Volumetric quantitative histogram analysis using diffusion-weighted magnetic resonance imaging to differentiate HCC from other primary liver cancers
- 36 Downloads
To evaluate the ability of volumetric quantitative apparent diffusion coefficient (ADC) histogram parameters and LI-RADS categorization to distinguish hepatocellular carcinoma (HCC) from other primary liver cancers [intrahepatic cholangiocarcinoma (ICC) and combined HCC-ICC].
Sixty-three consecutive patients (44 M/19F; mean age 62 years) with primary liver cancers and pre-treatment MRI including diffusion-weighted imaging (DWI) were included in this IRB-approved single-center retrospective study. Tumor type was categorized pathologically. Qualitative tumor features and LI-RADS categorization were assessed by 2 independent observers. Lesion volume of interest measurements (VOIs) were placed on ADC maps to extract first-order radiomics (histogram) features. ADC histogram metrics and qualitative findings were compared. Binary logistic regression and AUROC were used to assess performance for distinction of HCC from ICC and combined tumors.
Sixty-five lesions (HCC, n = 36; ICC, n = 17; and combined tumor, n = 12) were assessed. Only enhancement pattern (p < 0.015) and capsule were useful for tumor diagnosis (p < 0.014). ADC 5th/10th/95th percentiles were significant for discrimination between each tumor types (all p values < 0.05). Accuracy of LI-RADS for HCC diagnosis was 76.9% (p < 0.0001) and 69.2% (p = 0.001) for both observers. The combination of male gender, LI-RADS, and ADC 5th percentile yielded an AUROC/sensitivity/specificity/accuracy of 0.90/79.3%/88.9%/81.5% and 0.89/86.2%/77.8%/80.0% (all p values < 0.027) for the diagnosis of HCC compared to ICC and combined tumors for both observers, respectively.
The combination of quantitative ADC histogram parameters and LI-RADS categorization yielded the best prediction accuracy for distinction of HCC compared to ICC and combined HCC-ICC.
KeywordsDiffusion-weighted imaging (DWI) Apparent diffusion coefficient (ADC) Hepatocellular carcinoma (HCC) Intrahepatic cholangiocarcinoma (ICC) Combined HCC-ICC Histogram Tumor grade
No funding was provided for this study.
Compliance with ethical standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
- 4.Weber SM, Ribero D, O’Reilly EM, et al. (2015) Intrahepatic cholangiocarcinoma: expert consensus statement. HPB (Oxford) 17:669–680Google Scholar
- 7.Lee JH, Chung GE, Yu SJ, et al. (2011) Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma. J Clin Gastroenterol 45:69–75Google Scholar
- 8.Dodson RM, Weiss MJ, Cosgrove D, et al. (2013) Intrahepatic cholangiocarcinoma: management options and emerging therapies. J Am Coll Surg 217(736–750):e734Google Scholar
- 23.Lewis S, Besa C, Wagner M et al (2017) Prediction of the histopathologic findings of intrahepatic cholangiocarcinoma: qualitative and quantitative assessment of diffusion-weighted imaging. Eur Radiol. 10.1007/s00330-017-5156-6Google Scholar
- 29.Khatri G, Merrick L, Miller FH (2010) MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am 18(421–450):xGoogle Scholar
- 32.Washington MK, Berlin J, Branton PA, et al. (2010) Protocol for the examination of specimens from patients with carcinoma of the intrahepatic bile ducts. Arch Pathol Lab Med 134:e14–18Google Scholar
- 41.Gourtsoyianni S, Papanikolaou N, Yarmenitis S, et al. (2008) 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 18:486–492CrossRefGoogle Scholar
- 42.Wei Y, Gao F, Zheng D, et al. (2018) Intrahepatic cholangiocarcinoma in the setting of HBV-related cirrhosis: Differentiation with hepatocellular carcinoma by using Intravoxel incoherent motion diffusion-weighted MR imaging. Oncotarget 9:7975–7983Google Scholar
- 44.Lee J, Kim SH, Kang TW, Song KD, Choi D, Jang KT (2016) Mass-forming Intrahepatic Cholangiocarcinoma: Diffusion-weighted Imaging as a Preoperative Prognostic Marker. Radiology. 10.1148/radiol.2016151781:151781Google Scholar
- 50.O’Connor K, Walsh JC, Schaeffer DF (2014) Combined hepatocellular-cholangiocarcinoma (cHCC-CC): a distinct entity. Ann Hepatol 13:317–322Google Scholar