Intravoxel incoherent motion diffusion-weighted imaging of pancreas: Probing evidence of β-cell dysfunction in asymptomatic adults with hyperglycemia in vivo

PURPOSE

Early evaluation of β-cell dysfunction of hyperglycemic patients in asymptomatic adults would be valuable for timely prevention of the diabetes. This study aimed to evaluate functional changes in the pancreas using intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and determine whether it could be used as a non-invasive method of assessing β-cell dysfunction.

METHODS

This prospective cohort study was conducted from August 2022 to November 2022 in Jinan University Affiliated Guangdong Second General Hospital. Three groups were enrolled and underwent IVIM-DWI: confirmed patients with type 2 diabetes (T2DM); hyperglycemic patients in asymptomatic adults; and the volunteers with normal glucose tolerance (NGT). Imaging parameters were obtained: apparent diffusion coefficient (ADC), the true diffusion coefficient (Dt), the pseudo-diffusion coefficient (Dp), and the perfusion fraction (f). The β-cell function indexes were calculated from blood examinations: composite insulin sensitivity index (ISI), 60-min insulinogenic index (IGI60), and the disposition index (DI). We compared imaging parameters among three groups, calculated the diagnostic performance of them for differentiating different groups, and the reproducibility of them was evaluated using intraclass correlation coefficient (ICC).

RESULTS

The imaging parameters except f gradually decreased among the groups with significant differences for ADC (p < 0.0001), Dt (p < 0.0001), and Dp (p = 0.013). Dt demonstrated the best diagnostic performance for differentiating asymptomatic patients from NGT (Area Under Curve [AUC] = 0.815, p < 0.0001). IVIM-DWI parameters correlated with composite ISI and DI, of which, Dt has the highest correlation with DI (Pearson correlation coefficient [r] = 0.546, p < 0.0001). The ICC of IVIM-DWI parameters was very good, Dt was highest (Interobserver ICC = 0.938, 95% Confidence Interval [CI], 0.899-0.963; Intraobserver ICC = 0.941, 95% CI, 0.904-0.965).

CONCLUSION

IVIM-DWI is a non-invasive quantitative method that can identify β-cell dysfunction in the pancreas.

Field-of-view optimized and constrained undistorted single-shot study of intravoxel incoherent motion and diffusion-weighted imaging of the uterus during the menstrual cycle: a prospective study

PURPOSE

This study aimed to compare the variability of the uterus during the menses phase (MP), follicular phase (FP), and luteal phase (LP) of the menstrual cycle using intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI).

METHODS

This prospective study was conducted at the Guangdong Provincial Hospital of Traditional Chinese Medicine between January 2022 and January 2023. Women of childbearing age (18-45 years) with appropriate progesterone levels were included in this study. Conventional magnetic resonance imaging and IVIM-DWI scans were performed during the MP, FP, and LP. The differences in IVIM-DWI-derived parameters between these phases were then compared, and the overlap was quantitatively described.

RESULTS

The apparent diffusion coefficient (ADC) and pure molecular diffusion coefficient (D) values from the endometrium, uterine junctional zone (UJZ), and myometrium indicated statistical differences between the MP and FP and the MP and LP (ADC: endometrium, both P < 0.001; UJZ, P = 0.008 and P < 0.001, respectively; myometrium, P = 0.033 and P = 0.006, respectively; D: endometrium, both P < 0.001; UJZ, P = 0.008 and P = 0.006, respectively; myometrium, P = 0.041 and P = 0.045, respectively). The perfusion-related diffusion coefficient (D*) values from the myometrium indicated statistical differences between the FP and MP and the FP and LP (D*: myometrium, P = 0.049 and P = 0.009, respectively). The overlapping endometrium ratios between the MP and FP or LP were lower than 50% in the ADC and D values (ADC: overlapping of MP and FP: 33.33%, overlapping of MP and LP: 23.33%; D: overlapping of MP and FP: 40.00%, overlapping of MP and LP: 43.33%).

CONCLUSION

The ADC and IVIM-derived parameters indicated differences in the uterus in diverse phases of the menstrual cycle, especially in the endometrium in relation to ADC and D values.

Prediction of short-term treatment outcome of nasopharyngeal carcinoma based on voxel incoherent motion imaging and arterial spin labeling quantitative parameters

Purpose

To evaluate the early response of chemoradiotherapy (CRT) in nasopharyngeal carcinoma (NPC) based on intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and three-dimensional pseudo-continuous arterial spin labeling (3D pCASL).

