1. Diffusion-Weighted Imaging of the Chest
Antonio Luna, MD, Javier Sánchez-Gonzalez, PhD, Pilar Caro, MD 
Magnetic Resonance Imaging Clinics 
Volume 19, Issue 1, Pages (February 2011)
DOI: /j.mric
Copyright © 2011 Elsevier Inc. Terms and Conditions

2. Fig. 1
Differences in DWI using STIR and SPIR acquisition on a 3-T magnet. Two DWI images were acquired in the same patient affected by an epidermoid carcinoma (arrows) using the same b value (1000 s/mm2). (A) DWI with STIR (DWIBS) and (B) DWI with spectral fat suppression. Spectral fat suppression DWI has a higher signal-to-noise ratio compared with the DWIBS sequence.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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3. Fig. 2
Pulmonary metastasis of renal carcinoma at 3-T magnet. (A) Respiratory-triggered SS EPI DWI sequence with spectral fat suppression and a b value of 900 s/mm2 nicely depicts a metastasis in the upper lobe of left lung. (B) Black-blood STIR TSE shows the lesion similarly to DWI.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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4. Fig. 3
IVIM model applied to a renal carcinoma pulmonary metastasis (same case as Fig. 2). (A) Parametric D map shows a nodule in the upper left lobe with restricted diffusion. (B) Comparison of diffusion signal decay within the lesion using either the IVIM model estimation (solid line) or the conventional ADC estimation from the monoexponential model (dotted line). The effect of the perfusion contribution to the ADC estimation can be appreciated as fast signal decay in the lower b values caused by perfusion effect. The results of both models show a clear difference between the conventional ADC and the D measurements.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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5. Fig. 4
Synchronization on chest DWI. Five different approaches under different strategies of motion compensation of the same DWI sequence are shown, using the same b value (800 s/mm2) at a 3-T magnet, in a patient with small cell lung cancer (SCLC). (A) Free-breathing. (B) Breathhold. (C) Breathhold and cardiac trigger. (D) Respiratory trigger. (E) Respiratory and cardiac trigger. Higher signal of the mediastinal mass is shown in acquisitions with cardiac and respiratory control (C, E), caused by reduction of the signal loss on DWI related to respiratory and cardiac movement. On the contrary, in acquisitions without cardiac synchronization (A, B, and D), a loss of signal within the tumor is evident because of the cardiac movement effect over the DWI signal.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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6. Fig. 5
Pulmonary metastases of papillary thyroid carcinoma. (A) Axial black-blood STIR image shows several bilateral millimetric pulmonary metastases and enlarged prevascular and bilateral hilar lymphadenopathies, probably representing lymph node metastases. Respiratory-triggered SS EPI DWI sequence with SPIR on a 1.5-T magnet with b values of 150 s/mm2 (B) and 500 s/mm2 (C) demonstrate a lesser number of pulmonary metastases than STIR. The enlarged lymph nodes are also less evident.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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7. Fig. 6
Poorly differentiated adenocarcinoma. (A) Free breathe SS EPI DWI sequence with SPIR and a b value of 800 s/mm2 performed in a 1-T magnet shows restricted diffusion of the lesion, which is confirmed in the ADC map (B). The mass demonstrated an ADC value of 1.2 × 10−3 mm2/s. Notice the presence in A of a metastatic right hilar lymphadenopathy, which is detectable on the DWI sequence (arrow), which was not evident on T2 weighted (not shown).
