Intravoxel Incoherent Motion–derived Histogram Metrics for Assessment of Response after Combined Chemotherapy and Radiation Therapy in Rectal Cancer: Initial Experience and Comparison between Single-Section and Volumetric Analyses

Nougaret, Stéphanie; Vargas, Hebert Alberto; Lakhman, Yulia; Sudre, Romain; Richard, K. G.; Bibeau, Frédéric; Azria, D.; Assenat, Éric; Molinari, Nicolas; Pierredon, Marie-Ange; Rouanet, Philippe; Guiu, Boris

doi:10.1148/radiol.2016150702

Cited by 138 publications

(126 citation statements)

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“…suggested that clinical research should focus on slow-ADC within tissues and ignore the perfusion effect, thus to increase the clinical utility of IVIM in diagnosis, prognosis or treatment response. This issue was also confirmed by Nougaret et al 27,. who thought that slow-ADC value was better than ADC value derived from the mono-exponential model in assessing rectal cancer response to CRT.…”

Section: Discussionsupporting

confidence: 74%

“…The AUC of fast-ADC was smaller than that of slow-ADC, which demonstrated the lower diagnostic efficiency of fast-ADC in the discriminating malignant lesions and normal tissue. A recent study27 about rectal cancer indicated that fast-ADC and f value were not useful for assessing tumor response to CRT (combined chemotherapy and radiation therapy), which was explained by the poor reproducibility and high uncertainty of fast-ADC and f value19282930. These imperfections would limit the clinical utility of IVIM3132333435.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of non-Gaussian and Gaussian diffusion models of diffusion weighted imaging of rectal cancer at 3.0 T MRI

Zhang

Wang

Wen

et al. 2016

Sci Rep

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Water molecular diffusion in vivo tissue is much more complicated. We aimed to compare non-Gaussian diffusion models of diffusion-weighted imaging (DWI) including intra-voxel incoherent motion (IVIM), stretched-exponential model (SEM) and Gaussian diffusion model at 3.0 T MRI in patients with rectal cancer, and to determine the optimal model for investigating the water diffusion properties and characterization of rectal carcinoma. Fifty-nine consecutive patients with pathologically confirmed rectal adenocarcinoma underwent DWI with 16 b-values at a 3.0 T MRI system. DWI signals were fitted to the mono-exponential and non-Gaussian diffusion models (IVIM-mono, IVIM-bi and SEM) on primary tumor and adjacent normal rectal tissue. Parameters of standard apparent diffusion coefficient (ADC), slow- and fast-ADC, fraction of fast ADC (f), α value and distributed diffusion coefficient (DDC) were generated and compared between the tumor and normal tissues. The SEM exhibited the best fitting results of actual DWI signal in rectal cancer and the normal rectal wall (R2 = 0.998, 0.999 respectively). The DDC achieved relatively high area under the curve (AUC = 0.980) in differentiating tumor from normal rectal wall. Non-Gaussian diffusion models could assess tissue properties more accurately than the ADC derived Gaussian diffusion model. SEM may be used as a potential optimal model for characterization of rectal cancer.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Comparison of non-Gaussian and Gaussian diffusion models of diffusion weighted imaging of rectal cancer at 3.0 T MRI

Zhang

Wang

Wen

et al. 2016

Sci Rep

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“…However, the placing of a single ROI on a representative tumor image can lead to sampling bias and not provide accurate representation of the tumor heterogeneity 18, 19. Alternatively, a whole‐tumor ROI approach has been shown to largely reduce the sampling bias and to produce excellent interobserver agreement compared to single‐slice ROI analysis 20. Such an approach was also used in a study of Wilms' tumors, which was able to identify distinct cellular regions based on ADC histograms, and to determine the predominant histological cell types 21.…”

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confidence: 99%

Diffusion‐weighted MRI and intravoxel incoherent motion model for diagnosis of pediatric solid abdominal tumors

