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Mean ADC values and arterial phase hyperintensity discriminate small (≤ 3 cm) well-differentiated hepatocellular carcinoma from dysplastic nodule

  • Hepatobiliary
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Abstract

Background/aim

This research endeavor sought to distinguish small (≤ 3 cm) well-differentiated hepatocellular carcinoma (WD-HCC) from dysplastic nodules (DN) by employing traditional imaging features and mean apparent diffusion coefficient (mADC) values derived from diffusion-weighted imaging (DWI).

Materials and methods

In this retrospective analysis, we assessed a cohort of ninety patients with confirmed dysplastic nodules (DNs) (n = 71) or well-differentiated hepatocellular carcinoma (WD-HCC) (n = 41) who had undergone dynamic contrast-enhanced magnetic resonance imaging between March 2018 and June 2021. Multivariable logistic regression analyses were executed to pinpoint characteristics that can effectively differentiate histologic grades. A region-of-interest (ROI) encompassing all lesion voxels was delineated on each slice containing the mass in the ADC map. Subsequently, the whole-lesion mean ADC (mADC) were computed from these delineations. A receiver operating characteristic (ROC) curve was generated to assess the discriminatory efficacy of the mADC values in distinguishing between WD-HCC and DN.

Results

Among the histopathological types from benign to malignant, mADC showed a significant decrease (P < 0.001). The mADCs were effective in distinguishing WD-HCC from DN [AUC, 0.903 (95% CI 0.849–0.958)]. The best cutoffs for the Youden index were 0.0012 mm2/s for mADC, with moderate sensitivity (70.7%) and high specificity (94.4%). MRI features including hyperintensity at arterial phase (odds ratio, 21.2; P = 0.009), mADC < 0.0012 mm2/s (odds ratio, 52.2; P < 0.001) were independent predictors for WD-HCC at multivariable analysis. The AUC value of hyperintensity at arterial phase was 0.857 (95% CI 0.786–0.928). The composite diagnostic criterion of arterial hyperintensity + mADC < 0.0012 mm2/s showed good performance [AUC, 0.926 (95% CI 0.878–0.975)], displaying increased sensitivity compared to individual assessments involving arterial hyperintensity (P = 0.013), mADC < 0.0012 mm2/s (P = 0.004), or LR-5 (P < 0.001), with similar specificity compared to LR-5 (P = 0.193).

Conclusion

DN and WD-HCC displayed contrasting diffusion characteristics, attainable to distinguish with satisfactory accuracy. The utilization of arterial phase hyperintensity and mADC < 0.0012 on MRI facilitated the differentiation of WD-HCC from DN.

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Data availability

Authors will share deidentified individual participant imaging data upon reasonable request with researchers who provide a methodologically viable proposal and can do analyses that achieve the aims of the proposal. Data sharing requests can be directed to RG by email. A data access agreement is needed to gain access to data.

References

  1. Sung Hyuna,Ferlay Jacques,Siegel Rebecca L et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.CA Cancer J Clin, 2021, 71: 209-249.

    Article  PubMed  Google Scholar 

  2. Vogel A, Meyer T, Sapisochin G, Salem R, Saborowski A. Hepatocellular carcinoma. Lancet (London, England) 2022;400:1345-1362.

    Article  CAS  PubMed  Google Scholar 

  3. Wurmbach Elisa,Chen Ying-bei,Khitrov Greg et al. Genome-wide molecular profiles of HCV-induced dysplasia and hepatocellular carcinoma. Hepatology, 2007, 45: 938-47.

    Article  Google Scholar 

  4. Choi B I,Takayasu K,Han M C,Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis, and imaging findings. AJR Am J Roentgenol, 1993, 160: 1177-87.

    Article  CAS  PubMed  Google Scholar 

  5. Zech Christoph J,Reiser Maximilian F,Herrmann Karin A,Imaging of hepatocellular carcinoma by computed tomography and magnetic resonance imaging: state of the art. Dig Dis, 2009, 27: 114-24.

    Article  CAS  PubMed  Google Scholar 

  6. Park Young Nyun,Update on precursor and early lesions of hepatocellular carcinomas. Arch Pathol Lab Med, 2011, 135: 704-15.

    Article  CAS  PubMed  Google Scholar 

  7. Park Hyun Jeong,Choi Byung Ihn,Lee Eun Sun et al. How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis. Liver Cancer, 2017, 6: 189-203.

    Article  Google Scholar 

  8. Di Martino Michele,Anzidei Michele,Zaccagna Fulvio et al. Qualitative analysis of small (≤2 cm) regenerative nodules, dysplastic nodules and well-differentiated HCCs with gadoxetic acid MRI. BMC Med Imaging, 2016, 16: 62.

    Article  Google Scholar 

  9. Renzulli Matteo,Clemente Alfredo,Brocchi Stefano et al. LI-RADS: a great opportunity not to be missed. Eur J Gastroenterol Hepatol, 2019, 31: 283-288.

    Article  Google Scholar 

  10. Ronot Maxime,Fouque Olivia,Esvan Maxime et al. Comparison of the accuracy of AASLD and LI-RADS criteria for the non-invasive diagnosis of HCC smaller than 3 cm. J Hepatol, 2018, 68: 715-723.

    Article  Google Scholar 

  11. Choi Sang Hyun,Byun Jae Ho,Kim So Yeon et al. Liver Imaging Reporting and Data System v2014 With Gadoxetate Disodium-Enhanced Magnetic Resonance Imaging: Validation of LI-RADS Category 4 and 5 Criteria. Invest Radiol, 2016, 51: 483-90.

    Article  Google Scholar 

  12. Joo Ijin,Lee Jeong Min,Lee Dong Ho et al. Retrospective validation of a new diagnostic criterion for hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout with the aid of ancillary features? Eur Radiol, 2019, 29: 1724-1732.

    Article  Google Scholar 

  13. Holdsworth Samantha J,Bammer Roland,Magnetic resonance imaging techniques: fMRI, DWI, and PWI. Semin Neurol, 2008, 28: 395-406.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Koh Dow-Mu,Collins David J,Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol, 2007, 188: 1622-35.

    Article  Google Scholar 

  15. Zhang Kevin Sun,Schelb Patrick,Kohl Simon et al. Improvement of PI-RADS-dependent prostate cancer classification by quantitative image assessment using radiomics or mean ADC. Magn Reson Imaging, 2021, 82: 9-17.

    Article  Google Scholar 

  16. Joo Ijin,Kim So Yeon,Kang Tae Wook et al. Radiologic-Pathologic Correlation of Hepatobiliary Phase Hypointense Nodules without Arterial Phase Hyperenhancement at Gadoxetic Acid-enhanced MRI: A Multicenter Study. Radiology, 2020, 296: 335-345.

    Article  Google Scholar 

  17. Renzulli Matteo,Biselli Maurizio,Brocchi Stefano et al. New hallmark of hepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm. Gut, 2018, 67: 1674-1682.

    Article  Google Scholar 

  18. Choi Sang Hyun,Byun Jae Ho,Lim Young-Suk et al. Diagnostic criteria for hepatocellular carcinoma ⩽3 cm with hepatocyte-specific contrast-enhanced magnetic resonance imaging. J Hepatol, 2016, 64: 1099-1107.

    Article  Google Scholar 

  19. Park Min Jung,Kim Young Kon,Lee Mi Hee et al. Validation of diagnostic criteria using gadoxetic acid-enhanced and diffusion-weighted MR imaging for small hepatocellular carcinoma (<= 2.0 cm) in patients with hepatitis-induced liver cirrhosis. Acta Radiol, 2013, 54: 127-36.

    Article  Google Scholar 

  20. Lee Mi Hee,Kim Seong Hyun,Park Min Jung et al. Gadoxetic acid-enhanced hepatobiliary phase MRI and high-b-value diffusion-weighted imaging to distinguish well-differentiated hepatocellular carcinomas from benign nodules in patients with chronic liver disease. AJR Am J Roentgenol, 2011, 197: W868-75.

    Article  Google Scholar 

  21. Sano Katsuhiro,Ichikawa Tomoaki,Motosugi Utaroh et al. Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology, 2011, 261: 834-44.

