ADVANCED MR DIFFUSION-WEIGHTED IMAGING TECHNIQUES FOR MONITORING BRAIN HEALTH IN ATHLETES: PREDICTING RADIOTHERAPY RESPONSES FOR BRAIN METASTASES

Abstract

Objective: To assess the potential of MR diffusion-weighted imaging (DWI) in predicting the responsiveness of brain metastases (BM) to radiotherapy in athletes, a group potentially at risk due to repeated head traumas or other sports-related factors. Methods: We retrospectively analyzed clinical data from 115 patients treated for BM at our hospital from January 2020 to January 2021, including athletes from contact sports. All patients underwent radiotherapy and were monitored with DWI before treatment, 1 month after, and 6 months after treatment. Patients were categorized into a treatment response group (n = 81) and a nonresponse group (n = 34) based on treatment efficacy at 6 months. We measured changes in maximum tumor diameter, apparent diffusion coefficient (ADC), and relative ADC value (rADC) at each time point. Logistic regression identified risk factors for treatment non-response, and ROC curve analysis determined the predictive value of △ADC and △rADC for BM treatment efficacy. Results: The treatment response rate was 73.04%. Factors such as higher ECoG scores, squamous cell carcinoma tissue type, and EGFR mutation prevalence were significantly associated with treatment non-response. In the treatment response group, significant reductions in tumor diameter and increases in ADC and rADC values were noted both 1- and 6-months posttreatment. These changes were not observed in the non-response group. Early changes in △ADC and △rADC were significantly greater in the response group, suggesting their utility in early response prediction. Logistic regression highlighted EGFR mutation as a risk factor and early changes in △ADC and △rADC as protective factors against treatment non-responsiveness. Conclusion: DWI is effective for early assessment of radiotherapy response in BM, offering valuable insights for tailoring treatment plans. For athletes, who may have unique vulnerabilities to brain conditions, DWI provides a critical tool for early intervention and management, potentially guiding more personalized and timely therapeutic strategies.