Wagner Mathilde, Ronot Maxime, Doblas Sabrina, Giraudeau Céline, Van Beers Bernard, Belghiti Jacques, Paradis Valérie, Vilgrain Valérie
INSERM, UMR 1149, Paris Diderot University, 100, Bd du Général Leclerc, 92110, Clichy, France.
Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France.
Eur Radiol. 2016 Jan;26(1):206-15. doi: 10.1007/s00330-015-3800-6. Epub 2015 May 2.
To evaluate the value of diffusion-weighted imaging (DWI) in detecting residual tumours (RTs) in colorectal liver metastases (CLMs) following chemotherapy, with a focus on tumour periphery.
From January 2009-January 2012, 57 patients who underwent liver resection for CLMs with preoperative MRI (<3 months) including DWI were retrospectively included. CLMs were classified into three response groups on pathology: (1) major histological (MHR, RTs ≤ 10 %), (2) partial histological (PHR, RT = 10-49 %), and (3) no histological (NHR, RT ≥ 50 %). On DWI, regions of interest (ROIs) were drawn around the entire tumour and tumour periphery. Apparent diffusion (ADC) and pure diffusion (D) coefficients were calculated using a monoexponential fit, and compared using Kruskal-Wallis test on a lesion-per-lesion analysis.
111 CLMs were included. Fourteen (12.5 %), 42 (38 %) and 55 (49.5 %) CLMs presented a MHR, PHR and NHR, respectively. ADC and D of the peripheral ROIs were significantly higher in the MHR group (P = 0.013/P = 0.013). ADC and D from the entire tumour were not significantly different among the groups (P = 0.220/P = 0.103).
In CLM treated with chemotherapy, ADC and D values from the entire tumour are not related to the degree of RT, while peripheral zone diffusion parameters could help identify metastases with MHR.
Peripheral ADC and D of CLMs were higher with major pathological responses. Global ADC and D of CLMs were not different according to residual tumour. Diffusion-weighted images of CLM periphery could be an interesting biomarker of MHR. Diffusion-weighted images could be used to help tailor treatment.
评估弥散加权成像（DWI）在检测化疗后结直肠癌肝转移（CLM）残留肿瘤（RT）中的价值，重点关注肿瘤周边情况。
回顾性纳入2009年1月至2012年1月期间57例行CLM肝切除术且术前行MRI（<3个月）检查（包括DWI）的患者。CLM在病理上分为三个反应组：（1）主要组织学反应（MHR，RT≤10%），（2）部分组织学反应（PHR，RT = 10 - 49%），（3）无组织学反应（NHR，RT≥50%）。在DWI上，在整个肿瘤及其周边绘制感兴趣区（ROI）。使用单指数拟合计算表观扩散系数（ADC）和纯扩散系数（D），并在逐个病变分析中使用Kruskal - Wallis检验进行比较。
共纳入111个CLM。分别有14个（12.5%）、42个（38%）和55个（49.5%）CLM呈现MHR、PHR和NHR。MHR组周边ROI的ADC和D显著更高（P = 0.013/P = 0.013）。各组间整个肿瘤的ADC和D无显著差异（P = 0.220/P = 0.103）。
在接受化疗的CLM中，整个肿瘤的ADC和D值与RT程度无关，而周边区域扩散参数有助于识别具有MHR的转移灶。
CLM周边的ADC和D在主要病理反应时更高。CLM的整体ADC和D根据残留肿瘤情况无差异。CLM周边的弥散加权图像可能是MHR的一个有意义的生物标志物。弥散加权图像可用于辅助制定治疗方案。
