NAVIGATOR: an Italian regional imaging biobank to promote precision medicine for oncologic patients.

NAVIGATOR is an Italian regional project boosting precision medicine in oncology with the aim of making it more predictive, preventive, and personalised by advancing translational research based on quantitative imaging and integrative omics analyses. The project's goal is to develop an open imaging biobank for the collection and preservation of a large amount of standardised imaging multimodal datasets, including computed tomography, magnetic resonance imaging, and positron emission tomography data, together with the corresponding patient-related and omics-related relevant information extracted from regional healthcare services using an adapted privacy-preserving model. The project is based on an open-source imaging biobank and an open-science oriented virtual research environment (VRE). Available integrative omics and multi-imaging data of three use cases (prostate cancer, rectal cancer, and gastric cancer) will be collected. All data confined in NAVIGATOR (i.e., standard and novel imaging biomarkers, non-imaging data, health agency data) will be used to create a digital patient model, to support the reliable prediction of the disease phenotype and risk stratification. The VRE that relies on a well-established infrastructure, called D4Science.org, will further provide a multiset infrastructure for processing the integrative omics data, extracting specific radiomic signatures, and for identification and testing of novel imaging biomarkers through big data analytics and artificial intelligence.

Diffusion-weighted magnetic resonance imaging in the prediction and assessment of chemotherapy outcome in liver metastases.

PURPOSE: This study assessed the capability of magnetic resonance (MR) diffusion-weighted imaging (DwI) with measurement of apparent diffusion coefficient (ADC) in both predicting and evaluating the response to chemotherapy (CHT) of liver metastases by itself and along with preliminary dimensional assessment. METHODS AND MATERIALS: Patients affected by liver metastases from cancers of the digestive tract and breast were prospectively enrolled and underwent computed tomography and MR-DwI before CHT (time 0) and 20-25 days after the beginning of the second cycle (time 3). Moreover, MR-DwI was performed 10-15 (time 1) and 20-25 days (time 2) after the beginning of the first cycle. Maximum diameter and mean ADC value (×10(-3) mm(2)/s) of metastases were evaluated. Lesions were classified as progressive disease (PD), stable disease (SD) or partial response (PR) according to dimensional changes between time 0 and time 3, following RECIST 1.1 indications. Clinically, PD lesions were defined as nonresponding (NR), and SD and PR lesions as responding (R). Analysis of variance and ROC analyses were performed (significance at p < 0.05). RESULTS: Eighty-six metastases (33 patients) were classified as follows: 15 PD, 39 SD and 32 PR without significant differences in mean ADC values among the groups before CHT and at all corresponding times. The mean ADC values of SD and PR groups at times 1 (respectively 1.66 ± 0.36 and 1.59 ± 0.23), 2 (1.72 ± 0.42 and 1.68 ± 0.37) and 3 (1.86 ± 0.44 and 1.73 ± 0.39) were significantly higher than the corresponding values at time 0 (1.50 ± 0.30 and 1.39 ± 0.33). An accurate cutoff value of ADC increase or diameter decrease for the early identification of R or NR lesions was not found. CONCLUSION: The pretreatment ADC value of a liver metastasis does not seem useful in predicting the CHT outcome. A trend towards early ADC increase, alone or occurring with dimensional decrease, may be a good indicator of a responding lesion.

Focal liver lesion classification and characterization in noncirrhotic liver: a prospective comparison of diffusion-weighted magnetic resonance-related parameters.

PURPOSE: The objective of this study was to prospectively verify if diffusion-weighted magnetic resonance (DwMR)-related parameters such as perfusion fraction (f) and slow diffusion coefficient (D), according to Le Bihan theory, are more effective than apparent diffusion coefficient (ADC) for classification and characterization of the more frequent focal liver lesions (FLLs) in noncirrhotic liver. METHODS: Sixty-seven patients underwent standard liver magnetic resonance imaging (MRI) and free-breath multi-b DwMR study. Two regions of interest were defined by 2 observers, including 1 FLL for each patient (21 hemangiomas, 21 focal nodular hyperplasias, 25 metastases) and part of surrounding parenchyma, respectively. For every FLL, D, f, and ADC were estimated both as absolute value and as ratio between FLL and surrounding parenchyma by fitting the reduced equation of the bicompartmental model to experimental data; t test, analysis of variance, and receiver operating characteristic analysis were performed. RESULTS: t Test showed significant differences in ADClesion, f lesion, D lesion, ADCratio, and D ratio values between benign and malignant FLLs, more pronounced for ADClesion (P < 0.0009) and ADCratio (P = 0.001). Applying cutoff values of 1.55 × 10 mm/s (ADClesion) and 0.89 (ADCratio), the DwMR study presented sensitivities and specificities, respectively, of 84% and 80% (for ADClesion), 72% and 80% (ADCratio). CONCLUSIONS: Apparent diffusion coefficient (by fitting procedures) better performs than do D and f in FLL classification, especially when its values are less than 1.30 or greater than 2.00 × 10 mm/s.

