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Apparent diffusion coefficient value of diffusion-weighted imaging for hepatocellular carcinoma: correlation with the histologic differentiation and the expression of vascular endothelial growth factor.

Heo SH, Jeong YY, Shin SS, Kim JW, Lim HS, Lee JH, Koh YS, Cho CK, Kang HK - Korean J Radiol (2010)

Bottom Line: There was a significant correlation between the differentiation and the ADC value of the HCCs (r = -0.51, p = 0.012).The VEGF expression did not show correlation with the ADC value of the HCCs (r = 0.07, p = 0.74).Therefore, DWI with ADC measurement may be a valuable tool for noninvasively predicting the differentiation of HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam, Korea.

ABSTRACT

Objective: To evaluate whether the histopathological differentiation and the expression of vascular endothelial growth factor (VEGF) of hepatocellular carcinoma (HCC) do show correlation with the apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI).

Materials and methods: Twenty-seven HCCs from 27 patients who had undergone preoperative liver MRI (1.5T) and surgical resection were retrospectively reviewed. DWI was obtained with a single-shot, echo-planar imaging sequence in the axial plane (b values: 0 and 1,000 sec/mm(2)). On DWIs, the ADC value of the HCCs was measured by one radiologist, who was kept 'blinded' to the histological findings. Histopathologically, the differentiation was classified into well (n = 9), moderate (n = 9) and poor (n = 9). The expression of VEGF was semiquantitatively graded as grade 0 (n = 8), grade 1 (n = 9) and grade 2 (n = 10). We analyzed whether the histopathological differentiation and the expression of VEGF of the HCC showed correlation with the ADC value on DWI.

Results: The mean ADC value of the poorly-differentiated HCCs (0.9 +/- 0.13x10(-3) mm(2)/s) was lower than those of the well-differentiated HCCs (1.2 +/- 0.22x10(-3) mm(2)/s) (p = 0.031) and moderately-differentiated HCCs (1.1 +/- 0.01x10(-3) mm(2)/s) (p = 0.013). There was a significant correlation between the differentiation and the ADC value of the HCCs (r = -0.51, p = 0.012). The mean ADC of the HCCs with a VEGF expression grade of 0, 1 and 2 was 1.1 +/- 0.17, 1.1 +/- 0.21 and 1.1 +/- 0.18x10(-3) mm(2)/s, respectively. The VEGF expression did not show correlation with the ADC value of the HCCs (r = 0.07, p = 0.74).

Conclusion: The histopathological differentiation of HCC shows inverse correlation with the ADC value. Therefore, DWI with ADC measurement may be a valuable tool for noninvasively predicting the differentiation of HCC.

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51-year-old man with poorly-differentiated hepatocellular carcinoma.A. Axial diffusion-weighted image (TR/TE, 8,000 ms/92 ms; and b - 1,000 sec/mm2) shows 4 × 3.5 cm hepatocellular carcinoma with high signal intensity in left hepatic lobe (arrows).B. On diffusion coefficient map, apparent diffusion coefficient value of tumor (arrows) was 0.88 ± 0.04 (mean ± SD, ×10-3 mm2/s).C. Photomicrograph (Hematoxylin & Eosin staining, ×200) reveals poorly-differentiated hepatocellular carcinoma with irregular nuclei, marked hyperchromatism, and increased mitoses.
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Figure 3: 51-year-old man with poorly-differentiated hepatocellular carcinoma.A. Axial diffusion-weighted image (TR/TE, 8,000 ms/92 ms; and b - 1,000 sec/mm2) shows 4 × 3.5 cm hepatocellular carcinoma with high signal intensity in left hepatic lobe (arrows).B. On diffusion coefficient map, apparent diffusion coefficient value of tumor (arrows) was 0.88 ± 0.04 (mean ± SD, ×10-3 mm2/s).C. Photomicrograph (Hematoxylin & Eosin staining, ×200) reveals poorly-differentiated hepatocellular carcinoma with irregular nuclei, marked hyperchromatism, and increased mitoses.

Mentions: The mean ADC value of the well, moderately and poorly differentiated HCCs was 1.2 ± 0.22, 1.1 ± 0.10 and 0.9 ± 0.13 × 10-3 mm2/s, respectively (range: 0.95 - 1.56, 0.96 - 1.29 and 0.73 - 1.14×10-3 mm2/s, respectively) (Fig. 2A). There was a significant difference in the ADC values among the well-, moderately- and poorly differentiated HCCs (p = 0.026, the Kruskal-Wallis test). For pair-wise comparisons, the ADC value of the poorly-differentiated HCCs was significantly lower than that of the moderately-differentiated HCCs (p = 0.013) (Figs. 2A, 3, 4). There was no significant difference between the ADC value of the well and moderately-differentiated HCCs (p = 0.659) and that of the well and poorly-differentiated HCCs (p = 0.031), although the mean ADC value of the well-differentiated HCCs was higher than those of the moderately and poorly-differentiated HCCs (Fig. 2A). The differentiation was inversely correlated with the ADC value of the HCC, and this was significant correlation (r = -0.51, p = 0.012). An ADC of less than 0.99 × 10-3 mm2/s was found to be the most accurate threshold level for distinguishing HCC with poor differentiation from those with well and moderate differentiation. When this threshold level was applied to our study, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for predicting HCC with poor differentiation were 78%, 83%, 70%, 88% and 82%, respectively.


