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Agarwal, Nivedita, Aylin Tekes, Andrea Poretti, Avner Meoded, and Thierry Huisman. "Pitfalls in Diffusion-Weighted and Diffusion Tensor Imaging of the Pediatric Brain." Neuropediatrics 48, no. 05 (July 6, 2017): 340–49. http://dx.doi.org/10.1055/s-0037-1603979.
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AbstractDiffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are advanced magnetic resonance imaging (MRI) techniques that are based on differences in the diffusion rate of water molecules in brain tissue. DWI and DTI are widely used in pediatric neuroradiology to evaluate a wide spectrum of brain diseases. The interpretation of DWI and DTI images requires a basic knowledge of the underlying physics to detect potential pitfalls and avoid misinterpretation. Several DWI pitfalls are related to the dependency of DWI images not only on the diffusivity of water molecules, but also on various additional MRI phenomena such as the T1- and T2- relaxation characteristics and MRI-related artifacts. In addition, knowledge about the age of the child and interval between the onset of injury and acquisition of DWI/DTI images is important. Finally, qualitative evaluation (“eye-balling”) maybe misleading, and the application of quantitative measurements of DTI scalars may avoid misdiagnosis.
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Sastry, Guggilla Sai Sasidhar, Ramasahayam Srikar Reddy, and Dr L. Sathya Priya. "Development of MRI Scalar Maps using DWI Images." International Journal for Research in Applied Science and Engineering Technology 10, no. 11 (November 30, 2022): 303–11. http://dx.doi.org/10.22214/ijraset.2022.47312.
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Abstract: Neuroimaging has been dramatically advanced by diffusion-weighted and diffusion-tensor imaging (DWI/DTI). Moreover, DWI/DTI permits the examination of the brain's microarchitecture. A thorough understanding of the fundamentals is essential to better understanding pathological presences and avoiding misinterpretation of typical DWI/DTI abnormalities. Diffusion-weighted imaging (DWI) is based on the measurement of the thermal Brownian motion of water molecules, and Diffusion tensor imaging (DTI) is an MRI technique that calculates the axonal arrangement of the brain through anisotropic diffusion. FA, AD, RD, and MD maps are used to study the biological signature of white matter in diffusion MRI studies of brain aging, neurodevelopment, and neurologic injuries. These maps are normally expensive on the market because they are generated separately. Using the DIPY library, we will generate FA, AD, RD, and MD maps to make this process more costeffective.
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Caudill, Barry D., Wayne M. Harding, and Brent A. Moore. "Dwi prevention." Addictive Behaviors 26, no. 2 (March 2001): 155–66. http://dx.doi.org/10.1016/s0306-4603(00)00097-6.
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Tramontano, Liberatore, Carlo Cavaliere, Marco Salvatore, and Valentina Brancato. "The Role of Non-Gaussian Models of Diffusion Weighted MRI in Hepatocellular Carcinoma: A Systematic Review." Journal of Clinical Medicine 10, no. 12 (June 15, 2021): 2641. http://dx.doi.org/10.3390/jcm10122641.
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The importance of Diffusion Weighted Imaging (DWI) in hepatocellular carcinoma (HCC) has been widely handled in the literature. Due to the mono-exponential model limitations, several studies recently investigated the role of non-Gaussian DWI models in HCC. However, their results are variable and inconsistent. Therefore, the aim of this systematic review is to summarize current knowledge on non-Gaussian DWI techniques in HCC. A systematic search of the literature, including PubMed, Google Scholar, MEDLINE, and ScienceDirect databases, was performed to identify original articles since 2010 that evaluated the role of non-Gaussian DWI models for HCC diagnosis, grading, response to treatment, and prognosis. Studies were grouped and summarized according to the non-Gaussian DWI models investigated. We focused on the most used non-Gaussian DWI models (Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Stretched Exponential—SE). The quality of included studies was evaluated by using QUADAS-2 and QUIPS tools. Forty-three articles were included, with IVIM and DKI being the most investigated models. Although the role of non-Gaussian DWI models in clinical settings has not fully been established, our findings showed that their parameters may potentially play a role in HCC. Further studies are required to identify a standardized DWI acquisition protocol for HCC diagnosis, grading, response to treatment, and prognosis.
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Budjan, Johannes, Elke A. Sauter, Frank G. Zoellner, Andreas Lemke, Jens Wambsganss, Stefan O. Schoenberg, and Ulrike I. Attenberger. "Diffusion kurtosis imaging of the liver at 3 Tesla: in vivo comparison to standard diffusion-weighted imaging." Acta Radiologica 59, no. 1 (April 28, 2017): 18–25. http://dx.doi.org/10.1177/0284185117706608.
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Background Functional techniques like diffusion-weighted imaging (DWI) are gaining more and more importance in liver magnetic resonance imaging (MRI). Diffusion kurtosis imaging (DKI) is an advanced technique that might help to overcome current limitations of DWI. Purpose To evaluate DKI for the differentiation of hepatic lesions in comparison to conventional DWI at 3 Tesla. Material and Methods Fifty-six consecutive patients were examined using a routine abdominal MR protocol at 3 Tesla which included DWI with b-values of 50, 400, 800, and 1000 s/mm2. Apparent diffusion coefficient maps were calculated applying a standard mono-exponential fit, while a non-Gaussian kurtosis fit was used to obtain DKI maps. ADC as well as Kurtosis-corrected diffusion ( D) values were quantified by region of interest analysis and compared between lesions. Results Sixty-eight hepatic lesions (hepatocellular carcinoma [HCC] [n = 25]; hepatic adenoma [n = 4], cysts [n = 18]; hepatic hemangioma [HH] [n = 18]; and focal nodular hyperplasia [n = 3]) were identified. Differentiation of malignant and benign lesions was possible based on both DWI ADC as well as DKI D-values ( P values were in the range of 0.04 to < 0.0001). Conclusion In vivo abdominal DKI calculated using standard b-values is feasible and enables quantitative differentiation between malignant and benign liver lesions. Assessment of conventional ADC values leads to similar results when using b-values below 1000 s/mm2 for DKI calculation.
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Silvagni, Ettore, Alessandra Bortoluzzi, Massimo Borrelli, Andrea Bianchi, Enrico Fainardi, and Marcello Govoni. "Cerebral Microstructure Analysis by Diffusion-Based MRI in Systemic Lupus Erythematosus: Lessons Learned and Research Directions." Brain Sciences 12, no. 1 (December 31, 2021): 70. http://dx.doi.org/10.3390/brainsci12010070.
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Diffusion-based magnetic resonance imaging (MRI) studies, namely diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI), have been performed in the context of systemic lupus erythematosus (SLE), either with or without neuropsychiatric (NP) involvement, to deepen cerebral microstructure alterations. These techniques permit the measurement of the variations in random movement of water molecules in tissues, enabling their microarchitecture analysis. While DWI is recommended as part of the initial MRI assessment of SLE patients suspected for NP involvement, DTI is not routinely part of the instrumental evaluation for clinical purposes, and it has been mainly used for research. DWI and DTI studies revealed less restricted movement of water molecules inside cerebral white matter (WM), expression of a global loss of WM density, occurring in the context of SLE, prevalently, but not exclusively, in case of NP involvement. More advanced studies have combined DTI with other quantitative MRI techniques, to further characterize disease pathogenesis, while brain connectomes analysis revealed structural WM network disruption. In this narrative review, the authors provide a summary of the evidence regarding cerebral microstructure analysis by DWI and DTI studies in SLE, focusing on lessons learned and future research perspectives.
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Kim, Jeong Hun, Doh Hun Gwon, Gun Yeong Kim, Byeong Hwan Ahn, Min Su Lee, and Dong Seong Kim. "Comparison of Image Quality between 3D Shim DWI and i-shim DWI in Whole Body DWI." Journal of the Korean Society of MR Technology 28, no. 2 (September 30, 2018): 25–33. http://dx.doi.org/10.31159/ksmrt.2018.28.2.25.
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Ljimani, Alexandra, Anna Caroli, Christoffer Laustsen, Susan Francis, Iosif Alexandru Mendichovszky, Octavia Bane, Fabio Nery, et al. "Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI." Magnetic Resonance Materials in Physics, Biology and Medicine 33, no. 1 (November 1, 2019): 177–95. http://dx.doi.org/10.1007/s10334-019-00790-y.
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Abstract Objectives Standardization is an important milestone in the validation of DWI-based parameters as imaging biomarkers for renal disease. Here, we propose technical recommendations on three variants of renal DWI, monoexponential DWI, IVIM and DTI, as well as associated MRI biomarkers (ADC, D, D*, f, FA and MD) to aid ongoing international efforts on methodological harmonization. Materials and methods Reported DWI biomarkers from 194 prior renal DWI studies were extracted and Pearson correlations between diffusion biomarkers and protocol parameters were computed. Based on the literature review, surveys were designed for the consensus building. Survey data were collected via Delphi consensus process on renal DWI preparation, acquisition, analysis, and reporting. Consensus was defined as ≥ 75% agreement. Results Correlations were observed between reported diffusion biomarkers and protocol parameters. Out of 87 survey questions, 57 achieved consensus resolution, while many of the remaining questions were resolved by preference (65–74% agreement). Summary of the literature and survey data as well as recommendations for the preparation, acquisition, processing and reporting of renal DWI were provided. Discussion The consensus-based technical recommendations for renal DWI aim to facilitate inter-site harmonization and increase clinical impact of the technique on a larger scale by setting a framework for acquisition protocols for future renal DWI studies. We anticipate an iterative process with continuous updating of the recommendations according to progress in the field.
