Eur Radiol DOI 10.1007/s00330-014-3500-7

MAGNETIC RESONANCE

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 Riccardo Inchingolo & Anna Maria De Gaetano & Davide Curione & Marzia Ciresa & Luca Miele & Maurizio Pompili & Fabio Maria Vecchio & Felice Giuliante & Lorenzo Bonomo

Received: 7 May 2014 / Revised: 9 November 2014 / Accepted: 12 November 2014 # European Society of Radiology 2014

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. R. Inchingolo : A. M. De Gaetano : D. Curione : M. Ciresa : L. Bonomo Department of Bioimaging and Radiological Sciences, Institute of Radiology, “Agostino Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy L. Miele : M. Pompili Department of Internal Medicine, “Agostino Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy F. M. Vecchio Department of Anatomo-Pathology,“Agostino Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy F. Giuliante Department of Surgery,“Agostino Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy R. Inchingolo (*) Rome, Italy e-mail: [email protected]

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 (p20 mm, where, in addition to this value, three other ROIs≈1 cm2 were randomly placed inside

Table 1 MRI parameters

FS, fat suppression; TR, repetition time; TE, echo time; FA, flip angle; ST, slice thickness; SS, slice spacing; FOV, field of view; T1/T2-w, weighted; FSPGR, fast spoiled gradientecho; FSE, fast spin-echo; FRFSE, fast-recovery FSE; SSFSE, single-shot FSE;

Sequence

FS

TR/TE (ms)

FA

ST (mm)

SS (mm)

FOV (cm)

Matrix

Baseline T1-w 2D FSPGR in-phase opposed-phase T2-w FSE T2-w FRFSE T2-w SSFSE transverse

No No No Yes

180/4.4-2.2 180/4.4-2.2 2750/84 2350/80&140

80° 80° 90° 90°

7 7 5 7

1 1 1 1

48×48 48×48 48×48 48×48

256×224 256×224 256×224 256×224

No

893.3/90

90°

6

1

48×48

256×256

No

1157.5/60

90°

4

0

48×48

256×192

Yes Yes

3.1/1.5 4500/79.2

13° 90°

3.8 8

0 0

48×48 40×40

256×224 128×128

coronal Dynamic T1-w 3D FSPGR DWI

Eur Radiol

the lesion. If more than one ROI was placed, the average ADC value was used for analysis. In both groups, areas of intratumoral necrosis or hemorrhage were not included; for heterogeneous lesions, ROIs were chosen in more homogeneous areas. When the lesion was difficult to detect on ADC maps, T1- weighted or T2-weighted images were used for accurate ROI placement. The slice of the midsection of the nodule was selected to minimize the partial volume averaging effect and motion artefacts. For parenchymal evaluation, circular ROIs≈1 cm2 were placed in four areas of the liver (segment II-III, IV, V-VIII and VI-VII, respectively), away from vessels and bile ducts. ADCs and lesion-to-liver ADC ratios were each evaluated twice, and the measurements were averaged. To minimize recall bias, each reading session was separated by 4 weeks.

were HCCs and six were DNs; eight nodules were both iso/ hypointense on DWI and iso/hyperintense on DPI, all of which were DNs. The combination of DWI and DPI showed an increase in sensitivity and NPV (both 100 %) compared to the single criteria; however, specificity was 57.14 %. The results of ADC calculations are shown in Table 4. The mean ADC value of HCCs was lower than that of DNs, but without a statistically significant difference (p=0.245). However, the mean ADC ratio showed a statistically significant difference between HCCs and DNs (p

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.

To investigate the utility of diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and the correlation with hepatobiliary phase (del...
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