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Objective:To investigate the diagnostic value of diffusion kurtosis imaging (DKI) quantitative parameters in lymph node metastasis of rectal cancer.Methods:The clinicopathological data of 79 patients with rectal cancers in Shanxi Province Cancer Hospital from November 2016 to March 2017 were retrospectively analyzed. All patients underwent routine magnetic resonance image (MRI) sequence and DKI sequence examinations before the operation. The tumor region of interest (ROI) was delineated by two radiologists. Matlab software was applied to calculate DKI quantitative parameters including apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) in two groups, respectively; and the consistency analysis was performed by using the interclass correlation coefficients (ICC). According to the results of postoperative pathology, all patients were divided into lymph node metastasis group and lymph node non-metastasis group; ADC, MD, MK of both groups were compared. The pathological diagnosis results were taken as the gold standard, receiver operating characteristic (ROC) curves of DKI quantitative parameters in the diagnosis of lymph node metastasis of rectal cancer were plotted, the area under the curve (AUC) was calculated, the optimal diagnostic threshold was determined based on the Yoden index, and the sensitivity and specificity were calculated.Results:The ICC of ADC, MD and MK calculated by two physicians were 0.934 (0.833-0.975), 0.963 (0.905-0.981) and 0.971 (0.949-0.991), respectively, showing a good inter-observer consistency. Among the 79 patients with rectal adenocarcinoma, 36 cases were in lymph node metastasis group and 43 cases were in lymph node non-metastasis group. MK value in lymph node metastasis group was higher than that in lymph node non-metastasis group, and the difference was statistically significant (0.97±0.08 vs. 0.89±0.09; t = -4.07, P < 0.001), while the ADC and MD values in lymph node metastasis group were lower than those in lymph node non-metastasis group, and the differences were not statistically significant (all P > 0.05). The AUC of MK value in the diagnosis of lymph node metastasis of rectal cancer was 0.735, and the corresponding sensitivity and specificity were 55.56% and 88.37%, respectively. Conclusions:DKI quantitative parameter MK has a certain diagnostic value in predicting lymph node metastasis of rectal cancer.
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Objective:To analyze the prognostic value of nomogram model for cervical cancer based on the imaging features of diffusion kurtosis imaging (DKI) histogram.Methods:The DKI and clinical data of 272 patients with cervical cancer who were admitted to Affiliated Hospital of Guangdong Medical University from March 2015 to February 2022 were collected and retrospectively analyzed. All patients were randomly divided into the training group ( n=190) and validation group ( n=82) at a ratio of 7 vs. 3. The parameters of DKI histogram were obtained by GE AW 4.2 MRI software. The best prognostic imaging features were screened by LASSO regression. The DKI radiomics score was calculated by linear combination. The independent risk factors of prognosis were identified by univariate and multivariate regression analyses, and a nomogram model was constructed. The model discrimination was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). The internal consistency of the model was evaluated by the calibration map. Results:Adenocarcinoma ( HR=2.496, 95% CI=1.312-4.749, P=0.005), DKI score ( HR=24.087, 95% CI=6.062-95.711, P<0.001), depth of invasion ≥ 1/2 muscular layer ( HR=2.277, 95% CI=1.156-4.487, P=0.017) and neutrophil to lymphocyte ratio (NLR) ( HR=1.800, 95% CI=1.313-2.468, P<0.001) were the independent risk factors for prognosis of cervical cancer. The AUC of the nomogram model in the training and validation groups were 0.860 and 0.757, respectively. The calibration curve was well fitted with the 45° diagonal. The prediction results of long-term prognosis of this model were in good agreement with the actual situation. Conclusions:Adenocarcinoma, NLR, DKI score and depth of invasion ≥ 1/2 muscular layer are the independent risk factors for the prognosis of patients with cervical cancer. The constructed nomogram model could reliably predict the 3-year survival rate of patients with cervical cancer.
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Magnetic resonance imaging (MRI) is a very important imaging method for diagnosis and treatment of prostate cancer (PCa) in clinical practice. As functional MRI is growing and maturing, its quantitative parameters are expected to enhance the clinical value of MRI furtherly. Intravoxel incoherent motion diffusion imaging, diffusion tensor imaging, and diffusion kurtosis imaging, which were derived from diffusion weighted imaging, have provided richer and more accurate parameters. The newly-developed magnetic resonance elastography can complement the mechanical characteristics of PCa.
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Humans , Male , Diffusion Magnetic Resonance Imaging , Diffusion Tensor Imaging , Magnetic Resonance Imaging , Motion , Prostatic Neoplasms/diagnostic imagingABSTRACT
Objective To compare the difference in the microstructure of gray matter nucleus in basal ganglia of different movement subtypes of Parkinson's disease (PD) by diffusion kurtosis imaging (DKI) technique,and to analyze its clinical significance in the process of disease occurrence and development.Methods A total of 44 PD patients and 20 healthy controls (HC) admitted to the First Hospital of Shanxi Medical University from July 2017 to October 2018 were recruited into the study.The PD patients were classified into tremor dominant (TD) and non-tremor dominant (NTD) subtypes according to motor symptoms.All participants were scanned for DKI sequence.Fractional anisotropy (FA),mean kurtosis (MK),and mean diffusivity (MD) were obtained from bilateral red nucleus,substantia nigra,caudate nucleus,globus pallidus,putamen,and thalamus.The DKI of the deep brain nucleus in TD,NTD,HC groups was compared,and relationships between DKI and clinical measures were tested.Results Comparing the two substypes of PD with the HC group,the TD group had lower FA value (0.346±0.006 vs 0.389±0.009,U=-3.052,P=0.007),higher MK value (1.101±0.008 vs 0.981±0.006,U=-5.577,P=0.000) and higher MD value (1.005(0.919,1.082) vs 0.934 (0.899,0.970),U=2.493,P=0.038) in the substantia nigra ipsilateral to the more affected side than the HC group.The NTD group had higher MK value in the bilateral substantia nigra than the HC group (less affected side:1.090±0.022 vs 0.990±0.008,U=-4.102,P=0.000;more affected side:1.071±0.020 vs 0.981±0.006,U=-3.728,P=0.001).In the PD patients,the MK value in the substantia nigra ipsilateral to the more affected side showed a negative correlation with the Hoehn-Yahr (H-Y) grade,Unified Parkinson's Disease Rating Scale (UPDRS) Ⅲ scores,and non-tremor scores (r=-0.299,P=0.048;r=-0.366,P=0.015;r=-0.402,P=0.007).The FA values of the bilateral putamen of the TD group and the NTD group were lower than those of the HC group.The FA value in putamen contralateral to the more affected side was positively correlated with H-Y grade,UPDRS Ⅲ scores,and non-tremor scores (r=0.331,P=0.028;r=0.403,P=0.007;r=0.376,P=0.012).Compared with the HC group,the FA value of the bilateral globus pallidus was lower in the TD group.Comparing different subtypes of PD,only the FA and MK values of the bilateral thalamus were different.The tremor scores of PD patients were negatively correlated with the FA value of bilateral thalamus (less affected side:r=-0.371,P=0.013;more affected side:r=-0.402,P=0.007),and positively correlated with MK value (less affected side:r=0.547,P＜0.01;more affected side:r=0.532,P＜0.01).Conclusions The microstructure of the deep brain nucleus of PD is changed,while the TD and NTD patients have only differences in the microstructure changes of the thalamus.The changes in the microstructure of the thalamus are related to the severity of tremor in PD patients.
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Objective@#To investigate the difference in the microstructure of gray matter nucleus in different movement subtypes of Parkinson’s disease (PD) by diffusion kurtosis imaging (DKI) technique, and to analyze the correlation with clinical manifestations.@*Methods@#Ninety-seven patients with PD and 83 healthy controls performed conventional MRI sequence and DKI sequence scan. The PD patients were classified into gait disorder subtype (PIGD, n=57) and tremor dominant subtype (TD, n=40)subtypes according to motor symptoms. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Da), radial diffusivity(Dr), mean kurtosis (MK), axial kurtosis (Ka) and radial kurtosis (Dr) maps and data were generated by software after processing. DKI was performed for all subjects and data was collected from different brain regions in both hemispheres, including red nucleus(RN), substantia nigra pars reticulate(SNr), substantia nigra pars compacta(SNc), putamen(PUT), globus pallidus(GP), head of caudate nucleus (CN)and thalamus(THA).@*Results@#TD showed a higher MMSE score(P=0.019), but lower modified Hoehn-Yahr score than that in PIGD (P<0.001), there was no significant difference of age of onset, sex, limbs of onset or disease duration between two PD subgroups. Compared with healthy controls, both TD and PIGD showed down-regulated MD, Da and Dr and up-regulated Ka values(P<0.001); MK(0.83±0.26, 0.80±0.18) was increased in SNr both in TD and PIGD, while SNc, PUT and GP (0.84±0.20, 0.75±0.07, 0.81±0.14)were decreased only in TD (P=0.017, P=0.010, P=0.020, P<0.001, P=0.002). The Kr values of PUT and CN(0.71±0.17, 0.72±0.14) were reduced in PIGD, while CN(0.70±0.14) were reduced in TD respectively (P=0.002, P=0.031, P=0.007). The MK was lower in TD than that in PIGD (t=-2.214, P=0.029), and no significant difference was found in other grey matter nuclei between TD and PIGD(P>0.05). Moreover, there was no significant correlation between DKI value and disease duration, MMSE score or Hoehn-Yahr scale (P>0.05) in TD and PIGD.@*Conclusion@#There is heterogeneity of clinical symptoms between these two subgroups of PD. DKI can quantify the microstructural changes of grey matter nucleus in different type PD patient.
