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Kim JY, Yong HS, Kim TY, Kim JY, Jeon KJ, Huh JK. Volumetric changes in temporomandibular joint space following trans-oral vertical ramus osteotomy in patients with mandibular prognathism: a one-year follow-up study. Sci Rep 2024; 14:942. [PMID: 38200085 PMCID: PMC10781718 DOI: 10.1038/s41598-023-51050-y] [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: 09/14/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
This study measured and analyzed chronological changes in temporomandibular joint space volume by compartment following transoral vertical ramus osteotomy (TOVRO) using reconstructed 3-dimensional (3D) images of patients with mandibular prognathism. It included 70 joints of 35 patients who underwent TOVRO between January 2018 and December 2021. Computed tomography (CT) or cone-beam CT (CBCT) was performed before surgery (T0) and at 3 days (T1), 6 months (T2), and 12 months postoperatively (T3). These scans were then analyzed using 3D software. The volumes of the overall (Vjs), anterior (Vajs), posterior (Vpjs), medial (Vmjs), and lateral (Vljs) joint spaces were calculated at each time point. A linear mixed model and repeated-measures covariance pattern with unstructured covariance were used to evaluate significant changes in joint space volume over time. Vjs significantly increased to 134.54 ± 34.28 mm3 at T3 compared to T0 (p < 0.001). Vpjas and Vljs increased by 130.72 ± 10.07 mm3 and 109.98 ± 7.52 mm3 at T3 compared to T0, respectively (p < 0.001). However, no significant difference was observed between T0 and T2 in Vajs and Vmjs (p = 0.9999). The observed volume increases in Vpjs and Vljs appeared to contribute to the overall Vjs increase.
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Affiliation(s)
- Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Hae-Seong Yong
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Tae-Yeong Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Jun-Young Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea.
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Fieux M, Tournegros R, Hermann R, Tringali S. Allograft bone vs. bioactive glass in rehabilitation of canal wall-down surgery. Sci Rep 2023; 13:17945. [PMID: 37864103 PMCID: PMC10589328 DOI: 10.1038/s41598-023-44901-1] [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: 11/05/2022] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
Canal wall-down (CWD) mastoidectomy creates a radical cavity that modifies the anatomy and physiology of the middle ear, thus preventing it from being self-cleaning and causing epidermal stagnation in the posterior cavities. Canal wall-down tympanomastoidectomy with reconstruction (CWDTwR) can obliterate such radical cavities. The main objective of this study was to compare postoperative results after CWDTwR by using either bone allografts or 45S5 bioactive glass as a filling tissue with an 18-month follow-up. This was a single-center observational trial including all patients undergoing CWDTwR. Patients were divided into two groups according to the filling material used: allograft bone (AB group) or 45S5 bioactive glass (BG group). Clinical monitoring was performed regularly, with control imaging performed at 18 months (CT scan and DW MRI). The two groups were compared with the t test for quantitative variables and the chi square test for qualitative variables (no revision surgery, audiometric results, complications, mastoid obliteration volume). Thirty-two patients underwent CWDTwR between October 2015 and 2018. The mean age was 48 years, and 71.9% (23/32) were men. A total of 46.9% (15/32) of the patients had undergone at least 3 middle-ear surgeries prior to CWDTwR. The most frequent preoperative symptom was otorrhea (100.0%, 32/32), and only 12.5% (4/32) experienced dizziness. Fifteen and 17 patients underwent surgery with bone allografts and 45S5 bioactive glass, respectively. At 18 months post-operation, 53.3% of the patients (8/15) in the AB group presented with recurrent otorrhea versus 5.9% (1/17) of patients in the BG group (p = 0.005). Seventy-eight percent (7/9) of symptomatic patients had undergone revision surgery at 18 months postoperation: 40.0% (6/15) in the AB group and 5.9% (1/17) in the BG group (p = 0.033). One patient's surgery was cancelled due to the COVID-19 pandemic, and one patient refused surgery. The effects of CWDTwR with bone allografts are disappointing in early follow-up, with significant resorption leading to a 40.0% revision surgery rate. 45S5 BG is a simple solution, with preliminary results that are superior to those of AB. However, prospective controlled studies with longer follow-up times are needed to evaluate the value of BG versus other synthetic materials (such as hydroxyapatite) in surgical management of CWDTwR.Trial registration: retrospectively registered.
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Affiliation(s)
- Maxime Fieux
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France.
- Université de Lyon, Université Lyon 1, 69003, Lyon, France.
- UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69367, Lyon Cedex 07, France.
| | - Romain Tournegros
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France
| | - Ruben Hermann
- Université de Lyon, Université Lyon 1, 69003, Lyon, France
- Service d'ORL et de chirurgie cervico-faciale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Stéphane Tringali
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France
- Université de Lyon, Université Lyon 1, 69003, Lyon, France
- UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69367, Lyon Cedex 07, France
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Baassiri W, Bani-Sadr A, Capo G, Brinzeu A, Barrey CY. Three-Dimensional Volumetric Magnetic Resonance Imaging Analysis of Syringomyelia Evolution After Posterior Fossa Decompression for Chiari Malformation Type1. World Neurosurg 2023; 178:e566-e577. [PMID: 37532020 DOI: 10.1016/j.wneu.2023.07.121] [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: 04/20/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE This study aims to introduce a method of three-dimensional (3D) volume magnetic resonance imaging (MRI) measurements to evaluate the evolution of syringomyelia (SM) in adults with Chiari malformation type 1 (CM-1) after posterior fossa decompression (PFD), to provide reproducible and accurate measurements. METHODS Radiologic and clinical data were obtained for 28 patients. MRI 3D syrinx volumes were evaluated by 2 observers using Philips Healthcare Tumor Tracking tool. RESULTS The mean SM preoperative volume was 9.1 ± 15.3 cm3 versus 4.6 ± 8.7 cm3 postoperatively, corresponding to a volume variation reduced by -50% ± 33.4%. A total of 21 patients (75%) showed >25% reduction in SM volume postoperatively and 25 patients (89.2%) showed good to excellent postoperative clinical outcomes. Very high interobserver and intraobserver agreement was noted for 3D volumetric analysis with Cohen weighted κ coefficients (0.899-0.991). A negative correlation was found between the number of involved metameres and the postoperative SM volume reduction (Pearson correlation coefficient = 0.378; P = 0.047). Patients with better clinical outcomes had fewer syrinx septae (F = 8.830; P = 0.001). Similarly, better syrinx volume reduction was associated with fewer septae (F = 1.554; P = 0.233). A positive relationship was observed between clinical outcomes and postoperative syrinx volume reduction (F = 1.554; P= 0.233), with data similar to the reported literature. CONCLUSIONS This study shows that 3D volume measurement of the syrinx cavity on MRI is a reproducible and accurate method to assess the postoperative evolution of SM in CM-1 after PFD. Most patients (75%) showed a reduction of SM volume, with a mean volume decrease of 50%. The reliability is yet to be validated in further larger studies.
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Affiliation(s)
- Wassim Baassiri
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France.
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France
| | - Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrei Brinzeu
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Department of Neurosciences, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Cédric Yves Barrey
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Laboratory of Biomechanics, École nationale supérieure d'Arts et Métiers, Arts et Metiers ParisTech, Paris, France
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Yang S, Zhang Z, Su T, Chen Q, Wang H, Jin L. Comparison of quantitative volumetric analysis and linear measurement for predicting the survival of Barcelona Clinic Liver Cancer 0- and A stage hepatocellular carcinoma after radiofrequency ablation. Diagn Interv Radiol 2023; 29:450-459. [PMID: 37154818 PMCID: PMC10679614 DOI: 10.4274/dir.2023.222055] [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: 12/12/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The prognostic role of the tumor volume in patients with hepatocellular carcinoma (HCC) at the Barcelona Clinic Liver Cancer (BCLC) 0 and A stages remains unclear. This study aims to compare the volumetric measurement with linear measurement in early HCC burden profile and clarify the optimal cut-off value of the tumor volume. METHODS The consecutive patients diagnosed with HCC who underwent initial and curative-intent radiofrequency ablation (RFA) were included retrospectively. The segmentation was performed semi-automatically, and enhanced tumor volume (ETV) as well as total tumor volume (TTV) were obtained. The patients were categorized into high- and low-tumor burden groups according to various cutoff values derived from commonly used diameter values, X-tile software, and decision-tree analysis. The inter- and intra-reviewer agreements were measured using the intra-class correlation coefficient. Univariate and multivariate time-to-event Cox regression analyses were performed to identify the prognostic factors of overall survival. RESULTS A total of 73 patients with 81 lesions were analyzed in the whole cohort with a median follow-up of 31.0 (interquartile range: 16.0–36.3). In tumor segmentation, excellent consistency was observed in intra- and inter-reviewer assessments. There was a strong correlation between diameter-derived spherical volume and ETV as well as ETV and TTV. As opposed to all linear candidates and 4,188 mm3 (sphere equivalent to 2 cm in diameter), ETV >14,137 mm3 (sphere equivalent to 3 cm in diameter) or 23,000 mm3 (sphere equivalent to 3.5 cm in diameter) was identified as an independent risk factor of survival. Considering the value of hazard ratio and convenience to use, when ETV was at 23,000 mm3, it was regarded as the optimal volumetric cut-off value in differentiating survival risk. CONCLUSION The volumetric measurement outperforms linear measurement on tumor burden evaluation for survival stratification in patients at BCLC 0 and A stages HCC after RFA.
