Mohammadzadeh Saeed, Mohebbi Alisa, Zare Mehrad, Salahshour Faeze, Mohammadi Afshin
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
Universal Scientific Education and Research Network, Tehran, Iran, Islamic Republic of.
Abdom Radiol (NY). 2025 Aug 22. doi: 10.1007/s00261-025-05072-x.
This study evaluates the diagnostic performance of quantitative diffusion-weighted imaging (DWI), including both conventional and intravoxel incoherent motion (IVIM)-derived parameters, in differentiating hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC).
A systematic review and meta-analysis were conducted following a pre-registered protocol ( https://osf.io/9yhrg ). Relevant studies were identified through PubMed, Web of Science, Cochrane Library, and Embase up to March 8, 2025. Quantitative DWI parameters, including apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (pseudo-D), and perfusion fraction (f), were compared between HCC and ICC using a random-effects model. Sensitivity analysis and publication bias tests were performed.
Twenty-one studies encompassing 1109 HCC and 838 ICC lesions were included. Pooled ADC values did not differ significantly between HCC (1.10, 95% CI = 1.03 to 1.17) and ICC (1.16, 95% CI = 1.06 to 1.25) groups (p = 0.156). In contrast, D showed significant differentiation between HCC (0.89, 95% CI = 0.77 to 1.02) and ICC (1.04, 95% CI = 0.93 to 1.16), with p < 0.001. Moreover, the pseudo-D parameter demonstrated comparable values in ICC (53.3; 95% CI, 22.47-84.13) and HCC (49.35; 95% CI, 23.28-75.41) lesions (p = 0.912). Finally, the f parameter revealed significantly (p = 0.022) lower values for ICC (19.21, 95% CI = 12.98 to 25.44) compared to HCC (23.78, 95% CI = 14.76 to 32.8). For each parameter, we calculated pooled mean differences, standardized mean differences, percentage differences, sensitivity, specificity, and area under the curve.
While ADC retains clinical utility due to widespread availability, this meta-analysis establishes D as a superior biomarker over ADC for distinguishing ICC from HCC focal liver lesions. These findings support the integration of non-Gaussian DWI techniques in clinical practice for improved tumor characterization.
本研究评估定量扩散加权成像（DWI）的诊断性能，包括传统参数和体素内不相干运动（IVIM）衍生参数，以鉴别肝细胞癌（HCC）和肝内胆管癌（ICC）。
纳入了21项研究，包括1109个HCC病变和838个ICC病变。HCC组（1.10，95%CI=1.03至1.17）和ICC组（1.16，95%CI=1.06至1.25）的合并ADC值差异无统计学意义（p=0.156）。相比之下，D在HCC（0.89，95%CI=0.77至1.02）和ICC（1.04，95%CI=0.93至1.16）之间显示出显著差异，p<0.001。此外，伪D参数在ICC（53.3；95%CI，22.47-84.13）和HCC（49.35；95%CI，23.28-75.41）病变中的值相当（p=0.912）。最后，与HCC（23.78，95%CI=14.76至32.8）相比，ICC（19.21，95%CI=12.98至25.44）的f参数值显著较低（p=0.022）。对于每个参数，我们计算了合并平均差异、标准化平均差异、百分比差异、敏感性、特异性和曲线下面积。
虽然由于广泛应用，ADC仍具有临床实用性，但这项荟萃分析确定D作为一种比ADC更优越的生物标志物，用于区分ICC和HCC局灶性肝病变。这些发现支持在临床实践中整合非高斯DWI技术以改善肿瘤特征。
