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Zou M, Zhao Z, Zhang B, Mao H, Huang Y, Wang C. Pulmonary lesions: correlative study of dynamic triple-phase enhanced CT perfusion imaging with tumor angiogenesis and vascular endothelial growth factor expression. BMC Med Imaging 2021; 21:158. [PMID: 34717573 PMCID: PMC8556962 DOI: 10.1186/s12880-021-00692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background To investigate value of the quantitative perfusion parameters of dynamic triple-phase enhanced CT in differential diagnosis of pulmonary lesions, and explore the correlation between perfusion parameters of lung cancer with microvessel density (MVD) and vascular endothelial growth factor (VEGF). Methods 73 consecutive patients with lung lesions who successfully underwent pre-operative CT perfusion examination with dynamic triple-phase enhanced CT and received a final diagnosis by postoperative pathology or a clinical follow-up. The cases were divided into malignant and benign groups according to the pathological results. CT perfusion parameters, such as Median, Mean, Standard deviation (Std), Q10, Q25, Q50, Q75, Q90 of pulmonary artery perfusion (PAP), bronchial artery perfusion (BAP), perfusion index (PI) and arterial enhancement fraction (AEF) were obtained by performing computed tomography perfusion imaging (CTPI). Computed tomography perfusion (CTP) parameters were compared between malignant and benign lesions. The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CTP parameters in diagnosing malignant lesions. The correlations between CTP parameters with MVD and VEGF were analysed in 36 lung cancer patients who had extra sections be used for immunohistochemistry staining of CD34 and VEGF. Results BAP (Mean, Std, Q90) and PI Std of benign lesions were higher than malignant lesions (p < 0.05), and PAP (Q10, Q25), PI (Median, Mean, Q10, Q25, Q50) of malignant lesions were higher than the benign (p < 0.05). The area under the ROC curve of PI Mean, PI Q10 and PI Std was 0.722 (95% CI = [0.595–0.845]), 0.728 (95% CI = [0.612–0.844]) and 0.717 (95% CI = [0.598–0.835]) respectively. Partial perfusion parameters of BAP and AEF Q10 were positively correlated with MVD (p value range is < 0.001–0.037, ρ value range is 0.483–0.683), and partial perfusion parameters of PI were negatively correlated with MVD (p value range is 0.001–0.041,ρvalue range is − 0.523–− 0.343). Partial perfusion parameters of BAP and AEF Q10 were positively correlated with VEGF (p value range is 0.001–0.016, ρvalue range is 0.398–0.570), meanwhile some perfusion parameters of PAP and PI were negatively correlated with VEGF (p value range is 0.001–0.040, ρ value range is − 0.657–0.343). Conclusions Quantitative parameters of dynamic triple-phase enhanced CT can provide diagnostic basis for the differentiation of lung lesions, and there were connection with tumor angiogenesis and vascular endothelial growth factor expression.
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Affiliation(s)
- Mingyue Zou
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China.
