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European Radiology
Published in: European Radiology 5/2013

01-05-2013 | Hepatobiliary-Pancreas

Diffusion-weighted MR imaging for the differentiation of malignant from benign strictures in the periampullary region

Authors: Nam Kyung Lee, Suk Kim, Hyung Il Seo, Dong Uk Kim, Hyun Young Woo, Tae Un Kim

Published in: European Radiology | Issue 5/2013

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Abstract

Objectives

To investigate the value of DWI for differentiating malignant from benign strictures in the periampullary region.

Methods

We retrospectively analysed data from 78 patients who had undergone magnetic resonance cholangiopanreatography (MRCP) and diffusion-weighted imaging (DWI), in whom biliary strictures in the periampullary region were suspected. Twenty-two malignant and 56 benign lesions were included. One radiologist compared the signal intensity of malignant and benign periampullary lesions on DWI using b = 500 and 800 s/mm2. The signal intensity of bile was also compared, and an optimal b value was determined for periampullary lesions. Two other radiologists reviewed MRCP alone and combined DWI and MRCP for the possibility of malignant periampullary lesions. Diagnostic accuracy was calculated for each reviewer by receiver operating characteristic (ROC) curve analysis.

Results

Malignant periampullary lesions more frequently appeared hyperintense than benign lesions on DWI using the two b values (P < 0.001). Bile more frequently appeared hyperintense on DWI using b = 500 s/mm2 (87.2 %) than b = 800 s/mm2 (24.4 %). Therefore, b = 800 s/mm2 was determined as the preferred sequence. Diagnostic accuracy for malignant periampullary lesions improved for both reviewers after adding DWI; from 0.714 to 0.924 (P = 0.006, for reviewer 1) and from 0.714 to 0.919 (P = 0.007, reviewer 2).

Conclusions

Combined DWI with MRCP can improve the diagnostic accuracy for differentiating malignant from benign strictures in the periampullary region.

Key Points

• Diffusion-weighted magnetic resonance imaging provides yet more information about hepatobiliary structures.
• Diffusion-weighted imaging (DWI) has now been applied to the biliary tree.
• Most periampullary carcinomas appear hyperintense on high b value DWI.
• DWI can help differentiate between malignant and benign periampullary lesions.
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Metadata
Title
Diffusion-weighted MR imaging for the differentiation of malignant from benign strictures in the periampullary region
Authors
Nam Kyung Lee
Suk Kim
Hyung Il Seo
Dong Uk Kim
Hyun Young Woo
Tae Un Kim
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 5/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2725-6

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