Diffusion-weighted magnetic resonance imaging in metastatic gastrointestinal stromal tumor (GIST): a pilot study on the assessment of treatment response in comparison with 18F-FDG PET/CT

Abstract

Background

Diffusion-weighted magnetic resonance imaging (MRI) is increasingly being used for assessing the treatment succes in oncology, but the real clinical value needs to evaluated by comparison with other, already established, metabolic imaging techniques.

Purpose

To prospectively evaluate the clinical potential of diffusion-weighted MRI with apparent diffusion coefficient (ADC) mapping for gastrointestinal stromal tumor (GIST) response to targeted therapy compared with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT).

Material and Methods

Eight patients (mean age, 56 ± 11 years) known to have metastatic GIST underwent 18F-FDG PET/CT and MRI (T1Gd, DWI [b = 50,300,600], ADC mapping) simultaneously, before and after change in targeted therapy. MR and PET/CT examinations were first analyzed blindly. Second, PET/CT images were co-registered with T1Gd-MR images for lesion detection. Only 18F-FDG avid lesions were considered. Maximum standardized uptake value (SUV_max) and the corresponding minimum ADC_min were measured for the six largest lesions per patient, if any, on baseline and follow-up examinations. The relationship between changes in SUV_max and ADC_min was analyzed (Spearman's correlation).

Results

Twenty-four metastases (12 hepatic, 12 extra-hepatic) were compared on PET/CT and MR images. SUV_max decreased from 7.7 ± 8.1 g/mL to 5.5 ± 5.4 g/mL (P = 0.20), while ADC_min increased from 1.2 ± 0.3 × 10⁻³mm²/s to 1.5 ± 0.3 × 10⁻³mm²/s (P = 0.0002). There was a significant association between changes in SUV_max and ADC_min (rho = − 0.62, P = 0.0014), but not between changes in lesions size (P = 0.40).

Conclusion

Changes in ADC_min correlated with the response of 18F-FDG avid GIST to targeted therapy. Thus, diffusion-weighted MRI may represent a radiation-free alternative for follow-up treatment for metastatic GIST patients.

Keywords

Gastrointestinal stromal tumor (GIST)MR diffusion imaging 18F-FDG PET/CT apparent diffusion coefficient (ADC)standard uptake value (SUV)

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