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Dercle L, Lu L, Schwartz LH, Qian M, Tejpar S, Eggleton P, Zhao B, Piessevaux H. Radiomics Response Signature for Identification of Metastatic Colorectal Cancer Sensitive to Therapies Targeting EGFR Pathway. J Natl Cancer Inst 2021; 112:902-912. [PMID: 32016387 DOI: 10.1093/jnci/djaa017] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/05/2019] [Accepted: 01/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The authors sought to forecast survival and enhance treatment decisions for patients with liver metastatic colorectal cancer by using on-treatment radiomics signature to predict tumor sensitiveness to irinotecan, 5-fluorouracil, and leucovorin (FOLFIRI) alone (F) or in combination with cetuximab (FC). METHODS We retrospectively analyzed 667 metastatic colorectal cancer patients treated with F or FC. Computed tomography quality was classified as high (HQ) or standard (SD). Four datasets were created using the nomenclature (treatment) - (quality). Patients were randomly assigned (2:1) to training or validation sets: FCHQ: 78:38, FCSD: 124:62, FHQ: 78:51, FSD: 158:78. Four tumor-imaging biomarkers measured quantitative radiomics changes between standard of care computed tomography scans at baseline and 8 weeks. Using machine learning, the performance of the signature to classify tumors as treatment sensitive or treatment insensitive was trained and validated using receiver operating characteristic (ROC) curves. Hazard ratio and Cox regression models evaluated association with overall survival (OS). RESULTS The signature (area under the ROC curve [95% confidence interval (CI)]) used temporal decrease in tumor spatial heterogeneity plus boundary infiltration to successfully predict sensitivity to antiepidermal growth factor receptor therapy (FCHQ: 0.80 [95% CI = 0.69 to 0.94], FCSD: 0.72 [95% CI = 0.59 to 0.83]) but failed with chemotherapy (FHQ: 0.59 [95% CI = 0.44 to 0.72], FSD: 0.55 [95% CI = 0.43 to 0.66]). In cetuximab-containing sets, radiomics signature outperformed existing biomarkers (KRAS-mutational status, and tumor shrinkage by RECIST 1.1) for detection of treatment sensitivity and was strongly associated with OS (two-sided P < .005). CONCLUSIONS Radiomics response signature can serve as an intermediate surrogate marker of OS. The signature outperformed known biomarkers in providing an early prediction of treatment sensitivity and could be used to guide cetuximab treatment continuation decisions.
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Affiliation(s)
- Laurent Dercle
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.,Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Lin Lu
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Lawrence H Schwartz
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Min Qian
- Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Sabine Tejpar
- Molecular Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | | | - Binsheng Zhao
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Hubert Piessevaux
- Department of Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc, UCLouvain Brussels, Brussels, Belgium
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Effects of guided random sampling of TCCs on blood flow values in CT perfusion studies of lung tumors. Acad Radiol 2015; 22:58-69. [PMID: 25481516 DOI: 10.1016/j.acra.2014.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 07/30/2014] [Accepted: 08/01/2014] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Tissue perfusion is commonly used to evaluate lung tumor lesions through dynamic contrast-enhanced computed tomography (DCE-CT). The aim of this study was to improve the reliability of the blood flow (BF) maps by means of a guided sampling of the tissue time-concentration curves (TCCs). MATERIALS AND METHODS Fourteen selected CT perfusion (CTp) examinations from different patients with lung lesions were considered, according to different degrees of motion compensation. For each examination, two regions of interest (ROIs) referring to the target lesion and the arterial input were manually segmented. To obtain the perfusion parameters, we computed the maximum slope of the Hill equation, describing the pharmacokinetics of the contrast agent, and the TCC was fitted for each voxel. A guided iterative approach based on the Random Sample Consensus method was used to detect and exclude samples arising from motion artifacts through the assessment of the confidence level of each single temporal sample of the TCC compared to the model. Removing these samples permits to refine the model fitting, thus exploiting more reliable data. Goodness-of-fit measures of the fitted TCCs to the original data (eg, root mean square error and correlation distance) were used to assess the reliability of the BF values, so as to preserve the functional structure of the resulting perfusion map. We devised a quantitative index, the local coefficient of variation (lCV), to measure the spatial coherence of perfusion maps, from local to regional and global resolution. The effectiveness of the algorithm was tested under three different degrees of motion yielded by as many alignment procedures. RESULTS At pixel level, the proposed approach improved the reliability of BF values, quantitatively assessed through the correlation index. At ROI level, a comparative analysis emphasized how our approach "replaced" the noisy pixels, providing smoother parametric maps while preserving the main functional structure. Moreover, the implemented algorithm provides a more meaningful effect in correspondence of a higher motion degree. This was confirmed both quantitatively, using the lCV, and qualitatively, through visual inspection by expert radiologists. CONCLUSIONS Perfusion maps achieved with the proposed approach can now be used as a valid tool supporting radiologists in DCE-CTp studies. This represents a step forward to clinical utilization of these studies for staging, prognosis, and monitoring values of therapeutic regimens.
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Romano M, D’Antò M, Bifulco P, Fiore F, Cesarelli M. Robustness to noise of arterial blood flow estimation methods in CT perfusion. BMC Res Notes 2014; 7:540. [PMID: 25130498 PMCID: PMC4152598 DOI: 10.1186/1756-0500-7-540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perfusion CT is a technology which allows functional evaluation of tissue vascularity. Due to this potential, it is finding increasing utility in oncology. Although since its introduction continuous advances have interested CT technique, some issues have to be still defined, concerning both clinical and technical aspects. In this study, we dealt with the comparison of two widely employed mathematical models (dual input one compartment model - DOCM - and maximum slope - SM -) analyzing their robustness to the noise. METHODS We carried out a computer simulation process to quantify effect of noise on the evaluation of an important perfusion parameter (Arterial Blood Flow - BFa) in liver tumours. A total of 4500 liver TAC, corresponding to 3 fixed BFa values, were simulated using different arterial and portal TAC (computed from 5 real CT images) at 10 values of signal to noise ratio (SNR). BFa values were calculated by applying four different algorithms, specifically developed, to these noisy simulated curves. Three algorithms were developed to implement SM (one semiautomatic, one automatic and one automatic with filtering) and the last for the DOCM method. RESULTS In all the simulations, DOCM provided the best results, i.e., those with the lowest percentage error compared to the reference value of BFa. Concerning SM, the results are variable. Results obtained with the automatic algorithm with filtering are close to the reference value, but only if SNR is higher than 50. Vice versa, results obtained by means of the semiautomatic algorithm gave, in all simulations, the lowest results with the lowest standard deviation of the percentage error. CONCLUSIONS Since the use of DOCM is limited by the necessity that portal vein is visible in CT scans, significant restriction for patients' follow-up, we concluded that SM can be reliably employed. However, a proper software has to be used and an estimation of SNR would be carried out.
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Affiliation(s)
- Maria Romano
- />DIETI, University of Naples, “Federico II”, Naples, Italy
- />Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Rome, Italy
| | - Michela D’Antò
- />DIETI, University of Naples, “Federico II”, Naples, Italy
- />National Cancer Institute “Pascale Foundation”, Naples, Italy
| | - Paolo Bifulco
- />DIETI, University of Naples, “Federico II”, Naples, Italy
- />Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Rome, Italy
| | - Francesco Fiore
- />National Cancer Institute “Pascale Foundation”, Naples, Italy
| | - Mario Cesarelli
- />DIETI, University of Naples, “Federico II”, Naples, Italy
- />Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Rome, Italy
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Tixier F, Groves AM, Goh V, Hatt M, Ingrand P, Le Rest CC, Visvikis D. Correlation of intra-tumor 18F-FDG uptake heterogeneity indices with perfusion CT derived parameters in colorectal cancer. PLoS One 2014; 9:e99567. [PMID: 24926986 PMCID: PMC4057188 DOI: 10.1371/journal.pone.0099567] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/15/2014] [Indexed: 01/12/2023] Open
Abstract
METHODS Thirty patients with proven colorectal cancer prospectively underwent integrated 18F-FDG PET/DCE-CT to assess the metabolic-flow phenotype. Both CT blood flow parametric maps and PET images were analyzed. Correlations between PET heterogeneity and perfusion CT were assessed by Spearman's rank correlation analysis. RESULTS Blood flow visualization provided by DCE-CT images was significantly correlated with 18F-FDG PET metabolically active tumor volume as well as with uptake heterogeneity for patients with stage III/IV tumors (|ρ|:0.66 to 0.78; p-value<0.02). CONCLUSION The positive correlation found with tumor blood flow indicates that intra-tumor heterogeneity of 18F-FDG PET accumulation reflects to some extent tracer distribution and consequently indicates that 18F-FDG PET intra-tumor heterogeneity may be associated with physiological processes such as tumor vascularization.
