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INTRODUCTION: This study aims to explore the correlation between magnetic resonance diffusion parameters and simplified apparent diffusion coefficient (sADC) values calculated from various b-value combinations in patients with hepatocellular carcinoma (HCC). By comparing indices from Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Continuous Time Random Walk (CTRW) models with the sADC groups, we assess whether a reduced b-value protocol could yield similar diagnostic information, potentially simplifying future scans while aiding in the differentiation and grading of tumors.
METHODS: We enrolled 35 patients with diagnosed HCC and performed scans with 11 different b-values to acquire diffusion parameters. Tumor regions were manually delineated at their largest cross-section. Parameters measured included combinations of sADC (ranging from low to high b-values) and diffusion model parameters such as ADC_mono for the monoexponential model, S0, Dapp, and Kapp for DKI, Fp, DP, and Dt for IVIM, and alpha, beta, and Dm for CTRW.
RESULTS: Statistical analysis revealed that simplified ADC (sADC) values calculated from intermediate b-value combinations (e.g., 0, 500, 1000 s/mm²) exhibited strong correlations (r > 0.8, p < 0.001) with parameters from the IVIM, DKI, and CTRW models. Specifically, sADC values showed a strong correlation with Dapp and Kapp from DKI, suggesting that sADC may reflect tissue complexity similar to DKI. For IVIM, sADC correlated well with Fp and D*, indicating it could capture perfusion-related information. The alpha parameter from the CTRW model, which characterizes tissue heterogeneity, also showed a strong correlation with sADC values derived from high b-value combinations (e.g., 0, 800, 1600 s/mm²).
DISCUSSION: The strong correlations between sADC and the diffusion parameters of more complex models suggest that a simplified b-value protocol could indeed provide reliable diagnostic information for HCC characterization and grading. This has significant implications for clinical practice, as it suggests that a reduced b-value MR diffusion imaging protocol may be a viable alternative to the more complex and time-consuming multi-b-value analyses typically used. Furthermore, this simplification could result in faster scanning times, increased patient throughput, and reduced motion artifacts, potentially leading to improved patient comfort and decreased healthcare costs without compromising the diagnostic quality. Future research should aim to validate these findings in a larger cohort and to assess the clinical impact of implementing such simplified protocols in routine practice.
CONCLUSION: The study indicates potential b-value pairs that could streamline MR diffusion imaging for HCC by providing diagnostic information comparable to that obtained from more complex and time-consuming multi-b-value analyses. This could enhance scan efficiency, patient comfort, and possibly even healthcare costs, while maintaining diagnostic integrity for tumor characterization and grading.

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