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Affiliation(s)
- Siwei Yang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhiyuan Zhang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tianhao Su
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiyang Chen
- Department of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Haochen Wang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Long Jin
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Auer TA, Della Seta M, Collettini F, Chapiro J, Zschaeck S, Ghadjar P, Badakhshi H, Florange J, Hamm B, Budach V, Kaul D. Quantitative volumetric assessment of baseline enhancing tumor volume as an imaging biomarker predicts overall survival in patients with glioblastoma. Acta Radiol 2021; 62:1200-1207. [PMID: 32938221 DOI: 10.1177/0284185120953796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is the commonest malignant primary brain tumor and still has one of the worst prognoses among cancers in general. There is a need for non-invasive methods to predict individual prognosis in patients with GBM. PURPOSE To evaluate quantitative volumetric tissue assessment of enhancing tumor volume on cranial magnetic resonance imaging (MRI) as an imaging biomarker for predicting overall survival (OS) in patients with GBM. MATERIAL AND METHODS MRI scans of 49 patients with histopathologically confirmed GBM were analyzed retrospectively. Baseline contrast-enhanced (CE) MRI sequences were transferred to a segmentation-based three-dimensional quantification tool, and the enhancing tumor component was analyzed. Based on a cut-off percentage of the enhancing tumor volume (PoETV) of >84.78%, samples were dichotomized, and the OS and intracranial progression-free survival (PFS) were evaluated. Univariable and multivariable analyses, including variables such as sex, Karnofsky Performance Status score, O6-methylguanine-DNA-methyltransferase status, age, and resection status, were performed using the Cox regression model. RESULTS The median OS and PFS were 16.9 and 7 months in the entire cohort, respectively. Patients with a CE tumor volume of >84.78% showed a significantly shortened OS (12.9 months) compared to those with a CE tumor volume of ≤84.78% (17.7 months) (hazard ratio [HR] 2.72; 95% confidence interval [CI] 1.22-6.03; P = 0.01). Multivariable analysis confirmed that PoETV had a significant prognostic role (HR 2.47; 95% CI 1.08-5.65; P = 0.03). CONCLUSION We observed a correlation between PoETV and OS. This imaging biomarker may help predict the OS of patients with GBM.
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Affiliation(s)
- Timo A Auer
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marta Della Seta
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julius Chapiro
- Department of Radiology, Yale University, New Haven, CT, USA
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Harun Badakhshi
- Department of Radiation Oncology, Ernst von Bergmann Medical Center, Potsdam, Germany
| | - Julian Florange
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Ghani MA, Fereydooni A, Chen E, Letzen B, Laage-Gaupp F, Nezami N, Deng Y, Gan G, Thakur V, Lin M, Papademetris X, Schernthaner RE, Huber S, Chapiro J, Hong K, Georgiades C. Identifying enhancement-based staging markers on baseline MRI in patients with colorectal cancer liver metastases undergoing intra-arterial tumor therapy. Eur Radiol 2021; 31:8858-8867. [PMID: 34061209 DOI: 10.1007/s00330-021-08058-7] [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: 03/12/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine if three-dimensional whole liver and baseline tumor enhancement features on MRI can serve as staging biomarkers and help predict survival of patients with colorectal cancer liver metastases (CRCLM) more accurately than one-dimensional and non-enhancement-based features. METHODS This retrospective study included 88 patients with CRCLM, treated with transarterial chemoembolization or Y90 transarterial radioembolization between 2001 and 2014. Semi-automated segmentations of up to three dominant lesions were performed on pre-treatment MRI to calculate total tumor volume (TTV) and total liver volumes (TLV). Quantitative 3D analysis was performed to calculate enhancing tumor volume (ETV), enhancing tumor burden (ETB, calculated as ETV/TLV), enhancing liver volume (ELV), and enhancing liver burden (ELB, calculated as ELV/TLV). Overall and enhancing tumor diameters were also measured. A modified Kaplan-Meier method was used to determine appropriate cutoff values for each metric. The predictive value of each parameter was assessed by Kaplan-Meier survival curves and univariable and multivariable cox proportional hazard models. RESULTS All methods except whole liver (ELB, ELV) and one-dimensional/non-enhancement-based methods were independent predictors of survival. Multivariable analysis showed a HR of 2.1 (95% CI 1.3-3.4, p = 0.004) for enhancing tumor diameter, HR 1.7 (95% CI 1.1-2.8, p = 0.04) for TTV, HR 2.3 (95% CI 1.4-3.9, p < 0.001) for ETV, and HR 2.4 (95% CI 1.4-4.0, p = 0.001) for ETB. CONCLUSIONS Tumor enhancement of CRCLM on baseline MRI is strongly associated with patient survival after intra-arterial therapy, suggesting that enhancing tumor volume and enhancing tumor burden are better prognostic indicators than non-enhancement-based and one-dimensional-based markers. KEY POINTS • Tumor enhancement of colorectal cancer liver metastases on MRI prior to treatment with intra-arterial therapies is strongly associated with patient survival. • Three-dimensional, enhancement-based imaging biomarkers such as enhancing tumor volume and enhancing tumor burden may serve as the basis of a novel prognostic staging system for patients with liver-dominant colorectal cancer metastases.
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Affiliation(s)
- Mansur A Ghani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Arash Fereydooni
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Evan Chen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Brian Letzen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Fabian Laage-Gaupp
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Nariman Nezami
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA.,Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.,Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Yanhong Deng
- Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA
| | - Geliang Gan
- Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA
| | - Vinayak Thakur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Xenophon Papademetris
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA.,Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Ruediger E Schernthaner
- Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Diagnostic and Interventional Radiology, Hospital Landstraße, Vienna, Austria
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA. .,Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Kelvin Hong
- Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Christos Georgiades
- Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
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Ding J, Xiao H, Deng W, Liu F, Zhu R, Ha R. Feasibility of quantitative and volumetric enhancement measurement to assess tumor response in patients with breast cancer after early neoadjuvant chemotherapy. J Int Med Res 2021; 49:300060521991017. [PMID: 33682494 PMCID: PMC7944542 DOI: 10.1177/0300060521991017] [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] [Indexed: 01/03/2023] Open
Abstract
Objective To evaluate the feasibility of quantitative enhancing lesion volume (ELV) for evaluating the responsiveness of breast cancer patients to early neoadjuvant chemotherapy (NAC) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods Seventy-five women with breast cancer underwent DCE-MRI before and after NAC. Lesions were assessed by ELV, response evaluation criteria in solid tumors 1.1 (RECIST 1.1), and total lesion volume (TLV). The diagnostic and pathological predictive performances of the methods were compared and color maps were compared with pathological results. Results ELV identified 29%, 67%, and 4% of cases with partial response, stable disease, and progressive disease, respectively. There was no significant difference in evaluation performances among the methods. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of ELV for predicting pathologic response were 72%, 92%, 81.8%, 86.8%, and 85.3%, respectively, with the highest sensitivity, NPV, and accuracy of the three methods. The area under the receiver operating characteristic curve was also highest for ELV. Pre- and post-NAC color maps reflecting tumor activity were consistent with pathological necrosis. Conclusions ELV may help evaluate the responsiveness of breast cancer patients to NAC, and may provide a good tumor-response indicator through the ability to indicate tumor viability.
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Affiliation(s)
- Jie Ding
- Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hongyan Xiao
- The Pathology Department, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | | | - Fengjiao Liu
- Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Rongrong Zhu
- Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Ruoshui Ha
- Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
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Koç A, Kaya S. Is it possible to estimate volume of bone defects formed on dry sheep mandibles more practically by secondarily reconstructing section thickness of cone beam computed tomography images? Dentomaxillofac Radiol 2021; 50:20200400. [PMID: 33035111 DOI: 10.1259/dmfr.20200400] [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: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the effect of section thickness on volume estimations of bone defects scanned using cone beam computed tomography (CBCT). METHODS 25 bone defects were prepared on sheep mandibles and scanned using a KaVo 3D eXam (KaVo Dental, Biberach, Germany) CBCT device. Section thickness of images were reconstructed at 0.25, 0.5, and 0.75 mm to estimate the volume of these defects using the semiautomatic segmentation method. The volume averages obtained using microcomputed tomography and Archimedes' method served as reference values. The estimated volumes at each section thickness were compared with the actual volumes using the Friedman test. The accuracy of volume estimation was determined by the percentage error with respect to the reference values, and the mean absolute error (MAE) was calculated. RESULTS Volumetric values of bone defects obtained with CBCT at section thicknesses up to 0.5 mm were compatible with the actual volumes (p > 0.05). The percentage errors at section thicknesses of 0.25, 0.5, and 0.75 mm were -5.4%, -7.3%, and -13.1%, respectively. The mean absolute errors were 13.6 mm3, 15.7 mm3, and 18.2 mm3, respectively. CONCLUSIONS The section thickness values of CBCT images can be increased to a reasonable level to obtain accurate volume estimation results and save time. The semiautomatic segmentation method can be used reliably for volume estimations of bone defects.
