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Lai B, Yi Y, Yang X, Li X, Xu L, Yan Z, Yang L, Han R, Hu H, Duan X. Dynamic contrast-enhanced and diffusion-weighted MRI of cervical carcinoma: Correlations with Ki-67 proliferation status. Magn Reson Imaging 2024; 112:136-143. [PMID: 39029603 DOI: 10.1016/j.mri.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/15/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVES To investigate the association of quantitative parameter (apparent diffusion coefficient [ADC]) from diffusion-weighted imaging (DWI) and various quantitative and semiquantitative parameters from dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with Ki-67 proliferation index (PI) in cervical carcinoma (CC). METHODS A total of 102 individuals with CC who received 3.0 T MRI examination (DWI and DCE MRI) between October 2016 and December 2022 were enrolled in our investigation. Two radiologists separately assessed the ADC parameter and various quantitative and semiquantitative parameters including (volume transfer constant [Ktrans], rate constant [kep], extravascular extracellular space volume fraction [ve], volume fraction of plasma [vp], time to peak [TTP], maximum concentration [MaxCon], maximal slope [MaxSlope] and area under curve [AUC]) for each tumor. Their association with Ki-67 PI was analyzed by Spearman association analysis. The discrepancy between low-proliferation and high-proliferation groups was subsequently analyzed. The receiver operating characteristic (ROC) curve analysis utilized to identify optimal cut-off points for significant parameters. RESULTS Both ADC (ρ = -0.457, p < 0.001) and Ktrans (ρ = -0.467, p < 0.001) indicated a strong negative association with Ki-67 PI. Ki-67 PI showed positive correlations with TTP, MaxCon, MaxSlope and AUC (ρ = 0.202, 0.231, 0.309, 0.235, respectively; all p values<0.05). Compared with the low-proliferation group, high-Ki-67 group presented a significantly lower ADC (0.869 ± 0.125 × 10-3 mm2/s vs. 1.149 ± 0.318 × 10-3 mm2/s; p < 0.001) and Ktrans (1.314 ± 1.162 min-1vs. 0.391 ± 0.390 min-1; p < 0.001), also significantly higher MaxCon values (0.756 ± 0.959 vs. 0.422 ± 0.341; p < 0.05) and AUC values (2.373 ± 3.012 vs. 1.273 ± 1.000; p < 0.05). The cut-offs of ADC, Ktrans, MaxCon and AUC for discrimating low- and high-Ki-67 groups were 0.920 × 10-3 mm2/s, 0.304 min-1, 0.209 and 1.918, respectively. CONCLUSIONS ADC, Ktrans, TTP, MaxCon, MaxSlope and AUC are associated with Ki-67 PI. ADC and Ktrans exhibited high performance to discriminate low and high Ki-67 status of CC.
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Affiliation(s)
- Bingjia Lai
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yongju Yi
- Information Technology Department, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong, China
| | - Xiaojun Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Xiumei Li
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Longjiahui Xu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Zhuoheng Yan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Lu Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Riyu Han
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Huijun Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China.
| | - Xiaohui Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Li J, Ma Y, Yang C, Qiu G, Chen J, Tan X, Zhao Y. Radiomics analysis of R2* maps to predict early recurrence of single hepatocellular carcinoma after hepatectomy. Front Oncol 2024; 14:1277698. [PMID: 38463221 PMCID: PMC10920317 DOI: 10.3389/fonc.2024.1277698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
Objectives This study aimed to evaluate the effectiveness of radiomics analysis with R2* maps in predicting early recurrence (ER) in single hepatocellular carcinoma (HCC) following partial hepatectomy. Methods We conducted a retrospective analysis involving 202 patients with surgically confirmed single HCC having undergone preoperative magnetic resonance imaging between 2018 and 2021 at two different institutions. 126 patients from Institution 1 were assigned to the training set, and 76 patients from Institution 2 were assigned to the validation set. A least absolute shrinkage and selection operator (LASSO) regularization was conducted to operate a logistic regression, then features were identified to construct a radiomic score (Rad-score). Uni- and multi-variable tests were used to assess the correlations of clinicopathological features and Rad-score with ER. We then established a combined model encompassing the optimal Rad-score and clinical-pathological risk factors. Additionally, we formulated and validated a predictive nomogram for predicting ER in HCC. The nomogram's discrimination, calibration, and clinical utility were thoroughly evaluated. Results Multivariable logistic regression revealed the Rad-score, microvascular invasion (MVI), and α fetoprotein (AFP) level > 400 ng/mL as significant independent predictors of ER in HCC. We constructed a nomogram based on these significant factors. The areas under the receiver operator characteristic curve of the nomogram and precision-recall curve were 0.901 and 0.753, respectively, with an F1 score of 0.831 in the training set. These values in the validation set were 0.827, 0.659, and 0.808. Conclusion The nomogram that integrates the radiomic score, MVI, and AFP demonstrates high predictive efficacy for estimating the risk of ER in HCC. It facilitates personalized risk classification and therapeutic decision-making for HCC patients.
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Affiliation(s)
- Jia Li
- Department of Oncology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
| | - Yunhui Ma
- Department of Oncology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
| | - Chunyu Yang
- Department of Radiology, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Ganbin Qiu
- Imaging Department of Zhaoqing Medical College, Zhaoqing, China
| | - Jingmu Chen
- Department of Radiology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
| | - Xiaoliang Tan
- Department of Radiology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
| | - Yue Zhao
- Department of Radiology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
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Yang H, Xu Y, Dong M, Zhang Y, Gong J, Huang D, He J, Wei L, Huang S, Zhao L. Automated Prediction of Neoadjuvant Chemoradiotherapy Response in Locally Advanced Cervical Cancer Using Hybrid Model-Based MRI Radiomics. Diagnostics (Basel) 2023; 14:5. [PMID: 38201314 PMCID: PMC10795804 DOI: 10.3390/diagnostics14010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND This study aimed to develop a model that automatically predicts the neoadjuvant chemoradiotherapy (nCRT) response for patients with locally advanced cervical cancer (LACC) based on T2-weighted MR images and clinical parameters. METHODS A total of 138 patients were enrolled, and T2-weighted MR images and clinical information of the patients before treatment were collected. Clinical information included age, stage, pathological type, squamous cell carcinoma (SCC) level, and lymph node status. A hybrid model extracted the domain-specific features from the computational radiomics system, the abstract features from the deep learning network, and the clinical parameters. Then, it employed an ensemble learning classifier weighted by logistic regression (LR) classifier, support vector machine (SVM) classifier, K-Nearest Neighbor (KNN) classifier, and Bayesian classifier to predict the pathologic complete response (pCR). The area under the receiver operating characteristics curve (AUC), accuracy (ACC), true positive rate (TPR), true negative rate (TNR), and precision were used as evaluation metrics. RESULTS Among the 138 LACC patients, 74 were in the pCR group, and 64 were in the non-pCR group. There was no significant difference between the two cohorts in terms of tumor diameter (p = 0.787), lymph node (p = 0.068), and stage before radiotherapy (p = 0.846), respectively. The 109-dimension domain features and 1472-dimension abstract features from MRI images were used to form a hybrid model. The average AUC, ACC, TPR, TNR, and precision of the proposed hybrid model were about 0.80, 0.71, 0.75, 0.66, and 0.71, while the AUC values of using clinical parameters, domain-specific features, and abstract features alone were 0.61, 0.67 and 0.76, respectively. The AUC value of the model without an ensemble learning classifier was 0.76. CONCLUSIONS The proposed hybrid model can predict the radiotherapy response of patients with LACC, which might help radiation oncologists create personalized treatment plans for patients.
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Affiliation(s)
- Hua Yang
- Department of Radiation Oncology, Xijing Hospital of Air Force Medical University, Xi’an 710032, China; (H.Y.); (Y.Z.); (J.G.)
- Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
| | - Yinan Xu
- Key Lab of Intelligent Perception and Image Understanding of Ministry of Education, Xidian University, Xi’an 710071, China;
| | - Mohan Dong
- Department of Medical Education, Xijing Hospital of Air Force Medical University, Xi’an 710032, China;
| | - Ying Zhang
- Department of Radiation Oncology, Xijing Hospital of Air Force Medical University, Xi’an 710032, China; (H.Y.); (Y.Z.); (J.G.)
| | - Jie Gong
- Department of Radiation Oncology, Xijing Hospital of Air Force Medical University, Xi’an 710032, China; (H.Y.); (Y.Z.); (J.G.)
| | - Dong Huang
- Department of Military Biomedical Engineering, Air Force Medical University, Xi’an 710012, China;
| | - Junhua He
- Department of Radiation Oncology, 986 Hospital of Air Force Medical University, Xi’an 710054, China;
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital of Air Force Medical University, Xi’an 710032, China; (H.Y.); (Y.Z.); (J.G.)
| | - Shigao Huang
- Department of Radiation Oncology, Xijing Hospital of Air Force Medical University, Xi’an 710032, China; (H.Y.); (Y.Z.); (J.G.)
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital of Air Force Medical University, Xi’an 710032, China; (H.Y.); (Y.Z.); (J.G.)
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Zheng L, Yang C, Sheng R, Rao S, Wu L, Zeng M, Dai Y. Characterization of Microvascular Invasion in Hepatocellular Carcinoma Using Computational Modeling of Interstitial Fluid Pressure and Velocity. J Magn Reson Imaging 2023; 58:1366-1374. [PMID: 36762823 DOI: 10.1002/jmri.28644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Most solid tumors show increased interstitial fluid pressure (IFP), and this increased IFP is an obstacle to treatment. A noninvasive model for measuring IFP in hepatocellular carcinoma (HCC) is an unresolved issue. PURPOSE To develop a noninvasive model to measure IFP and interstitial fluid velocity (IFV) in HCC and to characterize the microvascular invasion (MVI) status by using this model. STUDY TYPE Retrospective. POPULATION A total of 97 HCC patients (mean age 57.6 ± 10.9 years, 77.3% males), 53 of them with MVI and 44 of them without MVI. FIELD STRENGTH/SEQUENCE A 3-T, three-dimensional spoiled gradient-recalled echo. ASSESSMENT MVI was defined as microscopic vascular invasion of small vessels within the peritumoral liver tissue. The volumes of interest (VOIs) were manually delineated and enclosed the tumor lesion and healthy liver parenchyma, respectively. The extended Tofts model (ETM) was used to estimate permeability parameters from all the VOIs. Subsequently, the continuity partial differential equation (PDE) was implemented and IFP and IFV were acquired. STATISTICAL TESTS Wilcoxon signed-ranks tests, histogram analysis, Mann-Whitney U test, Fisher's exact test, least absolute shrinkage and selection operator (LASSO) logistic regression, receiver operating characteristic (ROC) curve analysis with the area under the curve (AUC), Youden index, DeLong test, and Benjamini-Hochberg correction. A P value <0.05 was considered statistically significant. RESULTS The HCC lesions exhibited elevated IFP and reduced IFV. There were no significant differences in any measured demographic and clinical features between the MVI-positive and MVI-negative groups, except for tumor size. Nine IFP histogram analysis-derived parameters and seven IFV histogram analysis-derived parameters could be used to characterize the MVI status. LASSO regression selected five features: IFP maximum, IFP 10th percentile, IFP 90th percentile, IFV SD, and IFV 10th percentile. The combination of these features showed the highest AUC (0.781) and specificity (77.3%). DATA CONCLUSION A noninvasive IFP and IFV measurement model for HCC was developed. Specific IFP- and IFV-derived parameters exhibited significant association with the MVI status. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Liyun Zheng
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Yang
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ruofan Sheng
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengxiang Rao
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lifang Wu
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongming Dai
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
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Qiu G, Chen J, Liao W, Liu Y, Wen Z, Zhao Y. Gadoxetic acid-enhanced MRI combined with T1 mapping and clinical factors to predict Ki-67 expression of hepatocellular carcinoma. Front Oncol 2023; 13:1134646. [PMID: 37456233 PMCID: PMC10348748 DOI: 10.3389/fonc.2023.1134646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives To explore the predictive value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) combined with T1 mapping and clinical factors for Ki-67 expression in hepatocellular carcinoma (HCC). Methods A retrospective study was conducted on 185 patients with pathologically confirmed solitary HCC from two institutions. All patients underwent preoperative T1 mapping on gadoxetic acid-enhanced MRI. Patients from institution I (n = 124) and institution II (n = 61) were respectively assigned to the training and validation sets. Univariable and multivariable analyses were performed to assess the correlation of clinico-radiological factors with Ki-67 labeling index (LI). Based on the significant factors, a predictive nomogram was developed and validated for Ki-67 LI. The performance of the nomogram was evaluated on the basis of its calibration, discrimination, and clinical utility. Results Multivariable analysis showed that alpha-fetoprotein (AFP) levels > 20ng/mL, neutrophils to lymphocyte ratio > 2.25, non-smooth margin, tumor-to-liver signal intensity ratio in the hepatobiliary phase ≤ 0.6, and post-contrast T1 relaxation time > 705 msec were the independent predictors of Ki-67 LI. The nomogram based on these variables showed the best predictive performance with area under the receiver operator characteristic curve (AUROC) 0.899, area under the precision-recall curve (AUPRC) 0.946 and F1 score of 0.912; the respective values were 0.823, 0.879 and 0.857 in the validation set. The Kaplan-Meier curves illustrated that the cumulative recurrence probability at 2 years was significantly higher in patients with high Ki-67 LI than in those with low Ki-67 LI (39.6% [53/134] vs. 19.6% [10/51], p = 0.011). Conclusions Gadoxetic acid-enhanced MRI combined with T1 mapping and several clinical factors can preoperatively predict Ki-67 LI with high accuracy, and thus enable risk stratification and personalized treatment of HCC patients.