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Bonde, Apurva, Eduardo Andreazza Dal Lago, Bryan Foster, Sanaz Javadi, Sarah Palmquist, and Priya Bhosale. "Utility of the Diffusion Weighted Sequence in Gynecological Imaging: Review Article." Cancers 14, no. 18 (September 15, 2022): 4468. http://dx.doi.org/10.3390/cancers14184468.
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Functional imaging with diffusion-weighted imaging (DWI) is a complementary tool to conventional diagnostic magnetic resonance imaging sequences. It is being increasingly investigated to predict tumor response and assess tumor recurrence. We elucidate the specific technical modifications of DWI preferred for gynecological imaging, including the different b-values and planes for image acquisition. Additionally, we discuss the problems and potential pitfalls encountered during DWI interpretation and ways to overcome them. DWI has a wide range of clinical applications in malignant and non-malignant gynecological conditions. It provides supplemental information helpful in diagnosing and managing tubo-ovarian abscess, uterine fibroids, endometriosis, adnexal torsion, and dermoid. Similarly, DWI has diverse applications in gynecological oncology in diagnosis, staging, detection of recurrent disease, and tumor response assessment. Quantitative evaluation with apparent diffusion coefficient (ADC) measurement is being increasingly evaluated for correlation with various tumor parameters in managing gynecological malignancies aiding in preoperative treatment planning. Newer advanced DWI techniques of diffusion tensor imaging (DTI) and whole body DWI with background suppression (DWIBS) and their potential uses in pelvic nerve mapping, preoperative planning, and fertility-preserving surgeries are briefly discussed.
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Narag, Raymund E., Sheila Royo Maxwell, and Byung Lee. "A Phenomenological Approach to Assessing a DUI/DWI Program." International Journal of Offender Therapy and Comparative Criminology 57, no. 2 (February 1, 2012): 229–50. http://dx.doi.org/10.1177/0306624x11431685.
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In an effort to find a more proactive solution to the problem of drunk driving, a midwestern city has implemented a Driving Under the Influence or Driving While Impaired (DUI/DWI) Court program, a derivative of the popular drug courts. Eligible participants are those who have had two or more drunk-driving offenses but who have not been convicted of a violent offense. Participants volunteer for a 36-week program in exchange for a suspension of their prison sentence. Program elements include drug/alcohol monitoring, support groups, counseling, and extensive supervision. Using a phenomenological approach, this article describes the challenges faced by 20 participants, how they navigated the program requirements, their key realizations about their conditions, and their views on the viability and effectiveness of the program. The article uses qualitative interviews of participants and stakeholders collected for a process evaluation of the DUI program, and official records collected for programming purposes. Findings from this research can be used broadly for programming purposes and can be used by other court jurisdictions that are developing similar programs.
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Tristán-Vega, Antonio, and Santiago Aja-Fernández. "DWI filtering using joint information for DTI and HARDI." Medical Image Analysis 14, no. 2 (April 2010): 205–18. http://dx.doi.org/10.1016/j.media.2009.11.001.
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Demirci, Deniz. "DWI and DTI findings of skeletal muscles following exercise." International Journal of Academic Research 5, no. 6 (December 10, 2013): 53–57. http://dx.doi.org/10.7813/2075-4124.2013/5-6/a.7.
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Schellinger, Peter D., and Martin Köhrmann. "MRA/DWI Mismatch." Stroke 39, no. 9 (September 2008): 2423–24. http://dx.doi.org/10.1161/strokeaha.108.516963.
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Wieczorek, William F., and James J. Coyle. "Targeting DWI Prevention." Journal of Prevention & Intervention in the Community 17, no. 1 (June 10, 1998): 15–30. http://dx.doi.org/10.1300/j005v17n01_02.
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Granata, Vincenza, Roberta Fusco, Sergio Venanzio Setola, Raffaele Palaia, Vittorio Albino, Mauro Piccirillo, Robert Grimm, Antonella Petrillo, and Francesco Izzo. "Diffusion kurtosis imaging and conventional diffusion weighted imaging to assess electrochemotherapy response in locally advanced pancreatic cancer." Radiology and Oncology 53, no. 1 (January 19, 2019): 15–24. http://dx.doi.org/10.2478/raon-2019-0004.
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Abstract Background The aim of the study was to evaluate diagnostic performance of functional parameters derived by conventional mono-exponential approach of diffusion weighted imaging (DWI) and by diffusion kurtosis imaging (DKI) in the assessment of pancreatic tumours treated with electrochemotherapy (ECT). Patients and methods Twenty-one consecutive patients with locally advanced pancreatic adenocarcinoma subjected to ECT were enrolled in a clinical approved trial. Among twenty-one enrolled patients, 13/21 (61.9%) patients were subjected to MRI before and after ECT. DWI was performed with a 1.5 T scanner; a free breathing axial single shot echo planar DWI pulse sequence parameters were acquired using seven b value = 0, 50, 100, 150, 400, 800, 1000 s/mm2. Apparent diffusion coefficient by conventional mono-exponential approach and mean of diffusion coefficient (MD) and mean of diffusional kurtosis (MK) by DKI approach were derived from DWI. Receiver operating characteristic (ROC) analysis was performed and sensitivity, specificity, positive and negative predictive value were calculated. Results Among investigated diffusion parameters, only the MD derived by DKI showed a significant variation of values between pre and post treatment (p = 0.02 at Wilcoxon test) and a significant statistically difference for percentage change between responders and not responders (p = 0.01 at Kruskal Wallis test). MD had a good diagnostic performance with a sensitivity of 80%, a specificity of 100% and area under ROC of 0.933. Conclusions MD derived by DKI allows identifying responders and not responders patients subject to ECT treatment. MD had higher diagnostic performance to assess ECT response compared to conventional DWI derived parameters.
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Shahbazi-Gahrouei, Daryoush, Fahimeh Aminolroayaei, Hamide Nematollahi, Mohammad Ghaderian, and Sogand Shahbazi Gahrouei. "Advanced Magnetic Resonance Imaging Modalities for Breast Cancer Diagnosis: An Overview of Recent Findings and Perspectives." Diagnostics 12, no. 11 (November 9, 2022): 2741. http://dx.doi.org/10.3390/diagnostics12112741.
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Breast cancer is the most prevalent cancer among women and the leading cause of death. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are advanced magnetic resonance imaging (MRI) procedures that are widely used in the diagnostic and treatment evaluation of breast cancer. This review article describes the characteristics of new MRI methods and reviews recent findings on breast cancer diagnosis. This review study was performed on the literature sourced from scientific citation websites such as Google Scholar, PubMed, and Web of Science until July 2021. All relevant works published on the mentioned scientific citation websites were investigated. Because of the propensity of malignancies to limit diffusion, DWI can improve MRI diagnostic specificity. Diffusion tensor imaging gives additional information about diffusion directionality and anisotropy over traditional DWI. Recent findings showed that DWI and DTI and their characteristics may facilitate earlier and more accurate diagnosis, followed by better treatment. Overall, with the development of instruments and novel MRI modalities, it may be possible to diagnose breast cancer more effectively in the early stages.
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Gräfe, Daniel, Anne Päts, Andreas Merkenschlager, Christian Roth, Franz Wolfgang Hirsch, Jens Frahm, and Dirk Voit. "STEAM-DWI as a robust alternative to EPI-DWI: Evaluation in pediatric brain MRI." PLOS ONE 17, no. 5 (May 18, 2022): e0268523. http://dx.doi.org/10.1371/journal.pone.0268523.
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Purpose Diffusion-weighted imaging (DWI) is an essential element of almost every brain MRI examination. The most widely applied DWI technique, a single-shot echo-planar imaging DWI (EPI-DWI) sequence, suffers from a high sensitivity to magnetic field inhomogeneities. As an alternative, a single-shot stimulated echo acquisition mode diffusion-weighted MRI (STEAM-DWI) has recently been re-introduced after it became significantly faster. The aim of the study was to investigate the applicability of STEAM-DWI as a substitute to EPI-DWI in a daily routine of pediatric radiology. Methods Retrospectively, brain MRI examinations of 208 children with both EPI-DWI and STEAM-DWI were assessed. Visual resolution and diagnostic confidence were evaluated, the extent of susceptibility artifacts was quantified, and contrast-to-noise ratio was calculated in case of diffusion restriction. Furthermore, the correlation of apparent diffusion coefficient values between STEAM-DWI and EPI-DWI was tested. Results STEAM-DWI was inferior to EPI-DWI in visual resolution but with higher diagnostic confidence and lower artifact size. The apparent diffusion coefficient values of both sequences demonstrated excellent correlation. The contrast-to-noise ratio of STEAM-DWI was only half of that of EPI-DWI (58% resp. 112%). Conclusion STEAM-DWI is a robust alternative to EPI-DWI when increased susceptibility artifacts are to be expected. Drawbacks are a lower contrast-to-noise ratio and poorer visual resolution.
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Zheng, Yu-quan, and Xiao-mei Li. "Comparison of Diagnostic Effects of T2-Weighted Imaging, DWI, SWI, and DTI in Acute Cerebral Infarction." Cardiovascular Innovations and Applications 5, no. 4 (May 1, 2021): 283–87. http://dx.doi.org/10.15212/cvia.2021.0012.
