• Stacy Chu, Sasan Karimi, Kyung K Peck, Yoshiya Yamada, Eric Lis, John Lyo, Mark Bilsky, and Andrei I Holodny.
• Departments of *Radiology †Medical Physics ‡Radiation Oncology, and §Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
• Spine. 2013 Oct 15;38(22):E1418-24.

Study DesignThis was a retrospective study focusing on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess treatment response in patients with spinal metastases.ObjectiveTo demonstrate DCE-MRI changes before and after radiation treatment and correlating with other imaging and clinical findings.Summary Of Background DataCurrently, conventional imaging is limited in evaluating early treatment success or failure, which impacts patient care.MethodsConsecutive patients with known spinal metastases underwent DCE-MRI before and after radiotherapy. Perfusion data on 19 lesions were analyzed. Radiotherapy was classified as success (n = 17) or failure (n = 2) on the basis of evidence of tumor contraction (n = 4), negative positron emission tomography (n = 2), or stability for more than 11 months (n = 11). Perfusion parameters blood plasma volume (Vp), time-dependent leakage (Ktrans), area under the curve, and peak enhancement were derived from the signal intensity-time curves and changes in parameter values from pre- to post-treatment were calculated. Curve morphologies were also qualitatively assessed in 13 pre- and 13 post-treatment scans.ResultsVp was the strongest predictor of treatment response (false-positive rate = 9.38 × 10 and false-negative rate = 0.055). All successfully treated lesions showed decreases in Vp, and the 2 treatment failures showed drastic increases in Vp. Changes in area under the curve and peak enhancement demonstrated similar relationships to the observed treatment response, whereas changes in Ktrans showed no significant relationship. Signal intensity curve morphologies also demonstrated specificity for active disease (11 of 13) and treated disease (8 of 13).ConclusionChanges in perfusion, particularly Vp, reflect tumor responses to radiotherapy in spinal bone metastases. These changes were able to predict positive outcomes earlier than 6 months after treatment in 16 of 17 tumors. The ability of DCE-MRI to detect early treatment response has the potential to improve patient care and outcome.

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