Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver.

Aims: To investigate the use of diffusion weighted magnetic resonance imaging (DWI) and the apparent diffusion coefficient (ADC) values in the diagnosis of hemangioma. Materials and methods: The study population consisted of 72 patients with liver masses larger than 1 cm (72 focal lesions). DWI examination with a b value of 600 s/mm2 was carried out for all patients. After DWI examination, an ADC map was created and ADC values were measured for 72 liver masses and normal liver tissue (control group). The average ADC values of normal liver tissue and focal liver lesions, the “cut-off” ADC values, and the diagnostic sensitivity and specificity of the ADC map in diagnosing hemangioma, benign and malignant lesions were researched. Results: Of the 72 liver masses, 51 were benign and 21 were malignant. Benign lesions comprised 38 hemangiomas and 13 simple cysts. Malignant lesions comprised 9 hepatocellular carcinomas, and 12 metastases. The highest ADC values were measured for cysts (3.782±0.53×10-3 mm2/s) and hemangiomas (2.705±0.63×10-3 mm2/s). The average ADC value of hemangiomas was significantly higher than malignant lesions and the normal control group (p<0.001). The average ADC value of cysts were significantly higher when compared to hemangiomas and normal control group (p<0.001). To distinguish hemangiomas from malignant liver lesions, the “cut-off” ADC value of 1.800×10-3 mm2/s had a sensitivity of 97.4% and a specificity of 90.9%. To distinguish hemangioma from normal liver parenchyma the “cut-off” value of 1.858×10-3 mm2/s had a sensitivity of 97.4% and a specificity of 95.7%. To distinguish benign liver lesions from malignant liver lesions the “cut-off” value of 1.800×10-3 mm2/s had a sensitivity of 96.1% and a specificity of 90.0%. Conclusion: DWI and quantitative measurement of ADC values can be used in differential diagnosis of benign and malignant liver lesions and also in the diagnosis and differentiation of hemangiomas. When dynamic examination cannot distinguish cases with vascular metastasis and lesions from hemangioma, DWI and ADC values can be useful in the primary diagnosis and differential diagnosis. The technique does not require contrast material, so it can safely be used in patients with renal failure. Keywords:

Analysis of only 0-1 min clip or 1-4 min Clip for focal liver lesions during contrast-enhanced ultrasonography

Purpose: To evaluate the reliability of analysis of only 0-1min clips and 1-4min clips versus the entire clips in performing contrast-enhanced ultrasonography (CEUS) of focal liver lesions (FLLs). Methods: Contrast-enhanced ultrasonography (CEUS) examinations of 43 single FLLs were performed. All clips were analyzed in three ways, the entire clips, 0-1 min clips and 1-4 min clips, benign or malignant diagnosis and pathological diagnosis of each FLL were concluded by the three ways subsequently. Results: The results of correct diagnosis were assessed using Chi-square test. There was no difference with regard to benign or malignant diagnosis, between 0-1min clips and the entire clips, or between 1-4 min clips and the entire clips (p = 0.243 and p = 0.747, respectively). Moreover, no significant differences in pathological diagnosis existed between 0-1min clips and the entire clips, and 1- 4min clips versus entire clips (p=0.808 and p = 0.808, respectively). No significant differences existed among CEUS entire clip, 0-1min clip and 1-4min clip in identifying FLLs, and based on which the diagnosis of two different FLLs during CEUS with only one injection of contrast agent can be available. Conclusion: Only 0-1min clips or 1-4 min clips can be used to instead of the entre clip in performing CEUS of FLLs.