Variabilities in apparent diffusion coefficient (ADC) measurements of the spleen and the paraspinal muscle: A single center large cohort study.

Purpose: Evaluation of the variabilities in apparent diffusion coefficient (ADC) measurements of the spleen (ADC) and the paraspinal muscles (ADC) to identify the reference organ for normalizing the ADC from the abdominal diffusion weighted imaging (DWI).

Methods: Two MRI scanners, with 314 abdominal exams on the GE and 929 on the Siemens system, were used for MRI examinations including DWI (b-values, 50 and 800 s/mm). For a subset of 73 exams on the Siemens system a second exam was conducted. Four regions of interest (ROIs) in each exam were placed to measure the ADC and the bilateral ADC. ADC variability between patients (on each scanner separately), ADC variability due to ROI placement between the two ROIs in each organ, and variability in the subset between the first and second exams were assessed.

Results: The ADC was more scattered and variable than the ADC in the comparability (n = 929 and 314 for two MRI scanners, respectively) and repeatability (n = 73) datasets. The Bland-Altmann bias and limits of agreement (LoAs) for the ADC (ICC, 0.47; CV, 0.070) and ADC (ICC, 0.67; CV, 0.023) in the repeatability datasets (n = 73) were -0.1 (-25.7%-25.6%) and -0.3 (-8.8%-8.1%), respectively. For the Siemens system, the Bland-Altmann bias and LoAs for the ADC (ICC, 0.72; CV, 0.061) and ADC (ICC, 0.53; CV, 0.030) in the comparability datasets (n = 929) were 2.1 (-20.0%-24.2%) and 0.7 (-10.0%-11.4%), respectively. Similar findings have been found in the GE system (n = 314). The CVs for the ADC measurements were lower than those of the ADC both in the repeatability and the comparability analyses (all p < 0.001).

Conclusion: Paraspinal muscles demonstrate better reference characteristics than the spleen in estimating ADC variability of abdominal DWI.