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Qadir A, Singh N, Moe AAK, Cahoon G, Lye J, Chao M, Foroudi F, Uribe S. Potential of MRI in Assessing Treatment Response After Neoadjuvant Radiation Therapy Treatment in Breast Cancer Patients: A Scoping Review. Clin Breast Cancer 2024:S1526-8209(24)00136-8. [PMID: 38906720 DOI: 10.1016/j.clbc.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/07/2024] [Accepted: 05/26/2024] [Indexed: 06/23/2024]
Abstract
The objective of this scoping review is to evaluate the potential of Magnetic Resonance Imaging (MRI) and to determine which of the available MRI techniques reported in the literature are the most promising for assessing treatment response in breast cancer patients following neoadjuvant radiotherapy (NRT). Ovid Medline, Embase, CINAHL, and Cochrane databases were searched to identify relevant studies published from inception until March 13, 2023. After primary selection, 2 reviewers evaluated each study using a standardized data extraction template, guided by set inclusion and exclusion criteria. A total of 5 eligible studies were selected. The positive and negative predictive values for MRI predicting pathological complete response across the studies were 67% to 88% and 76% to 85%, respectively. MRI's potential in assessing postradiotherapy tumor sizes was greater for volume measurements than uni-dimensional longest diameter measurements; however, overestimation in surgical tumor sizes was observed. Apparent diffusion coefficient (ADC) values and Time to Enhance (TTE) was seen to increase post-NRT, with a notable difference between responders and nonresponders at 6 months, indicating a potential role in assessing treatment response. In conclusion, this review highlights tumor volume measurements, ADC, and TTE as promising MRI metrics for assessing treatment response post-NRT in breast cancer. However, further research with larger cohorts is needed to confirm their utility. If MRI can accurately identify responders from nonresponders to NRT, it could enable a more personalized and tailored treatment approach, potentially minimizing radiation therapy related toxicity and enhancing cosmetic outcomes.
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Affiliation(s)
- Ayyaz Qadir
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Nabita Singh
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Aung Aung Kywe Moe
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Glenn Cahoon
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Jessica Lye
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Chao
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Farshad Foroudi
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Sergio Uribe
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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Li Y, Zhang H, Yue L, Fu C, Grimm R, Li W, Guo W, Tong T. Whole tumor based texture analysis of magnetic resonance diffusion imaging for colorectal liver metastases: A prospective study for diffusion model comparison and early response biomarker. Eur J Radiol 2024; 170:111203. [PMID: 38007855 DOI: 10.1016/j.ejrad.2023.111203] [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: 08/27/2023] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic value of diffusion-related texture analysis parameters obtained from various magnetic resonance diffusion models as early predictors of the clinical response to chemotherapy in patients with colorectal liver metastases (CRLM). METHODS Patients (n = 145) with CRLM were prospectively and consecutively enrolled and scanned using diffusion-weighted imaging (DWI)-magnetic resonance imaging (MRI)/intravoxel incoherent motion (IVIM)/diffusion kurtosis imaging (DKI) before (baseline) and two-three weeks after (follow-up) commencing chemotherapy. Therapy response was evaluated based on the Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1). The histogram and texture parameters of each diffusion-related parametric map were analysed between the responding and non-responding groups, screened using LASSO, and fitted with binary logistic regression models. The diagnostic efficacy of each model in the early prediction of CRLM was analysed, and the corresponding receiver operating characteristic (ROC) curve was drawn. The area under the curve (AUC) and 95% confidence intervals (CI) were calculated. RESULTS Of the 145 analysed patients, 69 were in the responding group and 76 were in the non-responding group. Among all models, the difference value based on the histogram and texture features of the DKI-derived parameters performed best for the early prediction of CRLM treatment efficacy. The AUC of the DKI model in the validation set reached 0.795 (95% CI 0.652-0.938). Among the IVIM-derived parameters, the difference model based on D and D* performed best, and the AUC in the validation set reached 0.737 (95% CI 0.586-0.889). Finally, in the DWI sequence, the model comprising baseline features performed the best, with an AUC of 0.699 (95% CI 0.537-0.86) in the validation set. CONCLUSIONS Baseline DWI parameters and follow-up changes in IVIM and DKI parameters predicted the chemotherapeutic response in patients with CRLM. In addition, as very early predictors, DKI-derived parameters were more effective than DWI- and IVIM-related parameters, in which changes in D-parameters performed best.
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Affiliation(s)
- Yue Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Yue
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Caixia Fu
- MR Collaboration, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Wenhua Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Weijian Guo
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Baidya Kayal E, Bakhshi S, Kandasamy D, Sharma MC, Khan SA, Kumar VS, Khare K, Sharma R, Mehndiratta A. Non-invasive intravoxel incoherent motion MRI in prediction of histopathological response to neoadjuvant chemotherapy and survival outcome in osteosarcoma at the time of diagnosis. J Transl Med 2022; 20:625. [PMID: 36575510 PMCID: PMC9795762 DOI: 10.1186/s12967-022-03838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Early prediction of response to neoadjuvant chemotherapy (NACT) is important to aid personalized treatment in osteosarcoma. Diffusion-weighted Intravoxel Incoherent Motion (IVIM) MRI was used to evaluate the predictive value for response to NACT and survival outcome in osteosarcoma. METHODS Total fifty-five patients with biopsy-proven osteosarcoma were recruited prospectively, among them 35 patients were further analysed. Patients underwent 3 cycles of NACT (Cisplatin + Doxorubicin) followed by surgery and response adapted adjuvant chemotherapy. Treatment outcomes were histopathological response to NACT (good-response ≥ 50% necrosis and poor-response < 50% necrosis) and survival outcome (event-free survival (EFS) and overall survival (OS)). IVIM MRI was acquired at 1.5T at baseline (t0), after 1-cycle (t1) and after 3-cycles (t2) of NACT. Quantitative IVIM parameters (D, D*, f & D*.f) were estimated using advanced state-of-the-art spatial penalty based IVIM analysis method bi-exponential model with total-variation penalty function (BETV) at 3 time-points and histogram analysis was performed. RESULTS Good-responders: Poor-responders ratio was 13 (37%):22 (63%). EFS and OS were 31% and 69% with 16.27 and 25.9 months of median duration respectively. For predicting poor-response to NACT, IVIM parameters showed AUC = 0.87, Sensitivity = 86%, Specificity = 77% at t0, and AUC = 0.96, Sensitivity = 86%, Specificity = 100% at t1. Multivariate Cox regression analysis showed smaller tumour volume (HR = 1.002, p = 0.001) higher ADC-25th-percentile (HR = 0.047, p = 0.005) & D-Mean (HR = 0.1, p = 0.023) and lower D*-Mean (HR = 1.052, p = 0.039) were independent predictors of longer EFS (log-rank p-values: 0.054, 0.0034, 0.0017, 0.0019 respectively) and non-metastatic disease (HR = 4.33, p < 10-3), smaller tumour-volume (HR = 1.001, p = 0.042), lower D*-Mean (HR = 1.045, p = 0.056) and higher D*.f-skewness (HR = 0.544, p = 0.048) were independent predictors of longer OS (log-rank p-values: < 10-3, 0.07, < 10-3, 0.019 respectively). CONCLUSION IVIM parameters obtained with a 1.5T scanner along with novel BETV method and their histogram analysis indicating tumour heterogeneity were informative in characterizing NACT response and survival outcome in osteosarcoma.
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Affiliation(s)
- Esha Baidya Kayal
- grid.417967.a0000 0004 0558 8755Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016 India
| | - Sameer Bakhshi
- grid.413618.90000 0004 1767 6103Department of Medical Oncology, Dr. B.R. Ambedkar Institute-Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences, New Delhi, India
| | - Devasenathipathy Kandasamy
- grid.413618.90000 0004 1767 6103Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- grid.413618.90000 0004 1767 6103Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatesan Sampath Kumar
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Kedar Khare
- grid.417967.a0000 0004 0558 8755Department of Physics, Indian Institute of Technology Delhi, New Delhi, India
| | - Raju Sharma
- grid.413618.90000 0004 1767 6103Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Mehndiratta
- grid.417967.a0000 0004 0558 8755Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016 India ,grid.413618.90000 0004 1767 6103Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
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Wang PN, Velikina JV, Bancroft LCH, Samsonov AA, Kelcz F, Strigel RM, Holmes JH. The Influence of Data-Driven Compressed Sensing Reconstruction on Quantitative Pharmacokinetic Analysis in Breast DCE MRI. Tomography 2022; 8:1552-1569. [PMID: 35736876 PMCID: PMC9227412 DOI: 10.3390/tomography8030128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Radial acquisition with MOCCO reconstruction has been previously proposed for high spatial and temporal resolution breast DCE imaging. In this work, we characterize MOCCO across a wide range of temporal contrast enhancement in a digital reference object (DRO). Time-resolved radial data was simulated using a DRO with lesions in different PK parameters. The under sampled data were reconstructed at 5 s temporal resolution using the data-driven low-rank temporal model for MOCCO, compressed sensing with temporal total variation (CS-TV) and more conventional low-rank reconstruction (PCB). Our results demonstrated that MOCCO was able to recover curves with Ktrans values ranging from 0.01 to 0.8 min−1 and fixed Ve = 0.3, where the fitted results are within a 10% bias error range. MOCCO reconstruction showed less impact on the selection of different temporal models than conventional low-rank reconstruction and the greater error was observed with PCB. CS-TV showed overall underestimation in both Ktrans and Ve. For the Monte-Carlo simulations, MOCCO was found to provide the most accurate reconstruction results for curves with intermediate lesion kinetics in the presence of noise. Initial in vivo experiences are reported in one patient volunteer. Overall, MOCCO was able to provide reconstructed time-series data that resulted in a more accurate measurement of PK parameters than PCB and CS-TV.
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Affiliation(s)
- Ping Ni Wang
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA; (P.N.W.); (R.M.S.)
| | - Julia V. Velikina
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA; (J.V.V.); (L.C.H.B.); (A.A.S.); (F.K.)
| | - Leah C. Henze Bancroft
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA; (J.V.V.); (L.C.H.B.); (A.A.S.); (F.K.)
| | - Alexey A. Samsonov
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA; (J.V.V.); (L.C.H.B.); (A.A.S.); (F.K.)
| | - Frederick Kelcz
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA; (J.V.V.); (L.C.H.B.); (A.A.S.); (F.K.)
| | - Roberta M. Strigel
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA; (P.N.W.); (R.M.S.)
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA; (J.V.V.); (L.C.H.B.); (A.A.S.); (F.K.)
- Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - James H. Holmes
- Department of Radiology, University of Iowa, 169 Newton Road, Iowa City, IA 52333, USA
- Holden Comprehensive Cancer Center, University of Iowa, 169 Newton Road, Iowa City, IA 52333, USA
- Correspondence:
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Jeffers CD, Lawhn-Heath C, Butterfield RI, Hoffman JM, Scott PJH. SNMMI Clinical Trials Network Research Series for Technologists: Clinical Research Primer- Use of Imaging Agents in Therapeutic Drug Development and Approval. J Nucl Med Technol 2022; 50:jnmt.122.264372. [PMID: 35701219 DOI: 10.2967/jnmt.122.264372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
The process of bringing a new drug to market is complex and has recently necessitated a new drug discovery paradigm for the pharmaceutical industry that is both more efficient and more economical. Key to this has been the increasing use of nuclear medicine and molecular imaging to support drug discovery efforts by answering critical questions on the pathway for development and approval of a new therapeutic drug. Some of these questions include: (i) Does the new drug reach its intended target in the body at sufficient levels to effectively treat or diagnose disease without unacceptable toxicity? (ii) How is the drug absorbed, metabolized, and excreted? (iii) What is the effective dose in humans? To conduct the appropriate imaging studies to answer such questions, pharmaceutical companies are increasingly partnering with molecular imaging departments. Nuclear medicine technologists are critical to this process as they perform scans to collect the qualitative and quantitative imaging data used to measure study endpoints. This article describes preclinical and clinical research trials and provides an overview of the different ways that radiopharmaceuticals are used to answer critical questions during therapeutic drug development.
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Ma X, Ren X, Ma F, Cai S, Ning C, Liu J, Chen X, Zhang G, Qiang J. Volumetric apparent diffusion coefficient (ADC) histogram metrics as imaging biomarkers for pretreatment predicting response to fertility-sparing treatment in patients with endometrial cancer. Gynecol Oncol 2022; 165:594-602. [PMID: 35469683 DOI: 10.1016/j.ygyno.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the feasibility of volumetric apparent diffusion coefficient (ADC) histogram analysis for prediction of fertility-sparing treatment (FST) response in patients with endometrial cancer (EC). METHODS Pretreatment data of 54 EC patients with FST were retrospectively analyzed. Treatment response at each follow-up was pathologically evaluated. The associations of ADC histogram metrics (volume, minADC, maxADC, meanADC; 10th, 25th, 50th, 75th and 90th ADC percentiles; skewness; kurtosis) and baseline clinical characteristics with complete response (CR) at the second and third follow-ups, two-consecutive CR, and recurrence at the final follow-up were evaluated by uni- and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used for diagnostic performance evaluation. RESULTS Compared with non-CR patients, CR patients had significantly higher minADC and 10th and 25th ADC percentiles at the second follow-up (P = 0.008, 0.039, and 0.034, respectively) and higher minADC, older age, lower HE4 level, and higher overweight rate at the third follow-up (P = 0.001, 0.040, 0.021, and 0.004, respectively). Patients with two-consecutive CR had a significantly higher minADC than those without (P = 0.018). There was no association between ADC metrics or clinical characteristics and recurrence (all P > 0.05). MinADC yielded the largest AUC in predicting CR (0.688 and 0.735 at the second and third follow-up, respectively) and the presence of two-consecutive CR (0.753). When combined with patient age and HE4 level, the prediction of CR could be further improved at the third follow-up, with an AUC of 0.786. CONCLUSION Pretreatment minADC could be a potential imaging biomarker for predicting FST response. Clinical characteristics may have incremental value to minADC in predicting CR.
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Affiliation(s)
- Xiaoliang Ma
- Department of Radiology, Jinshan Hospital, Fudan University, Longhang Road, Shanghai, People's Republic of China
| | - Xiaojun Ren
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Fenghua Ma
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Shulei Cai
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Chengcheng Ning
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Jia Liu
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Guofu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China.
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Longhang Road, Shanghai, People's Republic of China.
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Noninvasive Method for Predicting the Expression of Ki67 and Prognosis in Non-Small-Cell Lung Cancer Patients: Radiomics. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7761589. [PMID: 35340222 PMCID: PMC8942651 DOI: 10.1155/2022/7761589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
Purpose In this study, we aimed to develop and validate a noninvasive method based on radiomics to evaluate the expression of Ki67 and prognosis of patients with non-small-cell lung cancer (NSCLC). Patients and Methods. A total of 120 patients with NSCLC were enrolled in this retrospective study. All patients were randomly assigned to a training dataset (n = 85) and test dataset (n = 35). According to the preprocessed F-FDG PET/CT image of each patient, a total of 384 radiomics features were extracted from the segmentation of regions of interest (ROIs). The Spearman correlation test and least absolute shrinkage and selection operator (LASSO), after normalization on the features matrix, were applied to reduce the dimensionality of the features. Furthermore, multivariable logistic regression analysis was used to propose a model for predicting Ki67. The survival curve was used to explore the prognostic significance of radiomics features. Results A total of 62 Ki67 positive patients and 58 Ki67 negative patients formed the training set and test training dataset and test dataset. Radiomics signatures showed good performance in predicting the expression of Ki67 with AUCs of 0.86 (training dataset) and 0.85 (test dataset). Validation and calibration showed that the radiomics had a strong predictive power in patients with NSCLC survival, which was significantly close to the effect of Ki67 expression on the survival of patients with NSCLC. Conclusion Radiomics signatures based on preoperative F-FDG PET/CT could distinguish the expression of Ki67, which also had a strong predictive performance for the survival outcome.
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Pang Y, Wang H, Li H. Medical Imaging Biomarker Discovery and Integration Towards AI-Based Personalized Radiotherapy. Front Oncol 2022; 11:764665. [PMID: 35111666 PMCID: PMC8801459 DOI: 10.3389/fonc.2021.764665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022] Open
Abstract
Intensity-modulated radiation therapy (IMRT) has been used for high-accurate physical dose distribution sculpture and employed to modulate different dose levels into Gross Tumor Volume (GTV), Clinical Target Volume (CTV) and Planning Target Volume (PTV). GTV, CTV and PTV can be prescribed at different dose levels, however, there is an emphasis that their dose distributions need to be uniform, despite the fact that most types of tumour are heterogeneous. With traditional radiomics and artificial intelligence (AI) techniques, we can identify biological target volume from functional images against conventional GTV derived from anatomical imaging. Functional imaging, such as multi parameter MRI and PET can be used to implement dose painting, which allows us to achieve dose escalation by increasing doses in certain areas that are therapy-resistant in the GTV and reducing doses in less aggressive areas. In this review, we firstly discuss several quantitative functional imaging techniques including PET-CT and multi-parameter MRI. Furthermore, theoretical and experimental comparisons for dose painting by contours (DPBC) and dose painting by numbers (DPBN), along with outcome analysis after dose painting are provided. The state-of-the-art AI-based biomarker diagnosis techniques is reviewed. Finally, we conclude major challenges and future directions in AI-based biomarkers to improve cancer diagnosis and radiotherapy treatment.
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Affiliation(s)
- Yaru Pang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Hui Wang
- Department of Chemical Engineering, University College London, London, United Kingdom
| | - He Li
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
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Daldrup-Link HE, Theruvath AJ, Baratto L, Hawk KE. One-stop local and whole-body staging of children with cancer. Pediatr Radiol 2022; 52:391-400. [PMID: 33929564 PMCID: PMC10874282 DOI: 10.1007/s00247-021-05076-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
Accurate staging and re-staging of cancer in children is crucial for patient management. Currently, children with a newly diagnosed cancer must undergo a series of imaging tests, which are stressful, time-consuming, partially redundant, expensive, and can require repetitive anesthesia. New approaches for pediatric cancer staging can evaluate the primary tumor and metastases in a single session. However, traditional one-stop imaging tests, such as CT and positron emission tomography (PET)/CT, are associated with considerable radiation exposure. This is particularly concerning for children because they are more sensitive to ionizing radiation than adults and they live long enough to experience secondary cancers later in life. In this review article we discuss child-tailored imaging tests for tumor detection and therapy response assessment - tests that can be obtained with substantially reduced radiation exposure compared to traditional CT and PET/CT scans. This includes diffusion-weighted imaging (DWI)/MRI and integrated [F-18]2-fluoro-2-deoxyglucose (18F-FDG) PET/MRI scans. While several investigators have compared the value of DWI/MRI and 18F-FDG PET/MRI for staging pediatric cancer, the value of these novel imaging technologies for cancer therapy monitoring has received surprisingly little attention. In this article, we share our experiences and review existing literature on this subject.
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Affiliation(s)
- Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA.
- Department of Pediatrics, Stanford University, Stanford, CA, USA.
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA.
| | - Ashok J Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
| | - Kristina Elizabeth Hawk
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
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Application of diffusion-weighted whole-body MRI for response monitoring in multiple myeloma after chemotherapy: a systematic review and meta-analysis. Eur Radiol 2022; 32:2135-2148. [PMID: 35028748 DOI: 10.1007/s00330-021-08311-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Myeloma Response Assessment and Diagnosis System recently published provides a framework for the standardised interpretation of DW-WBMRI in response assessment of multiple myeloma (MM) based on expert opinion. However, there is a lack of meta-analysis providing higher-level evidence to support the recommendations. In addition, some disagreement exists in the literature regarding the effect of timing and lesion subtypes on apparent diffusion coefficient (ADC) value changes post-treatment. METHOD Medline, Cochrane and Embase were searched from inception to 20th July 2021, using terms reflecting multiple myeloma and DW-WBMRI. Using PRISMA reporting guidelines, data were extracted by two investigators. Quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 method. RESULTS Of the 74 papers screened, 10 studies were included comprising 259 patients (127 males and 102 females) and 1744 reported lesions. Responders showed a significant absolute ADC change of 0.21×10-3 mm/s2 (95% CI, 0.01-0.41) with little evidence of heterogeneity (Cochran Q, p = 0.12, I2 = 45%) or publication bias (p = 0.737). Non-responders did not show a significant absolute difference in ADC (0.06 ×10-3 mm/s2, 95% CI, -0.07 to 0.19). A percentage ADC increase of 34.78% (95% CI, 10.75-58.81) was observed in responders. Meta-regression showed an inverse trend between ADC increases and time since chemotherapy initiation which did not reach statistical significance (R2 = 20.46, p = 0.282). CONCLUSIONS This meta-analysis supports the use of the DW-WBMRI as an imaging biomarker for response assessment. More evidence is needed to further characterise ADC changes by lesion subtypes over time. KEY POINTS • In multiple myeloma patients who received chemotherapy, responders have a significant absolute increase in ADC values that is not seen in non-responders. • A 35% increase in ADC from baseline values is found to classify response post-induction chemotherapy which corroborates with expert opinion from the Myeloma Response Assessment and Diagnosis System. • More evidence is needed to further characterise ADC changes by lesion subtypes over time after induction of therapy.
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11
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Guedes A, Oliveira MBDR, Melo ASD, Carmo CCMD. Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas. Rev Bras Ortop 2021; 58:179-190. [DOI: 10.1055/s-0041-1736569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/08/2021] [Indexed: 10/19/2022] Open
Abstract
ResumoA evolução na avaliação por imagens dos sarcomas musculoesqueléticos contribuiu para melhora significativa no prognóstico e na sobrevida dos portadores destas neoplasias. A caracterização precisa destas lesões, mediante utilização das modalidades de imagem mais adequadas a cada condição clínica apresentada, é de suma importância no delineamento da abordagem terapêutica a ser instituída, com impacto direto sobre os desfechos clínicos. O presente artigo busca atualizar o leitor a propósito das metodologias de imagem no contexto da avaliação local e sistêmica dos sarcomas ósseos e das partes moles.
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Affiliation(s)
- Alex Guedes
- Grupo de Oncologia Ortopédica, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
| | - Marcelo Bragança dos Reis Oliveira
- Serviço de Traumato-ortopedia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Adelina Sanches de Melo
- Serviço de Medicina Nuclear, Hospital Santa Izabel, Santa Casa da Misericórdia da Bahia, Salvador, BA, Brasil
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12
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Scherer J, Nolden M, Kleesiek J, Metzger J, Kades K, Schneider V, Bach M, Sedlaczek O, Bucher AM, Vogl TJ, Grünwald F, Kühn JP, Hoffmann RT, Kotzerke J, Bethge O, Schimmöller L, Antoch G, Müller HW, Daul A, Nikolaou K, la Fougère C, Kunz WG, Ingrisch M, Schachtner B, Ricke J, Bartenstein P, Nensa F, Radbruch A, Umutlu L, Forsting M, Seifert R, Herrmann K, Mayer P, Kauczor HU, Penzkofer T, Hamm B, Brenner W, Kloeckner R, Düber C, Schreckenberger M, Braren R, Kaissis G, Makowski M, Eiber M, Gafita A, Trager R, Weber WA, Neubauer J, Reisert M, Bock M, Bamberg F, Hennig J, Meyer PT, Ruf J, Haberkorn U, Schoenberg SO, Kuder T, Neher P, Floca R, Schlemmer HP, Maier-Hein K. Joint Imaging Platform for Federated Clinical Data Analytics. JCO Clin Cancer Inform 2021; 4:1027-1038. [PMID: 33166197 PMCID: PMC7713526 DOI: 10.1200/cci.20.00045] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Image analysis is one of the most promising applications of artificial intelligence (AI) in health care, potentially improving prediction, diagnosis, and treatment of diseases. Although scientific advances in this area critically depend on the accessibility of large-volume and high-quality data, sharing data between institutions faces various ethical and legal constraints as well as organizational and technical obstacles. METHODS The Joint Imaging Platform (JIP) of the German Cancer Consortium (DKTK) addresses these issues by providing federated data analysis technology in a secure and compliant way. Using the JIP, medical image data remain in the originator institutions, but analysis and AI algorithms are shared and jointly used. Common standards and interfaces to local systems ensure permanent data sovereignty of participating institutions. RESULTS The JIP is established in the radiology and nuclear medicine departments of 10 university hospitals in Germany (DKTK partner sites). In multiple complementary use cases, we show that the platform fulfills all relevant requirements to serve as a foundation for multicenter medical imaging trials and research on large cohorts, including the harmonization and integration of data, interactive analysis, automatic analysis, federated machine learning, and extensibility and maintenance processes, which are elementary for the sustainability of such a platform. CONCLUSION The results demonstrate the feasibility of using the JIP as a federated data analytics platform in heterogeneous clinical information technology and software landscapes, solving an important bottleneck for the application of AI to large-scale clinical imaging data.
