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

• Published in: PloS one Vol. 16; no. 2; p. e0247301
• Main Authors: Kovač, Jelena Djokić, Daković, Marko, Janković, Aleksandra, Mitrović, Milica, Dugalić, Vladimir, Galun, Daniel, Đurić-Stefanović, Aleksandra, Mašulović, Dragan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.02.2021; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Biopsy; Cancer; Cholangiocarcinoma; Cysts; Diagnosis; Diagnostic imaging; Diffusion; Diffusion coefficient; Growth patterns; Lesions; Liver; Liver diseases; Magnetic resonance imaging; Medicine; Medicine and Health Sciences; Metastases; Metastasis; Methods; Parameters; Patients; Physical Sciences; Quantitative analysis; Research and Analysis Methods; Tumors; Serbia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0247301

The utility of intravoxel incoherent motion (IVIM) related parameters in differentiation of hypovascular liver lesions is still unknown. 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). Seventy-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. The 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). IVIM-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.