The Role of Diffusion Weighted MRI in the Differentiation between Benign and Malignant Hepatic Focal Lesion

Abstract

Background: early detection and diagnosis of hepatic focal lesions are an important step in clinical work, which would allow effective surgical or mini-invasive therapy. With the advances in magnetic resonance imaging (MR) technology, diffusion-weighted magnetic resonance imaging (DWI) is now widely used as a standard imaging sequence in clinical work and shows its potential benefit in evaluation of the focal hepatic lesions. Aim of the work: the use of MR Diffusion imaging with both low and high B values to detect and differentiate between benign and malignant hepatic focal lesion. Methodology: the present study included 30 patients. They were El-Demerdash hospital patients with hepatic focal lesions. Patients underwent US or CT before MR examination. Results: thirty patients were included in this study, 20 males and 10 females. The patient’s age was ranging from 33 to 60 years. There were 24 primary hepatic focal lesions, (36.7% HCC, 3.3% focal nodular hyperplasia, 3.3% cysts, 13.3% hemangiomas, 6.7% cholangiocarcinoma, 16.7% regeneration nodule) and 6 metastatic lesions. Conclusion: we hope to use DWI to be helpful in the characterization of focal liver lesions, especially if the lesions show non classic appearance of contrast enhancement in Triphasic CT study and in patients with renal insufficiency with inability to use contrast enhancement. Recommendations: in our opinion, DWI is a useful adjunct to routine liver imaging (i.e. used as an additional sequence to the standard protocol study and not as a unique imaging series); it is fast, requires no intravenous contrast and is non-invasive. The radiologist has to be aware of the potential pitfalls and limitations of the technique. In patients who cannot receive gadolinium-based contrast agents, DW MR imaging has the potential to be a reasonable alternative technique to contrast-enhanced imaging. We suggest the following strategy for evaluating DWI features of FLLs. We believe that most of the FLLs can be practically classified as benign or malignant by using this scheme.