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Affiliation(s)
- Jonas Scherer
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Marco Nolden
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Kleesiek
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Jasmin Metzger
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Klaus Kades
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Verena Schneider
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Michael Bach
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Oliver Sedlaczek
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany
| | - Andreas M Bucher
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Frank Grünwald
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Jens-Peter Kühn
- German Cancer Consortium, Heidelberg, Germany.,Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- German Cancer Consortium, Heidelberg, Germany.,Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Jörg Kotzerke
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Oliver Bethge
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Lars Schimmöller
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Hans-Wilhelm Müller
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Andreas Daul
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Christian la Fougère
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin und Klinische Molekulare Bildgebung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Wolfgang G Kunz
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Michael Ingrisch
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Balthasar Schachtner
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,German Center of Lung Research, Giessen, Germany
| | - Jens Ricke
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Peter Bartenstein
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, München, Germany
| | - Felix Nensa
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Alexander Radbruch
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Lale Umutlu
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Michael Forsting
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Robert Seifert
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Essen AöR, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Essen AöR, Essen, Germany
| | - Philipp Mayer
- German Cancer Consortium, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- German Cancer Consortium, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany.,German Center of Lung Research, Giessen, Germany
| | - Tobias Penzkofer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Radiologie (mit dem Bereich Kinderradiologie), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Radiologie (mit dem Bereich Kinderradiologie), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Winfried Brenner
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roman Kloeckner
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Christoph Düber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Mathias Schreckenberger
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Rickmer Braren
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georgios Kaissis
- German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Computing, Imperial College London, London, United Kingdom
| | - Marcus Makowski
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrei Gafita
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rupert Trager
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jakob Neubauer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Marco Reisert
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Michael Bock
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Philipp Tobias Meyer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Juri Ruf
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Uwe Haberkorn
- German Cancer Consortium, Heidelberg, Germany.,Klinische Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - Stefan O Schoenberg
- German Cancer Consortium, Heidelberg, Germany.,Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Germany
| | - Tristan Kuder
- German Cancer Consortium, Heidelberg, Germany.,Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - Peter Neher
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Ralf Floca
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
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13
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Mui AWL, Lee AWM, Lee VHF, Ng WT, Vardhanabhuti V, Man SSY, Chua DTT, Law SCK, Guan XY. Prognostic and therapeutic evaluation of nasopharyngeal carcinoma by dynamic contrast-enhanced (DCE), diffusion-weighted (DW) magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Magn Reson Imaging 2021; 83:50-56. [PMID: 34246785 DOI: 10.1016/j.mri.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/11/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is an aggressive head and neck malignancy, and radiotherapy (with or without chemotherapy) is the primary treatment modality. Reliable tumour assessment during the treatment phase, which can portend the efficacy of radiotherapy and early identification of potential treatment failure in radioresistant disease, has been implicit for better cancer management. Technological advancement in the last decade has fostered the development of functional magnetic resonance imaging (fMRI) techniques into a promising tool for diagnostic and therapeutic assessments in head and neck cancer. Apart from conventional morphological assessment, early detection of the physiological environment by fMRI allows a more thorough investigation in monitoring tumour response. This article discusses the relevant fMRI utilities in NPC as an early prognostic and monitoring tool for treatment. Challenges and future developments of fMRI in radiation oncology are also discussed.
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Affiliation(s)
- Alan W L Mui
- Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Hong Kong; Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Anne W M Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Victor H F Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - W T Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Shei S Y Man
- Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Daniel T T Chua
- Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Stephen C K Law
- Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong
| | - X Y Guan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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14
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Ko CC, Yeh LR, Kuo YT, Chen JH. Imaging biomarkers for evaluating tumor response: RECIST and beyond. Biomark Res 2021; 9:52. [PMID: 34215324 PMCID: PMC8252278 DOI: 10.1186/s40364-021-00306-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
Response Evaluation Criteria in Solid Tumors (RECIST) is the gold standard for assessment of treatment response in solid tumors. Morphologic change of tumor size evaluated by RECIST is often correlated with survival length and has been considered as a surrogate endpoint of therapeutic efficacy. However, the detection of morphologic change alone may not be sufficient for assessing response to new anti-cancer medication in all solid tumors. During the past fifteen years, several molecular-targeted therapies and immunotherapies have emerged in cancer treatment which work by disrupting signaling pathways and inhibited cell growth. Tumor necrosis or lack of tumor progression is associated with a good therapeutic response even in the absence of tumor shrinkage. Therefore, the use of unmodified RECIST criteria to estimate morphological changes of tumor alone may not be sufficient to estimate tumor response for these new anti-cancer drugs. Several studies have reported the low reliability of RECIST in evaluating treatment response in different tumors such as hepatocellular carcinoma, lung cancer, prostate cancer, brain glioma, bone metastasis, and lymphoma. There is an increased need for new medical imaging biomarkers, considering the changes in tumor viability, metabolic activity, and attenuation, which are related to early tumor response. Promising imaging techniques, beyond RECIST, include dynamic contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI), diffusion-weight imaging (DWI), magnetic resonance spectroscopy (MRS), and 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET). This review outlines the current RECIST with their limitations and the new emerging concepts of imaging biomarkers in oncology.
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Affiliation(s)
- Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Lee-Ren Yeh
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jeon-Hor Chen
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan. .,Tu & Yuan Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, 164 Irvine Hall, Irvine, CA, 92697 - 5020, USA.
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15
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Tian M, He X, Jin C, He X, Wu S, Zhou R, Zhang X, Zhang K, Gu W, Wang J, Zhang H. Transpathology: molecular imaging-based pathology. Eur J Nucl Med Mol Imaging 2021; 48:2338-2350. [PMID: 33585964 PMCID: PMC8241651 DOI: 10.1007/s00259-021-05234-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022]
Abstract
Pathology is the medical specialty concerned with the study of the disease nature and causes, playing a key role in bridging basic researches and clinical medicine. In the course of development, pathology has significantly expanded our understanding of disease, and exerted enormous impact on the management of patients. However, challenges facing pathology, the inherent invasiveness of pathological practice and the persistent concerns on the sample representativeness, constitute its limitations. Molecular imaging is a noninvasive technique to visualize, characterize, and measure biological processes at the molecular level in living subjects. With the continuous development of equipment and probes, molecular imaging has enabled an increasingly precise evaluation of pathophysiological changes. A new pathophysiology visualization system based on molecular imaging is forming and shows the great potential to reform the pathological practice. Several improvements in "trans-," including trans-scale, transparency, and translation, would be driven by this new kind of pathological practice. Pathological changes could be evaluated in a trans-scale imaging mode; tissues could be transparentized to better present the underlying pathophysiological information; and the translational processes of basic research to the clinical practice would be better facilitated. Thus, transpathology would greatly facilitate in deciphering the pathophysiological events in a multiscale perspective, and supporting the precision medicine in the future.
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Affiliation(s)
- Mei Tian
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
| | - Xuexin He
- Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chentao Jin
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Xiao He
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Xiaohui Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Laboratory for Pathophysiological and Health Science, RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | - Weizhong Gu
- Department of Pathology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Wang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China.
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.
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16
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Lucia F, Miranda O, Bourbonne V, Martin E, Pradier O, Schick U. Integration of functional imaging in brachytherapy. Cancer Radiother 2021; 26:517-525. [PMID: 34172398 DOI: 10.1016/j.canrad.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/31/2022]
Abstract
Functional imaging allows the evaluation of numerous biological properties that could be considered at all steps of the therapeutic management of patients treated with brachytherapy. Indeed, it enables better initial staging of the disease, and some parameters may also be used as predictive biomarkers for treatment response, allowing better selection of patients eligible for brachytherapy. It may also improve the definition of target volumes with the aim of dose escalations by dose-painting. Finally, it could be useful during the follow-up to assess response to treatment. In this review, we report how functional imaging is integrated at the present time during the brachytherapy procedure, and what are its potential future contributions in the main tumour locations where brachytherapy is recommended. Functional imaging has great potential in the contact of brachytherapy, but still, several issues remain to be resolved before integrating it into clinical practice, especially as a biomarker or in dose painting strategies.
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Affiliation(s)
- F Lucia
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France.
| | - O Miranda
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
| | - V Bourbonne
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
| | - E Martin
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
| | - O Pradier
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
| | - U Schick
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
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Li X, Zhou X, Zeng M, Zhou Y, Zhang Y, Liou YL, Zhu H. Methylation of PAX1 gene promoter in the prediction of concurrent chemo-radiotherapy efficacy in cervical cancer. J Cancer 2021; 12:5136-5143. [PMID: 34335930 PMCID: PMC8317535 DOI: 10.7150/jca.57460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/13/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Cervical cancer is the fourth leading cause of cancer death among women worldwide. In currently, aberrant methylation of PAX1 is found in variety of solid tumors, including cervical cancer. In addition, the role of PAX1 gene methylation in cervical cancer and precancerous lesions screening has been confirmed in previous study. Here, we evaluated the predictive value of PAX1 methylation in concurrent chemo-radiotherapy (CCRT) outcomes in cervical cancer. Methods: This study enrolled 82 cervical cancer patients from August 2018 to August 2020. We compared the clinical results between different PAX1 methylation status. Hyper-methylation patients were subjects to MRI and quantitative methylation-specific PCR (QMSP) for PAX1 before, in the middle, immediately after, 1 month and 3 months after CCRT. The changes in PAX1 methylation during CCRT were analyzed. Results: The lower PAX1 methylation status were related to a poor tumor response. Based on the MRI findings three months post-treatment, the hypermethylated patients were classified into the complete response (CR; n=50) and partial remission (PR; n=18) groups. The average PAX1 △Cp value of CR and PR groups before radiotherapy was 5.08±1.98 and 4.32±2.00 respectively, and after concurrent chemo-radiotherapy was significantly increased to 17.35±4.96 and 16.99±6.17, respectively (P<0.05). Furthermore, the PAX1 △Cp value between CR and PR groups were significantly different at mid-treatment and performed well in predicting short-term efficacy (AUC 0.84) in this period, and its sensitivity and specificity for predicting PR were 0.72 and 0.88, respectively. Conclusion: The PAX1 methylation level may predict the sensitivity and efficacy of CCRT in cervical cancer.
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Affiliation(s)
- Xuanxuan Li
- Department of Oncology, Xiangya Hospital, Central South University, Hunan 410008 China
| | - Xue Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Hunan 410008 China
| | - Manting Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Hunan 410008 China
| | - Yangying Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Hunan 410008 China
| | - Yu Zhang
- Department of Obstetrics and Gynecology, Xiangya Hospital, Central South University, Hunan 410008 China
| | - Yu-Ligh Liou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Hunan 410008 China
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Hunan 410008 China
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18
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Baidya Kayal E, Kandasamy D, Khare K, Bakhshi S, Sharma R, Mehndiratta A. Texture analysis for chemotherapy response evaluation in osteosarcoma using MR imaging. NMR IN BIOMEDICINE 2021; 34:e4426. [PMID: 33078438 DOI: 10.1002/nbm.4426] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
The efficacy of MRI-based statistical texture analysis (TA) in predicting chemotherapy response among patients with osteosarcoma was assessed. Forty patients (male: female = 31:9; age = 17.2 ± 5.7 years) with biopsy-proven osteosarcoma were analyzed in this prospective study. Patients were scheduled for three cycles of neoadjuvant chemotherapy (NACT) and diffusion-weighted MRI acquisition at three time points: at baseline (t0), after the first NACT (t1) and after the third NACT (t2) using a 1.5 T scanner. Eight patients (nonsurvivors) died during NACT while 34 patients (survivors) completed the NACT regimen followed by surgery. Histopathological evaluation was performed in the resected tumor to assess NACT response (responder [≤50% viable tumor] and nonresponder [>50% viable tumor]) and revealed nonresponder: responder = 20:12. Apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) parameters, diffusion coefficient (D), perfusion coefficient (D*) and perfusion fraction (f) were evaluated. A total of 25 textural features were evaluated on ADC, D, D* and f parametric maps and structural T1-weighted (T1W) and T2-weighted (T2W) images in the entire tumor volume using 3D TA methods gray-level cooccurrence matrix (GLCM), neighborhood gray-tone-difference matrix (NGTDM) and run-length matrix (RLM). Receiver-operating-characteristic curve analysis was performed on the selected textural feature set to assess the role of TA features (a) as marker(s) of tumor aggressiveness leading to mortality at baseline and (b) in predicting the NACT response among survivors in the course of treatment. Findings showed that the NGTDM features coarseness, busyness and strength quantifying tumor heterogeneity in D, D* and f maps and T1W and T2W images were useful markers of tumor aggressiveness in identifying the nonsurvivor group (area-under-the-curve [AUC] = 0.82-0.88) at baseline. The GLCM features contrast and correlation, NGTDM features contrast and complexity and RLM feature short-run-low-gray-level-emphasis quantifying homogeneity/terogeneity in tumor were effective markers for predicting chemotherapeutic response using D (AUC = 0.80), D* (AUC = 0.80) and T2W (AUC = 0.70) at t0, and D* (AUC = 0.80) and f (AUC = 0.70) at t1. 3D statistical TA features might be useful as imaging-based markers for characterizing tumor aggressiveness and predicting chemotherapeutic response in patients with osteosarcoma.
