Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Magnetic Resonance Materials in Physics, Biology and Medicine
Published in: Magnetic Resonance Materials in Physics, Biology and Medicine 3/2013

01-06-2013 | Research Article

Diffusion-weighted imaging of the liver: usefulness of ADC values in the differential diagnosis of focal lesions and effect of ROI methods on ADC measurements

Authors: João Pedro Filipe, Luís Curvo-Semedo, João Casalta-Lopes, Maria Cristina Marques, Filipe Caseiro-Alves

Published in: Magnetic Resonance Materials in Physics, Biology and Medicine | Issue 3/2013

Login to get access

Abstract

Object

By measuring the apparent diffusion coefficient (ADC) of liver parenchyma and focal hepatic lesions (FHL) we proposed to investigate the utility of ADC in the differential diagnosis of hepatic disease and to determine the influence of region of interest (ROI) characteristics in those measurements.

Materials and methods

Ninety-three patients with at least one supracentimetric FHL, or parenchymal abnormality, were retrospectively evaluated. Diagnosis was based on histopathologic data or, alternatively, on a combination of consensus between imaging methods and 24 months of follow-up. Ninety lesions were evaluated with respiratory-triggered diffusion-weighted imaging (b values: 50 and 700 s/mm2): 14 hepatocellular carcinomas, 18 metastases, 10 focal nodular hyperplasias, four adenomas, 30 hemangiomas and 14 cysts. ADC of hepatic parenchyma was measured by placing ROIs in four different segments, and in FHLs by using three circular 1 cm2 ROIs and one ROI encompassing the full lesion. Data was statistically analyzed (p < 0.05 considered significant), and a receiver operating characteristic curve was assessed to evaluate the accuracy for the diagnosis of malignancy.

Results

Our measurements showed that parenchyma ADC was significantly higher in segment II and that ADCs of malignant lesions were significantly lower than those of benign lesions (p < 0.001). There was significant overlap between benign solid lesions and malignant lesions and the area under the curve for malignancy was 0.939 (sensitivity 89.7 %, specificity 90.6 %), using a cutoff of 1.43 × 10−3 mm2/s. No significant difference was found between ROIs of different characteristics.

