Diagnostic accuracy of apparent diffusion coefficient (ADC) value in differentiating malignant from benign solid liver lesions: a systematic review and meta-analysis

Abstract

Objectives: We undertook a systematic review and meta-analysis of the diagnostic performance of mean apparent diffusion coefficient (ADC) values derived by diffusion-weighted (DW)-MRI in the characterization of solid benign and malignant liver lesions, and to assess their value in discriminating these lesions in daily routine practice. Methods: A systematic review of PubMed, Embase, Scopus, and Web of Science was conducted to retrieve studies that used ADC values for differentiating solid benign/dysplastic nodules and malignant liver lesions. A bivariate random-effects model with pooled sensitivity and specificity values with 95% CI (confidence interval) was used. This meta-analysis was performed on the per-lesion basis. Summary receiver operating characteristic (SROC) plot and area under curve (AUC) were created. Results: A total of 14 original articles were retrieved. The combined (95% CI) sensitivity and specificity of mean ADC values for differentiating solid benign from malignant lesions were 78% (67 to 86%) and 74% (64 to 81%), respectively. The pooled (95% CI) positive and negative LRs were respectively 3 (2.3 to 3.8) and 0.3 (0.21 to 0.43). The DOR (95% CI) was 10 (7 to 15). The AUC (95% CI) of the SROC plot was 82% (78 to 85%). Reporting bias was negligible (P value of regression test = 0.36). Mean size of malignant lesions and breathing pattern of MRI were found to be sources of heterogeneity of pooled sensitivity. Conclusion: ADC measurement independently may not be an optimal diagnostic imaging method for differentiating solid malignant from solid benign hepatic lesions. The meta-analysis showed that ADC measurement had moderate diagnostic accuracy for characterizing solid liver lesions. Further prospective and comparative studies with pre-specified ADC thresholds could be performed to investigate the best MRI protocol and ADC threshold for characterizing solid liver lesions. Advances in knowledge: ADC measurement by DW-MRI does not have a good diagnostic performance to differentiate solid malignant from solid benign lesions. Therefore, we suggest not using ADC values in clinical practice to evaluate solid liver lesions.

Predictive Value of MRI with Serum Lectin-Reactive Alpha-Fetoprotein for Liver Cancer Recurrence after Percutaneous Radiofrequency Ablation

“…The ADC value is an important index of diffusion-weighted imaging in evaluating the diffusion movement of water molecules in tissues at the molecular level [ 12 ]. In previous studies, it was pointed out that after RFA treatment, cells in the ablation area will undergo degeneration and necrosis of varying degrees, with an increased number of water molecules between cells and tissues and a faster diffusion rate, which corresponds to the low signal on the diffusion image, resulting in an elevated ADC value [ 32 ]. Decreased ADC values in liver cancer patients indicated the opposite state to the abovementioned situation, that is, liver cancer is growing and developing.…”

Magnetic Resonance Cholangiopancreatography to Evaluate Improvement Effect of FXR Regulating Bile Acid on Hepatocellular Carcinoma with Obstructive Jaundice

“…e detection results of the changes of liver function in patients at di erent obstruction sites showed that after treatment, the serum ALT content of 55.7 ± 31.6 U/L, AST content of 66. Di usion is an irregular thermal movement process of water molecules, also known as Brownian motion, which can re ect the water molecule movement of human tissues and organs by measuring the ADC value, and then re ect the physiological and pathological characteristics of body tissue structure [20]. e results of MRI showed that ADC was 1.34 ± 0.32 × 10 −3 mm 2 /s in the control group, 1.24 ± 0.44 × 10 −3 mm 2 /s in patients with mild jaundice, 1.18 ± 0.67 × 10 −3 mm 2 /s in patients with moderate jaundice, and 1.02 ± 0.66 × 10 −3 mm 2 /s in patients with severe jaundice before treatment, and the di erence was statistically signi cant compared with the control group, P < 0.05; ADC was 1.17 ± 0.49 × 10 −3 mm 2 /s in patients with moderate jaundice and 1.20 ± 0.27 × 10 −3 mm 2 /s in patients with severe jaundice after treatment, and the di erence was statistically signi cant compared with that before treatment, P < 0.05. e possible mechanisms were analyzed as follows: (1) due to the increase in serum bilirubin, bile salts, and plasma endotoxin concentration, the apoptosis of hepatocytes was accelerated: the Na + -K + ATPase activity of hepatocytes was inhibited, resulting in cytotoxic edema and bile duct.…”

“…Diffusion is an irregular thermal movement process of water molecules, also known as Brownian motion, which can reflect the water molecule movement of human tissues and organs by measuring the ADC value, and then reflect the physiological and pathological characteristics of body tissue structure [ 20 ]. The results of MRI showed that ADC was 1.34 ± 0.32 × 10 −3 mm 2 /s in the control group, 1.24 ± 0.44 × 10 −3 mm 2 /s in patients with mild jaundice, 1.18 ± 0.67 × 10 −3 mm 2 /s in patients with moderate jaundice, and 1.02 ± 0.66 × 10 −3 mm 2 /s in patients with severe jaundice before treatment, and the difference was statistically significant compared with the control group, P < 0.05; ADC was 1.17 ± 0.49 × 10 −3 mm 2 /s in patients with moderate jaundice and 1.20 ± 0.27 × 10 −3 mm 2 /s in patients with severe jaundice after treatment, and the difference was statistically significant compared with that before treatment, P < 0.05.…”

Clinical translation of quantitative magnetic resonance imaging biomarkers – An overview and gap analysis of current practice

“…Box 1 describes the array of validation work that has been amassed by the DWI community to support this translation into clinical practice. However, decades of academic DWI studies show there is also potential for application-specific ADC thresholds to be defined [73][74][75] and for microstructural and membrane permeability measurements to be extracted via model fitting [76][77][78][79].…”