Could ADC values be a promising diagnostic criterion for differentiating malignant and benign hepatic lesions in Asian populations

Abstract

Background:Liver cancer exhibits geographic and ethnic differences in its prevalence and biology, which implies that it is impractical to develop universal guidelines for all patients. Thus, a meta-analysis was conducted to identify the accuracy of apparent diffusion coefficients (ADCs) for discriminating malignant from benign liver lesions in Asians.Methods:Eligible studies published in PubMed, Ovid, and Embase/Medline were updated onto October 2014. STATA 12.0 and Meta-Disc 1.4 were used to perform this meta-analysis.Results:Eight studies comprising 661 benign liver lesions and 598 malignant liver lesions fulfilled all the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.88 (95% confidence interval [CI] 0.75–0.95), 0.93 (95% CI 0.86–0.97), 12.42 (95% CI 6.09–25.31), 0.13 (95% CI 0.06–0.29), and 95.58 (95% CI 35.29–258.89), respectively. Overall, the area under the summary receiver-operating characteristic curve was 0.96 (95% CI 0.94–0.98). Heterogeneity was found to originate potentially from the type of benign lesion. A subgroup analysis showed that differentiating between hemangiomas, cysts, and malignant liver lesions produced a significantly higher diagnostic accuracy than that of solid liver lesions.Conclusion:Our meta-analysis indicated that ADC could be promising for characterizing liver lesions among Asians, indicating that the ADC value is a promising diagnostic criterion candidate. Meanwhile, the use of dual b values could be sufficient for liver lesion characterization. However, large-scale, high-quality trials should be conducted to identify specific standards, including cut-off values for further development of diffusion-weighted imaging as a routine clinical application among Asian populations.

Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemede Hepatoselüler Karsinom ve Karaciğer Metastazı Ayırımında Hedef İşaretinin ve Görünür Difüzyon Katsayısı Ölçümlerinin Tanısal Değeri

“…[29] The reason for this wide range may be the application of different DWI sequence parameters such as different b values and use or non-use of a parallel imaging technique. [15] In our study, we used a high b value, and as a result of this, we found an average ADC value for metastases close to the lower limit in the literature. In a large number of studies, ADC values of metastases were found to be lower than those of HCC, [9,10,13,14,18,19] while ADC values of metastases were found to be higher than those of HCC in several other studies.…”

“…In the literature, there are several studies investigating ADC values of focal liver masses. [9][10][11][12][13][14][15][16][17][18][19] In these studies, ADC values in benign lesions were found to be higher than those of malignant lesions. [9][10][11][12][13][14][15][16][17][18][19] However, there are overlaps of ADC values in both benign and malignant lesions.…”

“…[9][10][11][12][13][14][15][16][17][18][19] In these studies, ADC values in benign lesions were found to be higher than those of malignant lesions. [9][10][11][12][13][14][15][16][17][18][19] However, there are overlaps of ADC values in both benign and malignant lesions. [5,9,10,28] Therefore, the ADC value alone is not enough to characterize the lesion; morphological changes detected in DWI should also be taken into consideration.…”

“…However, in most of these studies, metastases were evaluated together with other lesions under the title of focal liver masses, and ADC measurements were taken into account in the evaluations. [9][10][11][12][13][14][15][16][17][18][19] In recent years, target sign appearance, which is formed based on signal properties of liver masses in DWI sequences, was defined in several studies. [20][21][22] In these studies, it was stated that target sign on DWI was observed more frequently in intrahepatic cholangiocellular carcinoma (ICC) compared with hepatocellular carcinoma (HCC) and hypovascular solitary metastases.…”

Is the level of diffusion restriction in celiac and cervico-thoracic sympathetic ganglia helpful in their proper recognition on PSMA ligand PET/MR?

“…It has been already reliably proved that many malignant tumors, as well as their metastases, show noticeable restricted diffusion, which is being taken into consideration in routine clinical daily practice as an additional tool in differential diagnosis and even grading malignancy, discriminating disease stages, predicting response to treatment, differentiating recurrence or residual mass from post-treatment changes [12][13][14][15][16][17][18][19].…”