ADC Cutoff Value Research Articles

Unveiling the mille-feuille sign: a key to diagnosing ovarian carcinosarcoma in addition to ovarian metastasis from colorectal carcinoma on MRI.

To clarify the diagnostic utility and formation of the Mille-feuille sign for ovarian carcinosarcoma (OCS) on MRI, and to evaluate the other MRI findings and serum markers compared to ovarian metastases from colorectal carcinoma (OMCRC). Three blinded radiologists retrospectively reviewed MR images of 12 patients with OCS, 18 with OMCRC, and 40 with primary ovarian carcinoma (POC) identified by the electronic database of radiology reports. The interobserver agreement was analyzed using Fleiss' kappa test. Their MRI characteristics and tumor markers were compared using Fisher's exact test and Mann-Whitney's U test. Receiver operating characteristic curve analyses were used to determine the cutoff points for the ADC value. This study was approved by the institutional ethics committee. Interobserver agreement analysis was moderate or higher for all MRI characteristics. The frequency of Mille-feuille sign was comparable for both OCS and OMCRC groups, and predominantly higher than that of the POC group (p < 0.001, p < 0.001), respectively. Pathologically, the Mille-feuille sign in OCS reflected alternating layers of tumor cells with stroma and necrosis or intraluminal necrotic debris. Compared to OMCRC, intratumoral hemorrhage (p = 0.02), margin irregularity (p = 0.048), unilateral adnexal mass (p = 0.02), and low ADC values (p < 0.01) were more frequently observed and serum CEA levels was significantly lower (p = 0.007) in the OCS group. Under setting of the cutoff value of ADC at 0.871 × 10-3mm2/s, the discriminative ability for OCS showed 66.7% sensitivity, 94.4% specificity, and 81.0% accuracy, respectively. The Mille-feuille sign was seen in both OCS and OMCRC. MR findings of intratumoral hemorrhage, margin irregularity, unilateral adnexal mass, low ADC values, and low serum CEA levels can be useful in differentiating OCS from OMCRC.

MR diffusion-weighted imaging precision in BIRADS downstaging

BackgroundBreast cancer is a major cause of both morbidity and mortality. Therefore, it is essential to promptly identify breast cancer in order to implement a more cautious surgical approach for disease treatment. Breast ultrasonography examination has long been used as a supplementary technique to mammography to evaluate palpable or mammographically detectable breast masses. Presently, Breast MRI has become an essential instrument for the detection and analysis of breast cancer. Diffusion-weighted imaging (DWI) is MRI technique that quantifies the movement of water molecules within tissue. It can provide valuable information about the density, viscosity, integrity of membranes, and microstructure of tissues. This study included sixty patients with Equivocal/high BIRADS lesions, underwent Mammography and /or U/S, CEMRI with DWI.Aim of the workThe aim of this study was to disclose MRDWI potency in depiction and assessment of different breast lesions unaccompanied by contrast-enhanced MRI with a view to avoid the high cost of the MRI contrast, lessen the number of needless biopsies and probably reclassify breast lesions of high BIRADS categories.ResultsThis prospective study included 58 patients (with 60 breast lesions), who came with sono-mammography breast lesions of BIRADS lesions > 2, comparison between sono-mammographic BIRADS and MRI BIRADS was done, where 40 cases were downgraded by MRBIRADS. On paralleling MRDWI unescorted by contrast-enhanced MRI with sono-mammographic BIRADS, 36 cases were downgraded. Correlation between pathology of the biopsied lesions with sono-mammography, MR BIRADS and MRDWI was done as well. Sono–mammography shows 88.9% sensitivity and 61.9% specificity with accuracy of 77.7%. Combined CE –MRI and DWI shows 94% sensitivity and 97.6% specificity with accuracy of 96%. While DWI solely shows 88.9% sensitivity and 90.5% specificity with accuracy of 96%. The cutoff value of ADC for prediction of malignancy was 0.9 with 94% sensitivity, 87% specificity and 83.3 accuracy.ConclusionsCEMRI is un-debatably effective in depicting and discriminating indeterminate breast lesions chiefly when combined with DWI. Yet, with the high expense of the contrast and in the event of contrast contraindications or unavailability, DWI has proven to be a convenient substitute for CE-MRI aiding in rendering the breast lesion BIRADS downgraded with diminishing the unneeded biopsies.

The role of diffusion-weighted MRI in the accurate diagnosis of vertebral compression fractures: A comparative study

IntroductionAccurately distinguishing between benign and malignant vertebral compression fractures is crucial for clinical management. This study evaluated the predictive accuracy of diffusion-weighted imaging (DWI) in differentiating the cause of vertebral fractures using MRI. MethodsA longitudinal cross-over study was conducted at Jinnah Postgraduate Medical Centre (JPMC) Karachi from July 2018 to January 2021. Patients with vertebral compression fractures underwent T1-weighted, T2-weighted, and DWI imaging with ADC mapping on a 1.5 T MRI scanner. Imaging findings were compared with histopathologic results and clinical follow-up. Sensitivity, specificity, and ROC curve analyses were performed. ResultsThe study enrolled 303 patients with a mean age of 43.6 ± 10.9 years, of whom 118 were male. DWI demonstrated high accuracy in predicting the cause of vertebral compression fractures, with a sensitivity of 96.2 %, a specificity of 76.2 %, and an area under the ROC curve of 0.857. The optimal ADC cut-off value was 0.82 × 10˄-3 mm˄2/s, which yielded a positive predictive value of 79.7 % and a negative predictive value of 95.4 %. ConclusionsDWI is a safe and non-invasive imaging modality with excellent predictive accuracy in differentiating between benign and malignant vertebral compression fractures. Iso- or hypointensity of collapsed vertebral bodies on DWI suggests a benign lesion, while T2-weighted hyperintensity is highly indicative of malignancy. Low signal on ADC is also highly indicative of malignant vertebral fractures. Incorporating DWI improves accuracy in assessing vertebral lesions, especially when standard sequences are inconclusive. Implications for practiceDWI revolutionizes vertebral compression fracture diagnosis, distinguishing between benign and malignant cases. This precision guides treatment decisions, minimizing the necessity for invasive procedures like biopsy. As a safe and reliable imaging method, DWI elevates patient care, ensuring accurate diagnostics and improved outcomes.

Characteristics and Role of Apparent Diffusion Coefficient (ADC) Value in Musculoskeletal Soft Tissue Tumor

Introduction: Musculoskeletal soft tissue tumors (STTs) consist of a group of malignant and benign tumors that present challenges in diagnosis and therapy. Adding diffusion-weighted imaging and apparent diffusion coefficient (DWI/ADC) ​​provides tissue characteristics that are different from those obtained by conventional MR techniques. Quantitative examination of the diffusion of water molecules in tissue is expressed as ADC value, which is expected to be more helpful in differentiating malignant and benign soft tissue masses. This study was carried out to determine the characteristics and role of ADC values ​​in musculoskeletal STTs. Methods: This research was conducted retrospectively. Analysis was performed using MRI results of patients with musculoskeletal STTs who met the inclusion and exclusion criteria. Three regions of interest (ROI) were assessed in the tumor area with the strongest contrast enhancement for DWI mapping, ADC, and ROI ADC value placement. An Independent T-test test was performed to determine the mean difference of ADC in each tumor category. Receiver Operating Characteristics (ROC) were generated to find the optimal cut-off value. Then, a diagnostic test was carried out to determine the sensitivity, specificity, PPV, and NPV of the ADC value. Results: There were 41 research subjects with musculoskeletal STTs with male predominance, in which 75.61% of cases were malignant. DWI/ADC showed that 78.05% of patients with musculoskeletal soft tissue tumors had restricted diffusion areas. In this study, the ADC cutoff value to differentiate benign and malignant musculoskeletal STT is 0,84 x 10-3mm2/s with 77.4% sensitivity and 90% specificity, 96% positive predictive value and 56.3% negative predictive value. Conclusion: In differentiating malignant and benign musculoskeletal STTs, the ADC value provides fair sensitivity, very good specificity, good positive predictive value, and low negative predictive value.

Multiparametric magnetic resonance imaging in the assessment of pathological axillary lymph nodes in cases of breast cancer

BackgroundBreast cancer is the most frequent cancer affecting females. It represents leading cause of death from all cancers in females. Traditionally, axillary staging was surgically assessed by axillary lymph node dissection (ALND), which is associated with complications. Sentinel lymph node biopsy (SLNB) is a minimally invasive surgical method for axillary staging in patients with primary breast cancer with lower morbidity and better quality of life. Clinical examination of the axilla is usually associated with a high false negative rate, so role of imaging is crucial to identify lymph nodes with or without suspicious features, to predict the pathological state of the lymph nodes and to direct the diagnostic and therapeutic process toward SLNB, ALND, or chemotherapy. Aim of this study was to assess axillary lymph nodes in breast cancer patients by magnetic resonance imaging and functional MRI preoperatively to determine its nature and eliminate invasive procedures as invasive dissection used in diagnosis.ResultsLymph node size cannot significantly predict malignant infiltration with p value 0.425, using cut-off value of 21.5 mm, with a sensitivity of 14.6% and specificity of 100%. Cortical thickness of lymph nodes can significantly predict malignant infiltration with p value 0.006, using cut-off value of 4.5 mm, with a sensitivity of 68.8%, specificity of 62.5%, and diagnostic accuracy of 64.1%. ADC can significantly predict lymph node infiltration with p value 0.011, using a cut-off value of 0.99, with sensitivity of 43.85, specificity of 100%, diagnostic accuracy of 57.8%, and AUC of 71.4%. There was a statistically significant correlation between pathological findings and DCE-MRI curve type III with p value 0.0001, showing a sensitivity of 37.5%, specificity of 100%, and diagnostic accuracy of 84.4% for detection of malignant lymph nodes.ConclusionsCortical thickness and effaced fatty hilum of lymph nodes can significantly predict malignant infiltration, while lymph node size cannot significantly predict malignant infiltration. Diffusion weighted images and ADC maps can be of significant value in predicting metastatic lymph nodes with approximate ADC cut-off value of 0.99. Kinetic MRI features of the axillary lymph nodes are not reliable enough to be used alone in the clinical management of breast cancer patients.

