Abdominal Radiology

, Volume 44, Issue 7, pp 2639–2647 | Cite as

Diffusion-weighted imaging as a part of PET/MR for small lesion detection in patients with primary abdominal and pelvic cancer, with or without TOF reconstruction technique

  • Tianbin Song
  • Bixiao Cui
  • Hongwei Yang
  • Jie Ma
  • Dongmei Shuai
  • Zhongwei Chen
  • Zhigang Liang
  • Yun Zhou
  • Jie LuEmail author



To investigate the value of diffusion-weighted imaging (DWI) in detection of small lesions (≤ 10 mm) in patients with primary abdominal and pelvic cancer in hybrid PET/MR with or without time-of-flight (TOF) technique.

Materials and methods

Twenty patients (11 females and 9 males, mean age 67.23 ± 12.90 years) with histologically confirmed primary abdominal and pelvic cancer underwent hybrid PET/MR examination. A total of 64 small lesions were included in this study, which were divided into two groups (≤ 10 mm and 10–30 mm). Visual scores of small lesion detection ability were rated by five-point ordinal scale. The visual scores and detectability of small lesions on TOF PET image, noTOF PET image, and DWI sequences of hybrid PET/MR examination with or without TOF technique were analyzed. Logistic regression model was established for analysis in the value of DWI in hybrid PET/MR examination with or without TOF technique in detection of the small lesions between two groups.


The visual evaluation revealed the small lesion (≤ 10 mm) visual scores of DWI (mean ± SD: 4.23 ± 1.41), TOF PET image (mean ± SD: 4.14 ± 0.89), and noTOF PET image (mean ± SD: 2.68 ± 1.13);.and the visual scores of small lesions (10–30 mm) on DWI (mean ± SD: 4.98 ± 0.15), TOF PET image (mean ± SD: 4.57 ± 0.59), and noTOF PET image (mean ± SD: 3.98 ± 1.05). The visual scores of all small lesions on DWI were higher than that on TOF PET data and noTOF PET data in both two groups (**P < 0.01). The missed diagnosis rates of small FDG avid lesions (≤ 10 mm) of DWI and noTOF PET image were 9.1% and 9.1%, respectively. However, the TOF PET-based clinical diagnosis detected all small lesions (≤ 30 mm). DWI was of great importance in detection of small lesions (≤ 10 mm) in the absence of TOF technique in PET/MR examination (**P < 0.01). DWI’s effect on detection of small lesions(10-30 mm) has shown no difference between PET/MR examinations with TOF and without TOF techniques (P > 0.05).


DWI has significant value in the detection of small lesions (≤ 10 mm) in hybrid PET/MR examination without TOF technique for patients with primary abdominal and pelvic cancer. However, it had less detection benefits in the small lesions (≤ 10 mm) in hybrid PET/MR examination with TOF PET image.


Diffusion-weighted imaging (DWI) Hybrid positron emission tomography/magnetic resonance (PET/MR) Time of flight (TOF) FDG 



This study was funded by a Grant from the National Key Research and Development Program of China (Grant No. 2016YFC0103000) and the National Natural Science Foundation of China (Grant No. 81671662) and the Beijing Municipal Administration of Hospitals’ Ascent Plan (Code: DFL20180802).