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Affiliation(s)
- Esha Baidya Kayal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | | | - Kedar Khare
- Department of Physics, Indian Institute of Technology Delhi, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R. Ambedkar Institute-Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
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Critchley HOD, Babayev E, Bulun SE, Clark S, Garcia-Grau I, Gregersen PK, Kilcoyne A, Kim JYJ, Lavender M, Marsh EE, Matteson KA, Maybin JA, Metz CN, Moreno I, Silk K, Sommer M, Simon C, Tariyal R, Taylor HS, Wagner GP, Griffith LG. Menstruation: science and society. Am J Obstet Gynecol 2020; 223:624-664. [PMID: 32707266 PMCID: PMC7661839 DOI: 10.1016/j.ajog.2020.06.004] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/13/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.
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Affiliation(s)
- Hilary O D Critchley
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, United Kingdom.
| | - Elnur Babayev
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Serdar E Bulun
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Iolanda Garcia-Grau
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain
| | - Peter K Gregersen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | | | | | | | - Erica E Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Kristen A Matteson
- Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Jacqueline A Maybin
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, United Kingdom
| | - Christine N Metz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | - Inmaculada Moreno
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain
| | - Kami Silk
- Department of Communication, University of Delaware, Newark, DE
| | - Marni Sommer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Carlos Simon
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain; Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | | | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Günter P Wagner
- Department of Ecology and Evolutionary Biology, Department of Obstetrics, Gynecology and Reproductive Sciences, Systems Biology Institute, Yale University, New Haven, CT; Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Linda G Griffith
- Center for Gynepathology Research, Massachusetts Institute of Technology, Cambridge, MA
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20
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Three-dimension amide proton transfer MRI of rectal adenocarcinoma: correlation with pathologic prognostic factors and comparison with diffusion kurtosis imaging. Eur Radiol 2020; 31:3286-3296. [PMID: 33125558 DOI: 10.1007/s00330-020-07397-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To investigate the utility of 3D amide proton transfer (APT) MRI in predicting pathologic factors for rectal adenocarcinoma, in comparison with diffusion kurtosis imaging. METHODS Sixty-one patients with rectal adenocarcinoma were enrolled in this prospective study. 3D APT and diffusion kurtosis imaging (DKI) were performed. Mean APT-weighted signal intensity (APTw SI), mean kurtosis (MK), mean diffusivity (MD), and ADC values of tumors were calculated on these maps. Pathological analysis included WHO grades, pT stages, pN stages, and extramural venous invasion (EMVI) status. Student's t test, Spearman correlation, and receiver operating characteristics (ROC) analysis were used for statistical analysis. RESULTS High-grade rectal adenocarcinoma showed significantly higher mean APTw SI and MK values (2.771 ± 0.384 vs 2.108 ± 0.409, 1.167 ± 0.216 vs 1.045 ± 0.175, respectively; p < 0.05). T3 rectal adenocarcinoma demonstrated higher mean APTw SI and MK than T2 tumors (2.433 ± 0.467 vs 1.900 ± 0.302, p < 0.05). No kurtosis, diffusivity, and ADC differences were found between T2 and T3 tumors. Tumors with lymph node metastasis and EMVI involvement showed significantly higher mean APTw SI, MK. No difference was found in diffusivity and ADC between pN0 and pN1-2 groups, and EMVI-negative and EMVI-positive statuses. Mean APTw SI exhibited a significantly high positive correlation with WHO grades, demonstrating 92.31% sensitivity and 79.17% specificity for distinguishing low- from high-grade rectal adenocarcinoma, providing a better diagnostic capacity than MK, MD, and mean ADC values. CONCLUSION 3D-APT could serve as a non-invasive biomarker for evaluating prognostic factors of rectal adenocarcinoma. KEY POINTS • Mean APTw SI was significantly higher in high-grade compared to low-grade rectal adenocarcinoma. • Mean APTw SI was significantly higher in T3 stage rectal adenocarcinoma, with lymph node metastasis, or in EMVI-positive status. • APTw SI exhibited greater diagnostic capability in discriminating low-grade from high-grade rectal adenocarcinoma, compared with kurtosis, diffusivity, and ADC.
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21
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Yang ZR, Liu MN, Yu JH, Yang YH, Chen TX, Han YC, Zhu L, Zhao JK, Fu XL, Cai XW. Treatment of stage III non-small cell lung cancer in the era of immunotherapy: pathological complete response to neoadjuvant pembrolizumab and chemotherapy. Transl Lung Cancer Res 2020; 9:2059-2073. [PMID: 33209626 PMCID: PMC7653116 DOI: 10.21037/tlcr-20-896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancers. The expected 5-year survival of stage III NSCLC ranges from 13% to 36% for stage III. Due to the heterogeneity and poor efficacy of stage III patients, there is great controversy on how to optimize the therapy strategy. Immunotherapy is providing better clinical efficacy to more NSCLC patients, and is rapidly extending its range of care from advanced stage to locally advanced stage and early stage NSCLC. Due to the patient’s strong treatment intention, drug availability, and a few encouraging results from clinical trials (NADIM, NCT02716038, etc.), the authors observed a case of stage III NSCLC that achieved complete remission after receiving neoadjuvant chemotherapy combined with immunotherapy. In view of such a satisfactory result in neoadjuvant therapy, this article discusses how comprehensive treatment for stage III NSCLC patients may be conducted and the manner in which various therapeutic techniques can be mastered in the era of immunotherapy. Immunotherapy has opened the exploratory space for finding resolutions to numerous challenges of treating stage III NSCLC. Further clinical studies and exploration of personalized treatment, guided by imaging data, and clinical and pathological biomarkers are imperative for the benefit of these patients.
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Affiliation(s)
- Zhang-Ru Yang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mi-Na Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Hua Yu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yun-Hai Yang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tian-Xiang Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Chen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ji-Kai Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Long Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xu-Wei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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22
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Chen B, Yang L, Zhang R, Luo W, Li W. Radiomics: an overview in lung cancer management-a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1191. [PMID: 33241040 PMCID: PMC7576016 DOI: 10.21037/atm-20-4589] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Radiomics is a novel approach for optimizing the analysis massive data from medical images to provide auxiliary guidance in clinical issues. Quantitative feature extraction is one of the critical steps of radiomics. The association between radiomics features and the clinicopathological information of diseases can be identified by several statistics methods. For instance, although significant progress has been made in the field of lung cancer, too many questions remain, especially for the individualized decisions. Radiomics offers a new tool to encode the characteristics of lung cancer which is the leading cause of cancer-related deaths worldwide. Here, we reviewed the workflow and clinical utility of radiomics in lung cancer management, including pulmonary nodules detection, classification, histopathology and genetics evaluation, clinical staging, therapy response, and prognosis prediction. Most of these studies showed positive results, indicating the potential value of radiomics in clinical practice. The implementation of radiomics is both feasible and invaluable, and has aided clinicians in ascertaining the nature of a disease with greater precision. However, it should be noted that radiomics in its current state cannot completely replace the work of therapists or tissue examination. The potential future trends of this modality were also remarked. More efforts are needed to overcome the limitations identified above in order to facilitate the widespread application of radiomics in the reasonably near future.
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Affiliation(s)
- Bojiang Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Lan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Wenxin Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
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Brenet E, Barbe C, Hoeffel C, Dubernard X, Merol JC, Fath L, Servagi-Vernat S, Labrousse M. Predictive Value of Early Post-Treatment Diffusion-Weighted MRI for Recurrence or Tumor Progression of Head and Neck Squamous Cell Carcinoma Treated with Chemo-Radiotherapy. Cancers (Basel) 2020; 12:cancers12051234. [PMID: 32422975 PMCID: PMC7281260 DOI: 10.3390/cancers12051234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022] Open
Abstract
Aims: To investigate the predictive capacity of early post-treatment diffusion-weighted magnetic resonance imaging (MRI) for recurrence or tumor progression in patients with no tumor residue after chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma, and, to assess the predictive capacity of pre-treatment diffusion-weighted MRI for persistent tumor residue post-CRT. Materials and Method: A single center cohort study was performed in one French hospital. All patients with squamous cell carcinoma receiving CRT (no surgical indication) were included. Two diffusion-weighted MRI were performed: one within 8 days before CRT and one 3 months after completing CRT with determination of median tumor apparent diffusion coefficient (ADC). Main outcome: The primary endpoint was progression-free survival. Results: 59 patients were included prior to CRT and 46 (78.0%) completed CRT. A post-CRT tumor residue was found in 19/46 (41.3%) patients. In univariate analysis, initial ADC was significantly lower in patients with residue post CRT (0.56 ± 0.11 versus 0.79 ± 0.13; p < 0.001). When initial ADC was dichotomized at the median, initial ADC lower than 0.7 was significantly more frequent in patients with residue post CRT (73.7% versus 11.1%, p < 0.0001). In multivariate analysis, only initial ADC lower than 0.7 was significantly associated with tumor residue (OR = 22.6; IC [4.9–103.6], p < 0.0001). Among 26 patients without tumor residue after CRT and followed up until 12 months, 6 (23.1%) presented recurrence or progression. Only univariate analysis was performed due to a small number of events. The only factor significantly associated with disease progression or early recurrence was the delta ADC (p = 0.0009). When ADC variation was dichotomized at the median, patients with ADC variation greater than 0.7 had time of disease-free survival significantly longer than patients with ADC variation lower than 0.7 (377.5 [286–402] days versus 253 [198–370], p < 0.0001). Conclusion and relevance: Diffusion-weighted MRI could be a technique that enables differentiation of patients with high potential for early recurrence for whom intensive post-CRT monitoring is mandatory. Prospective studies with more inclusions would be necessary to validate our results.
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Affiliation(s)
- Esteban Brenet
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
- Correspondence:
| | - Coralie Barbe
- Clinical Research Unit, Robert Debré University Hospital, 51100 Reims, France;
| | - Christine Hoeffel
- Department of Radiology, Robert Debré University Hospital, 51100 Reims, France;
| | - Xavier Dubernard
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
| | - Jean-Claude Merol
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
| | - Léa Fath
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Strasbourg, 67000 Strasbourg, France;
| | | | - Marc Labrousse
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
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Koçak B, Durmaz EŞ, Ateş E, Kılıçkesmez Ö. Radiomics with artificial intelligence: a practical guide for beginners. ACTA ACUST UNITED AC 2020; 25:485-495. [PMID: 31650960 DOI: 10.5152/dir.2019.19321] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Radiomics is a relatively new word for the field of radiology, meaning the extraction of a high number of quantitative features from medical images. Artificial intelligence (AI) is broadly a set of advanced computational algorithms that basically learn the patterns in the data provided to make predictions on unseen data sets. Radiomics can be coupled with AI because of its better capability of handling a massive amount of data compared with the traditional statistical methods. Together, the primary purpose of these fields is to extract and analyze as much and meaningful hidden quantitative data as possible to be used in decision support. Nowadays, both radiomics and AI have been getting attention for their remarkable success in various radiological tasks, which has been met with anxiety by most of the radiologists due to the fear of replacement by intelligent machines. Considering ever-developing advances in computational power and availability of large data sets, the marriage of humans and machines in future clinical practice seems inevitable. Therefore, regardless of their feelings, the radiologists should be familiar with these concepts. Our goal in this paper was three-fold: first, to familiarize radiologists with the radiomics and AI; second, to encourage the radiologists to get involved in these ever-developing fields; and, third, to provide a set of recommendations for good practice in design and assessment of future works.
