Assessment of early treatment response after CT-guided radiofrequency ablation of unresectable lung tumours by diffusion-weighted MRI: a pilot study

¹ Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan

	Abstract

The aim of this study was to evaluate prospectively the early treatment response after CT-guided radiofrequency ablation (RFA) of unresectable lung tumours by MRI including diffusion-weighted imaging (DWI). The study protocol was approved by the ethics committee of our hospital and signed consent was obtained from each patient. We studied 17 patients with 20 lung lesions (13 men and 4 women; mean age, 69±9.8 years; mean tumour size, 20.8±9.0 mm) who underwent RFA using a LeVeen electrode between November 2006 and January 2008. In these patients, RFA was performed for primary lung cancers (n = 10), as well as metastatic tumours from colorectal (n = 6) and cervical cancer (n = 1). MRI was performed on a 1.5T unit before and 3 days after ablation. We compared changes in the apparent diffusion coefficient (ADC) on DWI and response evaluation based on subsequent follow-up CT. 14 of the 20 treatment sessions showed no local progression on follow-up CT, whereas 6 treatment sessions showed local progression (range, 3–17 months; mean, 6 months). For the no-progression group, the ADC pre- and post-RFA were 1.15±0.31 x 10^-3 mm² s^-1 and 1.49±0.24 x 10^-3 mm² s^-1, respectively, while the respective ADC values for those that showed local progression were 1.05±0.27 x 10^-3 mm² s^-1 and 1.24±0.20 x 10^-3 mm² s^-1. The ADC of the ablated lesion was significantly higher than before the procedure (p<0.05). There was a significant difference in the ADC post-RFA between no-progression and local progression groups (p<0.05). Our prospective pilot study showed that the ADC without local progression was significantly higher than with local progression after RFA, suggesting that the ADC can predict the response to RFA for lung tumours. Further studies of a larger sample and longer follow-up are required to determine the usefulness of DWI.