The role of diffusion-weighted MR imaging in assessment of peritoneal lesions: radiologic-pathologic correlation

Bahaa Eldin Mahmoud,Lamiaa I A Metwally,Asmaa Ahmed Abdelzaher,Ahmed Abdellatif Mohamed

doi:10.1186/s43055-020-00271-6

Bahaa Eldin Mahmoud, Lamiaa I A Metwally + Show 2 more

Open Access

https://doi.org/10.1186/s43055-020-00271-6

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Abstract

BackgroundPeritoneal diseases can be caused by a wide spectrum of pathologies including benign, primary, and secondary malignant lesions. Benign peritoneal diseases can mimic malignancies and have overlapping clinical, pathophysiological, and imaging appearances. Biopsy and histological assessment remain the gold standard for characterization of the peritoneal lesions; however, functional MRI techniques like diffusion imaging with quantitative assessment by ADC (apparent diffusion coefficient) measurements can help in the detection and characterization of different peritoneal lesions. The aim of this study was to evaluate the role of diffusion MR imaging in differentiating between benign and malignant peritoneal lesions with correlation to their pathological results.ResultsForty patients with peritoneal lesions were included in the study. According to histopathological results, 20 of them were of benign nature, and the other 20 were malignant. The mean ADC value of the benign lesions was 1.5 ± 0.5 × 10−3 mm2/s while that of malignant lesions was 0.9 ± 0.3 × 10−3 mm2/s with statistically significant difference (p < 0.00001), and a cutoff value of 1.15 × 10−3 mm2/s can be used to differentiate benign and malignant lesions with 85% sensitivity and specificity. In particular, we compared the mean ADC values of the eight cases of peritoneal tuberculosis with that of fourteen cases of peritoneal carcinomatosa, and it was also statistically significant (p < 0.001). However, we did not find a statistically significant difference between the mean ADC value of the benign and malignant cystic peritoneal lesions (p = 0.5).ConclusionDiffusion MR imaging can provide a reliable non-invasive tool that can help in the differentiation between benign and malignant peritoneal lesions using qualitative and quantitative diffusion assessment through ADC measurements with a recommended cutoff value of 1.15 × 10−3 mm2/s.

Highlights

Peritoneal diseases can be caused by a wide spectrum of pathologies including benign, primary, and secondary malignant lesions
There is a wide spectrum of peritoneal diseases that can be caused by different benign and malignant pathologies
The aim of this study was to evaluate the role of diffusion MR imaging in differentiating between benign and malignant peritoneal lesions with correlation to their pathological results

Summary

Introduction

Peritoneal diseases can be caused by a wide spectrum of pathologies including benign, primary, and secondary malignant lesions. Benign peritoneal diseases can mimic malignancies and have overlapping clinical, pathophysiological, and imaging appearances. Biopsy and histological assessment remain the gold standard for characterization of the peritoneal lesions; functional MRI techniques like diffusion imaging with quantitative assessment by ADC (apparent diffusion coefficient) measurements can help in the detection and characterization of different peritoneal lesions. The mesentery is a double peritoneal layer which encloses the intestine and attaches it to the posterior abdominal wall. Ligaments are double layers of peritoneum between different organs or between an organ and abdominal walls. There is a wide spectrum of peritoneal diseases that can be caused by different benign and malignant pathologies. Benign diseases can mimic malignancies with overlapping clinical, pathophysiology, and imaging appearances. Histopathological examination of the peritoneal lesions whether by true cut biopsy, FNAC (fine needle aspiration cytology), or excisional biopsy is almost always required and considered the gold standard for diagnosis of the nature of peritoneal lesions [1]

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