Differential diagnosis of benign and malignant distal biliary strictures: Value of adding diffusion-weighted imaging to conventional magnetic resonance cholangiopancreatography

Yoo, Roh Eul; Lee, Jeong Min; Yoon, Jeong Hee; Han, Joon Koo; Choi, Byung Ihn

doi:10.1002/jmri.24304

Cited by 15 publications

(4 citation statements)

References 35 publications

(76 reference statements)

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“…Unenhanced T2- and T1-weighted images were obtained with the Half Fourier Single-shot Turbo Spin Echo sequence (HASTE) and the dual echo in- and opposed-phase Fast Low Angle Shot (FLASH) sequence techniques, respectively. MR cholangiography using 3 MR methods followed: 1) breath-hold single-section rapid acquisition with Turbo Spin Echo (TSE), 2) breath hold multi-section HASTE, and 3) respiratory-triggered multisection three-dimensional (3D) TSE ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Pancreas: Comparison with Conventional Single-Shot Echo-Planar Imaging

et al. 2015

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ObjectiveTo investigate the image quality (IQ) and apparent diffusion coefficient (ADC) of reduced field-of-view (FOV) di-ffusion-weighted imaging (DWI) of pancreas in comparison with full FOV DWI.Materials and MethodsIn this retrospective study, 2 readers independently performed qualitative analysis of full FOV DWI (FOV, 38 × 38 cm; b-value, 0 and 500 s/mm2) and reduced FOV DWI (FOV, 28 × 8.5 cm; b-value, 0 and 400 s/mm2). Both procedures were conducted with a two-dimensional spatially selective radiofrequency excitation pulse, in 102 patients with benign or malignant pancreatic diseases (mean size, 27.5 ± 14.4 mm). The study parameters included 1) anatomic structure visualization, 2) lesion conspicuity, 3) artifacts, 4) IQ score, and 5) subjective clinical utility for confirming or excluding initially considered differential diagnosis on conventional imaging. Another reader performed quantitative ADC measurements of focal pancreatic lesions and parenchyma. Wilcoxon signed-rank test was used to compare qualitative scores and ADCs between DWI sequences. Mann Whitney U-test was used to compare ADCs between the lesions and parenchyma.ResultsOn qualitative analysis, reduced FOV DWI showed better anatomic structure visualization (2.76 ± 0.79 at b = 0 s/mm2 and 2.81 ± 0.64 at b = 400 s/mm2), lesion conspicuity (3.11 ± 0.99 at b = 0 s/mm2 and 3.15 ± 0.79 at b = 400 s/mm2), IQ score (8.51 ± 2.05 at b = 0 s/mm2 and 8.79 ± 1.60 at b = 400 s/mm2), and higher clinical utility (3.41 ± 0.64), as compared to full FOV DWI (anatomic structure, 2.18 ± 0.59 at b = 0 s/mm2 and 2.56 ± 0.47 at b = 500 s/mm2; lesion conspicuity, 2.55 ± 1.07 at b = 0 s/mm2 and 2.89 ± 0.86 at b = 500 s/mm2; IQ score, 7.13 ± 1.83 at b = 0 s/mm2 and 8.17 ± 1.31 at b = 500 s/mm2; clinical utility, 3.14 ± 0.70) (p < 0.05). Artifacts were significantly improved on reduced FOV DWI (2.65 ± 0.68) at b = 0 s/mm2 (full FOV DWI, 2.41 ± 0.63) (p < 0.001). On quantitative analysis, there were no significant differences between the 2 DWI sequences in ADCs of various pancreatic lesions and parenchyma (p > 0.05). ADCs of adenocarcinomas (1.061 × 10-3 mm2/s ± 0.133 at reduced FOV and 1.079 × 10-3 mm2/s ± 0.135 at full FOV) and neuroendocrine tumors (0.983 × 10-3 mm2/s ± 0.152 at reduced FOV and 1.004 × 10-3 mm2/s ± 0.153 at full FOV) were significantly lower than those of parenchyma (1.191 × 10-3 mm2/s ± 0.125 at reduced FOV and 1.218 × 10-3 mm2/s ± 0.103 at full FOV) (p < 0.05).ConclusionReduced FOV DWI of the pancreas provides better overall IQ including better anatomic detail, lesion conspicuity and subjective clinical utility.

