Abstract
Purpose To combine Intravoxel Incoherent Motions (IVIM) imaging and diffusion kurtosis imaging (DKI) which can aid in the quantification of different biological inspirations including cellularity, vascularity, and microstructural heterogeneity to preoperatively grade rectal cancer. Methods A total of 58 rectal patients were included into this prospective study. MRI was performed with a 3T scanner. Different combinations of IVIM-derived and DKI-derived parameters were performed to grade rectal cancer. Pearson correlation coefficients were applied to evaluate the correlations. Binary logistic regression models were established via integrating different DWI parameters for screening the most sensitive parameter. Receiver operating characteristic analysis was performed for evaluating the diagnostic performance. Results For individual DWI-derived parameters, all parameters except the pseudodiffusion coefficient displayed the capability of grading rectal cancer (p < 0.05). The better discrimination between high- and low-grade rectal cancer was achieved with the combination of different DWI-derived parameters. Similarly, ROC analysis suggested the combination of D (true diffusion coefficient), f (perfusion fraction), and Kapp (apparent kurtosis coefficient) yielded the best diagnostic performance (AUC = 0.953, p < 0.001). According to the result of binary logistic analysis, cellularity-related D was the most sensitive predictor (odds ratio: 9.350 ± 2.239) for grading rectal cancer. Conclusion The combination of IVIM and DKI holds great potential in accurately grading rectal cancer as IVIM and DKI can provide the quantification of different biological inspirations including cellularity, vascularity, and microstructural heterogeneity.
Highlights
It has been reported that there were around 0.7 million new cases of rectal cancer, accounting for approximately 40% of 1.8 million new colorectal cancer cases in 2018
(2) Integrating these DWI-derived biological inspirations together will benefit the accurate grading of rectal cancer through more comprehensive tumor characterization. us, this research aimed to combine intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) to grade rectal cancer via integrating different DWI-derived biological inspirations
Exclusion criteria: (1) Poor quality of DKI or IVIM images caused by artifacts
Summary
It has been reported that there were around 0.7 million new cases of rectal cancer, accounting for approximately 40% of 1.8 million new colorectal cancer cases in 2018. The widespread therapeutic option for rectal cancer, neoadjuvant chemoradiotherapy, may inevitably lead to some serious side effects, especially when accurate evaluation of histopathological grade is not available [2, 4]. Erefore, noninvasive and accurate evaluation of the histopathologic grade of rectal cancer is of great clinical importance for directing subsequent clinical management. Due to the clinical significance of providing different biological inspirations, Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) has shown tremendous clinical potential. During the past few decades, much effort has been made to propose novel DWI models such as intravoxel incoherent motion (IVIM) [5], diffusion kurtosis imaging (DKI) [6], fractional order calculus (FROC) [7], and restriction spectrum imaging (RSI) [8] for characterizing tumor from different perspectives via different DWI-derived biological inspirations.
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