Comparison of tri-exponential decay versus bi-exponential decay and full fitting versus segmented fitting for modeling liver intravoxel incoherent motion diffusion MRI

Objectives To determine whether bi- or tri-exponential models, and full or segmented fittings, better fit the intravoxel incoherent motion (IVIM) imaging signal of healthy livers. Methods Diffusion-weighted images were acquired with a 3 T scanner using a respiratory-triggered echo-planar sequence and 16 b-values (0-800 s/mm(2)). Eighteen healthy volunteers had their livers scanned twice in the same session, and then once in another session. Liver parenchyma region-of-interest-based measurements were processed with bi-exponential and tri-exponential models, with both full fitting and segmented fitting (threshold b-value = 200 s/mm(2)). Results With the signal of all scans averaged, bi-exponential model full fitting showed D-slow = 1.14 x 10(-3) mm(2)/s, D-fast = 193.6 x 10(-3) mm(2)/s, and perfusion fraction (PF) = 16.9%, and segmented fitting showed D-slow = 0.98 x 10(-3) mm(2)/s, D-fast = 42.2 x 10(-3) mm(2)/s, and PF = 23.3%. IVIM parameters derived from the tri-exponential model were similar for full fitting and segmented fitting, with slow (D'(slow) = 0.98 x 10(-3) mm(2)/s; F'(slow) = 76.4 or 76.6%), fast (D'(fast) = 15.1 or 15.4 x 10(-3) mm(2)/s; F'(fast) = 11.8 or 11.7%) and very fast (D'(Vfast) = 445.0 or 448.8 x 10(-3) mm(2)/s; F'(Vfast) = 11.8 or 11.7%) diffusion compartments. The tri-exponential model provided an overall better fit than the bi-exponential model. For the bi-exponential model, full fitting provided a better fit at very low and low b-values compared with segmented fitting, with the latter tending to underestimate D-fast; however, the segmented method demonstrated lower error in signal prediction for high b-values. Compared with full fitting, tri-exponential segmented fitting offered better scan-rescan reproducibility. Conclusion For healthy liver, tri-exponential modeling is preferred to bi-exponential modeling. For the bi-exponential model, segmented fitting underestimates D-fast, but offers a more accurate estimation of D-slow.