    Article  Google Scholar 

  22. Kim Tae Kyoung,Lee Kyoung Ho,Jang Hyun-Jung et al. Analysis of gadobenate dimeglumine-enhanced MR findings for characterizing small (1-2-cm) hepatic nodules in patients at high risk for hepatocellular carcinoma. Radiology, 2011, 259: 730-8.

    Article  Google Scholar 

  23. Kim Young Kon,Lee Young Hwan,Kim Chong Soo et al. Added diagnostic value of T2-weighted MR imaging to gadolinium-enhanced three-dimensional dynamic MR imaging for the detection of small hepatocellular carcinomas. Eur J Radiol, 2008, 67: 304-310.

    Article  Google Scholar 

  24. Piana Gilles,Trinquart Ludovic,Meskine Nawel et al. New MR imaging criteria with a diffusion-weighted sequence for the diagnosis of hepatocellular carcinoma in chronic liver diseases. J Hepatol, 2011, 55: 126-32.

    Article  Google Scholar 

  25. Kim Young Kon,Kim Chong Soo,Han Young Min et al. Detection of liver malignancy with gadoxetic acid-enhanced MRI: is addition of diffusion-weighted MRI beneficial? Clin Radiol, 2011, 66: 489-96.

    Article  Google Scholar 

  26. Xie Sidong,Zhang Yao,Chen Jingbiao et al. Can modified LI-RADS increase the sensitivity of LI-RADS v2018 for the diagnosis of 10-19 mm hepatocellular carcinoma on gadoxetic acid-enhanced MRI? .Abdom Radiol (NY), 2022, 47: 596-607.

    Article  Google Scholar 

  27. Cha Dong Ik,Jang Kyung Mi,Kim Seong Hyun et al. Liver Imaging Reporting and Data System on CT and gadoxetic acid-enhanced MRI with diffusion-weighted imaging. Eur Radiol, 2017, 27: 4394-4405.

    Article  Google Scholar 

  28. Çolakoğlu Er Hale,Erden Ayşe,Mean ADC values discriminate rectal mucinous carcinomafrom rectal nonmucinous adenocarcinoma. Turk J Med Sci, 2017, 47: 1520-1525.

    Article  PubMed  Google Scholar 

  29. Kierans Andrea S,Bennett Genevieve L,Mussi Thais C 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: 164-71.

    Article  CAS  PubMed  Google Scholar 

  30. Zhong Xi,Guan Tianpei,Tang Danrui et al. Differentiation of small (≤ 3 cm) hepatocellular carcinomas from benign nodules in cirrhotic liver: the added additive value of MRI-based radiomics analysis to LI-RADS version 2018 algorithm. BMC Gastroenterol, 2021, 21: 155.

    Article  Google Scholar 

  31. Feuerlein Sebastian,Pauls Sandra,Juchems Markus S et al. Pitfalls in abdominal diffusion-weighted imaging: how predictive is restricted water diffusion for malignancy. AJR Am J Roentgenol, 2009, 193: 1070-6.

    Article  Google Scholar 

  32. Le Bihan Denis,Poupon Cyril,Amadon Alexis et al. Artifacts and pitfalls in diffusion MRI. J Magn Reson Imaging, 2006, 24: 478-88.

    Article  Google Scholar 

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Author notes

  1. Xiaodan Zong and Mingkai Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China

    Xiaodan Zong, Jianwen Li, Qilong Chen, Anping Shi, Xin Gao & Ruomi Guo

  2. Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China

    Mingkai Li

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Contributions

XZ and ML conceived of and designed the study. XZ, QC and XG were responsible for data collection. JL and XZ independently conducted the initial LI-RADS scoring while RG conducted the consensus reading. XZ, AS and ML did the statistical analysis. XZ and ML wrote the drafted report. RG critically revised the manuscript. All authors had access to all the raw datasets. All authors revised the report and approved the final version before submission.

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Correspondence to Ruomi Guo.

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Zong, X., Li, M., Li, J. et al. Mean ADC values and arterial phase hyperintensity discriminate small (≤ 3 cm) well-differentiated hepatocellular carcinoma from dysplastic nodule. Abdom Radiol 49, 1132–1143 (2024). https://doi.org/10.1007/s00261-023-04171-x

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