Value of diffusion-weighted imaging for evaluating chemotherapy response in osteosarcoma: A meta-analysis

Abstract

The histological examination of the tumor necrosis upon surgery remains the most reliable prognostic factor for osteosarcoma. However, the detection of more early prognostic factors is desirable in order to increase the survival rates and decrease the risk rates for iatrogenic toxicity. The purpose of the current systematic review and meta-analysis was to provide an up-to-date summary of the role of diffusion-weighted imaging (DWI) for the preoperative assessment of the chemotherapy response in osteosarcoma. Articles evaluating DWI for the preoperative assessment of the chemotherapy response of osteosarcoma were systematically searched for in four electronic literature databases. The mean difference in apparent diffusion coefficient (ADC) following neoadjuvant chemotherapy between good and poor histological responders was assessed in 5 studies. The mean difference in the ADC ratio (the percentage change in ADC between post-neoadjuvant and pre-neoadjuvant chemotherapy) reported in 3 studies was also assessed. Five articles with 106 patients fulfilled all of the inclusion criteria for the meta-analysis. Significant mean differences were found between good and poor responders in the ADC in the 5 studies (P=0.03) and the ADC ratio in the 3 studies (P<0.00001). The good responders demonstrated a higher ADC and a higher ADC ratio than the poor responders. DWI performed with ADC values was useful for predicting the chemotherapeutic response of osteosarcoma. This method may have promising potential as a preoperative non-invasive modality.

Keywords: apparent diffusion coefficient; chemotherapy response; diffusion-weighted imaging; meta-analysis; osteosarcoma.

Figure 1.

A flowchart of the study-selection procedure. ADC, apparent diffusion coefficient.

Figure 2.

Forest plot showing outcomes of (A) the mean difference of ADC between good and poor responders in all 5 studies and (B) ADC ratio between good and poor responders in the 3 studies. Heterogeneity among studies was also evaluated using the χ² statistical test and the inconsistency index I². ADC, apparent diffusion coefficient; SD, standard deviation; CI, confidence interval.

Figure 3.

Funnel plot of the diagnostic odds ratios of (A) all 5 ADC articles and (B) the 3 ADC ratio articles. ADC, apparent diffusion coefficient.