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Lee W, Choi G, Lee J, Park H. Registration and quantification network (RQnet) for IVIM-DKI analysis in MRI. Magn Reson Med 2022; 89:250-261. [PMID: 36121205 DOI: 10.1002/mrm.29454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE A deep learning method is proposed for aligning diffusion weighted images (DWIs) and estimating intravoxel incoherent motion-diffusion kurtosis imaging parameters simultaneously. METHODS We propose an unsupervised deep learning method that performs 2 tasks: registration and quantification for intravoxel incoherent motion-diffusion kurtosis imaging analysis. A common registration method in diffusion MRI is based on minimizing dissimilarity between various DWIs, which may result in registration errors due to different contrasts in different DWIs. We designed a novel unsupervised deep learning method for both accurate registration and quantification of various diffusion parameters. In order to generate motion-simulated training data and test data, 17 volunteers were scanned without moving their heads, and 4 volunteers moved their heads during the scan in a 3 Tesla MRI. In order to investigate the applicability of the proposed method to other organs, kidney images were also obtained. We compared the registration accuracy of the proposed method, statistical parametric mapping, and a deep learning method with a normalized cross-correlation loss. In the quantification part of the proposed method, a deep learning method that considered the diffusion gradient direction was used. RESULTS Simulations and experimental results showed that the proposed method accurately performed registration and quantification for intravoxel incoherent motion-diffusion kurtosis imaging analysis. The registration accuracy of the proposed method was high for all b values. Furthermore, quantification performance was analyzed through simulations and in vivo experiments, where the proposed method showed the best performance among the compared methods. CONCLUSION The proposed method aligns the DWIs and accurately quantifies the intravoxel incoherent motion-diffusion kurtosis imaging parameters.
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Affiliation(s)
- Wonil Lee
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Giyong Choi
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Jongyeon Lee
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - HyunWook Park
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
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Englund EK, Berry DB, Behun JJ, Ward SR, Frank LR, Shahidi B. IVIM Imaging of Paraspinal Muscles Following Moderate and High-Intensity Exercise in Healthy Individuals. FRONTIERS IN REHABILITATION SCIENCES 2022; 3. [PMID: 35959464 PMCID: PMC9365030 DOI: 10.3389/fresc.2022.910068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Quantification of the magnitude and spatial distribution of muscle blood flow changes following exercise may improve our understanding of the effectiveness of various exercise prescriptions. Intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) is a technique that quantifies molecular diffusion and microvascular blood flow, and has recently gained momentum as a method to evaluate a muscle's response to exercise. It has also been shown to predict responses to exercise-based physical therapy in individuals with low back pain. However, no study has evaluated the sensitivity of IVIM-MRI to exercise of varying intensity in humans. Here, we aimed to evaluate IVIM signal changes of the paraspinal muscles in response to moderate and high intensity lumbar extension exercise in healthy individuals. Methods IVIM data were collected in 11 healthy volunteers before and immediately after a 3-min bout of moderate and high-intensity resisted lumbar extension. IVIM data were analyzed to determine the average perfusion fraction (f), pseudo-diffusion coefficient (D*), and diffusion coefficient (D) in the bilateral paraspinal muscles. Changes in IVIM parameters were compared between the moderate and high intensity exercise bouts. Results Exercise increased all IVIM parameters, regardless of intensity (p < 0.003). Moderate intensity exercise resulted in a 11.2, 19.6, and 3.5% increase in f, D* and D, respectively. High intensity exercise led to a similar increase in f (12.2%), but much greater changes in D* (48.6%) and D (7.9%). Conclusion IVIM parameter increases suggest that both the moderate and high-intensity exercise conditions elicited measurable changes in blood flow (increased f and D*) and extravascular molecular diffusion rates (increased D), and that there was a dose-dependence of exercise intensity on D* and D.
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Affiliation(s)
- Erin K. Englund
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - David B. Berry
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
- Department of Nanoengineering, University of California, San Diego, La Jolla, CA, United States
| | - John J. Behun
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Lawrence R. Frank
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
- *Correspondence: Bahar Shahidi
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Gao F, Shi B, Wang P, Wang C, Fang X, Dong J, Lin T. The Value of Intravoxel Incoherent Motion Diffusion-Weighted Magnetic Resonance Imaging Combined With Texture Analysis of Evaluating the Extramural Vascular Invasion in Rectal Adenocarcinoma. Front Oncol 2022; 12:813138. [PMID: 35311135 PMCID: PMC8927647 DOI: 10.3389/fonc.2022.813138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/10/2022] [Indexed: 01/28/2023] Open
Abstract
Purpose This study aims to evaluate the value of 3.0T MRI Intravoxel Incoherent motion diffusion-weighted magnetic resonance imaging (IVIM-DWI) combined with texture analysis (TA) for evaluating extramural vascular invasion (EMVI) of rectal adenocarcinoma. Methods Ninety-six patients with pathologically confirmed rectal adenocarcinoma after surgical resections were collected. Patients were divided into the EMVI positive group (n=39) and the EMVI negative group (n=57). We measured the IVIM-DWI parameters and TA parameters of rectal adenocarcinoma. We compare the differences of the above parameters between the two groups and establish a prediction model through multivariate logistic regression analysis. the ROC curve was performed for parameters with each individual and in combination. Results ADC, D, D* value between the two groups were statistically significant (P= 0.015,0.031,0). Six groups of texture parameters were statistically significant between the two groups (P=0.007,0.037,0.011,0.005,0.007,0.002). Logistic regression prediction model shows that GLCM entropy_ALL DIRECTION_offset7_SD and D* are important independent predictors, and the AUC of the regression prediction model was 0.821, the sensitivity was 92.98%, the specificity was 61.54%, and the Yoden index was 0.5452. The AUC was significantly higher than that of other single parameters. Conclusion 3.0T MRI IVIM-DWI parameters combined with texture analysis can provide valuable information for EMVI evaluation of rectal adenocarcinoma before the operation.
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Affiliation(s)
| | | | | | | | | | | | - Tingting Lin
- *Correspondence: Jiangning Dong, ; Tingting Lin,
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Shahidi B, Behun JJ, Berry DB, Raiszadeh K, Englund EK. Intravoxel incoherent motion imaging predicts exercise-based rehabilitation response in individuals with low back pain. NMR IN BIOMEDICINE 2021; 34:e4595. [PMID: 34327758 DOI: 10.1002/nbm.4595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Exercises to strengthen and stabilize the trunk musculature are a common conservative treatment strategy for low back pain (LBP), despite the possible presence of impairments in muscle activation in this population. Intravoxel incoherent motion (IVIM) MRI permits evaluation of activation-induced blood flow through diffusion-weighted images that are sensitized to microvascular blood flow. In the current study we aimed to evaluate IVIM signal changes after exercise in patients with LBP compared with pain-free healthy controls and determine if these changes were related to reductions in disability with a 12-week rehabilitation program. We hypothesize that the magnitude of changes in IVIM parameters in the lumbar extensor muscles will be smaller in patients with LBP compared with those without LBP, and that these magnitudes will be correlated with responsiveness to a 12-week, resistance-based exercise program. IVIM MR data for molecular diffusion (D), blood flow pseudodiffusion (D*) and perfusion fraction (f) were collected before and immediately after an ~ 3-min session of high-intensity lumbar extension resistance exercise in 16 healthy participants and 17 participants with LBP. Improvements in LBP-related disability after the 12-week, machine-based, high-intensity exercise rehabilitation program were measured in the LBP group. We observed a significant increase in all IVIM parameters (f, D*, D) in response to exercise (p < 0.0001) and an interaction of group-by-time for D (p = 0.016). Thresholds were identified using receiver operating characteristic (ROC) curves for diffusion and pseudodiffusion coefficients, which predicted a reduction in LBP-related disability in response to the 12-week, exercise-based rehabilitation program. Exercise was associated with an increase in (f), capillary blood flow-based pseudodiffusion (D*) and diffusion coefficient (D), regardless of the presence of LBP. Additionally, subgroup analysis identified patients who were not responsive to the acute exercise session, for whom, based on ROC analysis, there was no clinically significant change in disability following the 12-week program.
