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Use of intravoxel incoherent motion diffusion-weighted MR imaging for assessment of treatment response to invasive fungal infection in the lung

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Abstract

Objectives

The purpose of this study was to determine whether intravoxel incoherent motion (IVIM) –derived parameters and apparent diffusion coefficient (ADC) could act as imaging biomarkers for predicting antifungal treatment response.

Methods

Forty-six consecutive patients (mean age, 33.9 ± 13.0 y) with newly diagnosed invasive fungal infection (IFI) in the lung according to EORTC/MSG criteria were prospectively enrolled. All patients underwent diffusion-weighted magnetic resonance (MR) imaging at 3.0 T using 11 b values (0-1000 sec/mm2). ADC, pseudodiffusion coffiecient D*, perfusion fraction f, and the diffusion coefficient D were compared between patients with favourable (n=32) and unfavourable response (n=14).

Results

f values were significantly lower in the unfavourable response group (12.6%±4.4%) than in the favourable response group (30.2%±8.6%) (Z=4.989, P<0.001). However, the ADC, D, and D* were not significantly different between the two groups (P>0.05). Receiver operating characteristic curve analyses showed f to be a significant predictor for differentiation, with a sensitivity of 93.8% and a specificity of 92.9%.

Conclusions

IVIM-MRI is potentially useful in the prediction of antifungal treatment response to patients with IFI in the lung. Our results indicate that a low perfusion fraction f may be a noninvasive imaging biomarker for unfavourable response.

Key Points

• Recognition of IFI indicating clinical outcome is important for treatment decision-making.

• IVIM can reflect diffusion and perfusion information of IFI lesions separately.

• Perfusion characteristics of IFI lesions could help differentiate treatment response.

• An initial low f may predict unfavourable response in IFI.

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Abbreviations

IFI:

invasive fungal infection

DWI:

diffusion-weighted imaging

ADC:

apparent diffusion coefficient

IVIM:

intravoxel incoherent motion

SNR:

signal-to-noise ratio

D:

pure diffusion

D*:

pseudodiffusion coefficient

f:

perfusion fraction

ROI:

region of interest

ROC:

receiver operating characteristic

ICC:

interclass correlation coefficient

AUC:

area under the ROC curve

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Acknowledgments

We thank Yingjie Mei, at Philips Healthcare, for providing the technical support. The scientific guarantor of this publication is Prof. Yikai Xu. The authors of this manuscript declare relationships with the following companies: Philips Electronics Ltd. One co-author (Queenie Chan) is an employee of Philips Electronics Hong Kong Ltd. Dr. Chan contributed to designing the study, the establishment of the radiology project, and editing and revising the manuscript. The authors state that this work has not received any funding. Prof. Jiyuan Zhou kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. None of the study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic study, performed at one institution.

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    Authors and Affiliations

    1. Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People’s Republic of China

      Chenggong Yan, Wei Xiong, Yuankui Wu, Caixia Li & Yikai Xu

    2. Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People’s Republic of China

      Jun Xu, Qi Wei, Ru Feng & Qifa Liu

    3. Philips Healthcare, Science Park East Avenue, Hong Kong Science Park, New Territories, Hong Kong

      Queenie Chan

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    1. Chenggong Yan
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    Chenggong Yan and Jun Xu contributed equally to this work.

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    Yan, C., Xu, J., Xiong, W. et al. Use of intravoxel incoherent motion diffusion-weighted MR imaging for assessment of treatment response to invasive fungal infection in the lung. Eur Radiol 27, 212–221 (2017). https://doi.org/10.1007/s00330-016-4380-9

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    • DOI: https://doi.org/10.1007/s00330-016-4380-9

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