Assessment of the percentage of apparent diffusion coefficient value changes as an early indicator of the response of colorectal hepatic metastases to chemotherapy

Nada Gamal El-Husseiny,Sherif Farouk El Zawawy,Sayed Mohamed Mehana

doi:10.1186/s43055-019-0070-3

Nada Gamal El-Husseiny, Sherif Farouk El Zawawy + Show 1 more

Open Access

https://doi.org/10.1186/s43055-019-0070-3

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Abstract

BackgroundColorectal cancer is considered one of the most common causes of cancer-related deaths worldwide. We aim to evaluate the efficacy of DWI-MRI in predicting response to chemotherapy in this cohort.The study included 30 lesions in 20 biopsy proven-colorectal cancer patients with hepatic metastasis larger than 1 cm. All patients underwent both triphasic CT with intravenous contrast, pre-chemotherapy MRI (axial T2 and DW sequences) which was repeated 21 days following chemotherapy. A follow-up CT was done 2 months later. The response of the lesions was evaluated using the RESCIST criteria. On MRI, the lesions corresponding to the ones chosen on CT were identified and the apparent diffusion coefficient (ADC) values of pre- and post-chemotherapy images were recorded and correlated with the CT results.ResultsIn the study, 17 (56.7%) of the lesions showed response to chemotherapy while 13 (43.3%) were non-responding. There was no significant difference in pretreatment ADC values between responding and non-responding lesions (p = 0.14). The mean percentage increase in ADC values in responding lesions was 42% compared to 18% in non-responding lesions (p < 0.001). Lesions that showed less than 18% increase were all found to be non-responsiveConclusionDWI-MRI has an emerging role in early assessment of early treatment response that can be detected before morphological response for patients with hepatic metastasis from colorectal cancer. Based on our study, the use of 25 % as the cutoff point of percent difference in ADC for detection of non-responding lesions proved to be successful only 21 days after the 1st chemotherapy cycle.

Highlights

Colorectal cancer is considered one of the most common causes of cancer-related deaths worldwide
Because therapy may result in modification in tissue composition despite constant tumor size; fatty liver infiltration after chemotherapy can affect the liver parenchyma impairing the assessment of lesions, functional techniques, such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI), which reveal alterations in tissue microstructure rather than macrostructure changes [4, 5]
We aim to investigate the efficacy of DWIMRI in predicting the response of liver metastases from colorectal cancer to systemic treatment

Summary

Introduction

Colorectal cancer is considered one of the most common causes of cancer-related deaths worldwide. The study included 30 lesions in 20 biopsy proven-colorectal cancer patients with hepatic metastasis larger than 1 cm. All patients underwent both triphasic CT with intravenous contrast, pre-chemotherapy MRI (axial T2 and DW sequences) which was repeated 21 days following chemotherapy. On MRI, the lesions corresponding to the ones chosen on CT were identified and the apparent diffusion coefficient (ADC) values of pre- and post-chemotherapy images were recorded and correlated with the CT results. Because therapy may result in modification in tissue composition despite constant tumor size; fatty liver infiltration after chemotherapy can affect the liver parenchyma impairing the assessment of lesions, functional techniques, such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI), which reveal alterations in tissue microstructure rather than macrostructure changes [4, 5]. Tumors with low ADC values before the beginning of the treatment that significantly increased following the first cycle of chemotherapy are suggested in cases of good therapeutic response with a greater decrease in tumor volume after chemotherapy [7, 8]

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