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Skrip LM, Moosburner S, Tang P, Guo J, Görner S, Tzschätzsch H, Brüggemann K, Walter KA, Hosse C, Fehrenbach U, Arnold A, Modest D, Krenzien F, Schöning W, Malinka T, Pratschke J, Papke B, Käs JA, Sack I, Sauer IM, Hillebrandt KH. Viscoelastic properties of colorectal liver metastases reflect tumour cell viability. J Transl Med 2024; 22:774. [PMID: 39152426 PMCID: PMC11328469 DOI: 10.1186/s12967-024-05559-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Colorectal cancer is the third most common tumour entity in the world and up to 50% of the patients develop liver metastases (CRLM) within five years. To improve and personalize therapeutic strategies, new diagnostic tools are urgently needed. For instance, biomechanical tumour properties measured by magnetic resonance elastography (MRE) could be implemented as such a diagnostic tool. We postulate that ex vivo MRE combined with histological and radiological evaluation of CRLM could provide biomechanics-based diagnostic markers for cell viability in tumours. METHODS 34 CRLM specimens from patients who had undergone hepatic resection were studied using ex vivo MRE in a frequency range from 500 Hz to 5300 Hz with increments of 400 Hz. Single frequency evaluation of shear wave speed and wave penetration rate as proxies for stiffness and viscosity was performed, along with rheological model fitting based on the spring-pot model and powerlaw exponent α, ranging between 0 (complete solid behaviour) and 1 (complete fluid behaviour). For histological analysis, samples were stained with H&E and categorized according to the degree of regression. Quantitative histologic analysis was performed to analyse nucleus size, aspect ratio, and density. Radiological response was assessed according to RECIST-criteria. RESULTS Five samples showed major response to chemotherapy, six samples partial response and 23 samples no response. For higher frequencies (> 2100 Hz), shear wave speed correlated significantly with the degree of regression (p ≤ 0.05) indicating stiffer properties with less viable tumour cells. Correspondingly, rheological analysis of α revealed more elastic-solid tissue properties at low cell viability and major response (α = 0.43 IQR 0.36, 0.47) than at higher cell viability and no response (α = 0.51 IQR 0.48, 0.55; p = 0.03). Quantitative histological analysis showed a decreased nuclear area and density as well as a higher nuclear aspect ratio in patients with major response to treatment compared to patients with no response (all p < 0.05). DISCUSSION Our results suggest that MRE could be useful in the characterization of biomechanical property changes associated with cell viability in CRLM. In the future, MRE could be applied in clinical diagnosis to support individually tailored therapy plans for patients with CRLM.
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Affiliation(s)
- Lisa-Marie Skrip
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Simon Moosburner
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Berlin, Germany
| | - Peter Tang
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jing Guo
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Steffen Görner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Heiko Tzschätzsch
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kristin Brüggemann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kilian Alexander Walter
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Clarissa Hosse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander Arnold
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dominik Modest
- Department of Hematology, Oncology, and Cancer Immunology (CVK/CCM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Malinka
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Björn Papke
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Josef A Käs
- Soft Matter Physics Division, Peter Debye Institute for Soft Matter Physics, University of Leipzig, Leipzig, Germany
| | - Ingolf Sack
- Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Karl H Hillebrandt
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Berlin, Germany
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2
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van Ewijk R, Chatziantoniou C, Adams M, Bertolini P, Bisogno G, Bouhamama A, Caro-Dominguez P, Charon V, Coma A, Dandis R, Devalck C, De Donno G, Ferrari A, Fiocco M, Gallego S, Giraudo C, Glosli H, Ter Horst SAJ, Jenney M, Klein WM, Leemans A, Leseur J, Mandeville HC, McHugh K, Merks JHM, Minard-Colin V, Moalla S, Morosi C, Orbach D, Ording Muller LS, Pace E, Di Paolo PL, Perruccio K, Quaglietta L, Renard M, van Rijn RR, Ruggiero A, Sirvent SI, De Luca A, Schoot RA. Quantitative diffusion-weighted MRI response assessment in rhabdomyosarcoma: an international retrospective study on behalf of the European paediatric Soft tissue sarcoma Study Group Imaging Committee. Pediatr Radiol 2023; 53:2539-2551. [PMID: 37682330 PMCID: PMC10635937 DOI: 10.1007/s00247-023-05745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To investigate the feasibility of diffusion-weighted magnetic resonance imaging (DW-MRI) as a predictive imaging marker after neoadjuvant chemotherapy in patients with rhabdomyosarcoma. MATERIAL AND METHODS We performed a multicenter retrospective study including pediatric, adolescent and young adult patients with rhabdomyosarcoma, Intergroup Rhabdomyosarcoma Study group III/IV, treated according to the European paediatric Soft tissue sarcoma Study Group (EpSSG) RMS2005 or MTS2008 studies. DW-MRI was performed according to institutional protocols. We performed two-dimensional single-slice tumor delineation. Areas of necrosis or hemorrhage were delineated to be excluded in the primary analysis. Mean, median and 5th and 95th apparent diffusion coefficient (ADC) were extracted. RESULTS Of 134 included patients, 82 had measurable tumor at diagnosis and response and DW-MRI scans of adequate quality and were included in the analysis. Technical heterogeneity in scan acquisition protocols and scanners was observed. Mean ADC at diagnosis was 1.1 (95% confidence interval [CI]: 1.1-1.2) (all ADC expressed in * 10-3 mm2/s), versus 1.6 (1.5-1.6) at response assessment. The 5th percentile ADC was 0.8 (0.7-0.9) at diagnosis and 1.1 (1.0-1.2) at response. Absolute change in mean ADC after neoadjuvant chemotherapy was 0.4 (0.3-0.5). Exploratory analyses for association between ADC and clinical parameters showed a significant difference in mean ADC at diagnosis for alveolar versus embryonal histology. Landmark analysis at nine weeks after the date of diagnosis showed no significant association (hazard ratio 1.3 [0.6-3.2]) between the mean ADC change and event-free survival. CONCLUSION A significant change in the 5th percentile and the mean ADC after chemotherapy was observed. Strong heterogeneity was identified in DW-MRI acquisition protocols between centers and in individual patients.
