Focal Liver Lesion Detection and Characterization with Diffusion-weighted MR Imaging: Comparison with Standard Breath-hold T2-weighted Imaging

Parikh, Tejas; Drew, Steve; Lee, Vivian S.; Wong, Samson; Hecht, Elizabeth M.; Babb, James S.; Taouli, Bachir

doi:10.1148/radiol.2463070432

Cited by 503 publications

(413 citation statements)

References 54 publications

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“…Our study shows also the potential role of ADC to differentiate between benign and malignant liver lesions, with 100% sensitivity and 100% specificity using either BH DWI and PACE DWI, higher than previously described (7,16,19). However, due to the small number of lesions and the limited spectrum of lesions included, the potential of ADC for lesion characterization is overestimated in our study.…”

Section: Discussioncontrasting

confidence: 68%

“…We believe that the improved lesion-to-liver contrast ratio translates into better lesion detection, although we did not directly evaluate it in the current study. This was demonstrated in a recent study, showing a higher detection rate of liver lesions using PACE DWI compared with BH DWI in 53 patients with 211 liver lesions (detection rate of 93.7% versus 84.3%, respectively, P ϭ 0.032) (19).…”

Section: Discussionmentioning

confidence: 62%

“…Lesion conspicuity was assessed by measuring the lesion-to-liver contrast ratio as [(SI lesion Ϫ SI liver) / SI liver] on b ϭ 0 and b ϭ 50 s/mm 2 , because liver lesions were typically detected with these b-values (19). Because of the limited spatial resolution of DWI, only lesions larger than 0.7 cm in diameter were evaluated.…”

Section: Liver Lesion Conspicuitymentioning

confidence: 99%

“…THERE IS A GROWING interest in using liver diffusionweighted imaging (DWI) for lesion detection and characterization, prediction of treatment response and assessment of chronic liver disease, by means of apparent diffusion coefficient (ADC) measurement (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The interest in DWI is motivated by the recently described risk of nephrogenic systemic fibrosis (21)(22)(23)(24), which makes DWI an attractive alternate method to Gadolinium-enhanced sequences.…”

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confidence: 99%

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Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Taouli

Sandberg

Stemmer

et al. 2009

Magnetic Resonance Imaging

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Purpose: To compare a free breathing navigator triggered single shot echoplanar imaging (SS EPI) diffusion-weighted imaging (DWI) sequence with prospective acquisition correction (PACE) with a breathhold (BH) DWI sequence for liver imaging. Materials and Methods:Thirty-four patients were evaluated with PACE-DWI and BH DWI of the liver using bvalues of 0, 50, and 500 s/mm 2 . There were 29 focal liver lesions in 18 patients. Qualitative evaluation was performed on a 3-point scale (1-3) by two independent observers (maximum score 9). Quantitative evaluation included estimated SNR (signal to noise ratio), lesion-to-liver contrast ratio, liver and lesion apparent diffusion coefficients (ADCs), and coefficient of variation (CV) of ADC in liver parenchyma and focal liver lesions (estimate of noise contamination in ADC).Results: PACE-DWI showed significantly better image quality, higher SNR and lesion-to-liver contrast ratio when compared with BH DWI. ADCs of liver and focal lesions with both sequences were significantly correlated (r ϭ 0.838 for liver parenchyma, and 0.904 for lesions, P Ͻ 0.0001), but lower with the BH sequence (P Ͻ 0.02). There was higher noise contamination in ADC measurement obtained with BH DWI (with a significantly higher SD and CV of ADC). Conclusion:The use of a navigator echo to trigger SS EPI DWI improves image quality and liver to lesion contrast, and enables a more precise ADC quantification compared with BH DWI acquisition. THERE IS A GROWING interest in using liver diffusionweighted imaging (DWI) for lesion detection and characterization, prediction of treatment response and assessment of chronic liver disease, by means of apparent diffusion coefficient (ADC) measurement (1-20). The interest in DWI is motivated by the recently described risk of nephrogenic systemic fibrosis (21-24), which makes DWI an attractive alternate method to Gadolinium-enhanced sequences. Most prior studies have used breathhold (BH) single shot echoplanar imaging (SS EPI) to acquire diffusion-weighted images, using various sets of b-values. SS EPI sequences are very fast, however, suffer from limited image quality, mostly related to limited signal to noise ratio (SNR) especially at higher b-values, and limited spatial resolution, which constitute an obstacle for its widespread use in clinical practice. Techniques such as parallel imaging (25,26) and pulse triggering (27) have been proposed to improve SS EPI image quality and precision of ADC measurement.There are several recent reports on the use of respiratory triggered acquisitions for liver DWI (15,16,[28][29][30][31]. However, only two studies have specifically compared different diffusion acquisition schemes for liver imaging (28,30). The first study (28) included a population of patients with liver lesions, and compared image quality and ADC of free breathing versus BH DWI. The second study included healthy volunteers, and compared BH, free breathing and respiratory triggered DWI (without navigator echoes) (30). There are, however, no reports on the use of a...

