Towards clinical translation of intravoxel incoherent motion MRI: acquisition and analysis consensus recommendations

Intravoxel incoherent motion (IVIM) MRI allows for simultaneous assessment of tissue microcirculation (perfusion) and diffusion of water. In single-center studies, IVIM has shown great potential for diagnosis, treatment outcome prediction, and treatment monitoring for many different diseases and organs. However, heterogeneity in data acquisition protocols, pre-processing pipelines, and post-processing routines yields differences in reported IVIM parameters, which has constrained large-scale deployment of IVIM. Moreover, deploying IVIM protocols and analysis typically requires technical expertise, further challenging wider use, especially for clinicians. In this consensus paper, to accelerate the deployment of IVIM, we provide recommendations and harmonize protocols for brain, breast, kidney, liver, muscle, and pancreas IVIM studies. For this goal we organized multiple questionnaires and held a dedicated workshop. To ensure a level of standardized, reproducible results, without restricting innovation, we suggest a small subset of b-values to always be measured and analyzed separately, and to which more extensive b-value sampling can be added for advanced investigations. We further introduce detailed recommendations on acquisition protocols and analysis pipelines. To increase consistency, repeatability, and reproducibility, we highly recommend that these protocols and pipelines be deployed by scientists and clinicians for IVIM studies. For advanced users who desire different protocols or analysis approaches, we suggest adding results from our suggested protocols and analysis pipeline in the supplemental part of their paper to enable retrospective studies.