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Affiliation(s)
- Alaettin Koç
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey
| | - Sema Kaya
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey
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MRI Monitoring of Residual Vestibular Schwannomas: Modeling and Predictors of Growth. Otol Neurotol 2020; 41:1131-1139. [DOI: 10.1097/mao.0000000000002742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Zoller G, Hahn H, Di Girolamo N. Technological Advances in Diagnostic Imaging in Exotic Pet Medicine. Vet Clin North Am Exot Anim Pract 2019; 22:397-417. [PMID: 31395322 DOI: 10.1016/j.cvex.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diagnostic imaging relies on interpretation of interactions between the body tissue and various energies, such as x-rays, ultrasound, and magnetic or nuclear energies, to differentiate normal from abnormal tissues. Major technological improvements regarding emission and detection of the energetic waves, as well as reconstruction and interpretation of the images, have occurred. These advances made possible visualization of smaller structures, quantitative evaluation of functional processes, and development of unique imaging-guided procedures. This article reviews the technological advances that allowed development of cone beam computed tomography, dual-energy x-ray absorptiometry, and contrast-enhanced ultrasonography, which all could have applications in exotic pet medicine.
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Affiliation(s)
- Graham Zoller
- Exotic Pet Department, Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France.
| | - Harriet Hahn
- Diagnostic Imaging Department, Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France
| | - Nicola Di Girolamo
- Tai Wai Small Animal and Exotic Hospital, 69-75 Chik Shun Street, Tai Wai, Sha Tin, New Territories, Hong Kong
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Della Seta M, Collettini F, Chapiro J, Angelidis A, Engeling F, Hamm B, Kaul D. A 3D quantitative imaging biomarker in pre-treatment MRI predicts overall survival after stereotactic radiation therapy of patients with a singular brain metastasis. Acta Radiol 2019; 60:1496-1503. [PMID: 30841703 DOI: 10.1177/0284185119831692] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Marta Della Seta
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - University Medicine, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius Chapiro
- Department of Radiology, Yale University, New Haven, CT, USA
| | - Alexander Angelidis
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
| | - Fidelis Engeling
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
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12
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Patella F, Pesapane F, Fumarola E, Zannoni S, Brambillasca P, Emili I, Costa G, Anderson V, Levy EB, Carrafiello G, Wood BJ. Assessment of the response of hepatocellular carcinoma to interventional radiology treatments. Future Oncol 2019; 15:1791-1804. [PMID: 31044615 DOI: 10.2217/fon-2018-0747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
According to Barcelona Clinic Liver Cancer (BCLC) guidelines, interventional radiology procedures are valuable treatment options for many hepatocellular carcinomas (HCCs) that are not amenable to resection or transplantation. Accurate assessment of the efficacy of therapies at earlier stages enables completion of treatment, optimal follow-up and to prevent potentially unnecessary treatments, side effects and costly failure. The goal of this review is to summarize and describe the radiological strategies that have been proposed to predict survival and to stratify HCC responses after interventional radiology therapies. New techniques currently in development are also described.
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Affiliation(s)
- Francesca Patella
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Filippo Pesapane
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Enrico Fumarola
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stefania Zannoni
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | | | - Ilaria Emili
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | - Guido Costa
- Università degli Studi di Milano, Postgraduate School of General Surgery, Milan, Italy
| | - Victoria Anderson
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Elliot B Levy
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | | | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
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13
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Pellerin O, Pereira H, Van Ngoc Ty C, Moussa N, Del Giudice C, Pernot S, Déan C, Chatellier G, Sapoval M. Is dual-phase C-arm CBCT sufficiently accurate for the diagnosis of colorectal cancer liver metastasis during liver intra-arterial treatment? Eur Radiol 2019; 29:5253-5263. [PMID: 30937583 DOI: 10.1007/s00330-019-06173-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to estimate the accuracy of dual-phase C-arm cone beam computed tomography (CBCT) for the detection of colorectal cancer liver metastases, as compared with multidetector computed tomography (MDCT). MATERIALS AND METHODS Between March 2014 and December 2016, 49 consecutive patients referred for intra-arterial treatment for colorectal cancer liver metastases were enrolled in a single-center observational study. All patients were examined with MDCT and with dual-phase C-arm cone beam computed tomography performed after iodine injection in the proper hepatic artery before intra-arterial treatment. Two blinded observers independently reviewed all examinations. Diagnostic accuracy was determined using both a six-cell matrix method and a "worst-case scenario." RESULTS Readers identified at MDCT 264 colorectal liver metastases and 43 other liver lesions. The early and late arterial phase showed 240 and 277 liver lesions respectively. A certainty of the diagnosis was obtained in 63% and 85% at the early (EAP) and late arterial phase (LAP), respectively. Streak artifacts or liver segment truncation, or inadequate enhancement was responsible for the inability to see or to correctly adjudicate a lesion to a diagnosis in 27% and 15% of the cases at the EAP and LAP. The "worst-case scenario" yielded a Se and Sp of 58% and 51%, respectively, at EAP and 84% and 70%, respectively, at LAP. CONCLUSION On CBCT, EAP showed limited accuracy. LAP provided the best tumor detectability. KEY POINTS • The early arterial phase (EAP) yielded poor accuracy: Se = 58% and Sp = 51% (p < 0.0001). • The late arterial phase (LAP) phase yielded good accuracy: Se = 84% and Se = 70% (p = 0.02). • The probability of a correct diagnosis at the EAP was 60%.
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Affiliation(s)
- Olivier Pellerin
- INSERM U970, Paris, France. .,Université Paris Descartes, Sorbonne Paris Cité, Paris, France. .,Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France.
| | - Helena Pereira
- Clinical Research Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM U1418, Paris, France
| | | | - Nadia Moussa
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
| | - Costantino Del Giudice
- INSERM U970, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
| | - Simon Pernot
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Digestive Oncology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Carole Déan
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
| | - Gilles Chatellier
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Clinical Research Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM U1418, Paris, France
| | - Marc Sapoval
- INSERM U970, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
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14
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León RL, Li KT, Brown BP. A retrospective segmentation analysis of placental volume by magnetic resonance imaging from first trimester to term gestation. Pediatr Radiol 2018; 48:1936-1944. [PMID: 30027370 DOI: 10.1007/s00247-018-4213-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/08/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abnormalities of the placenta affect 5-7% of pregnancies. Because disturbances in fetal growth are often preceded by dysfunction of the placenta or attenuation of its normal expansion, placental health warrants careful surveillance. There are limited normative data available for placental volume by MRI. OBJECTIVE To determine normative ranges of placental volume by MRI throughout gestation. MATERIALS AND METHODS In this cross-sectional retrospective analysis, we reviewed MRI examinations of pregnant females obtained between 2002 and 2017 at a single institution. We performed semi-automated segmentation of the placenta in images obtained in patients with no radiologic evidence of maternal or fetal pathology, using the Philips Intellispace Tumor Tracking Tool. RESULTS Placental segmentation was performed in 112 women and had a high degree of interrater reliability (single-measure intraclass correlation coefficient =0.978 with 95% confidence interval [CI] 0.956, 0.989; P<0.001). Normative data on placental volume by MRI increased nonlinearly from 6 weeks to 39 weeks of gestation, with wider variability of placental volume at higher gestational age (GA). We fit placental volumetric data to a polynomial curve of third order described as placental volume = -0.02*GA3 + 1.6*GA2 - 13.3*GA + 8.3. Placental volume showed positive correlation with estimated fetal weight (P=0.03) and birth weight (P=0.05). CONCLUSION This study provides normative placental volume by MRI from early first trimester to term gestation. Deviations in placental volume from normal might prove to be an imaging biomarker of adverse fetal health and neonatal outcome, and further studies are needed to more fully understand this metric. Assessment of placental volume should be considered in all routine fetal MRI examinations.
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Affiliation(s)
- Rachel L León
- Department of Pediatrics, Division of Neonatology, Riley Hospital for Children, Indiana University School of Medicine, 699 Riley Hospital Drive RR 208, Indianapolis, IN, 46202, USA.
| | - Kevin T Li
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brandon P Brown
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Tang X, Liu H, Chen L, Wang Q, Luo B, Xiang N, He Y, Zhu W, Zhang J. Semi-automatic volume measurement for orbital fat and total extraocular muscles based on Cube FSE-flex sequence in patients with thyroid-associated ophthalmopathy. Clin Radiol 2018; 73:759.e11-759.e17. [DOI: 10.1016/j.crad.2018.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/13/2018] [Indexed: 10/16/2022]
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16
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Zhao Y, Duran R, Bai W, Sahu S, Wang W, Kabus S, Lin M, Han G, Geschwind JF. Which Criteria Applied in Multi-Phasic CT Can Predict Early Tumor Response in Patients with Hepatocellular Carcinoma Treated Using Conventional TACE: RECIST, mRECIST, EASL or qEASL? Cardiovasc Intervent Radiol 2017; 41:433-442. [PMID: 29086058 DOI: 10.1007/s00270-017-1829-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/19/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE Our study aimed to evaluate quantitative tumor response assessment (quantitative EASL-[qEASL]) on computed tomography (CT) images in patients with hepatocellular carcinoma (HCC) treated using conventional transarterial chemoembolization (cTACE), compared to existing 1-dimensional and 2-dimensional methods (RECIST, mRECIST, EASL). MATERIALS AND METHODS In this IRB-approved, single-institution retrospective cohort study, 52 consecutive patients with intermediate-stage HCC were consecutively included. All patients underwent contrast-enhanced CT scan at baseline and 4 weeks after cTACE. RESULTS Median follow-up period was 13.5 months (range 1.2-54.1). RECIST, mRECIST and EASL identified progression in 2 (4%), 1 (2%) and 1 (2%) patients, respectively, whereas qEASL identified 10 (19%) patients. qEASL was the only tumor response method able to predict survival among different tumor response groups (P < 0.05), whereas RECIST, mRECIST and EASL did not (P > 0.05). Both EASL and qEASL were able to identify responders and non-responders and were predictive of survival (P < 0.05). Multivariate analysis showed that progression was an independent predictor of overall survival with hazard ratio of 1.9 (P = 0.025). Patients who demonstrated progression with qEASL had significantly shorter survival than those with non-progression (7.6 vs. 20.4 months, P = 0.012). Similar multivariate analysis using RECIST, mRECIST and EASL could not be performed because too few patients were categorized as progressive disease. CONCLUSION qEASL could be applied on CT images to assess tumor response following cTACE and is a more sensitive biomarker to predict survival and identify tumor progression than RECIST, mRECIST and EASL at an early time point. LEVEL OF EVIDENCE Level 2a, retrospective cohort study.
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Affiliation(s)
- Yan Zhao
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 West Changle Road, Xi'an, 710032, China.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Rafael Duran
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Wei Bai
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 West Changle Road, Xi'an, 710032, China
| | - Sonia Sahu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Wenjun Wang
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 West Changle Road, Xi'an, 710032, China
| | - Sven Kabus
- Philips Research Hamburg, Hamburg, Germany
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.,U/S Imaging and Interventions (UII), Philips Research North America, Cambridge, MS, USA
| | - Guohong Han
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 West Changle Road, Xi'an, 710032, China.
| | - Jean-François Geschwind
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.,PreScience Labs LLC, Westport, CT, USA
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17
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Smolka S, Chapiro J, Manzano W, Treilhard J, Reiner E, Deng Y, Zhao Y, Hamm B, Duncan JS, Gebauer B, Lin M, Geschwind JF. The impact of antiangiogenic therapy combined with Transarterial Chemoembolization on enhancement based quantitative tumor response assessment in patients with hepatocellular carcinoma. Clin Imaging 2017; 46:1-7. [PMID: 28668723 DOI: 10.1016/j.clinimag.2017.05.007] [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: 02/03/2017] [Revised: 04/16/2017] [Accepted: 05/09/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate whether bevacizumab compromises early response assessment after Transarterial Chemoembolization (TACE) in patients with hepatocellular carcinoma by 3D quantitative European Association for the Study of the Liver (qEASL) criteria in comparison to other imaging-based criteria. MATERIALS AND METHODS Each of 14 patients receiving TACE and bevacizumab was matched with two patients receiving TACE alone. Baseline and Follow-up MRI was retrospectively analyzed regarding qEASL and other imaging-based criteria. RESULTS Percentage-based qEASL achieved significant separation in both therapy arms (p=0.046 and p=0.015). Response and Overall Survival showed similar association among treatment groups (p=0.749). CONCLUSIONS Anti-angiogenic therapy with bevacizumab does not impede early response assessment by qEASL.
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Affiliation(s)
- Susanne Smolka
- Radiologie, Charité Universitätsmediz in Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Yale School of Medicine, Department of Radiology and Biomedical Imaging, 333 Cedar Street, New Haven, CT 06520, USA
| | - Julius Chapiro
- Yale School of Medicine, Department of Radiology and Biomedical Imaging, 333 Cedar Street, New Haven, CT 06520, USA
| | - Wilfred Manzano
- University of California, UC Irvine School of Medicine, 252 Irvine Hall, 1001 Health Sciences Road, Irvine, CA 92697-3950, USA
| | - John Treilhard
- Yale School of Engineering & Applied Science, Department of Biomedical Engineering, 300 Cedar Street, New Haven, CT 06519, USA
| | - Eric Reiner
- Yale School of Medicine, Department of Radiology and Biomedical Imaging, 333 Cedar Street, New Haven, CT 06520, USA
| | - Yanhong Deng
- Yale School of Public Health, Yale Center for Analytic Sciences, 300 George Street, Suite 555, New Haven, CT 06520, USA
| | - Yan Zhao
- Fourth Military Medical University of China, No. 169, Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Bernd Hamm
- Radiologie, Charité Universitätsmediz in Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - James S Duncan
- Yale School of Engineering & Applied Science, Department of Biomedical Engineering, 300 Cedar Street, New Haven, CT 06519, USA
| | - Bernhard Gebauer
- Radiologie, Charité Universitätsmediz in Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - MingDe Lin
- Philips Research North America, 2 Canal Park, 3rd Floor, Cambridge, MA 02141, USA
| | - Jean-François Geschwind
- Yale School of Medicine, Department of Radiology and Biomedical Imaging, 333 Cedar Street, New Haven, CT 06520, USA.
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18
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Stroehl YW, Letzen BS, van Breugel JMM, Geschwind JF, Chapiro J. Intra-arterial therapies for liver cancer: assessing tumor response. Expert Rev Anticancer Ther 2016; 17:119-127. [PMID: 27983883 DOI: 10.1080/14737140.2017.1273775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Intra-arterial therapies (IATs) play an integral role in the management of unresectable hepatocellular carcinoma and liver metastases. The ability to accurately assess tumor response to intra-arterial therapies is crucial for clinical management. Several one- and two-dimensional manual imaging-based response assessment techniques, based both on tumor size or enhancement, have shown to be highly subjective and merely surrogate for the actual tumor as a whole. Areas covered: Given the currently existing literature, we will discuss all available tumor assessment techniques and criteria for liver cancer with a strong emphasis on 3D quantitative imaging biomarkers of tumor response in this review. Expert commentary: The growing role of information technology in medicine has brought about the advent of software-assisted, segmentation-based assessment techniques that address the outstanding issues of a subjective reader and provide for more accurate assessment techniques for the locally treated lesions. Three-dimensional quantitative tumor assessment techniques are superior to one- and two-dimensional measurements. This allows for treatment alterations and more precise targeting, potentially resulting in improved patient outcome.
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Affiliation(s)
- Yasmin W Stroehl
- a Department of Diagnostic and Interventional Radiology , Charité , Berlin , Germany.,b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Brian S Letzen
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Johanna M M van Breugel
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Jean-Francois Geschwind
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Julius Chapiro
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
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19
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Gomes LR, Gomes MR, Gonçalves JR, Ruellas ACO, Wolford LM, Paniagua B, Benavides E, Cevidanes LHS. Cone beam computed tomography-based models versus multislice spiral computed tomography-based models for assessing condylar morphology. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:96-105. [PMID: 26679363 DOI: 10.1016/j.oooo.2015.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To quantitatively compare condylar morphology using cone beam computed tomography (CBCT) and multislice spiral computed tomography (MSCT) virtual three-dimensional surface models. STUDY DESIGN The sample consisted of secondary data analyses of CBCT and MSCT scans obtained for clinical purposes from 74 patients treated with condylar resection and prosthetic joint replacement. Three-dimensional surface models of 146 condyles were constructed from each scan modality. Across-subject models were approximated and voxel-based registration was performed between homologous CBCT and MSCT images, making it possible to create average CBCT- and MSCT-based condylar models. SPHARM-PDM software provided matching points on each corresponding model. ShapeAnalysisMANCOVA software assessed statistically significant differences between observers and imaging modalities. One-sample t-tests evaluated the null hypothesis that the mean differences between each CBCT- and MSCT-based model were not clinically significant (<.5 mm). Tests were conducted at a significance level of P < .05. RESULTS ShapeAnalysisMANCOVA showed no statistically significant difference between the average CBCT- and MSCT-based models (P > .68). During pairwise comparison, the mean difference observed was .406 mm (SD, .173). One sample t-test showed that mean differences between each set of paired CBCT- and MSCT-based models were not clinically significant (P = .411). CONCLUSION Three-dimensional surface models constructed from CBCT images are comparable to those derived from MSCT scans and may be considered reliable tools for assessing condylar morphology.
