Diffusion Kurtosis Imaging Model Research Articles

Utilization of diffusion-weighted derived mathematical models to predict prognostic factors of resectable rectal cancer.

This study explored models of monoexponential diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI), stretched exponential (SEM), fractional-order calculus (FROC), and continuous-time random-walk (CTRW) as diagnostic tools for assessing pathological prognostic factors in patients with resectable rectal cancer (RRC). RRC patients who underwent radical surgery were included. The apparent diffusion coefficient (ADC), the mean kurtosis (MK) and mean diffusion (MD) from the DKI model, the distributed diffusion coefficient (DDC) and α from the SEM model, D, β and u from the FROC model, and D, α and β from the CTRW model were assessed. There were a total of 181 patients. The area under the receiver operating characteristic (ROC) curve (AUC) of CTRW-α for predicting histology type was significantly higher than that of FROC-u (0.780 vs. 0.671, p = 0.043). The AUC of CTRW-α for predicting pT stage was significantly higher than that of FROC-u and ADC (0.786 vs.0.683, p = 0.043; 0.786 vs. 0.682, p = 0.030), the difference in predictive efficacy of FROC-u between ADC and MK was not statistically significant [0.683 vs. 0.682, p = 0.981; 0.683 vs. 0.703, p = 0.720]; the difference between the predictive efficacy of MK and ADC was not statistically significant (p = 0.696). The AUC of CTRW (α + β) (0.781) was significantly higher than that of FROC-u (0.781 vs. 0.625, p = 0.003) in predicting pN stage but not significantly different from that of MK (p = 0.108). The CTRW and DKI models may serve as imaging biomarkers to predict pathological prognostic factors in RRC patients before surgery.

A comparative study of mono-exponential and advanced diffusion-weighted imaging in differentiating stage IA endometrial carcinoma from benign endometrial lesions

PurposeThe purpose of the current investigation is to compare the efficacy of different diffusion models and diffusion kurtosis imaging (DKI) in differentiating stage IA endometrial carcinoma (IAEC) from benign endometrial lesions (BELs).MethodsPatients with IAEC, endometrial hyperplasia (EH), or a thickened endometrium confirmed between May 2016 and August 2022 were retrospectively enrolled. All of the patients underwent a preoperative pelvic magnetic resonance imaging (MRI) examination. The apparent diffusion coefficient (ADC) from the mono-exponential model, pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) from the bi-exponential model, distributed diffusion coefficient (DDC), water molecular diffusion heterogeneity index from the stretched-exponential model, diffusion coefficient (Dk) and diffusion kurtosis (K) from the DKI model were calculated. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficiency.ResultsA total of 90 patients with IAEC and 91 patients with BELs were enrolled. The values of ADC, D, DDC and Dk were significantly lower and D* and K were significantly higher in cases of IAEC (p < 0.05). Multivariate analysis showed that K was the only predictor. The area under the ROC curve of K was 0.864, significantly higher compared with the ADC (0.601), D (0.811), D* (0.638), DDC (0.743) and Dk (0.675). The sensitivity, specificity and accuracy of K were 78.89%, 85.71% and 80.66%, respectively.ConclusionAdvanced diffusion-weighted imaging models have good performance for differentiating IAEC from EH and endometrial thickening. Among all of the diffusion parameters, K showed the best performance and was the only independent predictor. Diffusion kurtosis imaging was defined as the most valuable model in the current context.

Investigating apparent differences between standard DKI and axisymmetric DKI and its consequences for biophysical parameter estimates.

The purpose of the study is to identify differences between axisymmetric diffusion kurtosis imaging (DKI) and standard DKI, their consequences for biophysical parameter estimates, and the protocol choice influence on parameter estimation. Noise-free and noisy, synthetic diffusion MRI human brain data is simulated using standard DKI for a standard and the fast "199" acquisition protocol. First the noise-free "baseline" difference between both DKI models is estimated and the influence of fiber complexity is investigated. Noisy data is used to establish the signal-to-noise ratio at which the baseline difference exceeds noise variability. The influence of protocol choices and denoising is investigated. The five axisymmetric DKI tensor metrics (AxTM), the parallel and perpendicular diffusivity and kurtosis and mean of the kurtosis tensor are used to compare both DKI models. Additionally, the baseline difference is also estimated for the five parameters of the WMTI-Watson model. The parallel and perpendicular kurtosis and all of the WMTI-Watson parameters had large baseline differences. Using a Westin or FA mask reduced the number of voxels with large baseline difference, that is, by selecting voxels with less complex fibers. For the noisy data, precision was worsened by the fast "199" protocol but adaptive denoising can help counteract these effects. For the diffusivities and mean of the kurtosis tensor, axisymmetric DKI with a standard protocol delivers similar results as standard DKI. Fiber complexity is one main driver of the baseline differences. Using the "199" protocol worsens precision in noisy data but adaptive denoising mitigates these effects.

Diffusion kurtosis imaging and standard diffusion imaging in the magnetic resonance imaging assessment of prostate cancer.

In recent years, magnetic resonance imaging (MRI) has shown excellent results in the study of the prostate gland. MRI has indeed shown to be advantageous in the prostate cancer (PCa) detection, as in guiding targeting biopsy, improving its diagnostic yield. Although current acquisition protocols provide for multiparametric acquisition, recent evidence has shown that biparametric protocols can be non-inferior in PCa detection. Diffusion-weighted imaging (DWI) sequence, in particular, plays a key role, particularly in the peripheral zone which accounts for the larger part of the prostate. High b-values are generally recommended, although with the possibility of obtaining non-Gaussian diffusion effects, which requires a more sophisticated model for the analysis, namely through the diffusion kurtosis imaging (DKI). Purpose of this narrative review was to analyze the current applications and clinical evidence regarding the use of DKI with a main focus on PCa detection, also in comparison with DWI. This narrative review synthesized the findings of literature retrieved from main researches, narrative and systematic reviews, and meta-analyses obtained from PubMed. DKI analyses the non-Gaussian water diffusivity and describe the effect of signal intensity decay related to high b-value through two main metrics (Dapp and Kapp). Differently from DWI-apparent diffusion coefficient (DWI-ADC) which reflects only water restriction outside of cells, DKI metrics are supposed to represent also the direct interaction of water molecules with cell membranes and intracellular compounds. This review describes current evidence on ADC and DKI metrics in clinical imaging, and finally collect the results derived from the main articles focused on DWI and DKI models in detecting PCa. DKI advantages, compared to conventional ADC analysis, still remain controversial. Wider application and greater technical knowledge of DKI, however, may help in proving its intrinsic validity in the field of oncology and therefore in the study of clinically significant PCa. Finally, a deep understanding of DKI is important for radiologists to better understand what Kapp and Dapp mean in the context of different cancer and how these metrics may vary specifically in PCa imaging.

Whole tumor based texture analysis of magnetic resonance diffusion imaging for colorectal liver metastases: A prospective study for diffusion model comparison and early response biomarker

PurposeTo evaluate and compare the diagnostic value of diffusion-related texture analysis parameters obtained from various magnetic resonance diffusion models as early predictors of the clinical response to chemotherapy in patients with colorectal liver metastases (CRLM). MethodsPatients (n = 145) with CRLM were prospectively and consecutively enrolled and scanned using diffusion-weighted imaging (DWI)-magnetic resonance imaging (MRI)/intravoxel incoherent motion (IVIM)/diffusion kurtosis imaging (DKI) before (baseline) and two–three weeks after (follow-up) commencing chemotherapy. Therapy response was evaluated based on the Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1). The histogram and texture parameters of each diffusion-related parametric map were analysed between the responding and non-responding groups, screened using LASSO, and fitted with binary logistic regression models. The diagnostic efficacy of each model in the early prediction of CRLM was analysed, and the corresponding receiver operating characteristic (ROC) curve was drawn. The area under the curve (AUC) and 95% confidence intervals (CI) were calculated. ResultsOf the 145 analysed patients, 69 were in the responding group and 76 were in the non-responding group. Among all models, the difference value based on the histogram and texture features of the DKI-derived parameters performed best for the early prediction of CRLM treatment efficacy. The AUC of the DKI model in the validation set reached 0.795 (95% CI 0.652–0.938). Among the IVIM-derived parameters, the difference model based on D and D* performed best, and the AUC in the validation set reached 0.737 (95% CI 0.586–0.889). Finally, in the DWI sequence, the model comprising baseline features performed the best, with an AUC of 0.699 (95% CI 0.537–0.86) in the validation set. ConclusionsBaseline DWI parameters and follow-up changes in IVIM and DKI parameters predicted the chemotherapeutic response in patients with CRLM. In addition, as very early predictors, DKI-derived parameters were more effective than DWI- and IVIM-related parameters, in which changes in D-parameters performed best.

T2*-corrected Q-Dixon and reduced-FOV diffusion kurtosis imaging (DKI) parameters: correlation with QCT-derived bone mineral density (BMD) and ability to identify abnormal BMD and osteoporosis in postmenopausal women.