Apparent diffusion coefficient value of diffusion-weighted imaging for hepatocellular carcinoma: correlation with the histologic differentiation and the expression of vascular endothelial growth factor.

Heo SH, Jeong YY, Shin SS, Kim JW, Lim HS, Lee JH, Koh YS, Cho CK, Kang HK - Korean J Radiol (2010)

51-year-old man with poorly-differentiated hepatocellular carcinoma.A. Axial diffusion-weighted image (TR/TE, 8,000 ms/92 ms; and b - 1,000 sec/mm2) shows 4 × 3.5 cm hepatocellular carcinoma with high signal intensity in left hepatic lobe (arrows).B. On diffusion coefficient map, apparent diffusion coefficient value of tumor (arrows) was 0.88 ± 0.04 (mean ± SD, ×10-3 mm2/s).C. Photomicrograph (Hematoxylin & Eosin staining, ×200) reveals poorly-differentiated hepatocellular carcinoma with irregular nuclei, marked hyperchromatism, and increased mitoses.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864856&req=5

Figure 3: 51-year-old man with poorly-differentiated hepatocellular carcinoma.A. Axial diffusion-weighted image (TR/TE, 8,000 ms/92 ms; and b - 1,000 sec/mm2) shows 4 × 3.5 cm hepatocellular carcinoma with high signal intensity in left hepatic lobe (arrows).B. On diffusion coefficient map, apparent diffusion coefficient value of tumor (arrows) was 0.88 ± 0.04 (mean ± SD, ×10-3 mm2/s).C. Photomicrograph (Hematoxylin & Eosin staining, ×200) reveals poorly-differentiated hepatocellular carcinoma with irregular nuclei, marked hyperchromatism, and increased mitoses.
Mentions: The mean ADC value of the well, moderately and poorly differentiated HCCs was 1.2 ± 0.22, 1.1 ± 0.10 and 0.9 ± 0.13 × 10-3 mm2/s, respectively (range: 0.95 - 1.56, 0.96 - 1.29 and 0.73 - 1.14×10-3 mm2/s, respectively) (Fig. 2A). There was a significant difference in the ADC values among the well-, moderately- and poorly differentiated HCCs (p = 0.026, the Kruskal-Wallis test). For pair-wise comparisons, the ADC value of the poorly-differentiated HCCs was significantly lower than that of the moderately-differentiated HCCs (p = 0.013) (Figs. 2A, 3, 4). There was no significant difference between the ADC value of the well and moderately-differentiated HCCs (p = 0.659) and that of the well and poorly-differentiated HCCs (p = 0.031), although the mean ADC value of the well-differentiated HCCs was higher than those of the moderately and poorly-differentiated HCCs (Fig. 2A). The differentiation was inversely correlated with the ADC value of the HCC, and this was significant correlation (r = -0.51, p = 0.012). An ADC of less than 0.99 × 10-3 mm2/s was found to be the most accurate threshold level for distinguishing HCC with poor differentiation from those with well and moderate differentiation. When this threshold level was applied to our study, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for predicting HCC with poor differentiation were 78%, 83%, 70%, 88% and 82%, respectively.

Bottom Line: There was a significant correlation between the differentiation and the ADC value of the HCCs (r = -0.51, p = 0.012).The VEGF expression did not show correlation with the ADC value of the HCCs (r = 0.07, p = 0.74).Therefore, DWI with ADC measurement may be a valuable tool for noninvasively predicting the differentiation of HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam, Korea.

ABSTRACT

Objective: To evaluate whether the histopathological differentiation and the expression of vascular endothelial growth factor (VEGF) of hepatocellular carcinoma (HCC) do show correlation with the apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI).

Materials and methods: Twenty-seven HCCs from 27 patients who had undergone preoperative liver MRI (1.5T) and surgical resection were retrospectively reviewed. DWI was obtained with a single-shot, echo-planar imaging sequence in the axial plane (b values: 0 and 1,000 sec/mm(2)). On DWIs, the ADC value of the HCCs was measured by one radiologist, who was kept 'blinded' to the histological findings. Histopathologically, the differentiation was classified into well (n = 9), moderate (n = 9) and poor (n = 9). The expression of VEGF was semiquantitatively graded as grade 0 (n = 8), grade 1 (n = 9) and grade 2 (n = 10). We analyzed whether the histopathological differentiation and the expression of VEGF of the HCC showed correlation with the ADC value on DWI.

Results: The mean ADC value of the poorly-differentiated HCCs (0.9 +/- 0.13x10(-3) mm(2)/s) was lower than those of the well-differentiated HCCs (1.2 +/- 0.22x10(-3) mm(2)/s) (p = 0.031) and moderately-differentiated HCCs (1.1 +/- 0.01x10(-3) mm(2)/s) (p = 0.013). There was a significant correlation between the differentiation and the ADC value of the HCCs (r = -0.51, p = 0.012). The mean ADC of the HCCs with a VEGF expression grade of 0, 1 and 2 was 1.1 +/- 0.17, 1.1 +/- 0.21 and 1.1 +/- 0.18x10(-3) mm(2)/s, respectively. The VEGF expression did not show correlation with the ADC value of the HCCs (r = 0.07, p = 0.74).

Conclusion: The histopathological differentiation of HCC shows inverse correlation with the ADC value. Therefore, DWI with ADC measurement may be a valuable tool for noninvasively predicting the differentiation of HCC.

Show MeSH
Related in: MedlinePlus