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Objective@#To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters in diagnosing prostate cancer(PCa) in transition zone (TZ) and stratifying pathologic Gleason grade of prostate cancer.@*Methods@#A total of 55 patients who were undergoing preoperative muti-parameters MRI of T2WI, DWI, IVIM and DKI model for the exploration of prostate cancer (January 2015 to June 2017) with pathologically confirmed by MRI-transrectal ultrasound (TRUS) targeted fusion biopsy were retrospectively included. Parameters were postprocessed by IVIM models including quantitation of perfusion fraction (f), diffusivity (D) and pseudo-diffusivity (D*) and DKI models including the mean diffusivity (MD), mean kurtosis (MK) and fractional anisotropy (FA) by outlining the 3D VOI. Independent sample t-test was used to compare the differences in lesion parameters between prostate cancer and BPH, low-risk (BPH+Gleason score 6 points) and medium-high-risk lesions (Gleason score ≥7 points). Correlation between ADC values, IVIM and DKI parameters and Gleason scores were assessed with Spearman analysis. Receiver operating characteristic curve analysis was used to evaluate the efficacy of various parameters in the differential diagnosis of prostate cancer and BPH with low-risk or high-risk.@*Results@#27 (36 focus) cases of PCa and 28 (40 focus) cases of benign prostatic hyperplasia (BPH) in PZ were included, meanwhile, the cases of GS ≥7 and and BPH+(GS=6) were 33,43,respectively. There were significant differences in ADC, D, MD, MK, and FA between patients in PCa-BHP group and high-low risk group in TZ (P<0.05), D* and f had no significant differences (P>0.05). ADC and MD showed relatively higher negativity correlations (r were -0.585 and -0.489, P<0.05) with GS of PCa in TZ. ADC exhibited a higher area under the curve (AUC 0.864) compared with D with area under the curve (AUC 0.853), however, the difference is not significant (P>0.05). Of model DKI in diagnose of PCa and BPH, the highest classification accuracy was MD(AUC 0.796). The AUC derived from multiple model parameters in different combination of ADC+D value, ADC+MD value, and ADC+MD+D value were 0.892, 0.884, and 0.897, respectively. ADC and D of IVIM model showed a significance difference between GS ≥7 and BPH+(GS=6) with a higher AUC of 0.826 and 0.743. The AUC was 0.851 of the combination of mean ADC and D, 0.846 of combination of mean ADC and MD, the AUC (0.856) of the combination of ADC, D and MD significant higher than any two combined parameters (P>0.05).@*Conclusions@#IVIM and DKI models may help to discriminate prostate cancer from BPH, and predict mid-higher GS PCa in TZ. But there is no significant advantage compared with ADC values. It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD.
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Objective@#To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score.@*Methods@#Twenty-one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in-bore MR-guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (Dapp), mean apparent kurtosis coefficient (Kapp) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent-samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer.@*Results@#Mean Dapp, 10th Dapp, 25th Dapp, 50th Dapp, 75th Dapp, 90th Dapp, minimum Dapp, maximum Dapp, mean Kapp, 50th Kapp, 75th Kapp, 90th Kapp, maximum Kapp between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th Kapp (r=0.630, P<0.05) and maximum Kapp (r=0.565, P<0.05) increased with the Gleason scores increasing.@*Conclusion@#Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.