Magnetic resonance diffusion-weighted imaging: quantitative evaluation of age-related changes in healthy liver parenchyma.

The purpose of this study was to verify in healthy liver parenchyma the possible influence of age on DwI-related parameters: apparent diffusion coefficient (ADC), perfusion fraction (PF), diffusion and pseudodiffusion coefficient (D and D*). Forty healthy adult volunteers (age range 26-86 years), divided into four age groups, were prospectively submitted to a breath-hold magnetic resonance diffusion imaging (MR-DwI) (two b values, 0-300 and 0-1000 s/mm²). A smaller cohort of 16 subjects underwent a free-breath multi-b acquisition (16 b values, 0-750 s/mm²). Quantitative analysis was performed by two observers with manually defined regions of interest, on the most homogeneous portion of the right liver lobe. Individual and group statistical analysis of data was performed: ANOVA to establish differences between groups and Pearson correlation coefficient to investigate the association between DwI parameters and age. The mean, S.D. and 95% limits of agreement of ADC values for each age-defined group are reported. ANOVA showed no significant differences between group means (P always >.05). No significant correlation between subjects' age and DwI parameters was established, both in breath-hold and free-breath acquisitions, on the whole range of adopted b values. Our study conducted on healthy liver parenchyma shows that there are no significant differences in ADC, PF, D and D* of younger or older subjects.

MR-diffusion weighted imaging of healthy liver parenchyma: repeatability and reproducibility of apparent diffusion coefficient measurement.

PURPOSE: To compare repeatability and reproducibility of four different methods of apparent diffusion coefficient (ADC) evaluation of liver parenchyma. In fact, repeatability and reproducibility assessment is mandatory in quantitative evaluations, however, these have not been accurately investigated in liver MR-diffusion-weighted studies. MATERIALS AND METHODS: Diffusion-weighted sequences, b-value = 0-1000 s/mm(2), were acquired on 30 healthy volunteers by a 1.5T scanner whose reliability has been validated by a phantom study. Four sampling methods, evaluating various parenchyma percentages by different-sized region-of-interests (ROIs), were compared by two observers: 70% and 30% of the volume, 4%-one-ROI-per-segment, and 4%-one-ROI-per-slice in the right-lobe. Ninety-five percent limits of agreement and intraclass correlation coefficient (ICC) were calculated. RESULTS: Complete measurements on the left lobe could be obtained in less than half of patients. The 4%-one-ROI-per-slice and 4%-one-ROI-per-segment yielded lower mean values compared with 30-70% volume methods (1343-1373 versus 1463-1560.10(-6) mm(2)/s, respectively). Repeatability was acceptable (ICCs approximately 0.80) whereas reproducibility was low (ICCs or=0.87) and reproducibility (ICCs to 0.82) for 30-70% V methods. CONCLUSION: ADC measurements were repeatable but not reproducible in our study. Reproducibility could be improved by taking averages on the right lobe with large ROI methods. Studies on procedures that standardize ADC measurements using more than two observers are needed.

The influence of diffusion- and relaxation-related factors on signal intensity: an introductive guide to magnetic resonance diffusion-weighted imaging studies.

In magnetic resonance diffusion-weighted imaging, signal intensity is influenced simultaneously by temperature, diffusivity, b value, pseudodiffusion, macroscopic motion, and T2-weighted intensity value. The purpose of this pictorial essay is to discuss and exemplify the influence that such factors and the related modifications have on signal intensity. Apparent diffusion coefficient, shine-through and pseudodiffusion will also be examined to show how T2-weighted signal intensity value and nondiffusional intravoxel incoherent motion can affect the diffusion-weighted imaging.