Open AccessPrediction of Poor Responders to Neoadjuvant Chemotherapy in Patients with Osteosarcoma: Additive Value of Diffusion-Weighted MRI including Volumetric Analysis to Standard MRI at 3T
Author(s) -
Seul Ki Lee,
Won-Hee Jee,
Chan Kwon Jung,
Soo Ah Im,
NackGyun Chung,
Yang-Guk Chung
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0229983
Subject(s) - osteosarcoma , diffusion mri , medicine , neoadjuvant therapy , chemotherapy , magnetic resonance imaging , nuclear medicine , oncology , radiology , pathology , cancer , breast cancer
Objective To evaluate the added value of diffusion weighted image (DWI) including volumetric analysis to standard magnetic resonance imaging (MRI) for predicting poor responders to neoadjuvant chemotherapy in patients with osteosarcoma at 3-Tesla. Methods 3-Tesla Standard MRI and DWI in 17 patients were reviewed by two independent readers. Standard MRI was reviewed using a five-level-confidence score. Two-dimensional (2D) apparent diffusion coefficient (ADC) mean and 2D ADC minimum were measured from a single-section region of interest. An ADC histogram derived from whole-tumor volume was generated including 3D ADC mean , 3D ADC skewness , and 3D ADC kurtosis . The Mann-Whitney- U test, receiver operating characteristic curve with area under the curve (AUC) analysis, and multivariate logistic regression analysis were performed. Results There were 13 poor responders and 4 good responders. Statistical differences were found in posttreatment and percent change of both 2D ADC mean and 2D ADC minimum , posttreatment 3D ADC mean , and posttreatment 3D ADC skewness between two groups. The best predictors of poor responders were posttreatment 2D ADC mean and posttreatment 3D ADC skewness . Sensitivity and specificity of the 1 st model (standard MRI alone), 2 nd model (standard MRI+posttreatment 2D ADC mean ), and 3 rd model (standard MRI+posttreatment 2D ADC mean +posttreatment 3D ADC skewness ) were 85% and 25%, 85% and 75%, and 85% and 100% for reader 1 and 77% and 25%, 77% and 50%, and 85% and 100% for reader 2, respectively. The AUC of the 1 st , 2 nd , and 3 rd models were 0.548, 0.798, and 0.923 for reader 1 and 0.510, 0.635, and 0.923 for reader 2, respectively. Conclusion The addition of DWI including volumetric analysis to standard MRI improves the diagnostic accuracy for predicting poor responders to neoadjuvant chemotherapy in patients with osteosarcoma at 3-Tesla.