Diffusion weighted imaging of liver lesions suspect for metastases: Apparent diffusion coefficient (ADC) values and lesion contrast are independent from Gd-EOB-DTPA administration

Abstract

PurposeGadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced liver MRI is widely used for detection and differentiation of focal liver lesions. Diffusion weighted imaging (DWI) including apparent diffusion coefficient (ADC) measurements is increasingly utilised as a fast and, with limitations, quantitative method for liver lesion detection and characterisation. Herein we investigate whether the administration of Gd-EOB-DTPA affects DWI. Materials and methods31 consecutive patients referred to standardised liver MRI (1.5T, Gd-EOB-DTPA, 0.025mmol/kg) were retrospectively reviewed. All underwent a breathhold DWI sequence before and after contrast agent administration (EPI-DWI, TR/TE (effective): 2100/62ms, b-values: 0 and 800s/mm2). Patients with previously treated liver lesions were excluded. Signal intensity of lesion, parenchyma and noise on DWI images as well as the ADC value were measured after identification by two observers in consensus using manually placed regions of interest. The reference standard was imaging follow-up determined separately by two radiologists. Data analysis included signal-to-noise (SNR) ratio and contrast-to-noise ratio (CNR) calculations, comparisons were drawn by employing multiple Bonferroni corrected Wilcoxon signed-rank tests. Results50 malignant and 39 benign lesions were identified. Neither SNR, CNR nor ADC values showed significant differences between pre- and postcontrast DWI. Both pre- and postcontrast ADC values differed significantly between benign and malignant lesions (P<0.001). ConclusionWe did not identify a significant influence of Gd-EOB-DTPA on DWI of liver lesions. This allows for individual tailoring of imaging protocols according to clinical needs.