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Podgórska J, Pasicz K, Skrzyński W, Gołębiewski B, Kuś P, Jasieniak J, Rogowska A, Kukołowicz P, Cieszanowski A. Application of diffusion kurtosis imaging in differential diagnosis of focal liver lesions. Pol J Radiol 2023; 88:e455-e460. [PMID: 38020499 PMCID: PMC10660143 DOI: 10.5114/pjr.2023.131911] [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: 07/17/2023] [Accepted: 08/26/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Diffusion kurtosis imaging (DKI) is an MRI method related to diffusion imaging (DWI) that is distinguished by a non-Gaussian calculation of water particles movements in tissues. The aim of the study was to assess DKI advantage over DWI in differentiating benign and malignant liver lesions. Material and methods Analysis included prospectively acquired group of 83 patients referred consecutively for 3T-MRI liver tumor examination, with 95 liver lesions (31 benign, 59 malignant). MRI assessments were performed with standard protocol and DKI sequence with seven b-values (0-2,000 s/mm2). Quantitative data were acquired by placing ROIs in liver tumors on all b-value images, ROI data extracted, and calculation of DWI and DKI parameters. ADC was calculated for all b-values (ADC0-2000) and for three values of b = 0, 500, and 750 (s/mm2) (ADC0-500-750). DKI and ADC parameters for benign and malignant lesions were compared, and ROC curves were plotted. Results Significant differences were obtained for all DKI and ADC parameters. ROC analysis showed AUC of DK, K, ADC0-2000, and ADC0-500-750 was 0.74, 0.77, 0.77, and 0.75, respectively. The highest sensitivity (of 0.91) was obtained for ADC0-2000. The highest specificity (0.65) and accuracy (0.80) was obtained for K. Conclusion DKI technique yields statistically comparable results with DWI technique.
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Affiliation(s)
- Joanna Podgórska
- 2 Department of Clinical Radiology, Warsaw Medical University, Poland
- Department of Radiology 1, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarzyna Pasicz
- Department of Medical Physics, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Witold Skrzyński
- Department of Medical Physics, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Bogumił Gołębiewski
- Department of Radiology 1, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Kuś
- Department of Radiology 1, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jakub Jasieniak
- Department of Radiology 1, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Agnieszka Rogowska
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Oncological Gastroenterology, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Paweł Kukołowicz
- Department of Medical Physics, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Andrzej Cieszanowski
- 2 Department of Clinical Radiology, Warsaw Medical University, Poland
- Department of Radiology 1, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Zhang Y, Wei H, Song B. Magnetic resonance imaging for treatment response evaluation and prognostication of hepatocellular carcinoma after thermal ablation. Insights Imaging 2023; 14:87. [PMID: 37188987 DOI: 10.1186/s13244-023-01440-7] [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: 12/12/2022] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
Hepatocellular carcinoma (HCC) accounts for the vast majority of primary liver cancer and constitutes a major global health challenge. Tumor ablation with either radiofrequency ablation (RFA) or microwave ablation (MWA) is recommended as a curative-intent treatment for early-stage HCC. Given the widespread use of thermal ablation in routine clinical practice, accurate evaluation of treatment response and patient outcomes has become crucial in optimizing individualized management strategies. Noninvasive imaging occupies the central role in the routine management of patients with HCC. Magnetic resonance imaging (MRI) could provide full wealth of information with respect to tumor morphology, hemodynamics, function and metabolism. With accumulation of liver MR imaging data, radiomics analysis has been increasingly applied to capture tumor heterogeneity and provide prognostication by extracting high-throughput quantitative imaging features from digital medical images. Emerging evidence suggests the potential role of several qualitative, quantitative and radiomic MRI features in prediction of treatment response and patient prognosis after ablation of HCC. Understanding the advancements of MRI in the evaluation of ablated HCCs may facilitate optimal patient care and improved outcomes. This review provides an overview of the emerging role of MRI in treatment response evaluation and prognostication of HCC patients undergoing ablation. CLINICAL RELEVANCE STATEMENT: MRI-based parameters can help predict treatment response and patient prognosis after HCC ablation and thus guide treatment planning. KEY POINTS: 1. ECA-MRI provides morphological and hemodynamic assessment of ablated HCC. 2. EOB-MRI provides more information for tumor response prediction after ablation. 3. DWI improve the characterization of HCC and optimize treatment decision. 4. Radiomics analysis enables characterization of tumor heterogeneity guidance of clinical decision-making. 5. Further studies with multiple radiologists and sufficient follow-up period are needed.
