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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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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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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 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 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 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 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) 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 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
OBJECTIVE: To compare the diagnostic performance of readout-segmented echo-planar imaging (RS-EPI)-based diffusion kurtosis imaging (DKI) and that of diffusion-weighted imaging (DWI) for differentiating malignant from benign masses in head and neck region. MATERIALS AND METHODS: Between December 2014 and April 2016, we retrospectively enrolled 72 consecutive patients with head and neck masses who had undergone RS-EPI-based DKI scan (b value of 0, 500, 1000, and 1500 s/mm2) for pretreatment evaluation. Imaging data were post-processed by using monoexponential and diffusion kurtosis (DK) model for quantitation of apparent diffusion coefficient (ADC), apparent diffusion for Gaussian distribution (Dapp), and apparent kurtosis coefficient (Kapp). Unpaired t test and Mann-Whitney U test were used to compare differences of quantitative parameters between malignant and benign groups. Receiver operating characteristic curve analyses were performed to determine and compare the diagnostic ability of quantitative parameters in predicting malignancy. RESULTS: Malignant group demonstrated significantly lower ADC (0.754 ± 0.167 vs. 1.222 ± 0.420, p < 0.001) and Dapp (1.029 ± 0.226 vs. 1.640 ± 0.445, p < 0.001) while higher Kapp (1.344 ± 0.309 vs. 0.715 ± 0.249, p < 0.001) than benign group. Using a combination of Dapp and Kapp as diagnostic index, significantly better differentiating performance was achieved than using ADC alone (area under curve: 0.956 vs. 0.876, p = 0.042). CONCLUSION: Compared to DWI, DKI could provide additional data related to tumor heterogeneity with significantly better differentiating performance. Its derived quantitative metrics could serve as a promising imaging biomarker for differentiating malignant from benign masses in head and neck region.
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Humans , Diffusion , Echo-Planar Imaging , Head , Magnetic Resonance Imaging , Neck , Population Characteristics , Retrospective Studies , ROC CurveABSTRACT
Objective In this prospective study,the performance between high-resolution diffusion-weighted imaging ( DWI) and diffusion kurtosis imaging ( DKI) for prediction of radiotherapy response in patients with nasopharyngeal carcinoma was compared. Methods Forty-one patients pathologically diagnosed with NPC received IMRT. All patients underwent conventional MRI,high-resolution DWI and DKI before and after radiotherapy (1-2 d after the plan dose was administered).All patients received conventional MRI during follow-up at 3,6,9 and 12 months after radiotherapy. According to the RECIST 1. 1( response evaluation criteria in solid tumors),all patients were divided into the response group (RG;n＝36) and non-response group (NRG;n＝5). The mean kurtosis coefficient (Kmean) and the mean diffusion coefficient (Dmean) of DKI and apparent diffusion coefficient ( ADC) of DWI were analyzed before and after radiotherapy. Results Among 41 patients,36 cases were assigned into the RG group and 5 in the NRG group. Before and after radiotherapy, all parameters significantly differed between two groups ( P＝0. 000-0. 013) except for the Dmeanand ADC prior to radiotherapy. At the end of radiotherapy,the sensitivity of Kmeanwas calculated as 87. 5% and the specificity was 91. 3% for predicting local control (optimal threshold＝0. 30, AUC: 0. 924; 95%CI: 0. 83-1. 00 ). Conclusion Kmeanvalue after radiotherapy is a potential biomarker for the early evaluation of clinical efficacy of radiotherapy in NPC patients.
