title: Comparison of magnetic resonance elastography and diffusion-weighted imaging for differentiating benign and malignant liver lesions.
abstract: OBJECTIVE
  Comparison of magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) for differentiating malignant and benign focal liver lesions (FLLs).
  
  
  METHODS
  Seventy-nine subjects with 124 FLLs (44 benign and 80 malignant) underwent both MRE and DWI. MRE was performed with a modified gradient-echo sequence and DWI with a free breathing technique (b = 0.500). Apparent diffusion coefficient (ADC) maps and stiffness maps were generated. FLL mean stiffness and ADC values were obtained by placing regions of interest over the FLLs on stiffness and ADC maps. The accuracy of MRE and DWI for differentiation of benign and malignant FLL was compared using receiver operating curve (ROC) analysis.
  
  
  RESULTS
  There was a significant negative correlation between stiffness and ADC (r = -0.54, p < 0.0001) of FLLs. Malignant FLLs had significantly higher mean stiffness (7.9kPa vs. 3.1kPa, p < 0.001) and lower mean ADC (129 vs. 200 × 10(-3)mm(2)/s, p < 0.001) than benign FLLs. The sensitivity/specificity/positive predictive value/negative predictive value for differentiating malignant from benign FLLs with MRE (cut-off, >4.54kPa) and DWI (cut-off, <151 × 10(-3)mm(2)/s) were 96.3/95.5/97.5/93.3% (p < 0.001) and 85/81.8/88.3/75% (p < 0.001), respectively. ROC analysis showed significantly higher accuracy for MRE than DWI (0.986 vs. 0.82, p = 0.0016).
  
  
  CONCLUSIONS
  MRE is significantly more accurate than DWI for differentiating benign and malignant FLLs.
  
  
  CONCLUSIONS
  • MRE is superior to DWI for differentiating benign and malignant focal liver lesions. • Benign lesions with large fibrous components may have higher stiffness with MRE. • Cholangiocarcinomas tend to have higher stiffness than hepatocellular carcinomas. • Hepatocellular adenomas tend to have lower stiffness than focal nodular hyperplasia. • MRE is superior to conventional MRI in differentiating benign and malignant liver lesions.
authors.affiliation: Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: Tiffany P
authors.initials: TP
authors.lastname: Hennedige
authors.affiliation: Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: James Thomas Patrick Decourcy
authors.initials: JT
authors.lastname: Hallinan
authors.affiliation: Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore.|South West Radiology, Liverpool, NSW, Australia.
authors.forename: Fiona P
authors.initials: FP
authors.lastname: Leung
authors.affiliation: Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: Lynette Li San
authors.initials: LL
authors.lastname: Teo
authors.affiliation: Department of Surgery, National University Health System, Singapore, Singapore.
authors.forename: Sridhar
authors.initials: S
authors.lastname: Iyer
authors.affiliation: Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore.|University of Calgary, Alberta, Canada.
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Surgery, National University Health System, Singapore, Singapore.
authors.forename: Stephen
authors.initials: S
authors.lastname: Chang
authors.affiliation: Department of Surgery, National University Health System, Singapore, Singapore.
authors.forename: Krishna Kumar
authors.initials: KK
authors.lastname: Madhavan
authors.affiliation: Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: Aileen
authors.initials: A
authors.lastname: Wee
authors.affiliation: Department of Radiology, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA. venkatesh.sudhakar@mayo.edu.
authors.forename: Sudhakar K
authors.initials: SK
authors.lastname: Venkatesh
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Benign liver lesion; Diffusion-weighted MR imaging; Focal liver lesions; Magnetic resonance elastography; Malignant liver lesion