The utility of DW-MRI in the diagnosis of pancreatic focal lesions

Abstract

BackgroundEarly diagnosis is crucial in management of pancreatic malignancy. DWMRI could be used in differentiating pancreatic lesions and judge about tumor aggressiveness. Patients & methodsFifty patients were included in this prospective study with mean age ±43 years. Histopathology & follow up clinical results revealed 34 malignant and 16 benign lesions. All patients underwent non-contrast MRI examination and DWI at different b-values with ADC value measurements. ResultsConventional MRI poorly diagnosed pancreatic focal lesions with 79% Sensitivity, 68% specificity & 76% accuracy. In DWI with high b-value of 1000, 31/34 malignant lesions showed restricted diffusion with low ADC value (≤1.5 × 10−3 mm2/s) while 14/16 benign lesions showed mixed diffusion with higher ADC values (≥1.7 × 10−3 mm2/s). DWI at high b-value of 1000 with chosen ADC value of 1.5 as a cut-off value revealed high sensitivity (91.18%), 87.5% specificity, 93.84% PPV, 82.35% NPV and 90% accuracy in differentiating benign from malignant pancreatic lesions. ConclusionDWMRI found to be a simple and non-invasive tool that aid in the diagnosis of pancreatic pathology with recommended high b-value and a cut-off ADC value of 1.5 that approved the highest sensitivity & specificity in differentiating benign from malignant pancreatic focal lesions.