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

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.

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

Acta Radiologica ◽

10.1177/0284185120927905 ◽

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.

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

International Archives of Otorhinolaryngology ◽

10.1055/s-0036-1597323 ◽

2017 ◽

Vol 21 (04) ◽

pp. 358-365 ◽

Cited By ~ 8

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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Utility of diffusion weighted mr in diffrentation between benign and malgnant breast lesions

QJM ◽

10.1093/qjmed/hcaa068.019 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A E E Rady ◽

H M Sakr ◽

Y I Abdelkhalie ◽

A S M Sadek

Keyword(s):

Diffusion Weighted Imaging ◽

Breast Lesions ◽

Adc Value ◽

Breast Masses ◽

Conventional Mri ◽

Diffusion Weighted ◽

Apparent Diffusion ◽

Malignant Breast ◽

Adc Values ◽

Value Measurement

Abstract Purpose of this Study is To evaluate the role of DWI MRI in the differentiation between benign and malignant breast lesions. Methods The study included 40 patients all of them were females with positive breast lesion detected by ultrasound or mammography (between 25 and 66 years of age) referred from surgery and oncology departments. Each patient included in the study was subjected to full history taking, mammography, ultrasonography and conventional MRI sequences and Diffusion Weighted imaging and ADC value measurement. Technique was performed using a standard 1.5 Tesla unit (Acheiva, Philips). Results The study showed significant results were obtained between ADC values of benign and malignant lesions (p < 0.001). Conclusion According to the results of this study we concluded that the addition of DW-MRI and ADC value measurements to the conventional MRI of the breast increased the accuracy of diagnosis and characterization of different breast masses. Also, the use of DW-MRI with ADC value measurements was found to be a valuable quantitative analysis. Keywords Breast masses– MRI – Diffusion weighted imaging Apparent diffusion coefficient.

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Evaluation of Carbapenemase Screening and Confirmation Tests with Enterobacteriaceae and Development of a Practical Diagnostic Algorithm

Journal of Clinical Microbiology ◽

10.1128/jcm.01692-14 ◽

2014 ◽

Vol 53 (1) ◽

pp. 95-104 ◽

Cited By ~ 47

Author(s):

Florian P. Maurer ◽

Claudio Castelberg ◽

Chantal Quiblier ◽

Guido V. Bloemberg ◽

Michael Hombach

Keyword(s):

Sensitivity And Specificity ◽

Predictive Value ◽

Diagnostic Algorithm ◽

Negative Control Group ◽

Negative Control ◽

Control Group ◽

Content Type ◽

Class B ◽

Mueller Hinton Agar ◽

Sensitivity Specificity

Reliable identification of carbapenemase-producing members of the familyEnterobacteriaceaeis necessary to limit their spread. This study aimed to develop a diagnostic flow chart using phenotypic screening and confirmation tests that is suitable for implementation in different types of clinical laboratories. A total of 334 clinicalEnterobacteriaceaeisolates genetically characterized with respect to carbapenemase, extended-spectrum β-lactamase (ESBL), and AmpC genes were analyzed. A total of 142/334 isolates (42.2%) were suspected of carbapenemase production, i.e., intermediate or resistant to ertapenem (ETP) and/or meropenem (MEM) and/or imipenem (IPM) according to EUCAST clinical breakpoints (CBPs). A group of 193/334 isolates (57.8%) showing susceptibility to ETP, MEM, and IPM was considered the negative-control group in this study. CLSI and EUCAST carbapenem CBPs and the new EUCAST MEM screening cutoff were evaluated as screening parameters. ETP, MEM, and IPM with or without aminophenylboronic acid (APBA) or EDTA combined-disk tests (CDTs) and the Carba NP-II test were evaluated as confirmation assays. EUCAST temocillin cutoffs were evaluated for OXA-48 detection. The EUCAST MEM screening cutoff (<25 mm) showed a sensitivity of 100%. The ETP APBA CDT on Mueller-Hinton agar containing cloxacillin (MH-CLX) displayed 100% sensitivity and specificity for class A carbapenemase confirmation. ETP and MEM EDTA CDTs showed 100% sensitivity and specificity for class B carbapenemases. Temocillin zone diameters/MIC testing on MH-CLX was highly specific for OXA-48 producers. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the Carba NP-II test were 78.9, 100, 100, and 98.7%, respectively. Combining the EUCAST MEM carbapenemase screening cutoff (<25 mm), ETP (or MEM), APBA, and EDTA CDTs, and temocillin disk diffusion on MH-CLX promises excellent performance for carbapenemase detection.

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A Comparative Analysis of DWI and Ultrasound in Thyroid Nodules

10.21203/rs.2.12244/v1 ◽

2019 ◽

Author(s):

Wei dan Kong ◽

Xiu hui Yue ◽

Ji liang Ren ◽

Xiao feng Tao

Keyword(s):

Sensitivity And Specificity ◽

Signal Intensity ◽

Intensity Ratio ◽

Diffusion Weighted Imaging ◽

Thyroid Nodules ◽

Signal Intensity Ratio ◽

Adc Value ◽

Diffusion Weighted ◽

Significant Difference ◽

Sensitivity Specificity

Abstract Background Diffusion weighted imaging and ultrasound are commonly used methods to examine thyroid nodules, but their comparative value is rarely studied. To evaluate the value of diffusion weighted imaging and ultrasound in differentiing benign and malignant thyroid nodules Methods A total of 100 patients with 137 nodules were enrolled. who underwent both diffusion weighted imaging and ultrasound before operation. T1 and T2 signal intensity ratio (SIR) of each thyroid nodule was calculated by measuring the mean signal intensity divided by that of paraspinal muscle. The value of ADC,signal intensity ratio (SIR) of benign and malignant thyroid nodules were analyzed by two independent sample t test. The sensitivity, specificity and accuracy of DWI and ultrasound were compared and analyzed by chi-square test. Results There was no significant difference in signal intensity ratio between benign and malignant thyroid nodules. The ADC value had significant difference. When the threshold value was 1.12 ×10-3 mm2/s, the maximum area under the curve was 0.944,The sensitivity, specificity and accuracy were 84.9%, 92.2% and 87.6% respectively. The sensitivity and specificity of ultrasound diagnosis were 90.1%, 80.4% and 86.9% respectively. Conclusion Ultrasound has high sensitivity in differentiating benign and malignant thyroid nodules, and ADC value has high specificity in differentiating thyroid nodules, but there is no statistical difference in sensitivity and specificity between the two. DWI and Ultrasound have their own advantages in differentiating benign and malignant thyroid nodules.

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DIFFUSION-WEIGHTED IMAGING IN MR MAMMOGRAPHY AS AN ALTERNATIVE TO BIOPSY IN THE EVALUATION OF INTERMEDIATE NON-MASS BREAST LESIONS

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v7.i2.2019.1021 ◽

2019 ◽

Vol 7 (2) ◽

pp. 171-179

Author(s):

Fatma Mohamed Awad

Keyword(s):

Diffusion Weighted Imaging ◽

Morphological Characteristics ◽

Breast Lesions ◽

Mr Mammography ◽

Adc Value ◽

Diffusion Weighted ◽

Contrast Enhanced ◽

Adc Values ◽

Malignant Lesions ◽

Mass Lesions

Background: Dynamic contrast-enhanced MRI is a sensitive tool for the diagnosis of breast cancer, however, its value is limited in cases of non-mass enhancement. Diffusion-weighted imaging (DWI) is promising in the diagnosis of non-mass breast lesions. Purpose: The aim of this study is to determine the value of diffusion-weighted imaging in the evaluation of intermediate non-mass breast lesions, as an alternative to biopsy. Materials and Methods: Thirty-three female patients between the ages of 38-56 years (mean age, 45 years) with non-mass lesions on MR mammography were included in this study. The lowest ADC values were obtained for the non-mass breast lesions. MR-guided core-needle biopsies were performed for 20 patients, while the other patients who refused biopsy, had yearly mammography and ultrasound every six months for two years. They also had at least one follow up MR mammography within the two years’ interval. Results: This study included 33 non-mass breast lesions detected on MR mammography. The lesion siz¬es ranged from 0.2 to 1.4 cm. The morphological characteristics of the lesions and their signal intensity curves on dynamic MR Mammography were recorded. For differentiation of benign and malignant lesions, a threshold ADC value of 1.03×10–3 mm2/s was used. The ADC values for all the lesions ranged from 1.3 x 10–3 mm2/s to 2.6 x 10–3 mm2/s. Conclusion: Diffusion-weighted imaging is effective in the evaluation of intermediate non-mass breast lesions on MR mammography and can be used as an alternative to biopsy.

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Quantitative Evaluation for Differential Diagnosis of Breast Lesions in Diffusion-Weighted MR Imaging

Health and Technology ◽

10.1007/s12553-021-00604-z ◽

2021 ◽

Author(s):

Winniecia Dkhar ◽

Rajagopal Kadavigere ◽

Samir Paruthikunnan Mustaffa

Keyword(s):

Differential Diagnosis ◽

Mr Imaging ◽

B Value ◽

Breast Lesions ◽

Benign Lesions ◽

Adc Value ◽

B Values ◽

Diffusion Weighted ◽

Adc Values ◽

Malignant Lesions

AbstractDiffusion-weighted MR Imaging is a rapidly emerging technique, that allows in-vivo mapping processes of the water diffusion in tissues. It has the potential capabilities for clinical application in breast imaging. The aim of this study was to find out the optimal b-value for calculation of ADC value for differential diagnosis of breast lesions. A total of 124 subjects (mean age 46 years) with 141 lesions were included. The protocol consists of axial T2 sequence for lesion localization and measurement and DW sequence with three sets of b-values of 0, 300, 600, and 1000 s/mm2. The mean ADC values of the breast lesions for b-values (0, 300, 600, and 1000) were 1.75 ± 0.18 × 10−3mm2/sec, 1.66 ± 0.12 × 10−3mm2/sec and 1.57 ± 0.15 × 10−3mm2/sec for the benign lesions and 1.26 ± 0.048 × 10−3mm2/sec, 1.14 ± 0.11 × 10−3mm2/sec and 0.93 ± 0.14 × 10−3mm2/sec for malignant lesions respectively. Statistical significant differences were noted on the ADC value of benign and malignant lesions among the three sets of b values (p = 0.001). ADC values of malignant lesion was significantly lower compared to benign lesions. The AUC (0.998) was substantially large for b-value of 0,600 s/mm2 with a threshold ADC cut off value of 1.28 × 10−3mm2/sec with 98.4% sensitivity, 93.2% specificity and 98.5% positive predictive value(PPV). In conclusion, diffusion weighted imaging has the ability for differential diagnosis of breast lesions with the optimal b value of 0,600 s/ mm2. DWI is a reliable tool for characterising breast lesions and may increase the overall specificity of breast MRI.