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Objective To explore the efficacy difference of diffusion kurtosis imaging (DKI) and ultrasound elastography (UE) in the diagnosis of liver fibrosis. Methods Thirty-five patients whose serological examination showed hepatitis B or hepatitis C virus infection, disease course≥ 1 year, and finally liver biopsy confirmed pathological fibrosis grade in Tianjin Second People's Hospital from December 2015 to April 2017 were prospectively enrolled as patient group. During the same period, twenty healthy volunteers who matched the age, sex and BMI with patient group and showed normal liver function within the last month were enrolled as control group. All of the subjects underwent DKI experiment, and subjects in patient group underwent UE experiment in addition. Liver mean apparent diffusion (MD) and mean kurtosis (MK) were obtained in all subjects and liver stiffness measurement (LSM) was obtained in patient group. The patient group was staged for hepatic fibrosis based on liver biopsy results (S0 to S4). Differences in liver MD and MK values between control and patient groups were tested using independent sample t test (normal distribution) or Mann-Whitney U test (skewed distribution). Differences in liver MD, MK, and LSM between patients with different fibrosis stages were tested using One-way ANOVA (normal distribution) or Kruskal-Wallis test (skewed distribution). The correlation between liver MD, MK and LSM values with fibrosis stages were analyzed using Pearson correlation test. The diagnostic performance in staging fibrosis was analyzed using ROC analysis. Results Liver MD in patient group was lower than that in control group, and the difference was statistically significant (P<0.01). There was no significant difference in liver MK between the two groups (P>0.05). The AUC value for the diagnosis of liver fibrosis by MD was 0.950 (95％CI:0.855 to 0.990). Of the 35 patients, 15 were S1 (mild fibrosis), 13 were S2 (moderate fibrosis), 4 were S3, 3 were S4 (S3+S4 were severe fibrosis). The difference of MD and LSM between different stages of liver fibrosis was statistically significant (P<0.05), and there was no significant difference in MK (P>0.05). Liver fibrosis stages was highly correlated with MD (r=-0.757, P<0.01), and had no correlation with MK (r=-0.010, P=0.956), and moderately correlated with LSM (r=0.440, P<0.01). The AUC values of liver MD and LSM for characterization of ≥S2 stage liver fibrosis were 0.867 and 0.800, respectively, without statistically significant difference (P=0.486). The AUC values for characterization of≥S3 stage liver fibrosis were 0.918 and 0.653, respectively, with a statistically significant difference (P=0.032). Conclusion MD derived from DKI can be used for noninvasive assessment of liver fibrosis, and it is superior to LSM in distinguishing different fibrosis stages and detecting severe fibrosis.
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Objective To evaluate the diagnostic efficacy of MRI diffusion kurtosis imaging (DKI) and quantitative dynamic contrast enhancement MRI (DCE-MRI) in benign and malignant breast lesions, and to explore the differential diagnosis ability for different pathological types and molecular subtype lesions. Methods Sixty four females were retrospectively enrolled in the study of MRI diffusion kurtosis imaging and quantitative dynamic contrast enhancement between November 20 and May 2017. All of them were confirmed to have benign or malignant lesions after surgical resection or puncture. All patients underwent axial T1WI, DKI and DCE-MRI examinations. The mean kurtosis (MK) and mean diffusivity (MD) values were calculated by the DKI model, and the hemodynamic parameters were obtained by quantitative dynamic contrast enhancement, including volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular space distribute volume per unit tissue volume (Ve) and blood volume fraction (Vp). Pathological analysis was performed to monitor the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2) and nuclear proliferation index Ki67. The breast cancer was divided into Luminal A type, Luminal B type, HER-2 positive and triple-negative 4 subtypes. The differences of DKI parameters and DCE-MRI parameters between benign and malignant breast lesions were compared using two independent samples t test (normal distribution and homogeneity of variance) or Mann-Whitney U test (skewed distribution or variance). ROC analysis was used to evaluate the value of DKI and DCE-MRI parameters in differential diagnosis of benign and malignant breast lesions with pathological results as the gold