Monitoring Response to Neoadjuvant Chemotherapy of Primary Osteosarcoma Using Diffusion Kurtosis Magnetic Resonance Imaging: Initial Findings

Objective: To determine whether diffusion kurtosis imaging (DKI) is effective in monitoring tumor response to neoadjuvant chemotherapy in patients with osteosarcoma. Materials and Methods: Twenty-nine osteosarcoma patients (20 men and 9 women; mean age, 17.6 +/- 7.8 years) who had undergone magnetic resonance imaging (MRI) and DKI before and after neoadjuvant chemotherapy were included. Tumor volume, apparent diffusion coefficient (ADC), mean diffusivity (MD), mean kurtosis (MK), and change ratio (Delta X) between preand post-treatment were calculated. Based on histologic response, the patients were divided into those with good response >= 90% necrosis, n = 12) and those with poor response (< 90% necrosis, n = 17). Several MRI parameters between the groups were compared using Student's t test. The correlation between image indexes and tumor necrosis was determined using Pearson's correlation, and diagnostic performance was compared using receiver operating characteristic curves. Results: In good responders, MDpost, ADC(post), and MKpost, values were significantly higher than in poor responders (p < 0.001, p < 0.001, and p = 0.042, respectively). The Delta MD and Delta ADC were also significantly higher in good responders than in poor responders (p < 0.001 and p = 0.01, respectively). However, no significant difference was observed in Delta MK (p = 0.092). and Delta MD showed high correlations with tumor necrosis rate (r = 0.669 and r = 0.622, respectively), and MDpost had higher diagnostic performance than ADC(post) (p = 0.037) and MKpost (p = 0.011). Similarly, Delta MD also showed higher diagnostic performance than Delta ADC (p = 0.033) and Delta MK (p = 0.037). Conclusion: MD is a promising biomarker for monitoring tumor response to preoperative chemotherapy in patients with osteosarcoma.