Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Radiol. 2023 Jun;163:110810. doi: 10.1016/j.ejrad.2023.110810. Epub 2023 Apr 7.
The evaluation of response to chemotherapy and targeted therapies in colorectal liver metastases has traditionally been based on size changes, as per the RECIST criteria. However, therapy may alter tissue composition and not only tumor size, therefore, functional imaging techniques such as diffusion-weighted magnetic resonance imaging (DWI) may offer a more comprehensive assessment of treatment response. The aim of this systematic review and meta-analysis was to evaluate the use of DWI in the prediction and assessment of response to treatment in colorectal liver metastases and to determine if there is a baseline apparent diffusion coefficient (ADC) cut-off value that can predict a favorable response. A literature search was conducted using the MEDLINE/PubMed database, and risk of bias was evaluated using the QUADAS-2 tool. The mean differences between responders and non-responders were pooled. A total of 16 studies met the inclusion criteria, and various diffusion-derived techniques and coefficients were found to have potential for predicting and assessing treatment response. However, discrepancies were noted between studies. The most consistent predictor of response was a lower baseline ADC value calculated using traditional mono-exponential methods. Non-mono-exponential techniques for calculating DWI-derived parameters were also reported. A meta-analysis of a subset of studies failed to establish a cut-off value of ADC due to heterogeneity, but revealed a pooled mean difference of -0.12 × 10 mm/s between responders and non-responders. The results of this systematic review suggest that diffusion-derived techniques and coefficients may contribute to the evaluation and prediction of treatment response in colorectal liver metastases. Further controlled prospective studies are needed to confirm these findings and to guide clinical and radiological decision-making in the management of patients with CRC liver metastases.
结直肠癌肝转移化疗和靶向治疗反应的评估传统上基于 RECIST 标准的大小变化。然而，治疗可能会改变组织成分，而不仅仅是肿瘤大小，因此，功能成像技术，如弥散加权磁共振成像（DWI），可能提供更全面的治疗反应评估。本系统评价和荟萃分析的目的是评估 DWI 在结直肠癌肝转移治疗反应预测和评估中的应用，并确定是否存在基线表观扩散系数（ADC）截断值可预测良好的反应。使用 MEDLINE/PubMed 数据库进行文献检索，并使用 QUADAS-2 工具评估偏倚风险。 responder 和 non-responder 之间的平均差异进行了汇总。共有 16 项研究符合纳入标准，发现各种弥散衍生技术和系数具有预测和评估治疗反应的潜力。然而，研究之间存在差异。反应的最一致预测因子是使用传统单指数方法计算的较低基线 ADC 值。还报告了用于计算 DWI 衍生参数的非单指数技术。对一组研究的荟萃分析未能确定由于异质性而导致 ADC 的截断值，但揭示了 responder 和 non-responder 之间的平均差异为 -0.12 × 10 mm/s。本系统评价的结果表明，弥散衍生技术和系数可能有助于评估和预测结直肠癌肝转移的治疗反应。需要进一步的对照前瞻性研究来证实这些发现，并指导结直肠癌肝转移患者管理中的临床和放射学决策。
