Abstract
Objective
The full diagnostic value of diffusion-weighted (DW) MRI in the evaluation of liver metastases remains uncertain. The aim of the present study was to assess the diagnostic accuracy of DW-MRI and contrast-enhanced MRI (CE-MRI) using extracellular gadolinium chelates, with the reference standard established by consensus interpretation of confirmatory imaging and histopathologic data.
Methods
MR examinations of 51 patients with extrahepatic malignancies were retrospectively reviewed by two independent observers who assessed DW-MRI and CE-MRI for detection of liver metastases.
Results
By reference standard, 93 liver lesions (49 metastases and 44 benign lesions) were identified in 27 patients, 11 patients had no liver lesions, and 13 patients had innumerable metastatic and/or benign lesions. There was no difference in diagnostic performance between the two methods for either observer for the diagnosis of metastatic lesions per patient. For per-lesion analysis, sensitivity of DW-MRI was equivalent to CE-MRI for observer 1 (67.3% vs. 63.3%, p = 0.67), but lower for observer 2 (65.3% vs. 83.7%, p = 0.007). By pooling data from both observers, the sensitivity of DW-MRI was 66.3% (65/98) and 73.5% (72/98) for CE-MRI, with no significant difference (p = 0.171).
Conclusion
DW-MRI is a reasonable alternative to CE-MRI for the detection of liver metastases.
Similar content being viewed by others
References
Cummings LC, Payes JD, Cooper GS (2007) Survival after hepatic resection in metastatic colorectal cancer: a population-based study. Cancer 109:718–726
Gillams AR, Lees WR (2009) Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol 19:1206–1213
Benoist S, Nordlinger B (2009) The role of preoperative chemotherapy in patients with resectable colorectal liver metastases. Ann Surg Oncol 16:2385–2390
Pozzo C, Barone C, Kemeny NE (2008) Advances in neoadjuvant therapy for colorectal cancer with liver metastases. Cancer Treat Rev 34:293–301
Rofsky NM, Lee VS, Laub G, Pollack MA, Krinsky GA, Thomasson D, Ambrosino MM, Weinreb JC (1999) Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology 212:876–884
Lee VS, Lavelle MT, Krinsky GA, Rofsky NM (2001) Volumetric MR imaging of the liver and applications. Magn Reson Imaging Clin N Am 9:697–716 v–vi
Semelka RC, Martin DR, Balci C, Lance T (2001) Focal liver lesions: comparison of dual-phase CT and multisequence multiplanar MR imaging including dynamic gadolinium enhancement. J Magn Reson Imaging 13:397–401
Braga L, Guller U, Semelka RC (2004) Modern hepatic imaging. Surg Clin North Am 84:375–400
Sadowski EA, Bennett LK, Chan MR, Wentland AL, Garrett AL, Garrett RW, Djamali A (2007) Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology 243:148–157
Thomsen HS, Marckmann P, Logager VB (2008) Update on nephrogenic systemic fibrosis. Magn Reson Imaging Clin N Am 16:551–560
Namimoto T, Yamashita Y, Sumi S, Tang Y, Takahashi M (1997) Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. Radiology 204:739–744
Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T (1998) Diffusion-weighted MR imaging with a single-shot echoplanar sequence: detection and characterization of focal hepatic lesions. AJR Am J Roentgenol 170:397–402
Okada Y, Ohtomo K, Kiryu S, Sasaki Y (1998) Breath-hold T2-weighted MRI of hepatic tumors: value of echo planar imaging with diffusion-sensitizing gradient. J Comput Assist Tomogr 22:364–371
Kim T, Murakami T, Takahashi S, Hori M, Tsuda K, Nakamura H (1999) Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR Am J Roentgenol 173:393–398
Yamada I, Aung W, Himeno Y, Nakagawa T, Shibuya H (1999) Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 210:617–623
Moteki T, Horikoshi H, Endo K (2002) Relationship between apparent diffusion coefficient and signal intensity in endometrial and other pelvic cysts. Magn Reson Imaging 20:463–470
Taouli B, Vilgrain V, Dumont E, Daire JL, Fan B, Menu Y (2003) Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 226:71–78
Moteki T, Sekine T (2004) Echo planar MR imaging of the liver: comparison of images with and without motion probing gradients. J Magn Reson Imaging 19:82–90
Yoshikawa T, Kawamitsu H, Mitchell DG, Ohno Y, Ku Y, Seo Y, Fujii M, Sugimura K (2006) ADC measurement of abdominal organs and lesions using parallel imaging technique. AJR Am J Roentgenol 187:1521–1530
Coenegrachts K, Delanote J, Ter Beek L, Haspeslagh M, Bipat S, Stoker J, Van Kerkhove F, Steyaert L, Rigauts H, Casselman JW (2007) Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques. Br J Radiol 80(955):524–531
Parikh T, Drew SJ, Lee VS, Wong S, Hecht EM, Babb JS, Taouli B (2008) Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246:812–822
Bruegel M, Gaa J, Waldt S, Woertler K, Holzapfel K, Kiefer B, Rummeny EJ (2008) Diagnosis of hepatic metastasis: comparison of respiration-triggered diffusion-weighted echo-planar MRI and five T2-weighted turbo spin-echo sequences. AJR Am J Roentgenol 191:1421–1429
Zech CJ, Herrmann KA, Dietrich O, Horger W, Reiser MF, Schoenberg SO (2008) Black-blood diffusion-weighted EPI acquisition of the liver with parallel imaging: comparison with a standard T2-weighted sequence for detection of focal liver lesions. Invest Radiol 43:261–266
Gourtsoyianni S, Papanikolaou N, Yarmenitis S, Maris T, Karantanas A, Gourtsoyiannis N (2008) Respiratory gated diffusion-weighted imaging of the liver: value of apparent diffusion coefficient measurements in the differentiation between most commonly encountered benign and malignant focal liver lesions. Eur Radiol 18:486–492
Vossen JA, Buijs M, Liapi E, Eng J, Bluemke DA, Kamel IR (2008) Receiver operating characteristic analysis of diffusion-weighted magnetic resonance imaging in differentiating hepatic hemangioma from other hypervascular liver lesions. J Comput Assist Tomogr 32:750–756
Bruegel M, Holzapfel K, Gaa J, Woertler K, Waldt S, Kiefer B, Stemmer A, Ganter C, Rummeny EJ (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18:477–485
Nasu K, Kuroki Y, Nawano S, Kuroki S, Tsukamoto T, Yamamoto S, Motoori K, Ueda T (2006) Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR Imaging. Radiology 239:122–130
Koh DM, Brown G, Riddell AM, Scurr E, Collins DJ, Allen SD, Chau I, Cunningham D, Desouza NM, Leach MO, Husband JE (2008) Detection of colorectal hepatic metastases using MnDPDP MR imaging and diffusion-weighted imaging (DWI) alone and in combination. Eur Radiol 18:903–910
Low RN, Gurney J (2007) Diffusion-weighted MRI (DWI) in the oncology patient: value of breathhold DWI compared to unenhanced and gadolinium-enhanced MRI. J Magn Reson Imaging 25:848–858
Bammer R, Keeling SL, Augustin M, Pruessmann KP, Wolf R, Stollberger R, Hartung HP, Fazekas F (2001) Improved diffusion-weighted single-shot echo-planar imaging (EPI) in stroke using sensitivity encoding (SENSE). Magn Reson Med 46:548–554
Taouli B, Martin AJ, Qayyum A, Merriman RB, Vigneron D, Yeh BM, Coakley FV (2004) Parallel imaging and diffusion tensor imaging for diffusion-weighted MRI of the liver: preliminary experience in healthy volunteers. AJR Am J Roentgenol 183:677–680
