Comparison of diffusion-weighted imaging and T2-weighted single shot fast spin-echo: Implications for LI-RADS characterization of hepatocellular carcinoma

Hicks, Robert M.; Yee, Judy; Ohliger, Michael A.; Weinstein, Stefanie; Kao, Jeffrey; Ikram, Nabia S.; Hope, Thomas A.

doi:10.1016/j.mri.2016.04.007

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…Rather, it is more important to detect focal hepatic lesions with high sensitivity in high-risk patients. T2WIs have a high sensitivity for detecting focal liver lesions, and DWIs are effective in detecting and characterizing HCC in cirrhotic patients [ 34 , 35 ], especially small HCC (<2 cm) [ 36 ]. In addition, high b-values on DWI offer excellent specificity in distinguishing HCC from benign cirrhotic nodules and pseudo-lesions [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol

Kim

Choi

et al. 2017

BMC Cancer

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BackgroundUltrasonography (US) is recommended as a standard surveillance tool for patients with a high risk of developing hepatocellular carcinoma (HCC). However, the low sensitivity of US for small HCC can lead to surveillance failure, resulting in advanced stage tumor presentations. For the early detection of HCC in high-risk patients and to improve survival and prognosis, a new efficient imaging tool with a high sensitivity for HCC detection is needed. The purpose of this study is to evaluate and compare the feasibility and efficacy of non-contrast magnetic resonance imaging (MRI) with US as a surveillance tool for HCC in patients with liver cirrhosis.MethodsMAGNUS-HCC is a prospective, multicenter clinical trial with a crossover design for a single arm of patients. This study was approved by six Institutional Review Boards, and informed consent was obtained from all participants. All patients will undergo liver US every 6 months and non-contrast liver MRI every 12 months during a follow-up period of 3 years. If a focal liver lesion suspected of harboring HCC is detected, dynamic liver computed tomography (CT) will be performed to confirm the diagnosis. After the last surveillance round, patients without suspicion of HCC or who are not diagnosed with HCC will be evaluated with a dynamic liver CT to exclude false-negative findings. The primary endpoint is to compare the rate of detection of HCC by US examinations performed at 6-month intervals with that of yearly non-contrast liver MRI studies during a 3-year follow-up. The secondary endpoint is the survival of the patients who developed HCC within the 3-year follow-up period.DiscussionMAGNUS-HCC is the first study to compare the feasibility of non-contrast MRI with US as a surveillance tool for the detection of HCC in high-risk patients. We anticipate that the evidence presented in this study will establish the efficacy of non-contrast MRI as a surveillance tool for HCC in high-risk patients.Trial registrationThe date of trial registration (NCT02551250) in this study was September 15, 2015, and follow-up is still ongoing.

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Section: Discussionmentioning

confidence: 99%

Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol

Kim

Choi

et al. 2017

BMC Cancer

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“…However, in contrast to ADC measurements, CNR measurements did not differ significantly between the three groups of benign nodules, nodules of intermediate malignancy, and progressed hepatocellular carcinomas. This suggests that the assessment of signal intensity and contrast on high b value images is compounded by mixed effects of diffusion‐weighting and T 2 ‐weighting . Therefore, we think that high b‐value DW images should not be used as surrogates for ADC maps, but ADC maps and high b‐value DW images should be assessed together.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that the assessment of signal intensity and contrast on high b value images is compounded by mixed effects of diffusion-weighting and T 2 -weighting. 35 Therefore, we think that high b-value DW images should not be used as surrogates for ADC maps, but ADC maps and high b-value DW images should be assessed together.…”

Section: Discussionmentioning

confidence: 99%

Comparison of pulsed and oscillating gradient diffusion‐weighted MRI for characterizing hepatocellular nodules in liver cirrhosis: ex vivo study in a rat model

