Histogram analysis of apparent diffusion coefficient map of diffusion-weighted MRI in endometrial cancer: a preliminary correlation study with histological grade

Woo, Sungmin; Cho, Jeong Yeon; Kim, Sang-Youn; Kim, Seung Hyup

doi:10.1177/0284185113514967

Cited by 113 publications

(94 citation statements)

References 25 publications

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“…By using this approach, minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (35). In a study of 33 patients, Woo et al (47) showed significant differences in ADCs between grades by using histographic analysis and total tumor volume. In their study, the 90th and 95th percentiles of ADCs were the most promising parameters for differentiating highfrom low-grade tumors (47).…”

Section: Discussionmentioning

confidence: 98%

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Nougaret¹,

Reinhold²,

AlSharif³

et al. 2015

Radiology

145

114

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Purpose:To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. Materials and Methods:The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24-91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion. Results:No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P , .0001).There was no significant difference in the ADCs between grades 1 and 2 tumors (P . .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P , .02). Conclusion:The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.q RSNA, 2015

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Section: Discussionmentioning

confidence: 98%

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Nougaret¹,

Reinhold²,

AlSharif³

et al. 2015

Radiology

145

114

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“…The histogram approach has been increasingly used for heterogeneous tissues, allowing interpretation of the complex nature and features seen in tumors 17. Previous studies in adults have utilized histogram analysis of ADC and cerebral blood volume (CBV), which has been applied to a variety of scenarios including differentiation of true tumor progression from pseudoprogression,28, 29 response to chemotherapy,30 and grading of tumors 31, 32, 33. Most previous pediatric studies have reported mean or median ADC values based on a single section or slice, which does not address the heterogeneity seen in many abdominal tumors 7, 8…”

Section: Discussionmentioning

confidence: 99%

Diffusion‐weighted MRI and intravoxel incoherent motion model for diagnosis of pediatric solid abdominal tumors

Meeus

Zarinabad

Manias

et al. 2017

Magnetic Resonance Imaging

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BackgroundPediatric retroperitoneal tumors in the renal bed are often large and heterogeneous, and their diagnosis based on conventional imaging alone is not possible. More advanced imaging methods, such as diffusion‐weighted (DW) MRI and the use of intravoxel incoherent motion (IVIM), have the potential to provide additional biomarkers that could facilitate their noninvasive diagnosis.PurposeTo assess the use of an IVIM model for diagnosis of childhood malignant abdominal tumors and discrimination of benign from malignant lesions.Study TypeRetrospective.PopulationForty‐two pediatric patients with abdominal lesions (n = 32 malignant, n = 10 benign), verified by histopathology.Field Strength/Sequence1.5T MRI system and a DW‐MRI sequence with six b‐values (0, 50, 100, 150, 600, 1000 s/mm2).AssessmentParameter maps of apparent diffusion coefficient (ADC), and IVIM maps of slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion fraction (f) were computed using a segmented fitting model. Histograms were constructed for whole‐tumor regions of each parameter.Statistical TestsComparison of histogram parameters of and their diagnostic performance was determined using Kruskal–Wallis, Mann–Whitney U, and receiver‐operating characteristic (ROC) analysis.ResultsIVIM parameters D* and f were significantly higher in neuroblastoma compared to Wilms' tumors (P < 0.05). The ROC analysis showed that the best diagnostic performance was achieved with D* 90th percentile (area under the curve [AUC] = 0.935; P = 0.002; cutoff value = 32,376 × 10−6 mm2/s) and f mean values (AUC = 1.00; P < 0.001; cutoff value = 14.7) in discriminating between neuroblastoma (n = 11) and Wilms' tumors (n = 8). Discrimination between tumor types was not possible with IVIM D or ADC parameters. Malignant tumors revealed significantly lower ADC, D, and higher D* values than in benign lesions (all P < 0.05).Data ConclusionIVIM perfusion parameters could distinguish between malignant childhood tumor types, providing potential imaging biomarkers for their diagnosis. Level of Evidence: 4 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2018;47:1475–1486.

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“…However, the commonly used average ADC measurement ignores the heterogeneity of the tumors, which is an important characteristic of both benign and malignant tumors. Due to its ability to analyze lesions pixel by pixel, histogram analysis was regarded as an effective method to deal with this problem (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). In a recent study, Donati et al (20) found that the 10th percentile ADC value correlated with Gleason score, suggesting the 10th percentile ADC value could help differentiate low-grade from intermediate or high-grade prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

“…ROI approach that places ROI on a representative section of the tumor, which is subjective and prone to sampling bias (14,17). A whole-tumor ROI approach that encompasses the entire tumor, would provide more information about the heterogeneity of the tumor, thus it can potentially eliminate sampling bias during data processing (13,16,17,19).…”

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Utility of histogram analysis of ADC maps for differentiating orbital tumors

Xu¹,

Hu²,

Su³

et al. 2016

Diagn Interv Radiol

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Histogram analysis of apparent diffusion coefficient map of diffusion-weighted MRI in endometrial cancer: a preliminary correlation study with histological grade

Abstract: Histogram analysis of ADC maps based on entire tumor volume can be useful for predicting the histological grade of endometrial cancer. The 90th and 95th percentiles of ADC were the most promising parameters for differentiating high from low grade.

Cited by 113 publications

References 25 publications

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Diffusion‐weighted MRI and intravoxel incoherent motion model for diagnosis of pediatric solid abdominal tumors

Utility of histogram analysis of ADC maps for differentiating orbital tumors

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