Comparison of Conventional DWI, Intravoxel Incoherent Motion Imaging, and Diffusion Kurtosis Imaging in Differentiating Lung Lesions

Abstract

PurposeTo compare conventional diffusion weighted imaging (DWI), intravoxel incoherent motion imaging (IVIM) and diffusion kurtosis imaging (DKI) in differentiating malignant and benign lung lesions.MethodFifty-five consecutive patients with lung lesions underwent multiple b-value DWI. The apparent diffusion coefficient (ADC), IVIM and DKI parameters were calculated using postprocessing software and compared between the malignant and benign groups. Receiver operating characteristic (ROC) analysis was performed for all parameters.ResultsADC and D were lower in malignant lesions than in benign lesions, while Kapp was higher (P < 0.05). The differences in D*, f, and Dapp between the two groups were not significant (P > 0.05). The areas under the curves (AUCs) of ADC, D, and Kapp were 0.816, 0.864, and 0.822. The combination of all the significant parameters yielded an AUC of 0.880. There were no significant differences in diagnostic efficacy among ADC, D, Kapp and the predictor factor (PRE).ConclusionsIn this study, traditional DWI (ADC), IVIM (D), and DKI (Kapp) all had good diagnostic performance in differentiating malignant lung lesions from benign lesions, but the combination of ADC, D, and Kapp value had better diagnostic efficacy than these parameters alone.

Differential value of diffusion kurtosis imaging and intravoxel incoherent motion in benign and malignant solitary pulmonary lesions

“…This is because the growth rate of malignant SPLs is faster, cell proliferation is more active, and the chance of necrosis, hemorrhage and cystic degeneration of tissues and cells is greater, resulting in more obvious internal heterogeneity of lesions. This is consistent with the findings of Zheng ( 17 ) and Das SK ( 27 ) et al. However, Wan et al.…”

“…The D* and f values have poor repeatability and large variability and are easily affected by the shape, size, and location of the lesion. In this study, the IVIM-related perfusion parameters D* and f of the whole-lesion histogram parameters, reflecting the microcirculation blood supply of tissue lesions, had little effect on differentiating benign and malignant SPLs, which is consistent with previous findings ( 17 , 18 , 29 ) and may be related to increased capillary angiogenesis not only in malignant lesions but also in benign lesions and the overlap of perfusion between benign and malignant lesions. The conventional IVIM model is prone to produce high amount of noise in estimating perfusion parameters.…”

“…( 18 ), while Zheng et al. ( 17 ) hold that there was no significant difference in the average Dk values of benign and malignant lung lesions. Compared with previous studies on benign and malignant lung lesions by DKI, IVIM and ADC, this study used the whole-lesion histogram analysis method, which can more comprehensively and objectively reflect the complexity and heterogeneity of the microenvironment structure in diseased tissue.…”

“…IVIM quantitative parameters are as follows: D, slow diffusion coefficient (ADC slow), which represents the diffusion motion of pure water molecules; D*, fast diffusion coefficient (ADC fast), which is the false diffusion coefficient generated by blood circulation, represents the incoherent movement of microcirculation in voxels and is proportional to the average capillary length and the average blood flow velocity; and f, perfusion fraction, representing the volume ratio of the microcirculation perfusion-related diffusion effect in voxels to the total diffusion effect, expressed as a percentage, which increases with the increase of tissue perfusion volume. The traditional ADC value includes the diffusion effect of water molecules and the perfusion effect of microcirculation, and the D value without the perfusion factor can more accurately reflect the diffusion conditions inside the tumor tissue ( 17 ). Dk and D are proportional to ADC.…”

“…The above studies indicate that IVIM and DKI have certain value in the differential diagnosis of benign and malignant lung lesions, but they are still in the exploratory stage. In addition, these studies ( 17 , 18 ) used quantitative parameters describing ROI at a single level to assess lung lesions, rarely combined with whole lesion histogram methods for further analysis, and did not reflect the overall characteristics of lesions.…”