Wagner

Doblas

Poté

et al. 2019

Magnetic Resonance Imaging

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Background In contrast to classical pulsed gradient diffusion‐weighted MRI, oscillating gradient diffusion‐weighted MR imaging (DWI) is sensitive to short distance diffusion changes at the intracellular level. Purpose To compare the diagnostic performance of pulsed and oscillating DWI for characterizing hepatocellular nodules in a rat model of hepatic cirrhosis. Study Type Prospective, experimental study. Animal Model Cirrhosis was induced by weekly intraperitoneal injection of diethylnitrosamine in Wistar rats. Field Strength/Sequence Ex vivo liver MRI was performed at 7T with T1‐weighted, T2‐weighted, pulsed, and oscillating gradient diffusion‐weighted sequences. Assessment Apparent diffusion coefficient from pulsed (ADCpulsed) and oscillating gradient (ADCoscillating) sequences was calculated in 82 nodules identified on the T1/T2‐weighted images and on pathological examination. Two pathologists classified the nodules in three categories: benign (regenerative and low‐grade dysplastic nodules), with intermediate malignancy (high‐grade dysplastic nodules and early hepatocellular carcinomas) and overtly malignant (progressed hepatocellular carcinomas). Statistical Tests Differences between groups were assessed with Kruskal–Wallis and Mann–Whitney tests. Results ADC, mainly ADCoscillating, increased in the group of nodules with intermediate malignancy (ADCpulsed: 0.75 ± 0.25 × 10‐3 mm2/s vs. 0.64 ± 0.07 × 10‐3 mm2/s in benign nodules, P = 0.025; ADCoscillating: 0.81 ± 0.20 × 10‐3 mm2/s vs. 0.65 ± 0.13 × 10‐3 mm2/s, P = 0.0008) and ADCpulsed decreased in the group of progressed hepatocellular carcinomas (ADCpulsed: 0.60 ± 0.08 × 10‐3 mm2/s, P = 0.042; ADCoscillating: 0.68 ± 0.08 × 10‐3 mm2/s, P = 0.1). Data Conclusion ADC during hepatocarcinogenesis in rats increased in nodules with intermediate malignancy and decreased in progressed hepatocellular carcinomas. Our results suggest that oscillating gradient DWI is more sensitive to the early steps of hepatocarcinogenesis and might be useful for differentiating between high‐grade dysplastic nodules / early hepatocellular carcinomas and regenerating nodules / low‐grade dysplastic nodules. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2020;51:1065–1074.

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“…19,21 Previous research has demonstrated the clinical potential of mono-exponential DWI or histogram analysis in evaluating the therapeutic response of HCC (for example: TACE or other novel targeted therapies) 22 and diagnostic value in combination with LI-RADS. 23,25 However, hardly ever were IVIM-derived histogram metrics applied for addressing the above issues. In view of the important functional insights provided by IVIM as well as the numerous potential quantitative markers provided by histogram analysis, IVIM-derived histogram metrics held great potential in accurately diagnosing patients with HCC of different grades in the LI-RADS category and evaluating the therapeutic response of TACE and other novel therapies.…”

Section: Diagnostic Performance Analysismentioning

confidence: 99%

<p>Evaluation of Multiple Prognostic Factors of Hepatocellular Carcinoma with Intra-Voxel Incoherent Motions Imaging by Extracting the Histogram Metrics</p>

Shi¹,

Han²,

Wang³

et al. 2020

CMAR

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To predict multiple prognostic factors of HCC including histopathologic grade, the expression of Ki67 as well as capsule formation with intravoxel incoherent motions imaging by extracting the histogram metrics. Patients and Methods: A total of 52 patients with HCC were recruited with the MR examinations undertaken at a 3T scanner. Histogram metrics were extracted from IVIMderived parametric maps. Independent student t-test was performed to explore the differences in metrics across different subtypes of prognostic factors. Spearman correlation test was utilized to evaluate the correlations between the IVIM metrics and prognostic factors. ROC analysis was applied to evaluate the diagnostic performance. Results: According to the independent student t-test, there were 18, 4, and 8 IVIM-derived histogram metrics showing the capability for differentiating the subtypes of histopathologic grade, Ki67, and capsule formation, respectively, with P-values of less than 0.05. Besides, there existed a lot of significant correlations between IVIM metrics and prognostic factors. Finally, by integrating different histogram metrics showing significant differences between various subgroups together via establishing logistic regression based diagnostic models, greatest diagnostic power was obtained for grading HCC (AUC=0.917), diagnosing patients with highly expressed Ki67 (AUC=0.861) and diagnosing patients with capsule formation (AUC=0.839). Conclusion: Multiple prognostic factors including histopathologic grade, Ki67 expression status, and capsule formation can be accurately predicted with assistance of histogram metrics sourced from a single IVIM scan.

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Comparison of diffusion-weighted imaging and T2-weighted single shot fast spin-echo: Implications for LI-RADS characterization of hepatocellular carcinoma

Cited by 12 publications

References 31 publications

Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol

Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol

Comparison of pulsed and oscillating gradient diffusion‐weighted MRI for characterizing hepatocellular nodules in liver cirrhosis: ex vivo study in a rat model

<p>Evaluation of Multiple Prognostic Factors of Hepatocellular Carcinoma with Intra-Voxel Incoherent Motions Imaging by Extracting the Histogram Metrics</p>

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