• Xianlun Zou, Yan Luo, Zhen Li, Yao Hu, Haojie Li, Hao Tang, Yaqi Shen, Daoyu Hu, and Ihab R Kamel.
• Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• J Magn Reson Imaging. 2019 Apr 1; 49 (4): 975-983.

BackgroundAccurate differentiation between intrahepatic mass-forming cholangiocarcinoma (IMCC) and hepatocellular carcinoma (HCC) is needed because treatment and prognosis differ significantly.PurposeTo explore whether volumetric apparent diffusion coefficient (ADC) histogram analysis can provide additional value to dynamic enhanced MRI in differentiating IMCC from HCC.Study TypeRetrospective.PopulationIn all, 131 patients with pathologically proven IMCC (n = 33) or HCC (n = 98).Field Strength/Sequence3.0T MRI/conventional T1 -weighted imaging (T1 WI), T2 WI, and diffusion-weighted imaging (DWI) with b value of 800 sec/mm2 , dynamic enhanced MRI with gadobenate dimeglumine.AssessmentDynamic enhanced MR images were analyzed by two independent reviewers using a five-point scale to determine the diagnosis. Volumetric ADC assessments were performed independently by two radiologists to obtain different histogram parameters for each lesion. Quantitative histogram parameters were compared between the IMCC group and HCC group. Diagnostic performance of dynamic enhanced MRI, volumetric ADC histogram analysis, and the combination of both were analyzed.Statistical TestsIntraclass correlation coefficient (ICC) analysis, independent Student's t-test, or Mann-Whitney U-test, receiver operator characteristic (ROC) curves analysis, and McNemar test.ResultsThe sensitivity and specificity for dynamic enhanced MRI to differentiate IMCC from HCC were 82.1% and 82.6%, respectively. For all volumetric ADC histogram parameters, the 75th percentile ADC (ADC75% ) had the highest AUC (0.791) in differentiating IMCC from HCC, with sensitivity and specificity of 69.7% and 77.6%, respectively. When combining dynamic enhanced MRI with ADC75% , the sensitivity and specificity were 82.1% and 91.9%, respectively. Compared to dynamic enhanced MRI alone, the specificity for combined dynamic enhanced MRI and ADC75% was significantly increased (P = 0.008).Data ConclusionVolumetric ADC histogram analysis provides additional value to dynamic enhanced MRI in differentiating IMCC from HCC.Level Of Evidence3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:975-983.© 2018 International Society for Magnetic Resonance in Medicine.

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