Lahrsow Maximilian, Albrecht Moritz H, Bickford Matthew W, Vogl Thomas J
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA.
Cardiovasc Intervent Radiol. 2017 Jun;40(6):852-859. doi: 10.1007/s00270-017-1634-0. Epub 2017 Mar 29.
To use absolute pretreatment apparent diffusion coefficients (ADC) derived from diffusion-weighted MR imaging (DWI) to predict response to repetitive cTACE for unresectable liver metastases of colorectal carcinoma (CRLM) at 1 and 3 months after start of treatment.
Fifty-five metastases in 34 patients were examined with DWI prior to treatment and 1 month after initial cTACE. Treatment was performed in 4-week intervals. Response was evaluated at 1 and 3 months after start of therapy. Metastases showing a decrease of ≥30% in axial diameter were classified as responding lesions.
One month after initial cTACE, seven lesions showed early response. There was no significant difference in absolute pretreatment ADC values between responding and non-responding lesions (p = 0.94). Three months after initial cTACE, 17 metastases showed response. There was a significant difference (p = 0.021) between absolute pretreatment ADC values of lesions showing response (median 1.08 × 10 mm/s) and no response (median 1.30 × 10 mm/s). Pretreatment ADC showed fair diagnostic value to predict response (AUC 0.7). Lesions showing response at 3 months also revealed a significant increase in ADC between measurements before treatment and at one month after initial cTACE (p < 0.001). Applying an increase in ADC of 12.17%, response at 3 months after initial cTACE could be predicted with a sensitivity and specificity of 77 and 74%, respectively (AUC 0.817). Furthermore, there was a strong and significant correlation (r = 0.651, p < 0.001) between percentage change in size after third cTACE and percentage change in ADC.
In patients with CRLM, ADC measurements are potential biomarkers for assessing response to cTACE.
利用扩散加权磁共振成像（DWI）得出的绝对治疗前表观扩散系数（ADC），预测不可切除的结直肠癌肝转移（CRLM）患者在开始治疗后1个月和3个月时对重复经动脉化疗栓塞术（cTACE）的反应。
对34例患者的55个转移灶在治疗前及首次cTACE后1个月进行DWI检查。治疗每隔4周进行一次。在治疗开始后1个月和3个月评估反应情况。轴向直径减小≥30%的转移灶被分类为反应性病灶。
首次cTACE后1个月，7个病灶显示早期反应。反应性病灶与无反应性病灶的绝对治疗前ADC值无显著差异（p = 0.94）。首次cTACE后3个月，17个转移灶显示有反应。有反应的病灶（中位数1.08×10⁻³mm²/s）与无反应的病灶（中位数1.30×10⁻³mm²/s）的绝对治疗前ADC值有显著差异（p = 0.021）。治疗前ADC对预测反应具有中等诊断价值（曲线下面积[AUC] 0.7）。在3个月时显示有反应的病灶在治疗前与首次cTACE后1个月的测量值之间ADC也有显著增加（p < 0.001）。应用ADC增加12.17%，可以分别以77%和74%的敏感性和特异性预测首次cTACE后3个月的反应（AUC 0.817）。此外，第三次cTACE后大小变化百分比与ADC变化百分比之间存在强且显著的相关性（r = 0.651，p < 0.001）。
在CRLM患者中，ADC测量是评估对cTACE反应的潜在生物标志物。
