Correlation Between IVIM-DWI and DCE-MRI Parameters in Soft Tissue Tumors: A Comparative Analysis of Benign and Malignant Lesions

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Abstract
Objective: The objective of this study was to investigate the relationship between intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced MRI (DCE-MRI) parameters in soft tissue tumors (STTs). Methods: This retrospective study included patients with histopathologically confirmed STTs who underwent both DCE-MRI and IVIM-DWI between March 2022 and February 2024. Patients with prior therapy and lipomatous tumors were excluded. DCE-MRI parameters (Ktrans, Kep, Ve, iAUC) were obtained from pharmacokinetic maps using manually placed regions of interest (ROIs) in the most perfused tumor areas, avoiding necrotic and cystic regions. Corresponding ROIs were applied to IVIM-DWI maps. IVIM parameters (D, D*, f) were calculated using 11 b-values. Results: Twenty-nine patients (mean age, 56 ± 18 years; 14 malignant, 15 benign) were included. Interobserver agreement was excellent for DCE-MRI parameters, whereas IVIM-DWI parameters showed moderate-to-good agreement, with D showing the lowest reproducibility. In malignant tumors, f demonstrated strong positive correlations with Ktrans (r = 0.81, p < 0.001) and iAUC (r = 0.79, p < 0.001), both of which remained significant after correction for multiple comparisons. fD* was higher in malignant than in benign lesions in the unadjusted group comparison; however, diagnostic performance was not evaluated in the present study. No significant differences were observed for DCE-MRI parameters between benign and malignant tumors. Conclusions: IVIM-DWI parameters demonstrated associations with DCE-MRI metrics in malignant STTs and may provide complementary information regarding tumor perfusion. However, the findings should be interpreted cautiously because ROI analysis was limited to a single representative slice. Further validation using larger cohorts and volumetric tumor assessment is required.

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