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Affiliation(s)
- Ganbin Qiu
- Imaging Department of Zhaoqing Medical College, Zhaoqing, China
- Department of Radiology, The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Jincan Chen
- Department of Radiology, The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Weixiong Liao
- Imaging Department of Zhaoqing Medical College, Zhaoqing, China
| | - Yonghui Liu
- Department of Radiology, The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Zhongyan Wen
- Department of Radiology, The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Yue Zhao
- Department of Radiology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Du Y, Zhang S, Liang T, Shang J, Guo C, Lian J, Gong H, Yang J, Niu G. Dynamic contrast-enhanced MRI perfusion parameters are imaging biomarkers for angiogenesis in lung cancer. Acta Radiol 2023; 64:572-580. [PMID: 35369721 DOI: 10.1177/02841851221088581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) may have the potential to reflect angiogenesis and proliferation of pulmonary neoplasms. PURPOSE To verify whether DCE-MRI can identify pulmonary neoplasm property and evaluate the correlation of DCE-MRI perfusion parameters with microvessel density (MVD) and Ki-67 in lung cancer. MATERIAL AND METHODS This study enrolled 65 patients with one pulmonary neoplasm who underwent computed tomography-guided percutaneous lung biopsy with pathological diagnosis (43 malignant, 22 benign; mean age = 59.71 ± 11.72 years). All patients did DCE-MRI before biopsy. Quantitative MRI parameters including endothelial transfer constant (Ktrans), flux rate constant (Kep), and fractional extravascular extracellular space (EES) volume (Ve) were calculated by extended Tofts linear model. MVD was evaluated by CD34-expressing tumor vessels. Proliferation was assessed by Ki-67 staining. The correlations of parameters with MVD and Ki-67 expression were analyzed. RESULTS Ktrans and Kep values were significantly increased in malignant lesions compared to benign lesions (P = 0.001 and 0.022, respectively), whereas no statistical difference in Ve was found. The CD34 expression was positively correlated to Ktrans (r = 0.608; P = 0.004) and Kep (r = 0.556; P = 0.001). Subsequent subtype analyses also showed positive correlations of Ktrans and Kep with MVD in adenocarcinoma group (r = 0.550 and 0.563; P = 0.012 and 0.015, respectively). No significant correlation was found between these parameters and Ki-67. CONCLUSION Ktrans and Kep may distinguish benign and malignant pulmonary neoplasm. Ktrans and Kep, with their positive correlation to MVD, can be used as non-invasive parameters reflecting lung cancer angiogenesis.
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Affiliation(s)
- Yonghao Du
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Shuo Zhang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jin Shang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Chenguang Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jie Lian
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Huilin Gong
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Gang Niu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
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Chartampilas E, Rafailidis V, Georgopoulou V, Kalarakis G, Hatzidakis A, Prassopoulos P. Current Imaging Diagnosis of Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14163997. [PMID: 36010991 PMCID: PMC9406360 DOI: 10.3390/cancers14163997] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The role of imaging in the management of hepatocellular carcinoma (HCC) has significantly evolved and expanded beyond the plain radiological confirmation of the tumor based on the typical appearance in a multiphase contrast-enhanced CT or MRI examination. The introduction of hepatobiliary contrast agents has enabled the diagnosis of hepatocarcinogenesis at earlier stages, while the application of ultrasound contrast agents has drastically upgraded the role of ultrasound in the diagnostic algorithms. Newer quantitative techniques assessing blood perfusion on CT and MRI not only allow earlier diagnosis and confident differentiation from other lesions, but they also provide biomarkers for the evaluation of treatment response. As distinct HCC subtypes are identified, their correlation with specific imaging features holds great promise for estimating tumor aggressiveness and prognosis. This review presents the current role of imaging and underlines its critical role in the successful management of patients with HCC. Abstract Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer related death worldwide. Radiology has traditionally played a central role in HCC management, ranging from screening of high-risk patients to non-invasive diagnosis, as well as the evaluation of treatment response and post-treatment follow-up. From liver ultrasonography with or without contrast to dynamic multiple phased CT and dynamic MRI with diffusion protocols, great progress has been achieved in the last decade. Throughout the last few years, pathological, biological, genetic, and immune-chemical analyses have revealed several tumoral subtypes with diverse biological behavior, highlighting the need for the re-evaluation of established radiological methods. Considering these changes, novel methods that provide functional and quantitative parameters in addition to morphological information are increasingly incorporated into modern diagnostic protocols for HCC. In this way, differential diagnosis became even more challenging throughout the last few years. Use of liver specific contrast agents, as well as CT/MRI perfusion techniques, seem to not only allow earlier detection and more accurate characterization of HCC lesions, but also make it possible to predict response to treatment and survival. Nevertheless, several limitations and technical considerations still exist. This review will describe and discuss all these imaging modalities and their advances in the imaging of HCC lesions in cirrhotic and non-cirrhotic livers. Sensitivity and specificity rates, method limitations, and technical considerations will be discussed.
