title: Use of intravoxel incoherent motion diffusion-weighted MR imaging for assessment of treatment response to invasive fungal infection in the lung.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Chenggong
authors.initials: C
authors.lastname: Yan
authors.affiliation: Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xiong
authors.affiliation: Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wei
authors.affiliation: Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Ru
authors.initials: R
authors.lastname: Feng
authors.affiliation: Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Yuankui
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Qifa
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
authors.forename: Caixia
authors.initials: C
authors.lastname: Li
authors.affiliation: Philips Healthcare, Science Park East Avenue, Hong Kong Science Park, New Territories, Hong Kong.
authors.forename: Queenie
authors.initials: Q
authors.lastname: Chan
authors.affiliation: Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China. yikaixu917@gmail.com.
authors.forename: Yikai
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D000077336:Caspofungin; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D000072742:Invasive Fungal Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D055666:Lipopeptides / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009038:Motion; D015588:Observer Variation; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin; D065819:Voriconazole
keywords: Diffusion-weighted imaging; Intravoxel incoherent motion; Invasive fungal infection; Lung MR; Treatment prediction