Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors?
Background There are limited data on utility of diffusion-weighted imaging (DWI) in the evaluation of pediatric liver lesions. Objective To determine whether qualitative and quantitative DWI can be used to differentiate benign and malignant pediatric liver lesions. Materials and methods We retrospec...
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| Veröffentlicht in: | Pediatric radiology 2018, Vol.48 (1), p.85-93 |
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| creator | Caro-Domínguez, Pablo Gupta, Abha A. Chavhan, Govind B. |
| description | Background
There are limited data on utility of diffusion-weighted imaging (DWI) in the evaluation of pediatric liver lesions.
Objective
To determine whether qualitative and quantitative DWI can be used to differentiate benign and malignant pediatric liver lesions.
Materials and methods
We retrospectively reviewed MRIs in children with focal liver lesions to qualitatively evaluate lesions noting diffusion restriction, T2 shine-through, increased diffusion, hypointensity on DWI and apparent diffusion coefficient (ADC) maps, and intermediate signal on both, and to measure ADC values. Pathology confirmation or a combination of clinical, laboratory and imaging features, and follow-up was used to determine final diagnosis.
Results
We included 112 focal hepatic lesions in 89 children (median age 11.5 years, 51 female), of which 92 lesions were benign and 20 malignant. Interobserver agreement was almost perfect for both qualitative (kappa 0.8735) and quantitative (intraclass correlation coefficient [ICC] 0.96) diffusion assessment. All malignant lesions showed diffusion restriction. Most benign lesions other than abscesses were not restricted. There was significant association of qualitative restriction with malignancy and non-restriction with benignancy (Fisher exact test
P |
| doi_str_mv | 10.1007/s00247-017-3984-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1940189812</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1983209644</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-71be6c83bbab339f33b83763f40671b3abf7cd60f5a725c65f10a7e8bc0b053b3</originalsourceid><addsrcrecordid>eNp1kMFqFTEUhkOxtNfqA7iRATfdpJ7kZCbJSuRitVBwo-uQzCTTlJnMNZmx-PZNuVVEcPUHznf-HD5C3jC4YgDyfQHgQlJgkqJWguoTsmMCOWVaqxdkBwiMghD6nLws5R4AsGV4Rs650pyhEjti9jY1QwxhK3FJ9MHH8W71QxNnO8Y01lFZa26x3DXOrw_ep5opjqmxaWhmO9WnTWtz8EO0a459M8WfPjfrNi-5fHhFToOdin_9nBfk-_Wnb_sv9Pbr55v9x1vao-Qrlcz5rlfonHWIOiA6hbLDIKCrM7QuyH7oILRW8rbv2sDASq9cDw5adHhBLo-9h7z82HxZzRxL76fJJr9sxTAtgCmtGK_ou3_Q-2XLqV5XKYUcdCdEpdiR6vNSSvbBHHKVkn8ZBubJvjnaN9W-ebJvdN15-9y8udkPfzZ-664APwKljtLo819f_7f1EaS4kDo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1983209644</pqid></control><display><type>article</type><title>Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors?</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Caro-Domínguez, Pablo ; Gupta, Abha A. ; Chavhan, Govind B.</creator><creatorcontrib>Caro-Domínguez, Pablo ; Gupta, Abha A. ; Chavhan, Govind B.</creatorcontrib><description>Background
There are limited data on utility of diffusion-weighted imaging (DWI) in the evaluation of pediatric liver lesions.
Objective
To determine whether qualitative and quantitative DWI can be used to differentiate benign and malignant pediatric liver lesions.
Materials and methods
We retrospectively reviewed MRIs in children with focal liver lesions to qualitatively evaluate lesions noting diffusion restriction, T2 shine-through, increased diffusion, hypointensity on DWI and apparent diffusion coefficient (ADC) maps, and intermediate signal on both, and to measure ADC values. Pathology confirmation or a combination of clinical, laboratory and imaging features, and follow-up was used to determine final diagnosis.
