INTRODUCTION: Glioblastoma (GBM) is the most common malignant primary brain tumor, and methods to improve the early detection of disease progression and evaluate treatment response are highly desirable. We therefore explored changes in whole-brain apparent diffusion coefficient (ADC) values with respect to survival (progression-free [PFS], overall [OS]) in a cohort of GBM patients followed at regular intervals until disease progression. METHODS: A total of 43 subjects met inclusion criteria and were analyzed retrospectively. Histogram data were extracted from standardized whole-brain ADC maps including skewness, kurtosis, entropy, median, mode, 15th percentile (p15) and 85th percentile (p85) values, and linear regression slopes (metrics versus time) were fitted. Regression slope directionality (positive/negative) was subjected to univariate Cox regression. The final model was determined by aLASSO on metrics above threshold. RESULTS: Skewness, kurtosis, median, p15 and p85 were all below threshold for both PFS and OS and were analyzed further. Median regression slope directionality best modeled PFS (p = 0.001; HR 3.3; 95% CI 1.6-6.7), while p85 was selected for OS (p = 0.002; HR 0.29; 95% CI 0.13-0.64). CONCLUSIONS: Our data show tantalizing potential in the use of whole-brain ADC measurements in the follow up of GBM patients, specifically serial median ADC values which correlated with PFS, and serial p85 values which correlated with OS. Whole-brain ADC measurements are fast and easy to perform, and free of ROI-placement bias.

• MeSH
• alkylační protinádorové látky terapeutické užití   MeSH
• chemoradioterapie mortalita   MeSH
• difuzní magnetická rezonance metody   MeSH
• glioblastom mortalita   patologie   terapie   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• míra přežití MeSH
• nádory mozku mortalita   patologie   terapie   MeSH
• následné studie MeSH
• počítačové zpracování obrazu metody   MeSH
• prognóza MeSH
• progrese nemoci MeSH
• retrospektivní studie MeSH
• temozolomid terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and more than 90% of neoplasms arising from the kidney. Uninformative percutaneous kidney biopsies vary from 10 to 23%. As a result, 7.5-33.6% of partial nephrectomies in patients with small renal masses (SRM) are performed on benign renal tumors. The aim of this study was to assess the feasibility of the apparent diffusion coefficient (ADC) of the diffusion-weighted imaging (DWI) of MRI, as RCC imaging biomarker for differentiation of SRM. METHOD: Adult patients (n = 158) with 170 SRM were enrolled into this study. The control group were healthy volunteers with normal clinical and radiologic findings (n = 15). All participants underwent MRI with DWI sequence included. RESULTS: Mean ADC values of solid RCC (1.65 ± 0.38 × 10-3 mm2/s) were lower than healthy renal parenchyma (2.47 ± 0.12 × 10-3 mm2/s, p < 0.05). There was no difference between mean ADC values of ccRCC, pRCC and chRCC (1.82 ± 0.22 × 10-3 vs 1.61 ± 0.07 × 10-3 vs 1.46 ± 0.09 × 10-3 mm2/s, respectively, p = ns). An inverse relationship between mean ADC values and Fuhrman grade of nuclear atypia of solid ccRCCs was observed: grade I-1.92 ± 0.11 × 10-3 mm2/s, grade II-1.84 ± 0.14 × 10-3 mm2/s, grade III-1.79 ± 0.10 × 10-3 mm2/s, grade IV-1.72 ± 0.06 × 10-3 mm2/s. This was significant (p < 0.05) only between tumors of I and IV grades. Significant difference (p < 0.05) between mean ADC values of solid RCCs, benign renal tumors and renal cysts was observed (1.65 ± 0.38 × 10-3 vs 2.23 ± 0.18 × 10-3 vs 3.15 ± 0.51 × 10-3 mm2/s, respectively). In addition, there was a significant difference (p < 0.05) in mean ADC values between benign cysts and cystic RCC (3.36 ± 0.35 × 10-3 vs 2.83 ± 0.21 × 10-3 mm2/s, respectively). CONCLUSION: ADC maps with b values of 0 and 800 s/mm2 can be used as an imaging biomarker, to differentiate benign SRM from malignant SRM. Using ADC value threshold of 1.75 × 10-3 mm2/s allows to differentiate solid RCC from solid benign kidney tumors with 91% sensitivity and 89% specificity; ADC value threshold of 2.96 × 10-3 mm2/s distinguishes cystic RCC from benign renal cysts with 90% sensitivity and 88% specificity. However, the possibility of differentiation between ccRCC histologic subtypes and grades, utilizing ADC values, is limited.