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Objective: To achieve precision medicine, the use of imaging methods to help the clinical detection of cerebral infarction is conducive to the clinical development of a treatment plan and increase of the cure rate and improvement of the prognosis of patients.Methods: In this work, T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and diffusion tensor imaging (DTI) examinations were performed on 34 patients with clinically diagnosed cerebral infarction to measure the difference in signal intensity between the lesion and its mirror area and make a comparative analysis by means of the Student-Newman-Keuls method.Results: The detection rate of T2WI was 79% (27/34), the detection rate of DWI was 97% (33/34), the detection rate of SWI was 88% (30/34), and the detection rate of DTI was 94% (32/34).Conclusion: The imaging performance was in the order DWI > DTI > SWI > T2WI for the diagnosis of cerebral infarction, and combined imaging is better than single imaging.
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Wang, Enfeng, Yin Wu, Jerry S. Cheung, Iris Yuwen Zhou, Takahiro Igarashi, XiaoAn Zhang, and Phillip Zhe Sun. "pH imaging reveals worsened tissue acidification in diffusion kurtosis lesion than the kurtosis/diffusion lesion mismatch in an animal model of acute stroke." Journal of Cerebral Blood Flow & Metabolism 37, no. 10 (July 28, 2017): 3325–33. http://dx.doi.org/10.1177/0271678x17721431.
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Diffusion weighted imaging (DWI) has been commonly used in acute stroke examination, yet a portion of DWI lesion may be salvageable. Recently, it has been shown that diffusion kurtosis imaging (DKI) defines the most severely damaged DWI lesion that does not renormalize following early reperfusion. We postulated that the diffusion and kurtosis lesion mismatch experience heterogeneous hemodynamic and/or metabolic injury. We investigated tissue perfusion, pH, diffusion, kurtosis and relaxation from regions of the contralateral normal area, diffusion lesion, kurtosis lesion and their mismatch in an animal model of acute stroke. Our study revealed significant kurtosis and diffusion lesion volume mismatch (19.7 ± 10.7%, P < 0.01). Although there was no significant difference in perfusion and diffusion between the kurtosis lesion and kurtosis/diffusion lesion mismatch, we showed lower pH in the kurtosis lesion (pH = 6.64 ± 0.12) from that of the kurtosis/diffusion lesion mismatch (6.84 ± 0.11, P < 0.05). Moreover, pH in the kurtosis lesion and kurtosis/diffusion mismatch agreed well with literature values for regions of ischemic core and penumbra, respectively. Our work documented initial evidence that DKI may reveal the heterogeneous metabolic derangement within the commonly used DWI lesion.
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Das, Sushant Kumar, Dong Jun Yang, Jin Liang Wang, Chuan Zhang, and Han Feng Yang. "Non-Gaussian diffusion imaging for malignant and benign pulmonary nodule differentiation: a preliminary study." Acta Radiologica 58, no. 1 (July 19, 2016): 19–26. http://dx.doi.org/10.1177/0284185116639763.
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Background Diffusion-weighted imaging (DWI) derived apparent diffusion coefficient (ADC) has demonstrated inconsistent results in pulmonary nodule differentiation. Diffusion kurtosis imaging (DKI), which quantifies non-Gaussian diffusion, is believed to better characterize tissue micro-structure than conventional DWI. Purpose To assess the feasibility of DKI in human lungs and to compare its diagnostic value with standard DWI in differentiating malignancies from benign pulmonary nodules. Material and Methods Thirty-five pulmonary nodules in 32 consecutive patients were evaluated by DKI by using 3b-values of 0, 500, and 1000 s/mm2 and conventional DWI with b values of 0 and 800 s/mm2. Two observers independently evaluated and compared diagnostic accuracy of mean kurtosis (MK) and ADC values in differentiating malignancies from benign pulmonary nodules. The intra- and inter-observer repeatability (intra-class correlation coefficient [ICC]) were also assessed for each derived measures. Results The diagnostic accuracy, and the area under curve (AUC) in differentiating malignancies from benign pulmonary nodule, were not significantly higher for MK (Obs. 1a: 85.70%, 0.87; Obs. 1b: 80.00%, 0.80; and Obs. 2: 82.80%, 0.91) as compared to ADC (Obs. 1a: 77.14%, 0.81; Obs. 1b: 80.00%, 0.85; and Obs. 2: 77.14%, 0.85 respectively). The intra- and inter-observer agreement (ICC) for malignant and benign lesions was substantial for each reading. Conclusion The initial results of this study indicate the feasibility of DKI in human lungs. However, there was no significant benefit of DKI derived MK values over ADC for malignant and benign pulmonary nodule differentiation.
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Ogawa, Masaki, Misugi Urano, Taku Takaishi, Hirohito Kan, Nobuyuki Arai, Hiroki Takahashi, Masayasu Hara, Miki Saito, and Yuta Shibamoto. "T-staging of rectal cancer: Utility of single-shot turbo spin-echo diffusion-weighted imaging with T2-weighted images and fusion images." PLOS ONE 16, no. 4 (April 21, 2021): e0249433. http://dx.doi.org/10.1371/journal.pone.0249433.
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Purpose The purpose of this study was to evaluate the usefulness of turbo spin-echo (TSE) DWI with fusion images in the T-staging compared with T2-weighted imaging (T2WI) alone and conventional echo-planner imaging (EPI) DWI. Methods In this prospective study, 4-mm-thick axial EPI-DWI, TSE-DWI, and T2WI were performed with the same slice locations for 20 patients with rectal cancer. Fusion images of DWI and T2WI were created for both EPI-DWI and TSE-DWI. Ten readers independently diagnosed the T-stages and scored the degree of confidence referring to T2WI alone and then to DWI, T2WI, and fusion images (DWI+T2WI) for each EPI-DWI and TSE-DWI. Visual score assessments of image quality were performed for each DWI. Results Inter-observer agreement of T-staging for 10 readers was slight on T2WI alone but fair on EPI-DWI+T2WI and excellent on TSE-DWI+T2WI images. No readers gave higher confidence scores for T2WI compared to EPI/TSE-DWI+T2WI and for EPI-DWI+T2WI compared to TSE-DWI+T2WI. In seven pathologically-proven cases, poor, poor to slight, and fair to perfect agreements with the pathological T-stage were observed with T2WI alone, EPI-DWI+T2WI, and TSE-DWI+T2WI, respectively. All readers gave higher scores regarding image distortion and lower scores regarding image noise for TSE-DWI compared to EPI-DWI. For DWI utility, higher scores were assigned for TSE-DWI compared to EPI-DWI in 7 readers and there were no significant differences in the other 3 readers. Conclusion TSE-DWI images might be more appropriate for image fusion with T2WI and rectal cancer T-staging compared with EPI-DWI and T2WI alone.
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Agung Wardana, Raynold Dwi. "Raynold Dwi Agung Wardana." ALINIER: Journal of Artificial Intelligence & Applications 2, no. 1 (May 31, 2021): 14–21. http://dx.doi.org/10.36040/alinier.v2i1.3268.
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Robot sepak bola beroda adalah suatu robot yang bekerja secara tim untuk melakukan permainan sepak bola. Peran penjaga gawang dalam permainan ini sangat penting di lapangan karena merupakan pertahan terakhir menyelamatkan bola sebelum bola masuk gawang pertahanan area sendiri. Robot sepak bola penjaga gawang dengan menggunakan metode odometry diatur oleh pergerakan pada robot menuju titik yang ditarget di (x,y) sehingga penggerakan robot penjaga gawang. Odometry yang menggunakan empat rotary encoder internal motor sebagai pembacaan pulsa, mempunyai selisih sudut motor satu 45⁰, motor dua 135⁰, motor tiga 225⁰, motor empat 315⁰. Dengan system metode PID untuk mengatur kecepatan roda sehingga didapatkan respon kecepatan yang cepat mencapai set point serta setabil. Pada pengujian metode ini memakai lapangan robot sepak bola beroda dengan ukuran setengah lapangan 4.5m x 6m, pada sensor rotary encoder internal motor sebesar 0.5 putaran 37.5 pulsa jarak dihasilkan 10 cm, 1 putaran 75 pulsa jarak dihasilkan 24 cm, 1,5 putaran 112.5 pulsa jarak dihasilkan 35 cm, 2 putaran 150 pulsa jarak dihasilkan 49 cm, dan Mean Error 1%.
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Habibie, Dedi Kusuma. "Dwi Fungsi Media Massa." Interaksi: Jurnal Ilmu Komunikasi 7, no. 2 (December 28, 2018): 79. http://dx.doi.org/10.14710/interaksi.7.2.79-86.
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Mass media should provide constructive information in order to full fill its function as a tool for developing nations. However, mass media usually face a conflict of interest in doing the role, for example in the Indonesian case there is a strong political economy interest of media owner that limiting media’s role as political control. This study sees those is a crucial problem of Indonesian media as it will decrease the quality of Indonesian media and as the consequences, it will lose public trust. By using descriptive qualitative method this article doing a theoretical review to explain the role of Indonesian media in the political communication and how the media doing their role as information and political channel in the political communication process. This study suggests the media do a role called ‘dwifungsi media’ that suggest media to do its function comprehensively.
