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KMID : 0880420170180030510
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Korean Journal of Radiology
2017 Volume.18 No. 3 p.510 ~ p.518
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Assessment of Cervical Cancer with a Parameter-Free Intravoxel Incoherent Motion Imaging Algorithm
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Becker Anton S.
Perucho Jose A.
Wurnig Moritz C.
Boss Andreas
Ghafoor Soleen
Khong Pek Lan
Lee Elaine Y. P.
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Abstract
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Objective: To 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 Methods: After 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.
Results: Biopsy 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).
Conclusion: The 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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KEYWORD
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Uterine cervical cancer, MRI, Diffusion MRI, Perfusion imaging, Technology assessment
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