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Affiliation(s)
- Liliane Rosas Gomes
- Department of Orthodontics, Faculdade de Odontologia de Araraquara, UNESP Universidade Estadual Paulista, Sao Paulo, Brazil; Department of Orthodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
| | | | - João Roberto Gonçalves
- Department of Orthodontics, Faculdade de Odontologia de Araraquara, UNESP Universidade Estadual Paulista, Sao Paulo, Brazil
| | | | - Larry M Wolford
- Departments of Oral and Maxillofacial Surgery and Orthodontics Texas, A&M University Health Science Center Baylor College of Dentistry, Baylor University Medical Center, Dallas, TX, USA
| | - Beatriz Paniagua
- Research Assistant Professor at the Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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3D quantitative assessment of response to fractionated stereotactic radiotherapy and single-session stereotactic radiosurgery of vestibular schwannoma. Eur Radiol 2015; 26:849-57. [PMID: 26139318 DOI: 10.1007/s00330-015-3895-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/19/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine clinical outcome of patients with vestibular schwannoma (VS) after treatment with fractionated stereotactic radiotherapy (FSRT) and single-session stereotactic radiosurgery (SRS) by using 3D quantitative response assessment on MRI. MATERIALS This retrospective analysis included 162 patients who underwent radiation therapy for sporadic VS. Measurements on T1-weighted contrast-enhanced MRI (in 2-year post-therapy intervals: 0-2, 2-4, 4-6, 6-8, 8-10, 10-12 years) were taken for total tumour volume (TTV) and enhancing tumour volume (ETV) based on a semi-automated technique. Patients were considered non-responders (NRs) if they required subsequent microsurgical resection or developed radiological progression and tumour-related symptoms. RESULTS Median follow-up was 4.1 years (range: 0.4-12.0). TTV and ETV decreased for both the FSRT and SRS groups. However, only the FSRT group achieved significant tumour shrinkage (p < 0.015 for TTV, p < 0.005 for ETV over time). The 11 NRs showed proportionally greater TTV (median TTV pre-treatment: 0.61 cm(3), 8-10 years after: 1.77 cm(3)) and ETV despite radiation therapy compared to responders (median TTV pre-treatment: 1.06 cm(3); 10-12 years after: 0.81 cm(3); p = 0.001). CONCLUSION 3D quantification of VS showed a significant decrease in TTV and ETV on FSRT-treated patients only. NR had significantly greater TTV and ETV over time. KEY POINTS Only FSRT not GK-treated patients showed significant tumour shrinkage over time. Clinical non-responders showed significantly less tumour shrinkage when compared to responders. 3D volumetric assessment of vestibular schwannoma shows advantages over unidimensional techniques.
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21
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Chapiro J, Duran R, Lin M, Schernthaner R, Lesage D, Wang Z, Savic LJ, Geschwind JF. Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver. Eur Radiol 2015; 25:1993-2003. [PMID: 25636420 PMCID: PMC4458393 DOI: 10.1007/s00330-015-3595-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study evaluated the predictive role of 1D, 2D and 3D quantitative, enhancement-based MRI regarding overall survival (OS) in patients with colorectal liver metastases (CLM) following intra-arterial therapies (IAT). METHODS This retrospective analysis included 29 patients who underwent transarterial chemoembolization (TACE) or radioembolization and received MRI within 6 weeks after therapy. Tumour response was assessed using 1D and 2D criteria (such as European Association for the Study of the Liver guidelines [EASL] and modified Response Evaluation Criteria in Solid Tumors [mRECIST]). In addition, a segmentation-based 3D quantification of overall (volumetric [v] RECIST) and enhancing lesion volume (quantitative [q] EASL) was performed on portal venous phase MRI. Accordingly, patients were classified as responders (R) and non-responders (NR). Survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios (HR). RESULTS Only enhancement-based criteria identified patients as responders. EASL and mRECIST did not predict patient survival (P = 0.27 and P = 0.44, respectively). Using uni- and multivariate analysis, qEASL was identified as the sole predictor of patient survival (9.9 months for R, 6.9 months for NR; P = 0.038; HR 0.4). CONCLUSION The ability of qEASL to predict survival early after IAT provides evidence for potential advantages of 3D quantitative tumour analysis. KEY POINTS • Volumetric assessment of colorectal liver metastases after intra-arterial therapy is feasible. • Early 3D quantitative tumour analysis after intra-arterial therapy may predict patient survival. • Volumetric tumour response assessment shows advantages over 1D and 2D techniques. • Enhancement-based MR response assessment is preferable to size-based measurements.
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Affiliation(s)
- Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA
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22
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Wang Z, Chapiro J, Schernthaner R, Duran R, Chen R, Geschwind JF, Lin M. Multimodality 3D Tumor Segmentation in HCC Patients Treated with TACE. Acad Radiol 2015; 22:840-5. [PMID: 25863795 DOI: 10.1016/j.acra.2015.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 02/12/2015] [Accepted: 03/08/2015] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To validate the concordance of a semiautomated multimodality lesion segmentation technique between contrast-enhanced magnetic resonance imaging (CE-MRI), cone-beam computed tomography (CBCT), and multidetector CT (MDCT) in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). MATERIALS AND METHODS This retrospective analysis included 45 patients with unresectable HCC who underwent baseline CE-MRI within 1 month before the treatment, intraprocedural CBCT during conventional TACE, and MDCT within 24 hours after TACE. Fourteen patients were excluded because of atypical lesion morphology, portal vein invasion, or small lesion size which precluded sufficient lesion visualization. Thirty-one patients with a total of 40 target lesions were included into the analysis. A tumor segmentation software, based on non-Euclidean geometry and theory of radial basis functions, was used to allow for the segmentation of target lesions in 3D on all three modalities. The algorithm created image-based masks located in a 3D region whose center and size were defined by the user, yielding the nomenclature "semiautomatic". On the basis of that, tumor volumes on all three modalities were calculated and compared using a linear regression model (R(2) values). Residual plots were used to analyze drift and variance of the values. RESULTS The mean value of tumor volumes was 18.72 ± 19.13 cm(3) (range, 0.41-59.16 cm(3)) on CE-MRI, 21.26 ± 21.99 cm(3) (range, 0.62-86.82 cm(3)) on CBCT, and 19.88 ± 20.88 cm(3) (range, 0.45-75.24 cm(3)) on MDCT. The average volumes of the tumor were not significantly different between CE-MRI and DP-CBCT, DP-CBCT and MDCT, MDCT and CE-MRI (P = .577, .770, and .794, respectively). A strong correlation between volumes on CE-MRI and CBCT, CBCT and MDCT, MDCT and CE-MRI was observed (R(2) = 0.974, 0.992 and 0.983, respectively). When plotting the residuals, no drift was observed for all methods showing deviations of no >10% of absolute volumes (in cm(3)). CONCLUSIONS A semiautomated 3D segmentation of HCC lesions treated with TACE provides high volumetric concordance across all tested imaging modalities.
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Tacher V, Lin M, Duran R, Yarmohammadi H, Lee H, Chapiro J, Chao M, Wang Z, Frangakis C, Sohn JH, Maltenfort MG, Pawlik T, Geschwind JF. Comparison of Existing Response Criteria in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Using a 3D Quantitative Approach. Radiology 2015; 278:275-84. [PMID: 26131913 DOI: 10.1148/radiol.2015142951] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare currently available non-three-dimensional methods (Response Evaluation Criteria in Solid Tumors [RECIST], European Association for Study of the Liver [EASL], modified RECIST [mRECIST[) with three-dimensional (3D) quantitative methods of the index tumor as early response markers in predicting patient survival after initial transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS This was a retrospective single-institution HIPAA-compliant and institutional review board-approved study. From November 2001 to November 2008, 491 consecutive patients underwent intraarterial therapy for liver cancer with either conventional TACE or TACE with drug-eluting beads. A diagnosis of hepatocellular carcinoma (HCC) was made in 290 of these patients. The response of the index tumor on pre- and post-TACE magnetic resonance images was assessed retrospectively in 78 treatment-naïve patients with HCC (63 male; mean age, 63 years ± 11 [standard deviation]). Each response assessment method (RECIST, mRECIST, EASL, and 3D methods of volumetric RECIST [vRECIST] and quantitative EASL [qEASL]) was used to classify patients as responders or nonresponders by following standard guidelines for the uni- and bidimensional measurements and by using the formula for a sphere for the 3D measurements. The Kaplan-Meier method with the log-rank test was performed for each method to evaluate its ability to help predict survival of responders and nonresponders. Uni- and multivariate Cox proportional hazard ratio models were used to identify covariates that had significant association with survival. RESULTS The uni- and bidimensional measurements of RECIST (hazard ratio, 0.6; 95% confidence interval [CI]: 0.3, 1.0; P = .09), mRECIST (hazard ratio, 0.6; 95% CI: 0.6, 1.0; P = .05), and EASL (hazard ratio, 1.1; 95% CI: 0.6, 2.2; P = .75) did not show a significant difference in survival between responders and nonresponders, whereas vRECIST (hazard ratio, 0.6; 95% CI: 0.3, 1.0; P = .04), qEASL (Vol) (hazard ratio, 0.5; 95% CI: 0.3, 0.9; P = .02), and qEASL (%) (hazard ratio, 0.3; 95% CI: 0.15, 0.60; P < .001) did show a significant difference between these groups. CONCLUSION The 3D-based imaging biomarkers qEASL and vRECIST were tumor response criteria that could be used to predict patient survival early after initial TACE and enabled clear identification of nonresponders.
