The Performance of the Diffusion-Weighted Magnetic Resonance Imaging using Apparent Diffusion Coefficient Measurement in Detecting Malignant Liver Lesions

Main Article Content

Julaluck Promsorn
Praewpan Na-udom
Panita Limpawattana
Nittaya Chamadol
Kulyada Somsap
Muckesh Harisinghani


 Background and Objective: ADC (Apparent diffusion coefficient)  values have been shown to be helpful for liver lesion characterization. There are; however, discrepancies in the ADC values and controversies regarding the optimal cutoff ADC values to differentiates malignant from benign liver lesions. The purpose of this study was to measure ADC values of malignant liver lesions and to identify the optimal cutoff ADC value to differentiate malignant from benign liver lesions.

Material and Methods: A retrospective study of 180 MRI (Magnetic resonance imaging) of liver during June 1, 2012 to December 31, 2014. ADC value was measured and compared between benign and malignant liver lesions. The optimal ADC value to differentiated between malignant and benign liver lesions was calculated.

Results: Seventy-nine malignant liver lesions included 52 CCAs, 20 HCCs, 7 liver metastases had median ADC value 1.06x10-3 mm2/sec. 101 benign liver lesions included 44 hemangiomas, 11 FNHs, 7 hepatic adenomas and 39 cysts had median ADC value 1.93x10-3 mm2/sec. The differences between the median ADC values of malignant liver lesions (1.06x10-3 mm2/sec) and benign liver lesions (1.93x10-3 mm2/sec) was statistically significant (p<0.05). The ADC value of <1.49x10-3 mm2/sec was the optimal cut-off values to indicate malignant liver mass with the sensitivity of 84.8%, specificity of 81.2%.

Conclusion: ADC value is useful for differentiating malignant from benign liver lesions with1.49x10-3 mm2/s as optimal cutoff ADC value.


Download data is not yet available.

Article Details

How to Cite
Promsorn J, Na-udom P, Limpawattana P, Chamadol N, Somsap K, Harisinghani M. The Performance of the Diffusion-Weighted Magnetic Resonance Imaging using Apparent Diffusion Coefficient Measurement in Detecting Malignant Liver Lesions. SRIMEDJ [Internet]. 2021 Apr. 7 [cited 2023 Jan. 27];36(2):149-56. Available from:
Original Articles