Materials and methods

Forty patients diagnosed with NPC were recruited and divided into complete remission (CR) and partial remission (PR) group after CRT. All patients underwent IVIM and ASL and the related parameters was obtained. These parameters include pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), average blood flow ( BF_avg), minimum blood flow (BF_min), and maximum blood flow (BF_max). Student's t test was used to compare the difference in ASL and IVIM derived parameters between CR and PR. The Areas under curve (AUC) of the receiver operating characteristic (ROC) was used to analyze the diagnostic performance of each parameter of ASL and IVIM to the treatment outcome.

Results

the D value of IVIM in CR group was lower than that of the PR group ( P = 0.014),. Among the parameters of ASL, the BF_avg and BF_max of the CR group were higher than those of the PR group(p = 0.004,0.013), but the BF_min had no statistical significance in the two groups（P = 0.54）. AUC of D, BF_avg, and BF_max is about 0.731, 0.753, and 0.724, respectively, all of their combined AUC diagnosis was 0.812.

Conclusion

The early response of NPC after CRT can predict by IVIM's diffusion parameters and ASL-related blood flow parameters.

Comparison of the Effects of Hepatic Steatosis on Monoexponential DWI, Intravoxel Incoherent Motion Diffusion-weighted Imaging and Diffusion Kurtosis Imaging

RATIONALE AND OBJECTIVES

Diffusion-weighted imaging (DWI) techniques have drawn attention for their capability of staging hepatic fibrosis. However, the diagnostic performance of DWI for hepatic fibrosis might be affected by hepatic steatosis because hepatic steatosis and fibrosis may have a similar effect on diffusion/perfusion parameters. Therefore, the purpose of our study is to investigate the effect of hepatic steatosis on DWI parameters.

MATERIALS AND METHODS

51 patients with MR elastography liver stiffness values below 3.45kPa underwent DWI with multiple b-values and a multi-echo Dixon sequence for fat quantification. Correlation analysis was conducted between fat fraction and DWI parameters, and DWI parameters were compared between steatosis and non-steatosis groups.

RESULTS

Significant negative correlation was observed between fat fraction and apparent diffusion coefficient (ADC) (r = -0.62, p <0.001), pure molecular diffusion (D) (r = -0.62, p <0.001), corrected ADC (D_app) (r = -0.36, p = 0.01) and a positive correlation with mean kurtosis (K_app) (r = 0.53, p <0.001). The results of the comparison of DWI parameters were that ADC, D and D_app were statistically lower in the steatosis group (p < 0.001, p < 0.001 and p = 0.026, respectively) and K_app was significantly higher in the steatosis group (p <0.001) compared to the non-steatosis group. However, perfusion-related parameters (D* and f) did not show any statistical significance.

CONCLUSION

DWI parameters except for perfusion-related parameters (D* and f) are affected by changes in hepatic steatosis. Thus, hepatic steatosis may be considered as a possible confounding factor in DWI-based assessment of liver fibrosis.

Noninvasive assessment of kidney dysfunction in children by using blood oxygenation level-dependent MRI and intravoxel incoherent motion diffusion-weighted imaging

Objectives

To explore whether multiparametric approach including blood oxygenation level-dependent MRI (BOLD-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) can be applied in the assessment of renal function in children with chronic kidney disease (CKD).

Materials and methods

This prospective study included 74 children (CKD stage 1–3, 51; CKD stage 4–5, 12; healthy volunteers, 11) for renal MRI examinations including coronal T2WI, axial T1WI and T2WI, BOLD-MRI, and DWI sequences. We measured the renal cortex and medulla T2*, ADC, D_t, D_p, and f_p values on BOLD and DWI images. Appropriate statistical methods were applied for comparing MRI-derived parameters among the three groups and calculating the correlation coefficients between MRI-derived parameters and clinical data. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of MRI-derived parameters.

Results

There were significant differences in cortex T2*, ADC, D_t, f_p and medulla T2*, ADC, D_t among the three groups. Cortex T2*, ADC, D_t, f_p and medulla T2*, ADC, D_t had a trend: CKD stage 4–5 < CKD stage 1–3 < healthy volunteers. Cortex and medulla T2*, ADC, D_t were significantly correlated with eGFR, serum creatinine (Scr), cystatin C. In addition, cortex T2* and eGFR showed the highest correlation coefficient (r = 0.824, p < 0.001). Cortex D_t and medulla T2* were optimal parameters for differentiating healthy volunteers and CKD stage 1–3 or CKD stage 4–5 and CKD stage 1–3, respectively.