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Affiliation(s)
- Florent Tixier
- INSERM, UMR1101, LaTIM, CHRU Morvan, Brest, France
- * E-mail: :
| | - Ashley M. Groves
- Institute of Nuclear Medicine, UCL, Euston Road, London, United Kingdom
| | - Vicky Goh
- Division of Imaging Sciences and Biomedical Engineering, Kings College London, St Thomas Hospital, London, United Kingdom
| | - Mathieu Hatt
- INSERM, UMR1101, LaTIM, CHRU Morvan, Brest, France
| | - Pierre Ingrand
- Epidemiology & Biostatistics, CIC Inserm 1402, CHU Milétrie, Poitiers, France
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Comparison of Quantitatively Analyzed Dynamic Area-Detector CT Using Various Mathematic Methods With FDG PET/CT in Management of Solitary Pulmonary Nodules. AJR Am J Roentgenol 2013; 200:W593-602. [DOI: 10.2214/ajr.12.9197] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ohno Y, Koyama H, Matsumoto K, Onishi Y, Takenaka D, Fujisawa Y, Yoshikawa T, Konishi M, Maniwa Y, Nishimura Y, Ito T, Sugimura K. Differentiation of Malignant and Benign Pulmonary Nodules with Quantitative First-Pass 320–Detector Row Perfusion CT versus FDG PET/CT. Radiology 2011; 258:599-609. [DOI: 10.1148/radiol.10100245] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Meijerink MR, van Waesberghe JHTM, van Schaik C, Boven E, van der Veldt AAM, van den Tol P, Meijer S, van Kuijk C. Perfusion CT and US of colorectal cancer liver metastases: a correlative study of two dynamic imaging modalities. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1626-1636. [PMID: 20800954 DOI: 10.1016/j.ultrasmedbio.2010.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 06/09/2010] [Accepted: 06/17/2010] [Indexed: 05/29/2023]
Abstract
The purpose of this study was to evaluate the correlation between dynamic-contrast-enhanced computed tomography (DCE-CT) and first-pass dynamic-contrast-enhanced ultrasound (DCE-US) of normal appearing liver parenchyma and of colorectal cancer liver metastases. Thirty patients with hepatic metastases from colorectal cancer underwent DCE-CT and DCE-US. To obtain DCE-US reproducibility measurements, double contrast-passages (2 × 2.4 mL SonoVue intravenous) were acquired. From several DCE-US-derived perfusion indices, the slope-value scored best with a reproducibility concordance correlation coefficient ranging from 0.75-0.93 and overall highest correlation to DCE-CT-derived variables (r = 0.52 to 0.73). The DCE-US-based tumor-to-liver perfusion gradient also showed a low test-retest variability and moderately correlated to DCE-CT (concordance correlation coefficient 0.87-0.92; r = 0.57 to 0.59). To conclude, DCE-US-based slope-value and tumor-to-liver perfusion gradient correlate best with DCE-CT perfusion values. However, both techniques cannot be used interchangeably. DCE-US should be restricted for studies in which a considerable change in perfusion is expected and for patients with a relatively high tumor blood flow at baseline.
