Preoperative histogram analysis of intravoxel incoherent motion (IVIM) for predicting microvascular invasion in patients with single hepatocellular carcinoma

Purpose To evaluate the value of intravoxel incoherent motion (IVIM) histogram analysis based on whole tumor volume in predicting microvascular invasion (MVI) of single hepatocellular carcinoma (HCC). Materials and Methods The study enrolled 41 patients with pathologically proven HCCs who underwent IVIM diffusion-weighted imaging with nine b values and contrast-enhanced magnetic resonance imaging (MRI). Histogram parameters including mean; skewness; kurtosis; and percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th) were derived from apparent diffusion coefficient (ADC), perfusion fraction (f), true diffusion coefficient (D), and pseudo diffusion coefficient (D*). Quantitative histogram parameters and clinical data were compared between HCCs with and without MVI. For significant parameters, receiver operating characteristic (ROC) curves were further plotted to compare the diagnosis performance for identifying MVI. Results The mean, 5th, 10th, 25th, 50th, and 75th percentiles of D, and the 5th, 10th, and 25th percentiles of ADC between HCCs with and without MVI were statistically significant (all P＜0.05). The histogram parameters of D* and f showed no statistically significant differences between HCCs with and without MVI (all P＞0.05). The areas under the ROC curves (AUCs) were 0.707–0.874 for D and 0.668–0.720 for ADC. The largest AUC of D (5th percentile) showed significantly higher accuracy than that of ADC or tumor size (P = 0.009–0.046). With a cut-off of 0.403 × 10−3 mm²/s, the 5th percentile of D value provided a sensitivity of 81% and a specificity of 85% in the prediction of MVI. Conclusions Histogram analysis of IVIM based on whole tumor volume can be useful for predicting MVI. The 5th percentile of D was most useful value to predict MVI of HCC.