Hepatic Cavernous Hemangiomas: Relationship between Speed of Intratumoral Enhancement during Dynamic MRI and Apparent Diffusion Coefficient on Diffusion-Weighted Imaging

Abstract

ObjectiveTo investigate the relationships between the apparent diffusion coefficients (ADCs) on diffusion-weighted imaging (DWI) and the speed of contrast-enhancement in hepatic hemangiomas.Materials and MethodsSixty-nine hepatic hemangiomas (≥ 1 cm) were evaluated with DWI, by using multiple b values (b = 50, 400, 800 s/mm2), followed by a gadolinium-enhanced dynamic MRI. The lesions were classified into three groups, according to the speed of contrast-enhancement on the portal phase. ADCs were measured on the ADC map automatically, and were calculated by using the two different b values (mADC50-400 with b values = 50 and 400; mADC400-800 with b values = 400 and 800 s/mm2).ResultsThe mean ADCs (× 10-3 mm2/s) were significantly higher in the rapid group (1.9 ± 0.44) than in the intermediate (1.7 ± 0.35, p = 0.046) or the slow groups (1.4 ± 0.34, p = 0.002). There were significant differences between the rapid and the slow groups in mADC50-400 (2.12 vs. 1.48; p = 0.008) and mADC400-800 (1.68 vs. 1.22, p = 0.010), and between the rapid and the intermediate groups in mADC50-400 (2.12 vs. 1.79, p = 0.049). Comparing mADC50-400 with mADC400-800, there was a significant difference only in the rapid group (p = 0.001).ConclusionHigher ADCs of rapidly-enhancing hemangiomas may be related to richer intralesional vascular perfusion. Also, the restricted diffusion may be attributed to the difference of structural characteristics of hemangioma.

Intrahepatic cholangiocarcinomas mimicking other lesions

“…Although considerable overlap exists between benign lesions and malignant tumors, and DWI cannot differentiate between different malignant tumors [33][34][35][36], restricted diffusion seen in an indeterminate lesion may strengthen the suspicion of a possible malignancy and help exclude perfusional anomalies, as was the case in our cohort, and may alert the radiologist of a need for continued followup of the lesions or for recommending biopsy. When the target sign is present on DWI, the diagnosis of cholangiocarcinoma should be entertained even if other findings are indeterminate [19].…”

Correlation of the Speed of Enhancement of Hepatic Hemangiomas with Intravoxel Incoherent Motion MR Imaging

“…The mean age of the 39 selected patients was 50 years (range: 26-75 years). The diagnosis of hemangiomas was established with the classical contrast enhancement pattern seen on MR and/or CT with no change in the size of the lesions for six months or more on serial CT (11). The longest diameter of the hepatic hemangiomas was measured by one radiologist (D. M.…”

“…The enhancement pattern of hemangiomas may affect the ADC values, since these values can depend on blood flow, perfusion, and/or diffusion within the hemangiomas (8)(9)(10). However, there are only a few studies examining the relationship between ADC values and the type or speed of enhancement of hepatic hemangiomas (8,11).…”

RE: Evaluation of Hepatic Hemangiomas with Diffusion Weighted Imaging

“…We are pleased to read the interesting article by Nam et al (1) published in the November/December issue of the 2012 Korean Journal of Radiology. The authors examined the correlation between the apparent diffusion coefficient (ADC) value of hepatic cavernous hemangiomas with enhancement patterns.…”