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Affiliation(s)
- Martijn R Meijerink
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
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Lind JSW, Meijerink MR, Dingemans AMC, van Kuijk C, Öllers MC, de Ruysscher D, Postmus PE, Smit EF. Dynamic contrast-enhanced CT in patients treated with sorafenib and erlotinib for non-small cell lung cancer: a new method of monitoring treatment? Eur Radiol 2010; 20:2890-8. [PMID: 20625738 PMCID: PMC2978316 DOI: 10.1007/s00330-010-1869-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/13/2010] [Accepted: 04/23/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We investigated the feasibility of serial dynamic contrast-enhanced computed tomography (DCE-CT) in patients with advanced/metastatic non-small cell lung cancer (NSCLC) receiving anti-angiogenic (sorafenib) and anti-EGFR (erlotinib) treatment, and correlated tumour blood flow (BF) with treatment outcome. METHODS DCE-CTs were performed at baseline and 3 and 6 weeks after starting treatment. Tumour BF, calculated with the maximum slope method, and percentage change were measured in 23 patients (14 male; median age 59 years). Tumour BF was compared at baseline and weeks 3 and 6; the relation with RECIST/Crabb response and progression-free survival (PFS) was assessed. RESULTS Mean tumour perfusion decreased from 39.2 ml/100 g/min at baseline to 15.1 ml/100 g/min at week 3 (p < 0.001) and 9.4 ml/100 g/min at week 6 (p < 0.001). Tumour perfusion was lower in RECIST and Crabb responders versus non-responders at week 3 (4.2 versus 17.7 ml/100 g/min, p = 0.03) and week 6 (0 versus 13.4 ml/100 g/min, p = 0.04). Patients with a decrease larger than the median at week 6 tended to have a longer PFS (7.1 versus 5.7 months, p = 0.06). CONCLUSION Serial DCE-CTs are feasible in patients with NSCLC and demonstrated a significant decrease in tumour BF following sorafenib/erlotinib therapy. Early changes in tumour BF correlated with objective response and showed a trend towards longer PFS.
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Affiliation(s)
- Joline S. W. Lind
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn R. Meijerink
- Department of Radiology, VU University Medical Center, De Boelelaan 1117, P.O. Box 7075, Amsterdam, the Netherlands
| | - Anne-Marie C. Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cornelis van Kuijk
- Department of Radiology, VU University Medical Center, De Boelelaan 1117, P.O. Box 7075, Amsterdam, the Netherlands
| | - Michel C. Öllers
- Department of Radiation Oncology (MAASTRO Clinic), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Pieter E. Postmus
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
| | - Egbert F. Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
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Meijerink MR, van Waesberghe JHT, van der Weide L, van den Tol P, Meijer S, Comans EF, Golding RP, van Kuijk C. Early detection of local RFA site recurrence using total liver volume perfusion CT initial experience. Acad Radiol 2009; 16:1215-22. [PMID: 19524457 DOI: 10.1016/j.acra.2009.03.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/28/2009] [Accepted: 03/30/2009] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to prospectively evaluate the feasibility of a novel total liver volume perfusion computed tomographic technique in demonstrating treatment-site recurrence of liver metastases after radiofrequency ablation (RFA). MATERIALS AND METHODS Eleven patients considered to be at increased risk for local RFA-site tumor recurrence underwent both positron emission tomography (PET) and perfusion computed tomography (CTP): a 12-phase scan of the entire liver acquired before and 11 times after contrast injection. After coregistration, blood flow maps were created using the maximum slope method. RESULTS In all cases, the CTP-derived blood flow maps fully paralleled the PET images in showing either the absence (nine of 13 lesions) or presence (four of 13 lesions) of local RFA-site recurrence. Marginal lesions with high hepatic arterial perfusion (>50 mL/min/100 g) and low portal venous perfusion (<10 mL/min/100 g) represented recurring vital tumor tissue (P < .05). CONCLUSION Total liver volume CTP seems feasible for the detection and localization of treatment-site recurrence after RFA.
