Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging for Prediction of Early Arterial Blood Flow Stasis in Radioembolization of Breast Cancer Liver Metastases

Purpose:. To retrospectively evaluate predictive value of intravoxel incoherent motion (IVIM) diffusion-Weighted imaging (DWI) for early arterial blood flaw stasis during transarterial rachoembolization (TARE) of liver dominant breast metastases (LdBM). Materials and Methods: Preinterventional 1.5T DWI (b0, b1, b2 = 0, 50, 800 s/mm(2)) data for 28 liver lobes of 18 female patients treated by resin-based radioembolization (10 bilobar and 8 unilobar treatments) were analyzed. Apparent diffusion coefficient (ADC) (0, 800) and an estimation of the true diffusion coefficient D' and of the perfusion fraction f' were calculated for the 2 largest metastases. Response rate at 3 months and survival were analyzed. Procedures without full dose application because of early stasis were assigned to, group A (n = 15), and procedures with full dose application were assigned to group B (n = 13). Results: Metastases in group A showed significantly lower f' (0.035 +/- 0.018 vs 0.076 +/- 0.015, P < .0001) and a trend toward lower ADC(0, 800) With values given in 10(-6) mm(2)/s (1,066 +/- 141 vs 1,189 +/- 176, P = .051); no group difference was shown for D'. Groups were best discriminated by weighted mean f' values of the 2 largest metastases with accuracy of 100%. Mean tumor diameter before and after TARE was 51 mm +/- 18 and 50 mm +/- 24 in group A and 47 mm +/- 27 and 48 mm +/- 32 for group B. Imaging response did not differ between groups (P = .545) Overall survival did not differ significantly between group A (230 d) and B (155 d) (P = .124). Conclusions: Perfusion-sensitive IVIM parameter f' may predict early blood flow stasis inpatients undergoing TARE for LdBM. Determination of this parameter before intervention may increase awareness of the interventionalist and increase safety Of microsphere administration.