High-flow haemangiomas versus hypervascular hepatocellular carcinoma showing “pseudo-washout” on gadoxetic acid-enhanced hepatic MRI: value of diffusion-weighted imaging in the differential diagnosis of small lesions

Aim To validate the usefulness of diffusion-weighted imaging (DWI) in the differentiation of high-flow haemangiomas showing pseudo-washout appearance on gadoxetic acid-enhanced hepatic MRI from small hypervascular hepatocellular carcinomas (HCCs). Materials and methods DWI (b=50, 800 s/mm2 ) with ap...

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Published in:Clinical radiology 2017-03, Vol.72 (3), p.247-254
Main Authors: Nam, S.J, Yu, J.-S, Cho, E.-S, Kim, J.H, Chung, J.-J
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular - diagnostic imaging
Carcinoma, Hepatocellular - pathology
Contrast Media
Diffusion Magnetic Resonance Imaging - methods
Female
Gadolinium DTPA
Hemangioma - diagnostic imaging
Hemangioma - pathology
Humans
Image Enhancement - methods
Liver Neoplasms - diagnostic imaging
Liver Neoplasms - pathology
Magnetic Resonance Imaging - methods
Male
Middle Aged
Neovascularization, Pathologic - diagnostic imaging
Neovascularization, Pathologic - pathology
Radiology
Reproducibility of Results
Sensitivity and Specificity
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creator Nam, S.J
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Cho, E.-S
Kim, J.H
Chung, J.-J
description Aim To validate the usefulness of diffusion-weighted imaging (DWI) in the differentiation of high-flow haemangiomas showing pseudo-washout appearance on gadoxetic acid-enhanced hepatic MRI from small hypervascular hepatocellular carcinomas (HCCs). Materials and methods DWI (b=50, 800 s/mm2 ) with apparent diffusion coefficient (ADC) maps for 50 haemangiomas (6.4±2.9 mm) showing intense enhancement on arterial dominant phase imaging and hypointensity on transitional and/or hepatobiliary phase imaging during gadoxetic acid-enhanced MRI were retrospectively analysed and compared with that of 113 hypervascular HCCs (12.8±3.7 mm). In addition to measurement of mean ADC values on DWI and contrast-to-noise ratio (CNR) on corresponding T2-weighted imaging, qualitative analysis of DWI was performed for each lesion by two independent observers using a five-point scale. Results Both of mean ADC value (1.902 versus 0.997×10−3  mm2 /s) and mean CNR (119.2 versus 36.9) for haemangioma were significantly larger than for HCC ( p
doi_str_mv 10.1016/j.crad.2016.09.020
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Materials and methods DWI (b=50, 800 s/mm2 ) with apparent diffusion coefficient (ADC) maps for 50 haemangiomas (6.4±2.9 mm) showing intense enhancement on arterial dominant phase imaging and hypointensity on transitional and/or hepatobiliary phase imaging during gadoxetic acid-enhanced MRI were retrospectively analysed and compared with that of 113 hypervascular HCCs (12.8±3.7 mm). In addition to measurement of mean ADC values on DWI and contrast-to-noise ratio (CNR) on corresponding T2-weighted imaging, qualitative analysis of DWI was performed for each lesion by two independent observers using a five-point scale. Results Both of mean ADC value (1.902 versus 0.997×10−3  mm2 /s) and mean CNR (119.2 versus 36.9) for haemangioma were significantly larger than for HCC ( p &lt;0.001). On receiver operating characteristic (ROC) analysis, an area under the curve (AUC) of 0.995 for ADC values was significantly larger than 0.915 for CNRs ( p =0.002). When the ADC value of 1.327×10−3  mm2 /s was used as the threshold for the diagnosis of haemangioma, the sensitivity and specificity were 98% and 97.3%, respectively. The mean sensitivity and specificity of qualitative analysis for the differentiation of haemangioma from HCC were 92% and 99.1%, respectively. Conclusion For high-flow small haemangiomas showing pseudo-washout appearance during gadoxetic acid-enhanced hepatic MRI, high b-factor DWI including an ADC map may provide additional information to enhance the confidence to exclude small hypervascular HCCs.</description><identifier>ISSN: 0009-9260</identifier><identifier>EISSN: 1365-229X</identifier><identifier>DOI: 10.1016/j.crad.2016.09.020</identifier><identifier>PMID: 27789027</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular - diagnostic imaging ; Carcinoma, Hepatocellular - pathology ; Contrast Media ; Diffusion Magnetic Resonance Imaging - methods ; Female ; Gadolinium DTPA ; Hemangioma - diagnostic imaging ; Hemangioma - pathology ; Humans ; Image Enhancement - methods ; Liver Neoplasms - diagnostic imaging ; Liver Neoplasms - pathology ; Magnetic Resonance Imaging - methods ; Male ; Middle Aged ; Neovascularization, Pathologic - diagnostic imaging ; Neovascularization, Pathologic - pathology ; Radiology ; Reproducibility of Results ; Sensitivity and Specificity</subject><ispartof>Clinical radiology, 2017-03, Vol.72 (3), p.247-254</ispartof><rights>The Royal College of Radiologists</rights><rights>2016 The Royal College of Radiologists</rights><rights>Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-41698a26bedbb158b871e2b093b5b689ad2cfe520b4f9ed91616ddb8086463153</citedby><cites>FETCH-LOGICAL-c477t-41698a26bedbb158b871e2b093b5b689ad2cfe520b4f9ed91616ddb8086463153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27789027$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nam, S.J</creatorcontrib><creatorcontrib>Yu, J.-S</creatorcontrib><creatorcontrib>Cho, E.-S</creatorcontrib><creatorcontrib>Kim, J.H</creatorcontrib><creatorcontrib>Chung, J.-J</creatorcontrib><title>High-flow haemangiomas versus hypervascular hepatocellular carcinoma showing “pseudo-washout” on gadoxetic acid-enhanced hepatic MRI: value of diffusion-weighted imaging in the differential diagnosis of small lesions</title><title>Clinical radiology</title><addtitle>Clin Radiol</addtitle><description>Aim To validate the usefulness of diffusion-weighted imaging (DWI) in the differentiation of high-flow haemangiomas showing pseudo-washout appearance on gadoxetic acid-enhanced hepatic MRI from small hypervascular hepatocellular carcinomas (HCCs). Materials and methods DWI (b=50, 800 s/mm2 ) with apparent diffusion coefficient (ADC) maps for 50 haemangiomas (6.4±2.9 mm) showing intense enhancement on arterial dominant phase imaging and hypointensity on transitional and/or hepatobiliary phase imaging during gadoxetic acid-enhanced MRI were retrospectively analysed and compared with that of 113 hypervascular HCCs (12.8±3.7 mm). In addition to measurement of mean ADC values on DWI and contrast-to-noise ratio (CNR) on corresponding T2-weighted imaging, qualitative analysis of DWI was performed for each lesion by two independent observers using a five-point scale. Results Both of mean ADC value (1.902 versus 0.997×10−3  mm2 /s) and mean CNR (119.2 versus 36.9) for haemangioma were significantly larger than for HCC ( p &lt;0.001). On receiver operating characteristic (ROC) analysis, an area under the curve (AUC) of 0.995 for ADC values was significantly larger than 0.915 for CNRs ( p =0.002). When the ADC value of 1.327×10−3  mm2 /s was used as the threshold for the diagnosis of haemangioma, the sensitivity and specificity were 98% and 97.3%, respectively. The mean sensitivity and specificity of qualitative analysis for the differentiation of haemangioma from HCC were 92% and 99.1%, respectively. 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Yu, J.-S ; Cho, E.-S ; Kim, J.H ; Chung, J.-J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-41698a26bedbb158b871e2b093b5b689ad2cfe520b4f9ed91616ddb8086463153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carcinoma, Hepatocellular - diagnostic imaging</topic><topic>Carcinoma, Hepatocellular - pathology</topic><topic>Contrast Media</topic><topic>Diffusion Magnetic Resonance Imaging - methods</topic><topic>Female</topic><topic>Gadolinium DTPA</topic><topic>Hemangioma - diagnostic imaging</topic><topic>Hemangioma - pathology</topic><topic>Humans</topic><topic>Image Enhancement - methods</topic><topic>Liver Neoplasms - diagnostic imaging</topic><topic>Liver Neoplasms - pathology</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neovascularization, Pathologic - diagnostic imaging</topic><topic>Neovascularization, Pathologic - pathology</topic><topic>Radiology</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nam, S.J</creatorcontrib><creatorcontrib>Yu, J.