Does diffusion-weighted magnetic resonance imaging help in the detection of renal parenchymal disease and staging/prognostication in chronic kidney disease?

Purpose: Diffusion-weighted imaging (DWI) in renal diseases is an upcoming modality, and its utility as an additional marker is yet to be proven. This study was intended to find the relationship between apparent diffusion coefficient (ADC) values with renal function tests and stages of chronic kidney disease (CKD) to assess renal dysfunction, and to label a cut-off for normal renal function and dysfunction. Material and methods: A prospective diagnostic study was conducted on 120 patients: 60 with deranged renal function tests (RFT) and 60 with normal RFT. DWI using a 1.5-Tesla MRI (at b-values of 0 and 500 s/mm2) was done. A region of interest of size 1-2 cm2 was placed on renal parenchyma in the region of medulla, one each, over the superior, mid, and lower regions of each kidney separately. ADC values were recorded for renal parenchyma and compared. Results: In patients with renal dysfunction ADC values were significantly lower than in patients with normal function (1.75 ± 0.25 vs. 2.28 ± 0.21 of right kidney and 1.79 ± 0.17 vs. 2.29 ± 0.21 of left kidney [×10-3 mm2/s]; p = 0.001). ADC values of different stages of CKD showed a decreasing trend with increasing stage. Conclusions: ADC values taken at all poles to get focal involvement of the kidney can be used to measure each kidney separately, and values can be individually correlated with the elevated renal parameters. The cut-off value of the mean ADC for individual kidneys was > 2.28 (×10-3 mm2/s) in normal renal function and < 2.00 (×10-3 mm2/s) in renal dysfunction

Utility of Diffusion-Weighted MRI with ADC Values in the Characterisation of Endometrial Lesions: A Prospective Cohort Study

Introduction: Endometrial lesions are a diagnostic dilemma for both radiologists, as well as, gynecologists. Characterising these lesions is crucial for effective management. The Apparent Diffusion Coefficient (ADC) reflects the molecular translational movement of water molecules. Malignant tumours, with higher cellularity than benign tumours, exhibit decreased ADC values compared to benign lesions. Aim: This study aimed to evaluate the diagnostic accuracy of ADC in conjunction with Diffusion-weighted Images (DWI) for differentiating malignant and benign endometrial lesions. Materials and Methods: A prospective cohort study was conducted at the Outpatient Department (OPD) of Radiodiagnosis at Sri Guru Ram Das Charitable Hospital in Amritsar, Punjab, India. The study spanned one year and seven months, from February 2020 to October 2021. A total of 100 female patients across all age groups with clinically suspected gynecological complaints related to the endometrium were included. Magnetic Resonance Imaging (MRI) was used to the examine the patients with endometrial lesions, and the results were compared with histopathology. The ADC values of benign and malignant lesions were statistically analysed using Student's t-test. Statistical significance was defined as a p-value < 0.05. Results: The mean age of participants with benign lesions was lower than that of those with malignant lesions (53.47±8.75 years and 60.00±13.93 years, respectively). The 100 individuals were divided into two groups: group I included individuals with benign lesions (58%), and group II comprised patients with malignant lesions (42%). Conventional MRI demonstrated a sensitivity of 86.2%, specificity of 91.8%, Positive Predictive Value (PPV) of 91.6%, and Negative Predictive Value (NPV) of 100% in lesion detection and differentiation. Combining DWI and ADC value mapping at a high b-value (b=800) in MRI significantly increased sensitivity (92.1%), specificity (97.9%), PPV (97.9%), and NPV (92.3%). Conclusion: The addition of DWI and ADC values to conventional MRI significantly improved the ability to distinguish malignant endometrial lesions from benign ones. However, histopathology remains the gold standard investigation as MRI inference cannot differentiate low-grade endometrial carcinoma from hyperplasia