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Objective To investigate the application value of diffusion kurtosis imaging (DKI) in the changes of prefrontal cortex microstructures in patients with mild cognitive impairment (MCI). Methods A total of 79 consecutive patients with cerebral small vascular disease admitted to the Department of Neurology, Chaoyang Hospital, Capital Medical University between January 2018 and December 2018 were enrolled retrospectively. They were confirmed by head MRI and MR angiography and Montreal cognitive assessment scale (MoCA) was used to assess the overall cognitive function. According to the presence or absence of MCI,79 patients were divided into MCI group (n = 46) and non-MCI group (rc = 33). The general clinical data of the two groups of patients were recorded and analyzed; neuropsychological assessment results, including MoCA scale, Hamilton depression rating scale (HAMD) , Hamilton anxiety rating scale (HAMA); conventional MR morphology, and DKI scan results. The prefrontal cortex of the patients was selected as the region of interest, i. e. , bilateral dorsolateral superior gyrus, medial superior frontal gyrus,anterior cingulate,and paracingulate gyrus; the DKI related parameters of the region of interest were measured, including mean diffusivity (MD) , fractional anisotropy (FA), axial kurtosis (AK),mean kurtosis (MK) ,and radial kurtosis (RK). The Bonferroni method was used to adjust P values for multiple comparisons of multiple regions of interest The P value was adjusted with P 0.05). (2) In the right anterior cingulate and paracingulate gyrus,the FA,AK and MK values of the MCI group were lower than those of the non-MCI group. The differences were statistically significant between groups (0. 16 ±0.03 us. 0. 18 ±0.03, 0. 64 ± 0.08 vs. 0.70 ± 0.06, and 0. 67 ± 0. 09 vs. 0. 73 ± 0. 06, all P 0. 008). In the left anterior cingulate and paracingulate gyrus,there were no significant differences in MD,FA, AK,MK and RK between the two groups (all P>0.008). (3) There were no significant differences in the MD,FA,AK,MK and RK values between the bilateral dorsolateral superior frontal gyrus and bilateral medial superior frontal gyrus (all P > 0. 008). Conclusions DKI technique can be used to observe the microstructural change of prefrontal cortex matter in patients with MCI. The parameters related to DKI have certain value in clinical imaging evaluation of patients with MCI.
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Objective To compare the value of diffusion kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) in evaluation of histological classification and grading of cervical squamous cell carcinoma and cervical adenocarcinoma. Methods DKI and IVIM data of 60 patients with cervical cancer were retrospectively analyzed, and MK, MD, D, D* and f values were measured. The differences of the parameters between cervical squamous cell carcinoma group (n=38) and cervical adenocarcinoma group (n=22) were analyzed, as well as among different graded subgroups. The diagnostic efficiency of each parameter was evaluated with ROC curve, the correlations between the parameters and pathological grades were analyzed using Spearman method. Results MK of cervical squamous cell carcinoma group was higher than that of cervical adenocarcinoma group, while MD, D, D* and f were lower than those of cervical adenocarcinoma group (all P<0.05). In both groups, the differences of MK, MD and D were statistically significant among different subgroups (all P<0.05), while in cervical adenocarcinoma group, the differences of f were also statistically significant among different subgroups (all P<0.05). MK had the highest AUC in diagnosing cervical squamous cell carcinoma and adenocarcinoma.Except for D*, there was correlation between other parameters and pathological grade (all P<0.05). Conclusion Compared with IVIM, DKI can more effectively evaluate cervical squamous cell carcinoma and cervical adenocarcinoma and their pathological grading.
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Objective To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters in diagnosing prostate cancer(PCa) in transition zone (TZ) and stratifying pathologic Gleason grade of prostate cancer. Methods A total of 55 patients who were undergoing preoperative muti?parameters MRI of T2WI, DWI, IVIM and DKI model for the exploration of prostate cancer (January 2015 to June 2017) with pathologically confirmed by MRI?transrectal ultrasound (TRUS) targeted fusion biopsy were retrospectively included. Parameters were postprocessed by IVIM models including quantitation of perfusion fraction (f), diffusivity (D) and pseudo?diffusivity (D*) and DKI models including the mean diffusivity (MD), mean kurtosis (MK) and fractional anisotropy (FA) by outlining the 3D VOI. Independent sample t?test was used to compare the differences in lesion parameters between prostate cancer and BPH, low?risk (BPH+Gleason score 6 points) and medium?high?risk lesions (Gleason score ≥7 points). Correlation between ADC values, IVIM and DKI parameters and Gleason scores were assessed with Spearman analysis.Receiver operating characteristic curve analysis was used to evaluate the efficacy of various parameters in the differential diagnosis of prostate cancer and BPH with low?risk or high?risk. Results 27 (36 focus) cases of PCa and 28 (40 focus) cases of benign prostatic hyperplasia(BPH) in PZ were included, meanwhile, the cases of GS≥7 and and BPH+(GS=6) were 33,43,respectively. There were significant differences in ADC, D, MD, MK, and FA between patients in PCa?BHP group and high?low risk group in TZ (P<0.05), D*and f had no significant differences (P>0.05). ADC and MD showed relatively higher negativity correlations (r were－0.585 and－0.489, P<0.05) with GS of PCa in TZ. ADC exhibited a higher area under the curve (AUC 0.864) compared with D with area under the curve (AUC 0.853), however, the difference is not significant (P>0.05). Of model DKI in diagnose of PCa and BPH, the highest classification accuracy was MD(AUC 0.796). The AUC derived from multiple model parameters in different combination of ADC+D value, ADC+MD value, and ADC+MD+D value were 0.892, 0.884, and 0.897, respectively. ADC and D of IVIM model showed a significance difference between GS≥7 and BPH+(GS=6) with a higher AUC of 0.826 and 0.743. The AUC was 0.851 of the combination of mean ADC and D, 0.846 of combination of mean ADC and MD, the AUC (0.856) of the combination of ADC, D and MD significant higher than any two combined parameters (P>0.05). Conclusions IVIM and DKI models may help to discriminate prostate cancer from BPH, and predict mid?higher GS PCa in TZ. But there is no significant advantage compared with ADC values. It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD.