• MeSH
• cystická onemocnění ledvin diagnóza   MeSH
• diferenciální diagnóza MeSH
• difuzní magnetická rezonance metody   MeSH
• dospělí MeSH
• karcinom z renálních buněk * diagnóza   patologie   chirurgie   MeSH
• léčba šetřící orgány metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ledvin * diagnóza   patologie   chirurgie   MeSH
• nefrektomie metody   MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Inferior vena cava (IVC) involvement by renal cell carcinoma (RCC) is associated with a higher disease stage and is considered a risk factor for poor prognosis. This study aimed to investigate the role of the apparent diffusion coefficient (ADC) of MRI 3D texture analysis in the differentiation of solid and friable tumour thrombus in patients with RCC. MATERIALS AND METHODS: The study involved 27 patients with RCC with tumour thrombus in the renal vein or IVC, surgically treated with nephrectomy and thrombectomy and in whom preoperatively abdominal MRI including the DWI sequence was conducted. For 3D texture analysis, the ADC map was used, and the first-order radiomic features were calculated from the whole volume of the thrombus. All tumour thrombi were histologically classified as solid or friable. RESULTS: The solid and friable thrombus was detected in 51.9 ​% and 48.1 ​% of patients, respectively. No differences in mean values of range, 90th percentile, interquartile range, kurtosis, uniformity and variance were found between groups. Equal sensitivity and specificity (93 ​% and 69 ​%, respectively) of ADC mean, median and entropy in differentiation between solid and friable tumour thrombus, with the highest AUC for entropy (0.808), were observed. Applying the skewness threshold value of 0.09 allowed us to achieve a sensitivity of 86 ​% and a specificity of 92 ​%. CONCLUSIONS: In patients with RCC and tumour thrombus in the renal vein or IVC, the 3D texture analysis based on ADC-map allows for precise differentiation of a solid from a friable thrombus.

• MeSH
• difuzní magnetická rezonance metody   MeSH
• dospělí MeSH
• karcinom z renálních buněk * diagnostické zobrazování   patologie   komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ledvin * diagnostické zobrazování   patologie   komplikace   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• senioři MeSH
• trombektomie metody   MeSH
• trombóza * diagnostické zobrazování   patologie   MeSH
• vena cava inferior diagnostické zobrazování   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Článek se souhrnně zabývá problematikou měření molekulární difúze pomoci magnetické rezonance (MR) a uvádí několik typických aplikací zobrazováni difuzních koeficientů v diagnostice např. mozkové ischemic, změn u pacientů s fenylketonurií nebo roztroušenou sklerózou (RS). Obrazy byly měřeny metodou difuzně váženého spinového echa Echo-planar Imaging (EPI) s následnou korekcí geometrické distorze obrazů a výpočtem ADC map (Apparent Diffusion Coeffici geometrické distorze obrazů a výpočtem ADC map (Apparent Diffusion Coefficient). Anizotropie difúze molekul v bílé mozkové hmotě je ukázána u zdravého mozku a jsou uvedeny také orientační hodnoty ADC ve trech základních směrech. Diagnostika mozkové ischemic měřením difuzně vážených obrazů je dnes již dobře známou metodou, která umožňuje nejen zobrazit tkáňové změny již několik minut po ischemické události, ale také rozlišit stáří ischemic. Výrazné změny • pokles až o 40 % - byly naměřeny u pacientů s fenylketonurií, a to v oblastech typických naopak jednat o typickou demyelinizaci, čemuž nasvědčuje prakticky normální hodnota NAA naměřená v těchto oblastech pomocí MR spektroskopie. Také u pacientů s RS jsme naměřili změny ADC, ale jejich velikost a směr (snížení či zvýšení) byly závislé na velikosti postižených míst a pravděpodobně i na jejich stáří.