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Moseley, Michael E., Kim Butts, Midori A. Yenari, Michael Marks, and Alex De Crespigny. "Clinical Aspects of DWI." NMR in Biomedicine 8, no. 7 (November 1995): 387–96. http://dx.doi.org/10.1002/nbm.1940080712.
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Cavanaugh, Michael R., and Travis W. Franklin. "Do DWI Courts Work? an Empirical Evaluation of a Texas DWI Court." Journal of Offender Rehabilitation 51, no. 4 (May 2012): 257–74. http://dx.doi.org/10.1080/10509674.2011.641074.
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Lei, Qiang, Qi Wan, Lishan Liu, Jianfeng Hu, Wei Zuo, Jianneng Li, Guihua Jiang, and Xinchun Li. "Values of Apparent Diffusion Coefficient and Lesion-to-Spinal Cord Signal Intensity in Diagnosing Solitary Pulmonary Lesions: Turbo Spin-Echo versus Echo-Planar Imaging Diffusion-Weighted Imaging." BioMed Research International 2021 (August 10, 2021): 1–8. http://dx.doi.org/10.1155/2021/3345953.
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Objective. This study is aimed at comparing the image quality and diagnostic performance of mean apparent diffusion coefficient (ADC) and lesion-to-spinal cord signal intensity ratio (LSR) derived from turbo spin-echo diffusion-weighted imaging (TSE-DWI) and echo-planar imaging- (EPI-) DWI in patients with a solitary pulmonary lesion (SPL). Methods. 33 patients with SPL underwent chest imaging using EPI-DWI and TSE-DWI with b = 600 s/mm2 in free breathing. A comparison of the distortion ratio (DR), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) was drawn between the two techniques using a Wilcoxon signed-rank test. The interprotocol reproducibility between quantitative parameters of EPI-DWI and TSE-DWI was evaluated using a Bland-Altman plot. ADCs and LSRs derived from EPI-DWI and TSE-DWI were calculated and compared between malignant and benign groups using the Mann–Whitney test. Results. TSE-DWI had similar SNR and CNR compared with EPI-DWI. DR was significantly lower on TSE-DWI than EPI-DWI. ADC and LSR showed slightly higher values with TSE-DWI, while the Bland-Altman analysis showed unacceptable limits of agreement between the two sequences. ADC and LSR of both DWI techniques differed significantly between lung cancer and benign lesions ( P < 0.05 ). The LSR(EPI-DWI) showed the highest area under the curve ( AUC = 0.818 ), followed by ADC(EPI-DWI) ( AUC = 0.789 ), ADC(TSE-DWI) ( AUC = 0.781 ), and LSR(TSE-DWI) ( AUC = 0.748 ), respectively. Among these parameters, the difference in diagnostic accuracy was not statistically significant. Conclusions. TSE-DWI provides significantly improved image quality in patients with SPL as compared with EPI-DWI. However, there was no difference in diagnostic efficacy between these two techniques, according to ADC and LSR.
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Hausmann, Daniel, Inga Todorski, Alexandra Pindur, Elisabeth Weiland, Thomas Benkert, Lars Bosshard, Michael Prummer, and Rahel A. Kubik-Huch. "Advanced Diffusion-Weighted Imaging Sequences for Breast MRI: Comprehensive Comparison of Improved Sequences and Ultra-High B-Values to Identify the Optimal Combination." Diagnostics 13, no. 4 (February 7, 2023): 607. http://dx.doi.org/10.3390/diagnostics13040607.
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This study investigated the image quality and choice of ultra-high b-value of two DWI breast-MRI research applications. The study cohort comprised 40 patients (20 malignant lesions). In addition to s-DWI with two m-b-values (b50 and b800) and three e-b-values (e-b1500, e-b2000, and e-b2500), z-DWI and IR m-b1500 DWI were applied. z-DWI was acquired with the same measured b-values and e-b-values as the standard sequence. For IR m-b1500 DWI, b50 and b1500 were measured, and e-b2000 and e-b2500 were mathematically extrapolated. Three readers used Likert scales to independently analyze all ultra-high b-values (b1500–b2500) for each DWI with regards to scan preference and image quality. ADC values were measured in all 20 lesions. z-DWI was the most preferred (54%), followed by IR m-b1500 DWI (46%). b1500 was significantly preferred over b2000 for z-DWI and IR m-b1500 DWI (p = 0.001 and p = 0.002, respectively). Lesion detection was not significantly different among sequences or b-values (p = 0.174). There were no significant differences in measured ADC values within lesions between s-DWI (ADC: 0.97 [±0.09] × 10−3 mm2/s) and z-DWI (ADC: 0.99 [±0.11] × 10−3 mm2/s; p = 1.000). However, there was a trend toward lower values in IR m-b1500 DWI (ADC: 0.80 [±0.06] × 10−3 mm2/s) than in s-DWI (p = 0.090) and z-DWI (p = 0.110). Overall, image quality was superior and there were fewer image artifacts when using the advanced sequences (z-DWI + IR m-b1500 DWI) compared with s-DWI. Considering scan preferences, we found that the optimal combination was z-DWI with a calculated b1500, especially regarding examination time.
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Chen, Haosheng, Junjie Liu, Zhen Lei, and Gibton Gretrhen. "The Value of CT and MRI Examination in the Diagnosis of Diffuse Axonal Injury." Journal of Medical Imaging and Health Informatics 10, no. 8 (August 1, 2020): 1955–61. http://dx.doi.org/10.1166/jmihi.2020.3106.
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Objective: To compare the number of detections of diffuse axonal injury (DAI) lesions between CT and MRI routine sequences (T1WI, T2WI, FLAIR) and special sequences (DWI, SWI). There is no difference in the detection rate of hemorrhagic lesions and non-hemorrhagic lesions with diffuse axonal injury, and more clinically valuable diagnostic methods are obtained to improve the clinical understanding of the detection and disease of diffuse axonal injury. Methods: The paper collected 37 cases of clinical data and imaging data of patients with diffuse axonal injury clinically diagnosed from March 2017 to January 2019 in our hospital. The patients underwent CT scan of the Department of Radiology in our hospital within 72 hours after the injury, and MRI was performed one week after admission according to the stable condition. The imaging data was obtained from the radiology consciousness readings. Results: A total of 37 patients underwent imaging studies. The number of missed CT scans in the brainstem was relatively small compared with other locations, and the number of missed diagnosis of lesions in the cerebellum was higher. In the conventional MRI sequence, FLAIR detected the most lesions, and the difference between the number of lesions detected by T1WI and T2WI was statistically significant (χ2 = 22.930, P = 0.011 < 0.05). Among the special sequences, the number of SWI lesions was the highest, and the difference between DWI and SWI was statistically significant (χ2 = 13.090, P = 0.002 < 0.05). The number of detected CT, FLAIR and SWI was compared. The number of SWI detected was the most, and the difference was statistically significant (χ2 = 19.634, P = 0.033 < 0.05). DWI had the highest detection rate for hemorrhagic lesions, followed by FLAIR (χ2 = 188.168, P < 0.001). SWI had the highest detection rate for hemorrhagic lesions, followed by DWI (χ2 = 1363.452, P < 0.001). Conclusion: The most common number of lesions detected in patients with DAI is the SWI sequence. For the detection of hemorrhagic lesions, SWI has obvious advantages. In non-hemorrhagic lesions, the detection rate of DWI is significantly higher than other sequences. Therefore, it can be said that the DWI and SWI sequences provide an important imaging basis for the definitive diagnosis of DAI, and have high application value.
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Ye, Chenfei, Heather Ting Ma, Jun Wu, Pengfei Yang, Xuhui Chen, Zhengyi Yang, and Jingbo Ma. "DWI-Based Neural Fingerprinting Technology: A Preliminary Study on Stroke Analysis." BioMed Research International 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/725052.
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Stroke is a common neural disorder in neurology clinics. Magnetic resonance imaging (MRI) has become an important tool to assess the neural physiological changes under stroke, such as diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI). Quantitative analysis of MRI images would help medical doctors to localize the stroke area in the diagnosis in terms of structural information and physiological characterization. However, current quantitative approaches can only provide localization of the disorder rather than measure physiological variation of subtypes of ischemic stroke. In the current study, we hypothesize that each kind of neural disorder would have its unique physiological characteristics, which could be reflected by DWI images on different gradients. Based on this hypothesis, a DWI-based neural fingerprinting technology was proposed to classify subtypes of ischemic stroke. The neural fingerprint was constructed by the signal intensity of the region of interest (ROI) on the DWI images under different gradients. The fingerprint derived from the manually drawn ROI could classify the subtypes with accuracy 100%. However, the classification accuracy was worse when using semiautomatic and automatic method in ROI segmentation. The preliminary results showed promising potential of DWI-based neural fingerprinting technology in stroke subtype classification. Further studies will be carried out for enhancing the fingerprinting accuracy and its application in other clinical practices.
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Grattan, Lauren E., Brittney S. Mengistu, Steven H. Bullock, Theresa Jackson Santo, and Dawnyéa D. Jackson. "Restricting Retail Hours of Alcohol Sales within an Army Community." Military Medicine 184, no. 9-10 (April 5, 2019): e400-e405. http://dx.doi.org/10.1093/milmed/usz044.
