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PurposeTo evaluate the diagnostic performance of apparent diffusion coefficient (ADC) parameters by region of interest (ROI) methods in differentiating mass-forming autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC).MethodsThe institutional review board approved this retrospective study and the requirement for informed consent was waived. Twenty-three patients with mass-forming AIP and 144 patients with PDAC underwent diffusion-weighted imaging with b-values of 0 s/mm2 and 800 s/mm2. The minimum, maximum, and mean ADC values obtained by placing ROIs within lesions and percentile ADC values (10th, 25th, 50th, 75th, and 90th) from entire-lesion histogram analysis were compared between the two groups by using Mann–Whitney U tests. The diagnostic performance was evaluated by receiver operating characteristic (ROC) curve analysis.ResultsThe minimum, maximum, and mean ADC values were significantly different between mass-forming AIP and PDAC groups. ROC curve analysis showed that the maximum ADC had the highest diagnostic performance (0.92), while the minimum ADC value had the lowest diagnostic performance (0.72). The AUC of minimum ADC was significantly lower than that of maximum or mean ADC (P < 0.0001, P < 0.0001). The AUC was lowest in 10th percentile ADC value and highest in 90th percentile value. The AUC increased along with the increase of percentile values.ConclusionEither the maximum or mean ADC value was effective in differentiating mass-forming AIP from the PDAC group, while the minimum ADC value might not be recommended.

Objectives To evaluate whether visual assessment of T2-weighted imaging (T2WI) or an apparent diffusion coefficient (ADC) could predict lymphovascular invasion (LVI) status in cases with clinically node-negative invasive breast cancer. Materials and methods One hundred and thirty-six patients with 136 lesions underwent MRI. Visual assessment of T2WI, tumour-ADC, peritumoral maximum-ADC and the peritumour-tumour ADC ratio (the ratio between them) were compared with LVI status of surgical specimens. Results No significant relationship was found between LVI and T2WI. Tumour-ADC was significantly lower in the LVI-positive ( n  = 77, 896 ± 148 × 10 −6  mm 2 /s) than the LVI-negative group ( n  = 59, 1002 ± 163 × 10 −6  mm 2 /s; p  < 0.0001). Peritumoral maximum-ADC was significantly higher in the LVI-positive (1805 ± 355 × 10 −6  mm 2 /s) than the LVI-negative group (1625 ± 346 × 10 −6  mm 2 /s; p  = 0.0003). Peritumour-tumour ADC ratio was significantly higher in the LVI-positive (2.05 ± 0.46) than the LVI-negative group (1.65 ± 0.40; p  < 0.0001). Receiver operating characteristic curve analysis revealed that the area under the curve (AUC) of the peritumour-tumour ADC ratio was the highest (0.81). The most effective threshold for the peritumour-tumour ADC ratio was 1.84, and the sensitivity, specificity, positive predictive value and negative predictive value were 77 % (59/77), 76 % (45/59), 81 % (59/73) and 71 % (45/63), respectively. Conclusions We suggest that the peritumour-tumour ADC ratio can assist in predicting LVI status on preoperative imaging. Key points • Tumour ADC was significantly lower in LVI-positive than LVI-negative breast cancer. • Peritumoral maximum-ADC was significantly higher in LVI-positive than LVI-negative breast cancer. • Peritumour-tumour ADC ratio was significantly higher in LVI-positive breast cancer. • Diagnostic performance of the peritumour-tumour ADC ratio was highest for positive LVI. • Peritumour-tumour ADC ratio showed higher diagnostic ability in postmenopausal than premenopausal patients.

