Validation of DWI in assessment of radiotreated bone metastases in elderly patients

Abstract

Bone metastases are commonly observed in oncologic patients with advanced disease. These metastases are considered the main cause of neoplastic pain, with more than half of oncologic patients experiencing neoplastic pain during the course of the disease due to bone involvement. Lung, breast, and prostate cancers are the primary causes of bone metastases. Magnetic resonance imaging (MRI), especially diffusion weighted imaging (DWI) sequences, is the focus of our research, as it has been proven to be an optimal predictive index to assess the radiation treatment in many patients. We included patients treated with standard fractioning of radiation therapy. First, we examined the irradiated lesions with the MRI-DWI technique, before treatment and 30 and 60 days after its completion. Then we combined the MRI results and clinical parameters in a table with a predictive score for the quality of life in patients with bone metastases. This was a significant predictor of the efficacy of radiation treatment, from both clinical and psychological points of view, as it can allow an early assessment of the response to RT and therefore better scheduling of the next therapeutic steps to be performed. The table of the score we proposed helped guide patient monitoring, enabling us to undertake, where possible, follow-up with therapeutic strategies tailored to each patient's needs.

Hereditary breast cancer: screening and risk reducing surgery

“…However, the combination of clinical breast examination, mammography and US has not sufficiently sensitive in high-risk women, as demonstrated by many series (11,25) and consequently, has a minor role in patients with hereditary predisposition to the disease. In fact, this diagnostic combination has demonstrated a sensitivity of 64% in our BRCA mutation carriers and a lower sensitivity than its estimated (83%) for detection in the general population, as well known from many studies (12,16,25,32,33). Furthermore, the higher sensitivity of MRI in lesion detection is consistent if considering its high capability to detect potential axillary nodal involvement.…”

Diagnostic Imaging Modalities to Assess Treatment Response of Bone Metastasis in Patients Receiving Palliative Radiotherapy: A Scoping Review of the Literature

“…17 From these imaging modalities, investigators evaluated the response to radiotherapy with regard to several underlying variables, including lesion size, 18,21,23 density, 6,14 -17,19,20 , metabolic tumor activity, 22 -24 and signal intensity. 25,26 Table 2 highlights the relationship between each of these underlying variables and the quantified metrics used to assess them.…”

“…Three studies evaluated signal intensity response to palliative radiotherapy. 20,25,26 Measurements of signal intensity comprised T1TSE MRI signal intensity, apparent diffusion coefficient (ADC) values, and a combination of ADC values and b values.…”

3D bone texture analysis as a potential predictor of radiation-induced insufficiency fractures

“…The combination of these effects results in a reduction in the bone mineral density (BMD) in patients undergoing pelvic RT (43). The incidence of IF seems to be higher than expected, although there are many discrepancies in the various study (5,(10)(11)(12)(13)(14)(44)(45)(46), probably due to the differences in the follow-up, as the choice of imaging may increase the detection of asymptomatic IFs. One study reported 89% of patients had findings compatible with IF after pelvic RT using magnetic resonance imaging (47), while another study reported 34% using bone scintigraphy (48).…”