Added Value of Diffusion-Weighted MRI for Evaluating Viable Tumor of Hepatocellular Carcinomas Treated With Radiotherapy in Patients With Chronic Liver Disease

Abstract

The purpose of this article is to evaluate the added value of diffusion-weighted imaging (DWI) to the diagnostic performance of conventional MRI in diagnosing viable hepatocellular carcinoma (HCC) tumors treated with radiotherapy in patients with chronic liver disease. Twenty-nine patients with viable tumor and 35 patients without viable tumor were enrolled. We assessed the signal intensity of viable tumor compared with irradiated liver on MRI and DWI. Signal intensity ratios and apparent diffusion coefficient (ADC) ratios of viable tumor to nonirradiated liver were also assessed on DWI with ADC maps. Two observers reviewed conventional MRI and combined MRI and DWI and rated them using a 5-point scale. Diagnostic performance was evaluated using a receiver operating characteristic (ROC) curve. Viable tumors showed hyperintensity on T2-weighted and arterial phase images (16/29 [55.2%]) and hypointensity on portal (22/29 [75.9%]), 3-minute late (19/29 [65.5%]), and hepatobiliary phase (23/29 [79.3%]) images. Twenty-seven (93.1%) viable tumors showed hyperintensity on DWI and hypointensity on ADC maps. Mean signal intensity ratios and ADC ratios of viable tumor on DWI with ADC maps were significantly higher and lower than those of irradiated liver. Diagnostic performance (area under the ROC curve) improved significantly after adding DWI, and interobserver agreement was moderate for conventional MRI (κ = 0.450) and good after adding DWI (κ = 0.748). Adding DWI to conventional MRI can improve the detection of viable HCC tumors treated with radiotherapy compared to conventional MRI alone.