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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2019 Sep 05

DOI: 10.23736/S1824-4785.19.03153-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Role of intravoxel incoherent motion parameters in gastro-esophageal cancer: relationship with 18F-FDG-PET, CT perfusion and MR perfusion imaging parameters

Khoschy SCHAWKAT 1, 4 , Bert-Ram SAH 1, 2, 4, Edwin E. TER VOERT 2, 4, Gaspar DELSO 2, Moritz WURNIG 1, 4, Anton S. BECKER 1, 4, Sebastian LEIBL 3, Paul M. SCHNEIDER 5, Cäcilia S. REINER 1, 4, Martin W. HUELLNER 2, 4, Patrick VEIT-HAIBACH 1, 2, 4, 6, 7, 8

1 Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; 2 Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; 3 Department of Pathology, University Hospital Zurich, Zurich, Switzerland; 4 University of Zurich, Zurich, Switzerland; 5 Department of Surgery, University Hospital of Zurich, Zurich, Switzerland; Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland; 6 University of Toronto, Toronto, Canada; 7 Toronto Joint Department of Medical Imaging, Toronto General Hospital, Toronto, Canada; 8 University Hospital of Zurich, Zurich, Switzerland


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BACKGROUND: Identification of pre-therapeutic predictive markers in gastro-esophageal cancer is essential for individual-oriented treatment. This study evaluated the relationship of multimodality parameters derived from intravoxel incoherent motion method (IVIM), 18F- FDG-PET, CT perfusion and dynamic contrast enhanced MRI in patients with gastro- esophageal cancer and investigated their histopathological correlation.
METHODS: Thirty-one consecutive patients (28 male; median age 63.9 years; range 37-84 years) with gastro-esophageal adenocarcinoma (n=22) and esophageal squamous cell carcinoma (n=9) were analyzed. IVIM parameters: pseudodiffusion (D*), perfusion fraction (fp), true diffusion (D) and the threshold b-value (bval); PET-parameters: SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG); CT perfusion parameters: blood flow (BF), blood volume (BV) and mean transit time (MTT); and MR perfusion parameters: time to enhance, positive enhancement integral, time-to-peak (TTP), maximum- slope-of-increase, and maximum-slope-of-decrease were determined, and correlated to each other and to histopathology.
RESULTS: IVIM and PET parameters showed significant negative correlations: MTV & bval (rs = -0.643, p = 0.002), TLG & bval (rs = -0.699, p < 0.01) and TLG & fp (rs = -0.577, p = 0.006). Positive correlation was found for TLG & D (rs = 0.705, p = 0.000). Negative correlation was found for bval & staging (rs = 0.590, p = 0.005). Positive correlation was found for positive enhancement interval & BV (rs = 0.547, p = 0.007), BF & regression index (rs = 0.753, p = 0.005) and for time-to-peak & staging (rs = 0.557, p = 0.005).
CONCLUSIONS: IVIM parameters (bval, fp, D) provide quantitative information and correlate with PET parameters (MTV, TLG) and staging. IVIM might be a useful tool for additional characterization of gastro-esophageal cancer.


KEY WORDS: MR; Perfusion; Intravoxel incoherent motion; Gastro-esophagel cancer; PET/CT

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