Diffusion-weighted MRI of the liver for early tumor response assessment: Promising technique but evidence is still lacking

Figures & data

Table I. Methodology DWI.

					Methodology DWI						Follow-up MRI
Article	Tumor	Therapy	No. patients	TR (ms)	TE (ms)	B-value (s/mm^2)	Acquisition	Slice thickness (mm)	Slice gap (mm)	Excitations	Interval^b	Before therapy (days^c)	Interval Pre- and post therapy (days^c)	Last treatment -follow-up MRI (days^c)
Buijs [3]	Breast-metastasis	TACE	14	5000-6500	110	500	Breathhold	8	2	NA	I	4 ± 5	60 ± 32	54 ± 33
Liapi [7]	Neuro-endocrine metastasis	TACE	26	5000-6500	110	500	Breathhold	8	2	NA	NA	NA	206 ± 201	NA
Rhee [10]	HCC	90y	20	2500	82	0, 500	One or more breathholds	8	4	NA	II	NA	NA	NA
Buijs [4]	Ocular melanoma metastasis	TACE	6	5000–6500	110	500	Breathhold	8	2	NA	I	16 (1–45)^d	79 (32–161)^d	33 (21–45)^d
Marugami [12]	Colorectal metastasis	HAIC	11	1400	67	0, 500, 1000	Free breathing	7	NA	2	III	NA	NA	NA
Vossen [8]	Leiomyo-sarcoma metastasis	TACE	10	5000–6500	110	500	Breathhold	8	2	NA	I	9 ± 18	57 ± 22	48 ± 24
Deng [9]	HCC	90y	6	2500	82	0, 500	One or more breathholds	8	4	NA	28–70 days	NA	NA	NA
Kamel [5]	HCC	TACE	38	5000–6500	110	500	Breathhold	8	2	NA	I	26 ± 10	111 ± 56	45 ± 15
Kamel [6]	HCC	90y	13	5000–6500	110	500	Breathhold	8	2	NA	I	24 (5–47)^d	55 (39–77)^d	34 (28–77)^d
Cui [11]	Colorectal/gastric metastasis	Chemo	29	NA	2750/ min	0, 800	Breathhold	6	1	4	IV	NA	NA	NA

^bI: 4–6 weeks after TACE and every 6–8 weeks, II: 0-3 weeks before and 1 and 3 months after therapy, III: Before and 9 days and 3 months after therapy, IV: Before, 3, 7 and 42 days after therapy

^cMean ± SD, ^dMean with range,TR: repetition time,TE: echo time, HCC: hepatocellular carcinoma,TACE: transarterial chemoembolization, ⁹⁰Y:Yttrium-90 radioembolization, HAIC: Hepatic arterial infusion chemotherapy, NA: not available

Table II. Results.

Article	ADC (mean ± SD)			Therapeutic response (RECIST)	Tumorsiz (mean ± SD)			Survival (months)
	All patients	Responders	Non-responders		All patients	Responders	Non-responders
Buijs [3]	26.5% ± 33.7%	NA	NA	Complete: 0 Partial^a: 26%	–18.2% ± 60.0%	NA	NA	25
Liapi [7]	18.5% ± 35.8%	NA	NA	Complete: 0 Partial: 23%	–17.9% ± 55.4%	NA	NA	78
Rhee [10]	1 month: 10.5% ± 23.1% 3 months: 11.0% ± 14.0%	21.7% ± 14.9%^x	–22.6 ± 8.13%	NA	–18,5% ± 31.5%	–33.3% ± 19.7%^x	27.6% ± 16.4%	NA
Buijs [4]	47.8% ± 54.8%	NA	NA	0	–16.3% ± 67.3%	NA	NA	NA
Marugami [12]	NA	Min-ADC: 17.9% ± 17.6%° Mean-ADC: 7.5% ± 16.5%°	Min-ADC: –10.5% ± 10.4% Mean-ADC: –6.7% ± 14.5%	NA	–11.7% (range –45.5-54.5%)	NA	NA	NA
Vossen [8]	20.3% ± 24.9%	NA	NA	0	–2.1% ± 68.8%	NA	NA	21
Deng [9]	56.1% ± 38.5%	NA	NA	NA	NA	NA	NA	NA
Kamel [5]	17.2% ± 38.4%	NA	NA	0	–10.0% ± 51.3%	NA	NA	19
Kamel [6]	18.2% ± 15.2%	NA	NA	0	–2.1% ± 50.0%	NA	NA	12
Cui [11]	NA	day 3: 25.4% ± NA day 7: 26.2% ± NA	day 3: 7.2% ± NA day 7: 9.7% ± NA	NA	NA	–38.6% ± 22.1%	–11.0% ± 50.0%	NA

ADC: Apparent diffusion coefficient, RECIST: Response Evaluation Criteria in Solid Tumors, NA: not available

^aOn a lesion-by-lesion basis. On a patient-by-patient basis all patients were non-responders

^xResponders are patients who exhibited tumor shrinkage at 3 months after ⁹⁰Y therapy °lesions with a reduction ratio > 0%

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