Intra-Individual, Inter-Vendor Comparison of Diffusion-Weighted MR Imaging of Upper Abdominal Organs at 3.0 Tesla with an Emphasis on the Value of Normalization with the Spleen

다국어 초록 (Multilingual Abstract)

Objective: To compare the apparent diffusion coefficient (ADC) values of upper abdominal organs with 2 different 3.0 tesla MR systems and to investigate the usefulness of normalization using the spleen.
Materials and Methods: Forty-one patients were enrolled in this prospective study, of which, 35 patients (M:F, 27:8; mean age ± standard deviation, 62.3 ± 12.3 years) were finally analyzed. In addition to the routine liver MR protocol, single-shot spin-echo echo-planar diffusion-weighted imaging using b values of 0, 50, 400, and 800 s/mm2 in 2 different MR systems was performed. ADC values of the liver, spleen, pancreas, kidney and liver lesion (if present) were measured and analyzed. ADC values of the spleen were used for normalization. The Pearson correlation, Spearman correlation, paired sample t test, Wilcoxon signed rank test and Bland-Altman method were used for statistical analysis.
Results: For all anatomical regions and liver lesions, both non-normalized and normalized ADC values from 2 different MR systems showed significant correlations (r = 0.5196–0.8488). Non-normalized ADC values of both MR systems differed significantly in all anatomical regions and liver lesions (p < 0.001). However, the normalized ADC of all anatomical regions and liver lesions did not differ significantly (p = 0.065–0.661), with significantly lower coefficient of variance than that of non-normalized ADC (p < 0.009).
Conclusion: Normalization of the abdominal ADC values using the spleen as a reference organ reduces differences between different MR systems, and could facilitate consistent use of ADC as an imaging biomarker for multi-center or longitudinal studies.

참고문헌 (Reference)

1 Zhang JL, "Variability of renal apparent diffusion coefficients: limitations of the monoexponential model for diffusion quantification" 254 : 783-792, 2010

2 Sasaki M, "Variability in absolute apparent diffusion coefficient values across different platforms may be substantial: a multivendor, multi-institutional comparison study" 249 : 624-630, 2008

3 Patterson DM, "Technology insight:water diffusion MRI--a potential new biomarker of response to cancer therapy" 5 : 220-233, 2008

4 Braithwaite AC, "Short- and midterm reproducibility of apparent diffusion coefficient measurements at 3.0-T diffusion-weighted imaging of the abdomen" 250 : 459-465, 2009

5 Kim SY, "Reproducibility of measurement of apparent diffusion coefficients of malignant hepatic tumors: effect of DWI techniques and calculation methods" 36 : 1131-1138, 2012

6 Koh DM, "Reproducibility and changes in the apparent diffusion coefficients of solid tumours treated with combretastatin A4 phosphate and bevacizumab in a twocentre phase I clinical trial" 19 : 2728-2738, 2009

7 Koh DM, "Predicting response of colorectal hepatic metastasis: value of pretreatment apparent diffusion coefficients" 188 : 1001-1008, 2007

8 Koh DM, "Practical aspects of assessing tumors using clinical diffusion-weighted imaging in the body" 6 : 211-224, 2007

9 Bruix J, "Management of hepatocellular carcinoma: an update" 53 : 1020-1022, 2011

10 Kim SY, "Malignant hepatic tumors: short-term reproducibility of apparent diffusion coefficients with breath-hold and respiratory-triggered diffusion-weighted MR imaging" 255 : 815-823, 2010

11 Chen X, "Liver diffusion-weighted MR imaging: reproducibility comparison of ADC measurements obtained with multiple breath-hold, free-breathing, respiratory-triggered, and navigator-triggered techniques" 271 : 113-125, 2014

12 Miquel ME, "In vitro and in vivo repeatability of abdominal diffusion-weighted MRI" 85 : 1507-1512, 2012

13 Kakite S, "Hepatocellular carcinoma: short-term reproducibility of apparent diffusion coefficient and intravoxel incoherent motion parameters at 3.0T" 41 : 149-156, 2015

14 Parikh T, "Focal liver lesion detection and characterization with diffusionweighted MR imaging: comparison with standard breath-hold T2-weighted imaging" 246 : 812-822, 2008

15 Thoeny HC, "Extracranial applications of diffusion-weighted magnetic resonance imaging" 17 : 1385-1393, 2007

16 Colagrande S, "Effects of gadoxetic acid on quantitative diffusion-weighted imaging of the liver" 38 : 365-370, 2013

17 Outwater EK, "Distinction between benign and malignant adrenal masses: value of T1-weighted chemical-shift MR imaging" 165 : 579-583, 1995

18 Rosenkrantz AB, "Diffusionweighted imaging of the abdomen at 3.0 Tesla: image quality and apparent diffusion coefficient reproducibility compared with 1.5 Tesla" 33 : 128-135, 2011

19 Kim T, "Diffusion-weighted single-shot echoplanar MR imaging for liver disease" 173 : 393-398, 1999

20 Lewin M, "Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C" 46 : 658-665, 2007

21 Padhani AR, "Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations" 11 : 102-125, 2009

22 Klasen J, "Diffusion-weighted imaging (DWI) of the spleen in patients with liver cirrhosis and portal hypertension" 31 : 1092-1096, 2013

23 Low RN, "Diffusion-weighted MRI (DWI) in the oncology patient: value of breathhold DWI compared to unenhanced and gadolinium-enhanced MRI" 25 : 848-858, 2007

24 Donati OF, "Diffusion-weighted MR imaging of upper abdominal organs: field strength and intervendor variability of apparent diffusion coefficients" 270 : 454-463, 2014

25 Taouli B, "Diffusion-weighted MR imaging of the liver" 254 : 47-66, 2010

26 Takahara T, "Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display" 22 : 275-282, 2004

27 Kinner S, "Diffusion weighted MR imaging in patients with HCC and liver cirrhosis after administration of different gadolinium contrast agents: is it still reliable?" 81 : e625-e628, 2012

28 Yamada I, "Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echoplanar MR imaging" 210 : 617-623, 1999

29 Do RK, "Diagnosis of liver fibrosis and cirrhosis with diffusionweighted imaging: value of normalized apparent diffusion coefficient using the spleen as reference organ" 195 : 671-676, 2010

30 Papanikolaou N, "Comparison between two-point and fourpoint methods for quantification of apparent diffusion coefficient of normal liver parenchyma and focal lesions. Value of normalization with spleen" 73 : 305-309, 2010

31 Kwee TC, "Comparison and reproducibility of ADC measurements in breathhold, respiratory triggered, and free-breathing diffusion-weighted MR imaging of the liver" 28 : 1141-1148, 2008

32 Bruegel M, "Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusionweighted single-shot echo-planar MR imaging technique" 18 : 477-485, 2008

33 Hinkle DE, "Applied statistics for the behavioral sciences" Houghton Mifflin 2003

34 Koinuma M, "Apparent diffusion coefficient measurements with diffusion-weighted magnetic resonance imaging for evaluation of hepatic fibrosis" 22 : 80-85, 2005

35 Corona-Villalobos CP, "Agreement and reproducibility of apparent diffusion coefficient measurements of dual-b-value and multib-value diffusion-weighted magnetic resonance imaging at 1.5 Tesla in phantom and in soft tissues of the abdomen" 37 : 46-51, 2013

36 Tsushima Y, "Adrenal masses:differentiation with chemical shift, fast low-angle shot MR imaging" 186 : 705-709, 1993

37 Yoshikawa T, "ADC measurement of abdominal organs and lesions using parallel imaging technique" 187 : 1521-1530, 2006