Diagnostic Value of Target Sign and Apparent Diffusion Coefficient Measurements in the Differentiation between Hepatocelular Carcinoma and Liver Metastasis on Diffusion Weighted Magnetic Resonance Imaging

Yıl 2023, , 473 - 478, 31.05.2023

Eda Albayrak , Özge Gümüşay , Sadık Server

https://doi.org/10.16899/jcm.1268072

Öz

Objective: The aim of our study is to investigate probable differences between the incidence of target sign detected by diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) values between metastases and hepatocellular carcinomas (HCC).
Materials and Methods: A total of 155 lesions obtained from 57 (female/male: 18/39) patients were included in the study. Dimensions of lesions, the appearance of lesions detected by DWI, minimum ADC (ADCmin) values, and average ADC (ADCav) values were evaluated with 1.5 Tesla MRI using b= 0 and b = 1000 s/mm2 values. Differences between metastases and HCC were investigated in terms of defined parameters. Also, ROC (receiver operating curve) analysis was used to evaluate the performance of ADCmin and ADCav parameters in distinguishing metastases from HCC.
Results: Of the lesions, 131 were metastases, while 24 were HCC. The image showing centrally hypointense, periphery hyperintense signal in DWI defined as target sign. Target sign detected in 72 metastatic lesions (55%) and 6 HCC lesions (25%) with DWI, and the rate of target sign detection was higher in the metastatic group compared with HCC (p<0.007). Also, ADCmin and ADCav values were found to be higher in the HCC group compared with the metastatic group (p<0.001). Based on ROC analysis optimal ADCmin and ADCav values were <758 x10-6 and <817x10-6 mm2/s, respectively, in distinguishing metastasis from HCC (Sensitivity: 0.412, 0.412; Specificity: 0.875, 0.917 respectively).
Conclusion: Target sign detected by DWI and ADC values can be used as MRI markers that enhance diagnostic accuracy in distinguishing between metastases and HCC.

Anahtar Kelimeler

Target Sign;, Diffusion-Weighted Magnetic Resonance Imaging;, Metastasis;, Hepatocellular Carcinoma

Destekleyen Kurum

Scientific Research Projects Unit of Tokat Gaziosmanpaşa University Medical Faculty

Proje Numarası

2016/10

Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemede Hepatoselüler Karsinom ve Karaciğer Metastazı Ayırımında Hedef İşaretinin ve Görünür Difüzyon Katsayısı Ölçümlerinin Tanısal Değeri

Öz

Öz
Amaç: Çalışmamızın amacı, metastazlar ve hepatoselüler karsinomlar (HCC) arasındaki difüzyon ağırlıklı manyetik rezonans görüntüleme (DWI) ile tespit edilen hedef işaret insidansı ve görünür difüzyon katsayısı (ADC) değerleri arasındaki olası farklılıkları araştırmaktır.
Gereç ve Yöntem: 57 (kadın/erkek: 18/39) hastadan elde edilen toplam 155 lezyon çalışmaya dahil edildi. Lezyonların boyutları, DWI ile tespit edilen lezyonların görünümü, minimum ADC (ADCmin) değerleri ve ortalama ADC (ADCav) değerleri, b= 0 ve b = 1000 s/mm2 değerleri kullanılarak 1,5 Tesla MRG ile değerlendirildi. Tanımlanan parametreler açısından metastazlar ve HCC arasındaki farklar araştırıldı. Ayrıca metastazları HCC'den ayırmada ADCmin ve ADCav parametrelerinin performansını değerlendirmek için ROC analizi kullanıldı.
Bulgular: Lezyonların 131'i metastaz, 24'ü HCC idi. Hedef işareti olarak tanımlanan, DWI'da merkezi hipointens, periferik hiperintens izlenen imaj DWI ile 72 metastatik lezyonda (%55) ve 6 HCC lezyonunda (%25) saptandı ve metastatik grupta hedef işareti saptanma oranı HCC'ye göre daha yüksekti (p<0,007). Ayrıca HCC grubunda, ADCmin ve ADCav değerleri metastatik gruba göre daha yüksek bulundu (p<0.001). ROC analizine dayalı olarak, metastazı HCC'den ayırmada optimal ADCmin ve ADCav değerleri sırasıyla <758 x10-6 ve <817x10-6 mm2/s idi (Duyarlılık: 0.412, 0.412; Özgüllük: sırasıyla 0.875, 0.917).
Sonuç: DWI ve ADC değerleri ile saptanan hedef işareti, metastaz ve HCC ayrımında tanısal doğruluğu artıran MRI belirteçleri olarak kullanılabilir.

Anahtar Kelimeler

Hedef İşareti, Difüzyon Ağırlıklı Manyetik Rezonans Görüntüleme;, metastaz;, Hepatosellüler karsinom