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Affiliation(s)
- Evangelos Chartampilas
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence:
| | - Vasileios Rafailidis
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Vivian Georgopoulou
- Radiology Department, Ippokratio General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Georgios Kalarakis
- Department of Diagnostic Radiology, Karolinska University Hospital, 14152 Stockholm, Sweden
- Department of Clinical Science, Division of Radiology, Intervention and Technology (CLINTEC), Karolinska Institutet, 14152 Stockholm, Sweden
- Department of Radiology, Medical School, University of Crete, 71500 Heraklion, Greece
| | - Adam Hatzidakis
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Panos Prassopoulos
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Tan CH, Chou SC, Inmutto N, Ma K, Sheng R, Shi Y, Zhou Z, Yamada A, Tateishi R. Gadoxetate-Enhanced MRI as a Diagnostic Tool in the Management of Hepatocellular Carcinoma: Report from a 2020 Asia-Pacific Multidisciplinary Expert Meeting. Korean J Radiol 2022; 23:697-719. [PMID: 35555884 PMCID: PMC9240294 DOI: 10.3348/kjr.2021.0593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/21/2022] [Accepted: 03/17/2022] [Indexed: 12/04/2022] Open
Abstract
Gadoxetate magnetic resonance imaging (MRI) is widely used in clinical practice for liver imaging. For optimal use, we must understand both its advantages and limitations. This article is the outcome of an online advisory board meeting and subsequent discussions by a multidisciplinary group of experts on liver diseases across the Asia-Pacific region, first held on September 28, 2020. Here, we review the technical considerations for the use of gadoxetate, its current role in the management of patients with hepatocellular carcinoma (HCC), and its relevance in consensus guidelines for HCC imaging diagnosis. In the latter part of this review, we examine recent evidence evaluating the impact of gadoxetate on clinical outcomes on a continuum from diagnosis to treatment decision-making and follow-up. In conclusion, we outline the potential future roles of gadoxetate MRI based on an evolving understanding of the clinical utility of this contrast agent in the management of patients at risk of, or with, HCC.
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Affiliation(s)
- Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Shu-Cheng Chou
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei City & Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nakarin Inmutto
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ke Ma
- Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - RuoFan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - YingHong Shi
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhongguo Zhou
- Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, The University of Tokyo Hospital, Tokyo, Japan
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Berks M, Little RA, Watson Y, Cheung S, Datta A, O'Connor JPB, Scaramuzza D, Parker GJM. A model selection framework to quantify microvascular liver function in gadoxetate-enhanced MRI: Application to healthy liver, diseased tissue, and hepatocellular carcinoma. Magn Reson Med 2021; 86:1829-1844. [PMID: 33973674 DOI: 10.1002/mrm.28798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE We introduce a novel, generalized tracer kinetic model selection framework to quantify microvascular characteristics of liver and tumor tissue in gadoxetate-enhanced dynamic contrast-enhanced MRI (DCE-MRI). METHODS Our framework includes a hierarchy of nested models, from which physiological parameters are derived in 2 regimes, corresponding to the active transport and free diffusion of gadoxetate. We use simulations to show the sensitivity of model selection and parameter estimation to temporal resolution, time-series duration, and noise. We apply the framework in 8 healthy volunteers (time-series duration up to 24 minutes) and 10 patients with hepatocellular carcinoma (6 minutes). RESULTS The active transport regime is preferred in 98.6% of voxels in volunteers, 82.1% of patients' non-tumorous liver, and 32.2% of tumor voxels. Interpatient variations correspond to known co-morbidities. Simulations suggest both datasets have sufficient temporal resolution and signal-to-noise ratio, while patient data would be improved by using a time-series duration of at least 12 minutes. CONCLUSIONS In patient data, gadoxetate exhibits different kinetics: (a) between liver and tumor regions and (b) within regions due to liver disease and/or tumor heterogeneity. Our generalized framework selects a physiological interpretation at each voxel, without preselecting a model for each region or duplicating time-consuming optimizations for models with identical functional forms.
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Affiliation(s)
- Michael Berks
- Division of Cancer Sciences, Quantitative Biomedical Imaging Laboratory, University of Manchester, Manchester, UK
| | - Ross A Little
- Division of Cancer Sciences, Quantitative Biomedical Imaging Laboratory, University of Manchester, Manchester, UK
| | - Yvonne Watson
- Division of Cancer Sciences, Quantitative Biomedical Imaging Laboratory, University of Manchester, Manchester, UK
| | - Sue Cheung
- Division of Cancer Sciences, Quantitative Biomedical Imaging Laboratory, University of Manchester, Manchester, UK
| | - Anubhav Datta
- Division of Cancer Sciences, Quantitative Biomedical Imaging Laboratory, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - James P B O'Connor
- Division of Cancer Sciences, Quantitative Biomedical Imaging Laboratory, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | | | - Geoff J M Parker
- Division of Cancer Sciences, Quantitative Biomedical Imaging Laboratory, University of Manchester, Manchester, UK
- Bioxydyn Ltd, Manchester, UK
- Centre for Medical Image Computing, University College London, London, UK
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Han T, Duan Q, Yang R, Wang Y, Yin H, Meng F, Liu Y, Qian T. Monitoring the therapeutic efficacy of CA4P in the rabbit VX2 liver tumor using dynamic contrast-enhanced MRI. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:587-594. [PMID: 34559047 DOI: 10.5152/dir.2021.20010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The present work aims to evaluate whether dynamic contrast-enhanced magnetic resonance Imaging (DCE-MRI) can monitor non-invasively the blocking effect on microvessels of the Combretastatin-A4-phosphate (CA4P) and assess the therapeutic efficacy. METHODS Forty rabbits were implanted the VX2 tumors specimens. Two weeks later, serial MRI (T1 weighted image, T2 weighted image and DCE) were performed at 0 h, 4 h, 24 h, 3 d and 7 d after CA4P (10 mg/kg) or saline treatment. The parameters of DCE (Ktrans, Kep, Ve and iAUC60) of enhancement tumor portions were measured. Then all the tumor samples were stained to count microvessel density (MVD). At last, two-way repeated measures ANOVA was used to analyze the difference between and within groups. The correlation between the Ktrans, Kep, Ve, iAUC60 and MVD was analyzed by using the Pearson correlation analysis and Spearman's rank correlation. RESULTS The Ktrans and iAUC60 in the CA4P group were lower than the values of the control group at 4 h after treatment, which have significant differences (D-value: -0.133 min-1, 95%CI: -0.169~-0.097 min-1,F = 59.109, p < 0.001 for Ktrans; D-value: -10.533 mmol/sec, 95%CI: -17.147~-3.919 mmol/sec,F = 11.110, and p = 0.003 for iAUC60). In the CA4P group, the Ktrans and iAUC60 reached the minimum values at 4 h. There were significant differences between 4 h and other different time points of the Ktrans and iAUC60 in the treatment group (all p < 0.01). The parameters Ktrans (r = 0.532, P = 0.016 and r = 0.681, P = 0.001, respectively) and iAUC60 (r = 0.580, P = 0.007 and r = 0.568, P = 0.009, respectively) of 7 days showed correlation with MVD in both groups, while Kep and Ve did not show correlation with MVD (P > 0.05). CONCLUSION The blocking effect of microvessels after CA4P treatment can be evaluated by DCE-MRI, and the parameters of quantitative Ktrans and semi- quantitative iAUC60 can assess the change of the tumor angiogenesis noninvasively.
