Application of non-Gaussian water diffusional kurtosis imaging in the assessment of uterine tumors: A preliminary study

Abstract

ObjectivesTo evaluate the interobserver reliability and value of diffusional kurtosis imaging (DKI) in the assessment of uterine tumors compared with those of conventional diffusion-weighted imaging (DWI).MethodsThis retrospective study was approved by our institutional review board, which waived the requirement for informed consent. Fifty-eight women (mean age: 55.0 ± 13.6 years; range: 30–89 years) with suspected malignant uterine tumors underwent 3-T magnetic resonance imaging using DKI and DWI. Twelve had coexisting leiomyoma. Two observers analyzed region-of-interest measurements of diffusivity (D), kurtosis (K), and the apparent diffusion coefficient (ADC) of uterine lesions and healthy adjacent tissues. Interobserver agreement was evaluated using the intra-class correlation coefficient (ICC). The mean values were compared using one-way analysis of variance with a post-hoc Tukey’s honestly significant difference test. The diagnostic accuracy of D and ADC in differentiating malignant tumors from benign leiomyomas was analyzed using receiver operating characteristic (ROC) analysis.ResultsThe ICCs between the two observers in evaluating D, K, and the ADC of the malignant tumors were higher than 0.84, suggesting excellent interobserver agreements. The mean D (×10−3 mm2/s) of uterine cancers (1.05 ± 0.41 and 1.09 ± 0.40 for observers 1 and 2, respectively) were significantly lower than those of leiomyoma (1.40 ± 0.37 and 1.56 ± 0.33, respectively; P < 0.05), healthy myometrium (1.72 ± 0.27 and 1.69 ± 0.30, respectively; P < 0.001), and healthy endometrium (1.53 ± 0.35 and 1.42 ± 0.37, respectively; P < 0.005). There was no significant difference in the area under the ROC curve between D and ADC. The mean K of uterine cancers (0.88 ± 0.28 and 0.90 ± 0.23, respectively) were higher than those of myometrium (0.72 ± 0.10 and 0.73 ± 0.10, respectively; P < 0.001), healthy endometrium (0.65 ± 0.13 and 0.60 ± 0.18, respectively; P < 0.001), and leiomyoma (0.76 ± 0.14 and 0.77 ± 0.16, respectively; not significant, P > 0.1).ConclusionsInterobserver agreements in evaluating D, K, and ADC were moderate to excellent. D performed equally to conventional DWI in differentiating between benign and malignant uterine lesions. The mean K of malignant uterine lesions was significantly higher than that of non-tumorous myometrium or endometrium.

3.0 T MRI IVIM-DWI for predicting the efficacy of neoadjuvant chemoradiation for locally advanced rectal cancer

“…DWI and its quantitative parameter ADC, which reflects the spread of rectal cancer, were widely studied by researcher at home and abroad due to their value of predicting and evaluating the curative effect of nCRT for colorectal cancer, but the results are not accepted by everyone. However, in fact, the free motion of water molecules in the human body is affected by many factors and is a non-Gaussian motion, so the ADC value cannot reflect the diffusion of water molecules truly [ 10 ]. Some researchers have proposed a more scientific intravoxel incoherent motion model to supplement it [ 11 – 13 ].…”

Intravoxel incoherent motion diffusion-weighted imaging for early assessment of combined anti-angiogenic/chemotherapy for colorectal cancer liver metastases

“…The DWI technique can non-invasively detect the diffusion of water molecules and indirectly reflect the microstructural changes of tissues and organs by measuring the apparent diffusion coefficient (ADC) value. The water molecule motion in the tissue, however, is not a simple diffusion, but is limited by the tissue barrier and the incoherent motion produced by blood perfusion, so that the actual measured ADC value is greater than the real diffusion value and fails to accurately reflect water molecule diffusion in the tumor tissue (24). Intravoxel incoherent motion DWI (IVIM-DWI), first proposed by Le Bihan et al in 1986 (25), is an imaging technique that provides quantitative parameters of water molecular motion while reflecting tissue perfusion, so as to more comprehensively analyze tissue diffusion imaging parameters and reveal pathophysiological changes in tumor tissues.…”