Differentiation Between Hepatic Hemangioma and Metastasis by Diffusion Weighted MRI

Abstract

Background: Diagnosis of hepatic focal lesions could be done by magnetic resonance imaging (MRI) study especially when diffusion-weighted magnetic resonance imaging (DWI) is included in the imaging protocol with apparent diffusion coefficient (ADC) quantification. Several studies have demonstrated that combining DWI with ADC measurement plays an important role in the detection and characterization of hepatic focal lesions and differentiating hemangioma from hepatic deposits. Objective: The current study aimed at evaluation of the role of diffusion weighted imaging differentiating between hepatic hemangioma and metastasis (1-4 lesions in number) by diffusion weighted MRI in patient pathologically proved to have primary malignancy. Patient and methods: Fifty cases were included; patients referred to Radiology Department of Mansoura University Hospital. There were 33 females and 17 male patients with age ranged from 26 to 82 years. All patients were subjected to proper history taking and DWI MRI. This study was using a 1.5 T Philips Ingenia MRI scanner. Results: ADC had significantly lower values in patients with metastatic hepatic lesions with mean ADC 0.93 (SD 0.21) x10 -3 mm 2 /sec. ADC had significantly higher values in patients with hemangioma with mean ADC 1.96 (SD 0.31) x10 -3 mm 2 /sec. The mean ADC value in the metastatic group was statistically significantly lower compared to the hemangioma group. ADC had sensitivity and specificity of 100 % and 95.8% respectively, and an accuracy of 97.4% in differentiating between hemangioma and metastasis cases, when a cut-off value of 1.55 x 10-3mm2/s was applied. Conclusion: Combined qualitative and quantitative analysis of DWI and ADC values respectively can help in differentiation between hepatic hemangioma and metastatic deposits. Using DWI and ADC in conjunction with conventional imaging found to be a simple and non-invasive tool that aid in differentiation between hepatic hemangioma and metastatic deposits.