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Affiliation(s)
| | - Qingqing Duan
- Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Rong Yang
- Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Yuzhe Wang
- Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Huabin Yin
- Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Fanhua Meng
- Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Yongjuan Liu
- Department of Pathology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Ting Qian
- Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
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Mao X, Guo Y, Wen F, Liang H, Sun W, Lu Z. Applying arterial enhancement fraction (AEF) texture features to predict the tumor response in hepatocellular carcinoma (HCC) treated with Transarterial chemoembolization (TACE). Cancer Imaging 2021; 21:49. [PMID: 34384496 PMCID: PMC8359085 DOI: 10.1186/s40644-021-00418-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background To evaluate the application of Arterial Enhancement Fraction (AEF) texture features in predicting the tumor response in Hepatocellular Carcinoma (HCC) treated with Transarterial Chemoembolization (TACE) by means of texture analysis. Methods HCC patients treated with TACE in Shengjing Hospital of China Medical University from June 2018 to December 2019 were retrospectively enrolled in this study. Pre-TACE Contrast Enhanced Computed Tomography (CECT) and imaging follow-up within 6 months were both acquired. The tumor responses were categorized according to the modified RECIST (mRECIST) criteria. Based on the CECT images, Region of Interest (ROI) of HCC lesion was drawn, the AEF calculation and texture analysis upon AEF values in the ROI were performed using CT-Kinetics (C.K., GE Healthcare, China). A total of 32 AEF texture features were extracted and compared between different tumor response groups. Multi-variate logistic regression was performed using certain AEF features to build the differential models to predict the tumor response. The Receiver Operator Characteristic (ROC) analysis was implemented to assess the discriminative performance of these models. Results Forty-five patients were finally enrolled in the study. Eight AEF texture features showed significant distinction between Improved and Un-improved patients (p < 0.05). In multi-variate logistic regression, 9 AEF texture features were applied into modeling to predict “Improved” outcome, and 4 AEF texture features were applied into modeling to predict “Un-worsened” outcome. The Area Under Curve (AUC), diagnostic accuracy, sensitivity, and specificity of the two models were 0.941, 0.911, 1.000, 0.826, and 0.824, 0.711, 0.581, 1.000, respectively. Conclusions Certain AEF heterogeneous features of HCC could possibly be utilized to predict the tumor response to TACE treatment.
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Affiliation(s)
- Xiaonan Mao
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Yan Guo
- GE Healthcare (China), Shanghai, China
| | - Feng Wen
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Hongyuan Liang
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Wei Sun
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Zaiming Lu
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China.
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Zhang Y, Li Z, Gao C, Shen J, Chen M, Liu Y, Cao Z, Pang P, Cui F, Xu M. Preoperative histogram parameters of dynamic contrast-enhanced MRI as a potential imaging biomarker for assessing the expression of Ki-67 in prostate cancer. Cancer Med 2021; 10:4240-4249. [PMID: 34117733 PMCID: PMC8267123 DOI: 10.1002/cam4.3912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To investigate whether preoperative histogram parameters of dynamic contrast‐enhanced MRI (DCE‐MRI) can assess the expression of Ki‐67 in prostate cancer (PCa). Materials and methods A consecutive series of 76 patients with pathology‐proven PCa who underwent routine DCE‐MRI scans were retrospectively recruited. Quantitative parameters including the volume transfer constant (Ktrans), rate contrast (Kep), extracellular‐extravascular volume fraction (Ve), and plasma volume (Vp) by outlining the three‐dimensional volume of interest (VOI) of all lesions were processed. Then, the histogram analyses of these quantitative parameters were performed. The Spearman rank correlation analysis was used to evaluate the correlation of these parameters and Ki‐67 expression of PCa. Receiver operating characteristic (ROC) curve analysis was adopted to evaluate the efficacy of these quantitative histogram parameters in identifying high Ki‐67 expression from low Ki‐67 expression of PCa. Results Eighty‐eight PCa lesions were enrolled in this study, including 31 lesions with high Ki‐67 expression and 57 lesions with low Ki‐67 expression. The median, mean, 75th percentile, and 90th percentile derived from Ktrans and Kep had a moderately positive correlation with Ki‐67 expression (r = 0.361–0.450, p < 0.05), in which both the median and mean of Ktrans had the highest positive correlation (r = 0.450, p < 0.05). The diagnostic efficacy of the Ktrans median, mean, 75th percentile, and 90th percentile, along with the Kep‐based median and mean was assessed by the ROC curve. The area under the curve (AUC) of the mean for Ktrans was the highest (0.826). When the cut‐off of the mean for Ktrans was ≥0.47/min, its Youden index, sensitivity, and specificity were 0.625, 0.871, and 0.754, respectively. The AUC of the median of Kep was the lowest (0.772). Conclusion The histogram of DCE‐MRI quantitative parameters is correlated with Ki‐67 expression, which has the potential to noninvasively assess the expression of Ki‐67 with patients of PCa.
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Affiliation(s)
- Yongsheng Zhang
- Department of Radiology, The Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiping Li
- Department of Radiology, The Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Chen Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianliang Shen
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Mingtao Chen
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yufeng Liu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhijian Cao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Peipei Pang
- GE Healthcare Life Sciences, Hangzhou, China
| | - Feng Cui
- Department of Radiology, The Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Maosheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,The First Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
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Feasibility of perfusion and early-uptake 18F-FDG PET/CT in primary hepatocellular carcinoma: a dual-input dual-compartment uptake model. Jpn J Radiol 2021; 39:1086-1096. [PMID: 34076855 DOI: 10.1007/s11604-021-01140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE PET enables a concurrent evaluation of perfusion status and metabolic activity. We aimed to evaluate the feasibility of perfusion and early-uptake 18F-FDG PET/CT in hepatocellular carcinoma (HCC) using a dual-input dual-compartment uptake model. MATERIALS AND METHODS Data from 5 min dynamic PET/CT and conventional PET/CT scans were retrospectively collected from 17 pathologically diagnosed HCCs. Parameters such as hepatic arterial blood flow (Fa), portal vein blood flow (Fv), total blood flow (F), hepatic arterial perfusion index (HPI), portal vein perfusion index (PPI), blood volume (BV), extracellular mean transit time (MTT) and intracellular uptake rate (Ki) were calculated. Fa, HPI, MTT and Ki images were generated and used to identify HCC. RESULTS Compared with the surrounding liver tissue, HCCs showed significant increases in Fa, HPI, Ki and the maximum standard uptake value (SUVmax) (all P < 0.001) and significant reductions in Fv (P < 0.05) and PPI (P < 0.001). F, BV and MTT (all P > 0.05) did not differ significantly between HCCs and the surrounding liver tissue. Perfusion and early-uptake PET/CT increased the positivity rate of HCCs from 52.9% with conventional PET/CT alone to 88.2% with the combined method (P < 0.05). CONCLUSIONS Perfusion and early-uptake PET/CT are feasible for diagnosing HCC and provide added functional information to enhance diagnostic performance.
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Song Q, Guo Y, Yao X, Rao S, Qian C, Ye D, Zeng M. Comparative study of evaluating the microcirculatory function status of primary small HCC between the CE (DCE-MRI) and Non-CE (IVIM-DWI) MR Perfusion Imaging. Abdom Radiol (NY) 2021; 46:2575-2583. [PMID: 33483778 DOI: 10.1007/s00261-020-02945-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/20/2020] [Accepted: 12/31/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the difference of evaluating the microcirculatory function status of primary small HCC between DCE-MRI with two-compartmental pharmacokinetic model and IVIM-DWI. METHODS 27 patients (22 men, 5 women; mean age, 49 years; range 36-65 years) with primary single sHCC who underwent IVIM-DWI and DCE-MRI before the operation were included in this retrospective study. The MR perfusion parameters are Ktrans, Ve, Kep, D, D* and f. Pathological results include pathological grade (low grade ≤ II, high grade > II) and MVD. The perfusion parameters and pathological results of sHCC were analyzed and compared in their relevance, sensitivity and specificity. Statistical methods included Spearman and ROC curve analysis. RESULTS The perfusion parameters (Ktrans, Kep, D*, f) were significantly positive correlated (r = 0.892, 0.808, 0.589 and 0.543, P = 0.000, 0.000, 0.001 and 0.003 with MVD of sHCC. The parameter Ve and D values were negatively correlated (r = - 0.454 and - 0.399, P = 0.017 and 0.039, respectively) with the pathological grade. Regarding the evaluation MVD of sHCC, the evaluation of the sensitivity and specificity performance was present in descending order: Ktrans > Kep > PF > D*. In the evaluation pathological grade of sHCC, the sensitivity and specificity were better by parameters D than Ve. CONCLUSION DCE-MRI is better than IVIM-DWI for evaluation microcirculation functional status of sHCC. But for evaluating the pathological grade, IVIM-DWI is better than DCE-MRI. Combination of the two imaging techniques may provide more comprehensive evaluation in microcirculation functional status of the sHCC.
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Affiliation(s)
- Qiong Song
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China
- Radiology Department, Xuzhou Mining Group General Hospital, Xuzhou, 221000, Jiangsu, People's Republic of China
- Shanghai Aitrox Technology Corporation Limited, Shanghai, 200032, People's Republic of China
| | - Yixian Guo
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Xiuzhong Yao
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Chengyao Qian
- Shanghai Aitrox Technology Corporation Limited, Shanghai, 200032, People's Republic of China
| | - Dexian Ye
- Shanghai Aitrox Technology Corporation Limited, Shanghai, 200032, People's Republic of China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China.
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Wang LL, Li JF, Lei JQ, Guo SL, Li JK, Xu YS, Dou Y. The value of the signal intensity of peritumoral tissue on Gd-EOB-DTPA dynamic enhanced MRI in assessment of microvascular invasion and pathological grade of hepatocellular carcinoma. Medicine (Baltimore) 2021; 100:e25804. [PMID: 34011043 PMCID: PMC8136999 DOI: 10.1097/md.0000000000025804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/15/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of the study was to assess the potential role of preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic enhanced MR imaging for diagnosing microvascular invasion (MVI) and pathological grade of hepatocellular carcinoma (HCC).A total of 113 consecutive HCC patients confirmed by histopathology underwent preoperative Gd-EOB-DTPA dynamic enhanced MRI were included. Signal intensity (SI) of peritumoral, normal liver tissue and tumor parenchyma during arterial phase and hepatobiliary phase (HBP) were analyzed. The receiver operating characteristic (ROC) curves were performed to assess the potential diagnostic capability for MVI and pathological grade of HCC. Kaplan-Meier method was performed to estimate the recurrence-free survival rate and compared using the log rank test.SI ratio of peritumoral tissue to normal liver in arterial phase (SIAp/Al) was independently associated with MVI [odds ratio (OR) = 3.115, 95% confidence interval (CI): 1.867-5.198] and pathological grades (OR = 1.437, 95% CI: 1.042-1.981). The area under the curve (AUC) of SIAp/Al was equivalent to the SI of tumor parenchyma on arterial phase (SIAt) in distinguishing low and high pathological grades. However, the AUC of SIAp/Al (0.851) was larger than peritumoral hypointensity on HBP (0.668) for distinguishing MVI. The recurrence-free survival rate of HCC patients with SIAp/Al<1.1 was higher than HCC with SIAp/Al≥1.1(P = .025).The SIAp/Al in preoperative Gd-EOB-DTPA dynamic enhanced MR imaging is a potential diagnosis marker for MVI and pathological grade of HCC noninvasively. The higher SIAp/Al may predict the poor prognosis of HCC after surgery.
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Affiliation(s)
- Li-Li Wang
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Jun-Feng Li
- First Clinical Medical School of Lanzhou University
- Institute of Infectious Diseases, Department of Infectious Diseases, First Hospital of Lanzhou University, Lanzhou, China
| | - Jun-Qiang Lei
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Shun-Lin Guo
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Jin-Kui Li
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Yong-Sheng Xu
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Yu Dou
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
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Li X, Wang Q, Dou Y, Zhang Y, Tao J, Yang L, Wang S. Soft tissue sarcoma: can dynamic contrast-enhanced (DCE) MRI be used to predict the histological grade? Skeletal Radiol 2020; 49:1829-1838. [PMID: 32519183 DOI: 10.1007/s00256-020-03491-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters reflect histological grade of soft tissue sarcoma (STS) MATERIALS AND METHODS: The medical records of 50 patients diagnosed with pathologically confirmed STS were retrospectively reviewed. Each STS was assessed with conventional contrast-enhanced MRI and DCE-MRI using a 3.0-T MRI system. The conventional MRI characteristics of low-grade (grade 1) and high-grade (grade 2 and grade 3) tumors were analyzed. Semi-quantitative parameters, including iAUC and TTP, and quantitative parameters, including Ktrans, Kep, and Ve, were derived from DCE-MRI. The diagnostic performances and optimal thresholds of various combinations of DCE-MRI parameters for predicting histological grades of STS were investigated using receiver operator characteristic (ROC) curves. RESULTS On conventional MRI, high-grade STSs were significantly larger (≥ 5 cm) and more likely to show a heterogeneous signal intensity on T2WI (> 75%), peritumoral hyperintensity on T2WI, or tumor necrosis (> 50%) compared with low-grade STS. On DCE-MRI, iAUC, TTP, Ktrans, and Kep were significant predictors of STS histological grade. Ktrans had a high diagnostic value for differentiating between high-grade and low-grade STSs. The combination of iAUC, TTP, and Ktrans yielded a higher AUC value (0.841) than the other models. CONCLUSION High-grade STSs were usually larger than low-grade STSs, had unclear boundaries, a heterogeneous signal intensity on T2-weighted image (T2WI), and extensive necrosis. On DCE-MRI, iAUC, TTP, Ktrans, and Kep could differentiate between high-grade and low-grade STSs. The combination of iAUC, TTP, and Ktrans had a high diagnostic performance for differentiating between STS histological grades.
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Affiliation(s)
- Xiangwen Li
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, Liaoning Province, China
| | - Qimeng Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, Liaoning Province, China
| | - Yanping Dou
- Department of Ultrasound, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yu Zhang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, Liaoning Province, China
| | - Juan Tao
- Department of Pathology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Lin Yang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, Liaoning Province, China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, Liaoning Province, China.
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Yang Y, Liu C, Qi L, Zhao T, Feng Y, Ai X, Zhao X, Li J, Zhu Q. Diagnosis of Pre-HCC Disease by Hepatobiliary-Specific Contrast-Enhanced Magnetic Resonance Imaging: A Review. Dig Dis Sci 2020; 65:2492-2502. [PMID: 31808004 DOI: 10.1007/s10620-019-05981-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
We first proposed a new concept, pre-hepatocellular carcinoma (HCC) disease, to describe the precancerous condition of HCC, which has received scant attention from clinicians. Pre-HCC disease is defined as chronic liver injury concurrent with hepatic low- or high-grade dysplastic nodular lesions. Precise diagnosis of pre-HCC disease may prevent or arrest HCC and contribute to relieving the HCC burden worldwide, although noninvasive diagnosis is difficult and biopsy is generally required. Fortunately, recent advances and extensive applications of hepatobiliary-specific contrast-enhanced magnetic resonance imaging will facilitate the noninvasive identification and characterization of pre-HCC disease. This review briefly discusses the new concept of pre-HCC disease and offers an overview of the role of hepatobiliary-specific contrast-enhanced magnetic resonance imaging for the diagnosis of pre-HCC disease.
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Affiliation(s)
- Yao Yang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Chenxi Liu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Linyu Qi
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Tong Zhao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Yuemin Feng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Xin Ai
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Jie Li
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China.
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Kennedy P. Editorial for “Diagnostic Value of Gd‐EOB‐DTPA‐Enhanced MRI for the Expression of Ki67 and Microvascular Density in Hepatocellular Carcinoma”. J Magn Reson Imaging 2020; 51:1764-1765. [DOI: 10.1002/jmri.27053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Paul Kennedy
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai New York New York USA
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Chen Y, Qin X, Long L, Zhang L, Huang Z, Jiang Z, Li C. Diagnostic Value of Gd‐EOB‐DTPA‐Enhanced MRI for the Expression of Ki67 and Microvascular Density in Hepatocellular Carcinoma. J Magn Reson Imaging 2019; 51:1755-1763. [PMID: 31675163 DOI: 10.1002/jmri.26974] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Yidi Chen
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Xiali Qin
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Liling Long
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Ling Zhang
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Zhongkui Huang
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Zijian Jiang
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Chenhui Li
- Siemens Healthineers, Department of MR Application, Guangdong Province, China
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20
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Yang D, She H, Wang X, Yang Z, Wang Z. Diagnostic accuracy of quantitative diffusion parameters in the pathological grading of hepatocellular carcinoma: A meta-analysis. J Magn Reson Imaging 2019; 51:1581-1593. [PMID: 31654537 DOI: 10.1002/jmri.26963] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accurate preoperative assessment of the pathological grade of hepatocellular carcinoma (HCC) could greatly benefit prognostic predictions. PURPOSE To assess and compare the diagnostic accuracy of the apparent diffusion coefficient (ADC) and tissue diffusivity (D) for the noninvasive pathological grading of HCC. STUDY TYPE Meta-analysis. DATA SOURCES PubMed/Medline, EMBASE, the Web of Science, and the Cochrane Library were searched to find related original articles published up to May 30, 2019. FIELD STRENGTH/SEQUENCE Diffusion-weighted imaging (DWI) and/or intravoxel incoherent motion (IVIM) were performed with a 1.5T or 3.0T scanner. ASSESSMENT The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the methodologic quality. STATISTICAL TESTS The bivariate random-effects model was used to obtain the pooled sensitivity and specificity, and the area under summary receiver operating characteristic curve (AUROC) was obtained. Subgroup analyses were performed. RESULTS A total of 16 original articles (1428 HCCs) were included. Most studies had a low to unclear risk of bias and minimal concerns regarding applicability. For the discrimination of well-differentiated HCCs, the pooled sensitivity and specificity of the ADC value were 85% and 92%, respectively. For the discrimination of poorly differentiated HCCs, the pooled sensitivity and specificity of the ADC value and D were 84% and 80%, and 92% and 77%, respectively. The summary AUROC of D (0.94) was significantly higher than that of ADC (0.89) (z = -2.718, P = 0.007). The subgroup analyses identified three covariates including size, number of included lesions in the studies, and blindness to the reference standard as possible sources of heterogeneity. DATA CONCLUSION This meta-analysis showed that the ADC and D values had a high to excellent accuracy for the noninvasive pathological grading of HCCs and that the D value was superior to the ADC value for discriminating poorly differentiated HCCs. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1581-1593.
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Affiliation(s)
- Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hualong She
- Department of Radiology, Affiliated Hospital of Xiangnan University, Chenzhou, China
| | - Xiaopei Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Ippolito D, Inchingolo R, Grazioli L, Drago SG, Nardella M, Gatti M, Faletti R. Recent advances in non-invasive magnetic resonance imaging assessment of hepatocellular carcinoma. World J Gastroenterol 2018; 24:2413-2426. [PMID: 29930464 PMCID: PMC6010944 DOI: 10.3748/wjg.v24.i23.2413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/27/2018] [Accepted: 05/12/2018] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance (MR) imaging of the liver is an important tool for the detection and characterization of focal liver lesions and for assessment of diffuse liver disease, having several intrinsic characteristics, represented by high soft tissue contrast, avoidance of ionizing radiation or iodinated contrast media, and more recently, by application of several functional imaging techniques (i.e., diffusion-weighted sequences, hepatobiliary contrast agents, perfusion imaging, magnetic resonance (MR)-elastography, and radiomics analysis). MR functional imaging techniques are extensively used both in routine practice and in the field of clinical and pre-clinical research because, through a qualitative rather than quantitative approach, they can offer valuable information about tumor tissue and tissue architecture, cellular biomarkers related to the hepatocellular functions, or tissue vascularization profiles related to tumor and tissue biology. This kind of approach offers in vivo physiological parameters, capable of evaluating physiological and pathological modifications of tissues, by the analysis of quantitative data that could be used in tumor detection, characterization, treatment selection, and follow-up, in addition to those obtained from standard morphological imaging. In this review we provide an overview of recent advanced techniques in MR for the diagnosis and staging of hepatocellular carcinoma, and their role in the assessment of response treatment evaluation.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan 20126, Italy
- Department of Diagnostic Radiology, HS Gerardo Monza, Monza (MB) 20900, Italy
| | - Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Luigi Grazioli
- Department of Radiology, University of Brescia “Spedali Civili”, Brescia 25123, Italy
| | - Silvia Girolama Drago
- School of Medicine, University of Milano-Bicocca, Milan 20126, Italy
- Department of Diagnostic Radiology, HS Gerardo Monza, Monza (MB) 20900, Italy
| | - Michele Nardella
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
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22
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Surov A, Meyer HJ, Leifels L, Höhn AK, Richter C, Winter K. Histogram analysis parameters of dynamic contrast-enhanced magnetic resonance imaging can predict histopathological findings including proliferation potential, cellularity, and nucleic areas in head and neck squamous cell carcinoma. Oncotarget 2018; 9:21070-21077. [PMID: 29765520 PMCID: PMC5940412 DOI: 10.18632/oncotarget.24920] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/06/2018] [Indexed: 02/07/2023] Open
Abstract
Our purpose was to analyze possible associations between histogram analysis parameters of dynamic contrast-enhanced magnetic resonance imaging DCE MRI and histopathological findings like proliferation index, cell count and nucleic areas in head and neck squamous cell carcinoma (HNSCC). 30 patients (mean age 57.0 years) with primary HNSCC were included in the study. In every case, histogram analysis parameters of Ktrans, Ve, and Kep were estimated using a mathlab based software. Tumor proliferation index, cell count, and nucleic areas were estimated on Ki 67 antigen stained specimens. Spearman's non-parametric rank sum correlation coefficients were calculated between DCE and different histopathological parameters. KI 67 correlated with Ktrans min (p = −0.386, P = 0.043) and s Ktrans skewness (p = 0.382, P = 0.045), Ve min (p = −0.473, P = 0.011), Ve entropy (p = 0.424, P = 0.025), and Kep entropy (p = 0.464, P = 0.013). Cell count correlated with Ktrans kurtosis (p = 0.40, P = 0.034), Ve entropy (p = 0.475, P = 0.011). Total nucleic area correlated with Ve max (p = 0.386, P = 0.042) and Ve entropy (p = 0.411, P = 0.030). In G1/2 tumors, only Ktrans entropy correlated well with total (P =0.78, P =0.013) and average nucleic areas (p = 0.655, P = 0.006). In G3 tumors, KI 67 correlated with Ve min (p = −0.552, P = 0.022) and Ve entropy (p = 0.524, P = 0.031). Ve max correlated with total nucleic area (p = 0.483, P = 0.049). Kep max correlated with total area (p = −0.51, P = 0.037), and Kep entropy with KI 67 (p = 0.567, P = 0.018). We concluded that histogram-based parameters skewness, kurtosis and entropy of Ktrans, Ve, and Kep can be used as markers for proliferation activity, cellularity and nucleic content in HNSCC. Tumor grading influences significantly associations between perfusion and histopathological parameters.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Leonard Leifels
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Cindy Richter
- Institute of Anatomy, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Karsten Winter
- Institute of Anatomy, University Hospital of Leipzig, 04103 Leipzig, Germany
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