The role of pre-treatment diffusion-weighted MRI in predicting long-term outcome of colorectal liver metastasis

Abstract

Objective: To determine the prognostic value of pre-treatment apparent diffusion coefficient (ADC) of colorectal liver metastases in predicting disease response, progression-free survival (PFS) and overall survival (OS). Methods: We retrospectively reviewed 102 patients who underwent pre-treatment diffusion-weighted MRI using a breath-hold (b50, 150, 500) or a free-breathing (b50, 50, 100, 250, 500, 750) technique. The mean ADC (b50-500) and mean flow-insensitive ADC (ADC high ) values (breathhold: b5150 and 500; free-breathing: b5100 and 500) of up to three hepatic lesions were evaluated in each patient. Clinical and laboratory parameters were recorded. Tumour response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria at 12 weeks after treatment. Associations between tumour response, ADC values and clinical/laboratory parameters were examined by one-way analysis of variance. The relationship of ADC with PFS and OS was determined by Kaplan-Meier analysis. Results: 62 patients responded to chemotherapy at 12 weeks. The pre-treatment mean ADC and mean ADC high were higher in the non-responding group than in the responding group (1.55 vs 1.36, p50.033; 1.40 vs 1.16, p50.024). However, the PFS and OS of the two groups of patients stratified by the median of mean ADC values or threshold derived by receiver operating characteristic analysis were not statistically significant. By multivariate Cox regression analysis, patients with #2 metastases and response to chemotherapy showed better PFS; white cell count #10 and surgical treatment were associated with better OS. Conclusion: Colorectal liver metastasis with higher pretreatment mean ADC and mean ADC high was associated with poorer response to chemotherapy. However, ADC and ADC high values did not predict the patient outcome in this study cohort. Advances in knowledge: High mean ADC values of colorectal liver metastases on pre-treatment diffusionweighted MRI is associated with poorer response to chemotherapy.Liver metastasis from colorectal cancer is common and is associated with poor survival. It has been shown that liver metastectomy [1], radiofrequency ablation [2] and good response to chemotherapy confer a favourable long-term outcome [3]. Given the impact of adverse effects of current treatments on quality of life, knowledge on the likelihood to respond to chemotherapy, progression-free survival (PFS) and overall survival (OS) will also facilitate clinical decision making on how aggressively to pursue the various therapeutic options.

Prognostic value of pretreatment diffusion-weighted magnetic resonance imaging for outcome prediction of colorectal cancer liver metastases undergoing 90Y-microsphere radioembolization

“…Some previous studies have already shown that lower pretreatment ADC values were linked to short-term tumorsize reduction of single CRC liver metastases undergoing chemotherapy, whilst being unable to predict final patient outcome (Cui et al 2008;Tam et al 2013). Both animal models and clinical studies have shown that necrotic lesions exhibit higher ADC values (Herneth et al 2003;Kokabi et al 2015).…”

Diffusion-Weighted Imaging of the Liver

“…Making this distinction would enable repeat treatment or alternative therapy if necessary. Furthermore, given the significant impact and adverse effects of current treatments, including chemotherapy and LRT, knowledge of how likely a lesion is to respond to therapy will also facilitate clinical decision-making in terms of how aggressively to pursue treatment 8 .…”

“…Furthermore, liver metastases with low pre-treatment ADC values have responded better to systemic chemotherapy compared to lesions with high pre-treatment ADC values in several series. High pre-treatment ADC value of liver metastases is therefore a potential predictor of poor response to chemotherapy 8,129,132 . Metastatic lesions with higher ADC values may in fact have diminished blood supply and consequentially, more baseline cellular hypoxia and necrosis, which may limit the effectiveness of therapy.…”

“…Quantification of apparent diffusion coefficient (ADC) has enabled differentiation of solid cellular lesions from cystic or necrotic lesions 6 . ADC quantification has also demonstrated promising results for predicting tumor response to therapy 7,8 . The purpose of this chapter is to review the basic principles of DWI, discuss protocol optimization, summarize the performance of DWI compared to conventional sequences, discuss the role of DWI in evaluation of treatment response and examine the potential role of DWI in the assessment of liver fibrosis.…”

Diagnostic performance of diffusion-weighted MRI for detection of pelvic metastatic lymph nodes in patients with cervical cancer: a systematic review and meta-analysis

“…19 Of late, DWI has been introduced for the differentiation of benign and malignant lesions in extracranial organs, especially for diagnosis of abdominal and pelvic organs. 20,21 Although multiple previous studies have discussed the feasibility of DWI in detecting and diagnosing cervical cancer, 22-24 the findings are inconclusive or conflicting. Thus, we undertook a meta-analysis to evaluate the possible benefit of DWI to differentiate metastatic from non-metastatic LNs in uterine cervical cancer.…”