Evaluation of a Simplified Intravoxel Incoherent Motion (IVIM) Analysis of Diffusion-Weighted Imaging for Prediction of Tumor Size Changes and Imaging Response in Breast Cancer Liver Metastases Undergoing Radioembolization: A Retrospective Single Center Analysis.

To investigate the value of a simplified intravoxel incoherent motion (IVIM) analysis for evaluation of therapy-induced tumor changes and response of breast cancer liver metastases (mBRC) undergoing radioembolization.In 21 females (mean age 54 years, range 43-72) with mBRC tumor size changes and response evaluation criteria in solid tumors (RECIST) response to 26 primary radioembolization procedures were analyzed. Standard 1.5-T liver magnetic resonance imaging including respiratory-gated diffusion-weighted imaging (DWI) with b0 = 0 s/mm, b1 = 50 s/mm, b2 = 800 s/mm before and 6 weeks after each treatment was performed. In addition to the apparent diffusion coefficient (ADC)(0,800), the estimated diffusion coefficient D' and the perfusion fraction f' were determined using a simplified IVIM approach. For each radioembolization, the 2 largest treated metastases (if available) were analyzed. Lesions were categorized according to size changes into group A (reduction of longest diameter [LD]) and group B (LD increase) after 3 months. Radioembolization procedures were further categorized into "response" (partial response and stable disease) and "nonresponse" (progressive disease) according to RECIST after 3 months. ADC and D' are given in 10 mm/s.Forty-five metastases were analyzed. Thirty-two lesions were categorized as A; 13 as B. Before therapy, group A lesions showed significantly larger f'-values than B (P = 0.001), but ADC(0,800) and D' did not differ. After therapy, in group A lesions the ADC(0,800)- and D'-values increased and f' decreased (P < 0.0001); in contrast in group B lesions f' increased (P = 0.001). Groups could be differentiated by preinterventional f' and by changes of D' and f' between pre and postinterventional imaging (area under the curve [AUC] of 0.903, 0.747 and 1.0, respectively).Preinterventional parameters did not differ between responders and nonresponders according to RECIST. ADC(0,800)- and D'-values showed a larger increase in responders compared with nonresponders (P = 0.013 and P = 0.001, respectively). After therapy f'-values decreased significantly in responders (P = 0.001). Good to excellent prediction of long-term RECIST response was possible by therapy-induced changes in LD, D', and f' (AUC 0.903, 0.879, and 0.867, respectively).A simplified IVIM model-based analysis of early post-treatment DWI can deliver additional information on tumor size changes and long-term RECIST response after radioembolization of mBRC. The estimated perfusion fraction f' is better suited for response assessment than the conventional ADC(0,800) or D'. This can be useful to guide further treatment strategy.
Competing Interests: CM is a consultant for SIRTEX Medical, PharmaCept, and GoreMedical. GMK has received payment for lectures from Philips Healthcare. For the remaining authors no conflicts of interest were declared.