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Meijerink MR, van Waesberghe JHTM, van der Weide L, van den Tol P, Meijer S, van Kuijk C. Total-liver-volume perfusion CT using 3-D image fusion to improve detection and characterization of liver metastases. Eur Radiol 2008; 18:2345-54. [PMID: 18491094 DOI: 10.1007/s00330-008-0996-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 02/26/2008] [Accepted: 03/08/2008] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to evaluate the feasibility of a total-liver-volume perfusion CT (CTP) technique for the detection and characterization of liver metastases. Twenty patients underwent helical CT of the total liver volume before and 11 times after intravenous contrast-material injection. To decrease distortion artifacts, all phases were co-registered using 3-D image fusion before creating blood-flow maps. Lesion-based sensitivity and specificity for liver metastases of first the conventional four phases (unenhanced, arterial, portal venous, and equilibrium) and later all 12 phases including blood-flow maps were determined as compared to intraoperative ultrasound and surgical exploration. Arterial and portal venous perfusion was calculated for normal-appearing and metastatic liver tissue. Total-liver-volume perfusion values were comparable to studies using single-level CTP. Compared to four-phase CT, total -liver-volume CTP increased sensitivity to 89.2 from 78.4% (P=0.046) and specificity to 82.6 from 78.3% (P=0.074). Total -liver-volume CTP is a noninvasive, quantitative, and feasible technique. Preliminary results suggest an improved detection of liver metastases for CTP compared to four-phase CT.
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Affiliation(s)
- Martijn R Meijerink
- Department of Radiology, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
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Hu CH, Wu QD, Hu XY, Fang XM, Zhang TH, Ding Y. Hemodynamic studies on brain CT perfusion imaging with varied injection rates. Clin Imaging 2007; 31:151-4. [PMID: 17449374 DOI: 10.1016/j.clinimag.2007.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 01/10/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to determine a contrast medium injection rate that ensures both accuracy for data and safety for operation by comparing hemodynamic parameters of brain CT perfusion imaging with varied injection rates. METHODS Twenty-four healthy volunteers were divided into three groups based on contrast medium injection rates (4.5, 6.0, and 7.5 ml/s). For all subjects, CT perfusion scanning was started at 4 s after antecubital venous bolus of contrast media injection. A perfusion-analyzing software package was used to produce a time-density curve in the anterior cerebral artery and the superior sagittal sinus and calculate the regional cerebral blood flow (rCBF) in the gray matter and the white matter. The hemodynamic indices were compared among the three groups, and statistical analysis was carried out using the F test. RESULTS The time for the arterial rise to reach the peak value for the 7.5-ml/s group was only 0.2 s ahead of the initiation time for the rise of the superior sagittal sinus. The differences of rCBF in the gray matter and the white matter among the three groups were statistically significant. rCBF in the gray matter and the white matter for the 7.5-ml/s group was 52.8 ml x min(-1) 100 g(-1) . (+/-3.1) and 21.9 ml x min(-1) . 100 g(-1) (+/-2.4), respectively. CONCLUSIONS The use of the 7.5-ml/s injection rate can meet the prerequisite of the maximum slope model, and the resulting rCBF can be very close to that measured by positron emission tomography. Therefore, 7.5 ml/s was an ideal contrast medium injection rate.
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Affiliation(s)
- Chun-Hong Hu
- Imaging Center, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215006, China.
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Hirasawa H, Tsushima Y, Hirasawa S, Takei H, Taketomi-Takahasi A, Takano A, Amanuma M, Endo K. Perfusion CT of breast carcinoma: arterial perfusion of nonscirrhous carcinoma was higher than that of scirrhous carcinoma. Acad Radiol 2007; 14:547-52. [PMID: 17434068 DOI: 10.1016/j.acra.2007.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 01/12/2007] [Accepted: 01/14/2007] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Our goals were to apply perfusion CT technique to breast tumor and to evaluate the correlation between arterial perfusion value and other tumor characteristics. MATERIALS AND METHODS Thirty-one female patients with primary breast tumors were included in this study. A single-slice dynamic CT was performed after an intravenous bolus injection of contrast material (40 ml; 370 mg I/ml) at 8 ml/sec. The parameters were calculated on a pixel-by-pixel basis by using maximum slope method, and quantitative maps of arterial perfusion were created. Statistical correlation between tumor size, patient age, and perfusion were assessed. Differences in perfusion between scirrhous and nonscirrhous carcinoma were also assessed. RESULTS Perfusion CT images were successfully created for 24 patients (mean age, 55.9 years old; range, 36-85 years). In five patients, dynamic CT was not performed due to lack of visualization of the breast tumor on unenhanced CT. In two patients, reliable perfusion CT image could not be created because of motion artifact. The mean perfusion for 24 tumors was 33.1 +/- 16.9 ml/min/100 ml (mean +/- SD; range, 14-78), and the tumor perfusion did not correlate with patient's age or tumor size (21.0 +/- 10.2 mm; range, 10-45 mm). The mean perfusion of nonscirrhous carcinoma (45.8 ml/min/100 ml; n = 11) was higher than that of scirrhous carcinoma (22.7 ml/min/100 ml; n = 11; P < .001). CONCLUSION Determination of the perfusion of breast carcinoma is feasible by dynamic CT and can be performed during a routine CT study without much supplementary burden on the patient. There are differences in blood flow between scirrhous and nonscirrhous breast carcinoma, and further research is needed to determine the impact of this finding.
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Affiliation(s)
- Hiromi Hirasawa
- Department of Diagnostic and Interventional Radiology, Gunma Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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Hirasawa S, Tsushima Y, Takei H, Hirasawa H, Taketomi-Takahashi A, Takano A, Oriuchi N, Endo K. Inverse correlation between tumor perfusion and glucose uptake in human head and neck tumors. Acad Radiol 2007; 14:312-8. [PMID: 17307664 DOI: 10.1016/j.acra.2006.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 12/28/2006] [Accepted: 12/29/2006] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES We sought to determine the relationship between tumor blood flow and glucose uptake in head and neck tumors using perfusion computed tomography (PCT) and fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET). MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this study. Sixteen patients (mean age, 67 years; age range, 36-89 years) who had known or suspected head and neck tumors (15 malignant tumors and one schwannoma) underwent PCT and FDG PET examinations. Tumor area was measured on conventional CT images. The PCT data were postprocessed using maximum slope method analysis, and standardized uptake value (SUV) was measured on FDG PET. RESULTS Mean arterial perfusion of the tumors was 61.56 mL/min/100 mL (range 22.17-102.7 mL/min/100 mL), and mean FDG SUV was 7.48 (range 2.74-17.1). A significant negative correlation between arterial perfusion and FDG SUV was found for malignant tumors (r = -0.538, P = .04, n = 15). CONCLUSION There was an inverse relationship between arterial perfusion and glucose uptake of head and neck malignant tumors, suggesting that the malignant tumors may depend on anaerobic glycolysis.
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Affiliation(s)
- Satoshi Hirasawa
- Department of Diagnostic and Interventional Radiology, Gunma Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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Meijerink MR, van Cruijsen H, Hoekman K, Kater M, van Schaik C, van Waesberghe JHTM, Giaccone G, Manoliu RA. The use of perfusion CT for the evaluation of therapy combining AZD2171 with gefitinib in cancer patients. Eur Radiol 2006; 17:1700-13. [PMID: 17072618 DOI: 10.1007/s00330-006-0425-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 07/27/2006] [Accepted: 07/31/2006] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to determine the feasibility of dynamic contrast-enhanced perfusion CT (CTP) in evaluating the hemodynamic response of tumors in the chest and abdomen treated with a combination of AZD2171 and gefitinib. Thirteen patients were examined just before and every 4-6 weeks after starting therapy. Following intravenous injection of a contrast agent, dynamic image acquisition was obtained at the level of a selected tumor location. To calculate perfusion, the maximum-slope method was used. Pre-treatment average perfusion for extra-hepatic masses was 84 ml/min/100 g, for liver masses arterial perfusion was 25 ml/min/100 g, and a portal perfusion of 30 ml/min/100 g was found. After the administration of AZD2171 and gefitinib, in extra-hepatic masses an initial decrease in perfusion of 18% was followed by a plateau and in liver masses an initial decrease of 39% within the lesions and of 36% within a rim region surrounding the lesions was followed by a tendency to recovery of hepatic artery flow. In conclusion, CTP is feasible in showing changes of perfusion induced by anti-angiogenic therapy.