Conclusion

ADC measurements can help to characterize FHLs and differentiate normal from pathological parenchyma. Any ROI above 1 cm2 can provide accurate ADC measurements in homogenous lesions.
Literature
1.
Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M (1986) MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 161(2):401–407PubMed
2.
Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168(2):497–505PubMed
3.
Le Bihan D, Johansen-Berg H (2012) Diffusion MRI at 25: exploring brain tissue structure and function. Neuroimage 61(2):324–341PubMedCrossRef
4.
5.
Kele PG, van der Jagt EJ (2010) Diffusion weighted imaging in the liver. World J Gastroenterol 16(13):1567–1576PubMedCrossRef
6.
Qayyum A (2009) Diffusion-weighted imaging in the abdomen and pelvis: concepts and applications. Radiographics 29(6):1797–1810PubMedCrossRef
7.
Stejskal EO, Tanner JE (1965) Spin diffusion measurements: spin echoes in the presence of a time-dependent field gradient. J Chem Phys 42(1):288CrossRef
8.
Thoeny HC, De Keyzer F (2007) Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol 17(6):1385–1393PubMedCrossRef
9.
Müller MF, Prasad P, Siewert B, Nissenbaum MA, Raptopoulos V, Edelman RR (1994) Abdominal diffusion mapping with use of a whole-body echo-planar system. Radiology 190(2):475–478PubMed
10.
Demir OI, Obuz F, Sağol O, Dicle O (2007) Contribution of diffusion-weighted MRI to the differential diagnosis of hepatic masses. Diagn Interv Radiol 13(2):81–86PubMed
11.
Koh D-M, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188(6):1622–1635PubMedCrossRef
12.
Taouli B, Vilgrain V, Dumont E, Daire J-L, Fan B, Menu Y (2003) 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 226(1):71–78PubMedCrossRef
13.
Goshima S, Kanematsu M, Kondo H, Yokoyama R, Kajita K, Tsuge Y et al (2008) Diffusion-weighted imaging of the liver: optimizing b value for the detection and characterization of benign and malignant hepatic lesions. J Magn Reson Imaging 28(3):691–697PubMedCrossRef
14.
Koh D-M, Takahara T, Imai Y, Collins DJ (2007) Practical aspects of assessing tumors using clinical diffusion-weighted imaging in the body. Magn Reson Med Sci 6(4):211–224PubMedCrossRef
15.
Taouli B, Sandberg A, Stemmer A, Parikh T, Wong S, Xu J et al (2009) Diffusion-weighted imaging of the liver: comparison of navigator triggered and breathhold. Acquisitions 30(3):561–568
16.
Kandpal H, Sharma R, Madhusudhan KS, Kapoor KS (2009) Respiratory-triggered versus breath-hold diffusion-weighted MRI of liver lesions: comparison of image quality and apparent diffusion coefficient values. AJR Am J Roentgenol 192(4):915–922PubMedCrossRef
17.
Parikh T, Drew SJ, Lee VS, Wong S, Hecht EM, Babb JS et al (2008) Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246(3):812–822PubMedCrossRef
18.
Nasu K, Kuroki Y, Fujii H, Minami M (2007) Hepatic pseudo-anisotropy: a specific artifact in hepatic diffusion-weighted images obtained with respiratory triggering. Magn Reson Mater Phy 20(4):205–211CrossRef
19.
Kwee TC, Takahara T, Niwa T, Ivancevic MK, Herigault G, Van Cauteren M et al (2009) Influence of cardiac motion on diffusion-weighted magnetic resonance imaging of the liver. Magn Reson Mater Phy 22(5):319–325CrossRef
20.
Stone AJ, Browne JE, Lennon B, Meaney JF, Fagan AJ (2012) Effect of motion on the ADC quantification accuracy of whole-body DWIBS. Magn Reson Mater Phy 25(4):263–266CrossRef
21.
Kim T, Murakami T, Takahashi S, Hori M, Tsuda K, Nakamura H (1999) Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR Am J Roentgenol 173(2):393–398PubMedCrossRef
22.
Bruegel M, Holzapfel K, Gaa J, Woertler K, Waldt S, Kiefer B et al (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18(3):477–485PubMedCrossRef
23.
Nasu K, Kuroki Y, Nawano S, Kuroki S, Tsukamoto T, Yamamoto S et al (2006) Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology 239(1):122–130PubMedCrossRef
24.
Coenegrachts K, Delanote J, Ter Beek L, Haspeslagh M, Bipat S, Stoker J et al (2007) Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques. Br J Radiol 80(955):524–531PubMedCrossRef
25.
Gourtsoyianni S, Papanikolaou N, Yarmenitis S, Maris T, Karantanas A, Gourtsoyiannis N (2008) Respiratory gated diffusion-weighted imaging of the liver: value of apparent diffusion coefficient measurements in the differentiation between most commonly encountered benign and malignant focal liver lesions. Eur Radiol 18(3):486–492PubMedCrossRef
26.
Holzapfel K, Bruegel M, Eiber M, Ganter C, Schuster T, Heinrich P et al (2010) Characterization of small (≤10 mm) focal liver lesions: value of respiratory-triggered echo-planar diffusion-weighted MR imaging. Eur J Radiol 76(1):89–95PubMedCrossRef
27.
Park MS, Kim S, Patel J, Hajdu CH, G Do RK, Mannelli L et al (2012) Hepatocellular carcinoma: detection with diffusion-weighted versus contrast-enhanced magnetic resonance imaging in pretransplant patients. Hepatology 56(1):140–148
28.
