From the Departments of Diagnostic and Interventional Radiology (A.B., P.B., N.A.K., C.K.K.) and Nuclear Medicine (A.H.), University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
Radiology. 2018 Sep;288(3):764-773. doi: 10.1148/radiol.2018170408. Epub 2018 May 22.
Purpose To determine the relationship between diffusion-weighted (DW) liver MR images obtained 4-6 weeks after lobar yttrium 90 (Y) treatment and overall survival in comparison with PET/CT or established oncologic factors known to affect survival. Materials and Methods The institutional review board approved this prospective intraindividual comparative study in 36 consecutive patients (25 women) with liver-dominant metastases (20 colorectal, 14 breast, two other) (mean age, 60 years ± 10 [standard deviation]) who underwent fluorine 18 (F) fluorodeoxyglucose (FDG) PET/CT and DW MRI before and 4-6 weeks after Y radioembolization. DW MRI response was defined as a mean minimal apparent diffusion coefficient increase of more than 30%; PET/CT response was defined as a mean maximal standardized uptake value decrease of more than 30%. Kaplan-Meier curves, log-rank test, and multivariable Cox regression analyses were used to compare patient survival as a function of imaging and Response Evaluation Criteria in Solid Tumors (RECIST) response, pretreatment Eastern Cooperative Oncology Group (ECOG) performance status (PS) (0 vs 1), hepatic tumor load (<25% vs ≥25%), and presence versus absence of extrahepatic disease. Results Thirty-five of the 36 patients were observed until death (median survival, 36 weeks). Response was observed with PET/CT in 18 of 36 patients (50%). Median survival was 39 weeks in patients who responded to PET/CT versus 27 weeks in those who did not (P = .60). Response was observed with DW MRI in 24 of 36 patients (67%). Median survival was 53 weeks in DW MRI responders versus 20 weeks in nonresponders (P = .01). At multivariable analysis, DW MRI response was the only independent predictor of survival (P < .01). Response based on RECIST parameters, ECOG PS, hepatic tumor load, and presence of extrahepatic metastases did not correlate with survival. Conclusion In patients with hepatic metastases undergoing Y radioembolization, prediction of response to therapy with DW MRI was superior to that with PET/CT and established oncologic factors.
与 PET/CT 或已知影响生存的既定肿瘤学因素相比，确定在叶 90 钇（Y）治疗后 4-6 周获得的弥散加权（DW）肝脏磁共振成像与总生存率之间的关系。
本机构审查委员会批准了这项前瞻性个体内比较研究，共纳入 36 例连续患者（25 例女性），这些患者均患有肝脏优势转移瘤（20 例结直肠癌，14 例乳腺癌，2 例其他）（平均年龄，60 岁±10[标准差]），这些患者在 Y 放射性栓塞治疗前和治疗后 4-6 周均接受了氟 18（F）氟脱氧葡萄糖（FDG）PET/CT 和 DW MRI 检查。DW MRI 反应定义为平均最小表观扩散系数增加超过 30%；PET/CT 反应定义为平均最大标准化摄取值下降超过 30%。Kaplan-Meier 曲线、对数秩检验和多变量 Cox 回归分析用于比较患者生存情况与成像和实体瘤反应评估标准（RECIST）反应、治疗前东部肿瘤协作组（ECOG）表现状态（PS）（0 与 1）、肝肿瘤负荷（<25%与≥25%）和是否存在肝外疾病的关系。
36 例患者中有 35 例观察到死亡（中位生存期为 36 周）。36 例患者中有 18 例（50%）PET/CT 检查有反应。PET/CT 有反应的患者中位生存期为 39 周，无反应的患者为 27 周（P=0.60）。36 例患者中有 24 例（67%）DW MRI 有反应。DW MRI 有反应的患者中位生存期为 53 周，无反应的患者为 20 周（P=0.01）。多变量分析显示，DW MRI 反应是唯一独立的生存预测因子（P<0.01）。基于 RECIST 参数、ECOG PS、肝肿瘤负荷和肝外转移存在的反应与生存无关。
在接受 Y 放射性栓塞治疗的肝脏转移患者中，DW MRI 预测治疗反应的效果优于 PET/CT 和既定的肿瘤学因素。
