Investig Magn Reson Imaging.  2018 Jun;22(2):79-85. 10.13104/imri.2018.22.2.79.

Pseudoglandular Formation in Hepatocellular Carcinoma Determines Apparent Diffusion Coefficient in Diffusion-Weighted MRI

• Park IK
• Yu JS
• Cho ES
• Kim JH
• Chung JJ

• KMID: 2415885
• DOI: http://doi.org/10.13104/imri.2018.22.2.79

Abstract

PURPOSE
To determine the impact of pseudoglandular formation on apparent diffusion coefficient (ADC) values of hepatocellular carcinoma (HCC) in diffusion-weighted imaging (DWI), and to validate the results using histopathological grades.
MATERIALS AND METHODS
We assessed 182 HCCs surgically resected from 169 consecutive patients. Each type of tumor pseudoglandular formation was categorized into "non-,""mixed-," or "pure-," based on official histopathology reports. The ADC for each tumor was independently measured, using the largest region of interest on the ADC map. Data were assessed using the analysis of variance test, with Bonferroni correction for post hoc analysis to stratify the relationship of ADCs with pseudoglandular formation, followed by subgroup analysis according to the histopathological tumor grades.
RESULTS
The mean ADC was significantly higher in pure pseudoglandular lesions (n = 5, 1.29 ± 0.08 × 10−3 mm2/s) than in non-pseudoglandular lesions (n = 132, 1.08 ± 0.17 × 10−3 mm2/s; P = 0.003) or mixed-pseudoglandular lesions (n = 45, 1.16 ± 0.24 × 10−3 mm2/s; P = 0.034). The ADC values and pseudoglandular formation were significantly correlated in moderately differentiated HCCs (n = 103; r = 0.307, P = 0.007), while well- (n = 19) and poorly-differentiated HCCs (n = 60) did not show significant correlation (r = 0.105 and 0.068, respectively; P = 0.600 and 0.685, respectively).
CONCLUSION
The degree of pseudoglandular formation could be one of the determinants of ADC in DWI of HCCs-especially moderately differentiated HCCs-while its influence does not appear to be significant in well- or poorly differentiated HCCs.

Keyword

Diffusion magnetic resonance imaging; Carcinoma, hepatocellular; Liver diseases; Liver neoplasms

MeSH Terms

Carcinoma, Hepatocellular*
Diffusion Magnetic Resonance Imaging
Diffusion*
Humans
Liver Diseases
Liver Neoplasms
Magnetic Resonance Imaging*

Figure

• 

  Fig. 1 Bland-Altman plot comparing interobserver agreement of apparent diffusion coefficients (ADCs). The blue line represents the absolute difference, while the two dotted red lines represent the 95% confidence interval of the mean difference. The mean absolute difference in the ADC measurements between the two observers is 0.010 × 10−3 mm2/s (limit of agreement, 0.20–0.66). ADC1 and 2 indicate ADCs measured by observers 1 and 2 (× 10−3 mm2/s), respectively.

• 

  Fig. 2 Illustrations and representative diffusion-weighted images (b = 800 s/mm2) with correspond-ing apparent diffusion coefficient (ADC) maps of the three architectural types of hepatocellular carcinomas. Non-pseudoglandular (a–c), mixed-pseudoglandular (d–f), and pure-pseudoglandular (g–i) types exhibit different ADC values, as measured by the regions-of-interest in the ADC maps, depending on the size and number of pseudoglandular formations.

• 

  Fig. 3 Box-and-whisker plots showing the distribution, mean, and range of apparent diffusion coefficient (ADC) values for each (a) pseudoglandular type and (b) tumor grade. Individual data are represented as squares. The horizontal line in each box indicates the median value and the box indicates data from the 25th to the 75th percentile. The whiskers show the upper and lower extremes of data; outliers are marked as separate squares. (a) The mean ADC was significantly higher in pure pseudoglandular lesions (n = 5, 1.29 ± 0.08 × 10−3 mm2/s) than in non-pseudoglandular lesions (n = 132, 1.08 ± 0.17 × 10−3 mm2/s; P = 0.003) or mixed-pseudoglandular lesions (n = 45, 1.16 ± 0.24 × 10−3 mm2/s; P = 0.034). (b) The poorly differentiated hepatocellular carcinomas (HCCs) (1.04 ± 0.16 × 10−3 mm2/s) exhibited a lower mean ADC than the well-differentiated HCCs (1.10 ± 0.15 × 10−3 mm2/s; P = 0.968) or moderately differentiated HCCs (1.14 ± 0.21 × 10−3 mm2/s; P = 0.010). mADC = mean ADC of two observers (× 10−3 mm2/s), md = moderately differentiated, pd = poorly differentiated, PG = pseudoglandular, wd = well differentiated

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