title: Added value of diffusion-weighted MR imaging in the diagnosis of ampullary carcinoma.
abstract: OBJECTIVE
  To evaluate the added value of diffusion-weighted magnetic resonance (MR) imaging in diagnostic performance of conventional MR imaging for diagnosis of ampullary carcinoma.
  
  
  METHODS
  This retrospective study was institutional review board approved, and informed consent was waived. Twenty-three patients with malignant ampullary obstruction and 39 patients with benign ampullary obstruction were included. Qualitative (signal intensity and enhancement pattern) and quantitative (apparent diffusion coefficient [ADC]) analyses were conducted for visible or expected locations of duodenal papillae. Two observers independently reviewed conventional MR images and subsequently reviewed combined conventional and diffusion-weighted MR images. A five-point scale for likelihood of ampullary carcinoma was used. Fisher exact test and Mann-Whitney U test were used for comparing groups, and diagnostic performance (receiver operating characteristic [ROC] curve analysis), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated.
  
  
  RESULTS
  Visible or expected duodenal papillae in benign group showed isointensity (27-38 of 39, 69%-97%) and similar enhancement pattern (27 of 39, 69%) to that of normal duodenal wall more frequently than in malignant group (seven to 18 of 23 [30%-78%] and three of 23 [13%], respectively) on conventional MR images (P < .05). On diffusion-weighted images, 21 of 23 (91%) ampullary carcinomas showed hyperintensity, whereas all benign cases showed isointensity compared with normal duodenal wall (P < .001). Mean ADC of ampullary carcinomas (1.23 × 10(-3) mm(2)/sec) was significantly lower than that of benign group (1.69 × 10(-3) mm(2)/sec) (P < .001). Diagnostic performance (area under ROC curve [Az]) of both observers improved significantly after additional review of diffusion-weighted images; Az improved from 0.923 to 0.992 (P = .029) for observer 1 and from 0.910 to 0.992 (P = .025) for observer 2. In addition, diagnostic accuracy, sensitivity, specificity, PPV, and NPV of combined conventional and diffusion-weighted MR images were higher than those of conventional MR images alone.
  
  
  CONCLUSIONS
  Addition of diffusion-weighted imaging to conventional MR imaging improves detection of ampullary carcinoma when compared with conventional MR imaging alone.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea.
authors.forename: Kyung Mi
authors.initials: KM
authors.lastname: Jang
authors.forename: Seong Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Soon Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Park
authors.forename: Dongil
authors.initials: D
authors.lastname: Choi
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D049448:Cholangiopancreatography, Magnetic Resonance; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA