Prognostic value of pretreatment diffusion-weighted magnetic resonance imaging for outcome prediction of colorectal cancer liver metastases undergoing 90Y-microsphere radioembolization

Purpose To investigate the clinical potential of pretreatment apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DWI) for therapy response and outcome prediction in patients with liver-predominant metastatic colorectal cancer (CRC) undergoing radioembolization with (90)Yttrium-microspheres (90Y-RE). Methods Forty-six consecutive patients with unresectable CRC liver metastases underwent standardized clinical DWI on a 1.5 T MR scanner prior to and 4-6 weeks after 90Y-RE. Pretreatment clinical parameters, ADC values derived from region-of-interest analysis, and the corresponding tumor sizes of three treated liver metastases per subject were recorded. Long-term tumor response to radioembolization was categorized into response (partial remission) and nonresponse (stable disease, progressive disease) according to Response Evaluation Criteria in Solid Tumors v1.1 (RECIST) 3 months after treatment. Associations between long-term tumor response and the clinical and imaging parameters were evaluated. The impact of pretreatment clinical and imaging parameters on progression-free survival (PFS) and overall survival (OS) was further assessed by Kaplan-Meier and multivariate Cox-regression analyses. Results Nonresponders had higher hepatic tumor burden (p = 0.021) and lower ADC values than patients responding to 90Y-RE, both pretreatment (986 +/- 215 vs. 1162 +/- 178; p = 0.036) and posttreatment (1180 +/- 350 vs. 1598 +/- 225; p = 0.002). ADC values higher than 935 x 10(-6) mm(2) (5 vs. 3 months; p = 0.022) and hepatic tumor burden <= 25% (6 vs. 3 months; p = 0.014) were associated with longer median PFS, whereas ADC > 935 x 10(-6) mm(2) (14 vs. 6 months; p = 0.02), hepatic tumor burden <= 25% (14 vs. 6 months; p = 0.048), size of the largest metastasis <4.7 cm (18 vs. 7 months; p = 0.024), and Eastern Cooperative Oncology Group (ECOG) score <1 (8 vs. 5 months; p = 0.045) were associated with longer median OS. On multivariate analysis, ADC > 935 x 10(-6) mm(2) and hepatic tumor burden <= 25% remained prognostic factors for PFS, and ADC > 935 x 10(-6) mm(2) and size of the largest metastasis <4.7 cm were independent predictors of OS. Conclusion Pretreatment ADC on DWI represents a valuable prognostic biomarker for predicting both the therapeutic efficacy and survival prognosis in CRC liver metastases treated by 90Y-RE, allowing risk stratification and potentially optimizing further treatment strategies.