Effectiveness of ADC histogram analysis in the diagnosis of focal liver lesions; is a contrast agent necessary?
Objective: The diagnostic success of apparent diffusion coefficient (ADC) histogram analysis in focal liver lesions, and the effects of quantitative data added to contrast-enhanced abdominal magnetic resonance imaging (MRI) on the diagnostic accuracy were investigated. Materials and Methods: The conventional MRI findings of 524 lesions in total were retrospectively examined. Contrast enhancement kinetics and ADC values for each lesion were found through an image analysis software. Results: Three hundred and fifty (67%) of the lesions were diagnosed as benign and 174 (33%) as malignant. Statistically significant difference was found between the benign and malignant lesion groups in terms of the minimum, maximum and mean ADC values (p<0.001). When optimal thresholds for minimum, maximum and mean ADC were taken as 1.47x10-3mm2/s; 1.85x10-3mm2/s; 1.72x10-3mm2/s respectively, sensitivity was found to be 97%; 83%; 95%, specificity was 100%; 98%; 99%, NPV was 100%; 99%; 99%, and PPV was 93%; 74%; 90%. ADC values added to MRI increased the diagnostic success for metastases (92%→96%), HCC (63%→73%), hemangioma (90%→99%) and FNH (56%→75%). Conclusion: ADC measurement could not show reasonable success in the diagnosis of specific lesions while being successful in the differentiation of benign and malignant lesions. Minimum ADC is more successful than mean and maximum ADC. A non-contrastenhanced MRI protocol based on the ADC measurement applicable to the selected patient group may be helpful.
___
- Fowler KJ, Brown JJ, Narra VR. Magnetic resonance imaging of
focal liver lesions: approach to imaging diagnosis. Hepatology
2011; 54:2227-37. doi: 10.1002/hep.24679
- Coenegrachts K. Magnetic resonance imaging of the liver:
New imaging strategies for evaluating focal liver lesions.
World J Radiol 2009; 1:72-85. doi: 10.4329/wjr.v1.i1.72
- Gandhi SN, Brown MA, Wong JG, Aguirre DA, Sirlin CB.
MR contrast agents for liver imaging: What, When, How.
Radiographics 2006; 26:1621-36. doi: 10.1148/rg.266065014
- Juluru K, Vogel-Claussen J, Macura KJ, Kamel IR, Steever
A, Bluemke DA. MR imaging in patients at risk for
developing nephrogenic systemic fibrosis: protocols,
practices, and imaging techniques to maximize patient safety.
Radiographics 2009; 29:9-22. doi:10.1148/rg.291085072
- Semelka RC, Ramalho M, AlObaidy M, Ramalho J. Gadolinium
in Humans: A Family of Disorders. Am J Roentgenol 2016;
207: 229-233. doi: 10.2214/AJR.15.15842
- Taouli B, Koh DM. Diffusion-weighted MR Imaging of the
Liver. Radiology 2010; 254:47-66. doi: 10.1148/radiol.09090021
- Bammer R. Basic principles of diffusion weighted imaging. Eur
J Radiol 2003; 45:169-84. doi: 10.1016/s0720-048x(02)00303-0
- Kim T, Murakami T, Takahashi S, Hori M, Tsuda K, Nakamura
H. Diffusion-weighted single-shot echoplanar mr imaging for
liver disease. Am J Roentgenol 1999; 173:393-8. doi: 10.2214/
ajr.173.2.10430143
- Parsai A, Zerizer I, Roche O, Gkoutzios P, Miquel ME.
Assessment of diffusion-weighted imaging for characterizing
focal liver lesions. Clin Imaging 2015; 39:278-84. doi:
10.1016/j.clinimag.2014.09.016
- Parikh T, Drew SJ, Lee VS, et al. Focal liver lesion detection
and characterization with diffusion-weighted MR imaging:
comparison with standard breath-hold T2-weighted imaging.
Radiology 2008; 246:812-22. doi: 10.1148/radiol.246.307.0432
- Bruegel M, Holzapfel K, Gaa J, et al. Characterization of
focal liver lesions by ADC measurements using a respiratory
triggered diffusion-weighted single-shot echo-planar MR
imaging technique. Eur Radiol 2008; 18:477-85. doi: 10.1007/
s00330.007.0785-9
- Miller FH, Hammond N, Siddiqi AJ, et al. Utility of diffusionweighted
MRI in distinguishing benign and malignant hepatic
lesions. J Magn Reson Imaging 2010; 32:138-47. doi: 10.1002/
jmri.22235
- Holzapfel K, Bruegel M, Eiber M, et al. Characterization
of small (≤10 mm) focal liver lesions: value of respiratorytriggered
echo-planar diffusion-weighted MR imaging. Eur J
Radiol 2010; 76: 89-95. doi: 10.1016/j.ejrad.2009.05.014
- Hirano M, Satake H, Ishigaki S, Ikeda M, Kawai H, Naganawa
S. Diffusion-weighted imaging of breast masses: comparison
of diagnostic performance using various apparent diffusion
coefficient parameters. Am J Roentgenol 2012; 198:717-22.
doi: 10.2214/AJR.11.7093
- Kitis O, Altay H, Calli C, Yunten N, Akalin T, Yurtseven T.
Minimum apparent diffusion coefficients in the evaluation of
brain tumors. Eur J Radiol 2005; 55:393-400. doi: 10.1016/j.
ejrad.2005.02.004
- Lee EJ, Lee SK, Agid R, Bae JM, Keller A, Terbrugge K.