The presented paper summarizes the problem of assessment of molecular diffusion by magnetic resonance (MR) and discuss several typical applications of diffusion imaging in the diagnosis e.g. of cerebral ischaemia, changes in patients with phenylketonuria or multiple sclerosis (MS). The images were measured using diffiision weighted (DW) spin echo Echo-planar Imaging (EPI) sequence with subsequent correction of the geometrical distorsion of images and calculation of ADC maps (Apparent Diffusion Coefficient). Anisotr opy of molecule diffusion in the white matter of the brain is demonstrated in a healthy brain, as well as approximate ADC values in three basic directions. The diagnosis of cerebral ischaemia by assessment of DW images is nowadays a well known method which makes it possible not only to visualize tissue changes already several minutes after the ischaemic attack but it can also differen¬ tiate the age of the ischaemia. Marked changes - a decline by as much as 40 % - were found in patients with phenylketonuria in areas typical by prolongation of T2. These changes are obviously associated with changes in the myelinization of white matter, but typical demyelinization is not necessarily involved, as suggested by normal NAA values assessed in these areas by MR spectroscopy. Also in patients with MS changes of ADC were found but their magnitude and direction (increase or decrease) depended on the size of the affected areas and probably on their age.

• MeSH
• anizotropie MeSH
• diagnostické zobrazování MeSH
• echoplanární zobrazování MeSH
• fenylketonurie MeSH
• ischemie mozku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• Schilderova difuzní cerebroskleróza MeSH
• Check Tag
• lidé MeSH

Accurate prediction of early treatment response to systemic therapy (ST) with tyrosine kinase inhibitors (TKI) in patients with metastatic renal cell carcinoma (mRCC) could help avoid ineffective and expensive treatment with serious side effects. Neither RECIST v.1.1 nor Choi criteria successfully discriminate between patients with mRCC who received ST having a short or long time to progression (TTP). There is no biomarker, which is able to predict early therapeutic response to TKIs application in patients with mRCC. The goal of our study was to investigate the potential of apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) of MRI in prediction of early therapeutic response to ST with pazopanib in patients with mRCC. The retrospective study enrolled 32 adult patients with conventional mRCC who received pazopanib (mean duration-7.5 ± 3.45). The mean duration of follow-up was 11.85 ± 4.34 months. In all patients as baseline examination and 1 month after treatment, 1.5T MRI including DWI sequence was performed followed by ADC measurement of the main renal lesion. For assessment of the therapeutic response, RECIST 1.1 is used. Partial response (PR), stable disease (SD) and progressive disease (PD) were observed in 12 (37.50%), 10 (31.25%) and 10 (31.25%) cases with mean TTP of 10.33 ± 2.06 months (95% confidence interval, CI = 9.05-11.61), 7.40 ± 2.50 months (95% CI = 5.61-9.19) and 4.20 ± 1.99 months (95% CI = 2.78-5.62) accordingly (p < 0.05). There was no difference in change of main lesions' longest size 1 month after ST in patients with PR, SD and PD. Comparison of mean ADC values before and 1 month after systemic treatment showed significant decrease by 19.11 ± 10.64% (95% CI = 12.35-25.87) and by 7.66 ± 6.72% (95% CI = 2.86-12.47) in subgroups with PR and SD, respectively (p < 0.05). There was shorter TTP in patients with mRCC if ADC of the main renal lesion 1 month after the ST increased from the baseline less than 1.73% compared to patients with ADC levels above this threshold: 5.29 ± 3.45 versus 9.50 ± 2.04 months accordingly (p < 0.001). Overall, our findings highlighted the use of ADC as a predictive biomarker for early therapeutic response assessment. Use of ADC will be effective and useful for reliable prediction of responders and non-responders to systemic treatment with pazopanib.

• MeSH
• difuzní magnetická rezonance metody   MeSH
• inhibitory angiogeneze terapeutické užití   MeSH
• Kaplanův-Meierův odhad MeSH
• karcinom z renálních buněk diagnostické zobrazování   farmakoterapie   mortalita   patologie   MeSH
• ledviny diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ledvin diagnostické zobrazování   farmakoterapie   mortalita   patologie   MeSH
• pyrimidiny terapeutické užití   MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• senioři MeSH
• sulfonamidy terapeutické užití   MeSH
• výsledek terapie MeSH
• zdraví dobrovolníci pro lékařské studie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