Compliance with ethical standards

Conflict of interest

These authors declared no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Pichler BJ, Wehrl HF, Kolb A, et al. (2008) Positron emission tomography/ magnetic resonance imaging: the next generation of multimodality imaging?.Semin Nucl Med 38:199-208.CrossRefGoogle Scholar
  2. 2.
    Schlemmer HP, Pichler BJ, Krieg R, et al. (2009) An integrated MR/PETsystem: prospective applications. Abdom Imaging 34:668-674.CrossRefGoogle Scholar
  3. 3.
    Kim SH, Cha ES, Kim HS, et al.(2009) Diffusion-weighted imaging of breast cancer: correlation of the apparent diffusion coefficient value with prognostic factors. J Magn Reson Imaging 30:615-620.CrossRefGoogle Scholar
  4. 4.
    Ye J, Kumar BS, Li XB, et al. (2017) Clinical applications of diffusion-weighted magnetic resonance imaging in diagnosis of renal lesions–a systematic review. Clin Physiol Funct Imaging 37:459-473.CrossRefGoogle Scholar
  5. 5.
    Guo W, Zhao S, Yang Y, et al. (2015) Histological grade of hepatocellular carcinoma predicted by quantitative diffusion-weighted imaging. Int J Clin Exp Med 8: 4164-4169.Google Scholar
  6. 6.
    Zhou Z, Liu X, Hu K, Zhang F. (2018)The clinical value of PET and PET/CT in the diagnosis and management of suspected cervical cancer recurrence. Nucl Med Commun 39: 97-102.Google Scholar
  7. 7.
    Gourtsoyianni S, Papanikolaou N, Yarmenitis S, et al.(2008) Respiratory gated diffusion-weighted imaging of the liver: value of apparent diffusion coefficient measurements in the differentiation between most commonly encountered benign and malignant focal liver lesions. Eur Radiol 18:486-492.CrossRefGoogle Scholar
  8. 8.
    Mehranian A, Zaidi H.(2015) Impact of time-of-flight PET on quantification errors in MR imaging-based attenuation correction. J Nucl Med 56:635-641.CrossRefGoogle Scholar
  9. 9.
    Lois C, Jakoby BW, Long MJ, et al. (2010) An assessment of the impact of incorporating time-of-flight information into clinical PET/CT imaging. J Nucl Med 51:237-245.CrossRefGoogle Scholar
  10. 10.
    Grueneisen J, Sawicki LM, Wetter A, et al. (2017)Evaluation of PET and MR datasets in integrated 18F-FDG PET/MRI: A comparison of different MR sequences for whole-body restaging of breast cancer patients. Eur J Radiol 89:14-19.CrossRefGoogle Scholar
  11. 11.
    Conti M. (2011) Why is TOF PET reconstruction a more robust method in the presence of inconsistent data? Phys Med Biol 56: 155-168.CrossRefGoogle Scholar
  12. 12.
    EI Fakhri G, Surti S, Trott CM, et al. (2011) Improvement in lesion detection with whole-body oncologic time-of-flight PET. J Nucl Med 52:347-353.CrossRefGoogle Scholar
  13. 13.
    Mazzaferro V, Regalia E, Doci R, et al. (1996)Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693-699.CrossRefGoogle Scholar
  14. 14.
    Akamatsu G, Mitsumoto K, Taniguchi T, et al. (2014) Influences of point-spread function and time-of-flight reconstructions on standardized uptake value of lymph node metastases in FDG-PET. Eur J Radiol 83:226-230.CrossRefGoogle Scholar
  15. 15.
    Eiber M, Fingerle AA, Brügel M, et al. (2012)Detection and classification of focal liver lesions in patients with colorectal cancer: retrospective comparison of diffusion-weighted MR imaging and multi-slice CT. Eur J Radiol 81:683-691.CrossRefGoogle Scholar
  16. 16.
    Promsorn J, Soontrapa W, Somsap K, et al. (2018) Evaluation of the diagnostic performance of apparent diffusion coefficient (ADC) values on diffusion-weighted magnetic resonance imaging (DWI) in differentiating between benign and metastatic lymph nodes in cases of cholangiocarcinoma. Abdom Radiol. Google Scholar
  17. 17.
    Roy C, Bierry G, Matau A, et al. (2010) Value of diffusion-weighted imaging to detect small malignant pelvic lymph nodes at 3 T. Eur Radiol 20:1803–1811CrossRefGoogle Scholar
