scholarly journals Evolving Concept Of Non Ischaemic Brain Lesions Through Diffusion Weighted MRI Imaging

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A Elkory ◽  
H M Mansour ◽  
A F Abdelghany ◽  
E H Abdeldayem
Keyword(s):  
Intracranial Hemorrhage ◽  
Brain Infarction ◽  
Brain Lesions ◽  
Demyelinating Diseases ◽  
Mri Imaging ◽  
Adc Value ◽  
Diffusion Weighted Images ◽  
Diffusion Weighted ◽  
Ischaemic Brain ◽  
Adc Values

Abstract Purpose to assess the role of Diffusion weighted images in evaluation and characterization of non ischemic brain lesions, which is essential in determining appropriate patient management . Methods and Material The included 100 patients with different brain lesions other than infarctions (37 males & 63 females) were further classified into 6 groups. These are intracranial infarctions, intracranial hemorrhage, intracranial masses (which is further subdivided into extra-axial and intra-axial masses), traumatic brain lesions, demyelinating diseases and others (encephalopathies and leukodystrophies). Their ages ranged from 8 days to 77 years with a mean age of 37.6 years. Results The ADC value of lesions of each group was then compared with that of normal appearing white matter (NAWM) in the same patients.In intracranial infections the ADC values of those lesions that showed true restriction (n = 6/7) ranged from 0.32 x 10-3 mm2/sec to 0.93 x 10-3 mm2/sec (with a mean of 0.63±0.2 x 10-3 mm2/sec) while that of NAWM in the same patients ranged from 0.76 x 10-3 mm2/sec to 0.94 x 10-3 mm2/sec (with a mean of 0.86±0.8 x 10-3 mm2/sec). In intracranial hemorrhage, 6 lesions showed true restriction with ADC values ranging from 0.25 x 10-3 mm2 / sec to 1.0 x 10-3 mm2 / sec (with a mean of 0.71±0.33 x 10-3 mm2 / sec) while the ADC value of the NAWM in the same patients ranged from 0.64 x 10-3 mm2 / sec to 0.7 x 10-3 mm2 / sec (with a mean of 0.68±0.04 x 10-3 mm2 / sec). In extra-axial masses, true restriction was identified in 16 patients with ADC values ranging from 0.43 x 10-3 mm2 / sec to 1.1 x 10-3 mm2 / sec (with a mean of 0.75±0.2 x 10-3 mm2 / sec). The ADC values of NAWM in the same patients ranged from 0.64 x 10-3 mm2 / sec to 0.76 x 10-3 mm2 / sec (with a mean of 0.68±0.04 x 10-3 mm2 / sec). In intra-axial masses, true restriction was identified in 32 patients with ADC values ranging from 0.34 x 10-3 mm2 / sec to 1.1 x 10-3 mm2 / sec (with a mean of 0.82±0.2 x 10-3 mm2 / sec). The ADC values of NAWM in the same patients ranged from 0.6 x 10-3 mm2 / sec to 0.85 x 10-3 mm2 / sec (with a mean of 0.69±0.06 x 10-3 mm2 / sec). Conclusion Diffusion MRI (or DWI) imaging has assumed an essential role in the detection of acute brain infarction and in the differentiation of acute infarction from other disease processes. DW MR imaging is also assuming an increasingly important role in the evaluation of many other intracranial disease processes. It shows promising value in the evaluation of intra-cranial infections, tumors, demyelinating diseases, traumatic brain lesiones as well as encephalopathies and leukodystrophies. Further evaluation of the ADC value could be of help especially in the evaluation of the grades of neoplastic processes, evaluation of the prognosis of traumatic brain lesions and in the assessment of the plaques of multiple sclerosis. We concluded that DWI is an essential sequence in the evaluation of different brain lesions and recommend its addition to the routine MRI examination of the brain.

scholarly journals The diagnostic utility of diffusion weighted MRI imaging and ADC ratio to distinguish benign from malignant renal masses: sorting the kittens from the tigers

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Suresh de Silva ◽  
Kathleen Rebecca Lockhart ◽  
Peter Aslan ◽  
Peter Nash ◽  
Anthony Hutton ◽  
...  
Keyword(s):  
Renal Mass ◽  
Clear Cell ◽  
Surgical Excision ◽  
Mri Imaging ◽  
Renal Masses ◽  
Post Contrast ◽  
Adc Value ◽  
Diffusion Weighted ◽  
Apparent Diffusion ◽  
Adc Values

Abstract Background MRI is playing an increasing role in risk stratification and non-invasive diagnosis of the undifferentiated small renal mass. This study was designed to assess the reliability of MRI in diagnostic evaluation of renal masses, specifically characterising lesions with diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values. Methods This is a retrospective analysis of patients undergoing MRI as part of their clinical workup for a renal mass suspicious for renal cell carcinoma (RCC) on CT or ultrasound followed by biopsy and/or surgical excision. All cases were conducted on 3 Tesla MRI, with conventional breath-held sequences, DWI and dynamic contrast enhanced phases. Tumour regions of interest were evaluated on ADC maps and compared with T2 weighted and post-contrast images. Results Of the 66 renal tumours included, 33 (50.0%) were Clear Cell RCC, 11 (16.7%) were Oncocytoma, nine (13.6%) were Angiomyolipoma (AML), nine (13.6%) were Papillary RCC and four (6.1%) were Chromophobe RCC. Oncocytoma had the largest ADC values, significantly larger than AMLs and all RCC subtypes (p < 0.001). The average ADC value was also significantly larger in Clear Cell RCCs compared to AMLs, and other RCC subtypes (p < 0.001). Conclusions MRI with DWI/ADC imaging may aid the differentiation of oncocytomas from RCCs and stratify RCC subtypes, Further studies are required to validate these findings. Trial registration: Not applicable/retrospective study.

scholarly journals Non-mass Enhancement in Breast MRI: Characterization with BI-RADS Descriptors and ADC Values

2021 ◽  
Vol 3 (2) ◽  
pp. 77-87
Author(s):  
Wolfgang Buchberger ◽  
Willi Oberaigner ◽  
Christian Kremser ◽  
Kurt Gautsch ◽  
Uwe Siebert
Keyword(s):  
Kinetic Curve ◽  
Breast Mri ◽  
Distribution Patterns ◽  
Adc Value ◽  
Diffusion Weighted Images ◽  
Diffusion Weighted ◽  
Apparent Diffusion ◽  
Adc Values ◽  
Curve Patterns ◽  
Mass Enhancement

Objectives: The purpose of this study was to assess the accuracy of contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in distinguishing benign from malignant non-mass-like breast lesions. Methods: 103 lesions showing non-mass-like enhancement in 100 consecutive patients were analyzed. Distribution, internal enhancement patterns, and contrast kinetic curve patterns were classified according to the BI-RADS lexicon. Apparent diffusion coefficient (ADC) values were obtained from manually placed regions of interest (ROIs) on diffusion-weighted images. The optimal ADC value threshold for the distinction between benign and malignant lesions was determined by ROC analysis. Univariate and multivariate analyses were performed to identify independent predictors of malignancy, and the probability of malignancy was calculated for various combinations of findings. Histological diagnosis obtained by means of core needle biopsy was used as gold standard. Results: According to the univariate and multivariate analysis, odds ratios for malignancy were significantly elevated for clumped or clustered ring internal enhancement and low ADC values (p < 0.001), whereas distribution patterns and contrast kinetic patterns were not significantly correlated with benignity or malignancy. In non-mass lesions with homogeneous or heterogeneous internal enhancement and ADC values greater than 1.26×10-3mm2/s, no malignancy was detected, while all other combinations of findings had a probability of malignancy ranging from 22.2 to 76.6%. Conclusions: A combination of BI-RADS descriptors of internal enhancement and ADC values is useful for the differential diagnosis of lesions showing non-mass enhancement. Lesions with homogeneous or heterogeneous enhancement and high ADC can be followed up, while all other lesions should be biopsied. Doi: 10.28991/SciMedJ-2021-0302-1 Full Text: PDF

scholarly journals Role of Quantitative Diffusion-Weighted Imaging in Differentiating Benign and Malignant Orbital Masses

2021 ◽  
Author(s):  
Preeti Mundhada ◽  
Sudarshan Rawat ◽  
Ullas Acharya ◽  
Dhananjay Raje
Keyword(s):  
Roc Curve ◽  
Diffusion Weighted Imaging ◽  
Care Hospital ◽  
Adc Value ◽  
Diffusion Weighted ◽  
Significant Difference ◽  
Orbital Masses ◽  
Adc Values ◽  
Orbital Lesions

Abstract Aim To determine the role of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating benign and malignant orbital masses. Materials and Methods After obtaining institutional ethical board approval and informed consent from all patients, an observational study was done for a period of 24 months in the radiology department of a tertiary care hospital in South India. Conventional magnetic resonance imaging and DWI using a 3T scanner was done for all patients with suspected orbital mass lesion. ADC value and clinicohistopathological correlation were studied for every patient. Chi-square test was used to compare the signal characteristics of DWI and ADC maps between benign and malignant lesions. A comparison of mean ADC values for benign and malignant masses was performed using Student’s t-test for independent samples. The cut-off value for ADC was obtained using the receiver operating characteristic (ROC) curve. Results Of 44 patients with orbital lesions, 70% were benign and 30% were malignant. There was a significant difference in the mean ADC values of benign and malignant orbital masses. Using ROC curve analysis, an optimal ADC threshold of 1.26 × 10−3 mm2/s was calculated for the prediction of malignancy with 100% sensitivity, 80.65% specificity, and 86.36% accuracy (95% confidence interval: 0.872, 1.00, p < 0.0001). Two ADC thresholds were used to characterize the orbital masses with more than 90% confidence. Conclusion Quantitative assessment of ADC is a useful noninvasive diagnostic tool for differentiating benign and malignant orbital masses. Malignant orbital lesions demonstrate significantly lower ADC values as compared with benign lesions.

