Diffusion-weighted MRI Before and After Robotic Radiosurgery (Cyberknife®) in Primary and Secondary Liver Malignancies: A Pilot Study

The purpose of this study was to evaluate the role of diffusion-weighted MR imaging (DW-MRI) in the assessment of treatment response of primary or secondary liver malignancies after stereotactic radiosurgery (SRS) using robotic radiosurgery. All patients who underwent SRS therapy for hepatic malignancies who had pre- and post-interventional MR examinations including DW-MRI at our hospital between 02/2010 and 02/2012 were included. A retrospective analysis of the institutional imaging database identified 13 patients (4 men, 9 women, mean age: 66 years) with a total of 14 primary or secondary liver malignancies. Criteria of tumor response to treatment were a decrease in size and/or loss of contrast enhancement as assessed with respect to RECIST criteria. Mean apparent diffusion coefficient (ADC) values for normal liver parenchyma and hepatic masses in each MR examination were calculated and compared using two-tailed, paired t-test with a significance level of 0.05. Mean ADC values of liver malignancies were 1.10 +/- 0.30 x 10(-3) mm(2)/s, 1.48 +/- 0.35 x 10(-3) mm(2)/s and 1.56 +/- 0.40 x 10(-3) mm(2)/s on pre- interventional, the first post-interventional, and the second post-interventional DW-MRI. There was a significant increase of ADC values between the pre- interventional examination and the first and second post-interventional follow-up exams (p < 0.01 and p = 0.01, respectively). However, there was no statistical difference between the ADC values of the first and second post-interventional MRI. ADC values of normal liver parenchyma did not show significant changes in ADC values during pre- and post-interventional MRI. ADC measurements may allow the evaluation of response to treatment of hepatic malignancies by SRS. ADC values of liver malignancies increase significantly after SRS treatment.