Abstract
BackgroundPreoperative chemotherapy is becoming standard therapy for liver metastasis from colorectal cancer, so early assessment of treatment response is crucial to make a reasonable therapeutic regimen and avoid overtreatment, especially for patients with severe side effects. The role of three non-mono-exponential diffusion models, such as the kurtosis model, the stretched exponential model and the statistical model, were explored in this study to early assess the response to chemotherapy in patients with liver metastasis from colorectal cancer.MethodsThirty-three patients diagnosed as colorectal liver metastasis were evaluated in this study. Diffusion-weighted images with b values (0, 200, 500, 1000, 1500, 2000 s/mm2) were acquired at 3.0 T. The parameters (ADCk, K, DDC,α, Dsand σ) were derived from three non-mono-exponential models (the kurtosis, stretched exponential and statistical models) as well as their corresponding percentage changes before and after chemotherapy. The difference in above parameters between the response and non-response groups were analyzed with independent-samples T-test (normality) and Mann–Whitney U-test (non-normality). Meanwhile, receiver operating characteristic curve (ROC) analyses were performed to assess the response to chemotherapy.ResultsSignificantly lower values of K (the kurtosis coefficient derived from the kurtosis model) and σ (the width of diffusion coefficient distribution in the statistical model) (P < 0.05) were observed in the respond group before treatment, as well as higher ΔK and Δσ values (P < 0.05) after the first cycle of chemotherapy were also found compared with the non-respond group. ROC analyses showed the K value acquired before treatment had the highest diagnostic performance (0.746) in distinguishing responders from non-responders. Furthermore, the high sensitivity (100%) and accuracy (76.3%) from the K value before treatment was found in assessing the response of colorectal liver metastasis to chemotherapy.ConclusionsThe non-mono-exponential diffusion models may be able to predict early response to chemotherapy in patients with colorectal liver metastasis.
Highlights
Preoperative chemotherapy is becoming standard therapy for liver metastasis from colorectal cancer, so early assessment of treatment response is crucial to make a reasonable therapeutic regimen and avoid overtreatment, especially for patients with severe side effects
For the rest of patients (n = 13), the diagnosis was were established by typical Magnetic resonance imaging (MRI) features of liver metastasis: 1) irregular or ill-defined borders with low T1 signal intensity (SI) and variable high T2 SI; 2) peripheral rim enhancement; 3) relatively hypoenhancement on portal or delayed phase in comparison with liver parenchyma; 4) interval growth of at least 20% in the longest axial diameter on serial cross-sectional imaging
The response group was composed of 17 patients with partial response (PR)
Summary
Preoperative chemotherapy is becoming standard therapy for liver metastasis from colorectal cancer, so early assessment of treatment response is crucial to make a reasonable therapeutic regimen and avoid overtreatment, especially for patients with severe side effects. The role of three non-mono-exponential diffusion models, such as the kurtosis model, the stretched exponential model and the statistical model, were explored in this study to early assess the response to chemotherapy in patients with liver metastasis from colorectal cancer. Neoadjuvant chemotherapy followed by residual tumor excision is becoming the standard of care for liver metastases [2]. Neoadjuvant chemotherapy can decrease tumor loading and improve survival quality [3]. Early evaluation of chemotherapy response is crucial for therapeutic strategy adjustment and preventing unnecessary medical interventions for the non-responders
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