Shaopeng Li1, Kexue Deng1, and Peng Wang2
1Department of Radiology, The First Affiliated Hospital of USTC, Southern District of Anhui Provincial Hospital, Hefei, China, 2Department of Radiology, The First Affiliated Hospital of USTC, Southern District of Anhui Provincial Hospital, hefei, China
Synopsis
During the evolution of hepatocellular carcinoma(HCC) from high differentiation to low differentiation, the number of tumor cells
increased and arranged more closely, the limited diffusion of water molecules
was more obvious. Meanwhile, the iron and fat content in the lesions decreased gradually. The ADC、D values derived from IVIM-DWI and FF、R2* values derived from IDEAL-IQ can accurately reflect the diffusion limitation and the changes of fat and iron content in HCC, so as to accurately evaluate the pathological grade of HCC.
Objective
The prognosis of hepatocellular carcinoma(HCC)
is closely related to its grade of pathological 1. Zhu et al showed that the
ADC and D values which derived from IVIM-DWI were statistically significant in HCC
with different degrees of differentiation 2. The D value of HCC with different
degrees of differentiation was lower than the ADC value, and the D value had
better diagnostic effect. Tsukahara et al showed that the stage of RN evolving
into HCC will be combined with iron deficiency 3, and the sign of steatosis was
a secondary sign of HCC specific malignancy. IDEAL-IQ can accurately evaluate
liver iron and fat content 4,5,6. This study investigated the value of IVIM-DWI
and IDEAL-IQ in grading of HCC.Methods
61 cases of hepatocellular cancer were confirmed
by pathology. All HCCs were divided into high、moderate and low differentiation group according
to the Edmondson-Steiner grading. For all patients underwent routine MR scans、IVIM-DWI and IDEAL-IQ
examination. Measure these parameters by checking ADW 4.6 workstation,
including ADC、D、D*、f and fat fraction(FF)、R2* values.
Comparison between groups was conducted with ANOVA test and S-N-K test and the
receiver operating characteristic curve (ROC) analysis was used to evaluate the
predictive efficiency of IVIM-DWI and IDEAL-IQ parameters in preoperative
grading. Correlation analysis of ADC, D, FF and R2 * and the HCC
differentiation by Spearman correlation analysis. The difference was
statistically significant when P<0.05.Results
There were 14 cases in the high differentiated
group, 30 cases in the moderate and 17 cases in the low differentiation group.
The mean ADC、D、D*、f and FF、R2* values of the high differentiation group
were (1.369±0.114)×10-3mm2/s、(1.075±0.131)×10-3mm2/s、(24.738±9.667)×10-3mm2/s、(0.264±0.08)%、(8.885±4.514)%、(27.937±2.724)Hz,
while those values of the moderate and low differentiation group were
(1.192±0.161)×10-3mm2/s、(0.861±0.131)×10-3mm2/s、(22.359±13.875)×10-3mm2/s、(0.327±0.164)%、(5.63±4.544)%、(21.15±4.535)Hz and
(0.996±0.195)×10-3mm2/s、(0.685±0.098)×10-3mm2/s、(22.898±15.721)×10-3mm2/s、(0.501±1.054)%、(3.23±1.599)%、(14.911±3.054)Hz,
respectively. The ADC、D、FF and R2* values had statistically significant
differences between the three groups (P<0.05). The D* value and f value had
no statistically significant difference between the three groups (P>0.05).
The areas under the ROC curve of ADC、D、FF and R2* values were 0.825、0.883、0.795、0.914 between
high-moderate differentiation group. The areas under the ROC curve of ADC、D、R2* values were 0.8、0.869、0.867 between
moderate-low differentiation group respectively. The ADC、D、FF and R2* values
were positively correlated with the differentiated degree of HCC, and the
correlation coefficients were 0.625, 0.633, 0.568 and 0.713.Conclusions
ADC、D、FF
and R2* values had an important reference value for evaluating the
differentiation of HCC. R2* value had the highest test efficiency between
high-moderate differentiation group, while D value had the highest test
efficiency between moderate-low differentiation group(the efficiency of R2*
value was slightly lower than that of D value). ADC、D、FF
and R2* values were correlated with the degree of HCC differentiation, and the
R2* value had the highest relativity.Acknowledgements
I am grateful to Kexue Deng and Peng Wang for their help and support in the design of the study and interpretation of the results.References
[1] Zhuang HK, Zhou
ZX, Ma
ZY,
et al. Prognostic Stratification Based on a Novel Nomogram for Solitary Large Hepatocellular
Carcinoma After Curative Resection [J]. Front Oncol, 2020,16(10):556489.
[2] Zhu SC, Liu
YH, Wei Y, et al. Intravoxel incoherent motion diffusion-weighted magnetic
resonance imaging for predicting histological grade of hepatocellular
carcinoma: Comparison with conventional diffusion-weighted imaging[J].World J
Gastroenterol,2018,24(8): 929-940.
[3] Tsukahara Y, Okajima Y, Yamada A, et al. The
peritumoral hypointense rim around hepatocellular carcinoma on T2*-weighted
magnetic resonance imaging: radiologic-pathologic correlation[J]. World J Surg
Oncol,2021,19(1):41-50.
[4] Wang Q, Ye F, Ma PQ,et al. Quantitative magnetic
resonance imaging evaluation of hepatic fat content with iron deposition: will
it be disturbed?[J].J Int Med Res,2019,47(5):1958-1974.
[5]
Chen YD, Long LL, Jiang ZJ, et al. Quantification of pancreatic proton density fat
fraction in diabetic pigs using MR imaging and IDEAL-IQ sequence[J].BMC Med
Imaging,2019,19(1):
38-45.
[6] Rajlawot K, Jiang T, Zhou J,et al. Accuracies of Chemical Shift
In/Opposed Phase and Chemical Shift Encoded Magnetic Resonance Imaging to
Detect Intratumoral Fat in Hepatocellular Carcinoma[J]. J Magn Reson Imaging,2021,53(6):1791-1802.