Can preoperative diffusion-weighted MRI predict postoperative hepatic insufficiency after curative resection of HBV-related hepatocellular carcinoma? A pilot study ☆,☆☆ Seung Up Kim a,g , Young Chul Kim c,1 , Ji Soo Choi c,1 , Kyung Sik Kim d,g , Gi Hong Choi d,g , Jin Sub Choi d,g , Jun Yong Park a,b,g , Do Young Kim a,b,g , Sang Hoon Ahn a,b,g , Eun Hee Choi e , Young Nyun Park f,g , Chae Yoon Chon a,b,g , Kwang-Hyub Han a,b,g , Myeong-Jin Kim b,c, ⁎ a Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea b Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea c Department of Radiology, Yonsei University College of Medicine, Seoul 120-752, South Korea d Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, South Korea e Department of Biostatistics, Yonsei University College of Medicine, Seoul 120-752, South Korea f Department of Pathology, Yonsei University College of Medicine, Seoul 120-752, South Korea g Liver Cirrhosis Clinical Research Center, Seoul 120-752, South Korea Received 29 August 2009; revised 30 December 2009; accepted 5 March 2010 Abstract Liver fibrosis determines the functional liver reserve. Several studies have reported that the apparent diffusion coefficient (ADC) values of diffusion-weighted magnetic resonance imaging (DW-MRI) can assess liver fibrosis. We investigated whether DW-MRI predicts postoperative hepatic insufficiency and liver fibrosis in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Twenty-six patients with HBV-related HCC who received preoperative DW-MRI on a 3-T MRI system were enrolled between July and December 2008. ADC values were measured twice by two observers. Three “b values” were used: 50, 400 and 800 s/mm 2 . Postoperative hepatic insufficiency was defined as persistent hyperbilirubinemia (total bilirubin level N5 mg/dl for more than 5 days after surgery) or postoperative death without other causes. The mean age (21 men and 5 women) was 51.4 years. Three patients experienced postoperative hepatic insufficiency. liver stiffness measurement predicted postoperative hepatic insufficiency, advanced fibrosis (F3–4), and cirrhosis significantly [area under the receiving operator characteristic curve (AUROC)=0.942, 0.771 and 0.818, respectively, with P=.047, 0.048 and 0.006, respectively]; ADC values of DW-MRI, however, did not (AUROC=0.797, 0.648 and 0.491, respectively, with P=.100, 0.313 and 0.938, respectively). Reliability of ADC values between right and left hepatic lobes (ρ=0.868 and ρ=0.910 in the first and second measures of Observer A; ρ=0.865 and ρ=0.831 in the first and second measures of Observer B) was high and the intra- and interobserver reliability (ρ=0.958 in observer A and ρ=0.977 in observer B; ρ=0.929 in the first measure and ρ=0.978 in the second measure between the two observers) were high. All reliability was significant (Pb.001). Our results suggest that DW-MRI on a 3-T MRI system is not suitable for predicting postoperative hepatic insufficiency, advanced liver fibrosis, and cirrhosis in patients with HBV-related HCC, despite significantly high reliability. © 2010 Elsevier Inc. All rights reserved. Keywords: Fibrosis; Cirrhosis; Chronic hepatitis B; Hepatitis B virus; Diffusion-weighted magnetic resonance imaging; Apparent diffusion coefficient; Liver stiffness measurement; Transient elastography; Hepatectomy; Hepatocellular carcinoma Available online at www.sciencedirect.com Magnetic Resonance Imaging 28 (2010) 802 – 811 ☆ Grant support: This study was supported by a grant from the Good Health R & D Project from the Ministry of Health, Welfare and Family Affairs, Republic of Korea (A050021), and in part by Brain Korea 21 Project for Medical Science. ☆☆ Ethics approval: This study was approved by the independent institutional review board of Severance Hospital. ⁎ Corresponding author. Department of Radiology, Yonsei University College of Medicine, 250 Seongsanno, Sodaemun-gu, Seoul 120-752, South Korea. Tel.: +82 2 2228 2369; fax: +82 2 393 3035. E-mail address: kimnex@yuhs.ac (M.-J. Kim). 1 Have contributed equally to this manuscripts. 0730-725X/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.mri.2010.03.018