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Objective To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score. Methods Twenty?one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in?bore MR?guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (Dapp), mean apparent kurtosis coefficient (Kapp) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent?samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer. Results Mean Dapp, 10th Dapp, 25th Dapp, 50th Dapp, 75th Dapp, 90th Dapp, minimum Dapp, maximum Dapp, mean Kapp, 50th Kapp, 75th Kapp, 90th Kapp, maximum Kapp between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th Kapp (r=0.630, P<0.05) and maximum Kapp (r=0.565, P<0.05) increased with the Gleason scores increasing. Conclusion Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.
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Objective To investigate the difference in the microstructure of gray matter nucleus in different movement subtypes of Parkinson’s disease (PD) by diffusion kurtosis imaging ( DKI) technique, and to analyze the correlation with clinical manifestations. Methods Ninety-seven patients with PD and 83 healthy controls performed conventional MRI sequence and DKI sequence scan. The PD patients were classi-fied into gait disorder subtype (PIGD,n=57) and tremor dominant subtype (TD,n=40)subtypes according to motor symptoms. Fractional anisotropy (FA),mean diffusivity (MD),axial diffusivity (Da),radial diffu-sivity(Dr),mean kurtosis (MK),axial kurtosis (Ka) and radial kurtosis (Dr) maps and data were genera-ted by software after processing. DKI was performed for all subjects and data was collected from different brain regions in both hemispheres,including red nucleus(RN),substantia nigra pars reticulate( SNr),sub-stantia nigra pars compacta(SNc),putamen(PUT),globus pallidus(GP),head of caudate nucleus (CN)and thalamus(THA). Results TD showed a higher MMSE score(P=0. 019),but lower modified Hoehn-Yahr score than that in PIGD (P<0. 001),there was no significant difference of age of onset,sex,limbs of onset or disease duration between two PD subgroups. Compared with healthy controls, both TD and PIGD showed down-regulated MD,Da and Dr and up-regulated Ka values(P<0. 001); MK(0. 83±0. 26,0. 80±0. 18) was increased in SNr both in TD and PIGD,while SNc,PUT and GP (0. 84± 0. 20,0. 75± 0. 07,0. 81± 0. 14) were decreased only in TD (P=0. 017,P=0. 010,P=0. 020,P<0. 001,P=0. 002). The Kr values of PUT and CN(0. 71±0. 17,0. 72±0. 14) were reduced in PIGD,while CN(0. 70±0. 14) were reduced in TD re-spectively (P=0. 002,P=0. 031,P=0. 007). The MK was lower in TD than that in PIGD (t=-2. 214,P=0. 029),and no significant difference was found in other grey matter nuclei between TD and PIGD ( P>0. 05). Moreover,there was no significant correlation between DKI value and disease duration,MMSE score or Hoehn-Yahr scale (P>0. 05) in TD and PIGD. Conclusion There is heterogeneity of clinical symptoms between these two subgroups of PD. DKI can quantify the microstructural changes of grey matter nucleus in different type PD patient.