| | - Bingqian Zhang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Haijia Mao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Yanan Huang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Cheng Wang
- Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
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Shi L, Zhou XL, Sun JJ, Huang JH, Wang X, Li K, Pang PP, Xu YJ, Chen M, Zhang MM. Whole-tumor perfusion CT using texture analysis in unresectable stage IIIA/B non-small cell lung cancer treated with recombinant human endostatin. Quant Imaging Med Surg 2019; 9:968-975. [PMID: 31367551 DOI: 10.21037/qims.2019.06.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background To observe the dynamic changes of blood perfusion with whole-tumor computed tomography (CT) perfusion imaging using texture analysis in patients with unresectable stage IIIA/B non-small cell lung cancer (NSCLC) treated with recombinant human endostatin (Endostar). Methods This phase II clinical trial recruited 11 patients diagnosed with stage IIIA/B NSCLC. Histological examination prior to treatment revealed squamous cell carcinoma in 4 cases and adenocarcinoma in 7 cases. All patients underwent contrast-enhanced perfusion CT at baseline and a second CT scan 1 week after treatment initiation with Endostar. CT perfusion images including blood flow (BF), blood volume (BV), and permeability (PMB) were imported into OmniKinetics software to quantitatively assess the texture features. Skewness, kurtosis, and entropy were calculated at baseline and after anti-angiogenic therapy. Changes in tumor were analyzed using Wilcoxon signed-rank test. The association of parameters with survival was evaluated using Cox proportional hazards regression model. Results There were no statistical differences in the mean values of BF, BV, and PMB before and after treatment (P=0.594, 0.477 and 0.328, respectively). The skewness on BF images demonstrated significant differences at baseline and after treatment (0.6±2.7 vs. 1.0±2.6, P=0.010), while skewness of BV and PMB showed no significant variation (P=0.477 and 0.213, respectively). The kurtosis and entropy for BF, BV and PMB showed no significant differences (all P>0.05). In adenocarcinoma, the mean BF showed no significant differences at baseline and after treatment (76.5±25.7 vs. 101.2±46.4, P=0.398), while skewness for BF was significantly higher after treatment than at baseline (-0.19±3.3 vs. 0.59±3.2, P=0.028). No significant associations were found between perfusion CT imaging parameters and progression-free survival. Conclusions These results suggested that blood perfusion showed improvement with whole-tumor perfusion CT using texture analysis in patients with stage IIIA/B NSCLC treated by Endostar.
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Affiliation(s)
- Lei Shi
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Hangzhou YITU Healthcare Technology Co., Ltd., Hangzhou 310000, China
| | - Xiang-Lan Zhou
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jing-Jing Sun
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jie-Hui Huang
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Xu Wang
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Kai Li
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | | | - Yu-Jin Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Min-Ming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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Seki S, Fujisawa Y, Yui M, Kishida Y, Koyama H, Ohyu S, Sugihara N, Yoshikawa T, Ohno Y. Dynamic Contrast-enhanced Area-detector CT vs Dynamic Contrast-enhanced Perfusion MRI vs FDG-PET/CT: Comparison of Utility for Quantitative Therapeutic Outcome Prediction for NSCLC Patients Undergoing Chemoradiotherapy. Magn Reson Med Sci 2019; 19:29-39. [PMID: 30880291 PMCID: PMC7067914 DOI: 10.2463/mrms.mp.2018-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To directly compare the utility for therapeutic outcome prediction of dynamic first-pass contrast-enhanced (CE)-perfusion area-detector computed tomography (ADCT), MR imaging assessed with the same mathematical method and 2-[fluorine-18]-fluoro-2-deoxy-d-glucose-positron emission tomography combined with CT (PET/CT) for non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy. MATERIALS AND METHODS Forty-three consecutive stage IIIB NSCLC patients, consisting of 25 males (mean age ± standard deviation: 66.6 ± 8.7 years) and 18 females (66.4 ± 8.2 years) underwent PET/CT, dynamic CE-perfusion ADCT and MR imaging, chemoradiotherapy, and follow-up examination. In each patient, total, pulmonary arterial, and systemic arterial perfusions were calculated from both perfusion data and SUVmax on PET/CT, assessed for each targeted lesion, and averaged to determine final values. Receiver operating characteristics analyses were performed to compare the utility for distinguishing responders from non-responders using Response Evaluation Criteria in Solid Tumor (RECIST) 1.1 criteria. Overall survival (OS) assessed with each index were compared between two groups by means of the Kaplan-Meier method followed by the log-rank test. RESULTS Area under the curve (Az) for total perfusion on ADCT was significantly larger than that of pulmonary arterial perfusion (P < 0.05). Az of total perfusion on MR imaging was significantly larger than that of pulmonary arterial perfusion (P < 0.05). Mean OS of responder and non-responder groups were significantly different for total and systemic arterial (P < 0.05) perfusion. CONCLUSION Dynamic first-pass CE-perfusion ADCT and MR imaging as well as PET/CT are useful for early prediction of treatment response by NSCLC patients treated with chemoradiotherapy.