BACKGROUND: Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults. The core of standard of care for newly diagnosed GBM was established in 2005 and includes maximum feasible surgical resection followed by radiation and temozolomide, with subsequent temozolomide with or without tumor-treating fields. Unfortunately, nearly all patients experience a recurrence. Bevacizumab (BV) is a commonly used second-line agent for such recurrences, but it has not been shown to impact overall survival, and short-term response is variable. METHODS: We collected MRI perfusion and diffusion images from 54 subjects with recurrent GBM treated only with radiation and temozolomide. They were subsequently treated with BV. Using machine learning, we created a model to predict short term response (6 months) and overall survival. We set time thresholds to maximize the separation of responders/survivors versus non-responders/short survivors. RESULTS: We were able to segregate 21 (68%) of 31 subjects into unlikely to respond categories based on Progression Free Survival at 6 months (PFS6) criteria. Twenty-two (69%) of 32 subjects could similarly be identified as unlikely to survive long using the machine learning algorithm. CONCLUSION: With the use of machine learning techniques to evaluate imaging features derived from pre- and post-treatment multimodal MRI, it is possible to identify an important fraction of patients who are either highly unlikely to respond, or highly likely to respond. This can be helpful is selecting patients that either should or should not be treated with BV.

• MeSH
• alkylační protinádorové látky terapeutické užití   MeSH
• bevacizumab terapeutické užití   MeSH
• časové faktory MeSH
• difuzní magnetická rezonance MeSH
• dospělí MeSH
• glioblastom farmakoterapie   patologie   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• lokální recidiva nádoru farmakoterapie   MeSH
• nádory mozku farmakoterapie   patologie   MeSH
• objem krve v mozku účinky léků   fyziologie   MeSH
• prediktivní hodnota testů * MeSH
• přežití bez známek nemoci MeSH
• protinádorové látky imunologicky aktivní terapeutické užití   MeSH
• radioterapie MeSH
• retrospektivní studie MeSH
• strojové učení MeSH
• temozolomid terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Renal cell carcinoma (RCC) represents the most common malignant epithelial neoplasm of the kidney. Accurate assessment of the renal masses, defining the histologic subtype and the grade of differentiation of the tumor, is vital to ensure an adequate case management as well as for staging and prognosis. Recently, diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) tends to be increasingly appealing for the clinicians as an imaging procedure of choice for the diagnosis and staging of the RCC, which is predetermined by several advantages over CT. The goal of the survey was to assess the applicability of the apparent diffusion coefficient (ADC) of the DWI MRI for the differential diagnostics, histologic subtyping, and defining the grade of differentiation of the RCC. METHODS: The study enrolled 288 adult patients with renal lesions: 188 patients with solid RCC-126 patients with clear cell subtype (ccRCC), 32 patients with papillary RCC (pRCC), 30 patients with chromophobe RCC (chRCC); 27 patient with cystic form or RCC (Bosniak cyst, category IV); 32 patients with renal angiomyolipoma (AML); 25 patients with renal oncocytoma (OC); and 16 patients with the renal abscess (AB). In total, 245 lesions were pathologically verified. As a reference, 19 healthy volunteers were included into the study. All patients underwent MRI of the kidneys, involving DWI with subsequent evaluation of the ADC. RESULTS: There was a reliable difference (p < 0.05) in mean ADC values between the normal renal parenchyma (NRP), solid RCC of different histologic subtypes and grades, cystic RCC, and benign renal lesions. The mean ADC values obtained in the result of the study were (×10(-3) mm(2)/s): 2.47 ± 0.12 in NRP, 1.63 ± 0.29 in all solid RCCs, 1.82 ± 0.22 in solid ccRCC (1.92 ± 0.11-Fuhrman grade I, 1.84 ± 0.14-Fuhrman grade II, 1.79 ± 0.10-Fuhrman grade III, 1.72 ± 0.06-Fuhrman grade IV), 1.61 ± 0.07 in pRCC, 1.46 ± 0.09 in chRCC, 2.68 ± 0.11 in cystic RCC, 2.13 ± 0.08 in AML, 2.26 ± 0.06 in OC, and 3.30 ± 0.07 in AB. CONCLUSION: The data received in our study demonstrate a substantial restriction of diffusion of hydrogen molecules in tissues of ccRCC in comparison with the healthy renal parenchyma preconditioned by the greater density of tumor. A statistically significant difference in mean ADC values of ccRCC with different grades of nuclear pleomorphism by Fuhrman was observed: Low-grade tumors showed higher mean ADC values compared to high-grade tumors. The modality of the MRI DWI along with ADC measurement allows to reliably differentiate between the solid RCC of main histologic subtypes and grades, cystic RCC, and the benign renal lesions.

