Functional tumour burden of peritoneal carcinomatosis derived from DWI could predict incomplete tumour debulking in advanced ovarian carcinoma

Lee, Elaine; An, He; Perucho, Jose Angelo Udal; Chiu, K.W.; Hui, Edward S.; Chu, Mandy Man Yee; Ngan, Hextan Y.S.

doi:10.1007/s00330-020-06887-6

Cited by 15 publications

(10 citation statements)

References 43 publications

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“…The homogeneous MR signal intensity of peritoneal carcinomatosis might be the cause of this. Essentially, T2WI alone did not possess the capability to characterize tissues at the microscopic level [ 22 ] and therefore could ignore infiltrating lesions with normal morphological characteristics but that bear invasiveness [ 36 ]. To detect peritoneal carcinomatosis, the sensitivity of using MRI alone was only 58%, the specificity was 87%, and the accuracy was 67% in a previous study [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The HCTVC was generated by removing hypointense pixels on T2WI, which represent unwanted noise, fat, and fibrous tissues, and high ADC values, which represent cyst, necrosis, and low-cellularity normal tissues; the overlapping parts that remained were considered high-cellularity tumor tissues [ 38 ]. K-means clustering has been widely used to separate different tissue types in various studies [ 36 , 38 – 40 ]. Some studies proposed discarding the highest ADC cluster, considered normal or cystic tissues, and the lowest ADC cluster, regarded as fibrous or fat tissues.…”

Section: Discussionmentioning

confidence: 99%

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Combining Diffusion-Weighted Imaging and T2-Weighted Imaging to Delineate Tumorous Tissue in Peritoneal Carcinomatosis: A Comparative Study with 18F-Fluoro-Deoxyglucose Positron Emission Tomography with Computed Tomography (FDG PET/CT)

2022

Med Sci Monit

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Background The high rate of malignancy of peritoneal carcinomatosis makes its accurate detection vital in treatment planning. The combination of anatomical and functional information, provided by T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), respectively, could potentially aid in the segmentation of tumors. The aim of this study was to compare the functional tumor volume estimated by a T2WI- and DWI-derived apparent diffusion coefficient (ADC) map, with metabolic tumor volume measured by 18F-fluoro-deoxyglucose positron emission tomography with computed tomography (FDG PET/CT). Material/Methods In 108 lesions from 108 patients with peritoneal carcinomatosis, gross tumor volume (GTV) was manually delineated on DWI. Within each region of interest, k-means clustering was used to exclude non-tumorous tissue from tumorous tissue. The high-cellularity tumor volume estimated from ADC (HCTV ADC ) and combined high-cellularity tumor volume (HCTV C ), which was estimated by combining anatomical information from T2WI and functional information from ADC, were generated. Taking metabolic tumor volume (MTV) in PET/CT as a reference, GTV, HCTV ADC , and HCTV C were compared with MTV. Results GTV ( P =0.017) and HCTV ADC ( P =0.048) differed significantly from MTV. However, the HCTV C measured by combining DWI and T2WI showed high concordance (ICC=0.99) with the MTV measured by FDG PET/CT in differentiating tumorous tissues with high cellularity from non-tumorous tissues. Conclusions In conclusion, our results suggested the potential value of this semiautomatic method serving as an alternative to PET/CT in radiotherapy tumor contouring.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combining Diffusion-Weighted Imaging and T2-Weighted Imaging to Delineate Tumorous Tissue in Peritoneal Carcinomatosis: A Comparative Study with 18F-Fluoro-Deoxyglucose Positron Emission Tomography with Computed Tomography (FDG PET/CT)

2022

Med Sci Monit

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“…HKU/HA HKW IRB UW 15-536). The data in this study were partially (44/50 patients) included in another study published by European Radiology on May 13, 2020 [ 15 ]. The inclusion criteria were as follows: 1) FIGO stage III/IV OC confirmed by histology, 2) local multidisciplinary meeting recommendation for primary debulking surgery or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) according to the European Society of Gynaecological Oncology guidelines on surgery for OC [ 8 ], 3) DWI performed before debulking surgery, and 4) a minimum of 18 months of follow-up.…”

Section: Methodsmentioning

confidence: 99%

“…Literature showed that apparent diffusion coefficient (ADC) could predict surgical outcome and chemotherapy response in OC [ 13 14 ]. A new scoring method for DWI that generated a new parameter called the functional peritoneal cancer index (fPCI) was shown to be significantly correlated with the sPCI [ 15 ]. fPCI could offer a semi-automated estimation of the PC burden.…”

Section: Introductionmentioning

confidence: 99%

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Association between High Diffusion-Weighted Imaging-Derived Functional Tumor Burden of Peritoneal Carcinomatosis and Overall Survival in Patients with Advanced Ovarian Carcinoma

