title: Evaluation of true diffusion, perfusion factor, and apparent diffusion coefficient in non-necrotic liver metastases and uncomplicated liver hemangiomas using black-blood echo planar imaging.
abstract: OBJECTIVE
  To assess the added value of true diffusion (D), perfusion factor (f) and apparent diffusion coefficient at low b-values (ADC(low)) for differentiation between liver metastases and hemangiomas based on respiratory-triggered high-resolution Black-Blood Single-Shot SpinEcho Echo Planar Imaging (BB SS SE-EPI).
  
  
  METHODS
  Twenty-five patients suspected for malignant colorectal liver lesions were included in this study. A total of 106 lesions were examined. Different b-value images were compared for lesion conspicuity, image quality and artifacts using rank order statistic (RIDIT) and Student's t-test. D, f, and ADC(low) values were calculated. Pearson correlation coefficient is used for comparison of interobserver variability.
  
  
  RESULTS
  Best lesion conspicuity (p<0.05) was achieved with BB SS SE-EPI (b=0 and 10s/mm(2)); best image quality (p<0.05) with b=10s/mm(2). Image artifacts were lowest (p<0.05) with b=0s/mm(2). Over the whole sample, D in metastases (D(met)) was significantly (p<0.05) lower than D in hemangiomas (D(hem)); f and ADC(low) of metastases (f(met), respectively, ADC(lowmet)) were significantly (p<0.05) higher than f and ADC(low) of hemangiomas (f(hem), respectively, ADC(lowhem)). All Pearson correlations were statistically significant at a 0.01 level.
  
  
  CONCLUSIONS
  This preliminary study shows the potential of BB SS SE-EPI as a useful technique to aid in differentiating between liver metastasis and hemangioma. The calculation of D, f and ADC(low) provides useful additional information for differentiating metastases from hemangiomas.
authors.affiliation: Department of Radiology, AZ St.-Jan AV, Ruddershove 10, B-8000 Bruges, Belgium. kenneth.coenegrachts@azbrugge.be
authors.forename: Kenneth
authors.initials: K
authors.lastname: Coenegrachts
authors.forename: Joost
authors.initials: J
authors.lastname: Delanote
authors.forename: Leon
authors.initials: L
authors.lastname: Ter Beek
authors.forename: Marc
authors.initials: M
authors.lastname: Haspeslagh
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Luc
authors.initials: L
authors.lastname: Steyaert
authors.forename: Hans
authors.initials: H
authors.lastname: Rigauts
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D003937:Diagnosis, Differential; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D006391:Hemangioma / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity