Diffusion-Weighted MR Imaging of Primary and Secondary Lung Cancer: Predictive Value for Response to Transpulmonary Chemoembolization and Transarterial Chemoperfusion

• Published in: Journal of vascular and interventional radiology Vol. 31; no. 2; pp. 301 - 310
• Main Authors: Vogl, Thomas J., Hoppe, Alexander T., Gruber-Rouh, Tatjana, Basten, Lajos, Dewes, Patricia, Hammerstingl, Renate M., Balaban, Ümniye, Mastrodicasa, Domenico, Thompson, Zachary M., Albrecht, Moritz H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2020
• Subjects: ADC; SD; PR; NSCLC; PD; DWI; TPCE; TACP; AUC
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2019.08.027

To examine predictive value of apparent diffusion coefficient (ADC) in diffusion-weighted imaging (DWI) for response of patients with primary and secondary lung neoplasms undergoing transpulmonary chemoembolization (TPCE) and transarterial chemoperfusion (TACP) treatment. Thirty-one patients (mean age ± SD 64 ± 12.4 y) with 42 lung target lesions (13 primary and 29 secondary) underwent DWI and subsequent ADC analysis on a 1.5T MR imaging scanner before and 30.3 days ± 6.4 after first session of TPCE or TACP. After 3.1 treatment sessions ± 1.4 performed in 2- to 4-week intervals, morphologic response was analyzed by comparing tumor diameter and volume before and after treatment on unenhanced T1-weighted MR images. On a per-lesion basis, response was classified according to Response Evaluation Criteria In Solid Tumors. Threshold ADC increase of 20.7% indicated volume response with 88% sensitivity and 78% specificity (area under the curve [AUC] = 0.84). Differences between ADC changes in volume response groups were significant (P = .002). AUC for volume response predicted by ADC before treatment was 0.77. Median ADC before treatment and mean ADC change were 1.09 × 10−3 mm2/second and 0.36 × 10−3 mm2/second ± 0.23, 1.45 × 10−3 mm2/second and 0.14 × 10−3 mm2/second ± 0.16, and 1.30 × 10−3 mm2/second and 0.06 × 10−3 mm2/second ± 0.19 in partial response, stable disease, and progressive disease groups. In primary lung cancer lesions, strong negative correlation of ADC change with change in diameter (ρ = −.87, P < .001) and volume (ρ = −.66, P = .016) was found. In metastases, respective correlation coefficients were ρ = −.18 (P = .356) and ρ = −.35 (P = .061). ADC quantification shows considerable diagnostic value for predicting response and monitoring TPCE and TACP treatment of patients with primary and secondary lung neoplasms.