Conventional evaluation of anti-tumor activity on the basis of tumor size is inadequate for immune checkpoint inhibitors (ICIs). We therefore aimed to assess the usefulness of intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) for evaluation of the therapeutic efficacy of ICIs.
A chest IVIM-MRI was performed before and 2, 4, and 8 weeks after administration of ICIs in patients with advanced non-small-cell lung cancer. Apparent diffusion coefficient (ADC), skewness of ADC (ADC), kurtosis of ADC (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were evaluated at each evaluation point and changes from the baseline (Δ).
Twenty patients were enrolled in this study. An increased ADC 8 weeks and decreased ADC and ΔADC 4 weeks after ICIs was associated with objective responses and longer progression-free survival (PFS). A decreased ΔADC at 4 weeks was associated with objective responses, disease control, and longer PFS and overall survival. There was no correlation between the efficacy of ICIs and D, D* and f. All of three patients who had pseudoprogression had decreased ΔADC at 4 weeks and two of them had decreased ΔADC at 4 weeks. Inversely, all five patients who had progressive disease (PD) did not have increased ΔADC at 4 weeks and only one of them had decreased ΔADC at 4 weeks.
Changes in histograms of ADC may be useful for predicting long-term efficacy and distinguishing between pseudoprogression and actual PD after ICIs.

Copyright © 2020. Published by Elsevier B.V.