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

European Radiology volume 23, pages 3466–3476 (2013)Cite this article

Abstract

Objectives

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.

Methods

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.

Results

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 %).

Conclusions

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.

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Abbreviations

ADC:

apparent diffusion coefficient

MIP:

maximum intensity projections

MPR:

multi-planar reformatted images

WB-ceMRI:

whole-body magnetic resonance imaging

WB-DWI:

whole-body diffusion-weighted imaging

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Radiology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    Giuseppe Petralia, Paul Summers, Sarah Alessi & Massimo Bellomi

  2. Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, England, UK

    Anwar Padhani

  3. Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    Sara Raimondi

  4. Dipartimento di Medicina del Lavoro “Clinica del Lavoro Luigi Devoto”, Sezione di Statistica Medica e Biometria “GA Maccacaro”, University of Milan, Milan, Italy

    Sara Raimondi

  5. Melanoma and Soft Tissue Sarcoma Surgery Division, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    Alessandro Testori

  6. School of Medicine, University of Milan, Milan, Italy

    Massimo Bellomi

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  1. Giuseppe Petralia
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  2. Anwar Padhani
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Correspondence to Giuseppe Petralia.

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Supplementary Table 1

Detailed summary of imaging findings per body region (DOC 45 kb)

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Petralia, G., Padhani, A., Summers, P. et al. Whole-body diffusion-weighted imaging: is it all we need for detecting metastases in melanoma patients?. Eur Radiol 23, 3466–3476 (2013). https://doi.org/10.1007/s00330-013-2968-x

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