Search

Background: There is still little research about histogram analysis of diffusion kurtosis imaging (DKI) using in prostate cancer at present., Purpose: To verify the utility of histogram analysis of DKI model in detection and assessment of aggressiveness of prostate cancer, compared with monoexponential model (MEM)., Material and Methods: Twenty-three patients were enrolled in this study. For DKI model and MEM, the D app , K app , and apparent diffusion coefficient (ADC) were obtained by using single-shot echo-planar imaging sequence. The pathologies were confirmed by in-bore magnetic resonance (MR)-guided biopsy. Regions of interest (ROI) were drawn manually in the position where biopsy needle was put. The mean values and histogram parameters in cancer and noncancerous foci were compared using independent-samples T test. Receiver operating characteristic curves were used to investigate the diagnostic efficiency. Spearman's test was used to evaluate the correlation of parameters and Gleason scores., Results: The mean, 10th, 25th, 50th, 75th, and 90th percentiles of ADC and D app were significantly lower in prostate cancer than non-cancerous foci ( P  < 0.001). The mean, 50th, 75th, and 90th percentiles of K app were significantly higher in prostate cancer ( P  < 0.05). There was no significant difference between the AUCs of two models (0.971 vs. 0.963, P  > 0.05). With the increasing Gleason scores, the 10th ADC decreased ( ρ  = -0.583, P  = 0.018), but the 90th K app increased ( ρ  = 0.642, P  = 0.007)., Conclusion: Histogram analysis of DKI model is feasible for diagnosing and grading prostate cancer, but it has no significant advantage over MEM.

Background: Many locally advanced rectal cancer (LARC) patients can benefit from neoadjuvant chemotherapy (NACT), with some achieving a pathological complete response (pCR). However, there is limited research reporting on the value of intravoxel incoherent motion (IVIM) in monitoring pCR in patients with LARC., Purpose: To identify whether IVIM parameters derived from whole-tumor volume (WTV) before and after NACT could accurately assess pCR in patients with LARC., Study Type: Prospective patient control study., Population: Fifty-one patients with LARC before and after NACT, prior to surgery., Field Strength/sequence: IVIM-diffusion imaging at 3T., Assessment: Apparent diffusion coefficient (ADC), slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion-related diffusion fraction (f) values were obtained on diffusion-weighted magnetic resonance images (DW-MRI) using WTV methods and calculated using a biexponential model before and after NACT., Statistical Tests: DWI-derived ADC and IVIM-derived parameters and their percentage changes (ΔADC%, ΔD%, ΔD*%, and Δf%) were compared using independent-samples t-test and Mann-Whitney U-test between the pCR and non-pCR groups. The diagnostic performance of IVIM parameters and their percentage changes were evaluated using receiver operating characteristic curves., Results: Compared with the non-pCR group, the pCR group exhibited significantly lower pre-ADC mean (P = 0.003) and pre-D values (P = 0.024), and significantly higher post-f (P = 0.002), ΔADC mean % (P = 0.002), ΔD% (P = 0.001), and Δf% values (P = 0.017). Receiver operating characteristic curves showed that the pre-D value had the best specificity (95.12%) and accuracy (86.27%) in predicting the pCR status, and ΔD% had the highest area under the curve (0.832) in assessing the pCR response to NACT., Data Conclusions: The IVIM-derived D value is a promising tool in predicting the pCR status before therapy. The percentage changes in D values after therapy may help assess the pCR status prior to surgery., Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017., (© 2017 International Society for Magnetic Resonance in Medicine.)

Purpose: To evaluate the diagnostic potential of DW-MRI relative parameters for differentiation of rectal cancers with different Kirsten rat sarcoma viral oncogene homologue (KRAS) mutation status., Methods: Fifty-one patients with rectal cancer underwent diffusion-weighted MR imaging with eight b values. ADCs (including Max-ADC, Min-ADC and Mean-ADC) and IVIM parameters (D, pure diffusion; f, perfusion fraction; D*, pseudodiffusion coefficient) were respectively calculated by mono- and bi-exponential analysis. Patients were stratified into two groups: KRAS wild type and mutant. The DW-MRI-derived parameters between the KRAS wild-type group and KRAS mutant group were compared using the Mann-Whitney U test. Receiver-operating characteristic (ROC) analysis of discrimination between KRAS wild-type and KRAS mutant rectal cancer was performed for the DW-MRI-derived parameters., Results: Max-ADC, Mean-ADC and D values were significantly lower in the KRAS mutant group than in the KRAS wild-type group, whereas a higher D* value was demonstrated in the KRAS mutant group. According to the ROC curve, Mean-ADC and D* values showed moderate diagnostic significance with the AUC values of 0.756 and 0.710, respectively. The cut-off values for Mean-ADC and D* were 1.43 × 10 -3 mm 2 /s and 26.58 × 10 -3 mm 2 /s, respectively., Conclusion: Rectal cancers had distinctive diffusion/perfusion characteristics in different KRAS mutation statuses. The DW-MRI-derived parameters, specifically Mean-ADC and D*, show a moderate diagnostic significance for KRAS status., Key Points: • Rectal cancers with different KRAS mutation statuses demonstrated distinctive diffusion/perfusion characteristics. • Max-ADC, Mean-ADC and D values were lower in the KRAS mutant group. • A higher D* value was demonstrated in the KRAS mutant group. • IVIM-DW MRI may potentially help preoperative KRAS mutant status prediction.

Objective: The objective of our study was to evaluate the intravoxel incoherent motion (IVIM)-DWI derived parameters and their relationships with tumor prognostic markers using 3-T MRI in patients with rectal cancer., Subjects and Methods: Fifty-two patients with histopathologically proven rectal cancer who underwent preoperative pelvic MRI were prospectively enrolled in this study. Diffusion and perfusion parameters including the apparent diffusion coefficient (ADC), pure diffusion coefficient, perfusion fraction, and pseudodiffusion coefficient derived from IVIMDWI were independently measured by two radiologists. Comparisons of IVIM-DWI-derived parameters in patients with different tumor prognostic markers were made using the independent-samples t test, ANOVA, and Mann-Whitney U test. The correlations between IVIM-DWI-derived parameters and tumor grade and tumor stage were further evaluated using Spearman correlation analysis. Interobserver agreement was evaluated using the intraclass correlation coefficient (ICC)., Results: Excellent interobserver reproducibility was obtained for the IVIM-DWI-derived parameters (range of ICCs with 95% limits of agreement = 0.9309-0.9948, which is narrow). ADC, pseudodiffusion coefficient, and perfusion fraction tended to rise with greater tumor differentiation (r = 0.520, p < 0.001; r = 0.447, p = 0.001; r = 0.354, p = 0.010, respectively). The pure diffusion coefficient and pseudodiffusion coefficient showed a trend of decreasing with increasing tumor stages (r = 0.479, p < 0.001; r = 0.517, p < 0.001). The group of patients with extramural vascular invasion (EMVI) showed lower pseudodiffusion coefficient values than the group of patients with no EMVI (p < 0.05)., Conclusion: IVIM-DWI-derived parameters in patients with rectal cancer, especially the pseudodiffusion coefficient, are associated with tumor grade and tumor stage and show statistically significant differences between subjects with EMVI and those without EMVI. IVIM-DWI-derived parameters would be helpful in predicting tumor aggressiveness and prognosis.

The aim of this study was to evaluate the short-term test-retest reproducibility of diffusion-weighted magnetic resonance imaging (DW-MRI) parameters of rectal cancer with 3.0T MRI.Twenty-six patients with rectal cancer underwent MRI, including diffusion-weighted imaging with 8 b values. Apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) parameters (D, pure diffusion; f, perfusion fraction; D*, pseudodiffusion coefficient) were, respectively, calculated. The short-term test-retest reproducibility, the intra and interobserver variation of the IVIM parameters were assessed based on the repeatability coefficient and Bland-Altman limits of agreement.There was no significant intra or interobserver difference observed in the parameters on the same DW-MRI scan. The corresponding repeatability coefficient of intra- and interobserver analysis for ADC, D, f, and D* was 5.4%, 11.1%, 55.4%, and 40.3%; 10.9%, 41.6%, 134.0%, and 177.6%, respectively. The test-retest repeatability coefficient for ADC, D, f, and D* was 19.1%, 24.5%, 126.3%, and 197.4%, respectively, greater than the intraobserver values.ADC and D have better short-term test-retest reproducibility than f and D*. Considering the poor test-retest reproducibility for f and D,* variance in these 2 parameters should be interpreted with caution in longitudinal studies on rectal cancer in which treatment response and recurrence are monitored.