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Open Access Highly Accessed Research article

Diffusion-weighted MRI characteristics of the cerebral metastasis to brain boundary predicts patient outcomes

Rasheed Zakaria126*, Kumar Das3, Mark Radon3, Maneesh Bhojak3, Philip R Rudland2, Vanessa Sluming4 and Michael D Jenkinson15

Author Affiliations

1 Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK

2 Institute of Integrative Biology, University of Liverpool, Liverpool, UK

3 Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK

4 Magnetic resonance and image analysis research centre (MARIARC), University of Liverpool, Liverpool, UK

5 Institute of Translational Medicine, University of Liverpool, Liverpool, UK

6 Neurosciences Research Centre, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK

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BMC Medical Imaging 2014, 14:26  doi:10.1186/1471-2342-14-26

Published: 3 August 2014

Abstract

Background

Diffusion-weighted MRI (DWI) has been used in neurosurgical practice mainly to distinguish cerebral metastases from abscess and glioma. There is evidence from other solid organ cancers and metastases that DWI may be used as a biomarker of prognosis and treatment response. We therefore investigated DWI characteristics of cerebral metastases and their peritumoral region recorded pre-operatively and related these to patient outcomes.

Methods

Retrospective analysis of 76 cases operated upon at a single institution with DWI performed pre-operatively at 1.5T. Maps of apparent diffusion coefficient (ADC) were generated using standard protocols. Readings were taken from the tumor, peritumoral region and across the brain-tumor interface. Patient outcomes were overall survival and time to local recurrence.

Results

A minimum ADC greater than 919.4 × 10-6 mm2/s within a metastasis predicted longer overall survival regardless of adjuvant therapies. This was not simply due to differences between the types of primary cancer because the effect was observed even in a subgroup of 36 patients with the same primary, non-small cell lung cancer. The change in diffusion across the tumor border and into peritumoral brain was measured by the “ADC transition coefficient” or ATC and this was more strongly predictive than ADC readings alone. Metastases with a sharp change in diffusion across their border (ATC >0.279) showed shorter overall survival compared to those with a more diffuse edge. The ATC was the only imaging measurement which independently predicted overall survival in multivariate analysis (hazard ratio 0.54, 95% CI 0.3 – 0.97, p = 0.04).

Conclusions

DWI demonstrates changes in the tumor, across the tumor edge and in the peritumoral region which may not be visible on conventional MRI and this may be useful in predicting patient outcomes for operated cerebral metastases.

Keywords:
Cerebral metastasis; Brain neoplasms; Secondary; Neoplasm invasiveness; Diffusion-weighted imaging; Apparent diffusion coefficient; MRI