Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Assessment of Cervical Cancer with a Parameter-Free Intravoxel Incoherent Motion Imaging Algorithm

  • Becker, Anton S. (Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich) ;
  • Perucho, Jose A. (Department of Diagnostic Radiology, The University of Hong Kong) ;
  • Wurnig, Moritz C. (Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich) ;
  • Boss, Andreas (Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich) ;
  • Ghafoor, Soleen (Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich) ;
  • Khong, Pek-Lan (Department of Diagnostic Radiology, The University of Hong Kong) ;
  • Lee, Elaine Y.P. (Department of Diagnostic Radiology, The University of Hong Kong)
  • Received : 2016.09.11
  • Accepted : 2016.11.13
  • Published : 2017.06.01
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Abstract

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 ($F_p$) 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 $35(22.5-50)s/mm^2$ in squamous cell carcinoma and $150(100-150)s/mm^2$ in adenocarcinoma (p < 0.05). Comparing squamous cell vs. adenocarcinoma, $D^*$ ($45.1[25.1-60.4]{\times}10^{-3}mm^2/s$ vs. $12.4[10.5-21.2]{\times}10^{-3}mm^2/s$) and $F_p$ (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 ($0.89[0.75-0.94]{\times}10^{-3}mm^2/s$ vs. $0.90[0.82-0.97]{\times}10^{-3}mm^2/s$, 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.

Keywords

Acknowledgement

Supported by : General Research Fund

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