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Role of diffusion weighted MR imaging in differentiating benign from malignant prostate lesions

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192525 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2341

Author(s):

Sachin . ◽

Kirti Chaturvedy ◽

R. N. Gehlot ◽

Prateek Sihag ◽

Suman Kumari ◽

...

Keyword(s):

Mr Imaging ◽

Diagnostic Accuracy ◽

Chronic Prostatitis ◽

Benign Lesion ◽

Malignant Lesion ◽

Adc Value ◽

Diffusion Weighted ◽

Adc Values ◽

The Mean ◽

Sensitivity Specificity

Background: The purpose of the study was to determine the diagnostic accuracy of diffusion weighted MR imaging and to propose a cut off ADC value in differentiating benign from malignant prostatic lesions considering histopathology as gold standard.Methods: It is a descriptive type of observational study done on 40 patients with clinical suspicion of prostate carcinoma and elevated PSA level more than 4ng/ml. The patients underwent Multiparametric prostate MRI and ADC values were calculated using ADC maps.Results: Of the 40 cases included in the study histopathology revealed a diagnosis of abscess (1), chronic prostatitis (2), BPH with chronic prostatitis (4), BPH (12), and malignancy (21). The mean and standard deviation (SD) of ADC values for the abscess (0.59), CP (0.83+0.16), BPH with CP (0.94+0.22), BPH (1.14+0.14) and malignancy (0.72+0.15) (x10-3mm2/s) were found in our study. The mean ADC value of malignant lesion was lower (0.727+0.149) as compare to benign lesion (1.034+0.216) and this difference was found to be statistically significant with p<0.001. By using ROC curve, ADC cut off value was calculated as 0.92 x 10-3mm2/s and sensitivity, specificity at this cut off value of ADC were 95.24% and 73.68% respectively. The PPV, NPV, diagnostic accuracy of at this cut off value of ADC were 80%, 93.33%, 85% respectively.Conclusions: Our study shows that DWI with ADC calculation helps in differentiation of Benign from Malignant prostatic lesions with high accuracy and this quantitative analysis should be incorporated in routine MRI evaluation of prostatic lesions

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

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1730120 ◽

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.

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Diffusion tensor imaging on 3-T MRI breast: diagnostic performance in comparison to diffusion-weighted imaging

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00473-6 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Dalia Abdelhady ◽

Amany Abdelbary ◽

Ahmed H. Afifi ◽

Alaa-eldin Abdelhamid ◽

Hebatallah H. M. Hassan

Keyword(s):

Breast Cancer ◽

Diffusion Tensor Imaging ◽

Sensitivity And Specificity ◽

Diffusion Weighted Imaging ◽

Diffusion Tensor ◽

Breast Mri ◽

Breast Lesions ◽

Dce Mri ◽

Additional Tool ◽

Diffusion Weighted

Abstract Background Breast cancer is the most prevalent cancer among females. Dynamic contrast-enhanced MRI (DCE-MRI) breast is highly sensitive (90%) in the detection of breast cancer. Despite its high sensitivity in detecting breast cancer, its specificity (72%) is moderate. Owing to 3-T breast MRI which has the advantage of a higher signal to noise ratio and shorter scanning time rather than the 1.5-T MRI, the adding of new techniques as diffusion tensor imaging (DTI) to breast MRI became more feasible. Diffusion-weighted imaging (DWI) which tracks the diffusion of the tissue water molecule as well as providing data about the integrity of the cell membrane has been used as a valuable additional tool of DCE-MRI to increase its specificity. Based on DWI, more details about the microstructure could be detected using diffusion tensor imaging. The DTI applies diffusion in many directions so apparent diffusion coefficient (ADC) will vary according to the measured direction raising its sensitivity to microstructure elements and cellular density. This study aimed to investigate the diagnostic accuracy of DTI in the assessment of breast lesions in comparison to DWI. Results By analyzing the data of the 50 cases (31 malignant cases and 19 benign cases), the sensitivity and specificity of DWI in differentiation between benign and malignant lesions were about 90% and 63% respectively with PPV 90% and NPV 62%, while the DTI showed lower sensitivity and specificity about 81% and 51.7%, respectively, with PPV 78.9% and NPV 54.8% (P-value ≤ 0.05). Conclusion While the DWI is still the most established diffusion parameter, DTI may be helpful in the further characterization of tumor microstructure and differentiation between benign and malignant breast lesions.

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