Zheng Cun-Jing, Yao Dian-Qi, Li Cai-Ying, Duan Xiao-Hui, Zhang Ge, Yan Zhuo-Heng, Shi Guang-Zi, Li Xin-Ming, Shen Jun, Wáng Yì Xiáng J
Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
J Gastrointest Oncol. 2025 Jun 30;16(3):1144-1156. doi: 10.21037/jgo-2025-59. Epub 2025 Jun 5.
Focal nodular hyperplasia (FNH) and liver cancers are commonly differentiated by contrast enhanced scan, particularly with the application of hepatobiliary-specific contrast agents. This study aims to investigate the diffusion-derived vessel density (DDVD) difference between liver FNH and liver malignant lesions [hepatocellular carcinoma (HCC) and metastasis].
The liver diffusion-weighted magnetic resonance imaging (MRI) dataset-1 had 8 cases of FNH, 56 cases of HCC, and 14 cases of liver metastases. Liver diffusion MRI dataset-2 had 10 cases of FNH, 78 cases of HCC. For dataset-1, DDVD and DDVD were calculated from =0 and =10 s/mm images, =0 and =20 s/mm images, respectively. For dataset-2, the measurement was conducted on =0, =2, and b=10 s/mm diffusion-weighted imaging (DWI) images. The ratios of lesion to adjacent liver tissue were taken as: DDVD ratio (DDVDr) = lesion DDVD/liver DDVD. For semi-quantitative analysis on =0 s/mm DWI image and DDVD map, relative to the adjacent liver signal, a liver lesion signal was assigned to five categories: low signal, iso-signal, slightly high signal, high signal, and markedly high signal.
FNH tended to have a lower DDVDr value than malignant lesions, both for dataset-1 (mean DDVDr value, FNH: 1.672, HCC: 5.807, metastases: 7.944) and dataset-2 (mean DDVDr value, FNH: 1.141 HCC: 3.340). For dataset-1, DDVDr had an area under receiver operating characteristic curve (AUROC) of 0.864, and a cutpoint value of >1.923 had a sensitivity of 81.4% and a specificity of 87.5% in suggesting malignancy. For dataset-2, DDVDr had an AUROC of 0.912, and a cutpoint value of >1.845 had a sensitivity of 79.7% and a specificity of 90% in suggesting malignancy. Consistent with quantitative measurement, semi-quantitative scoring showed that a drop from DWI high signal or slightly high signal to DDVD iso-signal suggested the diagnosis of FNH. Dataset-1 showed metastases had a higher DDVD signal than HCC, with markedly high signal on both DWI and DDVD map favoring the diagnosis of metastases.
FNH has a lower DDVD measure compared to HCC and Mets. A drop from DWI high signal or slightly high signal to DDVD iso-signal suggests the diagnosis of FNH.
局灶性结节性增生（FNH）和肝癌通常通过对比增强扫描进行鉴别，尤其是在应用肝胆特异性对比剂的情况下。本研究旨在探讨肝脏FNH与肝脏恶性病变[肝细胞癌（HCC）和转移瘤]之间的扩散衍生血管密度（DDVD）差异。
肝脏扩散加权磁共振成像（MRI）数据集1包括8例FNH、56例HCC和14例肝转移瘤。肝脏扩散MRI数据集2包括10例FNH、78例HCC。对于数据集1，分别从b=0和b=10 s/mm²图像、b=0和b=20 s/mm²图像计算DDVD和rDDVD。对于数据集2，在b=0、b=2和b=10 s/mm²扩散加权成像（DWI）图像上进行测量。病变与相邻肝组织的比值为：DDVD比值（DDVDr）=病变DDVD/肝脏DDVD。对于b=0 s/mm² DWI图像和DDVD图的半定量分析，相对于相邻肝脏信号，将肝脏病变信号分为五类：低信号、等信号、稍高信号、高信号和明显高信号。
对于数据集1（平均DDVDr值，FNH：1.672，HCC：5.807，转移瘤：7.944）和数据集2（平均DDVDr值，FNH：1.141，HCC：3.340），FNH的DDVDr值往往低于恶性病变。对于数据集1，DDVDr在受试者工作特征曲线（AUROC）下的面积为0.864，切点值>1.923在提示恶性方面的敏感性为81.4%，特异性为87.5%。对于数据集2，DDVDr的AUROC为0.912，切点值>1.845在提示恶性方面的敏感性为79.7%，特异性为90%。与定量测量一致，半定量评分显示从DWI高信号或稍高信号降至DDVD等信号提示FNH的诊断。数据集1显示转移瘤的DDVD信号高于HCC，DWI和DDVD图上的明显高信号有利于转移瘤的诊断。
与HCC和转移瘤相比，FNH的DDVD测量值较低。从DWI高信号或稍高信号降至DDVD等信号提示FNH的诊断。
