European Radiology

, Volume 29, Issue 2, pp 535–544 | Cite as

Intravoxel incoherent motion diffusion-weighted imaging for assessment of histologic grade of hepatocellular carcinoma: comparison of three methods for positioning region of interest

  • Yi Wei
  • Feifei Gao
  • Min Wang
  • Zixing Huang
  • Hehan Tang
  • Jiaxing Li
  • Yi Wang
  • Tong Zhang
  • Xiaocheng Wei
  • Dandan Zheng
  • Bin SongEmail author



To prospectively compare the diagnostic performances of three methods of region of interest (ROI) placement for the measurements of intravoxel incoherent motion (IVIM) diffusion-weighted MR imaging in differentiating the histologic grade of hepatocellular carcinoma (HCC).


Eighty-seven patients with 91 newly diagnosed HCCs were studied using IVIM imaging. Two attending radiologists separately identified the selection of tumour tissue for ROI positioning. Three different ROI positioning methods, namely the whole tumour volume (WTV) method, three-ROI method and one-section method, were used for the measurement. Kruskal–Wallis rank test or one-way ANOVA was used to compare the difference in IVIM parameters and ADC across the three different ROI positioning methods. Spearman correlation analysis was used to determine the correlation between each parameter and Edmondson–Steiner (E–S) grade. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic performance.


For the ADC and ADCslow, the mean value measured by using the WTV method was significant higher than the one-section and three-ROI methods (all p < 0.01). For the ADCslow, the highest area under curve (AUC) with a value of 0.969 was obtained by using the WTV method, followed by the one-section method (AUC = 0.938) and three-ROI method (AUC = 0.873). Additionally, for the ADC, AUC values were 0.861 for WTV method, 0.840 for one-section method and 0.806 for three-ROI method.


Different ROI positioning methods used significantly affect the IVIM parameters and ADC measurements. Measurements of ADCslow value derived from WTV method entailed the highest diagnostic performance in grading HCC.

Key Points

• Diffusion MRI is useful for non-invasively differentiating the histologic grade of hepatocellular carcinoma.

• Different ROI positioning methods used significantly affect the IVIM parameters and ADC measurements.

• IVIM model is advantageous over mono-exponential model for assessing the histologic grade of hepatocellular carcinoma.


Magnetic resonance imaging Hepatocellular carcinoma Diagnostic imaging 



Apparent diffusion coefficient


Pseudo ADC


True ADC


Area under curve


Diffusion-weighted imaging


Edmondson–steiner grade


Perfusion fraction


Hepatocellular carcinoma


Intravoxel incoherent motion


Receiver operating characteristics


Region of interest


Whole tumour volume



This study received funding by Research Grant of National Nature Science Foundation of China and Science (Grant number 81471658) and Technology Support Program of Sichuan Province (Grant number 2017SZ0003)

Compliance with ethical standards


The scientific guarantor of this publication is Bin Song.

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 (Yi Wei) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• prospective

• diagnostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, West China HospitalSichuan UniversityChengduChina
  2. 2.Department of RadiologyHenan Provincial People’s HospitalZhengzhouChina
  3. 3.Department of Liver surgery, West China HospitalSichuan UniversityChengduChina
  4. 4.GE Healthcare ChinaBeijingChina

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