Abstract
The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm2) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42±0.76×10–3 mm2/s. Exudates had a mean ADC value of 3.18±1.82×10–3 mm2/s. The optimum cutoff point for ADC values was 3.38×10–3 mm2/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements (r=–0.69, –0.66, and –0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity.
Similar content being viewed by others
References
Light RW (2000) Management of pleural effusions. J Formos Med Assoc 99:523–531
Broaddus VC, Light RW (1992) What is the origin of pleural transudates and exudates? Chest 102:658–659
Romero-Candeira S, Hernandez L, Romero-Brufao S et al. (2002) Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions? Chest 122:1524–1529
Peterman TA, Speicher CE (1984) Evaluating pleural effusions: a two-stage laboratory approach. J Am Med Assoc 252:1051–1053
Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77:507–513
Maruta T, Narabayashi I, Suematsu T et al. (1991) Clinical value of Gd-DTPA enhanced MRI of pulmonary and mediastinal tumors. Nippon Acta Radiol 51:504–515
Adachi S, Kono M, Kusumoto M, Itouji E, Sakai E, Tanaka K (1991) Gd-DTPA enhanced MRI: dynamic study in lung cancer patients. Abstract ECR '91 1:55
Frola C, Cantoni S, Turtulici I et al. (1997) Transudative vs exudative pleural effusions: differentiation using Gd-DTPA-enhanced MRI. Eur Radiol 7:860–864
Spüntrup E, Bücker A, Adam G, van Vaals JJ, Günther RW (2001) Differenzierung seröser und putrider Flüssigkeiten in-vitro und in-vivo mit Diffusion gewichteter MRT. Fortschr Röntgenstr 173:65–71
Chan JH, Tsui EY, Luk SH et al. (2001) Diffusion-weighted MR imaging of the liver: distinguishing hepatic abscess from cystic or necrotic tumor. Abdom Imaging 26:161–165
Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M (1986) MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 161:401–407
Stehling MJ, Howseman AM, Ordidge RJ et al. (1989) Whole-body echo-planar MR imaging at 0.5 T. Radiology 170:257–263
Porcel JM, Vives M (1999) Classic, abbreviated, and modified Light's criteria. Chest 116:1833–1836
Davis SD, Henschke CI, Yankelevitz DF, Cahill PT, Yi Y (1990) MR imaging of pleural effusions. J Comput Assist Tomogr 14:192–198
Moritani T, Shrier DA, Numaguchi Y et al. (2000) Diffusion-weighted echo-planar MR imaging: clinical applications and pitfalls. A pictorial essay. Clin Imaging 24:181–192
Basser PJ (2002) Diffusion and diffusion tensor MR imaging. In: Atlas SW (ed) Magnetic resonance imaging of the brain and spine, 3rd edn. Lippincott, Williams and Wilkins, Philadelphia, pp 197–213
Le Bihan D (1991) Molecular diffusion nuclear magnetic resonance imaging. Magn Reson Q 7:1–30
Ichikawa T, Haradome H, Hachiya J et al. (1999) Diffusion-weighted MR imaging with single-shot echo-planar imaging in the upper abdomen: preliminary clinical experience in 61 patients. Abdom Imaging 24:456–461
Yamada I, Aung W, Himeno Y, Nakagawa T, Shibuya H (1999) Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 210:617–623
Namimoto T, Yamashita Y, Sumi S, Tang Y, Takahashi M (1997) Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. Radiology 204:739–744
Moteki T, Ishizaka H (1999) Evaluation of cystic ovarian lesions using apparent diffusion coefficient calculated from reordered turboFLASH MR images. Magn Reson Imaging 17:955–963
Cercignani M, Horsfield MA (2001) The physical basis of diffusion-weighted MRI. J Neurol Sci 186:11–14
Stehling MK, Evans DF, Lamont G et al. (1989) Gastrointestinal tract: dynamic MR studies with echo-planar imaging. Radiology 171:41–46
Reimer P, Saini S, Hahn PF, Brady TJ, Cohen MS (1994) Clinical application of abdominal echoplanar imaging: optimization using a retrofitted EPI system. J Comput Assist Tomogr 18:673–679
Muller MF, Prasad P, Siewert B, Nissenbaum MA, Raptopoulos V, Edelman RR (1994) Abdominal diffusion mapping with use of a whole-body echo-planar system. Radiology 190:475–478
Muller MF, Prasad PV, Bimmler D, Kaiser A, Edelman RR (1994) Functional imaging of the kidney by means of measurement of the apparent diffusion coefficient. Radiology 193:711–715
Turner R, Le Bihan D, Maier J, Vavrek R, Hedges LK, Pekar J (1990) Echo-planar imaging of intravoxel incoherent motion. Radiology 177:407–414
Edelman RR, Gaa J, Wedeen VJ et al. (1994) In-vivo measurement of water diffusion in the human heart. Magn Reson Med 32:423–428
Kim T, Murakami T, Takahashi S, Hori M, Tsuda K, Nakamura H (1999) Diffusion-weighted single-shot echo-planar MR imaging for liver disease Am J Roentgenol 173:393–398
Yamada I, Aung W, Himeno Y, Nakagawa T, Shibuya H (1999) Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 210:617–623
Burdette JH, Elster AD, Ricci PE (1998) Calculation of apparent diffusion coefficients in brain using two-point and six-point methods. J Comput Assist Tomogr 22:792–794
Ulug AM, Beauchamp N Jr, Bryan RN, van Zijl PC (1997) Absolute quantitation of diffusion constants in human stroke. Stroke 28:483–490
Le Bihan D (1995) Molecular diffusion, tissue microdynamics and microstructure. NMR Biomed 8:375–386
Baranowska HM, Olszewski KJ (1996) The hydration of proteins in solutions by self-diffusion coefficients: NMR study. Biochim Biophys Acta 1289:312–314
Yamashita Y, Namimoto T, Mitsuzaki K et al. (1998) Mucin-producing tumor of the pancreas: diagnostic value of diffusion-weighted echo-planar MR imaging. Radiology 208:605–609
Eustace S, Masi M di, Adams J, Ward R, Caruthers S, McAlindon T (2000) In-vitro and in-vivo spin-echo diffusion imaging characteristics of synovial fluid: potential non-invasive differentiation of inflammatory and degenerative arthritis. Skeletal Radiol 29:320–323
Burgess LJ, Maritz FJ, Taljaard JJF (1995) Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates. Chest 107:1604–1609
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Baysal, T., Bulut, T., Gökirmak, M. et al. Diffusion-weighted MR imaging of pleural fluid: differentiation of transudative vs exudative pleural effusions. Eur Radiol 14, 890–896 (2004). https://doi.org/10.1007/s00330-003-1995-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-003-1995-4