Computed diffusion weighted imaging (cDWI) and voxelwise-computed diffusion weighted imaging (vcDWI) for oncologic liver imaging: A pilot study Ferdinand.

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Computed diffusion weighted imaging (cDWI) and voxelwise-computed diffusion weighted imaging (vcDWI) for oncologic liver imaging: A pilot study Ferdinand Seith, Petros Martirosian, Konstantin Nikolaou, Christian la Fougère, Nina Schwenzer, Holger Schmidt European Journal of Radiology Open Volume 5, Pages 108-113 (January 2018) DOI: 10.1016/j.ejro.2018.07.004 Copyright © 2018 The Authors Terms and Conditions

Fig. 1 Whisker box plots including median, first and third quartile, maximum and minimum of lesion contrast of measured and calculated b-values as well as in vcDWI. The mean lesion contrasts of cb1500 and vcDWI seem to be on a comparable level. However, highest variances in computed b-value images as well as in vcDWI are seen with b = 100/600, resulting in values partially close to zero. European Journal of Radiology Open 2018 5, 108-113DOI: (10.1016/j.ejro.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 2 Mean signal intensities of measured and computed b-values as well as vcDWI in lesions and organs. Note the superior signal intensity in lesions in vcDWI compared to measured and calculated b1500. Physiological spleen tissue also shows high signal intensity caused by high cellularity. European Journal of Radiology Open 2018 5, 108-113DOI: (10.1016/j.ejro.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 3 Coefficient of variation in physiological tissue and image background. Taking higher b-value images for the calculation of cb1000 and cb1500 decreases the covariance. Overall, vcDWI shows higher CV in physiological tissue; the high CV in vcDWI in kidneys and background are mainly caused by the very low signal intensity in those ROIs (see Fig. 2). European Journal of Radiology Open 2018 5, 108-113DOI: (10.1016/j.ejro.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 4 Relative differences of the mean signal intensities between measured and computed b-value images in %. A slight trend towards decreasing deviations with increasing upper b-values is present while b = 100/1000 provides overall best results for most organs in cb1500 from the b-value combinations tested. European Journal of Radiology Open 2018 5, 108-113DOI: (10.1016/j.ejro.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 5 Example of a 60 y/o male patient with melanoma and metastatic liver lesions. The larger lesion (white arrow) can clearly be seen in vcDWI as well as in computed and measured b-values (cb and mb, respectively); note the differences in lesion-to-liver contrast and image noise. One small lesion (dotted arrow) is visible in measured b-values (mb1000 and mb1500) but not in the calculated b-values (cb1000 and cb1500) based on b = 100/800. In vcDWI, this small lesion is clearly visible if the calculation is based on b = 100/1000; In contrast, the lesion is masked if the calculation is based on b = 100/800. European Journal of Radiology Open 2018 5, 108-113DOI: (10.1016/j.ejro.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 6 Example of a 71 y/o female patient with 68Ga-PET-positive liver metastases of a neuroendocrine tumor. The patient had undergone a partial liver resection and chemotherapy. The lesion shows a distinct PET tracer uptake (top row, left hand side: PET overlaid with T2 TSE) which stands for a high expression of the somatostatin receptor (SSR). The lesion does not provide a considerable diffusion restriction which is a common finding in metastases of NET under therapy. Thus, the lesion is not distinguishable in b = 1500 images (mb1500/cb1500) or vcDWI. However, in b = 1000 images (mb1000/cb1000), the lesion is visible which can be explained by a T2-shine-through effect. All calculated b-values as well as the vcDWI were based on b = 100/800. European Journal of Radiology Open 2018 5, 108-113DOI: (10.1016/j.ejro.2018.07.004) Copyright © 2018 The Authors Terms and Conditions