Role Of Diffusion-weighted MRI Research Articles

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.

Role of diffusion-weighted MRI in differentiation between benign and malignant anterior mediastinal masses.

Diffusion-weighted imaging (DWI) is considered to be a useful biomarker to characterize the cellularity of lesions, yet its application in the thorax to evaluate anterior mediastinal lesions has not been well investigated. The aims of our study were to describe the magnetic resonance (MR) characteristics of anterior mediastinal masses and to assess the role of apparent diffusion coefficient (ADC) value in distinguishing benign from malignant lesions of the anterior mediastinum. We conducted a retrospective cross-sectional study including 55 patients with anterior mediastinal masses who underwent preinterventional MR scanning with the following sequences: T1 VIBE DIXON pre and post-contrast, T2 HASTE, T2 TIRM, DWI-ADC map (b values of 0 and 2000 sec/mm2). The ADC measurements were obtained by two approaches: hot-spot ROI and whole-tumor histogram analysis. The lesions were grouped by three distinct ways: benign versus malignant, group A (benign lesions and type A, AB, B1 thymoma) versus group B (type B2, B3 thymoma and other malignant lesions), lymphoma versus other malignancies. The study was composed of 55 patients, with 5 benign lesions and 50 malignant lesions. The ADCmean, ADCmedian, ADC10, ADC90 in the histogram-based approach and the hot-spot-ROI-based mean ADC of the malignant lesions were significantly lower than those of benign lesions (P values< 0.05). The hot-spot-ROI-based mean ADC had the highest value in differentiation between benign and malignant mediastinal lesions, as well as between group A and group B; the ADC cutoffs (with sensitivity, specificity) to differentiate malignant from benign lesions and group A from group B were 1.17 x 10-3 mm2/sec (80%, 80%) and 0.99 x 10-3 mm2/sec (78.4%, 88.9%), respectively. The ADC values obtained by using the hot-spot-ROI-based and the histogram-based approaches are helpful in differentiating benign and malignant anterior mediastinal masses.

Role of diffusion-weighted MRI in recurrent rectal cancer treated with carbon ion radiotherapy.

Aim: To evaluate the association between pretreatment diffusion-weighted MRI (DW-MRI) and 12-month radiological response in locally recurrent rectal cancer treated with carbon ion radiotherapy. Methods: Histogram analysis was performed on pretreatment DW-MRI for patients re-irradiated with carbon ion radiotherapy for local recurrence of rectal cancer. Results: Atotal of 17 patients were enrolled in the study. Pretreatment DW-MRI b-value of 1000s/mm2 (b1000) and apparent diffusion coefficient (ADC) lesion medianvalues for 1-year nonresponders (six patients) and responders (11 patients)demonstrated a median (interquartileof median values) of 62.5 (23.9) and 34.0 (13.0) and 953.0 (277.0) and 942.5 (339.0) μm2/s, respectively. All b1000 histogram features (h-features)and ADC h-kurtosis showed statistically significant differences, whereas only b1000 h-median, b1000 h-interquartile rangeand ADC h-kurtosis demonstrated remarkable diagnostic accuracy. Conclusion: DW-MRI showed promising results in predicting carbon ion radiotherapy outcome in local recurrence of rectal cancer, particularlywith regard to b1000 h-median, b1000 h-interquartile range and ADC h-kurtosis.

The role of diffusion-weighted MRI in characterization of intracranial cystic lesions

Background Diffusion-weighted imaging (DWI) is reliable in diagnosing intracranial cysts. However, sometimes, it could not give satisfactory diagnostic confidence. Objective To study the role of DWI in differentiation between intracranial cysts and the usefulness of apparent diffusion coefficient. Patients and methods This study included 40 patients of different age groups with intracranial cysts. All patients included were subjected to full history taking, clinical examination, laboratory investigations, routine MRI examination, DWI, and apparent diffusion coefficient map. Results Receiver operating characteristic curve was generated to identify inflammatory intra-axial lesions and to obtain the best sensitivity (80%), specificity (83.3%), positive predictive value (80%), and negative predictive value (83.3%). The relationship was significant (P&lt;0.028). Receiver operating characteristic curve to identify epidermoid and arachnoid cysts and to obtain the best sensitivity (100%), specificity (100%), positive predictive value (100%), and negative predictive value (100%). The relationship was significant (P=0.013). Conclusion DWI is perfect in differentiating between necrotic tumors and abscesses, benign and malignant intracranial cysts, and between arachnoid and epidermoid cysts. But it failed in differentiating between lower-grade and high-grade glioma.

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 in differentiating between benign and malignant bone lesions: a prospective study

To evaluate the ability of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between benign and malignant bony tumours. This prospective study was conducted from October, 2018 to December, 2019. The study included 62 patients (37 male and 25 female) with clinically suspected bony lesions referred to the Radiology Department. Patients underwent clinical examination, radiography, computed tomography (CT), and ultrasonography examinations. MRI studies were conducted using a 1.5-T MRI machine, and post-processing analysis was done using a Philips Extended MRI workspace workstation. The mean apparent diffusion coefficient (ADC) value of benign lesions ranged between 0.85×10-3 and 2.44×10-3 mm2/s. The lowest ADC values were measured in a giant cell tumour and in an inclusion epidermoid cyst (0.85×10-3 and 0.93×10-3 mm2/s, respectively). The highest measurement was in bony cysts (2.44×10-3 mm2/s) followed by osteoid osteoma (2.2×10-3 mm2/s) and osteochondroma (1.85×10-3 mm2/s). Amongst malignant lesions, ADC values ranged from 0.42×10-3 to 2.4×10-3 mm2/s. The lowest value was measured in malignant round cell tumour Ewing's/primitive neuroectodermal tumour (PNET), and the highest was measured in conventional chondrosarcoma. Metastatic lesions were observed in 11 patients with a mean ADC value of 0.71×10-3 mm2/s, followed by osteosarcoma in six patients with a mean ADC value of 0.74×10-3 mm2/s. There was a significant difference between the mean, minimum, and maximum ADC values of benign and malignant tumours. The present findings indicate that the best cut-off ADC range to predict malignancy is 0.78-0.86×10-3 mm2/s, with a sensitivity of 89.47%, specificity of 97.22%, and accuracy of 94.55%.

The role of diffusion-weighted MRI in the evaluation of pediatric patient with orbital masses

Background Orbital lesions represent a spectrum of benign and malignant lesions in children that can be challenging to diagnose and treat. Imaging plays an important role in diagnosis, owing to a potentially limited clinical examination and risks associated with biopsy. MRI is a powerful tool for imaging the orbit, owing to the excellent tissue contrast it provides. Aim This study aims at assessing the ability of diffusion-weighted MRI to differentiate the benign from malignant orbital lesions. Patients and methods This study population included 50 pediatric patients; they all attended with orbital lesions. All patients had fulfilled specific inclusion and exclusion criteria. The patients were evaluated by MRI orbit and diffusion study in an attempt to differentiate the benign orbital lesions from malignant ones. Results The pool of our study is 50 pediatric patients (26 females and 24 males) with orbital lesions. The patients’ age ranged from 3 weeks to 18 years. A total of 27 (54%) patients were diagnosed as having malignant masses and 23 (46%) patients had benign lesions. Retinoblastoma is the commonest between the pathological diagnoses (28%) followed by rhabdomyosarcoma (18%). The calculated apparent diffusion coefficient (ADC) values of the lesions ranged from 0.69 to 0.95×10−3 mm2/s, with cutoff value of 1.04×10−3 mm2/s between benign and malignant orbital masses. Conclusion We concluded that the combination of conventional MRI finding and ADC calculation together with clinical finding could improve the diagnostic efficacy of MRI in the differentiation between benign and malignant orbital masses in pediatric age group with considering the cutoff ADC value between benign and malignant orbital masses.

