Diffusion MR Imaging in Evaluation of Treatment Response in Patients with Lung Cancer

Yıl 2023, Cilt: 13 Sayı: 1, 62 - 70, 26.04.2023

Melike Şener Sorgun Feray Aras Cihan Göktan Deniz Özel

Öz

Aim: To observe the change in apparent diffusion coefficient (ADC) value after chemoradiotherapy in lung cancer and to investigate the ability of the change in ADC values to detect response to treatment earlier than computed tomography (CT).
Material and Methods: This prospective study was performed in patients with a confirmed diagnosis of stage III-IV lung cancer and included 25 patients who underwent T2-weighted MR, diffusionweighted images (DWI), CT, and FDG PET/CT. Thoracic diffusion MRI and CT examinations were performed on patients who received chemoradiotherapy. Post-therapy; Thoracic diffusion MRI was repeated one week after the two cycles of chemotherapy and two weeks after the end of the radiotherapy, while post-therapy CT was performed four or five weeks after therapy. Before and after treatment, ADCmin, ADCmean, and SUVmax values were compared with each other.
Results: Data analysis revealed a statistically insignificant inverse correlation between the pre-therapy ADCmin and SUVmax (r=- 0.36; p=0.077) with ADCmean and SUVmax (r=-0.283; p=0.170). Post-therapy repeated measures revealed that increased ADCmin values were significantly higher with the tumor size change (r=- 0.872; p=0.000) and median size (r=-0.847; p=0.001) tumor on CT.
Conclusion: ADC measurements with DWI may be a new prognostic marker in lung cancers predicting early response to chemotherapy in lung cancer.

Anahtar Kelimeler

diffusion, apparent diffusion coefficient, lung cancer, responce to treatment, magnetic resonance imaging

Kaynakça

• 1. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: Int J Cancer. 2010;127:2893–2917.
• 2. Yilmaz HH, Yazihan N, Tunca D, et al. Cancer trends and incidence and mortality patterns in Turkey Jpn J Clin Oncol. 2011;41:10–16.
• 3. Loeb LA, Ernster VL, Warner KE, et al. Smoking and lung cancer: an overview. Cancer Res. 1984;44(12 Pt 1):5940-5958.
• 4. Spiro SG, Porter JC. Lung cancer--where are we today? Current advances in staging and nonsurgical treatment. Am J Respir Crit Care Med. 2002;166:1166–1196.
• 5. Cai Z, Liu Q. Understanding the Global Cancer Statistics 2018: implications for cancer control. Sci China Life Sci. 2021;64:1017–1020.
• 6. Desar IM, van Herpen CM, van Laarhoven HW, et al. Beyond RECIST. molecular and functional imaging techniques for evaluation of response to targeted therapy. Cancer Treat Rev. 2009;35:309–321.
• 7. Austin J. Sim, Evangelia Kaza, Lisa Singer, et al. A review of the role of MRI in diagnosis and treatment of early stage lung cancer. Clin Transl Radiat Oncol. 2020; 24:16–22.
• 8. Zhang Y, Chen J, Shen J, et al. Apparent diffusion coefficient values of necrotic and solid portion of lymph nodes: differential diagnostic value in cervical lymphadenopathy. Clin Radiol.2013;68:224-231.
• 9. Barnes A, Alonzi R, Blackledge M, et al. UK quantitative WB-DWI technical workgroup: consensus meeting recommendations on optimisation, quality control, processing and analysis of quantitative whole-body diffusion-weighted imaging for cancer. Br J Radiol.2018;91:20170577.
• 10. Cui Y, Zhang XP, Sun YS, et al. Apparent diffusion coefficient: potential imaging biomarker for prediction and early detection of response to chemotherapy in hepatic metastases. Radiology. 2008;248:894–900.
• 11. Chen L, Zhang J, Chen Y, et al. Relationship between apparent diffusion coefficient and tumour cellularity in lung cancer. PLoS One. 2014;9:e99865.
• 12. Eisenhauer E, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009; 45:228.
• 13. Lazzari C, Bulotta A, Ducceschi M, et al. Historical Evolution of Second-Line Therapy in Non-Small Cell Lung Cancer. Front Med (Lausanne). 2017;4:4.
• 14. Wei M, Ye Q, Wang X, et al. Early tumor shrinkage served as a prognostic factor for patients with stage III non-small cell lung cancer treated with concurrent chemoradiotherapy. Medicine (Baltimore)2018;97:e0632.
• 15. Vogl TJ, Emara EH, Elhawash E, et al. Feasibility of diffusionweighted magnetic resonance imaging in evaluation of early therapeutic response after CT-guided microwave ablation of inoperable lung neoplasms. Eur Radiol. 2021;19.
• 16. Jagoda P, Fleckenstein J, Sonnhoff M, et al. Diffusion-weighted MRI improves response assessment after definitive radiotherapy in patients with NSCLC. Cancer Imaging. 2021;21:21.
• 17. Langer NH, Langer SW, Johannesen HH, et al. Very Early Response Evaluation by PET/MR in Patients with Lung CancerTiming and Feasibility. Diagnostics (Basel) 2019 26;9:35.
• 18. Komori T, Narabayashi I, Matsumura K, et al. 2-(Fluorine18)-fluoro-2-deoxy-D-glucose positron emission tomography/ computed tomography versus whole-body diffusion-weighted MRI for detection of malignant lesions: initial experience. Ann Nucl Med. 2007;21:209–215.
• 19. Vogl TJ, Hoppe AT, Gruber-Rouh T, et al. Diffusion-Weighted MR Imaging of Primary and Secondary Lung Cancer: Predictive Value for Response to Transpulmonary Chemoembolization and Transarterial Chemoperfusion. J Vasc Interv Radiol. 2020;31:301-310.