Diagnostic Efficacy and Correlation of Intravoxel Incoherent Motion (IVIM) and Contrast-Enhanced (CE) MRI Perfusion Parameters in Oncology Imaging: A Systematic Review and Meta-Analysis

TL;DR

This paper compares IVIM MRI and contrast-enhanced MRI for cancer diagnosis, finding IVIM to be a viable non-contrast alternative in some cancers.

Contribution

A systematic review and meta-analysis showing IVIM MRI's diagnostic performance compared to CE MRI in oncology.

Findings

IVIM showed higher or equal diagnostic accuracy compared to CE MRI in breast and rectal cancers.

Correlations between IVIM and CE MRI parameters were weak to moderate.

IVIM offers a non-contrast alternative for oncology imaging but requires protocol optimization.

Abstract

Intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) is a noncontrast technique estimating diffusion and perfusion parameters via multiple b-values, essential for oncology imaging. However, there is limited collective evidence regarding the efficacy of IVIM in oncology imaging compared to contrast-enhanced (CE) MRI perfusion techniques. This systematic review and meta-analysis compared IVIM's diagnostic accuracy and correlation with CE MRI perfusion techniques.

Following PRISMA guidelines (PROSPERO-registered), a literature search across five databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) was conducted. Diagnostic metrics, including AUC, sensitivity, specificity, and correlation coefficients, were analyzed using a random-effects model, with heterogeneity and publication bias assessed via I2 statistics and Egger's test.

Eighteen studies on breast, rectal, and brain cancers were analyzed. For breast cancer, IVIM showed 83.50% sensitivity and 81.24% specificity compared to dynamic contrast-enhanced (DCE) MRI's 88.04% sensitivity and 65.98% specificity. In rectal cancer, IVIM achieved 70.9% sensitivity and 56.2% specificity, outperforming DCE MRI's 58.11% sensitivity and 72.49% specificity. For gliomas, IVIM demonstrated 92.27% sensitivity and 74.06% specificity compared to dynamic susceptibility contrast (DSC) MRI's 95.71% sensitivity and 92.91% specificity. Correlations between IVIM and CE parameters were weak to moderate.

IVIM demonstrated equal or superior diagnostic performance to CE MRI in breast cancer, rectal cancer, and gliomas, offering a noncontrast alternative. However, unclear parameter correlations warrant future studies focusing on IVIM protocol optimization based on perfusion regimes.

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