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Affiliation(s)
- Burak Koçak
- Department of Radiology İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Emine Şebnem Durmaz
- Department of Radiology, Büyükçekmece Mimar Sinan State Hospital, İstanbul, Turkey
| | - Ece Ateş
- Department of Radiology İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Özgür Kılıçkesmez
- Department of Radiology İstanbul Training and Research Hospital, İstanbul, Turkey
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25
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Karschnia P, Batchelor TT, Jordan JT, Shaw B, Winter SF, Barbiero FJ, Kaulen LD, Thon N, Tonn JC, Huttner AJ, Fulbright RK, Loeffler J, Dietrich J, Baehring JM. Primary dural lymphomas: Clinical presentation, management, and outcome. Cancer 2020; 126:2811-2820. [PMID: 32176324 DOI: 10.1002/cncr.32834] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/04/2020] [Accepted: 02/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clinical experience is limited for primary central nervous system (CNS) lymphoma that arises from the dura mater, which is denoted with the term primary dural lymphoma (PDL). This study was aimed at determining the relative incidence, presentation, and outcomes of PDL. METHODS The institutional databases of the Divisions of Neuro-Oncology at the Massachusetts General Hospital and the Yale School of Medicine were retrospectively searched for patients with primary CNS lymphoma. Patients with pathologically confirmed dural lymphoma and no evidence of primary cerebral or systemic involvement were identified. Clinical data, diagnostic findings, treatments, and outcomes were recorded. RESULTS A total of 20 patients with PDL were identified, and they represented 6.3% of the individuals with primary CNS lymphomas (20 of 316). Histopathological examination of PDL revealed the following underlying subtypes: diffuse large B-cell lymphoma (10 of 20 patients), marginal zone lymphoma (6 of 20), follicular lymphoma (2 of 20), undefined B-cell non-Hodgkin lymphoma (1 of 20), and T-cell non-Hodgkin lymphoma (1 of 20). On imaging, all tumors appeared as extra-axial masses with avid contrast enhancement and mostly mimicked meningioma. The median apparent diffusion coefficient value was 667 ± 26 mm2 /s. Cerebrospinal fluid analyses and symptoms were nonspecific, and the diagnosis rested on tissue analysis. Therapeutic approaches included surgery, radiotherapy, and chemotherapy. The median overall survival was not reached after 5 years. Three patients were deceased at database closure because of tumor progression. The extent of tumor resection correlated positively with overall survival (P = .044). CONCLUSIONS PDL is a rare variant of primary CNS lymphoma that can be radiographically mistaken for meningioma. The outcome is excellent with multimodality treatment, and aggressive surgery may convey a survival advantage in select cases.
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Affiliation(s)
- Philipp Karschnia
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Yale School of Medicine, New Haven, Connecticut.,Department of Neurosurgery, Ludwig Maximilian University, Munich, Germany
| | - Tracy T Batchelor
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Justin T Jordan
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Brian Shaw
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Sebastian F Winter
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Frank J Barbiero
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Leon D Kaulen
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Niklas Thon
- Department of Neurosurgery, Ludwig Maximilian University, Munich, Germany
| | | | - Anita J Huttner
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Robert K Fulbright
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Jay Loeffler
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorg Dietrich
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Joachim M Baehring
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
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Baidya Kayal E, Kandasamy D, Sharma R, Sharma MC, Bakhshi S, Mehndiratta A. SLIC-supervoxels-based response evaluation of osteosarcoma treated with neoadjuvant chemotherapy using multi-parametric MR imaging. Eur Radiol 2020; 30:3125-3136. [PMID: 32086578 DOI: 10.1007/s00330-019-06647-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/01/2019] [Accepted: 12/18/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Histopathological examination (HPE) is the current gold standard for assessing chemotherapy response to tumor, but it is possible only after surgery. The purpose of the study was to develop a noninvasive, imaging-based robust method to delineate, visualize, and quantify the proportions of necrosis and viable tissue present within the tumor along with peritumoral edema before and after neoadjuvant chemotherapy (NACT) and to evaluate treatment response with correlation to HPE necrosis after surgery. METHODS The MRI dataset of 30 patients (N = 30; male:female = 24:6; age = 17.6 ± 2.7 years) with osteosarcoma was acquired using 1.5 T Philips Achieva MRI scanner before (baseline) and after 3 cycles of NACT (follow-up). After NACT, all patients underwent surgical resection followed by HPE. Simple linear iterative clustering supervoxels and Otsu multithresholding were combined to develop the proposed method-SLICs+MTh-to subsegment and quantify viable and nonviable regions within tumor using multiparametric MRI. Manually drawn ground-truth ROIs and SLICs+MTh-based segmentation of tumor, edema, and necrosis were compared using Jacquard index (JI), Dice coefficient (DC), precision (P), and recall (R). Postcontrast T1W images (PC-T1W) were used to validate the SLICs+MTh-based necrosis. SLICs+MTh-based necrosis volume at follow-up was compared with HPE necrosis using paired t test (p ≤ 0.05). RESULTS Active tumor, necrosis, and edema were segmented with moderate to satisfactory accuracy (JI = 62-78%; DC = 72-87%; P = 67-87%; R = 63-88%). Qualitatively and quantitatively (DC = 74 ± 9%), the SLICs+MTh-based necrosis area correlated well with the hypointense necrosis areas in PC-T1W. No significant difference (paired t test, p = 0.26; Bland-Altman plot, bias = 2.47) between SLICs+MTh-based necrosis at follow-up and HPE necrosis was observed. CONCLUSION The proposed multiparametric MRI-based SLICs+MTh method performs noninvasive assessment of NACT response in osteosarcoma that may improve cancer treatment monitoring, planning, and overall prognosis. KEY POINTS • The simple linear iterative clustering supervoxels and Otsu multithresholding-based technique (SLICs+MTh) successfully estimates the proportion of necrosis, viable tumor, and edema in osteosarcoma in the course of chemotherapy. • The proposed technique is noninvasive and uses multiparametric MRI to measure necrosis as an indication of anticancer treatment response. • SLICs+MTh-based necrosis was in satisfactory agreement with histological necrosis after surgery.
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Affiliation(s)
- Esha Baidya Kayal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | | | - Raju Sharma
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R. Ambedkar Institute-Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences, New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India.
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27
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Zhang Y, Yue B, Zhao X, Chen H, Sun L, Zhang X, Hao D. Benign or Malignant Characterization of Soft-Tissue Tumors by Using Semiquantitative and Quantitative Parameters of Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Can Assoc Radiol J 2020; 71:92-99. [PMID: 32062994 DOI: 10.1177/0846537119888409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the efficacy of the semiquantitative and quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiating between benign and malignant soft-tissue tumors. METHODS A total of 45 patients with pathologically confirmed soft-tissue tumors (15 benign and 30 malignant tumors) underwent DCE-MRI. The semiquantitative parameters assessed were as follows: time to peak (TTP), maximum concentration (MAX Conc), area under the curve of time-concentration curve (AUC-TC), and maximum rise slope (MAX Slope). Quantitative DCE-MRI was analyzed with the extended Tofts-Kety model to assess the following quantitative parameters: volume transfer constant (Ktrans), microvascular permeability reflux constant (Kep), and distribute volume per unit tissue volume (Ve). Data were evaluated using the independent t test or Mann-Whitney U test and receiver operating characteristic (ROC) curves. RESULTS The TTP (P = .0035), MAX Conc (P = .0018), AUC-TC (P = .0018), MAX Slope (P = .0018), Ktrans (P = .0018), and Kep (P = .0035) were significantly different between the benign and malignant soft-tissue tumors. The AUC of the ROC curve demonstrated the diagnostic potential of TTP (0.778), MAX Conc (0.849), AUC-TC (0.831), MAX Slope (0.847), Ktrans (0.836), Kep (0.778), and Ve (0.638). CONCLUSIONS The use of semiquantitative and quantitative parameters of DCE-MRI enabled differentiation between benign and malignant soft-tissue tumors. The values of TTP were lower, while those of MAX Conc, AUC-TC, MAX Slope, Ktrans, and Kep were higher in malignant than in benign tumors.
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Affiliation(s)
- Yu Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Yue
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaodan Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lingling Sun
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Dapeng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Li Z, Han C, Wang L, Zhu J, Yin Y, Li B. Prognostic Value of Texture Analysis Based on Pretreatment DWI-Weighted MRI for Esophageal Squamous Cell Carcinoma Patients Treated With Concurrent Chemo-Radiotherapy. Front Oncol 2019; 9:1057. [PMID: 31681593 PMCID: PMC6811607 DOI: 10.3389/fonc.2019.01057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose: The purpose of the research was to assess the prognostic value of three-dimensional (3D) texture features based on diffusion-weighted magnetic resonance imaging (DWI) for esophageal squamous cell carcinoma (ESCC) patients undergoing concurrent chemo-radiotherapy (CRT). Methods: We prospectively enrolled 82 patients with ESCC into a cohort study. Two DWI sequences (b = 0 and b = 600 s/mm2) were acquired along with axial T2WI and T1WI before CRT. Two groups of features were examined: (1) clinical and demographic features (e.g., TNM stage, age and sex) and (2) changes in spatial texture characteristics of the apparent diffusion coefficient (ADC), which characterizes gray intensity changes in tumor areas, spatial pattern and distribution, and related changes caused by CRT. Reproducible feature sets without redundancy were statistically filtered and validated. The prognostic values associated with overall survival (OS) for each parameter were studied using Kaplan-Meier and Cox regression models for univariate and multivariate analyses, respectively. Results: Both univariate and multivariate Cox model analyses showed that the energy of intensity histogram texture (IHIST_energy), radiation dose, mean of the contrast in distance 1 of 26 directions (m_contrast_1), extreme difference of the homogeneity in distance 2 of 26 directions (Diff_homogeneity_2), mean of the inverse variance in distance 2 of 26 directions (m_lnversevariance_2), high-intensity small zone emphasis (HISE), and low-intensity large zone emphasis (LILE) were significantly associated with survival. The results showed that 6 texture parameters extracted from the ADC images before treatment could distinguish among high-, medium-, and low-risk groups (log-rank χ2 = 9.7; P = 0.00773). The biased C-index value was 0.715 (95% CI: 0.708 to 0.732) based on bootstrapping validation. Conclusions: The ADC 3D texture feature can be used as a useful biomarker to predict the survival of ESCC patients undergoing CRT. Combining ADC 3D texture features with conventional prognostic factors can generate reliable survival prediction models.
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Affiliation(s)
- Zhenjiang Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital, Jinan, China
| | - Chun Han
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lan Wang
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jian Zhu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital, Jinan, China
| | - Yong Yin
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital, Jinan, China
| | - Baosheng Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital, Jinan, China
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29
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Roy SF, Louie AV, Liberman M, Wong P, Bahig H. Pathologic response after modern radiotherapy for non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:S124-S134. [PMID: 31673516 PMCID: PMC6795577 DOI: 10.21037/tlcr.2019.09.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
Abstract
In non-small cell lung cancer (NSCLC), pathologic complete response (pCR) following radiotherapy treatment has been shown to be an independent prognostic factor for long-term survival, progression-free survival and locoregional control. PCR is considered a surrogate to therapeutic efficacy, years before survival data are available, and therefore can be used to guide treatment plans and additional therapeutic interventions post-surgical resection. Given the extensive fibrotic changes induced by radiotherapy in the lung, radiological assessment of response can potentially misrepresent pathologic response. The optimal timing for assessment of pathologic response after conventionally fractionated radiotherapy and stereotactic ablative radiotherapy (SABR) remains poorly understood. In this review, we summarize recent literature on pathologic response after radiotherapy for early stage and locally advanced NSCLC, we discuss current controversies around radiobiological considerations, and we present upcoming trials that will provide insight into current knowledge gaps.
