DWI of the Liver

  • Antonio LunaEmail author
  • Luis Luna


DWI has expanded its applications outside the brain in the last years because of technological improvements in gradient strengths and sequences. Nowadays, DWI forms part of “state-of-the-art” liver MRI protocols, although lack of standardization limits its widespread use. In this chapter, we analyze the main technical parameters of DWI of the liver in order to choose the most appropriate type of sequence according to the magnet and patient status. The characteristics on DWI of focal and diffuse liver disease are also summarized, outlining the currently established and potential clinical applications of this functional technique. DWI is probably the best noninvasive imaging test for detection of focal liver lesions using black-blood DWI sequences with low b values. DWI may help along with other MRI sequences in focal liver characterization. As in other organs, the potential of DWI in post-treatment monitorization and prediction of response to treatment have not been fully explored, with recent data supporting a growing role in this task. Besides, the role of this functional technique in diffuse liver disease is currently under evaluation.


Focal Nodular Hyperplasia Fibrosis Stage Focal Liver Lesion Dysplastic Nodule Diffuse Liver Disease 
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Further Reading

  1. Anderson SW, Soto JA, Milch HN et al (2011) Effect of disease progression on liver apparent diffusion coefficient values in a murine model of NASH at 11.7 Tesla MRI. J Magn Reson Imaging 33(4):882–888PubMedCrossRefGoogle Scholar
  2. Bittencourt LK, Matos C, Coutinho AC Jr (2011) Diffusion-weighted magnetic resonance imaging in the upper abdomen: technical issues and clinical applications. Magn Reson Imaging Clin N Am 19(1):111–131PubMedCrossRefGoogle Scholar
  3. Bonekamp S, Shen J, Salibi N et al (2011) Early response of hepatic malignancies to locoregional therapy-value of diffusion-weighted magnetic resonance imaging and proton magnetic resonance spectroscopy. J Comput Assist Tomogr 35(2):167–173PubMedCrossRefGoogle Scholar
  4. Bruegel M, Gaa J, Waldt S et al (2008) Diagnosis of hepatic metastasis: comparison of respiration-triggered diffusion-weighted echo-planar MRI and five T2-weighted turbo spin-echo sequences. Am J Roentgenol 191(5):1421–1429CrossRefGoogle Scholar
  5. Bruegel M, Holzapfel K, Gaa J et al (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(3):477–485; Epub Oct 25, 2007PubMedCrossRefGoogle Scholar
  6. Catalano OA, Choy G, Zhu A et al (2010) Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology 254(1):154–162PubMedCrossRefGoogle Scholar
  7. Chiu FY, Jao JC, Chen CY et al (2005) Effect of intravenous gadolinium-DTPA on diffusion-weighted magnetic resonance images for evaluation of focal hepatic lesions. J Comput Assist Tomogr 29(2):176–180PubMedCrossRefGoogle Scholar
  8. Choi JS, Kim MJ, Choi JY et al (2010) Diffusion-weighted MR imaging of liver on 3.0-Tesla system: effect of intravenous administration of gadoxetic acid disodium. Eur Radiol 20(5):1052–1060PubMedCrossRefGoogle Scholar
  9. Chung JC, Naik NK, Lewandowski RJ et al (2010) Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization. World J Gastroenterol 16(25):3161–3167PubMedCrossRefGoogle Scholar
  10. Coenegrachts K, De Geeter F, ter Beek L et al (2009) Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases. Eur Radiol 19:370–379PubMedCrossRefGoogle Scholar
  11. Coenegrachts K, Delanote J, Ter Beek L et al (2009) Evaluation of true diffusion, perfusion factor, and apparent diffusion coefficient in non-necrotic liver metastases and uncomplicated liver hemangiomas using black-blood echo planar imaging. Eur J Radiol 69:131–138PubMedCrossRefGoogle Scholar
  12. Coenegrachts K, Orlent H, ter Beek L et al (2008) Improved focal liver lesion detection: comparison of single-shot spin-echo echo-planar and superparamagnetic iron oxide (SPIO)-enhanced MRI. J Magn Reson Imaging 27:117–124PubMedCrossRefGoogle Scholar
  13. Cui Y, Zhang XP, Sun YS, Tang L, Shen L (2008) Apparent diffusion coefficient: potential imaging biomarker for prediction and early detection of response to chemotherapy in hepatic metastases. Radiology 248(3):894–900PubMedCrossRefGoogle Scholar
  14. Dale BM, Braithwaite AC, Boll DT et al (2010) Field strength and diffusion encoding technique affect the apparent diffusion coefficient measurements in diffusion-weighted imaging of the abdomen. Invest Radiol 45(2):104–108PubMedCrossRefGoogle Scholar
  15. Do RK, Chandarana H, Felker E et al (2010) Diagnosis of liver fibrosis and cirrhosis with diffusion-weighted imaging: value of normalized apparent diffusion coefficient using the spleen as reference organ. Am J Roentgenol 195(3):671–676CrossRefGoogle Scholar
  16. Eiber M, Fingerle AA, Brügel M et al (2011) Detection and classification of focal liver lesions in patients with colorectal cancer: retrospective comparison of diffusion-weighted MR imaging and multi-slice CT. Eur J Radiol. Feb 11, 2011 [Epub ahead of print]Google Scholar
  17. Erturk SM, Ichikawa T, Sano K et al (2008) Diffusion-weighted magnetic resonance imaging for characterization of focal liver masses: impact of parallel imaging (SENSE) and b value. J Comput Assist Tomogr 32(6):865–871PubMedCrossRefGoogle Scholar
  18. Fujimoto K, Tonan T, Azuma S et al (2011) Evaluation of the mean and entropy of apparent diffusion coefficient values in chronic hepatitis C: correlation with pathologic fibrosis stage and inflammatory activity grade. Radiology 258(3):739–748PubMedCrossRefGoogle Scholar
  19. Girometti R, Furlan A, Esposito G et al (2008) Relevance of b-values in evaluating liver fi brosis: a study in healthy and cirrhotic subjects using two single-shot spin-echo echo-planar diffusion-weighted sequences. J Magn Reson Imaging 28(2):411–419PubMedCrossRefGoogle Scholar
  20. Goshima S, Kanematsu M, Kondo H et al (2008) Diffusion-weighted imaging of the liver: optimizing b value for the detection and characterization of benign and malignant hepatic lesions. J Magn Reson Imaging 28:691–697PubMedCrossRefGoogle Scholar
  21. Gourtsoyianni S, Papanikolaou N, Yarmenitis S et al (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(3):486–492PubMedCrossRefGoogle Scholar
  22. Hardie AD, Naik M, Hecht EM et al (2010) Diagnosis of liver metastases: value of diffusion-weighted MRI compared with gadolinium-enhanced MRI. Eur Radiol 20:1431–1441PubMedCrossRefGoogle Scholar
  23. Heo SH, Jeong YY, Shin SS et al (2010) 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 11(3):295–303PubMedCrossRefGoogle Scholar
  24. Holzapfel K, Bruegel M, Eiber M et al (2010) Characterization of small (≤10 mm) focal liver lesions: value of respiratory-triggered echo-planar diffusion-weighted MR imaging. Eur J Radiol 76(1):89–95PubMedCrossRefGoogle Scholar
  25. Holzapfel K, Reiser-Erkan C, Fingerle AA et al (2011) Comparison of diffusion-weighted MR imaging and multidetector-row CT in the detection of liver metastases in patients operated for pancreatic cancer. Abdom Imaging 36(2):179–184PubMedCrossRefGoogle Scholar
  26. Hussain SM, De Becker J, Hop WC et al (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 21:219–229PubMedCrossRefGoogle Scholar
  27. Inan N, Arslan A, Akansel G et al (2007) Diffusion-weighted imaging in the differential diagnosis of simple and hydatid cysts of the liver. Am J Roentgenol 189(5):1031–1036CrossRefGoogle Scholar
  28. Kandpal H, Sharma R, Madhusudhan KS et al (2009) Respiratory-triggered versus breath-hold diffusion-weighted MRI of liver lesions: comparison of image quality and apparent diffusion coefficient values. Am J Roentgenol 192:915–922CrossRefGoogle Scholar
  29. Kenis C, Deckers F, De Foer B et al (2011) Diagnosis of liver metastases: can diffusion-weighted imaging (DWI) be used as a stand alone sequence? Eur J Radiol. Mar 3, 2011 [Epub ahead of print]Google Scholar
  30. Kim YK, Kim CS, Han YM et al (2011) Detection of liver malignancy with gadoxetic acid-enhanced MRI: is addition of diffusion-weighted MRI beneficial? Clin Radiol 66(6):489–496Google Scholar
  31. Kim T, Murakami T, Takahashi S et al (1999) Diffusion-weighted single-shot echoplanar MR imaging for liver disease. Am J Roentgenol 173(2):393–398CrossRefGoogle Scholar
  32. Koh DM, Blackledge M, Collins DJ et al (2009) Reproducibility and changes in the apparent diffusion coefficients of solid tumours treated with combretastatin A4 phosphate and bevacizumab in a two-centre phase I clinical trial. Eur Radiol 19(11):2728–2738PubMedCrossRefGoogle Scholar
