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      Diffusion weighted MR imaging in the differential diagnosis of haemangiomas and metastases of the liver

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          Abstract

          Background

          The purpose of the study was to evaluate the value of diffusion-weighted imaging in the differential diagnosis of haemangiomas from metastases of the liver.

          Patients and methods.

          We analyzed 69 lesions in 38 patients (33 haemangiomas; 36 metastases) in the retrospective study. Diffusion-weighted imaging was performed using a breath-hold single-shot echo-planar spin echo sequence with three b factors (0, 500 and 1000 sec/mm 2), and apparent diffusion coefficients (ADCs) were calculated. For the quantitative evaluation, signal intensity of the lesions, lesion-to-liver signal intensity ratios, ADC of the lesions, and lesion-to-liver ADC ratios were compared between the groups. The statistical significance was determined by student’s-t test.

          Results

          With the b factor 500 sec/mm 2, no statistical significance was achieved (p>0.05). With the b factor of 1000 sec/mm 2, both the signal intensity and lesion-to-liver signal intensity ratio of the metastases were significantly higher than those for haemangiomas (p<0.001). The cut-off value at 2.6 yielded a sensitivity of 86% and a specificity of 82% for the lesion-to-liver signal intensity ratio. The ADC, and lesion-to-liver ADC ratio of the metastases were significantly lower than those of haemangiomas (p<0.001). With cut-off value of 1.7, ADC ratio had a sensitivity of 88% and a specificity of 72% for ADC lesion/liver.

          Conclusions

          Diffusion-weighted imaging with high b value may help in the differential diagnosis of metastases from haemangiomas of the liver.

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          Most cited references24

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          ROC methodology in radiologic imaging.

          David Metz (1986)
          If the performance of a diagnostic imaging system is to be evaluated objectively and meaningfully, one must compare radiologists' image-based diagnoses with actual states of disease and health in a way that distinguishes between the inherent diagnostic capacity of the radiologists' interpretations of the images, and any tendencies to "under-read" or "over-read". ROC methodology provides the only known basis for distinguishing between these two aspects of diagnostic performance. After identifying the fundamental issues that motivate ROC analysis, this article develops ROC concepts in an intuitive way. The requirements of a valid ROC study and practical techniques for ROC data collection and data analysis are sketched briefly. A survey of the radiologic literature indicates the broad variety of evaluation studies in which ROC analysis has been employed.
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            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.

            To (a) evaluate liver diffusion isotropy, (b) compare two diffusion-weighted magnetic resonance (MR) imaging sequences for the characterization of focal hepatic lesions by using two or four b values, and (c) determine an apparent diffusion coefficient (ADC) threshold value to differentiate benign from malignant lesions. Sixty-six patients were examined with two single-shot echo-planar diffusion-weighted MR sequences. In the first sequence, liver diffusion isotropy was evaluated by using diffusion gradients in three directions with two b values. In the second sequence, a unidirectional diffusion gradient was used with four b values. ADCs were measured in 43 patients with 52 focal hepatic lesions more than 1 cm in diameter and in 23 patients with 14 normal and nine cirrhotic livers and were compared by using nonparametric tests. Diffusion in the liver parenchyma was isotropic. ADCs of focal hepatic lesions were significantly different between sequences (P <.01). The mean (+/- SD) ADCs in the first sequence were 0.94 x 10(-3) mm(2)/sec +/- 0.60 for metastases, 1.33 x 10(-3) mm(2)/sec +/- 0.13 for HCCs, 1.75 x 10(-3) mm(2)/sec +/- 0.46 for benign hepatocellular lesions, 2.95 x 10(-3) mm(2)/sec +/- 0.67 for hemangiomas, and 3.63 x 10(-3) mm(2)/sec +/- 0.56 for cysts. There was a significant difference between benign (2.45 x 10(-3) mm(2)/sec +/- 0.96, isotropic value) and malignant (1.08 x 10(-3) mm(2)/sec +/- 0.50) lesions (P <.01 for both sequences). Diffusion-weighted MR imaging can help differentiate benign from malignant hepatic lesions. The use of two b values in one direction could be sufficient for the design of MR sequences in the liver. Copyright RSNA, 2002
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              Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging.

              To determine the true diffusion coefficients of abdominal organs and hepatic lesions with intravoxel incoherent motion (IVIM) echo-planar magnetic resonance (MR) imaging. Seventy-eight patients suspected of having hepatic lesions were examined with IVIM echo-planar MR imaging at 1.5 T. There were 77 hepatic masses (27 hepatocellular carcinomas, 10 metastatic tumors, eight hemangiomas, and 32 cysts) in the 78 patients. The true diffusion coefficient D and the perfusion fraction f were calculated and compared with the apparent diffusion coefficient (ADC). Specific values of D were found for abdominal organs (liver, 0.72 x 10(-3) mm2/sec; spleen, 0.80 x 10(-3) mm2/sec; kidney, 1.38 x 10(-3) mm2/sec; gallbladder, 2.82 x 10(-3) mm2/sec) and for hepatic lesions (hepatocellular carcinoma, 1.02 x 10(-3) mm2/sec; metastasis, 1.16 x 10(-3) mm2/sec; hemangioma, 1.31 x 10(-3) mm2/sec; cysts, 3.03 x 10(-3) mm2/sec). The ADCs of solid organs and solid lesions were significantly higher than their D values, indicating a high contribution of perfusion to the ADCs. Perfusion contributes to the ADCs of abdominal organs and hepatic lesions. The D and f values are useful for the characterization of hepatic lesions.
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                Author and article information

                Journal
                Radiol Oncol
                Radiol Oncol
                RADO
                Radiology and Oncology
                Versita, Warsaw
                1318-2099
                1581-3207
                March 2010
                18 March 2010
                March 2010
                : 44
                : 1
                : 24-29
                Affiliations
                Department of Radiology, University of Kocaeli, Kocaeli, Turkey
                Author notes
                Correspondence to: Assist. Prof. Nagihan İnan, MD, PhD, Department of Radiology, University of Kocaeli, Tip Fak, Radyoloji AD, 41380 Umuttepe, Kocaeli, Turkey. Phone: +90 262 3037242; Fax: +90 26203038003; E-mail: inannagihan@ 123456ekolay.net

                Disclosure: No potential conflicts of interest were disclosed.

                Article
                rado-44-01-24
                10.2478/v10019-010-0001-4
                3423674
                22933887
                031a94c5-c9d0-44f6-bdd8-7e767c3b1601
                Copyright © by Association of Radiology & Oncology

                This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 5 August 2009
                : 5 September 2009
                Categories
                Research Article

                Oncology & Radiotherapy
                liver,diffusion-weighted imaging, apparent diffusion coefficient,magnetic resonance imaging,haemangioma,metastasis

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