Abdominal Radiology

, Volume 44, Issue 9, pp 3089–3098 | Cite as

Whole-lesion histogram analysis metrics of the apparent diffusion coefficient: a correlation study with histological grade of hepatocellular carcinoma

  • Yong-Sheng Xu
  • Hai-Feng Liu
  • Da-Li Xi
  • Jin-Kui Li
  • Zhao Liu
  • Rui-Feng Yan
  • Jun-Qiang LeiEmail author



The study evaluated the relationship between the histological grade of hepatocellular carcinoma (HCC) and the histogram-derived parameters of apparent diffusion coefficient (ADC) obtained from the whole-lesion assessment of diffusion-weighted magnetic resonance (MR) imaging in the liver.


A total of 51 patients were included. The parameters were correlated with the Edmondson-Steiner grades by using the Spearman correlation coefficient (ρ). The differences of ADC parameters between different tumor histological grades were compared using the Mann–Whitney U test. The extent to which each parameter aided in differentiating tumors with poor performance (III, IV) and fair performance (I, II) was assessed by using the area under the receiver operating characteristic curve (Az).


The 25th percentile ADC exhibits the most negative correlation with histological grade (ρ = − 0.397), followed by the 30th percentile ADC (ρ = − 0.395), the minimum ADC value (ρ = − 0.390) and the 20th percentile ADC (ρ = − 0.385), whereas the minimum ADC value yielded the highest Az (0.763) in the discrimination of tumor foci with poor differentiation from fairly differentiated HCCs. The minimum ADC of 4.15 × 10−3 mm2/s or lower was considered to indicate poorly differentiated performance, and the corresponding sensitivity and specificity were 66.7 and 90.9%, respectively.


The 25th percentile ADC showed a stronger correlation with the histological grade of HCC than other ADC parameters, and the minimum ADC value might be an optimal metric for determining poor and fair differentiations of HCC in DWI.


Hepatocellular carcinoma Diffusion-weighted imaging ADC histogram Histological differentiation 



This study was financially supported by the Fundamental Research Funds for the Central Universities (No. 561219012).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts to disclose.

Informed consent

Formal consent is not required for this type of study.


