Role Of Diffusion-weighted Imaging Research Articles

The Role of Diffusion-Weighted Images in the Evaluation of Complex Watershed Infarctions: Clinical Image

The Role of Diffusion-Weighted Images in the Evaluation of Complex Watershed Infarctions: Clinical Image

Magnetic resonance enterography and intestinal ultrasound for the assessment and monitoring of Crohn's disease.

Magnetic resonance enterography (MRE) and intestinal ultrasound (IUS) have developed rapidly in the last few decades, emerging as the primary non-invasive options for both diagnosing and monitoring Crohn's disease (CD). In this review, we evaluate the pertinent data relating to the use of MRE and IUS in CD. We summarise the key imaging features of CD activity, highlight their increasing role in both the clinical and research settings, and discuss how these modalities fit within the diagnostic pathway. We discuss how they can be used to assess disease activity and treatment responsiveness, including the emergence of activity scores for standardised reporting. Additionally, we address areas of controversy such as the use of contrast agents, the role of diffusion-weighted imaging, and discuss point-of-care ultrasound. We also highlight exciting new developments including the applications of artificial intelligence. Finally, we provide suggestions for future research priorities.

Utility of Chemical Shift Imaging and Diffusion-weighted Images/Apparent Diffusion Coefficient Maps as a Tool for Evaluation of Solid Renal Tumors.

To study the utility of chemical shift imaging (CSI) and diffusion-weighted images (DWI)/apparent diffusion coefficient (ADC) maps for the evaluation of solid renal tumors. Magnetic resonance imaging (MRI) has an equivalent application as computerized tomography (CT) in the characterization of renal masses. It offers a radiation-free imaging technique and has a better soft tissue contrast than CT. Also, MRI is favored in patients with chronic kidney disease. MRI is useful when findings on CT are equivocal. The role of DWI in characterizing solid renal lesions as malignant is encouraging, and DWI can be particularly useful when gadolinium is contraindicated. CSI is useful in differentiating angiomyolipoma (AML) from clear cell (cc) renal cell carcinoma (RCC). We did a cross-sectional study on 24 patients with solid renal masses. MRI of the upper abdomen (from the dome of the diaphragm to the iliac crest) will be done on an MRI machine in our department (1.5T, ACHIEVA, Phillips medical system) using the torso coil. There was no significant association seen in terms of ADC values and histological subtypes (χ2 = 11.222, p = 0.082). In our study, 50% (one out of two) of AML showed a signal drop, whereas 40% of cases (6 out of 15) of ccRCC and 66% (two out of three) of papillary RCC showed a signal drop. In this article, we concluded CSI, although a useful tool to look for microscopic fat, can't be used as a reliable marker to rule in cc-carcinoma as both AML and papillary cell carcinoma have microscopic fat. Further, no histological classification can be done on the basis of DWI/ADC images.

The Role of Diffusion-Weighted Imaging in the Evaluation of Treatment of Newly Diagnosed Type 2 Diabetic Patients.

To compare the pre and post-treatment pancreatic apparent diffusion coefficient (ADC) values of type II diabetes patients with control subjects, and also to evaluate its effectiveness in evaluating the response to treatment. The study included 35 newly diagnosed type 2 diabetic patients and 35 non-diabetic participants, matched for sex and age. Insulin and metformin treatment was given to the patients. Abdominal diffusion-weighted MR imaging was performed before and after the treatment. ADCs of the control group and patients pre and post-treatment were compared. In addition, the clinical parameters of the patients related to diabetes were recorded. There was a significant difference between the median pancreatic ADC values of the patients pre and post-treatment. While there was a significant difference between the median pancreatic ADC values of the patient and the control groups before the treatment, no significant difference after the treatment was observed. There was a positive correlation between mean pancreatic ADC values and age, as well as a negative correlation with Hb1Ac level and eGFR. Pancreatic ADC values of newly diagnosed type II diabetes patients can be used as a marker of pancreatic function in the evaluation of response to treatment and clinical decisions.

Diffusion-weighted imaging for determining response to neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis

ObjectivesTo determine the role of diffusion-weighted imaging (DWI) for predicting response to neoadjuvant therapy (NAT) in pancreatic cancer.Materials and methodsMEDLINE, EMBASE, and Cochrane Library databases were searched for studies evaluating the performance of apparent diffusion coefficient (ADC) to assess response to NAT. Data extracted included ADC pre- and post-NAT, for predicting response as defined by imaging, histopathology, or clinical reference standards. ADC values were compared with standardized mean differences. Risk of bias was assessed using the Quality Assessment of Diagnostic Studies (QUADAS-2).ResultsOf 337 studies, 7 were included in the analysis (161 patients). ADC values reported for the pre- and post-NAT assessments overlapped between responders and non-responders. One study reported inability of ADC increase after NAT for distinguishing responders and non-responders. A correlation with histopathological response was reported for pre- and post-NAT ADC in 4 studies. DWI’s diagnostic performance was reported to be high in three studies, with a 91.6–100% sensitivity and 62.5–94.7% specificity. Finally, heterogeneity and high risk of bias were identified across studies, affecting the domains of patient selection, index test, reference standard, and flow and timing.ConclusionDWI might be useful for determining response to NAT in pancreatic cancer. However, there are still too few studies on this matter, which are also heterogeneous and at high risk for bias. Further studies with standardized procedures for data acquisition and accurate reference standards are needed.Clinical relevance statementDiffusion-weighted MRI might be useful for assessing response to neoadjuvant therapy in pancreatic cancer. However, further studies with robust data are needed to provide specific recommendations for clinical practice.Key Points•The role of DWI with ADC measurements for assessing response to neoadjuvant therapy in pancreatic cancer is still unclear.•Pre- and post-neoadjuvant therapy ADC values overlap between responders and non-responders.•DWI has a reported high diagnostic performance for determining response when using histopathological or clinical reference standards; however, studies are still few and at high risk for bias.

The role of diffusion-weighted imaging and ADC value in head and neck lesions

The role of diffusion-weighted imaging and ADC value in head and neck lesions

The role of diffusion-weighted imaging in the diagnosis of early kidney damage

Objective: This study aimed to determine a threshold value for distinguishing early-stage chronic kidney disease (CKD) from moderate and advanced stages as well as patients with early-stage CKD from those with normal renal function using apparent diffusion coefficient (ADC) and normalized ADC values. Methods: This retrospective study enrolled 257 patients. Diffusion-weighted images were obtained with a set of b = 50,400,800 values. In each patient, six ADC values were measured from upper, middle, and lower areas of both kidneys, and three ADC values were measured from the spleen. Patients with CKD were classified into five subgroups and healthy patients were classified into two subgroups according to their glomerular filtration rate (GFR). Results: The renal ADC values were found to be positively correlated with GFR (r = 0.790, p < 0.001) and negatively correlated with creatinine levels (r = −0.709, p < 0.001). The mean ADC values of the stage 1 and 2 CKD groups were found to be significantly higher than those of advanced-stage CKD groups (p < 0.001), and these values were significantly lower in the stage 1 and 2 CKD groups than in the healthy group (p < 0.001). With a cut-off value of ≥1.791 for ADC, the sensitivity was 76.5% and the specificity was 85% while distinguishing between patients with early- and advanced-stage CKD. Conclusion: Renal and normalized ADC values are strongly correlated with CKD stages, and with the use of appropriate threshold values, the difference between early and advanced stages of CKD can be predicted.

Role of diffusion-weighted imaging in carotid plaque vulnerability assessment

BackgroundMR plaque imaging is a valuable tool in characterizing carotid atherosclerotic plaque and identifying high-risk features. There are limited data on the role of the widely available single-shot diffusion-weighted imaging (DWI) in plaque characterization along with histological correlation. This study aimed to correlate the plaque characteristics identified by MR imaging in vivo at the level of maximum stenosis with histological plaque characteristics in the postoperative specimen.MethodsPatients who underwent carotid endarterectomy in a tertiary care center during one and half years were prospectively recruited for non-contrast MR carotid plaque imaging (including single-shot EPI-DWI sequence) in a 3 Tesla MRI using a dedicated carotid coil. An experienced radiologist correlated DWI sequence findings with histopathology of postsurgical sections to confirm the high-risk features.ResultsTwenty-three patients (mean age 66.1 years ± SD 6.25) were evaluated, of which 65% were males and 96% were symptomatic. Apparent diffusion coefficient (ADC) values in location of plaques could differentiate histopathological unstable from stable plaques (0.83 × 10–3 mm2/s vs 1.7 × 10–3 mm2/s; p 0.001), with a sensitivity and specificity of 75% and 79%, respectively, at an ADC cutoff of 1.24 × 10–3 mm2/s. Plaques with and without lipid-rich necrotic core (0.86 × 10–3 mm2/s vs 1.44 × 10–3 mm2/s; p = 0.042) as well as intraplaque hemorrhage could be differentiated (0.751 × 10–3 mm2/s vs 1.352 × 10–3 mm2/s; p 0.037) using the apparent diffusion coefficients.ConclusionThe widely available single-shot EPI-DWI in assessing plaque characteristics in carotid stenosis is promising and correlated with histopathological features. Diffusion-weighted imaging will be a helpful adjunct in patients when contrast administration is intolerable.

Role of diffusion-weighted imaging and dynamic contrast enhanced magnetic resonance imaging in the diagnosis of early sacroiliitis in seronegative spondyloarthropathies, correlation with levels of acute phase reactants

Objective: Seronegative spondyloarthropathy (SpA) is a destructive disease. Early diagnosis is crucial to prevent morbidity. Magnetic resonance imaging (MRI) is the only imaging modality that can show early sacroiliitis. We aimed to investigate the utility of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in the detection, quantification and staging of early/acute SpA. We also investigated the relationship between contrast enhancement properties and apparent diffusion coefficient (ADC) values with laboratory parameters for inflammation such as ESR and CRP measurments. Patients and Methods: Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed on 85 patients that fulfilled the criteria. A positive MRI finding was defined as inflammation in subchondral bone representing active sacroiliitis. Kinetic analyses were performed, apparent diffusion coefficient (ADC) values were calculated, ESR and CRP levels were measured for quantification of inflammation. Statistical analyses were performed. Results: In acute SpA group; quantity, area and level of enhancement, values of ADC and Fenh, levels of CRP were significantly higher than those with chronic SpA. A high level of agreement was found between the ADC threshold value of 0.831x10 − 3 mm2/s and diagnosis according to Assessment of SpondyloArthritis International Society (ASAS) criteria (Kappa=0.794;p<0.001). Conclusion: Dynamic contrast-enhanced magnetic resonance imaging and DWI are advanced MR techniques which enable quantification of active inflammation. They are hallmarks for early SpA. Their combined use is superior to one alone in the diagnosis of early sacroiliitis.

The role of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging for the diagnosis of diabetic foot osteomyelitis: a preliminary report

PurposeTo assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusionweighted imaging (DWI) in diagnosing diabetic foot osteomyelitis (DFO).Material and methodsTwenty-five participants with suspected osteomyelitis were included, who underwent MRI including DCE-MRI and DWI sequences. It was subsequently followed by bone biopsy and microbiological analysis (gold standard). The participants were divided into 2 groups based on biopsy results: DFO-positive or DFO-negative. The semi-quantitative DCE-MRI parameters (SI0, SImax, SIrel, wash-in rate [WIR], and type of curve) and apparent diffusion coefficient (ADC) values were subsequently compared between the 2 groups.ResultsOut of the 25 cases, 19 were DFO-positive and 6 were DFO-negative on bone biopsy. The SI0, SImax, and WIR were significantly higher in DFO-positive cases (p-value 0.050, 0.023, and 0.004, respectively). No difference was seen in SIrel. 100% negative cases revealed type-I curve, and 94% of positive cases showed type-II curve. SI0 > 143.4 revealed a sensitivity of 94.7% and specificity of 83.3%. SImax had a sensitivity of 89.5% but lower specificity of 67.7% at a cut-off value of 408.35. The most significant difference was seen with WIR; p-value ~0.004. At the cut-off value of > 1.280, it had a specificity and sensitivity of 100% and 76%, respectively. Also, ADC values below 1.57 × 10-3 had a sensitivity of 88.2% and specificity of 80% for diagnosing DFO.ConclusionsDWI and DCE-MRI provide non-invasive sequences, which can help to increase the overall specificity and sensitivity of conventional MRI for the diagnosis of osteomyelitis, differentiating it from acute Charcot’s arthropathy.

The role of diffusion-weighted imaging on 3 tesla magnetic resonance in the clinical staging and pathological grading of clear cell renal carcinoma

The role of diffusion-weighted imaging on 3 tesla magnetic resonance in the clinical staging and pathological grading of clear cell renal carcinoma

English

BACKGROUND Prostate is an associated gland of the male reproductive system. Worldwide, among the men, prostate cancer (PC) is the second most common cancer. PC is the seventh commonest cancers among the Indian male. Studies reported that diffusion weighted imaging (DWI) and dynamic contrast enhanced imaging (DCE-MRI), can offer additional value in localizing cancer. A study was conducted to evaluate and correlate the role of DWI in detection and staging of PC and correlation with histopathology. METHODS A cross-sectional observational study was conducted in the Department of Radiodiagnosis, GSL Medical College, over a period of 18 months. Males with symptoms of nocturia, urinary urgency, frequency, hesitancy and bone pain were included in the study. Trans rectal ultrasound scan (TRUS) biopsy was collected, Gleason‘s score (GS) was considered for the histopathologic analysis. The evaluation of DWI as a tool for detection of PC was based on comparing the sensitivity and specificity of the results after taking histopathology as the gold standard test chi-square test was used to find the statistical significance and P &lt; 0.05 was considered statistically significant. RESULTS Total, 36 (82 %) were diagnosed to be malignant, maximum number (18; 50 %) were between 61 – 70 years age group. Peripheral zone is the most common (61.2 %; 22) area for the PC followed by transitional (33.3 %) and central zone (5.5 %). In this study, 16.6 % members had GS ≤6; Apparent diffusion coefficient (ADC) was ranged between 0.81 to 0.87 and mean + SD were 0.85 + 0.02. Out of the 22.2 % members whose GS was 7, the mean + SD ADC were 0.74 ± 0.02. For 22 (61 %) members, GS was &gt;8; the mean + SD ADC was 0.63 ± 0.08; statistically there was significant difference between the parameters. Magnetic resonance imaging (MRI) revealed that 61.3 % (27) cases as highly suspicious, 25 % (11) as probably malignant and 13.6 % (6) as indeterminate; the sensitivity for MRI was 94.5 % and specificity was 85.7 %. CONCLUSIONS Patients with increased prostate specific antigen (PSA), multi-parametric magnetic resonance imaging (MPMRI) is valuable, non-invasive and a better option to detect PC. Also helps in localizing the exact location. KEYWORDS Cancer, Tumour, Biopsy, Study

Pancreas and kidney changes in type 2 diabetes patients: the role of diffusion-weighted imaging

Background/aim The aim of this study was to compare renal and pancreatic apparent diffusion-coefficient (ADC) values of diabetic patients and control subjects and to examine their potential association with several diabetes-related clinical parameters.Materials and methods A total of 80 sex- and age-matched patients were included in the study. Of them, 40 were patients with type 2 diabetes and 40 were nondiabetic participants. Abdominal diffusion-weighted MRIs of both groups were retrospectively reviewed. Diabetes-related clinical parameters were recorded.Results The difference between the mean ADC values of the patient group and the control group was significant (p = 0.012). It was also found that the mean pancreatic ADC values of diabetic patients and the control group significantly differed (p = 0.02). Besides, there were positive correlations between the mean pancreatic ADC values and age, Hb1Ac level, treatment type, and disease duration (p < 0.05). While eGFR values positively correlated with the mean renal ADC values (p < 0.05), there were negative correlations between such values and age, serum creatinine level, and disease duration (p < 0.05).Conclusion Renal and pancreatic ADC values of diabetic patients could potentially play a role, as markers of renal and pancreatic functions, in clinical decisions in the follow-up of such patients.

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis and Grading of Hepatic Steatosis in Patients With Non-alcoholic Fatty Liver Disease: Comparison With Ultrasonography and Magnetic Resonance Spectroscopy

Nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of cirrhosis. Although magnetic resonance spectroscopy (MRS) is considered the gold standard, it has a few limitations. The role of diffusion-weighted imaging (DWI), which is a simpler sequence, in the diagnosis and grading of fatty liver is not well studied. The aim of the study was to investigate the value of DWI in the diagnosis and grading of hepatic steatosis in patients with NAFLD. Fifty-one adults (mean age: 38 years; 28 men, 23 women) with NAFLD, diagnosed clinically and by ultrasonography (USG), were included in the study after obtaining informed consent and approval from the institute ethics committee. USG was performed for grading of hepatic steatosis in all patients, followed by magnetic resonance imagingwith DWI and MRS, on a 1.5T scanner. The mean apparent diffusion coefficient (ADC) values and proton density fat fraction (PDFF) were calculated, and MRS was used as the gold standard. The mean ADC values were compared with the PDFF and USG grades. There was a weak correlation between ADC values and PDFF (r= -0.36; P < 0.05). In addition, there was a weak correlation between the ADC values of the liver and USG grade (r= -0.34; P < 0.05). However, an overall increase in USG grades and PDFF was associated with decrease in the mean ADC value (P < 0.001). DWI is not accurate in the diagnosis and grading of hepatic steatosis in patients with NAFLD. However, a significant increase in fat deposition in the liver lowers the ADC values.

Reliability of NI-RADS criteria in the interpretation of contrast-enhanced magnetic resonance imaging considering the potential role of diffusion-weighted imaging

ObjectivesTo assess inter- and intrareader agreement of the Neck Imaging Reporting and Data System (NI-RADS) used in contrast-enhanced magnetic resonance imaging (MRI) including analysis of diffusion-weighted imaging (DWI), which is currently not part of the NI-RADS criteria.MethodsThis retrospective study included anonymized surveillance contrast-enhanced MRI datasets of 104 patients treated for different head and neck cancers. Three radiologists experienced in head and neck imaging reported findings for the primary site and the neck using NI-RADS criteria in a first step and evaluated DWI sequences for the primary site in a second step. Thirty randomly selected imaging datasets were again presented to the readers. Kappa statistics and observed agreement (Ao) were calculated.ResultsInterreader agreement across all MRI datasets was moderate (κFleiss = 0.53) for NI-RADS categories assigned to the primary site, substantial for NI-RADS categories of the neck (κFleiss = 0.67), and almost perfect for DWI of the primary site (κFleiss = 0.83). Interreader agreement for the primary site was particularly low in cases of cancer recurrence (κFleiss = 0.35) and when categories 2a, 2b, and 3 were combined (κFleiss = 0.30). Intrareader agreement was considerably lower for NI-RADS categories of the primary site (range Ao = 53.3–70.0%) than for NI-RADS categories of the neck (range Ao = 83.3–90.0%) and DWI of the primary site (range Ao = 93.3–100.0%).ConclusionInterreader agreement of NI-RADS for reporting contrast-enhanced MRI findings is acceptable for the neck but limited for the primary site. Here, DWI has the potential to serve as a reliable additional criterion.Key Points• NI-RADS was originally designed for contrast-enhanced computed tomography with or without positron emission tomography but can also be used for contrast-enhanced magnetic resonance imaging alone.• Overall interreader agreement was acceptable for NI-RADS categories assigned to the neck but should be improved for the primary site, where it was inferior to DWI; similar tendencies were found for intrareader agreement.• DWI is currently no criterion of NI-RADS, but has shown potential to improve its reliability, especially for categories 2a, 2b, and 3 of the primary site.

Diffusion-Weighted Imaging Reflects Tumor Grading and Microvascular Invasion in Hepatocellular Carcinoma

Background: To date, there are inconsistent data about relationships between diffusion-weighted imaging (DWI) and tumor grading/microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Our purpose was to systematize the reported results regarding the role of DWI in prediction of tumor grading/MVI in HCC. Method: MEDLINE library, Scopus, and Embase data bases were screened up to December 2019. Overall, 29 studies with 2,715 tumors were included into the analysis. There were 20 studies regarding DWI and tumor grading, 8 studies about DWI and MVI, and 1 study investigated DWI, tumor grading, and MVI in HCC. Results: In 21 studies (1,799 tumors), mean apparent diffusion coefficient (ADC) values (ADC_mean) were used for distinguishing HCCs. ADC_mean of G1–3 lesions overlapped significantly. In 4 studies (461 lesions), minimum ADC (ADC_min) was used. ADC_min values in G1/2 lesions were over 0.80 × 10⁻³ mm²/s and in G3 tumors below 0.80 × 10⁻³ mm²/s. In 4 studies (241 tumors), true diffusion (D) was reported. A significant overlapping of D values between G1, G2, and G3 groups was found. ADC_mean and MVI were analyzed in 9 studies (1,059 HCCs). ADC_mean values of MIV+/MVI− lesions overlapped significantly. ADC_min was used in 4 studies (672 lesions). ADC_min values of MVI+ tumors were in the area under 1.00 × 10⁻³ mm²/s. In 3 studies (227 tumors), D was used. Also, D values of MVI+ lesions were predominantly in the area under 1.00 × 10⁻³ mm²/s. Conclusion: ADC_min reflects tumor grading, and ADC_min and D predict MVI in HCC. Therefore, these DWI parameters should be estimated for every HCC lesion for pretreatment tumor stratification. ADC_mean cannot predict tumor grading/MVI in HCC.

Role of Diffusion-Weighted Imaging in the diagnosis of Prostatic Cancer.

Background: Magnetic Resonance Imaging (MRI) plays a vital role in diagnosing prostatic cancer routinely done before biopsy for the lesion's extent and defining the correct path for ultrasound-guided prostate biopsy. Diffusion-Weighted Imaging (DWI) is a non-invasive MRI sequence that shows improved sensitivity and specificity in the same setting with no additional cost. The study aims to evaluate the diagnostic accuracy of DWI in the detection of prostatic cancer.&#x0D; Methodology: A cross-sectional study was conducted at the radiology department of Dr. Ziauddin University Hospital between 15/ 04 /2016 to 15/ 4 /2017. A total of 201 patients who were clinically suspected of having prostatic tumors were in this study's inclusion criteria. MRI, including DWI, was done. The final diagnosis was based on an analysis of the histopathology report.&#x0D; Results: Out of 201 males with clinical suspicious of prostatic cancer, 160 were diagnosed with prostatic cancer on histopathology. Of these, 150 were positive on DWI. The sensitivity of diffusion-weighted MRI was found to be 93.7%, 75.60% specificity, and 90.0% diagnostic accuracy (DA) for the diagnosis of prostatic cancer.&#x0D; Conclusion: Diffusion-weighted sequence in MRI examination has a vital role in diagnosing prostatic cancer and should be considered a routine pre-biopsy investigation along with MRI in clinically suspected cases of prostate cancer.

Does diffusion-weighted magnetic resonance imaging have a place in the differential diagnosis of brucella sacroiliitis and seronegative spondyloarthropathy?

The aim of this study is to investigate the role of diffusion-weighted imaging (DWI) in the differential diagnosis of sacroiliitis. To compare the sacroiliac magnetic resonance imaging (MRI) examinations of patients with suspected active sacroiliitis with patients with acute SpA MR findings and the DWI examinations of patients with acute brucella sacroiliitis, and thereby determine whether DWI can contribute to the differential diagnosis. A total of 84 patients were included in the study and were separated into three groups: group 1 (13 women, 6 men) comprised cases with brucella positive for sacroiliitis; group 2 (17 women, 19 men) comprised cases negative for brucella but with sacroiliitis; and group 3 (16 women, 13 men) comprised cases negative for brucella and sacroiliitis. The mean bone marrow apparent diffusion coefficient (ADC) values independently of edema were determined as 0.71 × 10-3 in sacroiliitis and brucella-positive patients, as 0.53 × 10-3 in brucella-negative and sacroiliitis-positive patients, and as 0.43 × 10-3 in the control group of brucella-negative sacroiliitis-negative patients. In the ADC measurements taken from areas of evident edema in patients with sacroiliitis, the mean values were 0.13 × 10-3 in the brucella-positive group and 0.12 × 10-3 in the brucella-negative group. By adding DWI, which is a rapid MR sequence, to sacroiliac joint MR examination, normal bone marrow and bone marrow with sacroiliitis can be objectively differentiated with ADC measurements in addition to visual evaluation.

Role of diffusion-weighted imaging in the diagnosis of cerebral venous thrombosis

ObjectiveTo evaluate the hyperintense signal (HIS) performance on diffusion-weighted imaging (DWI) in diagnosing cerebral venous thrombosis (CVT).MethodsSeventy-eight patients with CVT hospitalized from January 2004 to January 2015 were retrospectively studied alongside 78 controls without intracranial organic diseases. Diagnostic accuracy indices of HIS on DWI or T2-weighted imaging (T2WI) to diagnose CVT at different sites and states were analyzed.ResultsThe overall sensitivity of HIS on DWI for the diagnosis of CVT was significantly lower than that of HIS on T2WI (34.6% vs. 79.5%). HIS on T2WI was more sensitive than HIS on DWI in detecting thrombosis, especially in the superior sagittal sinus and transverse sinus. HIS on DWI was inversely related to the time between disease onset and imaging. Compared with HIS on T2WI, combining HIS on DWI and T2WI did not increase the sensitivity for detecting CVT. HIS on DWI was not detected in the control group, but HIS on T2WI was detected in 26.3% of control individuals. The specificity of HIS on DWI for CVT was higher than that of HIS on T2WI (97.4% vs. 76.9%).ConclusionHIS on DWI has a lower sensitivity, but a higher specificity, than HIS on T2WI for diagnosing CVT.

The role of Diffusion-Weighted Imaging in better delineating the extent of Diffuse Axonal Injury in a pediatric patient: A case report and brief review of the literature

Introduction: Diffuse axonal injury (DAI) is a major cause of disability in the pediatric patient. Herein we describe the MRI/DWI findings in a case with DAI. We also discuss the current role of CT and MRI with DWI in the evaluation of DAI.