Application of diffusion-weighted magnetic resonance imaging to predict the intracranial metastatic tumor response to gamma knife radiosurgery

J Neurooncol. 2014 Jun;118(2):351-361. doi: 10.1007/s11060-014-1439-9. Epub 2014 Apr 24.

Abstract

To evaluate the effect of stereotactic radiosurgery (SRS) on intracranial metastases with diffusion-weighted imaging/apparent diffusion coefficient maps. A total of 107 patients with 144 metastases larger than 1 cm in diameter were retrospectively reviewed. We calculated the DWI(Tumor/white matter) ratios (DWI(T/WM) ratio) between the metastases and the normal, contralateral frontal white matter at each time point. We also recorded the ADC values for metastases (ADCT values). The DWI(T/WM) ratio and ADCT values were assessed for correlation with the patients' tumor response, brain edema, and survival. A decrease in DWI(T/WM) ratios was seen in the controlled metastases, and an increase in the DWI(T/WM) ratio were seen in the metastases with poor tumor control. On the other hand, an increase in ADCT values was seen in the controlled metastases, and a decrease in ADCT values was seen in the metastases with poor control. The differences were significant (p value: 0.001 and 0.002, respectively). Sensitivity of a decrease in the DWI(T/WM) ratio to make an early prediction of tumor control was 83.9%, and specificity was 88.5%. When using the initial ADCT values of metastases to predict tumor response, sensitivity and specificity were 85.5 and 72.7%, respectively. DWI/ADC is a practical method for studying the efficacy of SRS and predicting early metastases response progression. A decrease signal on DWI and increased ADC values are indicators of good tumor control, and reflect the beneficial effect of SRS.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Edema / etiology
  • Brain Edema / surgery
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / pathology
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / surgery*
  • Diffusion Magnetic Resonance Imaging / methods*
  • Disease Progression
  • Female
  • Frontal Lobe / pathology
  • Frontal Lobe / surgery
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Radiosurgery*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Treatment Outcome
  • White Matter / pathology
  • White Matter / surgery