sequence of FS-3D-FISP., Methods: Forty patients (41 ankles) with iterative ankle pain who were scheduled for arthroscopy underwent MR scanning, including FS-3D-FISP, FSE T2WI and FSE PDWI sequences. The results of each sequence were then compared with the arthroscopic findings., Results: Using arthroscopic results as the standard of reference, the FS-3D-FISP images had the higher sensitivity (92.86%) than the other two sequences. The FS-3D-FISP sequence was well consistent with the result of arthroscopy. Kappa value (0.7590) was higher than the other two sequences (P < 0.01)., Conclusion: As a favorable scanning sequence, FS-3D-FISP imaging can show the early-stage pathological changes of articular cartilage and it has an excellent correlation with the arthroscopic findings. A 3-D reconstruction is helpful to determine the location and the degree of lesion and obtain a more accurate classification to guide clinical decisions.

Clinical diagnosis of lateral collateral ligamentous injury caused by ankle sprains depends primarily on clinical signs, and X-ray and CT images. None of these, however, provide direct or accurate information about ligamentous injury. MRI has long been testified as a useful tool in the demonstration of ligaments due to its good resolution of soft tissues. We confirmed the appearance of the lateral collateral ligaments of the ankle joints on MR images by comparing MR images with CT images of the ligaments enhanced by coating with contrast medium after dissection of six cadaver feet. Compare study of MR images reveals no difference in the natural position and the dorsal position (P > 0.05), whereas, taken into the consideration the long hour of MRI examination, the natural position is regarded as the optimal position for MRI performance. Measured on transverse MR images, lateral ligaments of acutely injured ankles were significantly thicker than those of normal ankles (P < 0.01). According to the MR images of normal and injured ankles, the lateral collateral ligaments injuries were classified as type I and type II. Osteal contusion, cartilaginous injury, musculotendinous injury, tenosynovitis, and peritenosynovitis were also observed by MRI in type I and type II acute lateral collateral ligament injury. All these complications have higher incidence in type II than in type I injury (P < 0.05). Thus, by comparing with the CT images and the anatomy we confirmed the normal appearance of the lateral collateral ligaments on MR images and figured out that the natural position is the optimal position for MRI performance. The thickness of the ligaments and incidence of the complications could be regarded as useful cue for the assistant in clinical diagnosis of the lateral collateral ligament injury.

Abstract: Background: To compare the diagnostic capability of diffusion-weighted magnetic resonance imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the N stage assessment in patients with non–small-cell lung cancer. Methods: We performed a meta-analysis of all available studies of the diagnostic performance of DWI and 18F-FDG PET/CT in the N stage assessment of patients with non–small-cell lung cancer. We determined the sensitivity and specificity across studies, calculated the positive and negative likelihood ratios (LR+ and LR−, respectively), and constructed the summary receiver operating characteristic curves using hierarchical regression models. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Results: A total of 19 studies met the inclusion criteria and included a total of 2845 pathologically confirmed patients. No publication bias was found. The methodologic quality was relatively high. The pooled sensitivity estimate of DWI (0.72, 95% confidence interval [CI] 0.63–0.80) was not significantly difference between PET/CT (0.75, 95% CI 0.68–0.81; P = 0.09). The pooled specificity estimate for DWI (0.95, 95% CI 0.85–0.98) was significantly greater than 18F-FDG PET/CT (0.89, 95% CI 0.85–0.91; P = 0.02). For DWI, the overall LR+ was 13.80 (95% CI 4.54–41.95) and the LR− was 0.29 (95% CI 0.21–0.40). For 18F-FDG PET/CT, LR+ was 6.67 (95% CI 5.20–8.56) and LR− was 0.28 (95% CI 0.22–0.37). Conclusions: Our study has confirmed that DWI has a high specificity for N staging of non–small-cell lung cancer compared with 18F-FDG PET/CT and has the potential to be a reliable alternative noninvasive imaging method for the preoperative staging of mediastinal and hilar lymph nodes in patients with non–small-cell lung cancer. [Copyright &y& Elsevier]

Abstract: Background and purpose: Evaluation of bone marrow infiltration is an essential step in the staging of lymphoma. The accuracy of 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG PET), combined 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and magnetic resonance imaging (MRI) in diagnosing bone marrow involvement of lymphoma has never been systematically assessed, and the present systematic review was aimed at this issue. Methods: MEDLINE, EMBASE, Cochrane library and some other databases, from January 1995 to July 2010, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of 18F-FDG PET, PET/CT and MRI for patients with bone marrow involvement of lymphoma were collected. We extracted data to calculate sensitivity, specificity, SROC curves and AUC and to test for heterogeneity. The statistic software called “Meta-Disc 1.4” was used for data analysis. Result: In 32 included studies, PET/CT had the highest pooled sensitivity, 91.6% (95%CI: 85.1, 95.9) and highest pooled specificity, 90.3% (95%CI: 85.9, 93.7). PET/CT also had the highest pooled DOR, 68.89 (95%CI: 15.88, 298.92). The AUC of PET, PET/CT, and MRI were 0.9430, 0.9505 and 0.8764. There was heterogeneity among studies and no evidence of publication bias. Conclusion: PET/CT was a highly sensitive and specific modality in diagnosing patients with bone marrow involvement in lymphoma. Compared with MRI and PET alone, PET/CT can play important roles in the staging of lymphoma. [Copyright &y& Elsevier]