Copyright ©The Author(s) 2017.
World J Hepatol. Sep 18, 2017; 9(26): 1081-1091
Published online Sep 18, 2017. doi: 10.4254/wjh.v9.i26.1081
Table 1 Comparison of SSEPI diffusion-weighted magnetic resonance imaging vs conventional magnetic resonance sequences for detection of hepatic metastases[15,20-22,27]
Ref.b value(s/mm2)Compared with (Seq)Sensitivity of DWI vs other sequencesAccuracy of DWI vs other sequencesAdvantages of DWI
Bruegel et al[27]50, 300, 6005 different T2-TSE (Turbo Spin Echo) sequences0.88-0.91 compared to 0.45-0.620.91-0.92 compared to 0.47-0.67Better sensitivity and accuracy
Zech et al[21]50Fat suppressed T2WI83% vs 61%-Better image quality
Fewer artifacts
Better sensitivity
Hardie et al[15]0, 50, 500Gadolinium enhanced T1WI66.3% vs 73.5%88.2% and 88.2% for DW-MRI, 90.2% and 92.2% for CE MRI, respectively, for observers 1 and 2Not significantly different
Donati et al[20]0, 150, 500Combined (Gd-EOB-DTPA) enhanced MRI/DWI vs Gd-EOB-DTPA enhanced MRI and DWI alone-Gd- EOB-DTPA/DWI: 0.84 and 0.83 vs 0.73 and 0.72 for DWI aloneIncrease in diagnostic confidence
No significant increase in diagnostic accuracy
Colagranade et al[22]0-500Added value of DWI for lesion detection in unenhanced and Gd-EOB-DTPA enhanced MRI-62.5% for unenhanced MRI w/o DWI-81.1% for unenhanced MRI w/o DWIDWI improved all statistical parameters in the unenhanced examinations, as for nodules either smaller or greater than 1 cm. In EOB-enhanced examinations DWI increased specificity/negative predictive value
-85.0% for unenhanced MRI+ DWI-89% for unenhanced MRI + DWI
-95.6% for CE MRI-92.9% for CEMRI
-97.3% for CE MRI + DWI-95.5% for CE MRI + DWI
Table 2 Liver lesion characterization based on ADC values[33,35,44,45,102]
Ref.Lesion typeMean ADC (10-3mm2/s)Sample sizeb-valuesConclusion
Parsai et al[44]Cyst2.662100, 200, 500, 750, and 1000 mm2/sADC cutoff value threshold of 1.6 × 10-3 mm2/s yielded higher accuracy for differentiating benign from malignant lesions. DWI is not reliable to differentiate malignant from benign solid lesions
Taouli et al[98]Cyst3.63520, 500Threshold ADC value of 1.5 × 10-3 mm2/s to differentiate between benign and malignant lesions, but with a significant overlap between benign hepatocellular lesions and HCCs
Parikh et al[35]Cyst2.542110, 50, 500Accuracy of 75.3% for differentiating benign from malignant, by using a threshold ADC of less than 1.60 × 10-3mm2/s . Equivalent performance of DW imaging and T2- weighted imaging for lesion characterization
Bruegel et al[33]Cyst3.0220450, 300, 60088% of lesions were correctly classified as benign or malignant using a threshold value of 1.63 × 10-3 mm2/s. Measurements of the ADCs of focal liver lesions on the basis of a respiratory triggered DW-SS-EPI sequence may constitute a useful supplementary method for lesion characterization
Gourtsoyianni et al[102]Cyst2.55370, 50, 500, 1000Sensitivity and specificity of 100% for differentiating benign from malignant lesions using a cutoff ADC value of 1.47 × 10-3 mm2/s
Table 3 Role of diffusion-weighted magnetic resonance in assessment of treatment response[75-79]
Ref.Treatment modalityTumor typeDW-MR parameter evaluatedStudy results/teaching point
Chapiro et al[79]TACEHCC(3D) quantitative enhancement-based and DW volumetric MRHigh accuracy and intermethod agreement of 3D quantitative techniques in the assessment of tumor necrosis after TACE is clinically relevant
High diagnostic performance of qEASL criteria and qADC may help in triaging patients for repeat treatment after a TACE session
Mannelli et al[87]TACEHCCADC measured with DWI in treatment responsePre TACE ADC obtained at 0, 50, 500 s/mm2b values before and after treatment may be used to predict HCC response to TACE
Park et al[42]RadiotherapyHCCDW MR vs conventional MR for treatment responseImproved detection of viable tumor when DW MR is added to conventional sequences
Yu et al[76]Radiation therapyHCCDW MRChange in ADC value before and after RT is related to local progression free survival. Hence ADC value and RECIST may substitute for mRECIST in patients who cannot receive contrast agents
Schraml et al[77]Radiofrequencyn = 16 HCC, 1 = cholangiocarcinoma, and 37 = metastases (28 colorectal cancer, 3 melanoma, 3 breast cancer, 1 pancreatic cancer, 1 gastric cancer, esophageal cancer)DW MR and mean ADC valuesADC-based evaluation of signal alterations adjacent to the ablation zone may contribute to the identification of local tumor progression and nontumoral post- treatment tissue changes