Comparison of mono-exponential, bi-exponential, and stretched exponential diffusion-weighted MR imaging models in differentiating hepatic hemangiomas from liver metastases

Purpose: This study aims to compare the diagnostic values of mono-exponential, bi-exponential, and stretched exponential diffusion-weighted imaging (DWI) in differentiating hepatic hemangiomas and liver metastases. Method: This prospective study was approved by our institutional review board, and written informed consent was obtained from all patients. In this study, 244 patients with known or suspected liver disease underwent magnetic resonance imaging. Among them, 37 patients who had focal hepatic lesions with a maximum diameter of >= 10 mm were evaluated. Using home-built software, two radiologists measured the DWI parameters of hepatic lesions for the three models: the apparent diffusion coefficient (ADC) from a mono-exponential model; the true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from a bi-exponential model; and the distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (alpha) from a stretched exponential model. The parameters were compared between hepatic hemangiomas and liver metastases. Results: In total, 64 focal hepatic lesions were evaluated, of which 22 were identified to be hepatic hemangiomas and 42 were liver metastases. ADC, D, f, and DDC values were significantly lower in liver metastases than in hepatic hemangiomas (P < 0.0001, < 0.0001, 0.015, and < 0.0001, respectively); whereas, the alpha value was significantly higher in liver metastases than in hepatic hemangiomas (P = 0.028). The areas under the ROC curve (AUCs) for differentiating hepatic hemangiomas and liver metastases in ADC, D, D*, f, DDC, and alpha were 0.940, 0.908, 0.608, 0.686, 0.952, and 0.667, respectively. The AUC values of ADC and DDC were significantly greater than those of D* (P < 0.0001), f (P = 0.0001), and alpha values (P = 0.0001). Conclusion: ADC and DDC values from the mono-exponential and stretched exponential models could be considered as quantitative imaging biomarkers for differentiating hepatic hemangiomas and liver metastases.

Automated summary

This study aimed to compare the diagnostic values of different diffusion-weighted imaging models in differentiating hepatic hemangiomas and liver metastases. The results showed that ADC and DDC values can be considered as quantitative imaging biomarkers for distinguishing these two types of liver lesions.