Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions

Frank H. Miller, Nancy Hammond, Aheed J. Siddiqi, Sagar Shroff, Gaurav Khatri, Yi Wang, Laura B. Merrick, Paul Nikolaidis

Research output: Contribution to journalArticlepeer-review

130 Scopus citations


Purpose: To evaluate apparent diffusion coefficient (ADC) values for characterization of a variety of focal liver lesions and specifically for differentiation of solid benign lesions (focal nodular hyperplasia [FNH] and adenomas) from solid malignant neoplasms (metastases and hepatocellular carcinoma [HCC]) in a large case series. Materials and Methods: A total of 542 lesions in 382 patients were evaluated. ADC values were measured in 166 hemangiomas, 112 hepatomas, 107 metastases, 95 cysts, 10 abscesses, 43 FNH, and nine adenomas. ADCs of 1.5 and 1.6 (×10-3 mm 2/second) were selected as threshold values to separate benign and malignant lesions. Sensitivity, specificity, positive, and negative predictive values (PPV, NPV) were calculated. Comparisons were carried out with studentized range test. Results: There was high interobserver agreement in ADC measurements for all lesion types. The mean ADCs for cysts was 3.40 (×10 -3 mm2/second), hemangiomas 2.26, FNH 1.79, adenomas 1.49, abscesses 1.97, HCC 1.53, and metastases 1.50. The mean ADC for benign lesions was 2.50 and for malignant lesions was 1.52. Cysts were easily distinguished from other lesions. There was, however, overlap between solid benign and malignant lesions. Conclusion: Benign lesions have higher mean ADC values than malignant lesions. However, ADC values of solid benign lesions (FNH and adenomas) are similar tomalignant lesions (metastases, HCC) limiting the value of diffusion weighted imaging (DWI) for differentiating solid livermasses.

Original languageEnglish (US)
Pages (from-to)138-147
Number of pages10
JournalJournal of Magnetic Resonance Imaging
Issue number1
StatePublished - Jul 2010


  • Adenoma
  • Diffusion
  • FNH
  • Hepatocellular carcinoma
  • Liver MR
  • Liver neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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