Effectiveness of ADC histogram analysis in the diagnosis of focal liver lesions; is a contrast agent necessary?

Abstract

Objective: The diagnostic success of apparent diffusion coefficient (ADC) histogram analysis in focal liver lesions, and the effects of quantitative data added to contrast-enhanced abdominal magnetic resonance imaging (MRI) on the diagnostic accuracy were investigated.

Materials and Methods: The conventional MRI findings of 524 lesions in total were retrospectively examined. Contrast enhancement kinetics and ADC values for each lesion were found through an image analysis software.

Results: Three hundred and fifty (67%) of the lesions were diagnosed as benign and 174 (33%) as malignant. Statistically significant difference was found between the benign and malignant lesion groups in terms of the minimum, maximum and mean ADC values (p<0.001). When optimal thresholds for minimum, maximum and mean ADC were taken as 1.47x10-3mm2/s; 1.85x10-3mm2/s; 1.72x10-3mm2/s respectively, sensitivity was found to be 97%; 83%; 95%, specificity was 100%; 98%; 99%, NPV was 100%; 99%; 99%, and PPV was 93%; 74%; 90%. ADC values added to MRI increased the diagnostic success for metastases (92%→96%), HCC (63%→73%), hemangioma (90%→99%) and FNH (56%→75%).

Conclusion: ADC measurement could not show reasonable success in the diagnosis of specific lesions while being successful in the differentiation of benign and malignant lesions. Minimum ADC is more successful than mean and maximum ADC. A non-contrastenhanced MRI protocol based on the ADC measurement applicable to the selected patient group may be helpful.

Keywords

• Contrast agent
• Liver lesions
• Diffusion weighted imaging (DWI)
• Apparent diffusion coefficient (ADC)

References

1. Fowler KJ, Brown JJ, Narra VR. Magnetic resonance imaging of focal liver lesions: approach to imaging diagnosis. Hepatology 2011; 54:2227-37. doi: 10.1002/hep.24679
2. Coenegrachts K. Magnetic resonance imaging of the liver: New imaging strategies for evaluating focal liver lesions. World J Radiol 2009; 1:72-85. doi: 10.4329/wjr.v1.i1.72
3. Gandhi SN, Brown MA, Wong JG, Aguirre DA, Sirlin CB. MR contrast agents for liver imaging: What, When, How. Radiographics 2006; 26:1621-36. doi: 10.1148/rg.266065014
4. Juluru K, Vogel-Claussen J, Macura KJ, Kamel IR, Steever A, Bluemke DA. MR imaging in patients at risk for developing nephrogenic systemic fibrosis: protocols, practices, and imaging techniques to maximize patient safety. Radiographics 2009; 29:9-22. doi:10.1148/rg.291085072
5. Semelka RC, Ramalho M, AlObaidy M, Ramalho J. Gadolinium in Humans: A Family of Disorders. Am J Roentgenol 2016; 207: 229-233. doi: 10.2214/AJR.15.15842
6. Taouli B, Koh DM. Diffusion-weighted MR Imaging of the Liver. Radiology 2010; 254:47-66. doi: 10.1148/radiol.09090021
7. Bammer R. Basic principles of diffusion weighted imaging. Eur J Radiol 2003; 45:169-84. doi: 10.1016/s0720-048x(02)00303-0
8. Kim T, Murakami T, Takahashi S, Hori M, Tsuda K, Nakamura H. Diffusion-weighted single-shot echoplanar mr imaging for liver disease. Am J Roentgenol 1999; 173:393-8. doi: 10.2214/ ajr.173.2.10430143

