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Role of diffusion-weighted imaging, apparent diffusion coefficient and correlation with hepatobiliary phase findings in the differentiation of hepatocellular carcinoma from dysplastic nodules in cirrhotic liver

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

To investigate the utility of diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and the correlation with hepatobiliary phase (delayed phase imaging, DPI) findings in the differentiation of cirrhotic hepatocellular nodules.

Methods

Forty-three patients with 53 pathology-proven nodules (29 hepatocellular carcinomas (HCCs), 13 high-grade (HGDNs) and 11 low-grade dysplastic nodules (LGDNs); mean size 2.17 cm, range 1–4 cm), who underwent liver MRI with DWI and DPI sequences, were retrospectively reviewed. Lesions were classified as hypointense, isointense, or hyperintense relative to the adjacent liver parenchyma. ADC of each nodule, of the surrounding parenchyma, and lesion-to-liver ratio were calculated.

Results

Hyperintensity versus iso/hypointensity on DWI, hypointensity versus iso/hyperintensity on DPI, and the mean lesion-to-liver ratio showed a statistically significant difference both between HCCs versus DNs and between “HCCs + HGDNs” versus LGDNs (p < 0.05); sensitivity, specificity, and accuracy for the diagnosis of “HCCs + HGDNs” were 96.8 %, 100 %, 97.4 % respectively when combining hyperintensity on DWI and hypointensity on DPI, and 90.9 %, 81.0 %, 83.6 % respectively when lesion-to-liver ratio was <0.95.

Conclusions

Hyperintensity on DWI, especially in association with hypointensity on DPI, and low lesion-to-liver ratios should raise the suspicion of HCC, or at least of HGDN, thus helping the characterization of atypically enhancing lesions.

Key points

• Usefulness of DWI and ADC is shown in differential diagnosis of cirrhotic nodules.

• Correlation of DWI with DPI improves differential diagnosis of cirrhotic nodules.

• Characterization of atypically enhancing lesions becomes more confident.

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Abbreviations

DNs:

dysplastic nodules

DPI:

delayed phase imaging

FLLs:

focal liver lesions

SI:

signal intensity

FNB:

fine-needle biopsy

CNB:

core-needle biopsy

HGDNs:

high-grade dysplastic nodules

LGDNs:

low-grade dysplastic nodules

PPV:

positive predictive value

NPV:

negative predictive value

FN:

false negative

FP:

false positive

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Acknowledgments

The scientific guarantor of this publication is Lorenzo Bonomo. 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. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was not required for this study because of its retrospective nature. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Bioimaging and Radiological Sciences, Institute of Radiology, “Agostino Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy

    Riccardo Inchingolo, Anna Maria De Gaetano, Davide Curione, Marzia Ciresa & Lorenzo Bonomo

  2. Department of Internal Medicine, “Agostino Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy

    Luca Miele & Maurizio Pompili

  3. Department of Anatomo-Pathology,“Agostino Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy

    Fabio Maria Vecchio

  4. Department of Surgery,“Agostino Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy

    Felice Giuliante

  5. Rome, Italy

    Riccardo Inchingolo

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  1. Riccardo Inchingolo
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Correspondence to Riccardo Inchingolo.

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Inchingolo, R., De Gaetano, A.M., Curione, D. et al. Role of diffusion-weighted imaging, apparent diffusion coefficient and correlation with hepatobiliary phase findings in the differentiation of hepatocellular carcinoma from dysplastic nodules in cirrhotic liver. Eur Radiol 25, 1087–1096 (2015). https://doi.org/10.1007/s00330-014-3500-7

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  • DOI: https://doi.org/10.1007/s00330-014-3500-7

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