Systematic Review on DWI

[R1nnegan]

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Hey radiologists, future radiologist, MD's, student

I am currently writing a bachelorthesis (a systematic review being the end product) about DWI-MRI technique. As I am not really very knowledgeable in medical physics nor in radiology I was wondering what your thoughts are on the use of DWI MRI and whether you are at all familiar with this technique.

My most important question has to do with the research question however as my supervisor has stated that he'd be really interested in finding an actual study in which DWI is not merely used retrospectively (to determine whether was a tumor). Instead he aked me to look for studies in which ADC changes (pretreatment vs 1w,2w,4w etc after CRT ) have led to changes in regimen (different chemo for example) and whether this led to a better treatment outcome/ longer progression free survival.
I mysef have quite some difficulty finding something like this so I was wondering whether you know about related studies being performed right now. I do of course know about the relative skepticism that still exists toward DWI and the values of ADC but from my supervisor's perspective (he's a medical physicist) the technique has improved significantly and quite similar experiment are being done right now (although not exactly the same). I was really hoping some of you were knowledgeable as well, pease feel free to post your views conerning DWI (or DCE, IVIM for that matter) and let me know!

 

[Cognovi]

To clarify, you would like to do a systematic review on the use of DWI to guide management of brain tumors.

 

[R1nnegan]

To clarify, you would like to do a systematic review on the use of DWI to guide management of brain tumors.

Yeah that's it! Although not explicitly brain tumors of course. (despite the fact that Glioblastomas are one of the main areas in which DWI is being investigated)
Although there are plenty of studies in which PFS is correlated to a higher ADC I have not been able to find an actual study in which treatment was changed in response to unfavourable DWI for example and that would be best although unlikely I believe.

 

[Cognovi]

Yeah that's it! Although not explicitly brain tumors of course. (despite the fact that Glioblastomas are one of the main areas in which DWI is being investigated)
Although there are plenty of studies in which PFS is correlated to a higher ADC I have not been able to find an actual study in which treatment was changed in response to unfavourable DWI for example and that would be best although unlikely I believe.

If you are not explicitly studying brain tumors, you'll find a lot more to work with in the stroke world.

 

[R1nnegan]

If you are not explicitly studying brain tumors, you'll find a lot more to work with in the stroke world.

I know, but DWI is a proven modality in the world of stroke and what I have to advocate or at least look for is its use in oncology (not specifically glioblastomas).

 

[tco]

You won't find a clinician who uses a single series to guide management. Maybe I'm just not correctly reading what you're writing, but what you're discussing would be involvement in a large clinical trial to test the efficacy of using DWI as a measure of treatment response. You're not going to find people in the real world doing this, because it's not standard of care, as far as I know.

 

[Cognovi]

Yeah that's it! Although not explicitly brain tumors of course.

what I have to advocate or at least look for is its use in oncology

Okay.

 

[R1nnegan]

Okay.

Lol Brain tumors are not the only example of DWI's use in oncology.
Lymphoma's, prostate cancer, hepatic carcinoma are all examples in which DWI assessment is being investigated

 

[R1nnegan]

You won't find a clinician who uses a single series to guide management. Maybe I'm just not correctly reading what you're writing, but what you're discussing would be involvement in a large clinical trial to test the efficacy of using DWI as a measure of treatment response. You're not going to find people in the real world doing this, because it's not standard of care, as far as I know.

Yes thats what I'm looking for, I know DWI is not standard of care so I would be comparing DWI+conventional imaging vs conventional imaging.

 

[cowme]

There are hundreds of studies that do exactly this. Do a pubmed search with the terms adc value and treatment response

 

[tco]

There are hundreds of studies that do exactly this. Do a pubmed search with the terms adc value and treatment response

But ADC is derived partly from DWI, not entirely. Maybe just splitting hairs...?