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Diffusion-Weighted Imaging of Surgically Resected Hepatocellular Carcinoma: Imaging Characteristics and Relationship Among Signal Intensity, Apparent Diffusion Coefficient, and Histopathologic Grade

¹ Department of Radiology, University of Tsukuba, Institute of Clinical Medicine, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan.
² Department of Radiology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan.
³ Department of Radiology, Social Insurance Yamanashi Hospital, Kofu, Yamanashi, Japan.
⁴ Department of Radiology, Yamanashi-kenritsu Chuo Hospital, Kofu, Yamanashi, Japan.

OBJECTIVE. The objective of our study was to determine the relationship between the signal intensity of hepatocellular carcinoma (HCC) assessed with diffusion-weighted imaging (DWI) and T2-weighted imaging and the apparent diffusion coefficient (ADC) with the histopathologic grade of each nodule.

MATERIALS AND METHODS. MR examinations including DWI and T2-weighted imaging of 125 surgically resected hypervascular HCCs in 99 patients were retrospectively reviewed. Pathologic examinations revealed 25 well-, 61 moderately, and 39 poorly differentiated HCCs. Two radiologists reviewed the images and classified the signal intensity of each tumor on DWI and T2-weighted imaging by mutual agreement. The incidence of each signal intensity and the relationship between signal intensity and histopathologic grade were assessed for each sequence. The relationship between the ADC and histopathologic grade was also evaluated.

RESULTS. On DWI, 11 of 125 HCCs appeared hypo- to isointense, 27 tumors appeared slightly hyperintense, and the remaining 87 tumors appeared obviously hyperintense to the surrounding liver. Overall, 91.2% (114/125) of HCCs showed hyperintensity to the surrounding hepatic parenchyma. Statistical analysis showed that this rate on DWI was significantly higher than that on T2 turbo spin-echo (TSE) imaging (p < 0.001). On DWI, the tumors tended to show a brighter signal with rising histopathologic grade (p = 0.031), but this trend was not observed on T2-weighted imaging. ADC measurements revealed that the mean ADCs of well-, moderately, and poorly differentiated HCCs were approximately 1.45, 1.46, and 1.36 x 10^–3 mm²/s, respectively. There was no significant correlation between ADC and histopathologic grade.

CONCLUSION. The histopathologic grade of HCC had no correlation with the ADC, but HCC tumors tended to show a higher signal on DWI as the histopathologic grade rose. However, predicting the correct histopathologic grade of each HCC before surgery on the basis of DWI findings was difficult because of the large overlap among histopathologic grades.

Keywords: apparent diffusion coefficient • diffusion-weighted imaging • hepatocellular carcinoma • histopathologic grade • signal intensity • T2-weighted imaging

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