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Repeatability and reproducibility of ADC measurements: a prospective multicenter whole-body-MRI study

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Multicenter oncology trials increasingly include MRI examinations with apparent diffusion coefficient (ADC) quantification for lesion characterization and follow-up. However, the repeatability and reproducibility (R&R) limits above which a true change in ADC can be considered relevant are poorly defined. This study assessed these limits in a standardized whole-body (WB)-MRI protocol.

Methods

A prospective, multicenter study was performed at three centers equipped with the same 3.0-T scanners to test a WB-MRI protocol including diffusion-weighted imaging (DWI). Eight healthy volunteers per center were enrolled to undergo test and retest examinations in the same center and a third examination in another center. ADC variability was assessed in multiple organs by two readers using two-way mixed ANOVA, Bland-Altman plots, coefficient of variation (CoV), and the upper limit of the 95% CI on repeatability (RC) and reproducibility (RDC) coefficients.

Results

CoV of ADC was not influenced by other factors (center, reader) than the organ. Based on the upper limit of the 95% CI on RC and RDC (from both readers), a change in ADC in an individual patient must be superior to 12% (cerebrum white matter), 16% (paraspinal muscle), 22% (renal cortex), 26% (central and peripheral zones of the prostate), 29% (renal medulla), 35% (liver), 45% (spleen), 50% (posterior iliac crest), 66% (L5 vertebra), 68% (femur), and 94% (acetabulum) to be significant.

Conclusions

This study proposes R&R limits above which ADC changes can be considered as a reliable quantitative endpoint to assess disease or treatment-related changes in the tissue microstructure in the setting of multicenter WB-MRI trials.

Key Points

• The present study showed the range of R&R of ADC in WB-MRI that may be achieved in a multicenter framework when a standardized protocol is deployed.

• R&R was not influenced by the site of acquisition of DW images.

• Clinically significant changes in ADC measured in a multicenter WB-MRI protocol performed with the same type of MRI scanner must be superior to 12% (cerebrum white matter), 16% (paraspinal muscle), 22% (renal cortex), 26% (central zone and peripheral zone of prostate), 29% (renal medulla), 35% (liver), 45% (spleen), 50% (posterior iliac crest), 66% (L5 vertebra), 68% (femur), and 94% (acetabulum) to be detected with a 95% confidence level.

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Abbreviations

95% CI:

95% confidence interval

ADC:

Apparent diffusion coefficient

CoV:

Coefficient of variation

DICOM:

Digital Imaging and Communications in Medicine

DWI:

Diffusion-weighted imaging

LoA:

Limits of agreement

R&R:

Repeatability and reproducibility

RC:

Repeatability coefficient

RDC:

Reproducibility coefficient

ROI:

Region of interest

WB:

Whole body

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Funding

This research was supported by Innoviris (Institut pour l’encouragement de la recherche scientifique et de l’innovation de la région Bruxelles-Capitale, Brussels, Belgium; Grant 2013-PFS-EH-7).

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Authors and Affiliations

  1. Institut de Recherche Expérimentale & Clinique (IREC) – Radiology Department, Université Catholique de Louvain (UCLouvain) – Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium

    Nicolas F. Michoux, Frank Peeters, Pierre Lu, Perrine Triqueneaux & Frédéric E. Lecouvet

  2. Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Jakub W. Ceranka & Jef Vandemeulebroucke

  3. Radiology Department, Université libre de Bruxelles, Hôpital Erasme, Brussels, Belgium

    Julie Absil & Thierry Metens

  4. European Organisation for Research and Treatment of Cancer, Brussels, Belgium

    Yan Liu & Laurence Collette

  5. MRI Department, UZ Brussel, Jette, Belgium

    Inneke Willekens, Carola Brussaard, Hubert Raeymaekers & Johan de Mey

  6. LISA (Laboratories of Image Synthesis and Analysis), Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium

    Olivier Debeir & Stephan Hahn

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  1. Nicolas F. Michoux
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  2. Jakub W. Ceranka
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  3. Jef Vandemeulebroucke
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  4. Frank Peeters
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  5. Pierre Lu
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  6. Julie Absil
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  8. Yan Liu
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  17. Frédéric E. Lecouvet
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Corresponding author

Correspondence to Nicolas F. Michoux.

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Guarantor

The scientific guarantor of this publication is Prof. Frédéric Lecouvet (Université Catholique de Louvain, Radiology Department, Brussels, Belgium).

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors have significant statistical expertise (Laurence Collette, PhD, EORTC; Nicolas Michoux, PhD, UCL).

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• prospective

• observational

• multicenter study

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Michoux, N.F., Ceranka, J.W., Vandemeulebroucke, J. et al. Repeatability and reproducibility of ADC measurements: a prospective multicenter whole-body-MRI study. Eur Radiol 31, 4514–4527 (2021). https://doi.org/10.1007/s00330-020-07522-0

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