The apparent diffusion coefficient (ADC) could predict tumor cellularity in cholangiocarcinoma (CCA), according to a study recently published in European Radiology.

“Furthermore, for the first time, associations between ADC values and complex histopathological features including tumor cell count, proliferation index, number of intratumoral lymphocytes, and tumoral stromal compartment were performed,” the authors wrote.

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This retrospective study included 149 patients who underwent a liver biopsy for a lesion measuring 5 mm or greater and had available magnetic resonance imaging (MRI) data with ADC prior to the biopsy.

The sample consisted of an almost even sex distribution, with 54.4% men, and a mean age of 65.5 years. The most common malignant tumor was hepatocellular cancer, present in 35.6% of the cases, followed by intrahepatic CCA in 19.5% and liver metastases of breast, colorectal, and pancreatic cancer in 18.8%, 16.1%, and 10.0%, respectively.

Among patients with CCA, the ADC effectively correlated with tumor cellularity, showcasing an association with both the tumor-stroma ratio and cell count. Both results were statistically significant.

The researchers also observed this pattern in other malignancies, including hepatocellular carcinoma. Regarding liver metastases, different results were evident. For example, in colorectal cancer metastasis, the ADC correlated with the cell count but not the tumor-stroma ratio, while Ki 67 did demonstrate an association with ADC. In breast cancer metastasis, only the tumor-stroma ratio correlated with ADC. Finally, pancreatic metastasis did not exhibit any associations with ADC.

The possibility of approximating cell count in patients with CCA using the ADC translates into important benefits for these patients.

“Therefore, ADC can also be used for monitoring cytoreductive treatment in this tumor entity,” the authors highlighted.

Moreover, the predictive value of ADC for tumor-stroma ratio is of great use in clinical practice since this ratio often serves as a key prognostic tool, as well as an indicator of vascular invasion and poor overall survival.


Surov A, Eger KI, Potratz J, Gottschling S, Wienke A, Jechorek D. Apparent diffusion coefficient correlates with different histopathological features in several intrahepatic tumors. Eur Radiol. Published online June 22, 2023. doi:10.1007/s00330-023-09788-6