The volumetric-tumour histogram-based analysis of intravoxel incoherent motion and non-Gaussian diffusion MRI: association with prognostic factors in HER2-positive breast cancer.
You Chao,Li Jianwei,Zhi Wenxiang,Chen Yanqiong,Yang Wentao,Gu Yajia,Peng Weijun
Journal of translational medicine
BACKGROUND:To evaluate the imaging biomarkers of human epidermal growth factor receptor 2 (HER2) positive breast cancer in comparison to other molecular subtypes and to determine the feasibility of identifying hormone receptor (HR) status and lymph node metastasis status using volumetric-tumour histogram-based analysis through intravoxel incoherent motion (IVIM) and non-Gaussian diffusion. METHODS:This study included 145 breast cancer patients with 148 lesions between January and November in 2018. Among the 148 lesions, 74 were confirmed to be HER2-positive. The volumetric-tumour histogram-based features were extracted from the combined IVIM and non-Gaussian diffusion model. IVIM and non-Gaussian diffusion parameters obtained from images of the subjects with different molecular prognostic biomarker statuses were compared by Student's t test or the Mann-Whitney U test. The area under the curve (AUC), sensitivity, and specificity at the best cut-off point were reported. The Spearman correlation coefficient was calculated to analyse the correlations of clinical tumor nodule metastasis (TNM) stage and Ki67 with the IVIM and non-Gaussian diffusion parameters. RESULTS:The entropy of mean kurtosis (MK) was significantly higher in the HER2-positive group than in the HER2-negative group (p = 0.015), with an AUC of 0.629 (95% CI 0.546, 0.707), a sensitivity of 62.6%, and a specificity of 66.2%. For HR status, the MD 5th percentile was higher in the HR-positive group of HER2-positive breast cancer (p = 0.041), with an AUC of 0.643 (95% CI 0.523, 0.751), while for lymph node status, the entropy of mean diffusivity (MK) was lower in the lymph node positive group (p = 0.040), with an AUC of 0.587 (95% CI 0.504, 0.668). The clinical TNM stage and Ki67 index were correlated with several histogram parameters. CONCLUSION:Volumetric-lesion histogram analysis of IVIM and the non-Gaussian diffusion model can be used to provide prognostic information about HER2-positive breast cancers and potentially contribute to individualized anti-HER2 targeted therapy plans .
10.1186/s12967-019-1911-6
Correlation study between intravoxel incoherent motion MRI and dynamic contrast-enhanced MRI in head and neck squamous cell carcinoma: Evaluation in primary tumors and metastatic nodes.
Marzi Simona,Piludu Francesca,Forina Chiara,Sanguineti Giuseppe,Covello Renato,Spriano Giuseppe,Vidiri Antonello
Magnetic resonance imaging
OBJECTIVE:To correlate intravoxel incoherent motion (IVIM) imaging and dynamic contrast-enhanced (DCE) MRI in head and neck squamous cell carcinoma (HNSCC). METHODS:Forty untreated patients with HNSCC were included retrospectively in the study. Perfusion fraction f, diffusion coefficient D and perfusion-related diffusion coefficient D* were extracted by bi-exponential fitting of IVIM data. Semi-quantitative DCE-MRI parameters, including positive enhancement integral (PEI) and maximum slope of increase (MSI), were calculated. The relationships between all variables were assessed by Spearman's test for correlation. RESULTS:27 primary tumors (PTs) and 23 lymph nodes (LNs) were analyzed. The residual sum of squares (RSS), used to assess the fit quality, was significantly different between PTs and LNs, with the last showing lower values. In LNs, D* and the product D*×f were positively related to both nPEI and nMSI, while no significant correlation was found in PTs. CONCLUSION:Evident relationships between D* and D*×f and DCE-MRI perfusion measurements were found in LNs, while no significant association emerged in PTs. This presumably is due to the poorer agreement between the experimental data and curve fitting for PTs, as compared to LNs. Additional work is warranted to improve the reliability of the IVIM parameter estimations in primary HNSCCs.
