Intravoxel incoherent motion diffusion‐weighted imaging of hepatocellular carcinoma: Is there a correlation with flow and perfusion metrics obtained with dynamic contrast‐enhanced MRI?

Abstract

Purpose To assess the correlation between intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) metrics in hepatocellular carcinoma (HCC) and liver parenchyma. Materials and Methods Twenty-five patients with HCC (M/F 23/2, mean age 58 years) underwent abdominal MRI at 1.5 or 3.0T, including IVIM-DWI (with 16 b-values) and DCE-MRI (3D FLASH sequence, mean temporal resolution of 2.3 sec). IVIM-DWI parameters (pseudodiffusion coefficient, D*, diffusion coefficient, D, and perfusion fraction, PF) were quantified in HCC lesions and liver parenchyma using a Bayesian fitting algorithm. DCE-MRI parameters (arterial flow, Fa, portal flow, Fp, total flow, Ft, mean transit time, MTT, distribution volume, DV, and arterial fraction, ART) were quantified using a dual-input single-compartment model. Correlations between IVIM-DWI and DCE-MRI parameters were assessed using a Spearman correlation test. Results Thirty-three HCC lesions (average size 5.0 ± 3.6 cm) were analyzed. D, D*, and PF were all significantly lower in HCC vs. liver (P < 0.05). Significantly higher Fa and ART and lower Fp were observed in HCC vs. liver (P < 0.001). Significant moderate to strong negative correlations were observed between ART and D* (r = −0.443, P = 0.028), ART and PF (r = −0.536, P = 0.006), ART and PFxD* (r = −0.655, P < 0.001), Fa and PF (r = 0.455, P = 0.023), and Fa and PFxD* (r = −0.475, P = 0.018) in liver parenchyma. There was no significant correlation between IVIM-DWI and DCE-MRI metrics in HCC lesions. Conclusion IVIM-DWI and DCE-MRI provide nonredundant information in HCC, while they correlate in liver parenchyma. These findings may be secondary to predominant portal inflow in the liver and tortuous vasculature and tissue heterogeneity in tumors.

Intravoxel incoherent motion: application in differentiation of hepatocellular carcinoma and focal nodular hyperplasia

“…However, they reflect different aspects of perfusion: D* is related to the length and velocity of the capillary network, whereas f reflects the fraction of the microcirculation that accounts for all diffusion in voxels. Unsurprisingly, several studies have observed similar mismatches for D* and f (29,(31)(32)(33), even in dynamic contrast enhancement research (34), which is another type of perfusion-related hemodynamic model. One convincing explanation for this contradiction is that f is dependent on echo time (TE): the longer the TE, the larger the f value.…”

“…Additionally, it should be noted that it is imprecise to fit the bi-exponential model for too few b values, although one report confirmed that only four b values were sufficient to estimate IVIM parameters (41). The SD or CV of D* is frequently large and is well known for its worse reproducibility and repeatability compared with the other three parameters (21,34,42,43). In spite of significant differences in the D* values between HCC and FNH, its efficacy was inferior to ADC total and D, as is generally accepted.…”

Liver intravoxel incoherent motion (IVIM) magnetic resonance imaging: a comprehensive review of published data on normal values and applications for fibrosis and tumor evaluation

“…Instead of rejecting data points, perform motion correction is Other post-processing technique such as image denoising and registration may also be helpful for IVIM quantification. These processing could potentially be more effective if it is applied on the images of the individual directions before averaging or directly on the raw data, which has not been attempted with IVIM study (35). However, it should be noted that the noise characteristics on MR magnitude images are much dependent on many factors of hardware, acquisition and reconstruction.…”

“…These shifts of phase in turn depend not only on the magnetic field but also on, among others, the K-space acquisition ordering mode, image resolution, acquisition segmentation, and receiver bandwidth. (35) reported that there was no information overlap (or can be interpreted as poor correlation) between IVIM parameters and dynamic contrast enhanced (DCE) MRI metrics.…”

Imaging biomarkers in oncology: Basics and application to MRI

“…However, one of the issues highlighted to date is the poor test–retest variability of f and D*, on the order of >100% in some cancers, eg, rectal . There also appears some contention as to technical/biological correlates: while some studies have shown a relationship between IVIM and DCE‐MRI parameters, others have not in some cancers, eg, hepatocellular carcinoma . One also has to be aware that flow from glandular secretions, eg, pancreas, may be difficult to separate from micro‐capillary perfusion.…”