High b-value diffusion-weighted magnetic resonance imaging for gallbladder lesions: differentiation between benignity and malignancy.
ABSTRACT BACKGROUND: Recently, the clinical application of diffusion-weighted magnetic resonance imaging (DWI) has been expanding to abdominal organs. However, only a few studies on gallbladder diseases have been published. The aim of this study was to evaluate the usefulness and limitations of high b-value DWI for gallbladder diseases. METHODS: A total of 153 patients (mean age 60 ± 15 years, 78 males) who had undergone DWI for evaluating gallbladder wall thickening or polypoid lesions were included in this study. Of these 153 patients, 36 had gallbladder cancer and 117 had benign gallbladder diseases (67 chronic cholecystitis, 44 adenomyomatosis, four cholesterol polyp, one gallbladder adenoma, and one xanthogranulomatous cholecystitis). We evaluated the positive signal rate with DWI and the apparent diffusion coefficient (ADC) value of each disease. RESULTS: The positive signal rate with DWI was significantly higher in gallbladder cancer (78 %) than in benign gallbladder diseases (22 %) (p < 0.001). The mean ADC value of gallbladder cancer was (1.83 ± 0.69) × 10(-3) mm(2)/s and that of benign gallbladder diseases was (2.60 ± 0.54) × 10(-3) mm(2)/s (p < 0.001). Benign gallbladder diseases with acute cholecystitis or a history of that had a higher positive signal rate with DWI (p < 0.001) and a lower ADC value (p = 0.018) than those without such conditions. CONCLUSION: DWI can contribute to the improvement of the diagnostic capability for gallbladder wall thickening or polypoid lesions by compensating for weaknesses of other modalities by its many advantages, although cases with acute cholecystitis or such history sometimes show false-positive on DWI.
SourceAvailable from: Reiji Sugita[Show abstract] [Hide abstract]
ABSTRACT: Background The aim of this study was to evaluate the usefulness of high b-value diffusion-weighted magnetic resonance imaging (DWI) for evaluating the histological degree of malignancy in patients with intraductal papillary mucinous neoplasm (IPMN).MethodsA total of 35 patients (mean age 68 ± 10 years, 23 males) who had undergone DWI before surgery were included in this study. Of these 35 patients, 13 had IPMN with low- or intermediate-grade dysplasia, eight had IPMN with high-grade dysplasia, and 14 had IPMN with an associated invasive carcinoma. We evaluated the positive signal rate on DWI and the apparent diffusion coefficient (ADC) value of each pathology.ResultsThe positive signal rate on DWI of IPMN with low- or intermediate-grade dysplasia, of IPMN with high-grade dysplasia, and of IPMN with an associated invasive carcinoma were 0% (0/13), 38% (3/8), and 93% (13/14), respectively. The sensitivity, specificity, and accuracy for malignancy (IPMN with high-grade dysplasia or IPMN with an associated invasive carcinoma) using DWI were 73%, 100%, and 83%, respectively. The mean ADC value of malignancy was significantly lower than that of benignity (P = 0.002).Conclusions Diffusion-weighted magnetic resonance imaging, easily applicable in addition to conventional MRI, is considered an efficient modality for evaluating the histological degree of malignancy in patients with IPMN.11/2014; 21(11). DOI:10.1002/jhbp.135
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ABSTRACT: Thickening of the gallbladder wall is observed in patients with gallbladder carcinoma, as well as in those with chronic cholecystitis. It is difficult to distinguish between benign and malignant gallbladder wall thickening with conventional diagnostic imaging techniques, such as abdominal ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI), particularly in patients with bile duct strictures. Currently, the fluorine-18 2-fluorodeoxyglucose positron emission tomography/CT (F-18 FDG PET/CT) scan is widely used in the differentiation of cholecystitis from gallbladder carcinoma. However, the F-18 FDG PET/CT scan may also be responsible for false-positive diagnosis. This case report focuses on a 74-year-old male who presented with thickening of the gallbladder wall and hilar bile duct stricture, originally misdiagnosed as gallbladder carcinoma by US and MRI. F-18 FDG PET/CT also demonstrated increased activity. This case was ultimately proven to be chronic cholecystitis by postoperative pathological examination and it is presented in order to emphasize the significance of considering the possibility of false-positive diagnosis by PET/CT, as a result of inflammatory lesions. Therefore, PET/CT should not be considered the gold standard for the discrimination between benign and malignant gallbladder wall thickening.Molecular and Clinical Oncology 05/2013; 1(3):517-520. DOI:10.3892/mco.2013.93
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ABSTRACT: The aim of the current study was to assess the efficiency of the apparent diffusion coefficient (ADC) measurement in diagnosis of acute cholecystitis and in differentiation of cholecystitis from extrinsic benign gallbladder wall thickening. Forty patients who were diagnosed to have acute cholecystitis by ultrasonographic examination were included in this study. The control group consisted of 18 patients without symptoms of gallstones and cholecystitis whose gallbladder walls were thickened due to cirrhotic ascites. Both groups were examined using diffusion weighted imaging, and the mean ADC values were compared using Student's t-test. The diagnoses of the 40 patients were proven by histopathological examination. The mean ADC values of patients diagnosed with cholecystitis (1.68 +/- A 0.36 x 10(-3) mm(2)/s) were significantly lower than the mean ADC values of the control group (2.35 +/- A 0.24 x 10(-3) mm(2)/s) (p < 0.05). Receiver operating characteristics curve analysis based on ADC revealed a cut-off value of 2.04 x 10(-3) mm(2)/s for the diagnosis of cholecystitis, with a sensitivity of 94 % and a specificity of 89.7 %. ADC value quantification may be an efficient method for making a diagnosis of cholecystitis and in differential diagnosis of cholecystitis from the extrinsic benign gallbladder wall thickening that can be seen during the course of cirrhotic ascites.Japanese journal of radiology 06/2014; 32(9). DOI:10.1007/s11604-014-0343-8 · 0.73 Impact Factor