title: Role of Diffusion Weighted Imaging (DWI) for Hepatocellular Carcinoma (HCC) Detection and its Grading on 3T MRI: A Prospective Study.
abstract: BACKGROUND
  Limited studies have evaluated the role of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) for histologically grading the hepatocellular carcinoma (HCC).
  
  
  OBJECTIVE
  To compare the efficacy of DWI with dynamic contrast enhanced magnetic resonance (DCEMR) in detection of HCC in cirrhosis, and to evaluate whether DWI can be used instead of DCEMR.
  
  
  METHODS
  20 patients of either sex with cirrhosis and suspected of having HCC on screening USG were included in this prospective study approved by the Institutional Ethics Committee. All patients underwent DCEMR of the abdomen on 3T scanner and fine needle aspiration of the lesions. MR protocol included T1WI, T2WI, DWI, and dynamic CEMR. The results of diffusion weighted imaging were compared with DCEMR to find the efficacy of DWI vis-à-vis CEMR.
  
  
  RESULTS
  DWI had a sensitivity and specificity of 100%, for diagnosis of lesions in cases having single lesion on CEMR, and sensitivity of 75% and specificity of 100% for diagnosis of lesions in cases having multiple lesions. There was a decreasing trend of ADC values with increasing grade of the tumor; however, the decreasing trend was not statistically significant. A cut-off ADC value of 0.8705 resulted in a sensitivity of 75% and specificity of 50% for differentiating between well-differentiated and other grades of HCC.
  
  
  CONCLUSIONS
  DWI can be used as an alternative for the detection and characterization of HCC, especially in patients with impaired renal function or contrast allergies precluding the use of contrast. In addition, DWI with ADC measurement may be helpful for non-invasive and preoperative prediction of the degree of differentiation of HCC.
authors.affiliation: Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
authors.forename: Shiva
authors.initials: S
authors.lastname: Shankar
authors.affiliation: Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Kalra
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
authors.forename: Anmol
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
authors.forename: Radhika
authors.initials: R
authors.lastname: Srinivasan
authors.affiliation: Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
authors.forename: Paramjeet
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Hepatology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
authors.forename: Radha K
authors.initials: RK
authors.lastname: Dhiman
authors.affiliation: Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
authors.affiliation: Department of Hepatology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Chawla
keywords: ADC; ADC, apparent diffusion coefficient; DCEMR; DCEMR, dynamic contrast enhanced magnetic resonance; DWI; DWI, diffusion weighted imaging; HASTE, half-Fourier acquisition single-shot turbo spin echo; HCC; HCC, hepatocellular carcinoma; TSE, turbo spin echo; VIBE, volume interpolated breath hold examination; grading