Histogram analysis of apparent diffusion coefficient from whole-body diffusion-weighted MRI to predict early response to chemotherapy in patients with metastatic colorectal cancer: preliminary results

• Published in: Clinical radiology Vol. 73; no. 9; pp. 832.e9 - 832.e16
• Main Authors: Lavdas, I., Rockall, A.G., Daulton, E., Kozlowski, K., Honeyfield, L., Aboagye, E.O., Sharma, R.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2018
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Diffusion Magnetic Resonance Imaging - methods; Disease Progression; England; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Treatment Outcome; Tumor Burden; Whole Body Imaging; England
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2018.04.011

To evaluate apparent diffusion coefficient (ADC) histogram analysis parameters, acquired from whole-body diffusion-weighted magnetic resonance imaging (DW-MRI), as very early predictors of response to chemotherapy in patients with metastatic colorectal cancer (mCRC). This was a single-institution prospective study, approved by the West Midlands-South Birmingham research ethics committee. All patients gave fully informed consent prior to imaging. Sixteen patients with histologically confirmed mCRC were enrolled to the study and 11 were successfully scanned with whole-body DW-MRI before (baseline) and 10.8±2.7 days after commencing chemotherapy (follow-up). Therapy response was assessed by RECIST 1.1. Mean ADC and histogram parameters (skewness, kurtosis, 25th, 50th, and 75th percentiles) were compared between progressors and non-progressors at baseline and follow-up. Receiver operating characteristics (ROC) analysis was performed for the statistically significant parameters. Data from metastases were also compared to normative tissue data acquired from healthy volunteers. Three patients had progressive disease (progressors) and eight had partial response/stable disease (non-progressors). Mean, 25th, 50th, and 75th percentiles were significantly lower for progressors at baseline (p=0.012, 0.012, 0.012 and 0.025 respectively) with areas under the ROC curves (AUC)=0.58, 0.50, 0.58 and 0.63, respectively. Skewness and kurtosis were significantly lower for non-progressors at follow-up (p=0.001 and 0.003 respectively) with AUC=0.67 and 0.79 respectively. ADC histogram analysis shows potential in discriminating progressive from non-progressive disease in patients with mCRC, who underwent whole-body DW-MRI. The technique can potentially be tested as a response assessment methodology in larger trials. •We propose ADC histogram analysis to categorise disease in patients with mCRC.•Skewness and kurtosis show significant reduction after therapy in non-progressors.•Whole body DW-MRI can be used to examine whole body metastatic tumour burden.•Quantitative whole body DW-MRI has the potential to be used as one-stop-shop treatment assessment methodology.