Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver.

Ozlem Tokgoz,Ilker Oz,Ebru Unlu,Ilker Unal,Elif Aktas,Emrah Caglar,Ismail Serifoglu

doi:10.4314/ahs.v16i1.30

Ozlem Tokgoz, Ilker Oz + Show 5 more

Open Access

https://doi.org/10.4314/ahs.v16i1.30

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Abstract

To investigate the use of diffusion weighted magnetic resonance imaging (DWI) and the apparent diffusion coefficient (ADC) values in the diagnosis of hemangioma. The study population consisted of 72 patients with liver masses larger than 1 cm (72 focal lesions). DWI examination with a b value of 600 s/mm2 was carried out for all patients. After DWI examination, an ADC map was created and ADC values were measured for 72 liver masses and normal liver tissue (control group). The average ADC values of normal liver tissue and focal liver lesions, the "cut-off" ADC values, and the diagnostic sensitivity and specificity of the ADC map in diagnosing hemangioma, benign and malignant lesions were researched. Of the 72 liver masses, 51 were benign and 21 were malignant. Benign lesions comprised 38 hemangiomas and 13 simple cysts. Malignant lesions comprised 9 hepatocellular carcinomas, and 12 metastases. The highest ADC values were measured for cysts (3.782±0.53×10(-3) mm(2)/s) and hemangiomas (2.705±0.63×10(-3) mm(2)/s). The average ADC value of hemangiomas was significantly higher than malignant lesions and the normal control group (p<0.001). The average ADC value of cysts were significantly higher when compared to hemangiomas and normal control group (p<0.001). To distinguish hemangiomas from malignant liver lesions, the "cut-off" ADC value of 1.800×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 90.9%. To distinguish hemangioma from normal liver parenchyma the "cut-off" value of 1.858×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 95.7%. To distinguish benign liver lesions from malignant liver lesions the "cut-off" value of 1.800×10(-3) mm(2)/s had a sensitivity of 96.1% and a specificity of 90.0%. DWI and quantitative measurement of ADC values can be used in differential diagnosis of benign and malignant liver lesions and also in the diagnosis and differentiation of hemangiomas. When dynamic examination cannot distinguish cases with vascular metastasis and lesions from hemangioma, DWI and ADC values can be useful in the primary diagnosis and differential diagnosis. The technique does not require contrast material, so it can safely be used in patients with renal failure.

Highlights

Diffusion weighted magnetic resonance imaging (DWI) measures the random movement of water molecules in the tissues
Distinguishing hemangioma from malignant liver lesions, the “cut-off ” apparent diffusion coefficient (ADC) value of 1.800×10-3 mm2/s had a sensitivity of 97.4% and a specificity of 90.9% (Table 2, Fig. 1)
DWI and quantitative measurement of ADC values can be used in differential diagnosis of benign and malignant liver lesions

Summary

Introduction

Diffusion weighted magnetic resonance imaging (DWI) measures the random movement of water molecules in the tissues. These studies calculated the apparent diffusion coefficient of tissue and lesions from diffusion weighted images and have shown that the technique could be used. Quantitative evaluations were made on images showing the amount of diffusion of water molecules called ADC maps. As with solid lesions and abscess, while the cell density in the lesion increases, the diffusion becomes limited; so, cellular lesions on DWI with high b values (a factor indicating MR gradient strength and duration) (b=400-1000 s/mm2) gain a hyperintense signal property; showing low numeric values on the ADC map. As cell density decreases, such as in cysts, hemangiomas and necrotic lesions, diffusion is fast and high ADC values were found. Using high “b” values, DWI only reflects diffusion, low “b” value DWI is comprised of both diffusion and perfusion components[15]

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