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Diffusion-weighted imaging of the liver: usefulness of ADC values in the differential diagnosis of focal lesions and effect of ROI methods on ADC measurements

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Abstract

Object

By measuring the apparent diffusion coefficient (ADC) of liver parenchyma and focal hepatic lesions (FHL) we proposed to investigate the utility of ADC in the differential diagnosis of hepatic disease and to determine the influence of region of interest (ROI) characteristics in those measurements.

Materials and methods

Ninety-three patients with at least one supracentimetric FHL, or parenchymal abnormality, were retrospectively evaluated. Diagnosis was based on histopathologic data or, alternatively, on a combination of consensus between imaging methods and 24 months of follow-up. Ninety lesions were evaluated with respiratory-triggered diffusion-weighted imaging (b values: 50 and 700 s/mm2): 14 hepatocellular carcinomas, 18 metastases, 10 focal nodular hyperplasias, four adenomas, 30 hemangiomas and 14 cysts. ADC of hepatic parenchyma was measured by placing ROIs in four different segments, and in FHLs by using three circular 1 cm2 ROIs and one ROI encompassing the full lesion. Data was statistically analyzed (p < 0.05 considered significant), and a receiver operating characteristic curve was assessed to evaluate the accuracy for the diagnosis of malignancy.

Results

Our measurements showed that parenchyma ADC was significantly higher in segment II and that ADCs of malignant lesions were significantly lower than those of benign lesions (p < 0.001). There was significant overlap between benign solid lesions and malignant lesions and the area under the curve for malignancy was 0.939 (sensitivity 89.7 %, specificity 90.6 %), using a cutoff of 1.43 × 10−3 mm2/s. No significant difference was found between ROIs of different characteristics.

Conclusion

ADC measurements can help to characterize FHLs and differentiate normal from pathological parenchyma. Any ROI above 1 cm2 can provide accurate ADC measurements in homogenous lesions.

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Abbreviations

DWI:

Diffusion-weighted imaging

MR:

Magnetic resonance

ADC:

Apparent diffusion coefficient

ROI:

Region of interest

EPI:

Echo-planar imaging

RT:

Respiratory triggering

SNR:

Signal-to-noise ratio

SD:

Standard deviation

HCC:

Hepatocellular carcinoma

FNH:

Focal nodular hyperplasia

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Acknowledgments

The authors thank Dr. Bárbara Oliveiros (Biophysics Unit, IBILI, University of Coimbra, Coimbra, Portugal) and Dr. Miguel Seco (Universitary Clinic of Radiology, Coimbra University Hospitals, Coimbra, Portugal) for the support in the production of this work.

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Authors and Affiliations

  1. Universitary Clinic of Radiology, Coimbra University Hospitals, Coimbra, Portugal

    João Pedro Filipe, Luís Curvo-Semedo, Maria Cristina Marques & Filipe Caseiro-Alves

  2. Biophysics Unit, IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    João Casalta-Lopes

  3. Beco das Palheiras, n° 7, 2430-605, Vieira de Leiria, Portugal

    João Pedro Filipe

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  1. João Pedro Filipe
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Correspondence to João Pedro Filipe.

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Filipe, J.P., Curvo-Semedo, L., Casalta-Lopes, J. et al. Diffusion-weighted imaging of the liver: usefulness of ADC values in the differential diagnosis of focal lesions and effect of ROI methods on ADC measurements. Magn Reson Mater Phy 26, 303–312 (2013). https://doi.org/10.1007/s10334-012-0348-1

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