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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8. Fig. 7
Pulmonary abscess and exudative pleural effusion. (A, B) Free breathe SS EPI DWI sequence with SPIR on a 1-T magnet with b values of 0 s/mm2 (A) and 800 s/mm2 (B) show a hyperintense mass located in the left lung along with an exudative pleural effusion. (C) The ADC map confirms the restriction of the mass, because it shows a minimal ADC value of 1 × 10−3 mm2/s.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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9. Fig. 8
Bronchioalveolar carcinoma. (A) Fluorodeoxyglucose PET shows ill-defined uptake of a peripheral lesion in right upper lobe (arrow), which was not considered suspicious for malignancy. (B) IVIM-DWI sequence at 3-T magnet with multiple b values (only shown 9) depicts the nodule as moderately hyperintense with high b values. (C) Parametric map of D confirms the lesional restricted diffusion. (D) Comparison of signal decay within the lesion using either the IVIM model estimation (black line) or the conventional ADC estimation from the monoexponential model (gray line). The ADC value is that of 1.85 × 10−3 mm2/s, in the range of a benign lesion. However, if one applies the bicompartimental model of DWI, one can calculate the lesional value of D, 1.23 × 10−3 mm2/s, in the range of a malignant lesion. In this case, the effect of the perfusion contribution to the ADC estimation may cause a false-positive, as was the PET.
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10. Fig. 9
Benign pulmonary nodule. Respiratory-triggered SS EPI DWI sequence with SPIR on a 1.5-T magnet with b values of 0 (A), 150 (B), and 600 s/mm2 (C) demonstrates a spiculated nodule in right lung (arrows) with progressive loss of signal while increasing the diffusion-weighting. An ADC value of 1.9 × 10−3 mm2/s suggests a benign lesions, as confirmed clinically in 6 years of imaging follow-up.
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11. Fig. 10
Central bronchogenic carcinoma with postobstructive consolidation. Coronal fusion image of a T2 TSE image and a SS EPI DWI sequence with a b value of 1000 s/mm2 allows a good depiction of the epidermoid carcinoma as an area of restricted diffusion (asterisk) surrounded by postobstructive consolidation, which does not demonstrate hyperintensity on DWI.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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12. Fig. 11
Recurrent poorly differentiated adenocarcinoma. A 64 year-old man with antecedent of NSCLC, treated 2 years before, and in clinical complete response. (A) Axial postcontrast THRIVE shows a spiculated lesion with heterogeneous enhancement. (B) IVIM-DWI sequence with a b value of 900 mm2/s depicts the nodule with focal areas of hyperintensity (arrows). (C) Parametric map of D confirms the restricted diffusion. Lesional D value, at the place where the ROI is positioned, was that of 1.5 × 10−3 mm2/s, consistent with recurrent lesion.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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13. Fig. 12
Metastatic adenopathies of poorly differentiated lung adenocarcinoma. (A, B) Free breathe SS EPI DWI sequence with SPIR on a 1-T magnet with a b value of 800 s/mm2 at two different levels demonstrates a mass with restricted diffusion in the superior segment of the right inferior lobe corresponding to a pulmonary adenocarcinoma (red arrow) (A) and metastatic right hilar (white arrow on A) and right paratracheal adenopathies (white arrow on B).
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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14. Fig. 13
Lymphadenitis in a patient with bronchioalveolar carcinoma (same case as Fig. 8). Respiratory-triggered SS EPI DWI sequence with SPIR on a 3-T magnet with b values of 300 s/mm2 (A) and 900 s/mm2 (B) demonstrates absence of restricted diffusion of a small right hilar lymph node (arrows on both images), which was confirmed as benign lymphadenitis on pathologic analysis. Notice the presence of fat signal overlap in both images, although consistent fat suppression was reached.
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15. Fig. 14
Staging of lung cancer with WB-DWI MR imaging. Coronal fusion image of a T2-weighted TSE sequence and a DWIBS acquisition (b value of 1000 s/mm2) reveals a huge mass in the inferior lobe of the right lung corresponding to a SCLC (asterisk). Metastasis in L2 vertebral body (green arrow) and right supraclavicular lymph node metastasis (yellow arrow) are depicted as areas of restricted diffusion.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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16. Fig. 15
Esophageal cancer. (A) Respiratory-triggered SS EPI DWI sequence with SPIR on a 1.5-T magnet with a b value of 1000 s/mm2 demonstrates a nodular area of restricted diffusion (arrow) corresponding to an esophageal cancer with T2 stage, which was not detectable on the axial T2 TSE image at the same level (B). The mural thickening of distal esophagus (arrows) is confirmed in an oblique sagittal dynamic balanced field echo acquisition after water swallowing (C).