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Affiliation(s)
- Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Cyrano Chatziantoniou
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands
| | - Madeleine Adams
- Department of Paediatric Oncology, Children's Hospital for Wales, University Hospital, Cardiff, UK
| | - Patrizia Bertolini
- Pediatric Hematology-Oncology Unit University-Hospital of Parma, Parma, Italy
| | - Gianni Bisogno
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy
| | - Amine Bouhamama
- Service de Radiologie Interventionnelle Oncologique, Centre Léon Bérard, Lyon, France
| | - Pablo Caro-Dominguez
- Pediatric Radiology Unit, Department of Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot S/N, Seville, Spain
| | | | - Ana Coma
- Paediatric Radiology Unit, Vall d´Hebron Hospital Campus, Barcelona, Spain
| | - Rana Dandis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | | | - Giulia De Donno
- Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Soledad Gallego
- Pediatric Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Chiara Giraudo
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine-DIMED, University of Padova, 35122, Padua, Italy
| | - Heidi Glosli
- Department of Paediatric Research, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Simone A J Ter Horst
- Department of Radiology and Nuclear Medicine, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Meriel Jenney
- Paediatric Oncology, Cardiff and Vale UHB, Cardiff, UK
| | - Willemijn M Klein
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Julie Leseur
- Service de Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - Henry C Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
| | - Kieran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Salma Moalla
- Department of Imaging, Institut Gustave Roussy, Villejuif, France
| | - Carlo Morosi
- Diagnostic and Interventional Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA With Cancer), Institut Curie, PSL Research University, Paris, France
| | - Lil-Sofie Ording Muller
- Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University Hospital, Ullevål, Norway
| | - Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Pier Luigi Di Paolo
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Katia Perruccio
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria, Ospedale Santa Maria Della Misericordia, Perugia, Italy
| | - Lucia Quaglietta
- Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Marleen Renard
- Department of Paediatric Hemato-Oncology, University Hospital Leuven, Louvain, Belgium
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara I Sirvent
- Pediatric Radiology Department, Hospital Niño Jesús, Madrid, Spain
| | - Alberto De Luca
- Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands
- Department of Neurology, UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Jackson A, Pathak R, deSouza NM, Liu Y, Jacobs BKM, Litiere S, Urbanowicz-Nijaki M, Julie C, Chiti A, Theysohn J, Ayuso JR, Stroobants S, Waterton JC. MRI Apparent Diffusion Coefficient (ADC) as a Biomarker of Tumour Response: Imaging-Pathology Correlation in Patients with Hepatic Metastases from Colorectal Cancer (EORTC 1423). Cancers (Basel) 2023; 15:3580. [PMID: 37509240 PMCID: PMC10377224 DOI: 10.3390/cancers15143580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Background: Tumour apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (MRI) is a putative pharmacodynamic/response biomarker but the relationship between drug-induced effects on the ADC and on the underlying pathology has not been adequately defined. Hypothesis: Changes in ADC during early chemotherapy reflect underlying histological markers of tumour response as measured by tumour regression grade (TRG). Methods: Twenty-six patients were enrolled in the study. Baseline, 14 days, and pre-surgery MRI were performed per study protocol. Surgical resection was performed in 23 of the enrolled patients; imaging-pathological correlation was obtained from 39 lesions from 21 patients. Results: There was no evidence of correlation between TRG and ADC changes at day 14 (study primary endpoint), and no significant correlation with other ADC metrics. In scans acquired one week prior to surgery, there was no significant correlation between ADC metrics and percentage of viable tumour, percentage necrosis, percentage fibrosis, or Ki67 index. Conclusions: Our hypothesis was not supported by the data. The lack of meaningful correlation between change in ADC and TRG is a robust finding which is not explained by variability or small sample size. Change in ADC is not a proxy for TRG in metastatic colorectal cancer.
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Affiliation(s)
- Alan Jackson
- Centre for Imaging Sciences, University of Manchester, Manchester M20 4GJ, UK
| | - Ryan Pathak
- Centre for Imaging Sciences, University of Manchester, Manchester M20 4GJ, UK
| | - Nandita M deSouza
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, London SW7 3RP, UK
| | - Yan Liu
- European Organisation for Research and Treatment of Cancer, 1200 Brussels, Belgium
| | - Bart K M Jacobs
- European Organisation for Research and Treatment of Cancer, 1200 Brussels, Belgium
| | - Saskia Litiere
- European Organisation for Research and Treatment of Cancer, 1200 Brussels, Belgium
| | | | - Catherine Julie
- EA 4340 BECCOH, UVSQ, Universite Paris-Saclay, 92104 Boulogne-Billancourt, France
- Department of Pathology, APHP-Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Arturo Chiti
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Bio-Medical Sciences, Humanitas University, 20072 Milan, Italy
| | - Jens Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - Juan R Ayuso
- Radiology Department-CDI, Hospital Clinic Universitari de Barcelona, 08036 Barcelona, Spain
| | - Sigrid Stroobants
- Molecular Imaging and Radiology, University of Antwerp, 2000 Antwerp, Belgium
| | - John C Waterton
- Centre for Imaging Sciences, University of Manchester, Manchester M20 4GJ, UK
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Sobeh T, Inbar Y, Apter S, Soffer S, Anteby R, Kraus M, Konen E, Klang E. Diffusion-weighted MRI for predicting and assessing treatment response of liver metastases from CRC - A systematic review and meta-analysis. Eur J Radiol 2023; 163:110810. [PMID: 37075628 DOI: 10.1016/j.ejrad.2023.110810] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
The evaluation of response to chemotherapy and targeted therapies in colorectal liver metastases has traditionally been based on size changes, as per the RECIST criteria. However, therapy may alter tissue composition and not only tumor size, therefore, functional imaging techniques such as diffusion-weighted magnetic resonance imaging (DWI) may offer a more comprehensive assessment of treatment response. The aim of this systematic review and meta-analysis was to evaluate the use of DWI in the prediction and assessment of response to treatment in colorectal liver metastases and to determine if there is a baseline apparent diffusion coefficient (ADC) cut-off value that can predict a favorable response. A literature search was conducted using the MEDLINE/PubMed database, and risk of bias was evaluated using the QUADAS-2 tool. The mean differences between responders and non-responders were pooled. A total of 16 studies met the inclusion criteria, and various diffusion-derived techniques and coefficients were found to have potential for predicting and assessing treatment response. However, discrepancies were noted between studies. The most consistent predictor of response was a lower baseline ADC value calculated using traditional mono-exponential methods. Non-mono-exponential techniques for calculating DWI-derived parameters were also reported. A meta-analysis of a subset of studies failed to establish a cut-off value of ADC due to heterogeneity, but revealed a pooled mean difference of -0.12 × 10-3 mm2/s between responders and non-responders. The results of this systematic review suggest that diffusion-derived techniques and coefficients may contribute to the evaluation and prediction of treatment response in colorectal liver metastases. Further controlled prospective studies are needed to confirm these findings and to guide clinical and radiological decision-making in the management of patients with CRC liver metastases.