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Affiliation(s)
- Bahar Shahidi
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - John J Behun
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - David B Berry
- Department of Nanoengineering, University of California, La Jolla, California, USA
| | | | - Erin K Englund
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
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Merisaari H, Federau C. Signal to noise and b-value analysis for optimal intra-voxel incoherent motion imaging in the brain. PLoS One 2021; 16:e0257545. [PMID: 34555054 PMCID: PMC8459980 DOI: 10.1371/journal.pone.0257545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022] Open
Abstract
Intravoxel incoherent motion (IVIM) is a method that can provide quantitative information about perfusion in the human body, in vivo, and without contrast agent. Unfortunately, the IVIM perfusion parameter maps are known to be relatively noisy in the brain, in particular for the pseudo-diffusion coefficient, which might hinder its potential broader use in clinical applications. Therefore, we studied the conditions to produce optimal IVIM perfusion images in the brain. IVIM imaging was performed on a 3-Tesla clinical system in four healthy volunteers, with 16 b values 0, 10, 20, 40, 80, 110, 140, 170, 200, 300, 400, 500, 600, 700, 800, 900 s/mm2, repeated 20 times. We analyzed the noise characteristics of the trace images as a function of b-value, and the homogeneity of the IVIM parameter maps across number of averages and sub-sets of the acquired b values. We found two peaks of noise of the trace images as function of b value, one due to thermal noise at high b-value, and one due to physiological noise at low b-value. The selection of b value distribution was found to have higher impact on the homogeneity of the IVIM parameter maps than the number of averages. Based on evaluations, we suggest an optimal b value acquisition scheme for a 12 min scan as 0 (7), 20 (4), 140 (19), 300 (9), 500 (19), 700 (1), 800 (4), 900 (1) s/mm2.
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Affiliation(s)
- Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Christian Federau
- Institute for Biomedical Engineering, ETH, Zürich and University Zürich, Zürich, Switzerland
- AI Medical, Zürich, Switzerland
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6
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Englund EK, Reiter DA, Shahidi B, Sigmund EE. Intravoxel Incoherent Motion Magnetic Resonance Imaging in Skeletal Muscle: Review and Future Directions. J Magn Reson Imaging 2021; 55:988-1012. [PMID: 34390617 DOI: 10.1002/jmri.27875] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/29/2022] Open
Abstract
Throughout the body, muscle structure and function can be interrogated using a variety of noninvasive magnetic resonance imaging (MRI) methods. Recently, intravoxel incoherent motion (IVIM) MRI has gained momentum as a method to evaluate components of blood flow and tissue diffusion simultaneously. Much of the prior research has focused on highly vascularized organs, including the brain, kidney, and liver. Unique aspects of skeletal muscle, including the relatively low perfusion at rest and large dynamic range of perfusion between resting and maximal hyperemic states, may influence the acquisition, postprocessing, and interpretation of IVIM data. Here, we introduce several of those unique features of skeletal muscle; review existing studies of IVIM in skeletal muscle at rest, in response to exercise, and in disease states; and consider possible confounds that should be addressed for muscle-specific evaluations. Most studies used segmented nonlinear least squares fitting with a b-value threshold of 200 sec/mm2 to obtain IVIM parameters of perfusion fraction (f), pseudo-diffusion coefficient (D*), and diffusion coefficient (D). In healthy individuals, across all muscles, the average ± standard deviation of D was 1.46 ± 0.30 × 10-3 mm2 /sec, D* was 29.7 ± 38.1 × 10-3 mm2 /sec, and f was 11.1 ± 6.7%. Comparisons of reported IVIM parameters in muscles of the back, thigh, and leg of healthy individuals showed no significant difference between anatomic locations. Throughout the body, exercise elicited a positive change of all IVIM parameters. Future directions including advanced postprocessing models and potential sequence modifications are discussed. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Erin K Englund
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David A Reiter
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA.,Department of Orthopedics, Emory University, Atlanta, Georgia, USA
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, UC San Diego, San Diego, California, USA
| | - Eric E Sigmund
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, New York, New York, USA.,Center for Advanced Imaging and Innovation (CAI2R), Bernard and Irene Schwarz Center for Biomedical Imaging (CBI), NYU Langone Health, New York, New York, USA
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7
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Chaturvedi A. Pediatric skeletal diffusion-weighted magnetic resonance imaging: part 1 - technical considerations and optimization strategies. Pediatr Radiol 2021; 51:1562-1574. [PMID: 33792751 DOI: 10.1007/s00247-021-04975-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/12/2020] [Accepted: 01/15/2021] [Indexed: 12/28/2022]
Abstract
Diffusion-weighted MRI, or DWI, is a fast, quantitative technique that is easily integrated into a morphological MR acquisition. The ability of DWI to aid in detecting multifocal skeletal pathology and in characterizing tissue cellularity to a level beyond that possible with other techniques makes it a niche component of multiparametric MR imaging of the skeleton. Besides its role in disease detection and establishing cellularity and character of osseous lesions, DWI continues to be examined as a surrogate biomarker for therapeutic response of several childhood bone tumors. There is increasing interest in harnessing DWI as a potential substitute to alternative modes of imaging evaluation that involve radiation or administration of intravenous contrast agent or radiopharmaceuticals, for example in early detection and diagnosis of capital femoral epiphyseal ischemia in cases of Legg-Calvé-Perthes disease, or diagnosis and staging of lymphoma. The expected evolution of skeletal diffusivity characteristics with maturation and the unique disease processes that affect the pediatric skeleton necessitate a pediatric-specific discussion. In this article, the author examines the developmentally appropriate normal appearances, technique, artifacts and pitfalls of pediatric skeletal DWI.
