DCE-MRI is more sensitive than IVIM-DWI for assessing anti-angiogenic treatment-induced changes in colorectal liver metastases.
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<h4>Background</h4>Diffusion weighted imaging (DWI) with intravoxel incoherent motion (IVIM) modelling can inform on tissue perfusion without exogenous contrast administration. Dynamic-contrast-enhanced (DCE) MRI can also characterise tissue perfusion, but requires a bolus injection of a Gadolinium-based contrast agent. This study compares the use of DCE-MRI and IVIM-DWI methods in assessing response to anti-angiogenic treatment in patients with colorectal liver metastases in a cohort with confirmed treatment response.<h4>Methods</h4>This prospective imaging study enrolled 25 participants with colorectal liver metastases to receive Regorafenib treatment. A target metastasis > 2 cm in each patient was imaged before and at 15 days after treatment on a 1.5T MR scanner using slice-matched IVIM-DWI and DCE-MRI protocols. MRI data were motion-corrected and tumour volumes of interest drawn on b=900 s/mm<sup>2</sup> diffusion-weighted images were transferred to DCE-MRI data for further analysis. The median value of four IVIM-DWI parameters [diffusion coefficient D (10<sup>-3</sup> mm<sup>2</sup>/s), perfusion fraction f (ml/ml), pseudodiffusion coefficient D* (10<sup>-3</sup> mm<sup>2</sup>/s), and their product fD* (mm<sup>2</sup>/s)] and three DCE-MRI parameters [volume transfer constant K<sup>trans</sup> (min<sup>-1</sup>), enhancement fraction EF (%), and their product KEF (min<sup>-1</sup>)] were recorded at each visit, before and after treatment. Changes in pre- and post-treatment measurements of all MR parameters were assessed using Wilcoxon signed-rank tests (P<0.05 was considered significant). DCE-MRI and IVIM-DWI parameter correlations were evaluated with Spearman rank tests. Functional MR parameters were also compared against Response Evaluation Criteria In Solid Tumours v.1.1 (RECIST) evaluations.<h4>Results</h4>Significant treatment-induced reductions of DCE-MRI parameters across the cohort were observed for EF (91.2 to 50.8%, P<0.001), KEF (0.095 to 0.045 min<sup>-1</sup>, P<0.001) and K<sup>trans</sup> (0.109 to 0.078 min<sup>-1</sup>, P=0.002). For IVIM-DWI, only D (a non-perfusion parameter) increased significantly post treatment (0.83 to 0.97 × 10<sup>-3</sup> mm<sup>2</sup>/s, P<0.001), while perfusion-related parameters showed no change. No strong correlations were found between DCE-MRI and IVIM-DWI parameters. A moderate correlation was found, after treatment, between K<sup>trans</sup> and D* (r=0.60; P=0.002) and fD* (r=0.67; P<0.001). When compared to RECIST v.1.1 evaluations, KEF and D correctly identified most clinical responders, whilst non-responders were incorrectly identified.<h4>Conclusion</h4>IVIM-DWI perfusion-related parameters showed limited sensitivity to the anti-angiogenic effects of Regorafenib treatment in colorectal liver metastases and showed low correlation with DCE-MRI parameters, despite profound and significant post-treatment reductions in DCE-MRI measurements.<h4>Trial registration</h4>NCT03010722 clinicaltrials.gov; registration date 6<sup>th</sup> January 2015.
Magnetic Resonance Imaging
Medicine (RMH Smith Cunningham)
Radiotherapy Physics Modelling
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Cancer imaging : the official publication of the International Cancer Imaging Society, 2021, 21 (1), pp. 67 - ?