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Detection of soft-tissue abscess: Comparison of diffusion-weighted imaging to contrast-enhanced MRI
Chang Woo Chun1, Joon-Yong Jung2, Jun Seung Baik2
1Department of Radiology, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
Purpose:
To compare the diagnostic performances of diffusion-weighted imaging (DWI)-combined magnetic resonance imaging (MRI) performed without intravenous contrast material with gadolinium contrast material-enhanced (CE) MRI for diagnosing soft-tissue abscesses.
Materials And Methods:
In all, 119 patients (mean age: 56 years) with skin and soft-tissue infection who underwent contrast-enhanced MRI with DWI (b = 0-800) were included. Two readers independently reviewed both image sets-nonenhanced conventional MR images (NECI)+DWI, and NECI+contrast enhanced fat-suppressed T1 -weighted imaging (CEFST1 )-for the presence of abscess. To compare the diagnostic performance for diagnosing abscess between NECI+DWI, and NECI+CEFST1 , McNemar tests for sensitivity and specificity, and areas under the receiver-operating characteristic curves (AUC) analyses, were performed. Interobserver agreements (κ) were calculated for each image set.
Results:
Forty of 119 patients were confirmed with abscess. Sensitivity and specificity were 90.0% and 88.6% for NECI+DWI, and 82.5% and 89.9% for NECI+CEFST1 in reader 1, whereas 77.5% and 88.6% for NECI+DWI, and 80.0% and 84.8% for NECI+CEFST1 in reader 2, respectively. There was no significant difference in sensitivities and specificities between NECI+DWI and NECI+CEFST1 (reader 1: P = 0.453, P = 0.999, reader 2: P = 0.999, P = 0.453, respectively). Likewise, AUC analyses demonstrated no significant difference between NECI+DWI and NECI+CEFST1 (P = 0.53 in reader 1, P = 0.97 in reader 2). Interobserver agreement between the two readers was substantial in both image sets: 0.80 (NECI+DWI), and 0.76 (NECI+CEFST1 ).
Conclusion:
Noncontrast-enhanced MRI with DWI has comparable diagnostic performance to contrast-enhanced MRI for diagnosing soft-tissue abscesses.
Level Of Evidence:
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:60-68.
Insights
Noncontrast-enhanced MRI with diffusion-weighted imaging (DWI) offers comparable diagnostic performance to contrast-enhanced MRI for detecting soft-tissue abscesses, potentially reducing the need for intravenous contrast agents.
Area of Science:
- Radiology
- Medical Imaging
Background:
- Soft-tissue abscesses require accurate diagnosis for effective treatment.
- Contrast-enhanced MRI is a standard imaging modality, but intravenous contrast agents carry risks.
- Diffusion-weighted imaging (DWI) offers functional information about tissue properties.
Purpose of the Study:
- To compare the diagnostic performance of noncontrast-enhanced MRI combined with DWI (NECI+DWI) against contrast-enhanced MRI (CE-MRI) for soft-tissue abscess detection.
- To evaluate if DWI can obviate the need for intravenous contrast in MRI for abscess diagnosis.
Main Methods:
- 119 patients with skin and soft-tissue infections underwent MRI including DWI and contrast-enhanced sequences.
- Two independent readers assessed nonenhanced conventional MR images (NECI)+DWI and NECI+contrast enhanced fat-suppressed T1-weighted imaging (CEFST1).
- Diagnostic performance metrics (sensitivity, specificity, AUC) and interobserver agreement were analyzed.
Main Results:
- Forty abscesses were confirmed.
- NECI+DWI showed sensitivity of 90.0% and specificity of 88.6% (Reader 1), and 77.5% and 88.6% (Reader 2).
- NECI+CEFST1 showed sensitivity of 82.5% and specificity of 89.9% (Reader 1), and 80.0% and 84.8% (Reader 2). No significant differences were found between the two methods.
Conclusions:
- Noncontrast-enhanced MRI with DWI demonstrates comparable diagnostic performance to contrast-enhanced MRI for soft-tissue abscesses.
- This approach may serve as a viable alternative to contrast-enhanced MRI, potentially improving patient safety and reducing costs.
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