Digital DiagnosticsDigital DiagnosticsDigital DiagnosticsDigital Diagnostics2712-84902712-8962Eco-Vector7731110.17816/DD77311Systematic reviewsСистематические обзоры系统评价Review ArticleObjective criteria for MRI evaluation of the effectiveness of treatment of bone metastases in patients with prostate cancer and breast cancer: systematic review and meta-analysisОбъективные критерии МРТ-оценки эффективности лечения метастазов в кости у больных раком предстательной железы и раком молочной железы: систематический обзор и метаанализMRT评估前列腺癌和乳腺癌骨骨治疗骨转移有效性的客观标准：系统评论和核心分析https://orcid.org/0000-0001-8970-4212RippVladislav O.РиппВладислав ОлеговичRippVladislav O.
Russian Federation

Radiologist of the MRI Department

Врач-рентгенолог

rippnba@gmail.comhttps://orcid.org/0000-0002-3549-4499BerezovskayaTatyana P.БерезовскаяТатьяна ПавловнаBerezovskayaTatyana P.

MD, Senior Research Associate, Dr. Sci. (Med.), Professor

главный научный сотрудник отделения МРТ, доктор медицинских наук, профессор

MD, Senior Research Associate, Dr. Sci. (Med.), Professor

berez@mrrc.obninsk.ruhttps://orcid.org/0000-0001-7689-6032IvanovSergey A.ИвановСергей АнатольевичIvanovSergey A.
Russian Federation

MD, Dr. Sci. (Med.), Professor

директор МРНЦ им А.Ф. Цыба, доктор медицинских наук, профессор РАН

MD, Dr. Sci. (Med.), Professor

oncourolog@gmail.comA. Tsyb Medical Radiological Research Center — branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian FederationМедицинский радиологический научный центр имени А.Ф. Цыба — филиал федерального государственного бюджетного учреждения, «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской ФедерацииA. Tsyb Medical Radiological Research Center — branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation2209202115102021232893000308202102092021Copyright ©; 2021, Ripp V.O., Berezovskaya T.P., Ivanov S.A.Copyright ©; 2021, Рипп В.О., Березовская Т.П., Иванов С.А.Copyright ©; 2021, Ripp V.O., Berezovskaya T.P., Ivanov S.A.2021Ripp V.O., Berezovskaya T.P., Ivanov S.A.Рипп В.О., Березовская Т.П., Иванов С.А.Ripp V.O., Berezovskaya T.P., Ivanov S.A.https://creativecommons.org/licenses/by-nc-nd/4.0https://jdigitaldiagnostics.com/DD/article/view/77311

BACKGROUND: The possibility of a personalized approach to the treatment of metastatic prostate cancer and breast cancer requires objective methods for the evaluation of the response of foci treatment in the skeleton. The proven high efficiency of MRI in detecting bone metastases, in combination with the absence of ionizing radiation, has laid the groundwork for using this method in monitoring the treatment course based on objective criteria for evaluation of the therapeutic outcome.

AIM: To assess the possibilities of quantitative and semi-quantitative parameters of MRI-evaluation of treatment efficacy (radiation, chemotherapy, hormone therapy, and targeted therapy) of bone metastases that were used in prostate and breast cancer clinical trials.

MATERIALS AND METHODS: We searched the databases Embase, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), eLibrary until April 1, 2021, using the following keywords: magnetic resonance imaging, MRI, DWI, treatment response, prostate or breast cancer, and bone metastasis. We only included studies related to the MRI-evaluation of treatment efficacy of any type of therapeutic intervention (with the exception of surgery) for metastatic skeletal lesions in this review.

RESULTS: We selected and analyzed 11 out of 312 sources found as a result of the search. It allowed us to identify four groups of objective MRI criteria for evaluating the therapeutic effect in metastatic bone lesions in patients with prostate and breast cancer, including the dynamics of sizes, signal intensity on DWI, ADC, and tumor total diffusion volume (tDV). Changes in these quantitative and semi-quantitative indicators, with only one exception, had the same direction, although they differed in numerical values. A random-effects model was used for analysis considering the presence of statistically significant heterogeneity (p <0,1 for χ2 test; I2 >40%),. The change in ADC as a result of treatment averaged +0.35 [+0.12; +0.49] ×10−3 mm2/s, with average values of ADC before treatment ― 0.83 [0.71; 1.03] ×10−3 mm2/s, after treatment ― 1.18 [0.83; 1.49] ×10−3 mm2/s.

CONCLUSION: MRI is an informative technique for the objective evaluation of the response of bone metastases to therapy in patients with prostate cancer and breast cancer based on quantitative and semi-quantitative parameters. It has significant potential as a diagnostic test instrument for monitoring the effectiveness of treatment of metastatic skeletal lesions.

