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Role of diffusion-weighted imaging in response prediction and evaluation after high dose rate brachytherapy in patients with colorectal liver metastases

Salma Karim
Salma Karim
, 
Ricarda Seidensticker
Ricarda Seidensticker
, 
Max Seidensticker
Max Seidensticker
, 
Jens Ricke
Jens Ricke
, 
Regina Schinner
Regina Schinner
, 
Karla Treitl
Karla Treitl
, 
Johannes Rübenthaler
Johannes Rübenthaler
, 
Maria Ingenerf
Maria Ingenerf
 oraz 
Christine Schmid-Tannwald
Christine Schmid-Tannwald
   | 21 lut 2024
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Article Category: Research Article
Data publikacji: 21 lut 2024
Zakres stron: 33 - 42
Otrzymano: 10 lis 2023
Przyjęty: 04 sty 2024
DOI: https://doi.org/10.2478/raon-2024-0017
Słowa kluczowe
© 2024 Salma Karim et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Flow diagram for this studyDWI = diffusion-weighted imaging; HDR-BT = high-dose-rate brachytherapy; NR-Mets = non-responding metastases; R-Mets = responding metastases; HDR-BT = high-dose-rate brachytherapy
Flow diagram for this studyDWI = diffusion-weighted imaging; HDR-BT = high-dose-rate brachytherapy; NR-Mets = non-responding metastases; R-Mets = responding metastases; HDR-BT = high-dose-rate brachytherapy

FIGURE 2.

Mean apparent diffusion coefficient (ADCmean) change in responding metastases (R-Mets) and NR-Mets between preinterventional MRI and first and second follow-up, respectivelyADC = apparent diffusion coefficient; NR-Mets = non-responding metastases, R-Mets = responding metastases
Mean apparent diffusion coefficient (ADCmean) change in responding metastases (R-Mets) and NR-Mets between preinterventional MRI and first and second follow-up, respectivelyADC = apparent diffusion coefficient; NR-Mets = non-responding metastases, R-Mets = responding metastases

FIGURE 3.

R-Met in a 62-year-old female. The pre-interventional diffusion-weighted imaging (DWI) shows two diffusion-restricted liver metastases with high signal on axial diffusion-weighted (DW)-MR image b = 800 s/mm2 (A) and low signal on apparent diffusion coefficient (ADC) map (B). The pre-interventional ADCmean of the metastases were 0.83 and 0.86 x 10−3 mm2/s. In the hepatobiliary phase (C) both metastases showed a hypointense signal. After high-dose-rate brachytherapy (HDR-BT), the metastases demonstrated a hyperintense signal on the axial DW-MR image (D) and a hyperintense signal on the ADC map (E) indicating less restricted diffusion compared to the pre-interventional image. The ADCmean increased to 1.41 and 1.53 x 10−3 mm2/s. in the hepatobiliary phase (F). The lesion showed central necrosis with a peripheral post-radiogenic hypointense rim. In the second follow-up the lesions showed no restricted diffusion (G) with a further increasing ADC (H) value of 2.09 and 2.07 x 10−3 mm2/s. There was a shrinkage in size of the metastases without a new hypointense defect in the hepatobiliary phase (I).
R-Met in a 62-year-old female. The pre-interventional diffusion-weighted imaging (DWI) shows two diffusion-restricted liver metastases with high signal on axial diffusion-weighted (DW)-MR image b = 800 s/mm2 (A) and low signal on apparent diffusion coefficient (ADC) map (B). The pre-interventional ADCmean of the metastases were 0.83 and 0.86 x 10−3 mm2/s. In the hepatobiliary phase (C) both metastases showed a hypointense signal. After high-dose-rate brachytherapy (HDR-BT), the metastases demonstrated a hyperintense signal on the axial DW-MR image (D) and a hyperintense signal on the ADC map (E) indicating less restricted diffusion compared to the pre-interventional image. The ADCmean increased to 1.41 and 1.53 x 10−3 mm2/s. in the hepatobiliary phase (F). The lesion showed central necrosis with a peripheral post-radiogenic hypointense rim. In the second follow-up the lesions showed no restricted diffusion (G) with a further increasing ADC (H) value of 2.09 and 2.07 x 10−3 mm2/s. There was a shrinkage in size of the metastases without a new hypointense defect in the hepatobiliary phase (I).

FIGURE 4.

Non-responding metastases (NR-met) in a 56-year-old male. In preinterventional MRI, metastasis (circle) shows restricted diffusion (A+B) with an mean apparent diffusion coefficient (ADCmean) of 0.86 x 10−3 mm2/s and a hypointense pattern on the liver-specific phase (C). Three months after high-dose-rate brachytherapy (HDR-BT), the metastasis showed visually partial restricted diffusion (D+E), but, with an increasing ADCmean of 1.52 x 10−3 mm2/s and hypointensity in the hepatobiliary phase (F). After 11 months, the lesion increased in size, shows a visually an increasing diffusion restriction (K+L) at the boarder (arrow) with a persistently ADCmean value of 1.53 x 10−3 mm2/s and a new defect in the hepatobiliary phase (arrow) (I) indicating local tumor recurrence.
Non-responding metastases (NR-met) in a 56-year-old male. In preinterventional MRI, metastasis (circle) shows restricted diffusion (A+B) with an mean apparent diffusion coefficient (ADCmean) of 0.86 x 10−3 mm2/s and a hypointense pattern on the liver-specific phase (C). Three months after high-dose-rate brachytherapy (HDR-BT), the metastasis showed visually partial restricted diffusion (D+E), but, with an increasing ADCmean of 1.52 x 10−3 mm2/s and hypointensity in the hepatobiliary phase (F). After 11 months, the lesion increased in size, shows a visually an increasing diffusion restriction (K+L) at the boarder (arrow) with a persistently ADCmean value of 1.53 x 10−3 mm2/s and a new defect in the hepatobiliary phase (arrow) (I) indicating local tumor recurrence.

Quantitative and qualitative results on baseline, 1. follow up and 2. follow up after local therapy of colorectal liver metastases with brachytherapy

Target lesions Responding metastases Non-responding metastases
Baseline 1. follow-up 2. follow-up Baseline 1. follow-up 2. follow-up
Size (cm) 2.2 +/− 1.2 1.7 +/− 0.9 1.0 +/−0.4 4.1 +/− 2.2 3.3 +/− 2.0 4.1 +/− 2.3
ADCmean 0.84 +/− 0.34 1.44 +/− 0.19 1.48+/− 0.44 1.21 +/− 0.34 1.49 +/− 0.35 1.28 +/− 0.32
ADCmin 0.44 +/− 0.24 0.82 +/− 0.25 0.9 +/− 0.38 0.44 +/− 0.23 0.54 +/− 0.41 0.4 +/− 0.32
Visually diffusion restriction 11/18 (61.11%) 2/18 (11.11%) 0/18 (0%) 8/11 (72.38%) 4/11 (36.36%) 8/11 (72.38%)
Intraindividual increase in between baseline and 1. follow-up between baseline and 2. follow up between baseline and 1. follow-up between baseline and 2. follow up
ADCmean (%) 175 187 127 106
ADCmin (%) 208 281 146 115
eISSN:
1581-3207
Język:
Angielski
Częstotliwość wydawania:
4 razy w roku
Dziedziny czasopisma:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
Kanał RSS czasopisma