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The Intra-Voxel Incoherent Motion (IVIM) model allows to estimate water diffusion and perfusion-related coefficients in biological tissues using diffusion weighted MR images. Among the available approaches to fit the IVIM bi-exponential decay, a segmented Bayesian algorithm with a Conditional Auto-Regressive (CAR) prior spatial regularization has been recently proposed to produce more reliable coefficient estimation. However, the CAR spatial regularization can generate inaccurate coefficient estimation, especially at the interfaces between different tissues. To overcome this problem, the segmented CAR model was coupled in this work with a k-means clustering approach, to separate different tissues and exclude voxels from other regions in the CAR prior specification. The proposed approach was compared with the original Bayesian CAR method without clustering and with a state-of-the-art Bayesian approach without CAR. The approaches were tested and compared on simulated images by calculating the estimation error and the coefficient of variation (CV). Furthermore, the proposed method was applied to some illustrative real images of oncologic patients. On simulated images, the proposed innovation reduced the average error of 47%, 21% and 58% for D, f and D*, respectively, compared to the state-of-the-art Bayesian approach, and of 48% and 34% for D and f, respectively, compared to the original CAR, while it achieved the same error for D*. The clustering approach was also able to consistently reduce the CV for each coefficient. On real images, the novel approach did not alter the IVIM maps obtained by the original CAR method, with the advantage of reducing their typical blotchy appearance at the boundaries. The proposed approach represents a valuable improvement over the state-of-the-art Bayesian CAR method and provides more reliable IVIM coefficient estimation, and is less sensitive to bias and inconsistency at tissue/tissue and tissue/background interfaces.

A Clustering Approach to Improve IntraVoxel Incoherent Motion Maps from DW-MRI Using Conditional Auto-Regressive Bayesian Model