How reliable are ADC measurements? A phantom and clinical study of cervical lymph nodes

OBJECTIVE: To assess the reliability of ADC measurements in vitro and in cervical lymph nodes of healthy volunteers. METHODS: We used a GE 1.5 T MRI scanner and a first ice-water phantom according to recommendations released by the Quantitative Imaging Biomarker Alliance (QIBA) for assessing ADC against reference values. We analysed the target size effect by using a second phantom made of six inserted spheres with diameters ranging from 10 to 37 mm. Thirteen healthy volunteers were also scanned to assess the inter- and intra-observer reproducibility of volumetric ADC measurements of cervical lymph nodes. RESULTS: On the ice-water phantom, the error in ADC measurements was less than 4.3 %. The spatial bias due to the non-linearity of gradient fields was found to be 24 % at 8 cm from the isocentre. ADC measure reliability decreased when addressing small targets due to partial volume effects (up to 12.8 %). The mean ADC value of cervical lymph nodes was 0.87.10(-3) ± 0.12.10(-3) mm(2)/s with a good intra-observer reliability. Inter-observer reproducibility featured a bias of -5.5 % due to segmentation issues. CONCLUSION: ADC is a potentially important imaging biomarker in oncology; however, variability issues preclude its broader adoption. Reliable use of ADC requires technical advances and systematic quality control. KEY POINTS: • ADC is a promising quantitative imaging biomarker. • ADC has a fair inter-reader variability and good intra-reader variability. • Partial volume effect, post-processing software and non-linearity of scanners are limiting factors. • No threshold values for detecting cervical lymph node malignancy can be drawn. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00330-017-5265-2) contains supplementary material, which is available to authorized users.