Rationale and Objectives
Magnetic resonance imaging plays an important role in the evaluation of patients with
known or suspected periampullary masses. The utilization of volumetric apparent diffusion
coefficient (ADC) histogram evaluation for the entire lesion eradicates the potential
for subjectivity in the region of interest placement, thus guaranteeing the accuracy
of computation and repeatability.
Purpose
To investigate the value of volumetric ADC histogram analysis in the differentiation
of intestinal-type (IPAC) and pancreatobiliary-type periampullary adenocarcinomas
(PPAC).
Materials and Methods
This retrospective study included 69 patients with histopathologically confirmed periampullary
adenocarcinoma (54 PPAC and 15 IPAC). Diffusion-weighted imaging was obtained at b
values of 1000 mm²/s. The histogram parameters of ADC values, comprising the mean,
minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well
as skewness, kurtosis, and variance, were calculated independently by two radiologists.
Using the interclass correlation coefficient, the interobserver agreement was evaluated.
Results
The ADC parameters for the PPAC group were all lower than those of the IPAC group.
The PPAC group had higher variance, skewness, and kurtosis than the IPAC group. However,
the difference between the kurtosis (P = .003), the 5th (P = .032), 10th (P = .043), and 25th (P = .037) percentiles of ADC values was statistically significant. The area under the
curve (AUC) of the kurtosis was the highest (AUC = 0.752; cut-off value = − 0.235; sensitivity = 61.1%; specificity = 80.0%).
Conclusion
Volumetric ADC histogram analysis with b values of 1000 mm²/s can discriminate subtypes
noninvasively before surgery.
Key Words
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Article info
Publication history
Published online: May 19, 2023
Accepted:
April 22,
2023
Received in revised form:
April 21,
2023
Received:
April 2,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved All rights reserved.