  1. 1.
    Colombo M, Lleo A. The impact of antiviral therapy on hepatocellular carcinoma epidemiology. Hepatic oncology 2018;5:Hep03.Google Scholar
  2. 2.
    Altekruse SF, Henley SJ, Cucinelli JE, et al. Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States. Am J Gastroenterol 2014;109:542-553.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shindoh J, Hasegawa K, Inoue Y, et al. Risk factors of post-operative recurrence and adequate surgical approach to improve long-term outcomes of hepatocellular carcinoma. HPB (Oxford) 2013;15:31-39.CrossRefGoogle Scholar
  4. 4.
    Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 1954;7:462-503.CrossRefGoogle Scholar
  5. 5.
    Zhou L, Rui JA, Zhou WX, et al. Edmondson-Steiner grade: A crucial predictor of recurrence and survival in hepatocellular carcinoma without microvascular invasio. Pathol Res Pract 2017;213:824-830.CrossRefPubMedGoogle Scholar
  6. 6.
    Zhou L, Rui JA, Ye DX, et al. Edmondson-Steiner grading increases the predictive efficiency of TNM staging for long-term survival of patients with hepatocellular carcinoma after curative resection. World J Surg 2008;32:1748-1756.CrossRefPubMedGoogle Scholar
  7. 7.
    Shankar S, Kalra N, Bhatia A, et al. Role of Diffusion Weighted Imaging (DWI) for Hepatocellular Carcinoma (HCC) Detection and its Grading on 3T MRI: A Prospective Study. J Clin Exp Hepatol 2016;6:303-310.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jiang T, Xu JH, Zou Y, et al. Diffusion-weighted imaging (DWI) of hepatocellular carcinomas: a retrospective analysis of the correlation between qualitative and quantitative DWI and tumour grade. Clin Radiol 2017;72:465-472.CrossRefPubMedGoogle Scholar
  9. 9.
    Li X, Zhang K, Shi Y, et al. Correlations between the minimum and mean apparent diffusion coefficient values of hepatocellular carcinoma and tumor grade. J Magn Reson Imaging 2016;44:1442-1447.CrossRefPubMedGoogle Scholar
  10. 10.
    An C, Park MS, Jeon HM, et al. Prediction of the histopathological grade of hepatocellular carcinoma using qualitative diffusion-weighted, dynamic, and hepatobiliary phase MRI. Eur Radiol 2012;22:1701-1708.CrossRefPubMedGoogle Scholar
  11. 11.
    Nishie A, Tajima T, Asayama Y, et al. Diagnostic performance of apparent diffusion coefficient for predicting histological grade of hepatocellular carcinoma. Eur J Radiol 2011;80:e29-33.CrossRefPubMedGoogle Scholar
  12. 12.
    Moriya T, Saito K, Tajima Y, et al. 3D analysis of apparent diffusion coefficient histograms in hepatocellular carcinoma: correlation with histological grade. Cancer Imaging 2017;17:1.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Heo SH, Jeong YY, Shin SS, et al. Apparent diffusion coefficient value of diffusion-weighted imaging for hepatocellular carcinoma: correlation with the histologic differentiation and the expression of vascular endothelial growth factor. Korean J Radiol 2010;11:295-303.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Muhi A, Ichikawa T, Motosugi U, et al. High-b-value diffusion-weighted MR imaging of hepatocellular lesions: estimation of grade of malignancy of hepatocellular carcinoma. J Magn Reson Imaging 2009;30:1005-1011.CrossRefGoogle Scholar
  15. 15.
    Guo W, Zhao S, Yang Y, et al. Histological grade of hepatocellular carcinoma predicted by quantitative diffusion-weighted imaging. Int J Clin Exp Med 2015;8:4164-4169.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Nakanishi M, Chuma M, Hige S, et al. Relationship between diffusion-weighted magnetic resonance imaging and histological tumor grading of hepatocellular carcinoma. Ann Surg Oncol 2012;19:1302-1309.CrossRefGoogle Scholar
  17. 17.
    Chang WC, Chen RC, Chou CT, et al. Histological grade of hepatocellular carcinoma correlates with arterial enhancement on gadoxetic acid-enhanced and diffusion-weighted MR images. Abdom Imaging 2014;39:1202-1212.CrossRefGoogle Scholar
  18. 18.
    Saito K, Moriyasu F, Sugimoto K, et al. Histological grade of differentiation of hepatocellular carcinoma: comparison of the efficacy of diffusion-weighted MRI with T2-weighted imaging and angiography-assisted CT. J Med Imaging Radiat Oncol 2012;56:261-269.CrossRefPubMedGoogle Scholar
  19. 19.
    Nasu K, Kuroki Y, Tsukamoto T, et al. Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. AJR Am J Roentgenol 2009;193:438-444.CrossRefPubMedGoogle Scholar
  20. 20.
    Donati OF, Mazaheri Y, Afaq A, et al. Prostate cancer aggressiveness: assessment with whole-lesion histogram analysis of the apparent diffusion coefficient. Radiology 2014;271:143-152.CrossRefGoogle Scholar
  21. 21.
    Japan LCSGO. The general rules for the clinical and pathological study of primary liver cancer. Jpn J Surg 1989;19:98-129.Google Scholar
  22. 22.
    Drevelegas K, Nikiforaki K, Constantinides M, et al. Apparent Diffusion Coefficient Quantification in Determining the Histological Diagnosis of Malignant Liver Lesions. J Cancer 2016;7:730-735.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kierans AS, Bennett GL, Mussi TC, et al. Characterization of malignancy of adnexal lesions using ADC entropy: comparison with mean ADC and qualitative DWI assessment. J Magn Reson Imaging 2013;37:164-171.CrossRefPubMedGoogle Scholar
  24. 24.
    Bruegel M, Holzapfel K, Gaa J, et al. Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 2008;18:477-485.CrossRefGoogle Scholar
  25. 25.
    Liau J, Lee J, Schroeder ME, et al. Cardiac motion in diffusion-weighted MRI of the liver: artifact and a method of correction. J Magn Reson Imaging 2012;35:318-327.CrossRefPubMedGoogle Scholar
  26. 26.
    Metens T, Absil J, Denolin V, et al. Liver apparent diffusion coefficient repeatability with individually predetermined optimal cardiac timing and artifact elimination by signal filtering. J Magn Reson Imaging 2016;43:1100-1110.CrossRefPubMedGoogle Scholar
  27. 27.
    Murtz P, Flacke S, Traber F, et al. Abdomen: diffusion-weighted MR imaging with pulse-triggered single-shot sequences. Radiology 2002;224:258-264.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyFirst Hospital of LanZhou UniversityLanzhouPeople’s Republic of China
  2. 2.First Clinical Medical College of LanZhou UniversityLanzhouPeople’s Republic of China
  3. 3.Department of PathologyFirst Hospital of LanZhou UniversityLanzhouPeople’s Republic of China

Personalised recommendations