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Section: Methodsmentioning

confidence: 99%

Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Pancreas: Comparison with Conventional Single-Shot Echo-Planar Imaging

et al. 2015

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“…Although periductal infiltrating type CC can show skipped lesions, it is more frequently observed in benign sclerosing cholangitis such as IgG4-related sclerosing cholangitis (156,159). DWI can show diffusion restriction in malignant strictures and it would provide additional value for differentiating malignant from benign strictures in extrahepatic CC (160,161). However, the added value of DWI for perihilar CC remains controversial compared with dynamic T1-weighted imaging (162,163).…”

Section: Benign Versus Malignant Biliary Stricturesmentioning

confidence: 99%

Imaging Diagnosis of Intrahepatic and Perihilar Cholangiocarcinoma: Recent Advances and Challenges

2018

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Cholangiocarcinoma, the second most common hepatobiliary malignancy after hepatocellular carcinoma, is a heterogeneous disease entity with widely varying radiologic features, clinical behavior, and treatment approaches. In the detection, characterization, staging, and resectability assessment of cholangiocarcinoma, imaging studies are indispensable. Herein, an overview of the state-of-the-art imaging techniques is presented for the evaluation of intrahepatic and perihilar cholangiocarcinoma, as well as complementary multimodality and multiparametric imaging approaches for a more comprehensive evaluation. In addition, classification systems, new pathologic concepts in cholangiocarcinogenesis and premalignant lesions, and current trends in treatment approaches, which are vital to the imaging interpretation of cholangiocarcinoma, will be discussed. RSNA, 2018.

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“…Therefore, the diagnostic value of a combined MRCP and dynamic study with or without DWI was not investigated; however, in an earlier study by Yoo et al, their results revealed that both the sensitivity and specificity of combined MRCP and DWI did not significantly differ from that of MRCP, DWI, and contrast-enhanced T1WI combined [18].…”

Section: Discussionmentioning

confidence: 97%

“…Although combining MRCP and contrast-enhanced MRI or EUS may facilitate the differential diagnosis of biliary strictures, the benefit of using contrast may not outweigh its risk for the development of nephrogenic systemic fibrosis in patients with poor renal function, and the routine use of EUS may also increase the medical costs and complexity of the diagnostic workup [18].…”

Section: Discussionmentioning

confidence: 99%

The role of combined diffusion weighted imaging and magnetic resonance cholangiopancreatography in the differential diagnosis of obstructive biliary disorders

Rabie

Mohallel

Bessa

et al. 2021

Egypt J Radiol Nucl Med

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Background The aim of this retrospective study was to highlight the role of adding DWI to the conventional MRCP in differentiating benign and malignant obstructive biliary pathologies. MRCP is a non-invasive modality for investigating the morphological features of the pancreaticobiliary system. It can provide indirect evidence of a malignant lesion, such as irregularity of the inner border and abrupt stenosis, with shouldering of the edge suggesting cholangiocarcinoma, while a short segment with regular margin and symmetric narrowing suggests a benign cause. Although these findings are highly sensitive, they are not specific. DWI can complement morphological information obtained by conventional MRCP by providing additional functional information concerning the alteration of tissue cellularity due to pathological processes. Results The overall accuracy of the diagnosis, sensitivity, and specificity of the conventional MRCP in differentiation between the benign and malignant biliary structures was significantly increased by combing it with the DWI. Conclusions Adding DWI to conventional MRCP significantly improved the diagnostic accuracy regarding the characterization of differentiating benign and malignant biliary strictures.

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Differential diagnosis of benign and malignant distal biliary strictures: Value of adding diffusion-weighted imaging to conventional magnetic resonance cholangiopancreatography

Abstract: The addition of DWI to MRCP significantly improved diagnostic accuracy in the characterization of distal biliary strictures.

Cited by 15 publications

References 35 publications

Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Pancreas: Comparison with Conventional Single-Shot Echo-Planar Imaging

Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Pancreas: Comparison with Conventional Single-Shot Echo-Planar Imaging

Imaging Diagnosis of Intrahepatic and Perihilar Cholangiocarcinoma: Recent Advances and Challenges

The role of combined diffusion weighted imaging and magnetic resonance cholangiopancreatography in the differential diagnosis of obstructive biliary disorders

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