Investigating diffusion patterns of brain metastases pre- and post-stereotactic radiosurgery: a feasibility study

Joseph Madamesila; Nicolas Ploquin; Salman Faruqi; Ekaterina Tchistiakova

doi:10.1088/2057-1976/ac1d89

Investigating diffusion patterns of brain metastases pre- and post-stereotactic radiosurgery: a feasibility study

Biomed Phys Eng Express. 2021 Sep 3;7(6). doi: 10.1088/2057-1976/ac1d89.

Authors

Joseph Madamesila¹, Nicolas Ploquin^{1

2}, Salman Faruqi³, Ekaterina Tchistiakova^{1

2}

Affiliations

¹ Department of Physics and Astronomy, University of Calgary, Canada.
² Department of Oncology, Division of Medical Physics, University of Calgary, Canada.
³ Department of Oncology, Division of Radiation Oncology, University of Calgary, Canada.

PMID: 34388735
DOI: 10.1088/2057-1976/ac1d89

Abstract

Purpose.Metastatic complications are responsible for 90% of cancer-associated mortality. Magnetic resonance imaging (MRI) can be used to observe the brain's microstructure and potentially correlate changes with metastasis occurrence. Diffusion weighted imaging (DWI) is an MRI technique that utilizes the kinetics of water molecules within the body. The aim of this study is to use DWI to characterize diffusion changes within brain metastases in cancer patients pre- and post-stereotactic radiosurgery (SRS).Methods.We retrospectively analyzed 113 metastases from 13 patients who underwent SRS for brain metastasis recurrence. Longitudinal apparent diffusion coefficient (ADC) maps were registered to Gd-T1 images and CT, and clinical metastasis ROIs from all SRS treatments were retrospectively transferred onto these ADC maps for analysis. Metastases were characterized based on pre-SRS diffusion pattern, primary cancer site, and post-SRS outcome. ADC values were calculated pre- and post-SRS.Results.ADC values were significantly elevated (980.2 × 10^-6mm²s^-1and 1040.3 × 10^-6mm²s^-1pre- and post-SRS, respectively) when compared to healthy brain tissue (826.8 × 10^-6mm²s^-1) for all metastases. Three identified pre-SRS patterns were significantly different before SRS and within 6 months post-SRS. No significant differences were observed between different primaries pre-SRS. Post-SRS, Lung metastases ADC decreased by 86.2 × 10^-6mm²s^-1, breast metastases increased by 116.7 × 10^-6mm²s^-1, and genitourinary metastases showed no significant ADC change. SRS outcomes showed ADC variability pre-treatment but no significant differences pre- and post-SRS, except at 6-9 months post-SRS where progressing metastases were elevated when compared to other response groups.Conclusion. This study provided a unique opportunity to characterize diffusion changes in brain metastases before their manifestation on standard Gd-T1 images and post-SRS. Identified patterns may improve early detection of brain metastases as well as predict their response to treatment.

Keywords: ADC; DWI; MRI; SRS; brain metastases; diffusion.

MeSH terms

Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / secondary
Diffusion Magnetic Resonance Imaging
Feasibility Studies
Humans
Radiosurgery* / adverse effects
Retrospective Studies