Assessment of different mathematical models for diffusion‐weighted imaging as quantitative biomarkers for differentiating benign from malignant solid hepatic lesions

Abstract

To quantitatively compare the monoexponential, biexponential, and stretched‐exponential diffusion‐weighted imaging (DWI) models in differentiating benign from malignant solid hepatic lesions. The institutional review board approved this retrospective study and waived the informed consent requirement. A total of 188 patients with 288 hepatic lesions included 202 malignant lesions and 86 benign lesions were assessed (confirmed by pathology or clinical follow‐up for 6 months). All patients underwent hepatic 3.0‐T MRI, including multi‐b DWI that used 12 b values. The ADC, D p, D t, perfusion fraction (f p), α, and DDC values for normal liver, benign liver lesions, and malignant liver lesions were calculated. Independent sample t tests were used for comparisons. The diagnostic performance of the parameters was evaluated using ROC analysis. The AUC value for each model was also calculated. The value of D p was significantly lower in benign lesions than in normal hepatic parenchyma while others were significantly higher (P < .001). Whereas Values of D t and α in malignant hepatic lesions were significantly higher than in normal hepatic parenchyma (P < .001), and the D p value was significantly lower (P < .001). Values of ADC, f p, DDC, and α for malignant hepatic lesions were significantly lower than those for benign hepatic lesions (P < .001). ROC analysis showed that the diagnostic value of the biexponential model of normal hepatic parenchyma vs benign hepatic lesions and normal hepatic parenchyma vs malignant hepatic lesions was high (0.946 and 0.876, respectively). In the differential diagnosis of benign and malignant hepatic lesions, DDC had the highest AUC value (0.819). The biexponential and stretched‐exponential DWI may provide additional information and improve the differential diagnosis of benign and malignant hepatic lesions compared with the monoexponential DWI.

Volumetric Apparent Diffusion Coefficient Histogram Analysis in Differentiating Intrahepatic Mass‐Forming Cholangiocarcinoma From Hepatocellular Carcinoma

“…Diffusion‐weighted imaging (DWI) has been widely applied in the liver . In the Liver Imaging Reporting and Data System (LI‐RADS) v. 2017, the presence of restricted diffusion was an ancillary feature favoring malignancy and the target appearance on DWI was characteristic of category LR‐M (probable or definite malignancy, not specific for HCC, eg, IMCC)…”

Evaluation of non‐monoexponential diffusion models for hepatocellular carcinoma using b values up to 2000 s/mm2: A short‐term repeatability study

“…If this assumption did not accord with the realistic microenvironment of HCC, the statistical model would not accurately fit the DW attenuation signals of HCC, and as a result, considerable fitting residuals would be produced. As for the stretched exponential model, the "heterogeneity" here refers to the heterogeneity of the exponential decay in the voxels, rather than the heterogeneity of the diffusion coefficient by the kurtosis and statistical models . This might be the main reason leading to the best fitting performance of the stretched exponential model.…”

“…As for the stretched exponential model, the "heterogeneity" here refers to the heterogeneity of the exponential decay in the voxels, rather than the heterogeneity of the diffusion coefficient by the kurtosis and statistical models. 29 This might be the main reason leading to the best fitting performance of the stretched exponential model. However, the parameter DDC of the stretched exponential model showed the lowest ICC and the highest WCV in the repeatability examination.…”

Differentiation of high-grade from low-grade diffuse gliomas using diffusion-weighted imaging: a comparative study of mono-, bi-, and stretched-exponential diffusion models

“…This model enables the measurement of the water diffusion heterogeneity index α, which ranges from 0 to 1 (a value of 1 indicates water diffusion). Accumulating evidence suggests that stretched-exponential DWI is useful for assessing gliomas [11][12][13][14][15][16] and other tumors, including breast [17], pancreatic [18], hepatic [19], prostate [20], bladder [21], and renal cancers [22].…”