Predicting Response of Colorectal Hepatic Metastasis: Value of Pretreatment Apparent Diffusion Coefficients
Dow-Mu Koh1,
Erica Scurr1,
David Collins2,
Baris Kanber2,
Andrew Norman1,
Martin O. Leach2 and
Janet E. Husband1
1 Academic Department of Radiology, Royal Marsden Hospital, Downs Rd., Sutton,
Surrey, United Kingdom, SM2 5PT.
2 Royal Marsden Hospital, Institute of Cancer Research, Sutton, Surrey, United
Kingdom, SM2 5NG.
View larger version (82K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1A —52-year-old man with hepatic metastasis. Diffusion-weighted
isotropic image with b value of 0 s/mm2 shows 2.5-cm metastatic
lesion of high signal intensity in right lobe of liver. Region of interest
surrounding lesion was copied onto B and C.
|
|
View larger version (135K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1B —52-year-old man with hepatic metastasis. Diffusion-weighted
isotropic image shows metastatic lesion with region of interest on
flow-sensitive apparent diffusion coefficient map obtained at b values of 0,
150, and 500 s/mm2.
|
|
View larger version (114K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1C —52-year-old man with hepatic metastasis. Diffusion-weighted
isotropic image shows metastatic lesion with region of interest on
flow-insensitive apparent diffusion coefficient map obtained at b values of
150 and 500 s/mm2.
|
|
View larger version (14K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2 —Box-and-whisker plots comparing pretreatment mean apparent diffusion
coefficients (ADCs) for images with b values of 0, 150, and 500
s/mm2 (ADC0-500) and those for images with b values of 150 and 500
s/mm2 (ADC150-500) in responding and nonresponding metastatic
lesions. Medians (lines through boxes) of mean ADC0-500 values are
higher than those of ADC150-500 values. There was better separation between
responding and nonresponding lesions with ADC150-500 values. Circles indicate
outliers.
|
|
View larger version (6K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 3 —Graph shows results of receiver operator characteristic (ROC)
analysis for differentiation of nonresponding and responding metastatic
lesions with pretreatment mean apparent diffusion coefficients for images with
b values of 150 and 500 s/mm2 (ADC150-500). Area under curve is
0.85. Because ability to confidently identify nonresponding metastases is
important, high specificity (100%) was chosen. Readout made at point marked
with circle showed that threshold ADC150-500 value of 1.69 x
10-3 mm2/s had 60% sensitivity and 100% specificity for
identification of lesions not responding to chemotherapy.
|
|
View larger version (13K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 4 —Graph shows linear regression relation (percentage change in size =
109.11 - [0.05 x ADC150-500]; R2 = 0.34; p
= 0.03) with 95% predictor intervals between percentage reduction in size and
mean pretreatment apparent diffusion coefficient for images with b values of
150 and 500 s/mm2 (ADC150-500). Responding lesions (black
circles) are distributed mainly in upper left quadrant and nonresponding
lesions (white circles) in lower right quadrant. Positive values on
y-axis indicate tumor regression, negative values indicate tumor
growth. Line through value of 30% on y-axis segregates responding
from nonresponding lesions. Line through value of 1.69 x 10-3
mm2/s on x-axis indicates likelihood of tumor
response.
|
|
View larger version (10K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 5A —Box-and-whisker plots show pretreatment (white) and
posttreatment (gray) mean apparent diffusion coefficients (ADCs) for
images with b values of 0, 150, and 500 s/mm2 (ADC0-500) and those
for images with b values of 150 and 500 s/mm2 (ADC150-500).
Responding metastatic lesions. Increase in median of mean ADC0-500 and mean
ADC150-500 among responding metastatic lesions after chemotherapy is evident.
Circles indicate outliers.
|
|
View larger version (11K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 5B —Box-and-whisker plots show pretreatment (white) and
posttreatment (gray) mean apparent diffusion coefficients (ADCs) for
images with b values of 0, 150, and 500 s/mm2 (ADC0-500) and those
for images with b values of 150 and 500 s/mm2 (ADC150-500).
Nonresponding metastatic lesions. No significant change in median of mean
ADC0-500 and mean ADC150-500 was observed after chemotherapy.
|
|
View larger version (124K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6A —49-year-old man with metastatic liver disease. Pretreatment
diffusion-weighted image with b value of 0 s/mm2 (A) and
apparent diffusion coefficient (ADC) map with b values of 150 and 500
s/mm2 (ADC150-500) (B) show 6.4-cm metastasis in right lobe
of liver.
|
|
View larger version (124K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6B —49-year-old man with metastatic liver disease. Pretreatment
diffusion-weighted image with b value of 0 s/mm2 (A) and
apparent diffusion coefficient (ADC) map with b values of 150 and 500
s/mm2 (ADC150-500) (B) show 6.4-cm metastasis in right lobe
of liver.
|
|
View larger version (116K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6C —49-year-old man with metastatic liver disease. After chemotherapy,
metastasis showed response with 30% reduction in size, as shown on
posttreatment (b = 0 s/mm2) diffusion-weighted image (C) and
on ADC150-500 map (D).
|
|
View larger version (133K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6D —49-year-old man with metastatic liver disease. After chemotherapy,
metastasis showed response with 30% reduction in size, as shown on
posttreatment (b = 0 s/mm2) diffusion-weighted image (C) and
on ADC150-500 map (D).
|
|
View larger version (10K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6E —49-year-old man with metastatic liver disease. Histograms of
ADC150-500 taken from tumor region of interest before (black) and
after (gray) treatment show decrease in number of pixels, shift of
histogram to right, and increase in mean ADC value after treatment.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2007 by the American Roentgen Ray Society.
