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. 2022 Oct 14:12:967450.
doi: 10.3389/fonc.2022.967450. eCollection 2022.

Predictive value of DCE-MRI and IVIM-DWI in osteosarcoma patients with neoadjuvant chemotherapy

Xibin Xia  1 , Lu Wen  1 , Feng Zhou  2 , Junjun Li  3 , Qiang Lu  1 , Jun Liu  1 , Xiaoping Yu  1
Affiliations

Predictive value of DCE-MRI and IVIM-DWI in osteosarcoma patients with neoadjuvant chemotherapy

Xibin Xia et al. Front Oncol. .

Abstract

Objective: To investigate the predictive value of dynamic contrast enhanced MRI (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for clinical outcomes of osteosarcoma patients with neoadjuvant chemotherapy.

Methods: The present prospective single-arm cohort study enrolled 163 patients of osteosarcoma during July 2017 to July 2022. All patients received the same treatment strategy of neoadjuvant chemotherapy. Both DCE-MRI and IVIM-DWI were conducted for the patients before the chemotherapy, as well as after one or two chemotherapy treatment cycles. The imaging parameters of contrast agent transfer rate between blood and tissue (Ktrans ), contrast agent back-flux rate constant (Kep ), extravascular extracellular fractional volume (Ve ), as well as pure diffusion coefficient (D value), pseudo-diffusion coefficient (D* value), apparent diffusion coefficient (ADC) and the perfusion fraction (f value) were recorded. RECIST standard [complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD)] was used as the main clinical outcome.

Results: After two treatment cycles, 112 (68.71%) cases were with CR and PR, 31 (19.02%) cases were with SD and 20 cases (12.27%) were with PD. After 1~2 treatment cycles, patients with CR/PR showed significantly markedly lower Ktrans , Kep , Ve values, while higher D, ADC and f values compared with SD or PD patients. Alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were positively correlated with values of Ktrans , Kep , and Ve , while negative correlation was observed between ALP and values of D, ADC and f, as well as between LDH and D and ADC after the whole treatment. D and Kep values after two treatment cycles showed the best predictive value for diagnosis of PD. The values of Ktran , Kep , ADC as well as ALP and LDH were all risk factors for PD after neoadjuvant chemotherapy.

Conclusion: DCE-MRI and IVIM-DWI have the potential to predict clinical outcomes of osteosarcoma patients with neoadjuvant chemotherapy.

Keywords: DCE-MRI; IVIM-DWI; clinical outcomes; osteosarcoma; predictor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Typical DCE-MRI and IVIM-DWI images and the parameters for an 18-year-old male patient. (A) Coronal T2WI before and after treatment. (B) Histological analysis. (C) Axial T2WI and Ktrans , Kep , Ve . (D) Images for D, D*, ADC and f.
Figure 2
Figure 2
Dynamic alteration of imaging parameters for osteosarcoma patients with different clinical outcomes during treatment period. (A) Ktrans , Kep , and Ve of DCE-MRI before treatment as well as after 1~2 cycles of the treatment. (B) changes of D, D*, ADC and f value of IVIM-DWI before treatment as well as after 1~2 cycles of the treatment. *p <0.05 vs PD, # p <0.05 vs SD, & p <0.05 vs CR/PR. Comparison for continuous data were analyzed by t test (paired or unpaired) or Mann-Whitney U test.
Figure 3
Figure 3
Serum levels of CEA, ALP and LDH in osteosarcoma patients before and after 2 cycles of the treatment. *p <0.05 vs PD, # p <0.05 vs SD, & p <0.05 vs CR/PR. Comparison for continuous data were analyzed by t test (paired or unpaired) or Mann-Whitney U test.
Figure 4
Figure 4
ROC curves of Ktrans , Kep , and Ve (A), as well as D, D*, ADC and f (B) in predicting PD.
See this image and copyright information in PMC

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