Special MR attributes as a part of PET/MRI: DWI

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Case 1: Identification of Small Lesion on DWI

Case History:

60 year old female with obstructive jaundice.

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Findings:

FDG PET/MRI was done for evaluation which revealed an FDG avid mass at the liver hilum (arrows in A, B, C). Another subcentimeter lesion is seen in segment IV an on DWI with restricted diffusion (D, E) which was most discernable on contrast CT (F) or fused PET/MR images(G).

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Case 2: Characterization of liver lesions on DWI

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Case History:

43 year old female with multifocal multicentric bilateral breast cancers.

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Findings:

Digital Mammogram of the bilateral breast in Cranio caudal (A, B) and Mediolateral oblique (MLO) views (C, D) showing radio-dense masses in bilateral breasts with enlarged axillary nodes. Axial post-contrast MR MIP image (right) showing multifocal & multicentric B/L breast masses and B/L axillary nodes.

Two discrete lesions were identified on DWI in liver, one of which in segment II appears bright on DWI &ADC ( arrows in B, C) with no enhancement (arrow in D) and no uptake (arrow in A) suggesting simple cyst. Another lesion in segment VI which appears bright on DWI (arrowhead in F) but dark on ADC(arrowhead in G ) and faintly identified in post-contrast VIBE (arrowhead in H) and is suspicious for metastasis.

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Case 3: Tiny Inconspicuous Deposits on DWI In the Ovary

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Case History:

72 year female with complex left adnexal mass on ultrasound for evaluation of suspected ovarian malignancy. PET/MRI revealed a Heterogeneously enhancing solid cystic mass in the left ovary ( arrows in A, B, C).

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Findings:

A T2 hypointense lesion is seen in the bilateral peripheral gland (L>>R) (red arrow in F, G) causing a capsular bulge. The lesion shows diffuse contrast enhancement (A, E) showing diffusion restriction (B, C) and increased Ga68 PSMA uptake in early scan (D) and no differential increase in uptake in delayed scans ( SUV max early 2.43; delayed 1.82)(H) clinching the diagnosis of an infective/inflammatory etiology more likely to be PROSTATITIS.

Diffusion images show multiple deposits in the perihepatic and bilateral paracolic regions which appear bright on DWI (arrows in D, E, F) and avid on fused PET/MRI images(G, H, I) . In addition, few tiny deposits are identified on DWI( arrows in J, K, L) with no FDG uptake on the corresponding PET MR fused images ( M, N, O) Diffusion-weighted images are extremely sensitive in identifying small peritoneal deposits in case of peritoneal dissemination seen commonly with ovarian and GI cancers.

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Case 4: Tiny Inconspicuous Bony Metastasis on DWI

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Case History:

62 year female with LABC for staging workup with PET/MRI.

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Findings:

 

DCE MRI of both breasts done as a part of PET MRI revealed an FDG avid mass(red arrow in B, C) involving the entire fibroglandular parenchyma with skin, nipple, chest wall infiltration, multiple axillary(arrow in A), internal mammary nodes( arrow in B).

DWI (A, D) revealed at least two subcentimeter focal marrow lesions in two dorsal vertebrae (arrows in diffusion-weighted images A and D)with faint suspicious FDG uptake on re-look (encircled area in B and E) suggesting possibility of metastasis and hence upstaging the disease.

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Case Study Prepared by:

This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).

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Read More about PET-MRI Scan at House Of Diagnostics in Delhi and NCR.

The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.

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