Focal Liver Lesion Classification and Characterization in Noncirrhotic Liver

Colagrande, Stefano; Regini, Francesco; Pasquinelli, F; Mazzoni, Lorenzo Nicola; Mungai, Francesco; Filippone, Antonella; Grazioli, Luigi

doi:10.1097/rct.10.1097/rct.0b013e3182951fe9

Cited by 12 publications

(5 citation statements)

References 49 publications

(71 reference statements)

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“…In our opinion, utilising ratio values theoretically nulls potential heterogeneity caused by covariates, leaving the ratio reflecting true difference between the lesion and background liver. This method had also been used in previous study to access hepatic lesions [ 18 ]. The use of lesion: background ADC ratio has also been described to assess prostate lesions on MRI [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ratio of ADC values between a lesion and the background liver can potentially negate these external factors and provide a more accurate representation of change in the diffusion with respect to normal tissue. In an earlier study, ADC ratio values were found to have better sensitivity and specificity than stand-alone ADC values in the interpretation of hepatic malignancies [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of ADCratio on liver MRI diffusion to discriminate benign versus malignant solid liver lesions

Jain

Kan

Edward

et al. 2018

European Journal of Radiology Open

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Purpose: The aim of this project is to investigate the usefulness of the absolute liver lesion ADC value and ratio of Apparent diffusion coefficient (ADC) values of a liver lesion and liver parenchyma to discriminate between a benign and malignant lesion.Methods: Liver MRI scans performed between January 2009 and June 2015 were retrospectively analysed. Scans were performed on either a 1.5 T or 3 T MRI unit. The type of liver lesion (benign or malignant) was determined by its radiological appearance, histology result and clinical management. Lesions with undetermined diagnosis or MRI studies degraded by artifacts were excluded. Liver cysts were also excluded from the analysis. ADC value of a lesion and liver parenchyma was measured and ADCratio was calculated. The values were analysed using independent samples t-testResults:Data set contained 39 benign lesions and 36 malignant lesions. Mean ADC value for benign lesions was 1678, and the mean value for malignant lesions was 1097 with a statistically significant difference of p < 0.001. All lesions with ADC value below 955 were malignant, while all lesions with ADC value above 1880 were benign. ADC value of 1260 was identified as the best available cut-off value for differentiating benign and malignant lesions, achieving sensitivity of 92%, specificity of 80% and an overall accuracy of 89%. The mean lesion to liver ADCratio for benign lesions was 1.3467 and for malignant lesions was 0.9038 with a statistically significant difference of p < 0.001. All lesions with ADCratio measuring <0.9 were malignant while lesions with ADCratio>1.5 were benign. ADCratio of 1.1 was identified statistically as the best available cut-off value for differentiating benign from malignant lesions, with sensitivity of 82%, specificity of 86% and an overall accuracy of 92%.Conclusion:Our dataset indicates that lesion to background liver ADCratio is superior in discriminating between benign and malignant focal lesions compared to absolute ADC values of the hepatic lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of ADCratio on liver MRI diffusion to discriminate benign versus malignant solid liver lesions

Jain

Kan

Edward

et al. 2018

European Journal of Radiology Open

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“… 30 We did not consider fitted ADC and intravoxel incoherent motion (IVIM) theory, because of the retrospective nature of this study; however, these results are not dissimilar from those presented in another of our recent works (prospective and based on IVIM theory parameters and fitted ADC). 31 When including b = 0 s/mm 2 images in ADC, these values could be slightly higher (probably around 10%), because of the larger contribution of perfusional IVIM in ADC.…”

Section: Discussionmentioning

confidence: 98%

“…Our study has three major limitations: first, it was a retrospective study so selection biases cannot be excluded and an overestimation of DwI accuracy in FLL classification and characterization is likely present, although not critical 31 ; second, during acquisition of Dw images cardiac motion artifacts and noise contamination might have distorted ADC values to a certain degree, in particular those of lesions located on the left lobe; third, both the ROI drawing and positioning on ADC map were highly operator-dependent so problems with reproducibility of the method should be considered.…”

Section: Discussionmentioning

confidence: 99%

Diffusion Weighted MR and Apparent Diffusion Coefficient Measurement in Classification and Characterization of Noncystic Focal Liver Lesions

et al. 2014

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The objective of this study was to assess the clinical role of apparent diffusion coefficient (ADC) analysis in noncystic focal liver lesion (FLL) classification/characterization.Six hundred liver magnetic resonances with multi-b (b = 50, 400, 800 s/mm2) diffusion-weighted imaging (DwI) were retrospectively reviewed. Mean ADC was measured in 388 lesions (195 benign and 193 malignant) excluding internal necrotic areas. Cystic benign lesions were excluded from analysis. Sensitivity and specificity in distinguishing benign from malignant lesions were calculated. Analysis of variance was performed to detect differences among subgroups of solid lesions.Mean ADC of malignant lesions was 0.980 × 10−3 mm2/s, significantly (P < 0.05) lower than mean ADC of benign lesions (1.433 × 10−3 mm2/s). Applying an ADC cutoff of 1.066 × 10−3 mm2/s, specificity and sensitivity for malignancy were respectively 86.6% and 73.6%. Of all lesions, >1/3 (39.5%) presented values lower than 1 × 10−3 mm2/s, with 90.0% chance of malignancy. Above 1.5 × 10−3 mm2/s (about 20% of all lesions) chance of malignancy was 9.5%.DwI cannot assist in noncystic FLL characterization, but can help in FLL classification in about half the cases.

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“…Previous studies revealed that the D values can provided relatively high diagnostic performance in differentiating malignant from benign liver lesions [6] , [7] . But it was also found that there was great overlap of D between benign and malignant liver lesions [8] . Also, no significant differences in the perfusion-related parameters (i.e.…”

Section: Introductionmentioning

confidence: 99%

Determination of Hepatocellular Carcinoma and Characterization of Hepatic Focal Lesions with Adaptive Multi-Exponential Intravoxel Incoherent Motion Model

Zhang

Kuai

et al. 2018

Translational Oncology

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PURPOSE: To distinguish hepatocellular carcinoma (HCC) from other types of hepatic lesions with the adaptive multi-exponential IVIM model. METHODS: 94 hepatic focal lesions, including 38 HCC, 16 metastasis, 12 focal nodular hyperplasia, 13 cholangiocarcinoma, and 15 hemangioma, were examined in this study. Diffusion-weighted images were acquired with 13 b values (b = 0, 3, …, 500 s/mm2) to measure the adaptive multi-exponential IVIM parameters, namely, pure diffusion coefficient (D), diffusion fraction (fd), pseudo-diffusion coefficient (Di*) and perfusion-related diffusion fraction (fi) of the ith perfusion component. Comparison of the parameters of and their diagnostic performance was determined using Mann-Whitney U test, independent-sample t test, one-way analysis of variance, Z test and receiver-operating characteristic analysis. RESULTS: D, D1* and D2* presented significantly difference between HCCs and other hepatic lesions, whereas fd, f1 and f2 did not show statistical differences. In the differential diagnosis of HCCs from other hepatic lesions, D2* (AUC, 0.927) provided best diagnostic performance among all parameters. Additionally, the number of exponential terms in the model was also an important indicator for distinguishing HCCs from other hepatic lesions. In the benign and malignant analysis, D gave the greatest AUC values, 0.895 or 0.853, for differentiation between malignant and benign lesions with three or two exponential terms. Most parameters were not significantly different between hypovascular and hypervascular lesions. For multiple comparisons, significant differences of D, D1* or D2* were found between certain lesion types. CONCLUSION: The adaptive multi-exponential IVIM model was useful and reliable to distinguish HCC from other hepatic lesions.

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Focal Liver Lesion Classification and Characterization in Noncirrhotic Liver

Abstract: Apparent diffusion coefficient (by fitting procedures) better performs than do D and f in FLL classification, especially when its values are less than 1.30 or greater than 2.00 × 10 mm/s.

Cited by 12 publications

References 49 publications

Evaluation of ADCratio on liver MRI diffusion to discriminate benign versus malignant solid liver lesions

Evaluation of ADCratio on liver MRI diffusion to discriminate benign versus malignant solid liver lesions

Diffusion Weighted MR and Apparent Diffusion Coefficient Measurement in Classification and Characterization of Noncystic Focal Liver Lesions

Determination of Hepatocellular Carcinoma and Characterization of Hepatic Focal Lesions with Adaptive Multi-Exponential Intravoxel Incoherent Motion Model

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