Intravoxel incoherent motion diffusion-weighted MR imaging of solid pancreatic masses: reliability and usefulness for characterization
- 161 Downloads
IVIM-DW imaging has shown potential usefulness in the study of pancreatic lesions. Controversial results are available regarding the reliability of the measurements of IVIM-derived parameters. The aim of this study was to evaluate the reliability and the diagnostic potential of IVIM-derived parameters in differentiation among focal solid pancreatic lesions and normal pancreas (NP).
Fifty-seven patients (34 carcinomas—PDACs, 18 neuroendocrine neoplasms—panNENs, and 5 autoimmune pancreatitis—AIP) and 50 subjects with NP underwent 1.5-T MR imaging including IVIM-DWI. Images were analyzed by two independent readers. Apparent diffusion coefficient (ADC), slow component of diffusion (D), incoherent microcirculation (Dp), and perfusion fraction (f) were calculated. Interobserver reliability was assessed with intraclass correlation coefficient (ICC). A Kruskal–Wallis H test with Steel–Dwass post hoc test was used for comparison. The diagnostic performance of each parameter was evaluated through receiver operating characteristic (ROC) curve analysis.
Overall interobserver agreement was excellent (ICC = 0.860, 0.937, 0.968, and 0.983 for ADC, D, Dp, and f). D, Dp, and f significantly differed among PDACs and panNENs (p = 0.002, < 0.001, and < 0.001), albeit without significant difference at the pairwise comparison of ROC curves (p = 0.08-0.74). Perfusion fraction was higher in AIP compared with PDACs (p = 0.024; AUC = 0.735). Dp and f were higher in panNENs compared with AIP (p = 0.029 and 0.023), without differences at ROC analysis (p = 0.07).
IVIM-derived parameters have excellent reliability and could help in differentiation among solid pancreatic lesions and NP.
KeywordsPancreas Intravoxel incoherent motion Diffusion-weighted imaging Pancreatic carcinoma Magnetic resonance imaging
Compliance with ethical standards
We state that this work has not received any funding.
Conflict of interest
Riccardo De Robertis, Nicolò Cardobi, Silvia Ortolani, Paolo Tinazzi Martini, and Mirko D’Onofrio declare no economic relationships with any companies, whose products or services may be related to the subject matter of the article. Alto Stemmer is an employee of Siemens Healthcare GmbH. Robert Grimm is an employee of Siemens Healthcare GmbH, owns stocks of Siemens AG, and holds patents filed by Siemens.
- 1.Barral M, Taouli B, Guiu B, et al. (2015) Diffusion-weighted MR imaging of the pancreas: current status and recommendations. Radiology 274:45–63Google Scholar
- 2.Brenner R, Metens T, Bali M, Demetter P, Matos C (2012) Pancreatic neuroendocrine tumor: added value of fusion of T2-weighted imaging and high b-value diffusion-weighted imaging for tumor detection. Eur J Radiol 81:e746–e749Google Scholar
- 3.De Robertis R, Tinazzi Martini P, Demozzi E, et al. (2015) Diffusion-weighted imaging of pancreatic cancer. World J Radiol 7:319–328Google Scholar
- 4.De Robertis R, D’Onofrio M, Zamboni G, et al. (2016) Pancreatic neuroendocrine neoplasms: clinical value of diffusion-weighted imaging. Neuroendocrinology 103:758–770Google Scholar
- 5.Fukukura Y, Shindo T, Hakamada H, et al. (2016) Diffusion-weighted MR imaging of the pancreas: optimizing b-value for visualization of pancreatic adenocarcinoma. Eur Radiol 26:3419–3427Google Scholar
- 6.Yi WM, Chen ZE, Paul Nikolaidis MD, et al. (2011) Diffusion-weighted magnetic resonance imaging of pancreatic adenocarcinomas: association with histopathology and tumor grade. J Magn Reson Imaging 33:136–142Google Scholar
- 7.Lotfalizadeh E, Ronot M, Wagner M, et al. (2017) Prediction of pancreatic neuroendocrine tumour grade with MR imaging features: added value of diffusion-weighted imaging. Eur Radiol 27:1748–1759Google Scholar
- 8.De Robertis R, Cingarlini S, Tinazzi Martini P, et al. (2017) Pancreatic neuroendocrine neoplasms: magnetic resonance imaging features according to grade and stage. World J Gastroenterol 23:275–285Google Scholar
- 9.Kim M, Kang TW, Kim YK, et al. (2016) Pancreatic neuroendocrine tumour: correlation of apparent diffusion coefficient or WHO classification with recurrence-free survival. Eur J Radiol 85:680–687Google Scholar
- 10.Fattahi R, Balci NC, Perman WH, et al. (2010) Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 29:350–356Google Scholar
- 11.Le Bihan D, Breton E, Lallemand D, et al. (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168:497–505Google Scholar
- 12.Dixon WT (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging: a modest proposal with tremendous potential. Radiology 168:566–567Google Scholar
- 13.Lemke A, Laun FB, Klauss M, et al. (2009) Differentiation of pancreas carcinoma from healthy pancreatic tissue using multiple b-values: comparison of apparent diffusion coefficient and intravoxel incoherent motion derived parameters. Invest Radiol 44:769–775Google Scholar
- 14.Klauss M, Lemke A, Grünberg K, et al. (2011) Intravoxel incoherent motion MRI for the differentiation between mass forming chronic pancreatitis and pancreatic carcinoma. Invest Radiol 46:57–63Google Scholar
- 15.Kang KM, Lee JM, Yoon JH, et al. (2014) Intravoxel incoherent motion diffusion-weighted MR imaging for characterization of focal pancreatic lesions. Radiology 270:444–453Google Scholar
- 16.Klau M, Mayer P, Bergmann F, et al. (2015) Correlation of histological vessel characteristics and diffusion-weighted imaging intravoxel incoherent motion-derived parameters in pancreatic ductal adenocarcinomas and pancreatic neuroendocrine tumors. Invest Radiol 50:792–797Google Scholar
- 17.Klauss M, Maier-Hein K, Tjaden C, et al. (2016) IVIM DW-MRI of autoimmune pancreatitis: therapy monitoring and differentiation from pancreatic cancer. Eur Radiol 26:2099–2106Google Scholar
- 18.Hecht EM, Liu MZ, Prince MR, et al. (2017) Can diffusion-weighted imaging serve as a biomarker of fibrosis in pancreatic adenocarcinoma? J Magn Reson Imaging 46:393–402Google Scholar
- 19.Ma C, Li Y, Wang L, et al. (2017) Intravoxel incoherent motion DWI of the pancreatic adenocarcinomas: monoexponential and biexponential apparent diffusion parameters and histopathological correlations. Cancer Imaging 17:12Google Scholar
- 20.Kim B, Lee SS, Sung YS, et al. (2017) Intravoxel incoherent motion diffusion-weighted imaging of the pancreas: characterization of benign and malignant pancreatic pathologies. J Magn Reson Imaging 45:260–269Google Scholar
- 21.Shimosegawa T, Chari ST, Frulloni L, et al. (2011) International consensus diagnostic criteria for autoimmune pancreatitis. Guidelines of the International Association of Pancreatology. Pancreas 40:352–358Google Scholar
- 22.Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284–290Google Scholar
- 23.Corrias G, Monti S, Horvat N, et al. (2018) Imaging features of malignant abdominal neuroendocrine tumors with rare presentation. Clin Imaging 8:59–64Google Scholar
- 24.Lalwani N, Mannelli L, Ganeshan DM, et al. (2015) Uncommon pancreatic tumors and pseudotumors. Abdom Imaging 40:167–180Google Scholar
- 25.De Robertis R, Tinazzi Martini P, Cingarlini S, et al. (2014) Digital subtraction of magnetic resonance images improves detection and characterization of pancreatic neuroendocrine neoplasms. J Comput Assist Tomogr 41:614–618Google Scholar
- 26.Falconi M, Eriksson B, Kaltsas G, et al. (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103:153–171Google Scholar
- 27.Hoshimoto S, Aiura K, Tanaka M, et al. (2016) Mass-forming type 1 autoimmune pancreatitis mimicking pancreatic cancer. J Dig Dis 17:202–209Google Scholar
- 28.Sugiyama Y, Fujinaga Y, Kadoya M, et al. (2012) Characteristic magnetic resonance features of focal autoimmune pancreatitis useful for differentiation from pancreatic cancer. Jpn J Radiol 30:296–309Google Scholar
- 29.Lee JH, Cheong H, Lee SS, et al. (2016) Perfusion assessment using intravoxel incoherent motion-based analysis of diffusion-weighted magnetic resonance imaging: validation through phantom experiments. Invest Radiol 51:520–528Google Scholar
- 30.Lee Y, Lee SS, Kim N, et al. (2015) Intravoxel incoherent motion diffusion-weighted MR imaging of the liver: effect of triggering methods on regional variability and measurement repeatability of quantitative parameters. Radiology 274:405–415Google Scholar
- 31.Andreou A, Koh DM, Collins DJ, et al. (2013) Measurement reproducibility of perfusion fraction and pseudodiffusion coefficient derived by intravoxel incoherent motion diffusion-weighted MR imaging in normal liver and metastases. Eur Radiol 23:428–434Google Scholar
- 32.Kartalis N, Loizou L, Edsborg N, Segersvard R, Albiin N (2012) Optimising diffusion-weighted MR imaging for demonstrating pancreatic cancer: a comparison of respiratory-triggered, free-breathing and breath-hold techniques. Eur Radiol 22:2186–2192Google Scholar