Fabrizio Boni, Presenter: Nothing to Disclose

Alessandro Napoli MD, Abstract Co-Author: Nothing to Disclose

Michele Anzidei MD, Abstract Co-Author: Nothing to Disclose

Vincenzo Noce MD, Abstract Co-Author: Nothing to Disclose

Daniel Rodrigues Garcia De Oliveira, Abstract Co-Author: Nothing to Disclose

Carlo Catalano MD, Abstract Co-Author: Nothing to Disclose

To evaluate potential of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) maps in the assessment of molecular changes in bone metastasis micro-environment caused by MR guided Focused Ultrasound (MRgFUS), and to correlate these modifications with clinical outcomes

23 patients with bone metastases underwent MRgFUS using the ExAblate 2100 system (InSightec). Minimal required imaging work-up consisted of CT and MR imaging to determine size and location of the lesions. Skeletal metastasis imaging was performed with a 3-T MR imaging unit (Discovery 750, GE; gd-BOPTA, Bracco).  After treatment, all patients were scheduled to undergo clinical follow-up examinations at 1, 3 and 6 months post-treatment. To evaluate treatment efficacy in terms of symptoms palliation, pain severity and pain interference scores were determined using Visual Analogue Scale (VAS) score. Additionally, all patients underwent follow-up MR imaging at 1, 3 and 6 months after treatment.  The margins of metastatic lesions were tracked manually on the baseline ADC. As quantitative parameter of treatment response, we calculated percentage of increase in ADC (ADC%) 

No  adverse events were recorded. We found an effective pain relief, with mean VAS score drop from an average baseline of 7.09±1.8, to 2.65±1.36 at first month follow-up to 1.04±1.91 at third month and to 1.09±1.99 at sixth month. Furthermore, patients treated with MRgFUS showed a mean increase in ADC value of +48.9% at first month follow-up (p<0.001), to +43.3% (p<0.001) at third month and to +42.8% (p<0.001) at sixth month, from baseline. Bivariate rank correlation  was calculated using ADC and VAS of the entire population over-time as variables, demonstrating a statistically significant, negative correlation between the values (ρ=-0.684; p=0.03) 

Our preliminary data showed that incremental ADC values positively correlated with MRgFUS clinically successful outcome in patients with bone metastases; a different percentage increase in ADC was evident among our population (partial vs complete responders). ADC value might play as an important early marker surrogate for clinical outcome in patients undergoing MRgFUS for painful bone metastasis 

MRgFUS treatment determines bone metastasis cell damage, correlate with clinical outcomes, as demonstrated by linear ADC modification

Boni, F, Napoli, A, Anzidei, M, Noce, V, De Oliveira, D, Catalano, C, MR-guided Focused Ultrasound (MRgFUS) for Treatment of Painful Bone Metastases: Can ADC Be Used to Predict Clinical Outcome? .  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13027775.html