Prognostic value of pretreatment diffusion-weighted magnetic resonance imaging for outcome prediction of colorectal cancer liver metastases undergoing 90Y-microsphere radioembolization

Schmeel, Frederic Carsten; Simon, Birgit; Luetkens, Julian A.; Träber, Frank; Meyer, Carsten H.; Schmeel, Leonard Christopher; Sabet, Amir; Ezziddin, Samer; Schild, Hans H.; Hadizadeh, Dariusch R.

doi:10.1007/s00432-017-2395-5

Cited by 21 publications

(14 citation statements)

References 36 publications

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“…Among the most common indications for clinical abdominal MRI is the detection, characterization, and follow-up of liver lesions. 23,26,40,82,83,[135][136][137][138][139][140][141][142] In the setting of cancer, detection of liver lesions often changes the disease stage and, hence, how the patient is treated. Not only the presence or absence of liver lesions is important, but often the number of liver lesions is of pivotal clinical significance.…”

Section: Current State Of Clinical Dissemination Applications and Cha...mentioning

confidence: 99%

“…Diffusion MRI is predominantly utilized for two purposes: (1) detection and (2) characterization of abnormalities. Among the most common indications for clinical abdominal MRI is the detection, characterization, and follow‐up of liver lesions 23,26,40,82,83,135–142 . In the setting of cancer, detection of liver lesions often changes the disease stage and, hence, how the patient is treated.…”

Section: Current Status Of Validation and Dissemination Of Diffusion Mrimentioning

confidence: 99%

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Quantitative diffusion MRI of the abdomen and pelvis

2021

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Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver, prostate, and other organs. Quantitative diffusion MRI is based on acquisitions with multiple diffusion encodings followed by quantitative mapping of diffusion parameters that are sensitive to tissue microstructure. Compared to qualitative diffusion‐weighted MRI, quantitative diffusion MRI can improve standardization of tissue characterization as needed for disease detection, staging, and treatment monitoring. However, similar to many other quantitative MRI methods, diffusion MRI faces multiple challenges including acquisition artifacts, signal modeling limitations, and biological variability. In abdominal and pelvic diffusion MRI, technical acquisition challenges include physiologic motion (respiratory, peristaltic, and pulsatile), image distortions, and low signal‐to‐noise ratio. If unaddressed, these challenges lead to poor technical performance (bias and precision) and clinical outcomes of quantitative diffusion MRI. Emerging and novel technical developments seek to address these challenges and may enable reliable quantitative diffusion MRI of the abdomen and pelvis. Through systematic validation in phantoms, volunteers, and patients, including multicenter studies to assess reproducibility, these emerging techniques may finally demonstrate the potential of quantitative diffusion MRI for abdominal and pelvic imaging applications.

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Section: Current State Of Clinical Dissemination Applications and Cha...mentioning

confidence: 99%

Section: Current Status Of Validation and Dissemination Of Diffusion Mrimentioning

confidence: 99%

Quantitative diffusion MRI of the abdomen and pelvis

2021

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“…In addition, it would be interesting to evaluate the prognostic value of preinterventional PET/CT and MRI parameters regarding their value for outcome prediction in further studies in a larger patient cohort. There are already promising studies which could demonstrate that ADC values allowed survival prognosis in colorectal liver metastases treated with 90 Y-micosphere radioembolization [31] as well as that ADC could be used as predictor for response to chemotherapy of liver metastases in colorectal cancer [32].…”

Section: Discussionmentioning

confidence: 99%

68Ga-DOTATATE PET/CT and MRI with Diffusion-Weighted Imaging (DWI) in Short- and Long-Term Assessment of Tumor Response of Neuroendocrine Liver Metastases (NELM) Following Transarterial Radioembolization (TARE)

