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Perfusion and diffusion characteristics of cervical cancer based on intraxovel incoherent motion MR imaging-a pilot study

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Abstract

Objectives

To investigate the tissue characteristics of cervical cancer based on the intravoxel incoherent motion (IVIM) model and to assess the IVIM parameters in tissue differentiation in the female pelvis.

Methods

Sixteen treatment-naïve cervical cancer and 17 age-matched healthy subjects were prospectively recruited for diffusion-weighted (b = 0–1,000 s/mm2) and standard pelvic MRI. Bi-exponential analysis was performed to derive the perfusion parameters f (perfusion fraction) and D* (pseudodiffusion coefficient) as well as the diffusion parameter D (true molecular diffusion coefficient) in cervical cancer (n = 16), normal cervix (n = 17), myometrium (n = 33) and leiomyoma (n = 14). Apparent diffusion coefficient (ADC) was calculated. Kruskal–Wallis test and receiver operating characteristics (ROC) curves were used.

Results

Cervical cancer had the lowest f (14.9 ± 2.6 %) and was significantly different from normal cervix and leiomyoma (p < 0.05). The D (0.86 ± 0.16 x 10-3 mm2/s) was lowest in cervical cancer and was significantly different from normal cervix and myometrium (p < 0.05) but not leiomyoma. No difference was observed in D*. D was consistently lower than ADC in all tissues. ROC curves indicated that f < 16.38 %, D < 1.04 × 10-3 mm2/s and ADC < 1.13 × 10-3 mm2/s could differentiate cervical cancer from non-malignant tissues (AUC 0.773–0.908).

Conclusions

Cervical cancer has low perfusion and diffusion IVIM characteristics with promising potential for tissue differentiation.

Key Points

• Diffusion-weighted MRI is increasingly applied in evaluation of cervical cancer.

• Cervical cancer has distinctive perfusion and diffusion characteristics.

• Intravoxel incoherent motion characteristics can differentiate cervical cancer from non-malignant uterine tissues.

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Abbreviations

ADC:

apparent diffusion coefficient

AUC:

area under the curve

D:

pure molecular diffusion

D*:

pseudo-diffusion coefficient

DCE:

dynamic contrast-enhanced

DW:

diffusion-weighted

f :

perfusion fraction

FIGO:

International Federation of Gynecology and Obstetrics

IVIM:

intravoxel incoherent motion

ROC:

receiver operating characteristics

ROI:

region of interest

SD:

standard deviation

SENSE:

sensitivity encoding

SNR:

signal-to-noise ratio

TR/TE:

repetition time/echo time

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Acknowledgments

We wish to express our gratitude to the gynaecologists and oncologists at the Queen Mary Hospital and the Pamela Youde Nethersole Eastern Hospital in their support of this study.

The scientific guarantor of this publication is Prof. Pek-Lan Khong. The authors of this manuscript declare relationships with the following companies: Dr. Q Chan is currently employed by Philips Medical Systems. This study has received funding by the Small Project Fund from The University of Hong Kong, project no. 201209176082. 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, case-control study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Room 406, Block K, 102 Pokfulam Road, Hong Kong, Hong Kong

    Elaine Yuen Phin Lee, Xue Yu & Pek-Lan Khong

  2. Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong

    Mandy Man Yee Chu & Hextan Yuen Sheung Ngan

  3. Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong

    Steven Wai Kwan Siu

  4. Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong

    Inda Sung Soong

  5. Philips Healthcare, Hong Kong, Hong Kong

    Queenie Chan

Authors
  1. Elaine Yuen Phin Lee
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  2. Xue Yu
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  3. Mandy Man Yee Chu
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  4. Hextan Yuen Sheung Ngan
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  7. Queenie Chan
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  8. Pek-Lan Khong
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Correspondence to Elaine Yuen Phin Lee.

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Lee, E.Y.P., Yu, X., Chu, M.M.Y. et al. Perfusion and diffusion characteristics of cervical cancer based on intraxovel incoherent motion MR imaging-a pilot study. Eur Radiol 24, 1506–1513 (2014). https://doi.org/10.1007/s00330-014-3160-7

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  • DOI: https://doi.org/10.1007/s00330-014-3160-7

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