Can diffusion-weighted imaging be used in the examination of peritoneal fluids?

Purpose: The aetiology of free fluid detected in the abdomen can be investigated with magnetic resonance imaging (MRI). The aim of this study is to investigate the effectiveness of diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values in the evaluation of abdominopelvic fluids.

Material and methods: Patients with abdominopelvic fluid detected on MRI of the lower abdomen were included in this retrospective, single-centre study. Paracentesis and fluid analysis was performed in these patients. The average ADC values in fluids were measured by a radiologist. A cut-off value was determined, and the specificity, sensitivity, negative predictive value (NPV), and positive predictive values (PPV) were calculated. Intra-observer agreement was investigated.

Results: The study comprised 41 (33 female) patients, and their mean age was 48 ± 4.02 years. The ADC values in infective fluids were significantly higher than in non-infective fluids (p < 0.001). The cut-off value used was 2.95 × 10^-3 mm²/s. According to this threshold value, sensitivity in distinguishing non-infective from infective fluids was 88%, specificity was 93.8%, PPV was 95.7%, and NPV was 83.3%. Intra-observer agreement was strong in ADC values (κ = 0.699) (p < 0.001).

Conclusions: We concluded that the ADC value is a non-invasive, reliable, reproducible imaging parameter that can be useful in the evaluation and characterization of abdominal fluids.