Glioblastoma (GB) is the deadliest primary brain tumor, largely due to inevitable recurrence of the disease after partial surgical resection or resistance to drug treatments. The study aimed to evaluate the predictive values of apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI), plasma levels of placental growth factor (PGF) and glial fibrillary acidic protein (GFAP), and their combination in GB recurrence. The study included 200 patients diagnosed with GB consisting of 136 with tumor recurrence and 64 without. DWI examinations and PGF and GFAP measurements in the plasma were performed preoperatively. The patients with recurrent disease exhibited a lower value of ADC with higher plasma PGF and GFAP levels than those with non-recurrence. The results of Pearson correlation analysis suggested the ADC shared negative correlations with plasma levels of PGF and GFAP in patients with recurrent GB. The plasma level of PGF was also found to be positively correlated with the plasma level of GFAP in patients with recurrent GB. The ADC, plasma levels of PGF and GFAP in predicting recurrent GB presented AUC: 0.75, 0.85, and 0.82, respectively. Combined analysis of two of three to evaluate the prediction showed AUCs of 0.98 (ADC and PGF), 0.96 (ADC and GFAP), and 0.84 (PGF and GFAP). Combined analysis of ADC and plasma PGF, ADC and plasma GFAP, PGF and GFAP to evaluate the prediction showed AUCs of 0.98, 0.96, and 0.84, respectively. Combined analysis of three of them to evaluate the prediction showed AUC as 0.98. The study demonstrates that combined ADC and plasma PGF showed a similar predictive value in recurrent GB after standard treatment as combined ADC, plasma PGF and GFAP together. Considering limited sample size and lack of more sample types in this study, additional value of plasma GFAP in predicting recurrent GB should be further investigated in larger-scale population or different sample sources.

Non-contrast MRI characteristics can help differentiate mucin plugs from mural nodules in pancreatic cystic lesions. To identify MRI features that differentiate non-enhancing lesions from true mural nodules in pancreatic cystic lesions. We retrospectively evaluated 90 patients with pancreatic cystic lesions containing 101 nodular components (62 non-enhancing, 22 benign enhancing, 17 high-risk). Two experienced radiologists independently assessed multiple non-contrast MRI characteristics, including signal-intensity patterns, shape, and their cyst-wall relationship. The reference standard was the contrast-enhanced pattern, with histopathology for resected specimens or minimum 2-year stability for presumed mucin plugs. Diagnostic performance was evaluated in binary logistic regression models. Only the non-enhancing lesions (41.9%) showed the "target sign" (layered appearance due to different central- and peripheral-portion signal intensities), providing 100% specificity for identifying non-enhancing lesions. The non-enhancing lesions were predominantly oval-shaped (93.5%) with posterior-wall attachment (85.5%), whereas enhancing lesions showed a complex morphology. On diffusion-weighted imaging (DWI), 93.5% of the non-enhancing lesions showed low signal intensity and 95.2% showed high apparent diffusion coefficient (ADC) values, contrasting with high DWI signal (82.4%) and low ADC values (82.4%) in the high-risk lesions. A multiparameter model achieved excellent diagnostic performance with an area under the curve of 0.97 for differentiating non-enhancing from enhancing lesions and 0.92 for distinguishing non- or benign enhancing from high-risk lesions. Non-contrast MRI features, particularly the target sign, shape characteristics, and cyst-wall relationship can reliably differentiate mucin plugs from true mural nodules in pancreatic cystic lesions, potentially reducing unnecessary invasive procedures.

Diffusion-weighted MRI and apparent diffusion coefficient in head and neck malignancies: practical utility for diagnosis, triage and post-treatment surveillance.

To evaluate the correlation between time-dependent diffusion MRI (td-dMRI) parameters and prognostic factors in nasopharyngeal carcinoma (NPC). 116 patients (105 NPC, 11 benign hyperplasia) were prospectively enrolled. Four td-dMRI-derived microstructural parameters, extracellular diffusivity (Dex), intracellular volume fraction (Vin), Diameter, and Cellularity, and apparent diffusion coefficient (ADC) at three oscillation frequencies (ADC0Hz, ADC30Hz, and ADC55Hz), were obtained. TNM stages and prognostic factors were recorded; continuous variables were dichotomized by optimal cut-offs. Correlations, between-group comparisons, and receiver operating characteristic analysis summarized diagnostic performance as the area under the curve (AUC). Programmed death ligand 1 was correlated with ADC values, with ADC55Hz achieving an AUC of 0.708. Epidermal growth factor receptor was correlated with Cellularity and Diameter (r = 0.341 and -0.329). Ki-67 expression was associated with Dex and ADC55Hz (r = 0.252 and 0.286). Vin, Cellularity and ADC0/30Hz were linked to histological subtype, with Vin achieving the highest AUC of 0.706. TNM stages were correlated with Diameter (r = 0.203 to 0.371) and Cellularity (r = -0.365 to -0.284). ADC30Hz best distinguished NPC (T1-2) from hyperplasia (AUC = 0.847). Negative correlations were observed between several parameters and Epstein-Barr virus (EBV)-based antibodies (r = -0.269 to -0.239). Vin and ADC0/30Hz differed across EBV DNA clearance groups after induction chemoimmunotherapy (p ≤ 0.038). td-dMRI-measured diameters correlated with pathological measurements (r = 0.772, p < 0.001). td-dMRI parameters may reflect tumor microstructure and show associations with prognostic factors in NPC, suggesting potential utility for risk stratification and treatment monitoring. Question Can microstructural parameters from time-dependent diffusion MRI (td-dMRI) noninvasively provide clinically meaningful prognostic information for nasopharyngeal carcinoma? Findings Differences in prognostic factor levels can be reflected by td-dMRI, and td-dMRI-derived diameter was correlated with pathology-derived diameter (r = 0.772, p < 0.001). Clinical relevance td-dMRI provides a noninvasive method to characterize tumor microstructure, potentially improving patient management strategies in nasopharyngeal carcinoma.

Compared to medulloblastoma (MB), atypical teratoid rhabdoid tumor (AT/RT) is characterized by a lower incidence, younger age at onset, and a poorer prognosis. Preoperative clinical and neuroimaging differentiation between these tumors remains challenging. This study aimed to evaluate the diagnostic utility of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in distinguishing AT/RT from MB in children. We retrospectively included 32 patients with AT/RT and 82 patients with MB confirmed by surgery and pathology in our hospital between 2010 and 2023. We analyzed the clinical data, preoperative MRI characteristics, and apparent diffusion coefficient (ADC) values of these patients to evaluate their diagnostic value. The overall survival time of AT/RT patients was significantly shorter than that of MB patients (P < 0.001), with a higher mortality rate (81.4% vs. 35.5%,P = 0.007). Significant differences were found between AT/RT and MB in T2WI signal, off-midline growth, supratentorial ventriculomegaly, cystic degeneration, hemorrhage, peritumoral edema, tumor boundary clarity, and metastasis/dissemination (P < 0.05). No significant differences were observed in gender, age, lesion size, T1WI signal, or enhancement pattern (P > 0.05). The mean ADC value differed significantly between the two groups (P < 0.001), with an optimal cut-off value of 0.622 × 10⁻3 mm2/s. MRI features, including more cystic degeneration, hemorrhage, supratentorial ventriculomegaly, and peritumoral edema, combined with a lower ADC value may provide reliable information to differentiate AT/RT from MB in children.

Oncocytic papillary cystadenoma of the parotid gland: characteristic multiparametric MRI signature.

To introduce and evaluate the feasibility of a novel RF-phase modulated gradient echo (GRE) method for quantitative diffusion MRI, aimed at mitigating geometric distortion and enabling high-resolution 3D quantitative diffusion/T2 mapping as a complementary alternative to conventional DWI. The proposed phase-based diffusion (PBD) method employs RF phase modulation to encode both diffusion and T2 information into the GRE signal phase. A closed-form analytical model enables joint apparent diffusion coefficient (ADC) and T2 mapping via iterative reconstruction. The method's feasibility was evaluated via Bloch equation simulations, phantom experiments, and preliminary in vivo imaging studies. Monte Carlo simulations revealed that PBD provides more accurate median ADC estimates at low signal-to-noise ratios (SNRs) compared to conventional single-shot echo-planar imaging (SS-EPI), although PBD exhibited greater variability. Phantom studies demonstrated good agreement for PBD-derived ADC values (e.g., R2 = 0.99) with reference methods and strong correlation for PBD-derived T2 values (e.g., R2 = 0.89), though the latter showed some systematic bias in phantoms. In vivo results from patients with benign or malignant prostate disease demonstrated the feasibility of the PBD method to provide high-resolution ADC and T2 maps with minimal geometric distortions relative to conventional SS-EPI. PBD provides ADC and T2 maps with improved geometric fidelity in phantoms and in vivo, and offers robust median ADC estimates from noisy data based on simulations. This combination of spatial precision and noise characteristics makes PBD promising for applications such as high-resolution DWI for prostate MRI.

To evaluate the diagnostic utility of simultaneous fluorine-18 fluorodeoxyglucose ( 18 F-FDG) PET/MRI quantitative parameters in characterizing glioma heterogeneity and predicting isocitrate dehydrogenase (IDH) mutation status, based on the 2021 WHO Classification. Twenty-five patients with histopathologically confirmed gliomas underwent preoperative simultaneous 18 F-FDG PET/MRI. Forty-one biopsy foci were analyzed. Maximum standardized uptake value (SUV max ), normalized SUV (nSUV) ratios, minimum apparent diffusion coefficient, perfusion index, and cerebral blood flow (CBF), were measured. Patients were stratified into low-grade and high-grade groups (including molecular glioblastoma), according to the 2021 WHO criteria. Generalized estimating equations (GEE) were used alongside standard nonparametric tests to account for clustered biopsy data. High-grade tumors exhibited significantly higher SUV and lower minimum apparent diffusion coefficient values compared to low-grade tumors ( P < 0.001). While perfusion parameters showed limited significance in standard unadjusted analyses, GEE analysis revealed them as highly significant predictors for high-grade status. IDH-wildtype (IDH-wt) tumors demonstrated significantly higher perfusion values ( P < 0.001) and tumor-to-white matter metabolic ratios (nSUV). Receiver operating characteristic analysis confirmed high diagnostic performance for SUV max [area under the curve (AUC) = 0.938] and CBF (AUC = 0.875) in discriminating tumor grade. Similarly, nSUV1 (AUC = 0.873) and CBF (AUC = 0.825) proved effective for predicting IDH-wt status. Simultaneous 18 F-FDG PET/MRI provides complementary metabolic and functional information for glioma characterization. When intratumoral heterogeneity is accounted for using GEE, perfusion parameters emerge as robust biomarkers for predicting high-grade histology and IDH-wt status. These findings support a multimodal approach to guide stereotactic biopsies to the most aggressive intratumoral foci.

This study aimed to evaluate whether MRI-based perfusion-diffusion habitat imaging derived from dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) can characterize intratumoral heterogeneity and evaluate associations with pathologic stage, synchronous distant metastasis, and exploratory survival outcomes in rectal adenocarcinoma. This retrospective study included 73 patients with pathologically confirmed rectal adenocarcinoma who underwent preoperative DCE-MRI and DWI scans. The volume transfer constant (Ktrans) and apparent diffusion coefficient (ADC) maps were generated from DCE and DWI data, respectively. After manual tumor segmentation and image co-registration, voxel-wise Ktrans and ADC values were clustered using a k-means algorithm to identify distinct spatial habitats. Quantitative metrics extracted from each habitat were compared across pathologic subgroups and entered into multivariable logistic regression models for T staging and association with synchronous distant metastasis. Three reproducible habitats were identified: Habitat 1, hyper-vasopermeability; Habitat 2, hypo-vasopermeability with hypo-cellularity; and Habitat 3, hypo-vasopermeability with hyper-cellularity. Compared with T1-2 tumors, T3-4 lesions showed significantly higher mean Ktrans and the extracellular-extravascular volume fraction (Ve) in Habitats 1 and 2 and lower mean ADC in Habitats 2 and 3. Multiple perfusion metrics from Habitat 1 significantly correlated with distant metastasis. The optimized logistic regression models achieved AUCs of 0.81 for T staging and 0.78 for distant metastasis prediction. Combined DCE-MRI and DWI habitat imaging enables voxel-level assessment of intratumoral heterogeneity in rectal cancer and may provide a noninvasive imaging biomarker for preoperative T staging and assessment of tumor heterogeneity and systemic disease-associated imaging features.

Fetal renal developmental abnormalities are among the most common congenital malformations and are associated with adverse perinatal outcomes. Although fetal magnetic resonance imaging (MRI) can provide complementary morphological and quantitative information, gestational age (GA)-specific reference values integrating fetal renal morphology and diffusion parameters remain limited. This study aimed to establish MRI-based reference values for normal fetal renal morphology and apparent diffusion coefficient (ADC) across gestation. In this retrospective single-center observational study, 313 singleton pregnancies (GA 23-38 weeks) with normal postnatal urinary outcomes underwent 1.5T fetal MRI, including T2-weighted and diffusion-weighted imaging sequences. Morphological parameters [anteroposterior, transverse and longitudinal diameters, and mean renal parenchymal thickness (MRPT) and functional parameters T2 relative signal intensity (RSI-T2) and apparent diffusion coefficient (ADC)] were measured for both kidneys. Reproducibility was assessed using intraclass correlation coefficients (ICC). Associations between MRI parameters and GA were evaluated using correlation and linear regression analyses. All measured parameters showed good to excellent inter-observer reproducibility. Renal diameters and MRPT increased significantly with GA (r = 0.72-0.89; all P < 0.0001). In contrast, renal ADC values showed moderate negative correlations with GA (right kidney: r =-0.47; left kidney: r =-0.52; both P < 0.0001). The regression equations for ADC (×10-3mm²/s) were ADC_right = 3.23 - 0.049 × GA and ADC_left = 3.46 - 0.058 × GA. This study provides GA-stratified reference ranges for key morphological and functional MRI parameters of normal fetal kidneys in the second and third trimesters. These quantitative benchmarks may provide a reference framework for fetal renal MRI assessment and for future studies of fetal renal abnormalities. Not applicable.

Early ADC changes in risk-model-defined brain regions precede contrast-enhancing lesions after proton therapy for low-grade glioma.

Epithelial ovarian cancer (EOC) can be broadly classified into type I and type II tumours, which exhibit distinct biological behaviours. Accurate preoperative differentiation between these subtypes is important for guiding treatment decisions and optimizing patient outcomes. To evaluate the diagnostic value of quantitative parameters derived from synthetic magnetic resonance imaging (SyMRI) alone and in combination with clinico-morphological features for differentiating type I from type II EOCs. This retrospective study included 92 patients with pathologically confirmed EOC, including 32 type I and 60 type II tumours, who underwent preoperative MRI. Quantitative parameters derived from SyMRI, including T1, T2, and proton density (PD), and DWI-derived apparent diffusion coefficient (ADC) values were measured from the solid components of the tumours. Clinico-morphological characteristics were also recorded. Differences between type I and type II EOCs were assessed using the independent Student's t, Mann-Whitney U test, or chi-squared tests. Multivariable logistic regression analysis was used to identify independent predictors and construct a combined model. The model's performance was evaluated using receiver operating characteristic (ROC) curve analysis. Type I EOCs exhibited significantly higher T1, T2, and ADC values than type II EOCs (all p < 0.05), whereas PD values did not differ significantly between the two groups (p = 0.746). Significant differences were also observed in patient age, serum CA125 levels, maximum tumour diameter, MRI enhancement characteristics, and texture (all p < 0.05). A multivariable analysis identified T1 value, CA125 level, maximum tumour diameter, and enhancement characteristics served as independent predictors. The combined model incorporating these variables achieved an AUC of 0.936, which was significantly higher than that of any individual parameter (all p < 0.05). SyMRI-derived quantitative parameters, particularly T1 values, may provide valuable biomarkers for differentiating EOC subtypes. A combined model integrating T1 values with clinico-morphological features showed high diagnostic performance and may support preoperative risk stratification and individualized treatment planning in patients with EOC.

To evaluate the diagnostic performance and inter-rater reliability of (O-RADS) MRI based on non-dynamic contrast-enhanced (DCE) MRI and the value of apparent diffusion coefficient (ADC) in the characterization of adnexal masses. Retrospective analysis was done for 148 patients with 191 adnexal masses who underwent non-DCE MRI and diffusion-weighted imaging (DWI). Two independent radiologists classified the masses into five categories according to O-RADS-MRI and measured ADCmean values for solid and cystic components. The final diagnoses were determined by postoperative histopathology. Logistic regression analysis was performed to detect predictors of malignancy. There was excellent inter-rater agreement in assessing O-RADS categories (kw=0.901 and 95% CI = 0.863 to 0.939). Solid tissue enhancement more than the myometrium at 30-40s at non-DCE MRI was statistically significantly higher in malignant lesions (p < 0.001). There was also excellent reliability (absolute inter-rater agreement) in measuring ADCmean values. The ADCmean of solid and cystic components at cutoff values of ≤ 1.3 × 10 - 3 mm2/s and > 2.07 × 10 -3mm²/s are perfect and excellent discriminators for differentiating malignant and benign adnexal masses (AUC = 1.000 and 0.952) respectively. Multivariate regression analysis revealed that the presence of simple fluid, low DW signal of cystic component, and ADCmean of cystic component > 2.07 × 10 -3mm²/s were statistically significant independent predictors of malignancy in an O-RADS-MRI score > 3 adnexal lesions. O-RADS-MRI score utilizing non-DCE MRI is a reliable system with high PPV. ADCmean value is a non-invasive excellent discriminator for differentiating adnexal lesions that could improve O-RADS-MRI score performance and treatment plan.

We investigated the utility of 18F-labeled prostate-specific membrane antigen positron emission tomography/computed tomography ([18F]PSMA-1007 PET/CT) for assessing residual tumor burden after neoadjuvant androgen deprivation therapy (nADT), compared with multiparametric magnetic resonance imaging (mpMRI). This retrospective study included 20 patients with prostate cancer treated with nADT followed by radical prostatectomy. All patients underwent baseline mpMRI, post-nADT mpMRI, and [18F]PSMA-1007 PET/CT. Lesion-based diagnostic performance of [18F]PSMA-1007 PET/CT and mpMRI was compared using generalized estimating equations. Apparent diffusion coefficient (ADC) and transfer constant (Ktrans) values were compared between baseline and post-nADT using Wilcoxon signed-rank tests and between tumor and benign prostatic hyperplasia (BPH) using Mann-Whitney U tests. Baseline mpMRI identified 23 biopsy-confirmed lesions, and post-nADT, 21 showed residual tumor on pathology. [18F]PSMA-1007 PET/CT demonstrated significantly higher sensitivity (90.5% vs. 23.8%, p < 0.001) and accuracy (87.0% vs. 26.1%, p < 0.001) than mpMRI. Median ADC increased significantly after nADT (0.849 to 1.174 × 10- 3 mm2/s, p = 0.005), while median Ktrans decreased (0.277 to 0.080min- 1, p = 0.005). Baseline ADC and Ktrans differed significantly between tumor and BPH (p = 0.001 and p = 0.012, respectively), but no significant post-nADT differences were observed (p = 0.831 and p = 0.701, respectively). Post-nADT SUVmax also did not differ between tumor and BPH (p = 0.639). [18F]PSMA-1007 PET showed higher sensitivity and accuracy than mpMRI in detecting residual tumor after short-term nADT and may be useful for further management planning. These preliminary findings support the feasibility of [18F]PSMA-1007 PET for post-treatment assessment.

To compare the diagnostic performance of Dual-Energy CT (DECT), Diffusion-Weighted MRI (DWI), and Chemical Shift MRI (CSI) in differentiating metastatic from non-metastatic cervical lymph nodes in patients with head and neck cancer, using histopathology as the reference standard. In this prospective cross-sectional study, 38 patients with suspected head and neck malignancy underwent DECT, DWI, and CSI prior to histopathological evaluation. A total of 194 lymph nodes were analysed. Quantitative parameters including DWI- apparent diffusion coefficient (ADC), DECT- normalised iodine concentration (NIC), spectral HU, electron density, effective atomic number and CSI in-out phase ratio were assessed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis, and comparison between modalities was performed using the DeLong test. Of 194 lymph nodes, 71 were metastatic and 122 were non-metastatic. ADC values were significantly lower in metastatic nodes (p < 0.0001). Dual-energy CT parameters and chemical shift MRI did not show statistically significant differences. ROC analysis demonstrated superior diagnostic performance of ADC compared to other parameters. DWI demonstrates superior diagnostic performance in differentiating metastatic cervical lymph nodes, while DECT and CSI show limited utility. Multiparametric MRI, particularly DWI, should be preferred for nodal characterization in head and neck cancer. This study provides direct comparative evidence showing that ADC-based DWI is significantly superior to DECT quantitative parameters and CSI for nodal metastasis detection, supporting its role as the primary functional imaging tool.

To characterize the relationship between the apparent diffusion coefficient (ADC) and dynamic viscosity in aqueous glycerin phantoms across different concentrations and temperatures, and to establish a controlled calibration framework for diffusion MRI measurements. Eight glycerin-water solutions (10-60 wt%) were prepared, and viscosities were measured with capillary viscometers at 24, 37, and 40°C. Diffusion-weighted imaging (DWI) was performed on a 3.0-T scanner using 15 b-values (0-1500s/mm²). Voxel-wise ADC maps were calculated by mono-exponential fitting, and ADC-viscosity relationships were modeled using linear and inverse fitting approaches. Viscosity increased with concentration and decreased with temperature, consistent with the known physical behavior of glycerin-water mixtures. ADC values were inversely related to viscosity and showed strong relationships at all temperatures (R² > 0.98). High-concentration samples exhibited reduced signal-to-noise ratio and greater fitting instability, limiting reliable analysis in the highest-viscosity range. Aqueous glycerin solutions provide practical phantom materials for evaluating ADC-viscosity relationships under controlled conditions. By anchoring MRI-derived ADC measurements to standard viscometer data, this study established a reproducible calibration framework for diffusion MRI system evaluation across a defined viscosity range.

Combination of color-Doppler ultrasound and MRI to improve lacrimal gland lesion characterization: A machine learning approach.

Accurate risk stratification in cervical cancer remains challenging, and imaging biomarkers may add prognostic value beyond staging. This systematic review was conducted to evaluate the published data on the integrated use of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and magnetic resonance imaging (MRI) in cervical cancer, with a specific analysis of the correlation between functional and anatomical imaging parameters and the identification of prognostic imaging markers. A comprehensive database search was conducted to identify studies that examined functional and anatomical imaging parameters using PET and MRI in the analysis of cervical cancer. A total of 328 articles were screened, and 107 full-text articles were reviewed. 34 studies were ultimately included in the systematic review. Thirty Four papers were reviewed for systematic review. Key functional and anatomical imaging parameters were analysed. 11 papers analysed PET standardised uptake value (SUV) and MRI apparent diffusion coefficient (ADC) correlations which were suitable for meta-analysis. Moderate negative correlations between SUV and ADC values were statistically significant across multiple studies. Furthermore, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were shown to be statistically correlated with tumour grade, FIGO staging and survival outcomes (disease-free survival, DFS, and overall survival, OS). Imaging parameters predictive of local recurrence, metastatic disease and survival outcomes were analysed. This systematic review of 34 studies on FDG PET and MRI in cervical cancer shows that imaging biomarkers predict recurrence, metastasis, and outcomes. Collectively, the literature supports the potential role of integrated PET/MRI biomarkers for improved prognostic stratification beyond conventional staging systems.

To evaluate whether pretreatment magnetic resonance imaging (MRI) parameters can predict short-term clinical response to dienogest (DNG) in patients with adenomyosis. This retrospective study included 78 patients with MRI-diagnosed adenomyosis who underwent pelvic MRI before hormonal therapy between October 2018 and July 2025. Quantitative MRI parameters included T2 signal intensity ratios, diffusion-weighted imaging (DWI) signal intensity ratios, normalized apparent diffusion coefficient (ADC), and uterine morphological parameters. Adenomyosis subtypes were classified according to the modified Kishi criteria. Short-term clinical response was assessed primarily 3-6months after treatment initiation as a composite clinical outcome encompassing symptom improvement (dysmenorrhea, menstrual blood loss, and/or hemoglobin levels) and treatment continuation; patients were classified as responders or non-responders. Predictive analyses were restricted to the DNG cohort because only one patient in the GnRH cohort was a non-responder. Of the 78 patients, 32 received gonadotropin-releasing hormone (GnRH) agonist or antagonist therapy and 46 received DNG. In the DNG cohort, 30 patients were responders and 16 were non-responders. MRI-based adenomyosis subtype, lesion distribution, and uterine morphological parameters were not significantly associated with response in DNG-treated patients. However, absolute ADC values were significantly higher in responders (1.03 vs. 0.89 × 10⁻3mm2/s, P = 0.036), as was the ADC signal intensity ratio relative to the endometrium (ADC SIRendo: 0.92 vs. 0.85, P = 0.034). Receiver operating characteristic analysis demonstrated moderate discrimination for both parameters (area under the curve = 0.70). Optimal cut-off values were 0.951 × 10⁻3mm2/s for ADC and 0.952 for ADC SIRendo. Quantitative diffusion MRI parameters were associated with short-term clinical response to DNG, whereas conventional morphological features were not. Diffusion-weighted MRI may provide complementary imaging biomarkers for adenomyosis stratification in DNG-treated patients; prospective validation with longer follow-up is warranted.

Diffusion tensor cardiovascular magnetic resonance differentiates pediatric dilated and hypertrophic cardiomyopathies.