The usefulness of diffusion-weighted MRI in the differentiation between focal uterine endometrial soft tissue lesions

Abstract Background Several endometrial conditions may be challenging for radiologists due to the overlap of imaging features and variable endometrial pathologies. MRI with DWI is the most commonly used imaging technique for the diagnosis and characterization of endometrial focal lesions. Results The 50 studied lesions were classified according to their histopathological results into the benign group (28 lesions, 56%) and the malignant group (22 lesions, 44%). Conventional MRI could correctly diagnose 39 of the 50 lesions (22/28 benign and 17/22 malignant lesions), achieving a sensitivity of 77.27%, specificity of 78.56%, accuracy of 78%, predictive positive value (PPV) of 73.91%, and negative positive value (NPV) of 81.48%. By combining DWI and apparent diffusion coefficient (ADC) value mapping at a high b value (b = 1000) in MRI, we could correctly diagnose 47 of the 50 lesions (26/28 benign and 21/22 malignant lesions), with increased sensitivity (95.45%), specificity (92.86%), accuracy (94%), PPV (91.3%), and NPV (96%). Conclusion Combining DWI with ADC mapping at a high b value in pelvic MRI examination is valuable in differentiating endometrial focal lesions with increased diagnostic sensitivity, specificity, and accuracy. Aim of the work This study aimed to evaluate the role of DWI in the diagnosis and differential diagnosis of benign and malignant focal endometrial masses.

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Apparent diffusion coefficient for differentiating between benign and malignant hepatic focal lesions

Egyptian Liver Journal ◽

10.1186/s43066-020-00068-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Sherif Abugamra ◽

Aya Yassin ◽

Asmaa Saber Mostafa Abdel-Rehim ◽

Dina Sayed Sheha

Keyword(s):

Hepatocellular Carcinoma ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Focal Lesion ◽

Benign Lesions ◽

Focal Lesions ◽

Significant Difference ◽

Apparent Diffusion ◽

Malignant Lesions ◽

The Mean

Abstract Background The aim of this study was to prospectively evaluate the role of diffusion weight MRI (DWI) in the characterization of hepatic focal lesions by using apparent diffusion coefficient (ADC). Thirty patients (18 women, 12 men; mean age 48.5 years) with hepatic focal lesions were included in this study. Patients underwent DW MR imaging with the SPLICE sequence. ADC of each focal lesion carcinoma was calculated from DW MR Images obtained with low and high b values. ADCs were compared among pathological types of focal lesions. Results Among the 30 patients included in the study, 46 focal lesions were detected. Twenty-four lesions were metastatic lesions from primary cancer, 7 lesions were hepatocellular carcinoma (HCC), 9 lesions were hemangiomas, and 6 lesions were simple cysts. There was highly significant difference between the mean ADC of the malignant lesions (metastasis and HCC) and the mean ADC of benign lesions (hemangiomas and cysts). The ADC of malignant lesion was much less than that of benign lesion. The mean ADC of malignant lesions (n = 31) was 0.73 ± 0.19 × 10−3 mm2/s, and the mean ADC of benign lesions (n = 15) was 1.94 ± 0.68 × 10−3 mm2/s (p value < 0.001). There was no significant difference between the cysts and hemangiomas. There was no statistically significant difference between the metastases and hepatocellular carcinoma. Conclusion ADCs values were able to differentiate benign from malignant lesions. ADC should be considered in the work up of patients with hepatic focal lesions.

