Intravoxel incoherent motion (IVIM) in diffusion-weighted imaging (DWI) for Hepatocellular carcinoma: correlation with histologic grade.

Vincenza Granata,Antonella Petrillo,Mauro Piccirillo,Francesco Izzo,Raffaele Palaia,Francesco Granata,Orlando Catalano,Benedetta Guarino,Fabiana Tatangelo,Antonio Avallone,Roberta Fusco

doi:10.18632/oncotarget.12689

Abstract

PurposeTo assess the correlation between DWI diffusion parameters obtained using Intravoxel Incoherent Motion Method (IVIM) and histological grade of Hepatocellular carcinoma (HCC).ResultsAccording to Edmondson-Steiner grade lesions were classified with grade 1 (14), grade 2 (30), grade 3 (18), and grade 4 (0). Apparent Diffusion Coefficient (ADC), perfusion fraction (fp), tissue diffusion coefficient (Dt) median values were statistically different in HCC groups with 1, 2, 3 histological grade (p<0.001). A significant correlation was reported between ADC, fp, Dt and histologic grade respectively of 0.687, 0.737 and 0.674. Receiver operating characteristic (ROC) analysis demonstrated that an ADC of 2.11×10-3 mm2/sec, an fp of 47.33% and an Dt of 0.94×10-3 mm2/sec were the optimal cutoff values to differentiate high histological grade (3) versus low histological grade (1-2), with a sensitivity and specificity for ADC of 100% and 100%, for fp of 100% and 89%, for Dt of 100% and 74%, respectively.Material and MethodsA retrospective approved study was performed including 34 patients with 62 HCCs. IVIM was performed to obtain ADC, fp, pseudo-diffusion coefficient (Dp), Dt coefficients. Kruskal Wallis, Spearman Correlation Coefficient, ROC analysis were performed.ConclusionsADC and IVIM-derived fp showed significantly better diagnostic performance in differentiating high-grade from low-grade HCC, and significant correlation was observed between ADC, fp, Dt and histological grade.

Highlights

Hepatocellular carcinoma (HCC) is one of the most common human solid tumors worldwide [1, 2]
Apparent Diffusion Coefficient (ADC), perfusion fraction, tissue diffusion coefficient (Dt) median values were statistically different in HCC groups with 1, 2, 3 histological grade (p
Receiver operating characteristic (ROC) analysis demonstrated that an ADC of 2.11x10-3 mm2/sec, an fp of 47.33% and an Dt of 0.94x10-3 mm2/sec were the optimal cutoff values to differentiate high histological grade (3) versus low histological grade (1-2), with a sensitivity and specificity for ADC of 100% and 100%, for fp of 100% and 89%, for Dt of 100% and 74%, respectively

Summary

Introduction

Hepatocellular carcinoma (HCC) is one of the most common human solid tumors worldwide [1, 2]. The MRI is the technique which best suits to characterize and to follow HCC patients [4, 5], no agreement regarding the study protocol and the impact of Diffusion-weighted imaging (DWI) has been found. DWI is used to assess treatment response of liver lesions after neoadjuvant therapy [10] or ablative techniques [11]. Another interesting field is the correlation between the quantitative and semi-quantitative values of DWI with histological grade of the tumor, as was seen in bladder [12], endometrial [13], breast [14], and brain cancers [15]. Our purpose was to test if DWI and IVIM parameters could correlate with histological grade of HCC and became a prognostic imaging factors

Methods

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Conclusion