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

• Published in: European radiology Vol. 24; no. 7; pp. 1506 - 1513
• Main Authors: Lee, Elaine Yuen Phin, Yu, Xue, Chu, Mandy Man Yee, Ngan, Hextan Yuen Sheung, Siu, Steven Wai Kwan, Soong, Inda Sung, Chan, Queenie, Khong, Pek-Lan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2014; Springer Nature B.V
• Subjects: Adult; Aged; Cervical cancer; Diagnosis, Differential; Diagnostic Radiology; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Imaging; Internal Medicine; Interventional Radiology; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Pilot Projects; Prospective Studies; Radiology; Reproducibility of Results; Ultrasound; Urogenital; Uterine Cervical Neoplasms - diagnosis; Young Adult; Diffusion; Perfusion; Diffusion-weighted MRI; Cervical cancer; Intravoxel incoherent motion
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-014-3160-7

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/mm
2
) 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
 mm
2
/s and ADC < 1.13 × 10
-3
 mm
2
/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.