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Abstract Introduction Excessive alcohol consumption continues to be a significant concern to overall military readiness; each year, it results in non-deployable active duty service members and service members separated from service. In 2009, The Community Preventive Services Task Force recommended limiting the hours of alcohol sales as an evidence-based and effective intervention to reduce alcohol-related harms. In June 2014, partnerships at an Army Installation in the Midwestern United States implemented a policy to reduce excessive alcohol consumption and associated alcohol-related harms. Although community-based interventions have been shown to successfully reduce alcohol-related negative consequences, little research has explored the effects of these interventions in military communities. Materials and Methods The intervention reduced the retail sale of alcoholic beverages by eight hours daily (11:01 pm to 6:59 am) within the installation community. The U.S. Army Public Health Review Board approved this study as public health practice. The quantitative assessment from a mixed-methods evaluation implemented an interrupted time series design to assess changes in the community resulting from the intervention. Revenue and crime data were collected 11 months and 12 months prior to and after the onset of the intervention, respectively, to quantify the adherence to and effectiveness of the policy. The outcome variables measured in the evaluation were Serious Incident Reports (SIRs) and Driving Under the Influence/Driving While Intoxicated (DUI/DWI) citations. A Wilcoxon Signed-Rank Test of significance was used to measure changes in crime outcomes post-policy. Results The results indicated that pre-policy rates of overall DUI/DWI citations, and DUI/DWI citations on-post were significantly higher than post-policy DUI/DWI citations (p < 0.05). The results also indicated that pre-policy rates of overall SIRS, alcohol-related SIRs, and SIRs occurring at night were not statistically higher than post-policy rates (p ≥ 0.05). The pre-policy DUI/DWI citations occurring off-post and DUI/DWI citations occurring at night did not reach statistical significance (p > 0.05). Policy adherence was good and total alcohol sales revenue remained stable before and after policy implementation. Conclusions This was the first known evaluation within a military community to report improvements in crime statistics following an eight hour reduction in daily retail sale hours of alcohol. The reduction in alcohol-related harms presented in this evaluation are typical for small communities implementing alcohol-related policies; however, the effect sizes reported here are larger than those reported in the current literature, suggesting that the policy positively impacted the installation community in decreasing alcohol-related harms. Evaluation data did not show statistically significant reductions in DUI/DWI citations and SIRs occurring during night hours. Further, the evaluation design disallows the ability to draw a causal relationship between the intervention and measured outcomes. Additional installations should consider implementing similar policies to determine if observed effects are replicable. Future studies should include a longitudinal design that would allow for long-lasting changes to be observed within the population, measurement of additional proximal outcomes (e.g., reported alcohol consumption), and investigating social and health outcomes both inside and outside the confines of the installation community.
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Juri, Hiroshi, Akira Higashiyama, Kiyohito Yamamoto, Yoshifumi Narumi, Haruhito Azuma, Kazuhiro Yamamoto, and Keigo Osuga. "Comparison of reduced field-of-view DWI and full field-of view DWI for the differentiation between non-muscle invasive bladder cancer and muscle invasive bladder cancer using VI-RADS." PLOS ONE 17, no. 7 (July 20, 2022): e0271470. http://dx.doi.org/10.1371/journal.pone.0271470.
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Purpose To evaluate whether reduced field-of-view (rFOV) DWI sequence improves the differentiation between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) using VI-RADS. Material and methods Eighty-nine patients underwent bladder MRI with full field-of-view (fFOV) DWI and rFOV DWI sequence. Images were independently evaluated by 2 radiologists. The sensitivities, specificities, accuracies, and areas under the curve (AUCs) for the differentiation between NMIBC and MIBC with fFOV DWI and with rFOV DWI sequence were calculated using VI-RADS. Apparent diffusion coefficients (ADC) values were measured for each patient and averaged. Results The sensitivity, specificity, accuracy, and AUC by reader 1 were 92%, 78%, 82% and 0.905 with fFOV DWI, and 92%, 86%, 88% and 0.916 with rFOV DWI sequence, respectively. The sensitivity, specificity, accuracy and AUC by reader 2 were 96%, 76%, 82% and 0.900 with conventional DWI, and 96%, 81%, 85% and 0.907 with rFOV DWI sequence, respectively. The specificity and accuracy of reader 1 were significantly better with rFOV DWI sequence than with fFOV DWI, in contrast there was no significant difference for the others. The average of ADC values of fFOV DWI and rFOV DWI sequence were 1.004×10−6 mm2/s and 1.003×10−6 mm2/s, respectively. Conclusion The diagnostic ability of rFOV DWI sequence may be better than that of fFOV DWI using VI-RADS for the differentiation between NMIBC and MIBC regardless of image-reading experience, it is controversial.
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Wouters, Anke, Patrick Dupont, Erich B. Ringelstein, Bo Norrving, Angel Chamorro, Martin Grond, Rico Laage, et al. "Association between the Perfusion/Diffusion and Diffusion/FLAIR Mismatch: Data from the AXIS2 Trial." Journal of Cerebral Blood Flow & Metabolism 35, no. 10 (June 3, 2015): 1681–86. http://dx.doi.org/10.1038/jcbfm.2015.108.
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The perfusion-/diffusion-weighted imaging (PWI/DWI) mismatch and the diffusion/fluid attenuated inversion recovery (DWI/FLAIR) mismatch are magnetic resonance imaging (MRI) markers of evolving brain ischemia. We examined whether the DWI/FLAIR mismatch was independently associated with the PWI/DWI mismatch. Furthermore, we determined whether the presence of the DWI/FLAIR mismatch in patients with the PWI/DWI mismatch would provide additional information regarding last seen normal time (LTM). We used data from the ‘AX200 for ischemic stroke’ trial (AXIS 2 study NCT00927836). We studied the association between the presence of the DWI/FLAIR and PWI/DWI mismatch, baseline National Institute of Health Stroke Scale (NIHSS), age, ischemic-core volume, gender, intravenous (IV) tissue plasminogen activator (tPA), and perfusion-mismatch volume in univariate analysis. Significant variables ( P < 0.05) were added into the final multivariate model. We analyzed 197 patients. Seventy-two (37%) had both the PWI/DWI and the DWI/FLAIR mismatch. Patients with the double mismatch pattern had a shorter LTM than patients with the PWI/DWI mismatch alone (Median difference 90 minutes, P < 0.01). Multivariate analysis confirmed the independent association between the two mismatch patterns (odds ratio (OR) 2.6, 95% confidence interval (CI) 1.2 to 5.4). Our study implies that the DWI/FLAIR mismatch and PWI/DWI mismatch are strongly associated, independent from LTM. Furthermore, in the presence of the PWI/DWI mismatch, the DWI/FLAIR pattern indicates a shorter LTM. This could have implications in selecting patients for reperfusion therapy.
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Lestro Henriques, Isabel, María Gutiérrez-Fernández, Berta Rodríguez-Frutos, Jaime Ramos-Cejudo, Laura Otero-Ortega, Teresa Navarro Hernanz, Sebastián Cerdán, José M. Ferro, and Exuperio Díez-Tejedor. "Intralesional Patterns of MRI ADC Maps Predict Outcome in Experimental Stroke." Cerebrovascular Diseases 39, no. 5-6 (2015): 293–301. http://dx.doi.org/10.1159/000381727.
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Background: After acute ischemia, the tissue that is at risk of infarction can be detected by perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch but the time that is needed to process PWI limits its use. As DWI is highly sensitive to acute ischemic tissue damage, we hypothesized that different ADC patterns represent areas with a different potential for recovery. Methods: In a model of permanent middle cerebral artery occlusion (pMCAO), Sprague-Dawley rats were randomly distributed to sham surgery and pMCAO. We further separated the pMCAO group according to intralesional ADC pattern (homogeneous or heterogeneous). At 24 h after ischemia induction, we analyzed lesion size, functional outcome, cell death expression, and brain protection markers including ROS enzyme NOX-4. MRI included DWI (ADC maps), DTI (tractography), and PWI (CBF, CBV and MTT). Results: The lesion size was similar in pMCAO rats. Animals with a heterogeneous pattern in ADC maps showed better functional outcome in Rotarod test (p = 0.032), less expression of cell death (p = 0.014) and NOX-4 (p = 0.0063), higher intralesional CBF (p = 0.0026) and larger PWI/DWI mismatch (p = 0.007). Conclusions: In a rodent model for ischemic stroke, intralesional heterogeneity in ADC maps was related to better functional outcome in lesions of similar size and interval after pMCAO. DWI ADC maps may assist in the early identification of ischemic tissue with an increased potential for recovery as higher expression of acute protection markers, lower expression of cell death, increased PWI/DWI mismatch, and higher intralesional CBF were present in animals with a heterogeneous ADC pattern.
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Steffen, Paul, Lara-Sophie Beyer, Rosalie McDonough, Christian Thaler, Tobias Faizy, Jens Fiehler, Joystone Gbadamosi, Christian R. Habermann, and Michael H. Schönfeld. "Improved Detectability of Brain Stem Ischemia by Combining Axial and Coronal Diffusion-Weighted Imaging." Stroke 52, no. 5 (May 2021): 1843–46. http://dx.doi.org/10.1161/strokeaha.120.032457.