  33. Koh DM, Collins DJ (2007) Diffusion weighted MRI in the body: applications and challenges in oncology. Am J Roentgenol 188:1622–1635CrossRefGoogle Scholar
  34. Koh DM, Erica S, Collins D et al (2004) Diffusion coefficients and the perfusion fraction of colorectal hepatic metastases estimated using single-shot echo-planar sensitivity-encoded (SENSE) diffusion-weighted MR imaging. Proc Int Soc Magn Reson Med 11:908Google Scholar
  35. Koh DM, Padhani AR (2010) Functional magnetic resonance imaging of the liver: parametric assessments beyond morphology. Magn Reson Imaging Clin N Am 18(3):565–585PubMedCrossRefGoogle Scholar
  36. Koh DM, Scurr E, Collins D et al (2007) Predicting response of colorectal hepatic metastasis: value of pretreatment apparent diffusion coefficients. Am J Roentgenol 188(4):1001–1008CrossRefGoogle Scholar
  37. Koike N, Cho A, Nasu K et al (2009) Role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of focal hepatic lesions. World J Gastroenterol 15:5805–5812PubMedCrossRefGoogle Scholar
  38. Koinuma M, Ohashi I, Hanafusa K et al (2005) Apparent diffusion coefficient measurements with diffusion-weighted ­magnetic resonance imaging for evaluation of hepatic fibrosis. J Magn Reson Imaging 22(1):80–85PubMedCrossRefGoogle Scholar
  39. Kubota K, Yamanishi T, Itoh S et al (2010) Role of diffusion-weighted imaging in evaluating therapeutic efficacy after transcatheter arterial chemoembolization for hepatocellular carcinoma. Oncol Rep 24(3):727–732PubMedCrossRefGoogle Scholar
  40. Kwee TC, Takahara T (2011) Diffusion-weighted MRI for detecting liver metastases: importance of the b-value. Eur Radiol 21(1):150PubMedCrossRefGoogle Scholar
  41. Kwee TC, Takahara T, Koh DM et al (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(5):1141–1148PubMedCrossRefGoogle Scholar
  42. Kwee TC, Takahara T, Niwa T et al (2009) Influence of cardiac motion on diffusion-weighted magnetic resonance imaging of the liver. Magn Reson Mater Phys 22:319–325CrossRefGoogle Scholar
  43. Le Bihan D, Breton E, Lallemand D et al (1986) MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 161(2):401–407PubMedGoogle Scholar
  44. Le Bihan D, Breton E, Lallemand D et al (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168:497–505PubMedGoogle Scholar
  45. Lewin M, Poujol-Robert A, Boëlle PY et al (2007) Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology 46(3):658–665PubMedGoogle Scholar
  46. Liu YB, Liang CH, Wang QS et al (2010) Clinical study of transcatheter arterial chemoembolization plus radiofrequency ablation in hepatocellular carcinoma by magnetic resonance imaging and functional diffusion-weighted imaging. Zhonghua Yi Xue Za Zhi 90(41):2922–2926PubMedGoogle Scholar
  47. Low RN (2007) Abdominal MRI advances in the detection of liver tumours and characterisation. Lancet Oncol 8:525–535PubMedCrossRefGoogle Scholar
  48. Luciani A, Vignaud A, Cavet M et al (2008) Liver cirrhosis: intravoxel incoherent motion MR imaging-Pilot study. Radiology 249(3):891–899PubMedCrossRefGoogle Scholar
  49. Miller FH, Hammond N, Siddiqi AJ et al (2010) Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 32(1):138–147PubMedCrossRefGoogle Scholar
  50. Moteki T, Horikoshi H (2011) Evaluation of noncirrhotic hepatic parenchyma with and without significant portal vein stenosis using diffusion-weighted echo-planar MR on the basis of multiple-perfusion-components theory. Magn Reson Imaging 29(1):64–73PubMedCrossRefGoogle Scholar
  51. Muhi A, Ichikawa T, Motosugi et al (2009) High-b-value diffusion-weighted MR imaging of hepatocellular lesions: estimation of grade of malignancy of hepatocellular carcinoma. J Magn Reson Imaging 30(5):1005–1011CrossRefGoogle Scholar
  52. Mwangi I, Hanna RF, Kased N et al (2010) Apparent diffusion coefficient of fibrosis and regenerative nodules in the cirrhotic liver at MRI. Am J Roentgenol 194(6):1515–1522CrossRefGoogle Scholar
  53. Nagayama M, Watanabe Y, Okumura A et al (2002) Blackblood T2-weighted SE-EPI imaging of the liver. Proc Int Soc Magn Reson Med 10:1963Google Scholar
  54. 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(1):122–130PubMedCrossRefGoogle Scholar
