Department of Radiology, Royal Marsden Hospital, Sutton, UK.
Br J Radiol. 2013 Oct;86(1030):20130281. doi: 10.1259/bjr.20130281. Epub 2013 Aug 30.
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).
We retrospectively reviewed 102 patients who underwent pre-treatment diffusion-weighted MRI using a breath-hold (b=0, 150, 500) or a free-breathing (b=0, 50, 100, 250, 500, 750) technique. The mean ADC (b=0-500) and mean flow-insensitive ADC (ADChigh) values (breath-hold: b=150 and 500; free-breathing: b=100 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.
62 patients responded to chemotherapy at 12 weeks. The pre-treatment mean ADC and mean ADChigh were higher in the non-responding group than in the responding group (1.55 vs 1.36, p=0.033; 1.40 vs 1.16, p=0.024). 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.
Colorectal liver metastasis with higher pre-treatment mean ADC and mean ADChigh was associated with poorer response to chemotherapy. However, ADC and ADChigh values did not predict the patient outcome in this study cohort.
High mean ADC values of colorectal liver metastases on pre-treatment diffusion-weighted MRI is associated with poorer response to chemotherapy.
确定结直肠肝转移瘤治疗前表观扩散系数（ADC）对预测疾病反应、无进展生存期（PFS）和总生存期（OS）的预后价值。
我们回顾性分析了 102 例接受呼吸暂停（b=0、150、500）或自由呼吸（b=0、50、100、250、500、750）技术的扩散加权 MRI 预处理的患者。对每位患者的三个肝病变的平均 ADC（b=0-500）和平均流动敏感 ADC（ADChigh）值（呼吸暂停：b=150 和 500；自由呼吸：b=100 和 500）进行评估。记录临床和实验室参数。治疗后 12 周采用实体瘤反应评估标准（RECIST）评估肿瘤反应。采用单因素方差分析检验肿瘤反应、ADC 值与临床/实验室参数之间的关系。采用 Kaplan-Meier 分析确定 ADC 与 PFS 和 OS 的关系。
62 例患者在 12 周时对化疗有反应。无反应组治疗前平均 ADC 和平均 ADChigh 值高于有反应组（1.55 比 1.36，p=0.033；1.40 比 1.16，p=0.024）。然而，根据平均 ADC 值中位数或受试者工作特征分析得出的阈值对患者进行分层后，两组患者的 PFS 和 OS 无统计学意义。多因素 Cox 回归分析显示，转移灶≤2 个和对化疗有反应的患者 PFS 较好；白细胞计数≤10 和手术治疗与 OS 较好相关。
结直肠肝转移瘤治疗前平均 ADC 和平均 ADChigh 值较高与对化疗的反应较差相关。然而，在本研究队列中，ADC 和 ADChigh 值不能预测患者的预后。
结直肠肝转移瘤治疗前扩散加权 MRI 的高平均 ADC 值与对化疗的反应较差相关。
