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  • Review Article
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Technology Insight: water diffusion MRI—a potential new biomarker of response to cancer therapy

Abstract

Diffusion-weighted MRI (DW-MRI) is a functional imaging technique that displays information about the extent and direction of random water motion in tissues. Water movement in tissues is modified by interactions with hydrophobic cellular membranes, intracellular organelles and macromolecules. DW-MRI provides information on extracellular-space tortuosity, tissue cellularity and the integrity of cellular membranes. Images can be sensitive to large or small displacements of water, therefore, macroscopic water flows and microscopic water displacements in the extracellular space can be depicted. Preclinical and clinical data indicate a number of potential roles of DW-MRI in the characterization of malignancy, including determination of lesion aggressiveness and monitoring response to therapy. This Review outlines the biological basis of observations made on DW-MRI and describes how measurements are acquired and quantified, and discusses the interpretation of images and limitations of the technique. The strength of evidence for adoption of DW-MRI as a biomarker for the assessment of tumor response is presented.

Key Points

  • Diffusion-weighted MRI (DW-MRI) provides quantitative information on extracellular space tortuosity, tissue cellularity and the integrity of cellular membranes of tumor tissues by use of rapid imaging protocols that can be routinely adopted into clinical practice

  • Recent advances enable the technique to be widely applied to tumor evaluation in the abdomen and pelvis, and have led to the development of whole-body diffusion-weighted imaging

  • There are convincing data to support use of DW-MRI in the characterization of malignancy, including determination of lesion aggressiveness and for monitoring response to a variety of treatments

  • Changes observed in response to therapy are dependent on the biological mechanism of action of the treatment and on the timing of the MRI observations in relation to administration of treatment

  • Major challenges to the widespread adoption of DW-MRI include the need for improved artifact control, standardization of data acquisition, qualitative and quantitative analysis methods and data display techniques

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Figure 1: Schematic illustration of the diffusion-weighted imaging sequence and the cause of signal loss by mobile protons.
Figure 2: Typical series of diffusion-weighted images of endometrial cancer in the pelvis.
Figure 3: Typical series of diffusion-weighted images of liver metastases from colon cancer.
Figure 4: Typical series of diffusion-weighted images of an endometrial polyp and a uterine fibroid.
Figure 5: Biological processes proposed to be involved in therapy induced changes in tumor ADC.

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Acknowledgements

We would like to thank Mr James d'Arcy and Dr Dow Mu-Koh from Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research and The Royal Marsden NHS Trust, Sutton, UK, for providing DiffusionView software which was used to create illustrations for this Review. Drs Dow Mu-Koh and N Jane Taylor (Mount Vernon Hospital, Northwood, UK) also provided many helpful perspectives on the manuscript.

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Correspondence to Anwar R Padhani.

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Supplementary information

Supplementary Box 1.

Glossary terms. (DOC 22 kb)

Supplementary Figure 1.

Fibroid undergoing infarction. (DOC 75 kb)

Supplementary Figure 2.

Nodal metastases from squamous carcinoma with image registration. (DOC 59 kb)

Supplementary Figure 3.

Antiangiogenic effects of Taxol chemotherapy on breast cancer. (DOC 72 kb)

Supplementary Figure 4.

Nodal involvement by Hodgkin's lymphomal. (DOC 46 kb)

Supplementary Figure 5.

Sacral metastases incompletely treated by chemoradiation. (DOC 118 kb)

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Patterson, D., Padhani, A. & Collins, D. Technology Insight: water diffusion MRI—a potential new biomarker of response to cancer therapy. Nat Rev Clin Oncol 5, 220–233 (2008). https://doi.org/10.1038/ncponc1073

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