Measurement and scan reproducibility of parameters of intravoxel incoherent motion in renal tumor and normal renal parenchyma: a preliminary research at 3.0 T MR
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Intravoxel incoherent motion
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Background The utility of intravoxel incoherent motion (IVIM) related parameters in differentiation of hypovascular liver lesions is still unknown. Purpose The purpose of this study was to evaluate the value of IVIM related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), and hypovascular liver metastases (HLM). Methods Seventy-four prospectively enrolled patients (21 IMC, and 53 HLM) underwent 1.5T magnetic resonance examination with IVIM diffusion-weighted imaging using seven b values (0–800 s/mm 2 ). Two independent readers performed quantitative analysis of IVIM-related parameters and ADC. Interobserver reliability was tested using a intraclass correlation coefficient. ADC, true diffusion coefficient ( D ), perfusion-related diffusion coefficient ( D *), and perfusion fraction (ƒ) were compared among the lesions using Kruskal-Wallis H test. The diagnostic accuracy of each parameter was assessed by receiver operating characteristic (ROC) curve analysis. Results The interobserver agreement was good for ADC (0.802), and excellent for D , D *, and ƒ (0.911, 0.927, and 0.942, respectively). ADC, and D values were significantly different among IMC and HLM (both p < 0.05), while there was no significant difference among these lesions for ƒ and D * ( p = 0.101, and p = 0.612, respectively). ROC analysis showed higher diagnostic performance of D in comparison to ADC (AUC = 0.879 vs 0.821). Conclusion IVIM-derived parameters in particular D , in addition to ADC, could help in differentiation between most common hypovascular malignant liver lesions, intrahepatic mass—forming cholangiocarcinoma and hypovascular liver metastases.
Intravoxel incoherent motion
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The purpose of this study was to evaluate whether intravoxel incoherent motion (IVIM) parameters can enhance the diagnostic performance of MRI in differentiating normal pancreatic parenchyma from solid pancreatic adenocarcinomas. This study included 113 participants: 66 patients diagnosed with pancreatic adenocarcinoma and 47 healthy volunteers. An MRI was conducted at 1.5 T MR unit, using nine b-values. Postprocessing involved analyzing both conventional monoexponential apparent diffusion coefficient (ADC) and IVIM parameters (diffusion coefficient D-pure molecular diffusion coefficient, perfusion-dependent diffusion coefficient D*-pseudodiffusion coeffitient, and perfusion fraction coefficient (f)) across four different b-value selections. Significantly higher parameters were found in the control group when using high b-values for the pure diffusion analysis and all b-values for the monoexponential analysis. Conversely, in the study group, the parameters were affected by low b-values. Most parameters could differentiate between normal and cancerous tissue, with D* showing the highest diagnostic performance (AUC 98–100%). A marked decrease in perfusion in the patients with pancreatic cancer, indicated by the significant differences in the D* medians between groups, was found. In conclusion, standard ADC maps alone may not suffice for a definitive pancreatic cancer diagnosis, and incorporating IVIM into MRI protocols is recommended, as the reduced tissue perfusion detected by the IVIM parameters is a promising marker for pancreatic adenocarcinoma.
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// Vincenza Granata 1 , Roberta Fusco 1 , Orlando Catalano 1 , Benedetta Guarino 1 , Francesco Granata 2 , Fabiana Tatangelo 3 , Antonio Avallone 4 , Mauro Piccirillo 5 , Raffaele Palaia 5 , Francesco Izzo 5 , Antonella Petrillo 1 1 Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli", Naples, I-80131, Italy 2 Department of Civil and Mechanical Engineering, "Università degli Studi di Cassino e del Lazio Meridionale", Cassino 03043, Italy 3 Departement of Pathology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli", Naples, I-80131, Italy 4 Department of Gastrointestinal Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli", Naples, I-80131, Italy 5 Department of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli", Naples, I-80131, Italy Correspondence to: Roberta Fusco, email: r.fusco@istitutotumori.na.it Keywords: HCC, magnetic resonance imaging, diffusion weighted imaging, histologic grade Received: July 06, 2016 Accepted: September 29, 2016 Published: October 15, 2016 ABSTRACT Purpose: To assess the correlation between DWI diffusion parameters obtained using Intravoxel Incoherent Motion Method (IVIM) and histological grade of Hepatocellular carcinoma (HCC). Results: According to Edmondson-Steiner grade lesions were classified with grade 1 (14), grade 2 (30), grade 3 (18), and grade 4 (0). Apparent Diffusion Coefficient (ADC), perfusion fraction (fp), tissue diffusion coefficient (Dt) median values were statistically different in HCC groups with 1, 2, 3 histological grade (p<0.001). A significant correlation was reported between ADC, fp, Dt and histologic grade respectively of 0.687, 0.737 and 0.674. Receiver operating characteristic (ROC) analysis demonstrated that an ADC of 2.11x10-3 mm2/sec, an fp of 47.33% and an Dt of 0.94x10-3 mm 2 /sec were the optimal cutoff values to differentiate high histological grade (3) versus low histological grade (1-2), with a sensitivity and specificity for ADC of 100% and 100%, for fp of 100% and 89%, for Dt of 100% and 74%, respectively. Material and Methods: A retrospective approved study was performed including 34 patients with 62 HCCs. IVIM was performed to obtain ADC, fp, pseudo-diffusion coefficient (Dp), Dt coefficients. Kruskal Wallis, Spearman Correlation Coefficient, ROC analysis were performed. Conclusions: ADC and IVIM-derived fp showed significantly better diagnostic performance in differentiating high-grade from low-grade HCC, and significant correlation was observed between ADC, fp, Dt and histological grade.
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Diffusion-weighted imaging (DWI) with the intravoxel incoherent motion (IVIM) model has shown promising results for providing both diffusion and perfusion information in cervical cancer; however, its use to predict and monitor the efficacy of neoadjuvant chemotherapy (NACT) in cervical cancer is relatively rare. The study aimed to evaluate the use of DWI with IVIM and monoexponential models to predict and monitor the efficacy of NACT in cervical cancer.Forty-two patients with primary cervical cancer underwent magnetic resonance exams at 3 time points (pre-NACT, 3 weeks after the first NACT cycle, and 3 weeks after the second NACT cycle). The response to treatment was determined according to the response evaluation criteria in solid tumors 3 weeks after the second NACT treatment, and the subjects were classified as two groups: responders and nonresponders groups. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion-related pseudo-diffusion coefficient (DFNx01), and perfusion fraction (f) values were determined. The differences in IVIM-derived variables and ADC between the different groups at the different time points were calculated using an independent samples t-test.The D and ADC values were all significantly higher for the responders than for the nonresponders at all 3 time points, but no significant differences were observed in the DFNx01 and f values. An analysis of the receiver operating characteristic (ROC) curves indicated that a D value threshold <0.93 × 10-3 mm 2 /s and an ADC threshold <1.11 × 10-3 mm 2 /s could differentiate responders from nonresponders at pre-NACT time point, yielding area under the curve (AUC) of which were 0.771 and 0.806, respectively. The ROC indicated that the AUCs of D and ADC at the 3 weeks after the first NACT cycle and 3 weeks after the second NACT cycle were 0.823, 0.763, and 0.787, 0.794, respectively. The AUC values of D and ADC at these 3 time points were not significantly different (P = 0.641, 0.512, and 0.547, respectively).D and ADC values may be useful for predicting and monitoring the efficacy of NACT in cervical cancer. An IVIM model may be equal to monoexponential model in predicting and monitoring the efficacy of NACT in cervical cancer.
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Objectives To explore the differences between intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and diffusion-weighted imaging (DWI) in evaluating the histopathological characters of pancreatic ductal adenocarcinoma (PDAC). Methods This retrospective study enrolled 50 patients with PDAC confirmed by pathology from December 2018 to May 2020. All patients underwent DWI and IVIM-DWI before surgeries. Patients were classified into low- and high-fibrosis groups. Apparent diffusion coefficient (ADC), diffusion coefficient (D), false diffusion coefficient (D*), and perfusion fraction (f) were measured by two radiologists, respectively in GE AW 4.7 post-processing station, wherein ADC values were derived by mono-exponential fits and f, D, D* values were derived by biexponential fits. The tumor tissue was stained with Sirius red, CD34, and CK19 to evaluate fibrosis, microvascular density (MVD), and tumor cell density. Furthermore, the correlation between ADC, D, D*, and f values and histopathological results was analyzed. Results The D values were lower in the high-fibrosis group than in the low-fibrosis group, while the f values were opposite. Further, no statistically significant differences were detected in ADC and D* values between the high- and low-fibrosis groups. The AUC of D and f values had higher evaluation efficacy in the high- and low-fibrosis groups than ADC values. A significant negative correlation was established between D values, and fibrosis and a significant positive correlation were observed between f values and fibrosis. No statistical difference was detected between DWI/IVIM parameters values and MVD or tumor cell density except for the positive correlation between D* values and tumor cell density. Conclusions D and f values derived from the IVIM model had higher sensitivity and diagnostic performance for grading fibrosis in PDAC compared to the conventional DWI model. IVIM-DWI may have the potential as an imaging biomarker for predicting the fibrosis grade of PDAC.
