الفهرس 
ACKNOWLEDGMENTSOnly 14 pages are availabe for public view
 |  | from | 217 |  |  |
| | | from | 217 | | |
Abstract
Forty six patients enrolled in our study, 25 were males and 21 were females their age ranged from 17 years to 64 years old. The patients were referred to Radiology Department, Assiut University Hospital, during the period from June 2014 till May 2018. All patients underwent whole body diffusion weighted magnetic resonance imaging examinations.
Our study included two distinctive types of patients who were referred to the Radiology Department either for the diagnosis of metastasis of a known primary tumor or for the diagnosis of spread of lymphoma.
In our study we tried to explore the presumed usability and value of whole-body DWI in detecting metastasis in patients with malignancies. In additions we extended the search into a unique group of malignancies which is lymphomas to investigate its value in this disease too.
Out of these 46 patients; 27 patients had metastases of a known primary tumor ( part I) and 19 patients had lymphoma (part II).
Part I of the study: Patients with metastasis: 27 patients; 12 patients were males and 15 were females. The age of the patients ranged from 20 years to more than 60 years.
The primary sites of the patients were breast in 8 patients, prostate in 5 patients, liver in 4 patients, colon in 3 patients, thyroid in 2 patients, lung in patients, ovaries in 2 patients, testes in one patient.
The number of bone metastases discovered by whole body DWI were 193, while the number of lymph node metastases were 96, liver metastases were 14, pulmonary metastases were 10 and brain metastases were 2.
The whole-body DWI was more accurate in detection of bone metastases, lymph node metastases, brain metastases, pulmonary metastases and hepatic metastases than other MRI sequences.
Our overall results for all metastasis show that the conventional MRI techniques included coronal STIR, coronal T1-weighted and axial T2-weighted images done for metastatic lesions showed sensitivities of 65.61%, 73.05% and 61.63% respectively, specificities of 87.10%, 93.36% and 71.57% respectively and accuracies of 78.15%, 84.35% and 68.31% respectively. Meanwhile; the addition of whole-body DWI technique had significantly improved overall sensitivity to 90.95% (p value <0.03, 0.04 and 0.02 for STIR, T1 and T2 respectively), specificity to 91.53% (p value =0.04, 0.05 and 0.04 respectively) and accuracy to 91.26% (0.02, 0.05, 0.03 respectively).
Part II: Patients with Lymphoma:
Nineteen patients were included in this part of the study. The age of the patients ranged from below 20 years up to more than 60 years. 13 patients were males and 6 were females.
Eleven had Hodgkin lymphoma and 8 with non-Hodgkin lymphoma. Lesions discovered by whole-body DWI are 433 lesions in the 19 patients. Only 377 lesions were proven to be involved by lymphoma. On the other hand whole-body DWI missed 42 lesions that were visible by other imaging modalities and were later proved to be malignant. Whole-body DWI exhibits different results depending on the organ of interest.
Our results for whole-body DWI show sensitivity of 90%, specificity of 68%, positive predictive value of 85%, negative predictive value of 79%, and accuracy of 83%.
For nodal involvement, in our study, we depended on size measurement (more than 1 cm) and also on restricted diffusion in DWI, the sensitivity of DWI was 81% and specificity was 68% and accuracy of 73%. Small lymph nodes adjacent to the lungs and the heart were not shown in DWI probably related to heart motion.
For extra nodal involvement, DWI was able to detect 286 lesions; 7 brain lesions, 4 splenic lesions, 6 hepatic lesions, 2 renal lesions, one stomach lesion and 266 boney lesions. , the sensitivity of DWI in detected extra nodal lesions was 72% and specificity was 83% and accuracy of 76%.
In this study, some difficulties in detecting splenic and renal lesions were believed that normal spleen already showed inherited restricted diffusion.
For bony involvement of lymphoma, whole body diffusion showed sensitivity of 95%, specificity of 75% and accuracy of 84% . While coronal STIR, coronal T1-weighted and axial T2-weighted images showed sensitivity of 77, 83 and 89% respectively. Specificity was 64, 82 and 67% respectively. Accuracy was 72, 82 and 60% respectively. The difference with DWI was statistically significant.