Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.
Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden.
Acta Radiol. 2023 Jan;64(1):51-57. doi: 10.1177/02841851221074496. Epub 2022 Jan 27.
The pathological response to preoperative chemotherapy of colorectal liver metastases (CRLMs) is predictive of long-term prognosis after liver resection. Accurate preoperative assessment of chemotherapy response could enable treatment optimization.
To investigate whether changes in lesion-apparent diffusion coefficient (ADC) measured with diffusion-weighted magnetic resonance imaging (MRI) can be used to assess pathological treatment response in patients with CRLMs undergoing preoperative chemotherapy.
Patients who underwent liver resection for CRLMs after preoperative chemotherapy between January 2011 and December 2019 were retrospectively included if they had undergone MRI before and after preoperative chemotherapy on the same 1.5-T MRI scanner with diffusion-weighted imaging with -values 50, 400, and 800 s/mm. The pathological chemotherapy response was assessed using the tumor regression grade (TRG) by AJCC/CAP. Lesions were divided into two groups: pathological responding (TRG 0-2) and non-responding (TRG 3). The change in lesion ADC after preoperative chemotherapy was compared between responding and non-responding lesions.
A total of 27 patients with 49 CRLMs were included, and 24/49 lesions showed a pathological chemotherapy response. After chemotherapy, ADC increased in both pathological responding (pretreatment ADC: 1.26 [95% confidence interval (CI)=1.06-1.37] vs. post-treatment ADC: 1.33 [95% CI=1.13-1.56] × 10 mm/s; = 0.026) and non-responding lesions (1.12 [95% CI=0.980-1.21] vs. 1.20 [95% CI=1.09-1.43] × 10 mm/s; = 0.018). There was no difference in median relative difference in ADC after chemotherapy between pathological responding and non-responding lesions (15.8 [95% CI=1.42-26.3] vs. 7.17 [95% CI=-4.31 to 31.2]%; = 0.795).
Changes in CRLM ADCs did not differ between pathological responding and non-responding lesions.
结直肠癌肝转移（CRLM）患者术前化疗的病理反应可预测肝切除术后的长期预后。准确的术前化疗反应评估可以优化治疗。
探讨术前化疗后扩散加权磁共振成像（MRI）测量的病变表观扩散系数（ADC）是否可用于评估 CRLM 患者的病理治疗反应。
回顾性纳入 2011 年 1 月至 2019 年 12 月期间在同一 1.5-T MRI 扫描仪上进行术前化疗后肝切除术治疗的 CRLM 患者。所有患者在术前化疗前后均接受 MRI 检查，包括扩散加权成像，b 值为 50、400 和 800 s/mm。采用 AJCC/CAP 的肿瘤回归分级（TRG）评估病理化疗反应。病变分为两组：病理反应（TRG 0-2）和无反应（TRG 3）。比较术前化疗后病变 ADC 的变化。
共纳入 27 例 49 个 CRLM 患者，其中 24/49 个病变表现出病理化疗反应。化疗后，病理反应组（预处理 ADC：1.26[95%置信区间（CI）=1.06-1.37]vs. 后处理 ADC：1.33[95% CI=1.13-1.56]×10⁻³mm/s； = 0.026）和无反应组（1.12[95% CI=0.980-1.21]vs. 1.20[95% CI=1.09-1.43]×10⁻³mm/s； = 0.018）的 ADC 值均升高。病理反应组和无反应组的化疗后 ADC 值的中位数相对变化无差异（15.8[95% CI=1.42-26.3]vs. 7.17[95% CI=-4.31 至 31.2]%； = 0.795）。
病理反应和无反应病变的 CRLM ADC 变化无差异。