Обоснование. Возможность персонифицированного подхода к лечению метастатического рака предстательной железы (РПЖ) и рака молочной железы (РМЖ) требует объективных методов оценки ответа на лечение очагов в скелете. Доказанная высокая эффективность МРТ в выявлении метастазов в кости в сочетании с отсутствием ионизирующего излучения создаёт предпосылки для использования метода в мониторировании хода лечения на основе объективных критериев оценки терапевтического эффекта.

Цель ― оценить возможности объективных количественных и полуколичественных МРТ-критериев в определении эффективности лечения (радио-, химио-, гормоно- и таргетная терапия) метастазов в кости, применявшихся в клинических исследованиях у больных РПЖ и РМЖ.

Материалы и методы. Поиск в базах данных Embase, PubMed, Cochrane Central Register of Controlled trials (CENTRAL), eLibrary осуществлялся до 01.06.2021 по ключевым словам «magnetic resonance imaging», «MRI», «DWI», «treatment response», «prostate cancer», «breast cancer», «bone metastasis» на английском и русском языках. В обзор включали только исследования по объективной МРТ-оценке эффективности любого типа лечебного воздействия (за исключением хирургии) при метастатическом поражении скелета.

Результаты. На основании анализа 11 исследований, отобранных из 312 источников, выделены 4 группы объективных МРТ-критериев оценки терапевтического эффекта при метастатическом поражении костей у больных РПЖ и РМЖ, включающих динамику размеров, интенсивности сигнала на диффузионно-взвешенном изображении, числовых значений измеряемого коэффициента диффузии (ИКД), общей опухолевой нагрузки. Изменения этих количественных и полуколичественных показателей во всех работах, за единственным исключением, имели одинаковую направленность, хотя и различались числовыми значениями. Учитывая статистически значимую гетерогенность (p <0,1 для критерия χ2 и при I2 >40%) для значений ИКД до и после лечения, для анализа использовалась модель случайных эффектов. Изменение ИКД в результате лечения в среднем составило +0,35 [+0,12; +0,49] ×10-3 мм2/с со средними значениями ИКД до лечения 0,83 [0,71; 1,03] ×10-3 мм2/с, после лечения ― 1,18 [0,83; 1,49] ×10-3 мм2/с.

Заключение. МРТ является информативной методикой для объективной оценки ответа костных метастазов на терапию у больных РПЖ и РМЖ на основе количественных и полуколичественных критериев и имеет значительный потенциал в качестве диагностического инструмента для мониторирования эффективности лечения метастатического поражения скелета.

论证转移性前列腺癌（PC）和乳腺癌（BC）的个体化治疗需要客观的方法来评估对骨骼病灶治疗的反应。经过验证的高效MRT在骨骼中鉴定与没有电离辐射的组合的鉴定产生的前提是使用该方法在监测基于评估治疗效果的客观标准治疗治疗方法时的先决条件。

目标是估计客观定量和半定量MRT标准的可能性，用于确定患有PC和BC患者的临床研究中使用的骨骼中的治疗的有效性（无线电，化学 - 激素和靶向治疗）。

材料与方法Embase，PubMed数据库，Cochrane Central寄存器（中央），Elibrary通过关键词“磁共振成像”，“MRI”，“DWI”，“治疗反应”，“前列腺”癌症“，”乳腺癌“， 英语和俄语”骨转移“。 概述仅包括在骨架的转移病变期间对任何类型治疗效果（外科除外）有效性的客观MRT评估的研究。

结果。根据分析选自312次来源的11项研究，4组客观MRI标准，用于估算PC和BC患者骨骼的转移损伤期间的治疗效果，包括尺寸的动态; 扩散加权图像上的信号强度; 测量扩散系数（MDC）的数值; 总肿瘤载荷。 所有作品中，这些定量和半定量指标的变化在唯一的例外，虽然它们具有相同的焦点，但它们的数值不同。 鉴于治疗前后的ICD值的统计学上显着的异质性（p <0,1 对于χ2标准和I2> 40％）进行治疗前后的MDC值，用于分析随机效应的模型。 治疗导致的 CDI 变化平均为 +0.35 [+0.12; +0.49] × 10-3 平方毫米/秒治疗前平均 ADC 值 0.83 [0.71; 1.03] × 10-3平方毫米/秒, 处理后 - 1.18 [0.83; 1.49] × 10-3 平方毫米/秒。

结论MRI 是一种基于定量和半定量标准客观评估前列腺癌和乳腺癌患者骨转移对治疗反应的信息技术，具有作为监测转移性骨骼病变治疗效果的诊断工具的巨大潜力。

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