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Objective To compare the value of diffusion kurtosis imaging (DKI) mode and mono-exponential mode in predicting the response to neoadjuvant chemotherapy (NAC) for locally advanced breast carcinoma using DWI.Methods From January 1,2013 to December 31,2016,eighty patients with locally advanced breast carcinoma were enrolled into this prospective clinical study.The diagnosis was confirmed on the basis of histopathological results.The clinical stage stayed at Ⅱ or Ⅲ.The patients would receive breast-conserving surgery after NAC.All the patients underwent DWI examination by using both mono-exponential mode and DKI mode before chemotherapy was initiated.The parameters included ADC,mean diffusivity (MD) and mean kurtosis (MK).Within 1 to 3 days before or after MRI examination,the patients underwent aspiration biopsy,received 4 to 8 cycles of NAC and followed by surgery.According to histologic grading before NAC,the patients were classified into well-differentiated and poor-differentiated group.According to the comparison between pathological results acquired from biopsy before NAC and specimen acquired after surgery,the patients were classified into pathologic complete response (pCR) and pathologic non-complete response (non-pCR) according to treatment effect.The imaging parameters were compared between the pCR and the non-pCR group using t test.The predicting ability of two imaging modes was compared and analyzed with ROC analysis.The relationships between multiple imaging parameters,pathologic,clinical characteristics of tumor and treatment effect were analyzed using logistic multi-variate regression analysis,and further analyzed using Wald test.Results There were 30 cases of pCR and 50 cases of non-pCR.The ADC and MD values were lower in the pCR group than in the non-pCR group (P＜0.05).MK value was higher in the pCR group than in the non-pCR group (P＜0.05).ROC analysis showed that the area under ROC curve of ADC,MD and MK in predicting treatment effect were 0.732,0.866 and 0.683 respectively.Logistic regression analysis showed that,according to predicting ability,MD,ADC and MK successively were the independent predictors for the early response to chemotherapy.Conclusion Compared with mono-exponential mode,DKI mode can reflect the real micro-environment and water diffusion restriction within the tumor area more reliably and accurately,and is more suitable to serve as an imaging technique for predicting the response to NAC for locally advanced breast carcinoma.
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Objective To explore the value of diffusion kurtosis imaging (DKI) in predicting radiotherapy sensitivity of esophageal cancer from the animal model level.Methods BALB/c nude mice were subcutaneously injected with Eca-109 cell lines to form xenograft tumors.The tumors received a single dose of 15 Gy (6 MV X-rays) in the experimental group or had no any treatment as control.The volume of transplanted tumor,the change of ADC,MK and MD values,and the tumor cell density and necrosis ratio of these two groups were observed at the corresponding time points.Results The growth of xenograft volume in the experimental group was suppressed and it was significantly smaller than that in the control group (t=3.206-6.149,P＜0.05) at the 7th day after radiotherapy.From the 3rd day after radiotherapy,the ADC and MD values of the experimental group were significantly higher than those of the control group,and the MK values was lower than those in the control group (tADC =-11.018--2.049,tMD =-6.609--2.052,tMK =2.492-9.323,P＜0.05).Meanwhile,the tumor cell density of the control group was higher than that of the experimental group,and the proportion of necrosis in the experimental group was higher than that in the control group (tdensity =-8.387--2.239,t is =2.980-17.430,P＜0.05).Conclusions A single large dose radiation could inhibit the growth of xenograft.ADC,MK,MD values changed at the early stage prior to morphological changes of tumor in consistent with the change of cell density and necrosis ratio.DKI has the potential value in predicting radiotherapy sensitivity of esophageal carcinoma.
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OBJECTIVE: To investigate the diagnostic value of diffusion kurtosis imaging (DKI) histogram analysis in hepatic fibrosis staging. MATERIALS AND METHODS: Thirty-six rats were divided into carbon tetrachloride-induced fibrosis groups (6 rats per group for 2, 4, 6, and 8 weeks) and a control group (n = 12). MRI was performed using a 3T scanner. Histograms of DKI were obtained for corrected apparent diffusion (D), kurtosis (K) and apparent diffusion coefficient (ADC). Mean, median, skewness, kurtosis and 25th and 75th percentiles were generated and compared according to the fibrosis stage and inflammatory activity. RESULTS: A total of 35 rats were included, and 12, 5, 5, 6, and 7 rats were diagnosed as F0–F4. The mean, median, 25th and 75th percentiles, kurtosis of D map, median, 25th percentile, skewness of K map, and 75th percentile of ADC map demonstrated significant correlation with fibrosis stage (r = −0.767 to 0.339, p < 0.001 to p = 0.039). The fibrosis score was the independent variable associated with histogram parameters compared with inflammatory activity grade (p < 0.001 to p = 0.041), except the median of K map (p = 0.185). Areas under the receiver operating characteristic curve of D were larger than K and ADC maps in fibrosis staging, although no significant differences existed in pairwise comparisons (p = 0.0512 to p = 0.847). CONCLUSION: Corrected apparent diffusion of DKI histogram analysis provides added value and better diagnostic performance to detect various liver fibrosis stages compared with ADC.