Taouli B, Tolia AJ, Losada M, Babb JS, Chan ES, Bannan MA et al (2007) Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience. AJR Am J Roentgenol 189(4):799–806PubMedCrossRef
29.
Lewin M, Poujol-Robert A, Boëlle P-Y, Wendum D, Lasnier E, Viallon M et al (2007) Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology 46(3):658–665PubMedCrossRef
30.
Girometti R, Furlan A, Esposito G, Bazzocchi M, Como G, Soldano F et al (2008) Relevance of b-values in evaluating liver fibrosis: a study in healthy and cirrhotic subjects using two single-shot spin-echo echo-planar diffusion-weighted sequences. J Magn Reson Imaging 28(2):411–419PubMedCrossRef
31.
Feuerlein S, Pauls S, Juchems MS, Stuber T, Hoffmann MHK, Brambs H-J et al (2009) Pitfalls in abdominal diffusion-weighted imaging: how predictive is restricted water diffusion for malignancy? AJR Am J Roentgenol 193(4):1070–1076PubMedCrossRef
32.
Cui Y, Zhang X-P, Sun Y-S, Tang L, Shen L (2008) Apparent diffusion coefficient: potential imaging biomarker for prediction and early detection of response to chemotherapy in hepatic metastases. Radiology 248(3):894–900PubMedCrossRef
33.
Goshima S, Kanematsu M, Kondo H, Yokoyama R, Tsuge Y, Shiratori Y et al (2008) Evaluating local hepatocellular carcinoma recurrence post-transcatheter arterial chemoembolization: is diffusion-weighted MRI reliable as an indicator? J Magn Reson Imaging 27(4):834–839PubMedCrossRef
34.
Kamel IR, Bluemke DA, Eng J, Liapi E, Messersmith W, Reyes DK et al (2006) The role of functional MR imaging in the assessment of tumor response after chemoembolization in patients with hepatocellular carcinoma. J Vasc Interv Radiol 17(3):505–512PubMedCrossRef
35.
Mannelli L, Kim S, Hajdu CH, Babb JS, Clark TWI, Taouli B (2009) Assessment of tumor necrosis of hepatocellular carcinoma after chemoembolization: diffusion-weighted and contrast-enhanced MRI with histopathologic correlation of the explanted liver. AJR Am J Roentgenol 193(4):1044–1052PubMedCrossRef
36.
Mürtz P, Flacke S, Träber F, van den Brink JS, Gieseke J, Schild HH (2002) Abdomen: diffusion-weighted MR imaging with pulse-triggered single-shot sequences. Radiology 224(1):258–264PubMedCrossRef
37.
Chung S, Breton E, Mannelli L, Axel L (2011) Liver stiffness assessment by tagged MRI of cardiac-induced liver motion. Magn Reson Med 65(4):949–955PubMedCrossRef
38.
Kwee TC, Takahara T, Koh D-M, Nievelstein RAJ, Luijten PR (2008) Comparison and reproducibility of ADC measurements in breathhold, respiratory triggered, and free-breathing diffusion-weighted MR imaging of the liver. J Magn Reson Imaging 28(5):1141–1148PubMedCrossRef
39.
Zech CJ, Reiser MF, Herrmann KA (2009) Imaging of hepatocellular carcinoma by computed tomography and magnetic resonance imaging: state of the art. Dig Dis 27(2):114–124PubMedCrossRef
40.
Koh DM, Scurr E, Collins DJ, Pirgon A, Kanber B, Karanjia N et al (2006) Colorectal hepatic metastases: quantitative measurements using single-shot echo-planar diffusion-weighted MR imaging. Eur Radiol 16(9):1898–1905PubMedCrossRef
41.
Vilgrain V, Boulos L, Vullierme MP, Denys A, Terris B, Menu Y (2000) Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics 20(2):379–397PubMed
42.
Dietrich O, Heiland S, Sartor K (2001) Noise correction for the exact determination of apparent diffusion coefficients at low SNR. Magn Reson Med 45(3):448–453PubMedCrossRef
43.
Goh V, Halligan S, Gharpuray A, Wellsted D, Sundin J, Bartram CI (2008) Quantitative assessment of colorectal cancer tumor vascular parameters by using perfusion CT: influence of tumor region of interest. Radiology 247(3):726–732PubMedCrossRef
Metadata
Title
Diffusion-weighted imaging of the liver: usefulness of ADC values in the differential diagnosis of focal lesions and effect of ROI methods on ADC measurements
Authors
João Pedro Filipe
Luís Curvo-Semedo
João Casalta-Lopes
Maria Cristina Marques
Filipe Caseiro-Alves
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Magnetic Resonance Materials in Physics, Biology and Medicine / Issue 3/2013
Print ISSN: 0968-5243
Electronic ISSN: 1352-8661
DOI
https://doi.org/10.1007/s10334-012-0348-1

Other articles of this Issue 3/2013

Magnetic Resonance Materials in Physics, Biology and Medicine 3/2013 Go to the issue

Research Article

Automatic 2D registration of renal perfusion image sequences by mutual information and adaptive prediction

Research Article

ECG-triggered non-enhanced MR angiography of peripheral arteries in comparison to DSA in patients with peripheral artery occlusive disease

Research Article

k-t BLAST and SENSE accelerated time-resolved three-dimensional phase contrast MRI in an intracranial aneurysm

Research Article

Magnetic resonance imaging in patients with granulomatosis with polyangiitis (Wegener’s) and subglottic stenosis

Research Article

1H NMR analysis of choline metabolites in fine-needle-aspirate biopsies of breast cancer

Research Article

Magnetization transfer for the assessment of bowel fibrosis in patients with Crohn’s disease: initial experience