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Wang Q, Yu G, Qiu J, Lu W. Application of Intravoxel Incoherent Motion in Clinical Liver Imaging: A Literature Review. J Magn Reson Imaging 2024; 60:417-440. [PMID: 37908165 DOI: 10.1002/jmri.29086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Abstract
Intravoxel incoherent motion (IVIM) modeling is a widely used double-exponential model for describing diffusion-weighted imaging (DWI) signal, with a slow component related to pure molecular diffusion and a fast component associated with microcirculatory perfusion, which compensates for the limitations of traditional DWI. IVIM is a noninvasive technique for obtaining liver pathological information and characterizing liver lesions, and has potential applications in the initial diagnosis and treatment monitoring of liver diseases. Recent studies have demonstrated that IVIM-derived parameters are useful for evaluating liver lesions, including nonalcoholic fatty liver disease (NAFLD), liver fibrosis and liver tumors. However, the results are not stable. Therefore, it is necessary to summarize the current applications of IVIM in liver disease research, identify existing shortcomings, and point out the future development direction. In this review, we searched for studies related to hepatic IVIM-DWI applications over the past two decades in the PubMed database. We first introduce the fundamental principles and influential factors of IVIM, and then discuss its application in NAFLD, liver fibrosis, and focal hepatic lesions. It has been found that IVIM is still unstable in ensuring the robustness and reproducibility of measurements in the assessment of liver fibrosis grade and liver tumors differentiation, due to inconsistent and substantial overlap in the range of IVIM-derived parameters for different fibrotic stages. In the end, the future direction of IVIM-DWI in the assessment of liver diseases is discussed, emphasizing the need for further research on the stability of IVIM-derived parameters, particularly perfusion-related parameters, in order to promote the clinical practice of IVIM-DWI. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Qi Wang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Guanghui Yu
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Weizhao Lu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
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Bian W, Huang Q, Zhang J, Li J, Song X, Cui S, Zheng Q, Niu J. Intravoxel incoherent motion diffusion-weighted MRI for the evaluation of early spleen involvement in acute leukemia. Quant Imaging Med Surg 2024; 14:98-110. [PMID: 38223126 PMCID: PMC10784019 DOI: 10.21037/qims-23-856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/30/2023] [Indexed: 01/16/2024]
Abstract
Background The spleen is a frequent organ of leukemia metastasis. This study aimed to investigate the value of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) for assessing pathologic changes in the spleen and identifying early spleen involvement in patients with acute leukemia (AL). Methods Patients with newly diagnosed AL and healthy controls were recruited between June 2020 and November 2022. All participants underwent abdominal IVIM diffusion-weighted imaging (DWI) at our hospital. IVIM parameters [pure diffusion coefficient (D); pseudo-diffusion coefficient (D*); and pseudo-perfusion fraction (f)] of the spleen were calculated by the segmented fitting method, and perfusion-diffusion ratio (PDR) was further calculated from the values of D, D* and f. Spleen volumes (SVs) were obtained by manually segmenting the spleen layer by layer. Clinical biomarkers of AL patients were collected. Patients were divided into splenomegaly group and normal SV group according to the individualized reference intervals for SV. IVIM parameters were compared among the control group, AL with normal SV group, and AL with splenomegaly group using one-way analysis of variance, followed by pairwise post hoc comparisons. The correlations of IVIM parameters with clinical biomarkers were analyzed in