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Role of intravoxel incoherent motion MR imaging in preoperative assessing HER2 status of gastric cancers. Oncotarget 2018; 8:49293-49302. [PMID: 28514733 PMCID: PMC5564768 DOI: 10.18632/oncotarget.17570] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/17/2017] [Indexed: 12/18/2022] Open
Abstract
Purpose To explore the role of intravoxel incoherent motion (IVIM) magnetic resonance (MR) imaging in evaluating human epidermal growth factor receptor 2 (HER2) status of gastric cancers preoperatively. Results The apparent diffusion coefficient (ADC) and pure diffusion coefficient (D) values correlated positively with HER2 scores of gastric cancers significantly (r = 0.276, P = 0.048; r = 0.481, P < 0.001, respectively). The ADC and D values of HER2 positive gastric cancers were significantly higher than those of HER2 negative tumors (P = 0.033, 0.007, respectively). With a cut-off value of 1.321 and 1.123 × 10−3 mm2/sec, the ADC and D values could distinguish HER2 positive gastric cancers from HER2 negative ones with an area under the curve of 0.733 and 0.762, respectively (P = 0.023, 0.011, respectively). Materials and methods Fifty-three patients with gastric cancers underwent IVIM MR imaging preoperatively. The values of ADC, D, pseudo diffusion coefficient (D*) and perfusion related fraction (f) of the lesions were obtained. Partial correlation test including tumor volume was performed to analyze correlations between IVIM values and HER2 scores excluding the impact of tumor size. IVIM parameters of gastric cancers with different HER2 status were compared using independent samples t test. Diagnostic performance of IVIM parameters in distinguishing HER2 positive gastric cancers from negative ones was tested with receiver operating characteristic analysis. Conclusions We confirmed the feasibility of IVIM MR imaging in preoperative assessment of HER2 status of gastric cancers, which might make up the shortfall of biopsy and facilitate personalized treatment for patients with gastric cancers.
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Zarghampour M, Fouladi DF, Pandey A, Ghasabeh MA, Pandey P, Varzaneh FN, Khoshpouri P, Shao N, Pan L, Grimm R, Kamel IR. Utility of volumetric contrast-enhanced and diffusion-weighted MRI in differentiating between common primary hypervascular liver tumors. J Magn Reson Imaging 2018; 48:1080-1090. [DOI: 10.1002/jmri.26032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/15/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Manijeh Zarghampour
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Daniel F. Fouladi
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Ankur Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Mounes Aliyari Ghasabeh
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Pallavi Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Farnaz Najmi Varzaneh
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Nannan Shao
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Li Pan
- Siemens Healthcare; Baltimore Maryland USA
| | | | - Ihab R. Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
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Li GF, Duan SJ, Yan LF, Wang W, Jing Y, Yan WQ, Sun Q, Wang SM, Nan HY, Xu TY, Zheng DD, Hu YC, Cui GB. Intravoxel incoherent motion diffusion-weighted MR imaging parameters predict pathological classification in thymic epithelial tumors. Oncotarget 2018; 8:44579-44592. [PMID: 28574817 PMCID: PMC5546503 DOI: 10.18632/oncotarget.17857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/12/2017] [Indexed: 12/20/2022] Open
Abstract
We evaluated the performance of intravoxel incoherent motion (IVIM) parameters for preoperatively predicting the subtype and Masaoka stage of thymic epithelial tumors (TETs). Seventy-seven patients with pathologically confirmed TETs underwent a diffusion weighted imaging (DWI) sequence with 9 b values. Differences in the slow diffusion coefficient (D), fast perfusion coefficient (D), and perfusion fraction (f) IVIM parameters, as well as the multi b-value fitted apparent diffusion coefficient (ADCmb), were compared among patients with low-risk (LRT) and high-risk thymomas (HRT) and thymic carcinomas (TC), and between early stage (stages I and II) and advanced stage (stages III and IV) TET patients. ADCmb, D, and D values were higher in the LRT group than in the HRT or TC group, but did not differ between the HRT and TC groups. The mean ADCmb, D, and D values were higher in the early stage TETs group than the advanced stage TETs group. The f values did not differ among the groups. These results suggest that IVIM DWI could be used to preoperatively predict subtype and Masaoka stage in TET patients.
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Affiliation(s)
- Gang-Feng Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shi-Jun Duan
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lin-Feng Yan
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yong Jing
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei-Qiang Yan
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Qian Sun
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shu-Mei Wang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hai-Yan Nan
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian-Yong Xu
- MR Research China, GE Healthcare China, Beijing, China
| | - Dan-Dan Zheng
- MR Research China, GE Healthcare China, Beijing, China
| | - Yu-Chuan Hu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Guang-Bin Cui
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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Luo M, Zhang L, Jiang XH, Zhang WD. Intravoxel incoherent motion: application in differentiation of hepatocellular carcinoma and focal nodular hyperplasia. Diagn Interv Radiol 2018; 23:263-271. [PMID: 28703102 DOI: 10.5152/dir.2017.16595] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to explore whether intravoxel incoherent motion (IVIM)-related parameters of hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) demonstrate differences that could be used to differentiate and improve diagnostic efficiency. METHODS A total of 27 patients, including 22 with HCC and 5 with FNH, underwent liver 3.0 T magnetic resonance imaging for routine sequences. They were concurrently examined by IVIM diffusion-weighted imaging (DWI) scanning with 11 different b values (0-800 s/mm2). IVIM-derived parameters, such as pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADCtotal), were quantified automatically by post-processing software and compared between HCC and FNH groups. A receiver operating characteristic (ROC) curve was then created to predict their diagnostic value. RESULTS D* was weak in terms of reproducibility among the other parameters. ADCtotal, D, and D* were significantly lower in the HCC group than in the FNH group, while f did not show a significant difference. ADCtotal and D had the largest area under the curve values (AUC; 0.915 and 0.897, respectively) and similarly high efficacy to differentiate the two conditions. CONCLUSION IVIM provides a new modality to differentiate the HCC and FNH. ADCtotal and D demonstrated outstanding and comparable diagnosing utility.
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Affiliation(s)
- Ma Luo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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Zhu SC, Liu YH, Wei Y, Li LL, Dou SW, Sun TY, Shi DP. Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging for predicting histological grade of hepatocellular carcinoma: Comparison with conventional diffusion-weighted imaging. World J Gastroenterol 2018; 24:929-940. [PMID: 29491686 PMCID: PMC5829156 DOI: 10.3748/wjg.v24.i8.929] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare intravoxel incoherent motion (IVIM)-derived parameters with conventional diffusion-weighted imaging (DWI) parameters in predicting the histological grade of hepatocellular carcinoma (HCC) and to evaluate the correlation between the parameters and the histological grades.
METHODS A retrospective study was performed. Sixty-two patients with surgically confirmed HCCs underwent diffusion-weighted magnetic resonance imaging with twelve b values (10-1200 s/mm2). The apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were calculated by two radiologists. The IVIM and conventional DWI parameters were compared among the different grades by using analysis of variance (ANOVA) and the Kruskal-Wallis test. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic efficiency of distinguishing between low-grade (grade 1, G1) and high-grade (grades 2 and 3, G2 and G3) HCC. The correlation between the parameters and the histological grades was assessed by using the Spearman correlation test. Bland-Altman analysis was used to evaluate the reproducibility of the two radiologists’ measurements.
RESULTS The differences in the ADC and D values among the groups with G1, G2, and G3 histological grades of HCCs were statistically significant (P < 0.001). The D* and f values had no significant differences among the different histological grades of HCC (P > 0.05). The ROC analyses demonstrated that the D and ADC values had better diagnostic performance in differentiating the low-grade HCC from the high-grade HCC, with areas under the curve (AUCs) of 0.909 and 0.843, respectively, measured by radiologist 1 and of 0.911 and 0.852, respectively, measured by radiologist 2. The following significant correlations were obtained between the ADC, D, and D* values and the histological grades: r = -0.619 (P < 0.001), r = -0.628 (P < 0.001), and r = -0.299 (P = 0.018), respectively, as measured by radiologist 1; r = -0.622 (P < 0.001), r = -0.633 (P < 0.001), and r = -0.303 (P = 0.017), respectively, as measured by radiologist 2. The intra-class correlation coefficient (ICC) values between the two observers were 0.996 for ADC, 0.997 for D, 0.996 for D*, and 0.992 for f values, which indicated excellent inter-observer agreement in the measurements between the two observers.
CONCLUSION The IVIM-derived D and ADC values show better diagnostic performance in differentiating high-grade HCC from low-grade HCC, and there is a moderate to good correlation between the ADC and D values and the histological grades.
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Affiliation(s)
- Shao-Cheng Zhu
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
| | - Yue-Hua Liu
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
- Medical College of Henan University, Kaifeng 475000, Henan Province, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
| | - Lin-Lin Li
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
| | - She-Wei Dou
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
| | - Ting-Yi Sun
- Department of Pathology, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
| | - Da-Peng Shi
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
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Granata V, Fusco R, Catalano O, Guarino B, Granata F, Tatangelo F, Avallone A, Piccirillo M, Palaia R, Izzo F, Petrillo A. Intravoxel incoherent motion (IVIM) in diffusion-weighted imaging (DWI) for Hepatocellular carcinoma: correlation with histologic grade. Oncotarget 2018; 7:79357-79364. [PMID: 27764817 PMCID: PMC5346719 DOI: 10.18632/oncotarget.12689] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/29/2016] [Indexed: 02/07/2023] Open
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 2.11×10-3 mm2/sec, an fp of 47.33% and an Dt of 0.94×10-3 mm2/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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Affiliation(s)
- Vincenza Granata
- Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Roberta Fusco
- Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Orlando Catalano
- Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Benedetta Guarino
- Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Francesco Granata
- Department of Civil and Mechanical Engineering, "Università degli Studi di Cassino e del Lazio Meridionale", Cassino 03043, Italy
| | - Fabiana Tatangelo
- Departement of Pathology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Antonio Avallone
- Department of Gastrointestinal Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Mauro Piccirillo
- Department of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Raffaele Palaia
- Department of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Francesco Izzo
- Department of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
| | - Antonella Petrillo
- Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, I-80131, Italy
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Intravoxel Incoherent Motion MRI of Rectal Cancer: Correlation of Diffusion and Perfusion Characteristics With Prognostic Tumor Markers. AJR Am J Roentgenol 2018; 210:W139-W147. [PMID: 29446674 DOI: 10.2214/ajr.17.18342] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the intravoxel incoherent motion (IVIM)-DWI derived parameters and their relationships with tumor prognostic markers using 3-T MRI in patients with rectal cancer. SUBJECTS AND METHODS Fifty-two patients with histopathologically proven rectal cancer who underwent preoperative pelvic MRI were prospectively enrolled in this study. Diffusion and perfusion parameters including the apparent diffusion coefficient (ADC), pure diffusion coefficient, perfusion fraction, and pseudodiffusion coefficient derived from IVIMDWI were independently measured by two radiologists. Comparisons of IVIM-DWI-derived parameters in patients with different tumor prognostic markers were made using the independent-samples t test, ANOVA, and Mann-Whitney U test. The correlations between IVIM-DWI-derived parameters and tumor grade and tumor stage were further evaluated using Spearman correlation analysis. Interobserver agreement was evaluated using the intraclass correlation coefficient (ICC). RESULTS Excellent interobserver reproducibility was obtained for the IVIM-DWI-derived parameters (range of ICCs with 95% limits of agreement = 0.9309-0.9948, which is narrow). ADC, pseudodiffusion coefficient, and perfusion fraction tended to rise with greater tumor differentiation (r = 0.520, p < 0.001; r = 0.447, p = 0.001; r = 0.354, p = 0.010, respectively). The pure diffusion coefficient and pseudodiffusion coefficient showed a trend of decreasing with increasing tumor stages (r = 0.479, p < 0.001; r = 0.517, p < 0.001). The group of patients with extramural vascular invasion (EMVI) showed lower pseudodiffusion coefficient values than the group of patients with no EMVI (p < 0.05). CONCLUSION IVIM-DWI-derived parameters in patients with rectal cancer, especially the pseudodiffusion coefficient, are associated with tumor grade and tumor stage and show statistically significant differences between subjects with EMVI and those without EMVI. IVIM-DWI-derived parameters would be helpful in predicting tumor aggressiveness and prognosis.