ROLE OF DIFFUSION WEIGHTED MRI IN ASSESSMENT OF BENIGN AND MALIGNANT HEPATIC FOCAL LESIONS IN ADULT AGE GROUP

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hanan Mohammed Hanafy ◽  
Ayman Mohammed Ibrahim ◽  
Haytham Mohamed Nasser ◽  
Moataz Metwally Elsayed
Keyword(s):  
Focal Lesions ◽  
Adc Value ◽  
Adult Age ◽  
Conventional Mri ◽  
Diffusion Weighted ◽  
Adc Values ◽  
Weighted Magnetic Resonance Imaging ◽  
Mri Sequences ◽  
Value Measurement

Abstract Purpose of this study is: To evaluate the role of diffusion weighted magnetic resonance imaging in differentiation between malignant & benign hepatic focal lesions. Methods The study included 38 patients all of them were with hepatic focal lesions detected by ultrasound (between 20 and 85 years of age) referred from GIT and oncology departments. Each patient included in the study was subjected to full history taking, ultrasonography and conventional MRI sequences, post Gd- DTPA dynamic and Diffusion Weighted imaging as well as ADC value measurement. Technique was performed using a standard 1.5 Tesla unit (Ingenia, Philips). Detailed MRI and laboratory investigations were done. Results The study showed significant results were obtained between ADC values of benign and malignant hepatic focal lesions (p &lt; 0.001). Conclusion We concluded in this study according to the obtained results that DWI sequence together with quantitative ADC values should be used as an essential sequence to supplement the conventional MRI sequences for proper detection and characterization of hepatic focal lesions.

Predicting axillary response to neoadjuvant chemotherapy: the role of diffusion weighted imaging

2021 ◽  
Author(s):  
Lucia Graña-López ◽  
Tania Pérez-Ramos ◽  
Fiz Andrés Maciñeira ◽  
Ángeles Villares ◽  
Manuel Vázquez-Caruncho
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Diffusion Weighted Imaging ◽  
Primary Tumour ◽  
Pathologic Complete Response ◽  
Tumour Response ◽  
Complete Response ◽  
Adc Value ◽  
Diffusion Weighted ◽  
Adc Values ◽  
Response To Neoadjuvant Chemotherapy

Objective: The aim of this study is to investigate whether the primary tumour response to neoadjuvant chemotherapy (NAC), based on the increase in the ADC-values (apparent diffusion coefficient) within the breast lesion, could help to predict axillary complete response. Methods: We retrospectively included 74 patients who were treated with NAC followed by surgery at Lucus Augusti Hospital between January 2015 and September 2020. Simple logistic regression was used to evaluate the factors associated with axillary pathological complete response, including the changes in breast tumour ADC-values due to the treatment. Results: Axillary complete response was correlated with negative oestrogen receptor status, Her2 positivity and response of primary tumour. It was achieved in 31% of the patients. In addition, the increase in the tumour ADC-values with NAC was higher for responders. Among the tumours that demonstrated an increase in ADC-value >0.92 ×10−3 mm2/s, 42.8% (15/35) showed axillary complete response. Eight (20.5%) breast cancers with an increase in ADC below the cut-off value were found to have no metastatic nodes after treatment (p = 0.038). Conclusion: Our results suggest that the performance of models predicting axillary response to NAC can be improved by adding the tumour response determined also using diffusion-weighted imaging. Advances in knowledge: For the fist time, we investigate the relation between tumour response to NAC, assessed using diffusion-weighted imaging, and axillary pathologic complete response.

