Abstract
PurposeTo compare the diagnostic efficiency of the mono-exponential model and bi-exponential model deriving from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in differentiating the pathological grade of esophageal squamous cell carcinoma (ESCC).MethodsFifty-four patients with ESCC were divided into three groups of poorly-differentiated (PD), moderately-differentiated (MD), and well-differentiated (WD), and underwent the IVIM-DWI scan. Mono-exponential (Dmono, D*mono, and fmono) and bi-exponential fit parameters (Dbi, D*bi, and fbi) were calculated using the IVIM data for the tumors. Mean parameter values of three groups were compared using a one-way ANOVA followed by post hoc tests. The receiver operating characteristic curve was drawn for differentiating pathological grade of ESCC. Correlations between pathological grades and IVIM parameters were analyzed.ResultsThere were significant differences in fmono and fbi among the PD, MD and WD ESCC groups (all p<0.05). The fmono were 0.32 ± 0.07, 0.23 ± 0.08, and 0.16 ± 0.05, respectively, and the fbi were 0.35 ± 0.08, 0.26 ± 0.10, and 0.18 ± 0.07, respectively. There was a significant difference in the Dmono between the WD and the PD group (1.48 ± 0.51* 10-3 mm2/s versus 1.05 ± 0.44*10-3 mm2/s, p<0.05), but there was no significant difference between the WD and MD groups, MD and PD groups (all p>0.05). The D*mono, Dbi, and D*bi showed no significant difference among the three groups (all p>0.05). The area under the curve (AUC) of Dmono, fmono and fbi in differentiating WD from PD ESCC were 0.764, 0.961 and 0.932, and the sensitivity and specificity were 92.9% and 60%, 92.9% and 90%, 85.7% and 100%, respectively. The AUC of fmono and fbi in differentiating MD from PD ESCC were 0.839 and 0.757, and the sensitivity and specificity were 78.6% and 80%, 85.7% and 70%, respectively. The AUC of fmono and fbi in differentiating MD from WD ESCC were 0.746 and 0.740, and the sensitivity and specificity were 65% and 85%, 80% and 60%, respectively. The pathologically differentiated grade was correlated with all IVIM parameters (all p<0.05).ConclusionsThe mono-exponential IVIM model is superior to the bi-exponential IVIM model in differentiating pathological grades of ESCC, which may be a promising imaging method to predict pathological grades of ESCC.
Highlights
Diffusion-weighted imaging (DWI) is a quantitative technology for evaluating the water motion of tissues without injecting contrast agents [1]
The purpose of the present study is to determine whether the bi-exponential or mono-exponential fit model of intravoxel incoherent motion (IVIM) can be used to distinguish the pathological grade of esophageal squamous cell carcinoma (ESCC), and which fitting model is more suitable for the pathological grade of ESCC
From January 2016 to February 2018, 68 consecutive patients with ESCC were enrolled in the present study according to the following inclusion criteria: patients with ESCC were confirmed by endoscopic pathology; and patients have not undergone any treatment for this disease before, such as radiotherapy, chemotherapy, and surgery; and MRI scan and IVIM-DWI were performed using the same magnetic resonance instrument
Summary
Diffusion-weighted imaging (DWI) is a quantitative technology for evaluating the water motion of tissues without injecting contrast agents [1]. It is a mono-compartmental model of water diffusion, and signal attenuation is mono-exponential as a function of b value in traditional DWI [2, 3]. IVIM-DWI has the advantage of separate evaluation of diffusion and perfusion changes in tissues [4]. As the constant progress achieved in this field, IVIM-DWI demonstrated the potential value for the diagnosis and pathological grade of esophageal carcinoma [12, 14, 15]
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