Role of Diffusion-Weighted MRI in Imaging of Mucormycosis in Paranasal Sinuses

Role of Diffusion-Weighted MRI in Imaging of Mucormycosis in Paranasal Sinuses

The role of diffusion-weighted MRI in the evaluation of intra-cranial lesions

The role of diffusion-weighted MRI in the evaluation of intra-cranial lesions

Role of diffusion-weighted MRI in characterization of mediastinal masses

BackgroundDiffusion MR imaging (DWI) is a widely available non-invasive non-contrast functional MR imaging technique with short acquisition time. It helps in the analysis of tissue characteristics based on the diffusion of water protons within the tissue. Quantitative assessment of a mass is possible by calculating its apparent diffusion coefficient (ADC) value which is inversely correlated with tissue cellularity. So, DWI has diagnostic potential to distinguish benign from malignant tumors because of the tendency of the latter to show lower ADC values and more restricted diffusion. The aim of our work is to evaluate the use of DWI and ADC value measurement in differentiation between benign and malignant mediastinal tumors.ResultsThis study included 44 cases of mediastinal masses: 27 males and 17 females. The mean ADC value of malignant mediastinal lesions was significantly lower than the mean ADC value of benign mediastinal lesions, with mean ADC 1.39 ± 0.26 in benign mediastinal lesions and mean ADC 0.86 ± 0.35 in malignant mediastinal lesions. This study also revealed that the cut-off threshold of ADC value for the differentiation between malignant and benign lesions was 1.11 × 10-3 mm2/s, with an area under ROC curve of 0.93. The sensitivity and specificity of our cutoff ADC values were 90.9% and 100%, with 100% positive predictive value and 76.9% negative predictive value.ConclusionDWI with calculation of ADC value is functional MR imaging technique used in the analysis of tissue characteristics and quantitative assessment of a mediastinal mass. So, it can distinguish benign from malignant tumors because of the tendency of the malignant lesions to show more restricted diffusion and lower ADC values.

The role of diffusion-weighted MRI and contrast-enhanced MRI for differentiation between solid renal masses and renal cell carcinoma subtypes

To assess the value of diffusion-weighted magnetic resonance imaging (DW-MRI) and contrast-enhanced MRI (CE-MRI) for differentiation between benign and malignant solid renal masses, renal cell carcinoma (RCC) subtypes, oncocytomas, and lipid-poor angiomyolipomas (LP-AML). Minimum or lowest 'apparent diffusion coefficient' (ADC1) and representative ADC values (ADC2) of 112 renal masses (n: 46 benign renal mass, n: 66 malignant renal mass) were measured on DW-MRI images (b 50, 400, 800s/mm2). Signal intensity (SI) measurements were performed in normal renal parenchyma and most avid enhanced area of the renal masses at precontrast, corticomedullary, and nephrographic phases on CE-MRI. Contrast enhancement rate (CER) and contrast enhancement index (CEI) values of renal masses were compared between benign-malignant renal masses and RCC subtypes, oncocytomas, and LP-AMLs. There was no significant difference between ADC1, ADC2 values, and SI of benign and malignant renal masses (p = 0.721, p = 0.255, p = 0.872). Mean ADC1 and ADC2 values of clear cell RCCs were significantly higher than nonclear cell RCCs (p = 0.005 p = 0.002). Mean CER value of clear cell RCCs was significantly higher than nonclear cell RCCs in nephrographic phase (p = 0.003). Mean CEI values of clear cell RCCs were significantly higher than nonclear cell RCCs in the corticomedullary and nephrographic phase (p = 0.027 vs. 0.008). LP-AMLs were differentiated from other renal masses with wash-out phenomenon. Combined usage of ADC, SI, CER, and CEI values may be useful for discrimination between RCC subtypes, oncocytomas, and lipid-poor AMLs.

Correlation between ultrasound-guided percutaneous breast biopsy and diffusion-weighted magnetic resonance imaging of the breast for evaluation of solid breast lesions

BackgroundMRI’s role had been increasing in breast imaging. In this study, we evaluated the role of diffusion-weighted MRI in correlation with ultrasound-guided percutaneous breast biopsy for diagnosis of solid breast lesions.ResultsSixty female patients were diagnosed by clinical examination and mammography and planned for ultrasound-guided breast biopsy. Diffusion-weighted MRI was done before the biopsy for results correlation. It was found that the diffusion-weighted MRI was valuable in evaluating solid female breast lesions, showing a sensitivity of 96%, specificity of 91.4%, positive predictive value of 100%, negative predictive value of 97%, and accuracy of 93.3% % compared to pathological results.ConclusionDiffusion-weighted MRI has a great role in evaluating solid breast lesions.

Ultra-High-b-Value Kurtosis Imaging for Noninvasive Tissue Characterization of Ovarian Lesions.

Background MRI with contrast material enhancement is the imaging modality of choice to evaluate sonographically indeterminate adnexal masses. The role of diffusion-weighted MRI, however, remains controversial. Purpose To evaluate the diagnostic performance of ultra-high-b-value diffusion kurtosis MRI in discriminating benign and malignant ovarian lesions. Materials and Methods This prospective cohort study evaluated consecutive women with sonographically indeterminate adnexal masses between November 2016 and December 2018. MRI at 3.0 T was performed, including diffusion-weighted MRI (b values of 0-2000 sec/mm2). Lesions were segmented on b of 1500 sec/mm2 by two readers in consensus and an additional independent reader by using full-lesion segmentations on a single transversal slice. Apparent diffusion coefficient (ADC) calculation and kurtosis fitting were performed. Differences in ADC, kurtosis-derived ADC (Dapp), and apparent kurtosis coefficient (Kapp) between malignant and benign lesions were assessed by using a logistic mixed model. Area under the receiver operating characteristic curve (AUC) for ADC, Dapp, and Kapp to discriminate malignant from benign lesions was calculated, as was specificity at a sensitivity level of 100%. Results from two independent reads were compared. Histopathologic analysis served as the reference standard. Results A total of 79 ovarian lesions in 58 women (mean age ± standard deviation, 48 years ± 14) were evaluated. Sixty-two (78%) lesions showed benign and 17 (22%) lesions showed malignant histologic findings. ADC and Dapp were lower and Kapp was higher in malignant lesions: median ADC, Dapp, and Kapp were 0.74 µm2/msec (range, 0.52-1.44 µm2/msec), 0.98 µm2/msec (range, 0.63-2.12 µm2/msec), and 1.01 (range, 0.69-1.30) for malignant lesions, and 1.13 µm2/msec (range, 0.35-2.63 µm2/msec), 1.45 µm2/msec (range, 0.44-3.34 µm2/msec), and 0.65 (range, 0.44-1.43) for benign lesions (P values of .01, .02, < .001, respectively). AUC for Kapp of 0.85 (95% confidence interval: 0.77, 0.94) was higher than was AUC from ADC of 0.78 (95% confidence interval: 0.67, 0.89; P = .047). Conclusion Diffusion-weighted MRI by using quantitative kurtosis variables is superior to apparent diffusion coefficient values in discriminating benign and malignant ovarian lesions and might be of future help in clinical practice, especially in patients with contraindication to contrast media application. © RSNA, 2020 Online supplemental material is available for this article.

THE ROLE OF DIFFUSION-WEIGHTED MRI OF PATIENTS WITH SPINE METASTASES

ABSTRACT Objective: The role of diffusion-weighted MRI in differential diagnostics and predicting the survival of patients with spine metastases was studied. Methods: The study included data from MRI and morphological studies of 23 patients with spine metastases. Results: The values obtained for the apparent diffusion coefficient (ADC) of tumors were compared with their histological type, cell density and Ki-67 proliferation index. The effect of ADC values on overall patient survival was also assessed. A reliable inverse correlation was established between ADC values and Ki-67 proliferation index for various types of spine metastases (r=-0.753, p=0.017). The dependence of ADC values and overall survival of patients with metastases in the spine is shown. Conclusion: The technique of diffusion-weighted MRI can be used as part of a comprehensive assessment in the preoperative planning of surgical treatment, and as a prognostic factor of overall survival for this group of patients. Level of Evidence II. Prognostic retrospective study,

The Role of Diffusion-weighted MRI and Follow-up Contrast-enhanced MRI in Correlation with the Adnexa MR Scoring System in the Diagnosis of Uterine Appendage Tumors

The paper analyzes the data available in the foreign and Russian literature over the past 10 years on main radiodiagnostic techniques and approaches in case of ovarian space-occupying lesions, by using both ultrasonic color Doppler mapping and complex MRI approaches in combination with routine MRI, diffusion-weighted MRI studies, and follow-up contrast-enhanced MRI. It shows that only the comprehensive introduction of the above radiodiagnostic techniques can achieve the necessary sensitivity and specificity of diagnosis of ovarian tumors. The system for assessing the risk index for ovarian tumor malignancy is discussed, by taking into account the menopausal status, the tumor marker CA-125, and ultrasonographic findings. The paper presents the Adnexa MR scoring system based on the breast imaging-reporting and data system (BI-RADS) that gives schemes for calculating and analyzing the risk of ovarian tumor malignancy in terms of certain MR criteria.

The role of diffusion-weighted MRI on the differentiation of complex adnexal masses

Background Conventional MRI has an established role in gynecologic imaging. However, increasing clinical demand for improved lesion characterization and disease mapping to optimize patient management has resulted in the incorporation of newer sequences, such as diffusion-weighted imaging (DWI), into routine protocols for pelvic MRI. DWI provides functional information on the microenvironment of water in tissues, hence augmenting the morphologic information derived from conventional MRIs. Objective The objective of this study was to highlight the role of DWI in differentiating benign from malignant complex adnexal masses. Patients and methods Twenty-five patients with adnexal masses underwent conventional MRI and DWI and the cases were proven by postsurgery pathological examination. Analysis of the pathological specimen with lesion morphology, signal characteristics, and correlation with the appearance at DWI followed by apparent diffusion coefficient values measurement were obtained. Results Twenty-five patients with adnexal mass lesions were included. Included masses proved benign in 18 (72%) and malignant in seven (28%). Restricted diffusion was observed in proved malignant masses (24%, n = 6/25). Benign tumors with high DWI signal intensity evidence at 24% also. The mean apparent diffusion coefficient value was 1.4+0.34×10−3 and 1.02+0.06×10−3 mm2/s, for benign and malignant masses, respectively. Conclusion DWI supported by conventional MRI data can confirm or exclude malignancy in suspicious ovarian masses. A combined analysis of quantitative and qualitative criteria and a knowledge of the sequence pitfalls are required.

Role of diffusion-weighted MRI in evaluation of patients with salivary gland tumors

Background and objectives Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values give appreciable information about tumor cellularity with tissue contrast between the active and necrotic areas within the tumor. Aim of the work The aim of this study was to investigate the capacity of diffusion MRI to predict benign and malignant salivary gland tumors, using ADC value and DWI. Patients and methods This study included 40 patients (24 male and 16 female). Sixteen patients had malignant lesions and 24 had benign ones. The DWI was obtained with b values including 0 and 800 mm2/s. The ADC was generated by measuring identical images at different b values and represented as ADC map, from which the ADC value was calculated. This was a prospective randomized controlled trial. Informed consent was obtained from parents or guardians. Results The absolute ADC value of lesions was significantly different between benign and malignant salivary gland tumors (P Conclusion The use of DWI and ADC values can provide better assessment of salivary gland tumors and predict benign and malignant lesions.

Role of Diffusion-Weighted MRI and Dynamic Contrast-Enhanced MRI in Early Staging of Bladder Cancer

Role of Diffusion-Weighted MRI and Dynamic Contrast-Enhanced MRI in Early Staging of Bladder Cancer

The role of diffusion-weighted MRI (DWI) in the differentiation of benign from malignant skeletal lesions of the pelvis

PurposeTo evaluate the utility of Diffusion-weighted MRI in the differentiation of benign from malignant skeletal lesions of the pelvis. Materials and methodsIn this retrospective study 33 patients with indeterminate skeletal lesions of the pelvis were evaluated with DWI. Minimum, mean, maximum ADC-values of the skeletal lesions were measured followed by qualitative assessment of DWI. All patients underwent histological confirmation using CT-guided biopsy or surgical resection. The histology of the skeletal lesions was correlated with the findings on DWI. ResultsThere were 13 malignant lesions and 20 benign lesions. The mean, minimum and maximum ADC values (×10–6mm2/s) for benign skeletal lesions was higher than the mean ADC-values for malignant lesions (1422.2 vs 1263.7; 780.4 vs 771.8; 1969.6 vs 1676.8 respectively). These differences were however not statistically significant (P-values=0.29; 0.94; 0.149 respectively). The sensitivity, specificity, positive predictive value and negative predictive value for qualitative assessment of Diffusion-weighted MRI in the differentiation of benign from malignant skeletal lesions were: 53.9%, 85%, 70%, 73.9% respectively. Qualitative assessment of DWI (restricted diffusion versus non-restricted diffusion) allowed differentiation of benign from malignant skeletal lesions (P-value=0.0259). ConclusionsQualitative assessment of DWI may aid in the differentiation of benign skeletal lesions from malignant skeletal lesions of the pelvis. Although DWI has a low sensitivity in the distinction of the two disease entities, it may be a useful adjunct due to its relatively high specificity. This is of particular importance in lymphoma where biopsy may only show chronic inflammatory cells and hence may be false negative.

The role of diffusion-weighted MRI on the study of brain complications related to heroin abuse

Heroin has physical effects on many parts of the body, for example, respiratory and digestive system, muscles, and nervous system. Neurologic complications include brain abscess, neuropathy, transverse myelitis, and leukoencephalopathy.Magnetic resonance image is more sensitive in detecting lesions with low signal on T1W and high signal on T2W, and FLAIR images in the white matter and other areas of brain. Imaging findings are similar to other leukoencephalopathies (hereditary diseases, abnormal metabolic diseases, and intoxications).In the course of finding ways to differentiate heroin-induced spongiform leukoencephalopathy from other leukoencephalopathies, attention has been changed to diffusion magnetic resonance imaging in recent years.Nevertheless, studies do not verify that diffusion-weighted image is a valuable tool in establishing the diagnosis.