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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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Role of FNAC in diagnosis of parotid lesions

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00096-8 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Ahmed Youssef ◽

Daren Cope ◽

Sundus Alsedra ◽

Mohamed Zahran ◽

Abdel Rahman El Tahan

Keyword(s):

Salivary Gland ◽

False Negative ◽

Benign Lesions ◽

True Negative ◽

Histopathological Correlation ◽

John Hunter ◽

Malignant Group ◽

Malignant Lesions ◽

Sensitivity Specificity

Abstract Background Salivary gland masses are considered challenging for diagnosis regarding its origin and whether benign or malignant. Unique features of FNAC as a safe and easy diagnostic procedure with little discomfort to the patient made it a favorable primary diagnostic tool. Information regarding the nature of parotid lesions whether being benign or malignant is the main objective of FNAC. We have done a restrospective study for FNAC for parotid masses performed in John Hunter hospital (Newcastle, NSW, Australia) along the peroid from 2014-2018. Histopathological correlation was done in 74 cases to test the accuracy of FNAC in diagnosis of parotid lesions. Results Of the total 74 FNAC done for parotid lesions in which a histopathological correlation was done, we get 46 (62.2%) benign lesions (37 neoplastic and 9 non-neoplastic) while 28 (37.8%) were malignant tumor. Pleomorphic adenoma was the most common in benign tumor side (45.7%) while SCC is the most common in malignant group (53.6%). Compatibility between FNAC and histological diagnosis was found in 74% (55/74), of which 78.3% in benign lesions (36/46) and in 68% of malignant lesions (19/28). FNA cytology was true positive in 21/74 cases (28.4%) and true negative in 41/74 (55.4%) cases. We have 5 (6.8%) false-negative and 7 (9.5%) false-positive results. As a result, we get sensitivity of 81%, specificity of 85%, and accuracy of 84%. Conclusion The role of FNAC in diagnosis of primary salivary gland pathology is considered with some debate about sensitivity/specificity; however, sometimes it should be repeated or correlated with clinical/histopathological confirmation.

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Clinical and Radiological Features of Urachal Carcinoma and Infection

Frontiers in Oncology ◽

10.3389/fonc.2021.702116 ◽

2021 ◽

Vol 11 ◽

Author(s):

Shichao Li ◽

Xiaoyan Meng ◽

Ping Liang ◽

Cui Feng ◽

Yaqi Shen ◽

...

Keyword(s):

Abdominal Pain ◽

Lymph Nodes ◽

Signal Intensity ◽

Bladder Wall ◽

Imaging Features ◽

Urachal Carcinoma ◽

Adc Value ◽

Exact Test ◽

Peripheral Lymph ◽

Apparent Diffusion

PurposeTo explore the clinical and radiological differences between urachal carcinoma and urachal infection.MethodsClinical and imaging information for 13 cases of urachal carcinoma and 14 cases of urachal infection confirmed by pathology were retrospectively analyzed. The size, location, shape, margin, lesion composition, calcification, T1 and T2 signal intensity, peripheral lymph nodes, degree of enhancement, adjacent bladder wall, and apparent diffusion coefficient (ADC) value were examined in both groups, and distinguish features were determined. The student t-test or Mann-Whitney U test was used for quantitative data, and Fisher’s exact test was used for qualitative data. Kappa coefficient consistency test was used to evaluate the interobserver agreement.ResultsSex, hematuria, abdominal pain, calcification, and thickening of adjacent bladder wall can distinguish between urachal carcinoma and urachal infection (p < 0.05). There were no statistical differences in age (p = 0.076), size (p = 0.797), location (p = 0.440), shape (p = 0.449), margin (p = 0.449), lesion composition (p = 0.459), T1 signal intensity (p = 0.196), T2 signal intensity (p = 0.555), peripheral lymph nodes (p = 0.236), degree of enhancements (p = 0.184) and ADC value (p = 0.780) between two groups.ConclusionThe following clinical and imaging features help distinguish urachal carcinoma from urachal infection: sex, hematuria, abdominal pain, calcification, and thickening of the adjacent bladder wall.

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Role of DWI in evaluation of HCC after radiofrequency ablation compared to dynamic MRI using MRI (3 T)

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00647-2 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Bahaa Mohamed Elrefaey Hasan ◽

Hanaa Abd ElKader Abd ElHamid ◽

Nivan Hany Khater ◽

Waseem ElGendy ◽

Ahmed S. Abdelrahman

Keyword(s):

Radiofrequency Ablation ◽

Dynamic Mri ◽

Reliable Technique ◽

Adc Value ◽

Cutoff Value ◽

Dce Mri ◽

Apparent Diffusion ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity ◽

A Prospective Study

Abstract Background The purpose of this study was to investigate the diagnostic performance of diffusion weight imaging (DWI), apparent diffusion coefficient (ADC) map, normalized ADC liver, and normalized ADC spleen compared to the dynamic contrast-enhanced MRI (DCE-MRI) in the evaluation of residual hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) using 3 T (T) magnetic resonance imaging (MRI). Results A prospective study was performed on 40 patients with radiofrequency-ablated HCC, and 15 (37.5%) patients had viable lesion post-RFA, while 25 (62.5%) had non-viable lesions. DCE-MRI had a sensitivity, specificity, and accuracy of 100%, 100%, and 100%, respectively, compared to DWI which had a sensitivity, specificity, and accuracy of 80%, 88%, and 85%, respectively, for identifying post-RFA viable HCC. The sensitivity, specificity, and accuracy of ADC at a cutoff value of 1.01 × 10−3 mm2/s were 80%, 100%, and 97.1%, respectively. The optimal cutoff value of normalized ADC liver was 0.81 with a sensitivity of 73.3%, specificity of 96%, and accuracy of 92.8%. The sensitivity, specificity, and accuracy of normalized ADC spleen at a cutoff value of 1.22 were 80%, 92%, and 91.1%, respectively. Conclusions DWI-MRI is a reliable technique for assessing HCC after radiofrequency ablation. DWI-MRI with ADC may be used as an alternate sequence for assessing radiofrequency-ablated lesions in individuals who have a contraindication to the contrast media, and the normalized ADC value may be of additional benefit.

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A simplified version of TI-RADS exhibits comparable diagnostic performance in malignancy risk stratification of thyroid nodules

10.21203/rs.3.rs-306585/v1 ◽

2021 ◽

Author(s):

Qingfang Chen ◽

Size Wu

Keyword(s):

Diagnostic Performance ◽

Thyroid Nodules ◽

Focal Lesions ◽

Multiple Parameters ◽

Golden Standard ◽

Benign Nodules ◽

Sensitivity Specificity ◽

Histopathological Results ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Abstract Evaluation of thyroid focal lesions using thyroid imaging reporting and data system (TIRADS) has been proceeding for a decade, but there is no consensus on any version of TIRADS. The purpose of this study was to validate a recently launched simplified Chinese version of TIRADS, with a compare to the American College of Radiology version of TIRADS. A total of 1306 patients with 1389 thyroid nodules were reviewed and assessed according the two TIRADSs, and the histopathological results were taken as golden standard. The results showed there were 973 benign nodules and 416 malignant nodules. The highest accuracies(AUCs)of C-TIRADS 4C and ACR-TIRADS 5 were taken as the optimized cut-off values for diagnosis. The sensitivity, specificity, PPV, NPV and AUC by C-TIRADS 4C and ACR-TIRADS 5 for thyroid nodule evaluation were 87.39%, 89.92%, 75.00%, 95.38% and 0.89, and 85.58%, 91.88%, 81.84%, 93.71% and 0.89, respectively, (P > 0.05 for all). We concluded that C-TIRADS and ACT-TIRADS have very good diagnostic performance in differentiating malignant from benign thyroid nodules by each optimized cut-off value, and the diagnostic performance of the fewer parameters based C-TIRADS 4C is comparable to the multiple parameters based ACR-TIRADS 5.

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Repeatability analysis of ADC histogram metrics of the uterus

Acta Radiologica ◽

10.1177/0284185118786062 ◽

2018 ◽

Vol 60 (4) ◽

pp. 526-534 ◽

Cited By ~ 2

Author(s):

Koichi Onodera ◽

Masamitsu Hatakenaka ◽

Naoya Yama ◽

Maki Onodera ◽

Tsuyoshi Saito ◽

...

