Apparent diffusion coefficient as a prognostic factor in clival chordoma

Abstract

Clival chordoma is a rare disease with high recurrence rates even after a combination of surgical resection and radiotherapy. Apparent diffusion coefficient (ADC) has been used to evaluate aggressive features of chordoma, but its utility for clival chordoma has not been explored specifically. In this study, the utility of preoperative ADC values was analyzed for predicting tumor progression and recurrence in patients with clival chordoma. Between 2012 and 2019, a total of 30 operated cases were analyzed with available preoperative ADC data. Receiver operating characteristic (ROC) analysis was used to obtain ADC cutoff values for predicting tumor aggressiveness. The mean and minimum ADC values were significantly lower in the aggressive tumor group than in the stable tumor group (both P < 0.001). ROC analysis showed that a mean cutoff ADC value of 1198 × 10−6 mm2/s and minimum ADC value of 895.5 × 10–6 mm2/s could be used to predict aggressive features of clival chordoma. Subtotal resection, partial resection, and mean and minimum ADC values that were lower than cutoff values were negative predictors of overall survival and progression-free survival. In conclusion, mean and minimum ADC values could be useful in predicting aggressiveness of clival chordoma.

Role of the apparent diffusion coefficient as a predictive factor for tumor recurrence in patients with intracranial epidermoid tumor

“…That is, we could predict the prognosis of intracranial epidermoid tumors using their preoperative ADC maps. These ndings are similar to those of previous reports showing that aggressive clival chordoma and high-grade meningioma and glioma have lower ADC values than those of less aggressive or low-grade tumors [13][14][15]. Therefore, close MRI follow-up is recommended for cases with minimum ADC values lower than the cutoff to screen for recurrence after surgery.…”

“…The EOR was shown to be a signi cant prognostic factor for recurrence in these studies, but there are no known preoperative factors that can predict tumor behavior. ADC values have been used to represent tumor characteristics in several central nervous system tumors [15,22,23], and DWI sequence is always taken for detection of epidermoid tumor recurrence [24]. Thus, in the present study, we analyzed 23 patients using ADC values, hypothesizing that they could be useful in predicting the recurrence of intracranial epidermoid tumors.…”

“…That is, there are differences in the characteristics of epidermoid tumors, such as in the production and accumulation of their components, although they are all classi ed as "intracranial epidermoid tumors". To re ect these differences, we measured the ADC values using preoperative DWI because the ADC has been shown to represent the nature of the tumor in several brain tumors [13][14][15]. Diffusion measurements re ect intra-and extra-cellular water motion and could indicate tumor characteristics [29].…”

“…The apparent diffusion coe cient (ADC) has been utilized to predict tumor behavior in central nervous system tumors such as glioma [13], meningioma [14], and chordoma [15] because it could re ect tumor cell characteristics. In the management of intracranial epidermoid tumors, preoperative, postoperative, and follow-up magnetic resonance imaging (MRI), including diffusion weighted image (DWI) sequences, are always conducted.…”

Managing a Complex Pituitary Tumor: A Case Study on Effective Diagnosis and Treatment of a Challenging Clival Lesion

“…ongoing research efforts aim to refine the diagnostic accuracy of traditional imaging techniques. This involves defining precise apparent diffusion coefficient value thresholds [8] for diagnosing clival chordomas, and assessing the efficacy of advanced imaging modalities, such as positron emission tomography-computed tomography, in accurately determining the epicenter of the disease [9]. Nevertheless, such methodologies ought to complement, rather than replace, histological diagnoses.…”