title: Early Assessment of Colorectal Cancer Patients with Liver Metastases Treated with Antiangiogenic Drugs: The Role of Intravoxel Incoherent Motion in Diffusion-Weighted Imaging.
abstract: OBJECTIVE
  To assess the feasibility and effectiveness of quantitative intravoxel incoherent motion (IVIM) of Diffusion-weighted imaging (DWI) in the assessment of liver metastases treated with targeted chemotherapy agents.
  
  
  METHODS
  12 patients with unresectable liver metastases from colorectal cancer were enrolled and received neoadjuvant FOLFIRI (5-fluorouracil, leucovorin, irinotecan) plus bevacizumab therapy. DWI was performed for 36 metastases at baseline and after 14 days from starting the treatment. In addition to the basic IVIM metrics, the product between pseudo-diffusivity and perfusion fraction was considered as a descriptor roughly analogous to the flow. Median diffusion parameters of Region of Interest (ROI) were used as representative values for each lesion. Normalized parameters in comparison with the median value of spleen were also collected. The percentual change of the diffusion parameters was calculated. The response to chemotherapy was evaluated according the Response Evaluation Criteria in Solid Tumors (RECIST) as calculated on whole-body CT scan obtained three months after treatment. Mann Whitney test and Receiver operating characteristic (ROC) analysis were performed.
  
  
  RESULTS
  24 lesions were categorized as responding and 12 as not responding. There was no statistically significant difference among absolute and normalized diffusion parameters between the pretreatment and the post-treatment findings. Instead, the perfusion fraction (fp) values showed a statistical difference between responder and non-responder lesions: sensitivity and specificity of fp variation was 62% and 93%, respectively.
  
  
  CONCLUSIONS
  IVIM parameters represent a valuable tool in the evaluation of the anti-angiogenic therapy in patients with liver metastases from colorectal cancer. A percentage change of fp represents the most effective DWI marker in the assessment of tumor response.
authors.affiliation: Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Granata
authors.affiliation: Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Fusco
authors.affiliation: Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Orlando
authors.initials: O
authors.lastname: Catalano
authors.affiliation: Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Filice
authors.affiliation: Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Daniela Maria
authors.initials: DM
authors.lastname: Amato
authors.affiliation: Department of Abdominal Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Nasti
authors.affiliation: Department of Abdominal Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Avallone
authors.affiliation: Department of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Izzo
authors.affiliation: Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale, via Mariano Semmola, Naples, I-80131, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Petrillo
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D000068258:Bevacizumab / Q000627:therapeutic use; D002166:Camptothecin / Q000031:analogs & derivatives; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005472:Fluorouracil; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002955:Leucovorin; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009038:Motion; D009362:Neoplasm Metastasis; D010477:Perfusion; D012372:ROC Curve; D013154:Spleen / Q000473:pathology; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin