The utility of apparent diffusion coefficient maps for evaluating chemotherapy response and prognosis in osteosarcoma.

Background: Assessing the response to neoadjuvant chemotherapy is crucial for determining surgical treatment strategies and optimizing personalized postoperative care in osteosarcoma patients. The apparent diffusion coefficient, derived from diffusion-weighted imaging, reflects tumor aggressiveness; however, its role in evaluating neoadjuvant chemotherapy response remains unclear. This study aimed to evaluate the utility of apparent diffusion coefficient maps in assessing chemotherapy-induced necrosis and prognosis in osteosarcoma.

Methods: Twenty osteosarcoma patients referred to our hospital between 2007 and 2020, for whom apparent diffusion coefficient maps were available, were included. The association between apparent diffusion coefficient values, tumor necrosis rate, and prognosis was analyzed.

Results: The study cohort consisted of 14 males and six females, with a median age of 16 years (range, 7-37). Tumor locations included the femur (12 patients), tibia (5), humerus (2), and scapula (1). Significant correlations were found between changes in mean apparent diffusion coefficient values pre- and post-neoadjuvant chemotherapy and tumor necrosis rate (r = 0.61, p < 0.01). Post-chemotherapy mean and minimum apparent diffusion coefficient values were significantly associated with overall survival (p = 0.04 for both).

Conclusions: This study demonstrates a strong correlation between chemotherapy effectiveness and apparent diffusion coefficient values in osteosarcoma. Future clinical efforts should focus on integrating apparent diffusion coefficient values into treatment strategies to improve patient outcomes.