Preoperative grading of presumptive lowgrade astrocytomas
on MR imaging: diagnostic value of minimum apparent
diffusion coefficient. Am J Neuroradiol 2008; 29:1872-7. doi:
10.3174/ajnr.A1254
- Murakami R, Hirai T, Sugahara T, et al. Grading astrocytic
tumors by using apparent diffusion coefficient parameters:
superiority of a oneversus two-parameter pilot method.
Radiology 2009; 251:838-45. doi: 10.1148/radiol.251.308.0899
- Park HJ, Kim SH, Jang KM, Lee SJ, Park MJ, Choi D.
Differentiating hepatic abscess from malignant mimickers:
value of diffusion-weighted imaging with an emphasis on the
periphery of the lesion. J Magn Reson Imaging 2013; 38:1333-
41. doi: 10.1002/jmri.24112
- Wei C, Tan J, Xu L, et al. Differential diagnosis between
hepatic metastases and benign focal lesions using DWI with
parallel acquisition technique: a metaanalysis. Tumour Biol
2015; 36:983-90. doi: 10.1007/s13277.014.2663-9
- Lee NK, Kim S, Kim DU, et al. Diffusion-weighted magnetic
resonance imaging for non-neoplastic conditions in the
hepatobiliary and pancreatic regions: pearls and potential
pitfalls in imaging interpretation. Abdom Imaging 2015;
40:643-62. doi: 10.1007/s00261.014.0235-5
- Parsai A, Zerizer I, Roche O, Gkoutzios P, Miquel ME.
Assessment of diffusion-weighted imaging for characterizing
focal liver lesions. Clin Imaging 2015; 39:278-84. doi:
10.1016/j.clinimag.2014.09.016
- Taouli B, Vilgrain V, Dumont E, Daire JL, Fan B, Menu Y.
Evaluation of liver diffusion isotropy and characterization
of focal hepatic lesions with two single-shot echo-planar
MR imaging sequences: prospective study in 66 patients.
Radiology 2003; 226: 71-8. doi: 10.1148/radiol.226.101.1904
- Zarghampour M, Fouladi DF, Pandey A, et al. Utility of
volumetric contrast-enhanced and diffusion-weighted MRI
in differentiating between common primary hypervascular
liver tumors. J Magn Reson Imaging 2018; 48:1080-90. doi:
10.1002/jmri.26032.
- Löwenthal D1, Zeile M, Lim WY, et al. Detection and
characterisation of focal liver lesions in colorectal carcinoma
patients: comparison of diffusion-weighted and Gd-EOBDTPA
enhanced MR imaging. European Radiology 2011;
21:832-40. doi: 10.1007/s00330.010.1977-2
- Shimada K, Isoda H, Hirokawa Y, Arizono S, Shibata T,
Togashi K. Comparison of gadolinium-EOB-DTPA-enhanced
and diffusion-weighted liver MRI for detection of small
hepatic metastases. European Radiology 2010; 20:2690-8. doi:
10.1007/s00330.010.1842-3
- Colagrande S, Castellani A, Nardi C, Lorini C, Calistri L,
Filippone A. The role of diffusion-weighted imaging in
the detection of hepatic metastases from colorectalcancer:
A comparison with unenhanced and Gd-EOB-DTPA
enhanced MRI. Eur J Radiol 2016; 85:1027-34. doi: 10.1016/j.
ejrad.2016.02.011
- Kim YK, Lee YH, Kwak HS, Kim CS, Han YM.
Detection of liver metastases: gadoxetic acid-enhanced
three-dimensionalMRimaging versus ferucarbotranenhanced
MR imaging. Eur J Radiol 2010; 73:131-6. doi: 10.1016/j.
ejrad.2008.09.027
- Zech CJ, Grazioli L, Jonas E. Health-economic evaluation
of three imaging strategies in patients with suspected
colorectal liver metastases: Gd-EOB-DTPA-enhanced MRI
vs. extracellular contrast media-enhanced MRI and 3-phase
MDCT in Germany, Italy and Sweden. Eur Radiol 2009;
19:753-63. doi: 10.1007/s00330.009.1432-4
- Hardie AD, Naik M, Hecht EM, et al. Diagnosis of liver
metastases: value of diffusion-weighted MRI compared with
gadolinium-enhanced MRI. Eur Radiol 2010; 20:1431-41. doi:
10.1007/s00330.009.1695-9
- Donati OF, Fischer MA, Chuck N, Hunziker R, Weishaupt
D, Reiner CS. Accuracy and confidence of Gd-EOB-DTPA
enhanced MRI and diffusion-weighted imaging aloneand in
combination for the diagnosis of liver metastases. Eur Radiol
2013; 82:822-8. doi: 10.1016/j.ejrad.2012.12.005
- Roux M, Pigneur F, Calderaro J, et al. Differentiation of focal
nodular hyperplasia from hepatocellular adenoma: Role of the
quantitative analysis of gadobenate dimeglumine-enhanced
hepatobiliary phase MRI. J Magn Reson Imaging 2015;
42:1249-58. doi: 10.1002/jmri.24897
- Fowler KJ, Brown JJ, Narra VR. Magnetic resonance imaging of
focal liver lesions: approach to imaging diagnosis. Hepatology
2011; 54:2227-37. doi: 10.1002/hep.24679