1 Department of Radiology, Gifu University Hospital, 1-1 Yanagido, 501-1194 Gifu, Japan.
AJR Am J Roentgenol. 2015 May;204(5):W543-9. doi: 10.2214/AJR.14.13235.
The objective of our study was to compare diffusion kurtosis imaging (DKI) with conventional diffusion-weighted imaging (DWI) for assessing the response to treatment in hypervascular hepatocellular carcinoma (HCC).
Sixty-two consecutive patients with treated or untreated hypervascular HCC underwent MRI of the liver including DKI (b values of 0, 100, 500, 1000, 1500, and 2000 s/mm(2)). The mean kurtosis (MK) and apparent diffusion coefficient (ADC) values of the hepatic parenchyma and of the HCCs were computed. The detectability of viable HCC based on MK and ADC values was compared. We also assessed the correlation between Child-Pugh grades and MK or ADC values.
For a total of 112 HCC nodules (viable, n = 63; nonviable, n = 49), the MK value was significantly higher for the viable group (mean ± SD, 0.81 ± 0.11) than for the non-viable group (0.57 ± 0.11) (p < 0.001). The mean ADC value was significantly lower for the viable group (1.44 ± 0.42 × 10(-3) mm(2)/s) than for the nonviable group (1.94 ± 0.52 × 10(-3) mm(2)/s) (p < 0.001). The sensitivity, specificity, and AUC of the ROC curve for the assessment of HCC viability were greater (p < 0.001) using MK (85.7%, 98.0%, and 0.95, respectively; cutoff value = 0.710) than using ADC (79.6%, 68.3%, and 0.77, respectively; cutoff value = 1.535 × 10(-3) mm(2)/s). Although the ADC of hepatic parenchyma was lower in patients with Child-Pugh grade B or C disease than in those with grade A disease (p = 0.02), no significant difference in MK (p = 0.45) was found among the Child-Pugh grades.
DKI can be a new option for the assessment of posttherapeutic response in HCC.
本研究旨在比较扩散峰度成像（DKI）与常规扩散加权成像（DWI）在评估富血管性肝细胞癌（HCC）治疗反应中的作用。
连续 62 例治疗或未治疗的富血管性 HCC 患者行肝脏 MRI 检查，包括 DKI（b 值分别为 0、100、500、1000、1500 和 2000 s/mm²）。计算肝实质和 HCC 的平均峰度（MK）和表观扩散系数（ADC）值。比较基于 MK 和 ADC 值检测活 HCC 的能力。还评估了 Child-Pugh 分级与 MK 或 ADC 值之间的相关性。
在总共 112 个 HCC 结节（存活，n=63；失活，n=49）中，存活组的 MK 值（均值±标准差，0.81±0.11）明显高于失活组（0.57±0.11）（p＜0.001）。存活组的平均 ADC 值（1.44±0.42×10⁻³mm²/s）明显低于失活组（1.94±0.52×10⁻³mm²/s）（p＜0.001）。使用 MK（85.7%、98.0%和 0.95，分别；截断值=0.710）评估 HCC 活力的敏感性、特异性和 ROC 曲线 AUC 均高于 ADC（79.6%、68.3%和 0.77，分别；截断值=1.535×10⁻³mm²/s）（p＜0.001）。Child-Pugh 分级 B 或 C 级患者的肝实质 ADC 值低于分级 A 级患者（p=0.02），但 MK 无显著差异（p=0.45）。
DKI 可能成为 HCC 治疗后反应评估的一种新选择。
