title: Lung adenocarcinoma: Assessment of epidermal growth factor receptor mutation status based on extended models of diffusion-weighted image.
abstract: To evaluate the diagnostic performance of extended models of diffusion-weighted (DW) imaging to help differentiate the epidermal growth factor receptor (EGFR) mutation status in stage IIIA-IV lung adenocarcinoma.
  
  
  
  This retrospective study had institutional research board approval and was HIPAA compliant. Preoperative extended DW imaging including intravoxel incoherent motion (IVIM) and diffusional kurtosis imaging (DKI) 3 Tesla MRI were retrospectively evaluated in 53 patients with pathologically confirmed non-early stage (IIIA-IV) lung adenocarcinoma. EGFR mutationsat exons 18-21 were determined by using polymerase chain reaction-based ARMS. Quantitative parameters (mean, kurtosis, skewness, 10thand 90thpercentiles) of IVIM (true-diffusion coefficient D, pseudo-diffusion coefficient D*, and perfusion fraction f) and DKI (kurtosis value Kapp, kurtosis corrected diffusion coefficient Dapp) were calculated by outlining entire-volume histogram analysis. Receiver operating characteristic analysis was constructed to determine the diagnostic performance of each parameter. Multivariate logistic regression was used to differentiate the probability of EGFR mutation status.
  
  
  
  Twenty-four of 53 patients with lung adenocarcinoma were EGFR mutations, which occurred most often in acinar (10 of 13 [76.9%]) and papillary predominant tumors (9 of 13 [69.2%]). Patients with EGFR mutation showed significant higher 10thpercentile of D, lower D* value in terms of kurtosis, and lower Kappvalue in terms of mean, skewness, 10thand 90thpercentiles (all P values < 0.05). The 90thKappshowed significantly higher sensitivity (97%; P < 0.05) and Az (0.817; P < 0.05) value. Multivariate logistic regression showed 90thKappwas a independent factor for determining EGFR mutation with odds ratio -1.657.
  
  
  
  Multiple IVIM and DKI parameters, especially the histogram 90thKappvalue, helped differentiate EGFR mutation status in stage IIIA-IV lung adenocarcinoma.
  
  
  
  3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:281-289.
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Yuan
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xue-Hui
authors.initials: XH
authors.lastname: Pu
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xiao-Quan
authors.initials: XQ
authors.lastname: Xu
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Zhang
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Li
authors.affiliation: GE healthcare, Shanghai, China.
authors.forename: Jiang-Fen
authors.initials: JF
authors.lastname: Wu
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Tong-Fu
authors.initials: TF
authors.lastname: Yu
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000235:genetics*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015233:Models, Statistical; D009154:Mutation; D020641:Polymorphism, Single Nucleotide / Q000235:genetics*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: C512478:EGFR protein, human; D066246:ErbB Receptors
keywords: adenocarcinoma of lung; diffusion; diffusion magnetic resonance imaging; epidermal growth factor; mutations; receptor