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Affiliation(s)
- Yun Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Hong Wei
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan, China.
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Evaluating the renal mild tubulointerstitial damage and renal function in IgAN patients: a comparative study based on diffusion kurtosis imaging and diffusion tensor imaging. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1350-1362. [PMID: 36749369 DOI: 10.1007/s00261-023-03822-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the performance of 3.0 T magnetic resonance diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) in evaluation of the degree of tubulointerstitial damage and renal function in Immunoglobulin A Nephropathy (IgAN) patients. METHODS Both DKI and DTI were performed in 40 IgAN patients and 17 healthy volunteers. IgAN patients were divided into two groups according to tubulointerstitial lesion score: Mild injury group, n = 24; Moderate-severe injury group, n = 16. DKI characteristic parameters [mean kurtosis (MK), axial kurtosis (Ka), radial kurtosis (Kr)] and DTI parameters [fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Da), radial diffusivity (Dr)] of renal cortex and medulla were measured and compared among different groups. Correlations between DKI, DTI parameters and clinicopathological characteristics were assessed. Diagnostic performance of DKI and DTI to evaluate tubulointerstitial damage of IgAN was compared. RESULTS Cortical MK, Kr, Da and parenchymal Ka significantly differed among three groups (P < 0.05). Cortical MK, Kr, Ka were negatively correlated with estimated glomerular filtration rate (eGFR) (MK: r = - 0.613; Kr: r = - 0.539; Ka: r = - 0.664) and positively correlated with tubulointerstitial lesion score (MK: r = 0.655; Kr: r = 0.577; Ka: r = 0.661) (all P < 0.001). Lower correlation coefficient was found among cortical FA, MD, Dr and eGFR, tubulointerstitial lesion score (all|r|< 0.350). The AUCs of DKI and DTI parameters for differentiating Mild injury group from control group were (cortical MK 0.822, cortical Ka 0.816; cortical FA 0.515, cortical MD 0.714) and for differentiating Mild injury group from Moderate-severe injury group were (cortical MK 0.813, cortical Ka 0.831; medulla FA 0.784, medulla MD 0.586). CONCLUSION Compared with DTI, DKI was more sensitive and accurate to probe the renal function and the tubulointerstitial damage of IgAN, especially the mild tubulointerstitial damage.
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Tang W, Zhou H, Quan T, Chen X, Zhang H, Lin Y, Wu R. XGboost Prediction Model Based on 3.0T Diffusion Kurtosis Imaging Improves the Diagnostic Accuracy of MRI BiRADS 4 Masses. Front Oncol 2022; 12:833680. [PMID: 35372060 PMCID: PMC8968064 DOI: 10.3389/fonc.2022.833680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The malignant probability of MRI BiRADS 4 breast lesions ranges from 2% to 95%, leading to unnecessary biopsies. The purpose of this study was to construct an optimal XGboost prediction model through a combination of DKI independently or jointly with other MR imaging features and clinical characterization, which was expected to reduce false positive rate of MRI BiRADS 4 masses and improve the diagnosis efficiency of breast cancer. METHODS 120 patients with 158 breast lesions were enrolled. DKI, Diffusion-weighted Imaging (DWI), Proton Magnetic Resonance Spectroscopy (1H-MRS) and Dynamic Contrast-Enhanced MRI (DCE-MRI) were performed on a 3.0-T scanner. Wilcoxon signed-rank test and χ2 test were used to compare patient's clinical characteristics, mean kurtosis (MK), mean diffusivity (MD), apparent diffusion coefficient (ADC), total choline (tCho) peak, extravascular extracellular volume fraction (Ve), flux rate constant (Kep) and volume transfer constant (Ktrans). ROC curve analysis was used to analyze the diagnostic performances of the imaging parameters. Spearman