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Bhatt S, Mandal S, Mehrotra G, Arora V, Singh U. Multidetector Computed Tomography Perfusion in Head and Neck Squamous Cell Carcinomas: Evaluation of a Dose Reduction Strategy. Indian J Radiol Imaging 2022; 32:451-459. [DOI: 10.1055/s-0042-1753469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Abstract
Background Computed tomography perfusion (CTp), a useful technique in oncology, is not widely utilized due to the high radiation dose delivered from it. It involves scanning the region of interest every second for 50 seconds following intravenous contrast administration. Doubling sampling interval (SI) to 2 seconds will half the radiation dose, but may impact its effectiveness, which needs to be evaluated.
Objectives To evaluate a dose reduction strategy in CTp by determining agreement between standard dose (SD) CTp (acquisition with SI 1 second) and low-dose CTp techniques with SI of 2 seconds (achieved either by reconstruction only or true low-dose acquisition).
Materials and methods This cross-sectional study was conducted on histopathology-proven head and neck squamous cell carcinoma (HNSCC) patients who underwent CTp on 64 slice multidetector CT. A total of 56 patients had SD and 24 patients underwent true low dose (LD) acquisition. SD data were also reconstructed at SI 2 seconds to obtain a dataset simulating low dose (low-dose reconstruction [LDr]). Paired t-test was applied to compare CTp in SD and LDr groups and the Bland–Altman plot drawn to calculate 95% confidence limit of agreement. The Kolmogorov–Smirnov test compared CTp parameters for LDr and LD groups.
Results There was no statistical difference in CTp parameters (except blood flow in malignant) in SD and LDr groups for both malignant and normal tissues. CTp of malignant tissue was not statistically different in LDr and LD groups but the radiation dose was half in the LD group.
Conclusion Reduction of radiation dose to half achieved by doubling the SI does not affect the CTp parameters significantly. So LD acquisitions will increase the use of CTp in HNSCC.
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Affiliation(s)
- Shuchi Bhatt
- Department of Radio-diagnosis, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Samrat Mandal
- Department of Radio-diagnosis, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Gopesh Mehrotra
- Department of Radio-diagnosis, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Vipin Arora
- Department of Otorhinolaryngology, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Usharani Singh
- Department of Pathology, University College of Medical Sciences, University of Delhi, Delhi, India
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Troeltzsch D, Shnayien S, Gaudin R, Bressem K, Kreutzer K, Heiland M, Hamm B, Niehues S. Diagnostic performance of dynamic volume perfusion CT for differentiation of head and neck cancer from healthy tissue and post-therapeutic changes. Clin Hemorheol Microcirc 2021; 78:93-101. [PMID: 33554889 DOI: 10.3233/ch-200919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-therapeutic tissue is bradytrophic and thus has low perfusion values in PCT. In contrast, malignant tissue is expected to show higher perfusion values as cancer growth partially depends on angiogenesis. OBJECTIVES This prospective study investigates perfusion computed tomography (PCT) for the post-therapeutic detection of cancer in the head and neck region. METHODS 85 patients underwent PCT for 1) initial work-up of head and neck cancer (HNC; n=22) or 2) for follow-up (n=63). Regions of interest (ROIs) were placed in confirmed tumour, a corresponding location of benign tissue, and reference tissue. Perfusion was calculated using a single input maximum slope algorithm. Statistical analysis was performed with the Mann-Whitney U-test. RESULTS PCT allowed significant differentiation of malignant tissue from post-therapeutic tissue after treatment for HNC (p=0.018). Significance was even greater after normalization of perfusion values (p=0.007). PCT allowed highly significant differentiation of HNC from reference tissue (p<0.001). CONCLUSIONS PCT provides significantly distinct perfusion values for malignant and benign as well as post-therapeutically altered tissue in the head and neck area, thus allowing differentiation of cancer from healthy tissue. Our results show that PCT in conjunction with a standard algorithm is a potentially powerful HNC diagnostic tool.
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Affiliation(s)
- Daniel Troeltzsch
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Robert Gaudin
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Keno Bressem
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan Niehues
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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van Amerongen MJ, Vos AM, van der Woude W, Nagtegaal ID, de Wilt JHW, Fütterer JJ, Hermans JJ. Does perfusion computed tomography correlate to pathology in colorectal liver metastases? PLoS One 2021; 16:e0245764. [PMID: 33497385 PMCID: PMC7837475 DOI: 10.1371/journal.pone.0245764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Targeted therapy against tumor angiogenesis is widely used in clinical practice for patients with colorectal liver metastases (CRLM). Possible predictive biomarkers for tumor angiogenesis, such as, microvessel density (MVD), hypoxia and cell proliferation, can be determined using immunohistochemical staining. However, patients ineligible for surgical treatment need to undergo invasive diagnostic interventions in order to determine these biomarkers. CT perfusion (CTP) is an emerging functional imaging technique, which can non-invasively determine vascular properties of solid tumors. The purpose of this study was to evaluate CTP with histological biomarkers in CRLM. Material and methods Patients with CRLM underwent CTP one day before liver surgery. CTP analysis was performed on the entire volume of the largest metastases in each patient. Dual-input maximum slope analysis was used and data concerning arterial flow (AF), portal flow (PF) and perfusion index (PI) were recorded. Immunohistochemical staining with CD34, M75/CA-IX and MIB-1 was performed on the rim in the midsection of the tumor to determine respectively MVD, hypoxia and cell proliferation. Results Twenty CRLM in 20 patients were studied. Mean size of the largest CRLM was 37 mm (95% CI 21–54 mm). Mean AF and PF were respectively 64 ml/min/100ml (95% CI 48–79) and 30 ml/min/100ml (95% CI 22–38). Mean PI was 68% (95% CI 62–73). No significant correlation was found between tumor growth patterns and CTP (p = 0.95). MVD did not significantly correlate to AF (r = 0.05; p = 0.84), PF (r = 0.17; p = 0.47) and PI (r = -0.12; p = 0.63). Cell proliferation also did not significantly correlate to AF (r = 0.07; p = 0.78), PF (r = -0.01; p = 0.95) and PI (r = 0.15; p = 0.52). Hypoxia did not significantly correlate to AF (r = -0.05; p = 0.83), however, significantly to PF (r = 0.51; p = 0.02) and a trend to negative correlation with PF (r = -0.43; p = 0.06). However, after controlling the false discovery rate, no significant correlation between CTP and used immunohistochemical biomarkers was found. Conclusion In conclusion, this feasibility study found a trend to negative correlation between PI and hypoxia, CTP might therefore possibly evaluate this prognostic marker in CRLM non-invasively. However, CTP is not an appropriate technique for the assessment of microvessels or cell proliferation in CRLM.
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Affiliation(s)
- M. J. van Amerongen
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - A. M. Vos
- Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - W. van der Woude
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I. D. Nagtegaal
- Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J. H. W. de Wilt
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J. J. Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J. J. Hermans
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Troeltzsch D, Niehues SM, Fluegge T, Neckel N, Heiland M, Hamm B, Shnayien S. The diagnostic performance of perfusion CT in the detection of local tumor recurrence in head and neck cancer. Clin Hemorheol Microcirc 2020; 76:171-177. [PMID: 32925013 DOI: 10.3233/ch-209209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Detecting local tumor recurrence from post-treatment changes in head and neck cancer (HNC) remains a challenge. Based on the hypothesis that post-therapeutically altered tissue is bradytroph, lower perfusion values are expected in perfusion CT (PCT) while higher perfusion values are expected in recurrent malignant tissue. OBJECTIVES This prospective study investigates PCT for post-treatment recurrent HNC detection with a maximum slope algorithm. METHODS A total of 80 patients who received PCT of the head and neck for post-therapy follow-up, of which 63 had no tumor recurrence and 17 presented a histopathologically confirmed recurrence were examined. Regions of interest were placed in the location of the initial tumor, in reference ipsilateral nuchal muscle tissue and the corresponding internal carotid artery. Perfusion was calculated using a single-input maximum slope algorithm. RESULTS With PCT, recurrent HNC can be differentiated from post-treatment tissue (p < 0.05). It further allows delineating recurrent tumor tissue from benign nuchal tissue of reference (p < 0.05). PCT data of patients with and without recurrent HNC are comparable as perfusion values of reference tissues in patients with and without HNC do not differ (p > 0.05). CONCLUSIONS PCT in combination with a commercially available maximum slope algorithm offers radiologists a reliable imaging tool to detect recurrent head and neck cancer within post-therapeutically altered tissue.
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Affiliation(s)
- Daniel Troeltzsch
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tabea Fluegge
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Norbert Neckel
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology Charité - Universitätsmedizin Berlin, Berlin, Germany
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Dankbaar JW, Oosterbroek J, Jager EA, de Jong HW, Raaijmakers CP, Willems SM, Terhaard CH, Philippens ME, Pameijer FA. Detection of cartilage invasion in laryngeal carcinoma with dynamic contrast-enhanced CT. Laryngoscope Investig Otolaryngol 2017; 2:373-379. [PMID: 29299511 PMCID: PMC5743155 DOI: 10.1002/lio2.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/11/2017] [Accepted: 09/16/2017] [Indexed: 12/23/2022] Open
Abstract
Objective Staging of laryngeal cancer largely depends on cartilage invasion. Presence of cartilage invasion affects treatment choice and prognosis. On MRI and contrast‐enhanced CT (CECT) it may be challenging to differentiate cartilage invasion from inflammation. The purpose of this study is to compare the diagnostic properties of dynamic contrast‐enhanced CT (DCECT) and CECT for visual detection of cartilage invasion in laryngeal cancer. Study Design Prospective cohort study. Methods Patients with T3 or T4 laryngeal squamous cell carcinoma treated with total laryngectomy were evaluated using 0.625 mm slice CT. DCECT derived permeability and blood volume maps and CECT images were visually evaluated for the presence of invasion of the cartilaginous T‐stage subsites of laryngeal cancer, by detecting continuity with the tumor‐bulk of increased permeability, increased blood volume, and enhancement. Histological evaluation of the surgical total laryngectomy specimen served as the gold standard. Sensitivity, specificity, negative predictive value, and positive predictive value were calculated and compared using the McNemar and Chi‐squared test. Results From 14 included patients, a total of 462 subsites were available for T‐stage analysis, of which 84 were cartilage. The median time between CT imaging and total laryngectomy was 1 day (range 1–34 days). There was no significant difference in the detection of cartilage invasion between DCECT and CECT. The sensitivity of CECT was better for all subsites combined (0.85 vs. 0.75; p < 0.01). Conclusion DCECT does not improve visual detection of cartilage invasion in T3 and T4 laryngeal cancer compared to CECT. Level of Evidence 2b, individual cohort study.
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Affiliation(s)
- Jan W Dankbaar
- Department of Radiology University Medical Center Utrecht the Netherlands.,Image Sciences Institute University Medical Center Utrecht the Netherlands
| | - Jaap Oosterbroek
- Department of Radiology University Medical Center Utrecht the Netherlands
| | - Elise A Jager
- Department of Radiotherapy University Medical Center Utrecht the Netherlands
| | - Hugo W de Jong
- Department of Radiology University Medical Center Utrecht the Netherlands.,Image Sciences Institute University Medical Center Utrecht the Netherlands
| | | | - Stefan M Willems
- Department of Pathology University Medical Center Utrecht the Netherlands
| | - Chris H Terhaard
- Department of Radiotherapy University Medical Center Utrecht the Netherlands
| | | | - Frank A Pameijer
- Department of Radiology University Medical Center Utrecht the Netherlands
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Chae SY, Suh S, Ryoo I, Park A, Noh KJ, Shim H, Seol HY. A semi-automated volumetric software for segmentation and perfusion parameter quantification of brain tumors using 320-row multidetector computed tomography: a validation study. Neuroradiology 2017; 59:461-469. [PMID: 28341992 DOI: 10.1007/s00234-017-1790-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/18/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE We developed a semi-automated volumetric software, NPerfusion, to segment brain tumors and quantify perfusion parameters on whole-brain CT perfusion (WBCTP) images. The purpose of this study was to assess the feasibility of the software and to validate its performance compared with manual segmentation. METHODS Twenty-nine patients with pathologically proven brain tumors who underwent preoperative WBCTP between August 2012 and February 2015 were included. Three perfusion parameters, arterial flow (AF), equivalent blood volume (EBV), and Patlak flow (PF, which is a measure of permeability of capillaries), of brain tumors were generated by a commercial software and then quantified volumetrically by NPerfusion, which also semi-automatically segmented tumor boundaries. The quantification was validated by comparison with that of manual segmentation in terms of the concordance correlation coefficient and Bland-Altman analysis. RESULTS With NPerfusion, we successfully performed segmentation and quantified whole volumetric perfusion parameters of all 29 brain tumors that showed consistent perfusion trends with previous studies. The validation of the perfusion parameter quantification exhibited almost perfect agreement with manual segmentation, with Lin concordance correlation coefficients (ρ c) for AF, EBV, and PF of 0.9988, 0.9994, and 0.9976, respectively. On Bland-Altman analysis, most differences between this software and manual segmentation on the commercial software were within the limit of agreement. CONCLUSIONS NPerfusion successfully performs segmentation of brain tumors and calculates perfusion parameters of brain tumors. We validated this semi-automated segmentation software by comparing it with manual segmentation. NPerfusion can be used to calculate volumetric perfusion parameters of brain tumors from WBCTP.
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Affiliation(s)
- Soo Young Chae
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea.
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea
| | - Arim Park
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea
| | - Kyoung Jin Noh
- Department of Electronic Engineering, Soonchunhyang University, Asan, South Korea
| | - Hackjoon Shim
- Toshiba Medical Systems Korea Co., Seoul, South Korea
| | - Hae Young Seol
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea
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Dickerson E, Srinivasan A. Advanced Imaging Techniques of the Skull Base. Radiol Clin North Am 2017; 55:189-200. [DOI: 10.1016/j.rcl.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Comparison between perfusion computed tomography and dynamic contrast-enhanced magnetic resonance imaging in assessing glioblastoma microvasculature. Eur J Radiol 2016; 87:120-124. [PMID: 28034567 DOI: 10.1016/j.ejrad.2016.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Perfusion computed tomography (PCT) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) provide independent measurements of biomarkers related to tumor perfusion. The aim of this study was to compare the two techniques in assessing glioblastoma microvasculature. MATERIALS AND METHODS Twenty-five patients diagnosed with glioblastoma (14 males and 11 females; 51±11years old, ranging from 33 to 70 years) were includede in this prospective study. All patients underwent both PCT and DCE-MRI. Imaging was performed on a 256-slice CT scanner and a 3-T MRI system. PCT yielded permeability surface-area product (PS) using deconvolution physiological models; meanwhile, DCE-MRI determined volume transfer constant (Ktrans) using the Tofts-Kermode compartment model. All cases were submitted to surgical intervention, and CD105-microvascular density (CD105-MVD) was measured in each glioblastoma specimen. Then, Spearman's correlation coefficients and Bland-Altman plots were obtained for PS, Ktrans and CD105-MVD. P<0.05 was considered statistically significant. RESULTS Tumor PS and Ktrans values were correlated with CD105-MVD (r=0.644, P<0.001; r=0.683, P<0.001). In addition, PS was correlated with Ktrans in glioblastoma (r=0.931, P<0.001). Finally, Bland-Altman plots showed no significant differences between PS and Ktrans (P=0.063). CONCLUSION PCT and DCE-MRI measurements of glioblastoma perfusion biomarkers have similar results, suggesting that both techniques may have comparable utility. Therefore, PCT may serve as an alternative modality to DCE-MRI for the in vivo evaluation of glioblastoma microvasculature.
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Fujima N, Yoshida D, Sakashita T, Homma A, Tsukahara A, Tha KK, Kudo K, Shirato H. Usefulness of Pseudocontinuous Arterial Spin-Labeling for the Assessment of Patients with Head and Neck Squamous Cell Carcinoma by Measuring Tumor Blood Flow in the Pretreatment and Early Treatment Period. AJNR Am J Neuroradiol 2016; 37:342-8. [PMID: 26427828 PMCID: PMC7959962 DOI: 10.3174/ajnr.a4513] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/06/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE For the assessment of the treatment response in non-surgical treatment, tumor blood flow provides the functional information of the tumor which is different from the morphological information such as tumor volume. The purpose of this study was to evaluate the diagnostic value of tumor blood flow values obtained by pseudocontinuous arterial spin-labeling in patients with head and neck squamous cell carcinoma. MATERIALS AND METHODS Forty-one patients with head and neck squamous cell carcinoma were evaluated by using pseudocontinuous arterial spin-labeling. Quantitative tumor blood flow was calculated at the pretreatment and the early treatment periods in all the patients, and the percentage change of tumor blood flow between the two was calculated. At the early treatment period, based on their tumor volume reduction rate, we divided the patients into stable disease and partial response groups for a subgroup analysis. The local control or failure was confirmed either by histopathology or by radiologic evaluation within the follow-up. RESULTS Pretreatment tumor blood flow in patients in the failure group was significantly lower than that in patients in the local control group. In the subgroup analysis of patients with stable disease, the percentage change of tumor blood flow was significantly larger (due to the tumor blood flow increase from pretreatment value) in the local control group than in the failure group. In addition, in patients with a partial response, the percentage change of tumor blood flow was significantly smaller (due to the tumor blood flow decrease from the pretreatment value) in the local control group than in the failure group. The accuracy for determination of the local control group or the failure group in pretreatment tumor blood flow was 0.83 and that in the combination use of the percentage change of tumor blood flow and tumor volume in the early treatment period was 0.93. CONCLUSIONS Tumor blood flow obtained by pseudocontinuous arterial spin-labeling can be useful for the determination of local control. The combined use of the percentage change of tumor blood flow and tumor volume had particularly high diagnostic accuracy.
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Affiliation(s)
- N Fujima
- From the Department of Diagnostic and Interventional Radiology (N.F., D.Y., A.T., K.K.), Hokkaido University Hospital, Sapporo, Japan
| | - D Yoshida
- From the Department of Diagnostic and Interventional Radiology (N.F., D.Y., A.T., K.K.), Hokkaido University Hospital, Sapporo, Japan
| | - T Sakashita
- Departments of Otolaryngology-Head and Neck Surgery (T.S., A.H.)
| | - A Homma
- Departments of Otolaryngology-Head and Neck Surgery (T.S., A.H.)
| | - A Tsukahara
- From the Department of Diagnostic and Interventional Radiology (N.F., D.Y., A.T., K.K.), Hokkaido University Hospital, Sapporo, Japan
| | - K K Tha
- Radiation Medicine (K.K.T., H.S.), Hokkaido University Graduate School of Medicine, Sapporo, Japan Global Station for Quantum Medical Science and Engineering (K.K.T., H.S.), Global Institution for Collaborative Research and Education, Sapporo, Japan
| | - K Kudo
- From the Department of Diagnostic and Interventional Radiology (N.F., D.Y., A.T., K.K.), Hokkaido University Hospital, Sapporo, Japan
| | - H Shirato
- Radiation Medicine (K.K.T., H.S.), Hokkaido University Graduate School of Medicine, Sapporo, Japan Global Station for Quantum Medical Science and Engineering (K.K.T., H.S.), Global Institution for Collaborative Research and Education, Sapporo, Japan
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Kim SM, Haider MA, Jaffray DA, Yeung IWT. Improved accuracy of quantitative parameter estimates in dynamic contrast-enhanced CT study with low temporal resolution. Med Phys 2016; 43:388. [PMID: 26745932 DOI: 10.1118/1.4937600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE A previously proposed method to reduce radiation dose to patient in dynamic contrast-enhanced (DCE) CT is enhanced by principal component analysis (PCA) filtering which improves the signal-to-noise ratio (SNR) of time-concentration curves in the DCE-CT study. The efficacy of the combined method to maintain the accuracy of kinetic parameter estimates at low temporal resolution is investigated with pixel-by-pixel kinetic analysis of DCE-CT data. METHODS The method is based on DCE-CT scanning performed with low temporal resolution to reduce the radiation dose to the patient. The arterial input function (AIF) with high temporal resolution can be generated with a coarsely sampled AIF through a previously published method of AIF estimation. To increase the SNR of time-concentration curves (tissue curves), first, a region-of-interest is segmented into squares composed of 3 × 3 pixels in size. Subsequently, the PCA filtering combined with a fraction of residual information criterion is applied to all the segmented squares for further improvement of their SNRs. The proposed method was applied to each DCE-CT data set of a cohort of 14 patients at varying levels of down-sampling. The kinetic analyses using the modified Tofts' model and singular value decomposition method, then, were carried out for each of the down-sampling schemes between the intervals from 2 to 15 s. The results were compared with analyses done with the measured data in high temporal resolution (i.e., original scanning frequency) as the reference. RESULTS The patients' AIFs were estimated to high accuracy based on the 11 orthonormal bases of arterial impulse responses established in the previous paper. In addition, noise in the images was effectively reduced by using five principal components of the tissue curves for filtering. Kinetic analyses using the proposed method showed superior results compared to those with down-sampling alone; they were able to maintain the accuracy in the quantitative histogram parameters of volume transfer constant [standard deviation (SD), 98th percentile, and range], rate constant (SD), blood volume fraction (mean, SD, 98th percentile, and range), and blood flow (mean, SD, median, 98th percentile, and range) for sampling intervals between 10 and 15 s. CONCLUSIONS The proposed method of PCA filtering combined with the AIF estimation technique allows low frequency scanning for DCE-CT study to reduce patient radiation dose. The results indicate that the method is useful in pixel-by-pixel kinetic analysis of DCE-CT data for patients with cervical cancer.
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Affiliation(s)
- Sun Mo Kim
- Radiation Medicine Program, Princess Margaret Hospital/University Health Network, Toronto, Ontario M5G 2M9, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada and Department of Medical Imaging, University of Toronto, Toronto, Ontario M5G 2M9, Canada
| | - David A Jaffray
- Radiation Medicine Program, Princess Margaret Hospital/University Health Network, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9, Canada
| | - Ivan W T Yeung
- Radiation Medicine Program, Princess Margaret Hospital/University Health Network, Toronto, Ontario M5G 2M9, Canada; Department of Medical Physics, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario L3Y 2P9, Canada; and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9, Canada
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Prestwich R, Vaidyanathan S, Scarsbrook A. Functional Imaging Biomarkers: Potential to Guide an Individualised Approach to Radiotherapy. Clin Oncol (R Coll Radiol) 2015; 27:588-600. [DOI: 10.1016/j.clon.2015.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 02/03/2023]
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Oosterbroek J, Bennink E, Philippens MEP, Raaijmakers CPJ, Viergever MA, de Jong HWAM. Comparison of DCE-CT models for quantitative evaluation ofKtransin larynx tumors. Phys Med Biol 2015; 60:3759-73. [DOI: 10.1088/0031-9155/60/9/3759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kim YJ, Jeong CB, Hwang JM, Yang HK, Lee SH, Kim KG. New parametric imaging method with fluorescein angiograms for detecting areas of capillary nonperfusion. Healthc Inform Res 2014; 20:191-8. [PMID: 25152832 PMCID: PMC4141133 DOI: 10.4258/hir.2014.20.3.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 07/22/2014] [Accepted: 07/25/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives Fluorescein angiography (FAG) is currently the most useful diagnostic modality for examining retinal circulation, and it is frequently used for the evaluation of patients with diabetic retinopathy, occlusive diseases, such as retinal venous and arterial occlusions, and wet macular degeneration. This paper presents a method for objectively evaluating retinal circulation by quantifying circulation-related parameters. Methods This method allows the semiautomatic preprocessing and registering of FAG images. The arterial input function is estimated from the registered set of FAG images using gamma-variate fitting. Then, the parameters can be computed by deconvolution on the basis of truncated singular value decomposition, and they can finally be presented as parametric color images in a combination of three colors, red, green, and blue. Results After the estimation of arterial input function, the parameters of relative blood flow and mean transit time were computed using deconvolution analysis based on truncated singular value decomposition. Conclusions The parametric color image is helpful to interpret the status of retinal blood circulation and provides quantitative data on retina ischemia without interobserver variability. This system easily provides the status of retinal blood circulation both qualitatively and quantitatively. It also helps to standardize FAG interpretation and may contribute to network-based telemedicine systems in the future.
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Affiliation(s)
- Young Jae Kim
- Biomedical Engineering Branch, Division of Convergence Technology, Research Institute, National Cancer Center, Goyang, Korea. ; Department of Plasma Bio Display, Kwangwoon Universiy, Seoul, Korea
| | - Chang Bu Jeong
- Biomedical Engineering Branch, Division of Convergence Technology, Research Institute, National Cancer Center, Goyang, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung Hyun Lee
- Department of Plasma Bio Display, Kwangwoon Universiy, Seoul, Korea
| | - Kwang Gi Kim
- Biomedical Engineering Branch, Division of Convergence Technology, Research Institute, National Cancer Center, Goyang, Korea
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Razek AAKA, Tawfik AM, Elsorogy LGA, Soliman NY. Perfusion CT of head and neck cancer. Eur J Radiol 2013; 83:537-44. [PMID: 24387935 DOI: 10.1016/j.ejrad.2013.12.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/05/2013] [Accepted: 12/08/2013] [Indexed: 12/17/2022]
Abstract
We aim to review the technique and clinical applications of perfusion CT (PCT) of head and neck cancer. The clinical value of PCT in the head and neck includes detection of head and neck squamous cell carcinoma (HNSCC) as it allows differentiation of HNSCC from normal muscles, demarcation of tumor boundaries and tumor local extension, evaluation of metastatic cervical lymph nodes as well as determination of the viable tumor portions as target for imaging-guided biopsy. PCT has been used for prediction of treatment outcome, differentiation between post-therapeutic changes and tumor recurrence as well as monitoring patient after radiotherapy and/or chemotherapy. PCT has a role in cervical lymphoma as it may help in detection of response to chemotherapy and early diagnosis of relapsing tumors.
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Affiliation(s)
| | - Ahmed Mohamed Tawfik
- Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura 13551, Egypt.
| | | | - Nermin Yehia Soliman
- Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura 13551, Egypt.
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16
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Detection of subsequent cervical lymph node metastasis in a patient with gingival carcinoma using computed tomography perfusion with a single-compartment kinetic model. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0153-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Zöllner FG, Weisser G, Reich M, Kaiser S, Schoenberg SO, Sourbron SP, Schad LR. UMMPerfusion: an open source software tool towards quantitative MRI perfusion analysis in clinical routine. J Digit Imaging 2013; 26:344-52. [PMID: 22832894 DOI: 10.1007/s10278-012-9510-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To develop a generic Open Source MRI perfusion analysis tool for quantitative parameter mapping to be used in a clinical workflow and methods for quality management of perfusion data. We implemented a classic, pixel-by-pixel deconvolution approach to quantify T1-weighted contrast-enhanced dynamic MR imaging (DCE-MRI) perfusion data as an OsiriX plug-in. It features parallel computing capabilities and an automated reporting scheme for quality management. Furthermore, by our implementation design, it could be easily extendable to other perfusion algorithms. Obtained results are saved as DICOM objects and directly added to the patient study. The plug-in was evaluated on ten MR perfusion data sets of the prostate and a calibration data set by comparing obtained parametric maps (plasma flow, volume of distribution, and mean transit time) to a widely used reference implementation in IDL. For all data, parametric maps could be calculated and the plug-in worked correctly and stable. On average, a deviation of 0.032 ± 0.02 ml/100 ml/min for the plasma flow, 0.004 ± 0.0007 ml/100 ml for the volume of distribution, and 0.037 ± 0.03 s for the mean transit time between our implementation and a reference implementation was observed. By using computer hardware with eight CPU cores, calculation time could be reduced by a factor of 2.5. We developed successfully an Open Source OsiriX plug-in for T1-DCE-MRI perfusion analysis in a routine quality managed clinical environment. Using model-free deconvolution, it allows for perfusion analysis in various clinical applications. By our plug-in, information about measured physiological processes can be obtained and transferred into clinical practice.
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Affiliation(s)
- Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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18
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Kim SM, Haider MA, Milosevic M, Yeung IWT. A comparison of dynamic contrast-enhanced CT and MR imaging-derived measurements in patients with cervical cancer. Clin Physiol Funct Imaging 2012; 33:150-61. [PMID: 23383694 DOI: 10.1111/cpf.12010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 10/26/2012] [Indexed: 11/30/2022]
Abstract
This work is to compare the kinetic parameters derived from the DCE-CT and -MR data of a group of 37 patients with cervical cancer. The modified Tofts model and the reference tissue method were applied to estimate kinetic parameters. In the MR kinetic analyses using the modified Tofts model for each patient data set, both the arterial input function (AIF) measured from DCE-MR images and a population-averaged AIF from the literature were applied to the analyses, while the measured AIF was used for the CT kinetic analysis. The kinetic parameters obtained from both modalities were compared. Significant moderate correlations were found in modified Tofts parameters [volume transfer constant(K(trans) ) and rate constant (k(ep) )] between CT and MR analysis for MR with the measured AIFs (R = 0·45, P<0·01 and R = 0·40, P<0·01 in high-K(trans) region; R = 0·38, P<0·01 and R = 0·80, P<0·01 in low-K(trans) region) as well as with the population-averaged AIF (R = 0·59, P<0·01 and R = 0·62, P<0·01 in high-K(trans) region; R = 0·50, P<0·01 and R = 0·63, P<0·01 in low-K(trans) region), respectively. In addition, from the Bland-Altman plot analysis, it was found that the systematic biases (the mean difference) between the modalities were drastically reduced in magnitude by adopting the population-averaged AIF for the MR analysis instead of the measured ones (from 51·5% to 18·9% for K(trans) and from 21·7% to 4·1% for k(ep) in high-K(trans) region; from 73·0% to 29·4% for K(trans) and from 63·4% to 24·5% for k(ep) in low-K(trans) region). The preliminary results showed the feasibility in the interchangeable use of the two imaging modalities in assessing cervical cancers.
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Affiliation(s)
- Sun Mo Kim
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, M5G 2M9, Canada
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19
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Veit-Haibach P, Schmid D, Strobel K, Soyka JD, Schaefer NG, Haerle SK, Huber G, Studer G, Seifert B, Hany TF. Combined PET/CT-perfusion in patients with head and neck cancers. Eur Radiol 2012; 23:163-73. [DOI: 10.1007/s00330-012-2564-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/18/2012] [Accepted: 05/24/2012] [Indexed: 12/23/2022]
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20
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Quon H, Brizel DM. Predictive and Prognostic Role of Functional Imaging of Head and Neck Squamous Cell Carcinomas. Semin Radiat Oncol 2012; 22:220-32. [DOI: 10.1016/j.semradonc.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Quelle place pour l’imagerie fonctionnelle en 2012 dans le suivi des traitements antiantigiogéniques ? ONCOLOGIE 2012. [DOI: 10.1007/s10269-012-2146-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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De Simone M, Muccio CF, Pagnotta SM, Esposito G, Cianfoni A. Comparison between CT and MR in perfusion imaging assessment of high-grade gliomas. Radiol Med 2012; 118:140-51. [DOI: 10.1007/s11547-012-0801-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 07/18/2011] [Indexed: 10/28/2022]
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23
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Donaldson SB, Betts G, Bonington SC, Homer JJ, Slevin NJ, Kershaw LE, Valentine H, West CM, Buckley DL. Perfusion Estimated With Rapid Dynamic Contrast-Enhanced Magnetic Resonance Imaging Correlates Inversely With Vascular Endothelial Growth Factor Expression and Pimonidazole Staining in Head-and-Neck Cancer: A Pilot Study. Int J Radiat Oncol Biol Phys 2011; 81:1176-83. [DOI: 10.1016/j.ijrobp.2010.09.039] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/02/2010] [Accepted: 09/12/2010] [Indexed: 11/26/2022]
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24
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Serkova NJ. Translational imaging endpoints to predict treatment response to novel targeted anticancer agents. Drug Resist Updat 2011; 14:224-35. [PMID: 21640633 DOI: 10.1016/j.drup.2011.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 04/20/2011] [Accepted: 04/26/2011] [Indexed: 01/22/2023]
Abstract
Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) Criteria have been traditionally used for the evaluation of therapeutic response to chemotherapeutic treatment regimens. They determine anatomic criteria for patients response to anti-cancer therapy based on morphological measurements of each target lesion. While this assessment is justified for cytotoxic (chemotherapeutic) drugs, it is now recognized that morphological imaging protocols are poorly suited to the evaluation of the efficacy of novel signal transduction inhibitors (STIs) which exhibit cytostatic rather than cytotoxic properties. New imaging technologies are now designed to evaluate, in a functional manner, modifications in tumor metabolic activity, cellularity, and vascularization before a reduction in tumor volume can be detected. Introduction of physiological imaging end-points, derived from dynamic contrast-enhanced (DCE) imaging protocols--including magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US)--allow for early assessment of disruption in tumor perfusion and permeability for targeted anti-angiogenic agents. Diffusion-weighted MRI (DWI) provides another physiological imaging end-point since tumor necrosis and cellularity are seen early in response to anti-angiogenic treatment. Changes in glucose and phospholipid turnover, based on metabolic MRI and positron emission tomography (PET), provide reliable markers for therapeutic response to novel receptor-targeting agents. Finally, novel molecular imaging techniques of protein and gene expression have been developed in animal models followed by a successful human application for gene therapy-based protocols.
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Affiliation(s)
- Natalie J Serkova
- Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Center, Aurora, CO 80045, USA.
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25
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Naish JH, McGrath DM, Bains LJ, Passera K, Roberts C, Watson Y, Cheung S, Taylor MB, Logue JP, Buckley DL, Tessier J, Young H, Waterton JC, Parker GJM. Comparison of dynamic contrast-enhanced MRI and dynamic contrast-enhanced CT biomarkers in bladder cancer. Magn Reson Med 2011; 66:219-26. [PMID: 21437971 DOI: 10.1002/mrm.22774] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/25/2010] [Accepted: 11/24/2010] [Indexed: 11/10/2022]
Abstract
Dynamic contrast-enhanced MRI (DCE-MRI) is frequently used to provide response biomarkers in clinical trials of novel cancer therapeutics but assessment of their physiological accuracy is difficult. DCE-CT provides an independent probe of similar pharmacokinetic processes and may be modeled in the same way as DCE-MRI to provide purportedly equivalent physiological parameters. In this study, DCE-MRI and DCE-CT were directly compared in subjects with primary bladder cancer to assess the degree to which the model parameters report modeled physiology rather than artefacts of the measurement technique and to determine the interchangeability of the techniques in a clinical trial setting. The biomarker K(trans) obtained by fitting an extended version of the Kety model voxelwise to both DCE-MRI and DCE-CT data was in excellent agreement (mean across subjects was 0.085 ± 0.030 min(-1) for DCE-MRI and 0.087 ± 0.033 min(-1) for DCE-CT, intermodality coefficient of variation 9%). The parameter v(p) derived from DCE-CT was significantly greater than that derived from DCE-MRI (0.018 ± 0.006 compared to 0.009 ± 0.008, P = 0.0007) and v(e) was in reasonable agreement only for low values. The study provides evidence that the biomarker K(trans) is a robust parameter indicative of the underlying physiology and relatively independent of the method of measurement.
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Affiliation(s)
- J H Naish
- Imaging Science and Biomedical Engineering, School of Cancer and Enabling Sciences, University of Manchester, Manchester, United Kingdom.
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Bains LJ, McGrath DM, Naish JH, Cheung S, Watson Y, Taylor MB, Logue JP, Parker GJM, Waterton JC, Buckley DL. Tracer kinetic analysis of dynamic contrast-enhanced MRI and CT bladder cancer data: A preliminary comparison to assess the magnitude of water exchange effects. Magn Reson Med 2011; 64:595-603. [PMID: 20665802 DOI: 10.1002/mrm.22430] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to determine the impact of water exchange on tracer kinetic parameter estimates derived from T(1)-weighted dynamic contrast-enhanced (DCE)-MRI data using a direct quantitative comparison with DCE-CT. Data were acquired from 12 patients with bladder cancer who underwent DCE-CT followed by DCE-MRI within a week. A two-compartment tracer kinetic model was fitted to the CT data, and two versions of the same model with modifications to account for the fast exchange and no exchange limits of water exchange were fitted to the MR data. The two-compartment tracer kinetic model provided estimates of the fractional plasma volume (v(p)), the extravascular extracellular space fraction (v(e)), plasma perfusion (F(p)), and the microvascular permeability surface area product. Our findings suggest that DCE-CT is an appropriate reference for DCE-MRI in bladder cancers as the only significant difference found between CT and MR parameter estimates were the no exchange limit estimates of v(p) (P = 0.002). These results suggest that although water exchange between the intracellular and extravascular-extracellular space has a negligible effect on DCE-MRI, vascular-extravascular-extracellular space water exchange may be more important.
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Affiliation(s)
- Lauren J Bains
- Imaging Science and Biomedical Engineering, School of Cancer and Imaging Sciences, University Manchester, Manchester, UK
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27
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64-row MDCT perfusion of head and neck squamous cell carcinoma: technical feasibility and quantitative analysis of perfusion parameters. Eur Radiol 2010; 21:113-21. [DOI: 10.1007/s00330-010-1898-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 06/06/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
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Abstract
Post-therapeutic imaging is crucial for treatment planning and control in patients with malignant lesions in the head and neck. Focussed on CT, PET-CT and MRI, imaging strategies for post-therapeutic follow-up have been developed and investigated during the last few years. This review should help to interpret the results of these studies and make the reader familiar with the latest developments.
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Kierkels RG, Backes WH, Janssen MH, Buijsen J, Beets-Tan RG, Lambin P, Lammering G, Oellers MC, Aerts HJ. Comparison Between Perfusion Computed Tomography and Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Rectal Cancer. Int J Radiat Oncol Biol Phys 2010; 77:400-8. [DOI: 10.1016/j.ijrobp.2009.05.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 05/19/2009] [Accepted: 05/19/2009] [Indexed: 11/24/2022]
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Yang C, Stadler WM, Karczmar GS, Milosevic M, Yeung I, Haider MA. Comparison of quantitative parameters in cervix cancer measured by dynamic contrast-enhanced MRI and CT. Magn Reson Med 2010; 63:1601-9. [PMID: 20512864 PMCID: PMC3089960 DOI: 10.1002/mrm.22371] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 01/08/2010] [Indexed: 01/15/2023]
Abstract
Cervical tumors of 38 cervix cancer patients were scanned by T(1)-weighted dynamic contrast enhanced (DCE) MRI and then by DCE-CT on the same day. Gadodiamide and iohexol were respectively used as the low-molecular-weight contrast agent in DCE-MRI and DCE-CT. Under an extended Tofts model, DCE-MRI data were analyzed using either individual arterial input functions estimated by a multiple reference tissue method or a population arterial input function by Parker et al., whereas DCE-CT data were analyzed using the arterial input function directly measured from the external iliac arteries. The derived quantitative parameters of cervical tumors were compared between DCE-MRI and DCE-CT. When using the individual multiple reference tissue method arterial input functions to analyze the DCE-MRI data, the correlation coefficients between DCE-MRI- and DCE-CT-derived parameters were, respectively, back-flux rate constant (r = 0.80), extravascular extracellular fractional volume (r = 0.73), contrast agent transfer rate (r = 0.62), and blood plasma volume (r = 0.32); when using the Parker population arterial input function, the correlation coefficients were back-flux rate constant (r = 0.79), extravascular extracellular fractional volume (r = 0.77), contrast agent transfer rate (r = 0.63), and blood plasma volume (r = 0.58). Tumor parametric maps derived by DCE-MRI and DCE-CT had very similar morphologies. However, the means of most derived quantitative parameters were significantly different between the two imaging methods. Close correlation of quantitative parameters derived from two independent imaging modalities suggests both are measuring similar tumor physiologic variables.
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Affiliation(s)
- Cheng Yang
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois, USA
| | - Walter M. Stadler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois, USA
| | | | - Michael Milosevic
- Radiation Medicine Program, University Health Network, and Princess Margaret Hospital, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ivan Yeung
- Radiation Medicine Program, University Health Network, and Princess Margaret Hospital, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Masoom A. Haider
- Department of Medical Imaging, Princess Margaret Hospital, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Bisdas S, Seitz O, Middendorp M, Chambron-Pinho N, Bisdas T, Vogl TJ, Hammerstingl R, Ernemann U, Mack MG. An exploratory pilot study into the association between microcirculatory parameters derived by MRI-based pharmacokinetic analysis and glucose utilization estimated by PET-CT imaging in head and neck cancer. Eur Radiol 2010; 20:2358-66. [PMID: 20443116 DOI: 10.1007/s00330-010-1803-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 03/17/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To examine the feasibility of deriving quantitative microcirculatory parameters and to investigate the relationship between vascular and metabolic characteristics of head and neck tumours in vivo, using dynamic contrast-enhanced (DCE) MRI and fluorodeoxyglucose (FDG) PET imaging. METHODS Twenty-seven patients with primary squamous cell carcinoma (SCCA) underwent DCE-MRI and combined PET/CT imaging. DCE-MRI data were post-processed by using commercially available software. Transfer constant (K (trans)), extravascular extracellular blood volume (v (e)), transfer constant from the extracellular extravascular space to plasma (k (ep)) and iAUC (initial area under the signal intensity-time curve) were calculated. 3D static PET data were acquired and standardised uptake values (SUV) calculated. RESULTS All microcirculatory parameters in tumours were higher than in normal muscle tissue (P ≤ 0.0019). Significant correlations were shown between k (ep) and K (trans) (ρ = 0.77), v (e) and k (ep) (ρ = -0.7), and iAUC and v (e) (ρ = 0.53). Significant correlations were observed for SUV(mean) and v (e) as well as iAUC (ρ = 0.42 and ρ = 0.66, respectively). SUV(max) was significantly correlated with iAUC (ρ = 0.69). CONCLUSIONS The demonstrated relationships between vascular and metabolic characteristics of primary SCCA imply a complex interaction between vascular delivery characteristics and tumour metabolism. The lack of correlation between SUV and K (trans)/k (ep) suggests that both diagnostic techniques may provide complementary information.
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Affiliation(s)
- Sotirios Bisdas
- Department of Neuroradiology, Eberhard Karls University Hospital, Hoppe Seyler Str. 3, 72076, Tübingen, Germany.
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Abstract
Anatomical and physiological imaging using CT and MRI are playing a critical role in patients' diagnosis, disease characterization and treatment planning. CT- and MRI-based protocols increasingly require an injection of iodinated CT and gadolinium (Gd)-based MRI contrast media. Although routinely used in clinical practice, iodinated and to a less extent Gd-based contrast media possess side effects: life-threatening contrast-induced nephropathy (CIN) is associated with CT and nephrogenic systemic fibrosis (NSF) with MRI contrast agents. CIN is defined as an acute decline in renal functions (serum creatinine increase > 0.5 mg/dl) after administration of iodinated contrast media. Patients with moderate-to-severe chronic kidney disease are considered the highest risk group for development of CIN. CIN is more common with ionic high-osmolar contrast CT media. NSF is a rare condition characterized by the formation of connective tissue in the skin and systemically in the lung, liver, heart and kidney. Patients with end stage kidney disease, acute kidney injury and stage 4-5 chronic kidney disease are at a high risk for NSF. The nonionic linear Gd-chelates are associated with the highest risk of NSF. This review summarizes the incidence, symptoms, safety profile of various CT and MRI contrast agents based on their physiochemical properties.
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Affiliation(s)
- Kendra M Hasebroock
- University of Colorado, Anschutz Medical Center, Cancer Center Animal MRI/PET/CT Core, Department of Anesthesiology and Radiology, Aurora, CO 80045, USA
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Bisdas S, Rumboldt Z, Surlan-Popovic K, Baghi M, Koh TS, Vogl TJ, Mack MG. Perfusion CT in squamous cell carcinoma of the upper aerodigestive tract: long-term predictive value of baseline perfusion CT measurements. AJNR Am J Neuroradiol 2009; 31:576-81. [PMID: 19875471 DOI: 10.3174/ajnr.a1852] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE PCT studies hold short-term predictive value in patients treated with chemoradiotherapy. Our aim was to examine the long-term predictive value of baseline PCT studies for local tumor control and overall survival in SCCA of the upper aerodigestive tract treated with chemoradiotherapy. MATERIALS AND METHODS Eighty-four patients with advanced SCCA underwent PCT followed by concomitant chemoradiation. The acquired perfusion maps represented BF, BV, MTT, and PS. Visual analysis of the parametric maps for identification of tumor perfusion patterns was conducted. ROC curves, t tests, and Kaplan-Meier survival curves were plotted for local disease control and overall survival. RESULTS The median time of local tumor control was 24 months. The BF and PS values were significantly higher in patients who had no recurrence than in those with local failure (P < or = .02). The BF and PS were predictive (P < or = .0006) but BV and MTT held no significant predictive values for local tumor control. The patients with high BF and PS had a longer local tumor control than the patients with hypoperfused tumors (P = .0007). A visually detected BF-BV mismatch had a sensitivity/specificity of 63%/66% (P = .03) and 59%/69% (P = .03) for local tumor control and OS, respectively. Patients without mismatch lived significantly longer than patients with mismatch (P = .01). CONCLUSIONS BF, PS, and mismatch of BF-BV are significant predictors of local tumor control after chemoradiation in SCCA of the upper aerodigestive tract.
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Affiliation(s)
- S Bisdas
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany.
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35
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Bisdas S, Baghi M, Wagenblast J, Bisdas T, Thng CH, Mack MG, Koh TS, Ernemann U. Tracer kinetics analysis of dynamic contrast-enhanced CT and MR data in patients with squamous cell carcinoma of the upper aerodigestive tract: comparison of the results. Clin Physiol Funct Imaging 2009; 29:339-46. [DOI: 10.1111/j.1475-097x.2009.00876.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wu H, Exner AA, Krupka TM, Weinberg BD, Patel R, Haaga JR. Radiofrequency ablation: post-ablation assessment using CT perfusion with pharmacological modulation in a rat subcutaneous tumor model. Acad Radiol 2009; 16:321-31. [PMID: 19201361 DOI: 10.1016/j.acra.2008.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/25/2008] [Accepted: 08/26/2008] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES Inflammatory reaction surrounding the ablated area is a major confounding factor in the early detection of viable tumor after radiofrequency (RF) ablation. A difference in the responsiveness of normal and tumor blood vessels to vasoactive agents may be used to distinguish these regions in post-ablation follow-up. The goal of this study was to examine longitudinal perfusion changes in untreated viable tumor and the peripheral hyperemic rim of RF-ablated tumor in response to a vasoconstrictor (phenylephrine) or vasodilator (hydralazine) in a subcutaneous rat tumor model. MATERIALS AND METHODS Bilateral subcutaneous shoulder tumors were inoculated in 24 BDIX rats and evenly divided into two groups (phenylephrine and hydralazine groups). One tumor in each animal was completely treated with RF ablation (at 90 +/- 2 degrees C for 3 minutes), and the other remained untreated. Computed tomographic perfusion scans before and after phenylephrine (10 microg/kg) or hydralazine (5 mg/kg) administration were performed 2, 7, and 14 days after ablation. Four rats per group were euthanized on each scan day, and pathologic evaluation was performed. The changes of blood flow in the peripheral rim of ablated tumor and untreated viable tumor in response to phenylephrine or hydralazine at each time point were compared. The diagnostic accuracy of viable tumor using the percentage change of blood flow in response to phenylephrine and hydralazine was compared using receiver-operating characteristic analysis. RESULTS The peripheral rim of ablated tumor presented with a hyperemic reaction with dilated vessels and congestion on day 2 after ablation, numerous inflammatory vessels on day 7, and granulation tissue formation on day 14. Phenylephrine significantly decreased the blood flow in the peripheral hyperemic rim of ablated tumor on days 2, 7, and 14 by 16.3 +/- 9.7% (P = .001), 24.0 +/- 22.6% (P = .007), and 31.1 +/- 25.4% (P = .045), respectively. In untreated viable tumor, the change in blood flow after phenylephrine was irregular and insignificant. Hydralazine decreased the blood flow in the peripheral rim of both ablated tumor and untreated viable tumor. Receiver-operating characteristic analysis showed that reliable tumor diagnosis using the percentage change of blood flow in response to phenylephrine was noted on days 2 and 7, for which the areas under the curve were 0.82 (95% confidence interval, 0.64-1.00) and 0.81 (95% confidence interval, 0.56-1.00), respectively. However, tumor diagnosis using the blood flow change in response to hydralazine was unreliable. CONCLUSION Phenylephrine markedly decreased blood flow in the peripheral hyperemic rim of ablated tumor but had little effect on the untreated viable tumor. Computed tomographic perfusion with phenylephrine may be useful in the long-term treatment assessment of RF ablation.
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Perfusion CT measurements in healthy cervical spinal cord: feasibility and repeatability of the study as well as interchangeability of the perfusion estimates using two commercially available software packages. Eur Radiol 2008; 18:2321-8. [PMID: 18431576 DOI: 10.1007/s00330-008-0973-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 03/16/2008] [Indexed: 10/22/2022]
Abstract
Our purpose was to examine the feasibility and reproducibility of perfusion CT studies in the cervical spinal cord and the interchangeability of the values obtained by two post-processing methods. The perfusion CT studies of 40 patients with neck tumours were post-processed using two software packages (Software-1: deconvolution-based analysis with adiabatic tissue homogeneity approach and Software-2: maximum-slope-model with Patlak analysis). Eight patients were examined twice for assessing the reproducibility of the technique. Two neuroradiologists separately post-processed the images with two arterial input functions (AIFs): (1) the internal carotid artery (ICA) and (2) the vertebral artery (VA). Maps of blood flow (F) in ml/min/100 g, blood volume (V) in ml/100 g, mean transit time (MTT) in seconds (s) and permeability (PS) in ml/min/100 g were generated. The mean F, V, MTT and PS (Software-1) with VA-AIF and ICA-AIF were 8.93, 1.12, 16.3, 1.88 and 8.57, 1.19, 16.85 and 1.94, respectively. The reproducibility of the techniques was satisfactory, while the V and MTT values (in Software-1) and the F and V values (in Software-2) were dependent on the site of the AIF (p >or= 0.03 and p=0.02, respectively). The interobserver agreement was very good. The significant differences in measurements for a single patient (%) using Software-1/Software-2 were +/-120%/110%, 90%/80%, 180% and 250%/130% for F, V, MTT and PS, respectively. Only F and PS values in the healthy tissue seemed to be interchangeable. Our results were in essential agreement with those derived by invasive measurements in animals. The cervical spine perfusion CT studies are feasible and reproducible. The present knowledge has to be validated with studies in spinal cord tumours in order to decide the usefulness of the perfusion CT in this field.
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