Differentiating between malignant and benign solid solitary pulmonary lesions: are intravoxel incoherent motion and diffusion kurtosis imaging superior to conventional diffusion-weighted imaging?

ObjectiveTo quantitatively compare the diagnostic values of various diffusion parameters obtained from mono- and biexponential diffusion-weighted imaging (DWI) models and diffusion kurtosis imaging (DKI) in differentiating between benign and malignant solitary pulmonary lesions (SPLs).MethodsMultiple b-value DWIs and DKIs were performed in 89 patients with SPL by using a 3-T magnetic resonance (MR) imaging unit. The apparent diffusion coefficient (ADC) of various b-value sets, true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), apparent diffusional kurtosis (K-app), and kurtosis-corrected diffusion coefficient (D-app) were calculated and compared between the malignant and benign groups using a Mann-Whitney U test. Receiver-operating characteristic analysis was performed for all parameters.ResultThe ADC((0, 150)) values of malignant tumors were lower than those of the benign group (p = 0.01). The ADC((0, 300)), ADC((0, 500)), ADC((0, 600),) ADC((0, 800)), ADC((0, 1000),) ADC(total), D, and D-app of malignant tumors were significantly lower than those of benign lesions (all p < 0.001). D*, f, and K-app showed no statistically significant differences between the two groups. ADC(total) showed the highest area under the curve (AUC = 0.862), followed by ADC((0, 800))(AUC = 0.844), ADC((0, 600))(AUC = 0.843), D(AUC = 0.834), ADC((0, 1000))(AUC = 0.834) and ADC((0, 500))(AUC = 0.824), D-app(AUC = 0.796), and ADC((0, 300)) (AUC = 0.773). However, the difference in diagnostic efficacy among these parameters was not statistically significant (p > 0.05).ConclusionIntravoxel incoherent motion (IVIM) and DKI-derived parameters have similar performance compared with conventional ADC in differentiating SPLs.Key Points center dot Mono- and biexponential DWI and DKI are feasible for differentiating SPLs.center dot ADC((0, 500))has better performance than ADC((0, <500))in assessing SPLs.center dot IVIM and DKI have similar performance compared with conventional DWI in differentiating SPLs.