Meeus

Zarinabad

Manias

et al. 2017

Magnetic Resonance Imaging

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BackgroundPediatric retroperitoneal tumors in the renal bed are often large and heterogeneous, and their diagnosis based on conventional imaging alone is not possible. More advanced imaging methods, such as diffusion‐weighted (DW) MRI and the use of intravoxel incoherent motion (IVIM), have the potential to provide additional biomarkers that could facilitate their noninvasive diagnosis.PurposeTo assess the use of an IVIM model for diagnosis of childhood malignant abdominal tumors and discrimination of benign from malignant lesions.Study TypeRetrospective.PopulationForty‐two pediatric patients with abdominal lesions (n = 32 malignant, n = 10 benign), verified by histopathology.Field Strength/Sequence1.5T MRI system and a DW‐MRI sequence with six b‐values (0, 50, 100, 150, 600, 1000 s/mm2).AssessmentParameter maps of apparent diffusion coefficient (ADC), and IVIM maps of slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion fraction (f) were computed using a segmented fitting model. Histograms were constructed for whole‐tumor regions of each parameter.Statistical TestsComparison of histogram parameters of and their diagnostic performance was determined using Kruskal–Wallis, Mann–Whitney U, and receiver‐operating characteristic (ROC) analysis.ResultsIVIM parameters D* and f were significantly higher in neuroblastoma compared to Wilms' tumors (P < 0.05). The ROC analysis showed that the best diagnostic performance was achieved with D* 90th percentile (area under the curve [AUC] = 0.935; P = 0.002; cutoff value = 32,376 × 10−6 mm2/s) and f mean values (AUC = 1.00; P < 0.001; cutoff value = 14.7) in discriminating between neuroblastoma (n = 11) and Wilms' tumors (n = 8). Discrimination between tumor types was not possible with IVIM D or ADC parameters. Malignant tumors revealed significantly lower ADC, D, and higher D* values than in benign lesions (all P < 0.05).Data ConclusionIVIM perfusion parameters could distinguish between malignant childhood tumor types, providing potential imaging biomarkers for their diagnosis. Level of Evidence: 4 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2018;47:1475–1486.

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“…The latter approach is most commonly advocated and has been shown to provide the most reproducible results [18, 19]. As such, it is now considered more or less the standard reference method of choice to acquire tumor ADC measurements.…”

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confidence: 99%

Measuring the apparent diffusion coefficient in primary rectal tumors: is there a benefit in performing histogram analyses?

et al. 2017

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PurposeThe apparent diffusion coefficient (ADC) is a potential prognostic imaging marker in rectal cancer. Typically, mean ADC values are used, derived from precise manual whole-volume tumor delineations by experts. The aim was first to explore whether non-precise circular delineation combined with histogram analysis can be a less cumbersome alternative to acquire similar ADC measurements and second to explore whether histogram analyses provide additional prognostic information.MethodsThirty-seven patients who underwent a primary staging MRI including diffusion-weighted imaging (DWI; b0, 25, 50, 100, 500, 1000; 1.5 T) were included. Volumes-of-interest (VOIs) were drawn on b1000-DWI: (a) precise delineation, manually tracing tumor boundaries (2 expert readers), and (b) non-precise delineation, drawing circular VOIs with a wide margin around the tumor (2 non-experts). Mean ADC and histogram metrics (mean, min, max, median, SD, skewness, kurtosis, 5th–95th percentiles) were derived from the VOIs and delineation time was recorded. Measurements were compared between the two methods and correlated with prognostic outcome parameters.ResultsMedian delineation time reduced from 47–165 s (precise) to 21–43 s (non-precise). The 45th percentile of the non-precise delineation showed the best correlation with the mean ADC from the precise delineation as the reference standard (ICC 0.71–0.75). None of the mean ADC or histogram parameters showed significant prognostic value; only the total tumor volume (VOI) was significantly larger in patients with positive clinical N stage and mesorectal fascia involvement.ConclusionWhen performing non-precise tumor delineation, histogram analysis (in specific 45th ADC percentile) may be used as an alternative to obtain similar ADC values as with precise whole tumor delineation. Histogram analyses are not beneficial to obtain additional prognostic information.

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Intravoxel Incoherent Motion–derived Histogram Metrics for Assessment of Response after Combined Chemotherapy and Radiation Therapy in Rectal Cancer: Initial Experience and Comparison between Single-Section and Volumetric Analyses

Cited by 138 publications

References 44 publications

Comparison of non-Gaussian and Gaussian diffusion models of diffusion weighted imaging of rectal cancer at 3.0 T MRI

Comparison of non-Gaussian and Gaussian diffusion models of diffusion weighted imaging of rectal cancer at 3.0 T MRI

Diffusion‐weighted MRI and intravoxel incoherent motion model for diagnosis of pediatric solid abdominal tumors

Measuring the apparent diffusion coefficient in primary rectal tumors: is there a benefit in performing histogram analyses?

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