Colorectal liver metastases: ADC as an imaging biomarker of tumor behavior and therapeutic response

Boraschi, Piero; Donati, Francescamaria; Cervelli, Rosa; Pacciardi, Federica; Tarantini, Gaia; Castagna, Maura; Urbani, Lucio; Lencioni, Riccardo

doi:10.1016/j.ejrad.2021.109609

Cited by 20 publications

(13 citation statements)

References 30 publications

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“…In fact, both pathological responding and non-responding lesions increased in ADC after chemotherapy. This is contrary to the findings of Boraschi et al (25), who found a linear correlation between the ADC difference after chemotherapy and pathological chemotherapy response and no ADC increase in lesions with no pathological response. In their study, the increase in ADC in pathological responding lesions was higher compared to responding lesions in the present study.…”

Section: Discussioncontrasting

confidence: 99%

“…In addition, the measurements by Boraschi et al (25), were conducted using DWI with b -values 0, 150, 500, 1000, and 1500 s/mm 2 using a 3-T scanner. One of the major challenges of using ADC as an imaging biomarker in the assessment of liver tumors is the reproducibility of quantitative measurements across MRI scanners and imaging sites.…”

Section: Discussionmentioning

confidence: 99%

“…To overcome this problem, it has been suggested that the change between pre- and post-treatment ADC measured using the same MRI scanner should be used rather than single absolute ADC measurements (24). Only a few previous studies have investigated the association between change in CRLM ADCs after preoperative chemotherapy and pathological chemotherapy response (25,26).…”

Section: Introductionmentioning

confidence: 99%

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Changes in apparent diffusion coefficient and pathological response in colorectal liver metastases after preoperative chemotherapy

et al. 2022

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Background The pathological response to preoperative chemotherapy of colorectal liver metastases (CRLMs) is predictive of long-term prognosis after liver resection. Accurate preoperative assessment of chemotherapy response could enable treatment optimization. Purpose To investigate whether changes in lesion-apparent diffusion coefficient (ADC) measured with diffusion-weighted magnetic resonance imaging (MRI) can be used to assess pathological treatment response in patients with CRLMs undergoing preoperative chemotherapy. Material and Methods Patients who underwent liver resection for CRLMs after preoperative chemotherapy between January 2011 and December 2019 were retrospectively included if they had undergone MRI before and after preoperative chemotherapy on the same 1.5-T MRI scanner with diffusion-weighted imaging with b-values 50, 400, and 800 s/mm2. The pathological chemotherapy response was assessed using the tumor regression grade (TRG) by AJCC/CAP. Lesions were divided into two groups: pathological responding (TRG 0–2) and non-responding (TRG 3). The change in lesion ADC after preoperative chemotherapy was compared between responding and non-responding lesions. Results A total of 27 patients with 49 CRLMs were included, and 24/49 lesions showed a pathological chemotherapy response. After chemotherapy, ADC increased in both pathological responding (pretreatment ADC: 1.26 [95% confidence interval (CI)=1.06–1.37] vs. post-treatment ADC: 1.33 [95% CI=1.13–1.56] × 10−3 mm2/s; P = 0.026) and non-responding lesions (1.12 [95% CI=0.980–1.21] vs. 1.20 [95% CI=1.09–1.43] × 10−3 mm2/s; P = 0.018). There was no difference in median relative difference in ADC after chemotherapy between pathological responding and non-responding lesions (15.8 [95% CI=1.42–26.3] vs. 7.17 [95% CI=−4.31 to 31.2]%; P = 0.795). Conclusion Changes in CRLM ADCs did not differ between pathological responding and non-responding lesions.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in apparent diffusion coefficient and pathological response in colorectal liver metastases after preoperative chemotherapy

et al. 2022

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“…Ideally, the minimum threshold for high liver function should be identified based on the immediate and long-term dose–response of the functional MRI parameter. Previous studies have reported on longitudinal changes in DWI and DCE-MRI parameters in liver cancer tumours following treatments such as chemotherapy, chemo-embolisation and radio-embolisation [ 123 , 124 , 125 ]. However, liver SBRT is a relatively new treatment and there is insufficient data on the radiation dose response of these parameters in tumours and the non-tumour cirrhosis-affected liver.…”

Section: Discussionmentioning

confidence: 99%

Role of Functional MRI in Liver SBRT: Current Use and Future Directions

Tadimalla

Wang

Haworth

2022

Cancers

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Stereotactic body radiation therapy (SBRT) is an emerging treatment for liver cancers whereby large doses of radiation can be delivered precisely to target lesions in 3–5 fractions. The target dose is limited by the dose that can be safely delivered to the non-tumour liver, which depends on the baseline liver functional reserve. Current liver SBRT guidelines assume uniform liver function in the non-tumour liver. However, the assumption of uniform liver function is false in liver disease due to the presence of cirrhosis, damage due to previous chemo- or ablative therapies or irradiation, and fatty liver disease. Anatomical information from magnetic resonance imaging (MRI) is increasingly being used for SBRT planning. While its current use is limited to the identification of target location and size, functional MRI techniques also offer the ability to quantify and spatially map liver tissue microstructure and function. This review summarises and discusses the advantages offered by functional MRI methods for SBRT treatment planning and the potential for adaptive SBRT workflows.

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“…With regard to patients, both HCC patients and colorectal liver metastases patients [ 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 ] could have impaired liver function due to cirrhosis or drug-induced liver injury [ 114 ], so, they are at increased risk of bleeding ( Figure 1 ) or biliary damage ( Figure 2 ). In addition, in immunocompromised patients, the risk of infection of the ablated area is high, with consequent risk of liver abscess [ 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 ].…”

Section: Complications and Risk Assessmentmentioning

confidence: 99%

Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect

Granata

Fusco

Muzio

et al. 2022

JCM

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One of the major fields of application of ablation treatment is liver tumors. With respect to HCC, ablation treatments are considered as upfront treatments in patients with early-stage disease, while in colorectal liver metastases (CLM), they can be employed as an upfront treatment or in association with surgical resection. The main prognostic feature of ablation is the tumor size, since the goal of the treatment is the necrosis of all viable tumor tissue with an adequate tumor-free margin. Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most employed ablation techniques. Ablation therapies in HCC and liver metastases have presented a challenge to radiologists, who need to assess response to determine complication-related treatment. Complications, defined as any unexpected variation from a procedural course, and adverse events, defined as any actual or potential injury related to the treatment, could occur either during the procedure or afterwards. To date, RFA and MWA have shown no statistically significant differences in mortality rates or major or minor complications. To reduce the rate of major complications, patient selection and risk assessment are essential. To determine the right cost-benefit ratio for the ablation method to be used, it is necessary to identify patients at high risk of infections, coagulation disorders and previous abdominal surgery interventions. Based on risk assessment, during the procedure as part of surveillance, the radiologists should pay attention to several complications, such as vascular, biliary, mechanical and infectious. Multiphase CT is an imaging tool chosen in emergency settings. The radiologist should report technical success, treatment efficacy, and complications. The complications should be assessed according to well-defined classification systems, and these complications should be categorized consistently according to severity and time of occurrence.

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Colorectal liver metastases: ADC as an imaging biomarker of tumor behavior and therapeutic response

Cited by 20 publications

References 30 publications

Changes in apparent diffusion coefficient and pathological response in colorectal liver metastases after preoperative chemotherapy

Changes in apparent diffusion coefficient and pathological response in colorectal liver metastases after preoperative chemotherapy

Role of Functional MRI in Liver SBRT: Current Use and Future Directions

Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect

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