WE-G-BRD-01: Diffusion Weighted MRI for Response Assessment of Inoperable Lung Tumors for Patients Undergoing SBRT Treatment

Abstract

Purpose: To investigate early changes in tumor Apparent Diffusion Coefficients derived from diffusion weighted (DW)-MRI of lung cancer patients undergoing SBRT, as a possible early predictor of treatment response. Methods: DW-MRI scans were performed in this prospective phase I IRB-approved study of inoperable lung tumors at various time-points during the course of SBRT treatments. Axial DW scan using multi b-values ranging from 0–1000 s/mm2 were acquired in treatment position on a 3T Philips MR scanner during simulation, one hour after the first fraction (8 Gy), after a total of 5 fractions (40 Gy) and 4 weeks after SBRT delivery. A monoexponential model based on a least square fit from all b values was performed on a pixel-by-pixel basis and ADC was calculated. GTVs drawn on 4DCT for planning were mapped on the T2w MRI (acquired at exhale) after deformable registration. These volumes were then mapped on DWI scan for ADC calculation after rigid registration between the anatomical scan and diffusion scan. T2w scan on followup time points were deformably registered to the pretreatment T2 scan. Results: The first two patients in this study were analyzed. Median ADC values were 1.48, 1.48, 1.62 and 1.83 (10−3×) mm2/s at pretreatment, after 8 Gy, after 40 Gy and 4 weeks posttreatment for the first patient and 1.57, 1.53, 1.66 and 1.72 (10−3×) mm2/s for the second patient. ADC increased more significantly after 4 weeks of treatment rather than immediately post treatment, implying that late ADC value may be a better predictor of tumor response for SBRT treatment. The fraction of tumor pixels at high ADC values increased at 4 weeks post treatment. Conclusion: The observed increase in ADC values before the end of radiotherapy may be a surrogate for tumor response, but further patient accrual will be necessary to determine its value.