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. 2013 Aug 26;8(8):e72679.
doi: 10.1371/journal.pone.0072679. eCollection 2013.

Noninvasive assessment of response to neoadjuvant chemotherapy in osteosarcoma of long bones with diffusion-weighted imaging: an initial in vivo study

Cheng-Sheng Wang  1 , Lian-Jun Du, Ming-Jue Si, Qi-Hua Yin, Liang Chen, Min Shu, Fei Yuan, Xiao-Chun Fei, Xiao-Yi Ding
Affiliations

Noninvasive assessment of response to neoadjuvant chemotherapy in osteosarcoma of long bones with diffusion-weighted imaging: an initial in vivo study

Cheng-Sheng Wang et al. PLoS One. .

Abstract

Objectives: The purpose of our study is to investigate whether diffusion-weighted imaging (DWI) is useful for monitoring the therapeutic response after neoadjuvant chemotherapy in osteosarcoma of long bones.

Materials and methods: Conventional magnetic resonance imaging (MRI) and DWI were obtained from 35 patients with histologically proven osteosarcomas. MR examinations were performed in all patients before and after 4 courses of preoperative neoadjuvant chemotherapy. Apparent diffusion coefficients (ADC) were measured. The degree of tumor necrosis was assessed macroscopically and histologically by two experienced pathologists after operation. Student's t test was performed for testing changes in ADC value. Pearson's correlation coefficient was used to estimate the correlation between necrosis rate and post- neoadjuvant chemotherapy ADC values. P<0.05 was considered to denote a significant difference.

Results: The difference of the whole osteosarcoma between pre- neoadjuvant chemotherapy ADC value (1.24±0.17×10(-3) mm(2)/s) and post- (1.93±0.39×10(-3) mm(2)/s) was significant difference (P<0.01). Regarding in patients with good response, the post- neoadjuvant chemotherapy values were significantly higher than the pre- neoadjuvant chemotherapy values (P<0.01). The post- neoadjuvant chemotherapy ADC value in patients with good response was higher than that of poor response (t = 8.995, P<0.01). The differences in post- neoadjuvant chemotherapy ADC between viable (1.03±0.17×10(-3) mm(2)/s) and necrotic (2.38±0.25×10(-3) mm(2)/s) tumor was highly significant (t = 23.905, P<0.01). A positive correlation between necrosis rates and the whole tumor ADC values (r = 0.769, P<0.01) was noted, but necrosis rates were not correlated with the ADC values of necrotic (r = -0.191, P = 0.272) and viable tumor areas (r = 0.292, P = 0.089).

Conclusions: DWI can identify residual viable tumor tissues and tumor necrosis induced by neoadjuvant chemotherapy in osteosarcoma. The ADC value can directly reflect the degree of tumor necrosis, and it is useful to evaluate the preoperative neoadjuvant chemotherapy response in patients with osteosarcoma.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Tissue processing of the resected specimen.
(A) Samples were collected from the center of the resected tumor. (B) After dividing the tissue into small pieces, all small pieces of tissues were embedded and numbered. Necrosis rate was determined.
Figure 2
Figure 2. Osteosarcoma of the distal femur in a 24-year-old man with good response.
(A∼C) DWI map, ADC map and ADC histogram before neoadjuvant chemotherapy. The signal intensity of tumor on DWI map was high. The ADC value of the whole tumor was 1.12×10−3 mm2/s with a green area. The ADC histogram was high and sharp. (D∼F) DWI map, ADC map and ADC histogram after neoadjuvant chemotherapy. The signal intensity of tumor on DWI map was decreased. The ADC value of the whole tumor was increased to 1.99×10−3 mm2/s with a subtotal red area. The ADC histogram was short, wide and moving to the right of the coordinate. Tumor necrosis rate of 92% was confirmed by postoperative pathological evaluation. The effectiveness of neoadjuvant chemotherapy was good.
Figure 3
Figure 3. Osteosarcoma of the distal femur in a 46-year-old woman with poor response.
(A∼C) DWI map, ADC map and ADC histogram before neoadjuvant chemotherapy. The tumor on DWI map was mixed high signal intensity. The ADC value of the whole tumor was 1.35×10−3 mm2/s with a subtotal green area. The ADC histogram was high and sharp. (D∼F) DWI map, ADC map and ADC histogram after neoadjuvant chemotherapy. The tumor on DWI map was mixed signal intensity. The ADC value of the whole tumor (1.31×10−3 mm2/s) and the ADC histogram were similar to those of pre- neoadjuvant chemotherapy. Tumor necrosis rate of 20% was confirmed by postoperative pathological evaluation. The effectiveness of neoadjuvant chemotherapy was poor.
Figure 4
Figure 4. Correlation of ADC values of the whole osteosarcomas with necrosis rates after neoadjuvant chemotherapy.
See this image and copyright information in PMC

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