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Affiliation(s)
- Apeksha Chaturvedi
- Division of Pediatric Radiology, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
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8
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Evaluating the clinical value of MRI multi-model diffusion-weighted imaging on liver fibrosis in chronic hepatitis B patients. Abdom Radiol (NY) 2021; 46:1552-1561. [PMID: 33051757 DOI: 10.1007/s00261-020-02806-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore the value of various diffusion parameters obtained from monoexponential, biexponential, and stretched exponential in assessing liver fibrosis in chronic hepatitis B (CHB). METHODS DWI and intravoxel incoherent motion (IVIM) MRI were performed prospectively on liver for 146 patients with CHB and 21 healthy volunteers. ADC values were obtained from monoexponential model imaging. Diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) obtained by biexponential model imaging, and stretched exponential model to obtain diffusion distribution coefficient (DDC) and diffusion heterogeneity index (α). Blood draw were performed on patients to obtain AST, ALT, and PLT, and then APRI and FIB-4 index were determined based on the serological diagnostic models. The fibrosis stage was staged (S0-S4) according to the pathology of liver puncture. Independent sample t test was used to compare the parameter values between liver fibrosis group and control group. One-way ANOVA was used to compare the parameters of different liver fibrosis grades. Bonferroni test was used for correcting multiple comparisons. Spearman correlation was used to analyze the correlation between each parameter and liver fibrosis grades. ROC was used to predict the diagnostic power of each parameter for liver fibrosis stages ≥ S2 and ≥ S3. RESULTS ADC, D, D*, f, and DDC values were significantly different between normal control group and hepatic fibrosis group (P < 0.05). There were significant differences in ADC, D*, f, and DDC value among liver fibrosis groups (P < 0.05). D* and DDC values were moderately negatively correlated with the grades of liver fibrosis (r = - 0.483, P < 0.001; r = - 0.622, P < 0.001). ADC and f values were slightly negatively correlated with the grades of liver fibrosis (r = - 0.295, P < 0.001; r = - 0.312, P < 0.001). DDC values have the highest diagnostic efficiency in liver fibrosis stages ≥ S2 and ≥ S3. The areas under ROC curve (AUC) were 0.813 and 0.832 for ≥ S2 and ≥ S3, respectively, the sensitivity is 83.72% and 73.53%, and the specificity of 83.33% and 66.04%, which were better than APRI and FIB-4. CONCLUSION D* obtained from biexponential and DDC obtained from stretched exponential DWI have better value in evaluating the degree of liver fibrosis in CHB.
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Hu YC, Yan LF, Han Y, Duan SJ, Sun Q, Li GF, Wang W, Wei XC, Zheng DD, Cui GB. Can the low and high b-value distribution influence the pseudodiffusion parameter derived from IVIM DWI in normal brain? BMC Med Imaging 2020; 20:14. [PMID: 32041549 PMCID: PMC7011602 DOI: 10.1186/s12880-020-0419-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background Our study aims to reveal whether the low b-values distribution, high b-values upper limit, and the number of excitation (NEX) influence the accuracy of the intravoxel incoherent motion (IVIM) parameter derived from multi-b-value diffusion-weighted imaging (DWI) in the brain. Methods This prospective study was approved by the local Ethics Committee and informed consent was obtained from each participant. The five consecutive multi-b DWI with different b-value protocols (0–3500 s/mm2) were performed in 22 male healthy volunteers on a 3.0-T MRI system. The IVIM parameters from normal white matter (WM) and gray matter (GM) including slow diffusion coefficient (D), fast perfusion coefficient (D*) and perfusion fraction (f) were compared for differences among defined groups with different IVIM protocols by one-way ANOVA. Results The D* and f value of WM or GM in groups with less low b-values distribution (less than or equal to 5 b-values) were significantly lower than ones in any other group with more low b-values distribution (all P < 0.05), but no significant differences among groups with more low b-values distribution (P > 0.05). In addition, no significant differences in the D, D* and f value of WM or GM were found between group with one and more NEX of low b-values distribution (all P > 0.05). IVIM parameters in normal WM and GM strongly depended on the choice of the high b-value upper limit. Conclusions Metrics of IVIM parameters can be affected by low and high b value distribution. Eight low b-values distribution with high b-value upper limit of 800–1000 s/mm2 may be the relatively proper set when performing brain IVIM studies.
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Affiliation(s)
- Yu-Chuan Hu
- Department of Radiology and Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Lin-Feng Yan
- Department of Radiology and Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Yu Han
- Department of Radiology and Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Shi-Jun Duan
- Department of Radiology and Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Qian Sun
- Department of Radiology and Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Gang-Feng Li
- Department of Radiology and Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Wen Wang
- Department of Radiology and Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China
| | - Xiao-Cheng Wei
- MR Research China, GE Healthcare China, Beijing, 100176, China
| | - Dan-Dan Zheng
- MR Research China, GE Healthcare China, Beijing, 100176, China
| | - Guang-Bin Cui
- Department of Radiology and Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, Shaanxi, People's Republic of China.
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10
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Ljimani A, Caroli A, Laustsen C, Francis S, Mendichovszky IA, Bane O, Nery F, Sharma K, Pohlmann A, Dekkers IA, Vallee JP, Derlin K, Notohamiprodjo M, Lim RP, Palmucci S, Serai SD, Periquito J, Wang ZJ, Froeling M, Thoeny HC, Prasad P, Schneider M, Niendorf T, Pullens P, Sourbron S, Sigmund EE. Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:177-195. [PMID: 31676990 PMCID: PMC7021760 DOI: 10.1007/s10334-019-00790-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 12/13/2022]
Abstract
Objectives Standardization is an important milestone in the validation of DWI-based parameters as imaging biomarkers for renal disease. Here, we propose technical recommendations on three variants of renal DWI, monoexponential DWI, IVIM and DTI, as well as associated MRI biomarkers (ADC, D, D*, f, FA and MD) to aid ongoing international efforts on methodological harmonization. Materials and methods Reported DWI biomarkers from 194 prior renal DWI studies were extracted and Pearson correlations between diffusion biomarkers and protocol parameters were computed. Based on the literature review, surveys were designed for the consensus building. Survey data were collected via Delphi consensus process on renal DWI preparation, acquisition, analysis, and reporting. Consensus was defined as ≥ 75% agreement. Results Correlations were observed between reported diffusion biomarkers and protocol parameters. Out of 87 survey questions, 57 achieved consensus resolution, while many of the remaining questions were resolved by preference (65–74% agreement). Summary of the literature and survey data as well as recommendations for the preparation, acquisition, processing and reporting of renal DWI were provided. Discussion The consensus-based technical recommendations for renal DWI aim to facilitate inter-site harmonization and increase clinical impact of the technique on a larger scale by setting a framework for acquisition protocols for future renal DWI studies. We anticipate an iterative process with continuous updating of the recommendations according to progress in the field. Electronic supplementary material The online version of this article (10.1007/s10334-019-00790-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Anna Caroli
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
| | | | - Octavia Bane
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fabio Nery
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kanishka Sharma
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Andreas Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, 13125, Berlin, Germany
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Paul Vallee
- Department of Diagnostic, Geneva University Hospital and University of Geneva, 1211, Geneva-14, Switzerland
| | - Katja Derlin
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Mike Notohamiprodjo
- Die Radiologie, Munich, Germany.,Department of Radiology, University Hospital Tuebingen, Tübingen, Germany
| | - Ruth P Lim
- Department of Radiology, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joao Periquito
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, 13125, Berlin, Germany
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harriet C Thoeny
- Department of Radiology, Hôpital Cantonal Fribourgois (HFR), University of Fribourg, 1708, Fribourg, Switzerland
| | - Pottumarthi Prasad
- Department of Radiology, Center for Advanced Imaging, NorthShore University Health System, Evanston, IL, USA
| | - Moritz Schneider
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center, German Center for Lung Research, Munich, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, 13125, Berlin, Germany
| | - Pim Pullens
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium.,Department of Radiology, University Hospital Ghent, Ghent, Belgium
| | - Steven Sourbron
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Eric E Sigmund
- Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), NYU Langone Health, New York, NY, USA
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Chabert S, Verdu J, Huerta G, Montalba C, Cox P, Riveros R, Uribe S, Salas R, Veloz A. Impact of b-Value Sampling Scheme on Brain IVIM Parameter Estimation in Healthy Subjects. Magn Reson Med Sci 2019; 19:216-226. [PMID: 31611542 PMCID: PMC7553810 DOI: 10.2463/mrms.mp.2019-0061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Intravoxel incoherent motion (IVIM) analysis has attracted the interest of the clinical community due to its close relationship with microperfusion. Nevertheless, there is no clear reference protocol for its implementation; one of the questions being which b-value distribution to use. This study aimed to stress the importance of the sampling scheme and to show that an optimized b-value distribution decreases the variance associated with IVIM parameters in the brain with respect to a regular distribution in healthy volunteers. Methods: Ten volunteers were included in this study; images were acquired on a 1.5T MR scanner. Two distributions of 16 b-values were used: one considered ‘regular’ due to its close association with that used in other studies, and the other considered ‘optimized’ according to previous studies. IVIM parameters were adjusted according to the bi-exponential model, using two-step method. Analysis was undertaken in ROI defined using in the Automated Anatomical Labeling atlas, and parameters distributions were compared in a total of 832 ROI. Results: Maps with fewer speckles were obtained with the ‘optimized’ distribution. Coefficients of variation did not change significantly for the estimation of the diffusion coefficient D but decreased by approximately 39% for the pseudo-diffusion coefficient estimation and by 21% for the perfusion fraction. Distributions of adjusted parameters were found significantly different in 50% of the cases for the perfusion fraction, in 80% of the cases for the pseudo-diffusion coefficient and 17% of the cases for the diffusion coefficient. Observations across brain areas show that the range of average values for IVIM parameters is smaller in the ‘optimized’ case. Conclusion: Using an optimized distribution, data are sampled in a way that the IVIM signal decay is better described and less variance is obtained in the fitted parameters. The increased precision gained could help to detect small variations in IVIM parameters.
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Affiliation(s)
- Stéren Chabert
- CINGS Centro de Investigación y Desarrollo de Ingeniería para la Salud, Universidad de Valparaíso.,Escuela de Ingenieria Civil Biomedica, Universidad de Valparaíso.,Millennium Nucleus for Cardiovascular Magnetic Resonance
| | - Jorge Verdu
- Escuela de Ingenieria Civil Biomedica, Universidad de Valparaíso.,Universidad Politécnica de Valencia
| | - Gamaliel Huerta
- Escuela de Ingenieria Civil Biomedica, Universidad de Valparaíso
| | - Cristian Montalba
- Center for Biomedical Imaging, Pontificia Universidad Católica de Chile
| | - Pablo Cox
- Servicio de Imagenología, Hospital Carlos van Buren
| | - Rodrigo Riveros
- Servicio de Imagenología, Hospital Carlos van Buren.,Facultad de Medicina, Universidad de Valparaíso
| | - Sergio Uribe
- Millennium Nucleus for Cardiovascular Magnetic Resonance.,Center for Biomedical Imaging, Pontificia Universidad Católica de Chile.,Radiology Department, Pontificia Universidad Católica de Chile
| | - Rodrigo Salas
- CINGS Centro de Investigación y Desarrollo de Ingeniería para la Salud, Universidad de Valparaíso.,Escuela de Ingenieria Civil Biomedica, Universidad de Valparaíso
| | - Alejandro Veloz
- CINGS Centro de Investigación y Desarrollo de Ingeniería para la Salud, Universidad de Valparaíso.,Escuela de Ingenieria Civil Biomedica, Universidad de Valparaíso
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12
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Wei Y, Gao F, Wang M, Huang Z, Tang H, Li J, Wang Y, Zhang T, Wei X, Zheng D, Song B. Intravoxel incoherent motion diffusion-weighted imaging for assessment of histologic grade of hepatocellular carcinoma: comparison of three methods for positioning region of interest. Eur Radiol 2019; 29:535-544. [PMID: 30027411 DOI: 10.1007/s00330-018-5638-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/13/2018] [Accepted: 06/28/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To prospectively compare the diagnostic performances of three methods of region of interest (ROI) placement for the measurements of intravoxel incoherent motion (IVIM) diffusion-weighted MR imaging in differentiating the histologic grade of hepatocellular carcinoma (HCC). METHODS Eighty-seven patients with 91 newly diagnosed HCCs were studied using IVIM imaging. Two attending radiologists separately identified the selection of tumour tissue for ROI positioning. Three different ROI positioning methods, namely the whole tumour volume (WTV) method, three-ROI method and one-section method, were used for the measurement. Kruskal-Wallis rank test or one-way ANOVA was used to compare the difference in IVIM parameters and ADC across the three different ROI positioning methods. Spearman correlation analysis was used to determine the correlation between each parameter and Edmondson-Steiner (E-S) grade. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic performance. RESULTS For the ADC and ADCslow, the mean value measured by using the WTV method was significant higher than the one-section and three-ROI methods (all p < 0.01). For the ADCslow, the highest area under curve (AUC) with a value of 0.969 was obtained by using the WTV method, followed by the one-section method (AUC = 0.938) and three-ROI method (AUC = 0.873). Additionally, for the ADC, AUC values were 0.861 for WTV method, 0.840 for one-section method and 0.806 for three-ROI method. CONCLUSIONS Different ROI positioning methods used significantly affect the IVIM parameters and ADC measurements. Measurements of ADCslow value derived from WTV method entailed the highest diagnostic performance in grading HCC. KEY POINTS • Diffusion MRI is useful for non-invasively differentiating the histologic grade of hepatocellular carcinoma. • Different ROI positioning methods used significantly affect the IVIM parameters and ADC measurements. • IVIM model is advantageous over mono-exponential model for assessing the histologic grade of hepatocellular carcinoma.
