The Utility and Efficiency of Diffusion Tensor Imaging Values to Determine Epidermal Growth Factor Receptor Gene Mutation Status in Brain Metastasis from Lung Adenocarcinoma; A Preliminary Study

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Author(s): Mehmet Ali Gultekin*, Hacı Mehmet Turk, Ismail Yurtsever, Bahar Atasoy, Altay Aliyev, Temel Fatih Yilmaz, Alpay Alkan.

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

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Background: We aimed to investigate whether there were any diffusion tensor imaging (DTI) value differences in brain metastases (BM) due to lung adenocarcinoma based on the epidermal growth factor receptor (EGFR) gene mutation status.

Material and Methods: 17 patients with 32 solid intracranial metastatic lesions from lung adenocarcinoma were included prospectively. Patients were divided according to the EGFR mutation status as EGFR (+) (group 1, n:8) and EGFR wild type (group 2, n:9). The fractional anisotropy (FA), apparent diffusion coefficient (ADC), normalized ADC (nADC), axial diffusivity (AD), and radial diffusivity (RD) values were measured from the solid component of the metastatic lesions and nADC values were calculated. DTI values were compared between group 1 and group 2. Receiver-operating characteristic analysis was used to obtain cut-off values for the parameters presenting a statistical difference between the EGFR gene mutation positive and wild type group.

Results: There were statistically significant differences in measured ADC, nADC, AD, and RD values between group 1 and group 2. The ADC, nADC, AD, and RD values were significantly lower in group 1. There was no significant difference in FA values between two groups. Analysis by the ROC curve method revealed a cut-off value of ≤721 x 10-6 mm2/s for ADC (Sensitivity=72.7, Specificity=85.7); ≤0.820 for nADC (Sensitivity=72.7, Specificity=90.5), ≤886 for AD (Sensitivity=81.8, Specificity=81.0), and ≤588 for RD (Sensitivity=63.6, Specificity=90.5) in differentiating EGFR mutation (+) group from wild type group.

Conclusion: Combination of the decreased ADC, nADC, AD, and RD values in BM due to lung adenocarcinoma can be important for predicting the EGFR gene mutation status. DTI features of the brain metastases from lung adenocarcinoma may be utilized to provide insight into the EGFR mutation status and guide the clinicians for initiation of targeted therapy.

Keywords: Lung adenocarcinoma, Brain metastases, EGFR, Diffusion tensor imaging, Gene mutation, DTI

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(E-pub Ahead of Print)
DOI: 10.2174/1573405615666191122122207
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