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High-flow haemangiomas versus hypervascular hepatocellular carcinoma showing "pseudo-washout" on gadoxetic acid-enhanced hepatic MRI: value of diffusion-weighted imaging in the differential diagnosis of small lesions

 S.J. Nam  ;  J.-S. Yu  ;  E.-S. Cho  ;  J.H. Kim  ;  J.-J. Chung 
 Clinical Radiology, Vol.72(3) : 247-254, 2017 
Journal Title
 Clinical Radiology 
Issue Date
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/diagnostic imaging* ; Carcinoma, Hepatocellular/pathology ; Contrast Media ; Diffusion Magnetic Resonance Imaging/methods* ; Female ; Gadolinium DTPA* ; Hemangioma/diagnostic imaging* ; Hemangioma/pathology ; Humans ; Image Enhancement/methods ; Liver Neoplasms/diagnostic imaging* ; Liver Neoplasms/pathology ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Neovascularization, Pathologic/diagnostic imaging ; Neovascularization, Pathologic/pathology ; Reproducibility of Results ; Sensitivity and Specificity
AIM: To validate the usefulness of diffusion-weighted imaging (DWI) in the differentiation of high-flow haemangiomas showing pseudo-washout appearance on gadoxetic acid-enhanced hepatic MRI from small hypervascular hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: DWI (b=50, 800 s/mm2) with apparent diffusion coefficient (ADC) maps for 50 haemangiomas (6.4±2.9 mm) showing intense enhancement on arterial dominant phase imaging and hypointensity on transitional and/or hepatobiliary phase imaging during gadoxetic acid-enhanced MRI were retrospectively analysed and compared with that of 113 hypervascular HCCs (12.8±3.7 mm). In addition to measurement of mean ADC values on DWI and contrast-to-noise ratio (CNR) on corresponding T2-weighted imaging, qualitative analysis of DWI was performed for each lesion by two independent observers using a five-point scale. RESULTS: Both of mean ADC value (1.902 versus 0.997×10-3 mm2/s) and mean CNR (119.2 versus 36.9) for haemangioma were significantly larger than for HCC (p<0.001). On receiver operating characteristic (ROC) analysis, an area under the curve (AUC) of 0.995 for ADC values was significantly larger than 0.915 for CNRs (p=0.002). When the ADC value of 1.327×10-3 mm2/s was used as the threshold for the diagnosis of haemangioma, the sensitivity and specificity were 98% and 97.3%, respectively. The mean sensitivity and specificity of qualitative analysis for the differentiation of haemangioma from HCC were 92% and 99.1%, respectively. CONCLUSION: For high-flow small haemangiomas showing pseudo-washout appearance during gadoxetic acid-enhanced hepatic MRI, high b-factor DWI including an ADC map may provide additional information to enhance the confidence to exclude small hypervascular HCCs.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김주희(Kim, Joo Hee) ORCID logo https://orcid.org/0000-0001-5383-3602
남세진(Nam, Se Jin)
유정식(Yu, Jeong Sik) ORCID logo https://orcid.org/0000-0002-8171-5838
정재준(Chung, Jae Joon) ORCID logo https://orcid.org/0000-0002-7447-1193
조은석(Cho, Eun Suk)
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