Clinical diagnosis
Case 309
【Progress】
ADC value of Case 1 with ovarian cancer was 0.53-0.59.
ADC value of Case 2 with uterine cervix cancer was 0.65-0.69.
ADC value of Case 3 with metastatic ovary cancer arisen from gastric cancer was 0.75-0.83.
ADC value of Case 4 with metastatic liver cancer arisen from gall bladder cancer was 0.64-0.67.
【Discussion】
An ADC value is a slope obtained by the relation of signal intensity strength on Diffusion WIMRI with degree of motion probing gradient (MPG) given during gradient echo T2WI. Concretely, first, graph is created; longitudinal axis is DWI signal intensity measured by logarithm (minus exhibition): transverse axis is degree of MPG (b = 0, 800, 1000, 2000). ADC is a slope measured by two points (b = 0, b = 800 or b = 0, b = 1000 or b = 0, b = 2000). As a result, the greater of water molecule diffusion ability grows the more increase of slope.
In general, ADC values of fresh infarction, mature abscess and hematoma immediately after, can be lowering to below 0.50, but their ADC values are gradually becoming high as time progress with absorbing mechanism advancing. It is known that ADC values of malignant tumors tend to be higher than benign tumors probably due to cellular dense, implying less space of water molecule diffusion.
In the present series, ADC values of ovarian cancer (0.53-0.59) were lowest. It is reported that ADC values of ovarian cancer were 1.09 and peritoneal dissemination were 0.956 (1). Ovarian cancer develops from borderline malignancy to poorly differentiated carcinoma: as grading of ovarian cancer advances, ADC values become lowering (1). ADC values of the present ovary cancer were 0.53-0.59, indicative of poorly adenocarcinoma or undifferentiated carcinoma.
ADC values of metastatic carcinoma from gastric cancer in our case were 0.75-0.83. ADC values of ovary carcinoma vary from 0.5 to 1.0 (2). Then, it is difficult to differentiate between metastatic ovary carcinoma and primary ovary carcinoma. However, when ADC values of the lesion were less than 0.70, the lesion might be referred not from gastric cancer but original ovary cancer.
ADC vales of gall bladder cancer were second lowest in our series, 0.64-0.67. It is reported that ADC values of gall bladder cancer become lower as tumor differentiation (3, 4). In the present case with gall bladder cancer, metastatic liver cancer was associated, indicating poorly differentiation of gall bladder cancer. ADC values of metastatic liver cancer from colon cancer were 0.90, those of HCC were 1.00, those of holangiocarcinoma were 1.10. ADC values of poorly differentiated gall bladder cancer can be lower than those of other three major liver tumors.
ADC values of uterine cervical cancer were third lowest, 0.65-0.69. It is reported that ADC vales of uterine cervical cancer were significantly lower than uterine endometrial carcinoma (usually adenocarcinoma, ADC values 0.90 – 1.00) (5). ADC values might be useful to differentiate between them.
【Summary】
We presented four cases with ovarian cancer, uterine cervix cancer, metastatic ovary cancer arisen from gastric cancer and metastatic liver cancer arisen from gall bladder cancer. ADC value of ovarian cancer was 0.53-0.59, ADC value of uterine cervix cancer was 0.65-0.69, ADC value of metastatic ovary cancer arisen from gastric cancer was 0.75-0.83, ADC value of metastatic liver cancer arisen from gall bladder cancer was 0.64-0.67. It is borne in mind that ADC values of ovarian cancer can be lowering to 0.5 level, ADC values of gall bladder carcinoma and uterine cervix carcinoma can be lowering to 0.6 level and ADC value of gastric carcinoma can be lowering to 0.8.
【References】
1.Ali RF et al. The Role of Diffusion Weighted Imaging in suspected cases of ovarian cancer. Egyptian Journal of Radiology and Nuclear Medicine 2020; 51: 3 – 11.
2.Liu S, et al. Apparent diffusion coefficient value of gastric cancer by diffusion-weighted imaging: correlations with the histological differentiation and Lauren classification. Eur J Radiol 2014; 83: 2122-2128.
3.Min JH, et al. Apparent diffusion coefficient as a potential marker for tumour differentiation, staging and long-term clinical outcomes in gallbladder cancer. Eur Radiol. 2019;29:411-421.
4.Lee NK, et al. Diffusion-weighted MRI for differentiation of benign from malignant lesions in the gallbladder. Clin Radiol. 2014;69:e78-85.
5.Keriakos N, et al. Diffusion weighted imaging in suspicious uterine tumors; how efficient is it? Egyptian Journal of Radiology and Nuclear Medicine. 2018; 49 https://ejrnm.springeropen.com
2023.9.1