Comparison of magnetic resonance elastography and diffusion-weighted imaging for differentiating benign and malignant liver lesions

Hennedige, Tiffany; Hallinan, James Thomas Patrick Decourcy; Leung, Fiona P.; Teo, Lynette; Iyer, Sridhar; Wang, Gang; Chang, Stephen; Madhavan, Krishnakumar; Wee, Aileen; Venkatesh, Sudhakar K.

doi:10.1007/s00330-015-3835-8

Cited by 58 publications

(45 citation statements)

References 28 publications

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“…A potential explanation for the difference in HCC stiffness may be due to different lesion inclusion. Stiffness values of 5.3 ± 2.2 kPa for cirrhotic background liver in our study are in line with the results of Venkatesh et al In another recent study by Hennedige et al [27] stiffness values of 55 untreated HCCs were evaluated. Using a similar MRE technique, the authors reported values of 7.7 ± 2.6 kPa, which is in accordance with our results.…”

Section: Discussionsupporting

confidence: 92%

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Value of tumor stiffness measured with MR elastography for assessment of response of hepatocellular carcinoma to locoregional therapy

et al. 2017

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Purpose To correlate tumor stiffness (TS) measured with MR elastography (MRE) with degree of tumor enhancement and necrosis on contrast-enhanced T1-weighted imaging (CE-T1WI) in hepatocellular carcinomas (HCC) treated with 90Yttrium radioembolization (RE) or transarterial chemoembolization plus radiofrequency ablation (TACE/RFA). Material and Methods This retrospective study was IRB-approved and the requirement for informed consent was waived. 52 patients (M/F 38/14, mean age 67 y) with HCC who underwent RE (n=22) or TACE/RFA (n=30) and 11 controls (M/F 6/5, mean age 64 y) with newly diagnosed untreated HCC were included. The MRI protocol included a 2D MRE sequence. TS and LS (liver stiffness) were measured on stiffness maps. Degree of tumor necrosis was assessed on subtraction images by two observers, and tumor enhancement ratios (ER) were calculated on CE-T1WI by one observer. Results 63 HCCs (mean size 3.2 ± 1.6 cm) were evaluated. TS was significantly lower in treated vs. untreated tumors (3.9 ± 1.8 vs. 6.9 ± 3.4 kPa, p=0.006) and also compared to LS (5.3 ± 2.2 kPa, p=0.002). There were significant correlations between TS and each of enhancement ratios (r=0.514, p=0.0001), and percentage of necrosis (r= -0.540, p=0.0001). The observed correlations were stronger in patients treated with RE (TS vs. ER, r=0.636, TS vs. necrosis, r= -0.711, both p=0.0001). Percentage of necrosis and T1-signal in native T1WI were significant independent predictors of TS (p=0.0001 and 0.001, respectively). Conclusion TS measured with MRE shows a significant correlation with tumor enhancement and necrosis, especially in HCCs treated with RE.

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Section: Discussionsupporting

confidence: 92%

“…Venkatesh et al [19] found a non-significant linear correlation between tumor size and stiffness and Hennedige et al [27] also reported an association between tumor size and stiffness. Our data show no such correlation.…”

Section: Discussionmentioning

confidence: 99%

Value of tumor stiffness measured with MR elastography for assessment of response of hepatocellular carcinoma to locoregional therapy

et al. 2017

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“…Tumor stiffness (kPa) was measured by an independent observer blinded to the clinical and tumor pathologic data as previously described [23,24]. Regions of interest (ROI) were drawn on the elastograms covering the HCC and in the case of HCCs with non-enhancing/necrotic components, only the solid portion was included in the ROI.…”

Section: Methodsmentioning

confidence: 99%

“…Magnetic resonance elastography (MRE) is a noninvasive MRI based technique for quantitatively assessing the mechanical properties of tissues and has been used clinically most extensively in the liver as a quantitative tool for diagnosing and staging liver fibrosis [21,22]. Moreover, MRE has been shown to be feasible for measuring liver tumor stiffness (kPa) and is more accurate than diffusion-weighted imaging (DWI) for differentiating benign and malignant focal liver lesions [23,24]. However, it is not known if tumor stiffness by MRE can differentiate HCC tumor pathologic features.…”

Section: Introductionmentioning

confidence: 99%

MR elastography of hepatocellular carcinoma: Correlation of tumor stiffness with histopathology features—Preliminary findings

Thompson

Wang

Chandan

et al. 2017

Magnetic Resonance Imaging

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Purpose To determine if tumor stiffness by MR Elastography (MRE) is associated with hepatocellular carcinoma (HCC) pathologic features. Material and Methods A retrospective review was undertaken of all patients with pathologically confirmed HCC who underwent MRE prior to locroregional therapy, surgical resection or transplant between 1/1/2007 to 12/31/2015. An independent observer measured tumor stiffness (kilopascals, kPa) by drawing regions of interest (ROI) covering the HCC and in the case of HCCs with non-enhancing/necrotic components, only the solid portion was included in the ROI. HCC tumor grade (WHO criteria), vascular invasion and tumor encapsulation were assessed from retrievable pathology specimens by an expert hepatobiliary pathologist. Tumor stiffness was compared by tumor grade, size, presence of capsule and vascular invasion using student’s t-test (or Exact Mann-Whitney test). Results 21 patients were identified who had pathologically confirmed HCC and tumor MRE data. 17 patients (81.0%) had underlying chronic liver disease. The mean±SD tumor size (cm) was 5.3±3.9 cm. The mean±SD tumor stiffness was 5.9±1.4 kPa. Tumors were graded as well differentiated (N=2), moderately differentiated (N=11) and poorly differentiated (N=8). There was a trend toward increased tumor stiffness in well/moderately differentiated HCC (6.5k±1.2 kPa; N=13) compared to poorly differentiated HCC (4.9±1.2 kPa; N=8) (p<0.01). There was no significant correlation between tumor stiffness and liver stiffness or tumor size. There was no significant difference in tumor stiffness by presence or etiology of chronic liver disease, vascular invasion or tumor encapsulation. Conclusion Preliminary data suggest that tumor stiffness by MRE may be able to differentiate HCC tumor grade.

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“…Our conclusions are limited by the low number of NFHs taken into account (n=4). Regarding HCAs, a recent study sustained that their mean ADC value is significantly higher than that of malignant FLLs [28]. 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.…”

Section: Inter-observer Variabilitymentioning

confidence: 99%

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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Comparison of magnetic resonance elastography and diffusion-weighted imaging for differentiating benign and malignant liver lesions

Cited by 58 publications

References 28 publications

Value of tumor stiffness measured with MR elastography for assessment of response of hepatocellular carcinoma to locoregional therapy

Value of tumor stiffness measured with MR elastography for assessment of response of hepatocellular carcinoma to locoregional therapy

MR elastography of hepatocellular carcinoma: Correlation of tumor stiffness with histopathology features—Preliminary findings

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

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