title: Preoperative diffusion-weighted imaging of single brain metastases correlates with patient survival times.
abstract: BACKGROUND
  MRI-based diffusion-weighted imaging (DWI) visualizes the local differences in water diffusion in vivo. The prognostic value of DWI signal intensities on the source images and apparent diffusion coefficient (ADC) maps respectively has not yet been studied in brain metastases (BM).
  
  
  METHODS
  We included into this retrospective analysis all patients operated for single BM at our institution between 2002 and 2010, in whom presurgical DWI and BM tissue samples were available. We recorded relevant clinical data, assessed DWI signal intensity and apparent diffusion coefficient (ADC) values and performed histopathological analysis of BM tissues. Statistical analyses including uni- and multivariate survival analyses were performed.
  
  
  RESULTS
  65 patients (34 female, 31 male) with a median overall survival time (OS) of 15 months (range 0-99 months) were available for this study. 19 (29.2%) patients presented with hyper-, 3 (4.6%) with iso-, and 43 (66.2%) with hypointense DWI. ADCmean values could be determined in 32 (49.2%) patients, ranged from 456.4 to 1691.8*10⁻⁶ mm²/s (median 969.5) and showed a highly significant correlation with DWI signal intensity. DWI hyperintensity correlated significantly with high amount of interstitial reticulin deposition. In univariate analysis, patients with hyperintense DWI (5 months) and low ADCmean values (7 months) had significantly worse OS than patients with iso/hypointense DWI (16 months) and high ADCmean values (30 months), respectively. In multivariate survival analysis, high ADCmean values retained independent statistical significance.
  
  
  CONCLUSIONS
  Preoperative DWI findings strongly and independently correlate with OS in patients operated for single BM and are related to interstitial fibrosis. Inclusion of DWI parameters into established risk stratification scores for BM patients should be considered.
authors: Institute of Neurology, Medical University of Vienna, Vienna, Austria.
authors: Anna Sophie
authors: AS
authors: Berghoff
authors: Thomas
authors: T
authors: Spanberger
authors: Aysegül
authors: A
authors: Ilhan-Mutlu
authors: Manuel
authors: M
authors: Magerle
authors: Markus
authors: M
authors: Hutterer
authors: Adelheid
authors: A
authors: Woehrer
authors: Monika
authors: M
authors: Hackl
authors: Georg
authors: G
authors: Widhalm
authors: Karin
authors: K
authors: Dieckmann
authors: Christine
authors: C
authors: Marosi
authors: Peter
authors: P
authors: Birner
authors: Daniela
authors: D
authors: Prayer
authors: Matthias
authors: M
authors: Preusser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
references: Int J Cancer. 2011 Jun 1;128(11):2527-35
references: 21365651
references: Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):510-4
references: 17931798
references: Br J Radiol. 2006 Aug;79(944):652-8
references: 16641420
references: Eur J Radiol. 2010 Apr;74(1):117-20
references: 19359117
references: AJNR Am J Neuroradiol. 2011 Mar;32(3):507-14
references: 21330399
references: J Neurooncol. 2009 Aug;94(1):87-96
references: 19229590
references: Eur J Neurol. 2006 Jul;13(7):674-81
references: 16834697
references: Eur J Surg Oncol. 2012 Apr;38(4):307-13
references: 22264965
references: AJNR Am J Neuroradiol. 2005 Feb;26(2):236-41
references: 15709118
references: Eur J Cancer. 2012 Dec;48(18):3439-47
references: 22883982
references: AJR Am J Roentgenol. 2012 Jan;198(1):75-82
references: 22194481
references: Curr Opin Neurol. 2012 Dec;25(6):786-94
references: 23108247
references: Int J Radiat Oncol Biol Phys. 1997 Mar 1;37(4):745-51
references: 9128946
references: Cancer. 2002 May 15;94(10):2698-705
references: 12173339
references: J Clin Oncol. 2012 Feb 1;30(4):419-25
references: 22203767
references: Eur J Radiol. 2006 Jun;58(3):394-403
references: 16527438
references: Eur J Nucl Med Mol Imaging. 2010 Nov;37(11):2011-20
references: 20607535
references: AJNR Am J Neuroradiol. 2010 Jan;31(1):60-6
references: 19729544
references: Breast Cancer Res Treat. 2011 Feb;125(3):687-96
references: 20361254
references: Br J Cancer. 2012 May 22;106(11):1850-3
references: 22531629
references: J Magn Reson Imaging. 2012 Jun;35(6):1365-71
references: 22271382
references: J Magn Reson Imaging. 1999 Jan;9(1):53-60
references: 10030650
references: Acta Radiol. 2012 Dec 1;53(10):1173-85
references: 23081958
references: Eur Radiol. 2012 Jun;22(6):1172-7
references: 22258519
references: Br J Cancer. 2012 Oct 23;107(9):1454-8
references: 23047551
references: AJNR Am J Neuroradiol. 2006 Aug;27(7):1419-25
references: 16908550
references: Radiology. 2008 Nov;249(2):624-30
references: 18936317
references: Radiology. 2000 Jun;215 Suppl:1105-10
references: 11037534
references: J Neurooncol. 2009 Dec;95(3):401-411
references: 19562257
references: AJR Am J Roentgenol. 2010 Sep;195(3):720-8
references: 20729452
references: Cell Oncol. 2007;29(5):387-98
references: 17726261
references: Childs Nerv Syst. 2011 Sep;27(9):1407-11
references: 21732119
references: Histopathology. 2012 May;60(6):885-94
references: 22335622