correlation analysis was performed to evaluate the associations of imaging parameters with prognostic factors and breast cancer molecular subtypes. The Least Absolute Shrinkage and Selectionator operator (lasso) and the area under the curve (AUC) of imaging parameters were used to select discriminative features for differentiating the breast benign lesions from malignant ones. Finally, an XGboost prediction model was constructed based on the discriminative features and its diagnostic efficiency was verified in BiRADS 4 masses. RESULTS MK derived from DKI performed better for differentiating between malignant and benign lesions than ADC, MD, tCho, Kep and Ktrans (p < 0.05). Also, MK was shown to be more strongly correlated with histological grade, Ki-67 expression and lymph node status. MD, MK, age, shape and menstrual status were selected to be the optimized feature subsets to construct an XGboost model, which exhibited superior diagnostic ability for breast cancer characterization and an improved evaluation of suspicious breast tumors in MRI BiRADS 4. CONCLUSIONS DKI is promising for breast cancer diagnosis and prognostic factor assessment. An optimized XGboost model that included DKI, age, shape and menstrual status is effective in improving the diagnostic accuracy of BiRADS 4 masses.
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Affiliation(s)
- Wan Tang
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Institute of Health Monitoring, Inspection and Protection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Han Zhou
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Tianhong Quan
- Department of Electronic and information Engineering, College of Engineering, Shantou University, Shantou, China
| | - Xiaoyan Chen
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Huanian Zhang
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yan Lin
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Renhua Wu
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou, China
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Cai W, Min X, Chen D, Fan C, Feng Z, Li B, Zhang P, You H, Xie J, Liu J, Wang L. Noninvasive Differentiation of Obstructive Azoospermia and Nonobstructive Azoospermia Using Multimodel Diffusion Weighted Imaging. Acad Radiol 2021; 28:1375-1382. [PMID: 32622745 DOI: 10.1016/j.acra.2020.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of parameters derived from multimodel diffusion weighted imaging (monoexponential, stretched-exponential diffusion weighted imaging and diffusion kurtosis imaging [DKI]) from noninvasive magnetic resonance imaging in distinguishing obstructive azoospermia (OA) from nonobstructive azoospermia (NOA). MATERIALS AND METHODS Forty-six patients with azoospermia were prospectively enrolled and classified into two groups (21 OA patients and 25 NOA patients). The multimodel parameters of diffusion-weighted imaging (DWI; apparent diffusion coefficient [ADC], distributed diffusion coefficient [DDC], diffusion heterogeneity [α], diffusion kurtosis diffusivity [Dapp], and diffusion kurtosis coefficient [Kapp]) were derived. The diagnostic performance of these parameters for the differentiation of OA and NOA patients were evaluated using receiver operating characteristic analysis. The area under the curve (AUC) was calculated to evaluate the diagnostic accuracy of each parameter. RESULTS All the parameters (ADC, α, DDC, Dapp, and Kapp) values were significantly different between OA and NOA (P < 0.001 for all). For the differentiation of OA from NOA, Kapp showed the highest AUC value (0.965), followed by DDC (0.946), Dapp (0.933), ADC (0.922), and α (0.887). Kapp had a significantly higher AUC than the conventional ADC (P < 0.05). CONCLUSION Parameters derived from multimodels of DWI have the potential for the noninvasive differentiation of OA and NOA. The Kapp value derived from the DKI model might serve as a useful imaging marker for the differentiation of azoospermia.
