Evaluating the Histopathology of Pancreatic Ductal Adenocarcinoma by Intravoxel Incoherent Motion-Diffusion Weighted Imaging Comparing With Diffusion-Weighted Imaging

Qi Liu; Jinggang Zhang; Man Jiang; Yue Zhang; Tongbing Chen; Jilei Zhang; Bei Li; Jie Chen; Wei Xing

doi:10.3389/fonc.2021.670085

Evaluating the Histopathology of Pancreatic Ductal Adenocarcinoma by Intravoxel Incoherent Motion-Diffusion Weighted Imaging Comparing With Diffusion-Weighted Imaging

Front Oncol. 2021 Jun 23:11:670085. doi: 10.3389/fonc.2021.670085. eCollection 2021.

Authors

Qi Liu¹, Jinggang Zhang¹, Man Jiang¹, Yue Zhang², Tongbing Chen³, Jilei Zhang⁴, Bei Li¹, Jie Chen¹, Wei Xing¹

Affiliations

¹ Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
² Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China.
³ Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
⁴ Clinical Science, Philips Healthcare, Shanghai, China.

Abstract

Objectives: To explore the differences between intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and diffusion-weighted imaging (DWI) in evaluating the histopathological characters of pancreatic ductal adenocarcinoma (PDAC).

Methods: This retrospective study enrolled 50 patients with PDAC confirmed by pathology from December 2018 to May 2020. All patients underwent DWI and IVIM-DWI before surgeries. Patients were classified into low- and high-fibrosis groups. Apparent diffusion coefficient (ADC), diffusion coefficient (D), false diffusion coefficient (D*), and perfusion fraction (f) were measured by two radiologists, respectively in GE AW 4.7 post-processing station, wherein ADC values were derived by mono-exponential fits and f, D, D* values were derived by biexponential fits. The tumor tissue was stained with Sirius red, CD34, and CK19 to evaluate fibrosis, microvascular density (MVD), and tumor cell density. Furthermore, the correlation between ADC, D, D*, and f values and histopathological results was analyzed.

Results: The D values were lower in the high-fibrosis group than in the low-fibrosis group, while the f values were opposite. Further, no statistically significant differences were detected in ADC and D* values between the high- and low-fibrosis groups. The AUC of D and f values had higher evaluation efficacy in the high- and low-fibrosis groups than ADC values. A significant negative correlation was established between D values, and fibrosis and a significant positive correlation were observed between f values and fibrosis. No statistical difference was detected between DWI/IVIM parameters values and MVD or tumor cell density except for the positive correlation between D* values and tumor cell density.

Conclusions: D and f values derived from the IVIM model had higher sensitivity and diagnostic performance for grading fibrosis in PDAC compared to the conventional DWI model. IVIM-DWI may have the potential as an imaging biomarker for predicting the fibrosis grade of PDAC.

Keywords: biomarker; diffusion-weighted imaging; fibrosis; intravoxel incoherent motion-diffusion weighted imaging; pancreatic ductal adenocarcinoma.