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Affiliation(s)
- Martijn R Meijerink
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
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Nakajima T, Oriuchi N, Tsushima Y, Funabasama S, Aoki J, Endo K. Noninvasive determination of regional myocardial perfusion with first-pass magnetic resonance (MR) imaging. Acad Radiol 2004; 11:802-8. [PMID: 15217598 DOI: 10.1016/j.acra.2004.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2003] [Revised: 01/07/2004] [Accepted: 01/22/2004] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES To develop a method to provide absolute values of regional myocardial perfusion by means of color maps, and to determine myocardial perfusion reserve using magnetic resonance imaging during the first pass of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). MATERIALS AND METHODS The study population consisted of five patients with hypertrophic cardiomyopathy, two with dilated cardiomyopathy, four with coronary artery disease, and one with normal coronary arteries who presented with mildly abnormal electrocardiogram findings. For each heartbeat, six continuous slices were acquired during the first pass of Gd-DTPA (0.05 mmol/kg body weight) before and during adenosine triphosphate (ATP) **stress using an electrocardiogram-triggered fast low-angle shot (FLASH) sequence on a 1.5-T magnetic resonance unit. Myocardial perfusion images were created and displayed by means of a color scale. The parameters were calculated pixel by pixel, using the upslope method. Myocardial perfusion reserve was then calculated, as the quotient of myocardial perfusion during ATP stress and perfusion before ATP stress. RESULTS Myocardial perfusion during ATP stress in patients with normal coronary arteries (n = 1) or after successful percutaneous coronary intervention (n = 2) was increased compared with that before ATP stress. However, the patients with coronary artery disease (n = 2) failed to show increased myocardial perfusion. The patients with hypertrophic cardiomyopathy showed increased myocardial perfusion during ATP stress, although two with dilated cardiomyopathy did not. CONCLUSION Our new technique can provide absolute values of regional myocardial perfusion by means of color maps, and has potential for widespread use for evaluation of ischemic and other types of heart disease.
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Affiliation(s)
- Takahito Nakajima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3.39.22 Showa.machi, Maebashi, 371.8511, Japan
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Funabasama S, Tsushima Y, Sanada S, Inoue K. [Hepatic perfusion CT imaging analyzed by the dual-input one-compartment model]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2004; 59:1548-54. [PMID: 15001870 DOI: 10.6009/jjrt.kj00000921686] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To improve liver-perfusion imaging by using the dual-input one-compartmental model. METHODS Single-level dynamic computed tomography (dynamic CT) was taken at the height of the hepatic hilum after a rapid intravenous injection using 40 ml of iodinated contrast material. From the time-density curve of each pixel on CT, we calculated blood-flow rate constants of liver inflow and outflow. For inflow, two constants were calculated at arterial and portal veins. We postulated that blood flow between hepatic vessels and the hepatic parenchyma could be analyzed by using the calculated constants, and made equations for liver perfusion mapping. The perfusion images obtained by this method were compared with those made by the maximum slope method. RESULTS We applied the method to a patient with hepatolithiasis. On dynamic CT, there was an abnormal enhancement pattern in the posterior segment of the liver. Perfusion CT images made by the dual-input one-compartment model demonstrated abnormal portal perfusion of the liver. In contrast, those made by the maximum-slope method did not represent the perfusion pattern well. CONCLUSION The dual-input one-compartmental model makes it possible to obtain more detailed information on liver hemodynamics.
