弥散加权成像在结直肠癌肝转移患者高剂量率近距离放疗后反应预测和评估中的作用。
Role of diffusion-weighted imaging in response prediction and evaluation after high dose rate brachytherapy in patients with colorectal liver metastases.
机构信息
Department of Radiology, University Hospital, LMU Munich, Germany.
ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumours of the GastroEntero-Pancreatic System at the University Hospital of Munich (GEPNET KUM), University Hospital of Munich, Munich, Germany.
出版信息
Radiol Oncol. 2024 Feb 21;58(1):33-42. doi: 10.2478/raon-2024-0017. eCollection 2024 Mar 1.
BACKGROUND
The aim of the study was to assess the role of diffusion-weighted imaging (DWI) to evaluate treatment response in patients with liver metastases of colorectal cancer.
PATIENTS AND METHODS
In this retrospective, observational cohort study, we included 19 patients with 18 responding metastases (R-Mets; follow-up at least one year) and 11 non-responding metastases (NR-Mets; local tumor recurrence within one year) who were treated with high-dose-rate brachytherapy (HDR-BT) and underwent pre- and post-interventional MRI. DWI (qualitatively, mean apparent diffusion coefficient [ADCmean], ADCmin, intraindividual change of ADCmean and ADCmin) were evaluated and compared between pre-interventional MRI, first follow-up after 3 months and second follow-up at the time of the local tumor recurrence (in NR-Mets, mean: 284 ± 122 d) or after 12 months (in R-Mets, mean: 387+/-64 d). Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) for detection of local tumor recurrence were calculated on second follow up, evaluating (1) DWI images only, and (2) DWI with Gd-enhanced T1-weighted images on hepatobiliary phase (contrast-enhanced [CE] T1-weight [T1w] hepatobiliary phase [hb]).
RESULTS
ADCmean significantly increased 3 months after HDR-BT in both groups (R-Mets: 1.48 ± 0.44 and NR-Mets: 1.49 ± 0.19 x 10 mm;/s, p < 0.0001 and p = 0.01), however, intraindividual change of ADCmean (175% .127%, p = 0.03) and ADCmin values (0.44 ± 0.24 to 0.82 ± 0.58 x 10 mm/s) significantly increased only in R-Mets (p < 0.0001 and p < 0.001). ADCmin was significant higher in R-Mets compared to NR-Mets on first follow-up (p = 0.04). Sensitivity (1 . 0.72), specificity (0.94 . 0.72), PPV (0.91 . 0.61) and NPV (1 . 0.81) could be improved by combining DWI with CE T1w hb compared to DWI only.
CONCLUSIONS
DW-MRI seems to be helpful in the qualitative and quantitative evaluation of treatment response after HDR-BT of colorectal metastases in the liver.
背景
本研究旨在评估扩散加权成像（DWI）在评估结直肠癌肝转移患者治疗反应中的作用。
患者和方法
在这项回顾性观察队列研究中，我们纳入了 19 名患者，其中 18 名转移灶有反应（R-Mets；随访至少 1 年），11 名转移灶无反应（NR-Mets；1 年内局部肿瘤复发），他们接受了高剂量率近距离放射治疗（HDR-BT），并进行了介入前和介入后 MRI。在介入前 MRI、3 个月后的第一次随访和局部肿瘤复发时的第二次随访（NR-Mets 中平均时间：284±122d）或 12 个月后（R-Mets 中平均时间：387±64d）评估了 DWI（定性、平均表观扩散系数[ADCmean]、ADCmin、ADCmean 和 ADCmin 的个体内变化），并对其进行了比较。在第二次随访时，仅评估 DWI 图像和（2）DWI 联合肝胆期钆增强 T1 加权图像（对比增强[CE] T1 加权[T1w]肝胆期[hb]），计算了检测局部肿瘤复发的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
结果
两组患者在 HDR-BT 后 3 个月时 ADCmean 均显著升高（R-Mets：1.48±0.44 和 NR-Mets：1.49±0.19×10mm/s，p<0.0001 和 p=0.01），但 R-Mets 患者的 ADCmean 个体内变化（175%±127%，p=0.03）和 ADCmin 值（0.44±0.24 至 0.82±0.58×10mm/s）显著升高，而 NR-Mets 患者无显著升高（p<0.0001 和 p<0.001）。R-Mets 患者在第一次随访时的 ADCmin 值显著高于 NR-Mets 患者（p=0.04）。与仅使用 DWI 相比，将 DWI 与 CE T1w hb 联合使用可提高灵敏度（1.0.72）、特异性（0.94.0.72）、PPV（0.91.0.61）和 NPV（1.0.81）。
结论
DWI 似乎有助于评估结直肠癌肝转移患者 HDR-BT 后的定性和定量治疗反应。
Zotero 插件