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 62%

Section: Liver Lesion Conspicuitymentioning

confidence: 99%

mentioning

confidence: 99%

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Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Taouli

Sandberg

Stemmer

et al. 2009

Magnetic Resonance Imaging

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147

122

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“…It is being increasingly used in liver diseases due to availability of echo-planar imaging and parallel imaging techniques which has considerably improved the quality of images with reduction of artifacts related to breathing, cardiac motion, and bowel peristalsis. 6 Even though previous studies have reported DWI to have improved sensitivity when combined with CEMR in diagnosing HCC, to the best of our knowledge, there is no previous prospective study directly comparing the efficacy of diffusion weighted imaging (DWI) against DCEMR in the diagnosis of HCC on a 3T MRI scanner. Among the several forecasters of recurrence of HCC after surgical resection, histological grading is the most important foretelling factor for early tumoral recurrence.…”

mentioning

confidence: 99%

Role of Diffusion Weighted Imaging (DWI) for Hepatocellular Carcinoma (HCC) Detection and its Grading on 3T MRI: A Prospective Study

Shankar

Kalra

Bhatia

et al. 2016

Journal of Clinical and Experimental Hepatology

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Background: Limited studies have evaluated the role of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) for histologically grading the hepatocellular carcinoma (HCC). Objective: To compare the efficacy of DWI with dynamic contrast enhanced magnetic resonance (DCEMR) in detection of HCC in cirrhosis, and to evaluate whether DWI can be used instead of DCEMR. Methods: 20 patients of either sex with cirrhosis and suspected of having HCC on screening USG were included in this prospective study approved by the Institutional Ethics Committee. All patients underwent DCEMR of the abdomen on 3T scanner and fine needle aspiration of the lesions. MR protocol included T1WI, T2WI, DWI, and dynamic CEMR. The results of diffusion weighted imaging were compared with DCEMR to find the efficacy of DWI vis-à-vis CEMR. Results: DWI had a sensitivity and specificity of 100%, for diagnosis of lesions in cases having single lesion on CEMR, and sensitivity of 75% and specificity of 100% for diagnosis of lesions in cases having multiple lesions. There was a decreasing trend of ADC values with increasing grade of the tumor; however, the decreasing trend was not statistically significant. A cut-off ADC value of 0.8705 resulted in a sensitivity of 75% and specificity of 50% for differentiating between welldifferentiated and other grades of HCC. Conclusion: DWI can be used as an alternative for the detection and characterization of HCC, especially in patients with impaired renal function or contrast allergies precluding the use of contrast. In addition, DWI with ADC measurement may be helpful for non-invasive and preoperative prediction of the degree of differentiation of HCC. ( J CLIN EXP HEPATOL 2016;6:303-310)

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Diagnostic imaging modalities

Baik

Kim

Jeong

2015

Cirrhosis: A Practical Guide to Management

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Focal Liver Lesion Detection and Characterization with Diffusion-weighted MR Imaging: Comparison with Standard Breath-hold T2-weighted Imaging

Abstract: DW MR imaging was better than standard breath-hold T2-weighted imaging for FLL detection and was equal to breath-hold T2-weighted imaging for FLL characterization.

Cited by 503 publications

References 54 publications

Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Role of Diffusion Weighted Imaging (DWI) for Hepatocellular Carcinoma (HCC) Detection and its Grading on 3T MRI: A Prospective Study

Diagnostic imaging modalities

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