Conclusions

BOLD-MRI and IVIM-DWI might be used as a feasible method for noninvasive assessment of renal function in children with CKD.

Quantitative study of preoperative staging of gastric cancer using intravoxel incoherent motion diffusion-weighted imaging as a potential clinical index

PURPOSE

To determine the utility of intravoxel incoherent motion (IVIM) diffusion-weighted imaging in quantitative analysis of preoperative tumor (T) and node (N) stages of gastric cancer, and to quantify the diagnostic threshold of IVIM parameters for serosal invasion and lymphatic metastasis.

MATERIALS AND METHODS

From October 2016 to February 2020, 98 patients with gastric cancer who were receiving treatment in Zhongshan Hospital, China, were subject to an IVIM sequence imaging analysis. The IVIM sequence data were imported into software for post-processing of tumor regions of interest, and the IVIM parameters (the microvascular volume fraction (f), the molecular diffusion coefficient (D) and perfusion-related incoherent microcirculation (D*) were calculated. The variation of these IVIM parameters with different tumor-node metastasis (TNM) stages were analyzed by one-way analysis of variance. The IVIM parameters of serosal invasion and lymphatic metastasis were examined by receiver operating characteristic curve analysis and t-tests.

RESULTS

A total of 98 gastric cancer patients (65 males and 33 females) with an average age of 61.9 years were enrolled in this study. There were 14 patients in stage T1, 14 in stage T2, 10 in stage T3 and 60 in stage T4_a+b. There were 37 patients in stage N0, 19 in stage N1, 18 in stage N2 and 24 in stage N3. Statistically significant associations were found between the D values and T stages of gastric cancer. The D values of stage T4 cancers were significantly different from those of stage T2, T3 and T4 cancers. The D value decreased with increasing T stage. The mean D values of stages were 1.432 × 10^-3 mm²/s (T1), 1.225 × 10^-3 mm²/s (T2), 1.154 × 10^-3 mm²/s (T3) and 0.9468 × 10^-3 mm²/s (T4). The extent of the invasion of serosa was found to be significantly correlated with D value, with the diagnostic threshold for D being 1.107 × 10^-3 mm²/s. In addition, different pathological N stages of gastric cancer lesions showed statistically significantly variations in f values, but no correlation was found with different N stages. Finally, the extent of lymphatic metastasis was found to be correlated with D values, with the diagnostic threshold being 1.1739 × 10^-3 mm²/s. There was no statistically significant correlation between the IVIM MRI parameters and tumor size. The grade of tumor was found to be significantly correlated with D* value, with the diagnostic threshold for D* being 1.516 × 10^-2 mm²/s. There was no statistically significant correlation between the ADC value and tumor size. There was a significant difference in the ADC values among different T and N stage cancers. ADC value had statistically significant to distinguish gastric cancer with or without serosal invasion, its detection efficiency was not as high as that of D value, with an AUC of 0.628 and 0.830, respectively. The ADC value was not statistically significant in distinguishing gastric cancer with or without lymphatic metastasis (P ≥ 0.05). The ADC value had not statistically significant in distinguishing gastric cancer between low and medium-high grade (P ≥ 0.05).

CONCLUSION

We found that significant differences existed between whole-volume IVIM parameters of different T or N stages in gastric cancers, and were able to quantify different T or N stages of gastric cancer by the values of these parameters. The results of this quantitative study provide new tools for evaluating the prognosis of gastric cancer and will be valuable for the development of an new imaging method for determining the morphological stages of gastric cancer.

3.0 T MRI IVIM-DWI for predicting the efficacy of neoadjuvant chemoradiation for locally advanced rectal cancer

Purpose

The purpose of this study was to determine the diagnostic performance of intravoxel incoherent motion (IVIM) on assessing response to neoadjuvant chemoradiation (nCRT) in patients with Locally Advanced Rectal Cancer (LARC).

Methods

50 patients with rectal cancer who underwent magnetic resonance (MR) imaging before and after nCRT, the values of pre-nCRT and post-nCRT IVIM-DWI parameters apparent diffusion coefficient (ADC), diffusion coefficient (D), false diffusion coefficient (D*), and perfusion fraction (f), together with the percentage changes (∆% parametric value) induced by nCRT were calculated. According to the patient's response to nCRT, the patients were divided into pathological complete response (pCR) and non-pCR groups, Good Response (GR) group and Poor Response (PR) group, and the above values were compared between different groups. Univariate and multiple logistic regression analysis were done to investigate the relation between different parameters and patient nCRT. Draw ROC curve according to sensitivity and specificity, and compare its diagnostic efficacy.

Results

There were no significant differences in the baseline data of 50 patients. After nCRT, the ADC and D values for LARC increased significantly (all p < 0.05). The pCR group (n = 9) had higher preD*, pref, postD*, ∆%ADC and ∆%D values than the non-pCR group (n = 41) (all p < 0.05). The GR group (n = 17) exhibited higher post D, ∆%ADC and ∆%D values than the PR group (n = 33) (all p < 0.05). From the results of Logistic regression analysis found that ∆%ADC and ∆%D were significantly correlated with patients' response to nCRT. Based on ROC analysis, ∆%D had a higher area under the curve value than ∆%ADC (p = 0.009) in discriminating the pCR from non-pCR groups.

Conclusions

IVIM-DWI technology may be helpful in identifying the pCR and GR patients to nCRT for LARC.

Intravoxel incoherent motion diffusion-weighted imaging for the assessment of renal fibrosis of chronic kidney disease: A preliminary study

PURPOSE

To investigate the potential of Intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI) for the assessment of renal fibrosis in chronic kidney disease (CKD), using histopathology as a reference standard.

METHODS

Eighty-five CKD patients and twenty healthy volunteers were recruited in this study. IVIM-DWI was performed in all of the participants, and all of the CKD patients underwent renal biopsy. The mean values of the true diffusion coefficient (D), pseudo diffusion coefficient (D*) and perfusion fraction (f) in the renal cortex and medulla were compared between the CKD patients and healthy volunteers. The Spearman correlation coefficient was calculated to assess the relationship between the D, D*,f values and the estimated glomerular filtration rate (eGFR), serum creatinine level (SCr), 24h urinary protein level (24h-UPRO), histopathological fibrosis scores.

RESULTS

The D, D* and f values were significantly lower in medulla than in the cortex for all of the participants. All of the IVIM parameters were significantly lower in the CKD patients than in the healthy controls. In the CKD patients, a significant negative correlation was found between the renal parenchymal D, D*,f values and the 24h-UPRO, as well as between the renal parenchymal D, f values and the SCr. There was a significant positive correlation between all of the IVIM parameters and the eGFR. All of the IVIM parameters exhibited a significant negative correlation with the histopathological fibrosis score.

CONCLUSION

IVIM-DWI shows great potential in the noninvasive assessment of renal fibrosis in CKD.

Combination of IVIM-DWI and 3D-ASL for differentiating true progression from pseudoprogression of Glioblastoma multiforme after concurrent chemoradiotherapy: study protocol of a prospective diagnostic trial

Background

Standard therapy for Glioblastoma multiforme (GBM) involves maximal safe tumor resection followed with radiotherapy and concurrent adjuvant temozolomide. About 20 to 30% patients undergoing their first post-radiation MRI show increased contrast enhancement which eventually recovers without any new treatment. This phenomenon is referred to as pseudoprogression. Differentiating tumor progression from pseudoprogression is critical for determining tumor treatment, yet this capacity remains a challenge for conventional magnetic resonance imaging (MRI). Thus, a prospective diagnostic trial has been established that utilizes multimodal MRI techniques to detect tumor progression at its early stage. The purpose of this trial is to explore the potential role of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and three-dimensional arterial spin labeling imaging (3D-ASL) in differentiating true progression from pseudoprogression of GBM. In addition, the diagnostic performance of quantitative parameters obtained from IVIM-DWI and 3D-ASL, including apparent diffusion coefficient (ADC), slow diffusion coefficient (D), fast diffusion coefficient (D*), perfusion fraction (f), and cerebral blood flow (CBF), will be evaluated.

Methods

Patients that recently received a histopathological diagnosis of GBM at our hospital are eligible for enrollment. The patients selected will receive standard concurrent chemoradiotherapy and adjuvant temozolomide after surgery, and then will undergo conventional MRI, IVIM-DWI, 3D-ASL, and contrast-enhanced MRI. The quantitative parameters, ADC, D, D*, f, and CBF, will be estimated for newly developed enhanced lesions. Further comparisons will be made with unpaired t-tests to evaluate parameter performance in differentiating true progression from pseudoprogression, while receiver-operating characteristic (ROC) analyses will determine the optimal thresholds, as well as sensitivity and specificity. Finally, relationships between these parameters will be assessed with Pearson’s correlation and partial correlation analyses.

Discussion

The results of this study may demonstrate the potential value of using multimodal MRI techniques to differentiate true progression from pseudoprogression in its early stages to help decision making in early intervention and improve the prognosis of GBM.