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Affiliation(s)
- Vania Tacher
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - MingDe Lin
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Rafael Duran
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Hooman Yarmohammadi
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Howard Lee
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Julius Chapiro
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Michael Chao
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Zhijun Wang
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Constantine Frangakis
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Jae Ho Sohn
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Mitchell Gil Maltenfort
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Timothy Pawlik
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Jean-François Geschwind
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
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Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2015; 38:1548-56. [PMID: 26001366 DOI: 10.1007/s00270-015-1129-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/26/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate whether intraprocedural 3D quantification of Lipiodol deposition on cone-beam computed tomography (CBCT) can predict tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). MATERIALS AND METHODS This IRB approved, retrospective analysis included 36 patients with 51 HCC target lesions, who underwent cTACE with CBCT. CE-MRI was acquired at baseline and 1 month after cTACE. Overall tumor volumes as well as intratumoral Lipiodol volumes on CBCT were measured and compared with the overall and necrotic (non-enhancing) tumor volumes on CE-MRI using the paired student's t test. Tumor response on CE-MRI was assessed using modified response evaluation criteria in solid tumors (mRECIST). A linear regression model was used to correlate tumor volumes, Lipiodol volumes, and the percentage of Lipiodol deposition on CBCT with the corresponding parameters on CE-MRI. Nonparametric spearman rank-order correlation and trend test were used to correlate the percentage of Lipiodol deposition in the tumor with tumor response. RESULT A strong correlation between overall tumor volumes on CBCT and CE-MRI was observed (R(2) = 0.986). In addition, a strong correlation was obtained between the volume of Lipiodol deposition on CBCT and tumor necrosis (in cm(3)) on CE-MRI (R(2) = 0.960), and between the percentage of Lipiodol deposition and tumor necrosis (R(2) = 0.979). Importantly, the extent of Lipiodol deposition (in percentage of total tumor volume) correlated strongly with tumor response on CE-MRI (Spearman rho = 0.84, p < 0.001). CONCLUSIONS Intraprocedural 3D quantification of Lipiodol deposition on CBCT can be used to predict tumor response on follow-up CE-MRI.
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Radiologic-pathologic analysis of quantitative 3D tumour enhancement on contrast-enhanced MR imaging: a study of ROI placement. Eur Radiol 2015; 26:103-13. [PMID: 25994198 DOI: 10.1007/s00330-015-3812-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/13/2015] [Accepted: 04/21/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the influence of region-of-interest (ROI) placement on 3D tumour enhancement [Quantitative European Association for the Study of the Liver (qEASL)] in hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE). METHODS Phase 1: 40 HCC patients had nine ROIs placed by one reader using systematic techniques (3 ipsilateral to the lesion, 3 contralateral to the lesion, and 3 dispersed throughout the liver) and qEASL variance was measured. Intra-class correlations were computed. Phase 2: 15 HCC patients with histosegmentation were selected. Six ROIs were systematically placed by AC (3 ROIs ipsilateral and 3 ROIs contralateral to the lesion). Three ROIs were placed by 2 radiologists. qEASL values were compared to histopathology by Pearson's correlation, linear regression, and median difference. RESULTS Phase 1: The dispersed method (abandoned in phase 2) had low consistency and high variance. Phase 2: qEASL correlated strongly with pathology in systematic methods [Pearson's correlation coefficient = 0.886 (ipsilateral) and 0.727 (contralateral)] and in clinical methods (0.625 and 0.879). However, ipsilateral placement matched best with pathology (median difference: 5.4 %; correlation: 0.89; regression CI: [0.904, 0.1409]). CONCLUSIONS qEASL is a robust method with comparable values among tested placements. Ipsilateral placement showed high consistency and better pathological correlation. KEY POINTS Ipsilateral and contralateral ROI placement produces high consistency and low variance. Both ROI placement methods produce qEASL values that correlate well with histopathology. Ipsilateral ROI placement produces best correlation to pathology along with high consistency.
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Tacher V, Radaelli A, Lin M, Geschwind JF. How I do it: Cone-beam CT during transarterial chemoembolization for liver cancer. Radiology 2015; 274:320-34. [PMID: 25625741 DOI: 10.1148/radiol.14131925] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cone-beam computed tomography (CBCT) is an imaging technique that provides computed tomographic (CT) images from a rotational scan acquired with a C-arm equipped with a flat panel detector. Utilizing CBCT images during interventional procedures bridges the gap between the world of diagnostic imaging (typically three-dimensional imaging but performed separately from the procedure) and that of interventional radiology (typically two-dimensional imaging). CBCT is capable of providing more information than standard two-dimensional angiography in localizing and/or visualizing liver tumors ("seeing" the tumor) and targeting tumors though precise microcatheter placement in close proximity to the tumors ("reaching" the tumor). It can also be useful in evaluating treatment success at the time of procedure ("assessing" treatment success). CBCT technology is rapidly evolving along with the development of various contrast material injection protocols and multiphasic CBCT techniques. The purpose of this article is to provide a review of the principles of CBCT imaging, including purpose and clinical evidence of the different techniques, and to introduce a decision-making algorithm as a guide for the routine utilization of CBCT during transarterial chemoembolization of liver cancer.
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Affiliation(s)
- Vania Tacher
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287 (V.T., J.F.G.); Department of Interventional X-ray, Philips Healthcare, Best, the Netherlands (A.R.); and Department of Clinical Informatics, Interventional, and Translational Solutions, Philips Research North America, Briarcliff Manor, NY (M.L.)
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Brodin NP, Tang J, Skalina K, Quinn TJ, Basu I, Guha C, Tomé WA. Semi-automatic cone beam CT segmentation of in vivo pre-clinical subcutaneous tumours provides an efficient non-invasive alternative for tumour volume measurements. Br J Radiol 2015; 88:20140776. [PMID: 25823502 DOI: 10.1259/bjr.20140776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and accuracy of using cone beam CT (CBCT) scans obtained in radiation studies using the small-animal radiation research platform to perform semi-automatic tumour segmentation of pre-clinical tumour volumes. METHODS Volume measurements were evaluated for different anatomical tumour sites, the flank, thigh and dorsum of the hind foot, for a variety of tumour cell lines. The estimated tumour volumes from CBCT and manual calliper measurements using different volume equations were compared with the "gold standard", measured by weighing the tumours following euthanasia and tumour resection. The correlation between tumour volumes estimated with the different methods, compared with the gold standard, was estimated by the Spearman's rank correlation coefficient, root-mean-square deviation and the coefficient of determination. RESULTS The semi-automatic CBCT volume segmentation performed favourably compared with manual calliper measures for flank tumours ≤2 cm(3) and thigh tumours ≤1 cm(3). For tumours >2 cm(3) or foot tumours, the CBCT method was not able to accurately segment the tumour volumes and manual calliper measures were superior. CONCLUSION We demonstrated that tumour volumes of flank and thigh tumours, obtained as a part of radiation studies using image-guided small-animal irradiators, can be estimated more efficiently and accurately using semi-automatic segmentation from CBCT scans. ADVANCES IN KNOWLEDGE This is the first study evaluating tumour volume assessment of pre-clinical subcutaneous tumours in different anatomical sites using on-board CBCT imaging. We also compared the accuracy of the CBCT method to manual calliper measures, using various volume calculation equations.