standard. The Mann-Whitney U test and Kruskal-Wallis H test were used to compare the differences of DKI and DCE-MRI parameters among different prognostic factors and molecular subtypes of breast cancer. Spearman rank correlation analysis was used to evaluate the correlation between DKI and DCE-MRI parameters and different prognostic factors. Results Sixty-four cases were single lesions, with breast cancer in 23 cases and 41 cases of benign lesions. In breast cancer, there were 9 cases of Luminal A type, 7 cases of Luminal B type, 3 cases of HER-2 positive type and 4 cases of triple negative type. The positive numbers of ER, PR and HER-2 were 14, 11 and 10 cases respectively. Nineteen cases showed high expression of Ki67, while 4 cases showed low expression. There were significant differences in MK, MD, Ktrans and Kep between benign and malignant lesions (P<0.05). However, there was no significant difference between Ve and Vp (P>0.05). The area under the ROC for the differential diagnosis of benign and malignant breast lesions were 0.897, 0.808, 0.844 and 0.842, respectively. The combined multi-parameter differential diagnosis improved the efficacy. Combined with the above four parameters, the area under the ROC was 0.950. The diagnosis Sensitivity, specificity and accuracy were 0.870, 0.951 and 0.922 respectively. The Ktrans and Vp values of patients with ER positive and ER negative, as well as Ve value of deferent lymph node status, were significantly different (P<0.05), but there was no significant difference between the other prognostic factors (P>0.05). There was a moderate positive correlation between ER and Ktrans and Vp values. There was a low positive correlation between lymph node status and Ve value (r= 0.6, 0.5 and 0.4, respectively, P<0.05). No correlation was found among other parameters and prognostic factors (P>0.05). There were no significant differences in DKI and DCE-MRI parameters among different subtypes of breast cancer patients (all P>0.05). Conclusion DKI combined with DCE-MRI can improve the differential diagnosis of breast lesions and some DCE-MRI parameters are related to prognostic factors.
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Objective To explore the application value of histogram quantitative analysis based on diffusion kurtosis imaging (DKI) in detecting prostate cancer (PCa) and assessing tumor aggressiveness. Methods One hundred and twenty patients were retrospectively enrolled in Zhongnan Hospital of Wuhan University from November 2014 to November 2016,with diagnosis confirmed by prostate biopsy,definitive Gleason score(GS) results and prostate MRI examinations. There were 90 tumor foci in 67 prostate cancer patients, including 23 cases with GS≤6 (37 tumor foci), 7 GS 3+4=7(7 tumor foci), 3 GS 4+3=7(3 tumor foci).Thirty four cases who were with GS≥8(43 tumor foci)were divided into low-grade PCa(37 GS≤6)and high-grade PCa(53 GS≥7).Fifty three patients were diagnosed with benign prostatic hyperplasia(BPH).All patients underwent conventional prostate MRI examination and multi b value DKI examination. The apparent diffusion coefficient(Dapp)corrected by non-Gaussian model,apparent kurtosis coefficient(Kapp)and ADC value were obtained for histogram analysis.Student's t test was executed to compare the differences of ADCs,Dappand Kappvalues between prostate cancer(PCa)and BPH,low-grade PCa and high-grade PCa.ROC curves were used to evaluate the diagnostic value of ADCs,Dappand Kappvalues in differentiating PCa from BPH and differentiating high-grade PCa from low-grade PCa. Pearson correlation was used to assess the correlations between the histogram quantitative parameters of ADCs,Dappand Kappvalues and Gleason score. Results Except skew of Kapp, the other histogram quantitative parameters of Kappbetween PCa and BPH were statistically significant (all P<0.05). Except the skew of Kapp, the other histogram quantitative parameters of Kappbetween low-grade PCa and high-grade PCa were statistically significant(all P<0.05).The median,mean and standard deviation of ADC,Dappand Kapphave good diagnostic value in detecting PCa from BPH and differing high-grade PCa from low-grade PCa.The area under ROC curve was ranging from 0.558 to 0.985.There were moderate to high correlations between median,mean of ADC(r=-0.701 and-0.676, respectively),median,mean of Dapp(r=-0.712 and-0.701,respectively),median,standard deviation,and kurtosis of Kapp(r=0.458,0.516 and-0.528,respectively)and Gleason score(all P<0.05).Conclusion The DKI parameters combined with histogram quantitative analysis is helpful in detecting prostate cancer and assessing tumor aggressiveness.