OJRad  Vol.4 No.1 , March 2014
Diffusion-Weighted MR Imaging of the Benign Hepatic Focal Lesions
ABSTRACT

Purpose: To determine the role of diffusion weighted MR imaging and apparent diffusion coefficient (ADC) in benign hepatic focal lesions. Method and Materials: This study included 47 patients (29 M, 18 F with mean age of 43 years) with benign hepatic focal lesions. They were cyst (n = 8), hemangioma (n = 23), abscess (n = 5), adenoma (n = 5), focal nodular hyperplasia (n = 4) and nodular regenerative hyperplasia (n = 2). They underwent routine MR imaging and diffusion MR weighted imaging using 1.5 tesla MR unit (Symphony-Siemens). Diffusion MR imaging was done using spin echo type of single shot echo planar imaging (EPI) with b value of 0, 500 & 1000 sec/mm2. The apparent diffusion coefficient (ADC) map was reconstructed and ADC value was measured. The mean ADC values correlated with histo-pathological results as well as follow-up imaging results. Results: Adequate ADC maps were obtained in 47 patients. The mean ADC values were 3.4 ± 0.12 × 10-3 mm2/sec in cystic lesion, 2.23 ± 0.08 × 10-3 mm2/sec in hemangioma, 1.94 ± 0.05 × 10-3 mm2/sec in abscess, 1.72 ± 0.07 × 10-3 in focal nodular hyperplasia, 1.65 ± 0.06 × 10-3 mm2/sec in adenoma, 1.62 ± 0.07 × 10-3 mm2/sec in nodular regenerative hyperplasia. The mean ADC values were significantly different within benign hepatic focal lesions (P < 0.001). The differences between the mean ADC values of FNH, adenoma and NRH were not statistically significant (P < 0.23). Conclusion: Diffusion weighted MR imaging is a new imaging modality for diagnosis and characterization of different benign hepatic focal lesions, particularly in patient with renal dysfunction.


Cite this paper
El-Badrawy, A. , Ashmallah, G. , Tawfik, A. , Abdelfattah, S. , Salah-Eldin, M. , Azmy, E. , El-Karef, A. , Salem, G. and Farouk, O. (2014) Diffusion-Weighted MR Imaging of the Benign Hepatic Focal Lesions. Open Journal of Radiology, 4, 136-143. doi: 10.4236/ojrad.2014.41018.
References
[1]   Koh, D.M. and Collins, D.J. (2007) Diffusion-Weighted MRI in the Body: Applications and Challenges in Oncology. American Journal of Roentgenology, 188, 1622-1635.
http://dx.doi.org/10.2214/AJR.06.1403

[2]   Taouli, B. and Koh, D.M. (2010) Diffusion-Weighted MR Imaging of the Liver. Radiology, 254, 47-66.
http://dx.doi.org/10.1148/radiol.09090021

[3]   Koike, N., Cho, A., Nasu, K., Seto, K., Nagaya, S., Ohshima, Y. and Ohkohchi, N. (2009) Role of Diffusion-Weighted Magnetic Resonance Imaging in the Differential Diagnosis of Focal Hepatic Lesions. World Journal of Gastroenterology, 15, 5805-5812. http://dx.doi.org/10.3748/wjg.15.5805

[4]   Maksimovic, R.M., Dunjic, M.S., Lilic, G.B., Milenkovic, R.M., Masulovic, D.M. and Milicevic, M. (2009) Diagnostic Value of Diffusion Weighted Imaging in Assessment of Malignant Focal Liver Lesions. Acta Chirurgica Iugoslavica, 56, 121-125. http://dx.doi.org/10.2298/ACI0904121M

[5]   Kandpal, H., Sharma, R., Madhusudhan, K.S. and Kapoor, K.S. (2009) Respiratory-Triggered versus Breath-Hold Diffusion-Weighted MRI of Liver Lesions: Comparison of Image Quality and Apparent Diffusion Coefficient Values. American Journal of Roentgenology, 192, 915-922.
http://dx.doi.org/10.2214/AJR.08.1260

