Diffusion-weighted and hepatobiliary phase gadoxetic acid-enhanced quantitative MR imaging for identification of complete pathologic response in colorectal liver metastases after preoperative chemotherapy

Purpose To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate colorectal liver metastasis (CRLM) with complete pathologic response from those with incomplete response in patients treated with preoperat...

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Published in:	Abdominal radiology (New York) Vol. 41; no. 2; pp. 231 - 238
Main Authors:	Hosseini-Nik, Hooman, Fischer, Sandra E., Moulton, Carol-Anne E., Karbhase, Gautam, Menezes, Ravi J., Gallinger, Steven, Jhaveri, Kartik S.
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-02-2016
Subjects:	Antineoplastic Combined Chemotherapy Protocols - therapeutic use Colorectal Neoplasms - drug therapy Colorectal Neoplasms - pathology Contrast Media Diffusion Magnetic Resonance Imaging - methods Female Gadolinium DTPA Gastroenterology Hepatectomy Hepatology Humans Imaging Liver Neoplasms - diagnostic imaging Liver Neoplasms - secondary Liver Neoplasms - therapy Male Medicine Medicine & Public Health Middle Aged Neoplasm, Residual - diagnostic imaging Prospective Studies Radiology Sensitivity and Specificity Treatment Outcome Diffusion-weighted imaging Chemotherapy Pathologic response Gadoxetic acid MRI Colorectal liver metastasis
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Abstract	Purpose To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate colorectal liver metastasis (CRLM) with complete pathologic response from those with incomplete response in patients treated with preoperative chemotherapy. Methods Gadoxetic acid-enhanced liver MRI and DWI were performed after completion of preoperative chemotherapy in patients with CRLM scheduled for liver resection. Metastases were classified as those with complete pathologic response (CR-CRLM) or incomplete response (IR-CRLM) according to postsurgical histopathology. Quantitative analysis was performed on non-contrast-enhanced images and hepatobiliary phase images following gadoxetic acid administration. Apparent diffusion coefficient values (ADC), normalized relative enhancement (NRE), and relative signal intensity difference (RSID) along with their diagnostic measures for detection of CR-CRLM were calculated for all lesions. Results In 23 patients, 10 CR-CRLM and 35 IR-CRLM (mean diameter, 21.2 mm) were evaluated. In CR-CRLM, ADC was significantly higher after exclusion of the outliers ( p = 0.030); and RSID was significantly lower ( p = 0.008). Combined indices range of ADC = 1.25−1.9 × 10 −3 mm 2 /s, NRE = 0−35% and RSID <120 had 60% sensitivity and 100% specificity for detection of CR-CRLM. Conclusion DWI and gadoxetic acid-enhanced MRI appear promising for the detection of CRLM with complete response to preoperative chemotherapy. This could have significant implications for liver resection planning after preoperative chemotherapy.
AbstractList	To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate colorectal liver metastasis (CRLM) with complete pathologic response from those with incomplete response in patients treated with preoperative chemotherapy. Gadoxetic acid-enhanced liver MRI and DWI were performed after completion of preoperative chemotherapy in patients with CRLM scheduled for liver resection. Metastases were classified as those with complete pathologic response (CR-CRLM) or incomplete response (IR-CRLM) according to postsurgical histopathology. Quantitative analysis was performed on non-contrast-enhanced images and hepatobiliary phase images following gadoxetic acid administration. Apparent diffusion coefficient values (ADC), normalized relative enhancement (NRE), and relative signal intensity difference (RSID) along with their diagnostic measures for detection of CR-CRLM were calculated for all lesions. In 23 patients, 10 CR-CRLM and 35 IR-CRLM (mean diameter, 21.2 mm) were evaluated. In CR-CRLM, ADC was significantly higher after exclusion of the outliers (p = 0.030); and RSID was significantly lower (p = 0.008). Combined indices range of ADC = 1.25-1.9 × 10(-3) mm(2)/s, NRE = 0-35% and RSID <120 had 60% sensitivity and 100% specificity for detection of CR-CRLM. DWI and gadoxetic acid-enhanced MRI appear promising for the detection of CRLM with complete response to preoperative chemotherapy. This could have significant implications for liver resection planning after preoperative chemotherapy. Purpose To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate colorectal liver metastasis (CRLM) with complete pathologic response from those with incomplete response in patients treated with preoperative chemotherapy. Methods Gadoxetic acid-enhanced liver MRI and DWI were performed after completion of preoperative chemotherapy in patients with CRLM scheduled for liver resection. Metastases were classified as those with complete pathologic response (CR-CRLM) or incomplete response (IR-CRLM) according