title: Liver metastases from colorectal cancer treated with conventional and antiangiogenetic chemotherapy:  evaluation with liver computed tomography perfusion and magnetic resonance diffusion-weighted imaging.
abstract: OBJECTIVE
  The objectives of the study were to determine whether perfusion computed tomography (CT-p) and magnetic resonance diffusion-weighted imaging (MR-DWI) can allow evaluation of the effects of chemotherapy combined with antiangiogenetic treatment on liver metastases in patients with advanced colorectal cancer and to determine if changes in CT-p and MR-DWI correlate with the response to therapy as assessed by conventional Response Evaluation Criteria in Solid Tumors (RECIST).
  
  
  METHODS
  Eighteen patients with liver metastases from colorectal cancer underwent CT-p and MR-DWI before and 6 months after chemotherapy and antiangiogenetic treatment. Lesions were classified according to RECIST criteria (complete response [CR], partial response [PR], stable disease [SD], and progressive disease) and calculations of CT-p parameters including blood flow (BF), blood volume (BV), capillary permeability (CP), and MR-DWI apparent diffusion coefficient (ADC) values were performed; RECIST, CT-p, and MR-DWI measurements at baseline and follow-up were tested for statistically significant differences using the paired-samples t test. Baseline and follow-up perfusion parameters of the lesions were also compared on the basis of therapy response assessed by RECIST criteria using independent-samples t test. P < 0.05 was considered indicative of a statistically significant difference for all statistical test.
  
  
  RESULTS
  Six patients (6/18; 33.3%) were classified as PR (), and the remaining 12 (12/18; 66.7%) were classified as SD. On a per-lesion basis, 2 (2/32; 6.3%) cannot be identified at follow-up, 6 (6/32; 18.8%) showed a decrease in size of more than 30%, and 24 (24/32; 75%) were substantially stable in size. No cases of progressive disease were demonstrated at follow-up. No statistically significant differences were demonstrated between PR, CR, and SD lesions for BF (P = 0.19), BV (P = 0.14), and ADC (P = 0.68) measurements, whereas CP was significantly higher in CR and PR lesions (P = 0.038). Considering differences between baseline and follow-up values, no statistically significant differences were noted between PR and CR lesions versus SD lesions for CT-p values (BF: P = 0.77; BV: P = 0.15; CP: P = 0.64). A statistically significant difference between PR and CR lesions and SD lesions was noted for ADC values (P = 0.047).
  
  
  CONCLUSIONS
  Both CT-p and MR-DWI can detect therapy-induced modifications in lesion vascularization before significant changes in size are evident.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy. michele.anzidei@gmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Anzidei
authors.forename: Alessandro
authors.initials: A
authors.lastname: Napoli
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zaccagna
authors.forename: Gaia
authors.initials: G
authors.lastname: Cartocci
authors.forename: Luca
authors.initials: L
authors.lastname: Saba
authors.forename: Guendalina
authors.initials: G
authors.lastname: Menichini
authors.forename: Beatrice
authors.initials: B
authors.lastname: Cavallo Marincola
authors.forename: Beatrice Cavallo
authors.initials: BC
authors.lastname: Marincola
authors.forename: Eugenio
authors.initials: E
authors.lastname: Marotta
authors.forename: Luisa
authors.initials: L
authors.lastname: Di Mare
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068258:Bevacizumab; D000069287:Capecitabine; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007479:Iopamidol / Q000031:analogs & derivatives; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D003287:Contrast Media; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; C057937:iomeprol; D000068258:Bevacizumab; D000069287:Capecitabine; D007479:Iopamidol; D005472:Fluorouracil