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Diffusion tensor imaging of cysts, hemangiomas, and metastases of the liver
Sukru Mehmet Erturk1, Tomoaki Ichikawa2, Emel Kaya3
1Department of Radiology, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey mehmeterturk@superonline.com.
Background:
Although diffusion-weighted magnetic resonance imaging imaging (DW-MRI) is commonly used to characterize hepatic lesions, the literature is sparse about the use of MR diffusion tensor imaging (DTI) in this regard. By using DTI, one is able to obtain not only apparent diffusion coefficients (ADCs) but also fractional anisotropy (Fa) values.
Purpose:
To evaluate DTI using ADC and Fa values in the imaging of hepatic cysts, hemangiomas, and metastases.
Material And Methods:
Sixty-six patients with 77 lesions were examined with DTI. There were 32 metastases, 13 cysts, and 32 hemangiomas. Two radiologists performed ADC and Fa measurements. Inter-observer agreement was evaluated using Bland-Altman plots. ADCs and Fa values were correlated using Pearson correlation. The differences were compared using ANOVA and Tukey tests. A ROC analysis was applied; sensitivities and specificities were calculated.
Results:
The inter-observer agreement was very good. The correlation between ADC and Fa was negative, weak, and significant (r = -0.36). The mean ADC value of cysts (3.30 ± 0.8 × 10(-3) mm(2)/s) was significantly higher than that of hemangiomas (2.23 ± 0.5 × 10(-3) mm(2)/s) and metastases (1.62 ± 0.4 × 10(-3) mm(2)/s). The mean Fa value of cysts (0.2 ± 0.05) was significantly lower than hemangiomas (0.37 ± 0.1) and metastases (0.46 ± 0.1). The Az values for discriminating metastases from benign hepatic lesions for ADC and Fa value were 0.885 and 0.731, respectively. The sensitivity and specificity of ADC and Fa were 87.5% and 84.4%, and 78.1% and 57.8%, respectively. The Az value for discriminating cysts from hemangiomas for Fa was 0.96. The sensitivity and specificity were 90.6% and 92.3%, respectively.
Conclusion:
Fa values may play a supportive role in the imaging of liver lesions. Whereas metastases tend to have low ADCs and high Fa values, cysts have high ADCs and low Fa values and hemangiomas have high ADCs and high Fa values.
Insights
Diffusion tensor imaging (DTI) using apparent diffusion coefficients (ADCs) and fractional anisotropy (Fa) values can help differentiate liver lesions. Metastases show low ADCs and high Fa, while cysts have high ADCs and low Fa, aiding diagnosis.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Diffusion-weighted magnetic resonance imaging (DW-MRI) is standard for hepatic lesions.
- Limited literature exists on Diffusion Tensor Imaging (DTI) for hepatic lesions.
- DTI provides both apparent diffusion coefficients (ADCs) and fractional anisotropy (Fa) values.
Purpose of the Study:
- To evaluate DTI parameters (ADC and Fa) for differentiating hepatic cysts, hemangiomas, and metastases.
- Assess the diagnostic performance of ADC and Fa in characterizing liver lesions.
Main Methods:
- DTI was performed on 66 patients with 77 hepatic lesions (32 metastases, 13 cysts, 32 hemangiomas).
- Two radiologists measured ADC and Fa values.
- Statistical analyses included Bland-Altman plots for inter-observer agreement, Pearson correlation, ANOVA, Tukey tests, and ROC analysis.
Main Results:
- High inter-observer agreement was observed.
- A significant negative correlation was found between ADC and Fa (r = -0.36).
- Cysts exhibited significantly higher mean ADC and lower mean Fa compared to hemangiomas and metastases.
- ROC analysis showed Az values of 0.885 for ADC and 0.731 for Fa in differentiating metastases from benign lesions.
- Fa achieved an Az of 0.96 for distinguishing cysts from hemangiomas.
Conclusions:
- Fa values can support the characterization of liver lesions.
- Metastases are associated with low ADCs and high Fa values.
- Hepatic cysts show high ADCs and low Fa values.
- Hemangiomas present with high ADCs and high Fa values.
