Comparison of Intravoxel incoherent motion imaging and multiecho dynamic contrast-based MRI in rectal cancer

Kine Mari Bakke; Endre Grøvik; Sebastian Meltzer; Anne Negård; Stein Harald Holmedal; Lars Tore G Mikalsen; Lars Gustav Lyckander; Anne H Ree; Kjell-Inge Gjesdal; Kathrine R Redalen; Atle Bjørnerud

doi:10.1002/jmri.26740

Comparison of Intravoxel incoherent motion imaging and multiecho dynamic contrast-based MRI in rectal cancer

J Magn Reson Imaging. 2019 Oct;50(4):1114-1124. doi: 10.1002/jmri.26740. Epub 2019 Apr 4.

Authors

Kine Mari Bakke^{1

2}, Endre Grøvik^{3

4}, Sebastian Meltzer¹, Anne Negård^{5

6}, Stein Harald Holmedal⁵, Lars Tore G Mikalsen³, Lars Gustav Lyckander⁷, Anne H Ree^{1

6}, Kjell-Inge Gjesdal^{1

8}, Kathrine R Redalen^{1

9}, Atle Bjørnerud^{2

3}

Affiliations

¹ Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
² Department of Physics, University of Oslo, Oslo, Norway.
³ Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
⁴ Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Drammen, Norway.
⁵ Department of Radiology, Akershus University Hospital, Lørenskog, Norway.
⁶ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷ Department of Pathology, Akershus University Hospital, Lørenskog, Norway.
⁸ Sunnmøre MR-klinikk, Ålesund, Norway.
⁹ Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

Background: Dynamic contrast-based MRI and intravoxel incoherent motion imaging (IVIM) MRI are both methods showing promise as diagnostic and prognostic tools in rectal cancer. Both methods aim at measuring perfusion-related parameters, but the relationship between them is unclear.

Purpose: To investigate the relationship between perfusion- and permeability-related parameters obtained by IVIM-MRI, T₁ -weighted dynamic contrast-enhanced (DCE)-MRI and T₂ *-weighted dynamic susceptibility contrast (DSC)-MRI.

Study type: Prospective.

Subjects: In all, 94 patients with histologically confirmed rectal cancer.

Field strength/sequence: Subjects underwent pretreatment 1.5T clinical procedure MRI, and in addition a study-specific diffusion-weighted sequence (b = 0, 25, 50, 100, 500, 1000, 1300 s/mm² ) and a multiecho dynamic contrast-based echo-planer imaging sequence.

Assessment: Median tumor values were obtained from IVIM (perfusion fraction [f], pseudodiffusion [D*], diffusion [D]), from the extended Tofts model applied to DCE data (K^trans , k_ep , v_p , v_e ) and from model free deconvolution of DSC (blood flow [BF] and area under curve). A subgroup of the excised tumors underwent immunohistochemistry with quantification of microvessel density and vessel size.

Statistical test: Spearman's rank correlation test.

Results: D* was correlated with BF (r_s = 0.47, P < 0.001), and f was negatively correlated with k_ep (r_s = -0.31, P = 0.002). BF was correlated with K^trans (r_s = 0.29, P = 0.004), but this correlation varied extensively when separating tumors into groups of low (r_s = 0.62, P < 0.001) and high (r_s = -0.06, P = 0.68) BF. K^trans was negatively correlated with vessel size (r_s = -0.82, P = 0.004) in the subgroup of tumors with high BF.

Data conclusion: We found an association between D* from IVIM and BF estimated from DSC-MRI. The relationship between IVIM and DCE-MRI was less clear. Comparing parameters from DSC-MRI and DCE-MRI highlights the importance of the underlying biology for the interpretation of these parameters.

Level of evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1114-1124.

Keywords: DCE; DSC; IVIM; perfusion; permeability; rectal cancer.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Contrast Media*
Female
Humans
Image Enhancement / methods*
Image Interpretation, Computer-Assisted / methods*
Magnetic Resonance Imaging / methods*
Male
Prospective Studies
Rectal Neoplasms / diagnostic imaging*
Rectum / diagnostic imaging
Reproducibility of Results

Substances

Contrast Media