10.1016/j.mri.2016.10.004
The prediction of the treatment response of cervical nodes using intravoxel incoherent motion diffusion-weighted imaging.
Marzi Simona,Piludu Francesca,Sanguineti Giuseppe,Marucci Laura,Farneti Alessia,Terrenato Irene,Pellini Raul,Benevolo Maria,Covello Renato,Vidiri Antonello
European journal of radiology
PURPOSE:To investigate the predictive role of Intravoxel Incoherent Motion Diffusion-Weighted Imaging (IVIM-DWI) parameters on cervical nodal response to chemo-radiotherapy (CRT) of head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS:Patients with pathologically confirmed HNSCC were included in the present prospective study, having at least one positive cervical lymph node (LN). They received concomitant CRT and underwent three serial IVIM-DWI investigations: before, at mid-treatment and after treatment completion. Tissue diffusion coefficient D, perfusion-related diffusion coefficient D* and perfusion fraction f were calculated by a bi-exponential fit. The two-sided Mann-Whitney rank test was used to compare the imaging parameters of patients with regional failure (RF) and regional control (RC). A p value lower than 0.05 was considered to be statistically significant. RESULTS:Thirty-four patients were accrued. Twenty-four out of 34 LN (70.6%) showed persistent RC after a median follow-up time of 27.6 months (range: 12.0-50.2 months), while ten cases of RF (29.4%) were confirmed with a median time of 6.8 months (range: 1.5-19.5 months). Patients with RC showed significantly lower pre-treatment D values compared to the RF patients (p=0.038). At mid-treatment, the patients with RF showed significantly higher D values (p=0.025), and exhibited larger percent reductions in f and the product D*×f from the baseline (p=0.008 and <0.001, respectively). No additional information was provided by the examination at the end of treatment. CONCLUSION:Pre-treatment and mid-treatment IVIM-DWI showed potential for prediction of treatment response of cervical LN in HNSCC patients.
10.1016/j.ejrad.2017.05.002
Role of quantitative intravoxel incoherent motion parameters in the preoperative diagnosis of nodal metastasis in patients with rectal carcinoma.
Qiu Lin,Liu Xiao-Ling,Liu Si-Run,Weng Ze-Ping,Chen Xiao-Qiao,Feng You-Zhen,Cai Xiang-Ran,Guo Chang-Yu
Journal of magnetic resonance imaging : JMRI
PURPOSE:To evaluate the diagnostic value of intravoxel incoherent motion imaging (IVIM) in differentiating metastatic and nonmetastatic lymph nodes in patients with rectal carcinoma. MATERIALS AND METHODS:In all, 68 patients with histologically proven rectal carcinoma underwent an IVIM sequence (b = 0, 25, 50, 75, 100, 150, 200, 400, 600, 800, 1000, 1200, 1500, and 2000 s/mm(2) ) on a 3.0T MRI scanner. The IVIM parameters (D, D*, f, and apparent diffusion coefficient [ADC] values) in metastatic and nonmetastatic lymph nodes were measured and calculated. Receiver-operating characteristic (ROC) analyses were conducted to determine the optimal thresholds, the sensitivities, and specificities for differentiation. RESULTS:Mean D, f, and ADC values of metastatic lymph nodes were significantly greater than those of the normal lymph nodes (P < 0.01), whereas the mean D* value of metastatic lymph node was statistically lower (P = 0.03). The AUC, sensitivity, specificity, and the cutoff value, respectively, for differentiating metastatic from nonmetastatic lymph nodes for D, D*, f, and ADC were as follows: D, 0.9460, 89.25%, 91.04%, and 1.14 × 10(-3) mm(2) /s; D*, 0.6930, 64.18%, 82.80%, and 7.02 × 10(-3) mm(2) /s; f, 0.7810, 92.47%, 55.22%, and 0.27%; ADC, 0.8970, 87.10%, 88.06%, and 0.80 × 10(-3) mm(2) /s. The ROC curves demonstrated that the area under the ROC (AUC) of the D, ADC, f, and D* values successively decreased, and D had the highest AUC, with D* values being lowest. CONCLUSION:An IVIM sequence may be helpful in diagnosing metastatic lymph nodes of rectal carcinoma. Average D and ADC values are more sensitive than f and D* values in this differentiation. J. MAGN. RESON. IMAGING 2016;44:1031-1039.
10.1002/jmri.25250
Magnetic resonance imaging features for predicting axillary lymph node metastasis in patients with breast cancer.
Zhao Ming,Wu Qiong,Guo Lili,Zhou Li,Fu Kuang
European journal of radiology
PURPOSE:The purpose of this study was to assess the clinical value of conventional magnetic resonance imaging (MRI) and intravoxel incoherent motion (IVIM) features for predicting the risk of axillary lymph node (ALN) metastasis in patients with breast cancer. METHODS:This retrospective study involved 265 patients with breast cancer who underwent 3.0 T breast magnetic resonance imaging examinations prior to surgery and other treatment. Of these, 119 underwent IVIM examination. The features of MRI and IVIM and postoperative pathologic results were collected. The association of MRI features of breast cancer with ALN metastasis were determined by univariate and multivariate analyses. Comparison of IVIM parameters between breast cancer patients with and without ALN metastasis was performed using the Mann-Whitney U test. RESULTS:Among the 265 patients, 144 (54.3%) had ALN metastasis, and 121 (45.7%) did not. The size and shape of the tumours, T2WI signal, inhomogeneous enhancement, washout intensity-time curves and the values of slow ADC, fast ADC and fraction of fast ADC parameters were significantly associated with ALN metastasis. The AUC of conventional MRI for diagnosing axillary lymph node metastasis was 0.722. The AUC of MRI combined with slow ADC, fast ADC and fraction of fast ADC parameters that were used to diagnose breast cancer with ALN metastasis were 0.814, 0.803 and 0.900, respectively. CONCLUSIONS:The features of IVIM parameters and conventional MRI can be used to predict the ALN metastasis in patients with breast cancer. MRI combined with fraction of fast ADC showed higher diagnostic efficiency for ALN metastasis in breast cancer than MRI did.
10.1016/j.ejrad.2020.109093
Non-invasive MR assessment of the microstructure and microcirculation in regional lymph nodes for rectal cancer: a study of intravoxel incoherent motion imaging.
Yang Xinyue,Chen Yan,Wen Ziqiang,Liu Yiyan,Xiao Xiaojuan,Liang Wen,Yu Shenping
Cancer imaging : the official publication of the International Cancer Imaging Society
BACKGROUND:The aim of this study is to evaluate the microstructure and microcirculation of regional lymph nodes (LNs) in rectal cancer by using non-invasive intravoxel incoherent motion MRI (IVIM-MRI), and to distinguish metastatic from non-metastatic LNs by quantitative parameters. METHODS:All recruited patients underwent IVIM-MRI (b = 0, 5, 10, 20, 30, 40, 60, 80, 100, 150, 200, 400, 600, 1000, 1500 and 2000 s/mm) on a 3.0 T MRI system. One hundred sixty-eight regional LNs with a short-axis diameter equal to or greater than 5 mm from 116 patients were evaluated by two radiologists independently, including 78 malignant LNs and 90 benign LNs. The following parameters were assessed: the short-axis diameter (S), long-axis diameter (L), short- to long-axis diameter ratio (S/L), pure diffusion coefficient (D), pseudo-diffusion coefficient (D), and perfusion factor (f). Intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement between two readers. Receiver operating characteristic curves were applied for analyzing statistically significant parameters. RESULTS:Interobserver agreement of IVIM-MRI parameters between two readers was excellent (ICCs> 0.75). The metastatic group exhibited higher S, L and D (P < 0.001), but lower f (P < 0.001) than the non-metastatic group. The area under the curve (95% CI, sensitivity, specificity) of the multi-parameter combined equation for D, f and S was 0.811 (0.744~0.868, 62.82%, 87.78%). The diagnostic performance of the multi-parameter model was better than that of an individual parameter (P < 0.05). CONCLUSION:IVIM-MRI parameters provided information about the microstructure and microcirculation of regional LNs in rectal cancer, also improved diagnostic performance in identifying metastatic LNs.
10.1186/s40644-019-0255-z
Application of Intravoxel Incoherent Motion (IVIM) Model for Differentiation Between Metastatic and Non-Metastatic Head and Neck Lymph Nodes.
Hejduk Beata,Bobek-Billewicz Barbara,Rutkowski Tomasz,Hebda Anna,Zawadzka Agata,Jurkowski Marek K
Polish journal of radiology
BACKGROUND:Application of intravoxel incoherent motion (IVIM) model parameters, including: true diffusion (D), pseudodiffusion (D*), and perfusion fraction (F), for differentiation between metastatic and non-metastatic head and neck lymph nodes. MATERIAL/METHODS:Diffusion-weighted images/apparent diffusion coefficient (DWI/ADC) images of 86 lymph nodes from 31 cancer patients were analyzed. DWI images were obtained with a 1.5T MRI scanner (Magnetom Avanto); b=0,50, 150, 300, 500, 750, 1000, 1200 s/mm. RESULTS:In the study group, there were 32 (37%) and 54 (67%) metastatic and non-metastatic lymph nodes, respectively. The mean values of D, D*, and F did not differ significantly between metastatic and non-metastatic lymph nodes. CONCLUSIONS:IVIM parameters are not useful for differentiation between metastatic and non-metastatic head and neck lymph nodes.
10.12659/PJR.902275
Lymph node metastasis in head and neck squamous carcinoma: Efficacy of intravoxel incoherent motion magnetic resonance imaging for the differential diagnosis.
Liang Long,Luo Xiaoning,Lian Zhouyang,Chen Wenbo,Zhang Bin,Dong Yuhao,Liang Changhong,Zhang Shuixing
European journal of radiology
PURPOSE:To evaluate the value of pure molecular diffusion(D), perfusion-related diffusion (D*), perfusion fraction (f) and apparent diffusion coefficient (ADC) based on intravoxel incoherent motion (IVIM) theory for differential diagnosis of metastatic lymph nodes (LNs) in head and neck squamous cell carcinoma(HNSCC). MATERIALS AND METHODS:29 patients with HNSCC and 20 patients with lymph node hyperplasia (LNH) were enrolled in this retrospective study, underwent magnetic resonance (MR) examination. IVIM Diffusion-weighted imaging (IVIM-DWI) was performed with 13 b values. D, D*, f and ADC values were compared between two groups. The diagnostic value of ADC, D, D* and D·D* value were evaluated by Receiver operating characteristic (ROC) curve. Two radiologists measured D, D*, f and ADC values independently. RESULTS:33 malignant LNs in HNSCC group and 22 benign LNs in LNH group (minimum diameter, ≥5mm) were successfully examined, ADC(P<0.05), D (P<0.01) and f (P<0.01) were significantly lower in malignant LNs than that in benign LNs, whereas D* was significantly higher (P<0.01). The area under the ROC curve (AUC) for D·D* was 0.983 and was larger than that for D* (0.952), D (0.78) and ADC (0.67). CONCLUSION:Our results indicate that IVIM DWI is feasible in the diagnosis of LN metastasis. D was significantly decreased in malignant LNs reflected increased nuclear-to-cytoplasmic ratio tissue, and D* was significantly increased reflected increased blood vessel generation and parenchymal perfusion in malignant LNs.
10.1016/j.ejrad.2017.02.039
Value of intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic from nonmetastatic mesorectal lymph nodes with different short-axis diameters in rectal cancer.
Journal of cancer research and therapeutics
BACKGROUND:Conventional magnetic resonance imaging (MRI) does not accurately evaluate lymph node (LN) status, which is essential for the treatment and prognosis assessment in patients with rectal cancer. OBJECTIVE:The aim of this study is to evaluate the diagnostic value of intravoxel incoherent motion (IVIM) MRI in differentiating metastatic and nonmetastatic mesorectal LNs with different short-axis diameters in rectal cancer patients. MATERIALS AND METHODS:Forty patients (154 LNs) were divided into three groups based on short-axis diameter: 3 mm ≤ × ≤5 mm, 5 mm < × ≤7 mm, and × >7 mm. MRI characteristics and IVIM parameters were compared between the metastatic and nonmetastatic LNs to determine the diagnostic value for discriminating them. RESULTS:In the 3 mm ≤ × ≤ 5 mm group, mean D values were significantly lower in metastatic than in the nonmetastatic LNs (P < 0.001). In the 5 mm < × ≤7 mm group, mean f values were significantly lower in metastatic than nonmetastatic LNs (P < 0.05). In the × >7 mm group, only the short-axis diameter of metastatic LNs was significantly greater than that of nonmetastatic LNs (P < 0.05). The area under the curve, sensitivity, specificity, and cutoff values were used for differentiating the metastatic from the nonmetastatic LNs. CONCLUSION:IVIM parameters can differentiate metastatic from nonmetastatic LNs with smaller short-axis diameters (× ≤7 mm) in rectal cancer, and the short-axis diameter is a significant factor in identifying metastatic and nonmetastatic LNs in larger short-axis diameter groups (× >7 mm).
10.4103/jcrt.JCRT_76_19
Discrimination between Metastatic and Nonmetastatic Mesorectal Lymph Nodes in Rectal Cancer Using Intravoxel Incoherent Motion Diffusion-weighted Magnetic Resonance Imaging.
Yu Xiao-ping,Wen Lu,Hou Jing,Bi Feng,Hu Pingsheng,Wang Hui,Wang Wei
Academic radiology
RATIONALE AND OBJECTIVES:The aim of the study was to investigate the diagnostic value of intravoxel incoherent motion diffusion-weighted magnetic resonance imaging (IVIM DWI) for discriminating nonmetastatic from metastatic mesorectal lymph nodes in rectal cancer. MATERIALS AND METHODS:IVIM DWI was performed preoperatively on 50 patients with rectal carcinoma. The short-axis diameter, short- to long-axis diameter ratio, and IVIM-based parameter (pure diffusion coefficient [D], pseudo-diffusion coefficient [D*] and perfusion fraction [f]) values were compared between the metastatic and nonmetastatic lymph node groups. RESULTS:The short-axis diameter; short- to long-axis diameter ratio; and D, D*, and f values for the nonmetastatic lymph node group (n = 28) were 6.446 ± 1.201 mm, 0.815 ± 0.099, 1.071 ± 0.234 × 10(-3) mm(2)/s, 15.443 ± 5.946 mm(2)/s and 0.261 ± 0.128, respectively, and were 9.045 ± 3.185 mm, 0.809 ± 0.099, 0.816 ± 0.121 × 10(-3) mm(2)/s, 11.679 ± 7.521 × 10(-3) mm(2)/s, and 0.190 ± 0.064, respectively, for the metastatic lymph node group (n = 31). The short-axis diameter for the metastatic group was significantly higher than for the nonmetastatic group (P <0.001). The metastatic group exhibited significantly lower D and D* values than the nonmetastatic group (P <0.01). The short- to long-axis diameter ratio and f values did not differ significantly between the two groups. Optimal cutoff values (area under the curve, sensitivity, and specificity) for distinguishing metastatic from nonmetastatic lymph nodes were as follows: short-axis diameter = 5.563 mm (0.783, 74.2%, 82.1%); D = 0.667 × 10(-3) mm(2)/s (0.885, 77.4%, 89.3%); and D* = 0.485 × 10(-3) mm(2)/s (0.727, 80.6%, 67.9%). CONCLUSION:IVIM DWI is useful to differentiate between metastatic and nonmetastatic mesorectal lymph nodes in rectal cancer.
