Intravoxel Incoherent Motion (IVIM) Diffusion Weighted Imaging (DWI) in the Periferic Prostate Cancer Detection and Stratification

Abstract

The aim of this study was to compare the Intravoxel Incoherent Motion (IVIM) parameters between healthy Peripheral Zone (PZ), Benign Prostatic Hyperplasia (BPH) and Prostate Cancer (PCa) and compare them to assess whether there was correlation with Gleason Score (GS) grading system. Thirty-one patients with suspect of PCa underwent 1.5T Multi-Parametric Magnetic Resonance Imaging (MP-MRI) with endorectal coil with a protocol including T2WI, DWI using 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, 1000 s/mm) and DCE. Monoexponential and IVIM model fits were used to calculate both apparent diffusion coefficient (ADC) and the following IVIM parameters: molecular diffusion coefficient (D), perfusion-related diffusion coefficient (D*) and perfusion fraction (f). The ADC and D values were significantly lower in the PCa (0.70 ± 0.16 × 10 mm/s and 0.88 ± 0.31 × 10 mm/s) compared to those found in the PZ (1.22 ± 0.20 × 10 mm/s and 1.78 ± 0.34 × 10 mm/s) and in the BPH (1.53 ± 0.23 × 10 mm/s and 1.11 ± 0.28 × 10 mm/s). The D* parameter was significantly increased in the PCa (5.35 ± 5.12 × 10 mm/s) compare to the healthy PZ (3.02 ± 2.86 × 10 mm/s), instead there was not significantly difference in the PCa compare to the BPH (5.61 ± 6.77 × 10 mm/s). The f was statistically lower in the PCa (9.01 ± 5.20%) compared to PZ (10.57 ± 9.30%), but not significantly different between PCa and BPH (9.29 ± 7.29%). The specificity, sensitivity and accuracy of T2WI associated with DWI and IVIM were higher (100, 98 and 99%, respectively) than for T2WI/DWI and IVIM alone (89, 92 and 90%, respectively). Only for ADC was found a statistical difference between low- and intermediate-/high-grade tumors. Adding IVIM to the MP-MRI could increase the diagnostic performance to detect clinically relevant PCa. ADC values have been found to have a rule to discriminate PCa reliably from normal areas and differed significantly in low- and intermediate-/high-grade PCa. In contrast, IVIM parameters were unable to distinguish between the different GS.

Intravoxel incoherent motion diffusion‐weighted imaging in assessing bladder cancer invasiveness and cell proliferation

“…Intravoxel incoherent motion (IVIM) DWI is an advanced imaging technique that has been explored in various tumor types, including breast, liver, prostate, pancreas, and brain tumors . IVIM‐DWI with multiple b‐values can provide three parameters through biexponential analysis: the pure diffusion coefficient (D), perfusion‐related incoherent microcirculation (D*), and the microvascular volume fraction (f).…”

“…Intravoxel incoherent motion (IVIM) DWI is an advanced imaging technique that has been explored in various tumor types, including breast, liver, prostate, pancreas, and brain tumors. [9][10][11][12][13] IVIM-DWI with multiple b-values can provide three parameters through biexponential analysis: the pure diffusion coefficient (D), perfusion-related incoherent microcirculation (D*), and the microvascular volume fraction (f ). Compared to conditional DWI, IVIM-DWI can reflect both perfusion and true diffusion-related effect in tumors, thus more accurately characterizing the actual status of diffusion in tumors without a contrast agent.…”

The prostate cancer focal therapy

“…Gland Surg 2018;7(2):89-102 gs.amegroups.com enhancing low-signal-intensity regions are expected at sites of treated PCa (representing necrosis), while focal areas of enhancement (representing viable tissue) are suspicious for recurrence (65). In the last decades, a resurgent interest for functional imaging based on a special theory named intravoxel incoherent motion (IVIM) developed (66) and there are studies demonstrating that extract IVIM parameters in mpMRI is clinically relevant for PCa detection (67)(68)(69). One appealing feature of these data is that applying IVIM protocol, the perfusion information could be obtained without the need for intravenous contrast media (68,70,71), which is especially relevant considering nephrogenic systemic fibrosis due to the gadolinium-based contrast (72,73) and the rising concern of gadolinium deposition in neural tissues (74).…”

Effects of Echo Time on IVIM Quantification of the Normal Prostate

“…Intravoxel incoherent motion (IVIM) is a diffusion model that aims to separate the perfusion effect from the diffusion effect. Some studies have applied IVIM in prostate imaging and showed promising results for the evaluation of prostate cancer 5 , 6 .…”