Hussain SM, De Becker J, Hop WC, Dwarkasing S, Wielopolski PA (2005) Can a single-shot black-blood T2-weighted spin-echo echo-planar imaging sequence with sensitivity encoding replace the respiratory-triggered turbo spin-echo sequence for the liver? An optimization and feasibility study. J Magn Reson Imaging 21:219–229
Vilgrain V, Flejou JF, Arrive L, Belghiti J, Najmark D, Menu Y, Zins M, Vullierme MP, Nahum H (1992) Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology 184:699–703
Arrive L, Flejou JF, Vilgrain V, Belghiti J, Najmark D, Zins M, Menu Y, Tubiana JM, Nahum H (1994) Hepatic adenoma: MR findings in 51 pathologically proved lesions. Radiology 193:507–512
Semelka RC, Brown ED, Ascher SM, Patt RH, Bagley AS, Li W, Edelman RR, Shoenut JP, Brown JJ (1994) Hepatic hemangiomas: a multi-institutional study of appearance on T2-weighted and serial gadolinium-enhanced gradient-echo MR images. Radiology 192:401–406
Mortele KJ, Praet M, Van Vlierberghe H, de Hemptinne B, Zou K, Ros PR (2002) Focal nodular hyperplasia of the liver: detection and characterization with plain and dynamic-enhanced MRI. Abdom Imaging 27:700–707
Earls JP, Theise ND, Weinreb JC, DeCorato DR, Krinsky GA, Rofsky NM, Mizrachi H, Teperman LW (1996) Dysplastic nodules and hepatocellular carcinoma: thin-section MR imaging of explanted cirrhotic livers with pathologic correlation. Radiology 201:207–214
Krinsky GA, Lee VS, Theise ND, Weinreb JC, Rofsky NM, Diflo T, Teperman LW (2001) Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology 219:445–454
Danet IM, Semelka RC, Leonardou P, Braga L, Vaidean G, Woosley JT, Kanematsu M (2003) Spectrum of MRI appearances of untreated metastases of the liver. AJR Am J Roentgenol 181:809–817
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Kwee TC, Takahara T, Koh DM, Nievelstein RA, Luijten PR (2008) Comparison and reproducibility of ADC measurements in breathhold, respiratory triggered, and free-breathing diffusion-weighted MR imaging of the liver. J Magn Reson Imaging 28:1141–1148
Taouli B, Sandberg A, Stemmer A, Parikh T, Wong S, Xu J, Lee VS (2009) Diffusion-weighted imaging of the liver: comparison of navigator triggered and breathhold acquisitions. J Magn Reson Imaging 30:561–568
Kandpal H, Sharma R, Madhusudhan KS, Kapoor KS (2009) Respiratory-triggered versus breath-hold diffusion-weighted MRI of liver lesions: comparison of image quality and apparent diffusion coefficient values. AJR Am J Roentgenol 192:915–922
Braithwaite AC, Dale BM, Boll DT, Merkle EM (2009) Short- and midterm reproducibility of apparent diffusion coefficient measurements at 3.0-T diffusion-weighted imaging of the abdomen. Radiology 250:459–465
van den Bos IC, Hussain SM, Krestin GP, Wielopolski PA (2008) Liver imaging at 3.0 T: diffusion-induced black-blood echo-planar imaging with large anatomic volumetric coverage as an alternative for specific absorption rate-intensive echo-train spin-echo sequences: feasibility study. Radiology 248:264–271
Kiryu S, Watanabe M, Kabasawa H, Akahane M, Aoki S, Ohtomo K (2006) Evaluation of super paramagnetic iron oxide-enhanced diffusion-weighted PROPELLER T2-fast spin echo magnetic resonance imaging: preliminary experience. J Comput Assist Tomogr 30:197–200
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hardie, A.D., Naik, M., Hecht, E.M. et al. Diagnosis of liver metastases: value of diffusion-weighted MRI compared with gadolinium-enhanced MRI. Eur Radiol 20, 1431–1441 (2010). https://doi.org/10.1007/s00330-009-1695-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-009-1695-9