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Affiliation(s)
- Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Feifei Gao
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Min Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiaxing Li
- Department of Liver surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tong Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | | | | | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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13
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Zhu S, Wei Y, Gao F, Li L, Liu Y, Huang Z, Tang H, Zheng D, Wei X, Sun T, Song B. Esophageal carcinoma: Intravoxel incoherent motion diffusion-weighted MRI parameters and histopathological correlations. J Magn Reson Imaging 2019; 49:253-261. [PMID: 29734492 DOI: 10.1002/jmri.26172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The pathological grade of esophageal carcinoma is highly determinant of patient prognosis, but it still cannot be adequately evaluated preoperatively. Compared with conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM) diffusion-weighted MRI can separate true molecular diffusion and perfusion in tissues and has been shown to be useful in characterizing malignant tumors. There is no report that compared IVIM and conventional DWI in grading esophageal carcinoma. PURPOSE To prospectively determine the diagnostic performance of conventional DWI and IVIM models in differentiating the pathological differentiated grade of esophageal carcinoma. STUDY TYPE Prospective. POPULATION A cohort comprising 81 patients with newly diagnosed esophageal squamous cell carcinoma (ESCC) between December 2015 and August 2017 were evaluated. FIELD STRENGTH/SEQUENCE 3.0T, axial echo-planer imaging, fast spin echo (FSE) sequence, IVIM sequence (b = 0, 20, 50, 80, 100, 150, 200, 400, 600, 800, 1000, 1200). ASSESSMENT Apparent diffusion coefficient (ADC), true ADC (ADCslow ), pseudo ADC (ADCfast ), and perfusion fraction (f) of each tumor were calculated by two independent radiologists. Histopathologic grade was used as the reference standard. STATISTICAL TESTS Games-Howell test; diagnostic accuracy; Spearman correlation; intraclass correlation coefficient; and Bland-Altman analysis. Receiver operating characteristics (ROC) curves. RESULTS ADCslow demonstrated the highest area under curve (AUC) with a value of 0.830 (95% confidence interval [CI]: 0.730-0.904) and 0.816 (95% CI: 0.714-0.893) by two radiologists, followed by ADC with a value of 0.754 (95% CI: 0.646-0.843) and 0.761 (95% CI: 0.653-0.848). Good correlation was obtained between the histologic grade and ADCslow (r(R1) = 0.748, r(R2) = 0.720) and ADC (r(R1) = 0.576, r(R2) = 0.571). DATA CONCLUSION ADCslow and ADC had a significantly higher performance than the ADCfast and f, and ADCslow had a significantly higher performance than the ADC. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:253-261.
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Affiliation(s)
- Shaocheng Zhu
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Feifei Gao
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Linlin Li
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yuehua Liu
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Tingyi Sun
- Department of Pathology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Donners R, Blackledge M, Tunariu N, Messiou C, Merkle EM, Koh DM. Quantitative Whole-Body Diffusion-Weighted MR Imaging. Magn Reson Imaging Clin N Am 2018; 26:479-494. [PMID: 30316462 DOI: 10.1016/j.mric.2018.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Whole-body diffusion-weighted MRI has emerged as a powerful diagnostic tool for disease detection and staging mainly used in systemic bone disease. The large field-of-view functional imaging technique highlights cellular tumor and suppresses normal tissue signal, allowing quantification of an estimate of total disease burden, summarized as the total diffusion volume (tDV), as well as global apparent diffusion coefficient (gADC) measurements. Both tDV and gADC have been shown to be repeatable quantitative parameters that indicate tumor heterogeneity and treatment effects, thus potential, noninvasive, imaging biomarkers informing on disease prognosis and therapy response.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Matthew Blackledge
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK
| | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Christina Messiou
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Elmar M Merkle
- Department of Radiology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK.
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15
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Hybrid quantitative MRI using chemical shift displacement and recovery-based simultaneous water and lipid imaging: A preliminary study. Magn Reson Imaging 2018; 50:61-67. [DOI: 10.1016/j.mri.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 01/03/2023]
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16
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Intravoxel Incoherent Motion: Model-Free Determination of Tissue Type in Abdominal Organs Using Machine Learning. Invest Radiol 2018; 52:747-757. [PMID: 28742733 DOI: 10.1097/rli.0000000000000400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE For diffusion data sets including low and high b-values, the intravoxel incoherent motion model is commonly applied to characterize tissue. The aim of the present study was to show that machine learning allows a model-free approach to determine tissue type without a priori assumptions on the underlying physiology. MATERIALS AND METHODS In 8 healthy volunteers, diffusion data sets were acquired using an echo-planar imaging sequence with 16 b-values in the range between 0 and 1000 s/mm. Using the k-nearest neighbors technique, the machine learning algorithm was trained to distinguish abdominal organs (liver, kidney, spleen, muscle) using the signal intensities at different b-values as training features. For systematic variation of model complexity (number of neighbors), performance was assessed by calculation of the accuracy and the kappa coefficient (κ). Most important b-values for tissue discrimination were determined by principal component analysis. RESULTS The optimal trade-off between model complexity and overfitting was found in the range between K = 11 to 13. On "real-world" data not previously applied to optimize the algorithm, the k-nearest neighbors algorithm was capable to accurately distinguish tissue types with best accuracy of 94.5% and κ = 0.92 reached for intermediate model complexity (K = 11). The principal component analysis showed that most important b-values are (with decreasing importance): b = 1000 s/mm, b = 970 s/mm, b = 750 s/mm, b = 20 s/mm, b = 620 s/mm, and b = 40 s/mm. Applying a reduced set of 6 most important b-values, still a similar accuracy was achieved on the real-world data set with an average accuracy of 93.7% and a κ coefficient of 0.91. CONCLUSIONS Machine learning allows for a model-free determination of tissue type using intra voxel incoherent motion signal decay curves as features. The technique may be useful for segmentation of abdominal organs or distinction between healthy and pathological tissues.
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Sigmund EE, Baete SH, Luo T, Patel K, Wang D, Rossi I, Duarte A, Bruno M, Mossa D, Femia A, Ramachandran S, Stoffel D, Babb JS, Franks AG, Bencardino J. MRI assessment of the thigh musculature in dermatomyositis and healthy subjects using diffusion tensor imaging, intravoxel incoherent motion and dynamic DTI. Eur Radiol 2018; 28:5304-5315. [DOI: 10.1007/s00330-018-5458-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 12/20/2022]
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18
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Effect of intravascular contrast agent on diffusion and perfusion fraction coefficients in the peripheral zone and prostate cancer. Magn Reson Imaging 2018; 51:120-127. [PMID: 29678542 DOI: 10.1016/j.mri.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 04/14/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine whether water diffusion and the perfusion fraction coefficients in prostate peripheral zone (PZ) and prostate cancer (PCa) are affected by intravenous contrast injection and explore the potential mechanism behind previously reported differences between pre- and post-contrast ADC values. METHODS Our institutional review board waived informed consent for this HIPAA-compliant, retrospective study, which included 32 patients (median age, 63 years; range, 47-77 years) with biopsy-proven, untreated PCa who underwent 3-Tesla MRI, including DW-MRI at b-values 0, 400, 700, 1000 s/mm2 before and after gadolinium injection. For regions of interest (ROIs) in presumed benign PZ and PZ PCa, apparent diffusion coefficient (ADC), perfusion fraction f, and diffusion coefficient D were estimated voxel-wise, and signal-to-noise ratio (SNR) and contrast-to-noise (CNR) were estimated. Pre- and post-contrast measurements were compared by Wilcoxon signed-rank test; P < 0.05 was considered significant. RESULTS In PZ, f (P = 0.002) was significantly higher on post-contrast imaging than on pre-contrast imaging, but ADC and D values did not change significantly (P = 0.562 and 0.295 respectively). In PCa, all parameters differed significantly between post-contrast and pre-contrast imaging (P < 0.0001 for ADC, P = 0.0084 for D, and P = 0.029 for f). On post-contrast imaging, SNR was not significantly different in PZ (P = 0.260) but was significantly lower in PCa (P < 0.0001); CNR did not change significantly (P = 0.059). CONCLUSION After contrast injection, ADC and D declined significantly in PCa only, while f increased significantly in both PCa and PZ. Pre- and post-contrast diffusion parameters cannot be used interchangeably for diagnostic purposes that require quantitative diffusion estimates.
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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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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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Priola AM, Priola SM, Gned D, Giraudo MT, Veltri A. Nonsuppressing normal thymus on chemical-shift MR imaging and anterior mediastinal lymphoma: differentiation with diffusion-weighted MR imaging by using the apparent diffusion coefficient. Eur Radiol 2017; 28:1427-1437. [PMID: 29143106 DOI: 10.1007/s00330-017-5142-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/14/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To prospectively evaluate usefulness of the apparent diffusion coefficient (ADC) in differentiating anterior mediastinal lymphoma from nonsuppressing normal thymus on chemical-shift MR, and to look at the relationship between patient age and ADC. METHODS Seventy-three young subjects (25 men, 48 women; age range, 9-29 years), who underwent chemical-shift MR and diffusion-weighted MR were divided into a normal thymus group (group A, 40 subjects), and a lymphoma group (group B, 33 patients). For group A, all subjects had normal thymus with no suppression on opposed-phase chemical-shift MR. Two readers measured the signal intensity index (SII) and ADC. Differences in SII and ADC between groups were tested using t-test. ADC was correlated with age using Pearson correlation coefficient. RESULTS Mean SII±standard deviation was 2.7±1.8% for group A and 2.2±2.4% for group B, with no significant difference between groups (P=.270). Mean ADC was 2.48±0.38x10-3mm2/s for group A and 1.24±0.23x10-3mm2/s for group B. A significant difference between groups was found (P<.001), with no overlap in range. Lastly, significant correlation was found between age and ADC (r=0.935, P<.001) in group A. CONCLUSIONS ADC of diffusion-weighted MR is a noninvasive and accurate parameter for differentiating lymphoma from nonsuppressing thymus on chemical-shift MR in young subjects. KEY POINTS • SII cannot differentiate mediastinal lymphoma from nonsuppressing normal thymus at visual assessment • ADC is useful for distinguishing nonsuppressing normal thymus from mediastinal lymphoma • ADC is more accurate than transverse-diameter and surface-area in this discrimination • ADC of normal thymus is age dependent and increases with increasing age.
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Affiliation(s)
- Adriano Massimiliano Priola
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy.
| | - Sandro Massimo Priola
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Dario Gned
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Maria Teresa Giraudo
- Department of Mathematics, "Giuseppe Peano", University of Torino, Via Carlo Alberto 10, 10123, Torino, Italy
| | - Andrea Veltri
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
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Ohno N, Miyati T, Chigusa T, Usui H, Ishida S, Hiramatsu Y, Kobayashi S, Gabata T, Alperin N. Technical Note: Development of a cranial phantom for assessing perfusion, diffusion, and biomechanics. Med Phys 2017; 44:1646-1654. [PMID: 28241107 DOI: 10.1002/mp.12182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 12/10/2016] [Accepted: 02/16/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A novel cranial phantom was developed to simulate the relationships among factors such as blood perfusion, water diffusion, and biomechanics in intracranial tissue. METHODS The cranial phantom consisted of a high-density polypropylene filter (mimicking brain parenchyma) with intra- and extrafilter spaces (mimicking cerebral artery and vein, respectively), and a capacitor space (mimicking the cerebrospinal fluid space). Pulsatile and steady flow with different flow rates were applied to the cranial phantom using a programmable pump. On 3.0-T MRI, the measurements of the internal pressure in the phantom, apparent diffusion coefficient (ADC) with monoexponential analysis in the filter, and total simulated cerebral blood flow (tSCBF) into the phantom were synchronized with the pulsatile flow. We obtained their maximum changes during the pulsation period (ΔP, ΔADC, and ΔtSCBF, respectively). Then, the compliance index (CI) was calculated by dividing the volume change (ΔV) by the ΔP in the phantom. Moreover, the same measurements were repeated after the compliance of the phantom was reduced by increasing the water volume in the capacitor space. Under steady flow conditions, we determined the regional SCBF (rSCBF) and perfusion-related and restricted diffusion coefficients (D* and D, respectively) with biexponential analysis in the filter. RESULTS The internal pressure, ADC, and tSCBF varied over the pulsation period depending on the input flow. Moreover, the ΔP, ΔADC, ΔtSCBF, and rSCBF increased with the input flow rate. Compared to the high compliance condition, in the low compliance condition, the ΔP and ΔADC were higher by factors of 2.5 and 1.3, respectively, and the CI was smaller by a factor of 2.7, whereas the ΔV was almost unchanged. The D* was strongly affected by the input flow. CONCLUSION Our original phantom models the relationships among the blood perfusion, water diffusion, and biomechanics of the intracranial tissue, potentially facilitating the validation of novel MRI techniques and optimization of imaging parameters.
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Affiliation(s)
- Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Tomohiro Chigusa
- Department of Radiology, Okazaki City Hospital, 3-1 Goshoai, Koryuji-cho, Okazaki, Aichi, 4448553, Japan
| | - Hikari Usui
- Department of Radiology, Yokohama City University Hospital, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Shota Ishida
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Yuki Hiramatsu
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Satoshi Kobayashi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan
| | - Noam Alperin
- Department of Radiology, University of Miami, 1150 NW 14th Street, Suite 713, FL, 33146, USA
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Li YT, Cercueil JP, Yuan J, Chen W, Loffroy R, Wáng YXJ. Liver intravoxel incoherent motion (IVIM) magnetic resonance imaging: a comprehensive review of published data on normal values and applications for fibrosis and tumor evaluation. Quant Imaging Med Surg 2017; 7:59-78. [PMID: 28275560 DOI: 10.21037/qims.2017.02.03] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A comprehensive literature review was performed on liver intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) technique and its applications. Heterogeneous data have been reported. IVIM parameters are magnetic field strength dependent to a mild extent. A lower Dslow (D) value at 3 T than at 1.5 T and higher perfusion fraction (PF) value at 3 T than at 1.5 T were noted. An increased number of b values are associated with increased IVIM parameter measurement accuracy. With the current status of art, IVIM technique is not yet capable of detecting early stage liver fibrosis and diagnosing liver fibrosis grades, nor can it differentiate liver tumors. Though IVIM parameters show promise for tumor treatment monitoring, till now how PF and Dfast (D*) add diagnostic value to Dslow or apparent diffusion coefficient (ADC) remains unclear. This paper shows the state-of-art IVIM MR technique is still not able to offer reliable measurement for liver. More works on the measurement robustness are warranted as they are essential to justify follow-up clinical studies on patients.
