title: Intravoxel incoherent motion diffusion-weighted MR imaging for characterization of focal pancreatic lesions.
abstract: OBJECTIVE
  To evaluate the diagnostic potential of apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM)-derived parameters for differentiation of common pancreatic tumors, chronic pancreatitis, and normal pancreas and for characterization of the malignancy potential of intraductal papillary mucinous neoplasms (IPMNs).
  
  
  METHODS
  The institutional review board approved this retrospective study, and informed consent was waived. Ninety-three consecutive patients with surgically resected and pathologically confirmed pancreatic tumors (39 pancreatic adenocarcinomas [PACs], 17 neuroendocrine tumors [NETs], and 37 IPMNs), seven patients with chronic pancreatitis, and 26 patients with a normal pancreas were included in this study. All patients underwent pancreatic 3.0-T magnetic resonance imaging, including IVIM diffusion-weighted imaging with 10 b values used (from 0 to 1000 sec/mm(2)). The ADC, slow component of diffusion (D(slow)), incoherent microcirculation (D(fast)), and perfusion fraction (f) were calculated. Steel-Dwass and Mann-Whitney U tests were used for comparison. The diagnostic performance of the parameters was evaluated by using receiver operating characteristic (ROC) analysis with Bonferroni correction.
  
  
  RESULTS
  Among ADC- and IVIM-derived parameters, D(fast) and f values of PACs were significantly lower than those of normal pancreas, chronic pancreatitis, and NETs (all P < .05 in post hoc analyses). For differentiation of PACs from NETs, f and D(fast) showed a significant difference (P < .0001 for both) and were more useful parameters than ADC and D(slow) in ROC analysis (all P < .05). Malignant IPMNs had significantly lower ADC and D(slow) values and higher D(fast) and f values when compared with benign IPMNs (all P < .05). In ROC analysis, f showed the highest area under the ROC curve value for distinguishing malignant from benign IPMNs.
  
  
  CONCLUSIONS
  IVIM-derived perfusion-related parameters could be helpful for the differentiation of common malignant tumors in the pancreas and for distinguishing malignant from benign IPMNs. D(fast) and f were more valuable parameters in the differentiation of PACs from NETs than were ADC and D(slow).
authors.affiliation: From the Department of Radiology, Division of Abdominal Imaging, Seoul National University College of Medicine, 28 Yeongon-dong, Jongno-gu, Seoul 110-744, Korea (K.M.K., J.M.L., J.H.Y., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (B.K.).
authors.forename: Koung Mi
authors.initials: KM
authors.lastname: Kang
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Yoon
authors.forename: Berthold
authors.initials: B
authors.lastname: Kiefer
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010195:Pancreatitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies