Intravoxel Incoherent Motion Imaging in Differentiation Borderline From Malignant Ovarian Epithelial Tumors: Correlation With Histological Cell Proliferation and Vessel Characteristics

Abstract

Background The differentiation of borderline from malignant ovarian epithelial tumors (OETs) is difficult based on morphologic characteristics. Diffusion and perfusion information from intravoxel incoherent motion (IVIM) diffusion‐weighted imaging (DWI) might be useful for this distinction. Purpose To investigate the potential of IVIM‐DWI in discriminating borderline from malignant OETs by correlating with cell proliferation and microvessel density (MVD). Study Type Prospective. Subjects Sixty‐six patients with OETs (22 borderline, BOETs; 44 malignant, MOETs) underwent IVIM‐DWI before surgery. Field Strength 3.0T IVIM‐DWI sequence with 12 b‐values (0–1000 sec/mm2). Assessment Apparent diffusion coefficient (ADC) and IVIM‐DWI parameters (diffusion coefficient [D], microvascular volume fraction [f], and pseudodiffusion coefficient [D*]) were measured. Cell proliferation and MVD was determined by immunohistochemical staining of Ki‐67 and CD‐31, respectively. Statistical Tests Mann–Whitney U‐test; two‐sample t‐test; intraclass correlation coefficient; Bland–Altman analysis; receiver operating characteristics (ROC) curves; and Spearman correlation. Results ADC and D in BOETs was significantly higher than those in MOETs (P < 0.001), while f in BOETs was significantly lower than those in MOETs (P < 0.001). No significant difference was found in D* between borderline and malignancies (P = 0.324). In the differential diagnosis of borderline from malignant OETs; D demonstrated the highest area under the curve (AUC) of 0.951, while ADC and f had a lower AUC of 0.921 and 0.847, respectively. The ADC and D was negatively correlated with cell proliferation (r = –0.682, r = –0.694, respectively, P < 0.001), while f was positively correlated with MVD of the OETs (r = 0.558, P < 0.001). Data Conclusion IVIM‐DWI may be a useful tool for differentiating BOETs from MOETs. D and f could be image biomarkers to reflect histopathological characteristics of cell proliferation and MVD in OETs. Level of Evidence: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:928–935.

Diagnostic value of WB-DWI versus 18F-FDG PET/CT for the detection of multiple myeloma

“…The ADC value was signi cantly higher than that of malignant ovarian epithelial tumors; the AUC of the ADC for differentiating benign and malignant tumors was shown to be 0.921. [26] However, in a study involving the differentiation of vertebral hemangioma from MM and other malignant bone focal deposits, when the ADC threshold was 0.872 and the AUC was 0.93, sensitivity was 84.7% and speci city was 91.8%. [27] In recent years, studies of PET/CT and WB-DWI have highlighted multiple reasons behind the misdiagnosis of bone disease.…”

Tumor Vessel Normalization: A Window to Enhancing Cancer Immunotherapy

“…125 The blood pseudodiffusion coefficient (D*) and perfusion fraction (f), parameters of IVIM DW-MRI, can satisfactorily reflect tumor angiogenesis and microvessel density. [126][127][128] In a study of CT26 colon carcinoma-bearing mice, IVIM DW-MRI was used to detect the process of tumor vascular normalization at different times after Endostar (recombinant human endostatin) treatment. 129 The D* and f values were well correlated with pericyte coverage and relative perfusion.…”

Intravoxel incoherent motion imaging used to assess tumor microvascular changes after transarterial chemoembolization in a rabbit VX2 liver tumor model

“…More specifically, intravoxel incoherent motion (IVIM) imaging is of particular use. In 1986, researchers proposed using a bi-exponential model to separate the diffusion of water molecules and the perfusion of microcirculation (13). With this method, researchers could obtain the apparent diffusion coefficient (ADC), the pure diffusion coefficient (D), the pseudodiffusion coefficient (D*), and the perfusion fraction (PF), parameters that not only reflect tissue diffusion more accurately but also provide information about tissue microcirculation perfusion (13).…”

“…In 1986, researchers proposed using a bi-exponential model to separate the diffusion of water molecules and the perfusion of microcirculation (13). With this method, researchers could obtain the apparent diffusion coefficient (ADC), the pure diffusion coefficient (D), the pseudodiffusion coefficient (D*), and the perfusion fraction (PF), parameters that not only reflect tissue diffusion more accurately but also provide information about tissue microcirculation perfusion (13). However, studies assessing IVIM imaging have differed in their conclusions regarding the role of these parameters in predicting treatment efficacy and assessing tumor MVD.…”