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Diffusion-Weighted MR Imaging of Focal Liver Lesions in the Left and Right Lobes

Posted Mar 31, 2013 Updated Apr 10, 2023
By Christine Schmid-Tannwald MD , Yulei Jiang PhD , Farid Dahi MD , Carsten Rist MD , Ila Sethi MD , Aytekin Oto MD
9 min read

Rationale and Objectives

To determine possible differences between the left and right hepatic lobes in apparent diffusion coefficient (ADC) values of benign and malignant focal liver lesions (FLLs) and normal liver parenchyma.

Materials and Methods

Thirty-six patients (16 males, 20 females; mean age 56.8 years) with FLLs of the same etiology in both the left and right hepatic lobes (13 patients with 26 benign FLLs and 23 patients with 46 malignant FLLs) who underwent 1.5T magnetic resonance imaging (MRI) including diffusion-weighted MRI (b values: 0 and 800 seconds/mm) with respiratory gating and without cardiac gating were included in this Health Insurance Portability and Accountability Act–compliant and institutional review board–approved study. ADC values of normal liver parenchyma and FLLs in each hepatic lobe were calculated and compared by using Student’s t -test and Wilcoxon signed-rank test, respectively.

Results

The mean ADC values of normal liver parenchyma, benign FLLs, and malignant FLLs were significantly higher ( P < .001, P = .003, and P = .005, respectively) in the left hepatic lobe (1.74 × 10 −3 , 1.81 × 10 −3 , and 1.48 × 10 −3 mm²/second, respectively) than in the right hepatic lobe (1.48 × 10 −3 , 1.54 × 10 −3 , and 1.24 × 10 −3 mm²/second, respectively).

Conclusion

ADC values of benign and malignant FLLs calculated from noncardiac-gated DW-MRI are significantly higher in the left hepatic lobe compared with the right hepatic lobe. This may be a limitation for characterization of FLLs based on ADC measurements.

Diffusion-weighted magnetic resonance imaging (DW-MRI) is used increasingly for the detection and characterization of focal liver lesions (FLLs). The apparent diffusion coefficient (ADC) value provides quantitative characterization of these lesions and is thought to help the differentiation between benign and malignant FLLs. In general, benign FLLs have higher ADC values than malignant FLLs, but there are also variable degrees of overlap between them . Several cutoff ADC values (1.4–1.6 × 10 −3 mm²/second) have been suggested in the literature for differentiating malignant from benign FLLs, with reported sensitivity of 74% to 100% and specificity of 77% to 100% .

Despite widespread clinical use of such advanced MRI techniques as ultrafast and single-shot or multishot echoplanar imaging, multichannel coil, and parallel imaging , however, DW-MRI in the abdomen is still known to be highly sensitive to motion. Several studies have documented that cardiac motion has an impact on DW-MRI of the abdomen, resulting in higher ADC values of normal liver parenchyma in the left hepatic lobe compared with the right hepatic lobe . Therefore, the ADC values of FLLs in the left hepatic lobe may be expected also to be higher than those in the right hepatic lobe. Variations in ADC values of FLLs because of their location in the liver may thus represent an important limitation of DW-MRI and potentially impact the usefulness of DW-MRI for characterizing FLLs. The purpose of this study was to determine whether ADC values of benign and malignant FLLs, calculated from noncardiac-gated DW-MRI, are different in the left and right hepatic lobes.

Materials and methods

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MRI

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Reference Standard

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Quantitative Analysis

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Statistical Analysis

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Results

Reference Standard

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Table 1

Type of Lesions

Benign Lesions ∗ Malignant Lesions ∗ Hemangioma ( n = 18)

Focal nodular hyperplasia ( n = 6)

Adenoma ( n = 2) 34 metastases ( n = 43) (Primary: adenocarcinoma of the pancreas: n = 4; neuroendocrine tumor: n = 2; carcinoid: n = 2; colorectal adenocarcinoma: n = 2; ovarian cancer: n = 1; renal cell carcinoma: n = 1; breast cancer: n = 1, lung cancer: n = 1; esophageal cancer: n = 1)