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Background and Purpose: To evaluate the benefit of a coronal diffusion-weighted imaging (DWI) in addition to standard axial DWI for the detection of brain stem infarctions. Methods: A retrospective analysis of patients with symptoms consistent with acute and subacute brain stem infarction who received magnetic resonance imaging, including axial and coronal DWI. Diffusion restrictions were identified by 2 independent raters blinded for the final clinical diagnosis in 3 separate reading steps: axial DWI, coronal DWI, and combined axial and coronal DWI. Lesion location and certainty level were both documented for each reading step. In cases of reader disagreement, an additional consensus reading was performed. Results: Two hundred thirty-nine patients were included. Of these, 124 patients (51.9%) were clinically diagnosed with brain stem infarction. Sensitivity, specificity, positive, and negative predictive values were best for combined DWI assessment (90.3%, 99.1%, 99.1%, and 90.5%) compared with axial (85.5%, 94.9%, 94.6%, and 85.8%) and coronal DWI alone (87.9%, 96.5%, 96.5%, and 88.1%). Diffusion restriction on combined DWI was diagnosed in 112/124 patients compared with 106/124 on axial DWI and 109/124 on coronal DWI. Interobserver agreement for the detection of brain stem lesions was the highest in the combined rating step (Cohen κ coefficient=0.94). Conclusions: Coronal DWI sequences might improve the detection rate of brain stem infarction compared with standard axial DWI. The combined coronal and axial DWI provides the best detection rate while minimally increasing scan times.
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Schulz, Anselm, Eivind Selstø Joelsen-Hatlehol, Kristoffer Watten Brudvik, Kjersti Karoline Aasand, Bettina Hanekamp, Ellen Viktil, Cathrine K. Johansen, and Johann Baptist Dormagen. "Preoperative detection of colorectal liver metastases: DWI alone or combined with MDCT is no substitute for Gd-EOB-DTPA-enhanced MRI." Acta Radiologica 61, no. 3 (July 23, 2019): 302–11. http://dx.doi.org/10.1177/0284185119864000.
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Background Magnetic resonance imaging (MRI) with hepatocyte specific contrast has the highest sensitivity for colorectal liver metastases but comes at high costs and long examination times. Purpose To evaluate if preoperative detection of colorectal liver metastases with less resource-consuming diffusion-weighted imaging (DWI) alone or in combination with multidetector computed tomography (MDCT) can compete with gadolinium-etoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI. Material and Methods Forty-four patients with 123 colorectal liver metastases received MDCT and Gd-EOB-DTPA-enhanced MRI including DWI before liver resection for colorectal liver metastases. Five image sets were evaluated by two radiologists. The DWI set consisted of DWI, ADC map, coronal, axial T2-weighted single-shot sequences. The DWI-T2F set contained additionally respiratory-triggered T2-weighted TSE-SPIR sequences. The MDCT set consisted of four-phase MDCT, the MDCT-DWI set also contained DWI. The CE-MRI set contained all MRI sequences including Gd-EOB-DTPA. Reference standards was histopathology and follow-up. Results CE-MRI set had highest sensitivity ( P ≤ 0.013) with 95% compared to 72%, 73%, 73%, and 87% the for DWI set, DWI-T2W-FS set, MDCT set, and MDCT-DWI set, respectively. The CE-MRI set had the highest sensitivity ( P≤0.012) for colorectal liver metastases <10 mm with 87% compared to 55%, 52%, 23%, and 58% for the DWI set, DWI-T2W-FS set, MDCT set, and MDCT-DWI set, respectively. The MDCT-DWI set improved sensitivity overall and in size-dependent subgroup analyses compared to the MDCT set ( P ≤ 0.031). The MDCT-DWI set showed the highest specificity of 98% followed by 98%, 98%, 95%, and 88% for the DWI set, DWI-T2W-FS set, MDCT set, and CE-MRI set, respectively. Conclusion The less resource and time-consuming DWI sets are inferior to Gd-EOB-DTPA-enhanced MRI for the detection of colorectal liver metastases. Gd-EOB-DTPA-enhanced MRI with its excellent sensitivity should be the preferred preoperative modality when meticulous lesion identification is essential. Combination of DWI with MDCT improved significantly sensitivity compared to each modality alone.
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Abu Hamdeh, Sami, Niklas Marklund, Anders Lewén, Tim Howells, Raili Raininko, Johan Wikström, and Per Enblad. "Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures." Journal of Neurosurgery 131, no. 2 (August 2019): 604–11. http://dx.doi.org/10.3171/2018.4.jns18185.
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OBJECTIVEIncreased intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) with diffuse axonal injury (DAI) is not well defined. This study investigated the occurrence of increased ICP and whether clinical factors and lesion localization on MRI were associated with increased ICP in patients with DAI.METHODSFifty-two patients with severe TBI (median age 24 years, range 9–61 years), who had undergone ICP monitoring and had DAI on MRI, as determined using T2*-weighted gradient echo, susceptibility-weighted imaging, and diffusion-weighted imaging (DWI) sequences, were enrolled. The proportion of good monitoring time (GMT) with ICP > 20 mm Hg during the first 120 hours postinjury was calculated and associations with clinical and MRI-related factors were evaluated using linear regression.RESULTSAll patients had episodes of ICP > 20 mm Hg. The mean proportion of GMT with ICP > 20 mm Hg was 5%, and 27% of the patients (14/52) spent more than 5% of GMT with ICP > 20 mm Hg. The Glasgow Coma Scale motor score at admission (p = 0.04) and lesions on DWI sequences in the substantia nigra and mesencephalic tegmentum (SN-T, p = 0.001) were associated with the proportion of GMT with ICP > 20 mm Hg. In multivariable linear regression, lesions on DWI sequences in SN-T (8% of GMT with ICP > 20 mm Hg, 95% CI 3%–13%, p = 0.004) and young age (−0.2% of GMT with ICP > 20 mm Hg, 95% CI −0.07% to −0.3%, p = 0.002) were associated with increased ICP.CONCLUSIONSIncreased ICP occurs in approximately one-third of patients with severe TBI who have DAI. Age and lesions on DWI sequences in the central mesencephalon (i.e., SN-T) are associated with elevated ICP. These findings suggest that MR lesion localization may aid prediction of increased ICP in patients with DAI.
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van Veluw, Susanne J., Arne Lauer, Andreas Charidimou, Narimene Bounemia, Li Xiong, Gregoire Boulouis, Panagiotis Fotiadis, et al. "Evolution of DWI lesions in cerebral amyloid angiopathy." Neurology 89, no. 21 (October 25, 2017): 2136–42. http://dx.doi.org/10.1212/wnl.0000000000004668.
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Objective:To address the pathophysiologic nature of small diffusion-weighted imaging (DWI) lesions in patients with cerebral amyloid angiopathy (CAA) who underwent serial MRI. Specifically, we tested (1) whether DWI lesions occurred preferentially in individuals with prior DWI lesions, (2) the cross-sectional association with chronic cortical cerebral microinfarcts (CMIs), and (3) the evolution of DWI lesions over time.Methods:Patients with probable CAA (n = 79) who underwent at least 2 MRI sessions were included. DWI lesions were assessed at each available time point. Lesion appearance and characteristics were assessed on available structural follow-up images. Presence and burden of other neuroimaging markers of small vessel disease (white matter hyperintensities, cerebral microbleeds, cortical superficial siderosis, and chronic cortical CMIs) were assessed as well.Results:Among 221 DWI scans (79 patients with 2 DWI scans; 40 with ≥3), 60 DWI lesions were found in 28 patients. Patients with DWI lesions at baseline were not more likely to have additional DWI lesions on follow-up compared to patients without DWI lesions at baseline. DWI lesions were associated with chronic cortical CMIs and cortical superficial siderosis, but not with other markers. For 39/60 DWI lesions, >1 MRI sequence was available at follow-up to determine lesion evolution. Twenty-four (62%) were demarcated as chronic lesions on follow-up MRI. Five appeared as cavitations, 18 as noncavitated infarcts, and 1 underwent hemorrhagic transformation.Conclusions:Based on their neuroimaging signature as well as their association with chronic cortical CMIs, DWI lesions appear to have an ischemic origin and represent one part of the CMI spectrum.
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Edlow, Brian L., Shelley Hurwitz, and Jonathan A. Edlow. "Diagnosis of DWI-negative acute ischemic stroke." Neurology 89, no. 3 (June 14, 2017): 256–62. http://dx.doi.org/10.1212/wnl.0000000000004120.
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Objective:To determine the prevalence of diffusion-weighted imaging (DWI)–negative acute ischemic stroke (AIS) and to identify clinical characteristics of patients with DWI-negative AIS.Methods:We systematically searched PubMed and Ovid/MEDLINE for relevant studies between 1992, the year that the DWI sequence entered clinical practice, and 2016. Studies were included based upon enrollment of consecutive patients presenting with a clinical diagnosis of AIS prior to imaging. Meta-analysis was performed to synthesize study-level data, estimate DWI-negative stroke prevalence, and estimate the odds ratios (ORs) for clinical characteristics associated with DWI-negative stroke.Results:Twelve articles including 3,236 AIS patients were included. The meta-analytic synthesis yielded a pooled prevalence of DWI-negative AIS of 6.8%, 95% confidence interval (CI) 4.9–9.3. In the 5 studies that reported proportion data for DWI-negative and DWI-positive AIS based on the ischemic vascular territory (n = 1,023 AIS patients), DWI-negative stroke was strongly associated with posterior circulation ischemia, as determined by clinical diagnosis at hospital discharge or repeat imaging (OR 5.1, 95% CI 2.3–11.6, p < 0.001).Conclusions:A small but significant percentage of patients with AIS have a negative DWI scan. Patients with neurologic deficits consistent with posterior circulation ischemia have 5 times the odds of having a negative DWI scan compared to patients with anterior circulation ischemia. AIS remains a clinical diagnosis and urgent reperfusion therapy should be considered even when an initial DWI scan is negative.