Bone marrow fat increases when the bone volume decreases. The composition of the bone marrow microenvironment can also become altered. Assessments of bone marrow fat and bone marrow structural heterogeneity have the potential to predict abnormal bone mineral density (BMD) and osteoporosis. This study aimed to investigate the diagnostic performance of T2*-corrected Q-Dixon and reduced-field-of-view (FOV) diffusion kurtosis imaging (DKI) parameters in determining abnormal BMD and osteoporosis in postmenopausal women. In this prospective study, the individuals who were eligible for inclusion included postmenopausal women (over 50-year-old) with suspected osteoporosis based on experiencing low back pain. This mono-center study was conducted in tertiary care in China. All of the patients were recruited by using the consecutive sampling method. Subjects who underwent T2*-corrected Q-Dixon and reduced-FOV DKI sequences were enrolled. Fat fraction (FF), T2*, mean kurtosis (MK), and mean diffusivity (MD) values were measured on L1, L2, and L3 vertebral bodies. Quantitative computed tomography (QCT) examinations served as the reference standard. All of the subjects were divided into three groups: normal (BMD >120 mg/cm3), osteopenia (BMD 80-120 mg/cm3), and osteoporosis (BMD <80 mg/cm3). One-way analysis of variance, correlation coefficient analysis, and receiver operating characteristic curve analysis were performed. Among all of the enrolled subjects, 52 were in the normal group, 51 were in the osteopenia group, and 52 were in the osteoporosis group. There were significant differences in FF, T2*, MK, and MD values between the three groups (P<0.001, P<0.001, P<0.001, and P=0.003, respectively). FF, T2*, and MK values exhibited significant negative correlations with BMD values (r=-0.739, P<0.001; r=-0,676, P<0.001; and r=-0.626, P<0.001, respectively). Excellent discriminatory capacity was observed in the Q-Dixon [area under the curve (AUC): 0.976, 95% confidence interval (CI): 0.955-0.997] differentiation between normal and abnormal BMD subjects. It was significantly better than the DKI (AUC: 0.812, 95% CI: 0.741-0.882) parameter combination (P<0.001), whereas the DKI model (AUC: 0.825, 95% CI: 0.739-0.910) performed comparably to the Q-Dixon model (AUC: 0.798, 95% CI: 0.710-0.886) for screening osteoporosis (P=0.57). FF and T2* values measured by using T2*-corrected Q-Dixon, as well as MK and MD values measured by using reduced-FOV DKI, may serve as potential imaging biomarkers in assessing abnormal BMD and osteoporosis in postmenopausal women.

Whole-lesion histogram analysis of multiple diffusion metrics for differentiating lung cancer from inflammatory lesions.

Whole-lesion histogram analysis can provide comprehensive assessment of tissues by calculating additional quantitative metrics such as skewness and kurtosis; however, few studies have evaluated its value in the differential diagnosis of lung lesions. To compare the diagnostic performance of conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) and diffusion kurtosis imaging (DKI) in differentiating lung cancer from focal inflammatory lesions, based on whole-lesion volume histogram analysis. Fifty-nine patients with solitary pulmonary lesions underwent multiple b-values DWIs, which were then postprocessed using mono-exponential, bi-exponential and DKI models. Histogram parameters of the apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f), apparent diffusional kurtosis (Kapp) and kurtosis-corrected diffusion coefficient (Dapp) were calculated and compared between the lung cancer and inflammatory lesion groups. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic performance. The ADCmean, ADCmedian, D mean and D median values of lung cancer were significantly lower than those of inflammatory lesions, while the ADCskewness, Kapp mean, Kapp median, Kapp SD, Kapp kurtosis and Dapp skewness values of lung cancer were significantly higher than those of inflammatory lesions (all p < 0.05). ADCskewness (p = 0.019) and D median (p = 0.031) were identified as independent predictors of lung cancer. D median showed the best performance for differentiating lung cancer from inflammatory lesions, with an area under the ROC curve of 0.777. Using a D median of 1.091 × 10-3 mm2/s as the optimal cut-off value, the sensitivity, specificity, positive predictive value and negative predictive value were 69.23%, 85.00%, 90.00% and 58.62%, respectively. Whole-lesion histogram analysis of DWI, IVIM and DKI parameters is a promising approach for differentiating lung cancer from inflammatory lesions, and D median shows the best performance in the differential diagnosis of solitary pulmonary lesions.

Correlation of Intravoxel Incoherent Motion and Diffusion Kurtosis MR Imaging Models With Reactive Stromal Grade in Prostate Cancer.

Reactive stroma is recognized as one of the independent prognostic factors in prostate cancer (PCa). Intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) may be useful for assessing the reactive stromal grade (RSG). To investigate whether IVIM and DKI models can evaluate RSG in PCa patients. Retrospective. A total of 56 PCa patients aged 73 years on average confirmed by MRI and transrectal ultrasound (MRI/TRUS) fusion biopsy divided into two subgroups (18 high RSG and 38 low RSG). A 3 T/T1 WI-fs, T1 WI, T2 WI-fs, T2 WI, DWI, IVIM, and DKI. Apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean diffusion (MD), mean kurtosis (MK) were obtained. Patients were divided into high RSG PCa (>50% reactive stroma) and low RSG PCa (≤50% reactive stroma) groups on hematoxylin and eosin (H&E) stained sections. Spearman correlation and independent sample t-test or Wilcoxon's rank sum test was used to investigate the relationship between each imaging parameter and RSG. The combined parameters were calculated using a binary logistic regression model. Receiver operating characteristic (ROC) analysis was used to explore the value of individual and combined parameters to differentiate between high and low RSG group. Area under the ROC curves (AUC) > 0.7 were used as reference standards. ADC, D, f, and MD values showed positive correlation with RSG (r=0.489, 0.619, 0.318, and 0.544, respectively); MK showed negative correlation with RSG (r=-0.444). ADC, D, f, and MD values were significantly lower in the low RSG group than in the high RSG group. The combined model showed the best diagnostic ability to differentiate low and high RSG groups (AUC=0.887). Parameters of IVIM and DKI may be promising methods for assessment of RSG in PCa patients. 3. Stage 3.