[6]   Gourtsoyianni, S., Papanikolaou, N., Yarmenitis, S., Maris, T., Karantanas, A. and Gourtsoyiannis, N. (2008) Respiratory Gated Diffusion-Weighted Imaging of the Liver: Value of Apparent Diffusion Coefficient Measurements in the Differentiation between Most Commonly Encountered Benign and Malignant Focal Liver Lesions. European Radiology, 18, 486-492. http://dx.doi.org/10.1007/s00330-007-0798-4

[7]   Oner, A.Y., Celik, H., Oktar, S.O. and Tali, T. (2006) Single Breath-Hold Diffusion-Weighted MRI of the Liver with Parallel Imaging: Initial Experience. Clinical Radiology, 61, 959-965. http://dx.doi.org/10.1016/j.crad.2006.06.014

[8]   Bruegel, M., Holzapfel, K., Gaa, J., Bruegel, M., Holzapfel, K., Gaa, J., Woertler, K., Waldt, S., Kiefer, B., Stemmer, A., Ganter, C. and Rummeny, E.J. (2008) Characterization of Focal Liver Lesions by ADC Measurements Using a Respiratory Triggered Diffusion-Weighted Single-Shot Echo-Planar MR Imaging Technique. European Radiology, 18, 477-485. http://dx.doi.org/10.1007/s00330-007-0785-9

[9]   Holzapfel, K., Bruegel, M., Eiber, M., Ganter, C., Schuster, T., Heinrich, P., Rummeny, E.J. and Gaa, J. (2009) Characterization of Small (http://dx.doi.org/10.1016/j.ejrad.2009.05.014

[10]   Parikh, T., Drew, S.J., Lee, V.S., Wong, S., Hecht, E.M., Babb, J.S. and Taouli, B. (2008) Focal Liver Lesion Detection and Characterization with Diffusion Weighted MR Imaging: Comparison with Standard Breath-Hold T2-Weighted Imaging. Radiology, 246, 812-822. http://dx.doi.org/10.1148/radiol.2463070432

[11]   Taouli, B., Vilgrain, V., Dumont, E., Daire, J.L., Fan, B. and Menu, Y. (2003) Evaluation of Liver Diffusion Isotropy and Characterization of Focal Hepatic Lesions with Two Single-Shot Echo-Planar MR Imaging Sequences: Prospective Study in 66 Patients. Radiology, 226, 71-78.
http://dx.doi.org/10.1148/radiol.2261011904

[12]   Miller, F.H., Hammond, N., Siddiqi, A.J., Shroff, S., Khatri, G., Wang, Y., Merrick, L.B. and Nikolaidis, P. (2010) Utility of Diffusion-Weighted MRI in Distinguishing Benign and Malignant Hepatic Lesions. Journal of Magnetic Resonance Imaging, 32, 138-147. http://dx.doi.org/10.1002/jmri.22235

[13]   Le Bihan, D. (1995) Molecular Diffusion, Tissue Microdynamics and Microstructure. NMR in Biomedicine, 8, 375386. http://dx.doi.org/10.1002/nbm.1940080711

[14]   Türkbey, B., Aras, O., Karabulut, N., Turgut, A.T., Akpinar, E., Alibek, S., Pang, Y., Ertürk, S.M., El Khouli, R.H., Bluemke, D.A. and Choyke, P.L. (2012) Diffusion-Weighted MRI for Detecting and Monitoring Cancer: A Review of Current Applications in Body Imaging. Diagnostic and Interventional Radiology, 18, 46-59.

[15]   Qayyum, A. (2009) Diffusion-Weighted Imaging in the Abdomen and Pelvis: Concepts and Applications. Radiographics, 29, 1797-1810. http://dx.doi.org/10.1148/rg.296095521

[16]   Sun, X.J., Quan, X.Y., Huang, F.H. and Xu, Y.K. (2005) Quantitative Evaluation of Diffusion-Weighted Magnetic Resonance Imaging of Focal Hepatic Lesions. Hepatobiliary and Pancreatic Disease International, 11, 6535-6537.