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Affiliation(s)
- Tamer Sobeh
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yael Inbar
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Apter
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel; Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Roi Anteby
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of General Surgery, Sheba Medical Center at Tel HaShomer, Israel
| | - Matan Kraus
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Eriksson S, Bengtsson J, Torén W, Lätt J, Andersson R, Sturesson C. Changes in apparent diffusion coefficient and pathological response in colorectal liver metastases after preoperative chemotherapy. Acta Radiol 2023; 64:51-57. [PMID: 35084232 DOI: 10.1177/02841851221074496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The pathological response to preoperative chemotherapy of colorectal liver metastases (CRLMs) is predictive of long-term prognosis after liver resection. Accurate preoperative assessment of chemotherapy response could enable treatment optimization. PURPOSE To investigate whether changes in lesion-apparent diffusion coefficient (ADC) measured with diffusion-weighted magnetic resonance imaging (MRI) can be used to assess pathological treatment response in patients with CRLMs undergoing preoperative chemotherapy. MATERIAL AND METHODS Patients who underwent liver resection for CRLMs after preoperative chemotherapy between January 2011 and December 2019 were retrospectively included if they had undergone MRI before and after preoperative chemotherapy on the same 1.5-T MRI scanner with diffusion-weighted imaging with b-values 50, 400, and 800 s/mm2. The pathological chemotherapy response was assessed using the tumor regression grade (TRG) by AJCC/CAP. Lesions were divided into two groups: pathological responding (TRG 0-2) and non-responding (TRG 3). The change in lesion ADC after preoperative chemotherapy was compared between responding and non-responding lesions. RESULTS A total of 27 patients with 49 CRLMs were included, and 24/49 lesions showed a pathological chemotherapy response. After chemotherapy, ADC increased in both pathological responding (pretreatment ADC: 1.26 [95% confidence interval (CI)=1.06-1.37] vs. post-treatment ADC: 1.33 [95% CI=1.13-1.56] × 10-3 mm2/s; P = 0.026) and non-responding lesions (1.12 [95% CI=0.980-1.21] vs. 1.20 [95% CI=1.09-1.43] × 10-3 mm2/s; P = 0.018). There was no difference in median relative difference in ADC after chemotherapy between pathological responding and non-responding lesions (15.8 [95% CI=1.42-26.3] vs. 7.17 [95% CI=-4.31 to 31.2]%; P = 0.795). CONCLUSION Changes in CRLM ADCs did not differ between pathological responding and non-responding lesions.
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Affiliation(s)
- Sam Eriksson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
| | - Johan Bengtsson
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - William Torén
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Jimmy Lätt
- Center for Medical Imaging and Physiology, Skane University Hospital, Lund, Sweden
| | - Roland Andersson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Christian Sturesson
- Surgery, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Dynamic contrast-enhanced and diffusion-weighted MR imaging in early prediction of pathologic response to neoadjuvant chemotherapy in locally advanced gastric cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3394-3405. [PMID: 35916943 DOI: 10.1007/s00261-022-03623-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the efficacy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the early prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC). METHODS Fifty patients with LAGC who were treated with NAC followed by radical gastrectomy were enrolled. Uncontrasted and DCE-MRI were performed within 1 week before NAC. According to tumor regression grading (TRG), patients were labeled as responders (TRG = 0 + 1) and non-responders (TRG = 2 + 3). Apparent diffusion coefficients (ADC) and DCE-MRI kinetics (Ktrans, Ve, and Kep) were compared between the two groups. Logistic regression analysis was performed to screen independent factors to predict the NAC efficacy. The relationship between MRI parameters and TRG was studied by Spearman's correlation analysis. Receiver-operating characteristic curve analyses were applied to evaluate the efficacy. RESULTS ADC, Ktrans, and Kep values were higher in responders than in non-responders (p < 0.05) and correlated with TRG (p < 0.05). The ADC and Kep values were independent markers for predicting TRG. The area under the curve, sensitivities, specificities of ADC, Ktrans, Kep, and ADC + Kep were 0.813, 0.699, 0.709, 0.886;73.64%, 65.54%, 63.21%, 70.37%; 86.47%, 54.97%, 79.47%, 95.65%; respectively. ADC + Kep demonstrated a higher efficacy than Ktrans and Kep (p = 0.012, 0.011), but without improvement compared with ADC (p > 0.05). CONCLUSION Both DWI and DCE-MRI can effectively predict the pathologic response to NAC in LAGC. A combination of ADC and Kep increased the efficacy, and ADC is the most valuable imaging parameter.
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Germani MM, Borelli B, Boraschi P, Antoniotti C, Ugolini C, Urbani L, Morelli L, Fontanini G, Masi G, Cremolini C, Moretto R. The management of colorectal liver metastases amenable of surgical resection: How to shape treatment strategies according to clinical, radiological, pathological and molecular features. Cancer Treat Rev 2022; 106:102382. [PMID: 35334281 DOI: 10.1016/j.ctrv.2022.102382] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 02/05/2023]
Abstract
Metastatic colorectal cancer (mCRC) patients have poor chances of long term survival, being < 15% of them still alive after 5 years from diagnosis. Nonetheless, patients with colorectal liver metastases (CRLM) may be eligible for metastases resection thus being able to achieve long-term disease remission and survival. The likelihood for patients with CRLM of being or becoming eligible for liver metastasectomy is increasing, thanks to the evolution of surgical techniques, the availability of active systemic treatments and the widespread diffusion of experienced multidisciplinary boards to manage these patients. However, disease relapse after liver surgery is common and occurs in two-thirds of resected patients. Therefore, adequate radiological staging and risk stratification is crucial for the optimal selection of patients candidate to surgery in order to maximize the benefit-risk ratio of liver metastasectomy and to individualize the treatment strategy. Based on the multidimensional assessment, three possible approaches are available: upfront liver surgery followed by adjuvant chemotherapy, perioperative chemotherapy preceding and following liver surgery, and an upfront systemic treatment including chemotherapy plus a targeted agent, both chosen according to patients' and tumours' characteristics, then followed by liver surgery if indicated. In this review, we describe the most important factors impacting the therapeutic choices in patients with resectable and potentially resectable CRLM, and we discuss the most promising factors that may reshape the future decision-making process of these patients.
