Dataset Information

Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma.

ABSTRACT:

Background

Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome.

Methods

38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADC_T1C, ADC_T2-FLAIR) and perfusion fraction (f_T1C, f_T2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated.

Results

Higher ADC_T2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95% CI 1.01-1.15, p = 0.025], lower f_T2-FLAIR at fraction 10 (OR = 2.11, 95% CI 1.04-4.27, p = 0.018), and lack of increase in ADC_T2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95% CI 1.02-1.22, p = 0.02) were associated with early progression. Combining ADC_T2-FLAIR at baseline, f_T2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher f_T2-FLAIR at fraction 10 (HR = 0.72, 95% CI 0.56-0.95, p = 0.018) was associated with longer PFS.

Conclusion

ADC_T2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or f_T2-FLAIR at fraction 10 significantly predicted early progression. f_T2-FLAIR at fraction 10 was associated with PFS.

SUBMITTER: Jabehdar Maralani P

PROVIDER: S-EPMC8186561 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BACKGROUND:Pediatric 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. PURPOSE:To assess the use of an IVIM model for diagnosis of childhood malignant abdominal tumors and discrimination of benign from malignant lesions. STUDY TYPE:Retrospective. POPULATION:Forty-two pediatric patients with abdominal lesions (n?=?32 malignant, n?=?10 benign), verified by histopathology. FIELD STRENGTH/SEQUENCE:1.5T MRI system and a DW-MRI sequence with six b-values (0, 50, 100, 150, 600, 1000 s/mm2 ). ASSESSMENT:Parameter 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 TESTS:Comparison of histogram parameters of and their diagnostic performance was determined using Kruskal-Wallis, Mann-Whitney U, and receiver-operating characteristic (ROC) analysis. RESULTS:IVIM 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 CONCLUSION:IVIM perfusion parameters could distinguish between malignant childhood tumor types, providing potential imaging biomarkers for their diagnosis. LEVEL OF EVIDENCE:4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1475-1486.

Project description:BackgroundThe spleen is a frequent organ of leukemia metastasis. This study aimed to investigate the value of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) for assessing pathologic changes in the spleen and identifying early spleen involvement in patients with acute leukemia (AL).MethodsPatients with newly diagnosed AL and healthy controls were recruited between June 2020 and November 2022. All participants underwent abdominal IVIM diffusion-weighted imaging (DWI) at our hospital. IVIM parameters [pure diffusion coefficient (D); pseudo-diffusion coefficient (D*); and pseudo-perfusion fraction (f)] of the spleen were calculated by the segmented fitting method, and perfusion-diffusion ratio (PDR) was further calculated from the values of D, D* and f. Spleen volumes (SVs) were obtained by manually segmenting the spleen layer by layer. Clinical biomarkers of AL patients were collected. Patients were divided into splenomegaly group and normal SV group according to the individualized reference intervals for SV. IVIM parameters were compared among the control group, AL with normal SV group, and AL with splenomegaly group using one-way analysis of variance, followed by pairwise post hoc comparisons. The correlations of IVIM parameters with clinical biomarkers were analyzed in AL patients. The diagnostic performances of IVIM parameters and their combinations for differentiating among the three groups were compared.ResultsSeventy-nine AL patients (AL with splenomegaly: n=54; AL with normal SV: n=25) and 55 healthy controls were evaluated. IVIM parameters were significantly different among the three groups (P<0.001 for D, D* and f; P=0.001 for PDR). D and PDR showed significant differences between the control and AL with normal SV groups in pairwise comparisons (P<0.001, and P=0.031, respectively). D was correlated with white blood cell (WBC) counts (r=-0.424; 95% CI: -0.570, -0.211; P<0.001), lactate dehydrogenase (LDH) (r=-0.285; 95% CI: -0.486, -0.011; P=0.011), and bone marrow blasts (r=-0.283; 95% CI: -0.476, -0.067; P=0.012). D* (r=-0.276; 95% CI: -0.470, -0.025; P=0.014), f (r=0.514; 95% CI: 0.342, 0.664; P<0.001) and PDR (r=0.343; 95% CI: 0.208, 0.549; P=0.002) were correlated with LDH. The combination of IVIM parameters (AUC: 0.830; 95% CI: 0.729, 0.905) demonstrated better diagnostic efficacy than the single D* (AUC: 0.721; 95% CI: 0.608, 0.816; Delong test: Z=2.012, P=0.044) and f (AUC: 0.647; 95% CI: 0.532, 0.752; Delong test: Z=2.829, P=0.005), but was not significantly different from the single D (AUC: 0.756; 95% CI: 0.647, 0.846; Delong test: Z=1.676, P=0.094) in differentiating the splenomegaly group and normal SV group.ConclusionsIVIM diffusion-weighted MRI could be a potential alternative for assessing pathologic changes in the spleen from cellularity and angiogenesis, and D and PDR may be viable indicators to identify early spleen involvement in patients with AL.

Project description:BackgroundThe present study analyzed whole-lesion histogram parameters from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) to explore the clinical value of IVIM histogram features in the differentiation of liver lesions.MethodsIn this retrospective study, 33 cases of hepatic hemangioma (HH), 22 cases of hepatic cysts (HC), and 34 cases of hepatocellular carcinoma (HCC) were underwent IVIM-DWI (b =0-600 s/mm2), which were confirmed pathologically and clinically. The data were processed by IVIM model to obtain the following quantitative indicators: perfusion fraction (f), slow diffusion coefficient (D), and pseudo-diffusion coefficient (or fast diffusion coefficient, D*). The region of interest in the largest solid part of the lesion was delineated for histogram analysis of the correlation between tissue image and lesion type. The relevant histogram parameters were obtained and statistically analyzed. The characteristic histogram parameters for HH, HC, and HCC were compared to find significantly different parameters. The diagnostic efficacies of these parameters for HH, liver cysts, and HCC were assessed using the receiver operating characteristic (ROC) curves.ResultsThere were significant differences in the maximum diameter, maximum value, minimum value, mean, median, standard deviation, uniformity, skewness, kurtosis, volume, 10th percentile (P10) of D, and 90th percentile (P90) of D between the three groups (P<0.05). The maximum diameter, minimum value, entropy, and volume of D* differed significantly between the three groups (P<0.05). The maximum diameter, minimum value, mean, median, skewness, kurtosis, volume, P10, and P90 of f differed significantly between the three groups (P<0.05). The largest area under the ROC curve (AUC) for both D* and f was that of volume (AUC =0.883 for both). When 1438.802 was used as the volume cut-off, the sensitivity and specificity of volume in differentiating between HH and HC were 87.88 and 77.27, respectively, and the sensitivity and specificity of volume in differentiating between HC and HCC were 77.27 and 85.29.ConclusionsA multiparametric histogram from IVIM-DWI magnetic resonance imaging (MRI) is an effective means of identifying HH, HC, and HCC that provides valuable reference information for clinical diagnosis.