European Radiology

, Volume 29, Issue 1, pp 411–421 | Cite as

Apparent diffusion coefficient as a potential marker for tumour differentiation, staging and long-term clinical outcomes in gallbladder cancer

  • Ji Hye Min
  • Tae Wook KangEmail author
  • Dong Ik Cha
  • Seong Hyun Kim
  • Kyung Sook Shin
  • Jeong Eun Lee
  • Kee-Taek Jang
  • Soo Hyun Ahn



To evaluate the correlation between tumour differentiation or stage of gallbladder cancer (GBC) and the apparent diffusion coefficient (ADC), as well as to assess whether ADC value can predict long-term disease-free survival (DFS) after surgery.


This retrospective study was approved by the institutional review board and the requirement for informed consent was waived. Between March 2008 and June 2016, 79 patients who underwent magnetic resonance (MR) imaging with diffusion-weighted image and subsequent surgery for GBC were included in this study. Correlations between quantitative ADC values and tumour differentiation or stage based on the American Joint Committee on Cancer (AJCC) were assessed using Spearman’s correlation analysis. Prognostic factors for DFS were identified with multivariate Cox regression analysis using imaging and clinical characteristics.


All patients were classified as having well- (n = 18), moderately (n = 35) or poorly differentiated GBCs (n = 26). The ADC value of GBCs was significantly correlated with tumour differentiation and AJCC stage (p < 0.001 and p < 0.001, respectively). Sixty-nine patients were followed up for 2.0–92.4 months (median, 23.5 months). On multivariate analysis, the significant prognostic factor for DFS was not tumour differentiation or AJCC stage but a binary tumour ADC value (hazard ratio, 4.29; p = 0.009). DFS rates were significantly different according to the classification of tumour ADC value (cut-off value = 1.04 × 10−3 mm2/s; p = 0.004).


The ADC value of GBCs was significantly correlated with tumour differentiation as well as AJCC stage. In addition, it predicted long-term outcomes after surgery in patients with GBC.

Key points

• ADC values of GBC and tumour differentiation were negatively correlated.

• Lower ADC values of GBC were significantly correlated with higher tumour stage.

• Tumour ADC value could be useful for risk stratification of GBC patients.


Gallbladder neoplasms Diffusion Magnetic resonance imaging Treatment outcome 



Apparent diffusion coefficient


American Joint Committee on Cancer


Confidence interval


Disease-free survival


Diffusion-weighted imaging


Gallbladder cancer


Hazard ratio


Magnetic resonance


National Comprehensive Cancer Network


Picture archiving and communication system




Tumour, node and metastasis



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Won Jae Lee.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Soo Hyun Ahn) has significant statistical expertise.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• Retrospective

• Prognostic study

• Performed at one institution

Supplementary material

330_2018_5602_MOESM1_ESM.docx (5.7 mb)
ESM 1 (DOCX 5792 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Ji Hye Min
    • 1
    • 2
  • Tae Wook Kang
    • 1
    Email author
  • Dong Ik Cha
    • 1
  • Seong Hyun Kim
    • 1
  • Kyung Sook Shin
    • 2
  • Jeong Eun Lee
    • 2
  • Kee-Taek Jang
    • 3
  • Soo Hyun Ahn
    • 4
  1. 1.Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology, Chungnam National University HospitalChungnam National University College of MedicineDaejeonRepublic of Korea
  3. 3.Department of Pathology and Translational Genomics, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  4. 4.Department of MathematicsAjou UniversitySuwonRepublic of Korea

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