Keyword(s):

Resonance Imaging ◽

Altman Plot ◽

Adc Value ◽

Pelvic Mri ◽

Bland Altman Plot ◽

Clinical Magnetic Resonance Imaging ◽

Apparent Diffusion ◽

Magnetic Resonance Imaging Mri ◽

High Repeatability ◽

Skewness And Kurtosis

Background Recently, histogram analysis based on voxel-wise apparent diffusion coefficient (ADC) value distribution has been increasingly performed. However, few studies have been reported regarding its repeatability. Purpose To evaluate the repeatability of ADC histogram metrics of the uterus in clinical magnetic resonance imaging (MRI). Material and Methods Thirty-three female patients who underwent pelvic MRI including diffusion-weighted imaging (DWI) were prospectively included after providing informed consent. Two sequential DWI acquisitions with identical parameters and position were obtained. Regions of interest (ROIs) for histologically confirmed uterine lesions (five cervical and three endometrial cancers, and one endometrial hyperplasia) and normal appearing tissues (21 endometrium and 33 myometrium) were assigned on the first DWI dataset and then pasted onto the second DWI dataset. ADC histogram metrics within the ROIs were calculated and repeatability was evaluated by calculating within-subject coefficient of variance (%) (wCV (%)) and Bland–Altman plot (%). Results ADC 10%, 25%, median, 75%, 90%, maximum, mean, and entropy showed high repeatability (wCV (%) < 7, 95% limit of agreement in Bland–Altman plot (%) < ±20), followed by ADC minimum (wCV (%) = 8.12, 95% limit of agreement in Bland–Altman plot (%) < ±30). However, ADC skewness and kurtosis showed very low repeatability in all evaluations. Conclusion ADC histogram metrics like ADC 10%, 25%, median, 75%, 90%, maximum, mean, and entropy are robust biomarkers and could be applicable to clinical use. However, ADC skewness and kurtosis lack robustness. Radiologists should keep these characteristics and limitations in mind when interpreting quantitative DWI.

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Apparent diffusion coefficient values of cryptorchid testes and malignant transformation of cryptorchidism (MTC) (seminoma) in postpubertal patients

British Journal of Radiology ◽

10.1259/bjr.20200624 ◽

2021 ◽

pp. 20200624

Author(s):

Renwei Liu ◽

Jianhua Li ◽

Yixiang Jiang ◽

Zhiqing Wu ◽

Yanzi Chen ◽

...

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Malignant Transformation ◽

Clinical Decision Making ◽

Characteristic Curve ◽

Adc Value ◽

Apparent Diffusion Coefficient Values ◽

Apparent Diffusion ◽

Adc Values ◽

Sensitivity Specificity

Objectives: Diffusion-weighted imaging signal contrast can be quantified by apparent diffusion coefficient (ADC) maps, which reflect the diffusion properties of the examined tissue and are helpful for identifying pathology. To determine ADC values of cryptorchid testes in post-pubertal patients and assess performance for characterizing cryptorchid testes. Methods: The medical records from 35 patients with unilateral scrotal vacuity were retrospectively reviewed. Data were analyzed in three groups: Group A, normal testes (i.e. the contralateral testes of the patients with cryptorchidism or MTC); Group B, cryptorchid testes; and Group C, malignant transformation of cryptorchidism (MTC) (seminoma). DWI used b-values of 0 and 800 s/mm2. Mean ADC values were compared using the independent samples t-test. The ability of ADC values was assessed using receiver operating characteristic curve analysis. The sensitivity, specificity, and accuracy were calculated. Results: Mean ADC values for normal testes, cryptorchid testes, and MTC were 1.18 ± 0.18×10−3 mm2/s, 1.82 ± 0.40×10−3 mm2/s, and 0.80 ± 0.06×10−3 mm2/s, respectively. There were statistically significant differences in mean ADC values between normal testes and cryptorchid testes or MTC (p < 0.001). The cut-off ADC value for differentiating normal testes from cryptorchid testes was 1.47 × 10−3 mm2/s. The sensitivity, specificity, and accuracy were 88%, 91%, and 90%, respectively. The cut-off ADC value for differentiating normal testes from MTC was 1.22 × 10−3 mm2/s. The sensitivity, specificity, and accuracy were 100%, 31%, and 43%, respectively. Conclusion: ADC values of cryptorchid testes may be used to inform clinical decision-making and also monitor testicular function in patients who retain undescended testicles or post-operatively. Advances in knowledge: Mean ADC values of cryptorchidism and MTC (seminoma) were used to reflect their pathological features.