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Affiliation(s)
- Shintaro Funabasama
- Department of Radiological Technology, Graduate School of Medical Science, Kanazawa University
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Tsushima Y, Funabasama S, Aoki J, Sanada S, Endo K. Quantitative perfusion map of malignant liver tumors, created from dynamic computed tomography data. Acad Radiol 2004; 11:215-23. [PMID: 14974597 DOI: 10.1016/s1076-6332(03)00578-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES To apply perfusion computed tomography (CT) technique to variable malignant liver tumors, and to define the usefulness of quantitative color mapping. MATERIALS AND METHODS Perfusion CT images were created for 36 malignant liver tumors in 28 patients (age, 66.4 +/- 10.1 years; range, 48-85) with metastatic liver tumors (n = 17; nine colorectal carcinomas, eight other malignant tumors) and hepatocellular carcinomas (n = 11). A single-slice dynamic CT was performed after an intravenous bolus injection of 40 mL of contrast material (320 mgI/mL) with 8 mL/sec. The parameters were calculated pixel-by-pixel using maximum slope method, and quantitative maps of arterial and portal perfusion were created. In four patients who underwent transcatheter arterial chemoembolization, perfusion CT was performed before and after transcatheter arterial chemoembolization. RESULTS In all patients, liver tumors were shown as hypervascular lesions on arterial perfusion CT. The average arterial perfusion value of the metastatic tumors from the colorectal carcinomas was 0.67 +/- 0.33 mL/min/mL, and that of hepatocellular carcinomas was 0.94 +/- 0.26 mL/min/mL (P = .03). The other metastatic tumors from various primary tumors showed a wide range (0.19-1.45 mL/min/mL) of arterial perfusion. Arterial perfusion of the liver tumors was obviously decreased after successful transcatheter arterial chemoembolization. In 12 of 15 tumors, in which portal perfusion CT images could be created, region-of-interest analysis showed no portal perfusion in the tumors. In two cases, decreased portal perfusion in the segments, which malignant tumors involved, was demonstrated. CONCLUSION Perfusion CT can provide quantitative information about arterial and portal perfusion of liver tumors, combined with good anatomic detail in one image. This technique has a potential to evaluate the angiogenesis of liver tumors, to show secondary changes in perfusion, such as decreased portal perfusion in apparently normal liver adjacent to metastases, and to monitor the therapeutic response in vivo.
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Affiliation(s)
- Yoshito Tsushima
- Department of Radiology, Motojima General Hospital, 3-8 Nishi-Honcho, Ohta, Gunma 373-0033, Japan
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Tsushima Y, Aoki J, Endo K. The effect of fatty infiltration on the liver tissue enhancement during portal phase computed tomography1. Acad Radiol 2003; 10:1008-12. [PMID: 13678089 DOI: 10.1016/s1076-6332(03)00152-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES To correlate the presence of fatty liver and the enhancement value of liver tissue during portal phase computed tomography. MATERIALS AND METHODS Liver tissue enhancements during portal phase computed tomography were measured in 16 fatty liver and 35 control patients. All patients intravenously received 100 mL of non-ionic contrast material (320 mg iodine/ mL) at a rate of 3 mL/second, and the image acquisition started at 70 seconds. Attenuation values were measured on the 80-second portal phase images and the corresponding unenhanced images, and the contrast enhancement value (HU) of the liver tissue was calculated. Adjusted enhancement values were also calculated with the following equation: adjusted enhancement value = enhancement value (HU)/[dose (grams of iodine)/body weight (kg)]. RESULTS The contrast enhancement value was significantly reduced in the fatty liver patients compared with the normal controls (37.0 +/- 7.2 vs 49.8 +/- 12.0 HU; P < .0001). This difference was still significant in adjusted enhancement value (80.1 +/- 13.7 vs 93.6 +/- 23.0 HU kg g(-1); P = .01). CONCLUSION The liver tissue with fatty infiltration was less enhanced than controls, probably because of decreased portal perfusion.
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Affiliation(s)
- Yoshito Tsushima
- Department of Radiology, Motojima General Hospital, 3-8 Nishi-Honcho, Ohta, Gunma 373-0033, Japan
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Tsushima Y, Funabasama S, Sanada S, Aoki J, Endo K. Perfusion changes of hepatic parenchyma due to infectious hepatobiliary disease: demonstration by perfusion CT. Comput Med Imaging Graph 2003; 27:289-91. [PMID: 12631513 DOI: 10.1016/s0895-6111(02)00079-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present two cases, in which perfusion CT demonstrated diffusely increased arterial and decreased portal perfusion of the liver parenchyma around liver abscess and infectious bilomas. These cases suggested that perfusion CT may be useful for a quantitative analysis of perfusion changes in infectious hepatobiliary diseases with good anatomical detail.
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Affiliation(s)
- Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Hospital, 3-14-16 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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