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Affiliation(s)
- Yáo T Li
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong SAR, China
| | - Jean-Pierre Cercueil
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China
| | - Weitian Chen
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong SAR, China
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong SAR, China
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24
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Becker AS, Wurnig MC, Finkenstaedt T, Boss A. Non-parametric intravoxel incoherent motion analysis of the thyroid gland. Heliyon 2017; 3:e00239. [PMID: 28180186 PMCID: PMC5288302 DOI: 10.1016/j.heliyon.2017.e00239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/12/2017] [Accepted: 01/24/2017] [Indexed: 02/04/2023] Open
Abstract
Purpose To implement a protocol for intravoxel incoherent motion (IVIM) of the thyroid, to determine base parameters in healthy volunteers, and to provide preliminary experience on clinical applicability in one patient. Materials and methods Eight healthy volunteers underwent 3T MRI using a diffusion weighted echo-planar imaging sequence with 12 different b-values between 0–800 s/mm2. The IVIM parameters diffusion coefficient D, pseudo-diffusion coefficient D*, perfusion fraction Fp, and the optimal b-values thresholds were calculated for each thyroid lobe, muscle tissue and the cerebrospinal fluid (CSF) using a non-parametric multi-step algorithm and compared with a Student's t-test. A p-value <0.05 was considered significant. Results Mean values for healthy thyroid tissue were: D 1.01 ± 0.13 × 10−3 mm2/s, D* 71.0 ± 52.5 × 10−3 mm2/s and Fp 17.1 ± 4.2%; for muscle: D 0.50 ± 0.21 × 10−3 mm2/s, D* 58.3 ± 99.2 × 10−3 mm2/s and Fp 26.5 ± 9.3%; and for CSF D 2.18 ± 0.93 × 10−3 mm2/s, D* 99.2 ± 41.2 × 10−3 mm2/s and Fp 74.6 ± 12.7%. The optimal b-value threshold separating diffusion and perfusion effects in thyroid ranged between 0–70 s/mm2. Healthy thyroid tissue showed similar Fp compared to muscle, both lower than CSF. Conclusions The proposed IVIM protocol provides surrogate markers on cellular diffusion restriction and perfusion; thereby providing a more comprehensive description of tissue properties compared to conventional DWI.
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Affiliation(s)
- Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Switzerland
| | - Moritz C Wurnig
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Switzerland
| | - Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Switzerland
| | - Andreas Boss
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Switzerland
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25
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Intravoxel Incoherent Motion Protocol Evaluation and Data Quality in Normal and Malignant Liver Tissue and Comparison to the Literature. Invest Radiol 2016; 51:90-9. [PMID: 26405835 DOI: 10.1097/rli.0000000000000207] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Although intravoxel incoherent motion (IVIM) becomes more and more popular, there is currently no clear consensus on the number and distribution of b-values to use. In this work, we (1) tested and evaluated the data quality of a 25-b-value IVIM protocol in patients with malignant liver lesions and normal liver tissue as a standard of reference, (2) calculated an optimal b-value distribution and compared with the standard of reference, and (3) compared the 25-b-value protocol with other proposed protocols in the literature. MATERIALS AND METHODS Intravoxel incoherent motion imaging with 25 b-values was performed at 3 T in a total of 15 patients with malignant liver lesions. Reference IVIM parameter maps were calculated in tumor and normal liver tissue. With these parameters, optimal IVIM protocols with reduced numbers of b-values were calculated. These optimal IVIM protocols were again applied to calculate new IVIM parameter maps that were compared with the reference parameter maps by calculating mean relative errors. In addition, 35 other IVIM protocols, as found in literature, were compared in a similar way with the 25-b-value protocol serving as a standard of reference. RESULTS The mean relative error depends on the number of b-values and their distribution. In tumor tissue, the error is higher and more variable than in normal-appearing liver tissue. The largest errors occur in tumor tissue and in the protocols having low numbers of b-values in the IVIM protocols. In the calculated optimal IVIM protocols, the mean relative errors decreased by 40% or more when the number of b-values included increased from 4 to 16. The mean relative errors in the protocols adapted from the literature vary substantially between the various b-value distributions. One optimized 16-b-value protocol, which was found in literature, reduced the average relative error by 80% when compared with 4- and 5-b-value protocols listed in literature. CONCLUSIONS Including more b-values and applying an optimized b-value distribution significantly reduces errors in the IVIM parameter estimates, thereby increasing its accuracy.This effect is even more pronounced in inhomogeneous tumor compared with that in normal liver tissue. However, when restrictions in acquisition time or patient-related factors apply, a minimum of 16 b-values should be considered for reliable results.
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26
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De Luca A, Bertoldo A, Froeling M. Effects of perfusion on DTI and DKI estimates in the skeletal muscle. Magn Reson Med 2016; 78:233-246. [PMID: 27538923 DOI: 10.1002/mrm.26373] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/28/2016] [Accepted: 07/18/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE In this study, we evaluated the effects of perfusion of the skeletal muscle on diffusion tensor imaging (DTI) and diffusional kurtosis imaging (DKI) parameters and their reproducibility. METHODS Diffusion tensor imaging and DKI models, with and without intravoxel incoherent motion (IVIM) correction, were applied to simulated data at different physiological conditions and signal-to-noise ratio levels. Next, the same models were applied to data of the right calf of five healthy volunteers, acquired twice at 3 telsa. For six muscles, we evaluated the correlation of the perfusion signal fraction, with parameters derived from DTI and DKI, and performed repeatability analysis with and without IVIM correction. Additionally, the IVIM correction was compared to a multishell acquisition approach that minimizes perfusion effects on DTI estimates. RESULTS Simulations and acquired data showed that DTI and DKI estimates were biased proportionally to the perfusion signal fraction, and that IVIM correction was needed for accurate estimation of the DTI and DKI parameters. However, taking perfusion into account did not improve repeatability. CONCLUSION Blood perfusion has an effect on DTI and DKI estimations, but it can be minimized with IVIM correction or multishell acquisition strategies. Magn Reson Med 78:233-246, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Alberto De Luca
- Department of Information Engineering, University of Padova, Padova, Italy.,Department of Radiology, University Medical Center, Utrecht, The Netherlands.,Neuroimaging Lab, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | | | - Martijn Froeling
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
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27
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Gambarota G, Hitti E, Leporq B, Saint-Jalmes H, Beuf O. Eliminating the blood-flow confounding effect in intravoxel incoherent motion (IVIM) using the non-negative least square analysis in liver. Magn Reson Med 2016; 77:310-317. [PMID: 26728917 DOI: 10.1002/mrm.26085] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 01/24/2023]
Abstract
PURPOSE Tissue perfusion measurements using intravoxel incoherent motion (IVIM) diffusion-MRI are of interest for investigations of liver pathologies. A confounding factor in the perfusion quantification is the partial volume between liver tissue and large blood vessels. The aim of this study was to assess and correct for this partial volume effect in the estimation of the perfusion fraction. METHODS MRI experiments were performed at 3 Tesla with a diffusion-MRI sequence at 12 b-values. Diffusion signal decays in liver were analyzed using the non-negative least square (NNLS) method and the biexponential fitting approach. RESULTS In some voxels, the NNLS analysis yielded a very fast-decaying component that was assigned to partial volume with the blood flowing in large vessels. Partial volume correction was performed by biexponential curve fitting, where the first data point (b = 0 s/mm2 ) was eliminated in voxels with a very fast-decaying component. Biexponential fitting with partial volume correction yielded parametric maps with perfusion fraction values smaller than biexponential fitting without partial volume correction. CONCLUSION The results of the current study indicate that the NNLS analysis in combination with biexponential curve fitting allows to correct for partial volume effects originating from blood flow in IVIM perfusion fraction measurements. Magn Reson Med 77:310-317, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Giulio Gambarota
