Esophageal carcinoma: Intravoxel incoherent motion diffusion-weighted MRI parameters and histopathological correlations

Shaocheng Zhu; Yi Wei; Feifei Gao; Linlin Li; Yuehua Liu; Zixing Huang; Hehan Tang; Dandan Zheng; Xiaocheng Wei; Tingyi Sun; Bin Song

doi:10.1002/jmri.26172

Esophageal carcinoma: Intravoxel incoherent motion diffusion-weighted MRI parameters and histopathological correlations

J Magn Reson Imaging. 2019 Jan;49(1):253-261. doi: 10.1002/jmri.26172. Epub 2018 May 7.

Authors

Shaocheng Zhu¹, Yi Wei², Feifei Gao¹, Linlin Li¹, Yuehua Liu¹, Zixing Huang², Hehan Tang², Dandan Zheng³, Xiaocheng Wei³, Tingyi Sun⁴, Bin Song²

Affiliations

¹ Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China.
² Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
³ GE Healthcare China, Beijing, China.
⁴ Department of Pathology, Henan Provincial People's Hospital, Zhengzhou, China.

PMID: 29734492
DOI: 10.1002/jmri.26172

Abstract

Background: The pathological grade of esophageal carcinoma is highly determinant of patient prognosis, but it still cannot be adequately evaluated preoperatively. Compared with conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM) diffusion-weighted MRI can separate true molecular diffusion and perfusion in tissues and has been shown to be useful in characterizing malignant tumors. There is no report that compared IVIM and conventional DWI in grading esophageal carcinoma.

Purpose: To prospectively determine the diagnostic performance of conventional DWI and IVIM models in differentiating the pathological differentiated grade of esophageal carcinoma.

Study type: Prospective.

Population: A cohort comprising 81 patients with newly diagnosed esophageal squamous cell carcinoma (ESCC) between December 2015 and August 2017 were evaluated.

Field strength/sequence: 3.0T, axial echo-planer imaging, fast spin echo (FSE) sequence, IVIM sequence (b = 0, 20, 50, 80, 100, 150, 200, 400, 600, 800, 1000, 1200).

Assessment: Apparent diffusion coefficient (ADC), true ADC (ADC_slow ), pseudo ADC (ADC_fast ), and perfusion fraction (f) of each tumor were calculated by two independent radiologists. Histopathologic grade was used as the reference standard.

Statistical tests: Games-Howell test; diagnostic accuracy; Spearman correlation; intraclass correlation coefficient; and Bland-Altman analysis. Receiver operating characteristics (ROC) curves.

Results: ADC_slow demonstrated the highest area under curve (AUC) with a value of 0.830 (95% confidence interval [CI]: 0.730-0.904) and 0.816 (95% CI: 0.714-0.893) by two radiologists, followed by ADC with a value of 0.754 (95% CI: 0.646-0.843) and 0.761 (95% CI: 0.653-0.848). Good correlation was obtained between the histologic grade and ADC_slow (r_(R1) = 0.748, r_(R2) = 0.720) and ADC (r_(R1) = 0.576, r_(R2) = 0.571).

Data conclusion: ADC_slow and ADC had a significantly higher performance than the ADC_fast and f, and ADC_slow had a significantly higher performance than the ADC.

Level of evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:253-261.

Keywords: diffusion weighted imaging; esophageal carcinoma; intravoxel incoherent motion; pathological differentiated grade.

MeSH terms

Aged
Aged, 80 and over
Algorithms
Area Under Curve
Biopsy
Carcinoma / diagnostic imaging*
Diffusion Magnetic Resonance Imaging
Esophageal Neoplasms / diagnostic imaging*
Esophageal Squamous Cell Carcinoma / diagnostic imaging
Female
Humans
Image Processing, Computer-Assisted
Male
Middle Aged
Motion
Prognosis
Prospective Studies
ROC Curve
Reproducibility of Results