Results
We included 112 focal hepatic lesions in 89 children (median age 11.5 years, 51 female), of which 92 lesions were benign and 20 malignant. Interobserver agreement was almost perfect for both qualitative (kappa 0.8735) and quantitative (intraclass correlation coefficient [ICC] 0.96) diffusion assessment. All malignant lesions showed diffusion restriction. Most benign lesions other than abscesses were not restricted. There was significant association of qualitative restriction with malignancy and non-restriction with benignancy (Fisher exact test
P
<0.0001). Mean normalized ADC values of malignant lesions (1.23x10
−3
mm
2
/s) were lower than benign lesions (1.62x10
−3
mm
2
/s; Student’s
t
-test,
P
<0.015). However, there was significant overlap of ADC between benign and malignant lesions, with wide range for each diagnosis. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.63 for predicting malignancy using an ADC cut-off value of ≤1.20x10
−3
mm
2
/s, yielding a sensitivity of 78% and a specificity of 54% for differentiating malignant from benign lesions.
Conclusion
Qualitative diffusion restriction in pediatric liver lesions is a good predictor of malignancy and can help to differentiate between benign and malignant lesions, in conjunction with conventional MR sequences. Even though malignant lesions demonstrated significantly lower ADC values than benign lesions, the use of quantitative diffusion remains limited in its utility for distinguishing them because of the significant overlap and wide ranges of ADC values.</description><identifier>ISSN: 0301-0449</identifier><identifier>EISSN: 1432-1998</identifier><identifier>DOI: 10.1007/s00247-017-3984-9</identifier><identifier>PMID: 28921384</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abscesses ; Benign ; Child ; Children ; Contrast Media ; Correlation coefficient ; Correlation coefficients ; Diagnosis ; Diagnosis, Differential ; Diffusion ; Diffusion coefficient ; Diffusion Magnetic Resonance Imaging - methods ; Female ; Gadolinium DTPA ; Humans ; Imaging ; Lesions ; Liver ; Liver cancer ; Liver Neoplasms - diagnostic imaging ; Liver Neoplasms - pathology ; Male ; Malignancy ; Medicine ; Medicine & Public Health ; Meglumine - analogs & derivatives ; Neuroradiology ; Nuclear Medicine ; Oncology ; Organometallic Compounds ; Original Article ; Pediatrics ; Qualitative analysis ; Radiology ; Retrospective Studies ; Reviews ; Sensitivity and Specificity ; Tumors ; Ultrasound</subject><ispartof>Pediatric radiology, 2018, Vol.48 (1), p.85-93</ispartof><rights>Springer-Verlag GmbH Germany 2017</rights><rights>Pediatric Radiology is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-71be6c83bbab339f33b83763f40671b3abf7cd60f5a725c65f10a7e8bc0b053b3</citedby><cites>FETCH-LOGICAL-c372t-71be6c83bbab339f33b83763f40671b3abf7cd60f5a725c65f10a7e8bc0b053b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00247-017-3984-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00247-017-3984-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28921384$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Caro-Domínguez, Pablo</creatorcontrib><creatorcontrib>Gupta, Abha A.</creatorcontrib><creatorcontrib>Chavhan, Govind B.</creatorcontrib><title>Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors?</title><title>Pediatric radiology</title><addtitle>Pediatr Radiol</addtitle><addtitle>Pediatr Radiol</addtitle><description>Background
There are limited data on utility of diffusion-weighted imaging (DWI) in the evaluation of pediatric liver lesions.
Objective
To determine whether qualitative and quantitative DWI can be used to differentiate benign and malignant pediatric liver lesions.
Materials and methods
We retrospectively reviewed MRIs in children with focal liver lesions to qualitatively evaluate lesions noting diffusion restriction, T2 shine-through, increased diffusion, hypointensity on DWI and apparent diffusion coefficient (ADC) maps, and intermediate signal on both, and to measure ADC values. Pathology confirmation or a combination of clinical, laboratory and imaging features, and follow-up was used to determine final diagnosis.