- INSERM, UMR 1099, Rennes, France.,Université de Rennes 1, LTSI, Rennes, France
| | - Eric Hitti
- INSERM, UMR 1099, Rennes, France.,Université de Rennes 1, LTSI, Rennes, France
| | - Benjamin Leporq
- Université de Lyon, CREATIS; CNRS UMR 5220; Inserm U1044; INSA-Lyon, Université Lyon 1, Villeurbanne, France
| | - Hervé Saint-Jalmes
- INSERM, UMR 1099, Rennes, France.,Université de Rennes 1, LTSI, Rennes, France.,CRLCC, Centre Eugène Marquis, Rennes, France
| | - Olivier Beuf
- Université de Lyon, CREATIS; CNRS UMR 5220; Inserm U1044; INSA-Lyon, Université Lyon 1, Villeurbanne, France
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28
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Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival. Eur Radiol 2015; 26:2126-38. [DOI: 10.1007/s00330-015-4031-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/15/2015] [Indexed: 01/22/2023]
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Intravoxel incoherent motion magnetic resonance imaging to predict vesicoureteral reflux in children with urinary tract infection. Eur Radiol 2015; 26:1670-7. [PMID: 26373765 DOI: 10.1007/s00330-015-3986-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/18/2015] [Accepted: 08/31/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To compare the diffusion parameters of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) between the "reflux" and the "non-reflux" kidneys, and to evaluate the feasibility of using IVIM DWI to predict vesicoureteral reflux (VUR) in children with a urinary tract infection (UTI). METHODS Eighty-three kidneys from 57 pediatric patients with a UTI were classified into "reflux" and "non-reflux" groups according to voiding cystourethrography (VCUG) results. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (PF) were measured and compared in the renal pelvis of both groups. Four indices (D*/ADC, PF/ADC, D*/D, and PF/D) were calculated and receiver operating characteristic (ROC) curve analyses were performed. RESULTS VURs were detected on VCUG in 21 kidneys. PF and D* were significantly higher in the "reflux" group than in the "non-reflux" group. The indices were all significantly higher. The PF/D index showed the best diagnostic performance in predicting VUR in children with UTI (Az = 0.864). CONCLUSION PF and D* were significantly higher in the "reflux" kidney than in the "non-reflux" kidney. Our new index (PF/D) could prove useful for predicting VUR. KEY POINTS • IVIM DWI is both radiation-free and contrast media-free. • IVIM DWI index is easily calculated by combining diffusion parameters. • IVIM DWI may help predict VUR in children with UTI. • PF is significantly higher in the "reflux" than the "non-reflux" kidneys. • A new VUR index, PF/D could prove useful for predicting VUR.
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30
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Goo HW. Whole-Body MRI in Children: Current Imaging Techniques and Clinical Applications. Korean J Radiol 2015; 16:973-85. [PMID: 26355493 PMCID: PMC4559794 DOI: 10.3348/kjr.2015.16.5.973] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/19/2015] [Indexed: 11/22/2022] Open
Abstract
Whole-body magnetic resonance imaging (MRI) is increasingly used in children to evaluate the extent and distribution of various neoplastic and non-neoplastic diseases. Not using ionizing radiation is a major advantage of pediatric whole-body MRI. Coronal and sagittal short tau inversion recovery imaging is most commonly used as the fundamental whole-body MRI protocol. Diffusion-weighted imaging and Dixon-based imaging, which has been recently incorporated into whole-body MRI, are promising pulse sequences, particularly for pediatric oncology. Other pulse sequences may be added to increase diagnostic capability of whole-body MRI. Of importance, the overall whole-body MRI examination time should be less than 30-60 minutes in children, regardless of the imaging protocol. Established and potentially useful clinical applications of pediatric whole-body MRI are described.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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31
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Bourillon C, Rahmouni A, Lin C, Belhadj K, Beaussart P, Vignaud A, Zerbib P, Pigneur F, Cuenod CA, Bessalem H, Cavet M, Boutekadjirt A, Haioun C, Luciani A. Intravoxel Incoherent Motion Diffusion-weighted Imaging of Multiple Myeloma Lesions: Correlation with Whole-Body Dynamic Contrast Agent-enhanced MR Imaging. Radiology 2015; 277:773-83. [PMID: 26131910 DOI: 10.1148/radiol.2015141728] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To correlate intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters with the enhancement patterns of bone marrow and focal lesion obtained on whole-body (WB) dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) images in patients with stage-III multiple myeloma (MM) before and after systemic therapy. MATERIALS AND METHODS Twenty-seven patients with MM were retrospectively included in this institutional review board-approved study. Requirement for written informed consent was waived. All patients underwent WB DCE MR imaging before treatment and 18 patients underwent repeat MR imaging 3 months after treatment. A transverse IVIM DWI sequence with 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, and 800 sec/mm(2)) was acquired within bone marrow and focal lesions. The IVIM parameters (perfusion fraction [f], molecular diffusion coefficient [D], and perfusion-related D [D*]) and apparent diffusion coefficient (ADC) were extracted for both focal lesions and bone marrow and correlated with focal lesions and maximal bone marrow enhancement (BMEmax) (Spearman correlation coefficient) at baseline and at follow-up (Wilcoxon signed-rank test). RESULTS D and ADC values positively correlated with BMEmax (r = 0.7, P < .001; and r = 0.455, P = .0435, respectively). Patients with increased BMEmax showed significantly increased ADC and D within bone marrow versus patients who did not have increased BMEmax (ADC, 0.67 × 10(-3) mm(2)/sec vs 0.54 × 10(-3) mm(2)/sec, P = .03; D, 0.58 × 10(-3) mm(2)/sec vs 0.42 × 10(-3) mm(2)/sec, P < .001). Within focal lesions, f was the maximum in lesions that showed enhancement followed by washout. After treatment in good responders, the significant decrease in maximal enhancement value of focal lesions (baseline vs after treatment, 213.9% ± 78.7 [standard deviation] vs 131% ± 53.6, respectively; P < .001) was accompanied by a significant decrease in f (baseline vs after treatment, 11% ± 3.8 vs 5.8% ± 4.7, respectively; P < .001). CONCLUSION Diffuse bone marrow involvement is associated with increased D. Hypervascular focal lesions with high maximal enhancement value of focal lesions also show high f value. Likewise, the decreased maximal enhancement value of focal lesions after treatment is accompanied by decreased f.
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Affiliation(s)
- Camille Bourillon
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Alain Rahmouni
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Chieh Lin
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Karim Belhadj
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Pauline Beaussart
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Alexandre Vignaud
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Pierre Zerbib
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Frédéric Pigneur
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Charles-André Cuenod
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Hocine Bessalem
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Madeleine Cavet
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Amal Boutekadjirt
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Corinne Haioun
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Alain Luciani
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
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