title: Multimodality imaging to predict response to systemic treatment in patients with advanced colorectal cancer.
abstract: OBJECTIVE
  Aim of this study was to investigate the potential of 18F-FDG PET, diffusion weighted imaging (DWI) and susceptibility-weighted (T2*) MRI to predict response to systemic treatment in patients with colorectal liver metastases. The predictive values of pretreatment measurements and of early changes one week after start of therapy, were evaluated.
  
  
  METHODS
  Imaging was performed prior to and one week after start of first line chemotherapy in 39 patients with colorectal liver metastases. 18F-FDG PET scans were performed on a PET/CT scanner and DWI and T2* were performed on a 1.5T MR scanner. The maximum standardized uptake values (SUV), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC) and T2* value were assessed in the same lesions. Up to 5 liver metastases per patient were analyzed. Outcome measures were progression free survival (PFS), overall survival (OS) and size response.
  
  
  RESULTS
  Pretreatment, high SUVmax, high TLG, low ADC and high T2* were associated with a shorter OS. Low pretreatment ADC value was associated with shorter PFS. After 1 week a significant drop in SUVmax and rise in ADC were observed. The drop in SUV was correlated with the rise in ADC (r=-0.58, p=0.002). Neither change in ADC nor in SUV was predictive of PFS or OS. T2* did not significantly change after start of treatment.
  
  
  CONCLUSIONS
  Pretreatment SUVmax, TLG, ADC, and T2* values in colorectal liver metastases are predictive of patient outcome. Despite sensitivity of DWI and 18F-FDG PET for early treatment effects, change in these parameters was not predictive of long term outcome.
authors.affiliation: Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Heijmen
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Edwin E G W
authors.initials: EE
authors.lastname: ter Voert
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Wim J G
authors.initials: WJ
authors.lastname: Oyen
authors.affiliation: Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Cornelis J A
authors.initials: CJ
authors.lastname: Punt
authors.affiliation: Department of Medical Oncology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
authors.forename: Dick Johan
authors.initials: DJ
authors.lastname: van Spronsen
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Arend
authors.initials: A
authors.lastname: Heerschap
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: Lioe-Fee
authors.initials: LF
authors.lastname: de Geus-Oei
authors.affiliation: Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Hanneke W M
authors.initials: HW
authors.lastname: van Laarhoven
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18
references.citation: AJR Am J Roentgenol. 2007 Apr;188(4):1001-8
references.pmid: 17377036
references.citation: Eur Radiol. 2007 Apr;17(4):861-72
references.pmid: 17043737
references.citation: Radiology. 2008 Sep;248(3):894-900
references.pmid: 18710982
references.citation: J Nucl Med. 2009 May;50 Suppl 1:43S-54S
references.pmid: 19403879
references.citation: J Nucl Med. 2009 May;50 Suppl 1:122S-50S
references.pmid: 19403881
references.citation: Cancer Treat Rev. 2009 Jun;35(4):309-21
references.pmid: 19136215
references.citation: Radiographics. 2009 Sep-Oct;29(5):1433-49
references.pmid: 19755604
references.citation: Eur J Nucl Med Mol Imaging. 2010 Jan;37(1):181-200
references.pmid: 19915839
references.citation: AJR Am J Roentgenol. 2010 Apr;194(4):W316-22
references.pmid: 20308476
references.citation: Clin Ther. 2010 Mar;32(3):437-53
references.pmid: 20399983
references.citation: Eur J Nucl Med Mol Imaging. 2010 Nov;37(11):2011-20
references.pmid: 20607535
references.citation: NMR Biomed. 2010 Aug;23(7):661-81
references.pmid: 20886562
references.citation: Radiology. 2010 Dec;257(3):643-52
references.pmid: 20858850
references.citation: J Nucl Med. 2010 Dec;51(12):1870-7
references.pmid: 21078791
references.citation: Magn Reson Imaging. 2011 Feb;29(2):153-9
references.pmid: 21129879
references.citation: Radiology. 2011 May;259(2):453-61
references.pmid: 21502392
references.citation: Hepatogastroenterology. 2011 Sep-Oct;58(110-111):1495-501
references.pmid: 21940314
references.citation: Ann Oncol. 2012 Jul;23(7):1687-93
references.pmid: 22112970
references.citation: Br J Cancer. 2012 Jun 5;106(12):1926-33
references.pmid: 22596235
references.citation: Crit Rev Oncol Hematol. 2012 Aug;83(2):194-207
references.pmid: 22269446
references.citation: Surg Oncol. 2012 Dec;21(4):309-15
references.pmid: 22884035
references.citation: Nucl Med Commun. 2014 May;35(5):472-7
references.pmid: 24509519
references.citation: Br J Cancer. 2002 Oct 7;87(8):868-75
references.pmid: 12373601
references.citation: J Natl Cancer Inst. 2000 Feb 2;92(3):205-16
references.pmid: 10655437
references.citation: Contrast Media Mol Imaging. 2014 May-Jun;9(3):237-45
references.pmid: 24700751
references.citation: J Nucl Med. 2004 Sep;45(9):1480-7
references.pmid: 15347714
references.citation: J Clin Oncol. 1996 Mar;14(3):700-8
references.pmid: 8622014
references.citation: Ann Surg. 2006 Aug;244(2):254-9
references.pmid: 16858188
references.citation: Ann Oncol. 2006 Nov;17(11):1650-5
references.pmid: 16936185
references.citation: AJR Am J Roentgenol. 2007 Jun;188(6):1622-35
references.pmid: 17515386