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Wu, Li, Jing Li, Caixia Fu, Bernd Kühn, and Xiaolin Wang. "Chemotherapy response of pancreatic cancer by diffusion-weighted imaging (DWI) and intravoxel incoherent motion DWI (IVIM-DWI) in an orthotopic mouse model." Magnetic Resonance Materials in Physics, Biology and Medicine 32, no. 4 (March 1, 2019): 501–9. http://dx.doi.org/10.1007/s10334-019-00745-3.
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Sagiyama, Koji, Yuji Watanabe, Ryotaro Kamei, Shingo Baba, and Hiroshi Honda. "Comparison of positron emission tomography diffusion-weighted imaging (PET/DWI) registration quality in a PET/MR scanner: Zoomed DWI vs. Conventional DWI." Journal of Magnetic Resonance Imaging 43, no. 4 (October 6, 2015): 853–58. http://dx.doi.org/10.1002/jmri.25059.
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Joan, Assa Watari, Maghfirotul Iffah, Nyoman Supriyani, I. Putu Eka Juliantara, and Kadek Yuda Astina. "STUDI LITERATUR PERANAN SEKUEN DWI-STIR DAN DWI-SPAIR PADA PENCITRAAN MRI BREAST DENGAN KASUS LESI PAYUDARA." JRI (Jurnal Radiografer Indonesia) 5, no. 1 (May 29, 2022): 1–5. http://dx.doi.org/10.55451/jri.v5i1.99.
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ABSTRACT
Background: Breast cancer is the most common case in Indonesia. One of the modalities for detecting breast cancer is MRI. The DWI sequence is one of the sequences used in MRI Breast. In breast DWI, the use of effective fat suppression techniques is essential. Several studies have stated that the most common fat suppression techniques used in breast MRI are STIR and SPAIR, because they are considered capable of optimally displaying lesion images. Signal intensity and image quality depend on fat suppression technique, the choice of method used for breast DWI should be considered, because it can affect lesion identification and ROI for calculating ADC used to differentiate benign and malignant lesions.
Methods: This study is a literature review study with descriptive qualitative research type. Collect and analyze library sources from several published data. After being reduced based on the topic, 6 main relevant articles were found to be used as a basis to review, describing and discussing the results according to the topic and then criticizing according to the author's view and determining conclusions.
Results: The results of this study showed that DWI-STIR and DWI-SPAIR on MRI Breast imaging have use in suppressing fat and can show the difference between benign and malignant lesions of the breast. With the difference in DWI-SPAIR, the results of SNR and CNR are higher, and DWI-STIR, the results are more homogeneous.
Conclusion: DWI-STIR and DWI-SPAIR can suppress fat and differentiate lesions well. DWI-SPAIR is better for lesion visibility on high-tesla MRI, and DWI-STIR is better for low-tesla MRI.
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Shi, Zhuo, Jiuming Jiang, Han Ouyang, Lizhi Xie, and Xinming Zhao. "With 3 Types of Respiratory Acquisition: 3.0 T Respiratory Triggered Acquisition Can Obtain Higher Quality DWI Images of the Upper Abdomen." Contrast Media & Molecular Imaging 2022 (July 9, 2022): 1–8. http://dx.doi.org/10.1155/2022/9579145.
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Objective. To compare the effects of 1.5 T and 3.0 T upper abdominal magnetic resonance diffusion-weighted imaging (DWI) under three acquisition techniques of breath holding, breath triggering, and free breathing, so as to provide a reference for the usage of upper abdominal DWI scanning. Methods. Twenty-one healthy subjects were selected from social volunteers and underwent routine magnetic resonance imaging (MRI) and DWI on 1.5 T and 3.0 T, respectively. DWI included three acquisition methods: breath triggering, breath holding, and free breathing, and b values were 100 and 800. The DWI image artifacts, image quality, apparent diffusion coefficient (ADC), and the signal-to-noise ratio (SNR) obtained through the three acquisition methods were compared. Results. The 1.5 T free-breathing DWI image quality was the best, while the 3.0 T had the best breath-triggered DWI image quality. The 3.0 T breath-triggered DWI image quality was better than the 1.5 T free-breathing DWI image ( P = 0.012 ), and the SNR of free-breathing DWI was the highest. Between the two field intensities, the SNR of the liver in the 3.0 T group was much lower than that in the 1.5 T group, and obvious differences were not observed in ADC values of normal liver, gallbladder, kidney, spleen, and pancreas. Conclusion. 3.0 T respiratory-triggered acquisition can obtain higher quality DWI images. But in the case of only 1.5 T field strength, free-breathing acquisition of DWI images should be selected.
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Singh, Tanoj Bahadur, Liwu Zhang, Xiaoting Huo, Guoping Liu, Hongyan Ni, Shun Zhang, Wenzhen Zhu, and Jianzhong Yin. "The Diagnostic Ability of rs-DWI to Detect Subtle Acute Infarction Lesion in the Different Regions of the Brain and the Comparison between Different b-Values." BioMed Research International 2018 (June 5, 2018): 1–8. http://dx.doi.org/10.1155/2018/7069192.
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Objective. To evaluate the diagnostic ability of rs-DWI to detect subtle acute infarction lesion in the different regions of the brain in comparison to routine DWI and the comparison between different b-values. Method. 35 acute brain infarction patients were included. The subtle acute infarction lesions in ss-DWI and rs-DWI sequence were evaluated in 9 anatomical regions of the brain, and the ss-EPI DWI was also acquired with different b-values of 0, 1000, 2000, and 3000s/mm2. The McNemar test was performed for comparing the diagnostic ability of ss-DWI and rs-DWI and different b-values. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the whole brain and in each anatomical region were calculated. Result. A total of 406 subtle acute infarction lesions were confirmed. The ss-DWI detected 338 subtle lesions, out of which 318 were true positive and 20 were false positive lesions. The rs-DWI detected 386 subtle lesions, out of which 385 were true positive lesions and 1 was true negative lesion. Sensitivity, specificity, positive predictive value, and negative predictive value in rs-DWI were better than ss-DWI in all anatomical regions of the brain. In the comparison of different b-values, b2000 was found better among b1000, b2000, and b3000. Conclusion. The rs-DWI offers a useful alternative to routine DWI for detecting the subtle acute infarctions, especially in the regions that are susceptible to distortion as in frontal cortex. In addition, high b-value can also provide benefit by increasing diffusion weighting but further raising can deteriorate image quality as SNR is decreased.
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Couture, Sophie, Marie Claude Ouimet, Christina Gianoulakis, Jacques Tremblay, N. M. K. Ng Ying Kin, Serge Brochu, Jens Pruessner, Katarina Dedovic, and Thomas G. Brown. "Lower Cortisol Activity is Associated with First-Time Driving while Impaired." Substance Abuse: Research and Treatment 9 (January 2015): SART.S21353. http://dx.doi.org/10.4137/sart.s21353.
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Driving while impaired (DWI) is a grave and persistent high-risk behavior. Previous work demonstrated that DWI recidivists had attenuated cortisol reactivity compared to non-DWI drivers. This suggests that cortisol is a neurobiological marker of high-risk driving. The present study tested the hypothesis that this initial finding would extend to first-time DWI (fDWI) offenders compared to non-DWI drivers. Male fDWI offenders ( n = 139) and non-DWI drivers ( n = 31) were exposed to a stress task, and their salivary cortisol activity (total output and reactivity) was measured. Participants also completed questionnaires on sensation seeking, impulsivity, substance use, and engagement in risky and criminal behaviors. As hypothesized, fDWI offenders, compared to non-DWI drivers, had lower cortisol reactivity; fDWI offenders also showed lower total output. In addition, cortisol activity was the most important predictor of group membership, after accounting for alcohol misuse patterns and consequences and other personality and problem behavior characteristics. The findings indicate that attenuated cortisol activity is an independent factor associated with DWI offending risk at an earlier stage in the DWI trajectory than previously detected.
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Schaefer, Pamela W., Julian He, George Hunter, Leena Hamberg, and Ramon G. Gonzalez. "Diffusion and Perfusion MRI in Predicting Final Infarct Volume: A Study of 81 Patients with Acute Stroke." Stroke 32, suppl_1 (January 2001): 343. http://dx.doi.org/10.1161/str.32.suppl_1.343-c.
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P25 Purpose: To assess the utility of diffusion weighted imaging, cerebral blood volume, cerebral blood flow and mean transit time mapping in predicting final infarct volume in 81 patients with acute ischemic stroke. Methods: DWI, CBV, CBF and MTT images were obtained in 81 patients within 53 hours of stroke onset. Follow-up CT or T2 weighted MR images were obtained at 1 day to 4 months. Ischemic region volumes were measured on all images. An analysis of covariance with the variables of age, sex, treatment, time from stroke onset to imaging, and lesion type was performed. Linear regressions of DWI, CBV, CBF and MTT versus final infarct volume were obtained. A mismatch was determined if there was greater than 20% difference in volume between the diffusion and perfusion images. Results: Analysis of covariance demonstrated that DWI best predicts final infarct volume and that CBV alone of the other variables significantly improves the DWI prediction of final infarct volume. Linear regression analysis yielded an R 2 of 0.90, slope of 1.24 for DWI versus follow-up, R 2 of 0.84, slope of 1.22 for CBV versus follow-up, R 2 of 0.37, slope of 0.44 for CBF versus follow-up and R 2 of 0.25, slope of 0.33 for MTT versus follow-up. 13/81 patients had a DWI - CBV mismatch with mean lesion growth of 121 % while 68/81 patients had a DWI - CBV match with mean lesion growth of 15%. 36/81 had a DWI - CBF mismatch with mean lesion growth of 56% while 45/81 had a DWI - CBF match with mean lesion growth of 13%. 43/81 had a DWI - MTT mismatch with mean lesion growth of 47%. 38/81 had a DWI - MTT match with mean lesion growth of 16%. Conclusions: Both DWI and CBV are very good predictors of final infarct volume. CBF and MTT maps identify tissue at risk of infarction not identified on DWI or CBV maps. Since this tissue does not always infarct, these maps greatly overestimate final infarct size.The identification of a DWI - CBV, DWI - CBF or DWI - MTT mismatch predicts much more lesion growth compared with a diffusion perfusion match. This is most dramatic for DWI - CBV mismatches. This information may be valuable in the assessment of new therapeutic strategies.
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Yoshizako, Takeshi, Rika Yoshida, Hiroya Asou, Megumi Nakamura, and Hajime Kitagaki. "Comparison between turbo spin-echo and echo planar diffusion-weighted imaging of the female pelvis with 3T MRI." Acta Radiologica Open 10, no. 2 (February 2021): 205846012199473. http://dx.doi.org/10.1177/2058460121994737.
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Background Echo-planar imaging (EPI)-diffusion-weighted imaging (DWI) may take unclear image affected by susceptibility, geometric distortions and chemical shift artifacts. Purpose To compare the image quality and usefulness of EPI-DWI and turbo spin echo (TSE)-DWI in female patients who required imaging of the pelvis. Material and Methods All 57 patients were examined with a 3.0-T MR scanner. Both TSE- and EPI-DWI were performed with b values of 0 and 1000 s/mm2. We compared geometric distortion, the contrast ratio (CR) of the myometrium to the muscle and the apparent diffusion coefficient (ADC) values for the myometrium and lesion. Two radiologists scored the TSE- and EPI-DWI of each patient for qualitative evaluation. Results The mean percent distortion was significantly smaller with TSE- than EPI-DWI ( p = 0.00). The CR was significantly higher with TSE- than EPI-DWI ( p = 0.003). There was a significant difference in the ADC value for the uterus and lesions between the EPI- and TSE-DWI ( p < 0.05). Finally, the ADC values of cancer were significantly different from those for the uterus and benign with both the two sequences ( p < 0.05). The scores for ghosting artifacts were higher with TSE- than EPI-DWI ( p = 0.019). But there were no significant differences between TSE- and EPI-DWI with regard to image contrast and overall image quality. Conclusion TSE-DWI on the female pelvis by 3T MRI produces less distortion and higher CR than EPI-DWI, but there is no difference in contrast and image quality.
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Suny, Ismail. "Dwi Abad Konstitusi Amerika Serikat." Jurnal Hukum & Pembangunan 16, no. 1 (June 14, 2017): 60. http://dx.doi.org/10.21143/jhp.vol16.no1.1192.
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Undang-undang Dasar tertulis yang sampai sekarang dianggap tertua adalah Konstitusi Amerika Serikat. Pemerintah yang didirikan oleh Konstitusi mulai berfungsi 4 Maret 1789, karena itu mulai berlakunya Konstitusi itu dimulai pada tanggal itu, hampir 2 abad yang lalu. Sejak 2 tahun yang lalu Amerika Serikat telah menyelenggarakan konferensi dan kegiatan-kegiatan lain yangmenandai peristiwa penting itu. Konferensi mengenai The Making of Constitutions telah diadakan pada tahun 1983 dengan sukses. Peserta-peserta Konferensi itu, hampir tanpa kecuali memainkan peranan berarti dalam pembuatan konstitusi negeri mereka masing-masing. Kertas kerja dan acara kerja mengenai pembuatan konstitusi oleh perancang-perancang konstitusiitu akan diterbitkan akhir tahun 1985 ini.
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Cabello, J. P., M. Riverol, and J. C. Masdeu. "ALS corticospinal degeneration on DWI." Neurology 62, no. 10 (May 24, 2004): 1834. http://dx.doi.org/10.1212/01.wnl.0000120554.29461.d8.
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Mao, Jiaji, Weike Zeng, Qinyuan Zhang, Zehong Yang, Xu Yan, Huiting Zhang, Mengzhu Wang, Guang Yang, Minxiong Zhou, and Jun Shen. "Differentiation between high-grade gliomas and solitary brain metastases: a comparison of five diffusion-weighted MRI models." BMC Medical Imaging 20, no. 1 (November 23, 2020). http://dx.doi.org/10.1186/s12880-020-00524-w.
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Abstract Background To compare the diagnostic performance of neurite orientation dispersion and density imaging (NODDI), mean apparent propagator magnetic resonance imaging (MAP-MRI), diffusion kurtosis imaging (DKI), diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) in distinguishing high-grade gliomas (HGGs) from solitary brain metastases (SBMs). Methods Patients with previously untreated, histopathologically confirmed HGGs (n = 20) or SBMs (n = 21) appearing as a solitary and contrast-enhancing lesion on structural MRI were prospectively recruited to undergo diffusion-weighted MRI. DWI data were obtained using a q-space Cartesian grid sampling procedure and were processed to generate parametric maps by fitting the NODDI, MAP-MRI, DKI, DTI and DWI models. The diffusion metrics of the contrast-enhancing tumor and peritumoral edema were measured. Differences in the diffusion metrics were compared between HGGs and SBMs, followed by receiver operating characteristic (ROC) analysis and the Hanley and McNeill test to determine their diagnostic performances. Results NODDI-based isotropic volume fraction (Viso) and orientation dispersion index (ODI); MAP-MRI-based mean-squared displacement (MSD) and q-space inverse variance (QIV); DKI-generated radial, mean diffusivity and fractional anisotropy (RDk, MDk and FAk); and DTI-generated radial, mean diffusivity and fractional anisotropy (RD, MD and FA) of the contrast-enhancing tumor were significantly different between HGGs and SBMs (p < 0.05). The best single discriminative parameters of each model were Viso, MSD, RDk and RD for NODDI, MAP-MRI, DKI and DTI, respectively. The AUC of Viso (0.871) was significantly higher than that of MSD (0.736), RDk (0.760) and RD (0.733) (p < 0.05). Conclusion NODDI outperforms MAP-MRI, DKI, DTI and DWI in differentiating between HGGs and SBMs. NODDI-based Viso has the highest performance.
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Hou, Mengyan, Kai Song, Jipeng Ren, Kaiyu Wang, Jinxia Guo, Yongchao Niu, Zhenyu Li, and Dongming Han. "Comparative analysis of the value of amide proton transfer-weighted imaging and diffusion kurtosis imaging in evaluating the histological grade of cervical squamous carcinoma." BMC Cancer 22, no. 1 (January 20, 2022). http://dx.doi.org/10.1186/s12885-022-09205-z.
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Abstract Background Uterine cervical cancer (UCC) was the fourth leading cause of cancer death among women worldwide. The conventional MRI hardly revealing the microstructure information. This study aimed to compare the value of amide proton transfer-weighted imaging (APTWI) and diffusion kurtosis imaging (DKI) in evaluating the histological grade of cervical squamous carcinoma (CSC) in addition to routine diffusion-weighted imaging (DWI). Methods Forty-six patients with CSC underwent pelvic DKI and APTWI. The magnetization transfer ratio asymmetry (MTRasym), apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) were calculated and compared based on the histological grade. Correlation coefficients between each parameter and histological grade were calculated. Results The MTRasym and MK values of grade 1 (G1) were significantly lower than those of grade 2 (G2), and those parameters of G2 were significantly lower than those of grade 3 (G3). The MD and ADC values of G1 were significantly higher than those of G2, and those of G2 were significantly higher than those of G3. MTRasym and MK were both positively correlated with histological grade (r = 0.789 and 0.743, P < 0.001), while MD and ADC were both negatively correlated with histological grade (r = − 0.732 and - 0.644, P < 0.001). For the diagnosis of G1 and G2 CSCs, AUC (APTWI+DKI + DWI) > AUC (DKI + DWI) > AUC (APTWI+DKI) > AUC (APTWI+DWI) > AUC (MTRasym) > AUC (MK) > AUC (MD) > AUC (ADC), where the differences between AUC (APTWI+DKI + DWI), AUC (DKI + DWI) and AUC (ADC) were significant. For the diagnosis of G2 and G3 CSCs, AUC (APTWI+DKI + DWI) > AUC (APTWI+DWI) > AUC (APTWI+DKI) > AUC (DKI + DWI) > AUC (MTRasym) > AUC (MK) > AUC (MD > AUC (ADC), where the differences between AUC (APTWI+DKI + DWI), AUC (APTWI+DWI) and AUC (ADC) were significant. Conclusion Compared with DWI and DKI, APTWI is more effective in identifying the histological grades of CSC. APTWI is recommended as a supplementary scan to routine DWI in CSCs.