Predictive Value of MRI in Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia.

Hypoxic-ischemic encephalopathy (HIE) is a severe pathology, and no unique predictive biomarker has been identified. Our aims are to identify associations of perinatal and outcome parameters with morphological anomalies and ADC values from MRI. The secondary aims are to define a predictive ADC threshold value and detect ADC value fluctuations between MRIs acquired within 7 days (MR0) and at 1 year (MR1) of birth in relation to perinatal and outcome parameters. Fifty-one term children affected by moderate HIE treated with hypothermia and undergoing MRI0 and MRI1 were recruited. Brain MRIs were evaluated through the van Rooij score, while ADC maps were co-registered on a standardized cerebral surface, on which 29 ROIs were drawn. Statistical analysis was performed in Matlab, with the statistical significance value at 0.05. ADC0 < ADC1 in the left and right thalami, left and right frontal white matter, right visual cortex, and the left dentate nucleus of children showing abnormal perinatal and neurodevelopmental parameters. At ROC analysis, the best prognostic ADC cut-off value was 1.535 mm2/s × 10-6 (sensitivity 80%, specificity 86%) in the right frontal white matter. ADC1 > ADC0 in the right visual cortex and left dentate nucleus, positively correlated with multiple abnormal perinatal and neurodevelopmental parameters. The van Rooij score was significantly higher in children presenting with sleep disorders. ADC values could be used as prognostic biomarkers to predict children's neurodevelopmental outcomes. Further studies are needed to address these crucial topics and validate our results. Early and multidisciplinary perinatal evaluation and the subsequent re-assessment of children are pivotal to identify physical and neuropsychological disorders to guarantee early and tailored therapy.

Magnetic resonance imaging with perfusion and diffusion in assessment of intra-spinal lesions

BackgroundMRI is the imaging modality of choice in detecting and evaluating spinal lesions. However, advanced techniques as diffusion and perfusion studies can help more in differentiation between neoplastic and non-neoplastic lesions. Our study aimed to detect the role of diffusion and T2* perfusion weighted imaging in characterization of different spinal lesions by measuring the relative cerebral blood volume (rCBV) and apparent diffusion coefficient value (ADC) of all lesions, comparing perfusion of lesion in relation to normal cord and detection of diffusion pattern of each lesion by observing its signal intensity at diffusion images and ADC map.ResultsFifty patients were included in this study. Twenty-five patients were with non-neoplastic lesions and twenty-five patients were with neoplastic lesions. The cutoff value of rCBV was 1.2 in differentiation between neoplastic and non-neoplastic lesions with 92% sensitivity and 100% specificity. The cutoff value of ADC was 1 in differentiation between neoplastic and non-neoplastic lesions with 56% sensitivity and 80% specificity.ConclusionsDiffusion and perfusion weighted images help in differentiation between neoplastic and non-neoplastic spinal lesions.

Correlation of Shear-Wave Elastography and Apparent Diffusion Coefficient Values in Breast Cancer and Their Relationship with the Prognostic Factors.

Diffusion-weighted imaging and elastography are widely accepted methods in the evaluation of breast masses, however, there is very limited data comparing the two methods. The apparent diffusion coefficient is a measure of the diffusion of water molecules obtained by diffusion-weighted imaging as a part of breast MRI. Breast elastography is an adjunct to conventional ultrasonography, which provides a noninvasive evaluation of the stiffness of the lesion. Theoretically, increased tissue density and stiffness are related to each other. The purpose of this study is to compare MRI ADC values of the breast masses with quantitative elastography based on ultrasound shear wave measurements and to investigate their possible relation with the prognostic factors and molecular subtypes. We retrospectively evaluated histopathologically proven 147 breast lesions. The molecular classification of malignant lesions was made according to the prognostic factors. Shear wave elastography was measured in kiloPascal (kPa) units which is a quantitative measure of tissue stiffness. DWI was obtained using a 1.5-T MRI system. ADC values were strongly inversely correlated with elasticity (r = -0.662, p &lt; 0.01) according to Pearson Correlation. In our study, the cut-off value of ADC was 1.00 × 10-3 cm2/s to achieve a sensitivity of 84.6% and specificity of 75.4%, and the cut-off value of elasticity was 105.5 kPa to achieve the sensitivity of 96.3% and specificity 76.9% to discriminate between the malignant and benign breast lesions. The status of prognostic factors was not correlated with the ADC values and elasticity. Elasticity and ADC values are correlated. Both cannot predict the status of prognostic factors and differentiate between molecular subtypes.