Advances in The Application and Research of Magnetic Resonance Diffusion Kurtosis Imaging in The Musculoskeletal System.

Magnetic resonance diffusion kurtosis imaging (DKI) is an emerging magnetic resonance imaging (MRI) technique that can reflect microstructural changes in tissue through non-Gaussian diffusion of water molecules. Compared to traditional diffusion weighted imaging (DWI), the DKI model has shown greater sensitivity for diagnosis of musculoskeletal diseases and can help formulate more reasonable treatment plans. Moreover, DKI is an important auxiliary examination for evaluation of the motor function of the musculoskeletal system. This article briefly introduces the basic principles of DKI and reviews the application and research of DKI in the evaluation of disorders of the musculoskeletal system (including bone tumors, soft tissue tumors, spinal lesions, chronic musculoskeletal diseases, musculoskeletal trauma, and developmental disorders) as well as the normal musculoskeletal tissues. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: 1.

Developing a Predictive Grading Model for Children with Gliomas Based on Diffusion Kurtosis Imaging Metrics: Accuracy and Clinical Correlations with Patient Survival.

Simple SummaryThe most frequent brain tumors in children are solid tumors. A significant fraction of pediatric brain tumors is represented by gliomas, which are heterogeneous. Diffusion kurtosis imaging metrics (MK, AK, RK, FA, and ADC) have shown promising results for glioma grading in adult patients; however, it is unclear whether this technique is accurate for diagnosing high grade pediatric gliomas and if it is correlated with patient survival. In our study, we performed a retrospective whole-tumor analysis on 59 children affected by gliomas and tested (1) if DKI metrics are accurate for grading pediatric gliomas and (2) if DKI metrics are correlated with patient overall survival and progression-free survival.Purpose: To develop a predictive grading model based on diffusion kurtosis imaging (DKI) metrics in children affected by gliomas, and to investigate the clinical impact of the predictive model by correlating with overall survival and progression-free survival. Materials and methods: 59 patients with a histological diagnosis of glioma were retrospectively studied (33 M, 26 F, median age 7.2 years). Patients were studied on a 3T scanner with a standardized MR protocol, including conventional and DKI sequences. Mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) maps were obtained. Whole tumour volumes (VOIs) were segmented semi-automatically. Mean DKI values were calculated for each metric. The quantitative values from DKI-derived metrics were used to develop a predictive grading model to develop a probability prediction of a high-grade glioma (pHGG). Three models were tested: DTI-based, DKI-based, and combined (DTI and DKI). The grading accuracy of the resulting probabilities was tested with a receiver operating characteristics (ROC) analysis for each model. In order to account for dataset imbalances between pLGG and pHGG, we applied a random synthetic minority oversampling technique (SMOTE) analysis. Lastly, the most accurate model predictions were correlated with progression-free survival (PFS) and overall survival (OS) using the Kaplan–Meier method. Results: The cohort included 46 patients with pLGG and 13 patients with pHGG. The developed model predictions yielded an AUC of 0.859 (95%CI: 0.752–0.966) for the DTI model, of 0.939 (95%CI: 0.879–1) for the DKI model, and of 0.946 (95%CI: 0.890–1) for the combined model, including input from both DTI and DKI metrics, which resulted in the most accurate model. Sample estimation with the random SMOTE analysis yielded an AUC of 0.98 on the testing set. Model predictions from the combined model were significantly correlated with PFS (25.2 months for pHGG vs. 40.0 months for pLGG, p < 0.001) and OS (28.9 months for pHGG vs. 44.9 months for pLGG, p < 0.001). Conclusions: a DKI-based predictive model was highly accurate for pediatric glioma grading. The combined model, derived from both DTI and DKI metrics, proved that DKI-based model predictions of tumour grade were significantly correlated with progression-free survival and overall survival.

