The Added Value of Magnetic Resonance Elastography to Diffusion Weighted Imaging in Differentiation of Hepatic Focal Lesions

Objective: This study aimed to determine how accurately magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) can distinguish malignant hepatic focal lesions from benign ones, and to examine the relationship between apparent diffusion coefficient (ADC) values and liver stiffness measurements.Methods: A prospective cohort of twenty-four individuals (aged 36–70 years) with focal liver lesions underwent MRI examinations incorporating both DWI and MRE techniques. For every lesion, ADC values and stiffness measurements (kPa) were obtained and compared with either histopathology or characteristic imaging features.Results: Of the evaluated lesions, nine (37.5%) were benign whereas fifteen (62.5%) were malignant. Malignant lesions demonstrated markedly lower ADC values (0.92 ± 0.18 × 10⁻³ mm²/s) and higher stiffness levels (7.59 ± 2.33 kPa) compared with benign lesions (1.46 ± 0.37 × 10⁻³ mm²/s and 3.29 ± 1.2 kPa, respectively), with statistically significant differences (p < 0.001). A moderate inverse correlation was identified between ADC and stiffness values (r = –0.446, p = 0.029). Receiver-operating characteristic analysis showed high diagnostic accuracy for both metrics, yielding AUCs of 0.941 for ADC and 0.963 for stiffness. MRE provided slightly higher sensitivity (93.3%) and specificity (88.9%) than DWI.Conclusion: Both MRE and DWI offer complementary quantitative markers for characterizing hepatic focal lesions. A combination of low ADC and increased shear stiffness strongly favors a malignant diagnosis.