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European Radiology
Published in: European Radiology 4/2015

01-04-2015 | Magnetic Resonance

Role of diffusion-weighted imaging, apparent diffusion coefficient and correlation with hepatobiliary phase findings in the differentiation of hepatocellular carcinoma from dysplastic nodules in cirrhotic liver

Authors: Riccardo Inchingolo, Anna Maria De Gaetano, Davide Curione, Marzia Ciresa, Luca Miele, Maurizio Pompili, Fabio Maria Vecchio, Felice Giuliante, Lorenzo Bonomo

Published in: European Radiology | Issue 4/2015

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Abstract

Objectives

To investigate the utility of diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and the correlation with hepatobiliary phase (delayed phase imaging, DPI) findings in the differentiation of cirrhotic hepatocellular nodules.

Methods

Forty-three patients with 53 pathology-proven nodules (29 hepatocellular carcinomas (HCCs), 13 high-grade (HGDNs) and 11 low-grade dysplastic nodules (LGDNs); mean size 2.17 cm, range 1–4 cm), who underwent liver MRI with DWI and DPI sequences, were retrospectively reviewed. Lesions were classified as hypointense, isointense, or hyperintense relative to the adjacent liver parenchyma. ADC of each nodule, of the surrounding parenchyma, and lesion-to-liver ratio were calculated.

Results

Hyperintensity versus iso/hypointensity on DWI, hypointensity versus iso/hyperintensity on DPI, and the mean lesion-to-liver ratio showed a statistically significant difference both between HCCs versus DNs and between “HCCs + HGDNs” versus LGDNs (p < 0.05); sensitivity, specificity, and accuracy for the diagnosis of “HCCs + HGDNs” were 96.8 %, 100 %, 97.4 % respectively when combining hyperintensity on DWI and hypointensity on DPI, and 90.9 %, 81.0 %, 83.6 % respectively when lesion-to-liver ratio was <0.95.

Conclusions

Hyperintensity on DWI, especially in association with hypointensity on DPI, and low lesion-to-liver ratios should raise the suspicion of HCC, or at least of HGDN, thus helping the characterization of atypically enhancing lesions.

Key points

• Usefulness of DWI and ADC is shown in differential diagnosis of cirrhotic nodules.
• Correlation of DWI with DPI improves differential diagnosis of cirrhotic nodules.
• Characterization of atypically enhancing lesions becomes more confident.
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Metadata
Title
Role of diffusion-weighted imaging, apparent diffusion coefficient and correlation with hepatobiliary phase findings in the differentiation of hepatocellular carcinoma from dysplastic nodules in cirrhotic liver
Authors
Riccardo Inchingolo
Anna Maria De Gaetano
Davide Curione
Marzia Ciresa
Luca Miele
Maurizio Pompili
Fabio Maria Vecchio
Felice Giuliante
Lorenzo Bonomo
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3500-7

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