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Intravoxel incoherent motion diffusion-weighted MR imaging in differentiation of lung cancer from obstructive lung consolidation: comparison and correlation with pharmacokinetic analysis from dynamic contrast-enhanced MR imaging

European Radiology volume 24, pages 1914–1922 (2014)Cite this article

Abstract

Objectives

To test whether parameters derived from intravoxel incoherent motion (IVIM) can be used to distinguish lung cancer from obstructive pulmonary consolidation by comparing them with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)-derived parameters and to evaluate the correlation between these quantitative parameters.

Methods

A total of 31 lung cancer patients, confirmed by pathology and obstructive consolidations confirmed by positron emission tomography/computed tomography (PET-CT), were recruited. All of them were assessed with structural MRI and IVIM and 17 of them underwent additional DCE-MRI examinations. Parameters derived from IVIM and DCE-MRI in the tumour and consolidation were analysed, and the optimal cut-off values in differential diagnosis were obtained.

Results

ADCtotal, D and f values were lower (P < 0.05), while IAUC60 was higher in lung cancers (P = 0.013) compared with obstructive pulmonary consolidations. According to the ROC curve, ADCtotal outperformed other perfusion and diffusion parameters with the optimal cut-off value of 1.409 × 10-3 mm2/s (AUC = 0.95). Poor correlations were found between parameters derived from IVIM and DCE-MRI.

Conclusions

IVIM-MRI is potentially useful in the differentiation of lung cancer and obstructive pulmonary consolidation. ADCtotal, D and f may be reliable independent discriminating markers, but D * is variable with low diagnostic accuracy.

Key Points

• Lung cancer and consolidation differentiation is essential for treatment decision-making.

• Perfusion and diffusion characteristics of lesions could help differential diagnosis.

• IVIM can separate reflection of tissue diffusivity and microcapillary perfusion.

• The relationship between perfusion quantified by IVIM and DCE-MRI is controversial.

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Abbreviations

PET-CT:

Positron emission tomography/computed tomography

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion weighted imaging

IVIM:

Intravoxel incoherent motion

SUV:

Standardised uptake value

ROIs:

Regions of interest

ROC:

Receiver operating characteristic

AUC:

Area under the curve

EES:

Extravascular extracellular space

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Acknowledgments

The scientific guarantor of this publication is Jiang Lin M.D., Ph.D; Professor; Deputy Chief of Department of Diagnostic Radiology of Shanghai Zhongshan Hospital, Shanghai Medical College of Fudan University. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This work is partly supported by a grant from Shanghai Health And Family Planning Committe(No. XBR2013115). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Shanghai Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200032, China

    Li-li Wang, Jiang Lin, Kai Liu, Cai-zhong Chen, Peng Lv & Meng-su Zeng

  2. Xiehe Hospital, Fujian Medical University, Fujian, 350001, China

    Li-li Wang

  3. MR Collaboration NEA, Siemens Ltd. China, Shanghai, China

    Hui Liu & Cai-xia Fu

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  1. Li-li Wang
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Correspondence to Jiang Lin.

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Wang, Ll., Lin, J., Liu, K. et al. Intravoxel incoherent motion diffusion-weighted MR imaging in differentiation of lung cancer from obstructive lung consolidation: comparison and correlation with pharmacokinetic analysis from dynamic contrast-enhanced MR imaging. Eur Radiol 24, 1914–1922 (2014). https://doi.org/10.1007/s00330-014-3176-z

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  • DOI: https://doi.org/10.1007/s00330-014-3176-z

Keywords

  • MR
  • Diffusion
  • Perfusion
  • Intravoxel incoherent motion
  • Lung cancer