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Published on: April 18, 2015
Intravoxel incoherent motion diffusion-weighted MR imaging for characterization of focal pancreatic lesions
Koung Mi Kang1, Jeong Min Lee, Jeong Hee Yoon
1From the Department of Radiology, Division of Abdominal Imaging, Seoul National University College of Medicine, 28 Yeongon-dong, Jongno-gu, Seoul 110-744, Korea (K.M.K., J.M.L., J.H.Y., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (B.K.).
Purpose:
To evaluate the diagnostic potential of apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM)-derived parameters for differentiation of common pancreatic tumors, chronic pancreatitis, and normal pancreas and for characterization of the malignancy potential of intraductal papillary mucinous neoplasms (IPMNs).
Materials And Methods:
The institutional review board approved this retrospective study, and informed consent was waived. Ninety-three consecutive patients with surgically resected and pathologically confirmed pancreatic tumors (39 pancreatic adenocarcinomas [PACs], 17 neuroendocrine tumors [NETs], and 37 IPMNs), seven patients with chronic pancreatitis, and 26 patients with a normal pancreas were included in this study. All patients underwent pancreatic 3.0-T magnetic resonance imaging, including IVIM diffusion-weighted imaging with 10 b values used (from 0 to 1000 sec/mm(2)). The ADC, slow component of diffusion (D(slow)), incoherent microcirculation (D(fast)), and perfusion fraction (f) were calculated. Steel-Dwass and Mann-Whitney U tests were used for comparison. The diagnostic performance of the parameters was evaluated by using receiver operating characteristic (ROC) analysis with Bonferroni correction.
Results:
Among ADC- and IVIM-derived parameters, D(fast) and f values of PACs were significantly lower than those of normal pancreas, chronic pancreatitis, and NETs (all P < .05 in post hoc analyses). For differentiation of PACs from NETs, f and D(fast) showed a significant difference (P < .0001 for both) and were more useful parameters than ADC and D(slow) in ROC analysis (all P < .05). Malignant IPMNs had significantly lower ADC and D(slow) values and higher D(fast) and f values when compared with benign IPMNs (all P < .05). In ROC analysis, f showed the highest area under the ROC curve value for distinguishing malignant from benign IPMNs.
Conclusion:
IVIM-derived perfusion-related parameters could be helpful for the differentiation of common malignant tumors in the pancreas and for distinguishing malignant from benign IPMNs. D(fast) and f were more valuable parameters in the differentiation of PACs from NETs than were ADC and D(slow).
Insights
Intravoxel incoherent motion (IVIM) parameters, specifically D(fast) and f, effectively differentiate pancreatic tumors and assess malignancy in IPMNs. These IVIM metrics outperform standard ADC values for distinguishing pancreatic neuroendocrine tumors from adenocarcinomas.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Pancreatic tumors pose diagnostic challenges.
- Differentiating benign from malignant pancreatic lesions is crucial for patient management.
- Current imaging techniques have limitations in characterizing pancreatic pathologies.
Purpose of the Study:
- To assess the diagnostic utility of apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) parameters.
- To differentiate common pancreatic tumors, chronic pancreatitis, and normal pancreas.
- To characterize the malignancy potential of intraductal papillary mucinous neoplasms (IPMNs).
Main Methods:
- Retrospective analysis of 93 patients with pancreatic tumors, 7 with chronic pancreatitis, and 26 with normal pancreas.
- 3.0-T MRI with IVIM diffusion-weighted imaging (10 b values).
- Calculation of ADC, D(slow), D(fast), and f; statistical comparison using Steel-Dwass and Mann-Whitney U tests; ROC analysis.
Main Results:
- D(fast) and f values were significantly lower in pancreatic adenocarcinomas (PACs) compared to normal pancreas, chronic pancreatitis, and neuroendocrine tumors (NETs).
- f and D(fast) showed significant differences for differentiating PACs from NETs, outperforming ADC and D(slow).
- Malignant IPMNs exhibited lower ADC and D(slow) but higher D(fast) and f values than benign IPMNs, with f demonstrating the highest diagnostic performance.
Conclusions:
- IVIM-derived perfusion parameters (D(fast) and f) aid in differentiating common pancreatic tumors.
- IVIM parameters are valuable for distinguishing malignant from benign IPMNs.
- D(fast) and f are superior to ADC and D(slow) for differentiating PACs from NETs.
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