Standard diffusion-weighted, diffusion kurtosis and intravoxel incoherent motion MR imaging of sinonasal malignancies: correlations with Ki-67 proliferation status

Eur Radiol. 2018 Jul;28(7):2923-2933. doi: 10.1007/s00330-017-5286-x. Epub 2018 Jan 30.


Objectives: To explore the correlations of parameters derived from standard diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) with the Ki-67 proliferation status.

Methods: Seventy-five patients with histologically proven sinonasal malignancies who underwent standard DWI, DKI and IVIM were retrospectively reviewed. The mean, minimum, maximum and whole standard DWI [apparent diffusion coefficient (ADC)], DKI [diffusion kurtosis (K) and diffusion coefficient (Dk)] and IVIM [pure diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f)] parameters were measured and correlated with the Ki-67 labelling index (LI). The Ki-67 LI was categorised as high (> 50%) or low (≤ 50%).

Results: The K and f values were positively correlated with the Ki-67 LI (rho = 0.295~0.532), whereas the ADC, Dk and D values were negatively correlated with the Ki-67 LI (rho = -0.443~-0.277). The ADC, Dk and D values were lower, whereas the K value was higher in sinonasal malignancies with a high Ki-67 LI than in those in a low Ki-67 LI (all p < 0.05). A higher maximum K value (Kmax > 0.977) independently predicted a high Ki-67 status [odds ratio (OR) = 7.614; 95% confidence interval (CI) = 2.197-38.674; p = 0.017].

Conclusion: ADC, Dk, K, D and f are correlated with Ki-67 LI. Kmax is the strongest independent factor for predicting Ki-67 status.

Key points: • DWI-derived parameters from different models are capable of providing different pathophysiological information. • DWI, DKI and IVIM parameters are associated with Ki-67 proliferation status. • K max derived from DKI is the strongest independent factor for the prediction of Ki-67 proliferation status.

Keywords: Diffusion magnetic resonance imaging; Immunohistochemistry; Magnetic resonance imaging; Neoplasms; Prognosis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Proliferation*
  • Diffusion Magnetic Resonance Imaging / methods
  • Diffusion Tensor Imaging / methods*
  • Female
  • Humans
  • Ki-67 Antigen / metabolism*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Nasal Cavity / diagnostic imaging
  • Nasal Cavity / metabolism
  • Nose Neoplasms / diagnostic imaging*
  • Nose Neoplasms / metabolism*
  • Paranasal Sinuses / diagnostic imaging
  • Paranasal Sinuses / metabolism
  • Retrospective Studies
  • Young Adult


  • Ki-67 Antigen