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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17. Fig. 16
Staging of Hodgkin's lymphoma in a 24-weeks pregnant woman. (A) Coronal TSE T2-weighted image and (B) coronal maximum intensity projection (MIP) of a DWIBS sequence with a b value of 1000 s/mm2 show disease limited to mediastinum and left laterocervical lymph nodes (arrows).
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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18. Fig. 17
Transudative pleural effusion in a patient with chronic renal failure. Respiratory-triggered SS EPI DWI sequence with SPIR on a 1.5-T magnet with b values of 0 s/mm2 (A) and 800 s/mm2 (B) demonstrates a bilateral pleural effusion, which does not show restriction of diffusion.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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19. Fig. 18
Detection of myocardial edema in acute myocarditis. (A) Short-axis double-inversion black-blood STIR demonstrates an area of myocardial edema in the anteroseptal wall (arrow). Respiratory- and cardiac-triggered SS EPI DWI sequences with SPIR on a 1.5-T magnet with b values of 150 s/mm2 (B) and 300 s/mm2 (C) also clearly depict the edematous myocardium as an area of focal hyperintensity (arrows). (D) On the corresponding ADC map the area of edema demonstrated restricted diffusion (arrow).
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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20. Fig. 19
Bronchogenic cyst. (A) Sagittal TSE T2-weighted sequence shows a hyperintense well-defined mass in the posterior mediastinum, which is cystic-appearing (asterisk). Respiratory-triggered SS EPI DWI sequence with SPIR on a 1.5-T magnet with b values of 0 s/mm2 (B) and 800 s/mm2 (C) demonstrate absence of restricted diffusion within the mass (asterisks), which helps to characterize it as cystic.
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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21. Fig. 20
Ex vivo DTI of a pig heart, using a conventional SE DWI sequence with a b value of 800 s/mm2. On the left row, short-axis source and fractional anisotropy images of the heart are presented. On the right, a three-dimensional DTI reconstruction reveals the organization and pathways of the heart fibers.
(Courtesy of Gerard Blasco, Radiology Department, Hospital Josep Trueta, Girona, Spain.)
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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22. Fig. 21
Hyperpolarized 3He pulmonary diffusion in a rat model of induced emphysema. (A) ADC map of a rat lung with emphysema-like disease induced using elastase in left lobe (right-side image in the figure). The emphysema can be considered as mild. (B) Graphic of mean ADC value of the entire pulmonary region comparing elastase-treated (left bars) with normal (right bars) rats, demonstrating higher ADC values in lungs with induced emphysema. The ADC was obtained using four b values between 0 and 2.4 s/cm2, and a bipolar sinusoidal diffusion gradient of 1.5-ms diffusion time. The data were accumulated at the end of the expiratory volume after three prewashes with pure 3He and 15 mbar inspiration.
(Courtesy of Angelos Kyriazis and Jesus Ruiz-Cabello, Research Center of Respiratory Diseases, Complutense University, Madrid, Spain.)
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
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23. Fig. 22
Hyperpolarized 129Xe pulmonary ventilation and diffusion on a healthy volunteer (top row) and subject with COPD (bottom row). Multiple ventilation defects and an increase in ADC values are detected in the COPD patient compared with the volunteer. The diffusion alterations are mainly located in both upper lobes.
(Courtesy of S. Kaushik and B. Driehuys, Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC.)
Magnetic Resonance Imaging Clinics  , 69-94DOI: ( /j.mric )
Copyright © 2011 Elsevier Inc. Terms and Conditions