68Ga-DOTATATE PET/CT and MRI with diffusion-weighted imaging (DWI) in short-and long-term assessment of tumor response of neuroendocrine liver metastases (NELM) following transarterial radioembolization (TARE)

Abstract

The aim of this study was to evaluate the role of SUV and ADC in assessing early response in patients with NELM following TARE. Thirty-two patients with pre-and postinterventional MRI with DWI and68Ga-DOTATATE PET/CT were included. ADC and SUV of three target lesions and of tumor-free spleen and liver tissue were determined on baseline and first follow-up imaging, and tumor to spleen (T/S) and tumor to liver (T/L) ratios were calculated. Response was assessed by RECIST 1.1 and mRECIST on first follow-up, and long-term response was defined as hepatic progression-free survival (HPFS) over 6, 12, and <24 months. In responders, intralesional ADC values increased and SUV decreased significantly regardless of standard of reference for response assessment (mRECIST/RECIST/HPFS > 6/12/24 m). Using ROC analysis, ∆SUV T/S ratio (max/max) and ∆SUV T/L ratio (max/mean) were found to be the best and most robust metrics to correlate with longer HPFS and were superior to ∆ADC. ∆T/S ratio (max/max) < 23% was identified as an optimal cut-off to discriminate patients with longer HPFS (30.2 m vs. 13.4 m; p = 0.0002). In conclusion, early percentage changes in SUV tumor-to-organ ratios on first follow-up seem to represent a prognostic marker for longer HPFS and may help in assessing therapeutic strategies.