Abstract
BackgroundTo investigate the added diagnostic value of diffusion-weighted imaging (DWI) of the liver and its impact on therapy decisions in patients with hepatic malignancy.MethodsInterdisciplinary gastrointestinal tumorboard cases concerning patients with hepatic malignancies discussed between 11/2015 and 06/2016 were included in this retrospective, single-center study. Two radiologists independently reviewed the respective liver MR-examination first without, then with DWI. The readers were blinded regarding number, position and size of hepatic malignancies. Cases in which DWI revealed additional findings concerning the hepatic tumor status as compared to conventional sequences alone were presented to experienced members of the interdisciplinary tumor board. In this retrospective setting changes in treatment decisions based on these additional findings in the DWI sequences were recorded.ResultsA total of 87 patients were included. DWI revealed additional findings in 12 patients (13,8%). These new findings had a direct effect on the therapy in 8 patients (9,2%): In 6 patients (6,9%) the surgical/interventional treatment was adapted (n = 5: extended resection, n = 1: with transarterial chemoembolization of a single hepatocellular carcinoma only detectable in DWI); 2 patients (2,3%) received systemic therapy (n = 1: neo-adjuvant, n = 1: palliative) based on the additional findings in DWI. In 4 patients (4.6%) additional DWI findings did not affect the therapeutic decision.ConclusionsDWI is a relevant diagnostic tool in oncologic imaging of the liver. By providing further information regarding tumor load in hepatic malignancies it can lead to a significant change in treatment.
Highlights
To investigate the added diagnostic value of diffusion-weighted imaging (DWI) of the liver and its impact on therapy decisions in patients with hepatic malignancy
As DWI has become an integral part of our daily imaging routine and a reliable diagnostic tool, this subject appears to be of major importance
MR imaging protocol Institutional standard imaging protocols consisted of the following sequences: coronal T2-weighted half acquisition single shot turbo spin echo (HASTE), axial T2-weighted turbo spin echo sequence (TSE) and spectral fat saturation pulse (SPIR) for fat suppression, axial T1 in- and opposedphase, axial echo planar imaging (EPI) for diffusionweighted imaging with b-values of 0, 400 and 800 s/ mm2 and dynamic axial T1-weighted volumetric interpolated breath-hold examination (VIBE) sequence with fat saturation using the Dixon technique [10] after intravenous injection of 0.1 mmol of gadobutrol (Gadovist, Bayer HealthCare, Leverkusen, Germany) per kg body weight or 0.025 mmol of gadoxetate disodium (Primovist, Bayer HealthCare) per kg body weight
Summary
To investigate the added diagnostic value of diffusion-weighted imaging (DWI) of the liver and its impact on therapy decisions in patients with hepatic malignancy. Several studies have assessed the diagnostic accuracy of DWI for the detection of intrahepatic lesions. A study evaluating the impact and added value of diffusion-weighted imaging on therapeutic decision making and, its direct impact on patient care has not yet been performed. As DWI has become an integral part of our daily imaging routine and a reliable diagnostic tool, this subject appears to be of major importance. Aim of our investigation was to quantify the additional information gained through the performance of DWI in oncologic imaging of the liver and evaluate its clinical impact on patient management and therapeutic options
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