Perfusion and diffusion characteristics of cervical cancer based on intraxovel incoherent motion MR imaging-a pilot study

Lee, Elaine; Yu, Xue; Chu, Mandy Man Yee; Ngan, Hextan Y.S.; Siu, Steven Wai Kwan; Soong, I.; Chan, Queenie; Khong, Pek‐Lan

doi:10.1007/s00330-014-3160-7

Cited by 62 publications

(59 citation statements)

References 19 publications

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“…In the conventional segmented biexponential fitting approach with an a priori selected, fixed b-value threshold, D * tended to be “unstable” due to an arbitrarily chosen b-value that did not correspond to the true physical properties of the tissue, because the derived IVIM parameters depend heavily on the b-value threshold used (10). Previously, D * did not even allow for differentiation between normal and cancerous tissue because of its high variability (7). The present finding that the ADC tends to underestimate perfusion restriction is consistent with results of a more extensive study demonstrating that parameters derived from a monoexponential model are clearly inferior in the differentiation of cervical cancer when compared to parameters from biexponential models such as IVIM (16).…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Cervical Cancer with a Parameter-Free Intravoxel Incoherent Motion Imaging Algorithm

et al. 2017

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ObjectiveTo evaluate the feasibility of a parameter-free intravoxel incoherent motion (IVIM) approach in cervical cancer, to assess the optimal b-value threshold, and to preliminarily examine differences in the derived perfusion and diffusion parameters for different histological cancer types.Materials and MethodsAfter Institutional Review Board approval, 19 female patients (mean age, 54 years; age range, 37–78 years) gave consent and were enrolled in this prospective magnetic resonance imaging study. Clinical staging and biopsy results were obtained. Echo-planar diffusion weighted sequences at 13 b-values were acquired at 3 tesla field strength. Single-sliced region-of-interest IVIM analysis with adaptive b-value thresholds was applied to each tumor, yielding the optimal fit and the optimal parameters for pseudodiffusion (D*), perfusion fraction (Fp) and diffusion coefficient (D). Monoexponential apparent diffusion coefficient (ADC) was calculated for comparison with D.ResultsBiopsy revealed squamous cell carcinoma in 10 patients and adenocarcinoma in 9. The b-value threshold (median [interquartile range]) depended on the histological type and was 35 (22.5–50) s/mm2 in squamous cell carcinoma and 150 (100–150) s/mm2 in adenocarcinoma (p < 0.05). Comparing squamous cell vs. adenocarcinoma, D* (45.1 [25.1–60.4] × 10−3 mm2/s vs. 12.4 [10.5–21.2] × 10−3 mm2/s) and Fp (7.5% [7.0–9.0%] vs. 9.9% [9.0–11.4%]) differed significantly between the subtypes (p < 0.02), whereas D did not (0.89 [0.75–0.94] × 10−3 mm2/s vs. 0.90 [0.82–0.97] × 10−3 mm2/s, p = 0.27). The residuals did not differ (0.74 [0.60–0.92] vs. 0.94 [0.67–1.01], p = 0.32). The ADC systematically underestimated the magnitude of diffusion restriction compared to D (p < 0.001).ConclusionThe parameter-free IVIM approach is feasible in cervical cancer. The b-value threshold and perfusion-related parameters depend on the tumor histology type.

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Section: Discussionmentioning

confidence: 99%

“…In other words, the signal decay is described by a biexponential instead of a monoexponential equation which yields a more accurate description of the underlying tissue properties (5). IVIM has recently been shown to differentiate among histopathological tumor types, and, in addition, correlates with tumor grades of cervical cancer (67). …”

Section: Introductionmentioning

confidence: 99%

Assessment of Cervical Cancer with a Parameter-Free Intravoxel Incoherent Motion Imaging Algorithm

et al. 2017

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“…For example, intravoxel incoherent motion (IVIM) is an imaging technique for the separate estimation of tissue perfusion and diffusivity using multi-b-value DWI [18, 20]. It has been shown that perfusion fraction of IVIM reflected microvessel density in different tumors [19, 21, 22]. …”

