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Preoperative diffusion-weighted imaging of single brain metastases correlates with patient survival times
Anna Sophie Berghoff1, Thomas Spanberger, Aysegül Ilhan-Mutlu
1Institute of Neurology, Medical University of Vienna, Vienna, Austria.
Background:
MRI-based diffusion-weighted imaging (DWI) visualizes the local differences in water diffusion in vivo. The prognostic value of DWI signal intensities on the source images and apparent diffusion coefficient (ADC) maps respectively has not yet been studied in brain metastases (BM).
Methods:
We included into this retrospective analysis all patients operated for single BM at our institution between 2002 and 2010, in whom presurgical DWI and BM tissue samples were available. We recorded relevant clinical data, assessed DWI signal intensity and apparent diffusion coefficient (ADC) values and performed histopathological analysis of BM tissues. Statistical analyses including uni- and multivariate survival analyses were performed.
Results:
65 patients (34 female, 31 male) with a median overall survival time (OS) of 15 months (range 0-99 months) were available for this study. 19 (29.2%) patients presented with hyper-, 3 (4.6%) with iso-, and 43 (66.2%) with hypointense DWI. ADCmean values could be determined in 32 (49.2%) patients, ranged from 456.4 to 1691.8*10⁻⁶ mm²/s (median 969.5) and showed a highly significant correlation with DWI signal intensity. DWI hyperintensity correlated significantly with high amount of interstitial reticulin deposition. In univariate analysis, patients with hyperintense DWI (5 months) and low ADCmean values (7 months) had significantly worse OS than patients with iso/hypointense DWI (16 months) and high ADCmean values (30 months), respectively. In multivariate survival analysis, high ADCmean values retained independent statistical significance.
Conclusions:
Preoperative DWI findings strongly and independently correlate with OS in patients operated for single BM and are related to interstitial fibrosis. Inclusion of DWI parameters into established risk stratification scores for BM patients should be considered.
Insights
Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values predict survival in patients with brain metastases (BM). Higher ADC values correlate with longer overall survival (OS) in operated BM patients.
Area of Science:
- Neuro-oncology
- Radiology
- Medical Imaging
Background:
- MRI-based diffusion-weighted imaging (DWI) visualizes water diffusion in vivo.
- The prognostic value of DWI signal intensities and apparent diffusion coefficient (ADC) maps in brain metastases (BM) has not been established.
Purpose of the Study:
- To investigate the prognostic value of DWI signal intensities and ADC values in patients operated for single BM.
- To determine the correlation between DWI findings, ADC values, and histopathological features.
Main Methods:
- Retrospective analysis of 65 patients operated for single BM between 2002 and 2010.
- Assessment of presurgical DWI signal intensity and ADC values.
- Histopathological analysis of BM tissues and correlation with imaging findings.
- Univariate and multivariate survival analyses were performed.
Main Results:
- DWI hyperintensity correlated with interstitial reticulin deposition.
- Patients with hyperintense DWI and low ADCmean values had significantly worse overall survival (OS).
- High ADCmean values were an independent predictor of better OS in multivariate analysis.
Conclusions:
- Preoperative DWI findings and ADC values independently correlate with OS in patients operated for single BM.
- DWI parameters are related to interstitial fibrosis in BM.
- DWI parameters should be considered for risk stratification scores in BM patients.
