OBJECTIVE. In this article, we present the basic principles of diffusion-weighted imaging (DWI) that can aid radiologists in the qualitative and quantitative interpretation of DW images. However, a detailed discussion of the physics of DWI is beyond the scope of this article. A short discussion ensues on the technical aspects of performing DWI in the body. The emerging applications of DWI for tumor detection, tumor characterization, distinguishing tumor tissue from nontumor tissue, and monitoring and predicting treatment response are highlighted. The challenges to widespread adoption of the technique for cancer imaging in the body are discussed. CONCLUSION. DWI derives its image contrast from differences in the motion of water molecules between tissues. Such imaging can be performed quickly without the need for the administration of exogenous contrast medium. The technique yields qualitative and quantitative information that reflects changes at a cellular level and provides unique insights about tumor cellularity and the integrity of cell membranes. Recent advances enable the technique to be widely applied for tumor evaluation in the abdomen and pelvis and have led to the development of whole-body DWI.

https://www.ajronline.org/doi/pdf/10.2214/AJR.06.1403

Diffusion-weighted MRI in the body: applications and challenges in oncology.

Diffusion-Weighted Magnetic Resonance Imaging as a Cancer Biomarker: Consensus and Recommendations

Diffusion-weighted MR images were compared with T2-weighted MR images and correlated with 1H spin-echo and 31P MR Spectroscopy for 6-8 h following a unilateral middle cerebral and bilateral carotid artery occlusion in eight cats. Diffusion-weighted images using strong gradient strengths (b values of 1413 s/mm2) displayed a significant relative hyperintensity in ischemic regions as early as 45 min after onset of ischemia whereas T2-weighted spin-echo images failed to clearly demonstrate brain injury up to 2-3 h postocclusion. Signal intensity ratios (SIR) of ischemic to normal tissues were greater in the diffusion-weighted images at all times than in either TE 80 or TE 160 ms T2-weighted MR images. Diffusion- and T2-weighted SIR did not correlate for the first 1-2 h postocclusion. Good correlation was found between diffusion-weighted SIR and ischemic disturbances of energy metabolism as detected by 31P and 1H MR Spectroscopy. Diffusion-weighted hyperintensity in ischemic tissues may be temperature-related, due to rapid accumulation of diffusion-restricted water in the intracellular space (cytotoxic edema) resulting from the breakdown of the transmembrane pump and/or to microscopic brain pulsations. © 1990 Academic Press, Inc.

Early detection of regional cerebral ischemia in cats: comparison of diffusion- and T2-weighted MRI and spectroscopy.

Quantification of non-Gaussianity for water diffusion in brain by means of diffusional kurtosis imaging (DKI) is reviewed. Diffusional non-Gaussianity is a consequence of tissue structure that creates diffusion barriers and compartments. The degree of non-Gaussianity is conveniently quantified by the diffusional kurtosis and derivative metrics, such as the mean, axial, and radial kurtoses. DKI is a diffusion-weighted MRI technique that allows the diffusional kurtosis to be estimated with clinical scanners using standard diffusion-weighted pulse sequences and relatively modest acquisition times. DKI is an extension of the widely used diffusion tensor imaging method, but requires the use of at least 3 b-values and 15 diffusion directions. This review discusses the underlying theory of DKI as well as practical considerations related to data acquisition and post-processing. It is argued that the diffusional kurtosis is sensitive to diffusional heterogeneity and suggested that DKI may be useful for investigating ischemic stroke and neuropathologies, such as Alzheimer’s disease and schizophrenia.

MRI quantification of non-Gaussian water diffusion by kurtosis analysis.

Purpose
To evaluate the value of diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions.

Materials and Methods
Fifty-two female subjects (mean age = 58 years, age range = 25–75 years) with histopathologically proven breast lesions underwent DWI of the breasts with a single-shot echo-planar imaging (EPI) sequence using large b values. The computed mean apparent diffusion coefficients (ADCs) of the breast lesions and cell density were then correlated.

Results
The ADCs varied substantially between benign breast lesions ((1.57 ± 0.23) × 10−3 mm2/second) and malignant breast lesions ((0.97 ± 0.20) × 10−3 mm2/second). In addition, the mean ADCs of the breast lesions correlated well with tumor cellularity (P < 0.01, r = −0.542).

Conclusion
The ADC would be an effective parameter in distinguishing between malignant and benign breast lesions. Further, tumor cellularity has a significant influence on the ADCs obtained in both benign and malignant breast tumors. J. Magn. Reson. Imaging 2002;16:172–178. © 2002 Wiley-Liss, Inc.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmri.10140

Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging.

Intravoxel incoherent motion (IVIM) imaging is a method the authors developed to visualize microscopic motions of water. In biologic tissues, these motions include molecular diffusion and microcirculation of blood in the capillary network. IVIM images are quantified by an apparent diffusion coefficient (ADC), which integrates the effects of both diffusion and perfusion. The aim of this work was to demonstrate how much perfusion contributes to the ADC and to present a method for obtaining separate images of diffusion and perfusion. Images were obtained at 0.5 T with high-resolution multisection sequences and without the use of contrast material. Results in a phantom made of resin microspheres demonstrated the ability of the method to separately evaluate diffusion and perfusion. The method was then applied in patients with brain and bone tumors and brain ischemia. Clinical results showed significant promise of the method for tissue characterization by perfusion patterns and for functional studies in the eva...

Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging.

Imagerie de self-diffusion in vivo par résonance magnétique nucléaire

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Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging.

Imagerie de self-diffusion in vivo par résonance magnétique nucléaire