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Value of apparent diffusion coefficient (ADC) in evaluating response of carcinoma of the cervix treated with chemoradiotherapy

South African Journal of Radiology ◽

10.4102/sajr.v17i1.203 ◽

2013 ◽

Vol 17 (1) ◽

pp. 11-15

Author(s):

A.J. Le Roux ◽

F.A. Gebremariam ◽

W.S Harmse

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Tumour Size ◽

Tumour Response ◽

Region Of Interest ◽

Response To Therapy ◽

Adc Value ◽

Pelvic Mri ◽

Apparent Diffusion ◽

Adc Values

Objective: To determine whether the apparent diffusion coefficient (ADC) value obtained by diffusion-weighted magnetic resonance imaging (DW-MRI) can be used as a reliable detector of response of carcinoma of the cervix treated with chemoradiotherapy, compared with conventional T2-weighted MRI.Design: A prospective cohort study was performed.Setting: Department of Oncology, Universitas-National Hospital Complex, Bloemfontein.Subjects: Seventeen women with advanced cervical cancer, FIGO staging IIB - IVB, were selected for chemoradiation.Outcome measures: Patients underwent pelvic MRI before therapy, 14 days after onset of therapy, and in the last week of treatment (5th/6th week). Axial and sagittal conventional T2 was followed by DW-MRI in the axial plane from which a tumour region of interest (ROI) was manually drawn to calculate ADC values using b-values of 500 and 1 000 s/mm2.Results: ADC values for cervical carcinoma increased after treatment with chemoradiation. The most significant observation was seen 14 days after treatment was started. The mean ADC value increased with 20% (b=500 s/mm2) and 24% (b=1 000 s/mm2) (statistically significant, p<0.05) compared with a decrease in tumour size of only 8%, which was not statistically significant (p=0.075). Responders showed a larger change in ADC values than non-responders.Conclusion: The study showed considerable promise in the ability of ADC to identify early tumour response to therapy. DW-MRI is a non-invasive functional imaging technique that may in future change management in oncology by early identification of non-responders, hence avoiding unnecessary treatment.

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TO SEPARATELY ASSESS THE DIAGNOSTIC POTENTIAL OF TVS & MRI IN THE TERMS OF SENSITIVITY AND SPECIFICITY BY CORRELATING THE IMAGING FINDINGS WITH HISTOPATHOLOGY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i6.1209 ◽

2020 ◽

Vol 4 (6) ◽

Author(s):

Suraj Mathur

Keyword(s):

Transvaginal Ultrasound ◽

High Sensitivity ◽

Imaging Evaluation ◽

Medical College ◽

Conventional Mri ◽

Diagnostic Potential ◽

Adc Mapping ◽

Malignant Lesions ◽

Sensitivity Specificity

This prospective study was done in the Department of Radio diagnosis Govt. Medical College, Kozhikode. A total of 65 patients who were referred to our department with clinical suspicion of endometrial lesions and incidentally detected endometrial lesions on ultrasonography underwent transvaginal ultrasound and subsequent Imaging evaluation of pelvis MRI has very high sensitivity (95%) and specificity (98%) and is almost as accurate (97%) as histopathology in differentiating benign from malignant lesions. Addition of DWI with ADC mapping to conventional MRI increases its accuracy even more. However there is inherent limitation to MRI in detecting carcinoma in situ and micrometastasis. Keywords: TVS, MRI, Sensitivity, Specificity, Histopathology.

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