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This study investigated the impact of different ROI placement and analysis methods on the diagnostic performance of simplified IVIM-DWI for differentiating liver lesions. 1.5/3.0-T DWI data from a respiratory-gated MRI sequence (b = 0, 50, 250, 800 s/mm 2 ) were analyzed in patients with malignant (n = 74/54) and benign (n = 35/19) lesions. Apparent diffusion coefficient ADC = ADC(0,800) and IVIM parameters D 1 ′ = ADC(50,800), D 2 ′ = ADC(250,800), f 1 ′ = f(0,50,800), f 2 ′ = f(0,250,800), and D*' = D*(0,50,250,800) were calculated voxel-wise. For each lesion, a representative 2D-ROI, a 3D-ROI whole lesion, and a 3D-ROI from “good” slices were placed, including and excluding centrally deviating areas (CDA) if present, and analyzed with various histogram metrics. The diagnostic performance of 2D- and 3D-ROIs was not significantly different; e.g. AUC (ADC/D 1 ′/f 1 ′) were 0.958/0.902/0.622 for 2D- and 0.942/0.892/0.712 for whole lesion 3D-ROIs excluding CDA at 1.5 T ( p  > 0.05). For 2D- and 3D-ROIs, AUC (ADC/D 1 ′/D 2 ′) were significantly higher, when CDA were excluded. With CDA included, AUC (ADC/D 1 ′/D 2 ′/f 1 ′/D*') improved when low percentiles were used instead of averages, and was then comparable to the results of average ROI analysis excluding CDA. For lesion differentiation the use of a representative 2D-ROI is sufficient. CDA should be excluded from ROIs by hand or automatically using low percentiles of diffusion coefficients.

Comparison of different ROI analysis methods for liver lesion characterization with simplified intravoxel incoherent motion (IVIM)