Purpose: The purpose of this study was to examine the correlation of diffusion and perfusion quantitative MR parameters, on patients with malignant soft tissue tumors. In addition, we investigated the spatial agreement of hallmarks of malignancy as indicated by diffusion and perfusion biomarkers respectively.
Methods: Nonlinear least squares were used for the quantification of the DWI and DCE derived parameters for 25 patients of histologically proven soft tissue sarcoma scanned at a 1.5 T scanner. 4D data were analyzed by an in house built software implemented in Python 3.5 resulting in voxel based parametric maps based on the Intra-Voxel Incoherent Motion (IVIM), Extended Toft's (ETM) and Gamma Capillary Transit time (GCTT) models. The root mean squared error (RMSE) was also used for assessing the accuracy of the DCE fitting models.
Results: A good Pearson's correlation (r > 0.5) was found between micro-perfusion fraction (f-IVIM) and plasma volume (vp-GCTT). There was no significant correlation between all other possible pairs of DCE and DWI derived parameters. Following thresholding the indicators of malignancy from both imaging methods, the percentage of volume overlap between regions of high cellularity and high vascular permeability ranged from 6% to 30%.
Conclusion: A free correlation study among all DCE and DWI derived pairs of parameters, showed a linear relationship between f-IVIM and vp-GCTT in patients with soft tissue sarcomas. DCE in conjunction with DWI MRI can provide useful information on sites of aggressive characteristics for guiding the pre-operative biopsy and for overall treatment planning.
Keywords: Diffusion Weighted Imaging; Dynamic contrast enhanced MR imaging; Intravoxel incoherent motion; Musculoskeletal tumors; Soft tissue sarcoma.
Copyright © 2019 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.