AL patients. The diagnostic performances of IVIM parameters and their combinations for differentiating among the three groups were compared. Results Seventy-nine AL patients (AL with splenomegaly: n=54; AL with normal SV: n=25) and 55 healthy controls were evaluated. IVIM parameters were significantly different among the three groups (P<0.001 for D, D* and f; P=0.001 for PDR). D and PDR showed significant differences between the control and AL with normal SV groups in pairwise comparisons (P<0.001, and P=0.031, respectively). D was correlated with white blood cell (WBC) counts (r=-0.424; 95% CI: -0.570, -0.211; P<0.001), lactate dehydrogenase (LDH) (r=-0.285; 95% CI: -0.486, -0.011; P=0.011), and bone marrow blasts (r=-0.283; 95% CI: -0.476, -0.067; P=0.012). D* (r=-0.276; 95% CI: -0.470, -0.025; P=0.014), f (r=0.514; 95% CI: 0.342, 0.664; P<0.001) and PDR (r=0.343; 95% CI: 0.208, 0.549; P=0.002) were correlated with LDH. The combination of IVIM parameters (AUC: 0.830; 95% CI: 0.729, 0.905) demonstrated better diagnostic efficacy than the single D* (AUC: 0.721; 95% CI: 0.608, 0.816; Delong test: Z=2.012, P=0.044) and f (AUC: 0.647; 95% CI: 0.532, 0.752; Delong test: Z=2.829, P=0.005), but was not significantly different from the single D (AUC: 0.756; 95% CI: 0.647, 0.846; Delong test: Z=1.676, P=0.094) in differentiating the splenomegaly group and normal SV group. Conclusions IVIM diffusion-weighted MRI could be a potential alternative for assessing pathologic changes in the spleen from cellularity and angiogenesis, and D and PDR may be viable indicators to identify early spleen involvement in patients with AL.
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Affiliation(s)
- Wenjin Bian
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qianqian Huang
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Jianling Zhang
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Jianting Li
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoli Song
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Sha Cui
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qian Zheng
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinliang Niu
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, China
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Zhang J, Huang Q, Bian W, Wang J, Guan H, Niu J. Imaging Techniques and Clinical Application of the Marrow-Blood Barrier in Hematological Malignancies. Diagnostics (Basel) 2023; 14:18. [PMID: 38201327 PMCID: PMC10795601 DOI: 10.3390/diagnostics14010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The pathways through which mature blood cells in the bone marrow (BM) enter the blood stream and exit the BM, hematopoietic stem cells in the peripheral blood return to the BM, and other substances exit the BM are referred to as the marrow-blood barrier (MBB). This barrier plays an important role in the restrictive sequestration of blood cells, the release of mature blood cells, and the entry and exit of particulate matter. In some blood diseases and tumors, the presence of immature cells in the blood suggests that the MBB is damaged, mainly manifesting as increased permeability, especially in angiogenesis. Some imaging methods have been used to monitor the integrity and permeability of the MBB, such as DCE-MRI, IVIM, ASL, BOLD-MRI, and microfluidic devices, which contribute to understanding the process of related diseases and developing appropriate treatment options. In this review, we briefly introduce the theory of MBB imaging modalities along with their clinical applications.
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Affiliation(s)
- Jianling Zhang
- Department of Medical Imaging, Shanxi Medical University, 56 Xinjian South Road, Taiyuan 030001, China; (J.Z.); (Q.H.); (W.B.)
| | - Qianqian Huang
- Department of Medical Imaging, Shanxi Medical University, 56 Xinjian South Road, Taiyuan 030001, China; (J.Z.); (Q.H.); (W.B.)
| | - Wenjin Bian
- Department of Medical Imaging, Shanxi Medical University, 56 Xinjian South Road, Taiyuan 030001, China; (J.Z.); (Q.H.); (W.B.)