Intravoxel incoherent motion imaging combined with diffusion kurtosis imaging to assess the response to radiotherapy in a rabbit VX2 malignant bone tumor model

PurposeTo combine intravoxel incoherent motion (IVIM) imaging and diffusion kurtosis imaging (DKI) parameters for the evaluation of radiotherapy response in rabbit VX2 malignant bone tumor model.Material and methodsForty-seven rabbits with bone tumor were prospectively enrolled and divided into pre-treatment, considerable effect and slight effect group. Treatment response was evaluated using IVIM-DKI. IVIM-based parameters (tissue diffusion [Dt], pseudo-diffusion [Dp], perfusion fraction [fp]), and DKI-based parameters (mean diffusion coefficient [MD] and mean kurtosis [MK]) were calculated for each animal. Corresponding changes in MRI parameters before and after radiotherapy in each group were studied with one-way ANOVA. Correlations of diffusion parameters of IVIM and DKI model were computed using Pearson’s correlation test. A diagnostic model combining different diffusion parameters was established using binary logistic regression, and its ROC curve was used to evaluate its diagnostic performance for determining considerable and slight effect to malignant bone tumor.ResultsAfter radiotherapy, Dt and MD increased, whereas fp and MK decreased (p < 0.05). The differences in Dt, fp, MD, and MK between considerable effect and slight effect groups were statistically significant (p < 0.05). A combination of Dt, fp, and MK had the best diagnostic performance for differentiating considerable effect from slight effect (AUC = 0.913, p < 0.001).ConclusionsA combination of IVIM- and DKI-based parameters allowed the non-invasive assessment of cellular, vascular, and microstructural changes in malignant bone tumors after radiotherapy, and holds great potential for monitoring the efficacy of tumor radiotherapy.

Quantitative measurement of diffusion-weighted imaging signal using expression-controlled aquaporin-4 cells: Comparative study of 2-compartment and diffusion kurtosis imaging models.

The purpose of this study was to compare parameter estimates for the 2-compartment and diffusion kurtosis imaging models obtained from diffusion-weighted imaging (DWI) of aquaporin-4 (AQP4) expression-controlled cells, and to look for biomarkers that indicate differences in the cell membrane water permeability. DWI was performed on AQP4-expressing and non-expressing cells and the signal was analyzed with the 2-compartment and diffusion kurtosis imaging models. For the 2-compartment model, the diffusion coefficients (Df, Ds) and volume fractions (Ff, Fs, Ff = 1-Fs) of the fast and slow compartments were estimated. For the diffusion kurtosis imaging model, estimates of the diffusion kurtosis (K) and corrected diffusion coefficient (D) were obtained. For the 2-compartment model, Ds and Fs showed clear differences between AQP4-expressing and non-expressing cells. Fs was also sensitive to cell density. There was no clear relationship with the cell type for the diffusion kurtosis imaging model parameters. Changes to cell membrane water permeability due to AQP4 expression affected DWI of cell suspensions. For the 2-compartment and diffusion kurtosis imaging models, Ds was the parameter most sensitive to differences in AQP4 expression.

Discriminating rectal cancer grades using restriction spectrum imaging.

Restriction spectrum imaging (RSI) is a novel diffusion MRI model that separates water diffusion into several microscopic compartments. The restricted compartment correlating to the tumor cellularity is expected to be a potential indicator of rectal cancer aggressiveness. Our aim was to assess the ability of RSI model for rectal tumor grading. Fifty-eight patients with different rectal cancer grading confirmed by biopsy were involved in this study. DWI acquisitions were performed using single-shot echo-planar imaging (SS-EPI) with multi-b-values at 3T. We applied a three-compartment RSI model, along with ADC model and diffusion kurtosis imaging (DKI) model, to DWI images of 58 patients. ROC and AUC were used to compare the performance of the three models in differentiating the low grade (G1 + G2) and high grade (G3). Mean ± standard deviation, ANOVA, ROC analysis, and correlation analysis were used in this study. The volume fraction of restricted compartment C1 from RSI was significantly correlated with grades (r = 0.403, P = 0.002). It showed significant difference between G1 and G3 (P = 0.008) and between G2 and G3 (P = 0.01). As for the low-grade and high-grade discrimination, significant difference was found in C1 (P < 0.001). The AUC of C1 for differentiation between low-grade and high-grade groups was 0.753 with a sensitivity of 72.0% and a specificity of 70.0%. The three-compartment RSI model was able to discriminate the rectal cancer of low and high grades. The results outperform the traditional ADC model and DKI model in rectal cancer grading.

A Joint Framework for Denoising and Estimating Diffusion Kurtosis Tensors Using Multiple Prior Information.