Trial registration

This study has been registered at ClinicalTrials.gov (NCT02622620) on November 18, 2015 and published on March 28, 2016.

Intravoxel incoherent motion diffusion-weighted imaging for monitoring chemotherapeutic efficacy in gastric cancer

AIM: To assess intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for monitoring early efficacy of chemotherapy in a human gastric cancer mouse model.

METHODS: IVIM-DWI was performed with 12 b-values (0-800 s/mm²) in 25 human gastric cancer-bearing nude mice at baseline (day 0), and then they were randomly divided into control and 1-, 3-, 5- and 7-d treatment groups (n = 5 per group). The control group underwent longitudinal MRI scans at days 1, 3, 5 and 7, and the treatment groups underwent subsequent MRI scans after a specified 5-fluorouracil/calcium folinate treatment. Together with tumor volumes (TV), the apparent diffusion coefficient (ADC) and IVIM parameters [true water molecular diffusion coefficient (D), perfusion fraction (f) and pseudo-related diffusion coefficient (D^*)] were measured. The differences in those parameters from baseline to each measurement (ΔTV%, ΔADC%, ΔD%, Δf% and ΔD^*%) were calculated. After image acquisition, tumor necrosis, microvessel density (MVD) and cellular apoptosis were evaluated by hematoxylin-eosin (HE), CD31 and terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) staining respectively, to confirm the imaging findings. Mann-Whitney test and Spearman's correlation coefficient analysis were performed.

RESULTS: The observed relative volume increase (ΔTV%) in the treatment group were significantly smaller than those in the control group at day 5 (ΔTV_treatment% = 19.63% ± 3.01% and ΔTV_control% = 83.60% ± 14.87%, P = 0.008) and day 7 (ΔTV_treatment% = 29.07% ± 10.01% and ΔTV_control% = 177.06% ± 63.00%, P = 0.008). The difference in ΔTV% between the treatment and the control groups was not significant at days 1 and 3 after a short duration of treatment. Increases in ADC in the treatment group (ΔADC%_treatment, median, 30.10% ± 18.32%, 36.11% ± 21.82%, 45.22% ± 24.36%) were significantly higher compared with the control group (ΔADC%_control, median, 4.98% ± 3.39%, 6.26% ± 3.08%, 9.24% ± 6.33%) at days 3, 5 and 7 (P = 0.008, P = 0.016, P = 0.008, respectively). Increases in D in the treatment group (ΔD%_treatment, median 17.12% ± 8.20%, 24.16% ± 16.87%, 38.54% ± 19.36%) were higher than those in the control group (ΔD%_control, median -0.13% ± 4.23%, 5.89% ± 4.56%, 5.54% ± 4.44%) at days 1, 3, and 5 (P = 0.032, P = 0.008, P = 0.016, respectively). Relative changes in f were significantly lower in the treatment group compared with the control group at days 1, 3, 5 and 7 follow-up (median, -34.13% ± 16.61% vs 1.68% ± 3.40%, P = 0.016; -50.64% ± 6.82% vs 3.01% ± 6.50%, P = 0.008; -49.93% ± 6.05% vs 0.97% ± 4.38%, P = 0.008, and -46.22% ± 7.75% vs 8.14% ± 6.75%, P = 0.008, respectively). D* in the treatment group decreased significantly compared to those in the control group at all time points (median, -32.10% ± 12.22% vs 1.85% ± 5.54%, P = 0.008; -44.14% ± 14.83% vs 2.29% ± 10.38%, P = 0.008; -59.06% ± 19.10% vs 3.86% ± 5.10%, P = 0.008 and -47.20% ± 20.48% vs 7.13% ± 9.88%, P = 0.016, respectively). Furthermore, histopathologic findings showed positive correlations with ADC and D and tumor necrosis (r_s = 0.720, P < 0.001; r_s = 0.522, P = 0.007, respectively). The cellular apoptosis of the tumor also showed positive correlations with ADC and D (r_s = 0.626, P = 0.001; r_s = 0.542, P = 0.005, respectively). Perfusion-related parameters (f and D^*) were positively correlated to MVD (r_s = 0.618, P = 0.001; r_s = 0.538, P = 0.006, respectively), and negatively correlated to cellular apoptosis of the tumor (r_s = -0.550, P = 0.004; r_s = -0.692, P < 0.001, respectively).

CONCLUSION: IVIM-DWI is potentially useful for predicting the early efficacy of chemotherapy in a human gastric cancer mouse model.