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Huang Z, Guo Z, Ni J, Zuo M, Zhang T, Ma R, An C, Huang J. Four types of tumor progression after microwave ablation of single hepatocellular carcinoma of ≤5 cm: incidence, risk factors and clinical significance. Int J Hyperthermia 2021; 38:1164-1173. [PMID: 34376111 DOI: 10.1080/02656736.2021.1962548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate the incidence, risk factors and clinical significance of four types of tumor progression (TP) after microwave ablation (MWA) of single hepatocellular carcinoma (HCC) of <5 cm. METHODS The data of 340 treatment-naïve, HCC patients with a single HCC of <5 cm underwent MWA between April 2012 and November 2017 were retrospectively reviewed. TPs including local tumor progression (LTP), intrahepatic distant recurrence (IDR), aggressive intrasegmental recurrence (AIR) and extrahepatic distant recurrence (EDR) were reviewed and compared between BCLC stage 0 and A. Univariate and multivariate analysis were performed on clinicopathological variables and different TPs to identify factors affecting long-term overall survival (OS). RESULTS In a median follow-up period of 25.6 months (range, 3.1-61.4 months), the rate of LTP, IDR, AIR and EDR was 6.2% (21/340), 29.1% (98/340), 3.2% (11/340) and 7.9% (27/340). The four types of TP occurrence rates in BCLC stage 0 were comparable to those in BCLC stage A (p = 0.492, 0.971, 0.681 and 0.219). Univariate analysis showed that age (p < 0.001, hazard ratio [HR] = 2.783), comorbidities (p = 0.042, HR = 1.864), IDR, AIR and EDR (p = 0.027, HR = 1.719; p = 0.001, HR = 3.628; p = 0.009, HR = 2.638) were independently associated with OS. Multivariate analysis showed older age (p < 0.001, HR = 2.478), the occurrence of AIR (p < 0.001, HR = 2.648) and the occurrence of EDR (p = 0.002, HR = 2.222), were associated with poor OS. CONCLUSIONS The occurrence rate of IDR is the highest of all TPs following MWA of a single HCC of <5cm. Old age, AIR and EDR had an adverse effect on long-term OS.
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Affiliation(s)
- Zhimei Huang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhixing Guo
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiayan Ni
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Mengxuan Zuo
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tianqi Zhang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rong Ma
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Chao An
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jinhua Huang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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The Role of Non-Gaussian Models of Diffusion Weighted MRI in Hepatocellular Carcinoma: A Systematic Review. J Clin Med 2021; 10:jcm10122641. [PMID: 34203995 PMCID: PMC8232758 DOI: 10.3390/jcm10122641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
The importance of Diffusion Weighted Imaging (DWI) in hepatocellular carcinoma (HCC) has been widely handled in the literature. Due to the mono-exponential model limitations, several studies recently investigated the role of non-Gaussian DWI models in HCC. However, their results are variable and inconsistent. Therefore, the aim of this systematic review is to summarize current knowledge on non-Gaussian DWI techniques in HCC. A systematic search of the literature, including PubMed, Google Scholar, MEDLINE, and ScienceDirect databases, was performed to identify original articles since 2010 that evaluated the role of non-Gaussian DWI models for HCC diagnosis, grading, response to treatment, and prognosis. Studies were grouped and summarized according to the non-Gaussian DWI models investigated. We focused on the most used non-Gaussian DWI models (Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Stretched Exponential—SE). The quality of included studies was evaluated by using QUADAS-2 and QUIPS tools. Forty-three articles were included, with IVIM and DKI being the most investigated models. Although the role of non-Gaussian DWI models in clinical settings has not fully been established, our findings showed that their parameters may potentially play a role in HCC. Further studies are required to identify a standardized DWI acquisition protocol for HCC diagnosis, grading, response to treatment, and prognosis.
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Zhang AD, Su XH, Wang YF, Shi GF, Han C, Zhang N. Predicting the effects of radiotherapy based on diffusion kurtosis imaging in a xenograft mouse model of esophageal carcinoma. Exp Ther Med 2021; 21:327. [PMID: 33732300 PMCID: PMC7903468 DOI: 10.3892/etm.2021.9758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to assess the predictive value of diffusion kurtosis imaging (DKI) on the effects of radiotherapy in a xenograft model of esophageal cancer. A total of 40 tumor-bearing mice, established by injection of Eca-109 cells in nude mice, were used. The experimental group (n=24) received a single dose of 15 Gy (6 MV by X-ray), and the control group (n=16) did not receive any treatment. Tumor volume, apparent diffusion coefficient (ADC), mean kurtosis (MK) and mean diffusivity (MD) of the two groups were compared, and the expression of aquaporin (AQP) 3 and necrosis ratio at matched time points in xenografts were also observed. There was a significant difference between the two groups from the 7th day of radiotherapy onwards; the xenograft volume of the experimental group was significantly smaller compared with the control group (P<0.05). On the 3rd day, the ADC and MD of the experimental group was significantly higher compared with the control group, and MK was significantly lower compared with the control group (P<0.05). On the 3rd day, AQP3 expression in the experimental group was lower compared with the control group, and the proportion of necrotic cells was higher compared with the control group (P<0.05). Single large fraction dose radiotherapy inhibited the growth of a xenografted esophageal tumor. Changes in ADC, MK and MD were observed prior to morphological changes in the tumor. The change in AQP3 expression and necrosis ratio was in also agreement with the DKI parameters assessed. DKI may thus provide early predictive ability on the effect of radiotherapy in esophageal carcinoma.
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Affiliation(s)
- An-Du Zhang
- Department of Radiotherapy, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Xiao-Hua Su
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Yan-Fei Wang
- Department of CT and MRI, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Gao-Feng Shi
- Department of CT and MRI, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Chun Han
- Department of Radiotherapy, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Nan Zhang
- Department of Radiotherapy, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
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Wang GZ, Guo LF, Gao GH, Li Y, Wang XZ, Yuan ZG. Magnetic Resonance Diffusion Kurtosis Imaging versus Diffusion-Weighted Imaging in Evaluating the Pathological Grade of Hepatocellular Carcinoma. Cancer Manag Res 2020; 12:5147-5158. [PMID: 32636677 PMCID: PMC7334009 DOI: 10.2147/cmar.s254371] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/21/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To investigate the diagnostic efficacy of diffusion kurtosis imaging (DKI) and conventional diffusion-weighted imaging (DWI) for pathological grading. Methods From December 2015 to January 2017, consecutive patients suspected of having hepatocellular carcinoma (HCC) without prior treatment were prospectively enrolled in this study. MRI examinations were performed before surgical treatment. HCC patients confirmed by surgical pathology were included in the study. The mean diffusivity (MD) values, mean kurtosis (MK) values, and apparent diffusion coefficient (ADC) were calculated. The differences and correlations of these parameters among different pathological grades were analyzed. The diagnostic efficiency of DKI and DWI for predicting high-grade HCC was evaluated by receiver operating characteristic (ROC) curves. Logistic regression analyses were used to evaluate the predictive factors for pathological grade. Results A total of 128 patients (79 males and 49 females, age: 56.9±10.9 years, range, 32–80) with primary HCC were included: grade I: 22 (17.2%) patients, grade II: 37 (28.9%) patients, grade III: 43 (33.6%) patients, grade IV: 26 (20.3%) patients. The MK values of stage I, II, III, and IV were 0.86±0.13, 1.06±0.11, 1.27±0.17, and 1.57±0.13, respectively. The MK values were significantly higher in the high-grade group than in the low-grade group and were positively correlated with pathological grade (rho =0.7417, P<0.001). The MK value demonstrated a larger area under the curve (AUC), with a value of 0.93 than the MD value, which had an AUC of 0.815 (P<0.001), and ADC, which had an AUC of 0.662 (P=0.01). The MK value (>1.19), ADC (≤1.29×10–3 mm2/s), and HBV (+) were independent predictors for the pathological grade of HCCs. Conclusion The MK values derived from DKI and the ADC values obtained from traditional DWI were more valuable than the MD values in predicting the histological grade of HCCs and could potentially guide clinical treatment before surgery.
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Affiliation(s)
- Guang-Zhi Wang
- Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China.,Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Weifang 261053, People's Republic of China
| | - Ling-Fei Guo
- Department of MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China
| | - Gui-Hua Gao
- Department of MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China
| | - Yao Li
- Zhucheng People's Hospital Affiliated to Weifang Medical University, Weifang 262200, People's Republic of China
| | - Xi-Zhen Wang
- Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Weifang 261053, People's Republic of China
| | - Zhen-Guo Yuan
- Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China.,Department of MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China
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