Maria Luiza Testa1, Rubens Chojniak1, Letícia Silva Sene1, Aline Santos Damascena2, Marcos Duarte Guimarães1, Janio Szklaruk3, Edson Marchiori4. 1. Department of Diagnostic Radiology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil. 2. CIPE - International Center for Research, A.C. Camargo Cancer Center, São Paulo, SP, Brazil. 3. Department of Diagnostic Radiology, The University of Texas - MD Anderson Cancer Center, Houston, Texas, United States of America. 4. Department of Radiology, Federal University of Rio de Janeiro, Petrópolis, Rio de Janeiro, Brazil.
Abstract
OBJECTIVE: Apparent diffusion coefficient (ADC) values calculated through magnetic resonance imaging have been proposed as a useful tool to distinguish benign from malignant liver lesions. Most studies however included simple cysts in their analysis. Liver cysts are easy to diagnose, have very high ADC values and their inclusion facilitates differentiation in the ADC values between benign and malignant liver lesions groups. We prospectively evaluated the ability of ADC values to differentiate metastatic liver lesions from all benign or only solid benign liver lesions. MATERIAL AND METHODS: Sixty-seven adult cancer patients with 188 liver lesions were evaluated. Lesions were categorized as metastatic or benign throughout imaging and clinical evaluation. One hundred and five (105) metastatic lesions and 83 benign lesions including hemangiomas (37), cysts (42), adenomas (2) and focal nodular hyperplasias (2) were evaluated. ADC values were calculated for each lesion utilizing two b values (0 and 600 sec/mm2). RESULTS: The average ADC value for cysts was 2.4×10(-3) mm2/sec (CI: 2.1-2.6), for solid benign lesions was 1.4×10(-3) mm2/sec (CI: 1.1-1.7) and for metastases was 1.0×10(-3) mm2/sec (CI: 0.8-1.3). There was a difference between the ADC values of metastases and benign solid lesions (p<0.0001). With the ADC value of 1.5×10(-3) mm2/sec as a cut off it is possible to distinguish metastatic from benign liver lesions, including cysts, with an accuracy of 78%. But to distinguish metastatic from benign solid liver lesions the best ADC cut off value was 1.2×10(-3) mm2/sec and the accuracy drops to 71%. CONCLUSIONS: ADC values proved to be helpful in the distinction between metastasis and benign solid hepatic lesions. But the exclusion of cysts in the analysis point out to a lower cut off value and lower accuracy than previously reported.
OBJECTIVE: Apparent diffusion coefficient (ADC) values calculated through magnetic resonance imaging have been proposed as a useful tool to distinguish benign from malignant liver lesions. Most studies however included simple cysts in their analysis. Liver cysts are easy to diagnose, have very high ADC values and their inclusion facilitates differentiation in the ADC values between benign and malignant liver lesions groups. We prospectively evaluated the ability of ADC values to differentiate metastatic liver lesions from all benign or only solid benign liver lesions. MATERIAL AND METHODS: Sixty-seven adult cancerpatients with 188 liver lesions were evaluated. Lesions were categorized as metastatic or benign throughout imaging and clinical evaluation. One hundred and five (105) metastatic lesions and 83 benign lesions including hemangiomas (37), cysts (42), adenomas (2) and focal nodular hyperplasias (2) were evaluated. ADC values were calculated for each lesion utilizing two b values (0 and 600 sec/mm2). RESULTS: The average ADC value for cysts was 2.4×10(-3) mm2/sec (CI: 2.1-2.6), for solid benign lesions was 1.4×10(-3) mm2/sec (CI: 1.1-1.7) and for metastases was 1.0×10(-3) mm2/sec (CI: 0.8-1.3). There was a difference between the ADC values of metastases and benign solid lesions (p<0.0001). With the ADC value of 1.5×10(-3) mm2/sec as a cut off it is possible to distinguish metastatic from benign liver lesions, including cysts, with an accuracy of 78%. But to distinguish metastatic from benign solid liver lesions the best ADC cut off value was 1.2×10(-3) mm2/sec and the accuracy drops to 71%. CONCLUSIONS: ADC values proved to be helpful in the distinction between metastasis and benign solid hepatic lesions. But the exclusion of cysts in the analysis point out to a lower cut off value and lower accuracy than previously reported.
Authors: K Coenegrachts; J Delanote; L Ter Beek; M Haspeslagh; S Bipat; J Stoker; F Van Kerkhove; L Steyaert; H Rigauts; J W Casselman Journal: Br J Radiol Date: 2007-05-17 Impact factor: 3.039
Authors: Tejas Parikh; Stephen J Drew; Vivian S Lee; Samson Wong; Elizabeth M Hecht; James S Babb; Bachir Taouli Journal: Radiology Date: 2008-01-25 Impact factor: 11.105