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Affiliation(s)
- Shinichiro Seki
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine.,Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine
| | | | | | - Yuji Kishida
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine
| | - Hisanobu Koyama
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine
| | | | | | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine.,Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine
| | - Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine.,Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine
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Yang DM, Palma D, Louie A, Malthaner R, Fortin D, Rodrigues G, Yaremko B, Laba J, Gaede S, Warner A, Inculet R, Lee TY. Assessment of tumour response after stereotactic ablative radiation therapy for lung cancer: A prospective quantitative hybrid 18 F-fluorodeoxyglucose-positron emission tomography and CT perfusion study. J Med Imaging Radiat Oncol 2018; 63:94-101. [PMID: 30281918 DOI: 10.1111/1754-9485.12807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/25/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Stereotactic ablative radiotherapy (SABR) is a guideline-recommended treatment for inoperable stage I non-small cell lung cancer (NSCLC), but imaging assessment of response after SABR is difficult. The goal of this study was to evaluate imaging-based biomarkers of tumour response using dynamic 18 F-FDG-PET and CT perfusion (CTP). METHODS Thirty-one patients with early-stage NSCLC participated in this prospective correlative study. Each underwent dynamic 18 F-FDG-PET/CTP studies on a PET/CT scanner pre- and 8 weeks post-SABR. The dynamic 18 F-FDG-PET measured the tumour SUVmax , SUVmean and the following parameters: K1 , k2 , k3 , k4 and Ki , all using the Johnson-Wilson-Lee kinetic model. CTP quantitatively mapped BF, BV, MTT and PS in tumours and measured largest tumour diameter. Since free-breathing was allowed during CTP scanning, non-rigid image registration of CT images was applied to minimize misregistration before generating the CTP functional maps. Differences between pre- and post-SABR imaging-based parameters were compared. RESULTS Tumour size changed only slightly after SABR (median 26 mm pre-SABR vs. 23 mm post-SABR; P = 0.01). However, dynamic 18 F-FDG-PET and CTP study showed substantial and significant changes in SUVmax , SUVmean , k3 , k4 and Ki . Significant decreases were evident in SUVmax (median 6.1 vs. 2.6; P < 0.001), SUVmean (median 2.5 vs. 1.5; P < 0.001), k3 (relative decrease of 52%; P = 0.002), Ki (relative decrease of 27%; P = 0.03), whereas there was an increase in k4 (+367%; P < 0.001). CONCLUSIONS Hybrid 18 F-FDG-PET/CTP allowed the response of NSCLC to SABR to be assessed regarding metabolic and functional parameters. Future studies are needed, with correlation with long-term outcomes, to evaluate these findings as potential imaging biomarkers of response.
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Affiliation(s)
- Dae-Myoung Yang
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - David Palma
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Alexander Louie
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Richard Malthaner
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Dalilah Fortin
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - George Rodrigues
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Brian Yaremko
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Joanna Laba
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada.,Department of Engineering and Physics, Western University, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Richard Inculet
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Ting-Yim Lee
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
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Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Advanced Cervical Carcinoma: The Advantage of Perfusion Parameters From the Peripheral Region in Predicting the Early Response to Radiotherapy. Int J Gynecol Cancer 2018; 28:1342-1349. [DOI: 10.1097/igc.0000000000001308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThis study aimed to investigate the importance of perfusion parameters from the peripheral region in predicting the early response to radiotherapy for advanced cervical carcinoma by using dynamic contrast-enhanced (DCE) perfusion magnetic resonance imaging (MRI).MethodsOne hundred eight patients with advanced cervical carcinoma were enrolled into this study. Dynamic contrast-enhanced perfusion MR examinations were performed for all the patients before radiotherapy. Perfusion parameters were obtained from the central region and the peripheral region of tumor respectively. After radiotherapy, the patients were classified into responders and nonresponders according to tumor shrinkage on the basis of follow-up MRI examination. The mean follow-up time lasted 12 months. The perfusion parameters were compared between the 2 groups. The relationship between perfusion parameters from 2 different regions of tumor and treatment effect was analyzed.ResultsThe mean value of volume transfer constant (Ktrans), rate constant (Kep) or extravascular extracellular volume fraction (Ve) from the peripheral region was higher than that from the central region of tumor, respectively (P = 0.01, 004, 0.03). Responders had higher Ktransperipheral (Ktrans from the peripheral region) and Ktranscentral (Ktrans from the central region) values than nonresponders (P = 0.04, 0.01). Responders had higher Kepperipheral (Kep from the peripheral region) than nonresponders (P = 0.03). Responders had lower Veperipheral (Ve from the peripheral region) than nonresponders (P = 0.04). At logistic regression analysis, the perfusion parameters that had predicting value were Ktransperipheral, Veperipheral, Kepperipheral and Ktranscentral according to diagnostic potency.ConclusionsCompared with perfusion parameters from the central region of tumor, perfusion parameters from the peripheral region are more valuable in predicting the early response to radiotherapy for advanced cervical carcinoma.
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Ohno Y, Koyama H, Lee HY, Miura S, Yoshikawa T, Sugimura K. Contrast-enhanced CT- and MRI-based perfusion assessment for pulmonary diseases: basics and clinical applications. Diagn Interv Radiol 2017; 22:407-21. [PMID: 27523813 DOI: 10.5152/dir.2016.16123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Assessment of regional pulmonary perfusion as well as nodule and tumor perfusions in various pulmonary diseases are currently performed by means of nuclear medicine studies requiring radioactive macroaggregates, dual-energy computed tomography (CT), and dynamic first-pass contrast-enhanced perfusion CT techniques and unenhanced and dynamic first-pass contrast enhanced perfusion magnetic resonance imaging (MRI), as well as time-resolved three-dimensional or four-dimensional contrast-enhanced magnetic resonance angiography (MRA). Perfusion scintigraphy, single-photon emission tomography (SPECT) and SPECT fused with CT have been established as clinically available scintigraphic methods; however, they are limited by perfusion information with poor spatial resolution and other shortcomings. Although positron emission tomography with 15O water can measure absolute pulmonary perfusion, it requires a cyclotron for generation of a tracer with an extremely short half-life (2 min), and can only be performed for academic purposes. Therefore, clinicians are concentrating their efforts on the application of CT-based and MRI-based quantitative and qualitative perfusion assessment to various pulmonary diseases. This review article covers 1) the basics of dual-energy CT and dynamic first-pass contrast-enhanced perfusion CT techniques, 2) the basics of time-resolved contrast-enhanced MRA and dynamic first-pass contrast-enhanced perfusion MRI, and 3) clinical applications of contrast-enhanced CT- and MRI-based perfusion assessment for patients with pulmonary nodule, lung cancer, and pulmonary vascular diseases. We believe that these new techniques can be useful in routine clinical practice for not only thoracic oncology patients, but also patients with different pulmonary vascular diseases.
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Affiliation(s)
- Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology and Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
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Ohno Y, Fujisawa Y, Koyama H, Kishida Y, Seki S, Sugihara N, Yoshikawa T. Dynamic contrast-enhanced perfusion area-detector CT assessed with various mathematical models: Its capability for therapeutic outcome prediction for non-small cell lung cancer patients with chemoradiotherapy as compared with that of FDG-PET/CT. Eur J Radiol 2016; 86:83-91. [PMID: 28027771 DOI: 10.1016/j.ejrad.2016.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy. MATERIALS AND METHODS Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR+PR) and 2) stable or progressive disease (SD+PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUVmax, and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared. RESULTS The step-wise regression test showed that therapeutic effect (r2=0.63, p=0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUVmax. Mean overall survival showed a significant difference for total perfusion (p=0.003) and systemic arterial perfusion (p=0.04). CONCLUSION Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy.
