Value of intravoxel incoherent motion and diffusion kurtosis imaging in predicting peritumoural infiltration of soft-tissue sarcoma: a prospective study based on MRI-histopathology comparisons
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1Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China.
Aim:
To investigate the performance of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in the identification of peritumoural infiltration of soft-tissue sarcoma (STS).
Materials And Methods:
From July 2018 to January 2020, 34 STS patients who underwent 3-T magnetic resonance imaging (MRI), including IVIM and DKI, were reviewed. The standard apparent diffusion coefficient (ADC), true diffusion (D), pseudo-diffusion coefficient (D∗), perfusion fraction (f), mean kurtosis (MK), and mean diffusion (MD) of each lesion were analysed independently by two observers. An MRI-histopathology control method was used to ensure the correspondence of MRI sections with histopathological sections. Differences in STS with and without infiltration were evaluated. The area under the curve (AUC) was used to determine the best cut-off point for different parameters. Interobserver agreement was assessed using the intraclass correlation coefficient.
Results:
Standard ADC, D, MK, and MD values reliably distinguished STS that had positive and negative infiltration. The MD value had the best diagnostic performance. Use of an MD cut-off value of 2.35 × 10-3 mm2/s to distinguish positive and negative infiltration had an AUC of 0.85, accuracy of 88.2%, sensitivity of 94.4%, and specificity of 81.3%. The two independent observers had nearly perfect agreement for all parameters.
Conclusion:
The standard ADC and D value of IVIM, and the MK and MD values of DKI reliably identify the presence of peritumoural infiltration of STS.
Insights
Intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) effectively identify soft-tissue sarcoma (STS) infiltration. Mean diffusion (MD) values showed the best diagnostic performance in distinguishing between infiltrating and non-infiltrating STS.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Peritumoural infiltration in soft-tissue sarcoma (STS) is crucial for treatment planning.
- Accurate identification of infiltration impacts surgical margins and patient outcomes.
- Advanced MRI techniques may improve the detection of STS infiltration.
Purpose of the Study:
- To evaluate the efficacy of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in identifying peritumoural infiltration in STS.
- To compare the diagnostic performance of various IVIM and DKI parameters for STS infiltration detection.
Main Methods:
- 34 STS patients underwent 3-T MRI with IVIM and DKI sequences.
- Analysis of standard apparent diffusion coefficient (ADC), true diffusion (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean kurtosis (MK), and mean diffusion (MD).
- MRI-histopathology correlation and receiver operating characteristic (ROC) analysis to determine optimal cut-off values.
Main Results:
- Standard ADC, D, MK, and MD values reliably differentiated STS with and without infiltration.
- Mean diffusion (MD) demonstrated the highest diagnostic performance (AUC=0.85, accuracy=88.2%).
- High interobserver agreement (intraclass correlation coefficient) was observed for all parameters.
Conclusions:
- IVIM (ADC, D) and DKI (MK, MD) parameters are reliable for identifying peritumoural infiltration in STS.
- MD is a key parameter for distinguishing infiltrating from non-infiltrating STS.
- These advanced MRI techniques enhance the diagnostic capability for STS staging.