Diffusion kurtosis imaging (DKI) has been shown to be valuable in a wide range of neuroscientific and clinical applications. However, reliable estimation of DKI tensors is often compromised by noise, especially for the kurtosis tensor (KT). Here, we propose a joint denoising and estimating framework that integrates multiple sources of prior information, including nonlocal structural self-similarity (NSS), local spatial smoothness (LSS), physical relevance (PR) of the DKI model, and noise characteristics of magnitude diffusion MRI (dMRI) images for improved estimation of DKI tensors. The local and nonlocal spatial smoothing constraints are complementary to each other, making the proposed framework highly effective in reducing the noise fluctuations on DKI tensors, especially KT. As an additional refinement, we propose to impose a physically relevant constraint within our joint denoising and estimation framework. We further adopt the first-moment noise-corrected fitting model (M1NCM) to remove the noncentral χ -distribution noise bias. The effectiveness of integrating multiple sources of priors into the joint framework is verified by comparing the proposed M1NCM-NSS-LSS-PR method with various versions of M1NCM-based estimators and two state-of-the-art methods. Results show that the proposed method outperformed the compared methods in simulations and in-vivo dMRI datasets of both spatially stationary and nonstationary noise distributions. The in-vivo experiments also show that the proposed M1NCM-NSS-LSS-PR method was robust to the number of diffusion directions.

Whole-Tumor Histogram Analysis of Multiple Diffusion Metrics for Glioma Genotyping.

Background The isocitrate dehydrogenase (IDH) genotype and 1p/19q codeletion status are key molecular markers included in glioma pathologic diagnosis. Advanced diffusion models provide additional microstructural information. Purpose To compare the diagnostic performance of histogram features of multiple diffusion metrics in predicting glioma IDH and 1p/19q genotyping. Materials and Methods In this prospective study, participants were enrolled from December 2018 to December 2020. Diffusion-weighted imaging was performed by using a spin-echo echo-planar imaging sequence with five b values (500, 1000, 1500, 2000, and 2500 sec/mm2) in 30 directions for every b value and one b value of 0. Diffusion metrics of diffusion-tensor imaging (DTI), diffusion-kurtosis imaging (DKI), neurite orientation dispersion and density imaging (NODDI), and mean apparent propagator (MAP) were calculated, and their histogram features were analyzed in regions that included the entire tumor and peritumoral edema. Comparisons between groups were performed according to IDH genotype and 1p/19q codeletion status. Logistic regression analysis was used to predict the IDH and 1p/19q genotypes. Results A total of 215 participants (115 men, 100 women; mean age, 48 years ± 13 [standard deviation]) with grade II (n = 68), grade III (n = 35), and grade IV (n = 112) glioma were included. Among the DTI, DKI, NODDI, MAP, and total diffusion models, there were no significant differences in the areas under the receiver operating characteristic curve (AUCs) for predicting IDH mutations (AUC, 0.76, 0.82, 0.78, 0.81, and 0.82, respectively; P > .05) and 1p/19q codeletion in gliomas with IDH mutations (AUC, 0.83, 0.81, 0.82, 0.83, and 0.88, respectively; P > .05). A regression model with an R2 value of 0.84 was used for the Ki-67 labeling index and histogram features of the diffusion metrics. Conclusion Whole-tumor histogram analysis of multiple diffusion metrics is a promising approach for glioma isocitrate dehydrogenase and 1p/19q genotyping, and the performance of diffusion-tensor imaging is similar to that of advanced diffusion models. Clinical trial registration no. ChiCTR2100048119 © RSNA, 2021 Online supplemental material is available for this article. An earlier incorrect version appeared online. This article was corrected on December 14, 2021.

Radiomic Features of T2-weighted Imaging and Diffusion Kurtosis Imaging in Differentiating Clinicopathological Characteristics of Cervical Carcinoma

Clinicopathological characteristics including histological subtypes, tumour grades and International Federation of Gynecology and Obstetrics (FIGO) stages are crucial factors in the clinical decision for cervical carcinoma (CC). The purpose of this study was to evaluate the ability of T2-weighted imaging (T2WI) and diffusion kurtosis imaging (DKI) radiomics in differentiating clinicopathological characteristics of CC. One hundred and seventeen histologically confirmed CC patients (mean age 56.5 ± 14.0 years) with pre-treatment magnetic resonance imaging were retrospectively reviewed. DKI was acquired with 4 b-values (0-1500 s/mm2). Volumes of interest were contoured around the tumours on T2WI and DKI. Radiomic features including shape, first-order and grey-level co-occurrence matrix with wavelet transforms were extracted. Intraclass correlation coeffient between 2 radiologists was used for features reduction. Feature selection was achieved by elastic net and minimum redundancy maximum relevance. Selected features were used to build random forest (RF) models. The performances for differentiating histological subtypes, tumour grades and FIGO stages were assessed by receiver operating characteristic analysis. Area under the curves (AUCs) for T2WI-only RF models for discriminating histological subtypes, tumour grades and FIGO stages were 0.762, 0.686, and 0.719. AUCs for DWI-only models were 0.663, 0.645, and 0.868, respectively. AUCs of the combined T2WI and DKI models were 0.823, 0.790, and 0.850, respectively. T2WI and DKI radiomic features could differentiate the clinicopathological characteristics of CC. A combined model showed excellent diagnostic discrimination for histological subtypes, while a DKI-only model presented the best performance in differentiating FIGO stages.