Proje Numarası

2016/10

Kaynakça

• 1. Danet IM, Semelka RC, Leonardou P, et al. Spectrum of MRI appearances of untreated metastases of the liver. AJR Am J Roentgenol. 2003;181:809-817.
• 2. Sadowski EA, Bennett LK, Chan MR, et al. Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology 2007;243:148–157.
• 3. Thomsen HS, Marckmann P, Logager VB. Update on nephrogenic systemic fibrosis. Magn Reson Imaging Clin N Am 2008;16:551–560.
• 4. Hardie AD, Naik M, Hecht EM, et al. Diagnosis of liver metastases: value of diffusion-weighted MRI compared with gadolinium-enhanced MRI. Eur. Radiol 2010;20:1431–1441.
• 5. Lincke T, Zech CJ. Liver metastases: Detection and staging. Eur J Radiol. 2017;97:76-82.
• 6. Shenoy-Bhangle A, Baliyan V, Kordbacheh H, Guimaraes AR, Kambadakone A. Diffusion weighted magnetic resonance imaging of liver: Principles, clinical applications and recent updates. World J Hepatol 2017;18;9:1081-1091.
• 7. Kele PG, van der Jagt EJ. Diffusion weighted imaging in the liver. World J. Gastroenterol. 2010;16:1567–1576.
• 8. Barral M, Eveno C, Hoeffel C, et al. Diffusion-weighted magnetic resonance imaging in colorectal cancer. J. Visc. Surg. 2016;153:361–369.
• 9. Holzapfel K, Bruegel M, Eiber M, et al. Characterization of small (≤10 mm) focal liver lesions: value of respiratory-triggered echo-planar diffusion-weighted MR imaging. Eur. J. Radiol 2010;76:89–95.
• 10. Kandpal H, Sharma R, Madhusudhan KS, Kapoor KS. Respiratory-triggered versus breath-hold diffusion-weighted MRI of liver lesions: comparison of image quality and apparent diffusion coefficient values. Am. J. Roentgenol 2009;192:915–922.
• 11. Namimoto T, Nakagawa M, Kizaki Y, et al. Characterization of Liver Tumors by Diffusion-Weighted Imaging: Comparison of Diagnostic Performance Using the Mean and Minimum Apparent Diffusion Coefficient. J Comput Assist Tomogr 2015;39:453-461.
• 12. Sun XJ, Quan XY, Huang FH, Xu YK. Quantitative evaluation of diffusion-weighted magnetic resonance imaging of focal hepatic lesions. World J Gastroenterol 2005;11:6535-6537.
• 13. Koike N, Cho A, Nasu K, et al. Role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of focal hepatic lesions. World J Gastroenterol 2009;15:5805-5812.
• 14. Watanabe H, Kanematsu M, Goshima S, et al. Characterizing focal hepatic lesions by free-breathing intravoxel incoherent motion MRI at 3.0 T. Acta Radiol 2014;55:1166–1173.
• 15. Peng J, Li JJ, Li J, et al. Could ADC values be a promising diagnostic criterion for differentiating malignant and benign hepatic lesions in Asian populations: A meta-analysis. . Medicine (Baltimore). 2016;95:e5470.
• 16. Bruegel M, Holzapfel K, Gaa J, et al. Characterization of focal liver lesions. Eur Radiol 2008;18:477-4785.
• 17. Parikh T, Drew SJ, Lee VS, et al. Focal liver lesion detection and characterization with diffusion weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 2008; 246: 812-822.
• 18. Parsai A, Zerizer I, Roche O, Gkoutzios P, Miquel ME. Assessment of diffusion-weighted imaging for characterizing focal liverlesions. Clin Imaging 2015; 39: 278-284.
• 19. Gourtsoyianni S, Papanikolaou N, Yarmenitis S, Maris T, Karantanas A, Gourtsoyiannis N. 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. Eur Radiol 2008;18:486-492.
• 20. Kovač JD, Galun D , Đurić-Stefanović A, et al. Intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases: is the differential diagnosis using diffusion-weighted MRI possible? Acta Radiol. 2017;58:1417-1426.
• 21. Min JH, Kim YK, Choi SY, et al. Differentiation between cholangiocarcinoma and hepatocellular carcinoma with target sign on diffusion-weighted imaging and hepatobiliary phase gadoxetic acid-enhanced MR imaging: Classification tree analysis applying capsule and septum. Eur J Radiol 2017;92:1–10.
• 22. Park HJ, Kim YK, Park MJ, Lee WJ. Small intrahepatic mass-forming cholangiocarcinoma: target sign on diffusion-weighted imaging for differentiation from hepatocellular carcinoma, Abdom. Imaging 2013;38:793–801.
• 23. Llovet JM, Zucman-Rossi J, Pikarsky E, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016;14;2:16018.
• 24. Joo I, Lee JM, Lee SM, Lee JS, Park JY, Han JK. Diagnostic accuracy of liver imaging reporting and data system (LI-RADS) v2014 for intrahepatic mass-forming cholangiocarcinomas in patients with chronic liver disease on gadoxetic acid enhanced MRI. J. Magn. Reson. Imaging 2016;44:1330–1338.
• 25. Granata V, Catalano O, Fusco R, et al. The target sign in colorectal liver metastases: an atypical Gd-EOB-DTPA "uptake" on the hepatobiliary phase of MR imaging. Abdom Imaging. 2015;40:2364–2371.
• 26. Ha S, Lee CH, Kim BH, et al. Paradoxical uptake of Gd-EOB-DTPA on the hepatobiliary phase in the evaluation of hepatic metastasis from breast cancer: is the ‘‘target sign’’ a common finding? Magn Reson Imaging 2012;30:1083–1090.
• 27. Milot L, Guindi M, Gallinger S, et al. MR imaging correlates of intratumoral tissue types within colorectal liver metastases: a high-spatial-resolution fresh ex vivo radiologic-pathologic correlation study. Radiology 2010;254:747–754.
• 28. Bruegel M, Rummeny EJ. Hepatic metastases: use of diffusion-weighted echo-planar imaging. Abdom. Imaging 2010;35:454–461.
• 29. Kanematsu M, Kondo H, Goshima S, et al. Imaging liver metastases: review and update, Eur. J. Radiol. 2006;58:217–228.