Integrated PET-IVIM-DKI MRI for predicting lymphovascular invasion in NSCLC

Area of Science:

• Radiology and Imaging Science
• Oncology
• Medical Physics

Background:

• Lymphovascular invasion (LVI) is a critical prognostic factor in non-small cell lung cancer (NSCLC).
• Accurate prediction of LVI is essential for guiding treatment decisions and improving patient outcomes.
• Current methods for LVI assessment have limitations, necessitating advanced imaging techniques.

Purpose of the Study:

• To evaluate the diagnostic performance of ¹⁸F-FDG Positron Emission Tomography (PET) and multiparametric Magnetic Resonance Imaging (MRI), including Intravoxel Incoherent Motion (IVIM) and Diffusion Kurtosis Imaging (DKI).
• To assess the combined value of PET and advanced MRI parameters in predicting LVI in NSCLC.
• To identify optimal imaging biomarkers for LVI detection in NSCLC.

Main Methods:

• A cohort of 73 NSCLC patients undergoing integrated ¹⁸F-FDG PET/MRI was analyzed.
• Quantitative PET parameters (SUVmax, MTV, TLG) and IVIM/DKI MRI parameters (ADCstand, D, MK, MD) were measured.
• Diagnostic efficacy was evaluated using Receiver Operating Characteristic (ROC) curve analysis, and logistic regression models identified independent predictors and optimal combinations.

Main Results:

• Significant differences in PET-derived (SUVmax, MTV, TLG) and MRI-derived (ADCstand, D, MK, MD) parameters were observed between patients with and without LVI (p < 0.05).
• Multivariate analysis identified metabolic tumor volume (MTV) and true diffusion coefficient (D) as independent predictors of LVI.
• The combined model of MTV and D demonstrated the highest predictive value, with an Area Under the Curve (AUC) of 0.841, sensitivity of 63.83%, and specificity of 92.31%.

Conclusions:

• Integrated ¹⁸F-FDG PET/MRI, utilizing advanced multiparametric techniques like IVIM and DKI, can effectively evaluate LVI status in NSCLC.
• Metabolic and diffusion parameters show comparable efficacy in predicting LVI, but their combination offers enhanced diagnostic performance.
• The combined model of MTV and D provides a highly valuable, non-invasive tool for LVI assessment, potentially guiding clinical management strategies for NSCLC.