Survival Prediction Analysis in Glioblastoma With Diffusion Kurtosis Imaging.

Simple SummaryGlioblastoma (GBM) is the most common and aggressive primary brain tumor. Diffusion kurtosis imaging (DKI) has characterized non-Gaussian diffusion behaviors in brain normal tissue and gliomas, but there are very limited efforts in investigating treatment responses of kurtosis in GBM. This study aimed to investigate whether any parameter derived from the DKI is a significant predictor of overall survival (OS). We found that the large mean, 80 and 90 percentile kurtosis values in the contrast enhanced gross tumor volume (Gd-GTV) on post-Gd T1-weighted images pre-RT were significantly associated with reduced OS. In the multivariate Cox model, the mean kurtosis Gd-GTV pre-RT after considering effects of age, extent of surgery, and methylation were significant predictors of OS. In addition, the 80 and 90 percentile kurtosis values in Gd-GTV post RT were significantly associated with progression free survival (PFS). The DKI model demonstrates the potential to predict outcomes in the patients with GBM.PurposeNon-Gaussian diffusion behaviors in gliomas have been characterized by diffusion kurtosis imaging (DKI). But there are very limited efforts in investigating the kurtosis in glioblastoma (GBM) and its prognostic and predictive values. This study aimed to investigate whether any of the diffusion kurtosis parameters derived from DKI is a significant predictor of overall survival.Methods and MaterialsThirty-three patients with GBM had pre-radiation therapy (RT) and mid-RT diffusion weighted (DW) images. Kurtosis and diffusion coefficient (DC) values in the contrast enhanced gross tumor volume (Gd-GTV) on post-Gd T1 weighted images pre-RT and mid-RT were calculated. Univariate and multivariate Cox models were used to evaluate the DKI parameters and clinical factors for prediction of OS and PFS.ResultsThe large mean kurtosis values in the Gd-GTV pre-RT were significantly associated with reduced OS (p = 0.02), but the values at mid-RT were not (p > 0.8). In the multivariate Cox model, the mean kurtosis in the Gd-GTV pre-RT (p = 0.009) was still a significant predictor of OS after adjusting effects of age, O6-Methylguanine-DNA Methyl transferase (MGMT) methylation and extent of resection. In Gd-GTV post-RT, 80 and 90 percentile kurtosis values were significant predictors (p ≤ 0.05) for progression free survival (PFS).ConclusionThe DKI model demonstrates the potential to predict OS and PFS in the patients with GBM. Further development and histopathological validation of the DKI model will warrant its role in clinical management of GBM.

Prediction of muscle invasion of bladder cancer: A comparison between DKI and conventional DWI

ObjectivesTo prospectively compare the diagnostic efficacy of conventional diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in differentiating between muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC). MethodsMultiple b value DWIs were performed using a 3-T magnetic resonance (MR) imaging unit in fifty-one patients with bladder cancer including MIBC and NMIBC confirmed by histopathological findings. DWI data were postprocessed using mono-exponential and DKI models to calculate the apparent diffusion coefficient (ADC), apparent diffusional kurtosis (Kapp), and kurtosis-corrected diffusion coefficient (Dapp). Receiver-operating characteristic (ROC) analysis was performed to compare the diagnostic efficacy of all diffusion parameters. ResultsAll parameters differed significantly between MIBC and NIMBC including increased Kapp, decreased Dapp and ADC (all p < 0.001). Only the combination of Dapp and Kapp was significantly higher than ADC (p < 0.05), whilst Dapp and Kapp were not statistically different from ADC. ConclusionsBoth conventional DWI and DKI models are beneficial in differentiating between MIBC and NMIBC, whilst the combination of Dapp and Kapp can produce a more robust value than conventional ADC value in evaluating aggressiveness of bladder cancer.

Differentiation between high-grade gliomas and solitary brain metastases: a comparison of five diffusion-weighted MRI models

BackgroundTo compare the diagnostic performance of neurite orientation dispersion and density imaging (NODDI), mean apparent propagator magnetic resonance imaging (MAP-MRI), diffusion kurtosis imaging (DKI), diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) in distinguishing high-grade gliomas (HGGs) from solitary brain metastases (SBMs).MethodsPatients with previously untreated, histopathologically confirmed HGGs (n = 20) or SBMs (n = 21) appearing as a solitary and contrast-enhancing lesion on structural MRI were prospectively recruited to undergo diffusion-weighted MRI. DWI data were obtained using a q-space Cartesian grid sampling procedure and were processed to generate parametric maps by fitting the NODDI, MAP-MRI, DKI, DTI and DWI models. The diffusion metrics of the contrast-enhancing tumor and peritumoral edema were measured. Differences in the diffusion metrics were compared between HGGs and SBMs, followed by receiver operating characteristic (ROC) analysis and the Hanley and McNeill test to determine their diagnostic performances.ResultsNODDI-based isotropic volume fraction (Viso) and orientation dispersion index (ODI); MAP-MRI-based mean-squared displacement (MSD) and q-space inverse variance (QIV); DKI-generated radial, mean diffusivity and fractional anisotropy (RDk, MDk and FAk); and DTI-generated radial, mean diffusivity and fractional anisotropy (RD, MD and FA) of the contrast-enhancing tumor were significantly different between HGGs and SBMs (p < 0.05). The best single discriminative parameters of each model were Viso, MSD, RDk and RD for NODDI, MAP-MRI, DKI and DTI, respectively. The AUC of Viso (0.871) was significantly higher than that of MSD (0.736), RDk (0.760) and RD (0.733) (p < 0.05).ConclusionNODDI outperforms MAP-MRI, DKI, DTI and DWI in differentiating between HGGs and SBMs. NODDI-based Viso has the highest performance.

Diffusion kurtosis imaging: correlation analysis of quantitative model parameters with molecular features in advanced lung adenocarcinoma.

Background:Due to development of magnetic resonance-based functional imaging, it is easier to detect micro-structural alterations of tumor tissues. The aim of this study was to conduct a preliminary evaluation of the correlation of non-Gaussian diffusion kurtosis imaging (DKI) parameters with expression of molecular markers (epidermal growth factor receptor [EGFR]; anaplastic lymphoma kinase [ALK]; Ki-67 protein) in patients with advanced lung adenocarcinoma, using routine diffusion-weighted imaging as the reference standard.Methods:Data from patients with primary lung adenocarcinoma diagnosed at Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS) from 2016 to 2019 were collected for retrospective analysis. The pathologic and magnetic resonance imaging data of 96 patients who met the inclusion criteria were included in this study. Specifically, the Kapp and Dapp parameters measured from the DKI model; apparent diffusion coefficient (ADC) value from the diffusion-weighted imaging model; and the EGFR, ALK, and Ki-67 biomarkers detected by immunohistochemistry and/or molecular biology techniques after biopsy or surgery were evaluated. The relations between quantitative parameters (ADC, Kapp, Dapp) and pathologic outcomes (EGFR, ALK, and Ki-67 expression) were analyzed by Spearman correlation test.Results:Of the 96 lung adenocarcinoma lesions (from 96 patients), the number of EGFR- and ALK-positive and high Ki-67 expressing lesions were 53, 12, and 83, respectively. The Kapp values were significantly higher among patients with EGFR-positive mutations (0.81 ± 0.12 vs. 0.66 ± 0.10, t = 6.41, P < 0.001), ALK rearrangement-negative (0.76 ± 0.12 vs. 0.60 ± 0.15, t = 4.09, P < 0.001), and high Ki-67 proliferative index (PI) (0.76 ± 0.12 vs. 0.58 ± 0.13, t = 4.88, P < 0.001). The Dapp values were significantly lower among patients with high Ki-67 PI (3.19 ± 0.69 μm2/ms vs. 4.20 ± 0.83 μm2/ms, t = 4.80, P < 0.001) and EGFR-positive mutations (3.11 ± 0.73 μm2/ms vs. 3.59 ± 0.77 μm2/ms, t = 3.12, P = 0.002). The differences in mean Dapp (3.73 ± 1.26 μm2/ms vs. 3.26 ± 0.68 μm2/ms, t = 1.96, P = 0.053) or ADC values ([1.34 ± 0.81] × 10−3 mm2/s vs. [1.33 ± 0.41] × 10−3 mm2/s, t = 0.07, P = 0.941) between the groups with or without ALK rearrangements were not statistically significant. The ADC values were significantly lower among patients with EGFR-positive mutation ([1.19 ± 0.37] × 10−3 mm2/s vs. [1.50 ± 0.53] × 10−3 mm2/s, t = 3.38, P = 0.001) and high Ki-67 PI ([1.28 ± 0.39] × 10−3 mm2/s vs. [1.67 ± 0.77] × 10−3 mm2/s, t = 2.88, P = 0.005). Kapp was strongly positively correlated with EGFR mutations (r = 0.844, P = 0.008), strongly positively correlated with Ki-67 PI (r = 0.882, P = 0.001), and strongly negatively correlated with ALK rearrangements (r = −0.772, P = 0.001). Dapp was moderately correlated with EGFR mutations (r = −0.650, P = 0.024) or Ki-67 PI (r = −0.734, P = 0.012). ADC was moderately correlated with Ki-67 PI (r = −0.679, P = 0.033).Conclusions:The Kapp value of DKI parameters was strongly correlated with different expression of EGFR, ALK, and Ki-67 in advanced lung adenocarcinoma. The results potentially indicate a surrogate measure of the status of different molecular markers assessed by non-invasive imaging tools.