# Preoperative esophageal cancer staging assessment based on intravoxel incoherent motion and apparent diffusion coefficient: a comparative study of maximum-diameter slice region of interest and whole volume of interest analysis

## TL;DR

This study explores how MRI-based IVIM and ADC parameters can help stage esophageal cancer, comparing different measurement methods for accuracy and reliability.

## Contribution

The study introduces a comparative analysis of ROI delineation strategies for IVIM and ADC in preoperative esophageal cancer staging.

## Key findings

- Full-volume measurements showed better interobserver reproducibility than single-slice measurements.
- Single-slice ADC_max and D_min were linked to advanced T stages, while whole-volume ADC_std also correlated with T staging.
- Whole-volume analysis outperformed single-slice for N staging, with better diagnostic performance for lymph node metastasis.

## Abstract

MRI-based intravoxel incoherent motion (IVIM) and apparent diffusion coefficient (ADC) parameters evaluate molecular diffusion and microvascular perfusion. This study assessed their utility in esophageal squamous cell carcinoma (ESCC) staging, compared different measurement approaches, and explored their predictive value for surgical staging.

Eighty prospectively enrolled ESCC patients (61 males, 19 females; median age 70 years) from February 2020 to August 2020 underwent 3.0T IVIM-DWI with respiratory-triggered and fat saturation techniques. Tumor ADC and IVIM parameters were calculated (b-values: 0–1000 s/mm²) for maximum-diameter slices and whole-volume regions of interest (ROI), and their correlations with T (tumor)/N (lymph node involvement) staging were analyzed.

Full-volume measurements demonstrated higher interobserver reproducibility than single-slice measurements. For T staging, tumors with lower single-slice ADC_max and D_min values, as well as lower whole-volume ADC_std, were more likely to present with advanced stages (all p < 0.05). Parameters derived from the maximum-diameter slice provided higher diagnostic accuracy for T-stage discrimination compared with whole-volume analysis (AUC 0.75 vs. 0.70). For N staging, single-slice D_mean was associated with nodal involvement, while whole-volume analysis revealed that lower D_max, f_mean, f_min, and D*_std along with higher D*_min were correlated with lymph node metastasis, yielding better diagnostic performance (AUC 0.70 vs. 0.60).

MRI-derived IVIM and ADC parameters provide non-invasive biomarkers for ESCC staging with the potential to guide preoperative decision-making, while exploring different ROI delineation strategies may further enhance research and clinical application.

The online version contains supplementary material available at 10.1186/s12880-025-01973-x.