European Radiology

, Volume 23, Issue 12, pp 3466–3476 | Cite as

Whole-body diffusion-weighted imaging: is it all we need for detecting metastases in melanoma patients?

  • Giuseppe PetraliaEmail author
  • Anwar Padhani
  • Paul Summers
  • Sarah Alessi
  • Sara Raimondi
  • Alessandro Testori
  • Massimo Bellomi



To investigate whether whole-body diffusion-weighted imaging (WB-DWI) alone is adequate for detecting metastases in melanoma patients, or if standard WB contrast-enhanced magnetic resonance imaging (WB-ceMRI) is required.


Seventy-one WB-DWI studies were performed quarterly along with whole-body MRI including contrast-enhanced sequences (WB-ceMRI) in 19 patients with advanced melanoma. The reference standard was biopsy, other imaging investigations, or changes observed on follow-up. Findings of metastasis in separate WB-DWI and WB-DWI + WB-ceMRI readings were compared using κ statistics. Additionally, the distribution of findings was examined and calculated per body region (brain, neck, chest, abdomen, liver, pelvis, subcutaneous tissues, bones) and diagnostic accuracy (DA), sensitivity, specificity, negative predictive value, and positive predictive value were calculated per patient.


The eight examinations that were positive by the reference standard contained a total of 14 metastatic findings. With almost perfect agreement between techniques (κ = 85 %, 95 % CI 70–100 %) for detection of examinations with metastatic findings, and complete agreement in extracranial metastasis detection, 10 metastases were detected using WB-DWI and 13 using WB-DWI + WB-ceMRI. WB-DWI and WB-DWI + WB-MRI had equivalent per patient DA (79 %).


WB-DWI without additional WB-ceMRI sequences is promising for the detection of extracranial metastases in melanoma patients, but contrast-enhanced MRI is required for evaluating the brain.

Key Points

Whole-body (WB) magnetic resonance imaging (MRI) is increasingly used for oncological disease assessment.

WB diffusion-weighted MRI detects extracranial metastases in melanoma patients.

Contrast-enhanced MRI is only required for detecting brain metastases.

WB-DWI is inferior to low-dose CT for detecting lung metastases.


Whole-body imaging Diffusion-weighted MRI Melanoma Metastasis Contrast-enhanced MRI 

Abbreviations and acronyms


apparent diffusion coefficient


maximum intensity projections


multi-planar reformatted images


whole-body magnetic resonance imaging


whole-body diffusion-weighted imaging



We thank Guarniflon S.p.A. for the financial support of Dr. Alessi. Funding sources had no influence in acquisition, analysis, or interpretation of the data.

Supplementary material

330_2013_2968_MOESM1_ESM.doc (46 kb)
Supplementary Table 1 Detailed summary of imaging findings per body region (DOC 45 kb)


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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Giuseppe Petralia
    • 1
    Email author
  • Anwar Padhani
    • 2
  • Paul Summers
    • 1
  • Sarah Alessi
    • 1
  • Sara Raimondi
    • 3
    • 4
  • Alessandro Testori
    • 5
  • Massimo Bellomi
    • 1
    • 6
  1. 1.Department of RadiologyEuropean Institute of OncologyMilanItaly
  2. 2.Paul Strickland Scanner Centre, Mount Vernon Cancer CentreMiddlesexUK
  3. 3.Division of Epidemiology and BiostatisticsEuropean Institute of OncologyMilanItaly
  4. 4.Dipartimento di Medicina del Lavoro “Clinica del Lavoro Luigi Devoto”, Sezione di Statistica Medica e Biometria “GA Maccacaro”University of MilanMilanItaly
  5. 5.Melanoma and Soft Tissue Sarcoma Surgery DivisionEuropean Institute of OncologyMilanItaly
  6. 6.School of MedicineUniversity of MilanMilanItaly

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