Intravoxel Incoherent Motion Diffusion-Weighted Imaging for Evaluation of the Cell Density and Angiogenesis of Cirrhosis-Related Nodules in an Experimental Rat Model: Comparison and Correlation With Dynamic Contrast-Enhanced MRI: IVIM and DCE-MR for Cirrhosis-Related Nodules

BACKGROUND: Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced MRI (DCE-MRI) are sensitive imaging modalities for detecting liver lesions, but their value in evaluating cirrhosis-related nodules remains unclear. PURPOSE: To investigate whether IVIM-DWI and DCE-MRI can differentiate different types of cirrhosis-related nodules, and whether these modalities can monitor changes in cell density and angiogenesis during the malignant transformation of cirrhosis-related nodules in a rat model STUDY TYPE: Prospective. ANIMAL MODEL: Thirty-five male Sprague-Dawley rats with 106 cirrhosis-related nodules (19 regenerative nodules [RNs], 47 dysplastic nodules [DNs], and 40 hepatocellular carcinomas [HCCs]). FIELD STRENGTH/SEQUENCE: IVIM-DWI and DCE sequence at 3.0T MRI. ASSESSMENT: IVIM-DWI parameters (D, D*, f, and apparent diffusion coefficient [ADC]) and DCE-MRI parameters (K(trans) , Kep , and Ve ) were calculated by two radiologists using postprocessing software. The "cell density" and "unpaired arterial ratio" were analyzed with a microscope by two pathologists. STATISTICAL TESTS: MRI parameters were compared among the different types of nodules by one-way analysis of variance or the Kruskal-Wallis test. The Pearson correlation test was used to analyze the correlation of MRI parameters with the pathological types of nodules, cell density, and unpaired arterial ratio. RESULTS: The K(trans) , Kep , and Ve values of HCCs were significantly higher than those of DNs and RNs. D and ADC values were significantly lower in HCCs than in DNs and RNs. There were moderate positive correlations of K(trans) with the pathological types of nodules and the unpaired arterial ratio. Moderate negative correlations were observed among D, ADC, and the pathological types of nodules, between D and cell density, and between ADC and cell density. DATA CONCLUSION: IVIM-DWI and DCE-MRI are valuable in differentiating different types of cirrhotic-related nodules. D and ADC are correlated with changes in cell density during the malignant transformation of cirrhosis-related nodules, while K(trans) is correlated with increased angiogenesis. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2020;51:812-823.