10.1016/j.acra.2015.12.013
A preliminary exploration of the intravoxel incoherent motion applied in the preoperative evaluation of mediastinal lymph node metastasis of lung cancer.
Ye Xin,Chen Shuo,Tian Yaru,You Bin,Zhang Wenqian,Zhao Yan,Jiang Tao,Hu Bin,Li Hui
Journal of thoracic disease
BACKGROUND:The aim of this study was to investigate the diagnostic value of the intravoxel incoherent motion (IVIM) for distinguishing non-metastatic from metastatic mediastinal lymph nodes in lung cancer. METHODS:IVIM-diffusion weighted imaging (DWI) exams were performed preoperatively on 66 patients with lung cancer from October 2015 to June 2016 in Beijing Chao-Yang Hospital, Capital Medical University. Fifty patients underwent enhanced chest computed tomography (CT) in our hospital, while the other 16 patients already had enhanced chest CT images when they were admitted. The patients' complete preoperative examination included chest magnetic resonance imaging (MRI), enhanced chest CT, head MRI, bone scanning and cardiopulmonary function testing. None of the patients were receiving any treatment for their cancer prior to their evaluation and surgery, including neoadjuvant chemotherapy, radiation therapy, immunotherapy or gene targeted therapy. The following IVIM parameters of the mediastinal lymph nodes were measured: the short axis diameter, apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f). All of the patients underwent lobectomy and lymph node dissection. We compared the CT and MRI results and analysed the IVIM parameters of the pathologically determined non-metastatic and metastatic mediastinal lymph nodes in our 50 patients to generate the ROC curves and determine the best cut-off value for diagnosis. The remaining 16 patients' IVIM parameters were used to verify the diagnostic cut-off value. This study was approved by the institutional research ethics committee of Beijing Chao-Yang Hospital (2014-S-166), and all the patients signed the MRI informed consent. RESULTS:In this study, MRI was used to measure 140 groups of mediastinal lymph nodes in 50 cases, and the results showed that 19 groups of mediastinal lymph nodes were metastatic, while 121 groups of mediastinal lymph nodes were non-metastatic. The pathological analysis showed that 20 groups of mediastinal lymph nodes were metastatic and 120 groups of mediastinal lymph nodes were non-metastatic. CT was used to measure 273 groups of mediastinal lymph nodes, and the result showed that 34 groups of mediastinal lymph nodes were metastatic, while 239 groups of mediastinal lymph nodes were non-metastatic. The pathological analysis showed that 20 groups of mediastinal lymph nodes were metastatic and 253 groups of mediastinal lymph nodes were non-metastatic. The ADC, D, D*, f values and the short axis diameters of the non-metastatic lymph nodes (n=121) were 2.9370±0.743×10, 0.533±0.175×10, 0.384±0.121×10 mm/s, 0.426±0.120, 6.903±1.831 mm, respectively, and 1.863±0.691×10, 0.454±0.204×10, 0.358±0.106×10 mm/s, 0.413±0.085, 7.705±2.213 mm, respectively, for the metastatic lymph nodes (n=19). The ADC and D values of the non-metastatic lymph nodes were significantly higher than the values for the metastatic lymph nodes (P<0.01); the other parameters (D*, f, and short axis diameter) did not show significantly different results between the two groups. The optimal cut-off values [area under the curve (AUC), sensitivity, and specificity] for distinguishing metastatic from non-metastatic lymph nodes were as follows: ADC =1.890×10 mm/s (0.897, 93.3%, 80.0%), Youden index 0.733; and D =0.344×10 mm/s (0.651, 90.8%, 50.0%), Youden index 0.651. When these cut-off values were applied as the diagnostic criteria in the remaining cases and compared with the pathology results, the diagnostic performance was good. CONCLUSIONS:IVIM is useful to distinguish metastatic from non-metastatic lymph nodes in lung cancer. The ADC and the D values are significantly lower in metastatic lymph nodes, making these parameters more sensitive than the other parameters (D*, f, and short axis diameter). As a result, IVIM can be used in the N-stage diagnosis of lung cancer.
10.21037/jtd.2017.03.110
Prediction of treatment response in head and neck carcinomas using IVIM-DWI: Evaluation of lymph node metastasis.
Hauser Thomas,Essig Marco,Jensen Alexandra,Laun Frederik B,Münter Marc,Maier-Hein Klaus H,Stieltjes Bram
European journal of radiology
PURPOSE:To obtain diffusion and microperfusion measures in lymph node metastases of head and neck squamous cell carcinomas (HNSCC) using intravoxel incoherent motion (IVIM) imaging. The obtained IVIM parameters were used to characterize lymph nodes in the staging phase and longitudinal follow-up was performed to evaluate the potential predictive value of these parameters considering therapy response. METHODS:Fifteen patients with lymph node metastases of histologically confirmed locally advanced HNSCC were examined using diffusion weighted imaging (DWI) before a nonsurgical organ preserving therapy. DWI imaging was performed at 3T using eight different b-values ranging from 0 to 800s/mm(2). Using the IVIM-approach, the perfusion fraction f and the diffusion coefficient D were extracted using a biexponential fit. A follow-up period of 13.5 months was available for all patients. One patient with a macroscopically necrotic lymph node was excluded from analyses. A region of interest (ROI)-analysis was performed in all patients. RESULTS:Locoregional failure (LRF) was present in 3 of 15 patients within 13.5 months follow-up. The initial f-value was significantly higher (p=0.01) in patients with LRF (14.5±0.6% vs. 7.7±2.6%) compared to patients with locoregional control (LRC). The initial diffusion coefficient D did not differ significantly (p=0.30) between the two groups (0.97±0.15×10(-3)mm(2)/s vs. 0.88±0.13×10(-3)mm(2)/s). CONCLUSIONS:Our results indicate that a high initial perfusion fraction f in lymph nodes may predict poor treatment response in patients with HNSCC due to locoregional failure.
10.1016/j.ejrad.2014.02.013
Higher-order diffusion MRI characterization of mesorectal lymph nodes in rectal cancer.
Ianuş Andrada,Santiago Ines,Galzerano Antonio,Montesinos Paula,Loução Nuno,Sanchez-Gonzalez Javier,Alexander Daniel C,Matos Celso,Shemesh Noam
Magnetic resonance in medicine
PURPOSE:Mesorectal lymph node staging plays an important role in treatment decision making. Here, we explore the benefit of higher-order diffusion MRI models accounting for non-Gaussian diffusion effects to classify mesorectal lymph nodes both 1) ex vivo at ultrahigh field correlated with histology and 2) in vivo in a clinical scanner upon patient staging. METHODS:The preclinical investigation included 54 mesorectal lymph nodes, which were scanned at 16.4 T with an extensive diffusion MRI acquisition. Eight diffusion models were compared in terms of goodness of fit, lymph node classification ability, and histology correlation. In the clinical part of this study, 10 rectal cancer patients were scanned with diffusion MRI at 1.5 T, and 72 lymph nodes were analyzed with Apparent Diffusion Coefficient (ADC), Intravoxel Incoherent Motion (IVIM), Kurtosis, and IVIM-Kurtosis. RESULTS:Compartment models including restricted and anisotropic diffusion improved the preclinical data fit, as well as the lymph node classification, compared to standard ADC. The comparison with histology revealed only moderate correlations, and the highest values were observed between diffusion anisotropy metrics and cell area fraction. In the clinical study, the diffusivity from IVIM-Kurtosis was the only metric showing significant differences between benign (0.80 ± 0.30 μm /ms) and malignant (1.02 ± 0.41 μm /ms, P = .03) nodes. IVIM-Kurtosis also yielded the largest area under the receiver operating characteristic curve (0.73) and significantly improved the node differentiation when added to the standard visual analysis by experts based on T -weighted imaging. CONCLUSION:Higher-order diffusion MRI models perform better than standard ADC and may be of added value for mesorectal lymph node classification in rectal cancer patients.