• MeSH
• diferenciální diagnóza MeSH
• difuzní magnetická rezonance metody   MeSH
• dospělí MeSH
• karcinom z renálních buněk * diagnóza   patologie   MeSH
• ledviny * diagnostické zobrazování   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• přesnost dimenzionálního měření MeSH
• prognóza MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• staging nádorů MeSH
• stupeň nádoru MeSH
• výběr pacientů MeSH
• zlepšení kvality MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To prospectively determine institutional cut-off values of apparent diffusion coefficients (ADCs) and concentration of tissue metabolites measured by MR spectroscopy (MRS) for early differentiation between glioblastoma (GBM) relapse and treatment-related changes after standard treatment. MATERIALS AND METHODS: Twenty-four GBM patients who received gross total resection and standard adjuvant therapy underwent MRI examination focusing on the enhancing region suspected of tumor recurrence. ADC maps, concentrations of N-acetylaspartate, choline, creatine, lipids, and lactate, and metabolite ratios were determined. Final diagnosis as determined by biopsy or follow-up imaging was correlated to the results of advanced MRI findings. RESULTS: Eighteen (75%) and 6 (25%) patients developed tumor recurrence and pseudoprogression, respectively. Mean time to radiographic progression from the end of chemoradiotherapy was 5.8 ± 5.6 months. Significant differences in ADC and MRS data were observed between those with progression and pseudoprogression. Recurrence was characterized by N-acetylaspartate ≤ 1.5 mM, choline/N-acetylaspartate ≥ 1.4 (sensitivity 100%, specificity 91.7%), N-acetylaspartate/creatine ≤ 0.7, and ADC ≤ 1300 × 10(-6) mm(2)/s (sensitivity 100%, specificity 100%). CONCLUSION: Institutional validation of cut-off values obtained from advanced MRI methods is warranted not only for diagnosis of GBM recurrence, but also as enrollment criteria in salvage clinical trials and for reporting of outcomes of initial treatment.

• MeSH
• chemoradioterapie metody   MeSH
• dakarbazin analogy a deriváty   terapeutické užití   MeSH
• glioblastom diagnóza   metabolismus   terapie   MeSH
• hodnocení výsledků zdravotní péče metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru diagnóza   metabolismus   prevence a kontrola   MeSH
• molekulární zobrazování metody   MeSH
• nádorové biomarkery metabolismus   MeSH
• nádory mozku diagnóza   metabolismus   terapie   MeSH
• následné studie MeSH
• prognóza MeSH
• protonová magnetická rezonanční spektroskopie metody   MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• výsledek terapie MeSH
• zobrazování difuzních tenzorů MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

PURPOSE: The main aim of the study was to compare the diagnostic performance of Prostate Imaging Reporting and Data System (PI-RADS) versions 1 and 2 for detection of prostate carcinoma (PCa) and clinically significant prostate carcinoma (CSPCa). The second aim was to evaluate the potential benefit of adding the apparent diffusion coefficient (ADC) and prostate specific antigen (PSA) density to the standard evaluation protocol. METHODS: A total of 167 consecutive patients with elevated PSA underwent magnetic resonance imaging. The images were evaluated prospectively using both versions of the PI-RADS and the results compared with 12-core template biopsy and magnetic resonance/transrectal ultrasound fusion biopsy. Receiver-operating characteristic (ROC) curves were compared for each scoring system using DeLong\'s test. The area under the curve (AUC) was calculated for ADC and PSA density for lesions scored 4. RESULTS: PI-RADS V2 had high discriminative ability for PCa prediction with an AUC of 0.824 (95% CI 0.763 to 0.885), compared to an AUC of 0.724 (95% CI 0.654 to 0.794) for PI-RADS V1 (p = 0.0335). ADC demonstrated a higher discriminative ability with an AUC of 0.702 (95% CI 0.548 to 0.856) in CSPCa prediction. Using the obtained ADC threshold of 828x10^-6 mm^2/s improved specificity to 86.73% with a sensitivity of 60.38%. CONCLUSION: PI-RADS version 2 exhibited significantly higher discriminative ability for PCa and CSPCa detection compared to PI-RADS version 1. Using the ADC can improve the tumor predictability of PI-RADS version 2 in lesions scored 4.