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Huang YC, Chen TW, Zhang XM, Zeng NL, Li R, Tang YL, Chen F, Chen YL. Intravoxel incoherent motion diffusion-weighted imaging of resectable oesophageal squamous cell carcinoma: association with tumour stage. Br J Radiol 2018; 91:20170421. [PMID: 29308923 DOI: 10.1259/bjr.20170421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine whether intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) derived parameters can be associated with tumour stage of oesophageal squamous cell carcinoma (SCC). METHODS 60 patients with resectable oesophageal SCC and 20 healthy individuals underwent oesophageal DWI-using multi b-values with a 3.0 T MR system. Pure diffusion coefficient (D), perfusion-related incoherent microcirculation (D*), microvascular volume fraction (f) and apparent diffusion coefficient (ADC) were measured on DWI. Statistical analyses were performed to determine associations of DWI-derived parameters with T-stage. RESULTS ADC (r = -0.842), D (r = -0.729), D* (r = -0.301) and f (r = -0.817) were negatively correlated with T-stage of oesophageal SCC (all p < 0.01), and the multinominal regression analyses revealed that IVIM-derived parameters including D (p = 0.038; odds ratio <1) and f (p < 0.001; odds ratio <1) were associated with T-stage. The Mann-Whitney U tests with Bonferroni correction showed that D, f and ADC could discriminate oesophageal SCC, especially T1-staged tumour, from normal oesophagus (all p < 0.05) while D* could not (p > 0.05). By receiver operating characteristic analyses, f could be the best indicator for detecting oesophageal SCC with an area under receiver operating characteristic (AUC) of 0.964, especially T1-staged cancer with an AUC of 0.984, and for discriminating T1-stages between T0-1 and T2-3 with an AUC of 0.957, and between T0-2 and T3 with an AUC of 0.945 in comparison with any other DWI-derived parameter. CONCLUSIONS IVIM derived parameters can be associated with T-stage of oesophageal SCC. Advances in knowledge (1) IVIM-derived parameters are negatively correlated with stage of oesophageal SCC. (2) Among IVIM-derived parameters, microvascular volume fraction helps detect and stage oesophageal SCC.
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Affiliation(s)
- Yu-Cheng Huang
- 1 Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College , Nanchong, Sichuan , China.,2 Department of Radiology, Dazhou Central Hospital , Dazhou, Sichuan , China
| | - Tian-Wu Chen
- 1 Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College , Nanchong, Sichuan , China
| | - Xiao-Ming Zhang
- 1 Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College , Nanchong, Sichuan , China
| | - Nan-Lin Zeng
- 1 Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College , Nanchong, Sichuan , China
| | - Rui Li
- 1 Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College , Nanchong, Sichuan , China
| | - Yu-Lian Tang
- 1 Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College , Nanchong, Sichuan , China
| | - Fan Chen
- 1 Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College , Nanchong, Sichuan , China
| | - Yan-Li Chen
- 1 Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College , Nanchong, Sichuan , China
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Wei Y, Gao F, Zheng D, Huang Z, Wang M, Hu F, Chen C, Duan T, Chen J, Cao L, Song B. Intrahepatic cholangiocarcinoma in the setting of HBV-related cirrhosis: Differentiation with hepatocellular carcinoma by using Intravoxel incoherent motion diffusion-weighted MR imaging. Oncotarget 2018; 9:7975-7983. [PMID: 29487707 PMCID: PMC5814274 DOI: 10.18632/oncotarget.23807] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/13/2017] [Indexed: 02/05/2023] Open
Abstract
Accurate preoperative differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) in the setting of cirrhotic liver is of great clinical significance because the treatment and prognosis of these entities differ markedly. Through a retrospectively research, we sought to determine the diagnostic performances of intravoxel incoherent motion (IVIM) and diffusion weighted imaging (DWI) parameters in the differentiating of ICC and HCC. According to the results, we found that apparent diffusion coefficient (ADC) derived from mono-exponential model and true ADC (ADCslow) derived from bi-exponential model can be used to distinguish the ICC and HCC, and ADCslowentailed the higher diagnostic performance than ADC. However, pseudo-ADC (ADCfast) and perfusion fraction (f) can not be used to differentiate ICC and HCC. These results suggested that IVIM and DWI parameters can be useful in differentiating ICC and HCC and might be helpful in selecting the treatment plan and predicting prognosis.
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Affiliation(s)
- Yi Wei
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Feifei Gao
- 2 Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | | | - Zixing Huang
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Wang
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fubi Hu
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chenyang Chen
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Duan
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Chen
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Likun Cao
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Lu K, Chen X, Yan J, Li X, Huang C, Wan Q, Deng X, Zou Q. The Effect of Feeding Behavior on Hypothalamus in Obese Type 2 Diabetic Rats with Glucagon-like Peptide-1 Receptor Agonist Intervention. Obes Facts 2018; 11:181-194. [PMID: 29788009 PMCID: PMC6103358 DOI: 10.1159/000486316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/13/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the utility of intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI) derived parameters in hypothalamus for monitoring the effect of Exendin-4 (Ex-4) intervention on the feeding behavior in obese diabetic rats within early feeding. METHODS 21 obese and 19 non-obese rats which were treated with streptozotocin injections were initially divided into an obese diabetes group (OD, n = 10), a non-obese diabetes group (D, n = 8), an obese group (O, n = 9) and a non-obese group (N, n = 9). Then, the rats in the 4 groups received subcutaneous injections of Ex-4, and feeding behavior was examined at 5, 35, 65, 95, and 125 min. The hypothalamic function was evaluated by IVIM-DWI. Finally, the relationship between the hypothalamic function and the amount of food intake was analyzed. RESULTS In comparison with the N group, the food intake significantly decreased in the O , OD, and D groups in response to Ex-4. Furthermore, a significant positive correlation was found between food intake and D values at different times from 5 to 125 min after Ex-4 intervention in all 4 groups. CONCLUSION A direct correlation between the change of hypothalamic function and feeding behavior was detected in OD rats with Ex-4 intervention in the early feeding period. The hypothalamic D value derived from IVIM-DWI is promising to reflect the dynamic change of hypothalamic function due to intervention.
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Affiliation(s)
- Ke Lu
- Department of Endocrinology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyan Chen
- Department of Endocrinology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Dr. Xiaoyan Chen, Department of Endocrinology, First Affiliated Hospital of Guangzhou Medical University, 510120 Guangzhou, China,
| | - Jianhua Yan
- Department of Radiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinchun Li
- Department of MRI, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chen Huang
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Qi Wan
- Department of MRI, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuelian Deng
- Department of Endocrinology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiao Zou
- Department of MRI, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Xu Q, Xu Y, Sun H, Chan Q, Shi K, Song A, Wang W. Quantitative intravoxel incoherent motion parameters derived from whole-tumor volume for assessing pathological complete response to neoadjuvant chemotherapy in locally advanced rectal cancer. J Magn Reson Imaging 2017; 48:248-258. [PMID: 29281151 DOI: 10.1002/jmri.25931] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many locally advanced rectal cancer (LARC) patients can benefit from neoadjuvant chemotherapy (NACT), with some achieving a pathological complete response (pCR). However, there is limited research reporting on the value of intravoxel incoherent motion (IVIM) in monitoring pCR in patients with LARC. PURPOSE To identify whether IVIM parameters derived from whole-tumor volume (WTV) before and after NACT could accurately assess pCR in patients with LARC. STUDY TYPE Prospective patient control study. POPULATION Fifty-one patients with LARC before and after NACT, prior to surgery. FIELD STRENGTH/SEQUENCE IVIM-diffusion imaging at 3T. ASSESSMENT Apparent diffusion coefficient (ADC), slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion-related diffusion fraction (f) values were obtained on diffusion-weighted magnetic resonance images (DW-MRI) using WTV methods and calculated using a biexponential model before and after NACT. STATISTICAL TESTS DWI-derived ADC and IVIM-derived parameters and their percentage changes (ΔADC%, ΔD%, ΔD*%, and Δf%) were compared using independent-samples t-test and Mann-Whitney U-test between the pCR and non-pCR groups. The diagnostic performance of IVIM parameters and their percentage changes were evaluated using receiver operating characteristic curves. RESULTS Compared with the non-pCR group, the pCR group exhibited significantly lower pre-ADCmean (P = 0.003) and pre-D values (P = 0.024), and significantly higher post-f (P = 0.002), ΔADCmean % (P = 0.002), ΔD% (P = 0.001), and Δf% values (P = 0.017). Receiver operating characteristic curves showed that the pre-D value had the best specificity (95.12%) and accuracy (86.27%) in predicting the pCR status, and ΔD% had the highest area under the curve (0.832) in assessing the pCR response to NACT. DATA CONCLUSIONS The IVIM-derived D value is a promising tool in predicting the pCR status before therapy. The percentage changes in D values after therapy may help assess the pCR status prior to surgery. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
- Qiaoyu Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Queenie Chan
- Philips Healthcare, Shatin, New Territories, Hong Kong, China
| | | | - Aiping Song
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Wu Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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112
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Lim HK, Jee WH, Jung JY, Paek MY, Kim I, Jung CK, Chung YG. Intravoxel incoherent motion diffusion-weighted MR imaging for differentiation of benign and malignant musculoskeletal tumours at 3 T. Br J Radiol 2017; 91:20170636. [PMID: 29144153 DOI: 10.1259/bjr.20170636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the intravoxel incoherent motion (IVIM) diffusion-weighted (DW) MRI for differentiating between benign and malignant musculoskeletal tumours at 3 T. METHODS 65 patients with treatment-naïve musculoskeletal tumours (47 malignant and 23 benign lesions) who underwent 3 T MRI including IVIM DW imaging were included. IVIM-derived parameters included pure diffusion coefficient (D), perfusion related incoherent microcirculation (D*, pseudodiffusion coefficient), and perfusion fraction (f). IVIM parameters and mono-exponential apparent diffusion coefficient (ADC) were retrospectively measured by two independent musculoskeletal radiologists. RESULTS D and ADC values of malignant tumours (923 ± 360, 965 ± 353 µm2 s-1, respectively) were significantly lower than those of benign tumours (1668 ± 546, 1689 ± 526 µm2 s-1) (p < 0.001). F values of malignant tumours (9.6%) were significantly higher than those of benign tumours (7.2%) (p = 0.021), whereas D* values showed no significant difference (p > 0.05). The area under the receiver operating characteristic (ROC) curve of D, ADC and f were 0.874, 0.880 and 0.671, respectively. Using cut-off values of D and ADC of 1200 µm2 s-1, the sensitivity, specificity and accuracy were 92, 83, 89%, 92, 87 and 90%, respectively. CONCLUSION D and ADC may be more accurate and reliable for differentiation of malignant from benign musculoskeletal tumours than f and D* at 3 T IVIM DW imaging. Advances in knowledge: Among IVIM-derived parameters, D is more accurate and reliable in differentiating malignant from benign musculoskeletal tumours than f and D* at 3.0T IVIM DW imaging. There was no significant difference in the diagnostic performance of D and ADC.
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Affiliation(s)
- Hyun Kyong Lim
- 1 Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Won-Hee Jee
- 1 Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Joon-Yong Jung
- 1 Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Mun Young Paek
- 2 Department of Diagnostic Imaging, Siemens Healthcare Korea , Siemens Healthcare Korea , Seoul , Republic of Korea
| | - InSeong Kim
- 2 Department of Diagnostic Imaging, Siemens Healthcare Korea , Siemens Healthcare Korea , Seoul , Republic of Korea
| | - Chan-Kwon Jung
- 3 Department of Pathology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Yang-Guk Chung
- 4 Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
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Abstract
Diffusion-weighted imaging (DWI) is increasingly incorporated into routine body magnetic resonance imaging protocols. DWI can assist with lesion detection and even in characterization. Quantitative DWI has exhibited promise in the discrimination between benign and malignant pathology, in the evaluation of the biologic aggressiveness, and in the assessment of the response to treatment. Unfortunately, inconsistencies in DWI acquisition parameters and analysis have hampered widespread clinical utilization. Focusing primarily on liver applications, this article will review the basic principles of quantitative DWI. In addition to standard mono-exponential fitting, the authors will discuss intravoxel incoherent motion and diffusion kurtosis imaging that involve more sophisticated approaches to diffusion quantification.
