Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2025; 17(8): 108679
Published online Aug 15, 2025. doi: 10.4251/wjgo.v17.i8.108679
Value of intravoxel incoherent motion and diffusion kurtosis imaging to differentiate hepatocellular carcinoma and intrahepatic cholangiocarcinoma
Shan-Mei Li, Meng-Wei Feng, Guang-Hai Ji, Xiao-Peng Song, Wei Mao, Tao Zhou, Xiao-Fang Guo, Zi-Long Yuan, Yu-Lin Liu
Shan-Mei Li, Meng-Wei Feng, Xiao-Fang Guo, Zi-Long Yuan, Yu-Lin Liu, Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, Hubei Province, China
Guang-Hai Ji, Department of Radiology, The First Affiliated Hospital of Yangtze University, The First People’s Hospital of Jingzhou, Jingzhou 434000, Hubei Province, China
Xiao-Peng Song, Wei Mao, United Imaging Healthcare Advanced Technology Research Institute, Shanghai 201807, China
Tao Zhou, Department of Radiology, People's Hospital Affiliated to Shandong First Medical University, Jinan 271199, Shandong Province, China
Co-first authors: Shan-Mei Li and Meng-Wei Feng.
Co-corresponding authors: Zi-Long Yuan and Yu-Lin Liu.
Author contributions: Li SM proposed, designed and conducted liver tumors analysis, collection of clinical data, performed data analysis and prepared the first draft of the manuscript; Feng MW was responsible for patient screening, enrollment, collection MRI images of HCC and ICC; Li SM and Feng MW have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; Ji GH contributed data collection and analysis; Song XP and Mao W responsible for data re-analysis and re-interpretation; Zhou T responsible for figure plotting and fund support; Guo XF conceived and supervised the manuscript; Yuan ZL conceptualized, designed, and supervised the whole process of the project; Yuan ZL and Liu YL were crucial for the publication of this manuscript and other manuscripts still in preparation, have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors, Liu YL applied for and obtained the funds for this research project; all authors have read and approved the final manuscript.
Supported by Chutian Talents of Hubei, No. CTYC001; Talent Project of Hubei Cancer Hospital, No. 2025HBCHLHRC001; and Clinical Medical Science and Technology of Jinan, No. 202134053.
Institutional review board statement: The study was reviewed and approved by the Hubei Cancer Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: Data used and/or analyzed in the current study could be acquired from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zi-Long Yuan, Associate Professor, Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 116 Zhuodaoquan South Road, Hongshan District, Wuhan 430079, Hubei Province, China. yuanzilong0213@126.com
Received: April 21, 2025
Revised: May 27, 2025
Accepted: June 30, 2025
Published online: August 15, 2025
Processing time: 115 Days and 23.3 Hours
Abstract
BACKGROUND

The differential diagnosis between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) is crucial. The individual differences of patients increase the complexity of diagnosis. Currently, imaging diagnosis mainly relies on conventional computed tomography and magnetic resonance imaging (MRI), but few studies have investigated MRI functional imaging. This study combined MRI functional imaging including intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI), facilitating differential diagnosis.

AIM

To explore the differential diagnostic value of IVIM imaging and DKI in differentiating between HCC and ICC.

METHODS

A total of 58 patients who underwent multi-b-value diffusion weighted imaging (DWI) on a 3.0 T magnetic MRI scanner were enrolled in this study. Standard apparent diffusion coefficient (SADC), IVIM quantitative parameters, including pure diffusion coefficient (D), pseudo diffusion coefficient (Dstar), and perfusion fraction (f), as well as the DKI quantitative parameters mean diffusion coefficient (MD) and mean kurtosis coefficient (MK) were computed by multi-b DWI images. The χ2 test was used for classified data, and a one-way analysis of variance was performed for counted data. P < 0.05 indicated statistical significance. The diagnostic value of parameters in HCC and ICC was analyzed using the receiver operating characteristic (ROC) curve.

RESULTS

The SADC, D, and MD values were significantly lower in the HCC group compared to the ICC group, whereas MK was significantly higher in the HCC group than in the ICC group (P < 0.05). No significant difference in Dstar and f was observed between the HCC group and the ICC group (P > 0.05). The optimal cutoff levels of the total values of SADC, D, MK, MD and all associated parameters were 1.25 × 10-3 mm²/second, 1.32 × 10-3 mm²/second, 650.2 × 10-3 mm²/second, 1.41 × 10-3 mm²/second and 0.46 × 10-3 mm²/second, respectively. The sensitivity of diagnosis was 95%, 80%, 90%, 100%, and 70%, respectively, the specificity of diagnosis was 67.39%, 69.57%, 67.39%, 43.48%, and 93.48%, respectively, and the area under the ROC curve was 0.874, 0.793, 0.733, 0.757, and 0.895, respectively.

CONCLUSION

SADC, D, MK, and MD could be used to distinguish HCC from ICC, with the diagnostic value reaching a maximum after establishing a joint model.

Keywords: Hepatocellular carcinoma; Magnetic resonance imaging; Intrahepatic cholangiocarcinoma; Intravoxel incoherent motion; Diffusion kurtosis imaging

Core Tip: This study employed intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) for liver cancer and intrahepatic cholangiocarcinoma. The findings suggest that the parameters standard apparent diffusion coefficient (SADC) and pure diffusion coefficient from IVIM and mean kurtosis coefficient and mean diffusion coefficient from DKI, can differentiate between the two tumor types. Among them SADC demonstrated the highest diagnostic value, and particularly when used in the joint model. The innovation of this lies in the application of the DKI sequence for the first time and analyze its value.