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Differential diagnosis of benign and malignant distal biliary strictures: Value of adding diffusion‐weighted imaging to conventional magnetic resonance cholangiopancreatography
Author(s) -
Yoo RohEul,
Lee Jeong Min,
Yoon Jeong Hee,
Kim Jung Hoon,
Han Joon Koo,
Choi Byung Ihn
Publication year - 2014
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.24304
Subject(s) - medicine , magnetic resonance cholangiopancreatography , magnetic resonance imaging , radiology , mcnemar's test , malignancy , diffusion mri , receiver operating characteristic , diagnostic accuracy , differential diagnosis , nuclear medicine , diffusion weighted magnetic resonance imaging , endoscopic retrograde cholangiopancreatography , pancreatitis , pathology , mathematics , statistics
Purpose To determine the value of adding diffusion‐weighted imaging (DWI) to conventional magnetic resonance cholangiopancreatography (MRCP) for differentiating benign from malignant distal biliary strictures. Materials and Methods Two independent readers reviewed three image sets (1: MRCP alone; 2: MRCP and DWI combined; and 3: MRCP, DWI, and contrast‐enhanced T1‐weighted imaging [T1WI] combined) of 60 patients with suspected distal biliary strictures and rated the probability of malignancy. Diagnostic performance and accuracy were compared using the receiver operating characteristic (ROC) curves and McNemar two‐tailed test. κ coefficients were calculated to assess the interobserver agreement. Results The Az value and accuracy improved significantly after additional review of DWI for both readers: Az = 0.780 vs. 0.916 ( P = 0.003) for Reader 1 and 0.784 vs. 0.853 ( P = 0.037) for Reader 2; accuracy = 69% vs. 93% for Reader 1 ( P < 0.001) and 57% vs. 85% for Reader 2 ( P = 0.002). No significant difference in the Az values and accuracy was found between MRCP and DWI combined, and MRCP, DWI, and contrast‐enhanced T1WI combined ( P > 0.050). There was substantial interobserver agreement in all three image sets (κ = 0.695‐0.732). Conclusion The addition of DWI to MRCP significantly improved diagnostic accuracy in the characterization of distal biliary strictures. J. Magn. Reson. Imaging 2014;39:1509–1517 . © 2013 Wiley Periodicals, Inc .