2. Learning Outcomes
What is Diffusion?
How DWI is acquired?
Clinical applications of DWI
Diffusion Tensor Imaging?
3. Introduction
Diffusion Weighted Imaging (DWI)
Effective for diagnosis of various diseases
Vital technique
Brain imaging protocols (integral part)
It’s role is expanding to other body imaging
4. What is Diffusion?
Diffusion means random movement of
water protons
Brownian motion- water protons diffuse
randomly in space
Protons (H2O) diffuse to dissipate their
thermal energy
Difference in mobility of H2O molecules
b/w tissues gives contrast in DWI
DWI helps to characterize tissues and
pathology
5. Types of Diffusion
Isotropic Diffusion
Possibility of water protons moving in any one
particular direction is equal to the probability that it
will move in any other direction
Isotropic means uniformity in all directions
Anisotropic Diffusion
Water diffusion has preferred direction
Water can move easily in one direction than other
Isotropic diffusion basis for routine DWI
Anisotropic basis for DTI (diffusion tensor imaging) or
tractography
6.
7. How do we acquire DWI?
“Stejskal-Tanner pulsed gradient spin echo seq;”
First experimental sequence described for the
acquisition of DWI
Forms the basis for all DWI performed today
It is a T2-w SE sequence with diffusion gradients
applied before and after the 180 degree pulse
Now, diffusion gradients can be applied to various
seq;
Mostly applied to EPI seq; with infinite T2
10. Terms and Concepts
The b-value
It indicates the magnitude of DWI provided by the
diffusion gradients
It also indicates sensitivity of the seq; to the
diffusion
Expressed in sec/mm2
Depends on amplitude, separation and duration of
DG
The b-value increases with DG strength & Duration
of their applications of the two gradients
As b-value increases the signal from water reduces
Highest value of b=1000 only for tissues with very
high T2 relaxation time
11.
12.
13. Diffusion "trace"
Isotropic diffusion forms the basis for the routine
DWI
Also their will be some anisotropic movement of
H2O as well
Especially in brain from white matter tracts
To reduce this anisotropy the image with higher b-
value like b=1000 is acquired in all three directions
X, Y and Z axes
Diffusion changes along all three axes are then
averaged to get a ‘trace’ diffusion image
14.
15. ADC: Apparent Diffusion Coefficient
ADC is measure of diffusion
Calculated mathematically from b-value=0 and
higher b-value images
Signal attenuation of a tissue with increasing
value plotted on graph with relative signal
intensity on y-axis and b-value of x-axis
Resultant slope of line is ADC
Done on pixel by pixel basis by computer
To user it is available as ADC map
ADC is independent of ‘B’
Reduced ADC is ‘restricted diffusion’ [bright area]
on DWI
While on same area will be dark on ADC map
ADC value from map for AOI measured in
19. T2 Shine Through
Signal intensity on DWI (higher b-value images) not
only depends on ADC but also on T2 relaxation time
of tissue
High T2 tissue appears bright on DWI (even not
restricted)
ADC map helps to differentiate T2 shine through
from actual
Or T2 shine through are exponential images formed
by ratio of DWI images divided by T2-w (b=0)
images in same series
These images are called eADC by some vendors
(Philips)
Truly restricted area is bright on eADCeADC
20. Images available to view
DWI routinely performed with EPI sequence
Acquisition time is typically less than a minute
With preset post-processing few sets of images
are available for viewing immediately after
acquisition
Depending in the number of b-values used these
images typically include b=0, higher b-values
images and ADC map
Higher b-value images considered as DWI
21. Clinical Applications of DWI
DWI in Stroke
Failure of Na-K ATPase pump tissue ischemia
Results in influx of extracellular water into cells
This is called cytotoxic edema
Net shift of water molecules from extracellular into
restricted intracellular space
Overall, reduction in diffusion of water molecule in
that area
Manifested as bright signal on DWI and dark signal
on ADC map
DWI can detect early ischemic tissue (minute to
hours)
DWI shows stroke lesion earliest (failure of T2
appears normal)
23. Epidermoid versus Arachnoid cyst
Epidermoid composed of keratin, debris and solid
cholesterol
Provide hindrance to diffusion of H2O molecules
Epidermoid is seen as bright lesion on DWI
Arachnoid cyst is clear CSF containing cyst, it will
not be bright on DWI will be same as CSF in the
signal intensity
DWI can detect a residual epidermoid
27. DWI in brain tumors
Abscess on DWI
Lymphoma on DWI
Moreover, following imaging are
done on DWI as well
•Medulloblastoma
•Ependymoma
•Abdominal Imaging
28. DWI Body Imaging
Use of DWI in body imaging is new
Big obstacles in DWI imaging are motion and
short T2 of various organs
Imaging done with breathe-hold & respiratory
triggering
DWI mainly used in tumor imaging and in follow-
up imaging
For staging tumor and lymphoma whole body
imaging with background suppression is used in-
replacement to PET
DWIBS (DW whole body imaging with
background body signal suppression)
Final DWIBS images shows only diffusion
30. Diffusion Tensor Imaging
Routine DTI based on anisotropic diffusion of water
molecules
Tensor is mathematical formalism used to model
anisotropic dif:
Technique
MR scanner X, Y and Z are never perfectly parallel
to the WM tracts at every point in the image
In DTI, images are acquired in at least six, usually
12-24 directions instead of three in usual trace
diffusion
Pure ADC for each pixel is calculated from these
images in multiple directions
This is called ‘principal eigen value’
31. Images formed with principal eigen value is called
DTI that gives orientation of fiber tracts
Uses:
DTI measure the magnitude of the ADC in the
preferred direction of water diffusion and
perpendicular to the direction
The resultant image shows WM tracts very well
Hence this technique is called ‘tractography’
Various maps used to indicate orientation of fiber
tracts include FA (fractional anisotropy)
RA (regional anisotropy) and VA (volume ratio) maps
Tractography for the assessment of relationship of
tracts with tumor, tumor invasion of tracts and
preoperative planning
Used to evaluate WM tracts in various congenital