Whole-Body-MR-Diffusion Weighted Imaging in Oncology

Abstract

The clinical implementation of whole body diffusion weighted imaging (WB-DWI) for tumor-detection, -characterization and therapy monitoring is well underway. The method is fast, robust and combined with its wide availability on modern MRI scanners, it has a vast potential clinical impact. Owing to the high tumor to background contrast, its main application areas are simple detection of tumor suspicious lesions (primary tumor, recurrence, and metastasis), tumor grading and therapy monitoring. WB-DWI has a strong diagnostic potential regarding the evaluation of bone marrow and its diseases and as thus, tumor detection and therapy monitoring of bone metastasis is of particular interest. The assessment of a lymphatic tumor spreading is constricted. One of the major hurdles that still hamper the wide clinical application of WB-DWI is a lack of standardization of measurement parameters that limit the comparability of current research results.

Key Points:

• Owing to the high tumor to background contrast WB-DWI allows fast assessment of tumor distribution and total tumor burden.

• WB-DWI allows therapy monitoring.

• WB-DWI is widely available.

Citation Format:

• Wilhelm T, Stieltjes B, Schlemmer HP. Whole-Body-MR-Diffusion Weighted Imaging in Oncology. Fortschr Röntgenstr 2013; 185: 950-958

Zusammenfassung

Die Ganzkörper-Diffusionsbildgebung (GK-DWI) befindet sich aktuell auf dem Weg, ein praxistaugliches Instrument der Detektion und Charakterisierung von Tumoren und des Therapiemonitorings zu werden. In Zukunft ist aufgrund der robusten Technologie, der schnellen Durchführbarkeit und der Möglichkeit der Implementierung der entsprechenden Protokolle an den meisten modernen MRT-Geräten eine weitverbreitete klinische Anwendung zu erwarten. Die Anwendungsmöglichkeiten liegen aufgrund des hohen Tumor-zu-Normalgewebe-Kontrasts in der vereinfachten Detektion tumorsuspekter Läsionen (Primärtumor, Rezidiv, Metastasen) sowie im Tumorgrading und im Therapiemonitoring. Besondere Eigenschaften sind der GK-DWI in der diagnostischen Beurteilung sowie im Therapieansprechen des Knochenmarks und seiner Erkrankungen zuzuschreiben, sodass ein potenziell großes Anwendungsgebiet in der Detektion und dem Therapiemonitoring ossärer Tumorausbreitungen liegen könnte. Die Beurteilung einer lymphatischen Tumorausbreitung ist nur eingeschränkt möglich. Das Hauptproblem in der praktischen Umsetzung der GK-DWI besteht aktuell allerdings noch in der fehlenden Standardisierung der Sequenzparameter und der damit verbundenen fehlenden Vergleichbarkeit von Studienergebnissen.

Key words

MR-diffusion/perfusion - metastases - treatment effects

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