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Affiliation(s)
- Marco Maria Germani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Beatrice Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Piero Boraschi
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lucio Urbani
- Unit of General Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Luca Morelli
- General Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
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8
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Donati F, Casini C, Cervelli R, Morganti R, Boraschi P. Diffusion-weighted MRI of solid pancreatic lesions: Comparison between reduced field-of-view and large field-of-view sequences. Eur J Radiol 2021; 143:109936. [PMID: 34464906 DOI: 10.1016/j.ejrad.2021.109936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/14/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the image quality, presence of artifacts and apparent diffusion coefficient (ADC) values of reduced field-of-view (rFOV) and large FOV (lFOV) single-shot spin-echo echo-planar diffusion-weighted imaging (DWI) in the evaluation of solid pancreatic lesion. METHOD The 3T MR examinations of 60 patients with solid pancreatic lesions were examined. Two Readers independently performed qualitative analysis and quantitative measurements of the ADC values of the solid pancreatic lesions in both rFOV and lFOV DWI sequence. The qualitative analysis parameters included: 1) Sharpness, 2) Distortion, Ghosting, Motion and Susceptibility artifacts, 3) Lesion Conspicuity and 4) Overall Image Quality. These parameters were evaluated using a 4-point scale. The T-test for paired data was used to compare qualitative scores and the ADC values of the rFOV and lFOV DWI sequences, and to assess inter-reader agreement. RESULTS The qualitative analysis yielded scores for the rFOV DWI sequence, which were better for sharpness, artifacts, and overall image quality as compared to the lFOV DWI sequence according to the only Reader 2 (the most experienced) (p ≤ 0.001). As to lesion conspicuity, no significant difference was found by either Reader (p ≥ 0.245). As to quantitative analysis, both Readers found no significant difference between the two sequences in the ADC values of various solid pancreatic lesions (p ≥ 0.156). CONCLUSIONS The rFOV DWI sequence of the pancreas provides better anatomic structure visualization, reduced artifacts, and better overall image quality as compared to the lFOV DWI sequence according to the Reader with the more experience in abdominal MRI. The ADC values were not significantly different in the two sequences. The rFOV DWI sequence could be included in the standard MRI protocol for the pancreas.
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Affiliation(s)
- Francescamaria Donati
- Department of Diagnostic Imaging - Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Chiara Casini
- Diagnostic and Interventional Radiology - University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Rosa Cervelli
- Diagnostic and Interventional Radiology - University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Riccardo Morganti
- Departmental Section of Statistical Support for Clinical Trials - Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Piero Boraschi
- Department of Diagnostic Imaging - Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
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9
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Uutela A, Ovissi A, Hakkarainen A, Ristimäki A, Lundbom N, Kallio R, Soveri LM, Salminen T, Ålgars A, Halonen P, Ristamäki R, Nordin A, Blanco Sequeiros R, Rinta-Kiikka I, Lantto E, Virtanen J, Pääkkö E, Liukkonen E, Saunavaara J, Ryymin P, Lammentausta E, Osterlund P, Isoniemi H. Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy: a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and 1H-MR spectroscopy compared with histology (subgroup in the RAXO trial). ESMO Open 2021; 6:100208. [PMID: 34325107 PMCID: PMC8332656 DOI: 10.1016/j.esmoop.2021.100208] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer liver metastases respond to chemotherapy and targeted agents not only by shrinking, but also by morphologic and metabolic changes. The aim of this study was to evaluate the value of advanced magnetic resonance imaging (MRI) methods in predicting treatment response and survival. PATIENTS AND METHODS We investigated contrast-enhanced MRI, apparent diffusion coefficient (ADC) in diffusion-weighted imaging and 1H-magnetic resonance spectroscopy (1H-MRS) in detecting early morphologic and metabolic changes in borderline or resectable liver metastases, as a response to first-line neoadjuvant or conversion therapy in a prospective substudy of the RAXO trial (NCT01531621, EudraCT2011-003158-24). MRI findings were compared with histology of resected liver metastases and Kaplan-Meier estimates of overall survival (OS). RESULTS In 2012-2018, 52 patients at four Finnish university hospitals were recruited. Forty-seven patients received neoadjuvant or conversion chemotherapy and 40 liver resections were carried out. Low ADC values (below median) of the representative liver metastases, at baseline and after systemic therapy, were associated with partial response according to RECIST criteria, but not with morphologic MRI changes or histology. Decreasing ADC values following systemic therapy were associated with improved OS compared to unchanged or increasing ADC, both in the liver resected subgroup (5-year OS rate 100% and 34%, respectively, P = 0.022) and systemic therapy subgroup (5-year OS rate 62% and 23%, P = 0.049). 1H-MRS revealed steatohepatosis induced by systemic therapy. CONCLUSIONS Low ADC values at baseline or during systemic therapy were associated with treatment response by RECIST but not with histology, morphologic or detectable metabolic changes. A decreasing ADC during systemic therapy is associated with improved OS both in all patients receiving systemic therapy and in the resected subgroup.
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Affiliation(s)
- A Uutela
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Ovissi
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Hakkarainen
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Helsinki, Finland
| | - A Ristimäki
- Department of Pathology, HUS Diagnostic Centre and Applied Tumour Genomics, Research Programs Unit, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - N Lundbom
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Kallio
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - L M Soveri
- Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, Home Care Geriatric Clinic and Palliative Care, Hyvinkää, Finland
| | - T Salminen
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - A Ålgars
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Halonen
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - R Ristamäki
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - A Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Blanco Sequeiros
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland; Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - I Rinta-Kiikka
- Department of Radiology, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Medical Physics, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland
| | - E Lantto
- Department of Radiology, Päijät-Häme Central Hospital, Lahti, Finland
| | - J Virtanen
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - E Pääkkö
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - E Liukkonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - J Saunavaara
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Ryymin
- Department of Radiology, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Medical Physics, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland
| | - E Lammentausta
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - P Osterlund
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland; Department of Pathology/Oncology, Karolinska Institutet and Karolinska sjukhuset - Tema Cancer, Stockholm, Sweden.
