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Role of diffusion-weighted imaging in response prediction and evaluation after high dose rate brachytherapy in patients with colorectal liver metastases Cover

Role of diffusion-weighted imaging in response prediction and evaluation after high dose rate brachytherapy in patients with colorectal liver metastases

Radiology and Oncology
Volume 58 (2024): Issue 1 (March 2024)
By:
Open Access
|Feb 2024

Figures & Tables

FIGURE 1.

Flow diagram for this studyDWI = diffusion-weighted imaging; HDR-BT = high-dose-rate brachytherapy; NR-Mets = non-responding metastases; R-Mets = responding metastases; HDR-BT = high-dose-rate brachytherapy
Flow diagram for this studyDWI = diffusion-weighted imaging; HDR-BT = high-dose-rate brachytherapy; NR-Mets = non-responding metastases; R-Mets = responding metastases; HDR-BT = high-dose-rate brachytherapy

FIGURE 2.

Mean apparent diffusion coefficient (ADCmean) change in responding metastases (R-Mets) and NR-Mets between preinterventional MRI and first and second follow-up, respectivelyADC = apparent diffusion coefficient; NR-Mets = non-responding metastases, R-Mets = responding metastases
Mean apparent diffusion coefficient (ADCmean) change in responding metastases (R-Mets) and NR-Mets between preinterventional MRI and first and second follow-up, respectivelyADC = apparent diffusion coefficient; NR-Mets = non-responding metastases, R-Mets = responding metastases

FIGURE 3.

R-Met in a 62-year-old female. The pre-interventional diffusion-weighted imaging (DWI) shows two diffusion-restricted liver metastases with high signal on axial diffusion-weighted (DW)-MR image b = 800 s/mm2 (A) and low signal on apparent diffusion coefficient (ADC) map (B). The pre-interventional ADCmean of the metastases were 0.83 and 0.86 x 10−3 mm2/s. In the hepatobiliary phase (C) both metastases showed a hypointense signal. After high-dose-rate brachytherapy (HDR-BT), the metastases demonstrated a hyperintense signal on the axial DW-MR image (D) and a hyperintense signal on the ADC map (E) indicating less restricted diffusion compared to the pre-interventional image. The ADCmean increased to 1.41 and 1.53 x 10−3 mm2/s. in the hepatobiliary phase (F). The lesion showed central necrosis with a peripheral post-radiogenic hypointense rim. In the second follow-up the lesions showed no restricted diffusion (G) with a further increasing ADC (H) value of 2.09 and 2.07 x 10−3 mm2/s. There was a shrinkage in size of the metastases without a new hypointense defect in the hepatobiliary phase (I).
R-Met in a 62-year-old female. The pre-interventional diffusion-weighted imaging (DWI) shows two diffusion-restricted liver metastases with high signal on axial diffusion-weighted (DW)-MR image b = 800 s/mm2 (A) and low signal on apparent diffusion coefficient (ADC) map (B). The pre-interventional ADCmean of the metastases were 0.83 and 0.86 x 10−3 mm2/s. In the hepatobiliary phase (C) both metastases showed a hypointense signal. After high-dose-rate brachytherapy (HDR-BT), the metastases demonstrated a hyperintense signal on the axial DW-MR image (D) and a hyperintense signal on the ADC map (E) indicating less restricted diffusion compared to the pre-interventional image. The ADCmean increased to 1.41 and 1.53 x 10−3 mm2/s. in the hepatobiliary phase (F). The lesion showed central necrosis with a peripheral post-radiogenic hypointense rim. In the second follow-up the lesions showed no restricted diffusion (G) with a further increasing ADC (H) value of 2.09 and 2.07 x 10−3 mm2/s. There was a shrinkage in size of the metastases without a new hypointense defect in the hepatobiliary phase (I).

FIGURE 4.

Non-responding metastases (NR-met) in a 56-year-old male. In preinterventional MRI, metastasis (circle) shows restricted diffusion (A+B) with an mean apparent diffusion coefficient (ADCmean) of 0.86 x 10−3 mm2/s and a hypointense pattern on the liver-specific phase (C). Three months after high-dose-rate brachytherapy (HDR-BT), the metastasis showed visually partial restricted diffusion (D+E), but, with an increasing ADCmean of 1.52 x 10−3 mm2/s and hypointensity in the hepatobiliary phase (F). After 11 months, the lesion increased in size, shows a visually an increasing diffusion restriction (K+L) at the boarder (arrow) with a persistently ADCmean value of 1.53 x 10−3 mm2/s and a new defect in the hepatobiliary phase (arrow) (I) indicating local tumor recurrence.
Non-responding metastases (NR-met) in a 56-year-old male. In preinterventional MRI, metastasis (circle) shows restricted diffusion (A+B) with an mean apparent diffusion coefficient (ADCmean) of 0.86 x 10−3 mm2/s and a hypointense pattern on the liver-specific phase (C). Three months after high-dose-rate brachytherapy (HDR-BT), the metastasis showed visually partial restricted diffusion (D+E), but, with an increasing ADCmean of 1.52 x 10−3 mm2/s and hypointensity in the hepatobiliary phase (F). After 11 months, the lesion increased in size, shows a visually an increasing diffusion restriction (K+L) at the boarder (arrow) with a persistently ADCmean value of 1.53 x 10−3 mm2/s and a new defect in the hepatobiliary phase (arrow) (I) indicating local tumor recurrence.

Quantitative and qualitative results on baseline, 1_ follow up and 2_ follow up after local therapy of colorectal liver metastases with brachytherapy

Target lesionsResponding metastasesNon-responding metastases
Baseline1. follow-up2. follow-upBaseline1. follow-up2. follow-up
Size (cm)2.2 +/− 1.21.7 +/− 0.91.0 +/−0.44.1 +/− 2.23.3 +/− 2.04.1 +/− 2.3
ADCmean0.84 +/− 0.341.44 +/− 0.191.48+/− 0.441.21 +/− 0.341.49 +/− 0.351.28 +/− 0.32
ADCmin0.44 +/− 0.240.82 +/− 0.250.9 +/− 0.380.44 +/− 0.230.54 +/− 0.410.4 +/− 0.32
Visually diffusion restriction11/18 (61.11%)2/18 (11.11%)0/18 (0%)8/11 (72.38%)4/11 (36.36%)8/11 (72.38%)
Intraindividual increase inbetween baseline and 1. follow-upbetween baseline and 2. follow up between baseline and 1. follow-upbetween baseline and 2. follow up
ADCmean (%)175187 127106
ADCmin (%)208281 146115
DOI: https://doi.org/10.2478/raon-2024-0017 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 33 - 42
Submitted on: Nov 10, 2023
Accepted on: Jan 4, 2024
Published on: Feb 21, 2024
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year
Keywords:
liver,
HDR-brachytherapy,
diffusion-weighted imaging,
apparent diffusion coefficient,
colorectal liver metastases
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2024 Salma Karim, Ricarda Seidensticker, Max Seidensticker, Jens Ricke, Regina Schinner, Karla Treitl, Johannes Rübenthaler, Maria Ingenerf, Christine Schmid-Tannwald, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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