Objectives To evaluate whether apparent diffusion coefficient (ADC) parameters could identify invasive components in cases with ductal carcinoma in situ (DCIS) diagnosed by biopsy. Methods This retrospective study was approved by the institutional review board and the requirement to obtain informed consent was waived. Sixty-nine consecutive women with 70 lesions diagnosed with DCIS by biopsy underwent breast magnetic resonance (MR) imaging. Multiple regions of interest were placed (as many as possible) within the lesion on ADC maps. The minimum ADC values and the ADC difference values obtained as the difference between minimum and maximum ADCs were evaluated. Results Surgical specimens revealed 51 lesions with pure DCIS and the remaining 19 lesions with DCIS with invasive components (DCIS-IC). The minimum ADC value for DCIS-IC (0.99 ± 0.04 × 10 −3  mm 2 /s) was significantly lower than that of pure DCIS (1.15 ± 0.03 × 10 −3  mm 2 /s) ( P   =  0.0037). The ADC difference value for DCIS-IC (0.38 ± 0.05 × 10 −3  mm 2 /s) was significantly higher than that of pure DCIS (0.17 ± 0.03 × 10 −3  mm 2 /s). ROC curve analysis for differentiating DCIS-IC from pure DCIS revealed that the area under the curve was 0.71 for minimum ADC value and 0.77 for ADC difference value. Conclusions The minimum ADC values and ADC difference values could suggest the presence of invasive components. Key Points • Identification of invasive components in DCIS before treatment is clinically important. • Diffusion-weighted MR imaging can help lesion assessment in breast cancer. • The minimum ADC value may suggest the presence of an invasive component in DCIS. • The ADC difference value also suggests the presence of an invasive component in DCIS. • Preoperative evaluation of diffusion-weighted MR imaging may help surgical planning for DCIS.

The optimal management for acute traumatic cervical spinal cord injury (SCI) is unknown. To determine whether early surgical decompression results in better motor recovery than delayed surgical treatment in patients with acute traumatic incomplete cervical SCI associated with preexisting canal stenosis but without bone injury. This multicenter randomized clinical trial was conducted in 43 tertiary referral centers in Japan from December 2011 through November 2019. Patients aged 20 to 79 years with motor-incomplete cervical SCI with preexisting canal stenosis (American Spinal Injury Association [ASIA] Impairment Scale C; without fracture or dislocation) were included. Data were analyzed from September to November 2020. Patients were randomized to undergo surgical treatment within 24 hours after admission or delayed surgical treatment after at least 2 weeks of conservative treatment. The primary end points were improvement in the mean ASIA motor score, total score of the spinal cord independence measure, and the proportion of patients able to walk independently at 1 year after injury. Among 72 randomized patients, 70 patients (mean [SD] age, 65.1 [9.4] years; age range, 41-79 years; 5 [7%] women and 65 [93%] men) were included in the full analysis population (37 patients assigned to early surgical treatment and 33 patients assigned to delayed surgical treatment). Of these, 56 patients (80%) had data available for at least 1 primary outcome at 1 year. There was no significant difference among primary end points for the early surgical treatment group compared with the delayed surgical treatment group (mean [SD] change in ASIA motor score, 53.7 [14.7] vs 48.5 [19.1]; difference, 5.2; 95% CI, -4.2 to 14.5; P = .27; mean [SD] SCIM total score, 77.9 [22.7] vs 71.3 [27.3]; P = .34; able to walk independently, 21 of 30 patients [70.0%] vs 16 of 26 patients [61.5%]; P = .51). A mixed-design analysis of variance revealed a significant difference in the mean change in ASIA motor scores between the groups (F1,49 = 4.80; P = .03). The early surgical treatment group, compared with the delayed surgical treatment group, had greater motor scores than the delayed surgical treatment group at 2 weeks (mean [SD] score, 34.2 [18.8] vs 18.9 [20.9]), 3 months (mean [SD] score, 49.1 [15.1] vs 37.2 [20.9]), and 6 months (mean [SD] score, 51.5 [13.9] vs 41.3 [23.4]) after injury. Adverse events were common in both groups (eg, worsening of paralysis, 6 patients vs 6 patients; death, 3 patients vs 3 patients). These findings suggest that among patients with cervical SCI, early surgical treatment produced similar motor regain at 1 year after injury as delayed surgical treatment but showed accelerated recovery within the first 6 months. These exploratory results suggest that early surgical treatment leads to faster neurological recovery, which requires further validation. ClinicalTrials.gov Identifier: NCT01485458; umin.ac.jp/ctr Identifier: UMIN000006780.