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Affiliation(s)
- Myles T Taffel
- Department of Radiology, New York University School of Medicine, New York, NY
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114
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Meeus EM, Zarinabad N, Manias KA, Novak J, Rose HEL, Dehghani H, Foster K, Morland B, Peet AC. Diffusion-weighted MRI and intravoxel incoherent motion model for diagnosis of pediatric solid abdominal tumors. J Magn Reson Imaging 2017; 47:1475-1486. [PMID: 29159937 PMCID: PMC6001424 DOI: 10.1002/jmri.25901] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/06/2017] [Indexed: 12/24/2022] Open
Abstract
Background Pediatric retroperitoneal tumors in the renal bed are often large and heterogeneous, and their diagnosis based on conventional imaging alone is not possible. More advanced imaging methods, such as diffusion‐weighted (DW) MRI and the use of intravoxel incoherent motion (IVIM), have the potential to provide additional biomarkers that could facilitate their noninvasive diagnosis. Purpose To assess the use of an IVIM model for diagnosis of childhood malignant abdominal tumors and discrimination of benign from malignant lesions. Study Type Retrospective. Population Forty‐two pediatric patients with abdominal lesions (n = 32 malignant, n = 10 benign), verified by histopathology. Field Strength/Sequence 1.5T MRI system and a DW‐MRI sequence with six b‐values (0, 50, 100, 150, 600, 1000 s/mm2). Assessment Parameter maps of apparent diffusion coefficient (ADC), and IVIM maps of slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion fraction (f) were computed using a segmented fitting model. Histograms were constructed for whole‐tumor regions of each parameter. Statistical Tests Comparison of histogram parameters of and their diagnostic performance was determined using Kruskal–Wallis, Mann–Whitney U, and receiver‐operating characteristic (ROC) analysis. Results IVIM parameters D* and f were significantly higher in neuroblastoma compared to Wilms' tumors (P < 0.05). The ROC analysis showed that the best diagnostic performance was achieved with D* 90th percentile (area under the curve [AUC] = 0.935; P = 0.002; cutoff value = 32,376 × 10−6 mm2/s) and f mean values (AUC = 1.00; P < 0.001; cutoff value = 14.7) in discriminating between neuroblastoma (n = 11) and Wilms' tumors (n = 8). Discrimination between tumor types was not possible with IVIM D or ADC parameters. Malignant tumors revealed significantly lower ADC, D, and higher D* values than in benign lesions (all P < 0.05). Data Conclusion IVIM perfusion parameters could distinguish between malignant childhood tumor types, providing potential imaging biomarkers for their diagnosis. Level of Evidence: 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1475–1486.
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Affiliation(s)
- Emma M Meeus
- Physical Sciences of Imaging in Biomedical Sciences (PSIBS) Doctoral Training Centre, University of Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, UK.,Department of Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Niloufar Zarinabad
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK.,Department of Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Karen A Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK.,Department of Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Jan Novak
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK.,Department of Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Heather E L Rose
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK.,Department of Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Hamid Dehghani
- Physical Sciences of Imaging in Biomedical Sciences (PSIBS) Doctoral Training Centre, University of Birmingham, UK.,School of Computer Science, University of Birmingham, UK
| | - Katharine Foster
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Bruce Morland
- Department of Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK.,Department of Oncology, Birmingham Children's Hospital, Birmingham, UK
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115
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Federau C. Intravoxel incoherent motion MRI as a means to measure in vivo perfusion: A review of the evidence. NMR IN BIOMEDICINE 2017; 30. [PMID: 28885745 DOI: 10.1002/nbm.3780] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/19/2017] [Accepted: 07/07/2017] [Indexed: 05/07/2023]
Abstract
The idea that in vivo intravoxel incoherent motion magnetic resonance signal is influenced by blood motion in the microvasculature is exciting, because it suggests that local and quantitative perfusion information can be obtained in a simple and elegant way from a few diffusion-weighted images, without contrast injection. When the method was proposed in the late 1980s some doubts appeared as to its feasibility, and, probably because the signal to noise and image quality at the time was not sufficient, no obvious experimental evidence could be produced to alleviate them. Helped by the tremendous improvements seen in the last three decades in MR hardware, pulse design, and post-processing capabilities, an increasing number of encouraging reports on the value of intravoxel incoherent motion perfusion imaging have emerged. The aim of this article is to review the current published evidence on the feasibility of in vivo perfusion imaging with intravoxel incoherent motion MRI.
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Affiliation(s)
- Christian Federau
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, Petersgraben, Basle, Switzerland
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116
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Meeus EM, Novak J, Dehghani H, Peet AC. Rapid measurement of intravoxel incoherent motion (IVIM) derived perfusion fraction for clinical magnetic resonance imaging. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:269-283. [PMID: 29075909 PMCID: PMC5871652 DOI: 10.1007/s10334-017-0656-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to investigate the reliability of intravoxel incoherent motion (IVIM) model derived parameters D and f and their dependence on b value distributions with a rapid three b value acquisition protocol. MATERIALS AND METHODS Diffusion models for brain, kidney, and liver were assessed for bias, error, and reproducibility for the estimated IVIM parameters using b values 0 and 1000, and a b value between 200 and 900, at signal-to-noise ratios (SNR) 40, 55, and 80. Relative errors were used to estimate optimal b value distributions for each tissue scenario. Sixteen volunteers underwent brain DW-MRI, for which bias and coefficient of variation were determined in the grey matter. RESULTS Bias had a large influence in the estimation of D and f for the low-perfused brain model, particularly at lower b values, with the same trends being confirmed by in vivo imaging. Significant differences were demonstrated in vivo for estimation of D (P = 0.029) and f (P < 0.001) with [300,1000] and [500,1000] distributions. The effect of bias was considerably lower for the high-perfused models. The optimal b value distributions were estimated to be brain500,1000, kidney300,1000, and liver200,1000. CONCLUSION IVIM parameters can be estimated using a rapid DW-MRI protocol, where the optimal b value distribution depends on tissue characteristics and compromise between bias and variability.
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Affiliation(s)
- Emma M Meeus
- Physical Sciences of Imaging in Biomedical Sciences (PSIBS) Doctoral Training Centre, University of Birmingham, Birmingham, B15 2TT, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Jan Novak
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Hamid Dehghani
- Physical Sciences of Imaging in Biomedical Sciences (PSIBS) Doctoral Training Centre, University of Birmingham, Birmingham, B15 2TT, UK.,School of Computer Science, University of Birmingham, Birmingham, B15 2TT, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK. .,Department of Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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117
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Luo M, Zhang L, Jiang XH, Zhang WD. Intravoxel Incoherent Motion Diffusion-weighted Imaging: Evaluation of the Differentiation of Solid Hepatic Lesions. Transl Oncol 2017; 10:831-838. [PMID: 28866259 PMCID: PMC5595232 DOI: 10.1016/j.tranon.2017.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate whether intravoxel incoherent motion (IVIM)-related parameters could be used to differentiate malignant from benign focal liver lesions (FLLs) and to improve diagnostic efficiency. METHODS Seventy-four patients with 75 lesions, including 51 malignant FLLs and 24 benign FLLs, underwent liver 3.0-T magnetic resonance imaging for routine examination sequences. IVIM diffusion-weighted imaging (DWI) with 11 b values (0-800s/mm2) was also acquired concurrently. Apparent diffusion coefficient (ADCtotal) and IVIM-derived parameters, such as the pure diffusion coefficient (D), the pseudodiffusion coefficient (D⁎), and the perfusion fraction (f), were calculated and compared between the two groups. A receiver operating characteristic curve analysis was performed to assess their diagnostic value. RESULTS ADCtotal, D, and f were significantly lower in the malignant group than in the benign group, whereas D⁎ did not show a statistical difference. D had a larger area under the curve value (0.968) and higher sensitivity (92.30%) for differentiation. CONCLUSION IVIM is a useful method to differentiate malignant and benign FLLs. The D value showed higher efficacy to detect hepatic solid lesions.
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Affiliation(s)
- Ma Luo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Ling Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Xin-Hua Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Wei-Dong Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
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Lee Y, Lee SS, Cheong H, Lee CK, Kim N, Son WC, Hong SM. Intravoxel incoherent motion MRI for monitoring the therapeutic response of hepatocellular carcinoma to sorafenib treatment in mouse xenograft tumor models. Acta Radiol 2017; 58:1045-1053. [PMID: 28273738 DOI: 10.1177/0284185116683576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background With the introduction of targeted therapies, there has been a growing need for non-invasive imaging methods which accurately evaluate therapeutic effects and overcome the limitations of tumor size-based therapeutic response assessments. Purpose To assess diagnostic values of intra-voxel incoherent motion (IVIM) imaging in evaluating therapeutic effects of sorafenib on hepatocellular carcinoma (HCC) using mouse xenograft model. Material and Methods Twenty-four mice bearing Huh-7 were divided into a control group and two treatment groups received sorafenib doses of 5 mg/kg (5 mg-Tx) or 30 mg/kg (30 mg-Tx). IVIM imaging was performed using 10 b-values (0-900 s/mm2). The apparent diffusion coefficient (ADC), diffusion coefficient ( D), and perfusion fraction ( f) were measured for whole tumors and tumor periphery. Changes between baseline and post-treatment parameters ( Δ ADC, Δ D, and Δ f) were calculated, and these parameters were compared with microvessel density (MVD) and area of tumor cell death. Results The post-treatment f and Δ f for tumor periphery were significantly higher in control group, followed by 5 mg-Tx and 30 mg-Tx ( P < 0.001). MVD showed significant positive correlation with post-treatment f ( r = 0.584, P = 0.003) and negative correlation with D ( r = -0.495, P = 0.014) for tumor periphery, while no parameter showed significant correlation with area of tumor cell death. Conclusion The f is significantly correlated with MVD of HCC, and could potentially be used to evaluate the anti-angiogenic effects of sorafenib.
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Affiliation(s)
- Yedaun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Current address: Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyunhee Cheong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chang Kyung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Woo-Chan Son
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Mo Hong
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Ichikawa S, Motosugi U, Hernando D, Morisaka H, Enomoto N, Matsuda M, Onishi H. Histological Grading of Hepatocellular Carcinomas with Intravoxel Incoherent Motion Diffusion-weighted Imaging: Inconsistent Results Depending on the Fitting Method. Magn Reson Med Sci 2017; 17:168-173. [PMID: 28819085 PMCID: PMC5891343 DOI: 10.2463/mrms.mp.2017-0047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To compare the abilities of three intravoxel incoherent motion (IVIM) imaging approximation methods to discriminate the histological grade of hepatocellular carcinomas (HCCs). Methods: Fifty-eight patients (60 HCCs) underwent IVIM imaging with 11 b-values (0–1000 s/mm2). Slow (D) and fast diffusion coefficients (D*) and the perfusion fraction (f) were calculated for the HCCs using the mean signal intensities in regions of interest drawn by two radiologists. Three approximation methods were used. First, all three parameters were obtained simultaneously using non-linear fitting (method A). Second, D was obtained using linear fitting (b = 500 and 1000), followed by non-linear fitting for D* and f (method B). Third, D was obtained by linear fitting, f was obtained using the regression line intersection and signals at b = 0, and non-linear fitting was used for D* (method C). A receiver operating characteristic analysis was performed to reveal the abilities of these methods to distinguish poorly-differentiated from well-to-moderately-differentiated HCCs. Inter-reader agreements were assessed using intraclass correlation coefficients (ICCs). Results: The measurements of D, D*, and f in methods B and C (Az-value, 0.658–0.881) had better discrimination abilities than did those in method A (Az-value, 0.527–0.607). The ICCs of D and f were good to excellent (0.639–0.835) with all methods. The ICCs of D* were moderate with methods B (0.580) and C (0.463) and good with method A (0.705). Conclusion: The IVIM parameters may vary depending on the fitting methods, and therefore, further technical refinement may be needed.
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Affiliation(s)
| | | | | | - Hiroyuki Morisaka
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center
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Evaluating histologic differentiation of hepatitis B virus-related hepatocellular carcinoma using intravoxel incoherent motion and AFP levels alone and in combination. Abdom Radiol (NY) 2017; 42:2079-2088. [PMID: 28337521 DOI: 10.1007/s00261-017-1107-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate histologic differentiation of hepatitis B virus (HBV)-related hepatocellular carcinomas (HCCs) using apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM)-derived metrics and to compare findings with alpha-fetoprotein (AFP) levels alone and in combination. MATERIALS AND METHOD One hundred and six chronic HBV-related HCC patients who underwent IVIM diffusion-weighted magnetic resonance imaging with eleven b values were enrolled. Mean ADC, diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) values were determined for all detected lesions. The metrics and AFP levels of different histologically differentiated groups were compared. Spearman's rank correlation was used to assess the statistical dependence among the histologically differentiated HCCs. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance of these metrics and AFP levels alone and in combination. RESULTS ADC, D, and f values and AFP levels were significantly different among well-, moderately, and poorly differentiated HCCs. The four metrics were significantly correlated with histologic differentiation. The area under the ROC curve (AUC-ROC) of ADC, D, f, and AFP for diagnosing well-differentiated HCCs was 0.903, 0.84, 0.782, and 0.806, respectively, and the AUC-ROC of above metrics for diagnosing poorly differentiated HCCs was 0.787, 0.726, 0.624, and 0.633, respectively. The combination of ADC and AFP provided an AUC-ROC of 0.945 for well-differentiated HCC. However, this did not provide better performance for diagnosing poorly differentiated HCC. CONCLUSION ADC, IVIM metrics, and AFP levels may be useful for evaluating histologic differentiation of HBV-related HCCs, and the combination of ADC and AFP provides better diagnostic performance for well-differentiated HCC.
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Wang F, Wang Y, Zhou Y, Liu C, Xie L, Zhou Z, Liang D, Shen Y, Yao Z, Liu J. Comparison between types I and II epithelial ovarian cancer using histogram analysis of monoexponential, biexponential, and stretched-exponential diffusion models. J Magn Reson Imaging 2017; 46:1797-1809. [PMID: 28379611 DOI: 10.1002/jmri.25722] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/14/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the utility of histogram analysis of monoexponential, biexponential, and stretched-exponential models to a dualistic model of epithelial ovarian cancer (EOC). MATERIALS AND METHODS Fifty-two patients with histopathologically proven EOC underwent preoperative magnetic resonance imaging (MRI) (including diffusion-weighted imaging [DWI] with 11 b-values) using a 3.0T system and were divided into two groups: types I and II. Apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), distributed diffusion coefficient (DDC), and intravoxel water diffusion heterogeneity (α) histograms were obtained based on solid components of the entire tumor. The following metrics of each histogram were compared between two types: 1) mean; 2) median; 3) 10th percentile and 90th percentile. Conventional MRI morphological features were also recorded. RESULTS Significant morphological features for predicting EOC type were maximum diameter (P = 0.007), texture of lesion (P = 0.001), and peritoneal implants (P = 0.001). For ADC, D, f, DDC, and α, all metrics were significantly lower in type II than type I (P < 0.05). Mean, median, 10th, and 90th percentile of D* were not significantly different (P = 0.336, 0.154, 0.779, and 0.203, respectively). Most histogram metrics of ADC, D, and DDC had significantly higher area under the receiver operating characteristic curve values than those of f and α (P < 0.05) CONCLUSION: It is feasible to grade EOC by morphological features and three models with histogram analysis. ADC, D, and DDC have better performance than f and α; f and α may provide additional information. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1797-1809.
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Affiliation(s)
- Feng Wang
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, P.R. China
| | - Yuxiang Wang
- Department of Pathology, School of Basic Medical Science, Peking University Third Hospital, Peking University Health Science Center, Beijing, P.R. China
| | - Yan Zhou
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, P.R. China
| | - Congrong Liu
- Department of Pathology, School of Basic Medical Science, Peking University Third Hospital, Peking University Health Science Center, Beijing, P.R. China
| | - Lizhi Xie
- GE Healthcare, MR Research China, Beijing, P.R. China
| | - Zhenyu Zhou
- GE Healthcare, MR Research China, Beijing, P.R. China
| | - Dong Liang
- Siemens Ltd., China, Chaoyang District, Beijing, P.R. China
| | - Yang Shen
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, P.R. China
| | - Zhihang Yao
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, P.R. China
| | - Jianyu Liu
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, P.R. China
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Shi C, Zhang D, Xiao Z, Wang L, Ma R, Chen H, Luo L. Ultrahigh b-values MRI in normal human prostate: Initial research on reproducibility and age-related differences. J Magn Reson Imaging 2017; 46:801-812. [PMID: 28267238 DOI: 10.1002/jmri.25629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/27/2016] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To investigate the reproducibility of diffusion-weighted imaging (DWI) with ultrahigh b-values, and analyze the age-related differences in normal prostates. MATERIALS AND METHODS In all, 67 healthy participants were divided into three age groups (group A, 15-30 years; group B, 31-50 years; group C, ≥51 years), and underwent DWI scanning twice with 15 b-factors from 0 to 3000 at 3.0T. Triexponential fits were applied to calculate the molecular diffusion coefficient (D), the pseudo-diffusion coefficient (D*), the ultrahigh apparent diffusion coefficient (ADCuh ), and perfusion fraction (f). The interobserver and short-term interscan reproducibility were evaluated, and the change in these parameters with age were assessed. RESULTS The D, ADCuh , and f values presented good to excellent reproducibility. With increasing age, a trend of increasing D values was observed, with significant difference in both peripheral zone (PZ, P = 0.01) and central gland (CG, P = 0.01) of normal prostate tissue. The f value increased in the CG beginning at 50 years of age while the ADCuh value decreased in the PZ after 50 years of age; all of them showed significant differences between groups A and C and groups B and C (P = 0.01/0.01). CONCLUSION The D, ADCuh , and f values have good to excellent reproducibility in the normal prostate, and these values change with age. The ultrahigh b-values magnetic resonance imaging (MRI) can provide additional information (ADCuh ), which is different from the IVIM (intravoxel incoherent motion)-derived parameters. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:801-812.
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Affiliation(s)
- Changzheng Shi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China
| | - Dong Zhang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China
| | - Zeyu Xiao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China
| | - Li Wang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, P.R. China
| | - Rong Ma
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China
| | - Hanwei Chen
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, P.R. China
| | - Liangping Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P.R. China
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Keil VC, Mädler B, Gielen GH, Pintea B, Hiththetiya K, Gaspranova AR, Gieseke J, Simon M, Schild HH, Hadizadeh DR. Intravoxel incoherent motion MRI in the brain: Impact of the fitting model on perfusion fraction and lesion differentiability. J Magn Reson Imaging 2017; 46:1187-1199. [PMID: 28152250 DOI: 10.1002/jmri.25615] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To investigate the effect of the choice of the curve-fitting model on the perfusion fraction (fIVIM ) with regard to tissue type characterization, correlation with microvascular anatomy, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters. Several curve-fitting models coexist in intravoxel incoherent motion (IVIM) MRI to derive the (fIVIM ). MATERIALS AND METHODS In all, 29 patients with brain lesions (12 gliomas, 11 meningiomas, three metastases, two gliotic scars, one multiple sclerosis) underwent IVIM-MRI (32 b-values, 0 to 2000 s/mm2 ) at 3T. fIVIM was determined by classic monoexponential, biexponential, and a novel nonnegative least squares (NNLS) fitting in 352 regions of interest (lesion-containing and normal-appearing tissue) and tested their correlation with DCE-MRI kinetic parameters and microvascular anatomy derived from 57 region of interest (ROI)-based biopsies and their capacities to differentiate histologically different lesions. RESULTS fIVIM differed significantly between all three models and all tissue types (monoexponential confidence interval in percent [CI 3.4-3.8]; biexponential [CI 11.21-12.45]; NNLS [CI 2.06-2.60]; all P < 0.001). For all models an increase in fIVIM was associated with a shift to larger vessels and higher vessel area / tissue area ratio (regression coefficient 0.07-0.52; P = 0.04-0.001). Correlation with kinetic parameters derived from DCE-MRI was usually not significant. Only biexponential fitting allowed differentiation of both gliosis from edema and high- from low-grade glioma (both P < 0.001). CONCLUSION The curve-fitting model has an important impact on fIVIM and its capacity to differentiate tissues. fIVIM may possibly be used to assess microvascular anatomy and is weakly correlated with DCE-MRI kinetic parameters. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1187-1199.
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Affiliation(s)
- Vera C Keil
- University Hospital Bonn/Germany, Department of Radiology, Bonn, Germany
| | | | - Gerrit H Gielen
- University Hospital Bonn/Germany, Department of Neuropathology, Center for Pathology, Bonn, Germany
| | - Bogdan Pintea
- BG Krankenhaus Bergmannsheil, Bochum/Germany, Bochum, Germany
| | | | - Alisa R Gaspranova
- University Hospital Bonn/Germany, Department of Radiology, Bonn, Germany
| | | | - Matthias Simon
- Ev. Krankenhaus Bielefeld/Germany, Department of Neurosurgery, Bielefeld, Germany.,University Hospital Bonn/Germany, Department of Neurosurgery and Stereotaxy, Bonn, Germany
| | - Hans H Schild
- University Hospital Bonn/Germany, Department of Radiology, Bonn, Germany
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Pan F, Den J, Zhang C, Wang H, Cheng J, Wu W, Hong N, Wang Y. The Therapeutic Response of Gastrointestinal Stromal Tumors to Imatinib Treatment Assessed by Intravoxel Incoherent Motion Diffusion-Weighted Magnetic Resonance Imaging with Histopathological Correlation. PLoS One 2016; 11:e0167720. [PMID: 27911930 PMCID: PMC5135126 DOI: 10.1371/journal.pone.0167720] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023] Open
Abstract
Purpose To exploit the intravoxel incoherent motion (IVIM) diffusion-weighted (DW) MRI when evaluating the therapeutic response of gastrointestinal stromal tumors (GIST) to Imatinib in a mouse model. Materials and Methods Mice with xenografts bearing cells from the GIST-T1 cell line were randomly divided into a treated group receiving Imatinib and a control group. DWMRI scans with 14 b-values (0–1500 s/mm2) were performed before and after treatment (days 1, 3 and 7). IVIM related parameters perfusion fractions (fp) and perfusion-related diffusion coefficients (D*) and the conventional apparent diffusion coefficients (ADC) were calculated by fitting the DWMRI signal decay. The mean changes from baseline to each post-treatment time point for each measurement (ΔADC, Δfp and ΔD*) were calculated. The differences of mean changes between the two groups were tested for statistical significance. Histopathological analyses including Ki-67, CD31, TUNEL and H&E were conducted in conjunction with the MRI scans. Results Increases in ADC of the treated group were higher than those of the control group after treatment, whereas statistical significances were not observed. Compared to the control group, D* in the treated group decreased significantly (ΔD*treated = -41%, -49%, and -49% with P = 0.0001, 0.0001 and 0.0001), and fp increased significantly (Δfptreated = 79%, 82% and 110%, with P = 0.001, 0.0001 and P = 0.0007) on days 1, 3 and 7 after treatment. Histopathological analyses demonstrated different tumor tissue characteristics between the treated and control groups. Conclusion IVIM measurements may serve as more sensitive imaging biomarkers than ADC when assessing GIST response to Imatinib as early as one day after treatment.
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Affiliation(s)
- Feng Pan
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
| | - Jie Den
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Chunfang Zhang
- People’s Hospital, Peking University, Clinical Epidemiology and Medical Statistics, Beijing, China
| | - He Wang
- GE Healthcare, Shanghai, China
| | - Jin Cheng
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
| | - Weizhen Wu
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
| | - Nan Hong
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
| | - Yi Wang
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
- * E-mail:
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Saito K, Tajima Y, Harada TL. Diffusion-weighted imaging of the liver: Current applications. World J Radiol 2016; 8:857-867. [PMID: 27928467 PMCID: PMC5120245 DOI: 10.4329/wjr.v8.i11.857] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/10/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI) of the liver can be performed using most commercially available machines and is currently accepted in routine sequence. This sequence has some potential as an imaging biomarker for fibrosis, tumor detection/characterization, and following/predicting therapy. To improve reliability including accuracy and reproducibility, researchers have validated this new technique in terms of image acquisition, data sampling, and analysis. The added value of DWI in contrast-enhanced magnetic resonance imaging was established in the detection of malignant liver lesions. However, some limitations remain in terms of lesion characterization and fibrosis detection. Furthermore, the methodologies of image acquisition and data analysis have been inconsistent. Therefore, researchers should make every effort to not only improve accuracy and reproducibility but also standardize imaging parameters.
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Park HJ, Sung YS, Lee SS, Lee Y, Cheong H, Kim YJ, Lee MG. Intravoxel incoherent motion diffusion-weighted MRI of the abdomen: The effect of fitting algorithms on the accuracy and reliability of the parameters. J Magn Reson Imaging 2016; 45:1637-1647. [PMID: 27865032 DOI: 10.1002/jmri.25535] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/13/2016] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To evaluate the influence of fitting methods on the accuracy and reliability of intravoxel incoherent motion (IVIM) parameters, with a particular emphasis on the constraint function. MATERIALS AND METHODS Diffusion-weighted (DW) imaging data were analyzed using IVIM-based full-fitting (simultaneous fit of all parameters) and segmented-fitting (step-by-step fit of each parameter), each with and without the constraint function, to estimate the molecular diffusion coefficient (Dslow ), perfusion fraction (f), and flow-related diffusion coefficient (Dfast ). Computational simulations were performed at variable signal-to-noise ratios to evaluate the relative error (RE) and coefficient of variation (CV) of the estimated IVIM parameters. DW imaging of the abdomen was performed twice at 1.5 Tesla using nine b-values (0-900 s/mm2 ) in 12 health volunteers (6 men and 6 women; mean age: 30 years). The measurement repeatability of IVIM parameters in the liver and the pancreas was evaluated using the within-subject coefficient of variation (w CV). RESULTS In simulations, full-fitting without the constraint function yielded the largest RE (P < 0.001 for Dslow and f; P ≤ 0.044 for Dfast ) and CV (P ≤ 0.033 for Dslow and f; P ≤ 0.473 for Dfast ) for IVIM parameters among all four algorithms. In volunteer imaging, full-fitting without the constraint function also resulted in the poorest repeatability for Dslow (w CV, 17.12%-65.45%) and f (w CV, 19.35%-42.84%) in the liver and pancreas, while the other algorithms had similar repeatability values (w CV, 4.05%-11.99% for Dslow and 9.65%-18.66% for f). Measurement repeatability of Dfast (w CV, 29.52%-85.01%) was the poorest among the IVIM parameters. CONCLUSION For accurate and reliable measurement of IVIM parameters, segmented fitting or full-fitting with the constraint function should be used for IVIM-based analysis of DW imaging. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1637-1647.