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Background Nonmuscle‐invasive bladder cancer (NMIBC, Stage T1 or lower) is treated with transurethral resection (TUR), while muscle‐invasive bladder cancer (MIBC, Stage T2 or more) requires neoadjuvant chemotherapy before radical cystectomy. Hence, preoperative differentiation is vital. Purpose To investigate whether intravoxel incoherent motion (IVIM) diffusion‐weighted imaging (DWI) can differentiate NMIBC from MIBC and to assess whether there were correlations between IVIM parameters and the Ki‐67 labeling index (LI). Study Type Retrospective. Subjects Thirty‐six patients diagnosed with bladder cancer confirmed by histopathological findings. Field Strength/Sequence 3.0T magnetic resonance imaging (MRI) DWI with eight b‐values ranging from 0 to 1000 s/mm 2 . Assessment Molecular diffusion coefficient (D), perfusion‐related diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC) were calculated by biexponential and monoexponential models fits, respectively. Statistical Tests Comparisons were made between the MIBC and NMIBC group, and differences were analyzed by comparing the areas under the receiver‐operating characteristic curves (AUCs). The correlations between these parameters and Ki‐67 LI were assessed by Spearman's rank correlation analysis. Results The ADC and D value were significantly lower in patients with MIBC compared to those with NMIBC ( P < 0.01). No significant ( P > 0.05) differences were observed in D* and f. The AUC of D value (0.894) was significantly ( P < 0.05) larger than the ADC value (0.786), with sensitivities and specificities of 95% and 87.5% (D) and 80% and 68.7% (ADC), respectively. In addition, the D and ADC values were significantly correlated with Ki‐67 LI ( r = –0.785, r = –0.643, respectively; both P < 0.01). Data Conclusion The D value obtained from IVIM exhibited better performance than conventional DWI for distinguishing NMIBC from MIBC and may serve as a potential imaging biomarker for bladder cancer invasion. Level of Evidence: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1054–1060.
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Background The performance of diffusion-weighted imaging parameters for characterizing hepatic tumors is controversial. Purpose To compare the performances of apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM)-derived parameters, including the pure diffusion coefficient (D), perfusion coefficient (D*), and perfusion fraction (f), in the characterization of common solid hepatic tumors. Material and Methods Twelve healthy volunteers and 43 patients underwent free-breath diffusion-weighted magnetic resonance imaging (DW-MRI) of the liver using eight b values (10–800 s/mm 2 ). Twelve regions of interest (ROIs) of normal liver tissue in healthy volunteers and 49 hepatic lesions (23 hepatocellular carcinomas [HCCs], 16 hemangiomas, and 10 metastases) were measured. Conventional ADC (0,500) and ADC total obtained by the mono-exponential model, as well as D, D*, and f were calculated. Student t-tests and receiver operating characteristic (ROC) analysis were also performed. Results ADC (0,500) , ADC total , and D were significantly lower in the malignant group ([1.48 ± 0.35] × 10 −3 mm 2 /s; [1.35 ± 0.30] × 10 −3 mm 2 /s; [1.18 ± 0.33] × 10 −3 mm 2 /s) compared to the hemangioma group ([2.74 ± 1.03] × 10 −3 mm 2 /s; [2.61 ± 0.81] × 10 −3 mm 2 /s; [1.97 ± 0.79] × 10 −3 mm 2 /s]. D* did not differ among multiple comparisons. For the area under the ROC curve (AUC-ROC), the maximum value was attained with ADC total (0.983) and was closely followed by ADC (0,500) (0.967), with lower values obtained for D (0.837), f (0.649), and D* (0.599). Statistically significant differences were found between the AUC-ROC of both ADCs (ADC total and ADC (0,500) ) and D. There was no statistically significant difference between the AUC-ROC of ADC total and ADC (0,500) . Conclusion ADCs showed superior diagnostic performance compared to IVIM-derived parameters in detecting differences between the malignant group and hemangioma group.
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The intravoxel incoherent motion (IVIM) method of magnetic resonance imaging (MRI) analysis can provide information regarding many physiological and pathological processes. This study aimed to investigate whether IVIM-derived parameters and the apparent diffusion coefficient (ADC) can act as imaging biomarkers for predicting non-small cell lung cancer (NSCLC) response to anti-tumor therapy and compare their performances.This prospective study included 45 patients with NSCLC treated with chemotherapy (29 men and 16 women, mean age 57.9±9.7 years). Diffusion-weighted imaging was performed with 13 b-values before and 2-4 weeks after treatment. The IVIM parameter pseudo-diffusion coefficient (D*), perfusion fraction (f), diffusion coefficient (D), and ADC from a mono-exponential model were obtained. Responses 2 months after chemotherapy were assessed. The diagnostic performance was evaluated, and optimal cut-off values were determined by receiver operating characteristic (ROC) curve analysis, and the differences of progression-free survival (PFS) in groups of responders and non-responders were tested by Cox regression and Kaplan-Meier survival analyses.Of 45 patients, 30 (66.7%) were categorized as responders, and 15 as non-responders. Differences in the diffusion coefficient D and ADC between responders and non-responders were statistically significant (all P<0.05). Conversely, differences in f and D* between responders and non-responders were both not statistically significance (all P>0.05). The ROC analyses showed the change in D value (ΔD) was the best predictor of early response to anti-tumor therapy [area under the ROC curve (AUC), 0.764]. The Cox-regression model showed that all ADC and D parameters were independent predictors of PFS, with a range of reduction in risk from 56.2% to 82.7%, and ΔD criteria responders had the highest reduction (82.7%).ADC and D derived from IVIM are potentially useful for the prediction of NSCLC treatment response to anti-tumor therapy. Although ΔD is best at predicting response to treatment, ΔADC measurement may simplify manual efforts and reduce the workload.
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