[17]   Herneth, A.M., Guccione, S. and Bednarski, M. (2003) Apparent Diffusion Coefficient: A Quantitative Parameter for in Vivo Tumor Characterization. European Journal of Radiology, 45, 208-213.
http://dx.doi.org/10.1016/S0720-048X(02)00310-8

[18]   Kele, P.G. and van der Jagt, E.J. (2010) Diffusion Weighted Imaging in the Liver. World Journal of Gastroenterology, 16, 1567-1576. http://dx.doi.org/10.3748/wjg.v16.i13.1567

[19]   Yamada, I., Aung, W., Himeno, Y., Nakagawa, T. and Shibuya, H. (1999) Diffusion Coefficients in Abdominal Organs and Hepatic Lesions: Evaluation with Intravoxel Incoherent Motion Echo-Planar MR Imaging. Radiology, 210, 617623. http://dx.doi.org/10.1148/radiology.210.3.r99fe17617

[20]   Yoshikawa, T., Kawamitsu, H. and Mitchell, D.G. (2006) ADC Measurement of Abdominal Organs and Lesions Using Parallel Imaging Technique. American Journal of Roentgenology, 187, 1521-1530.
http://dx.doi.org/10.2214/AJR.05.0778

[21]   Moteki, T. and Horikoshi, H. (2006) Evaluation of Hepatic Lesions and Hepatic Parenchyma Using DiffusionWeighted Echo-Planar MR with Three Values of Gradient b-Factor. Journal of Magnetic Resonance Imaging, 24, 637645. http://dx.doi.org/10.1002/jmri.20682

[22]   Quan, X.Y., Sun, X.J., Yu, Z.J. and Tang, M. (2005) Evaluation of Diffusion Weighted Imaging of Magnetic Resonance Imaging in Small Focal Hepatic Lesions: A Quantitative Study in 56 Cases. Hepatobiliary & Pancreatic Diseases International, 4, 406-409.

[23]   Inan, N., Kilinc, F., Sarisoy, T., Gumustas, S., Akansel, G. and Demirci, A. (2010) Diffusion Weighted MR Imaging in the Differential Diagnosis of Haemangiomas and Metastases of the Liver. Radiology and Oncology, 44, 24-29.
http://dx.doi.org/10.2478/v10019-010-0001-4

[24]   Goshima, S., Kanematsu, M., Kondo, H., Yokoyama, R., Kajita, K., Tsuge, Y., Watanabe, H., Shiratori, Y., Onozuka, M. and Moriyama, N. (2008) Diffusion-Weighted Imaging of the Liver: Optimizing b Value for the Detection and Characterization of Benign and Malignant Hepatic Lesions. Journal of Magnetic Resonance Imaging, 28, 691-697.
http://dx.doi.org/10.1002/jmri.21467

[25]   Desprechins, B., Stadnik, T., Koerts, G., Shabana, W., Breucq, C. and Osteaux, M. (1999) Use of Diffusion-Weighted MR Imaging in Differential Diagnosis between Intracerebral Necrotic Tumors and Cerebral Abscesses. American Journal of Neuroradiology, 20, 1252-1257.

[26]   Lyng, H., Haraldseth, O. and Rofstad, E.K. (2000) Measurement of Cell Density and Necrotic Fraction in Human Melanoma Xenografts by Diffusion Weighted Magnetic Resonance Imaging. Magnetic Resonance in Medicine, 43, 828836. http://dx.doi.org/10.1002/1522-2594(200006)43:6<828::AID-MRM8>3.0.CO;2-P

[27]   Feuerlein, S., Pauls, S., Juchems, M.S., Stuber, T., Hoffmann, M.H.K., Brambs, H.J. and Ernst, A.S. (2009) Pitfalls in Abdominal Diffusion-Weighted Imaging: How Predictive Is Restricted Water Diffusion for Malignancy. American Journal of Roentgenology, 194, 1070-1076.
http://dx.doi.org/10.2214/AJR.08.2093

[28]   Agnello, F., Ronot, M., Valla, D.C., Sinkus, R., Van Beers, B.E. and Vilgrain, V. (2012) High-b-Value DiffusionWeighted MR Imaging of Benign Hepatocellular Lesions: Quantitative and Qualitative Analysis. Radiology, 262, 511519. http://dx.doi.org/10.1148/radiol.11110922

[29]   Humphries, P.D., Sebire, N.J., Siegel, M.J. and Olsen, O.E. (2007) Tumors in Pediatric Patients at Diffusion Weighted MR Imaging: Apparent Diffusion Coefficient and Tumor Cellularity. Radiology, 245, 848-854.
http://dx.doi.org/10.1148/radiol.2452061535

 
 
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