Perucho

Chiu

et al. 2022

Korean J Radiol

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Objective To investigate the association between functional tumor burden of peritoneal carcinomatosis (PC) derived from diffusion-weighted imaging (DWI) and overall survival in patients with advanced ovarian carcinoma (OC). Materials and Methods This prospective study was approved by the local research ethics committee, and informed consent was obtained. Fifty patients (mean age ± standard deviation, 57 ± 12 years) with stage III–IV OC scheduled for primary or interval debulking surgery (IDS) were recruited between June 2016 and December 2021. DWI (b values: 0, 400, and 800 s/mm 2 ) was acquired with a 16-channel phased-array torso coil. The functional PC burden on DWI was derived based on K-means clustering to discard fat, air, and normal tissue. A score similar to the surgical peritoneal cancer index was assigned to each abdominopelvic region, with additional scores assigned to the involvement of critical sites, denoted as the functional peritoneal cancer index (fPCI). The apparent diffusion coefficient (ADC) of the largest lesion was calculated. Patients were dichotomized by immediate surgical outcome into high- and low-risk groups (with and without residual disease, respectively) with subsequent survival analysis using the Kaplan-Meier curve and log-rank test. Multivariable Cox proportional hazards regression was used to evaluate the association between DWI-derived results and overall survival. Results Fifteen (30.0%) patients underwent primary debulking surgery, and 35 (70.0%) patients received neoadjuvant chemotherapy followed by IDS. Complete tumor debulking was achieved in 32 patients. Patients with residual disease after debulking surgery had reduced overall survival ( p = 0.043). The fPCI/ADC was negatively associated with overall survival when accounted for clinicopathological information with a hazard ratio of 1.254 for high fPCI/ADC (95% confidence interval, 1.007–1.560; p = 0.043). Conclusion A high DWI-derived functional tumor burden was associated with decreased overall survival in patients with advanced OC.

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Diffusion‐Weighted Magnetic Resonance Imaging and Morphological Characteristics Evaluation for Outcome Prediction of Primary Debulking Surgery for Advanced High‐Grade Serous Ovarian Carcinoma

Deng

et al. 2022

Magnetic Resonance Imaging

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Background: Preoperative assessment of whether a successful primary debulking surgery (PDS) can be performed in patients with advanced high-grade serous ovarian carcinoma (HGSOC) remains a challenge. A reliable model to precisely predict resectability is highly demanded. Purpose: To investigate the value of diffusion-weighted MRI (DW-MRI) combined with morphological characteristics to predict the PDS outcome in advanced HGSOC patients. Study Type: Prospective. Subjects: A total of 95 consecutive patients with histopathologically confirmed advanced HGSOC (ranged from 39 to 77 years). Fields Strength/Sequence: A 3.0 T, readout-segmented echo-planar DWI. Assessment: The MRI morphological characteristics of the primary ovarian tumor, a peritoneal carcinomatosis index (PCI) derived from DWI (DWI-PCI) and histogram analysis of the primary ovarian tumor and the largest peritoneal carcinomatosis were assessed by three radiologists. Three different models were developed to predict the resectability, including a clinicoradiologic model combing MRI morphological characteristic with ascites and CA125 level; DWI-PCI alone; and a fusion model combining the clinical-morphological information and DWI-PCI. Statistical Tests: Multivariate logistic regression analyses, receiver operating characteristic (ROC) curve, net reclassification index (NRI) and integrated discrimination improvement (IDI) were used. A P < 0.05 was considered to be statistically significant. Results: Sixty-seven cases appeared as a definite mass, whereas 28 cases as an infiltrative mass. The morphological characteristics and DWI-PCI were independent factors for predicting the resectability, with an AUC of 0.724 and 0.824, respectively. The multivariable predictive model consisted of morphological characteristics, CA-125, and the amount of ascites, with an incremental AUC of 0.818. Combining the application of a clinicoradiologic model and

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Functional tumour burden of peritoneal carcinomatosis derived from DWI could predict incomplete tumour debulking in advanced ovarian carcinoma

Cited by 15 publications

References 43 publications

Combining Diffusion-Weighted Imaging and T2-Weighted Imaging to Delineate Tumorous Tissue in Peritoneal Carcinomatosis: A Comparative Study with 18F-Fluoro-Deoxyglucose Positron Emission Tomography with Computed Tomography (FDG PET/CT)

Combining Diffusion-Weighted Imaging and T2-Weighted Imaging to Delineate Tumorous Tissue in Peritoneal Carcinomatosis: A Comparative Study with 18F-Fluoro-Deoxyglucose Positron Emission Tomography with Computed Tomography (FDG PET/CT)

Association between High Diffusion-Weighted Imaging-Derived Functional Tumor Burden of Peritoneal Carcinomatosis and Overall Survival in Patients with Advanced Ovarian Carcinoma

Diffusion‐Weighted Magnetic Resonance Imaging and Morphological Characteristics Evaluation for Outcome Prediction of Primary Debulking Surgery for Advanced High‐Grade Serous Ovarian Carcinoma

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