| | - H Isoniemi
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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10
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Zhu HB, Xu D, Ye M, Sun L, Zhang XY, Li XT, Nie P, Xing BC, Sun YS. Deep learning-assisted magnetic resonance imaging prediction of tumor response to chemotherapy in patients with colorectal liver metastases. Int J Cancer 2021; 148:1717-1730. [PMID: 33284998 DOI: 10.1002/ijc.33427] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/03/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
Accurate evaluation of tumor response to preoperative chemotherapy is crucial for assigning appropriate patients with colorectal liver metastases (CRLM) to surgery or conservative therapy. However, there is no well-recognized method for predicting pathological response before surgery. Our study constructed and validated a deep learning algorithm using prechemotherapy and postchemotherapy magnetic resonance imaging (MRI) to predict pathological response in CRLM. CRLM patients from center one who had ≤5 lesions and were scheduled to receive preoperative chemotherapy followed by liver resection between January 2013 and November 2016, were included prospectively and chronologically divided into a training cohort (80% of patients) and a testing cohort (20% of patients). Patients from center two were included January 2017 and December 2018 as an external validation cohort. MRI-based models were constructed to discriminate according to pathology tumor regression grade (TRG) between the response (TRG1/2) and nonresponse (TRG3/4/5) groups at the lesion level. From center one, 155 patients (328 lesions) were included; chronologically, 101 (264 lesions) in the training cohort and 54 (64 lesions) in the testing cohort. The model achieved better accuracy (0.875 vs 0.578) and AUC (0.849 vs 0.615) than RECIST for discriminating response; it also distinguished the survival outcomes after hepatectomy better than the RECIST criteria. Evaluations of the external validation cohort (25 patients, 61 lesions) also showed good ability with an AUC of 0.833. In conclusion, the MRI-based deep learning model provided accurate prediction of pathological tumor response to preoperative chemotherapy in patients with CRLM and may inform individualized treatment.
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Affiliation(s)
- Hai-Bin Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Da Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng Ye
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Li Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Pei Nie
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bao-Cai Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
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11
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Boraschi P, Donati F, Cervelli R, Pacciardi F, Tarantini G, Castagna M, Urbani L, Lencioni R. Colorectal liver metastases: ADC as an imaging biomarker of tumor behavior and therapeutic response. Eur J Radiol 2021; 137:109609. [PMID: 33647779 DOI: 10.1016/j.ejrad.2021.109609] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To correlate the ADC values of colorectal liver metastases, evaluated before (preADC) and after (postADC) neoadjuvant chemotherapy (ChT), as well as their difference (ΔADC), with the histological tumor regression grade (TRG) and to determine whether the preADC value can be predictive of the lesion ChT response. METHOD Twenty-four patients with colorectal liver metastases, who had undergone 3 T-MRI before and after ChT and were subsequently treated by parenchymal-spearing surgery, were retrospectively included. Diffusion-weighted MRI (DW-MRI) was performed using a spin-echo echo-planar sequence with multiple b values, obtaining an ADC map. Fitted ADC values were calculated for each lesion before and after ChT. The maximum diameter of each lesion in both examinations was recorded. Diameter variations and RECIST1.1 criteria were assessed. All MRI findings were histopathologically correlated to TRG of resected liver metastases. Statistical analysis was performed on a per-lesion basis. RESULTS A total of 58 colorectal liver metastases were analysed; after ChT, 8 out of 58 lesions disappeared. TRG1, TRG2, TRG3, TRG4 and TRG5 were observed in 6, 12, 12, 13 and 7 lesions, respectively. The preADC values showed a different distribution according to the TRG scores (p = 0.0027), even though the distribution was not linear. The postADC and ΔADC values were significant different based on the TRG system (both p < 0.0001). A significant correlation between the lesion TRG and the evaluation according to RECIST1.1 criteria was observed by a per-lesion analysis (p = 0.0009). CONCLUSIONS PostADC and ΔADC could be proposed as reliable biomarkers to assess tumor treatment response after preoperative ChT in patients with colorectal liver metastases.
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Affiliation(s)
- Piero Boraschi
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, Pisa, 56124, Italy.
| | - Francescamaria Donati
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, Pisa, 56124, Italy
| | - Rosa Cervelli
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - Federica Pacciardi
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, Pisa, 56124, Italy
| | - Gaia Tarantini
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - Maura Castagna
- Unit of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa, 56126, Italy
| | - Lucio Urbani
- Department of General Surgery, Pisa University Hospital, Via Paradisa 2, Pisa, 56124, Italy
| | - Riccardo Lencioni
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
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12
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Xu D, Yan XL, Liu JM, Li J, Xing BC. The characteristics and long-term survival of patients with colorectal liver metastases with pathological complete response after chemotherapy. J Cancer 2020; 11:6256-6263. [PMID: 33033509 PMCID: PMC7532511 DOI: 10.7150/jca.47911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/13/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose: Preoperative chemotherapy is widely used for colorectal liver metastasis (CRLM). Pathological complete response (PCR) after chemotherapy indicates complete tumor regression and an extremely favorable prognosis. This study aimed to explore the characteristics and long-term survival of CRLM patients with pCR, who underwent surgery after preoperative chemotherapy. Methods: We retrospectively analyzed the clinical data of 494 CRLM patients who underwent hepatectomy after preoperative chemotherapy between January 2006 and January 2019. pCR was defined as the absence of any cancer cells on pathological examination. Results: Thirty (6.07%) patients achieved pCR after preoperative chemotherapy; 70% patients who achieved pCR did not experience recurrence and were cured after hepatectomy. The long-term prognosis of patients with pCR was extremely favorable, with 10-year overall and disease-free survivals of 85.2% and 73.7%, respectively; these were significantly better than those of patients without pCR (31.3% and 15.2%, respectively). Liver metastases <3 cm, preoperative carcinoembryonic antigen level ≤20 ng/mL, primary T stage 1-2, and right-sided primary tumors were independent predictors for pCR. Conclusion: pCR occurred in 6% of patients with CRLM after preoperative chemotherapy. Patients with a smaller tumor burden are more likely to benefit from chemotherapy and achieve pCR.
