Korean J Radiol.  2017 Jun;18(3):510-518. 10.3348/kjr.2017.18.3.510.

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

• Becker AS
• Perucho JA
• Wurnig MC
• Boss A
• Ghafoor S
• Khong PL
• Lee EY

• KMID: 2427306
• DOI: http://doi.org/10.3348/kjr.2017.18.3.510

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/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 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] × 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.

Keyword

Uterine cervical cancer; MRI; Diffusion MRI; Perfusion imaging; Technology assessment

MeSH Terms

Adenocarcinoma/*diagnosis/diagnostic imaging/pathology
Adult
Aged
*Algorithms
Area Under Curve
Carcinoma, Squamous Cell/*diagnosis/diagnostic imaging/pathology
Diffusion Magnetic Resonance Imaging
Female
Humans
Middle Aged
Neoplasm Staging
Prospective Studies
ROC Curve
Uterine Cervical Neoplasms/*diagnosis/diagnostic imaging/pathology

Figure

• 

  Fig. 1 ROI definition.Top left panel: screenshot of exemplary ROI definition in zoomed section of b0 image (top row, middle). Remaining panels: diffusion signal decay series at single slice position of 53-year-old patient with adenocarcinoma arising from cervix. ROI = region of interest

• 

  Fig. 2 Example signal decay with fitted curve candidates at different b-value thresholds (dotted lines).Best fit, i.e., curve with smallest sum of squared residuals, is drawn as continuous line (b-value threshold = 150 s/mm2 in (A), and 10 s/mm2 in (B)). One sample of adenocarcinoma is shown in (A), sample of squamous cell carcinoma is shown in (B). Signal is given in arbitrary units (AU) normalized to maximum of 1 and minimum of 0.

• 

  Fig. 3 Boxplot of optimal b-value thresholds (defined as yielding smallest sum of squared residuals to fit, which are depicted on far right as “residuals”) and IVIM parameters D, D*, and Fp of two examined histological cancer types adenocarcinoma (Ad.) and squamous cell carcinoma (SCC).IVIM = intravoxel incoherent motion

• 

  Fig. 4 Parametric maps depicting three IVIM parameters D, D*, and Fp in one case of squamous cell carcinoma (SCC) in top row, and adenocarcinoma (Ad.) in bottom row (both outlined and marked with white arrow).Difference in Fp is subtle, but can be appreciated in right column with color scale set to maximum of 0.3 for this example. IVIM = intravoxel incoherent motion

• 

  Fig. 5 Receiver operator characteristics curve of three IVIM derived parameters for differentiation of adenocarcinoma (Ad.) and squamous cell carcinoma (SCC).Az was 0.82 (Fp, D*) and 0.81 (b-value threshold). IVIM = intravoxel incoherent motion

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