Hepatocellular carcinoma ( n = 12)

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Evaluation of Normal Liver Parenchyma

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Table 2

Comparison of ROI Size for Calculation of ADC Values between the Left and Right Hepatic Lobes

Mean ± SD in ROI Size (mm²)P Value (Using Mann-Whitney Rank Sum Test) Left Hepatic Lobe Right Hepatic Lobe Normal liver parenchyma 742.02 ± 483.49 972.47 ± 619.30 .379 FLL 369.72 ± 654.10 356.8 ± 415.40 .477

ADC, apparent diffusion coefficient; FLL, focal liver lesions; ROI, region of interest; SD, standard deviation.

Table 3

Comparison of ADC Values between the Left and Right Hepatic Lobes and between Benign and Malignant FLLs

Mean ± SD ADC Values (10 −3 mm²/second)P Value (Using Mann-Whitney Rank Sum Test ∗ and Unpaired t -Test, Respectively) Left Hepatic Lobe Right Hepatic Lobe Normal liver parenchyma 1.78 ± 0.28 1.48 ± 0.27 <.001 FLLs Benign 1.81 ± 0.25 1.54 ± 0.19 .003 Malignant 1.48 ± 0.31 1.24 ± 0.26 .005P value <.001 <.001

ADC, apparent diffusion coefficient; FLL, focal liver lesions; SD, standard deviation.

Figure 1, A 65-year-old female with hepatic metastasis from renal cell carcinoma. Normal liver parenchyma demonstrates homogenous enhancement ( circles ) on the contrast-enhanced T1-weighted gradient-echo image (a) obtained at the venous phase. On axial diffusion-weighted magnetic resonance imaging with b = 800 s/mm² at the same anatomic level (b) , liver parenchyma in the left hepatic lobe shows hypointense signal compared with the right hepatic lobe. The normal liver parenchyma in the left hepatic lobe demonstrates increased signal on apparent diffusion coefficient (ADC) map (c) compared with the normal liver parenchyma in the right hepatic lobe, indicating higher ADC values in the left hepatic lobe compared with the right hepatic lobe, which was confirmed by quantitative ADC measurements: 1.61 × 10 −3 mm²/second ( left lobe ) vs. 1.43 × 10 −3 mm²/second ( right lobe ).

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Evaluation of FLLs

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Figure 2, A 34-year-old female with two focal nodular hyperplasias (FNH) in the liver. FNH in both hepatic lobes demonstrate homogenous enhancement ( circles ) on the contrast enhanced T1-weighted gradient-echo image (a) obtained at the arterial phase. Axial diffusion-weighted magnetic resonance imaging with b = 800 s/mm² at the same anatomic level (b) shows signal loss of both FNH ( arrows ). Axial apparent diffusion coefficient (ADC) map (c) shows that the FNH in the left hepatic lobe ( circle ) has a brighter signal compared with the FNH in the right hepatic lobe ( circle ), indicating a higher ADC value in the left hepatic lobe compared with the right hepatic lobe: 2.16 × 10 −3 mm²/second ( left lobe ) vs. 1.28 × 10 −3 mm²/second ( right lobe ).

Figure 3, A 72-year-old female with hepatic metastasis from medullary thyroid cancer. Metastases in both hepatic lobes have hyperintense signal ( arrows ) on the T2-weighted images (a,b) . Metastases in both lobes show restricted diffusion with high signal on axial diffusion-weighted magnetic resonance imaging with b = 800 s/mm² (c,d) . The metastasis in the left hepatic lobe ( e , arrow ) demonstrates a brighter signal on the axial apparent diffusion coefficient (ADC) map compared with the metastasis in the right hepatic lobe ( f , arrow ), indicating higher ADC value of the metastasis in the left hepatic lobe: 1.89 × 10 −3 mm²/second ( left lobe ) vs. 1.43 × 10 −3 mm²/second ( right lobe ).

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Discussion

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Academic Radiology, Volume 20, Issue 4
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