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Affiliation(s)
- Simon F. Roy
- Department of Pathology, University of Montreal, Montreal, QC, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Philip Wong
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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30
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Haldorsen IS, Lura N, Blaakær J, Fischerova D, Werner HMJ. What Is the Role of Imaging at Primary Diagnostic Work-Up in Uterine Cervical Cancer? Curr Oncol Rep 2019; 21:77. [PMID: 31359169 PMCID: PMC6663927 DOI: 10.1007/s11912-019-0824-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW For uterine cervical cancer, the recently revised International Federation of Gynecology and Obstetrics (FIGO) staging system (2018) incorporates imaging and pathology assessments in its staging. In this review we summarize the reported staging performances of conventional and novel imaging methods and provide an overview of promising novel imaging methods relevant for cervical cancer patient care. RECENT FINDINGS Diagnostic imaging during the primary diagnostic work-up is recommended to better assess tumor extent and metastatic disease and is now reflected in the 2018 FIGO stages 3C1 and 3C2 (positive pelvic and/or paraaortic lymph nodes). For pretreatment local staging, imaging by transvaginal or transrectal ultrasound (TVS, TRS) and/or magnetic resonance imaging (MRI) is instrumental to define pelvic tumor extent, including a more accurate assessment of tumor size, stromal invasion depth, and parametrial invasion. In locally advanced cervical cancer, positron emission tomography-computed tomography (PET-CT) or computed tomography (CT) is recommended, since the identification of metastatic lymph nodes and distant metastases has therapeutic consequences. Furthermore, novel imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for further improving risk stratification and individualization of treatment. Diagnostic imaging by MRI/TVS/TRS and PET-CT/CT is instrumental for pretreatment staging in uterine cervical cancer and guides optimal treatment strategy. Novel imaging techniques may also provide functional biomarkers with potential relevance for developing more targeted treatment strategies in cervical cancer.
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Affiliation(s)
- Ingfrid S Haldorsen
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway.
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway.
| | - Njål Lura
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway
| | - Jan Blaakær
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | - Daniela Fischerova
- Gynecological Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Henrica M J Werner
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Clinical Science, University of Bergen, 5020, Bergen, Norway
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31
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Krikken E, van der Kemp WJM, van Diest PJ, van Dalen T, van Laarhoven HWM, Luijten PR, Klomp DWJ, Wijnen JP. Early detection of changes in phospholipid metabolism during neoadjuvant chemotherapy in breast cancer patients using phosphorus magnetic resonance spectroscopy at 7T. NMR IN BIOMEDICINE 2019; 32:e4086. [PMID: 30924571 PMCID: PMC6593799 DOI: 10.1002/nbm.4086] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 05/14/2023]
Abstract
The purpose of this work was to investigate whether noninvasive early detection (after the first cycle) of response to neoadjuvant chemotherapy (NAC) in breast cancer patients was possible. 31 P-MRSI at 7 T was used to determine different phosphor metabolites ratios and correlate this to pathological response. 31 P-MRSI was performed in 12 breast cancer patients treated with NAC. 31 P spectra were fitted and aligned to the frequency of phosphoethanolamine (PE). Metabolic signal ratios for phosphomonoesters/phosphodiesters (PME/PDE), phosphocholine/glycerophosphatidylcholine (PC/GPtC), phosphoethanolamine/glycerophosphoethanolamine (PE/GPE) and phosphomonoesters/in-organic phosphate (PME/Pi) were determined from spectral fitting of the individual spectra and the summed spectra before and after the first cycle of NAC. Metabolic ratios were subsequently related to pathological response. Additionally, the correlation between the measured metabolic ratios and Ki-67 levels was determined using linear regression. Four patients had a pathological complete response after treatment, five patients a partial pathological response, and three patients did not respond to NAC. In the summed spectrum after the first cycle of NAC, PME/Pi and PME/PDE decreased by 18 and 13%, respectively. A subtle difference among the different response groups was observed in PME/PDE, where the nonresponders showed an increase and the partial and complete responders a decrease (P = 0.32). No significant changes in metabolic ratios were found. However, a significant association between PE/Pi and the Ki-67 index was found (P = 0.03). We demonstrated that it is possible to detect subtle changes in 31 P metabolites with a 7 T MR system after the first cycle of NAC treatment in breast cancer patients. Nonresponders showed different changes in metabolic ratios compared with partial and complete responders, in particular for PME/PDE; however, more patients need to be included to investigate its clinical value.
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Affiliation(s)
- Erwin Krikken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wybe J M van der Kemp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W J Klomp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannie P Wijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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32
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Savadjiev P, Chong J, Dohan A, Agnus V, Forghani R, Reinhold C, Gallix B. Image-based biomarkers for solid tumor quantification. Eur Radiol 2019; 29:5431-5440. [PMID: 30963275 DOI: 10.1007/s00330-019-06169-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 02/06/2023]
Abstract
The last few decades have witnessed tremendous technological developments in image-based biomarkers for tumor quantification and characterization. Initially limited to manual one- and two-dimensional size measurements, image biomarkers have evolved to harness developments not only in image acquisition technology but also in image processing and analysis algorithms. At the same time, clinical validation remains a major challenge for the vast majority of these novel techniques, and there is still a major gap between the latest technological developments and image biomarkers used in everyday clinical practice. Currently, the imaging biomarker field is attracting increasing attention not only because of the tremendous interest in cutting-edge therapeutic developments and personalized medicine but also because of the recent progress in the application of artificial intelligence (AI) algorithms to large-scale datasets. Thus, the goal of the present article is to review the current state of the art for image biomarkers and their use for characterization and predictive quantification of solid tumors. Beginning with an overview of validated imaging biomarkers in current clinical practice, we proceed to a review of AI-based methods for tumor characterization, such as radiomics-based approaches and deep learning.Key Points• Recent years have seen tremendous technological developments in image-based biomarkers for tumor quantification and characterization.• Image-based biomarkers can be used on an ongoing basis, in a non-invasive (or mildly invasive) way, to monitor the development and progression of the disease or its response to therapy.• We review the current state of the art for image biomarkers, as well as the recent developments in artificial intelligence (AI) algorithms for image processing and analysis.
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Affiliation(s)
- Peter Savadjiev
- Department of Diagnostic Radiology, McGill University, Montreal, QC, Canada
| | - Jaron Chong
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Anthony Dohan
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada.,Department of Body and Interventional Imaging, Hôpital Lariboisière-AP-HP, Université Diderot-Paris 7 and INSERM U965, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France
| | - Vincent Agnus
- Institut de chirurgie guidée par l'image IHU Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - Reza Forghani
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada.,Department of Radiology, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Caroline Reinhold
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Benoit Gallix
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada. .,Institut de chirurgie guidée par l'image IHU Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
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33
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Lee DH, Kim SH, Lee SM, Han JK. Prediction of Treatment Outcome of Chemotherapy Using Perfusion Computed Tomography in Patients with Unresectable Advanced Gastric Cancer. Korean J Radiol 2019; 20:589-598. [PMID: 30887741 PMCID: PMC6424833 DOI: 10.3348/kjr.2018.0306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To evaluate whether data acquired from perfusion computed tomography (PCT) parameters can aid in the prediction of treatment outcome after palliative chemotherapy in patients with unresectable advanced gastric cancer (AGC). Materials and Methods Twenty-one patients with unresectable AGCs, who underwent both PCT and palliative chemotherapy, were prospectively included. Treatment response was assessed according to Response Evaluation Criteria in Solid Tumors version 1.1 (i.e., patients who achieved complete or partial response were classified as responders). The relationship between tumor response and PCT parameters was evaluated using the Mann-Whitney test and receiver operating characteristic analysis. One-year survival was estimated using the Kaplan-Meier method. Results After chemotherapy, six patients exhibited partial response and were allocated to the responder group while the remaining 15 patients were allocated to the non-responder group. Permeability surface (PS) value was shown to be significantly different between the responder and non-responder groups (51.0 mL/100 g/min vs. 23.4 mL/100 g/min, respectively; p = 0.002), whereas other PCT parameters did not demonstrate a significant difference. The area under the curve for prediction in responders was 0.911 (p = 0.004) for PS value, with a sensitivity of 100% (6/6) and specificity of 80% (12/15) at a cut-off value of 29.7 mL/100 g/min. One-year survival in nine patients with PS value > 29.7 mL/100 g/min was 66.7%, which was significantly higher than that in the 12 patients (33.3%) with PS value ≤ 29.7 mL/100 g/min (p = 0.019). Conclusion Perfusion parameter data acquired from PCT demonstrated predictive value for treatment outcome after palliative chemotherapy, reflected by the significantly higher PS value in the responder group compared with the non-responder group.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Sang Min Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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da Silva Neto OP, Araújo JDL, Caldas Oliveira AG, Cutrim M, Silva AC, Paiva AC, Gattass M. Pathophysiological mapping of tumor habitats in the breast in DCE-MRI using molecular texture descriptor. Comput Biol Med 2019; 106:114-125. [PMID: 30711799 DOI: 10.1016/j.compbiomed.2019.01.017] [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] [Received: 08/27/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND We propose a computational methodology capable of detecting and analyzing breast tumor habitats in images acquired by magnetic resonance imaging with dynamic contrast enhancement (DCE-MRI), based on the pathophysiological behavior of the contrast agent (CA). METHODS The proposed methodology comprises three steps. In summary, the first step is the acquisition of images from the Quantitative Imaging Network Breast. In the second step, the segmentation of the breasts is performed to remove the background, noise, and other unwanted objects from the image. In the third step, the generation of habitats is performed by applying two techniques: the molecular texture descriptor (MTD) that highlights the CA regions in the breast, and pathophysiological texture mapping (MPT), which generates tumor habitats based on the behavior of the CA. The combined use of these two techniques allows the automatic detection of tumors in the breast and analysis of each separate habitat with respect to their malignancy type. RESULTS The results found in this study were promising, with 100% of breast tumors being identified. The segmentation results exhibited an accuracy of 99.95%, sensitivity of 71.07%, specificity of 99.98%, and volumetric similarity of 77.75%. Moreover, we were able to classify the malignancy of the tumors, with 6 classified as malignant type III (WashOut) and 14 as malignant type II (Plateau), for a total of 20 cases. CONCLUSION We proposed a method for the automatic detection of tumors in the breast in DCE-MRI and performed the pathophysiological mapping of tumor habitats by analyzing the behavior of the CA, combining MTD and MPT, which allowed the mapping of internal tumor habitats.
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Affiliation(s)
| | | | | | | | | | | | - Marcelo Gattass
- Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Multiparametric MR Imaging of Soft Tissue Tumors and Pseudotumors. Magn Reson Imaging Clin N Am 2018; 26:543-558. [DOI: 10.1016/j.mric.2018.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Meng M, Xue H, Lei J, Wang Q, Liu J, Li Y, Sun T, Xu H, Jin Z. A novel approach to monitoring the efficacy of anti-tumor treatments in animal models: combining functional MRI and texture analysis. BMC Cancer 2018; 18:833. [PMID: 30126367 PMCID: PMC6102870 DOI: 10.1186/s12885-018-4684-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/19/2018] [Indexed: 01/09/2023] Open
Abstract
Background The aim of this study was to evaluate the early anti-tumor efficiency of different therapeutic agents with a combination of multi-b-value DWI, DCE-MRI and texture analysis. Methods Eighteen 4 T1 homograft tumor models were divided into control, paclitaxel monotherapy and paclitaxel and bevacizumab combination therapy groups (n = 6) that underwent multi-b-value DWI, DCE-MRI and texture analysis before and 15 days after treatment. Results After treatment, the tumors in the control group were significantly larger than those in the combination group (P = 0.018). In multi-b-value DWI, the ADCslow obviously increased in the combination group compared to that in the others (P < 0.01). The f increased in the control and paclitaxel groups, but the combination group showed a significant decrease versus the others (P < 0.02). Additionally, in DCE-MRI, the decreasing Ktrans showed an evident difference between the combination and control groups (P = 0.003) due to the latter’s increasing Ktrans. The intra-group comparisons of tumor texture in pre-, mid- and post-treatments showed that the entropy had all significantly increased in all groups (P < 0.01, SSF = 0–6), though the MPP, mean and SD increased only in the combination group (PMPP,mean,SD < 0.05, SSF = 4–6). Moreover, the inter-group comparisons revealed that the mean and MPP exhibited significant differences after treatment (Pmean,MPP < 0.05, SSF = 0–3). Conclusion All these results suggest some strong correlations among DWI, DCE and texture analysis, which are beneficial for further study and clinical research.