Section: Introductionmentioning

confidence: 99%

Correlations between intravoxel incoherent motion (IVIM) parameters and histological findings in rectal cancer: preliminary results

et al. 2017

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Our purpose was to correlate different intravoxel incoherent motion (IVIM), histopathological and clinical parameters in rectal cancer. 17 patients with histologically proven rectal cancer investigated on a 3.T device were included into the study. DWI was performed using a multi-slice single-shot echo-planar imaging sequence with b values of 0, 50, 200, 500 and 1000 s/mm.2 A polygonal region of interest was drawn within the tumors on every b image. The following parameters were retrieved from IVIM: apparent diffusion coefficient (ADC), true diffusion (D), pseudo diffusion coefficient (D*), perfusion factor (f), and relative perfusion f·D*. In every case, cell count, nucleic areas, proliferation index KI 67, and microvessel density were estimated on histopathological specimens. Pearson's correlation coefficient was used to analyze the association between the parameters. ADC correlated well with KI 67 index and D tended to correlate with cell count and KI 67. ADC and D tended to correlate with total nucleic area. The perfusion factor f correlated well with stained vessel area, total vessel area, and vessel count. D* and fD* correlated with mean vessel diameter. Distant metastasized tumors had higher D* and fD* values. IVIM parameter reflected different clinical and histopathological features in rectal cancer.

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“…Previous studies have shown lower ADCs in poorly differentiated tumours than in well/moderately differentiated tumours, but attempts to distinguish between squamous cell carcinoma and adenocarcinoma using ADC estimates have yielded mixed results [21, 22]. Use of a bi-exponential model has indicated a lower perfusion fraction ( f ) and diffusion coefficient (D) in cervical tumours than in normal cervix [23]. Assessment of the relationships between fitted parameters of DW-MRI models and tumour histopathology would establish the ability of a model to detect differences between grades and types of tumour, and the potential to detect treatment effects that may not be described by the ADC derived from the mono-exponential model.…”

Section: Introductionmentioning

confidence: 99%

Separation of type and grade in cervical tumours using non-mono-exponential models of diffusion-weighted MRI

et al. 2016

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ObjectivesAssessment of empirical diffusion-weighted MRI (DW-MRI) models in cervical tumours to investigate whether fitted parameters distinguish between types and grades of tumours.MethodsForty-two patients (24 squamous cell carcinomas, 14 well/moderately differentiated, 10 poorly differentiated; 15 adenocarcinomas, 13 well/moderately differentiated, two poorly differentiated; three rare types) were imaged at 3 T using nine b-values (0 to 800 s mm-2). Mono-exponential, stretched exponential, kurtosis, statistical, and bi-exponential models were fitted. Model preference was assessed using Bayesian Information Criterion analysis. Differences in fitted parameters between tumour types/grades and correlation between fitted parameters were assessed using two-way analysis of variance and Pearson's linear correlation coefficient, respectively.ResultsNon-mono-exponential models were preferred by 83 % of tumours with bi-exponential and stretched exponential models preferred by the largest numbers of tumours. Apparent diffusion coefficient (ADC) and diffusion coefficients from non-mono-exponential models were significantly lower in poorly differentiated tumours than well/moderately differentiated tumours. α (stretched exponential), K (kurtosis), f and D* (bi-exponential) were significantly different between tumour types. Strong correlation was observed between ADC and diffusion coefficients from other models.ConclusionsNon-mono-exponential models were preferred to the mono-exponential model in DW-MRI data from cervical tumours. Parameters of non-mono-exponential models showed significant differences between types and grades of tumours.Key Points• Non-mono-exponential DW-MRI models are preferred in the majority of cervical tumours.• Poorly differentiated cervical tumours exhibit lower diffusion coefficients than well/moderately differentiated tumours.• Non-mono-exponential model parameters α, K, f, and D* differ between tumour types.• Micro-structural features are likely to affect parameters in non-mono-exponential models differently.

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Perfusion and diffusion characteristics of cervical cancer based on intraxovel incoherent motion MR imaging-a pilot study

Abstract: • Diffusion-weighted MRI is increasingly applied in evaluation of cervical cancer. • Cervical cancer has distinctive perfusion and diffusion characteristics. • Intravoxel incoherent motion characteristics can differentiate cervical cancer from non-malignant uterine tissues.

Cited by 62 publications

References 19 publications

Assessment of Cervical Cancer with a Parameter-Free Intravoxel Incoherent Motion Imaging Algorithm

Assessment of Cervical Cancer with a Parameter-Free Intravoxel Incoherent Motion Imaging Algorithm

Correlations between intravoxel incoherent motion (IVIM) parameters and histological findings in rectal cancer: preliminary results

Separation of type and grade in cervical tumours using non-mono-exponential models of diffusion-weighted MRI

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