Incorporating diffusion-weighted imaging in a diagnostic algorithm for multiparametric MR mammography

2021 ◽  
pp. 028418512110418
Author(s):  
Katerina Vassiou ◽  
Michael Fanariotis ◽  
Ioannis Tsougos ◽  
Ioannis Fezoulidis
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Region Of Interest ◽  
Diagnostic Algorithm ◽  
Breast Lesions ◽  
Adc Value ◽  
Diffusion Weighted ◽  
Adc Values ◽  
Single Formula ◽  
Sensitivity Specificity

Background Apparent diffusion coefficient (ADC) measurements are not incorporated in BI-RADS classification. Purpose To assess the probability of malignancy of breast lesions at magnetic resonance mammography (MRM) at 3 T, by combining ADC measurements with the BI-RADS score, in order to improve the specificity of MRM. Material and Methods A total of 296 biopsy-proven breast lesions were included in this prospective study. MRM was performed at 3 T, using a standard protocol with dynamic sequence (DCE-MRI) and an extra echo-planar diffusion-weighted sequence. A freehand region of interest was drawn inside the lesion, and ADC values were calculated. Each lesion was categorized according to the BI-RADS classification. Logistic regression analysis was employed to predict the probability of malignancy of a lesion. The model combined the BI-RADS classification and the ADC value. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. Results In total, 153 malignant and 143 benign lesions were analyzed; 257 lesions were masses and 39 lesions were non-mass-like enhancements. The sensitivity and specificity of the combined method were 96% and 86%, respectively, in contrast to 95% and 81% with BI-RADS classification alone. Conclusion We propose a method of assessing the probability of malignancy in breast lesions by combining BI-RADS score and ADC values into a single formula, increasing sensitivity and specificity compared to BI-RADS classification alone.

Clinical suspicion of spondylodiscitis with equivocal MRI findings: does diffusion-weighted imaging prove helpful here?

2020 ◽  
pp. 028418512092790
Author(s):  
Jeanette Henkelmann ◽  
Kristina Bremicker ◽  
Timm Denecke ◽  
Karl-Titus Hoffmann ◽  
Ralf Henkelmann ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Region Of Interest ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Mri Findings ◽  
Adc Value ◽  
Diffusion Weighted ◽  
Adc Values

Background Despite the high sensitivity of magnetic resonance imaging (MRI), early detection of spondylodiscitis (SpD) remains challenging due to its low specificity. Purpose To assess the diagnostic value of diffusion-weighted imaging (DWI) in suspected cases of SpD with ambiguous early MRI findings in the differentiation of degenerative disorders (DD). Material and Methods In this prospective study, 52 patients suspected of having SpD underwent a whole-spine 3-T MRI scan comprising sagittal DWI. Of 58 conspicuous, T2-weighted, signal increased discs, 39 were successfully evaluated using DWI. Apparent diffusion coefficient (ADC) values and ADC maps were blindly analyzed using the region of interest of the conspicuous disc and a normal adjacent reference disc. Intraindividual ratios (conspicuous disc: reference disc) were calculated. Results All conspicuous discs showed increased absolute ADC values, which did not differ significantly between SpD (n = 22) and DD (n = 17). However, ADC ratio was significantly higher in SpD vs. DD ( P < 0.05). In receiver operating characteristic curve analysis, an ADC ratio threshold of 1.6 resulted in 45% sensitivity and 88% specificity (area under the curve = 0.69) for SpD diagnosis. Conclusion The absolute ADC value does not provide a reliable diagnosis of SpD. Increased diffusivity can be an indication of infection but should always be discussed in the context of existing disc degeneration.

scholarly journals Differentiating Benign from Malignant Sinonasal Lesions: Feasibility of Diffusion Weighted MRI

2017 ◽  
Vol 21 (04) ◽  
pp. 358-365 ◽  
Author(s):  
Khaled El-Gerby ◽  
Mohammad El-Anwar
Keyword(s):  
Predictive Value ◽  
Quantitative Methods ◽  
Malignant Tumors ◽  
Adc Value ◽  
Diffusion Weighted ◽  
Tumor Tissues ◽  
Apparent Diffusion ◽  
Diagnostic Role ◽  
Adc Values ◽  
Histopathological Results

Introduction Appearance of nasal masses on routine CT and MRI are not pathognomonic. We utilized the apparent diffusion coefficient (ADC) value obtained from diffusion weighted image (DWI) to detect the differences in the microstructures of tumor and non-tumor tissues. Objective The objective of our study was to evaluate the diagnostic role of DWI and ADC values in differentiating between malignant and benign sinonasal lesions and its correlation with histopathological results as the reference standard. Methods Patients with nasal and / or paranasal mass underwent CT, MRI, and DWI before any surgical intervention. We used diagnostic sinonasal endoscopy and biopsy to confirm the diagnosis after MRI. Results When we used ADC value of (1.2 × 10–3 mm2/s) as a cut-off value for differentiating benign from malignant sinonasal lesions, we achieved 90% accuracy, 100% sensitivity, 88.4% specificity, 77.8% positive predictive value, and 100% negative predictive value. At this cut-off, benign lesions show statistically significant higher ADC value than malignant tumors. Conclusion DW MRI and ADC value calculation are promising quantitative methods helping to differentiate between malignant and benign sinonasal lesions. Thus, they are effective methods compared with other conventional methods with short imaging time thus it is recommended to be incorporated into routine evaluations.

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