Are complex DCE-MRI models supported by clinical data?

Purpose: To ascertain whether complex dynamic contrast enhanced (DCE) MRI tracer kinetic models are supported by data acquired in the clinic and to determine the consequences of limited contrast-to-noise. Methods: Generically representative in silico and clinical (cervical cancer) DCE-MRI data were examined. Bayesian model selection evaluated support for four compartmental DCE-MRI models: the Tofts model (TM), Extended Tofts model, Compartmental Tissue Uptake model (CTUM), and Two-Compartment Exchange model. Results: Complex DCE-MRI models were more sensitive to noise than simpler models with respect to both model selection and parameter estimation. Indeed, as contrast-to-noise decreased, complex DCE models became less probable and simpler models more probable. The less complex TM and CTUM were the optimal models for the DCE-MRI data acquired in the clinic. [In cervical tumors, K^trans, F_p, and PS increased after radiotherapy (P = 0.004, 0.002, and 0.014, respectively)]. Conclusion: Caution is advised when considering application of complex DCE-MRI kinetic models to data acquired in the clinic. It follows that data-driven model selection is an important prerequisite to DCE-MRI analysis. Model selection is particularly important when high-order, multiparametric models are under consideration. (Parameters obtained from kinetic modeling of cervical cancer clinical DCE-MRI data showed significant changes at an early stage of radiotherapy.) Magn Reson Med 77:1329–1339, 2017.