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Affiliation(s)
- Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, Korea
| | - Yedaun Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hyunhee Cheong
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, Korea
| | - Yeong Jae Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, Korea
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Hu XX, Yang ZX, Liang HY, Ding Y, Grimm R, Fu CX, Liu H, Yan X, Ji Y, Zeng MS, Rao SX. Whole-tumor MRI histogram analyses of hepatocellular carcinoma: Correlations with Ki-67 labeling index. J Magn Reson Imaging 2016; 46:383-392. [PMID: 27862582 DOI: 10.1002/jmri.25555] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate whether whole-tumor histogram-derived parameters for an apparent diffusion coefficient (ADC) map and contrast-enhanced magnetic resonance imaging (MRI) could aid in assessing Ki-67 labeling index (LI) of hepatocellular carcinoma (HCC). MATERIALS AND METHODS In all, 57 patients with HCC who underwent pretreatment MRI with a 3T MR scanner were included retrospectively. Histogram parameters including mean, median, standard deviation, skewness, kurtosis, and percentiles (5th , 25th , 75th , 95th ) were derived from the ADC map and MR enhancement. Correlations between histogram parameters and Ki-67 LI were evaluated and differences between low Ki-67 (≤10%) and high Ki-67 (>10%) groups were assessed. RESULTS Mean, median, 5th , 25th , 75th percentiles of ADC, and mean, median, 25th , 75th , 95th percentiles of enhancement of arterial phase (AP) demonstrated significant inverse correlations with Ki-67 LI (rho up to -0.48 for ADC, -0.43 for AP) and showed significant differences between low and high Ki-67 groups (P < 0.001-0.04). Areas under the receiver operator characteristics (ROC) curve for identification of high Ki-67 were 0.78, 0.77, 0.79, 0.82, and 0.76 for mean, median, 5th , 25th , 75th percentiles of ADC, respectively, and 0.74, 0.81, 0.76, 0.82, 0.69 for mean, median, 25th , 75th , 95th percentiles of AP, respectively. CONCLUSION Histogram-derived parameters of ADC and AP were potentially helpful for predicting Ki-67 LI of HCC. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;46:383-392.
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Affiliation(s)
- Xin-Xing Hu
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute, Shanghai, China
| | - Zhao-Xia Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute, Shanghai, China
| | - He-Yue Liang
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute, Shanghai, China
| | - Ying Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute, Shanghai, China
| | - Robert Grimm
- MR Application Development, Siemens Healthcare, Erlangen, Germany
| | - Cai-Xia Fu
- Siemens Shenzhen Magnetic Resonance, Shenzhen, China
| | - Hui Liu
- MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China
| | - Xu Yan
- MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China
| | - Yuan Ji
- Department of Pathology, Zhongshan hospital, Fudan University, Shanghai, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute, Shanghai, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute, Shanghai, China
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Peng J, Li JJ, Li J, Li HW, Xu GP, Jia RR, Zhang XN, Zhao Y. Could ADC values be a promising diagnostic criterion for differentiating malignant and benign hepatic lesions in Asian populations: A meta-analysis. Medicine (Baltimore) 2016; 95:e5470. [PMID: 27902599 PMCID: PMC5134810 DOI: 10.1097/md.0000000000005470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Liver cancer exhibits geographic and ethnic differences in its prevalence and biology, which implies that it is impractical to develop universal guidelines for all patients. Thus, a meta-analysis was conducted to identify the accuracy of apparent diffusion coefficients (ADCs) for discriminating malignant from benign liver lesions in Asians. METHODS Eligible studies published in PubMed, Ovid, and Embase/Medline were updated onto October 2014. STATA 12.0 and Meta-Disc 1.4 were used to perform this meta-analysis. RESULTS Eight studies comprising 661 benign liver lesions and 598 malignant liver lesions fulfilled all the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.88 (95% confidence interval [CI] 0.75-0.95), 0.93 (95% CI 0.86-0.97), 12.42 (95% CI 6.09-25.31), 0.13 (95% CI 0.06-0.29), and 95.58 (95% CI 35.29-258.89), respectively. Overall, the area under the summary receiver-operating characteristic curve was 0.96 (95% CI 0.94-0.98). Heterogeneity was found to originate potentially from the type of benign lesion. A subgroup analysis showed that differentiating between hemangiomas, cysts, and malignant liver lesions produced a significantly higher diagnostic accuracy than that of solid liver lesions. CONCLUSION Our meta-analysis indicated that ADC could be promising for characterizing liver lesions among Asians, indicating that the ADC value is a promising diagnostic criterion candidate. Meanwhile, the use of dual b values could be sufficient for liver lesion characterization. However, large-scale, high-quality trials should be conducted to identify specific standards, including cut-off values for further development of diffusion-weighted imaging as a routine clinical application among Asian populations.
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Mürtz P, Penner AH, Pfeiffer AK, Sprinkart AM, Pieper CC, König R, Block W, Schild HH, Willinek WA, Kukuk GM. Intravoxel incoherent motion model-based analysis of diffusion-weighted magnetic resonance imaging with 3 b-values for response assessment in locoregional therapy of hepatocellular carcinoma. Onco Targets Ther 2016; 9:6425-6433. [PMID: 27799790 PMCID: PMC5079699 DOI: 10.2147/ott.s113909] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The aim of this study was to evaluate an intravoxel incoherent motion (IVIM) model–based analysis of diffusion-weighted imaging (DWI) for assessing the response of hepatocellular carcinoma (HCC) to locoregional therapy. Patients and methods Respiratory-gated DWI (b=0, 50, and 800 s/mm2) was retrospectively analyzed in 25 patients who underwent magnetic resonance imaging at 1.5 T before and 6 weeks following the first cycle of transarterial chemoembolization therapy, transarterial ethanol-lipiodol embolization therapy, and transarterial radioembolization therapy. In addition to the determination of apparent diffusion coefficient, ADC(0,800), an estimation of the diffusion coefficient, D′, and the perfusion fraction, f′, was performed by using a simplified IVIM approach. Parameters were analyzed voxel-wise. Tumor response was assessed in a central slice by using a region of interest (ROI) covering the whole tumor. HCCs were categorized into two groups, responders and nonresponders, according to tumor size changes on first and second follow ups (if available) and changes of contrast-enhanced region on the first follow up. Results In total, 31 HCCs were analyzed: 17 lesions were assigned to responders and 14 were to nonresponders. In responders, ADC(0,800) and D′ were increased after therapy by ~30% (P=0.00004) and ~42% (P=0.00001), respectively, whereas f′ was decreased by ~37% (P=0.00094). No significant changes were found in nonresponders. Responders and nonresponders were better differentiated by changes in D′ than by changes in ADC(0,800) (area under the curve =0.878 vs 0.819 or 0.714, respectively). Conclusion In patients with HCCs undergoing embolization therapy, diffusion changes were better reflected by D′ than by conventional ADC(0,800), which is influenced by counteracting perfusion changes as assessed by f′.
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Affiliation(s)
- Petra Mürtz
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | | | | | - Claus C Pieper
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Roy König
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Wolfgang Block
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Guido M Kukuk
- Department of Radiology, University of Bonn, Bonn, Germany
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Contribution of mono-exponential, bi-exponential and stretched exponential model-based diffusion-weighted MR imaging in the diagnosis and differentiation of uterine cervical carcinoma. Eur Radiol 2016; 27:2400-2410. [DOI: 10.1007/s00330-016-4596-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/24/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
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Choi IY, Lee SS, Sung YS, Cheong H, Lee H, Byun JH, Kim SY, Lee SJ, Shin YM, Lee MG. Intravoxel incoherent motion diffusion-weighted imaging for characterizing focal hepatic lesions: Correlation with lesion enhancement. J Magn Reson Imaging 2016; 45:1589-1598. [PMID: 27664970 DOI: 10.1002/jmri.25492] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/10/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate the value of intravoxel incoherent motion (IVIM) parameters for characterizing focal hepatic lesions, and to assess the correlation between IVIM parameters and arterial nodule enhancement. MATERIALS AND METHODS We retrospectively evaluated 161 lesions (91 hepatocellular carcinomas [HCCs], 27 intrahepatic cholangiocarcinomas [IHCCs], 20 hemangiomas, 9 combined hepatocellular-cholangiocarcinomas, 9 metastases, and 5 other tumors) in 161 patients (105 men and 56 women; mean age, 56.4 years). Diffusion-weighted imaging was performed using nine b-values (0-900 s/mm2 ) at 1.5T. Apparent diffusion coefficient (ADC), molecular diffusion coefficient (Dslow ), perfusion fraction (f), and perfusion-related diffusion coefficient (Dfast ) were compared among the hepatic lesions using analysis of variance (ANOVA). Receiver-operating-characteristic analysis was performed to assess diagnostic performance. The enhancement fraction (EF) and the relative enhancement (RE) of the hepatic lesions on arterial phase gadoxetic acid-enhanced images were correlated with the IVIM parameters using Spearman's test. RESULTS For the differentiation of hemangiomas from malignant tumors, Dslow showed the largest area under the curve (0.933) among all parameters. Although ADC did not show any difference among malignant lesions (P ≥ 0.28), HCCs showed a significantly lower Dslow than IHCC (P < 0.001) and a higher f than did IHCC (P < 0.001) and metastasis (P = 0.027); f had a significant positive correlation with EF (r = 0.420, P < 0.001) and RE (r = 0.264, P = 0.001). CONCLUSION IVIM parameters are more helpful in characterizing malignant hepatic lesions than ADC; f may reflect the extent and degree of hepatic nodule enhancement in the arterial phase, and may allow for differentiation of HCC from IHCC and metastasis. LEVEL OF EVIDENCE 3 J. MAGN. RESON. IMAGING 2017;45:1589-1598.
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Affiliation(s)
- In Young Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyunhee Cheong
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hoyoung Lee
- University of Ulsan, College of Medicine, Seoul, Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Liu J, Wan Y, Wang Z, Qi Y, Qu P, Liu Y. Perfusion and diffusion characteristics of endometrial malignancy based on intravoxel incoherent motion MRI at 3.0 T: comparison with normal endometrium. Acta Radiol 2016; 57:1140-8. [PMID: 26663037 DOI: 10.1177/0284185115618550] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/26/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND There has been a growing need for a non-invasive imaging method for the accurate diagnosis and differentiation of endometrial malignancy (EM). PURPOSE To study tissue characteristics of EM using an intravoxel incoherent motion (IVIM) model and to assess their diagnostic potential. MATERIAL AND METHODS Sixty-eight EMs and 31 healthy participants were prospectively recruited for diffusion-weighted (13 b-values, b = 0-3,000 s/mm(2)) and standard magnetic resonance imaging (MRI). A bi-exponential analysis was performed to derive f (perfusion fraction), D* (pseudodiffusion coefficient), and D (true diffusion coefficient) in EM and normal endometrium (NE). Apparent diffusion coefficient (ADC) was calculated. Student's t test, the Mann-Whitney U test and a receiver operating characteristics (ROC) curve analysis were performed. RESULTS EM had lower f (37.809 ± 12.158%) and was significantly different from NE (P < 0.001). However, the EMs had higher D (0.503 ± 0.155 × 10(-3) mm(2)/s) and D* (19.796 ± 20.029 × 10(-3) mm(2)/s) and were all significantly different from NE (P < 0.001). D was significantly lower than ADC in NE (P < 0.001) but not in EM (P > 0.05). f ≤ 48.5%, D > 0.432 × 10(-3) mm(2)/s, D* > 4.94 × 10(-3) mm(2)/s, and ADC ≤ 0.542 × 10(-3) mm(2)/s could diagnose EM (AUC 0.786-0.961). CONCLUSION EM has distinctive IVIM perfusion and diffusion characteristics with promising potential for earlier non-invasive diagnosis.
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Affiliation(s)
- Jingyan Liu
- No. 2 Department of Radiology, Tianjin Hospital, Tianjin, China, PR China
| | - Yeda Wan
- No. 2 Department of Radiology, Tianjin Hospital, Tianjin, China, PR China
| | - Zhi Wang
- No. 2 Department of Radiology, Tianjin Hospital, Tianjin, China, PR China
| | - Yang Qi
- No. 2 Department of Radiology, Tianjin Hospital, Tianjin, China, PR China
| | - Pengpeng Qu
- Department of Gynecologic Oncology, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China, PR China
| | - Yixin Liu
- Department of Pathology, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China, PR China
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133
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Yuan J, Wong OL, Lo GG, Chan HHL, Wong TT, Cheung PSY. Statistical assessment of bi-exponential diffusion weighted imaging signal characteristics induced by intravoxel incoherent motion in malignant breast tumors. Quant Imaging Med Surg 2016; 6:418-429. [PMID: 27709078 DOI: 10.21037/qims.2016.08.05] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study is to statistically assess whether bi-exponential intravoxel incoherent motion (IVIM) model better characterizes diffusion weighted imaging (DWI) signal of malignant breast tumor than mono-exponential Gaussian diffusion model. METHODS 3 T DWI data of 29 malignant breast tumors were retrospectively included. Linear least-square mono-exponential fitting and segmented least-square bi-exponential fitting were used for apparent diffusion coefficient (ADC) and IVIM parameter quantification, respectively. F-test and Akaike Information Criterion (AIC) were used to statistically assess the preference of mono-exponential and bi-exponential model using region-of-interests (ROI)-averaged and voxel-wise analysis. RESULTS For ROI-averaged analysis, 15 tumors were significantly better fitted by bi-exponential function and 14 tumors exhibited mono-exponential behavior. The calculated ADC, D (true diffusion coefficient) and f (pseudo-diffusion fraction) showed no significant differences between mono-exponential and bi-exponential preferable tumors. Voxel-wise analysis revealed that 27 tumors contained more voxels exhibiting mono-exponential DWI decay while only 2 tumors presented more bi-exponential decay voxels. ADC was consistently and significantly larger than D for both ROI-averaged and voxel-wise analysis. CONCLUSIONS Although the presence of IVIM effect in malignant breast tumors could be suggested, statistical assessment shows that bi-exponential fitting does not necessarily better represent the DWI signal decay in breast cancer under clinically typical acquisition protocol and signal-to-noise ratio (SNR). Our study indicates the importance to statistically examine the breast cancer DWI signal characteristics in practice.
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Affiliation(s)
- Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Oi Lei Wong
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Gladys G Lo
- Department of Diagnostic and Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Helen H L Chan
- Department of Diagnostic and Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Ting Ting Wong
- Breast Care Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, China
| | - Polly S Y Cheung
- Breast Care Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, China
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Pieper CC, Willinek WA, Meyer C, Ahmadzadehfar H, Kukuk GM, Sprinkart AM, Block W, Schild HH, Mürtz P. Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging for Prediction of Early Arterial Blood Flow Stasis in Radioembolization of Breast Cancer Liver Metastases. J Vasc Interv Radiol 2016; 27:1320-1328. [PMID: 27402526 DOI: 10.1016/j.jvir.2016.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/06/2016] [Accepted: 04/15/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To retrospectively evaluate predictive value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for early arterial blood flow stasis during transarterial radioembolization (TARE) of liver dominant breast metastases (LdBM). MATERIALS AND METHODS Preinterventional 1.5T DWI (b0, b1, b2 = 0, 50, 800 s/mm(2)) data for 28 liver lobes of 18 female patients treated by resin-based radioembolization (10 bilobar and 8 unilobar treatments) were analyzed. Apparent diffusion coefficient (ADC) (0, 800) and an estimation of the true diffusion coefficient D' and of the perfusion fraction f' were calculated for the 2 largest metastases. Response rate at 3 months and survival were analyzed. Procedures without full dose application because of early stasis were assigned to group A (n = 15), and procedures with full dose application were assigned to group B (n = 13). RESULTS Metastases in group A showed significantly lower f' (0.035 ± 0.018 vs 0.076 ± 0.015, P < .0001) and a trend toward lower ADC(0, 800) with values given in 10(-6) mm(2)/s (1,066 ± 141 vs 1,189 ± 176, P = .051); no group difference was shown for D'. Groups were best discriminated by weighted mean f' values of the 2 largest metastases with accuracy of 100%. Mean tumor diameter before and after TARE was 51 mm ± 18 and 50 mm ± 24 in group A and 47 mm ± 27 and 48 mm ± 32 for group B. Imaging response did not differ between groups (P = .545). Overall survival did not differ significantly between group A (230 d) and B (155 d) (P = .124). CONCLUSIONS Perfusion-sensitive IVIM parameter f' may predict early blood flow stasis in patients undergoing TARE for LdBM. Determination of this parameter before intervention may increase awareness of the interventionalist and increase safety of microsphere administration.
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Affiliation(s)
- Claus Christian Pieper
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany.
| | | | - Carsten Meyer
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany
| | - Hojjat Ahmadzadehfar
- Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany
| | - Guido Matthias Kukuk
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany
| | - Alois Martin Sprinkart
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany
| | - Wolfgang Block
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany
| | - Hans Heinz Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany
| | - Petra Mürtz
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany
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Pieper CC, Meyer C, Sprinkart AM, Block W, Ahmadzadehfar H, Schild HH, Mürtz P, Kukuk GM. The value of intravoxel incoherent motion model-based diffusion-weighted imaging for outcome prediction in resin-based radioembolization of breast cancer liver metastases. Onco Targets Ther 2016; 9:4089-98. [PMID: 27462163 PMCID: PMC4940017 DOI: 10.2147/ott.s104770] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To evaluate prognostic values of clinical and diffusion-weighted magnetic resonance imaging-derived intravoxel incoherent motion (IVIM) parameters in patients undergoing primary radioembolization for metastatic breast cancer liver metastases. Subjects and methods A total of 21 females (mean age 54 years, range 43–72 years) with liver-dominant metastatic breast cancer underwent standard liver magnetic resonance imaging (1.5 T, diffusion-weighted imaging with b-values of 0, 50, and 800 s/mm2) before and 4–6 weeks after radioembolization. The IVIM model-derived estimated diffusion coefficient D’ and the perfusion fraction f’ were evaluated by averaging the values of the two largest treated metastases in each patient. Kaplan–Meier and Cox regression analyses for overall survival (OS) were performed. Investigated parameters were changes in f’- and D’-values after therapy, age, sex, Eastern Cooperative Oncology Group (ECOG) status, grading of primary tumor, hepatic tumor burden, presence of extrahepatic disease, baseline bilirubin, previous bevacizumab therapy, early stasis during radioembolization, chemotherapy after radioembolization, repeated radioembolization and Response Evaluation Criteria in Solid Tumors (RECIST) response at 6-week follow-up. Results Median OS after radioembolization was 6 (range 1.5–54.9) months. In patients with therapy-induced decreasing or stable f’-values, median OS was significantly longer than in those with increased f’-values (7.6 [range 2.6–54.9] vs 2.6 [range 1.5–17.4] months, P<0.0001). Longer median OS was also seen in patients with increased D’-values (6 [range 1.6–54.9] vs 2.8 [range 1.5–17.4] months, P=0.008). Patients with remission or stable disease (responders) according to RECIST survived longer than nonresponders (7.2 [range 2.6–54.9] vs 2.6 [range 1.5–17.4] months, P<0.0001). An ECOG status ≤1 resulted in longer median OS than >1 (7.6 [range 2.6–54.9] vs 1.7 [range 1.5–4.5] months, P<0.0001). Pretreatment IVIM parameters and the other clinical characteristics were not associated with OS. Classification by f’-value changes and ECOG status remained as independent predictors of OS on multivariate analysis, while RECIST response and D’-value changes did not predict survival. Conclusion Following radioembolization of breast cancer liver metastases, early changes in the IVIM model-derived perfusion fraction f’ and baseline ECOG score were predictive of patient outcome, and may thus help to guide treatment strategy.
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136
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Düwel S, Durst M, Gringeri CV, Kosanke Y, Gross C, Janich MA, Haase A, Glaser SJ, Schwaiger M, Schulte RF, Braren R, Menzel MI. Multiparametric human hepatocellular carcinoma characterization and therapy response evaluation by hyperpolarized (13) C MRSI. NMR IN BIOMEDICINE 2016; 29:952-960. [PMID: 27195474 DOI: 10.1002/nbm.3561] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 03/30/2016] [Accepted: 04/26/2016] [Indexed: 06/05/2023]
Abstract
Individual tumor characterization and treatment response monitoring based on current medical imaging methods remain challenging. This work investigates hyperpolarized (13) C compounds in an orthotopic rat hepatocellular carcinoma (HCC) model system before and after transcatheter arterial embolization (TAE). HCC ranks amongst the top six most common cancer types in humans and accounts for one-third of cancer-related deaths worldwide. Early therapy response monitoring could aid in the development of personalized therapy approaches and novel therapeutic concepts. Measurements with selectively (13) C-labeled and hyperpolarized urea, pyruvate and fumarate were performed in tumor-bearing rats before and after TAE. Two-dimensional, slice-selective MRSI was used to obtain spatially resolved maps of tumor perfusion, cell energy metabolic conversion rates and necrosis, which were additionally correlated with immunohistochemistry. All three injected compounds, taken together with their respective metabolites, exhibited similar signal distributions. TAE induced a decrease in blood flow into the tumor and thus a decrease in tumor to muscle and tumor to liver ratios of urea, pyruvate and its metabolites, alanine and lactate, whereas conversion rates remained stable or increased on TAE in tumor, muscle and liver tissue. Conversion from fumarate to malate successfully indicated individual levels of necrosis, and global malate signals after TAE suggested the washout of fumarase or malate itself on necrosis. This study presents a combination of three (13) C compounds as novel candidate biomarkers for a comprehensive characterization of genetically and molecularly diverse HCC using hyperpolarized MRSI, enabling the simultaneous detection of differences in tumor perfusion, metabolism and necrosis. If, as in this study, bolus dynamics are not required and qualitative perfusion information is sufficient, the desired information could be extracted from hyperpolarized fumarate and pyruvate alone, acquired at higher fields with better spectral separation. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Stephan Düwel
- Institute of Medical Engineering, Technische Universität München, Garching, Germany
- Department of Chemistry, Technische Universität München, Garching, Germany
| | - Markus Durst
- Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Concetta V Gringeri
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Yvonne Kosanke
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claudia Gross
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Axel Haase
- Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | - Steffen J Glaser
- Department of Chemistry, Technische Universität München, Garching, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Rickmer Braren
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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137
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Huang YQ, Liang HY, Yang ZX, Ding Y, Zeng MS, Rao SX. Value of MR histogram analyses for prediction of microvascular invasion of hepatocellular carcinoma. Medicine (Baltimore) 2016; 95:e4034. [PMID: 27368028 PMCID: PMC4937942 DOI: 10.1097/md.0000000000004034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The objective is to explore the value of preoperative magnetic resonance (MR) histogram analyses in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC).Fifty-one patients with histologically confirmed HCC who underwent diffusion-weighted and contrast-enhanced MR imaging were included. Histogram analyses were performed and mean, variance, skewness, kurtosis, 1th, 10th, 50th, 90th, and 99th percentiles were derived. Quantitative histogram parameters were compared between HCCs with and without MVI. Receiver operating characteristics (ROC) analyses were generated to compare the diagnostic performance of tumor size, histogram analyses of apparent diffusion coefficient (ADC) maps, and MR enhancement.The mean, 1th, 10th, and 50th percentiles of ADC maps, and the mean, variance. 1th, 10th, 50th, 90th, and 99th percentiles of the portal venous phase (PVP) images were significantly different between the groups with and without MVI (P <0.05), with area under the ROC curves (AUCs) of 0.66 to 0.74 for ADC and 0.76 to 0.88 for PVP. The largest AUC of PVP (1th percentile) showed significantly higher accuracy compared with that of arterial phase (AP) or tumor size (P <0.001).MR histogram analyses-in particular for 1th percentile for PVP images-held promise for prediction of MVI of HCC.
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Affiliation(s)
- Ya-Qin Huang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Imaging Institute, Shanghai, China
- Department of Radiology, The Ningbo First Hospital, Ningbo, China
| | - He-Yue Liang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Imaging Institute, Shanghai, China
| | - Zhao-Xia Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Imaging Institute, Shanghai, China
| | - Ying Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Imaging Institute, Shanghai, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Imaging Institute, Shanghai, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Imaging Institute, Shanghai, China
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Yang K, Zhang XM, Yang L, Xu H, Peng J. Advanced imaging techniques in the therapeutic response of transarterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol 2016; 22:4835-4847. [PMID: 27239110 PMCID: PMC4873876 DOI: 10.3748/wjg.v22.i20.4835] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/29/2016] [Accepted: 04/20/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity and mortality in patients with chronic liver disease. Transarterial chemoembolization (TACE) can significantly improve the survival rate of patients with HCC and is the first treatment choice for patients who are not suitable for surgical resections. The evaluation of the response to TACE treatment affects not only the assessment of the therapy efficacy but also the development of the next step in the treatment plan. The use of imaging to examine changes in tumor volume to assess the response of solid tumors to treatment has been controversial. In recent years, the emergence of new imaging technology has made it possible to observe the response of tumors to treatment prior to any morphological changes. In this article, the advances in studies reporting the use of computed tomography perfusion imaging, diffusion-weighted magnetic resonance imaging (MRI), intravoxel incoherent motion, diffusion kurtosis imaging, magnetic resonance spectroscopy, magnetic resonance perfusion-weighted imaging, blood oxygen level-dependent MRI, positron emission tomography (PET)/computed tomography and PET/MRI to assess the TACE treatment response are reviewed.
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139
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Klauss M, Mayer P, Maier-Hein K, Laun FB, Mehrabi A, Kauczor HU, Stieltjes B. IVIM-diffusion-MRI for the differentiation of solid benign and malign hypervascular liver lesions-Evaluation with two different MR scanners. Eur J Radiol 2016; 85:1289-94. [PMID: 27235876 DOI: 10.1016/j.ejrad.2016.04.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) as the most common malign and benign liver tumors are both hypervascularized and potentially difficult to differentiate. DWI in liver MRI has been shown to be helpful in the classification of liver lesions, although with a substantial ADC-values-overlap. First results suggest that IVIM allows for improved characterization of liver lesions. In this study we evaluated IVIM-derived parameters in HCC and FNH with two different MR-scanners. MATERIAL AND METHODS 72 patients (29 FNH, 43HCC) were examined prospectively using two 1.5 T-MRI scanners (Aera/MagnetomAvanto, Siemens, Germany). Quantitative analysis of IVIM-derived parameters and ADC800-values was performed independently by two radiologists. The concordance between the reviewers was tested using a Pearson-/Spearman-correlation. The mean values for significant differences between FNHs and HCCs and between the two MR scanners were compared using a two-tailed t-test/Mann-Whitney-U test. An ROC analysis assessing the diagnostic performance of the parameters was performed. RESULTS The concordance between the two f-, D- and D*-measurements were r=0.81, 0.81 and 0.84, and r=0.58 for ADC-values. D-values and ADC800-values were significantly lower in HCC compared to FNH (p<0.001), there was no significant difference for f and D*. D had the largest AUC (0.76) for the differentiation between the two entities. Most parameters were not significantly different between the two MRIs. CONCLUSION IVIM-derived D and ADC are comparable for the differentiation between HCC and FNH. Since ADC-measurement means less effort than IVIM, ADC should be used for the differentiation between the two entities. Furthermore, quantitative results obtained from different scanners match closely.
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Affiliation(s)
- Miriam Klauss
- University of Heidelberg, Dpt. of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Philipp Mayer
- University of Heidelberg, Dpt. of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Klaus Maier-Hein
- DKFZ, Dept. of Medical and Biological Informatics, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Frederik B Laun
- DKFZ, Dept. of Medical Physics in Medicine, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Arineb Mehrabi
- University of Heidelberg, Dpt. of Surgery, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Dpt. of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Bram Stieltjes
- University of Basel, Dept. of Radiology, Petersgraben 4, 4031 Basel, Switzerland.
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140
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Pieper CC, Sprinkart AM, Meyer C, König R, Schild HH, Kukuk GM, Mürtz P. Evaluation of a Simplified Intravoxel Incoherent Motion (IVIM) Analysis of Diffusion-Weighted Imaging for Prediction of Tumor Size Changes and Imaging Response in Breast Cancer Liver Metastases Undergoing Radioembolization: A Retrospective Single Center Analysis. Medicine (Baltimore) 2016; 95:e3275. [PMID: 27057887 PMCID: PMC4998803 DOI: 10.1097/md.0000000000003275] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/10/2016] [Accepted: 03/04/2016] [Indexed: 12/11/2022] Open
Abstract
To investigate the value of a simplified intravoxel incoherent motion (IVIM) analysis for evaluation of therapy-induced tumor changes and response of breast cancer liver metastases (mBRC) undergoing radioembolization.In 21 females (mean age 54 years, range 43-72) with mBRC tumor size changes and response evaluation criteria in solid tumors (RECIST) response to 26 primary radioembolization procedures were analyzed. Standard 1.5-T liver magnetic resonance imaging including respiratory-gated diffusion-weighted imaging (DWI) with b0 = 0 s/mm, b1 = 50 s/mm, b2 = 800 s/mm before and 6 weeks after each treatment was performed. In addition to the apparent diffusion coefficient (ADC)(0,800), the estimated diffusion coefficient D' and the perfusion fraction f' were determined using a simplified IVIM approach. For each radioembolization, the 2 largest treated metastases (if available) were analyzed. Lesions were categorized according to size changes into group A (reduction of longest diameter [LD]) and group B (LD increase) after 3 months. Radioembolization procedures were further categorized into "response" (partial response and stable disease) and "nonresponse" (progressive disease) according to RECIST after 3 months. ADC and D' are given in 10 mm/s.Forty-five metastases were analyzed. Thirty-two lesions were categorized as A; 13 as B. Before therapy, group A lesions showed significantly larger f'-values than B (P = 0.001), but ADC(0,800) and D' did not differ. After therapy, in group A lesions the ADC(0,800)- and D'-values increased and f' decreased (P < 0.0001); in contrast in group B lesions f' increased (P = 0.001). Groups could be differentiated by preinterventional f' and by changes of D' and f' between pre and postinterventional imaging (area under the curve [AUC] of 0.903, 0.747 and 1.0, respectively).Preinterventional parameters did not differ between responders and nonresponders according to RECIST. ADC(0,800)- and D'-values showed a larger increase in responders compared with nonresponders (P = 0.013 and P = 0.001, respectively). After therapy f'-values decreased significantly in responders (P = 0.001). Good to excellent prediction of long-term RECIST response was possible by therapy-induced changes in LD, D', and f' (AUC 0.903, 0.879, and 0.867, respectively).A simplified IVIM model-based analysis of early post-treatment DWI can deliver additional information on tumor size changes and long-term RECIST response after radioembolization of mBRC. The estimated perfusion fraction f' is better suited for response assessment than the conventional ADC(0,800) or D'. This can be useful to guide further treatment strategy.
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Affiliation(s)
- Claus C Pieper
- From the Department of Radiology, University of Bonn, Bonn, Germany
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141
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Hoogenboom TC, Thursz M, Aboagye EO, Sharma R. Functional imaging of hepatocellular carcinoma. Hepat Oncol 2016; 3:137-153. [PMID: 30191034 DOI: 10.2217/hep-2015-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/20/2016] [Indexed: 02/06/2023] Open
Abstract
Imaging plays a key role in the clinical management of hepatocellular carcinoma (HCC), but conventional imaging techniques have limited sensitivity in visualizing small tumors and assessing response to locoregional treatments and sorafenib. Functional imaging techniques allow visualization of organ and tumor physiology. Assessment of functional characteristics of tissue, such as metabolism, proliferation and stiffness, may overcome some of the limitations of structural imaging. In particular, novel molecular imaging agents offer a potential tool for early diagnosis of HCC, and radiomics may aid in response assessment and generate prognostic models. Further prospective research is warranted to evaluate emerging techniques and their cost-effectiveness in the context of HCC in order to improve detection and response assessment.
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Affiliation(s)
- Tim Ch Hoogenboom
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Mark Thursz
- Department of Hepatology, Imperial College NHS Trust, 10th Floor, Norfolk Place, St Mary's Hospital, London, UK.,Department of Hepatology, Imperial College NHS Trust, 10th Floor, Norfolk Place, St Mary's Hospital, London, UK
| | - Eric O Aboagye
- Comprehensive Cancer Imaging Centre at Imperial College, Faculty of Medicine, Imperial College London, GN1, Ground Floor, Commonwealth building, Hammersmith Campus, London, UK.,Comprehensive Cancer Imaging Centre at Imperial College, Faculty of Medicine, Imperial College London, GN1, Ground Floor, Commonwealth building, Hammersmith Campus, London, UK
| | - Rohini Sharma
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Nougaret S, Vargas HA, Lakhman Y, Sudre R, Do RKG, Bibeau F, Azria D, Assenat E, Molinari N, Pierredon MA, Rouanet P, Guiu B. Intravoxel Incoherent Motion-derived Histogram Metrics for Assessment of Response after Combined Chemotherapy and Radiation Therapy in Rectal Cancer: Initial Experience and Comparison between Single-Section and Volumetric Analyses. Radiology 2016; 280:446-54. [PMID: 26919562 DOI: 10.1148/radiol.2016150702] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To determine the diagnostic performance of intravoxel incoherent motion (IVIM) parameters and apparent diffusion coefficient (ADC) to assess response to combined chemotherapy and radiation therapy (CRT) in patients with rectal cancer by using histogram analysis derived from whole-tumor volumes and single-section regions of interest (ROIs). Materials and Methods The institutional review board approved this retrospective study of 31 patients with rectal cancer who underwent magnetic resonance (MR) imaging before and after CRT, including diffusion-weighted imaging with 34 b values prior to surgery. Patient consent was not required. ADC, perfusion-related diffusion fraction (f), slow diffusion coefficient (D), and fast diffusion coefficient (D*) were calculated on MR images acquired before and after CRT by using biexponential fitting. ADC and IVIM histogram metrics and median values were obtained by using whole-tumor volume and single-section ROI analyses. All ADC and IVIM parameters obtained before and after CRT were compared with histopathologic findings by using t tests with Holm-Sidak correction. Receiver operating characteristic curves were generated to evaluate the diagnostic performance of IVIM parameters derived from whole-tumor volume and single-section ROIs for prediction of histopathologic response. Results Extreme values aside, results of histogram analysis of ADC and IVIM were equivalent to median values for tumor response assessment (P > .06). Prior to CRT, none of the median ADC and IVIM diffusion metrics correlated with subsequent tumor response (P > .36). Median D and ADC values derived from either whole-volume or single-section analysis increased significantly after CRT (P ≤ .01) and were significantly higher in good versus poor responders (P ≤ .02). Median IVIM f and D* values did not significantly change after CRT and were not associated with tumor response to CRT (P > .36). Interobserver agreement was excellent for whole-tumor volume analysis (range, 0.91-0.95) but was only moderate for single-section ROI analysis (range, 0.50-0.63). Conclusion Median D and ADC values obtained after CRT were useful for discrimination between good and poor responders. Histogram metrics did not add to the median values for assessment of tumor response. Volumetric analysis demonstrated better interobserver reproducibility when compared with single-section ROI analysis. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Stephanie Nougaret
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Hebert Alberto Vargas
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Yulia Lakhman
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Romain Sudre
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Richard K G Do
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Frederic Bibeau
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - David Azria
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Eric Assenat
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Nicolas Molinari
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Marie-Ange Pierredon
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Philippe Rouanet
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
| | - Boris Guiu
- From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.)
