title: Prediction of the histopathological grade of hepatocellular carcinoma using qualitative diffusion-weighted, dynamic, and hepatobiliary phase MRI.
abstract: OBJECTIVE
  To investigate the effectiveness of qualitative diffusion-weighted imaging (DWI), subtraction of unenhanced from arterial phase images, and hepatobiliary phase (HBP) images in estimating the histopathological grade of hepatocellular carcinoma (HCC).
  
  
  METHODS
  We retrospectively reviewed gadoxetic acid-enhanced magnetic resonance images of 175 patients with 201 surgically resected HCCs. The signal intensity and its relationship with histopathological grade were assessed for each sequence and a combination of sequences.
  
  
  RESULTS
  There was a tendency towards higher grades in tumours showing restricted diffusion on DWI (P < 0.001) or arterial enhancement on subtraction imaging (P < 0.001), but not hepatocyte-defect on HBP images (P = 0.33). When lesions were divided into three groups based on combined findings on DWI and subtraction imaging, a linear trend was observed between group and grade (P < 0.001). The positive predictive value (PPV) of the combination of no restricted diffusion and no arterial enhancement in predicting well-differentiated HCC was 100%, higher than the PPV of individual findings on DWI (74%) or subtraction imaging (81%).
  
  
  CONCLUSIONS
  DWI and subtraction imaging are helpful for predicting the histopathological grade of HCC, especially when the two sequences are considered together.
  
  
  CONCLUSIONS
  • Predicting the histopathological grade of hepatocellular carcinoma (HCC) preoperatively is important. • Diffusion-weighted imaging (DWI) and subtraction imaging are recently developed MR techniques. • Retrospective study showed DWI and subtraction imaging helps predict HCC grades. • Management of patients with HCC becomes more appropriate.
authors.affiliation: Department of Diagnostic Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Chansik
authors.initials: C
authors.lastname: An
authors.forename: Mi-Suk
authors.initials: MS
authors.lastname: Park
authors.forename: Hyae-Min
authors.initials: HM
authors.lastname: Jeon
authors.forename: Yeo-Eun
authors.initials: YE
authors.lastname: Kim
authors.forename: Woo-Suk
authors.initials: WS
authors.lastname: Chung
authors.forename: Yong Eun
authors.initials: YE
authors.lastname: Chung
authors.forename: Myeong-Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Ki Whang
authors.initials: KW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D004058:Diffusion; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA / Q000494:pharmacology; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013382:Subtraction Technique
chemical_list: C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA