Diagnostic accuracy of quantitative diffusion parameters in the pathological grading of hepatocellular carcinoma: A meta‐analysis

She, Hualong; Wang, Xiaopei; Yang, Zhenghan; Wang, Zhenchang

doi:10.1002/jmri.26963

“…IVIM imaging can reflect the characteristics of lesions in terms of cell density, microcirculation perfusion, and tissue complexity (18). As reported previously, a decrease in both ADC and D values may be attributed to the increased cellular density, nuclear-tocytoplasmic ratios, and architectural complications in highergrade HCC (27). In line with our findings, Zhu et al reported a downward shift of D and ADC values from low-to high-grade HCC (8).…”

Section: Discussionsupporting

confidence: 90%

Comparative Study of Amide Proton Transfer Imaging and Intravoxel Incoherent Motion Imaging for Predicting Histologic Grade of Hepatocellular Carcinoma

Wu

¹

,

Jia

²

,

Li

³

et al. 2020

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Background: Preoperative grading of hepatocellular carcinoma (HCC) is an important factor associated with prognosis after liver resection. The promising prediction of the differentiation of HCC remains a challenge. The purpose of our study was to investigate the value of amide proton transfer (APT) imaging in predicting the histological grade of HCC, compared with the intravoxel incoherent motion (IVIM) imaging.Methods: From September 2018 to February 2020, 88 patients with HCC were enrolled and divided into four groups (G1, G2, G3, and G4) based on the histologic grades. Preoperative APT signal intensity (SI), apparent diffusion coefficient (ADC), true molecular diffusion coefficient (D), pseudo-diffusion coefficient (D * ), and perfusion fraction (f) of HCC were independently measured by two radiologists. The averaged values of those parameters were compared using an analysis of variance. The Spearman rank analysis was used to compare the correlation between those imaging parameters and the histological grades. Receiver operating characteristic (ROC) curve analysis was used to explore the predictive performance.Results: There were significant differences in APT SI, ADC, D, and f among the four grades of HCC (all P < 0.001). A moderate to good relationship was found between APT SI and the histologic grade of HCC (r = 0.679, P < 0.001). APT SI had an area under the ROC curve (AUC) of 0.890 (95% CI: 0.805-0.947) for differentiating low-from high-grade HCC, and the corresponding sensitivity and specificity were 85.71% and 82.05%, respectively. Comparison of ROC curves demonstrated that the AUC of APT SI was significantly higher than those of IVIM-derived parameter (Z = 2.603, P = 0.0092; Z = 2.099, P = 0.0358; Z = 4.023, P = 0.0001; Z = 2.435, P = 0.0149, compared with ADC, D, D * , and f, respectively). Moreover, the combination of both techniques further improved the diagnostic performance, with an AUC of 0.929 (95% CI: 0.854-0.973). Conclusion:APT imaging may be a potential noninvasive biomarker for the prediction of histologic grading of HCC and complements IVIM imaging for the more accurate and comprehensive characterization of HCC.

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“…Furthermore, a meta-analysis of the use of DWI and IVIM in HCC grading showed the usefulness of D and ADC, but not IVIM parameters [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Perfusion-Diffusion Ratio: A New IVIM Approach in Differentiating Solid Benign and Malignant Primary Lesions of the Liver

Podgórska

¹

,

Pasicz

²

,

Skrzyński

³

et al. 2022

BioMed Research International

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Introduction. In order to improve the efficacy of intravoxel incoherent motion (IVIM) parameters in characterising specific tissues, a new concept is introduced: the perfusion–diffusion ratio (PDR), which expresses the relationship between the signal S b decline rate as a result of IVIM and the rate of signal S b decline due to diffusion. The aim of this study was to investigate this novel approach in the differentiation of solid primary liver lesions. Material and Methods. Eighty-three patients referred for liver MRI between August 2017 and January 2020 with a suspected liver tumour were prospectively examined with the standard liver MRI protocol extended by DWI-IVIM sequence. Patients with no liver lesions, haemangiomas, or metastases were excluded. The final study population consisted of 34 patients with primary solid liver masses, 9 with FNH, 4 with regenerative nodules, 10 with HCC, and 11 with CCC. The PDR coefficient was introduced, defined as the ratio of the rate of signal S b decrease due to the IVIM effect to the rate of signal S b decrease due to the diffusion process, for b = 0 . Results. No significant differences were found between benign and malignant lesions in the case of IVIM parameters ( f , D , or D ∗ ) and ADC. Significant differences were observed only for PDR, with lower values for malignant lesions ( p = 0.03 ). The ROC analysis yielded an AUC value for PDR equal to 0.74, with a cut-off value of 5.06, sensitivity of 81%, specificity of 77%, and accuracy of 79%. Conclusion. PDR proved to be more effective than IVIM parameters and ADC in the differentiation of solid benign and malignant primary liver lesions.

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“…In 2020, a meta-analysis ( 52 ) summarized the diagnostic efficacy of ADC value (six studies, 693 HCCs) for well-differentiated HCC, and D (four studies, 304 HCCs) was better than ADC value (13 studies, 1,239 HCCs) in differentiating poorly differentiated HCC (Z = −2.718, P = 0.007). However, some studies ( 15 , 25 , 31 , 33 – 35 , 38 , 40 , 42 , 49 – 51 ) were not included in that meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

The Roles of Diffusion Kurtosis Imaging and Intravoxel Incoherent Motion Diffusion-Weighted Imaging Parameters in Preoperative Evaluation of Pathological Grades and Microvascular Invasion in Hepatocellular Carcinoma

Wang

¹

,

Yan²,

Wang

³

et al. 2022

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BackgroundCurrently, there are disputes about the parameters of diffusion kurtosis imaging (DKI), intravoxel incoherent motion (IVIM), and diffusion-weighted imaging (DWI) in predicting pathological grades and microvascular invasion (MVI) in hepatocellular carcinoma (HCC). The aim of our study was to investigate and compare the predictive power of DKI and IVIM-DWI parameters for preoperative evaluation of pathological grades and MVI in HCC.MethodsPubMed, Web of Science, and Embase databases were searched for relevant studies published from inception to October 2021. Review Manager 5.3 was used to summarize standardized mean differences (SMDs) of mean kurtosis (MK), mean diffusivity (MD), tissue diffusivity (D), pseudo diffusivity (D*), perfusion fraction (f), mean apparent diffusion coefficient (ADCmean), and minimum apparent diffusion coefficient (ADCmin). Stata12.0 was used to pool the sensitivity, specificity, and area under the curve (AUC). Overall, 42 up-to-standard studies with 3,807 cases of HCC were included in the meta-analysis.ResultsThe SMDs of ADCmean, ADCmin, and D values, but not those of D* and f values, significantly differed between well, moderately, and poorly differentiated HCC (P < 0.01). The sensitivity, specificity, and AUC of the MK, D, ADCmean, and ADCmin for preoperative prediction of poorly differentiated HCC were 69%/94%/0.89, 87%/80%/0.89, 82%/75%/0.86, and 83%/64%/0.81, respectively. In addition, the sensitivity, specificity, and AUC of the D and ADCmean for preoperative prediction of well-differentiated HCC were 87%/83%/0.92 and 82%/88%/0.90, respectively. The SMDs of ADCmean, ADCmin, D, MD, and MK values, but not f values, showed significant differences (P < 0.01) between MVI-positive (MVI+) and MVI-negative (MVI-) HCC. The sensitivity and specificity of D and ADCmean for preoperative prediction of MVI+ were 80%/80% and 74%/71%, respectively; the AUC of the D (0.87) was significantly higher than that of ADCmean (0.78) (Z = −2.208, P = 0.027). Sensitivity analysis showed that the results of the above parameters were stable and reliable, and subgroup analysis confirmed a good prediction effect.ConclusionDKI parameters (MD and MK) and IVIM-DWI parameters (D value, ADCmean, and ADCmin) can be used as a noninvasive and simple preoperative examination method to predict the grade and MVI in HCC. Compared with ADCmean and ADCmin, MD and D values have higher diagnostic efficacy in predicting the grades of HCC, and D value has superior diagnostic efficacy to ADCmean in predicting MVI+ in HCC. However, f value cannot predict the grade or MVI in HCC.

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Diagnostic accuracy of quantitative diffusion parameters in the pathological grading of hepatocellular carcinoma: A meta‐analysis

Cited by 18 publications

References 39 publications

Comparative Study of Amide Proton Transfer Imaging and Intravoxel Incoherent Motion Imaging for Predicting Histologic Grade of Hepatocellular Carcinoma

Comparative Study of Amide Proton Transfer Imaging and Intravoxel Incoherent Motion Imaging for Predicting Histologic Grade of Hepatocellular Carcinoma

Perfusion-Diffusion Ratio: A New IVIM Approach in Differentiating Solid Benign and Malignant Primary Lesions of the Liver

The Roles of Diffusion Kurtosis Imaging and Intravoxel Incoherent Motion Diffusion-Weighted Imaging Parameters in Preoperative Evaluation of Pathological Grades and Microvascular Invasion in Hepatocellular Carcinoma

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