Volumetric analysis of intravoxel incoherent motion diffusion-weighted imaging in preoperative assessment of non-small cell lung cancer.

PURPOSE: To evaluate the potential of intravoxel incoherent motion (IVIM) and apparent diffusion coefficient (ADC) in the prediction of tumor grade, lymph node metastasis and pleural invasion of non-small cell lung cancer (NSCLC) before surgery.

MATERIALS AND

METHODS

65 patients diagnosed with NSCLC by surgery were enrolled. IVIM-DWI (10 b-values, 0-1000 s/mm2) was performed before surgery. The mean and minimum ADC (ADCmean, ADCmin) and IVIM parameters D, D* and f were independently measured and calculated by 2 radiologists by drawing regions of interest (ROIs) including the solid component of the whole tumor. Intraclass correlation coefficients (ICCs) were analysed. Spearman analysis was used to determine the correlation between IVIM parameters and tumor differentiation. Independent sample t-tests (normal distribution) or Mann-Whitney U tests (non-normal distribution) were used to compare the differences between the parameters in moderately-well and poorly differentiated groups, with and without lymph node metastasis and pleural invasion groups. Receiver operating characteristic (ROC) curves were generated.

RESULTS

The ADCmean, ADCmin, D and f values were negatively correlated with the pathological grades of tumor (P < 0.05). The ADCmean and D values of patients with poor differentiation and lymph node metastasis were significantly lower than that of patients with moderately-well differentiation and without lymph node metastasis (P < 0.001-0.012). The D value was significantly lower and f value was significantly higher among patients with pleural invasion than those without (P =   0.033 and < 0.001). ROC analysis showed that the area under the ROC curve (AUC) was larger for D in predicting the degree of differentiation (0.832) and lymph node metastasis (0.806), and higher for f in predicting pleural invasion (0.832).

CONCLUSIONS

IVIM is useful for predicting the tumor differentiation, lymph node metastasis and pleural invasion in NSCLC patients before surgery.