Histological grade of differentiation of hepatocellular carcinoma: Comparison of the efficacy of diffusion‐weighted MRI with T2‐weighted imaging and angiography‐assisted CT

Saito, Kazuhiro; Sugimoto, Katsutoshi; Nishio, Ryota; Saguchi, Toru; Akata, Soichi; Tokuuye, Koichi

doi:10.1111/j.1754-9485.2012.02374.x

Cited by 32 publications

(21 citation statements)

References 33 publications

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“…20,21 After this, few studies 23,24 were done to differentiate between benign and malignant hepatic lesions and also to differentiate between various grades of HCC. Nasu et al, 19 Piana et al, 15 and Saito et al 25 showed that there exists no relationship between ADC values and histopathological grades of HCC, whereas Heo et al 26 and Nishie et al 27 said that the ADC values of HCC had an inverse correlation with the degree of differentiation. In the present study, even though there was a decreasing trend of ADC values with increasing grade of tumor, however the decreasing trend was not statistically significant (P value of 0.118).…”

Section: Role Of Diffusion Weighted Imaging For Hepatocellular Carcinmentioning

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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Section: Role Of Diffusion Weighted Imaging For Hepatocellular Carcinmentioning

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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“…Details on the main published studies regarding ADC measurement and correlations with the pathological grade of HCCs are reported in Table 1. Overall, literature data show that HCC dedifferentiation tends to be associated with a decrease of the ADC value, despite differences between studies [23][24][25][26][27][28][29] . Apart from the direct correlation with the pathological grade, Nakanishi et al [29] found that ADC quantification might have a clinical prognostic value, being significantly lower in patients with early recurrence after surgery than in those without early recurrence.…”

Section: Primary Liver Tumorsmentioning

confidence: 97%

“…Arterial blood supply tends to increase during hepatocarcinogenesis. Perfusion imaging techniques [24] 99 0, 500 1.29 (WD); 1.22 (MD); 1.21 (PD) Saito et al [25] 32 100, 800 1.25 (WD); 1.12 (MD); 1.13 (PD) Muhi et al [26] 73 500, 800 0.91 (WD); 0.71 (MD); 0.68 (PD) Nishie et al [27] 80 0, 500, 1000 1.21 (WD); 1.14 (MD); 0.76 (PD) Heo et al [28] 27 0, 1000 1.20 (WD); 1.10 (MD); 0.90 (PD) Nakanishi et al [29] 44 0, 50, 1000 might provide more structural limitations than fibrosis alone. Legrand et al [44] reported that mean ADC values did not significantly differ between tumors having < 50% and those having > 50% of fibrotic stroma, or between tumors containing dense fibrosis and those containing loose fibrosis.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Robertis¹,

Martini²,

Demozzi³

et al. 2015

WJG

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Diffusion-weighted imaging (DWI), dynamic contrastenhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for posttreatment assessment, even at an early stage. or altered cellular membranes will present diffusion restriction, which is depicted as signal hyperintensity areas on high b-value DW images and hypointensity on the apparent diffusion coefficient (ADC) maps; ADC measurement can also quantify water molecules' diffusion. As dedifferentiation or therapies may induce microscopic changes in neoplastic tissues that could modify water molecules' diffusion, DWI can distinguish between different degrees of malignancy and can be also proposed for post-treatment monitoring. Moreover, DWI can be performed in a single session with DCE-MRI, thus providing a comprehensive "one-step" morphological and functional evaluation of hepatobilio-pancreatic tumors.Perfusion imaging techniques evaluate changes in signal intensity (DCE-MRI) or density (pCT) after contrast medium injection, being therefore able to assess microvascularization through the evaluation of the dynamics of contrast medium distribution from vessels to the neoplastic tissue. Perfusion parameters are therefore theoretically good candidates for the evaluation of microscopic vascular differences between lesions with different pathological grade and for the assessment of treatment response, especially after chemoembolization or during treatments with antiangiogenic drugs.This editorial analyzes up-to-date literature data regarding the application of functional imaging techniques, apart from molecular imaging, to hepatic and pancreatic tumors, with particular emphasis on correlations to pathological features, prognostic stratification and therapeutic response assessment. FUNCTIONAL IMAGING TECHNIQUES: TECHNICAL BASESIn 1965 Stejskal and Tanne...

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“…[13][14][15][16][17][18][19][20][21] In a study of qualitative and visual assessment using DW imaging, dynamic and hepatobiliary phase had limitations for predicting the histological grade, despite combining all these findings. 22 However, previous studies have shown that quantitative assessments including the apparent diffusion coefficient (ADC), lesion-to-liver contrast-to-noise ratio (CNR), and relative intensity ratio on hepatobiliary and arterial phase imaging seemed feasible for predicting HCC grade, 13,14,[16][17][18][19]21,23 but the clinical application of these parameters remains controversial.Recently, quantitative assessments of DW imaging using the lesion-to-liver CNR and relative contrast ratio (RCR) were shown to be superior to the ADC for predicting HCC histological grade. 16,23 However, these studies had the limitation that diagnostic accuracy was not sufficiently revealed in discriminating pHCCs from other HCCs.…”

mentioning

confidence: 98%

“…11,12 Moreover, diffusion-weighted (DW) MRI and hepatobiliary phase T1W imaging with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) have been used to predict HCC grade in several studies. [13][14][15][16][17][18][19][20][21] In a study of qualitative and visual assessment using DW imaging, dynamic and hepatobiliary phase had limitations for predicting the histological grade, despite combining all these findings. 22 However, previous studies have shown that quantitative assessments including the apparent diffusion coefficient (ADC), lesion-to-liver contrast-to-noise ratio (CNR), and relative intensity ratio on hepatobiliary and arterial phase imaging seemed feasible for predicting HCC grade, 13,14,[16][17][18][19]21,23 but the clinical application of these parameters remains controversial.…”

mentioning

confidence: 98%

Hepatocellular Carcinoma Histological Grade Prediction

Iwasa

Kitazume²,

Tateishi³

et al. 2016

Journal of Computer Assisted Tomography

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Histological grade of differentiation of hepatocellular carcinoma: Comparison of the efficacy of diffusion‐weighted MRI with T2‐weighted imaging and angiography‐assisted CT

Abstract: DWI was useful for evaluating the histological grade of differentiation of HCC.

Cited by 32 publications

References 33 publications

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

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

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Hepatocellular Carcinoma Histological Grade Prediction

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