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Diffusion-weighted MR imaging of pleural fluid: differentiation of transudative vs exudative pleural effusions
T Baysal1, T Bulut, M Gökirmak
1Department of Radiology, Inönü University School of Medicine, Turgut Ozal Medical Center, 44069 Malatya, Turkey. tamerbaysal@hotmail.com
Abstract:
The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm(2)) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42+/-0.76 x 10(-3) mm(2)/s. Exudates had a mean ADC value of 3.18+/-1.82 x 10(-3) mm(2)/s. The optimum cutoff point for ADC values was 3.38 x 10(-3) mm(2)/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements ( r=-0.69, -0.66, and -0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity.
Insights
Diffusion-weighted MRI (DWI) shows promise in distinguishing between transudative and exudative pleural effusions. This non-invasive technique may offer an alternative to thoracentesis for characterizing effusions.
Area of Science:
- Radiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Pleural effusions require differentiation between transudative and exudative types for appropriate management.
- Current diagnostic methods, such as thoracentesis, are invasive and carry potential risks.
Purpose of the Study:
- To evaluate the efficacy of diffusion-weighted MRI (DWI) in differentiating transudative from exudative pleural effusions.
- To assess the diagnostic performance of apparent diffusion coefficient (ADC) values in pleural effusion characterization.
Main Methods:
- Diffusion-weighted imaging (DWI) using echo-planar imaging (EPI) with b values of 0 and 1000 s/mm(2) was performed on 52 patients with pleural effusion.
- Apparent diffusion coefficient (ADC) values were calculated from reconstructed regions of interest.
- Pleural fluid analysis following thoracentesis served as the reference standard.
Main Results:
- Transudative effusions (n=20) had a mean ADC value of 3.42±0.76 x 10(-3) mm(2)/s, while exudative effusions (n=32) had a mean ADC value of 3.18±1.82 x 10(-3) mm(2)/s.
- An optimal ADC cutoff of 3.38 x 10(-3) mm(2)/s yielded a sensitivity of 90.6% and specificity of 85%.
- Significant negative correlations were observed between ADC values and pleural fluid protein, albumin, and lactate dehydrogenase (LDH) levels.
Conclusions:
- DWI, utilizing ADC values, demonstrates high accuracy in differentiating transudative from exudative pleural effusions.
- This non-invasive MRI technique shows potential to reduce or eliminate the need for invasive thoracentesis.
- Diffusion-weighted imaging offers a promising alternative for the characterization of pleural effusions, minimizing patient morbidity.