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Keywords:
Neoplasia, Cirrhosis, Cancer, Diagnostic procedure, Computer Applications-Detection, diagnosis, Acceptance testing, PACS, MR-Diffusion/Perfusion, MR, Oncology, Liver, Abdomen
Authors:
V. Karagöz, A. Aslan, M. Acar; Istanbul/TR
DOI:
10.1594/ecr2015/C-2092
Results
From the RIS,
72 patients met the inclusion criteria and were enrolled in the study.
Chronic liver disease was present in all patients.
Of the patients,
54 were male (75%) and 18 were female (25%).
A total of 82 nodules obtained from the patients were included in the study.
Of theses,
27 nodules were diagnosed as DN and 55 nodules accepted as HCC on the basis of dynamic multiphasic MRI criteria described by AASLD or histopathological findings.
Histopathological evaluation of surgical or tru-cut needle biopsy specimens was confirmed as HCC diagnosis in 15 patients and DN in 10 patients.
The mean age of patients who had a diagnosis of DN was 62.22 ± 8.05 (range 51 to 75) years and patients who had a diagnosis of HCC was 64.45 ± 8.04 (range 49 to 79) years (p = 0.241).
All lesions detected on dynamic contrast enhanced MRI were visible on DW-MRI and ADC maps.
The mean diameter of DN was 18.49 ± 12.47 mm (range 7 – 68 mm) and of HCC nodules was 72.5 ± 47.96 mm (range 10-201 mm) (p < 0.001).
The SI of DN was hypointense in 5 (18.5%) nodules and isointense in 22 (81.5%) nodules,
while the SI of HCC nodules was hypointense in 1 (1.8%) nodule,
isointense in 5 (9.1%) nodules and hyperintense in 49 (89.1%) nodules on DW-MRI (p < 0.001).
The sensitivity,
specificity,
positive predictive value (PPV) and negative predictive value (NPV) of hyper SI on DW-MRI for diagnosing HCC were 89%,
100%,
100% and 81.8% respectively.
The mean ADC value of DN was 1.25 ± 0.22 and of HCC nodules was 1.03 ± 0.25 (p < 0.001).
The mean ADC ratio was 0.96 ± 0.22 in DN and 0.76 ± 0.17 in HCC nodules and was statistically significant (p < 0.001).
ROC analysis of the ADC and ADC ratios are summarized in Table 1.
A cut off value of 1.10 for ADC and 0.86 for ADC ratio had the best sensitivity,
specificity,
PPV and NPV for the differentiation of HCC nodules from DN (Table 2).
There were negative and insignificant correlations between the size of HCC nodules and ADC and ADC ratio (r = -0.210,
p = 0.124 and r = -0.104,
p = 0.451 respectively).
Table 1.
ROC analysis of ADC and ADC ratio values for detecting HCC nodules.
Variables |
Area under curve
|
Std.
Error
|
p
|
Asymptotic 95% CI*
|
|
|
|
|
Lower Bound
|
Upper Bound
|
ADC
|
0.776
|
0.054
|
< 0.001
|
0.671
|
0.882
|
ADC ratio
|
0.867
|
0.040
|
< 0.001
|
0.789
|
0.945
|
Abbreviations: * CI; confidence interval.
Table 2.
Statistical data derived from ADC and ADC ratios to determine HCC nodules in patients with chronic liver disease by DW-MRI.
Values
|
Sensitivity
|
Specifity
|
PPD*
|
NPD**
|
Accuracy
|
P
|
ADC ≤ 1.10
|
85
|
70
|
73.91
|
82.35
|
77.5
|
< 0.001
|
ADCratio≤0.86
|
78
|
80
|
79.59
|
78.43
|
79
|
< 0.001
|
Abbreviations: * PPD; positive predictive value,
** NPD; negative predictive value.
Serum AFP levels were obtained in 50 HCC nodules and in 27 DN.
The mean AFP level was 53.02 ± 209.47 µg/L in DN and was 1257.02 ± 4386 µg/L (p < 0.058).
There were negative and insignificant correlations between the serum level of AFP and ADC and ADC ratio in HCC nodules (r = -0.175,
p = 0.223 and r = -0.042,
p = 0.77,
respectively).