High-risk breast lesions: role of multi-parametric DCE-MRI in detection and histopathological upgrade prediction

BackgroundHigh-risk breast lesions represent 3–21% of all breast lesions and are non-obligate precursors of malignancy. Various studies have evaluated the value of DCE-MRI including DWI and ADC mapping in the detection of high-risk breast lesions, differentiating them from malignant lesions and predicting upgrade risk after surgical excision reducing misdiagnosis and overtreatment. This study is a retrospective review of all image-guided breast biopsy procedures performed in 2021 at our institution, identified 68 patients with histopathologically proven high-risk breast and available MRI examinations with no concurrent ipsilateral malignancy. Image analysis of MRI examinations included morphological criteria, enhancement pattern, dynamic curves, DWI and ADC mapping assessment. Since our knowledge of high-risk breast lesions is still growing, this study is important to evaluate the merits of DCE-MRI in the assessment of high-risk breast lesions, to allow optimization of treatment, better limit it to those women at risk, and avoid overtreatment in women at low risk.ResultsThe mean ADC value of high-risk breast lesions was not significantly different from that of malignant breast lesions (p value = 0.015). Non-mass enhancement and type III enhancing curve proved to be significant indicators of high-risk breast lesions upgrade in surgical pathology. Cut-off average ADC value for differentiating upgraded high-risk lesions from non-upgraded high-risk lesions proved 1.24 mm2/sec with sensitivity and specificity of 94 & 100%, respectively.DiscussionManagement of high-risk breast lesions is important in the screening setting, as they are non-obligate precursors of malignancy, and also function as risk indicators. Frequency and upgrade rates of high-risk lesions detected by MRI provide a reference for clinical management. DCE-MRI has a high negative predictive value in predicting the upgrade risk of high-risk lesions. In this study, non-mass enhancement and type III curve were proven to be indicators of high-risk lesion upgrade. Limitations of the study included small number of patients and limited follow-up period.ConclusionsThe use of multi-parametric DCE-MRI including DWI and ADC mapping provides complementary information to detect high-risk breast lesions and predict their upgrade rate.

Role of diffusion-weighted MRI for prediction of regional lymph node positivity in radiologically organ-confined renal tumour: a prospective study

BackgroundLymph node metastasis is one of the major factors that decide the prognosis of renal cell carcinoma. Presently, lymphadenectomy is only accepted as the most precise and dependable staging method to detect lymph node invasion; still, its therapeutic value for renal cell carcinoma is controversial. Diffusion-weighted magnetic resonance imaging along with its apparent diffusion coefficient value has already shown great value as a non-invasive modality to detect early microstructural changes in various human tumours. The present study is done to know the role of DWMRI in determining regional lymph node positivity in radiologically organ-confined renal cell carcinoma.MethodsIn this prospective study, we measured the ADC value of renal mass and regional lymph node in patient of RCC. ADC value < 1.25 is taken as cut-off to determine lymph node involvement. A malignant lymph node was confirmed by histopathology postoperatively. After that, we analysed the data retrospectively and studied the association between cut-off ADC value and lymph node positivity.ResultsTotal 44 patients of RCC were evaluated in the study. Out of 44 patients, lymph node was found to be malignant on histopathology in 25 (56.8%) patients, and of these, 23 patients had ADC value < 1.25. This association was statistically significant (p < 0.05). The findings of DW MRI were accurate in 72.7% of patients with sensitivity of 63.1%, specificity of 80% and positive predictive value of 70.5%.ConclusionsLymph node with ADC value < 1.25 × 10–3 mm2/s has higher probabilities of harbouring malignant cell, so ADC value of DWMRI can be used as a sensitive and specific parameter to differentiate malignant lymph node from benign lymph node. However, our futuristic observation needs to be validated by multi-institutional large sample cohort.

Rapid diagnosis of Plasmodium falciparum malaria using a point-of-care loop-mediated isothermal amplification device.