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Affiliation(s)
- Da Xu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiao-Luan Yan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jia-Ming Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Juan Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Bao-Cai Xing
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
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13
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Song T, Yao Q, Qu J, Zhang H, Zhao Y, Qin J, Feng W, Zhang S, Han X, Wang S, Yan X, Li H. The value of intravoxel incoherent motion diffusion-weighted imaging in predicting the pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma. Eur Radiol 2020; 31:1391-1400. [PMID: 32901300 DOI: 10.1007/s00330-020-07248-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/05/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the prediction of pathologic response to neoadjuvant chemotherapy (NAC) in locally advanced esophageal squamous cell carcinoma (ESCC). MATERIAL AND METHODS Forty patients with locally advanced ESCC who were treated with NAC followed by radical resection were prospectively enrolled from September 2015 to May 2018. MRI and IVIM were performed within 1 week before and 2-3 weeks after NAC, prior to surgery. Parameters including apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), and pseudodiffusion fraction (f) before and after NAC were measured. Pathologic response was evaluated according to the AJCC tumor regression grade (TRG) system. The changes in IVIM values before and after therapy in different TRG groups were assessed. Receiver operating characteristic (ROC) curves analysis was used to determine the best cutoff value for predicting the pathologic response to NAC. RESULTS Twenty-two patients were identified as TRG 2 (responders), and eighteen as TRG 3 (non-responders) in pathologic evaluation. The ADC, D, and f values increased significantly after NAC. The post-NAC D and ΔD values of responders were significantly higher than those of non-responders. The area under the curve (AUC) was 0.722 for post-NAC D and 0.859 for ΔD in predicting pathologic response. The cutoff values of post-NAC D and ΔD were 1.685 × 10-3 mm2/s and 0.350 × 10-3 mm2/s, respectively. CONCLUSION IVIM-DWI may be used as an effective functional imaging technique to predict pathologic response to NAC in locally advanced ESCC. KEY POINTS • The optimal cutoff values of post-NAC D and ΔD for predicting pathologic response to NAC in locally advanced ESCC were 1.685 × 10-3 mm2/s and 0.350 × 10-3 mm2/s, respectively. • Pathologic response to NAC in locally advanced ESCC was favorable in patients with post-NAC D and ΔD values that were higher than the optimal cutoff values. • IVIM-DWI can potentially be used to preoperatively predict pathologic response to NAC in esophageal carcinoma. Accurate quantification of the D value derived from IVIM-DWI may eventually translate into an effective and non-invasive marker to predict therapeutic efficacy.
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Affiliation(s)
- Tao Song
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Qi Yao
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Jinrong Qu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China.
| | - Hongkai Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Yan Zhao
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Jianjun Qin
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Wen Feng
- Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Shouning Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Xianhua Han
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, XI'an, 710065, China
| | - Xu Yan
- MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China
| | - Hailiang Li
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
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14
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Paulatto L, Dioguardi Burgio M, Sartoris R, Beaufrère A, Cauchy F, Paradis V, Vilgrain V, Ronot M. Colorectal liver metastases: radiopathological correlation. Insights Imaging 2020; 11:99. [PMID: 32844319 PMCID: PMC7447704 DOI: 10.1186/s13244-020-00904-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
With the development of chemotherapy regimens, targeted therapies, and hepatic surgery, the survival of patients with colorectal liver metastases (CRLM) has dramatically improved. Imaging plays a central role for the diagnosis, staging, and treatment allocation in these patients. To interpret CRLM on imaging, radiologists must be familiar with the main imaging features of untreated tumors as well as the modifications induced by systemic therapies, and their meaning in relation to pathological tumor response and tumor biology. CRLM have the same histological features as the primary tumor. Most are “non-otherwise specified” (NOS) adenocarcinomas. The mucinous tumor is the most common of the rare subtypes. In NOS tumors, imaging usually differentiates central areas of necrosis from peripheral proliferating tumors and desmoplastic reaction. Areas of mucin mixed with fibrosis are seen in mucinous subtypes to help differentiate the metastases from other tumors cysts or hemangiomas. After treatment, the viable tumor is gradually replaced by ischemic-like necrosis and fibrosis, and remnants cells are mainly located on the periphery of tumors. Imaging can help predict the degree of tumor response, but changes can be difficult to differentiate from the pretherapeutic appearance. When chemotherapy is interrupted or in case of resistance to treatment, a peripheral infiltrating halo of tumor growth may appear. The purpose of the article is to illustrate the significance of the imaging features of colorectal liver metastases during systemic therapy, using radiopathological correlations.
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Affiliation(s)
- Luisa Paulatto
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France
| | - Marco Dioguardi Burgio
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Riccardo Sartoris
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Aurélie Beaufrère
- INSERM U1149, CRI, Paris, France.,Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France
| | - François Cauchy
- Department of HPB Surgery, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France
| | - Valérie Paradis
- INSERM U1149, CRI, Paris, France.,Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France. .,Université de Paris, Paris, France. .,INSERM U1149, CRI, Paris, France.
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15
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Zhang H, Li W, Fu C, Grimm R, Chen Z, Zhang W, Qiu L, Wang C, Zhang X, Yue L, Hu X, Guo W, Tong T. Comparison of intravoxel incoherent motion imaging, diffusion kurtosis imaging, and conventional DWI in predicting the chemotherapeutic response of colorectal liver metastases. Eur J Radiol 2020; 130:109149. [PMID: 32659615 DOI: 10.1016/j.ejrad.2020.109149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/04/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the usefulness and performance of intravoxel incoherent motion imaging (IVIM) with diffusion kurtosis imaging (DKI) and conventional DWI for predicting the chemotherapeutic response of colorectal liver metastases (CRLMs). METHOD A prospective study was conducted. Up to February 2018, forty consecutive patients treated with the standard first-line chemotherapy regimens were enrolled. MRI was performed within 1 week before chemotherapy, as well as 2-3 weeks and 6-8 weeks after chemotherapy. The apparent diffusion coefficient map, IVIM and DKI parameter maps were calculated using a prototype postprocessing software. The response was assessed by the Response Evaluation Criteria in Solid Tumors. The parameters were compared between the responding group (complete and partial response) and the nonresponding group (stable and progressive disease). RESULTS A total of 15 responding and 25 nonresponding patients were evaluated. Low baseline ADC, Dslow, and D values (P = 0.001, <0.001, and =0.003, respectively) and a high baseline K value (P = 0.002) were independently associated with a good response to chemotherapy. The combination of all the significant parameters yielded an AUC of 0.867. After treatment, the ADC, Dslow, and D values all showed an upward trend, while the K value showed a decreasing trend, but there were no significant differences (P > 0.05). CONCLUSION The study showed that the pretreatment IVIM (Dslow), DKI (D and K), and conventional DWI (ADC) parameters all demonstrated a good diagnostic performance in predicting the chemotherapeutic response of CRLMs.
