The role of quantitative diffusion-weighted imaging in characterization of hypovascular liver lesions: A prospective comparison of intravoxel incoherent motion derived parameters and apparent diffusion coefficient.

Jelena Djokić Kovač,Vladimir Dugalić,Aleksandra Janković,Milica Mitrović,Daniel Galun,Aleksandra Đurić-Stefanović,Dragan Mašulović,Marko Daković,Gayle E Woloschak

doi:10.1371/journal.pone.0247301

Jelena Djokić Kovač, Vladimir Dugalić + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0247301

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Journal: PloS one	Publication Date: Feb 19, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: University of Belgrade, Centar za Promociju Nauke

Abstract

BackgroundThe utility of intravoxel incoherent motion (IVIM) related parameters in differentiation of hypovascular liver lesions is still unknown.PurposeThe purpose of this study was to evaluate the value of IVIM related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), and hypovascular liver metastases (HLM).MethodsSeventy-four prospectively enrolled patients (21 IMC, and 53 HLM) underwent 1.5T magnetic resonance examination with IVIM diffusion-weighted imaging using seven b values (0–800 s/mm2). Two independent readers performed quantitative analysis of IVIM-related parameters and ADC. Interobserver reliability was tested using a intraclass correlation coefficient. ADC, true diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (ƒ) were compared among the lesions using Kruskal-Wallis H test. The diagnostic accuracy of each parameter was assessed by receiver operating characteristic (ROC) curve analysis.ResultsThe interobserver agreement was good for ADC (0.802), and excellent for D, D*, and ƒ (0.911, 0.927, and 0.942, respectively). ADC, and D values were significantly different among IMC and HLM (both p < 0.05), while there was no significant difference among these lesions for ƒ and D* (p = 0.101, and p = 0.612, respectively). ROC analysis showed higher diagnostic performance of D in comparison to ADC (AUC = 0.879 vs 0.821).ConclusionIVIM-derived parameters in particular D, in addition to ADC, could help in differentiation between most common hypovascular malignant liver lesions, intrahepatic mass—forming cholangiocarcinoma and hypovascular liver metastases.

Highlights

Diffusion-weighted imaging (DWI) is increasingly used in everyday clinical magnetic resonance imaging (MRI) for focal liver lesions detection, characterization, and assessment of treatment response
The purpose of this study was to evaluate the value of intravoxel incoherent motion (IVIM) related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), and hypovascular liver metastases (HLM)
The interobserver agreement was good for ADC (0.802), and excellent for D, D*, and ƒ (0.911, 0.927, and 0.942, respectively)

Summary

Introduction

Diffusion-weighted imaging (DWI) is increasingly used in everyday clinical magnetic resonance imaging (MRI) for focal liver lesions detection, characterization, and assessment of treatment response. Many previous studies reported the utility of DWI in differentiation among malignant and benign liver lesions, the great overlap of ADC values limits its use in clinical practice [3,4]. Regarding the use of IVIM in the evaluation of focal liver lesions, previous studies mainly focused on differentiation of malignant from benign lesions [5,9,10,11,12]. The purpose of this study was to evaluate the value of IVIM related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), and hypovascular liver metastases (HLM)

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