Comparison of intravoxel incoherent motion diffusion-weighted MR imaging with dynamic contrast-enhanced MRI for differentiating lung cancer from benign solitary pulmonary lesions

Abstract

Background To compare intravoxel incoherent motion (IVIM) and pharmacokinetic analysis dynamic contrast-enhanced MR imaging (DCE-MRI) in distinguishing lung cancer (LC) from benign solitary pulmonary lesions (SPL). Methods This prospective study was approved by the institutional review board, and written informed consent was obtained. Eighty-one consecutive patients considered for SPL underwent DW-IVIM and DCE-3T MRI. ADC, D, D, and f were calculated with mono- and bi-exponential models. Ktrans, kep, ve, and vp were calculated with the modified Tofts model. Receiver operating characteristic (ROC) analysis was constructed to determine the diagnostic performance of IVIM and DCE-MRI in discriminating LC from benignity. Results There were 29 patients with a total of 48 benign SPL and 52 LCs: 4 small cell carcinomas (SCLC), 19 squamous cell carcinomas (SCC), and 29 adenocarcinomas (Adeno-Ca). Both Adeno-Ca (ADC: 1.19 ± 0.23 × 10-3 mm2/s; D:1.12 ± 0.35 × 10-3 mm2/s; ve:0.27 ± 0.13; Ktrans:0.24 ± 0.09 min-1; kep:0.90 ± 0.45 min-1) and SCC (1.13± 0.28 × 10-3 mm2/s; 1.02 ± 0.32 10-3 mm2/s; 0.32 ± 0.14; 0.26 ± 0.08 min-1; 0.90 ± 0.48 min-1) had significantly lower ADC, D, ve and larger Ktrans, kep than benignity (1.37 ± 0.38 × 10-3 mm2/s; 1.34 ± 0.45 × 10-3 mm2/s; 0.42 ± 0.19; 0.19 ± 0.08 min-1; 0.53 ± 0.26 min-1). D (72.2%) had significantly higher accuracy (72.2%) and higher sensitivity (91.3%) than other imaging indices (accuracy: 55.5-68.0%; sensitivity: 41.3-78.3%; all P < 0.01) except for accuracy in kep (70.8%; P > 0.05) in discriminating LC from benignity. Ktrans exhibited significantly higher specificity (84.6%) than the other indices (38.5-73.1%; P < 0.01). These results can be improved by combined D and Ktrans, leading to a sensitivity, specificity and accuracy of 94.2%, 92%, and 93.5%, respectively. Conclusion IVIM-derived D and DCE-derived Ktrans are two promising parameters for differentiating LC from benignity. J. MAGN. RESON. IMAGING 2016;43:669-679.