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Affiliation(s)
- Ming Meng
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Huadan Xue
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jing Lei
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Qin Wang
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jingjuan Liu
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yuan Li
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Ting Sun
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Haiyan Xu
- Department of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Institute of Basic Medical Sciences, No.5 Dongdan, Dongcheng District, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Comparison of methods for estimation of the intravoxel incoherent motion (IVIM) diffusion coefficient (D) and perfusion fraction (f). MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2018; 31:715-723. [DOI: 10.1007/s10334-018-0697-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/03/2018] [Accepted: 07/25/2018] [Indexed: 12/11/2022]
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Zhu Q, Tannenbaum S, Kurtzman SH, DeFusco P, Ricci A, Vavadi H, Zhou F, Xu C, Merkulov A, Hegde P, Kane M, Wang L, Sabbath K. Identifying an early treatment window for predicting breast cancer response to neoadjuvant chemotherapy using immunohistopathology and hemoglobin parameters. Breast Cancer Res 2018; 20:56. [PMID: 29898762 PMCID: PMC6001175 DOI: 10.1186/s13058-018-0975-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Breast cancer pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) varies with tumor subtype. The purpose of this study was to identify an early treatment window for predicting pCR based on tumor subtype, pretreatment total hemoglobin (tHb) level, and early changes in tHb following NAC. METHODS Twenty-two patients (mean age 56 years, range 34-74 years) were assessed using a near-infrared imager coupled with an Ultrasound system prior to treatment, 7 days after the first treatment, at the end of each of the first three cycles, and before their definitive surgery. Pathologic responses were dichotomized by the Miller-Payne system. Tumor vascularity was assessed from tHb; vascularity changes during NAC were assessed from a percentage tHb normalized to the pretreatment level (%tHb). After training the logistic prediction models using the previous study data, we assessed the early treatment window for predicting pathological response according to their tumor subtype (human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), triple-negative (TN)) based on tHb, and %tHb measured at different cycles and evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS In the new study cohort, maximum pretreatment tHb and %tHb changes after cycles 1, 2, and 3 were significantly higher in responder Miller-Payne 4-5 tumors (n = 13) than non-or partial responder Miller-Payne 1-3 tumors (n = 9). However, no significance was found at day 7. The AUC of the predictive power of pretreatment tHb in the cohort was 0.75, which was similar to the performance of the HER2 subtype as a single predictor (AUC of 0.78). A greater predictive power of pretreatment tHb was found within each subtype, with AUCs of 0.88, 0.69, and 0.72, in the HER2, ER, and TN subtypes, respectively. Using pretreatment tHb and cycle 1 %tHb, AUC reached 0.96, 0.91, and 0.90 in HER2, ER, and TN subtypes, respectively, and 0.95 regardless of subtype. Additional cycle 2 %tHb measurements moderately improved prediction for the HER2 subtype but did not improve prediction for the ER and TN subtypes. CONCLUSIONS By combining tumor subtypes with tHb, we predicted the pCR of breast cancer to NAC before treatment. Prediction accuracy can be significantly improved by incorporating cycle 1 and 2 %tHb for the HER2 subtype and cycle 1 %tHb for the ER and TN subtypes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02092636 . Registered in March 2014.
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Affiliation(s)
- Quing Zhu
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 300D, St. Louis, MO 63130 USA
| | - Susan Tannenbaum
- University of Connecticut Health Center, Farmington, CT 06030 USA
| | | | | | | | | | - Feifei Zhou
- University of Connecticut, Storrs, CT 06269 USA
| | - Chen Xu
- New York City College of Technology, City University of New York (CUNY), New York, USA
| | - Alex Merkulov
- University of Connecticut Health Center, Farmington, CT 06030 USA
| | - Poornima Hegde
- University of Connecticut Health Center, Farmington, CT 06030 USA
| | - Mark Kane
- University of Connecticut Health Center, Farmington, CT 06030 USA
| | - Liqun Wang
- Department of Statistics, University of Manitoba, 186 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada
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Krikken E, Khlebnikov V, Zaiss M, Jibodh RA, van Diest PJ, Luijten PR, Klomp DWJ, van Laarhoven HWM, Wijnen JP. Amide chemical exchange saturation transfer at 7 T: a possible biomarker for detecting early response to neoadjuvant chemotherapy in breast cancer patients. Breast Cancer Res 2018; 20:51. [PMID: 29898745 PMCID: PMC6001024 DOI: 10.1186/s13058-018-0982-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The purpose of this work was to investigate noninvasive early detection of treatment response of breast cancer patients to neoadjuvant chemotherapy (NAC) using chemical exchange saturation transfer (CEST) measurements sensitive to amide proton transfer (APT) at 7 T. METHODS CEST images were acquired in 10 tumors of nine breast cancer patients treated with NAC. APT signals in the tumor, before and after the first cycle of NAC, were quantified using a three-pool Lorentzian fit of the z-spectra in the region of interest. The changes in APT were subsequently related to pathological response after surgery defined by the Miller-Payne system. RESULTS Significant differences (P < 0.05, unpaired Mann-Whitney test) were found in the APT signal before and after the first cycle of NAC in six out of 10 lesions, of which two showed a pathological complete response. Of the remaining four lesions, one showed a pathological complete response. No significant difference in changes of APT signal were found between the different pathological responses to NAC treatment (P > 0.05, Kruskal-Wallis test). CONCLUSIONS This preliminary study shows the feasibility of using APT CEST magnetic resonance imaging as a noninvasive biomarker to assess the effect of NAC in an early stage of NAC treatment of breast cancer patients. TRIAL REGISTRATION Registration number, NL49333.041.14/ NTR4980 . Registered on 16 October 2014.
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Affiliation(s)
- Erwin Krikken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vitaliy Khlebnikov
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moritz Zaiss
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Rajni A. Jibodh
- Department of Medical Oncology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Paul J. van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter R. Luijten
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W. J. Klomp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jannie P. Wijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Wang P, Thapa D, Wu G, Sun Q, Cai H, Tuo F. A study on diffusion and kurtosis features of cervical cancer based on non-Gaussian diffusion weighted model. Magn Reson Imaging 2018; 47:60-66. [PMID: 29103978 DOI: 10.1016/j.mri.2017.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/12/2017] [Accepted: 10/31/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the diffusion and kurtosis features of cervical cancer (CC) and study the feasibility of diffusion kurtosis imaging (DKI) based on the non-Gaussian diffusion-weighted model to differentiate the stage and grade of CC. METHODS A total of 50 patients with pathologically confirmed CC were enrolled. MRI examinations including DKI (with 5b values 200, 500, 1000, 1500, and 2000smm-2 were performed before any treatment. The apparent coefficient (Dapp) and the apparent kurtosis value (Kapp) were derived from the non-gaussian diffusion model, and the apparent diffusion coefficient (ADC) was derived from the Gaussian model. The parameters of CC and normal tissue (myometrium) were obtained, analyzed statistically, and evaluated with respect to differentiating stage and grade between the tissue and the CC. RESULTS ADC and Dapp values of CC were significantly lower than that of the normal myometrium (P=0.024 and P<0.001, respectively), while the Kapp value was not found to exhibit a significant difference. Compared to the well/moderately differentiated CC, poorly differentiated CC had a significantly decreased mean ADC and Dapp (P=0.018 and P=0.026, respectively); however, the mean Kapp (P=0.035) increased significantly. In the clinical staging, the DKI sequence was advantageous over conventional MRI sequences (degree of accuracy: 90% vs. 74%), Although in the quantitative analysis, these parameters did not show a significant difference. CONCLUSIONS The pilot study demonstrated that these diffusion and kurtosis indices from DKI based on the non-Gaussian diffusion-weighted model putatively differentiated the grade and stage of CC.
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Affiliation(s)
- Panying Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China
| | - Deepa Thapa
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China
| | - Guangyao Wu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China.
| | - Qunqi Sun
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China; Department of Radiology, Yuebei People's Hospital, Shantou University Medical College, Shaoguan, 512026, PR China
| | - Hongbin Cai
- Department of Female Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China
| | - Fei Tuo
- Department of Female Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China
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Abstract
Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in the accuracy of target delineation in MRI-guided radiation therapy may improve clinical outcomes in a variety of cancer types. However, some considerations should be recognized including patient motion during image acquisition and geometric accuracy of images. Moreover, MR-compatible immobilization devices need to be used when acquiring images in the treatment position while minimizing patient motion during the scan time. Finally, synthetic CT images (i.e. electron density maps) and digitally reconstructed radiograph images should be generated from MRI images for dose calculation and image guidance prior to treatment. A short review of the concepts and techniques that have been developed for implementation of MRI-only workflows in radiation therapy is provided in this document.
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Affiliation(s)
- Amir M. Owrangi
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Peter B. Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, 2308, Australia
- Department of Radiation Oncology, Calvary Mater Hospital, Newcastle, NSW, 2298, Australia
| | - Carri K. Glide-Hurst
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan
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Abstract
Molecular imaging (mainly PET and MR imaging) has played important roles in gynecologic oncology. Emerging MR-based technologies, including DWI, CEST, DCE-MR imaging, MRS, and DNP, as well as FDG-PET and many novel PET radiotracers, will continuously improve practices. In combination with radiomics analysis, a new era of decision making in personalized medicine and precisely guided radiation treatment planning or real-time surgical interventions is being entered into, which will directly impact on patient survival. Prospective trials with well-defined endpoints are encouraged to evaluate the multiple facets of these emerging imaging tools in the management of gynecologic malignancies.
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Affiliation(s)
- Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan
| | - Chyong-Huey Lai
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan.
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan
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Mogensen MB, Loft A, Aznar M, Axelsen T, Vainer B, Osterlind K, Kjaer A. FLT-PET for early response evaluation of colorectal cancer patients with liver metastases: a prospective study. EJNMMI Res 2017; 7:56. [PMID: 28695424 PMCID: PMC5503853 DOI: 10.1186/s13550-017-0302-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/20/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fluoro-L-thymidine (FLT) is a positron emission tomography/computed tomography (PET/CT) tracer which reflects proliferative activity in a cancer lesion. The main objective of this prospective explorative study was to evaluate whether FLT-PET can be used for the early evaluation of treatment response in colorectal cancer patients (CRC) with liver metastases. Patients with metastatic CRC having at least one measurable (>1 cm) liver metastasis receiving first-line chemotherapy were included. A FLT-PET/CT scan was performed at baseline and after the first treatment. The maximum and mean standardised uptake values (SUVmax, SUVmean) were measured. After three cycles of chemotherapy, treatment response was assessed by CT scan based on RECIST 1.1. RESULTS Thirty-nine consecutive patients were included of which 27 were evaluable. Dropout was mainly due to disease complications. Nineteen patients (70%) had a partial response, seven (26%) had stable disease and one (4%) had progressive disease. A total of 23 patients (85%) had a decrease in FLT uptake following the first treatment. The patient with progressive disease had the highest increase in FLT uptake in SUVmax. There was no correlation between the response according to RECIST and the early changes in FLT uptake measured as SUVmax (p = 0.24). CONCLUSIONS No correlation was found between early changes in FLT uptake after the first cycle of treatment and the response evaluated from subsequent CT scans. It seems unlikely that FLT-PET can be used on its own for the early response evaluation of metastatic CRC.
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Affiliation(s)
- Marie Benzon Mogensen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Marianne Aznar
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Axelsen
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ben Vainer
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kell Osterlind
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Abstract
Radiomics, the high-throughput mining of quantitative image features from standard-of-care medical imaging that enables data to be extracted and applied within clinical-decision support systems to improve diagnostic, prognostic, and predictive accuracy, is gaining importance in cancer research. Radiomic analysis exploits sophisticated image analysis tools and the rapid development and validation of medical imaging data that uses image-based signatures for precision diagnosis and treatment, providing a powerful tool in modern medicine. Herein, we describe the process of radiomics, its pitfalls, challenges, opportunities, and its capacity to improve clinical decision making, emphasizing the utility for patients with cancer. Currently, the field of radiomics lacks standardized evaluation of both the scientific integrity and the clinical relevance of the numerous published radiomics investigations resulting from the rapid growth of this area. Rigorous evaluation criteria and reporting guidelines need to be established in order for radiomics to mature as a discipline. Herein, we provide guidance for investigations to meet this urgent need in the field of radiomics.