Kiesl

Karim

Beyer

et al. 2021

Cancers

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The aim of this study was to evaluate the role of SUV and ADC in assessing early response in patients with NELM following TARE. Thirty-two patients with pre- and postinterventional MRI with DWI and 68Ga-DOTATATE PET/CT were included. ADC and SUV of three target lesions and of tumor-free spleen and liver tissue were determined on baseline and first follow-up imaging, and tumor to spleen (T/S) and tumor to liver (T/L) ratios were calculated. Response was assessed by RECIST 1.1 and mRECIST on first follow-up, and long-term response was defined as hepatic progression-free survival (HPFS) over 6, 12, and <24 months. In responders, intralesional ADC values increased and SUV decreased significantly regardless of standard of reference for response assessment (mRECIST/RECIST/HPFS > 6/12/24 m). Using ROC analysis, ΔSUV T/S ratio (max/max) and ΔSUV T/L ratio (max/mean) were found to be the best and most robust metrics to correlate with longer HPFS and were superior to ΔADC. ΔT/S ratio (max/max) < 23% was identified as an optimal cut-off to discriminate patients with longer HPFS (30.2 m vs. 13.4 m; p = 0.0002). In conclusion, early percentage changes in SUV tumor-to-organ ratios on first follow-up seem to represent a prognostic marker for longer HPFS and may help in assessing therapeutic strategies.

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“…Several factors are associated with shorter survival after radioembolization of colorectal liver metastases: an Eastern Cooperative Oncology Group performance status of greater than or equal to 1, prior chemotherapy, uncontrolled ascites, elevated liver function tests, low albumin level, LSF of greater than 10%, presence of extrahepatic metastases, lymphovascular invasion of the primary tumor, carcinoembryonic antigen level of greater than 62 ng/mL, KRAS mutant tumors, greater than 25% tumor involvement of the treated liver volume, and low apparent diffusion coefficient values on diffusionweighted MRI (35,40,41,(66)(67)(68)(69). Many of these factors are simply markers of more aggressive tumors that would respond poorly to any treatment (10,70), and data on whether these factors can be used to choose one therapy option over another are limited.…”

Section: Discussionmentioning

confidence: 99%

Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes

2017

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Liver metastases are a major cause of death from colorectal cancer. Intraarterial therapy options for colorectal liver metastases include chemoinfusion via a hepatic arterial pump or port, irinotecan-loaded drug-eluting beads, and radioembolization using Y microspheres. Intraarterial therapy allows the delivery of a high dose of chemotherapy or radiation into liver tumors while minimizing the impact on liver parenchyma and avoiding systemic effects. Specificity in intraarterial therapy can be achieved both through preferential arterial flow to the tumor and through selective catheter positioning. In this review, we discuss indications, contraindications, preprocedure evaluation, activity prescription, follow-up, outcomes, and complications of radioembolization of colorectal liver metastases. Methods for preventing off-target embolization, increasing the specificity of microsphere delivery, and reducing the lung-shunt fraction are discussed. There are 2 types ofY microspheres: resin and glass. Because glass microspheres have a higher activity per particle, they can deliver a particular radiation dose with fewer particles, likely reducing embolic effects. Glass microspheres thus may be more suitable when early stasis or reflux is a concern, in the setting of hepatocellular carcinoma with portal vein invasion, and for radiation segmentectomy. Because resin microspheres have a lower activity per particle, more particles are needed to deliver a particular radiation dose. Resin microspheres thus may be preferable for larger tumors and those with high arterial flow. In addition, resin microspheres have been approved by the U.S. Food and Drug Administration for colorectal liver metastases, whereas institutional review board approval is required before glass microspheres can be used under a compassionate-use or research protocol. Finally, radiation segmentectomy involves delivering a calculated lobar activity of Y microspheres selectively to treat a tumor involving 1 or 2 liver segments. This technique administers a very high radiation dose and effectively causes the ablation of tumors that are too large or are in a location considered unsafe for thermal ablation. The selective delivery spares surrounding normal liver, reducing the risk of liver failure.

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Prognostic value of pretreatment diffusion-weighted magnetic resonance imaging for outcome prediction of colorectal cancer liver metastases undergoing 90Y-microsphere radioembolization

Abstract: Pretreatment ADC on DWI represents a valuable prognostic biomarker for predicting both the therapeutic efficacy and survival prognosis in CRC liver metastases treated by 90Y-RE, allowing risk stratification and potentially optimizing further treatment strategies.

Cited by 21 publications

References 36 publications

Quantitative diffusion MRI of the abdomen and pelvis

Quantitative diffusion MRI of the abdomen and pelvis

68Ga-DOTATATE PET/CT and MRI with Diffusion-Weighted Imaging (DWI) in Short- and Long-Term Assessment of Tumor Response of Neuroendocrine Liver Metastases (NELM) Following Transarterial Radioembolization (TARE)

Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes

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