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The role of intravoxel incoherent motion (IVIM) parameters in characterization of hypovascular liver lesions: the raw diffusion weighted images and IVIM data

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Dec 31, 2020 version files 2.18 GB

Abstract

Background: The utility of intravoxel incoherent motion (IVIM) related parameters in differentiation of hypovascular liver lesions is still unknown.

Purpose: The purpose of this study was to evaluate the value of IVIM related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), hypovascular liver metastases (HLM) and primary hepatic lymphoma (PHL).

Methods: Seventy-seven prospectively enrolled patients (21 IMC, 53 HLM, and 3 PHL) underwent 1,5T magnetic resonance examination with IVIM diffusion-weighted imaging using seven b values (0-800 s/mm2). Two independent readers performed quantitative analysis of IVIM-related parameters and ADC. Interobserver agreement was tested using a Pearson/Spearman-correlation.

Results: ADC, true diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (ƒ) were compared among the lesions using Kruskal-Wallis H test. The diagnostic accuracy of each parameter was assessed by receiver operating curve (ROC) analysis. ADC, and D were significantly different among IMC and HLM with higher diagnostic performance of D (AUC=0.879 vs 0.821). Patients with PHL had significantly lower ADC, D and ƒ compared with IMC (p<0.001, p<0.001, and p=0.041, respectively) with highest diagnostic accuracy of D (AUC=0.905). D and ƒ were lower in PHL in comparison to HLM (p=0.031, and p=0.01). Good interobserver agreement was found among two readers (r=0.811 for ADC, 0.902 for D, 0.899 for D*, and 0.911 for ƒ maps).

Conclusion: IVIM-derived parameters in particular D, in addition to ADC, could help in differentiation among most common hypovascular malignant liver lesions. Moreover, they can be used for characterization of rare hypovascular entities such as primary hepatic lymphoma.