LAMP diagnosis of malaria is simple and cost-effective with acceptable sensitivity and specificity as compared to standard diagnostic modules such as microscopy, RDTs and nested PCR, and thus its deployment for onsite screening of malaria in resource-limited regions is under consideration. However, the requirement of an electricity-operated dry bath and bulky read-out unit is still a major concern. In an effort to simplify this limitation, we have developed a portable LAMP device and fluorescence readout unit which can be used in the rapid point-of-care diagnosis of malaria. We have developed a point-of-care diagnostic LAMP device that is easy to operate by a mobile application, and the results can be quantified with a fluorescent readout unit. The diagnostic performance of the device was evaluated in 90 P. falciparum-infected clinical isolates stored at 4°C for 6-7 years and 10 freshly collected isolates from healthy volunteers. The LOD and quantitative ability of LAMP in estimating parasitemia levels were revealed with laboratory-grown P. falciparum strain (3D7). The LAMP assay performed in our device was exclusive for P. falciparum detection with sensitivity and specificity determined to be 98.89% and 100%, respectively, in clinical isolates. The LOD was documented to be 1 parasite/µl at the cut-off ADC value of 20. Parasite density estimated from ADC values showed concordance with microscopically determined parasite density of the cultured P. falciparum 3D7 strain. The LAMP assay performed in our device provides a possible portable platform for its deployment in the point-of-care diagnosis of malaria. Further validation of the quantitative ability of the assay with freshly collected or properly stored clinical samples of known parasitemia is necessary for field applicability.

Role of 18F-FDG PET/CT in assessment of HCC patients after therapeutic interventions compared to DW MRI

BackgroundHepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide in both men and women. Early-stage HCCs are treated either by curative surgical resection and/or by locoregional interventions, such as radiofrequency ablation or trans-arterial chemoembolization. Functional imaging as diffusion-weighted magnetic resonance imaging (DW MRI) and metabolic imaging with 18F-positron emission tomography/computed tomography (18F-FDG PET/CT) has been used for assessment of treatment response. This retrospective study was conducted on 29 patients known to have HCC with locoregional therapeutic interventions and referred for radiological follow-up searching for residual/recurrence neoplasia or metastatic deposits. The study aimed to assess the benefits of using the metabolic parameters of 18F-FDG PET/CT in the follow-up of HCC patients after therapeutic interventions in comparison with DW MRI.ResultsRegarding qualitative assessment of residual active viable HCC by PET/CT and DW MRI, the sensitivity, specificity, PPV, NPP and accuracy were 77.3%, 91.7%, 94.4%, 68.8%, 82.4% and 95.5%, 75%, 87.5%, 90%, 88.2%, respectively. The optimal cutoff point of the SUVmax to differentiate viable from non-viable HCC was 3.4 (AUC = 0.898), with sensitivity, specificity, PPV and NPV of 77.27%, 100.0%, 100.0% and 66.7%, respectively. The optimal ADC cutoff value for discrimination between viable and non-viable HCC was 1247 mm2/s (AUC = 0.976) with sensitivity, specificity, PPV and NPV of 90.48%, 100.0%, 100.0% and 83.3%, respectively. New hepatic lesions were found in 38.2% of patients by DW MRI, while detected only in 26.5% of patients by PET/CT. The PET/CT revealed extrahepatic metastasis in 44.1% of patients, while detected only in 8.8% of patients by DW MRI.ConclusionsDWI was more sensitive than PET/CT for detecting tumor residual and hepatic recurrence compared to PET/CT which was much better in detecting distant metastases.

Added values of diffusion weighted imaging, Dynamic contrast enhancement and opposed phase MRI in evaluation of bony lesions around the knee &amp; ankle joints

Background: Magnetic resonance imaging (MRI) represents the most advanced imaging technique in diagnosis of bone tumors being more sensitive in assessing bone marrow changes and extent of tumors compared to CT and plain X-ray. The distinction between malignant and benign neoplasms is mandatory for appropriate therapeutic choices and planning. MRI has the upper hand in the assessment of such tumors due to its brilliant soft tissue discrimination. The use of multiparametric MRI techniques increase accuracy of discrimination between malignant and benign lesions. Results: This prospective study included 34 patients; 16 males and 18 females with musculoskeletal complaint around the knee &amp; ankle joints. Their age ranged from 10 to 65 years (mean age was 26.65 ± 17.23 years). The cut off value of ADC for bony lesions (by ROC curve) was ≤ 1 to be considered malignant. At this cut off point; the sensitivity of ADC to detect malignant and to exclude benign lesions was 83.3 % and the specificity was 86.4 %. The cut off value for SIR for bony lesions (by ROC curve) was ≥ 0.89 to be considered malignant.

“DIFFERENTIATING BENIGN FROM MALIGNANT BREAST LESIONS- CLINICAL, HISTOPATHOLOGICAL AND IMAGING CORRELATION”

Introduction: Breast cancer is the second most common cancer in Indian women. Breast cancer is a signicant cause of worldwide morbidity and mortality. Mammography and ultrasound are used as the rst line of investigation for the early detection and localization of breast tumors. Mammography has high sensitivity in case of patients with fatty parenchyma however low sensitivity in case of patients with dense breasts, implants, and post-surgical scar, thus breast MRI with higher sensitivity and specicity due to its ability to depict excellent soft-tissue contrast has become increasingly important in the detection of breast cancer. DCE-MRI has improved specicity in characterizing breast lesions by analysis of time-intensity curves. Diffusion-weighted imaging can improve the sensitivity and specicity of MRI in the evaluation of breast lesions by calculating the ADC values a quantitative measure that is a useful tool for tumor detection and differentiating between benign and malignant breast lesions. To evaluate the role of diffusion-weighted MRI andObjective: dynamic contrast-enhanced MRI in differentiating benign from malignant breast lesions and to compare the ndings of diffusion-weighted MRI and dynamic enhanced MRI with histopathological or FNAC ndings. A totalMaterial And Methods: of 30 patients with palpable breast lumps with either positive or negative ndings on mammography and ultrasound were included in this study. All patients included in this study rst underwent lm-screen mammography. Ultrasonography was done with convex and linear probes. This was followed by MRI. T1W axial, T2W axial, SPAIR/ Fat Saturated T2 weighted axial images were acquired in appropriate imaging planes. Diffusion-weighted images were obtained using b values of 0 and 1000 and ADC values were calculated. Dynamic contrast-enhanced MR was performed using fat-suppressed 3D T1 weighted images after injection of gadolinium and time-intensity curves were generated. A single precontrast scan was followed by 4 post- contrast scans which were obtained for a total duration of 4 min 24 seconds. Findings of the MRI (Diffusion-weighted and dynamic contrast enhancement) were analyzed and correlated with histopathological and FNAC ndings to evaluate their use as a diagnostic modality. A total of 30 female patients presenting with palpable breast lumps were included in theResults: study. Out of 30 patients, 20 cases were malignant (66.67%) and 10 cases were benign (33.3%). Fibroadenoma accounted for a majority of benign lesions (4 out of 10 benign lesions) while IDC accounted for the majority of malignant lesions (15 out of 20 malignant lesions). Dynamic CE-MR is a reliable tool for differentiating between benign and malignant lesions based on kinetic curves. 7 out of 10 benign lesions showed a type I curve while the rest showed a type II curve while the majority (15/20) of malignant lesions showed a type III curve. 8 out of 10 benign breast lesions did not show restricted diffusion on DWI while all malignant lesions showed restricted diffusion on DWI. In our study, the mean ADC value for benign lesions was 1.59 x 10 mm/s while the mean ADC value for malignant lesions was 0.88 x 10 mm/s. Using the ROC curve, the cut-off value of ADC was calculated to be 1.19 x 10 mm/s which gives sensitivity and specicity of 95% and 90% respectively. The individual sensitivity for DCE-MRI and DWI was calculated to be 95% and 95% while the individual specicity for DCE-MRI and DWI was calculated to be 70% and 90% respectively. After a combined analysis of DCE-MRI and DWI using a positive result from any of the two techniques as malignancy, the sensitivity and specicity were 95% and 80% respectively.

Efficacy of diffusion‐weighted imaging in the diagnosis of osteoporosis suggested by the correlation between mandibular cortex width and apparent diffusion coefficient of the mandibular bone marrow

AbstractPurposeThe objectives of the study were as follows: (i) to compare MCW and ADC stratified by menopause and osteoporosis, (ii) to calculate the correlation of the MCW on panoramic radiographs with the ADC in the mandibular bone marrow, and (iii) to investigate the utility of DWI of the jaws in the diagnosis of osteoporosis.Material and MethodThis study analyzed 87 normal patients and 23 patients with osteoporosis. The patients were divided into three groups: premenopausal (n = 33), postmenopausal (n = 54), and osteoporosis (n = 23). We investigated the MCW and mean ADC of the mandibular bone marrow. We analyzed the data using the Spearman's correlation coefficients, Kruskal‐Wallis test, and post‐hoc Mann‐Whitney tests with Bonferroni adjustments, and a receiver operating characteristic (ROC) curve was plotted. Statistical significance was set at P &lt; 0.05.ResultsThere were significant between‐three group differences in both the mean ADC and mean MCW (p &lt; 0.001). Furthermore, there was a significant positive correlation between MCW and the ADC of the mandibular bone marrow in postmenopausal group (p &lt; 0.05). The ROC analysis revealed a cutoff ADC value of 0.62 to distinguish between the postmenopausal and those with osteoporosis.ConclusionsIn addition to evaluating the MCW, which is currently used for osteoporosis evaluation, measuring the ADC of the mandibular bone marrow could contribute toward the examination of osteoporosis.

Role of diffusion-weighted MRI in evaluation of pediatric musculoskeletal soft tissue masses

BackgroundIn pediatric patients, soft tissue masses encompass a wide heterogeneous group of benign and malignant lesions. MRI is a powerful diagnostic tool in the workup of soft tissue tumors in children, and it helps in characterization of lesion and evaluation of the extent of the lesion. However, conventional MRI techniques are not specific in differentiating benign from malignant lesions. So to improve characterization of tumors, DWI was added to MRI techniques as it increases sensitivity and specificity by detecting the micro-diffusion changes of water into intra- and extracellular spaces. The aim of this work was to highlight the diagnostic value of DWI in detection and characterization of different musculoskeletal soft tissue masses in pediatrics.ResultsThere was a statistically significant difference regarding the mean ADC value of benign and malignant masses (P value = 0.001*). The mean ADC value for all benign masses (n = 41) was 1.495 ± 0.55 SD × 10–3 mm2/s, while the mean ADC value for all malignant masses (n = 21) was 0.449 ± 0.27 SD × 10–3 mm2/s. The cutoff ADC value between benign and malignant masses was 0.88 × 10–3 mm2/s. This cutoff ADC value has sensitivity of 100.0%, specificity of 92.3%, PPV of 66.7%, NPV of 100.0% and diagnostic accuracy of 93.3%.ConclusionIn pediatric patients, DWI is an innovative valuable noninvasive imaging technique for characterization of musculoskeletal soft tissue masses and discrimination between benign and malignant masses.

Role of diffusion weighted MRI imaging in characterization of hepatic focal lesions in cirrhotic patients in comparison to dynamic cross sectional imaging

Abstract Aim of work The aim of the study is to show the feasibility of diffusion weighted (DWI) MRI with calculation of the apparent diffusion coefficient in characterization of hepatic focal lesions as well as differentiating benign from malignant lesions in cirrhotic patients. Patients and Methods The study included 35 patients (25 males and 10 females) by cross sectional study and convenient sampling at the Demerdash hospital, inclusion criteria: patients diagnosed by hepatic focal lesions on top of post-viral induced cirrhosis, detected by ultrasound, triphasic CT or dynamic MRI imaging. All patients to be included in the study underwent characterization of hepatic focal lesions to differentiate benign from malignant lesions using a combination of characteristic imaging criteria, including contrast enhancement patterns on MRI. Sequences used were T2 weighted imaging, T2 Spectral Attenuated Inversion Recovery (SPAIR), and diffusion weighted imaging sequences with estimation of the ADC map and calculation of the ADC values. Results Our study was carried on a total of 35 patients including 25 males and 10 female patients having a mean age of 59 ± 10.2 years (58.1 ± 11 and 61.2 ± 8 years for the male and female patients respectively). DWI and ADC showed statistically significant difference among the benign and malignant focal lesions in terms of their diffusion restriction criteria ( P &amp;lt; 0.0001), with a sensitivity, specificity, positive and negative predictive values of 100% (95% CI = 89.5 – 100%), 92.3% (95% CI = 79.6 – 97.3%), 91.6% (95% CI = 78.1 – 97.1%) and 100% (95% CI = 90.3 – 100%), as well as a likelihood ratio of 13. On comparing the ADC values of the focal lesions for the benign and malignant focal lesions, the malignant lesions showed statistically significant lower means as compared to the benign lesions (malignant = 1.08 ± 0.28 x 10-3 mm2/s, benign =2.0 ± 0 x 10-3 mm2/s, P &amp;lt; 0.0001). ROC curve analysis of the ADC values of the benign and malignant focal lesions was highly significant (P &amp;lt; 0.0001), with an area under curve of 0.9745 (97.45% overall accuracy), giving an ADC cut-off value of (&amp;lt; 0.98 x 10-3 mm2/s) for malignant lesions with 97.2% sensitivity (95% CI = 85.83% - 99.86%), 97.2% specificity (95% CI = 85.83% - 99.86%) and a likelihood ratio of 35. Summary and conclusion DWI MRI and the calculation of the ADC are great non invasive possible tools to detect and characterize hepatic focal lesions as well as to differentiate benign from malignant lesions in cirrhotic patients especially in patients with renal impairment and allergy to contrast media also to avoid unnecessary biopsies.

The role of functional imaging; DWI, ADC and 18F-FDG PET/CT in the evaluation of HCC treatment response after transarterial chemoembolization

BackgroundThe transcatheter arterial chemoembolization (TACE) is one of the treatment lines for patients with hepatocellular carcinoma (HCC), this study was conducted to assess the role of functional imaging including the DWI, ADC and 18F-2-fluoro-2-deoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) for detection of residual HCC after TACE as compared to the structural liver imaging reporting and data system (LI-RADS).ResultsThe optimal cut off value of standardized uptake value ratio (SUVmax/liver SUVmean ratio) for detection of residual viable HCC after TACE was 1.09 with 88.9%, 87.5% and 88.6% sensitivity, specificity, and accuracy respectively, a lower diagnostic value was noted in the qualitative visual FDG PET/CT assessment with sensitivity, specificity, and accuracy of 81.5%, 75% and 80% respectively. The sensitivity, specificity, and accuracy of DWI for identification of post-TACE viable HCC were 77.8%, 75%, and 77.1% respectively. The optimal cut off value of ADC for the diagnosis of variable HCC was 1.32 × 10−3 mm2/s with sensitivity, specificity, and accuracy of 81.5%, 75%, and 80% respectively.ConclusionsDWI, ADC and FDG PET/CT are effective functional imaging modalities for the evaluation of viable residual HCC post-TACE with comparable findings for the dynamic cross-section imaging.

DWI and ADC value versus ADC ratio in the characterization of solid renal masses: radiologic-pathologic correlation

BackgroundRenal masses are becoming an increasingly common finding on cross-sectional images. Characterization of the nature of the lesion either neoplastic or not, benign or malignant as well as further subtype characterization is becoming an important factor in determining management plan. The purpose of our study with to assess the sensitivity and specificity of both ADC mean value and ADC ratio in such characterization along with the calculation of different cutoff values to differentiate between different varieties, using pathological data as the main gold standard for diagnosis.ResultsOur study included 50 patients with a total of 72 masses. A final diagnosis was reached in 69 masses by pathological examination and three masses had clinical and laboratory signs of infection. We had a total of 49 malignant lesions (68%) and 23 benign lesions (32%). The ADC value of ccRCC (1.4 × 10−3 mm2/s) was significantly higher than all other renal masses. A cutoff ADC value of > 1.1 and a cutoff ADC ratio of > 0.56 can be used to differentiate between clear cell renal cell carcinoma and other lesions and an ADC value of < 0.8 and an ADC ratio of ≤ 0.56 to differentiate papillary renal cell carcinoma from other masses. There was no statistically significant ADC value to differentiate between benign and malignant lesions but a statistically significant ADC ratio (> 0.52) was reached.ConclusionADC value and ADC ratio can be used as an adjunct tool in the characterization of different renal masses, with ADC ratio having a higher sensitivity, which can affect the prognosis and management of the patient.

Nongaussian Intravoxel Incoherent Motion Diffusion Weighted and Fast Exchange Regime Dynamic Contrast-Enhanced-MRI of Nasopharyngeal Carcinoma: Preliminary Study for Predicting Locoregional Failure.

Simple SummaryPre-treatment (TX) prediction of the risk of locoregional failure (LRF) will allow for TX individualization in patients with nasopharyngeal carcinoma (NPC). The aim of the present study was to identify whether the quantitative metrics from pre-TX non-Gaussian intravoxel incoherent motion (NGIVIM) diffusion weighted (DW-) and fast exchange regime (FXR) dynamic contrast enhanced can predict patients with LRF in NPC. Cumulative incidence (CI) analysis and Fine-Gray (FG) proportional subhazards modeling were conducted in a sample of 29 NPC patients considering death as a competing risk. NGIVIM and FXR derived quantitative metric values from primary tumors classified the patients with and without LRF in NPC. The CI analysis and FG modeling results suggest that the quantitative metrics obtained from DW- and DCE-MRI may improve LRF patients’ prediction in NPC.The aim of the present study was to identify whether the quantitative metrics from pre-treatment (TX) non-Gaussian intravoxel incoherent motion (NGIVIM) diffusion weighted (DW-) and fast exchange regime (FXR) dynamic contrast enhanced (DCE)-MRI can predict patients with locoregional failure (LRF) in nasopharyngeal carcinoma (NPC). Twenty-nine NPC patients underwent pre-TX DW- and DCE-MRI on a 3T MR scanner. DW imaging data from primary tumors were fitted to monoexponential (ADC) and NGIVIM (D, D*, f, and K) models. The metrics Ktrans, ve, and τi were estimated using the FXR model. Cumulative incidence (CI) analysis and Fine-Gray (FG) modeling were performed considering death as a competing risk. Mean ve values were significantly different between patients with and without LRF (p = 0.03). Mean f values showed a trend towards the difference between the groups (p = 0.08). Histograms exhibited inter primary tumor heterogeneity. The CI curves showed significant differences for the dichotomized cutoff value of ADC ≤ 0.68 × 10−3 (mm2/s), D ≤ 0.74 × 10−3 (mm2/s), and f ≤ 0.18 (p < 0.05). τi ≤ 0.89 (s) cutoff value showed borderline significance (p = 0.098). FG’s modeling showed a significant difference for the K cutoff value of ≤0.86 (p = 0.034). Results suggest that the role of pre-TX NGIVIM DW- and FXR DCE-MRI-derived metrics for predicting LRF in NPC than alone.