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Animals , Rats , Carbon , Diagnosis , Diffusion , Fibrosis , Liver , Liver Cirrhosis , Magnetic Resonance Imaging , ROC CurveABSTRACT
Purpose To explore the application value of diffusion kurtosis imaging (DKI) in assessing brain injury in different clinical stages caused by carbon monoxide (CO) poisoning. Materials and Methods MR plain scan, diffusion weighted imaging (DWI) and DKI scans were performed in 26 patients with acute CO poisoning, 17 patients with delayed neuropsychologic sequelae (DNS), 15 patients with chronic phase, and 21 healthy volunteers (control group). The DKI parameter values in regions of interest among the four groups were compared, and the correlation between the values of each parameter and DWI apparent diffusion coefficient (ADC) value was analyzed. Results ①The mean kurtosis (MK) values in the area of pallidum in acute phase, DNS phase, and chronic phase were 1.51±0.15, 1.07±0.11 and 0.59±0.11, respectively; among which the MK value in acute phase was significantly higher than that in the control group (1.06±0.06, P<0.05), and the chronic phase was significantly lower than the DNS phase and the control group (P<0.05); compared with the control group, the MK in centrum semiovale and subcallosal zone was relatively higher in acute phase and DNS phase, lower in chronic phase, both showing the most significant increase in DNS phase (P<0.05). ②In each region of interest, the MK value and mean diffusivity (MD) all showed an increase after decrease. Among them, MD values in the area of pallidum in acute phase were significantly lower than those in DNS and control group (0.74±0.11 vs. 0.85±0.07 and 0.98±0.12, P<0.05), and the centrum semiovale and callosum were the smallest in DNS phase (0.67±0.09 and 0.80±0.05, respectively), significantly lower than that in the control group (P<0.05). ③The fractional anisotropy (FA) values of all regions of interest showed a progressive decrease in different clinical stages, in which pallidum and centrum semiovale were the lowest in chronic phase (0.19±0.04 and 0.22±0.03, respectively), significantly lower than those in DNS phase and the control group (P<0.05). ④There was a positive correlation between MD values and ADC values in different clinical stages of CO poisoning in each region of interest (P<0.01). Conclusion DKI can quantitatively evaluate the changes of brain gray matter microarchitecture after CO poisoning, which is helpful to understand the characteristics of brain injury in different clinical stages caused by CO poisoning from the microscopic level.
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Purpose To synthetically evaluate MR diffusion kurtosis imaging (DKI) using Meta-analysis to differentiate diagnostic value of benign and malignant breast lesions and quantitatively analyze mean kurtosis (MK) values of benign and malignant breast lesions in an attempt to provide evidence-based facts for clinical decision making. Materials and Methods Computer-based retrieval of Chinese and English literatures concerning differential diagnosis of benign and malignant breast lesions with application of DKI publicly published at home and abroad in PubMed, Ebsco, Embase, CNKI, Cochrane Library, CBM, VIP Data database from January. 1, 2006 to September. 30, 2017. Two valuators independently screened and extracted data according to inclusion and exclusion criteria, and drew on QUADAS for quality assessment, Stata 12.0 and Meta-Disc 1.4 software for Meta analysis and extraction of relevant parameters. Results Totally 8 up-to-standard literatures were included, including 3 in English and 5 in Chinese. The total number of focus was 689. Corresponding effect model analysis revealed that MK value in malignant breast lesion group was higher than that in benign lesion group, the difference of which was statistically significant. The optimal diagnostic threshold was determined by the maximum Youden index, which was approximately 0.71 in size,with combined sensitivity of 0.907(95% CI 0.860-0.939),specificity of 0.910(95% CI 0.856-0.945),positive likelihood ratio of 10.053(95% CI 6.293-16.059),negative likelihood ratio of 0.102(95% CI 0.068-0.154),and diagnostic test odds ratio of 98.203(95% CI 55.014-175.296).The area under receiver operating characteristic curve was 0.96.MK value suggested 94% posterior malignant rate of malignant breast lesions, and 13% malignant rate of benign breast lesions. Conclusion MK value has high diagnostic value for benign and malignant breast lesions with good sensitivity and specificity.
