Diffusion-weighted magnetic resonance imaging predicts survival in patients with liver-predominant metastatic colorectal cancer shortly after selective internal radiation therapy.
OBJECTIVE
To investigate whether quantifications of apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) can predict overall survival (OS) in patients with liver-predominant metastatic colorectal cancer (CRC) following selective internal radiation therapy with90Yttrium-microspheres (SIRT).


METHODS
Forty-four patients underwent DWI 19 ± 16 days before and 36 ± 10 days after SIRT. Tumour-size and intratumoral minimal ADC (minADC) values were measured for 132 liver metastases on baseline and follow-up DWI. Optimal functional imaging response to treatment was determined by receiver operating characteristics and defined as ≥22 % increase in post-therapeutic minADC. Survival analysis was performed with the Kaplan-Meier method and Cox-regression comparing various variables with potential impact on OS.


RESULTS
Median OS was 8 months. The following parameters were significantly associated with median OS: optimal functional imaging response (18 vs. 5 months; p < 0.001), hepatic tumour burden <50 % (8 vs. 5 months; p = 0.018), Eastern Cooperative Oncology Group performance scale <1 (10 vs. 4 months; p = 0.012) and progressive disease according to Response and Evaluation Criteria in Solid Tumours (8 vs. 3 months; p = 0.001). On multivariate analysis, optimal functional imaging response and hepatic tumour burden remained independent predictors of OS.


CONCLUSIONS
Functional imaging response assessment using minADC changes on DWI may predict survival in CRC shortly after SIRT.


CONCLUSIONS
• Relative minADC changes may predict survival in liver-predominant metastatic colorectal cancer following SIRT • Intratumoral minADC changes by ≥22 % were best to predict an improved overall survival • Functional imaging response assessment is feasible before anatomic tumour-size changes occur • minADC changes might guide future therapy management in sequential lobar radioembolization approaches.
Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany. Carsten.Schmeel@ukb.uni-bonn.de.
Frederic Carsten
FC
Schmeel
Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Birgit
B
Simon
Department of Nuclear Medicine, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.|Department of Nuclear Medicine, University Hospital Essen, Universität Duisburg-Essen, Essen, Germany.
Amir
A
Sabet
Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Julian Alexander
JA
Luetkens
Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Frank
F
Träber
Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Leonard Christopher
LC
Schmeel
Department of Nuclear Medicine, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.|Department of Nuclear Medicine, University Hospital Saarland, Universität des Saarlandes, Homburg, Germany.
Samer
S
Ezziddin
Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Hans Heinz
HH
Schild
Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Dariusch Reza
DR
Hadizadeh
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D015021:Yttrium Radioisotopes
Apparent diffusion coefficient; Colorectal cancer; Functional imaging; MRI; Radioembolization