| | - Jun Wang
- Department of Radiology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan 030001, China;
| | - Haonan Guan
- MR Research China, GE Healthcare, Beijing 100176, China;
| | - Jinliang Niu
- Department of Radiology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan 030001, China;
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Qi YM, Xiao EH. Advances in application of novel magnetic resonance imaging technologies in liver disease diagnosis. World J Gastroenterol 2023; 29:4384-4396. [PMID: 37576700 PMCID: PMC10415971 DOI: 10.3748/wjg.v29.i28.4384] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
Liver disease is a major health concern globally, with high morbidity and mor-tality rates. Precise diagnosis and assessment are vital for guiding treatment approaches, predicting outcomes, and improving patient prognosis. Magnetic resonance imaging (MRI) is a non-invasive diagnostic technique that has been widely used for detecting liver disease. Recent advancements in MRI technology, such as diffusion weighted imaging, intravoxel incoherent motion, magnetic resonance elastography, chemical exchange saturation transfer, magnetic resonance spectroscopy, hyperpolarized MR, contrast-enhanced MRI, and ra-diomics, have significantly improved the accuracy and effectiveness of liver disease diagnosis. This review aims to discuss the progress in new MRI technologies for liver diagnosis. By summarizing current research findings, we aim to provide a comprehensive reference for researchers and clinicians to optimize the use of MRI in liver disease diagnosis and improve patient prognosis.
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Affiliation(s)
- Yi-Ming Qi
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China
| | - En-Hua Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China
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Cui J, Zheng J, Niu W, Bian W, Wang J, Niu J. Quantitative IVIM parameters evaluating perfusion changes in brain parenchyma in patients newly diagnosed with acute leukemia: Compared with healthy participants. Front Neurol 2023; 14:1093003. [PMID: 36816571 PMCID: PMC9932664 DOI: 10.3389/fneur.2023.1093003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/03/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose To study the value of quantitative IVIM parameters in evaluating cerebral blood perfusion changes in patients newly diagnosed with acute leukemia (AL) by comparing them with healthy participants. Materials and methods This prospective study consecutively recruited 49 participants with newly diagnosed AL and 40 normal controls between July 2020 and September 2022. All participants underwent an MRI of the brain using an axial T1-weighted and an IVIM sequence. The IVIM parameters (water diffusion coefficient, sADC, pseudoperfusion fraction, f; diffusion coefficient, D, pseudodiffusion coefficient, D *, and perfusion-diffusion ratio, PDR) and peripheral white blood cell (WBC) counts were obtained. An unpaired t-test or the Mann-Whitney U-test was performed to compare the differences in gray matter (GM) and white matter (WM) of healthy participants and AL patients and the differences in IVIM parameters between healthy participants and patients with AL. In addition, multivariate (logistic regression) analyses were used to identify independent predictors and then, the receiver operating characteristic curve (ROC) analyses were performed. Results 40 healthy participants and 49 patients with newly diagnosed AL were evaluated. In healthy participants, sADC, PDR, D and f values of GM were significantly higher than those of WM (t = 5.844, t = 3.838, t = 7.711, z = -2.184, respectively, all P < 0.05). In AL patients, the D, f and sADC values of GM were significantly higher than those of WM (t = 3.450, t = 6.262, t = 4.053, respectively, all P < 0.05). The sADC and f value from AL patients were significantly lower than those from healthy participants in GM (z = -2.537, P = 0.011; and z = -2.583, P = 0.010, respectively) and WM (z = -2.969, P = 0.003; z = -2.923, P = 0.003, respectively). The WBC counts of AL patients were significantly higher than those of healthy participants (t = 3.147, P = 0.002). Multivariate analyses showed that the f values of GM and WM were independent predictors of AL (P = 0.030, and 0.010, respectively), with the optimal cut-off value at 7.08% (AUC ROC curve: 0.661, specificity: 11.4%, sensitivity: 98%) and 13.77% (AUC ROC curve: 0.682, specificity: 79.5%, sensitivity: 59.2%). Conclusion The IVIM parameters of brain parenchyma in patients newly diagnosed with AL differed from those of the healthy participants. The changes of cerebral blood flow perfusion are expected to provide new ideas for studying central nervous system infiltration in AL.
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Affiliation(s)
- Jianing Cui
- Medical Imaging Department, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jing Zheng
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Weiran Niu
- Department of Mental Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenjin Bian
- Medical Imaging Department, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jun Wang
- Department of Radiology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinliang Niu
- Department of Radiology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Jinliang Niu ✉
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Zhou Y, Zheng J, Yang C, Peng J, Liu N, Yang L, Zhang XM. Application of intravoxel incoherent motion diffusion-weighted imaging in hepatocellular carcinoma. World J Gastroenterol 2022; 28:3334-3345. [PMID: 36158259 PMCID: PMC9346463 DOI: 10.3748/wjg.v28.i27.3334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/26/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
The morbidity and mortality of hepatocellular carcinoma (HCC) rank 6th and 4th, respectively, among malignant tumors worldwide. Traditional diffusion-weighted imaging (DWI) uses the apparent diffusion coefficient (ADC) obtained by applying the monoexponential model to reflect water molecule diffusion in active tissue; however, the value of ADC is affected by microcirculation perfusion. Using a biexponential model, intravoxel incoherent motion (IVIM)-DWI quantitatively measures information related to pure water molecule diffusion and microcirculation perfusion, thus compensating for the shortcomings of DWI. The number of studies examining the application of IVIM-DWI in patients with HCC has gradually increased over the last few years, and many results show that IVIM-DWI has vital value for HCC differentiation, pathological grading, and predicting and evaluating the treatment response. The present study principally reviews the principle of IVIM-DWI and its research progress in HCC differentiation, pathological grading, predicting and evaluating the treatment response, predicting postoperative recurrence and predicting gene expression prediction.
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Affiliation(s)
- Yi Zhou
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, People's Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| | - Jing Zheng
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Cui Yang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, Panzhihua Central Hospital, Panzhihua 617000, Sichuan Province, China
| | - Juan Peng
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, Sichuan Provincial People's Hospital Jinniu Hospital, Chengdu Jinniu District People's Hospital, Chengdu 610007, Sichuan Province, China
| | - Ning Liu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Lin Yang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiao-Ming Zhang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Imaging Diagnosis of Primary Liver Cancer Using Magnetic Resonance Dilated Weighted Imaging and the Treatment Effect of Sorafenib. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8586943. [PMID: 35799672 PMCID: PMC9256338 DOI: 10.1155/2022/8586943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/21/2022]
Abstract
Objective This work explores the application value of dilated weighted imaging (DWI) in the diagnosis of primary liver cancer (PLC) and the effect of sorafenib in the treatment of PLC. Methods 88 patients with PLC who were treated in The First Affiliated Hospital of Northwest University from March 2019 to March 2021 were selected and randomly rolled into an experimental group and a control group, with 44 cases in each group. Patients in both groups were treated with transcatheter arterial chemoembolization (TACE), and the patients in the experimental group were treated with oral sorafenib on the basis of TACE. The indicators of complications, short-term efficacy (STE), and long-term efficacy (LTE) of the two groups were observed. All patients received DWI and magnetic resonance (MR) plain scan. The diagnostic accuracy and misdiagnosis rate of the two methods in diagnosing the PLC were compared. Results The accuracy, specificity, and sensitivity of MR plain scan were 68%, 88%, and 89%, respectively, while those of DWI were 96%, 95%, and 94.2%, respectively. It indicated that the accuracy, specificity, and sensitivity of DWI in diagnosing lesions were better than those of MR plain scan, especially the diagnostic accuracy (P < 0.05). The objective response rate (ORR) and disease control rate (DCR) of the STE in the experimental group were 30% and 97%, respectively, and those in the control group were 6% and 54.5%, respectively. The experimental group's mean progression-free survival (mPFS) and mean overall survival (mOS) were 12 and 25 months, respectively, while the control group's were 8 and 19 months, respectively. It was concluded that the mPFS and mOS of patients receiving TACE combined with oral sorafenib were much higher than those receiving TACE only (P < 0.05). Conclusion DWI and TACE combined with sorafenib had high application value in the diagnosis and treatment of PLC.
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