Lesion discrimination with breath-hold hepatic diffusion-weighted imaging: A meta-analysis

Chen, Zhiguang; Zhang, Siwei; Huang, Yan; Pan, Ruihuan

doi:10.3748/wjg.v21.i5.1621

Cited by 20 publications

(25 citation statements)

References 28 publications

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“…Previous papers highlighted a significant overlap between the ADC value of benign solid FLLs (such as FNH and HCA) and malignant FLLs [26,27]. Our series shows a slight difference between the mean ADC values for NFHs (1036), not significantly higher than the mean ADC value for malignant FLLs (953).…”

Section: Inter-observer Variabilitycontrasting

confidence: 49%

“…3). The signal intensity of hemangiomas on the ADC map is slightly lower than the signal of biliary cysts [25,26].…”

Section: Inter-observer Variabilitymentioning

confidence: 84%

“…The result needs to be proved by further studies, but additional research is difficult due to the fact that HCAs are rare lesions and obtaining statistically relevant series will be difficult. The meta-analysis by Chen et al [26] reports no significant differences between ADC values of FNHs and adenomas. There is a possibility that the variations of the ADC values and of the DWI b-800 aspects of liver HCAs are due to different histological subtypes.…”

Section: Inter-observer Variabilitymentioning

confidence: 94%

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Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Caraiani

Chiorean

Fenesan

et al. 2015

JGLD

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Background & Aims: To assess the role of diffusion weighted imaging sequence (DWI), routinely used in hepatic magnetic resonance imaging (MRI) for the differentiation of focal liver lesions (FLLs) as benign or malignant. Method: 99 FLLs assessed by liver MRI in 80 patients were included in the present study. All lesions were retrospectively analyzed by two experienced radiologists, independent from each other, who were not aware of the previous results obtained by using different imaging techniques. All included FLLs had a final histological diagnosis or a final diagnosis based on consensus reading by two experienced radiologists and follow-up at 6 months. The FLLs signal was qualitatively appreciated on the b-800 sequences and on the apparent diffusion coefficient (ADC) map. The ADC value of each FLL was measured and the ADC ratio between the ADC value of the assessed FLL and that of the surrounding liver parenchyma were calculated. Results: The mean ADC value for benign FLLs as assessed by the two independent readers was 1.78 x 10¯³ and 1.72 x 10¯³, respectively. The mean ADC value for malignant FLLs was 0.92 x 10¯³ for the first reader and 0.95 x 10¯³ for the second reader. The mean ADC ratio for benign FLLs was 1.91 and 1.85 for the two readers and for malignant FLLs was 0.91 and 0.94, respectively. Using an ADC value lower than 1.024 x 10¯³ offers a specificity of 100% and a sensitivity of 62.5% for the diagnosis of malignant FLLs. The ADC value is an indicator which is less prone to interobserver variability (correlation of 0.919→1). The ADC ratio has, as the analysis of the ROC curve shows, the best predictive value for differentiation between benign and malignant FLLs. Analysis of the signal intensity on the DWI b-800 image alone is of no significance in differentiating benign from malignant FLLs (p>0.05). Conclusions: The ADC value and the ADC ratio assessed on liver DWI are useful diagnostic tools in the differential diagnosis of benign vs. malignant FLLs. Quantitative methods such as calculating the ADC value or ADC ratio have better diagnostic value than the qualitative techniques.

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Section: Inter-observer Variabilitycontrasting

confidence: 49%

“…3). The signal intensity of hemangiomas on the ADC map is slightly lower than the signal of biliary cysts [25,26].…”

Section: Inter-observer Variabilitymentioning

confidence: 84%

Section: Inter-observer Variabilitymentioning

confidence: 94%

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Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Caraiani

Chiorean

Fenesan

et al. 2015

JGLD

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“…There has been promising evidence that ADC may be a viable tool to help discriminate benign versus malignant character of a hepatic lesion [ 1 , 6 , [8] , [9] , [10] , [11] , [12] , [13] ]. However, there have been conflicting reports in literature regarding the usefulness of DWI in this regard.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of ADCratio on liver MRI diffusion to discriminate benign versus malignant solid liver lesions

Jain

Kan

Edward

et al. 2018

European Journal of Radiology Open

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Purpose: The aim of this project is to investigate the usefulness of the absolute liver lesion ADC value and ratio of Apparent diffusion coefficient (ADC) values of a liver lesion and liver parenchyma to discriminate between a benign and malignant lesion.Methods: Liver MRI scans performed between January 2009 and June 2015 were retrospectively analysed. Scans were performed on either a 1.5 T or 3 T MRI unit. The type of liver lesion (benign or malignant) was determined by its radiological appearance, histology result and clinical management. Lesions with undetermined diagnosis or MRI studies degraded by artifacts were excluded. Liver cysts were also excluded from the analysis. ADC value of a lesion and liver parenchyma was measured and ADCratio was calculated. The values were analysed using independent samples t-testResults:Data set contained 39 benign lesions and 36 malignant lesions. Mean ADC value for benign lesions was 1678, and the mean value for malignant lesions was 1097 with a statistically significant difference of p < 0.001. All lesions with ADC value below 955 were malignant, while all lesions with ADC value above 1880 were benign. ADC value of 1260 was identified as the best available cut-off value for differentiating benign and malignant lesions, achieving sensitivity of 92%, specificity of 80% and an overall accuracy of 89%. The mean lesion to liver ADCratio for benign lesions was 1.3467 and for malignant lesions was 0.9038 with a statistically significant difference of p < 0.001. All lesions with ADCratio measuring <0.9 were malignant while lesions with ADCratio>1.5 were benign. ADCratio of 1.1 was identified statistically as the best available cut-off value for differentiating benign from malignant lesions, with sensitivity of 82%, specificity of 86% and an overall accuracy of 92%.Conclusion:Our dataset indicates that lesion to background liver ADCratio is superior in discriminating between benign and malignant focal lesions compared to absolute ADC values of the hepatic lesions.

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“…In contrast, two earlier meta-analyses showed that DWI had high sensitivity (81% and 93%) for detecting HCCs[13,36]. We speculate that the reasons for the difference in the rate of sensitivity between our results and those of the two prior meta-analyses might be related to patient selection bias, the background of liver parenchyma in patients with chronic liver disease (cirrhotic or not), and/or the tumor characteristics ( e.g ., tumor size and malignant grade)[13,36]. …”

Section: Discussionmentioning

confidence: 89%

Image quality and diagnostic performance of free-breathing diffusion-weighted imaging for hepatocellular carcinoma

Takayama

Nishie

Asayama

et al. 2017

WJH

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AIMTo retrospectively evaluate the diagnostic performance of free-breathing diffusion-weighted imaging (FB-DWI) with modified imaging parameter settings for detecting hepatocellular carcinomas (HCCs).METHODSFifty-one patients at risk for HCC were scanned with both FB-DWI and respiratory-triggered DWI with the navigator echo respiratory-triggering technique (RT-DWI). Qualitatively, the sharpness of the liver contour, the image noise and the chemical shift artifacts on each DWI with b-values of 1000 s/mm2 were independently evaluated by three radiologists using 4-point scoring. We compared the image quality scores of each observer between the two DWI methods, using the Wilcoxon signed-rank test. Quantitatively, we compared the signal-to-noise ratios (SNRs) of the liver parenchyma and lesion-to-nonlesion contrast-to-noise ratios (CNRs) after measuring the signal intensity on each DWI with a b-factor of 1000 s/mm2. The average SNRs and CNRs between the two DWI methods were compared by the paired t-test. The detectability of HCC on each DWI was also analyzed by three radiologists. The detectability provided by the two DWI methods was compared using McNemar’s test.RESULTSFor all observers, the averaged image quality scores of FB-DWI were: Sharpness of the liver contour [observer (Obs)-1, 3.08 ± 0.81; Obs-2, 2.98 ± 0.73; Obs-3, 3.54 ± 0.75], those of the distortion (Obs-1, 2.94 ± 0.50; Obs-2, 2.71 ± 0.70; Obs-3, 3.27 ± 0.53), and the chemical shift artifacts (Obs-1, 3.38 ± 0.60; Obs-2, 3.15 ± 1.07; Obs-3, 3.21 ± 0.85). The averaged image quality scores of RT-DWI were: Sharpness of the liver contour (Obs-1, 2.33 ± 0.65; Obs-2, 2.37 ± 0.74; Obs-3, 2.75 ± 0.81), distortion (Obs-1, 2.81 ± 0.56; Obs-2, 2.25 ± 0.74; Obs-3, 2.96 ± 0.71), and the chemical shift artifacts (Obs-1, 2.92 ± 0.59; Obs-2, 2.21 ± 0.85; Obs-3, 2.77 ± 1.08). All image quality scores of FB-DWI were significantly higher than those of RT-DWI (P < 0.05). The average SNR of the normal liver parenchyma by FB-DWI (11.0 ± 4.8) was not significantly different from that shown by RT-DWI (11.0 ± 5.0); nor were the lesion-to-nonlesion CNRs significantly different (FB-DWI, 21.4 ± 17.7; RT-DWI, 20.1 ± 15.1). For all three observers, the detectability of FB-DWI (Obs-1, 43.6%; Obs-2, 53.6%; and Obs-3, 45.0%) was significantly higher than that of RT-DWI (Obs-1, 29.1%; Obs-2, 43.6%; and Obs-3, 34.5%) (P < 0.05).CONCLUSIONFB-DWI showed better image quality and higher detectability of HCC compared to RT-DWI, without significantly reducing the SNRs of the liver parenchyma and lesion-to-nonlesion CNRs.

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Lesion discrimination with breath-hold hepatic diffusion-weighted imaging: A meta-analysis

Abstract: Breath-hold DWI is useful for differentiating between malignant and benign hepatic lesions. The diffusion characteristics of benign lesions that mimic malignant ones have rarely been investigated.

Cited by 20 publications

References 28 publications

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Evaluation of ADCratio on liver MRI diffusion to discriminate benign versus malignant solid liver lesions

Image quality and diagnostic performance of free-breathing diffusion-weighted imaging for hepatocellular carcinoma

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