Efficacy of Diffusion-Weighted Imaging in Neoadjuvant Chemotherapy for Osteosarcoma: A Systematic Review and Meta-Analysis

Abstract Background Early prediction of response to neoadjuvant chemotherapy (NACT) is important to aid personalized treatment in osteosarcoma. Diffusion-weighted Intravoxel Incoherent Motion (IVIM) MRI was used to evaluate the predictive value for response to NACT and survival outcome in osteosarcoma. Methods Total fifty-five patients with biopsy-proven osteosarcoma were recruited prospectively, among them 35 patients were further analysed. Patients underwent 3 cycles of NACT (Cisplatin + Doxorubicin) followed by surgery and response adapted adjuvant chemotherapy. Treatment outcomes were histopathological response to NACT (good-response ≥ 50% necrosis and poor-response &lt; 50% necrosis) and survival outcome (event-free survival (EFS) and overall survival (OS)). IVIM MRI was acquired at 1.5T at baseline (t0), after 1-cycle (t1) and after 3-cycles (t2) of NACT. Quantitative IVIM parameters ( D, D*, f &amp; D*.f ) were estimated using advanced state-of-the-art spatial penalty based IVIM analysis method bi-exponential model with total-variation penalty function (BETV) at 3 time-points and histogram analysis was performed. Results Good-responders: Poor-responders ratio was 13 (37%):22 (63%). EFS and OS were 31% and 69% with 16.27 and 25.9 months of median duration respectively. For predicting poor-response to NACT, IVIM parameters showed AUC = 0.87, Sensitivity = 86%, Specificity = 77% at t0, and AUC = 0.96, Sensitivity = 86%, Specificity = 100% at t1. Multivariate Cox regression analysis showed smaller tumour volume (HR = 1.002, p = 0.001) higher ADC -25 th -percentile (HR = 0.047, p = 0.005) &amp; D -Mean (HR = 0.1, p = 0.023) and lower D*- Mean (HR = 1.052, p = 0.039) were independent predictors of longer EFS (log-rank p -values: 0.054, 0.0034, 0.0017, 0.0019 respectively) and non-metastatic disease (HR = 4.33, p &lt; 10 –3 ), smaller tumour-volume (HR = 1.001, p = 0.042), lower D* -Mean (HR = 1.045, p = 0.056) and higher D*.f- skewness (HR = 0.544, p = 0.048) were independent predictors of longer OS (log-rank p -values: &lt; 10 –3 , 0.07, &lt; 10 –3 , 0.019 respectively). Conclusion IVIM parameters obtained with a 1.5T scanner along with novel BETV method and their histogram analysis indicating tumour heterogeneity were informative in characterizing NACT response and survival outcome in osteosarcoma. 

https://translational-medicine.biomedcentral.com/counter/pdf/10.1186/s12967-022-03838-1

Non-invasive intravoxel incoherent motion MRI in prediction of histopathological response to neoadjuvant chemotherapy and survival outcome in osteosarcoma at the time of diagnosis

Colorectal cancer (CRC) is a complex malignancy requiring multimodal treatment strategies, including neoadjuvant chemoradiation therapy (Neo-CRT), to improve patient outcomes. However, the response to Neo-CRT varies among individuals, which necessitates the development of reliable predictors of treatment response. The present study aimed to investigate the role of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) perfusion in predicting treatment response in CRC patients after Neo-CRT. 

Role of Intravoxel Incoherent Motion and Dynamic-Contrast-Enhanced Perfusion in Response Prediction of Patients with Colorectal Cancer after Neoadjuvant Chemotherapy

Purpose. To investigate the value of intravoxel incoherent motion (IVIM) magnetic resonance imaging in the evaluation of the osteosarcoma (OS) response to preoperative neoadjuvant chemotherapy (NAC) in teens. Methods. Eighteen consecutive osteosarcoma patients (12 males and 6 females) diagnosed by histopathology were enrolled. All enrolled patients received NAC and underwent MRI examinations before and after 2 cycles of NAC. The volume (V), apparent diffusion coefficient (ADC), (slow) diffusion coefficient (D), pseudo-perfusion (fast) diffusion coefficient (D⁎or D star), and perfusion fractions (f) of the OS before and after NAC were measured and analysed. The sensitivity and the specificity of the ADC, D, D⁎ and values and the correlation between changes in volume ( ) and the IVIM-derived parameters ( , , and ) were also calculated and analysed. Paired Student’s t-tests, receiver operating characteristic (ROC) curves, and Spearman correlation analyses were used. Results. The mean volume of the OS after NAC decreased significantly (61.55±9.3 cm3 vs 40.26±4.1 cm3) (P 0.05). The AUC values of ADC (0.938) and D (0.943) were higher than those of D⁎ (0.574) and f (0.765). The sensitivity and specificity of ADC (0.778, 1) and D (0.944, 0.833) values were superior to those of D⁎ (0.278, 0.722) and f (0.5, 0.944) values. No significant correlations were found between the and , , and values (P>0.05). Conclusion. IVIM-derived parameters ADC and D have the potential to be imaging biomarkers for evaluation of the therapeutic response to NAC in OS patients.

/pdf/the-value-of-intravoxel-incoherent-motion-ivim-magnetic-5bok8nkbfk.pdf

The Value of Intravoxel Incoherent Motion (IVIM) Magnetic Resonance Imaging in the Evaluation of the Osteosarcoma Response to Preoperative Neoadjuvant Chemotherapy in Teens

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The Value of Intravoxel Incoherent Motion (IVIM) Magnetic Resonance Imaging in the Evaluation of the Osteosarcoma Response to Preoperative Neoadjuvant Chemotherapy in Teens