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Affiliation(s)
- N P Brodin
- 1 Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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Chapiro J, Duran R, Lin M, Werner JD, Wang Z, Schernthaner R, Savic LJ, Lessne ML, Geschwind JF, Hong K. Three-Dimensional Quantitative Assessment of Uterine Fibroid Response after Uterine Artery Embolization Using Contrast-Enhanced MR Imaging. J Vasc Interv Radiol 2015; 26:670-678.e2. [PMID: 25638750 DOI: 10.1016/j.jvir.2014.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/31/2014] [Accepted: 11/10/2014] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To evaluate the clinical feasibility and diagnostic accuracy of three-dimensional (3D) quantitative magnetic resonance (MR) imaging for the assessment of total lesion volume (TLV) and enhancing lesion volume (ELV) before and after uterine artery embolization (UAE). MATERIALS AND METHODS This retrospective study included 25 patients with uterine fibroids who underwent UAE and received contrast-enhanced MR imaging before and after the procedure. TLV was calculated using a semiautomated 3D segmentation of the dominant lesion on contrast-enhanced MR imaging, and ELV was defined as voxels within TLV where the enhancement exceeded the value of a region of interest placed in hypoenhancing soft tissue (left psoas muscle). ELV was expressed in relative (% of TLV) and absolute (in cm(3)) metrics. Results were compared with manual measurements and correlated with symptomatic outcome using a linear regression model. RESULTS Although 3D quantitative measurements of TLV demonstrated a strong correlation with the manual technique (R(2) = 0.93), measurements of ELV after UAE showed significant disagreement between techniques (R(2) = 0.72; residual standard error, 15.8). Six patients (24%) remained symptomatic and were classified as nonresponders. When stratified according to response, no difference in % ELV between responders and nonresponders was observed. When assessed using cm(3) ELV, responders showed a significantly lower mean ELV compared with nonresponders (4.1 cm(3) [range, 0.3-19.8 cm(3)] vs 77 cm(3) [range, 11.91-296 cm(3)]; P < .01). CONCLUSIONS The use of segmentation-based 3D quantification of lesion enhancement is feasible and diagnostically accurate and could be considered as an MR imaging response marker for clinical outcome after UAE.
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Affiliation(s)
- Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287; Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - MingDe Lin
- Clinical Informatics, Interventional, and Translational Solutions, Philips Research North America, Briarcliff Manor, New York
| | - John D Werner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Zhijun Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Rüdiger Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Lynn Jeanette Savic
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287; Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Mark L Lessne
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287.
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Chapiro J, Duran R, Lin M, Schernthaner RE, Wang Z, Gorodetski B, Geschwind JF. Identifying Staging Markers for Hepatocellular Carcinoma before Transarterial Chemoembolization: Comparison of Three-dimensional Quantitative versus Non-three-dimensional Imaging Markers. Radiology 2014; 275:438-47. [PMID: 25531387 DOI: 10.1148/radiol.14141180] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose To test and compare the association between radiologic measurements of lesion diameter, volume, and enhancement on baseline magnetic resonance (MR) images with overall survival and tumor response in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods This HIPAA-compliant retrospective, single-institution analysis was approved by the institutional review board, with waiver of informed consent. It included 79 patients with unresectable HCC who were treated with TACE. Baseline arterial phase contrast material-enhanced (CE) MR imaging was used to measure the overall and enhancing tumor diameters. A segmentation-based three-dimensional quantification of the overall and enhancing tumor volumes was performed in each patient. Numeric cutoff values (5 cm for diameters and 65 cm(3) for volumes) were used to stratify the patient cohort in two groups. Tumor response rates according to Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) guidelines were recorded for all groups. Survival was evaluated by using Kaplan-Meier analysis and was compared by using Cox proportional hazard ratios (HRs) after univariate and multivariate analysis. Results Stratification according to overall and enhancing tumor diameters did not result in a significant separation of survival curves (HR, 1.4; 95% confidence interval [CI]: 0.7, 2.5; P = .234; and HR, 1.6; 95% CI: 0.9, 2.8; P = .08, respectively). The stratification according to overall and enhancing tumor volume achieved significance (HR, 1.8; 95% CI: 0.9, 3.4; P = .022; and HR, 1.8; 95% CI: 1.1, 3.1; P = .017, respectively). As for tumor response, higher response rates were observed in smaller lesions compared with larger lesions, when the 5-cm threshold (27% vs 15% for mRECIST and 45% vs 24% for EASL) was used. Conclusion As opposed to anatomic tumor diameter as the most commonly used staging marker, volumetric assessment of lesion size and enhancement on baseline CE MR images is strongly associated with survival of patients with HCC who were treated with TACE.
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Affiliation(s)
- Julius Chapiro
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, the Johns Hopkins Hospital, 1800 Orleans St, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287 (J.C., R.D., M.L., R.E.S., Z.W., B.G., J.F.G.); Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany (J.C., B.G.); and U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.)
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Transarterial chemoembolization in soft-tissue sarcoma metastases to the liver - the use of imaging biomarkers as predictors of patient survival. Eur J Radiol 2014; 84:424-430. [PMID: 25542065 DOI: 10.1016/j.ejrad.2014.11.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 11/14/2014] [Accepted: 11/28/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The clinical management of patients with metastatic soft-tissue sarcoma of the liver is complicated by the paucity of reliable clinical data. This study evaluated the safety profile, survival outcome as well as the role of imaging biomarkers of tumor response in metastatic soft-tissue sarcoma (mSTS) of the liver treated with conventional transarterial chemoembolization (cTACE). MATERIALS/METHODS This retrospective analysis included 30 patients with mSTS of the liver treated with cTACE. The safety profile, overall survival (OS) and progression-free survival (PFS) after the procedure were evaluated. Tumor response in each patient was assessed using RECIST, modified (m) RECIST and EASL guidelines. In addition, a 3D quantification of the enhancing tumor volume (quantitative [q] EASL) was performed. For each method, patients were classified as responders (R) and non-responders (NR), and evaluated using Kaplan-Meier and multivariate Cox proportional hazard ratio (HR) analysis. RESULTS No Grade III or IV toxicities were reported in a total of 77 procedures (mean, 2.6/patient). Median OS was 21.2 months (95% CI, 13.4-28.9) and PFS was 6.3 months (95% CI, 4.4-8.2). The enhancement-based techniques identified 11 (44%), 12 (48%) and 12 (48%) patients as R according to EASL, mRECIST and qEASL, respectively. No stratification was achieved with RECIST. Multivariate analysis identified tumor response according to mRECIST and qEASL as reliable predictors of improved patient survival (P=0.019; HR 0.3 [0.1-0.8] and P=0.006; HR 0.2 [0.1-0.6], respectively). CONCLUSION This study confirmed the role of cTACE as a safe salvage therapy option in patients with mSTS of the liver. The demonstrated advantages of enhancement-based tumor response assessment techniques over size-based criteria validate mRECIST and qEASL as preferable methods after intraarterial therapy.
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Chapiro J, Lin M, Duran R, Schernthaner RE, Geschwind JF. Assessing tumor response after loco-regional liver cancer therapies: the role of 3D MRI. Expert Rev Anticancer Ther 2014; 15:199-205. [PMID: 25371052 DOI: 10.1586/14737140.2015.978861] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Assessing the tumor response of liver cancer lesions after intraarterial therapies is of major clinical interest. Over the last two decades, tumor response criteria have come a long way from purely size-based, anatomic methods such as the Response Evaluation Criteria in Solid Tumors towards more functional, enhancement- and diffusion-based parameters with a strong emphasis on MRI as the ultimate imaging modality. However, the relatively low reproducibility of those one- and 2D techniques (modified Response Evaluation Criteria in Solid Tumors and the European Association for the Study of the Liver criteria) provided the rationale for the development of new, 3D quantitative assessment techniques. This review will summarize and compare the existing methodologies used for 3D quantitative tumor analysis and provide an overview of the published clinical evidence for the benefits of 3D quantitative tumor response assessment techniques.
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Affiliation(s)
- Julius Chapiro
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287, USA
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Wang Z, Lin M, Lesage D, Chen R, Chapiro J, Gu T, Tacher V, Duran R, Geschwind JF. Three-dimensional evaluation of lipiodol retention in HCC after chemoembolization: a quantitative comparison between CBCT and MDCT. Acad Radiol 2014; 21:393-9. [PMID: 24507426 PMCID: PMC3979929 DOI: 10.1016/j.acra.2013.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/02/2013] [Accepted: 11/03/2013] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the capability of cone-beam computed tomography (CBCT) acquired immediately after transcatheter arterial chemoembolization (TACE) in determining lipiodol retention quantitatively and volumetrically when compared to 1-day postprocedure unenhanced multidetector computed tomography (MDCT). MATERIALS AND METHODS From June to December 2012, 15 patients met the inclusion criteria of unresectable hepatocellular carcinoma (HCC) that was treated with conventional TACE (cTACE) and had intraprocedural CBCT and 1-day post-TACE MDCT. Four patients were excluded because the lipiodol was diffuse throughout the entire liver or lipiodol deposition was not clear on both CBCT and MDCT. Eleven patients with a total of 31 target lesions were included in the analysis. A quantitative three-dimensional software was used to assess complete, localized, and diffuse lipiodol deposition. Tumor volume, lipiodol volume in the tumor, percent lipiodol retention, and lipiodol enhancement in Hounsfield units (HU) were calculated and compared between CBCT and MDCT using two-tailed Student's t test and Bland-Altman plots. RESULTS The mean value of tumor volume, lipiodol-deposited regions, calculated average percent lipiodol retention, and HU value of CBCT were not significantly different from those of MDCT (tumor volume: 9.37 ± 11.35 cm(3) vs 9.34 ± 11.44 cm(3), P = .991; lipiodol volume: 7.84 ± 9.34 cm(3) vs 7.84 ± 9.60 cm(3), P = .998; lipiodol retention: 89.3% ± 14.7% vs. 90.2% ± 14.9%, P = .811; HU value: 307.7 ± 160.1 HU vs. 257.2 ± 120.0 HU, P = .139). Bland-Altman plots showed only minimal difference and high agreement when comparing CBCT to MDCT. CONCLUSIONS CBCT has a similar capability, intraprocedurally, to assess lipiodol deposition in three dimensions for patients with HCC treated with cTACE when compared to MDCT.
