title: Differentiation between cavernous hemangiomas and untreated malignant neoplasms of the liver with free-breathing diffusion-weighted MR imaging: comparison with T2-weighted fast spin-echo MR imaging.
abstract: OBJECTIVE
  To test interobserver variability of ADC measurements and compare the diagnostic performances of free-breathing diffusion-weighted (FBDW) with that of T2-weighted FSE (T2WFSE) MR imaging for differentiating between cavernous hemangiomas and untreated malignant hepatic neoplasms.
  
  
  METHODS
  Thirty-five patients with cavernous hemangiomas and 35 with untreated hepatic malignant neoplasms had FBDW and T2WFSE MR imaging. Hepatic lesions were characterized with ADC measurement and visual evaluation. Interobserver agreement for ADC measurement was calculated. Association between ADC value and lesion type was assessed using univariate analysis. Sensitivity, specificity and accuracy of ADC values and visual evaluation of MR images for the diagnosis of untreated malignant hepatic neoplasm were compared.
  
  
  RESULTS
  ADC measurements showed excellent interobserver correlation (intraclass correlation coefficient=0.980). Malignant neoplasms had lower ADC values than hemangiomas for the two observers (1.11×10(-3) mm2/s±.21×10(-3) vs. 1.77×10(-3) mm2/s±.29×10(-3) for observer 1 and 1.11×10(-3) mm2/s±.19×10(-3) vs. 1.79×10(-3) mm2/s±.32×10(-3) for observer 2) and univariate analysis found significant correlations between lesion type and ADC values. Depending on ADC threshold value, accuracy for the diagnosis of malignant neoplasm varied from 82.9% to 94.3%. Using visual evaluation, FBDW showed better specificity and accuracy than T2WFSE MR images for the diagnosis of malignant neoplasm (97.1% vs. 77.1% and 94.3% vs. 62.9%, respectively).
  
  
  CONCLUSIONS
  FBDW imaging provides reproducible quantitative information and surpasses the value of T2WFSE MR imaging for differentiating between cavernous hemangiomas and untreated malignant hepatic neoplasms.
authors.affiliation: Department of Abdominal Imaging, Unité 965 INSERM/Paris7, Hôpital Lariboisière-AP-HP and Université Diderot-Paris 7, 2, rue Ambroise Paré, 75475, Paris Cedex 10, France. philippe.soyer@irb.aphp.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Soyer
authors.forename: Lucie
authors.initials: L
authors.lastname: Corno
authors.forename: Mourad
authors.initials: M
authors.lastname: Boudiaf
authors.forename: Mounir
authors.initials: M
authors.lastname: Aout
authors.forename: Marc
authors.initials: M
authors.lastname: Sirol
authors.forename: Vinciane
authors.initials: V
authors.lastname: Placé
authors.forename: Florent
authors.initials: F
authors.lastname: Duchat
authors.forename: Youcef
authors.initials: Y
authors.lastname: Guerrache
authors.forename: Yann
authors.initials: Y
authors.lastname: Fargeaudou
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
authors.forename: Lounis
authors.initials: L
authors.lastname: Hamzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006392:Hemangioma, Cavernous / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media