Figure 1.
Demonstration of water molecules motion in the intra and
extracellular spaces and within the extracellular space providing
information on the degree of cellularity of the tissues. On
A, there are a greater number of cells restricting the
water molecules motion; on B, the cellularity is decreased,
with satisfactory molecular motion.
Figure 2.
A 37-year-old female patient presenting with glioblastoma multiforme
affecting the right parietal lobe. On A, areas of
hypersignal are observed at the diffusion sequence (arrows),
presenting correlation with areas of signal loss on the ADC map
(B), demonstrating restriction to water
molecules motion and increased cellularity. Courtesy of Dr. Leonardo
Vedolin – Hospital Moinhos de Vento, Porto Alegre, RS,
Brazil.
Figure 3.
Diffusion-weighted images with different b values from a 47 year-old
female patient presenting with liver hemangioma in the transition
between the V and VI segments. The image with b value = 50
s/mm2 is more “anatomical”, with
attenuation of the perfusion effects, i.e., attenuation of the vessels
and spinal fluid (A). On the images with higher b
values (B,C) one observes, progressively,
attenuation of signal intensity in the healthy tissues, however the
hemangioma persists with high signal intensity (tissue with greater
cellularity/ T2 effect). Courtesy of Dr. Gustavo Luersen
– Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.
Figure 4.
Liver metastases in a 66-year-old female patient presenting with
colon adenocarcinoma, undergoing treatment with antiangiogenic drug
bevacizumab. Diffusion-weighted images with different b values: 200
s/mm2 (A) and 600
s/mm2 (B). The necrotic
center of the metastatic lesions (green ROI and white arrow)
shows attenuation of signal intensity, with increasing b values
indicating less restriction to diffusion. In comparison, the peripheral
zone of the tumor (purple ROI) presents increased cellularity
and little signal attenuation with the increase of the b value.
Figure 5.
Quantitative analysis of DWI. A 70-year-old male patient presenting
with heterogeneous lesion in the hepatic segments VI/VII, with
small satellite lesions. On A, diffusion-weighted image
(b = 600 s/ mm2) demonstrating high
signal intensity in the peripheral zone of the dominant lesion (ROI
1 – purple), low central signal (ROI 2 –
purple) and high signal intensity in the satellite lesions
(ROI 3 – green). On B, ADC map
demonstrates correspondence with DWI, with low values in ROI 1 (1.3
× 10–3) and in ROI 3 (1.1 ×
10–3) and higher value in ROI 2 (1.7
× 10–3). The anatomopathological analysis
confirmed the tumor heterogeneity, a moderately differentiated
cholangiocarcinoma with areas of necrosis.
Figure 6.
Dynamic MRI (DSC-MRI) of a high-grade neuroglial tumor
(arrow) in a 16-year-old patient. On A, axial
post-gadolinium T1-weighted image showing two ROIs: 1 (purple)
located in the tumor lesion, and 2 (green) located in the
healthy tissue. On B, the respective time-signal intensity
curve demonstrates greater perfusion in the tumor region in relation to
the healthy tissue (> 2.0). On C, the rBV
map superimposed on the contrast-enhanced axial T1-weighted image
demonstrates increased perfusion in the tumor ROI
(arrow).
Figure 7.
A 30-year-old female patient presenting with multicentric invasive
ductal carcinoma in the right breast and fibroadenoma in the left
breast. On A, one observes contrast-enhanced, dynamic 3D
MIP image with subtraction, demonstrating the presence of multiple
breast nodules at right and one retroareolar nodule at left. On
B, C and D it is possible to
observe that the contrast-enhancement pattern of the breast nodules at
right demonstrates characteristics of washout curve and plateau type 3,
sometimes observed in malignant nodules. On E, the analysis
of the kinetic curve of the breast nodule at left demonstrates
characteristics different from the others, showing a type 1 curve, a
pattern that is more frequently observed in benign nodules. Courtesy of
Dr. Almir Galvão Vieira Bitencourt – A.C.Camargo Cancer
Center, São Paulo, SP, Brazil.
Figure 8.
A 55-year-old male patient. Tumor resection (glioblastoma
multiforme) in the left temporal lobe six months ago, undergoing
treatment with radiotherapy and temodal. MRI scan with advanced
techniques was requested for differential diagnosis between recurrence
and radionecrosis in post-gadolinium enhancement areas in the surgical
site. On A, one observes contrast-enhanced T1-weighted
image demonstrating enhancement of the surgical site (arrow).
On B, one observes increased perfusion (arrow) on
the rBV map (the ROI in this area, compared with a contralateral
area of healthy white matter, presenting a ratio >2.6, a value
which has been proposed for tumor recurrence. On C and
D, the spectroscopy study demonstrates decreased peak
of the metabolite N-acetyl aspartate (NAA) and increased
choline peak (Cho), corroborating the diagnosis. Courtesy of
Dr. Leonardo Vedolin – Hospital Moinhos de Vento, Porto Alegre,
RS, Brazil.
Figure 9.
On A, DWI (b = 1000
s/mm2) with high signal intensity in the medial
region from 5 o'clock to 7 o'clock (arrow) in the
peripheral zone. On B, T2-weighted image demonstrates a
subtle ill defined area (arrow). At spectroscopy
(C), increased choline peak is observed, with
decreased citrate peak (ratio choline + creatine/citrate
= 2.7) in the area demonstrated by the ROI of the image on
B. On D, the ADC map demonstrates the same
area with low signal intensity (arrow) at 6 o'clock in
the peripheral zone. On E, the dynamic contrast-enhanced
image demonstrates enhancement in the medial region (from 5
o'clock to 7 o'clock). On F, the kinetic
curve presents intense and early enhancement (washin) tending
towards rapid clearance (washout). Such parameters represent
an area suspected for malignancy.
Figure 10.
WBMRI is useful in the detection of metastases, particularly in
brain, liver and bone lesions. On this figure, a 65-year-old female
patient presenting with lung adenocarcinoma in the upper right lobe
(long arrow) with metastasis to the left adrenal gland
(short arrow). Coronal WBMRI demonstrates the lesions at the
diffusion-weighted sequence.
Figure 11.
A 69-year-old male patient presenting with a solid and spiculated
mass in the right upper lobe, incidentally detected at radiography and
with histological diagnosis of adenocarcinoma. At PET/CT
(A), there was only normal FDG uptake by the
lesion, with no sign of intrathoracic or distant metastases. WBMRI
(B) demonstrated irregular hypersignal in the
lung lesion and in the dorsal musculature identified on C,
D and E, the latter not demonstrated at
PET/CT (F). Biopsy confirmed the diagnosis
of pulmonary adenocarcinoma metastasis.
Figure 12.
A 71-year-old male patient presenting with squamous cell
carcinoma in the right upper lobe, with no sign of metastatic
lesions at PET/MRI. In this case, there was a fusion of the
coronal MRI T1-weighted image with the functional image acquired
with FDG-PET/CT.
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