Hepatocellular carcinoma: IVIM diffusion quantification for prediction of tumor necrosis compared to enhancement ratios Suguru Kakite, Hadrien A. Dyvorne,

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C. In the hepatobiliary phase, the lesion shows hypointensity (arrow).

C. T2WI shows a hyperintense mass and T1WI shows a hypointense mass.

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Hepatocellular carcinoma: IVIM diffusion quantification for prediction of tumor necrosis compared to enhancement ratios Suguru Kakite, Hadrien A. Dyvorne, Karen M. Lee, Guido H. Jajamovich, Ashley Knight-Greenfield, Bachir Taouli European Journal of Radiology Open Volume 3, Pages 1-7 (January 2016) DOI: 10.1016/j.ejro.2015.11.002 Copyright © 2015 The Authors Terms and Conditions

Fig. 1 59 year-old male patient with partially necrotic HCC post TACE. (a) Axial contrast-enhanced T1 weighted image obtained at portal venous phase, (b) axial fat suppressed SS EPI DW image at b800. Both demonstrate a partially necrotic HCC with solid enhancing component with restricted diffusion (arrow) and nonenhancing necrotic component hypointense on DW-MRI (short arrows). (c) Magnified b800 DW image shows ROI placement in solid and necrotic components. (d) Fitting diffusion curve in whole HCC lesion. The following parameters were obtained in solid/necrotic HCC components/background liver: D 1.21/1.57/0.77×10−3mm2/s, D* 17.53/9.44/8.03×10−3mm2/s, PF 15.81%/23.33%/21.58%, ADC 1.47/1.97/1.09×10−3mm2/s, and enhancement ratios (during portal venous phase) 113.0%/−16.4%/47.8%. European Journal of Radiology Open 2016 3, 1-7DOI: (10.1016/j.ejro.2015.11.002) Copyright © 2015 The Authors Terms and Conditions

Fig. 2 Box-plot distribution of IVIM parameters and enhancement ratios (obtained during arterial and portal venous phases) in necrotic and solid HCC components. D: true diffusion coefficient (×10−3mm2/s), D*: pseudodiffusion coefficient (×10−3mm2/s), PF: perfusion fraction (%), ADC: apparent diffusion coefficient, ER: enhancement ratio (%), AP: arterial phase, PVP: portal venous phase. European Journal of Radiology Open 2016 3, 1-7DOI: (10.1016/j.ejro.2015.11.002) Copyright © 2015 The Authors Terms and Conditions

Fig. 3 Correlation plots between each of IVIM DW-MRI parameters and enhancement ratios obtained during portal venous phase (y-axis) with percentage tumor necrosis (x-axis) assessed on image subtraction. D: true diffusion coefficient (×10−3mm2/s), PF: perfusion fraction (%), ADC: apparent diffusion coefficient, ER: enhancement ratio (%), PVP: portal venous phase. European Journal of Radiology Open 2016 3, 1-7DOI: (10.1016/j.ejro.2015.11.002) Copyright © 2015 The Authors Terms and Conditions

Fig. 4 ROC curves showing performances of D, ADC, enhancement ratio (ER) at portal venous phase, and combination of D+ER for prediction of complete tumor necrosis (see Table 4 for AUC values). D: true diffusion coefficient (×10−3mm2/s), ADC: apparent diffusion coefficient, ER: enhancement ratio (%), PVP: portal venous phase. European Journal of Radiology Open 2016 3, 1-7DOI: (10.1016/j.ejro.2015.11.002) Copyright © 2015 The Authors Terms and Conditions