Results
We included 112 focal hepatic lesions in 89 children (median age 11.5 years, 51 female), of which 92 lesions were benign and 20 malignant. Interobserver agreement was almost perfect for both qualitative (kappa 0.8735) and quantitative (intraclass correlation coefficient [ICC] 0.96) diffusion assessment. All malignant lesions showed diffusion restriction. Most benign lesions other than abscesses were not restricted. There was significant association of qualitative restriction with malignancy and non-restriction with benignancy (Fisher exact test
P
<0.0001). Mean normalized ADC values of malignant lesions (1.23x10
−3
mm
2
/s) were lower than benign lesions (1.62x10
−3
mm
2
/s; Student’s
t
-test,
P
<0.015). However, there was significant overlap of ADC between benign and malignant lesions, with wide range for each diagnosis. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.63 for predicting malignancy using an ADC cut-off value of ≤1.20x10
−3
mm
2
/s, yielding a sensitivity of 78% and a specificity of 54% for differentiating malignant from benign lesions.
Conclusion
Qualitative diffusion restriction in pediatric liver lesions is a good predictor of malignancy and can help to differentiate between benign and malignant lesions, in conjunction with conventional MR sequences. Even though malignant lesions demonstrated significantly lower ADC values than benign lesions, the use of quantitative diffusion remains limited in its utility for distinguishing them because of the significant overlap and wide ranges of ADC values.</description><subject>Abscesses</subject><subject>Benign</subject><subject>Child</subject><subject>Children</subject><subject>Contrast Media</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>Diagnosis</subject><subject>Diagnosis, Differential</subject><subject>Diffusion</subject><subject>Diffusion coefficient</subject><subject>Diffusion Magnetic Resonance Imaging - methods</subject><subject>Female</subject><subject>Gadolinium DTPA</subject><subject>Humans</subject><subject>Imaging</subject><subject>Lesions</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver Neoplasms - diagnostic imaging</subject><subject>Liver Neoplasms - pathology</subject><subject>Male</subject><subject>Malignancy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meglumine - analogs & derivatives</subject><subject>Neuroradiology</subject><subject>Nuclear Medicine</subject><subject>Oncology</subject><subject>Organometallic Compounds</subject><subject>Original Article</subject><subject>Pediatrics</subject><subject>Qualitative analysis</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Reviews</subject><subject>Sensitivity and Specificity</subject><subject>Tumors</subject><subject>Ultrasound</subject><issn>0301-0449</issn><issn>1432-1998</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kMFqFTEUhkOxtNfqA7iRATfdpJ7kZCbJSuRitVBwo-uQzCTTlJnMNZmx-PZNuVVEcPUHznf-HD5C3jC4YgDyfQHgQlJgkqJWguoTsmMCOWVaqxdkBwiMghD6nLws5R4AsGV4Rs650pyhEjti9jY1QwxhK3FJ9MHH8W71QxNnO8Y01lFZa26x3DXOrw_ep5opjqmxaWhmO9WnTWtz8EO0a459M8WfPjfrNi-5fHhFToOdin_9nBfk-_Wnb_sv9Pbr55v9x1vao-Qrlcz5rlfonHWIOiA6hbLDIKCrM7QuyH7oILRW8rbv2sDASq9cDw5adHhBLo-9h7z82HxZzRxL76fJJr9sxTAtgCmtGK_ou3_Q-2XLqV5XKYUcdCdEpdiR6vNSSvbBHHKVkn8ZBubJvjnaN9W-ebJvdN15-9y8udkPfzZ-664APwKljtLo819f_7f1EaS4kDo</recordid><startdate>2018</startdate><enddate>2018</enddate><creator>Caro-Domínguez, Pablo</creator><creator>Gupta, Abha A.</creator><creator>Chavhan, Govind B.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>2018</creationdate><title>Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors?</title><author>Caro-Domínguez, Pablo ; Gupta, Abha A. ; Chavhan, Govind B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-71be6c83bbab339f33b83763f40671b3abf7cd60f5a725c65f10a7e8bc0b053b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abscesses</topic><topic>Benign</topic><topic>Child</topic><topic>Children</topic><topic>Contrast Media</topic><topic>Correlation coefficient</topic><topic>Correlation coefficients</topic><topic>Diagnosis</topic><topic>Diagnosis, Differential</topic><topic>Diffusion</topic><topic>Diffusion coefficient</topic><topic>Diffusion Magnetic Resonance Imaging - methods</topic><topic>Female</topic><topic>Gadolinium DTPA</topic><topic>Humans</topic><topic>Imaging</topic><topic>Lesions</topic><topic>Liver</topic><topic>Liver cancer</topic><topic>Liver Neoplasms - diagnostic imaging</topic><topic>Liver Neoplasms - pathology</topic><topic>Male</topic><topic>Malignancy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meglumine - analogs & derivatives</topic><topic>Neuroradiology</topic><topic>Nuclear Medicine</topic><topic>Oncology</topic><topic>Organometallic Compounds</topic><topic>Original Article</topic><topic>Pediatrics</topic><topic>Qualitative analysis</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Reviews</topic><topic>Sensitivity and Specificity</topic><topic>Tumors</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Caro-Domínguez, Pablo</creatorcontrib><creatorcontrib>Gupta, Abha A.</creatorcontrib><creatorcontrib>Chavhan, Govind B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Caro-Domínguez, Pablo</au><au>Gupta, Abha A.</au><au>Chavhan, Govind B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors?</atitle><jtitle>Pediatric radiology</jtitle><stitle>Pediatr Radiol</stitle><addtitle>Pediatr Radiol</addtitle><date>2018</date><risdate>2018</risdate><volume>48</volume><issue>1</issue><spage>85</spage><epage>93</epage><pages>85-93</pages><issn>0301-0449</issn><eissn>1432-1998</eissn><abstract>Background
There are limited data on utility of diffusion-weighted imaging (DWI) in the evaluation of pediatric liver lesions.
Objective
To determine whether qualitative and quantitative DWI can be used to differentiate benign and malignant pediatric liver lesions.
Materials and methods
We retrospectively reviewed MRIs in children with focal liver lesions to qualitatively evaluate lesions noting diffusion restriction, T2 shine-through, increased diffusion, hypointensity on DWI and apparent diffusion coefficient (ADC) maps, and intermediate signal on both, and to measure ADC values. Pathology confirmation or a combination of clinical, laboratory and imaging features, and follow-up was used to determine final diagnosis.
Results
We included 112 focal hepatic lesions in 89 children (median age 11.5 years, 51 female), of which 92 lesions were benign and 20 malignant. Interobserver agreement was almost perfect for both qualitative (kappa 0.8735) and quantitative (intraclass correlation coefficient [ICC] 0.96) diffusion assessment. All malignant lesions showed diffusion restriction. Most benign lesions other than abscesses were not restricted. There was significant association of qualitative restriction with malignancy and non-restriction with benignancy (Fisher exact test
P
<0.0001). Mean normalized ADC values of malignant lesions (1.23x10
−3
mm
2
/s) were lower than benign lesions (1.62x10
−3
mm
2
/s; Student’s
t
-test,
P
<0.015). However, there was significant overlap of ADC between benign and malignant lesions, with wide range for each diagnosis. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.63 for predicting malignancy using an ADC cut-off value of ≤1.20x10
−3
mm
2
/s, yielding a sensitivity of 78% and a specificity of 54% for differentiating malignant from benign lesions.
Conclusion
Qualitative diffusion restriction in pediatric liver lesions is a good predictor of malignancy and can help to differentiate between benign and malignant lesions, in conjunction with conventional MR sequences. Even though malignant lesions demonstrated significantly lower ADC values than benign lesions, the use of quantitative diffusion remains limited in its utility for distinguishing them because of the significant overlap and wide ranges of ADC values.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28921384</pmid><doi>10.1007/s00247-017-3984-9</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Pediatric radiology, 2018, Vol.48 (1), p.85-93 |
| issn | 0301-0449 1432-1998 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1940189812 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Abscesses Benign Child Children Contrast Media Correlation coefficient Correlation coefficients Diagnosis Diagnosis, Differential Diffusion Diffusion coefficient Diffusion Magnetic Resonance Imaging - methods Female Gadolinium DTPA Humans Imaging Lesions Liver Liver cancer Liver Neoplasms - diagnostic imaging Liver Neoplasms - pathology Male Malignancy Medicine Medicine & Public Health Meglumine - analogs & derivatives Neuroradiology Nuclear Medicine Oncology Organometallic Compounds Original Article Pediatrics Qualitative analysis Radiology Retrospective Studies Reviews Sensitivity and Specificity Tumors Ultrasound |
| title | Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors? |
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