9. Parsai A, Zerizer I, Roche O, Gkoutzios P, Miquel ME. Assessment of diffusion-weighted imaging for characterizing focal liver lesions. Clin Imaging 2015; 39:278-84. doi: 10.1016/j.clinimag.2014.09.016
10. Parikh T, Drew SJ, Lee VS, et al. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 2008; 246:812-22. doi: 10.1148/radiol.246.307.0432
11. Bruegel M, Holzapfel K, Gaa J, et al. Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 2008; 18:477-85. doi: 10.1007/ s00330.007.0785-9
12. Miller FH, Hammond N, Siddiqi AJ, et al. Utility of diffusionweighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 2010; 32:138-47. doi: 10.1002/ jmri.22235
13. Holzapfel K, Bruegel M, Eiber M, et al. Characterization of small (≤10 mm) focal liver lesions: value of respiratorytriggered echo-planar diffusion-weighted MR imaging. Eur J Radiol 2010; 76: 89-95. doi: 10.1016/j.ejrad.2009.05.014
14. Hirano M, Satake H, Ishigaki S, Ikeda M, Kawai H, Naganawa S. Diffusion-weighted imaging of breast masses: comparison of diagnostic performance using various apparent diffusion coefficient parameters. Am J Roentgenol 2012; 198:717-22. doi: 10.2214/AJR.11.7093
15. Kitis O, Altay H, Calli C, Yunten N, Akalin T, Yurtseven T. Minimum apparent diffusion coefficients in the evaluation of brain tumors. Eur J Radiol 2005; 55:393-400. doi: 10.1016/j. ejrad.2005.02.004
16. Lee EJ, Lee SK, Agid R, Bae JM, Keller A, Terbrugge K. Preoperative grading of presumptive lowgrade astrocytomas on MR imaging: diagnostic value of minimum apparent diffusion coefficient. Am J Neuroradiol 2008; 29:1872-7. doi: 10.3174/ajnr.A1254
17. Murakami R, Hirai T, Sugahara T, et al. Grading astrocytic tumors by using apparent diffusion coefficient parameters: superiority of a oneversus two-parameter pilot method. Radiology 2009; 251:838-45. doi: 10.1148/radiol.251.308.0899
18. Park HJ, Kim SH, Jang KM, Lee SJ, Park MJ, Choi D. Differentiating hepatic abscess from malignant mimickers: value of diffusion-weighted imaging with an emphasis on the periphery of the lesion. J Magn Reson Imaging 2013; 38:1333- 41. doi: 10.1002/jmri.24112
19. Wei C, Tan J, Xu L, et al. Differential diagnosis between hepatic metastases and benign focal lesions using DWI with parallel acquisition technique: a metaanalysis. Tumour Biol 2015; 36:983-90. doi: 10.1007/s13277.014.2663-9
20. Lee NK, Kim S, Kim DU, et al. Diffusion-weighted magnetic resonance imaging for non-neoplastic conditions in the hepatobiliary and pancreatic regions: pearls and potential pitfalls in imaging interpretation. Abdom Imaging 2015; 40:643-62. doi: 10.1007/s00261.014.0235-5
21. Parsai A, Zerizer I, Roche O, Gkoutzios P, Miquel ME. Assessment of diffusion-weighted imaging for characterizing focal liver lesions. Clin Imaging 2015; 39:278-84. doi: 10.1016/j.clinimag.2014.09.016
22. Taouli B, Vilgrain V, Dumont E, Daire JL, Fan B, Menu Y. Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 2003; 226: 71-8. doi: 10.1148/radiol.226.101.1904
23. Zarghampour M, Fouladi DF, Pandey A, et al. Utility of volumetric contrast-enhanced and diffusion-weighted MRI in differentiating between common primary hypervascular liver tumors. J Magn Reson Imaging 2018; 48:1080-90. doi: 10.1002/jmri.26032.
24. Löwenthal D1, Zeile M, Lim WY, et al. Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOBDTPA enhanced MR imaging. European Radiology 2011; 21:832-40. doi: 10.1007/s00330.010.1977-2
25. Shimada K, Isoda H, Hirokawa Y, Arizono S, Shibata T, Togashi K. Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases. European Radiology 2010; 20:2690-8. doi: 10.1007/s00330.010.1842-3
26. Colagrande S, Castellani A, Nardi C, Lorini C, Calistri L, Filippone A. The role of diffusion-weighted imaging in the detection of hepatic metastases from colorectalcancer: A comparison with unenhanced and Gd-EOB-DTPA enhanced MRI. Eur J Radiol 2016; 85:1027-34. doi: 10.1016/j. ejrad.2016.02.011
27. Kim YK, Lee YH, Kwak HS, Kim CS, Han YM. Detection of liver metastases: gadoxetic acid-enhanced three-dimensionalMRimaging versus ferucarbotranenhanced MR imaging. Eur J Radiol 2010; 73:131-6. doi: 10.1016/j. ejrad.2008.09.027
28. Zech CJ, Grazioli L, Jonas E. Health-economic evaluation of three imaging strategies in patients with suspected colorectal liver metastases: Gd-EOB-DTPA-enhanced MRI vs. extracellular contrast media-enhanced MRI and 3-phase MDCT in Germany, Italy and Sweden. Eur Radiol 2009; 19:753-63. doi: 10.1007/s00330.009.1432-4
29. Hardie AD, Naik M, Hecht EM, et al. Diagnosis of liver metastases: value of diffusion-weighted MRI compared with gadolinium-enhanced MRI. Eur Radiol 2010; 20:1431-41. doi: 10.1007/s00330.009.1695-9
30. Donati OF, Fischer MA, Chuck N, Hunziker R, Weishaupt D, Reiner CS. Accuracy and confidence of Gd-EOB-DTPA enhanced MRI and diffusion-weighted imaging aloneand in combination for the diagnosis of liver metastases. Eur Radiol 2013; 82:822-8. doi: 10.1016/j.ejrad.2012.12.005
31. Roux M, Pigneur F, Calderaro J, et al. Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI. J Magn Reson Imaging 2015; 42:1249-58. doi: 10.1002/jmri.24897
32. Fowler KJ, Brown JJ, Narra VR. Magnetic resonance imaging of focal liver lesions: approach to imaging diagnosis. Hepatology 2011; 54:2227-37. doi: 10.1002/hep.24679