Metastatic Ovarian and Primary Peritoneal Cancer: Assessing Chemotherapy Response with Diffusion-weighted MR Imaging—Value of Histogram Analysis of Apparent Diffusion Coefficients

Kyriazi, Stavroula; Collins, David J.; Messiou, Christina; Pennert, Kjell; Rob, Davidson; Giles, Sharon; Kaye, Stan B.; deSouza, Nandita M.

doi:10.1148/radiol.11110577

Cited by 212 publications

(163 citation statements)

References 30 publications

(42 reference statements)

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“…Also, though the repeatability study was a pilot, the data obtained are comparable to data from other soft-tissue tumors (23,25,26) and indicate that the size of ADC change in responders to treatment was approximately twice that of the repeatability of the measurement.…”

Section: Discussionsupporting

confidence: 63%

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Giles

Messiou²,

Collins³

et al. 2014

Radiology

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177

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FRCP, FRCP Nandita M. deSouza, MD, FRCP, FRCR Purpose:To determine the feasibility of whole-body diffusionweighted (DW) magnetic resonance (MR) imaging for assessment of treatment response in myeloma. Materials and Methods:This prospective single-institution study was HIPAAcompliant with local research ethics committee approval. Written informed consent was obtained from each subject. Eight healthy volunteers (cohort 1a) and seven myeloma patients (cohort 1b) were imaged twice to assess repeatability of quantitative apparent diffusion coefficient (ADC) estimates. Thirty-four additional myeloma patients (cohort 2) underwent whole-body DW imaging before treatment; 26 completed a posttreatment imaging. Wholebody DW data were compared before and after treatment by using qualitative (ie, observer scores) and quantitative (ie, whole-body segmentation of marrow ADC) methods. Serum paraproteins and/or light chains or bone marrow biopsy defined response. Results:Whole-body DW imaging scores were significantly different between observers (P , .001), but change in scores between observers after treatment was not (P = .49). Sensitivity and specificity for detecting response according to observer scores were 86% (18 of 21 patients) and 80% (4 of 5 patients) for both observers. ADC measurement was repeatable: mean coefficient of variation was 3.8% in healthy volunteers and 2.8% in myeloma patients. Pretreatment ADC in cohort 2 was significantly different from that in cohort 1a (P = .03), but not from that in cohort 1b (P = .2). Mean ADC increased in 95% (19 of 20) of responding patients and decreased in all (five of five) nonresponders (P = .002). A 3.3% increase in ADC helped identify response with 90% sensitivity and 100% specificity; an 8% increase (greater than repeatability of cohort 1b) resulted in 70% sensitivity and 100% specificity. There was a significant negative correlation between change in ADC and change in laboratory markers of response (r = 20.614; P = .001). Conclusion:Preliminary work demonstrates whole-body DW imaging is a repeatable, quantifiable technique for assessment of treatment response in myeloma.q RSNA, 2014 1

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Section: Discussionsupporting

confidence: 63%

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Giles

Messiou²,

Collins³

et al. 2014

Radiology

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177

142

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“…Moreover, in our study we used ADC histograms instead of mean and/or minimum ADCs only (29−31). ADC histographic analysis enables examination of the heterogeneity of diffusion in a tumor by allowing classification of domains of different diffusivity (34,35). By using this approach, minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (35).…”

Section: Discussionmentioning

confidence: 99%

“…For example, Tozer et al (33) showed that ADCs below the 50th percentile histographic mode and skewness allowed discrimination between astrocytomas and oligodendrogliomas. In body imaging, Kyriazi et al (34) showed an increase in ADCs and a later decrease in skewness and kurtosis in response to chemotherapy in patients GENITOURINARY IMAGING: Myometrial and Lymphovascular Invasion and Endometrial Tumor Grade Nougaret et al with metastatic ovarian and primary peritoneal cancer. More recently, ADC histographic analysis has been applied in patients with cervical cancer to the whole tumor volume instead of to selected ROIs to eliminate sampling bias (35).…”

Section: Author Contributionsmentioning

confidence: 99%

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Nougaret¹,

Reinhold²,

AlSharif³

et al. 2015

Radiology

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Purpose:To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. Materials and Methods:The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24-91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion. Results:No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P , .0001).There was no significant difference in the ADCs between grades 1 and 2 tumors (P . .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P , .02). Conclusion:The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.q RSNA, 2015

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“…The histogram approach has been increasingly used for heterogeneous tissues, allowing interpretation of the complex nature and features seen in tumors 17. Previous studies in adults have utilized histogram analysis of ADC and cerebral blood volume (CBV), which has been applied to a variety of scenarios including differentiation of true tumor progression from pseudoprogression,28, 29 response to chemotherapy,30 and grading of tumors 31, 32, 33. Most previous pediatric studies have reported mean or median ADC values based on a single section or slice, which does not address the heterogeneity seen in many abdominal tumors 7, 8…”

Section: Discussionmentioning

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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Metastatic Ovarian and Primary Peritoneal Cancer: Assessing Chemotherapy Response with Diffusion-weighted MR Imaging—Value of Histogram Analysis of Apparent Diffusion Coefficients

Abstract: An early increase of ADCs and later decrease of skew and kurtosis characterize chemotherapy response. Quantitative DW MR imaging can aid in early monitoring of treatment efficacy in patients with advanced ovarian cancer.

Cited by 212 publications

References 30 publications

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

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

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