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Abdominal Radiology

, Volume 44, Issue 11, pp 3595–3605 | Cite as

Tumor detectability and conspicuity comparison of standard b1000 and ultrahigh b2000 diffusion-weighted imaging in rectal cancer

  • Andrea Delli PizziEmail author
  • Daniele Caposiena
  • Domenico Mastrodicasa
  • Stefano Trebeschi
  • Doenja Lambregts
  • Consuelo Rosa
  • Roberta Cianci
  • Barbara Seccia
  • Barbara Sessa
  • Filippo Maria Di Flamminio
  • Piero Chiacchiaretta
  • Luciana Caravatta
  • Sebastiano Cinalli
  • Pierluigi Di Sebastiano
  • Massimo Caulo
  • Domenico Genovesi
  • Regina Beets-Tan
  • Raffaella Basilico
Special Section: Rectal Cancer

Abstract

Purpose

To compare tumor detectability and conspicuity of standard b = 1000 s/mm2 (b1000) versus ultrahigh b = 2000 s/mm2 (b2000) diffusion-weighted imaging (DWI) in rectal cancer.

Methods

Fifty-five patients for a total of 81 3T DWI-MR scans were retrospectively evaluated by two differently experienced readers. A comparison between b1000 and b2000 for tumor detectability and conspicuity was performed. The conspicuity was qualitatively and quantitatively assessed by using three-point scale and whole tumor volume manual delineation, respectively. Receiver-operating characteristic curve (ROC) with area under the curve (AUC) analysis provided diagnostic accuracy in tumor detectability of restaging MR scans. Qualitative scores and quantitative features including mean signal intensity, variance, 10th percentile and 90th percentile, were compared using the Wilcoxon test. Interobserver agreement (IOA) for qualitative and quantitative data was calculated using Cohen’s Kappa and intraclass correlation coefficient (ICC) respectively.

Results

Diagnostic accuracy was comparable between b1000 and b2000 for both readers (p > 0.05). Overall quality scores were significantly better for b2000 than b1000 (2.29 vs 1.65 Reader 1, p = 0.01; 2.18 vs 1.69 Reader 2, p = 0.04). IOA was equally good for both b values (k = 0.86 b1000, k = 0.86 b2000). Quantitative analysis revealed more uniform signal (measured in variance) of b2000 in both healthy surrounding tissue (p < 0.05) and tumor (p < 0.05), with less outliers (measured using 10th and 90th percentile). Additionally, b2000 offered lower mean signal intensity in tissue sorrounding the tumor (p < 0.05). Finally, ICC improved from 0.92 (b1000) to 0.97 (b2000).

Conclusion

Ultrahigh b value (b2000) may improve rectal cancer conspicuity and introbserver agreement maintaining comparable diagnostic accuracy to standard b1000.

Keywords

Rectal cancer Diffusion-weighted imaging Ultrahigh b value b2000 Tumor conspicuity Tumor detectability Treatment response 

Notes

Acknowledgements

The authors thank Daniele Petrucci and Darien Calvo Garcia for their insightful contribution on the MR protocol settings and the acquisition of data; Paolo Raimondi for the surgical specimen and pathology showed in Fig. 4.

Author contributions

All authors were involved in patient management and wrote and/or reviewed the report. Written consent to publication was obtained.

Funding

No grant support.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patients included in this study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Andrea Delli Pizzi
    • 1
    Email author
  • Daniele Caposiena
    • 1
  • Domenico Mastrodicasa
    • 2
  • Stefano Trebeschi
    • 3
  • Doenja Lambregts
    • 3
  • Consuelo Rosa
    • 4
  • Roberta Cianci
    • 1
  • Barbara Seccia
    • 1
  • Barbara Sessa
    • 1
  • Filippo Maria Di Flamminio
    • 1
  • Piero Chiacchiaretta
    • 1
  • Luciana Caravatta
    • 4
  • Sebastiano Cinalli
    • 5
  • Pierluigi Di Sebastiano
    • 6
  • Massimo Caulo
    • 1
  • Domenico Genovesi
    • 4
  • Regina Beets-Tan
    • 3
  • Raffaella Basilico
    • 1
  1. 1.Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies“G. d’Annunzio” UniversityChietiItaly
  2. 2.Department of RadiologyStanford University School of MedicineStanfordUSA
  3. 3.Department of RadiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
  4. 4.Radiation Oncology UnitSS Annunziata HospitalChietiItaly
  5. 5.Section of Pathological Anatomy, Department of Medicine and Aging SciencesG. D’Annunzio UniversityChietiItaly
  6. 6.Division of Surgical Oncology“SS Annunziata” HospitalChietiItaly

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