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Affiliation(s)
- Huan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenhua Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany
| | - Zhiyu Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lixin Qiu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chenchen Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaowei Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Yue
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoxin Hu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijian Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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16
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Hazhirkarzar B, Khoshpouri P, Shaghaghi M, Ghasabeh MA, Pawlik TM, Kamel IR. Current state of the art imaging approaches for colorectal liver metastasis. Hepatobiliary Surg Nutr 2020; 9:35-48. [PMID: 32140477 DOI: 10.21037/hbsn.2019.05.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
One of the most common cancers worldwide, colorectal cancer (CRC) has been associated with significant morbidity and mortality and therefore represents an enormous burden to the health care system. Recent advances in CRC treatments have provided patients with primary and metastatic CRC a better long-term prognosis. The presence of synchronous or metachronous metastasis has been associated, however, with worse survival. The most common site of metastatic disease is the liver. A variety of treatment modalities aimed at targeting colorectal liver metastases (CRLM) has been demonstrated to improve the prognosis of these patients. Loco-regional approaches such as surgical resection and tumor ablation (operative and percutaneous) can provide patients with a chance at long-term disease control and even cure in select populations. Patient selection is important in defining the most suitable treatment option for CRLM in order to provide the best possible survival benefit while avoiding unnecessary interventions and adverse events. Medical imaging plays a crucial role in evaluating the characteristics of CRLMs and disease resectability. Size of tumors, proximity to adjacent anatomical structures, and volume of the unaffected liver are among the most important imaging parameters to determine the suitability of patients for surgical management or other appropriate treatment approaches. We herein provide a comprehensive overview of current-state-of-the-art imaging in the management of CRLM, including staging, treatment planning, response and survival assessment, and post-treatment surveillance. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are two most commonly used techniques, which can be used solely or in combination with functional imaging modalities such as positron emission tomography (PET) and diffusion weighted imaging (DWI). Providing up-to-date evidence on advantages and disadvantages of imaging modalities and tumor assessment criteria, the current review offers a practice guide to assist providers in choosing the most suitable imaging approach for patients with CRLM.
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Affiliation(s)
- Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounes Aliyari Ghasabeh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Szklaruk J, Son JB, Wei W, Bhosale P, Javadi S, Ma J. Comparison of free breathing and respiratory triggered diffusion-weighted imaging sequences for liver imaging. World J Radiol 2019; 11:134-143. [PMID: 31798795 PMCID: PMC6885723 DOI: 10.4329/wjr.v11.i11.134] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/26/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has become a useful tool in the detection, characterization, and evaluation of response to treatment of many cancers, including malignant liver lesions. DWI offers higher image contrast between lesions and normal liver tissue than other sequences. DWI images acquired at two or more b-values can be used to derive an apparent diffusion coefficient (ADC). DWI in the body has several technical challenges. This include ghosting artifacts, mis-registration and susceptibility artifacts. New DWI sequences have been developed to overcome some of these challenges. Our goal is to evaluate 3 new DWI sequences for liver imaging.
AIM To qualitatively and quantitatively compare 3 DWI sequences for liver imaging: free-breathing (FB), simultaneous multislice (SMS), and prospective acquisition correction (PACE).
METHODS Magnetic resonance imaging (MRI) was performed in 20 patients in this prospective study. The MR study included 3 separate DWI sequences: FB-DWI, SMS-DWI, and PACE-DWI. The image quality, mean ADC, standard deviations (SD) of ADC, and ADC histogram were compared. Wilcoxon signed-rank tests were used to compare qualitative image quality. A linear mixed model was used to compare the mean ADC and the SDs of the ADC values. All tests were 2-sided and P values of < 0.05 were considered statistically significant.
RESULTS There were 56 lesions (50 malignant) evaluated in this study. The mean qualitative image quality score of PACE-DWI was 4.48. This was significantly better than that of SMS-DWI (4.22) and FB-DWI (3.15) (P < 0.05). Quantitatively, the mean ADC values from the 3 different sequences did not significantly differ for each liver lesion. FB-DWI had a markedly higher variation in the SD of the ADC values than did SMS-DWI and PACE-DWI. We found statistically significant differences in the SDs of the ADC values for FB-DWI vs PACE-DWI (P < 0.0001) and for FB-DWI vs SMS-DWI (P = 0.03). The SD of the ADC values was not statistically significant for PACE-DWI and SMS-DWI (P = 0.18). The quality of the PACE-DWI ADC histograms were considered better than the SMS-DWI and FB-DWI.
CONCLUSION Compared to FB-DWI, both PACE-DWI and SMS-DWI provide better image quality and decreased quantitative variability in the measurement of ADC values of liver lesions.
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Affiliation(s)
- Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Wei Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Sanaz Javadi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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18
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Pöhler GH, Ringe KI. [Computed tomography and/or magnetic resonance imaging of the liver : How, why, what for?]. Radiologe 2019; 59:804-811. [PMID: 31414150 DOI: 10.1007/s00117-019-00583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CLINICAL PROBLEM Colorectal metastases are the most common malignant liver lesions. Imaging of the liver in patients with colorectal carcinoma is performed for early detection of liver metastases (CRLM) at the time of initial tumor diagnosis, for monitoring and follow-up in order to exclude or diagnose metachronous metastases. STANDARD RADIOLOGICAL METHODS Radiological imaging includes primarily multislice computed tomography (CT) and magnetic resonance imaging (MRI), which play an important role regarding therapeutic management and assessment of prognosis. PERFORMANCE, ACHIEVEMENTS Contrast-enhanced CT is broadly available and allows for rapid image acquisition including the possibility for complete tumor staging. MRI, on the other hand, is characterized by very good soft tissue contrast and has-especially with the use of diffusion-weighted imaging and administration of liver-specific contrast agents-the highest sensitivity for detection of metastases smaller than 1 cm. PRACTICAL RECOMMENDATIONS The choice of imaging in daily routine is often dependent on availability and clinical question. Frequently, e.g. for assessment of resectability (extent of metastases, anatomic relation of lesions to critical structures), both modalities may be implemented in combination.
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Affiliation(s)
- G H Pöhler
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K I Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland.
