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

Journal of Translational Medicine

Research

Esha Baidya Kayal¹  Amit Mehndiratta²  Sameer Bakhshi³  Shah Alam Khan⁴  Venkatesan Sampath Kumar⁴  Mehar Chand Sharma⁵  Kedar Khare⁶  Raju Sharma⁷  Devasenathipathy Kandasamy⁷ 

[1] Centre for Biomedical Engineering, Indian Institute of Technology Delhi, 110016, Hauz Khas, New Delhi, India;Centre for Biomedical Engineering, Indian Institute of Technology Delhi, 110016, Hauz Khas, New Delhi, India;Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India;Department of Medical Oncology, Dr. B.R. Ambedkar Institute-Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences, New Delhi, India;Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India;Department of Pathology, All India Institute of Medical Sciences, New Delhi, India;Department of Physics, Indian Institute of Technology Delhi, New Delhi, India;Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India;

关键词: Intravoxel incoherent motion;    Diffusion weighted imaging;    Biomarkers;    Chemotherapy response evaluation;    Survival outcome;    Osteosarcoma;   

DOI  :  10.1186/s12967-022-03838-1

 received in 2022-10-04, accepted in 2022-12-19,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundEarly 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.MethodsTotal 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 < 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 & 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.ResultsGood-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-25th-percentile (HR = 0.047, p = 0.005) & 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 < 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: < 10–3, 0.07, < 10–3, 0.019 respectively).ConclusionIVIM 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.

【 授权许可】

CC BY   
© The Author(s) 2022

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