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      Comparison of magnetic resonance diffusion-weighted imaging characteristics between cystic lesions and normal pancreatic parenchyma

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          Abstract

          Introduction:

          Diffusion weighted imaging (DWI) is a form of magnetic resonance imaging (MRI) based on measuring the random Brownian motion of water molecules within a tissue. The aim of this study was to show the significance of diffusion-weighted imaging (DWI) in differentiating pancreatic cystic formations from normal pancreatic parenchyma using MRI 1.5 T.

          Methods:

          A total of 52 patients were included in the study (25 with pancreatic cystic formations and 27 with normal MRI findings of the pancreas). DWI technique was used with b values of 0.500 and 1 000 mm 2/s at 1.5 T. The signal intensity was measured, as well as apparent diffusion coefficient (ADC). Visual estimation of the signal intensity of detected cystic lesions was performed and compared to the normal appearance of pancreas.

          Results:

          The highest signal intensity of the cystic lesions with hyper-signal was observed with DWI b0 value in the pancreatic head (M 185.1 ± 47.205, p < 0.05). Similarly, the highest apparent diffusion coefficient (ADC) value of the cystic formations with hyper-signal was observed in the pancreatic head (2.09 x 10 -3 mm 2/s, p < 0.05). In the group with healthy pancreas, the highest signal intensity was observed with DWI b0 value (M 76.40 ± 18.28, p < 0.05). The observed ADC value in this group was 1.21 x 10 -3 mm 2/s in the head, 1.24 x 10 -3 mm 2/s in the neck, 1.21 x 10 -3 mm 2/s in the body, and 1.06 x 10 -3 mm 2/s in the tail; p > 0.05.

          Conclusions:

          Differences in signal intensity and ADC values have an important diagnostic value in differentiating the cystic formations from normal pancreatic parenchyma in MRI examination.

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          Most cited references11

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          MRI artifact reduction and quality improvement in the upper abdomen with PROPELLER and prospective acquisition correction (PACE) technique.

          The purpose of this study was to evaluate the effectiveness of the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER [BLADE in the MR systems from Siemens Medical Solutions]) with a respiratory compensation technique for motion correction, image noise reduction, improved sharpness of liver edge, and image quality of the upper abdomen. Twenty healthy adult volunteers with a mean age of 28 years (age range, 23-42 years) underwent upper abdominal MRI with a 1.5-T scanner. For each subject, fat-saturated T2-weighted turbo spin-echo (TSE) sequences with respiratory compensation (prospective acquisition correction [PACE]) were performed with and without the BLADE technique. Ghosting artifact, artifacts except ghosting artifact such as respiratory motion and bowel movement, sharpness of liver edge, image noise, and overall image quality were evaluated visually by three radiologists using a 5-point scale for qualitative analysis. The Wilcoxon's signed rank test was used to determine whether a significant difference existed between images with and without BLADE. A p value less than 0.05 was considered to be statistically significant. In the BLADE images, image artifacts, sharpness of liver edge, image noise, and overall image quality were significantly improved (p < 0.001). With the BLADE technique, T2-weighted TSE images of the upper abdomen could provide reduced image artifacts including ghosting artifact and image noise and provide better image quality.
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            Diffusion-weighted imaging of the healthy pancreas: apparent diffusion coefficient values of the normal head, body, and tail calculated from different sets of b-values.

            To evaluate differences in apparent diffusion coefficient (ADC) values between head, body, and tail regions and the impact of sets of b-values used in diffusion weighted imaging (DWI) of the normal pancreas. In 51 healthy volunteers echo-planar DWI of the pancreas was prospectively performed with b-values of 50, 400, and 800 s/mm(2) . All four possible combinations of b-values were used to calculate ADC values in a total of 587 regions in the pancreas head, body, and tail regions. Dependency of ADC values on the anatomical regions and on the applied sets of b-values was calculated using multivariate analysis of variance (ANOVA). Mean ADC values differed significantly between the anatomical regions with the lowest values measured in the pancreatic tail (head 1.13 ± 0.20, body 1.05 ± 0.20, and tail 0.94 ± 0.18 × 10(-3) mm(2) /s; P < 0.05). ANOVA showed no dependency of ADC values on the sets of b-values used. ADC values differed significantly between the pancreatic head, body, and tail region, with decreasing ADC values toward the tail. Cautious interpretation of DWI results with adjusted, normalized values adapted to the anatomical region seems advisable. The knowledge of such differences may enhance the method's capability to differentiate between different pancreatic pathologies. Copyright © 2011 Wiley-Liss, Inc.
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              Diffusion-weighted magnetic resonance imaging of the pancreas.

              Diffusion-weighted imaging (DWI) assesses the random motion of the water protons. The technique is more frequently used in body imaging, and recent investigations showed its use in pancreatic imaging. Diffusion-weighted imaging can be helpful as a complementary imaging method in the differentiation between mass-forming focal pancreatitis and pancreatic adenocarcinoma. The apparent diffusion coefficient (ADC) values derived from DWI can distinguish between simple pancreatic cyst, inflammatory cysts, and cystic neoplasms of the pancreas. Presence of parenchymal fibrosis in chronic pancreatitis causes diffusion restriction and results in lower ADC values on baseline DWI. The ADC values reveal either delayed peak after secretin stimulation or lower peak values in patients with early chronic pancreatitis, which may be helpful to depict chronic pancreatitis in its earliest stage. In this paper, we reviewed the technical aspects of DWI and its use in pancreatic imaging.
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                Author and article information

                Journal
                JHS
                Journal of Health Sciences
                University of Sarajevo Faculty of Health Studies (Bosnia )
                2232-7576
                1986-8049
                2016
                : 6
                : 3
                : 149-153
                Affiliations
                [1]Clinic for Radiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
                Author notes
                [* ]Corresponding author: Fuad Julardžija, Clinic of Radiology, Clinical Center University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina. Phone: +38733298229, E-mail: fudo_78@ 123456yahoo.com
                Article
                JHS-6-149
                10.17532/jhsci.2016.375
                1fadf565-341f-4a65-8e6e-d186515ac71b
                Copyright: © 2016 Fuad Julardžija et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 October 2016
                : 22 November 2016
                Categories
                RESEARCH ARTICLE

                Nursing,General medicine,Medicine,Molecular medicine,Life sciences
                pancreas,Diffusion weighted imaging,normal pancreas appearance,magnetic resonance imaging,cystic formations

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