Diffusion-weighted MRI for predicting and assessing treatment response of liver metastases from CRC - A systematic review and meta-analysis

Tamer Sobeh; Yael Inbar; Sara Apter; Shelly Soffer; Roi Anteby; Matan Kraus; Eli Konen; Eyal Klang

doi:10.1016/j.ejrad.2023.110810

Diffusion-weighted MRI for predicting and assessing treatment response of liver metastases from CRC - A systematic review and meta-analysis

Eur J Radiol. 2023 Jun:163:110810. doi: 10.1016/j.ejrad.2023.110810. Epub 2023 Apr 7.

Authors

Tamer Sobeh¹, Yael Inbar², Sara Apter², Shelly Soffer³, Roi Anteby⁴, Matan Kraus², Eli Konen², Eyal Klang²

Affiliations

¹ Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: tamer.sobeh@gmail.com.
² Institute of Medical Imaging, Sheba Medical Center at Tel HaShomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Internal Medicine B, Assuta Medical Center, Ashdod, Israel; Ben-Gurion University of the Negev, Be'er Sheva, Israel.
⁴ Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of General Surgery, Sheba Medical Center at Tel HaShomer, Israel.

PMID: 37075628
DOI: 10.1016/j.ejrad.2023.110810

Abstract

The evaluation of response to chemotherapy and targeted therapies in colorectal liver metastases has traditionally been based on size changes, as per the RECIST criteria. However, therapy may alter tissue composition and not only tumor size, therefore, functional imaging techniques such as diffusion-weighted magnetic resonance imaging (DWI) may offer a more comprehensive assessment of treatment response. The aim of this systematic review and meta-analysis was to evaluate the use of DWI in the prediction and assessment of response to treatment in colorectal liver metastases and to determine if there is a baseline apparent diffusion coefficient (ADC) cut-off value that can predict a favorable response. A literature search was conducted using the MEDLINE/PubMed database, and risk of bias was evaluated using the QUADAS-2 tool. The mean differences between responders and non-responders were pooled. A total of 16 studies met the inclusion criteria, and various diffusion-derived techniques and coefficients were found to have potential for predicting and assessing treatment response. However, discrepancies were noted between studies. The most consistent predictor of response was a lower baseline ADC value calculated using traditional mono-exponential methods. Non-mono-exponential techniques for calculating DWI-derived parameters were also reported. A meta-analysis of a subset of studies failed to establish a cut-off value of ADC due to heterogeneity, but revealed a pooled mean difference of -0.12 × 10^-3 mm²/s between responders and non-responders. The results of this systematic review suggest that diffusion-derived techniques and coefficients may contribute to the evaluation and prediction of treatment response in colorectal liver metastases. Further controlled prospective studies are needed to confirm these findings and to guide clinical and radiological decision-making in the management of patients with CRC liver metastases.

Keywords: Apparent diffusion coefficient; Colorectal cancer; Diffusion weighted imaging; Liver metastasis; Magnetic resonance imaging; Treatment response.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Colorectal Neoplasms* / diagnostic imaging
Colorectal Neoplasms* / pathology
Colorectal Neoplasms* / therapy
Diffusion Magnetic Resonance Imaging / methods
Embolization, Therapeutic*
Humans
Liver Neoplasms* / drug therapy
Liver Neoplasms* / therapy
Prospective Studies
Treatment Outcome