1.Assessment of Cervical Cancer with a Parameter-Free Intravoxel Incoherent Motion Imaging Algorithm.
Anton S BECKER ; Jose A PERUCHO ; Moritz C WURNIG ; Andreas BOSS ; Soleen GHAFOOR ; Pek Lan KHONG ; Elaine Y P LEE
Korean Journal of Radiology 2017;18(3):510-518
OBJECTIVE: To evaluate the feasibility of a parameter-free intravoxel incoherent motion (IVIM) approach in cervical cancer, to assess the optimal b-value threshold, and to preliminarily examine differences in the derived perfusion and diffusion parameters for different histological cancer types. MATERIALS AND METHODS: After Institutional Review Board approval, 19 female patients (mean age, 54 years; age range, 37–78 years) gave consent and were enrolled in this prospective magnetic resonance imaging study. Clinical staging and biopsy results were obtained. Echo-planar diffusion weighted sequences at 13 b-values were acquired at 3 tesla field strength. Single-sliced region-of-interest IVIM analysis with adaptive b-value thresholds was applied to each tumor, yielding the optimal fit and the optimal parameters for pseudodiffusion (D*), perfusion fraction (F(p)) and diffusion coefficient (D). Monoexponential apparent diffusion coefficient (ADC) was calculated for comparison with D. RESULTS: Biopsy revealed squamous cell carcinoma in 10 patients and adenocarcinoma in 9. The b-value threshold (median [interquartile range]) depended on the histological type and was 35 (22.5–50) s/mm² in squamous cell carcinoma and 150 (100–150) s/mm² in adenocarcinoma (p < 0.05). Comparing squamous cell vs. adenocarcinoma, D* (45.1 [25.1–60.4] × 10⁻³ mm²/s vs. 12.4 [10.5–21.2] × 10⁻³ mm²/s) and F(p) (7.5% [7.0–9.0%] vs. 9.9% [9.0–11.4%]) differed significantly between the subtypes (p < 0.02), whereas D did not (0.89 [0.75–0.94] × 10⁻³ mm²/s vs. 0.90 [0.82–0.97] × 10⁻³ mm²/s, p = 0.27). The residuals did not differ (0.74 [0.60–0.92] vs. 0.94 [0.67–1.01], p = 0.32). The ADC systematically underestimated the magnitude of diffusion restriction compared to D (p < 0.001). CONCLUSION: The parameter-free IVIM approach is feasible in cervical cancer. The b-value threshold and perfusion-related parameters depend on the tumor histology type.
Adenocarcinoma
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Biopsy
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Carcinoma, Squamous Cell
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Diffusion
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Diffusion Magnetic Resonance Imaging
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Epithelial Cells
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Ethics Committees, Research
;
Female
;
Humans
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Magnetic Resonance Imaging
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Perfusion
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Perfusion Imaging
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Prospective Studies
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Technology Assessment, Biomedical
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Uterine Cervical Neoplasms*
2.B-Value Optimization in the Estimation of Intravoxel Incoherent Motion Parameters in Patients with Cervical Cancer
Jose Angelo Udal PERUCHO ; Hing Chiu Charles CHANG ; Varut VARDHANABHUTI ; Mandi WANG ; Anton Sebastian BECKER ; Moritz Christoph WURNIG ; Elaine Yuen Phin LEE
Korean Journal of Radiology 2020;21(2):218-227
3.Association between High Diffusion-Weighted Imaging-Derived Functional Tumor Burden of Peritoneal Carcinomatosis and Overall Survival in Patients with Advanced Ovarian Carcinoma
He AN ; Jose AU PERUCHO ; Keith WH CHIU ; Edward S HUI ; Mandy MY CHU ; Siew Fei NGU ; Hextan YS NGAN ; Elaine YP LEE
Korean Journal of Radiology 2022;23(5):539-547
Objective:
To investigate the association between functional tumor burden of peritoneal carcinomatosis (PC) derived from diffusion-weighted imaging (DWI) and overall survival in patients with advanced ovarian carcinoma (OC).
Materials and Methods:
This prospective study was approved by the local research ethics committee, and informed consent was obtained. Fifty patients (mean age ± standard deviation, 57 ± 12 years) with stage III–IV OC scheduled for primary or interval debulking surgery (IDS) were recruited between June 2016 and December 2021. DWI (b values: 0, 400, and 800 s/mm2 ) was acquired with a 16-channel phased-array torso coil. The functional PC burden on DWI was derived based on K-means clustering to discard fat, air, and normal tissue. A score similar to the surgical peritoneal cancer index was assigned to each abdominopelvic region, with additional scores assigned to the involvement of critical sites, denoted as the functional peritoneal cancer index (fPCI). The apparent diffusion coefficient (ADC) of the largest lesion was calculated. Patients were dichotomized by immediate surgical outcome into high- and low-risk groups (with and without residual disease, respectively) with subsequent survival analysis using the Kaplan-Meier curve and log-rank test. Multivariable Cox proportional hazards regression was used to evaluate the association between DWI-derived results and overall survival.
Results:
Fifteen (30.0%) patients underwent primary debulking surgery, and 35 (70.0%) patients received neoadjuvant chemotherapy followed by IDS. Complete tumor debulking was achieved in 32 patients. Patients with residual disease after debulking surgery had reduced overall survival (p = 0.043). The fPCI/ADC was negatively associated with overall survival when accounted for clinicopathological information with a hazard ratio of 1.254 for high fPCI/ADC (95% confidence interval, 1.007–1.560; p = 0.043).
Conclusion
A high DWI-derived functional tumor burden was associated with decreased overall survival in patients with advanced OC.