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The predictive capacity of apparent diffusion coefficient (ADC) in response assessment of brain metastases following radiation

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Abstract

To investigate the predictive capacity of the apparent diffusion coefficient (ADC) as a biomarker of radiation response in brain metastases. Seventy brain metastases from 42 patients treated with either stereotactic radiosurgery or whole brain radiotherapy were imaged at baseline, 1 week, and 1 month post-treatment using diffusion-weighted MRI. Mean and median relative ADC for metastases was calculated by normalizing ADC measurements to baseline ADC. At 1 year post-treatment, or last available follow-up MRI, volume criteria determined final tumour response status. Uni- and multivariate analysis was used to account for factors associated with tumour response at 1 week and 1 month. A generalized estimating equations model took into consideration multiple tumours per subject. Optimal thresholds that distinguished responders from non-responders, as well as sensitivity and specificity were determined by receiver operator characteristic analysis and Youden’s index. Lower relative ADC values distinguished responders from non-responders at 1 week and 1 month (P < 0.05). Optimal cut-off values for response were 1.060 at 1 week with a sensitivity and specificity of 75.0 and 56.3 %, respectively. At 1 month, the cut-off was 0.971 with a sensitivity and specificity of 70.0 and 68.8 %, respectively. A multivariate general estimating equations analysis identified no prior radiation [odds ratio (OR) 0.211 and 0.137, P = 0.033 and 0.0177], and a lower median relative ADC at 1 week and 1 month (OR 0.619 and 0.694, P = 0.0036 and 0.005), as predictors of tumour response. Lower relative ADC values at 1 week and 1 month following radiation distinguished responders from non-responders and may be a promising biomarker of early radiation response.

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Acknowledgments

Raphael Jakubovic and Stephanie Zhou contributed equally as first author of this investigation.

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Authors and Affiliations

  1. Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada

    Raphael Jakubovic, Chris Heyn & Richard Aviv

  2. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Stephanie Zhou, Hany Soliman, Liyang Zhang & Arjun Sahgal

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  1. Raphael Jakubovic
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Correspondence to Arjun Sahgal.

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Jakubovic, R., Zhou, S., Heyn, C. et al. The predictive capacity of apparent diffusion coefficient (ADC) in response assessment of brain metastases following radiation. Clin Exp Metastasis 33, 277–284 (2016). https://doi.org/10.1007/s10585-016-9778-x

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  • DOI: https://doi.org/10.1007/s10585-016-9778-x

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