to postsurgical histopathology. Quantitative analysis was performed on non-contrast-enhanced images and hepatobiliary phase images following gadoxetic acid administration. Apparent diffusion coefficient values (ADC), normalized relative enhancement (NRE), and relative signal intensity difference (RSID) along with their diagnostic measures for detection of CR-CRLM were calculated for all lesions. Results In 23 patients, 10 CR-CRLM and 35 IR-CRLM (mean diameter, 21.2 mm) were evaluated. In CR-CRLM, ADC was significantly higher after exclusion of the outliers ( p = 0.030); and RSID was significantly lower ( p = 0.008). Combined indices range of ADC = 1.25−1.9 × 10 −3 mm 2 /s, NRE = 0−35% and RSID <120 had 60% sensitivity and 100% specificity for detection of CR-CRLM. Conclusion DWI and gadoxetic acid-enhanced MRI appear promising for the detection of CRLM with complete response to preoperative chemotherapy. This could have significant implications for liver resection planning after preoperative chemotherapy. PURPOSETo evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate colorectal liver metastasis (CRLM) with complete pathologic response from those with incomplete response in patients treated with preoperative chemotherapy.METHODSGadoxetic acid-enhanced liver MRI and DWI were performed after completion of preoperative chemotherapy in patients with CRLM scheduled for liver resection. Metastases were classified as those with complete pathologic response (CR-CRLM) or incomplete response (IR-CRLM) according to postsurgical histopathology. Quantitative analysis was performed on non-contrast-enhanced images and hepatobiliary phase images following gadoxetic acid administration. Apparent diffusion coefficient values (ADC), normalized relative enhancement (NRE), and relative signal intensity difference (RSID) along with their diagnostic measures for detection of CR-CRLM were calculated for all lesions.RESULTSIn 23 patients, 10 CR-CRLM and 35 IR-CRLM (mean diameter, 21.2 mm) were evaluated. In CR-CRLM, ADC was significantly higher after exclusion of the outliers (p = 0.030); and RSID was significantly lower (p = 0.008). Combined indices range of ADC = 1.25-1.9 × 10(-3) mm(2)/s, NRE = 0-35% and RSID <120 had 60% sensitivity and 100% specificity for detection of CR-CRLM.CONCLUSIONDWI and gadoxetic acid-enhanced MRI appear promising for the detection of CRLM with complete response to preoperative chemotherapy. This could have significant implications for liver resection planning after preoperative chemotherapy.
Author	Hosseini-Nik, Hooman Karbhase, Gautam Gallinger, Steven Menezes, Ravi J. Fischer, Sandra E. Jhaveri, Kartik S. Moulton, Carol-Anne E.
Author_xml	– sequence: 1 givenname: Hooman surname: Hosseini-Nik fullname: Hosseini-Nik, Hooman organization: Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital – sequence: 2 givenname: Sandra E. surname: Fischer fullname: Fischer, Sandra E. organization: Department of Pathology, University Health Network, University of Toronto – sequence: 3 givenname: Carol-Anne E. surname: Moulton fullname: Moulton, Carol-Anne E. organization: Department of Surgery, University Health Network, University of Toronto – sequence: 4 givenname: Gautam surname: Karbhase fullname: Karbhase, Gautam organization: Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital – sequence: 5 givenname: Ravi J. surname: Menezes fullname: Menezes, Ravi J. organization: Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto – sequence: 6 givenname: Steven surname: Gallinger fullname: Gallinger, Steven organization: Department of Surgery, University Health Network, University of Toronto – sequence: 7 givenname: Kartik S. surname: Jhaveri fullname: Jhaveri, Kartik S. email: kartik.jhaveri@uhn.ca organization: Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26867904$$D View this record in MEDLINE/PubMed
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Snippet	Purpose To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to... To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate... PURPOSETo evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate...
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SubjectTerms	Antineoplastic Combined Chemotherapy Protocols - therapeutic use Colorectal Neoplasms - drug therapy Colorectal Neoplasms - pathology Contrast Media Diffusion Magnetic Resonance Imaging - methods Female Gadolinium DTPA Gastroenterology Hepatectomy Hepatology Humans Imaging Liver Neoplasms - diagnostic imaging Liver Neoplasms - secondary Liver Neoplasms - therapy Male Medicine Medicine & Public Health Middle Aged Neoplasm, Residual - diagnostic imaging Prospective Studies Radiology Sensitivity and Specificity Treatment Outcome
Title	Diffusion-weighted and hepatobiliary phase gadoxetic acid-enhanced quantitative MR imaging for identification of complete pathologic response in colorectal liver metastases after preoperative chemotherapy
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