Comparison of Apparent Diffusion Coefficient and Intravoxel Incoherent Motion for Differentiating among Glioblastoma, Metastasis, and Lymphoma Focusing on Diffusion-Related Parameter

Abstract

Background and PurposeBrain tumor cellularity has been assessed by using apparent diffusion coefficient (ADC). However, the ADC value might be influenced by both perfusion and true molecular diffusion, and the perfusion effect on ADC can limit the reliability of ADC in the characterization of tumor cellularity, especially, in hypervascular brain tumors. In contrast, the IVIM technique estimates parameter values for diffusion and perfusion effects separately. The purpose of our study was to compare ADC and IVIM for differentiating among glioblastoma, metastatic tumor, and primary CNS lymphoma (PCNSL) focusing on diffusion-related parameter.Materials and MethodsWe retrospectively reviewed the data of 128 patients with pathologically confirmed glioblastoma (n = 55), metastasis (n = 31), and PCNSL (n = 42) prior to any treatment. Two neuroradiologists independently calculated the maximum IVIM-f (fmax) and minimum IVIM-D (Dmin) by using 16 different b-values with a bi-exponential fitting of diffusion signal decay, minimum ADC (ADCmin) by using 0 and 1000 b-values with a mono-exponential fitting and maximum normalized cerebral blood volume (nCBVmax). The differences in fmax, Dmin, nCBVmax, and ADCmin among the three tumor pathologies were determined by one-way ANOVA with multiple comparisons. The fmax and Dmin were correlated to the corresponding nCBV and ADC using partial correlation analysis, respectively.ResultsUsing a mono-exponential fitting of diffusion signal decay, the mean ADCmin was significantly lower in PCNSL than in glioblastoma and metastasis. However, using a bi-exponential fitting, the mean Dmin did not significantly differ in the three groups. The mean fmax significantly increased in the glioblastomas (reader 1, 0.103; reader 2, 0.109) and the metastasis (reader 1, 0.105; reader 2, 0.107), compared to the primary CNS lymphomas (reader 1, 0.025; reader 2, 0.023) (P < .001 for each). The correlation between fmax and the corresponding nCBV was highest in glioblastoma group, and the correlation between Dmin and the corresponding ADC was highest in primary CNS lymphomas group.ConclusionUnlike ADC value derived from a mono-exponential fitting of diffusion signal, diffusion-related parametric value derived from a bi-exponential fitting with separation of perfusion effect doesn’t differ among glioblastoma, metastasis, and PCNSL.

Role of quantitative intravoxel incoherent motion parameters in the preoperative diagnosis of nodal metastasis in patients with rectal carcinoma

“…Our result is concordant with these prior studies . The limited value of D* was previously explained by poor reproducibility . However, Lai et al suggested that D* could be a reliable parameter for differentiating nasopharyngeal carcinoma and postchemoradiation fibrosis.…”

“…Le Bihan et al were the first to describe the intravoxel incoherent motion (IVIM) modeling of DWI data and presented that it can separately account for tissue diffusion and microcapillary perfusion. It has been used in the diagnosis of several types of tumors and nodal metastasis in patients with head and neck carcinoma . The purpose of the current study was to investigate the usefulness of quantitative IVIM parameters in the preoperative diagnosis of nodal metastasis in patients with rectal carcinoma.…”

Correlation and Characteristics of Intravoxel Incoherent Motion and Arterial Spin Labeling Techniques Versus Multiple Parameters Obtained on Dynamic Susceptibility Contrast Perfusion MRI for Brain Tumors

“…The D and DDC were not correlated with any perfusion parameters derived from DSC, but the alpha value analyzed by the stretched model was moderately correlated with the DSC-rBF. The D and DDC are independent in terms of perfusion information, but the non-Gaussian effect of IVIM is somewhat related to the rBF (16,30).…”

“…The IVIM procedure concurrently determines perfusion and diffusion parameters of tumors (3,(15)(16)(17)(18)(19)(20) without the need for contrast medium (3,9). This method has major advantages because it is safe, repeatable, quantitative, and independent of arterial input function (3,16,19). Although IVIM is used to assess head and neck tumors (5,19), breast tumors, and other kinds of tumors and diseases (8,18), its characteristics and differences from other perfusion MRI techniques remain unknown.…”

Can reduced field‐of‐view diffusion sequence help assess microsatellite instability in FIGO stage 1 endometrial cancer?

“…Using the acquired DWI images, ADC maps of all three planes were calculated. Additionally, the multiple b‐value sagittal rFOV DWI images were used to calculate the IVIM diffusion using the biexponential model . The IVIM‐derived parameters evaluated were true diffusion coefficient (D t ), pseudodiffusion coefficient (diffusion within the microcirculation) (D*), perfusion fraction (contribution of water moving in capillaries) (f), and ADC.…”