-S</creatorcontrib><creatorcontrib>Cho, E.-S</creatorcontrib><creatorcontrib>Kim, J.H</creatorcontrib><creatorcontrib>Chung, J.-J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nam, S.J</au><au>Yu, J.-S</au><au>Cho, E.-S</au><au>Kim, J.H</au><au>Chung, J.-J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-flow haemangiomas versus hypervascular hepatocellular carcinoma showing “pseudo-washout” on gadoxetic acid-enhanced hepatic MRI: value of diffusion-weighted imaging in the differential diagnosis of small lesions</atitle><jtitle>Clinical radiology</jtitle><addtitle>Clin Radiol</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>72</volume><issue>3</issue><spage>247</spage><epage>254</epage><pages>247-254</pages><issn>0009-9260</issn><eissn>1365-229X</eissn><abstract>Aim To validate the usefulness of diffusion-weighted imaging (DWI) in the differentiation of high-flow haemangiomas showing pseudo-washout appearance on gadoxetic acid-enhanced hepatic MRI from small hypervascular hepatocellular carcinomas (HCCs). Materials and methods DWI (b=50, 800 s/mm2 ) with apparent diffusion coefficient (ADC) maps for 50 haemangiomas (6.4±2.9 mm) showing intense enhancement on arterial dominant phase imaging and hypointensity on transitional and/or hepatobiliary phase imaging during gadoxetic acid-enhanced MRI were retrospectively analysed and compared with that of 113 hypervascular HCCs (12.8±3.7 mm). In addition to measurement of mean ADC values on DWI and contrast-to-noise ratio (CNR) on corresponding T2-weighted imaging, qualitative analysis of DWI was performed for each lesion by two independent observers using a five-point scale. Results Both of mean ADC value (1.902 versus 0.997×10−3  mm2 /s) and mean CNR (119.2 versus 36.9) for haemangioma were significantly larger than for HCC ( p &lt;0.001). On receiver operating characteristic (ROC) analysis, an area under the curve (AUC) of 0.995 for ADC values was significantly larger than 0.915 for CNRs ( p =0.002). When the ADC value of 1.327×10−3  mm2 /s was used as the threshold for the diagnosis of haemangioma, the sensitivity and specificity were 98% and 97.3%, respectively. The mean sensitivity and specificity of qualitative analysis for the differentiation of haemangioma from HCC were 92% and 99.1%, respectively. Conclusion For high-flow small haemangiomas showing pseudo-washout appearance during gadoxetic acid-enhanced hepatic MRI, high b-factor DWI including an ADC map may provide additional information to enhance the confidence to exclude small hypervascular HCCs.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>27789027</pmid><doi>10.1016/j.crad.2016.09.020</doi><tpages>8</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular - diagnostic imaging
Carcinoma, Hepatocellular - pathology
Contrast Media
Diffusion Magnetic Resonance Imaging - methods
Female
Gadolinium DTPA
Hemangioma - diagnostic imaging
Hemangioma - pathology
Humans
Image Enhancement - methods
Liver Neoplasms - diagnostic imaging
Liver Neoplasms - pathology
Magnetic Resonance Imaging - methods
Male
Middle Aged
Neovascularization, Pathologic - diagnostic imaging
Neovascularization, Pathologic - pathology
Radiology
Reproducibility of Results
Sensitivity and Specificity
title High-flow haemangiomas versus hypervascular hepatocellular carcinoma showing “pseudo-washout” on gadoxetic acid-enhanced hepatic MRI: value of diffusion-weighted imaging in the differential diagnosis of small lesions
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