• MeSH
• adenokarcinom diagnóza   diagnostické zobrazování   patologie   MeSH
• biopsie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory prostaty diagnóza   diagnostické zobrazování   patologie   MeSH
• prospektivní studie MeSH
• prostata diagnostické zobrazování   patologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ultrasonografie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Úvod:Zobrazení difuze pomocí magnetické rezonance (DWI) a zobrazení tenzorů difuze (DTI) jsou metody poměrně často využívané při MR dia­gnostice mozku. Využití těchto metod pro zobrazení míchy je technicky náročnější a méně časté. Cílem této pilotní práce je shrnutí zkušeností autorů s technikou DWI a DTI z hlediska možného přínosu pro diferenciální dia­gnostiku míšních lézí. Metodika: Retrospektivně jsme hodnotili DWI/DTI nálezy u 11 pacientů s patologickým nálezem míchy při konvenčním MR zobrazení. Spektrum dia­gnóz zahrnovalo míšní ischemii, demyelinizaci, ependymom, myelitidu, radiační myelopatii a cévní malformaci. Měřili jsme hodnoty ADC (Apparent Diffusion Coefficient) a v případě DTI i frakční anizotropie (FA) míchy, dále byly hodnoceny nálezy deterministické DTI traktografie. Výsledky: U čtyř pacientů s míšní ischemií byl pozorován pokles ADC hodnoty v místě léze oproti nepostiženému úseku o 36–61 %. Okrsky restrikce difuze byly patrné i u pacienta s radiační myelopatií. U dvou pacientů s ependymomem bylo patrné roztlačení míšních traktů a výrazné snížení hodnoty FA (0,247 a 0,299). U ostatních pacientů nebyla patrná patologie na traktografii, u pacientů s demyelinizací jsme pozorovali středně výrazný pokles hodnoty FA (0,494 a 0,471). Závěr: DWI/DTI míchy může dle našich zkušeností přispět ke správnému nasměrování diferenciálnědia­gnostické rozvahy zejména průkazem restrikce difuze u míšních ischemií a zhodnocením obrazu traktografie u míšních tumorů. Další výzkum na větších souborech pacientů by mohl otevřít možnosti diferenciace jednotlivých patologií pomocí kvantifikace DTI parametrů.

Introduction: Diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) are magnetic resonance imaging methods, nowadays commonly used to depict the brain. Application of these methods for the spinal cord imaging is technically more demanding and less frequent. The aim of this pilot study was to summarize authors' current experience with DWI and DTI of the spinal cord, considering the potential value for the differential dia­gnosis of the spinal cord lesions. Methods: We retrospectively evaluated DWI/DTI findings in a group of 11 patients with pathological findings of the spinal cord on conventional MRI examination. The dia­gnosis comprised spinal cord ischemia, multiple sclerosis, myelitis, radiation myelopathy and arteriovenous malformations. We measured apparent diffusion coefficient (ADC) in all patients and, of the DTI data, we also measured fractional anisotropy (FA) values and evaluated the deterministic tractography reconstructions. Results: In four patients with spinal cord ischemia, we observed a decrease of the ADC values of the spinal cord lesions compared to the normal‑appearing segment within a range 36–61%. Small areas of restricted diffusion of the spinal cord were found also in a patient with radiation myelopathy. In two patients with spinal cord tumors, DTI tractography showed displacement and/or disruption of the spinal cord tracts and marked decrease of the FA values (0.247 and 0.299). No abnormalities were observed on tractography in the rest of the patients, moderate decrease of the FA values was found in patients within demyelinating lesions of the spinal cord (0.494 and 0.471). Conclusion: DWI/DTI of the spinal cord may contribute to the correct direction of the differential dia­gnostic considerations through depiction of restricted diffusion within the spinal cord ischemia and evaluation of tractography in patients with spinal cord tumors. Further research with larger numbers of patients might enable differentiation of the spinal ­cord lesions based on quantification of DTI parameters.

• Klíčová slova
• onemocnění míchy, zobrazení tenzorů difuze, difuzně vážené zobrazení magnetickou rezonancí,
• MeSH
• diferenciální diagnóza MeSH
• difuzní magnetická rezonance * statistika a číselné údaje   MeSH
• dospělí MeSH
• ependymom diagnóza   patologie   MeSH
• ischemie MeSH
• komprese míchy diagnóza   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míšní ischemie diagnóza   patologie   MeSH
• mladiství MeSH
• myelitida diagnóza   patologie   MeSH
• nemoci míchy * diagnóza   patologie   MeSH
• neurozobrazování metody   MeSH
• pilotní projekty MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• roztroušená skleróza diagnóza   patologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zobrazování difuzních tenzorů * metody   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH