Purpose: To compare the diagnostic performances of diffusion-weighted imaging (DWI)-combined magnetic resonance imaging (MRI) performed without intravenous contrast material with gadolinium contrast material-enhanced (CE) MRI for diagnosing soft-tissue abscesses. Materials and Methods: In all, 119 patients (mean age: 56 years) with skin and soft-tissue infection who underwent contrast-enhanced MRI with DWI (b 5 0-800) were included. Two readers independently reviewed both image setsnonenhanced conventional MR images (NECI)1DWI, and NECI1contrast enhanced fat-suppressed T 1 -weighted imaging (CEFST 1 )-for the presence of abscess. To compare the diagnostic performance for diagnosing abscess between NECI1DWI, and NECI1CEFST 1 , McNemar tests for sensitivity and specificity, and areas under the receiver-operating characteristic curves (AUC) analyses, were performed. Interobserver agreements (j) were calculated for each image set. Results: Forty of 119 patients were confirmed with abscess. Sensitivity and specificity were 90.0% and 88.6% for NECI1DWI, and 82.5% and 89.9% for NECI1CEFST 1 in reader 1, whereas 77.5% and 88.6% for NECI1DWI, and 80.0% and 84.8% for NECI1CEFST 1 in reader 2, respectively. There was no significant difference in sensitivities and specificities between NECI1DWI and NECI1CEFST 1 (reader 1: P 5 0.453, P 5 0.999, reader 2: P 5 0.999, P 5 0.453, respectively). Likewise, AUC analyses demonstrated no significant difference between NECI1DWI and NECI1CEFST 1 (P 5 0.53 in reader 1, P 5 0.97 in reader 2). Interobserver agreement between the two readers was substantial in both image sets: 0.80 (NECI1DWI), and 0.76 (NECI1CEFST 1 ). Conclusion: Noncontrast-enhanced MRI with DWI has comparable diagnostic performance to contrast-enhanced MRI for diagnosing soft-tissue abscesses. Level of Evidence: 3 Technical Efficacy: Stage 2
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