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Objective To investigate the changes of microstructure and blood perfusion of thalamus and basal ganglia in patients with untreated depressive disorder using diffusion kurtosis imaging (DKI) and three-dimensional arterial spin labeling (3D ASL) perfusion imaging.Methods Totally 21 untreated patients with depressive disorder (disease group) and 32 healthy volunteers (control group) underwent DKI,3D ASL and routine MR scanning were enrolled.DKI parameters (mean kurtosis [MK],axial kurtosis [Ka],radial kurtosis [Kr],fractional anisotropy [FA],mean diffusivity [MD],axial diffusivity [Da] and radial diffusivity [Dr]) and 3D ASL parameters (cerebral blood flow [CBF]) of bilateral heads of caudate nucleus,thalamus and putamens were measured and compared between the 2 groups.Results Compared with control group,Ka of left caudate head in disease group was significantly higher,while Kr was significantly lower (both P＜ 0.05).Ka of right putamens in disease group was significantly higher than that in control group (P＜0.05).Compared with control group,CBF of left caudate head and bilateral putamens decreased significantly in disease group (all P＜0.05).Conclusion Untreated depressed patients show abnormal DKI parameters and blood perfusion in basal ganglia,which indicating that microstructure integrity is impaired and blood perfusion decreases.The abnormalities in basal ganglia microstructure and blood perfusion may serve as one of the neuroimaging features of depressive disorders.
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Objective@#To investigate the diagnostic value of diffusion kurtosis imaging (DKI) and its combination with DWI for differentiating benign and malignant breast lesions.@*Methods@#Eighty two patients with clinically suspected breast lesions from May 2016 to February 2017 in the Cancer Hospital of Chinese Academy of Medical Sciences were prospectively enrolled in the study. Mammary MRI was performed in all the all patients (89 lesions), and the pathology results were confirmed by surgery or biopsies. All of them underwent 3.0 T MR examinations, including conventional fat-suppression imaging, DWI, DKI and dynamic contrast-enhanced MR imaging (DCE-MRI). The ADC values, mean diffusivity (MD), and mean diffusion kurtosis (MK) values of lesions were obtained, and the lesion morphology, enhancement patterns, and time-signal intensity curve (TIC) types were observed. Independent-samples t test, Mann-Whitney U test were used for the comparison of DKI and DWI between benign and malignant breast lesions. The characteristics of the lesions, enhancement manners and TIC between benign and malignant lesions were analyzed with χ2 test. ROC was used to evaluate the efficacy of DKI and DWI parameters in the differential diagnosis of benign and malignant breast lesions.@*Results@#There was no statistically difference for major axis, fiber types (P>0.05, respectively). The shape of enhancement mode and TIC had statistical significance (P<0.05, respectively). The ADC and MD values were significantly lower in malignant than in benign lesions. Conversely, MK value was significantly higher in malignant lesions than in benign ones, there was a statistically significant difference between these parameters (P<0.05, respectively). Among ADC, MD and MK values, the area under the curve (AUC) of MD for differentiating the benign lesions from the malignancy had the highest diagnosis efficiency (0.975), which was higher than the AUC of MK (0.969) and ADC (0.873). Combing the parameters of DWI and DKI, the diagnostic performance was superior to the single parameter. The AUC of the combination of MD and MK was 0.977, and the parameters of DKI combined with ADC-value had a equal diagnosis efficiency for the combination of MD and MK, which the areas under the ROC curve was 0.978.@*Conclusion@#The parameters derived from DKI can be used to distinguish benign breast lesions from malignant, and the combination of DKI and DWI could obtain a better diagnostic performance than single parameter.
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Objective To explore the clinical applicability of diffusion kurtosis imaging (DKI)in children with spastic hemiplegic cerebral palsy.Methods 22 children with spastic hemiplegic cerebral palsy and age-matched 22 normal children were selected in this study,and were treated with routine brain MRI and DKI to test the white matter area of tractus corticospinalis on brainstem plane, anterior limb of internal capsule,posterior limb of inter capsule,genu of corpus callosum and the splenium of corpus callosum.The fractional alanisotropy(FA)value and mean kurtosis (MK)value of deep gray nuclei area in thalamus,lenticular nucleus and head of caudate nucleus were examined.Furthermore,gross motor function classification system (GMFCS)was performed for the children in research group.Two independent sample t test was applied in the comparison of groups.The correlation between DKI parameters and cerebral palsy gross motor function was analyzed by Spearman analysis.Results As for MK value,there were statistically significant differences in all different brain areas between the research group and the control group(P<0.05).And for FA value,there was statistically significant difference only in white matter area between the research group and the control group (P<0.05).However,there was no statistically significant difference in cerebral deep gray nuclei area (P>0.05).The GMFCS score was negatively correlated with the FA value,and was positively correlated with the MK value.Conclusion DKI can reflect the damaged situation of gray matter in children with cerebral palsy,and its parameter values can be used to monitor the children with cerebral palsy as evaluation indicators.