J Korean Soc Magn Reson Med.  2014 Sep;18(3):208-218. 10.13104/jksmrm.2014.18.3.208.

Correlation of the Speed of Enhancement of Hepatic Hemangiomas with Intravoxel Incoherent Motion MR Imaging

• Yang DM
• Jahng GH
• Kim HC
• Kim SW
• Kim HG

• KMID: 1999920
• DOI: http://doi.org/10.13104/jksmrm.2014.18.3.208

Abstract

PURPOSE
To evaluate the relationship between the speed of enhancement of hepatic hemangiomas on gadolinium-enhanced MRI and ADC values by using various parameters, including the D, f, D* and ADC(fit) on intravoxel incoherent motion (IVIM) MR Imaging.
MATERIALS AND METHODS
The institutional review board approved this retrospective study. A total of 47 hepatic hemangiomas from 39 patients were included (20 men and 19 women). The hemangiomas were classified into three types according to the enhancement speed of the hepatic hemangiomas on gadolinium-enhanced dynamic T1-weighted images: rapid (Type A), intermediate (Type B), and slow (Type C) enhancement. The D, f, D* and ADC(fit) values were calculated using IVIM MR imaging. The diffusion/perfusion parameters and ADC values were compared among the three types of hemangiomas.
RESULTS
Both the ADC(fit) and D values of type C were significantly lower than those of type A (P = 0.0022, P = 0.0085). However, for the f and D*, there were no significant differences among the three types. On DWI with all b values (50, 200, 500 and 800 sec/mm2), the ADC values of type C were significantly lower than those of the type A (P < 0.012). For b values with 800 sec/mm2, the ADC800 values of the type C hemangiomas were significantly lower than those of type B (P = 0.0021). We found a negative correlation between hepatic hemangioma enhancement type and ADC50 (rho= -0.357, P = 0.014), ADC200 (rho= -0.537, P = 0.0001), ADC500 (rho= -0.614, P = 0.0001), and ADC800(rho= -0.607, P = 0.0001). Therefore, four ADC values of ADC50, ADC200, ADC500, and ADC800 were decreased with decreasing enhancement speed.
CONCLUSION
Hepatic hemangiomas had variable ADCs according to the type of enhancement, and the reduced ADCs in slowly enhancing hemangiomas may be related to the reduced pure molecular diffusion (D).

Keyword

Hepatic hemangioma; Liver MRI; Diffusion-weighted imaging; Incoherent intravoxel motion MR; Imaging

MeSH Terms

Diffusion
Ethics Committees, Research
Hemangioma*
Humans
Magnetic Resonance Imaging*
Male
Retrospective Studies

Figure

• 

  Fig. 1 MR images of 47-year-old man with slow enhancing hepatic hemangioma. (a, b) Transverse dynamic fat-suppressed T1-weighted images shows a hepatic lesion in the right lobe (arrow), which is no enhancement in the arterial phase (a) and minimal peripheral nodular enhancement in the delayed phase (b). (c, d) Diffusion weighted image (b = 50, 800 sec/mm2) show that the signal intensity of the lesion remains high (arrow). (e-h) The D, f, D* and ADCfit values of the lesion (arrow) were 1.44 × 10-3 mm2/sec, 30 (%), 6.2 × 10-3 mm2 /sec and 1.64 × 10-3 mm2/sec., respectively.

• 

  Fig. 2 MR images of 42-year-old man with rapid enhancing hepatic hemangioma. (a) On arterial phase of transverse dynamic fat-suppressed T1-weighted image, there is a homogeneously enhancing mass in the right lobe (arrow). (b, c) Diffusion weighted image (b = 50 sec/mm2) shows that the signal intensity of the lesion (arrow) remains high. But the signal intensity of the lesion (arrow) is reduced on diffusion weighted image using high b value (b = 800 sec/mm2) (d-g) The D, f, D* and ADCfit values of the lesion (arrow) were 2.04 × 10-3 mm2/sec, 30.1 (%), 35.2 × 10-3 mm2/sec and 2.14 × 10-3 mm2/sec., respectively.

• 

  Fig. 3 Box plots of (a) D, (b) D*, (c) f, and (d) ADCfit according to speed of enhancement of hemangiomas. Top and bottom of boxes are 25th and 75th percentiles of the values, respectively. Length of box represents the interquartile range within the 50th percentiles of values. The horizontal line inside the box indicates median values. Data points outside box are outliers and are smaller than the lower quartile minus 1.5 times the interquartile range or larger than the upper quartile plus 1.5 times the interquartile range.

• 

  Fig. 4 Plot of the diffusion MR imaging signal attenuation against the b value according to the speed of enhancement of hemangiomas. Type A included hemangiomas with rapid enhancement. Type B included hemangiomas with intermediate enhancement. Type C hemangiomas had slow enhancement.

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