title: Utility of intravoxel incoherent motion MR imaging for distinguishing recurrent metastatic tumor from treatment effect following gamma knife radiosurgery: initial experience.
abstract: OBJECTIVE
  Intravoxel incoherent motion MR imaging can simultaneously measure the diffusion and perfusion characteristics of brain tumors. Our aim was to determine the utility of intravoxel incoherent motion-derived perfusion and diffusion parameters for assessing the treatment response of metastatic brain tumor following gamma knife radiosurgery.
  
  
  METHODS
  Ninety-one consecutive patients with metastatic brain tumor treated with gamma knife radiosurgery were assessed by using intravoxel incoherent motion imaging. Two readers independently calculated the 90th percentile and the 10th percentile histogram cutoffs for perfusion, normalized CBV, diffusion, and ADC. Areas under the receiver operating characteristic curve and interreader agreement were assessed.
  
  
  RESULTS
  With the combination of the 90th percentile histogram cutoff for perfusion and the 10th percentile histogram cutoff for diffusion, the sensitivity and specificity for differentiating recurrent tumor and treatment were 79.5% and 92.3% for reader 1 and 84.6% and 94.2% for reader 2, respectively. With the combination of the 90th percentile histogram cutoff for normalized CBV and the 10th percentile histogram cutoff for ADC, the sensitivity and specificity for differentiating recurrent tumor and treatment were 69.2% and 100.0% for reader 1 and 74.3% and 100.0% for reader 2, respectively. Compared with the combination of 90th percentile histogram cutoff for normalized CBV and the 10th percentile histogram cutoff for ADC, adding intravoxel incoherent motion to 90th percentile histogram cutoff for normalized CBV substantially improved the diagnostic accuracy for differentiating recurrent tumor and treatment from 86.8% to 92.3% for reader 1 and from 89.0% to 93.4% for reader 2, respectively. The intraclass correlation coefficients between readers were higher for perfusion parameters (intraclass correlation coefficient range, 0.84-0.89) than for diffusion parameters (intraclass correlation coefficient range, 0.68-0.79).
  
  
  CONCLUSIONS
  Following gamma knife radiosurgery, intravoxel incoherent motion MR imaging can be used as a noninvasive imaging biomarker for differentiating recurrent tumor from treatment effect in patients with metastatic brain tumor.
authors: From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: D Y
authors: DY
authors: Kim
authors: From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. radhskim@gmail.com.
authors: H S
authors: HS
authors: Kim
authors: From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: M J
authors: MJ
authors: Goh
authors: From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: C G
authors: CG
authors: Choi
authors: From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: S J
authors: SJ
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009038:Motion; D059906:Neuroimaging / Q000379:methods; D012372:ROC Curve; D016634:Radiosurgery / Q000009:adverse effects*; D012680:Sensitivity and Specificity