Lung adenocarcinoma: Assessment of epidermal growth factor receptor mutation status based on extended models of diffusion‐weighted image

• Published in: Journal of magnetic resonance imaging Vol. 46; no. 1; pp. 281 - 289
• Main Authors: Yuan, Mei, Pu, Xue‐Hui, Xu, Xiao‐Quan, Zhang, Yu‐Dong, Zhong, Yan, Li, Hai, Wu, Jiang‐Fen, Yu, Tong‐Fu
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2017
• Subjects: Adenocarcinoma; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - genetics; Adenocarcinoma of Lung; Adult; Aged; Diagnostic systems; diffusion; Diffusion coefficient; diffusion magnetic resonance imaging; Diffusion Magnetic Resonance Imaging - methods; Effectiveness; Epidermal growth factor; Epidermal growth factor receptors; ErbB Receptors - genetics; Exons; Female; Genetic Predisposition to Disease - genetics; Humans; Image Interpretation, Computer-Assisted - methods; Kurtosis; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - genetics; Lungs; Magnetic resonance imaging; Male; Mathematical models; Middle Aged; Models, Biological; Models, Statistical; Mutation; mutations; Patients; Perfusion; Polymerase chain reaction; Polymorphism, Single Nucleotide - genetics; receptor; Regression analysis; Reproducibility of Results; Sensitivity; Sensitivity and Specificity; Skewness; Tumors; diffusion; diffusion magnetic resonance imaging; mutations; receptor; epidermal growth factor; adenocarcinoma of lung
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.25572

Purpose 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. Materials and Methods 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, 10th and 90th percentiles) 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. Results 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 10th percentile of D, lower D* value in terms of kurtosis, and lower Kapp value in terms of mean, skewness, 10th and 90th percentiles (all P values < 0.05). The 90th Kapp showed significantly higher sensitivity (97%; P < 0.05) and Az (0.817; P < 0.05) value. Multivariate logistic regression showed 90th Kapp was a independent factor for determining EGFR mutation with odds ratio ‐1.657. Conclusion Multiple IVIM and DKI parameters, especially the histogram 90th Kapp value, helped differentiate EGFR mutation status in stage IIIA‐IV lung adenocarcinoma. Level of Evidence: 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:281–289