European Journal of Cardiovascular Medicine

Background:  Liver diseases represent a significant global health concern, necessitating accurate detection and characterization of focal liver lesions (FLLs). Precise differentiation between benign and malignant lesions, as well as distinguishing primary liver lesions from metastases, is pivotal for effective clinical management. This study aims to compare the efficacy of respiratory-triggered diffusion-weighted single-shot echo planar imaging (RT DW-SS-EPI) and T2 weighted turbo spin echo imaging (T2W TSE) in detecting and characterizing FLLs. Additionally, the study aims to determine the apparent diffusion coefficients (ADCs) of FLLs and normal liver parenchyma. Methods: A total of 30 patients with suspected focal liver lesions and 10 healthy volunteers without FLLs were enrolled. Patients referred for MRI with clinical suspicion of FLLs were included. The study employed respiratory-triggered fat-suppressed single-shot echo-planar DW imaging in the transverse plane with tridirectional diffusion gradients and three b values (0, 500, and 1000 sec/mm²). ADC maps were generated, and routine MR sequences were obtained using a 1.5 Tesla MRI scanner. ADC values were calculated using operator-defined regions of interest (ROIs), and differences in ADC values were analyzed. Results: The study encompassed 85 lesions in 30 patients, including 23 hepatocellular carcinomas (HCCs), 4 cholangiocellular carcinomas, 36 metastatic lesions, and 22 benign lesions. Males comprised 63.3% of participants. DWI demonstrated significantly higher FLL detection rates than T2WI (p < 0.001), particularly for malignant lesions (98.4% with DWI vs. 76.5% with T2WI). No significant difference was observed in detecting HCCs alone. DWI exhibited superior detection capabilities for both liver lobes compared to T2WI. Mean ADC values for various lesion types showed significant differences, with malignant lesions displaying lower ADC values than benign lesions (p < 0.001). Conclusion: Respiratory-triggered diffusion-weighted MRI (RT DWI) emerges as a valuable and contrast-free diagnostic tool for detecting and characterizing focal liver lesions. DWI outperformed T2 weighted imaging in detecting malignant lesions and showed potential for accurate differentiation between benign and malignant lesions based on ADC values. The study highlights DWI's clinical utility for liver lesion evaluation in routine practice.