IVIM MRI for Staging and Lymph Node Prediction in ESCC

Tao Song and the team aimed to prospectively evaluate the diagnostic performance of intravoxel incoherent motion (IVIM) combined with the integrated slice-specific dynamic shimming (iShim) technique for staging primary esophageal squamous cell carcinoma (ESCC) and predicting lymph node metastases. This study investigates how IVIM can be utilized to enhance the assessment of tumor staging and predict lymph node involvement preoperatively.

They performed an inclusive analysis involving 63 patients with ESCC who were prospectively enrolled from April 2016 to April 2019. MRI and intravoxel incoherent motion (IVIM) imaging using the iShim technique (b = 0, 25, 50, 75, 100, 200, 400, 600, 800 s/mm²) were conducted on a 3.0T MRI system before surgery. Primary tumor apparent diffusion coefficient (ADC) and IVIM parameters, including the true diffusion coefficient (D), pseudodiffusion coefficient (D*), and pseudodiffusion fraction (f), were measured by 2 independent radiologists.

Differences in D, D*, f, and ADC values across various T and N stages were assessed. Intraclass correlation coefficients (ICCs) were calculated to evaluate the interobserver agreement between the 2 readers. The diagnostic performances of D, D*, f, and ADC values for primary tumor staging and lymph node metastasis prediction were determined using receiver operating characteristic (ROC) curve analysis.

The inter-observer consensus was excellent for IVIM parameters and ADC (D: ICC = 0.922; D*: ICC = 0.892; f: ICC = 0.948; ADC: ICC = 0.958). The ADC, D, D*, and f values of group T1 + T2 were significantly higher than those of group T3 + T4a [ADC: (2.55 ± 0.43) ×10⁻³ mm²/s vs. (2.27 ± 0.40) ×10⁻³ mm²/s, t = 2.670, P = 0.010; D: (1.82 ± 0.39) ×10⁻³ mm²/s vs. (1.53 ± 0.33) ×10⁻³ mm²/s, t = 3.189, P = 0.002; D*: 46.45 (30.30, 55.53) ×10⁻³ mm²/s vs. 32.30 (18.60, 40.95) ×10⁻³ mm²/s, z = -2.408, P = 0.016; f: 0.45 ± 0.12 vs. 0.37 ± 0.12, t = 2.538, P = 0.014].

The ADC, D, and f values of the lymph nodes-positive (N+) group were significantly lower than those of the lymph nodes-negative (N0) group [ADC: (2.10 ± 0.33) ×10⁻³ mm²/s vs. (2.55 ± 0.40) ×10⁻³ mm²/s, t = -4.564, P < 0.001; D: (1.44 ± 0.30) ×10⁻³ mm²/s vs. (1.78 ± 0.37) ×10⁻³ mm²/s, t = -3.726, P < 0.001; f: 0.32 ± 0.10 vs. 0.45 ± 0.11, t = -4.524, P < 0.001].

The combination of D, D*, and f yielded the highest area under the curve (AUC) (0.814) in distinguishing group T1 + T2 from group T3 + T4a. D combined with f provided the highest diagnostic performance (AUC = 0.849) in identifying group N+ and group N0 of ESCC.

The study concluded that IVIM is an effective functional imaging technique for evaluating the preoperative stage of primary tumors and predicting the presence of lymph node metastases in ESCC.

This study was funded by the Projects of the General Programs of the National Natural Science Foundation of China (No.81972802, 82271979), Natural Science Foundation of Henan Province (No.182300410355), Henan Province Medical Science and Technology Research Program Provincial Department to jointly build key projects (No.SBGJ202002021), Special funding of the Henan Health Science and Technology Innovation Talent Project (No.YXKC2020011), Henan Province focuses on research and development and promotion(No. 212102310133), and Innovation Scientists and Technicians Troop Construction Projects of Henan Province (No.20160913) in the design of the study, data collection and analysis.

Source: https://pubmed.ncbi.nlm.nih.gov/39210470/

Song T, Lu S, Qu J, et al. (2024). “Intravoxel incoherent motion diffusion-weighted imaging in evaluating preoperative staging of esophageal squamous cell carcinoma : Evaluation of preoperative stage of primary tumour and prediction of lymph node metastases from esophageal cancer using IVIM: a prospective study.” Cancer Imaging. 2024;24(1):116. Published 2024 Aug 29. doi:10.1186/s40644-024-00765-w