  55. Nasu K, Kuroki Y, Tsukamoto T et al (2009) Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. Am J Roentgenol 193(2):438–444CrossRefGoogle Scholar
  56. Oruç E, Yıldırım N, Topal NB et al (2010) The role of diffusion-weighted MRI in the classification of liver hydatid cysts and differentiation of simple cysts and abscesses from hydatid cysts. Diagn Interv Radiol 16(4):279–287PubMedGoogle Scholar
  57. Papanikolaou N, Gourtsoyianni S, Yarmenitis S et al (2010) Comparison between two-point and four-point methods for quantification of apparent diffusion coefficient of normal liver parenchyma and focal lesions. Value of normalization with spleen. Eur J Radiol 73(2):305–309PubMedCrossRefGoogle Scholar
  58. Parikh T, Drew SJ, Lee VS et al (2008) Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246(3):812PubMedCrossRefGoogle Scholar
  59. Patel J, Sigmund EE, Rusinek H et al (2010) Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrast-enhanced MRI alone and in combination: preliminary experience. J Magn Reson Imaging 31(3):589–600PubMedCrossRefGoogle Scholar
  60. Piana G, Trinquart L, Meskine N et al (2011) New MR imaging criteria with a diffusion-weighted sequence for the diagnosis of hepatocellular carcinoma in chronic liver diseases. J Hepatol 55(1):126–132Google Scholar
  61. Sandrasegaran K, Akisik FM, Lin C et al (2009) Value of diffusion-weighted MRI for assessing liver fibrosis and cirrhosis. Am J Roentgenol 193(6):1556–1560CrossRefGoogle Scholar
  62. Sandrasegaran K, Akisik FM, Lin C et al (2009) The value of diffusion-weighted imaging in characterizing focal liver masses. Acad Radiol 16:1208–1214PubMedCrossRefGoogle Scholar
  63. Schraml C, Schwenzer NF, Martirosian P et al (2009) Diffusion-weighted MRI of advanced hepatocellular carcinoma during sorafenib treatment: initial results. Am J Roentgenol 193(4):301–307CrossRefGoogle Scholar
  64. Shimada K, Isoda H, Hirokawa Y et al (2010) Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases. Eur Radiol 20(11):2690–2698PubMedCrossRefGoogle Scholar
  65. Sun XJ, Quan XY, Huang FH et al (2005) Quantitative evaluation of diffusion-weighted magnetic resonance imaging of focal hepatic lesions. World J Gastroenterol 11:6535–6537PubMedGoogle Scholar
  66. Taouli B, Chouli M, Martin AJ et al (2008) Chronic hepatitis: role of diffusion-weighted imaging and diffusion tensor imaging for the diagnosis of liver fibrosis and inflammation. J Magn Reson Imaging 28(1):89–95PubMedCrossRefGoogle Scholar
  67. Taouli B, Koh DM (2010) Diffusion-weighted MR imaging of the liver. Radiology 254:47–66PubMedCrossRefGoogle Scholar
  68. Taouli B, Tolia AJ, Losada M et al (2007) Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience. Am J Roentgenol 189(4):799–806CrossRefGoogle Scholar
  69. Taouli B, Vilgrain V, Dumont E et al (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 226:71–78PubMedCrossRefGoogle Scholar
  70. Turner R, Le Bihan D, Maier J et al (1990) Echo-planar imaging of intravoxel incoherent motion. Radiology 177(2):407–414PubMedGoogle Scholar
  71. Wang Y, Ganger DR, Levitsky J et al (2011) Assessment of chronic hepatitis and fibrosis: comparison of MR elastography and diffusion-weighted imaging. Am J Roentgenol 196(3):553–561CrossRefGoogle Scholar
  72. Wang H, Wang XY, Jiang XX et al (2010) Comparison of diffusion-weighted with T2-weighted Imaging for detection of small hepatocellular carcinoma in cirrhosis: preliminary quantitative study at 3-T. Acad Radiol 17(2):239–243PubMedCrossRefGoogle Scholar
  73. Watanabe H, Kanematsu M, Goshima S et al (2011) Staging hepatic fibrosis: comparison of gadoxetate disodium-enhanced and diffusion-weighted MR imaging – preliminary observations. Radiology 259(1):142–150PubMedCrossRefGoogle Scholar
  74. Xu PJ, Yan FH, Wang JH et al (2010) Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 34(4):506–512PubMedCrossRefGoogle Scholar
  75. Yamada I, Aung W, Himeno Y et al (1999) Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 210(3):617–623PubMedGoogle Scholar
  76. Zech CJ, Herrmann KA, Dietrich O et al (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(4):261–266PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Health Time GroupJaénSpain
  2. 2.MRI SectionClínica Las Nieves, SERCOSAJaénSpain

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