Role of Adc in Differentiating Hepatocellular Adenoma Vs. Hepatocellular Carcinoma and Metastatic Liver Lesions: Systematic Review and Meta-Analysis Publisher



Zare M ; Mohebbi A ; Hodoodi ST ; Mohammadi A
Source: Abdominal Radiology Published:2026

Abstract

Purpose: Differentiating hepatocellular adenoma (HCA) from malignant focal liver lesions (FLLs), including hepatocellular carcinoma (HCC), and metastases, is challenging yet clinically important. Given biopsy-associated bleeding risks in suspected HCA and differing treatment strategies, accurate noninvasive imaging biomarkers are needed. Methods: A systematic literature search of PubMed, Embase, Web of Science, and Cochrane Library up to August 10, 2025, identified studies reporting quantitative apparent diffusion coefficient (ADC) values for histologically or imaging-confirmed HCA and malignant FLLs. Data extraction and risk-of-bias assessment were performed independently by two reviewers using QUADAS-2. Random-effects meta-analysis calculated pooled mean ADC values, mean differences, standardized mean differences (SMDs), and percentage differences. Results: Sixteen studies comprising 1279 lesions (212 HCA, 697 HCC, 370 metastases) were included. Mean ADC values were 1.34 × 10⁻³ mm²/s for HCA, 1.23 × 10⁻³ mm²/s for HCC, and 1.25 × 10⁻³ mm²/s for metastases. HCA demonstrated modest yet significantly higher ADC than HCC (mean difference = 0.12 × 10⁻³ mm²/s, p = 0.042; SMD = 0.35). No significant difference was observed between HCA and metastases (mean difference = 0.17 × 10⁻³ mm²/s, p = 0.153; SMD = 0.54), likely reflecting heterogeneity in metastatic biology. Publication bias assessment was negative for all comparisons. Conclusion: ADC values were slightly higher in HCA than HCC but largely overlapped with metastases; given the small effect sizes and substantial unexplained heterogeneity, despite the claims by several included studies, ADC currently has only a limited, complementary role in lesion characterization and cannot reliably replace biopsy. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.