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Affiliation(s)
- Zhijun Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - MingDe Lin
- Clinical Informatics, Interventional, and Translational Solutions (CIITS), Philips Research North America, Briarcliff Manor, NY, USA
| | | | - Rongxin Chen
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Tara Gu
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Vania Tacher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
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Tacher V, Lin M, Bhagat N, Abi Jaoudeh N, Radaelli A, Noordhoek N, Carelsen B, Wood BJ, Geschwind JF. Dual-phase cone-beam computed tomography to see, reach, and treat hepatocellular carcinoma during drug-eluting beads transarterial chemo-embolization. J Vis Exp 2013:50795. [PMID: 24326874 PMCID: PMC3910428 DOI: 10.3791/50795] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional (3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.
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Affiliation(s)
- Vania Tacher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital
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Chen R, Geschwind JF, Wang Z, Tacher V, Lin M. Quantitative assessment of lipiodol deposition after chemoembolization: comparison between cone-beam CT and multidetector CT. J Vasc Interv Radiol 2013; 24:1837-44. [PMID: 24094672 PMCID: PMC3840104 DOI: 10.1016/j.jvir.2013.08.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the ability of cone-beam computed tomography (CBCT) performed directly after transarterial chemoembolization to assess ethiodized oil (Lipiodol) deposition in hepatocellular carcinoma (HCC) and compare it with unenhanced multidetector computed tomography (CT). MATERIALS AND METHODS Conventional transarterial chemoembolization was used to treat 15 patients with HCC, and CBCT was performed to assess Lipiodol deposition directly after transarterial chemoembolization. Unenhanced multidetector CT was performed 24 hours after transarterial chemoembolization. Four patients were excluded because the margin of tumor or area of Lipiodol deposition was unclear. The image enhancement density of the entire tumor and liver parenchyma was measured by ImageJ software, and tumor-to-liver contrast (TLC) was calculated. In addition, volumetric measurement of tumor and Lipiodol was performed by semiautomatic three-dimensional volume segmentation and compared using linear regression to evaluate consistency between the two imaging modalities. RESULTS The mean value of TLC on CBCT was not significantly different from TLC on multidetector CT (337.7 HU ± 233.5 vs 283.0 HU ± 152.1, P = .103).The average volume of the whole tumor and of only the regions with Lipiodol deposition and the calculated average percentage of Lipiodol retention on CBCT were not significantly different compared with multidetector CT (tumor volume, 9.6 cm(3) ± 11.8 vs 10.8 cm(3) ± 14.2, P = .142; Lipiodol volume, 6.3 cm(3) ± 7.7 vs 7.0 cm(3) ± 8.1, P = .214; percentage of Lipiodol retention, 68.9% ± 24.0% vs 72.2% ± 23.1%, P = .578). Additionally, there was a high correlation in the volume of tumor and Lipiodol between CBCT and multidetector CT (R(2) = 0.919 and 0.903). CONCLUSIONS The quantitative image enhancement and volume analyses demonstrate that CBCT is similar to multidetector CT in assessing Lipiodol deposition in HCC after transarterial chemoembolization.
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Affiliation(s)
- Rongxin Chen
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Zhijun Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Vania Tacher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - MingDe Lin
- Clinical Informatics, Interventional, and Translational Solutions (CIITS), Philips Research North America, Briarcliff Manor, NY, USA
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Lin M, Pellerin O, Bhagat N, Rao PP, Loffroy R, Ardon R, Mory B, Reyes DK, Geschwind JF. Quantitative and volumetric European Association for the Study of the Liver and Response Evaluation Criteria in Solid Tumors measurements: feasibility of a semiautomated software method to assess tumor response after transcatheter arterial chemoembolization. J Vasc Interv Radiol 2013. [PMID: 23177109 DOI: 10.1016/j.jvir.2012.08.028] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To show that hepatic tumor volume and enhancement pattern measurements can be obtained in a time-efficient and reproducible manner on a voxel-by-voxel basis to provide a true three-dimensional (3D) volumetric assessment. MATERIALS AND METHODS Magnetic resonance (MR) imaging data obtained from 20 patients recruited for a single-institution prospective study were retrospectively evaluated. All patients had a diagnosis of hepatocellular carcinoma (HCC) and underwent drug-eluting beads (DEB) transcatheter arterial chemoembolization for the first time. All patients had undergone contrast-enhanced MR imaging before and after DEB transcatheter arterial chemoembolization; poor image quality excluded 3 patients, resulting in a final count of 17 patients. Volumetric RECIST (vRECIST) and quantitative EASL (qEASL) were measured, and segmentation and processing times were recorded. RESULTS There were 34 scans analyzed. The time for semiautomatic segmentation was 65 seconds±33 (range, 40-200 seconds). vRECIST and qEASL of each tumor were computed<1 minute for each. CONCLUSIONS Semiautomatic quantitative tumor enhancement (qEASL) and volume (vRECIST) assessment is feasible in a workflow-efficient time frame. Clinical correlation is necessary, but vRECIST and qEASL could become part of the assessment of intraarterial therapy for interventional radiologists.
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Affiliation(s)
- MingDe Lin
- Clinical Informatics, Interventional, and Translational Solutions (CIITS), Philips Research North America, Briarcliff Manor, New York, USA
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Tacher V, Lin M, Chao M, Gjesteby L, Bhagat N, Mahammedi A, Ardon R, Mory B, Geschwind JF. Semiautomatic volumetric tumor segmentation for hepatocellular carcinoma: comparison between C-arm cone beam computed tomography and MRI. Acad Radiol 2013; 20:446-52. [PMID: 23498985 PMCID: PMC3602801 DOI: 10.1016/j.acra.2012.11.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/01/2012] [Accepted: 11/14/2012] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the precision and reproducibility of a semiautomatic tumor segmentation software in measuring tumor volume of hepatocellular carcinoma (HCC) before the first transarterial chemo-embolization (TACE) on contrast-enhancement magnetic resonance imaging (CE-MRI) and intraprocedural dual-phase C-arm cone beam computed tomography (DP-CBCT) images. MATERIALS AND METHODS Nineteen HCCs were targeted in 19 patients (one per patient) who underwent baseline diagnostic CE-MRI and an intraprocedural DP-CBCT. The images were obtained from CE-MRI (arterial phase of an intravenous contrast medium injection) and DP-CBCT (delayed phase of an intra-arterial contrast medium injection) before the actual embolization. Three readers measured tumor volumes using a semiautomatic three-dimensional volumetric segmentation software that used a region-growing method employing non-Euclidean radial basis functions. Segmentation time and spatial position were recorded. The tumor volume measurements between image sets were compared using linear regression and Student's t-test, and evaluated with intraclass-correlation analysis (ICC). The inter-rater Dice similarity coefficient (DSC) assessed the segmentation spatial localization. RESULTS All 19 HCCs were analyzed. On CE-MRI and DP-CBCT examinations, respectively, 1) the mean segmented tumor volumes were 87 ± 8 cm(3) (2-873) and 92 ± 10 cm(3) (1-954), with no statistical difference of segmented volumes by readers of each tumor between the two imaging modalities and the mean time required for segmentation was 66 ± 45 seconds (21-173) and 85 ± 34 seconds (17-214) (P = .19); 2) the ICCs were 0.99 and 0.974, showing a strong correlation among readers; and 3) the inter-rater DSCs showed a good to excellent inter-user agreement on the spatial localization of the tumor segmentation (0.70 ± 0.07 and 0.74 ± 0.05, P = .07). CONCLUSION This study shows a strong correlation, a high precision, and excellent reproducibility of semiautomatic tumor segmentation software in measuring tumor volume on CE-MRI and DP-CBCT images. The use of the segmentation software on DP-CBCT and CE-MRI can be a valuable and highly accurate tool to measure the volume of hepatic tumors.
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Affiliation(s)
- Vania Tacher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - MingDe Lin
- Clinical Informatics, Interventional, and Translational Solutions (CIITS), Philips Research North America, Briarcliff Manor, NY, USA
| | - Michael Chao
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lars Gjesteby
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nikhil Bhagat
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Abdelkader Mahammedi
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
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