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Hectors SJ, Wagner M, Besa C, Bane O, Dyvorne HA, Fiel MI, Zhu H, Donovan M, Taouli B. Intravoxel incoherent motion diffusion-weighted imaging of hepatocellular carcinoma: Is there a correlation with flow and perfusion metrics obtained with dynamic contrast-enhanced MRI? J Magn Reson Imaging 2016; 44:856-64. [PMID: 26919327 DOI: 10.1002/jmri.25194] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/28/2016] [Accepted: 01/30/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To assess the correlation between intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) metrics in hepatocellular carcinoma (HCC) and liver parenchyma. MATERIALS AND METHODS Twenty-five patients with HCC (M/F 23/2, mean age 58 years) underwent abdominal MRI at 1.5 or 3.0T, including IVIM-DWI (with 16 b-values) and DCE-MRI (3D FLASH sequence, mean temporal resolution of 2.3 sec). IVIM-DWI parameters (pseudodiffusion coefficient, D*, diffusion coefficient, D, and perfusion fraction, PF) were quantified in HCC lesions and liver parenchyma using a Bayesian fitting algorithm. DCE-MRI parameters (arterial flow, Fa , portal flow, Fp , total flow, Ft , mean transit time, MTT, distribution volume, DV, and arterial fraction, ART) were quantified using a dual-input single-compartment model. Correlations between IVIM-DWI and DCE-MRI parameters were assessed using a Spearman correlation test. RESULTS Thirty-three HCC lesions (average size 5.0 ± 3.6 cm) were analyzed. D, D*, and PF were all significantly lower in HCC vs. liver (P < 0.05). Significantly higher Fa and ART and lower Fp were observed in HCC vs. liver (P < 0.001). Significant moderate to strong negative correlations were observed between ART and D* (r = -0.443, P = 0.028), ART and PF (r = -0.536, P = 0.006), ART and PFxD* (r = -0.655, P < 0.001), Fa and PF (r = 0.455, P = 0.023), and Fa and PFxD* (r = -0.475, P = 0.018) in liver parenchyma. There was no significant correlation between IVIM-DWI and DCE-MRI metrics in HCC lesions. CONCLUSION IVIM-DWI and DCE-MRI provide nonredundant information in HCC, while they correlate in liver parenchyma. These findings may be secondary to predominant portal inflow in the liver and tortuous vasculature and tissue heterogeneity in tumors. J. MAGN. RESON. IMAGING 2016;44:856-864.
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Affiliation(s)
- Stefanie J Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cecilia Besa
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hadrien A Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hongfa Zhu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. .,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Luna A, Pahwa S, Bonini C, Alcalá-Mata L, Wright KL, Gulani V. Multiparametric MR Imaging in Abdominal Malignancies. Magn Reson Imaging Clin N Am 2016; 24:157-186. [PMID: 26613880 PMCID: PMC4974463 DOI: 10.1016/j.mric.2015.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Modern MR imaging protocols can yield both anatomic and functional information for the assessment of hepatobiliary and pancreatic malignancies. Diffusion-weighted imaging is fully integrated into state-of-the-art protocols for tumor detection, characterization, and therapy monitoring. Hepatobiliary contrast agents have gained ground in the evaluation of focal liver lesions during the last years. Perfusion MR imaging is expected to have a central role for monitoring therapy in body tumors treated with antivascular drugs. Approaches such as Magnetic resonance (MR) elastography and (1)H-MR spectroscopy are still confined to research centers, but with the potential to grow in a short time frame.
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Affiliation(s)
- Antonio Luna
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain; Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.
| | - Shivani Pahwa
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lidia Alcalá-Mata
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain
| | - Katherine L Wright
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Gulani
- Department of Radiology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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Shirota N, Saito K, Sugimoto K, Takara K, Moriyasu F, Tokuuye K. Intravoxel incoherent motion MRI as a biomarker of sorafenib treatment for advanced hepatocellular carcinoma: a pilot study. Cancer Imaging 2016; 16:1. [PMID: 26822946 PMCID: PMC4731920 DOI: 10.1186/s40644-016-0059-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/24/2016] [Indexed: 02/09/2023] Open
Abstract
Background To evaluate the association between the therapeutic outcomes of sorafenib for advanced hepatocellular carcinoma (HCC) and the parameters of intravoxel incoherent motion (IVIM). Methods Nine patients were evaluated prospectively. All patients were Child-Pugh score A. The mean dimension of the lesion was 32 mm (range: 15–74 mm). MR images were obtained using a 1.5-Tesla superconductive MRI system. Diffusion-weighted imaging was performed under breath-holding using b-values of 0, 50, 100, 150, 200, 400, and 800 s/mm2. The following IVIM parameters were calculated: apparent diffusion coefficient, true diffusion coefficient (DC), pseudo-diffusion coefficient, and perfusion fraction. MRI was performed before treatment and at 1, 2, and 4 weeks after beginning treatment. Tumor response at 4 weeks was assessed by CT or MRI using modified RECIST. IVIM parameters of the treatment responders and non-responders were compared. Results The DC of responders at baseline was significantly higher than that of the non-responders. The sensitivity and specificity, when a DC of 0.8 (10−3 mm2/s) or higher was considered to be a responder, were 100 % and 67 %, respectively. No significant differences were found in the other parameters between the responders and the non-responders. All IVIM parameters of the responders and non-responders did not change significantly after treatment. Conclusion The DC before treatment may be a useful parameter for predicting the therapeutic outcome of sorafenib for advanced HCC.
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Affiliation(s)
- Natsuhiko Shirota
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Kenichi Takara
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
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Hennedige T, Venkatesh SK. Advances in computed tomography and magnetic resonance imaging of hepatocellular carcinoma. World J Gastroenterol 2016; 22:205-220. [PMID: 26755871 PMCID: PMC4698486 DOI: 10.3748/wjg.v22.i1.205] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Imaging is important for establishing a diagnosis of HCC and early diagnosis is imperative as several potentially curative treatments are available when HCC is small. Hepatocarcinogenesis occurs in a stepwise manner on a background of chronic liver disease or cirrhosis wherein multiple genes are altered resulting in a range of cirrhosis-associated nodules. This progression is related to increased cellularity, neovascularity and size of the nodule. An understanding of the stepwise progression may aid in early diagnosis. Dynamic and multiphase contrast-enhanced computed tomography and magnetic resonance imaging still form the cornerstone in the diagnosis of HCC. An overview of the current diagnostic standards of HCC in accordance to the more common practicing guidelines and their differences will be reviewed. Ancillary features contribute to diagnostic confidence and has been incorporated into the more recent Liver Imaging Reporting and Data System. The use of hepatocyte-specific contrast agents is increasing and gradually changing the standard of diagnosis of HCC; the most significant benefit being the lack of uptake in the hepatocyte phase in the earlier stages of HCC progression. An outline of supplementary techniques in the imaging of HCC will also be reviewed.
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Comparison of Free-Breathing With Navigator-Triggered Technique in Diffusion Weighted Imaging for Evaluation of Small Hepatocellular Carcinoma: Effect on Image Quality and Intravoxel Incoherent Motion Parameters. J Comput Assist Tomogr 2015. [PMID: 26196345 DOI: 10.1097/rct.0000000000000278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the effect on image quality and intravoxel incoherent motion (IVIM) parameters of small hepatocellular carcinoma (HCC) from choice of either free-breathing (FB) or navigator-triggered (NT) diffusion-weighted (DW) imaging. METHODS Thirty patients with 37 small HCCs underwent IVIM DW imaging using 12 b values (0-800 s/mm) with 2 sequences: NT, FB. A biexponential analysis with the Bayesian method yielded true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) in small HCCs and liver parenchyma. Apparent diffusion coefficient (ADC) was also calculated. The acquisition time and image quality scores were assessed for 2 sequences. Independent sample t test was used to compare image quality, signal intensity ratio, IVIM parameters, and ADC values between the 2 sequences; reproducibility of IVIM parameters, and ADC values between 2 sequences was assessed with the Bland-Altman method (BA-LA). RESULTS Image quality with NT sequence was superior to that with FB acquisition (P = 0.02). The mean acquisition time for FB scheme was shorter than that of NT sequence (6 minutes 14 seconds vs 10 minutes 21 seconds ± 10 seconds P < 0.01). The signal intensity ratio of small HCCs did not vary significantly between the 2 sequences. The ADC and IVIM parameters from the 2 sequences show no significant difference. Reproducibility of D*and f parameters in small HCC was poor (BA-LA: 95% confidence interval, -180.8% to 189.2% for D* and -133.8% to 174.9% for f). A moderate reproducibility of D and ADC parameters was observed (BA-LA: 95% confidence interval, -83.5% to 76.8% for D and -74.4% to 88.2% for ADC) between the 2 sequences. CONCLUSIONS The NT DW imaging technique offers no advantage in IVIM parameters measurements of small HCC except better image quality, whereas FB technique offers greater confidence in fitted diffusion parameters for matched acquisition periods.
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Ye W, Li J, Guo C, Chen S, Liu YB, Liu Z, Wu H, Wang G, Liang C. Can intravoxel incoherent motion diffusion-weighted imaging characterize the cellular injury and microcirculation alteration in hepatic ischemia-reperfusion injury? An animal study. J Magn Reson Imaging 2015; 43:1327-36. [PMID: 26686869 DOI: 10.1002/jmri.25092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/28/2015] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To investigate whether intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) can be used to quantitatively analyze the cellular injury and microcirculation alterations in hepatic ischemia-reperfusion injury (HIRI). MATERIALS AND METHODS Thirty-two New Zealand white rabbits were randomly and equally assigned to the sham group, 1-hour, 4-hour, and 12-hour groups according to the reperfusion time after 1 hour of ischemia using a 70% liver ischemia-reperfusion injury model. All the animals underwent IVIM-DWI with 12 b values at 1.5T. The imaging parameters (IVIM parameters and apparent diffusion coefficient [ADC]) among different groups were compared. The correlations between imaging parameters and histological scores, and the ratio of serum aspartate aminotransferase to serum alanine aminotransferase (serum AST/ALT) were analyzed. RESULTS During the first hour of HIRI, true diffusion coefficient (D) and ADC significantly decreased (P < 0.05), while there was no significant decrease in perfusion fraction (f) (P = 0.708). There was fair to good correlation between histological scores and f (rs = -0.493 with the sham cases excluded, and -0.682 with all cases, both P < 0.05) and ADC (rs = -0.479 with the sham cases excluded, and -0.766 with all cases, both P < 0.05). There was no correlation between imaging parameters and serum AST/ALT with the sham cases excluded (P = 0.673 for f, 0.568 for D, 0.403 for ADC), and good correlation between D, ADC, and serum AST/ALT (r = 0.747 and 0.748, both P < 0.001) with all cases. CONCLUSION IVIM-DWI can quantitatively characterize an animal model of HIRI, with D and ADC sensitive in early detection of cellular injury, as well as fair to good correlation between f, ADC, and microcirculation alteration. J. Magn. Reson. Imaging 2016;43:1327-1336.
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Affiliation(s)
- Weitao Ye
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Jinglei Li
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Chengwei Guo
- Department of Radiology, 252 Hospital of PLA, Baoding, Hebei Province, P.R. China
| | - Shuting Chen
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Yu-Bao Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Zaiyi Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Haijun Wu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Guangyi Wang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Changhong Liang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
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Kakite S, Dyvorne HA, Lee KM, Jajamovich GH, Knight-Greenfield A, Taouli B. Hepatocellular carcinoma: IVIM diffusion quantification for prediction of tumor necrosis compared to enhancement ratios. Eur J Radiol Open 2015; 3:1-7. [PMID: 27069971 PMCID: PMC4811854 DOI: 10.1016/j.ejro.2015.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/21/2015] [Indexed: 02/07/2023] Open
Abstract
Purpose To correlate intra voxel incoherent motion (IVIM) diffusion parameters of liver parenchyma and hepatocellular carcinoma (HCC) with degree of liver/tumor enhancement and necrosis; and to assess the diagnostic performance of diffusion parameters vs. enhancement ratios (ER) for prediction of complete tumor necrosis. Patients and methods In this IRB approved HIPAA compliant study, we included 46 patients with HCC who underwent IVIM diffusion-weighted (DW) MRI in addition to routine sequences at 3.0 T. True diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (PF) and apparent diffusion coefficient (ADC) were quantified in tumors and liver parenchyma. Tumor ER were calculated using contrast-enhanced imaging, and degree of tumor necrosis was assessed using post-contrast image subtraction. IVIM parameters and ER were compared between HCC and background liver and between necrotic and viable tumor components. ROC analysis for prediction of complete tumor necrosis was performed. Results 79 HCCs were assessed (mean size 2.5 cm). D, PF and ADC were significantly higher in HCC vs. liver (p < 0.0001). There were weak significant negative/positive correlations between D/PF and ER, and significant correlations between D/PF/ADC and tumor necrosis (for D, r 0.452, p < 0.001). Among diffusion parameters, D had the highest area under the curve (AUC 0.811) for predicting complete tumor necrosis. ER outperformed diffusion parameters for prediction of complete tumor necrosis (AUC > 0.95, p < 0.002). Conclusion D has a reasonable diagnostic performance for predicting complete tumor necrosis, however lower than that of contrast-enhanced imaging.
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Affiliation(s)
- Suguru Kakite
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
| | - Hadrien A Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
| | - Karen M Lee
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
| | - Guido H Jajamovich
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
| | - Ashley Knight-Greenfield
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
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