1. Koh DM, Collins DJ. Diffusion-weight MRI in the body: applications and challenges in oncology. AJR Am j Roentgenol 2007;188:1622-1635.
2. Gourtsoyianni S, Papanikolaou N, Yarmenitis S, Maris T, Karantanas A, Gourtsoyiannis N. Respiratory gated diffusion-weighted imaging of the liver: value of apparent diffusion coefficient measurements in the differentiation between most commonly encountered benign and malignant focal liver lesion. Eur Radiol 2008; 18: 486-492.
3. Vergara ML, Fenandez M, Rodrigo MT. Diffusion-Weighted MRI Characterization of solid liver lesions. Rev Chil Radiol 2010; 16(1): 5-10.
4. Kim T, Murakami T, Takahashi S, Hori M, Tsuda K, Nakamura H. Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR Rm I Roentgenol 1999; 173: 393-398.
5. Taouli B, Vilgrain V, Dumont E, Daire JL, Fan B, Menu Y. Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 2003;226:71–78.
6. Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T. Diffusion-weighted MR imaging with a single-shot echoplanar sequence: detection and characterization of focal hepatic lesions. Am J Roentgenol 1998;170:397–402.
7.Bruegel M, Holzapfel K, Gaa J, Woertler K, Waldt S, Kiefer B, et al. Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echoplanar MR imaging technique. EurRadiol 2008 ;18: 477-485.
8. Miller FH, Hammond N, Siddiqi AJ, Shroff S, Khatri G, Wang Y, et al. Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J MagnReson Imaging 2010;32:138–147.
9. Sandrasegaran K, Akisik FM, Lin C, Tahir B, Rajan J, Aisen AM. The value of diffusion-weighted imaging in characterizing focal liver masses. AcadRadiol 2009;16:1208-1214.
10. Chen ZG, Xu L, Zhang SW, Huang Y, Pan RH. Lesion discrimination with breath-hold hepatic diffusion-weighted imaging: a meta-analysis. World J Gastroenterol 2015; 21(5): 1621-1627.
11. Wei C, Tan J, Xu L, Juan L, Zhang SW, Wang L, et al. Differential diagnosis between hepatic metastases and benign focal lesions using DWI with parallel acquisition technique: a meta-analysis. Tumor Biol 2015;36:983-990.
12. Caraiani C, Chiorean L, Fenesan DI, Lebovici A, Feier D, Gersak M, et al. Diffusion weighted magnetic resonance imaging for the classification of focal liver lesions as benign or malignant. J Gastrointestin Liver Dis 2015; 24:309-317.
13. Hasan NMA, Zaki KF, Alam-Eldeen MH, Hamedi HR. Benign versus malignant focal liver lesions: diagnostic value of qualitative and quantitative diffusion weighted MR imaging. The Egyptian journal of radiology and nuclear medicine 2016;47:1211-1220.
14. Xia D, Jing J, Shen H, Wu J. Value of diffusion-weighted magnetic resonance images for discrimination of focal benign and malignant hepatic lesions: a mata-analysis. J MagnReson Imaging 2010;32:130-137.
15. Li Y, Chen Z, Wang J. Differential diagnosis between malignant and benign hepatic tumors using apparent diffusion coefficient on 1.5-T MR imaging: a meta analysis. Eur J Radio l2012;81:484-490.
16. Cieszanowski A, Anysz-Grodzicka A, Szeszkowski W, Kaczynski B, Maj E, Gornicka B, et al. Characterization of focal liver lesions using quantitative techniques: comparison of apparent diffusion coefficient values and T2 relaxation time. EurRadiol 2012;22:2514-2524.
17. Demir OI, Obuz F, Sagol O, Dicle O. Contribution of diffusion-weighted MRI to the differential diagnosis of hepatic masses. DiagnIntervRadiol 2007;13(2):81-86.
18. Tokgoz O, Unlu E, Unal I, Serifoglu I, Oz I, Aktas E, et al. Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver. Afri Health Sci 2016;16(1):227-233.
19. Holzapfel K, Bruegel M, Eiber M, Ganter C, Schuster T, Heinrich P, et al. Characterization of small (≤10 mm) focal liver lesions: Value of respiratory-triggered echoplaner diffusion-weighted MR imaging. Eur J Radiol 2010;76:89-95.
20. Koike N, Cho A, Nasu K, Seto K, Nagaya S, Ohshima Y, et al. Role of diffusion-weighted magnetic imaging in the differential diagnosis of focal hepatic lesions. World J Gastroenterol 2009;15(46):5805-5812.
21. Saito K, Tajima Y, Harada TL. Diffusion-weighted imaging of the liver: current applications. World J Radiol 2016;8(11):857-867.
22. Battal B, Kocaoglu M, Akgun V, Karademir I, Deveci S, Guvenc I, et al. Diffusion-weighted imaging in the characterization of focal liver lesions: efficacy of visual assessment. J comput Assist Tomogr 2011;35(3):326-331.
23. Erturk SM, Ichikawa T, Sano K, Motosugi U, Sou H, Araki T. Diffusion weighted magnatic resonance imaging for characterization of focal liver masses: Impact of parallel imaging (SENSE) and b value. J comput Assist Tomogr 2008;32:865-871.
24. Lyng H, Harald seth O, Rofstad EK. Measurement of cell density and necrotic fraction in human melanoma xenografts by diffusion weighted magnetic resonance imaging. MagnReson Med 2000;43:828-836.
25. Sugita R, Yamazaki T, Furuta A, Itoh K, Fujita N, Takahashi S. High B value diffusion-weighted MRI for detecting gallbladder carcinoma: preliminary study and results. EurRadiol 2009;19:1794-1798.
26. Yamada Rijswijk CS, Kunz P, Hogendoorn PC, Taminiau AH, Doornbos J, Bloem JL. Diffusion-weighted MRI in the characterization of soft tissue tumors. J MagnReson Imaging 2002;15:302-307.
27. Yamada I, Aung W, HimenoY,Nakagawa T, Shibuya H.Diffusion coefficients in abdominalorgans and hepatic lesions: evaluationwithintravoxel incoherent motionecho-planar MR imaging. Radiology 1999;210(3):617–623.
28. Sun XJ, Quan XY, Huang FH, Xu YK. Quantitative evaluation of
diffusion-weighted magnetic resonance imaging of focal hepatic lesions. World
J Gastroenterol 2005;11:6535–6537.
29. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology1983;148(3):839-843.
30. Testa ML, Chojniak R, Sene LS, Damascena AS, Guimaraes MD, Szkiaruk J, et al. Is DWI/ADC a useful tool in the characterization of focal hepatic lesions suspected of malignancy?.PLoS ONE 9(7): e101944. doi:10.1371/journal.pone.0101944
31. Goya C, Hamidi C, Onder H, Inal A, Tekbas G, Firat U, et al. Primary and metastatic liver malignancy: utility low and high B value (1600-2000). Hepatogastroenterology 2015; 62(140):962-5.
32. Green A, Uttaravichien T, Bhudhisawasdi V,Chartbanchachai W, Elkins DB, Marieng EO, et al. Cholangiocarcinoma in north east Thailand. A hospital-based study. Trop Geogr Med 1991; 43(1-2):193-198.
33. Cui XY, Chen HW.Role of diffusion-weighted magnetic resonance imaging inthe diagnosis of extrahepatic cholangiocarcinoma. World J Gastroenterol 2010; 16(25): 3196-3201.