Soft tissue sarcomas: IVIM and DKI correlate with the expression of HIF-1α on direct comparison of MRI and pathological slices

To investigate the correlation of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters with the expression of HIF-1α in soft tissue sarcoma (STS). This prospective study was approved by the institutional ethics committee. Written informed consent was obtained from all patients. Forty patients with STS who underwent 3.0 T MRI, including IVIM and DKI, were included in the study. Standard apparent diffusion coefficient (ADC), true ADC (Dslow), pseudo ADC (Dfast), perfusion fraction (f), mean kurtosis (MK), and mean diffusivity (MD) of each lesion were independently analyzed by two observers. An MRI-pathology control method was used to ensure correspondence between the MRI slices and the pathological sections. Spearman analysis, independent sample t test, Mann-Whitney U test, chi-squared test, and receiver operating characteristic (ROC) curve analysis were performed. Dslow and MD values showed a negative correlation with HIF-1α expression (r = − 0.469, − 0.588). MK and f values showed a positive correlation with HIF-1α expression (r = 0.779, 0.572). Dslow, MD, MK, and f values showed significant differences between the high- and low-expression groups. The MK value showed the best diagnostic ability. The optimal cut-off MK value of 0.604 was associated with 78.3% sensitivity and 88.2% specificity (area under the curve, 0.867). This preliminary study demonstrated the association of IVIM and DKI parameters with the expression of HIF-1α in STS. • IVIM and DKI parameters are correlated with the expression of HIF-1α in STS. • The MRI-pathology control method can be used in clinical studies to ensure correspondence between MRI slices and pathology sections.