Journal Article

DCE-MRI is more sensitive than IVIM-DWI for assessing anti-angiogenic treatment-induced changes in colorectal liver metastases

Collins, David J, Khan, Khurum, Fassan, Matteo, Chau, Ian, Rata, Mihaela, Leach, Martin O, Valeri, Nicola, Picchia, Simona, d’Arcy, James, Winfield, Jessica M, Cunningham, David, Orton, Matthew R, Koh, Dow-Mu, Tunariu, Nina, Bali, Maria Antonietta

2021

Overview

Background 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. Methods 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 2 diffusion-weighted images were transferred to DCE-MRI data for further analysis. The median value of four IVIM-DWI parameters [diffusion coefficient D (10 −3 mm 2 /s), perfusion fraction f (ml/ml), pseudodiffusion coefficient D* (10 −3 mm 2 /s), and their product fD* (mm 2 /s)] and three DCE-MRI parameters [volume transfer constant K trans (min −1 ), enhancement fraction EF (%), and their product KEF (min −1 )] 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. Results 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 −1 , P <0.001) and K trans (0.109 to 0.078 min −1 , P =0.002). For IVIM-DWI, only D (a non-perfusion parameter) increased significantly post treatment (0.83 to 0.97 × 10 −3 mm 2 /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 trans 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. Conclusion 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. Trial registration NCT03010722 clinicaltrials.gov; registration date 6 th January 2015.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Antiangiogenics / Cancer / Cancer Research / Care and treatment / Clinical trial / Colorectal liver metastasis / Colorectal Neoplasms - diagnostic imaging / Colorectal Neoplasms - drug therapy / Contrast agents / Contrast media / Correlation / Diffusion / Diffusion coefficient / Drunk driving / Dynamic contrast enhanced MRI (DCE-MRI) / Evaluation / Gadolinium / Humans / Imaging / Inhibitor drugs / Intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) / Liver / Liver Neoplasms - diagnostic imaging / Liver Neoplasms - drug therapy / Magnetic Resonance Imaging / Medical imaging / Medicine / Medicine & Public Health / Metastasis / Nuclear Medicine / Oncology / Parameter identification / Parameter sensitivity / Patients / Perfusion / Prospective Studies / Radiology / Rank tests / Rankings / Research Article / Software / Tumors