Diffusion-weighted imaging of the liver: Current applications

Saito, Kazuhiro; Tajima, Yu; Harada, Taiyo L

doi:10.4329/wjr.v8.i11.857

Cited by 26 publications

(18 citation statements)

References 114 publications

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“…Diffusion-weighted imaging (DWI) has been widely applied to characterize and grade hepatic lesions (10)(11)(12)(13)(14). Despite an abundant number of favorable results, the validity of conventional DWI is challenged by the fact that it is based on the assumption of Gaussian water diffusion (15).…”

Section: Introductionmentioning

confidence: 99%

Diffusion kurtosis imaging (DKI) of hepatocellular carcinoma: correlation with microvascular invasion and histologic grade

Cao¹,

Chen²,

Duan³

et al. 2019

Quant. Imaging Med. Surg

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Background: The aim of this study was to prospectively evaluate the diagnostic efficacy of diffusion kurtosis imaging (DKI) in predicting microvascular invasion (MVI) and histologic grade of hepatocellular carcinoma (HCC) with comparison to the conventional diffusion-weighted imaging (DWI). Methods: This prospective study was approved by the Institutional Review Board, and written informed consent was obtained from all patients. From September 2015 to January 2017, 74 consecutive HCC patients were enrolled in this study. Preoperative magnetic resonance imaging including DKI protocol was performed, and patients were followed up for at least one year after surgery. Diffusion parameters including the mean corrected apparent diffusion coefficient (MD), mean apparent kurtosis coefficient (MK), and apparent diffusion coefficient (ADC) were calculated. Differences of diffusion parameters among different histopathological groups were compared. For parameters that were significantly different between pathological groups, receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic efficiency for identifying MVI and predicting high-grade HCC. Univariate and multivariate logistic regression analyses were used to evaluate the relative value of clinical and laboratory variables and diffusion parameters as risk factors for early recurrence (≤1 year). Results: Among all the studied diffusion parameters, only MK differed significantly between the MVIpositive and MVI-negative group (0.91±0.10 vs. 0.82±0.09, P<0.001), and showed moderate diagnostic efficacy (AUC =0.77) for identifying MVI. High-grade HCCs showed significantly higher MK values (0.93±0.10 vs. 0.82±0.09, P<0.001), along with MD (1.34±0.18 vs. 1.54±0.22, P<0.001) and ADC values (1.17±0.15 vs. 1.30±0.16, P=0.001) than low-grade HCCs. For differentiating high-grade from low-grade HCCs, MK demonstrated a higher area under the ROC curve (AUC) and significantly higher specificity than MD and ADC (AUC =0.81 vs. 0.76 and 0.74; specificity =82.2% vs. 60.0% and 60.0%, P=0.02). In addition, higher MK (OR =5.700, P=0.002) and Barcelona Clinic Liver Cancer (BCLC) stage C (OR =6.329, P=0.005) were independent risk factors for early HCC recurrence. Conclusions: DKI-derived MK values outperformed conventional ADC values for predicting MVI and histologic grade of HCC, and are associated with increased risk of early tumor recurrence.

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Section: Introductionmentioning

confidence: 99%

Diffusion kurtosis imaging (DKI) of hepatocellular carcinoma: correlation with microvascular invasion and histologic grade

Cao¹,

Chen²,

Duan³

et al. 2019

Quant. Imaging Med. Surg

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“…A maximum b value of 300 s/mm 2 finally used in this study is considered as a very low value. While brain DWI is usually performed with b values around 1000 s/mm 2 , for abdomen and liver lower maximum b values of 500–800 s/mm 2 [16, 17, 22] are recommended, as higher values would increase the echo time (TE) as well as motion sensitivity and, thus, lower the signal-to-noise ratio [23] in organs that are prone to motion artifacts such as liver, e.g., due to respiration.…”

Section: Discussionmentioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging using a preclinical 1 T PET/MRI in healthy and tumor-bearing rats

et al. 2019

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Background Hybrid positron emission tomography and magnetic resonance imaging (PET/MRI) scanners are increasingly used for both clinical and preclinical imaging. Especially functional MRI sequences such as diffusion-weighted imaging (DWI) are of great interest as they provide information on a molecular level, thus, can be used as surrogate biomarkers. Due to technical restrictions, MR sequences need to be adapted for each system to perform reliable imaging. There is, to our knowledge, no suitable DWI protocol for 1 Tesla PET/MRI scanners. We aimed to establish such DWI protocol with focus on the choice of b values, suitable for longitudinal monitoring of tumor characteristics in a rat liver tumor model. Material and methods DWI was first performed in 18 healthy rat livers using the scanner-dependent maximum of 4 b values (0, 100, 200, 300 s/mm 2 ). Apparent diffusion coefficients (ADC) were calculated from different b value combinations and compared to the reference measurement with four b values. T2-weighted MRI and optimized DWI with best agreement between accuracy, scanning time, and system performance stability were used to monitor orthotopic hepatocellular carcinomas (HCC) in five rats of which three underwent additional 2-deoxy-2-( 18 F)fluoro- d -glucose(FDG)-PET imaging. ADCs were calculated for the tumor and the surrounding liver parenchyma and verified by histopathological analysis. Results Compared to the reference measurements, the combination b = 0, 200, 300 s/mm 2 showed the highest correlation coefficient ( r s = 0.92) and agreement while reducing the acquisition time. However, measurements with less than four b values yielded significantly higher ADCs ( p < 0.001). When monitoring the HCC, an expected drop of the ADC was observed over time. These findings were paralleled by FDG-PET showing both an increase in tumor size and uptake heterogeneity. Interestingly, surrounding liver parenchyma also showed a change in ADC values revealing varying levels of inflammation by immunohistochemistry. Conclusion We established a respiratory-gated DWI protocol for a preclinical 1 T PET/MRI scanner allowing to monitor growth-related changes in ADC values of orthotopic HCC liver tumors. By monitoring the changes in tumor ADCs over time, different cellular stages were described. However, each study needs to adapt the protocol further according to their question to generate best possible results. Electronic supplementary material The online version of this article (10.1186/s13550-019-0489-6) contains supplementary material, which is available to authori...

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“…Arterial flash was defined as a vivid early arterial enhancement of the lesion compared to the remainder of the liver, while contrast wash-out as an early hypointensity of the lesion compared to the rest of the liver parenchyma [12]. Diffusion restriction is defined as an objective hyperintensity of the lesion in all b-values, including the highest, with corresponding hypointensity on the ADC map [13].…”

Section: Methodsmentioning

confidence: 99%

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

Scheau

Lupescu

2017

JGLD

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Background & Aims: Emerging minimally invasive treatments for hepatocellular carcinoma (HCC) can significantly improve a patient’s prognosis, but they may alter the imaging features of the treated nodules. This study focuses on a series of patients presenting with a rare pathology, the nodule-in-nodule imaging pattern of HCC, analyzes the imaging features and discusses possible approaches for the diagnosis of tumoral recurrence.Method: Nine patients recruited over two years, having HCC with nodule-in-nodule imaging pattern on diagnosis, and treated by transarterial chemoembolization were monitored by magnetic resonance imaging (MRI). Nodule morphology, dynamic contrast behavior and size progression were followed in this study.Results: All patients showed tumor recurrence. In 7 nodules, a T2 weighted-imaging hyperintense signal of the HCC foci was found, with isointensity of the background nodule. Restricted diffusion within the HCC foci was found in 6 cases but with no statistical significance. Dynamic contrast images evaluation showed a “classical” enhancement pattern in five patients. All nodules had hypointense HCC foci in the hepatobiliary phase. Four patients demonstrated progressive disease according to the mRECIST criteria.Conclusions: Due to the particularly challenging nodule characteristics, the sensitivity in diagnosing HCC foci in these nodules is about 77% when using conventional imaging criteria related to nodule morphology. Contrast media uptake curves may be altered by changes in nodule hemodynamics caused by embolization. The diagnostic rate may be significantly increased by considering the tumoral size increase in follow-up studies and completing the study with a hepatobiliary phase using Acidum Gadoxeticum.Abbreviations. ADC: Apparent diffusion coefficient; CT: Computed tomography; DEB-TACE: drug-eluting beads transarterial chemoembolization; DWI: Diffusion-weighted imaging; Gd-EOB-DTPA: acidum gadoxeticum; HCC: hepatocellular carcinoma; HBV: hepatitis virus B; HCV: hepatitis virus C; HDV: hepatitis virus D; IN-OPP: in-phase and out-of-phase; mRECIST: modified Response Evaluation Criteria in Solid Tumors; MRI: Magnetic resonance imaging; ROI: region of interest; TACE: Transarterial chemoembolization; WI: weighted imaging.

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Diffusion-weighted imaging of the liver: Current applications

Cited by 26 publications

References 114 publications

Diffusion kurtosis imaging (DKI) of hepatocellular carcinoma: correlation with microvascular invasion and histologic grade

Diffusion kurtosis imaging (DKI) of hepatocellular carcinoma: correlation with microvascular invasion and histologic grade

Diffusion-weighted magnetic resonance imaging using a preclinical 1 T PET/MRI in healthy and tumor-bearing rats

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

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