Volumetric Apparent Diffusion Coefficient Histogram Analysis in Differentiating Intrahepatic Mass-Forming Cholangiocarcinoma From Hepatocellular Carcinoma

Abstract

Background: Accurate differentiation between intrahepatic mass-forming cholangiocarcinoma (IMCC) and hepatocellular carcinoma (HCC) is needed because treatment and prognosis differ significantly.

Purpose: To explore whether volumetric apparent diffusion coefficient (ADC) histogram analysis can provide additional value to dynamic enhanced MRI in differentiating IMCC from HCC.

Study type: Retrospective.

Population: In all, 131 patients with pathologically proven IMCC (n = 33) or HCC (n = 98).

Field strength/sequence: 3.0T MRI/conventional T₁ -weighted imaging (T₁ WI), T₂ WI, and diffusion-weighted imaging (DWI) with b value of 800 sec/mm² , dynamic enhanced MRI with gadobenate dimeglumine.

Assessment: Dynamic enhanced MR images were analyzed by two independent reviewers using a five-point scale to determine the diagnosis. Volumetric ADC assessments were performed independently by two radiologists to obtain different histogram parameters for each lesion. Quantitative histogram parameters were compared between the IMCC group and HCC group. Diagnostic performance of dynamic enhanced MRI, volumetric ADC histogram analysis, and the combination of both were analyzed.

Statistical tests: Intraclass correlation coefficient (ICC) analysis, independent Student's t-test, or Mann-Whitney U-test, receiver operator characteristic (ROC) curves analysis, and McNemar test.

Results: The sensitivity and specificity for dynamic enhanced MRI to differentiate IMCC from HCC were 82.1% and 82.6%, respectively. For all volumetric ADC histogram parameters, the 75th percentile ADC (ADC_75% ) had the highest AUC (0.791) in differentiating IMCC from HCC, with sensitivity and specificity of 69.7% and 77.6%, respectively. When combining dynamic enhanced MRI with ADC_75% , the sensitivity and specificity were 82.1% and 91.9%, respectively. Compared to dynamic enhanced MRI alone, the specificity for combined dynamic enhanced MRI and ADC_75% was significantly increased (P = 0.008).

Data conclusion: Volumetric ADC histogram analysis provides additional value to dynamic enhanced MRI in differentiating IMCC from HCC.

Level of evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:975-983.

Keywords: apparent diffusion coefficient; cholangiocarcinoma; hepatocellular carcinoma; histogram analysis; magnetic resonance imaging.