10.1002/mrm.28102
Discrimination of Malignant versus Benign Mediastinal Lymph Nodes Using Diffusion MRI with an IVIM Model.
Qi Li-Ping,Yan Wan-Pu,Chen Ke-Neng,Zhong Zheng,Li Xiao-Ting,Cai Kejia,Sun Ying-Shi,Zhou Xiaohong Joe
European radiology
OBJECTIVES:To investigate the value of an intravoxel incoherent motion (IVIM) diffusion model for discriminating malignant versus benign mediastinal lymph nodes (MLN). METHODS:Thirty-five subjects with enlarged MLN were scanned at 1.5 Tesla. Diffusion-weighted imaging was performed with eight b-values. IVIM parameters D, D*, and f, as well as apparent diffusion coefficient (ADC) from a mono-exponential model were obtained. 91 nodes (49 malignant and 42 benign) were analysed with pathologic (n=90) or radiologic (n=1) confirmations. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance. RESULTS:The mean values of D, ADC, and f for the malignant group were significantly lower than those for the benign group (p<0.001), while D* showed no significant difference (p=0.281). In the ROC analysis, the combination of D and f produced the largest area under the curve (0.953) compared to ADC or other individual IVIM parameters, leading to the best specificity (92.9%) and diagnostic accuracy (90.1%). CONCLUSION:This study demonstrates that the combination of IVIM parameters can improve differentiation between malignant and benign MLN as compared to using ADC alone. KEY POINTS:• Diffusion MRI is useful for non-invasively discriminating malignant versus benign lymph nodes. • A mono-exponential model is not adequate to characterise diffusion process in lymph nodes. • IVIM model is advantageous over mono-exponential model for assessing lymph node malignancy. • Combination of IVIM parameters improves differentiation of malignant versus benign lymph nodes.
10.1007/s00330-017-5049-8
Preoperative evaluation of pelvine lymph node metastasis in high risk prostate cancer with intravoxel incoherent motion (IVIM) MRI.
Sauer Markus,Klene Christiane,Kaul Michael,Quitzke Azien,Avanesov Maxim,Behzadi Cyrus,Budäus Lars,Beyersdorff Dirk,Adam Gerhard,Regier Marc
European journal of radiology
OBJECTIVES:To evaluate benign and malignant pelvine lymph nodes in prostate cancer patients with biexponential intravoxel incoherent motion (IVIM) MRI of the prostate prior to radical prostatectomy. METHODS:The ethics committee approved this retrospective study with waiver of informed consent. From February 2012 to November 2013 43 patients with histopathologically proven prostatic cancer were included. All patients were examined applying a standardized MRI protocol including IVIM diffusion weighted imaging with multiple b-values ranging from 0 to 950 s/mm². MR imaging was performed one day prior to radical prostatectomy. Thereafter, extended lymph node resection was performed. For each MRI all visible lymph nodes were registered and calculated as individual regions of interest. These findings were correlated with postoperative pathology. The apparent diffusion coefficient ADC, the diffusion coefficient D and the perfusion fraction f were calculated from IVIM DWI using a biexponential fit. RESULTS:A total of 120 lymph nodes were detected on MRI. 95 of these were determined as benign and 25 as malignant. The average ADC was significantly lower in malignant compared to benign lymph nodes (0.88 × 10 vs 1.67 × 10 mm²/s, p < 0.001). Likewise, the average diffusion coefficient D was significantly lower in lymph node metastasis (0.54 × 10 vs 1.10 × 10 mm²/s, p < .001). The signal rate due to perfusion was significantly higher in malignant compared to benign nodes (33.4% vs. 27.1%, p = 0.02). CONCLUSIONS:Applying biexponential IVIM MRI demonstrates significant differences in diffusion parameters ADC and D, as well as in the perfusion fraction f for benign and malignant lymph nodes. Therefore, IVIM might help to further improve the preoperative assessment of lymph nodes in MRI.
10.1016/j.ejrad.2018.07.029