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Background  To evaluate the feasibility of two-colour index maps containing combined diffusion and perfusion information from simplified intravoxel incoherent motion (IVIM) for liver lesion malignancy assessment.    Methods  Diffusion-weighted data from a respiratory-gated 1.5-T magnetic resonance sequence were analysed in 109 patients with liver lesions. With three  b  values (0, 50, 800 s/mm 2 ) estimated diffusion coefficient D′, perfusion fraction f′, and apparent diffusion coefficient (ADC) maps were calculated and analysed for regions of interest (ROIs). D′ and f′ cutoff values were determined by differentiating haemangiomas from other lesions and focal nodular hyperplasias from other lesions, respectively. Combined I Df  index maps were generated with a voxel value set to 100, if both D′ and f′ voxel values were lower than their cutoff values (1,529.4 × 10 -6  mm 2 /s and 114.4 × 10 -3 , respectively), otherwise to 0. Moreover, I ADC  index maps were generated from ADC cutoff value (1,338.5 × 10 -6  mm 2 /s) obtained by differentiating benign from malignant lesions. Discriminatory power was assessed for both I Df  and I ADC . Index maps were displayed as two-colour overlays to  b -800 images and visually assessed within the translucent hyperintense areas.    Results  For I Df , the same diagnostic accuracy was achieved as for the combined use of parameters D′ and f′ (93.6%). Compared to I ADC , I Df  showed a higher diagnostic accuracy. Visual judgment of I Df  yielded an accuracy (95.4%) similar to that of quantitative analysis (93.6%).    Conclusion  Voxel-wise combined two-colour index maps I Df  provide similar diagnostic accuracy as ROI-based combination of estimated IVIM parameters D′ and f′ and are suitable for visual assessment of liver lesion malignancy.

Simplified intravoxel incoherent motion diffusion-weighted MRI of liver lesions: feasibility of combined two-colour index maps