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19
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Alis D, Durmaz ESM, Gulsen F, Bas A, Kabasakal L, Sager S, Numan F. Prognostic value of ADC measurements in predicting overall survival in patients undergoing 90Y radioembolization for colorectal cancer liver metastases. Clin Imaging 2019; 57:124-130. [PMID: 31220677 DOI: 10.1016/j.clinimag.2019.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 05/06/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
Abstract
AIM To assess the ability of diffusion-weighted imaging (DWI) in predicting the overall survival in patients who underwent Yttrium 90 radioembolization (90Y-RE) for colorectal liver metastases (CLM) with other well-established clinical and imaging parameters by comparing the pre- and post-treatment apparent diffusion coefficient (ADC) values of the lesions. METHODS A total of 81 metastatic lesions of 27 consecutive patients who underwent DWI before and after the 90Y-RE session were enrolled in the study. ADC values were calculated from the entire (ADCe) and peripheral (ADCp) tumor on pre- and post-treatment DWI, and any relative increase in ADC >0% accepted as a functional imaging response. The impact of functional imaging response in addition to other well-known parameters including Response Evaluation Criteria in Solid Tumors (RECIST), hepatic tumor burden, Eastern Cooperative Oncology Group performance status (ECOG-PS) and the presence of extrahepatic metastases in predicting overall survival (OS) was assessed using Kaplan-Meier curves and Cox-regression analyses. RESULTS The median OS of the patients was 10 months (range, 6-20 months) while the median OS of the responders being significantly longer than the non-responders for ADCe and ADCp (median 11 vs 7 months, P = 0.003; median 12 vs. 7 months, P < 0.0001, respectively). The RECIST score was also significantly affected the OS (progressive or stable disease median 8 months vs. partial response 15 indent months, P = 0.019). The other parameters including hepatic tumor burden, gender, ECOG score, the involvement of the liver lobes, and the presence of extrahepatic metastases were not associated with the OS. In multivariate analysis, only ADCp remained as an independent predictor of OS (P = 0.003, HR = 19.878). CONCLUSION Any increase in relative ADCp or ADCe values after Y90-RE treatment was associated with longer OS in CLM patients, and DWI seems to be valuable imaging biomarker in predicting OS in CLM patients during the early post-interventional period after 90Y-RE.
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Affiliation(s)
- Deniz Alis
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
| | - Emine Sebnem Memis Durmaz
- Ministry of Health, Buyukcekmece Mimar Sinan Hospital, Buyukcekmece, Department of Radiology, Istanbul, Turkey
| | - Fatih Gulsen
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Interventional Radiology, Fatih, Istanbul, Turkey
| | - Ahmet Bas
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Interventional Radiology, Fatih, Istanbul, Turkey
| | - Levent Kabasakal
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Nuclear Medicine, Fatih, Istanbul, Turkey.
| | - Sait Sager
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Nuclear Medicine, Fatih, Istanbul, Turkey
| | - Furuzan Numan
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Interventional Radiology, Fatih, Istanbul, Turkey
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20
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Cong Q, Li G, Wang Y, Zhang S, Zhang H. DW-MRI for esophageal squamous cell carcinoma, correlations between ADC values with histologic differentiation and VEGF expression: A retrospective study. Oncol Lett 2019; 17:2770-2776. [PMID: 30854051 PMCID: PMC6365896 DOI: 10.3892/ol.2019.9934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 09/04/2018] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to assess the correlations between diffusion-weighted magnetic resonance imaging (DW-MRI) features with the histologic differentiation and the expression of vascular endothelial growth factor (VEGF) in esophageal squamous cell carcinoma (ESCC). A total of 52 patients with ESCC included in the present study received radiotherapy, and all patients underwent contrast enhanced MRI and DW-MRI prior to and following radiotherapy. The diffusion sensitivity coefficient (b value) was set as 800 s/mm2. Apparent diffusion coefficient (ADC) values were automatically computed. VEGF expression was evaluated by immunohistochemical staining. The results demonstrated that the pathological grading of ESCC was positively correlated with ADC values (r=0.635, P=0.0007), and the VEGF expression was inversely correlated with ADC values (r=−0.321, P=0.008). However, no correlation was identified between the pathological grading and the VEGF expression (r=0.178, P=0.284). All patients were categorized as complete response (CR) or partial response (PR) and the ADC values were increased significantly following radiotherapy. The mean ADC values in the CR group were higher than the PR group prior to radiotherapy (t=5.156, P=0.0004). Therefore, we concluded that the DWI with ADC value measurement may represent the grade of tumor histologic differentiation and the degree of VEGF expression, and may also serve as a useful marker to predict radiotherapy and anti-VEGF response in ESCC. ADC value may be a substitution for assessing tumor angiogenesis and novel prognostic factor and contribute to the treatment of ESCC.
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Affiliation(s)
- Qingxue Cong
- Department of Radiotherapy, Daqing Longnan Hospital, Daqing, Heilongjiang 163453, P.R. China.,Department of Radiotherapy, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Guang Li
- Department of Radiotherapy, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yongfeng Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Shanguo Zhang
- Department of Radiology, Daqing Longnan Hospital, Daqing, Heilongjiang 163453, P.R. China
| | - Hao Zhang
- Department of Oncology, Daqing Longnan Hospital, Daqing, Heilongjiang 163453, P.R. China
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21
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Granata V, Fusco R, Avallone A, Catalano O, Piccirillo M, Palaia R, Nasti G, Petrillo A, Izzo F. A radiologist's point of view in the presurgical and intraoperative setting of colorectal liver metastases. Future Oncol 2018; 14:2189-2206. [PMID: 30084273 DOI: 10.2217/fon-2018-0080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Multidisciplinary management of patients with metastatic colorectal cancer requires in each phase an adequate choice of the most appropriate imaging modality. The first challenging step is liver lesions detection and characterization, using several imaging modality ultrasound, computed tomography, magnetic resonance and positron emission tomography. The criteria to establish the metastases resectability have been modified. Not only the lesions number and site but also the functional volume remnant after surgery and the quality of the nontumoral liver must be taken into account. Radiologists should identify the liver functional volume remnant and during liver surgical procedures should collaborate with the surgeon to identify all lesions, including those that disappeared after the therapy, using intraoperative ultrasound with or without contrast medium.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Roberta Fusco
- Radiology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Antonio Avallone
- Abdominal Oncology Division, Istitutonazionale Tumori - IRCSS - Fondazione G Pascale, Napoli, Italia
| | - Orlando Catalano
- Radiology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Mauro Piccirillo
- Hepatobiliary Surgical Oncology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Guglielmo Nasti
- Abdominal Oncology Division, Istitutonazionale Tumori - IRCSS - Fondazione G Pascale, Napoli, Italia
| | - Antonella Petrillo
- Radiology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
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