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Affiliation(s)
- Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan.
| | | | - Hisanobu Koyama
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuji Kishida
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichiro Seki
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan
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Strauch LS, Eriksen RØ, Sandgaard M, Kristensen TS, Nielsen MB, Lauridsen CA. Assessing Tumor Response to Treatment in Patients with Lung Cancer Using Dynamic Contrast-Enhanced CT. Diagnostics (Basel) 2016; 6:diagnostics6030028. [PMID: 27455330 PMCID: PMC5039562 DOI: 10.3390/diagnostics6030028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to provide an overview of the literature available on dynamic contrast-enhanced computed tomography (DCE-CT) as a tool to evaluate treatment response in patients with lung cancer. This systematic review was compiled according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles concerning treatment response in patients with lung cancer assessed with DCE-CT were included. To assess the validity of each study we implemented Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The initial search yielded 651 publications, and 16 articles were included in this study. The articles were divided into groups of treatment. In studies where patients were treated with systemic chemotherapy with or without anti-angiogenic drugs, four out of the seven studies found a significant decrease in permeability after treatment. Four out of five studies that measured blood flow post anti-angiogenic treatments found that blood flow was significantly decreased. DCE-CT may be a useful tool in assessing treatment response in patients with lung cancer. It seems that particularly permeability and blood flow are important perfusion values for predicting treatment outcome. However, the heterogeneity in scan protocols, scan parameters, and time between scans makes it difficult to compare the included studies.
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Affiliation(s)
- Louise S Strauch
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
- Department of Technology, Faculty of Health and Technology, Metropolitan University College, 2200 Copenhagen, Denmark.
| | - Rie Ø Eriksen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
- Department of Technology, Faculty of Health and Technology, Metropolitan University College, 2200 Copenhagen, Denmark.
| | - Michael Sandgaard
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Thomas S Kristensen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Michael B Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Carsten A Lauridsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
- Department of Technology, Faculty of Health and Technology, Metropolitan University College, 2200 Copenhagen, Denmark.
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Weller A, O'Brien MER, Ahmed M, Popat S, Bhosle J, McDonald F, Yap TA, Du Y, Vlahos I, deSouza NM. Mechanism and non-mechanism based imaging biomarkers for assessing biological response to treatment in non-small cell lung cancer. Eur J Cancer 2016; 59:65-78. [PMID: 27016624 DOI: 10.1016/j.ejca.2016.02.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Abstract
Therapeutic options in locally advanced non-small cell lung cancer (NSCLC) have expanded in the past decade to include a palate of targeted interventions such as high dose targeted thermal ablations, radiotherapy and growing platform of antibody and small molecule therapies and immunotherapies. Although these therapies have varied mechanisms of action, they often induce changes in tumour architecture and microenvironment such that response is not always accompanied by early reduction in tumour mass, and evaluation by criteria other than size is needed to report more effectively on response. Functional imaging techniques, which probe the tumour and its microenvironment through novel positron emission tomography and magnetic resonance imaging techniques, offer more detailed insights into and quantitation of tumour response than is available on anatomical imaging alone. Use of these biomarkers, or other rational combinations as readouts of pathological response in NSCLC have potential to provide more accurate predictors of treatment outcomes. In this article, the robustness of the more commonly available positron emission tomography and magnetic resonance imaging biomarker indices is examined and the evidence for their application in NSCLC is reviewed.
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Affiliation(s)
- A Weller
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK.
| | - M E R O'Brien
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - M Ahmed
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - S Popat
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - J Bhosle
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - F McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - T A Yap
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Y Du
- Department of Nuclear Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - I Vlahos
- Radiology Department, St George's Hospital NHS Trust, London, SW17 0QT, UK
| | - N M deSouza
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK
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Dynamic contrast-enhanced perfusion area detector CT for non-small cell lung cancer patients: Influence of mathematical models on early prediction capabilities for treatment response and recurrence after chemoradiotherapy. Eur J Radiol 2015; 85:176-186. [PMID: 26724663 DOI: 10.1016/j.ejrad.2015.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/23/2015] [Accepted: 11/04/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the capability and influence of the mathematical method on dynamic contrast-enhanced (CE-) perfusion area detector CT (ADCT) for early prediction of treatment response as well as progression free and overall survival (PFS and OS) of non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy. MATERIALS AND METHODS Sixty-six consecutive stage III NSCLC patients underwent dynamic CE-perfusion ADCT examinations, chemoradiotherapy and follow-up examinations. Response Evaluation Criteria in Solid Tumors (RECIST) criteria were used to divide all patients into responders and non-responders. Differences in each of the indices for all targeted lesions between measurements obtained 2 weeks prior to the first and the third course of chemotherapy were determined for all patients. ROC analyses were employed to determine the capability of perfusion indices as markers for distinguishing RECIST responders from non-responders. To evaluate their capability for early prediction of therapeutic effect, OS of perfusion index-based responders and non-responders were compared by using the Kaplan-Meier method followed by log-rank test. RESULTS Area under the curve (Az) for total perfusion by means of the dual-input maximum slope method was significantly larger than that of pulmonary arterial perfusion using the same method (p=0.007) and of perfusion with the single-input maximum slope method (p=0.007). Mean OS demonstrated significantly difference between responder- and non-responder groups for total perfusion (p=0.02). CONCLUSION Mathematical models have significant influence on assessment for early prediction of treatment response, disease progression and overall survival using dynamic CE-perfusion ADCT for NSCLC patients treated with chemoradiotherapy.
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Henzler T, Shi J, Jafarov H, Schoenberg SO, Manegold C, Fink C, Schmid-Bindert G. Functional CT imaging techniques for the assessment of angiogenesis in lung cancer. Transl Lung Cancer Res 2015; 1:78-83. [PMID: 25806158 DOI: 10.3978/j.issn.2218-6751.2012.01.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 01/06/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Hashim Jafarov
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
| | - Christian Manegold
- Interdisciplinary Thoracic Oncology, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Germany
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
| | - Gerald Schmid-Bindert
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
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Gallaher J, Babu A, Plevritis S, Anderson ARA. Bridging population and tissue scale tumor dynamics: a new paradigm for understanding differences in tumor growth and metastatic disease. Cancer Res 2014; 74:426-435. [PMID: 24408919 DOI: 10.1158/0008-5472.can-13-0759] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To provide a better understanding of the relationship between primary tumor growth rates and metastatic burden, we present a method that bridges tumor growth dynamics at the population level, extracted from the SEER database, to those at the tissue level. Specifically, with this method, we are able to relate estimates of tumor growth rates and metastatic burden derived from a population-level model to estimates of the primary tumor vascular response and the circulating tumor cell (CTC) fraction derived from a tissue-level model. Variation in the population-level model parameters produces differences in cancer-specific survival and cure fraction. Variation in the tissue-level model parameters produces different primary tumor dynamics that subsequently lead to different growth dynamics of the CTCs. Our method to bridge the population and tissue scales was applied to lung and breast cancer separately, and the results were compared. The population model suggests that lung tumors grow faster and shed a significant number of lethal metastatic cells at small sizes, whereas breast tumors grow slower and do not significantly shed lethal metastatic cells until becoming larger. Although the tissue-level model does not explicitly model the metastatic population, we are able to disengage the direct dependency of the metastatic burden on primary tumor growth by introducing the CTC population as an intermediary and assuming dependency. We calibrate the tissue-level model to produce results consistent with the population model while also revealing a more dynamic relationship between the primary tumor and the CTCs. This leads to exponential tumor growth in lung and power law tumor growth in breast. We conclude that the vascular response of the primary tumor is a major player in the dynamics of both the primary tumor and the CTCs, and is significantly different in breast and lung cancer.
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Affiliation(s)
- Jill Gallaher
- Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, FL 33612
| | - Aravind Babu
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA 94305
| | - Sylvia Plevritis
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305
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Nishino M, Jackman DM, Hatabu H, Jänne PA, Johnson BE, Van den Abbeele AD. Imaging of lung cancer in the era of molecular medicine. Acad Radiol 2011; 18:424-36. [PMID: 21277232 DOI: 10.1016/j.acra.2010.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/28/2010] [Accepted: 10/30/2010] [Indexed: 12/17/2022]
Abstract
Recent discoveries characterizing the molecular basis of lung cancer brought fundamental changes in lung cancer treatment. The authors review the molecular pathogenesis of lung cancer, including genomic abnormalities, targeted therapies, and resistance mechanisms, and discuss lung cancer imaging with novel techniques. Knowledge of the molecular basis of lung cancer is essential for radiologists to properly interpret imaging and assess response to therapy. Quantitative and functional imaging helps assessing the biologic behavior of lung cancer.
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