Diffusion-weighted Imaging as a Treatment Response Biomarker for Evaluating Bone Metastases in Prostate Cancer: A Pilot Study
Diffusion-weighted Imaging as a Treatment Response Biomarker for Evaluating Bone Metastases in Prostate Cancer: A Pilot Study
复制标题
DOI：
10.1148/radiol.2016160646
复制
发表时间：
2017-04-01
期刊：
影响因子：
19.7
通讯作者：
Tunariu, Nina
中科院分区：
文献类型：
--
作者：
Perez-Lopez, Raquel;Mateo, Joaquin;Tunariu, Nina
目的：确定全身弥散加权成像（DWI）评估转移性去势抵抗性前列腺癌（mCRPC）患者骨转移对治疗的反应的有效性。材料和方法：多（腺苷二磷酸核糖）聚合酶抑制剂奥拉帕尼用于mCRPC的II期前瞻性临床试验包括前瞻性磁共振（MR）成像亚研究；本研究得到了机构研究委员会的批准，并获得了书面知情同意书。在基线和奥拉帕尼给药12周后，使用1.5-T MR成像进行全身DWI。描绘与骨转移相符的DWI图像上异常信号强度区域，得出总扩散体积（tDV）；对5个靶病变也进行了评估。采用Mann-Whitney检验和logistic回归评估骨转移体积变化和中位表观扩散系数（ADC）与治疗反应的关系；采用Spearman相关性(r)评价与前列腺特异性抗原水平和循环肿瘤细胞计数的相关性。结果：纳入21例患者。所有6名对奥拉帕尼有反应的患者tDV均下降，而所有无反应的患者tDV均未下降；反应者和无反应者之间的差异是显著的（P = 0.001）。中位ADC的增加与反应几率的增加相关（优势比为1.08；95%可信区间[CI]: 1.00, 1.15; P = 0.04）。tDV的变化与前列腺特异性抗原水平和循环肿瘤细胞计数的最佳百分比变化呈正相关（r = 0.63 [95% CI: 0.27, 0.83]和r = 0.77 [95% CI: 0.51, 0.90]）。在评估5个目标病灶时，体积减小与疗效相关（体积增大的比值比为0.89;95% CI: 0.80, 0.99; P = 0.037）。结论：本初步研究表明，全身DWI评估骨转移体积的减小和中位ADC的增加可能被用作mCRPC患者对奥拉帕尼反应的指标。在CC BY 4.0许可下发布。
Purpose: To determine the usefulness of whole-body diffusion-weighted imaging (DWI) to assess the response of bone metastases to treatment in patients with metastatic castration-resistant prostate cancer (mCRPC).Materials and Methods: A phase II prospective clinical trial of the poly-(adenosine diphosphate-ribose) polymerase inhibitor olaparib in mCRPC included a prospective magnetic resonance (MR) imaging substudy; the study was approved by the institutional research board, and written informed consent was obtained. Whole-body DWI was performed at baseline and after 12 weeks of olaparib administration by using 1.5-T MR imaging. Areas of abnormal signal intensity on DWI images in keeping with bone metastases were delineated to derive total diffusion volume (tDV); five target lesions were also evaluated. Associations of changes in volume of bone metastases and median apparent diffusion coefficient (ADC) with response to treatment were assessed by using the Mann-Whitney test and logistic regression; correlation with prostate-specific antigen level and circulating tumor cell count were assessed by using Spearman correlation (r).Results: Twenty-one patients were included. All six responders to olaparib showed a decrease in tDV, while no decrease was observed in all nonresponders; this difference between responders and nonresponders was significant (P = .001). Increases in median ADC were associated with increased odds of response (odds ratio, 1.08; 95% confidence interval [CI]: 1.00, 1.15; P = .04). A positive association was detected between changes in tDV and best percentage change in prostate-specific antigen level and circulating tumor cell count (r = 0.63 [95% CI: 0.27, 0.83] and r = 0.77 [95% CI: 0.51, 0.90], respectively). When assessing five target lesions, decreases in volume were associated with response (odds ratio for volume increase, 0.89; 95% CI: 0.80, 0.99; P = .037).Conclusion: This pilot study showed that decreases in volume and increases in median ADC of bone metastases assessed with whole-body DWI can potentially be used as indicators of response to olaparib in mCRPC. Published under a CC BY 4.0 license.