Role of functional magnetic resonance imaging in assessing metastatic leiomyosarcoma response to chemoembolization.
OBJECTIVE
To assess the value of functional magnetic resonance (MR) imaging in the evaluation of early tumor response after transarterial chemoembolization (TACE) for metastatic leiomyosarcoma and compare tumor response using functional MR imaging versus traditional imaging response assessment, which is based on tumor size.


METHODS
We evaluated 31 lesions in 10 patients with liver metastases from leiomyosarcoma using MR imaging studies before and after TACE. Diffusion and contrast-enhanced MR imaging was performed on a 1.5-T unit. Imaging protocol consisted of T2-weighted fast spin-echo images, breath-hold diffusion-weighted echo-planar images, and breath-hold unenhanced and contrast-enhanced T1-weighted 3-dimensional fat-suppressed spoiled gradient-echo images in the arterial phase (20 seconds) and portal venous phase (60 seconds). Parameters evaluated included change in tumor size, enhancement, and apparent diffusion coefficient (ADC) values. Median survival was also calculated for the entire cohort.


RESULTS
The 31 lesions evaluated had a mean size of 4.8 cm before treatment. Tumor size decreased only by 2% immediately after treatment. Decrease of tumor enhancement after treatment was significant (P < 0.0001) in the arterial phase (69%) as well as in the portal venous phase (64%). After TACE, mean tumor ADC increased by 20% (P = 0.0015), whereas mean nontreated liver, spleen, and muscle ADC values did not change significantly (P = 0.44, P = 0.287, and P = 0.098, respectively). Patient survival from time of first TACE was 21 months for the entire cohort.


CONCLUSIONS
In patients with leiomyosarcoma and liver metastases who were treated with TACE, significant early changes in the treated lesions occurred on functional MR imaging. These include decrease in tumor enhancement and increase in tumor ADC value, suggesting increasing tumor necrosis and cell death. Changes in tumor size were small and inadequate to assess treatment response, suggesting limitation of the current response criteria in the early assessment of tumor response.
Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD 21287, USA.
Josephina A
JA
Vossen
Ihab R
IR
Kamel
Manon
M
Buijs
Eleni
E
Liapi
Christos S
CS
Georgiades
Kelvin
K
Hong
Jean-Francois H
JF
Geschwind
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016461:Chemoembolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008113:Liver Neoplasms / Q000556:secondary; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome