Original Research

Utility of volumetric contrast-enhanced and diffusion-weighted MRI in differentiating between common primary hypervascular liver tumors

Manijeh Zarghampour MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Daniel F. Fouladi MD,

Daniel F. Fouladi MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Ankur Pandey MD,

Ankur Pandey MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Mounes Aliyari Ghasabeh MD,

Mounes Aliyari Ghasabeh MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Pallavi Pandey MD,

Pallavi Pandey MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Farnaz Najmi Varzaneh MD,

Farnaz Najmi Varzaneh MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Pegah Khoshpouri MD,

Pegah Khoshpouri MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Nannan Shao MD,

Nannan Shao MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Li Pan PhD,

Li Pan PhD

Siemens Healthcare, Baltimore, Maryland, USA

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Robert Grimm PhD,

Robert Grimm PhD

Siemens Healthcare, Erlangen, Germany

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Ihab R. Kamel MD, PhD,

Corresponding Author

Ihab R. Kamel MD, PhD

[email protected]

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Address reprint requests to: I.R.K., Clinical Director, MRI, Professor of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, MRI 143, Baltimore, MD 21287. E-mail: [email protected]Search for more papers by this author

Manijeh Zarghampour MD,

Manijeh Zarghampour MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Daniel F. Fouladi MD,

Daniel F. Fouladi MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Ankur Pandey MD,

Ankur Pandey MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Mounes Aliyari Ghasabeh MD,

Mounes Aliyari Ghasabeh MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Search for more papers by this author

Pallavi Pandey MD,

Pallavi Pandey MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Farnaz Najmi Varzaneh MD,

Farnaz Najmi Varzaneh MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Search for more papers by this author

Pegah Khoshpouri MD,

Pegah Khoshpouri MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Nannan Shao MD,

Nannan Shao MD

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Li Pan PhD,

Li Pan PhD

Siemens Healthcare, Baltimore, Maryland, USA

Search for more papers by this author

Robert Grimm PhD,

Robert Grimm PhD

Siemens Healthcare, Erlangen, Germany

Search for more papers by this author

Ihab R. Kamel MD, PhD,

Corresponding Author

Ihab R. Kamel MD, PhD

[email protected]

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

First published: 06 April 2018

https://doi.org/10.1002/jmri.26032

Citations: 21

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Abstract

Background

Differentiating between hepatocellular carcinoma (HCC), focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) is usually achievable by MRI. However, in some cases with atypical imaging findings accurate diagnosis may be difficult.

Purpose

To assess the diagnostic value of volumetric contrast-enhanced (CE) and volumetric diffusion-weighted imaging (DWI) in differentiating between HCC, FNH, and HCA.

Study Type

Retrospective.

Subjects

In all, 143 patients (206 lesions): 42 HCA (81 lesions), 51 FNH (65 lesions), and 50 HCC (60 lesions).

Field Strength/sequence

1.5T MRI, T₁-T₂WI, DWI.

Assessment

Patients underwent CE-MRI and DWI (b = 0, 750 mm²/s). Volumetric assessment of lesions' contrast enhancement and apparent diffusion coefficient (ADC) was performed with semiautomatic software after 3D image registration and segmentation by an observer and compared between three lesion groups. The diagnosis of lesions was based on histopathology, typical MRI findings, and/or follow-up.

Statistical Tests

Independent t-test was used to compare parameters between two groups, one-way analysis of variance (ANOVA) between three groups, and receiver operator characteristic curve (ROC) analysis to define under-curve area and optimal cutoff.

Results

Mean values (±standard deviation) for HCC, FNH, and HCA, respectively, were: 1) arterial enhancement (%), 40.5 ± 13.2, 88.6 ± 32.6, 69.6 ± 25.1; 2) venous enhancement (%) 72.4 ± 22.1, 95.2 ± 30.9, 80.7 ± 30.6; and 3) ADC (10⁻⁶ mm²/s) 1404.5 ± 168.1, 1413.4 ± 232.1, 1070.1 ± 232.1. ADC was the best differentiator of HCA from FNH (at 1211 × 10⁻⁶ mm²/s; sensitivity 80.4%, specificity 71.7%) and arterial enhancement was the best differentiator of HCC from both HCA (at 48%; sensitivity 80.0%, specificity 80.5%) and FNH (at 52%; sensitivity 85.7%, specificity 85.4%). A combination of arterial enhancement and ADC (at 50% and 1227 × 10⁻⁶ mm²/s) differentiated three types of tumors with high specificity (87.9%).

Data Conclusion

Volumetric CE-MRI and volumetric DWI can help to differentiate between HCC, FNH, and HCA.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018;48:1080–1090.

Conflict of Interest

There is no conflict of interest or industry support for this project. No funding was provided from Siemens for this particular project

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Citing Literature

Volume48, Issue4

October 2018

Pages 1080-1090

Utility of volumetric contrast-enhanced and diffusion-weighted MRI in differentiating between common primary hypervascular liver tumors

Abstract

Background

Purpose

Study Type

Subjects

Field Strength/sequence

Assessment

Statistical Tests

Results

Data Conclusion

Conflict of Interest

References

Citing Literature

References

Information

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Utility of volumetric contrast-enhanced and diffusion-weighted MRI in differentiating between common primary hypervascular liver tumors

Abstract

Background

Purpose

Study Type

Subjects

Field Strength/sequence

Assessment

Statistical Tests

Results

Data Conclusion

Conflict of Interest

References

Citing Literature

References

Related

Information