title: Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver.
abstract: OBJECTIVE
  To investigate the use of diffusion weighted magnetic resonance imaging (DWI) and the apparent diffusion coefficient (ADC) values in the diagnosis of hemangioma.
  
  
  METHODS
  The study population consisted of 72 patients with liver masses larger than 1 cm (72 focal lesions). DWI examination with a b value of 600 s/mm2 was carried out for all patients. After DWI examination, an ADC map was created and ADC values were measured for 72 liver masses and normal liver tissue (control group). The average ADC values of normal liver tissue and focal liver lesions, the "cut-off" ADC values, and the diagnostic sensitivity and specificity of the ADC map in diagnosing hemangioma, benign and malignant lesions were researched.
  
  
  RESULTS
  Of the 72 liver masses, 51 were benign and 21 were malignant. Benign lesions comprised 38 hemangiomas and 13 simple cysts. Malignant lesions comprised 9 hepatocellular carcinomas, and 12 metastases. The highest ADC values were measured for cysts (3.782±0.53×10(-3) mm(2)/s) and hemangiomas (2.705±0.63×10(-3) mm(2)/s). The average ADC value of hemangiomas was significantly higher than malignant lesions and the normal control group (p<0.001). The average ADC value of cysts were significantly higher when compared to hemangiomas and normal control group (p<0.001). To distinguish hemangiomas from malignant liver lesions, the "cut-off" ADC value of 1.800×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 90.9%. To distinguish hemangioma from normal liver parenchyma the "cut-off" value of 1.858×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 95.7%. To distinguish benign liver lesions from malignant liver lesions the "cut-off" value of 1.800×10(-3) mm(2)/s had a sensitivity of 96.1% and a specificity of 90.0%.
  
  
  CONCLUSIONS
  DWI and quantitative measurement of ADC values can be used in differential diagnosis of benign and malignant liver lesions and also in the diagnosis and differentiation of hemangiomas. When dynamic examination cannot distinguish cases with vascular metastasis and lesions from hemangioma, DWI and ADC values can be useful in the primary diagnosis and differential diagnosis. The technique does not require contrast material, so it can safely be used in patients with renal failure.
authors.affiliation: Ankara Oncology Training and Research Hospital, Department of Radiology, Ankara/Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Tokgoz
authors.affiliation: Afyon Kocatepe University, School of Medicine, Department of Radiology, Afyon.
authors.forename: Ebru
authors.initials: E
authors.lastname: Unlu
authors.affiliation: Cukurova University, School of Medicine, Department of Biostatistics, Adana.
authors.forename: Ilker
authors.initials: I
authors.lastname: Unal
authors.affiliation: Bulent Ecevit University, School of Medicine, Department of Radiology, Zonguldak, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Serifoglu
authors.affiliation: Bulent Ecevit University, School of Medicine, Department of Radiology, Zonguldak, Turkey.
authors.forename: Ilker
authors.initials: I
authors.lastname: Oz
authors.affiliation: Ankara Oncology Training and Research Hospital, Department of Radiology, Ankara/Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Aktas
authors.affiliation: Bulent Ecevit University, School of Medicine, Department of Radiology, Zonguldak, Turkey.
authors.forename: Emrah
authors.initials: E
authors.lastname: Caglar
mesh_terms: D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000473:pathology; D006392:Hemangioma, Cavernous / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: Liver; apparent diffusion coefficient; diffusion weighted magnetic resonance imaging; hemangioma