Preoperative diffusion-weighted imaging of single brain metastases correlates with patient survival times

• Published in: PloS one 2013-02, Vol.8 (2), p.e55464-e55464
• Main Authors: Berghoff, Anna Sophie, Spanberger, Thomas, Ilhan-Mutlu, Aysegül, Magerle, Manuel, Hutterer, Markus, Woehrer, Adelheid, Hackl, Monika, Widhalm, Georg, Dieckmann, Karin, Marosi, Christine, Birner, Peter, Prayer, Daniela, Preusser, Matthias
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brain; Brain - pathology; Brain cancer; Brain mapping; Brain Neoplasms - pathology; Brain research; Breast cancer; Cancer metastasis; Correlation; Diffusion; Diffusion coefficient; Diffusion Magnetic Resonance Imaging - methods; Driving while intoxicated; Ethics; Female; Fibrosis; Humans; Lung cancer; Magnetic resonance imaging; Male; Median (statistics); Medical diagnosis; Medical prognosis; Medical research; Medicine; Metastases; Metastasis; Middle Aged; Nervous system; Neuroimaging; Neurology; NMR; Nuclear magnetic resonance; Patient outcomes; Patients; Prognosis; Radiation therapy; Radiology; Retrospective Studies; Statistical analysis; Statistical methods; Statistics; Studies; Surgery; Survival; Tissue analysis; Tissues; Tumors; Women's health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0055464

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). 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. 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. 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.