Rationale and Objectives
To compare diffusion-weighted (DW) with standard T2-weighted imaging for quantitative evaluation of small hepatocellular carcinoma (HCC) in cirrhosis.
Materials and Methods
Fourteen patients (all men; mean age, 58.6 years; age range, 45-69 years) with 22 small HCCs (<3 cm and >1 cm in diameter) in cirrhosis were included in the study. DW imaging with breath-hold single-shot echo planar imaging (b = 0, 800 seconds/mm 2 ) and T2-weighted imaging with respiratory triggering fat-suppressed fast spin-echo sequence were performed on a 3-T magnetic resonance unit using an eight-channel torso phased-array coil. The signal intensity (SI) of HCC and liver were measured at workstation. Contrast-to-noise ratio (CNR), contrast ratio (CR, SI lesion /SI liver ), and apparent diffusion coefficient (ADC) values were calculated. CNRs and CRs obtained with DW and T2-weighted images, and ADCs of HCC and liver were compared using nonparametric tests.
Results
Two lesions were excluded because of artifacts on DW images. Thus 20 lesions were analyzed. The CNRs obtained with T2-weighted images (27.12 ± 21.12) were significantly higher ( P = .02) than those with DW images (17.52 ± 13.50). There were no significant difference between the CRs obtained with T2-weighted images (1.83 ± 0.56) and DW images (2.01 ± 0.67). There were no significant difference between the mean ADCs of HCC (1.22 × 10 −3 mm 2 /second ± 0.24) and the cirrhotic liver (1.17 × 10 −3 mm 2 /second ± 0.17), either.
Conclusion
DW imaging with high b value was not superior to standard T2-weighted imaging in terms of lesion conspicuity of small HCC in cirrhosis.
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and develops predominantly in patients who have underlying chronic hepatitis or cirrhosis, with highest incidences occurring in Africa, Southeast Asia, and China . Therefore, it is clinically important to detect HCC at an early stage for prompt surgical resection, transplantation, or local therapy to ensure a better chance of survival.
Diffusion-weighted (DW) imaging is a noninvasive method used to show microscopic motion of water in tissue. Some studies have been performed on the use of DW imaging for focal liver lesion (FLL) detection and characterization. A limited number of studies involved the direct comparison of DW and T2-weighted imaging in terms of FLL detection. Results showed improved assessment with DW imaging by using low b values compared with that with T2-weighted imaging.
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Materials and methods
Patients
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MR Imaging
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DW imaging
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T2-weighted imaging
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Image Analysis
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Statistical Analysis
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Results
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Discussion
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