  18. 18.
    Holzapfel K, Bruegel M, Eiber M, et al. (2010) Characterization of small (≤ 10 mm) focal liver lesions: value of respiratory-triggered echo-planar diffusion-weighted MR imaging. Eur J Radiol 76:89–95CrossRefGoogle Scholar
  19. 19.
    Baltzer PA, Schelhorn J, Benndorf M, et al. (2013) Diagnosis of focal liver lesions suspected of metastases by diffusion-weighted imaging (DWI): systematic comparison favors free-breathing technique. Clin Imaging 37:97–103CrossRefGoogle Scholar
  20. 20.
    AAssar OS, Fischbein NJ, Caputo GR, et al. (1999) Metastatic head and neck cancer:role and usefulness of FDG PET in locating occult primary tumors. Radiology 210:177–181CrossRefGoogle Scholar
  21. 21.
    Havrilesky LJ, Kulasingam SL, Matchar DB, et al. (2005) FDG-PET for management of cervical and ovarian cancer. Gynecol Oncol 97:183–191CrossRefGoogle Scholar
  22. 22.
    Buchbender C, Hartung-Knemeyer V, Beiderwellen K, et al. (2013) Diffusion-weighted imaging as part of hybrid PET/MRI protocols for whole-body cancer staging: does it benefit lesion detection? Eur J Radiol 82:877–882CrossRefGoogle Scholar
  23. 23.
    Heusch P, Sproll C, Buchbender C, et al. (2014) Diagnostic accuracy of ultrasound, 18F-FDG-PET/CT, and fused 18F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC. Clin Oral Investig 18:969–978CrossRefGoogle Scholar
  24. 24.
    Thoeny HC, Forstner R, De Keyzer F (2012) Genitourinary applications of diffusion weighted MR imaging in the pelvis. Radiology 263:326–342CrossRefGoogle Scholar
  25. 25.
    Soussan M, Des Guetz G, Barrau V, et al. (2012) Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy. Eur Radiol 22:1479–1487CrossRefGoogle Scholar
  26. 26.
    Mayerhoefer ME, Karanikas G, Kletter K, et al. (2014) Evaluation of diffusion-weighted MRI for pretherapeutic assessment and staging of lymphoma: results of a prospective study in 140 patients. Clin Cancer Res 20:2984–2993CrossRefGoogle Scholar
  27. 27.
    Michielsen K, Vergote I, Op de Beeck K, et al. (2014) Whole-body MRI with diffusion weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT. Eur Radiol 24:889–901CrossRefGoogle Scholar
  28. 28.
    Grueneisen J, Schaarschmidt BM, Beiderwellen K, et al. (2014) Diagnostic value of diffusion-weighted imaging in simultaneous 18F-FDG PET/MR imaging for whole-body staging of women with pelvic malignancies. J Nucl Med 55:1930–1935CrossRefGoogle Scholar
  29. 29.
    Surti S (2015) Update on time-of-flight PET imaging. J Nucl Med 56:98–105CrossRefGoogle Scholar
  30. 30.
    Rogasch JM, Steffen IG, Hofheinz F, et al. (2015) The association of tumor-to background ratios and SUVmax deviations related to point spread function and time-of-flight F18-FDG-PET/CT reconstruction in colorectal liver metastases. EJNMMI Res 5:31CrossRefGoogle Scholar
  31. 31.
    Shang K, Cui B, Ma J, et al. (2017) Clinical evaluation of whole-body oncologic PET with time-of-flight and point-spread function for the hybrid PET/MR system. Eur J Radiol 93:70–75CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tianbin Song
    • 1
  • Bixiao Cui
    • 1
  • Hongwei Yang
    • 1
  • Jie Ma
    • 1
  • Dongmei Shuai
    • 1
  • Zhongwei Chen
    • 2
  • Zhigang Liang
    • 1
  • Yun Zhou
    • 3
  • Jie Lu
    • 1
    • 4
    • 5
    Email author
  1. 1.Department of Nuclear Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
  2. 2.GE HealthcareBeijingChina
  3. 3.Mallinckrodt Institute of RadiologyWashington University in St. Louis School of MedicineSt. LouisUSA
  4. 4.Department of Radiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
  5. 5.Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina

Personalised recommendations