Wu Huita, Li Bangkai, Yang Zike, Ji Haonan, Guo Yifang, Lin Jianzhong, Wang Xin
Department of Oncology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Quant Imaging Med Surg. 2022 Sep;12(9):4587-4600. doi: 10.21037/qims-21-1220.
To explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the early assessment of colorectal cancer liver metastases (CRLM).
A total of 34 patients with pathologically confirmed unresectable CRLM were enrolled. All participants uniformly received capecitabine and oxaliplatin (CAPOX) plus bevacizumab chemotherapy as standard first-line treatment for advanced colorectal cancer (CRC). Participants underwent 1.5-T conventional magnetic resonance imaging (MRI) and IVIM-DWI sequence scans with 9 b values (0 to 1,000 s/mm) before treatment and at 3 weeks of treatment, and conventional MRI scans were performed at 6 and 12 weeks after the initial treatment. The IVIM-DWI parameters in the tumor target area were extracted using image post-processing software, including perfusion fraction (f), true diffusion coefficient (D), and false diffusion coefficient (D*). The response assessment was based on the Response Evaluation Criteria in Solid Tumors (RECIST) v. 1.1 by measuring the longest tumor diameter on dynamic contrast-enhanced (DCE) T1-weighted images.
According to the RECIST v. 1.1 criteria, the 34 participants were divided into a response group (n=16) and a non-response group (n=18). In the response group, the f value was significantly lowered (P=0.001) and the D value was significantly increased after treatment (P=0.002). In the non-response group, the D value was increased slightly after treatment (P=0.039), and there was no significant difference in the f value and the D* value. In addition, the f value at baseline was significantly greater in the response group than in the non-response group (0.221±0.033 0.175±0.040; P=0.001). The receiver operating characteristic (ROC) curve analysis showed that the percentage change of the f value obtained the largest area under the curve (AUC =0.797), and the AUC obtained by the Fisher's linear discriminant analysis (FLDA) method (Δf & ΔD combination) was 0.819.
The IVIM-DWI parameters (f values and D values) provided effective assessment of the therapeutic effect of CAPOX combined with bevacizumab in patients with CRLM at an early stage, and the f value of the pre-treatment tumor area was shown to be useful for predicting the treatment response of patients.
探讨体素内不相干运动扩散加权成像（IVIM-DWI）在结直肠癌肝转移（CRLM）早期评估中的价值。
共纳入34例经病理证实为不可切除CRLM的患者。所有参与者均接受卡培他滨和奥沙利铂（CAPOX）联合贝伐单抗化疗，作为晚期结直肠癌（CRC）的标准一线治疗。参与者在治疗前和治疗3周时接受1.5-T常规磁共振成像（MRI）和具有9个b值（0至1000 s/mm²）的IVIM-DWI序列扫描，并在初始治疗后6周和12周进行常规MRI扫描。使用图像后处理软件提取肿瘤靶区的IVIM-DWI参数，包括灌注分数（f）、真实扩散系数（D）和伪扩散系数（D*）。基于实体瘤疗效评价标准（RECIST）v.1.1，通过测量动态对比增强（DCE）T1加权图像上最长肿瘤直径进行疗效评估。
根据RECIST v.1.1标准，34名参与者分为反应组（n = 16）和无反应组（n = 18）。反应组治疗后f值显著降低（P = 0.001），D值显著升高（P = 0.002）。无反应组治疗后D值略有升高（P = 0.039），f值和D*值无显著差异。此外，反应组基线时的f值显著高于无反应组（0.221±0.033对0.175±0.040；P = 0.001）。受试者操作特征（ROC）曲线分析显示，f值的变化百分比获得最大曲线下面积（AUC = 0.797），费舍尔线性判别分析（FLDA）方法（Δf与ΔD组合）获得的AUC为0.819。
IVIM-DWI参数（f值和D值）为早期评估CAPOX联合贝伐单抗治疗CRLM患者的疗效提供了有效依据，且治疗前肿瘤区域的f值对预测患者的治疗反应具有重要价值。
