Differentiation between cavernous hemangiomas and untreated malignant neoplasms of the liver with free-breathing diffusion-weighted MR imaging: Comparison with T2-weighted fast spin-echo MR imaging

Soyer, Philippe; Corno, Lucie; Boudiaf, Mourad; Aout, Mounir; Sirol, Marc; Placé, Vinciane; Duchat, Florent; Guerrache, Youcef; Fargeaudou, Y.; Vicaut, Éric; Pocard, Marc; Hamzi, Lounis

doi:10.1016/j.ejrad.2010.08.011

Cited by 30 publications

(15 citation statements)

References 27 publications

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“…In Asia, the ranges of the mean ADC values of HCC, hepatic metastasis, and hemangiomas were approximately 0.68 to 3.15, 1.06 to 2.55, and 2.00 to 7.58 (×10 −3 mm 2 /s), respectively, [35–39,41] whereas the corresponding ADC values for European patients were 0.94 to 1.19, 0.87 to 1.16, and 1.55 to 1.89 (×10 −3 mm 2 /s), respectively. [51–55] The ADC ranges for each lesion in Asia vary greatly from those in Europe, which supports our viewpoint that geographic heterogeneity cannot be ignored when estimating the diagnostic accuracy of ADC values in liver diseases.…”

Section: Discussionsupporting

confidence: 71%

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

Peng

Jiang

et al. 2016

Medicine

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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.

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Section: Discussionsupporting

confidence: 71%

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

Peng

Jiang

et al. 2016

Medicine

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“…Previous studies have examined the benefit of DWI MR in the characterization of focal hepatic lesions: visual and quantitative assessments with DWI have been found useful in distinguishing hepatic hemangiomas and cysts from malignant hepatic lesions [3], [6], [19]; although, there is considerable overlap between the ADC values of solid benign (i.e. FNH and adenoma) and malignant lesions [5].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Dynamic and Liver-Specific Gadoxetic Acid Contrast-Enhanced MRI versus Apparent Diffusion Coefficients

et al. 2013

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BackgroundHepatic lesions often present diagnostic connundrums with conventional MR techniques. Hepatobiliary phase contrast-enhanced imaging with gadoxetic acid can aid in the characterization of such lesions. However, quantitative measures describing late-phase enhancement must be assessed relative to their accuracy of hepatic lesion classification.Purpose: To compare quantitative parameters in gadoxetic acid contrast-enhanced dynamic and hepatobiliary phase imaging versus apparent diffusion coefficients in hepatic lesion characterization.Material and Methods57 patients with focal hepatic lesions on gadoxetic acid MR were included. Lesion enhancement at standard post-contrast time points and in the hepatobiliary phase (HB; 15 and 25 minutes post-contrast) was assessed via calculation of contrast (CR) and enhancement ratios (ER). Apparent diffusion coefficient (ADC) values were also obtained. Values for these parameters were compared among lesions and ROC analyses performed.Results: HB enhancement was greatest with FNH and adenomas. HB ER parameters but not HB CR could distinguish HCC from benign entities (0.9 ER ROC AUC versus 0.5 CR ROC AUC). There was no statistically significant difference found between the 15 and 25 minutes HB time points in detection of any lesion (p>0.4). ADC values were statistically significantly higher with hemangiomas (p<0.05) without greater accuracy in lesion detection relative to HB phase parameters.ConclusionHepatobiliary phase gadoxetic acid contrast-enhanced MR characterizes focal hepatic lesions more accurately than ADC and conventional dynamic post-contrast time point enhancement parameters. ER values are generally superior to CR. No discernible benefit of 25 minute versus 15 minute delayed imaging is demonstrated.

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“…They achieved a 77% specificity and 88% PPV with a T 2 relaxation time threshold of <112 ms being indicative of malignant lesion. Soyer et al [13] differentiated CHL from untreated malignant hepatic neoplasms with free-breathing diffusion-weighted MRI with a scan time around 2 minutes. With two independent readers, they reported a sensitivity of 65.7%∼100%, a specificity of 85.7%∼100% and an accuracy of 82.9%∼94.3% depending on which threshold was applied to the ADC values.…”

Section: Discussionmentioning

confidence: 99%

“…Characterization of CHL and HCC using ultrasonography (US) and contrast-enhanced computed tomography (CT) is well established and routinely applied in liver lesion diagnosis [5]–[7]. Both qualitative and quantitative magnetic resonance imaging (MRI) methods are also used for the diagnosis of liver diseases [8]–[13]. Subjective qualitative analysis depends on interpreters’ experience and expertise, thereby potentially limiting its diagnostic accuracy and reproducibility.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, administration of gadolinium contrast agents is required for this type of subjective interpretation. Several noninvasive, quantitative MR methods for differentiating malignant tumors from benign hepatic lesions have also been proposed, including calculated T 2 relaxation times [9]–[11] and apparent diffusion coefficient (ADC) derived from diffusion weighted imaging [13]. Despite the availability of these non-invasive methods mentioned above, the considerable overlaps, sequence dependent results, and long acquisition times have prevented their wide use in routine clinical applications.…”

Section: Introductionmentioning

confidence: 99%

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Utility of R2* Obtained from T2*-Weighted Imaging in Differentiating Hepatocellular Carcinomas from Cavernous Hemangiomas of the Liver

et al. 2014

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PurposeTo evaluate the feasibility of applying R2* values to differentiate hepatocellular carcinomas (HCC) from cavernous hemangiomas of the liver (CHL).Materials and MethodsThis retrospective study was approved by the participating Institutional Review Board and written informed consent for all subjects were obtained. Seventy-three patients with 79 pathologically identified HCCs and 65 patients with 91 clinically or pathologically identified CHLs were enrolled in this study. All subjects underwent a breath-hold multi-echo T2* weighted MR imaging on a 1.5T clinical MR scanner. R2* values from HCC and CHL groups were compared using the Mann-Whitney non-parametric U test. A cut-off value of R2* was evaluated with receiver operator characteristic (ROC) analysis.ResultsThe mean R2* value was 23.32±12.23 Hz (95% confidence interval [CI]: 20.58 Hz, 26.06 Hz) for the HCC group, and 3.66±2.37 Hz (95% CI: 3.17 Hz, 4.15 Hz) for the CHL group. The mean R2* value for HCC was significantly higher than that of CHL (p<0.001). A threshold of 9.48 Hz for the minimum R2* value in the diagnosis of HCC resulted in a sensitivity of 96.20% (76 out of 79 patients), and a specificity of 97.80% (89 out of 91 patients). The positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy for HCC were 97.44% (76 out of 78 patients), 96.74% (89 out of 92 patients) and 97.06% (165 out of 170 patients), respectively. The AUC for differentiation between these two groups was 0.994 (95% CI: 0.980, 1.000).ConclusionsR2* is a significant MRI biomarker to differentiate HCC from CHL with satisfying sensitivity and specificity.

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Differentiation between cavernous hemangiomas and untreated malignant neoplasms of the liver with free-breathing diffusion-weighted MR imaging: Comparison with T2-weighted fast spin-echo MR imaging

Cited by 30 publications

References 27 publications

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

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

Comparison of Dynamic and Liver-Specific Gadoxetic Acid Contrast-Enhanced MRI versus Apparent Diffusion Coefficients

Utility of R2* Obtained from T2*-Weighted Imaging in Differentiating Hepatocellular Carcinomas from Cavernous Hemangiomas of the Liver

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