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Surov A, Meyer HJ, Wienke A. Associations between apparent diffusion coefficient (ADC) and KI 67 in different tumors: a meta-analysis. Part 1: ADC mean. Oncotarget 2017; 8:75434-75444. [PMID: 29088879 PMCID: PMC5650434 DOI: 10.18632/oncotarget.20406] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/15/2017] [Indexed: 02/07/2023] Open
Abstract
Diffusion weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique based on measure of water diffusion in tissues. This diffusion can be quantified by apparent diffusion coefficient (ADC). Some reports indicated that ADC can reflect tumor proliferation potential. The purpose of this meta-analysis was to provide evident data regarding associations between ADC and KI 67 in different tumors. Studies investigating the relationship between ADC and KI 67 in different tumors were identified. MEDLINE library was screened for associations between ADC and KI 67 in different tumors up to April 2017. Overall, 42 studies with 2026 patients were identified. The following data were extracted from the literature: authors, year of publication, number of patients, tumor type, and correlation coefficients. Associations between ADC and KI 67 were analyzed by Spearman's correlation coefficient. The reported Pearson correlation coefficients in some studies were converted into Spearman correlation coefficients. The pooled correlation coefficient between ADCmean and KI 67 for all included tumors was ρ = -0.44. Furthermore, correlation coefficient for every tumor entity was calculated. The calculated correlation coefficients were as follows: ovarian cancer: ρ = -0.62, urothelial carcinomas: ρ = -0.56, cerebral lymphoma: ρ = -0.55, neuroendocrine tumors: ρ = -0.52, glioma: ρ = -0.51, lung cancer: ρ = -0.50, prostatic cancer: ρ = -0.43, rectal cancer: ρ = -0.42, pituitary adenoma:ρ = -0.44, meningioma, ρ = -0.43, hepatocellular carcinoma: ρ = -0.37, breast cancer: ρ = -0.22.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Halle, Germany
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Thibault G, Tudorica A, Afzal A, Chui SYC, Naik A, Troxell ML, Kemmer KA, Oh KY, Roy N, Jafarian N, Holtorf ML, Huang W, Song X. DCE-MRI Texture Features for Early Prediction of Breast Cancer Therapy Response. ACTA ACUST UNITED AC 2017; 3:23-32. [PMID: 28691102 PMCID: PMC5500247 DOI: 10.18383/j.tom.2016.00241] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study investigates the effectiveness of hundreds of texture features extracted from voxel-based dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parametric maps for early prediction of breast cancer response to neoadjuvant chemotherapy (NAC). In total, 38 patients with breast cancer underwent DCE-MRI before (baseline) and after the first of the 6-8 NAC cycles. Quantitative pharmacokinetic (PK) parameters and semiquantitative metrics were estimated from DCE-MRI time-course data. The residual cancer burden (RCB) index value was computed based on pathological analysis of surgical specimens after NAC completion. In total, 1043 texture features were extracted from each of the 13 parametric maps of quantitative PK or semiquantitative metric, and their capabilities for early prediction of RCB were examined by correlating feature changes between the 2 MRI studies with RCB. There were 1069 pairs of feature-map combinations that showed effectiveness for response prediction with 4 correlation coefficients >0.7. The 3-dimensional gray-level cooccurrence matrix was the most effective feature extraction method for therapy response prediction, and, in general, the statistical features describing texture heterogeneity were the most effective features. Quantitative PK parameters, particularly those estimated with the shutter-speed model, were more likely to generate effective features for prediction response compared with the semiquantitative metrics. The best feature-map pair could predict pathologic complete response with 100% sensitivity and 100% specificity using our cohort. In conclusion, breast tumor heterogeneity in microvasculature as measured by texture features of voxel-based DCE-MRI parametric maps could be a useful biomarker for early prediction of NAC response.
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Affiliation(s)
- Guillaume Thibault
- Center Spatial Systems Biomedicine, BME, Oregon Health & Science University, Portland, Oregon
| | - Alina Tudorica
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Aneela Afzal
- Department of Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon
| | - Stephen Y-C Chui
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.,Department of Medical Oncology, Oregon Health & Science University, Portland, Oregon
| | - Arpana Naik
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.,Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon
| | - Megan L Troxell
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.,Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Kathleen A Kemmer
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.,Department of Medical Oncology, Oregon Health & Science University, Portland, Oregon
| | - Karen Y Oh
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Nicole Roy
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Neda Jafarian
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Megan L Holtorf
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Wei Huang
- Department of Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon.,Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Xubo Song
- Center for Spoken Language Understanding, Oregon Health & Science University, Portland, Oregon
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Lindgren A, Anttila M, Rautiainen S, Arponen O, Kivelä A, Mäkinen P, Härmä K, Hämäläinen K, Kosma VM, Ylä-Herttuala S, Vanninen R, Sallinen H. Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI. Eur Radiol 2017; 27:4002-4012. [PMID: 28289938 PMCID: PMC5544807 DOI: 10.1007/s00330-017-4786-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/01/2017] [Accepted: 02/16/2017] [Indexed: 11/24/2022]
Abstract
Objectives We aimed to investigate whether apparent diffusion coefficients (ADCs) measured by 3.0T diffusion-weighted magnetic resonance imaging (DWI) associate with histological aggressiveness of ovarian cancer (OC) or predict the clinical outcome. This prospective study enrolled 40 patients with primary OC, treated 2011-2014. Methods DWI was performed prior to surgery. Two observers used whole lesion single plane region of interest (WLsp-ROI) and five small ROIs (S-ROI) to analyze ADCs. Samples from tumours and metastases were collected during surgery. Immunohistochemistry and quantitative reverse transcription polymerase chain reaction (qRT-PCR) were used to measure the expression of vascular endothelial growth factor (VEGF) and its receptors. Results The interobserver reliability of ADC measurements was excellent for primary tumours ICC 0.912 (WLsp-ROI). Low ADCs significantly associated with poorly differentiated OC (WLsp-ROI P = 0.035). In primary tumours, lower ADCs significantly associated with high Ki-67 (P = 0.001) and low VEGF (P = 0.001) expression. In metastases, lower ADCs (WLsp-ROI) significantly correlated with low VEGF receptors mRNA levels. ADCs had predictive value; 3-year overall survival was poorer in patients with lower ADCs (WLsp-ROI P = 0.023, S-ROI P = 0.038). Conclusion Reduced ADCs are associated with histological severity and worse outcome in OC. ADCs measured with WLsp-ROI may serve as a prognostic biomarker of OC. Key Points • Reduced ADCs correlate with prognostic markers: poor differentiation and high Ki-67 expression • ADCs also significantly correlated with VEGF protein expression in primary tumours • Lower ADC values are associated with poorer survival in ovarian cancer • Whole lesion single plane-ROI ADCs may be used as a prognostic biomarker in OC
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Affiliation(s)
- Auni Lindgren
- Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
| | - Maarit Anttila
- Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Gynaecology, University of Eastern Finland, Kuopio, Finland
| | - Suvi Rautiainen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Otso Arponen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Annukka Kivelä
- Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Petri Mäkinen
- Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Härmä
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Kirsi Hämäläinen
- Department of Pathology and Forensic Medicine, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
| | - Veli-Matti Kosma
- Department of Pathology and Forensic Medicine, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.,Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Hanna Sallinen
- Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland. .,Institute of Clinical Medicine, School of Medicine, Gynaecology, University of Eastern Finland, Kuopio, Finland. .,Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
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48
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Lambin P, Zindler J, Vanneste BGL, De Voorde LV, Eekers D, Compter I, Panth KM, Peerlings J, Larue RTHM, Deist TM, Jochems A, Lustberg T, van Soest J, de Jong EEC, Even AJG, Reymen B, Rekers N, van Gisbergen M, Roelofs E, Carvalho S, Leijenaar RTH, Zegers CML, Jacobs M, van Timmeren J, Brouwers P, Lal JA, Dubois L, Yaromina A, Van Limbergen EJ, Berbee M, van Elmpt W, Oberije C, Ramaekers B, Dekker A, Boersma LJ, Hoebers F, Smits KM, Berlanga AJ, Walsh S. Decision support systems for personalized and participative radiation oncology. Adv Drug Deliv Rev 2017; 109:131-153. [PMID: 26774327 DOI: 10.1016/j.addr.2016.01.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/08/2015] [Accepted: 01/06/2016] [Indexed: 12/12/2022]
Abstract
A paradigm shift from current population based medicine to personalized and participative medicine is underway. This transition is being supported by the development of clinical decision support systems based on prediction models of treatment outcome. In radiation oncology, these models 'learn' using advanced and innovative information technologies (ideally in a distributed fashion - please watch the animation: http://youtu.be/ZDJFOxpwqEA) from all available/appropriate medical data (clinical, treatment, imaging, biological/genetic, etc.) to achieve the highest possible accuracy with respect to prediction of tumor response and normal tissue toxicity. In this position paper, we deliver an overview of the factors that are associated with outcome in radiation oncology and discuss the methodology behind the development of accurate prediction models, which is a multi-faceted process. Subsequent to initial development/validation and clinical introduction, decision support systems should be constantly re-evaluated (through quality assurance procedures) in different patient datasets in order to refine and re-optimize the models, ensuring the continuous utility of the models. In the reasonably near future, decision support systems will be fully integrated within the clinic, with data and knowledge being shared in a standardized, dynamic, and potentially global manner enabling truly personalized and participative medicine.
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Affiliation(s)
- Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Jaap Zindler
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ben G L Vanneste
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lien Van De Voorde
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daniëlle Eekers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Inge Compter
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kranthi Marella Panth
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jurgen Peerlings
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ruben T H M Larue
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Timo M Deist
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Arthur Jochems
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Tim Lustberg
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Johan van Soest
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Evelyn E C de Jong
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Aniek J G Even
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bart Reymen
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Nicolle Rekers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marike van Gisbergen
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sara Carvalho
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ralph T H Leijenaar
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Catharina M L Zegers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maria Jacobs
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Janita van Timmeren
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Patricia Brouwers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jonathan A Lal
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ludwig Dubois
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ala Yaromina
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Evert Jan Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cary Oberije
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bram Ramaekers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kim M Smits
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Adriana J Berlanga
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sean Walsh
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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49
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Abstract
Although endometrial cancer is surgicopathologically staged, preoperative imaging is recommended for diagnostic work-up to tailor surgery and adjuvant treatment. For preoperative staging, imaging by transvaginal ultrasound (TVU) and/or magnetic resonance imaging (MRI) is valuable to assess local tumor extent, and positron emission tomography-CT (PET-CT) and/or computed tomography (CT) to assess lymph node metastases and distant spread. Preoperative imaging may identify deep myometrial invasion, cervical stromal involvement, pelvic and/or paraaortic lymph node metastases, and distant spread, however, with reported limitations in accuracies and reproducibility. Novel structural and functional imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for improving risk stratification. In this review, we summarize the reported staging performances of conventional and novel preoperative imaging methods and provide an overview of promising novel imaging methods relevant for endometrial cancer care.
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Affiliation(s)
- Ingfrid S Haldorsen
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway.
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway.
| | - Helga B Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5020, Bergen, Norway
- Department of Clinical Science, University of Bergen, 5020, Bergen, Norway
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50
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Huang W, Beckett BR, Tudorica A, Meyer JM, Afzal A, Chen Y, Mansoor A, Hayden JB, Doung YC, Hung AY, Holtorf ML, Aston TJ, Ryan CW. Evaluation of Soft Tissue Sarcoma Response to Preoperative Chemoradiotherapy Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2016; 2:308-316. [PMID: 28066805 PMCID: PMC5215747 DOI: 10.18383/j.tom.2016.00202] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study aims to assess the utility of quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters in comparison with imaging tumor size for early prediction and evaluation of soft tissue sarcoma response to preoperative chemoradiotherapy. In total, 20 patients with intermediate- to high-grade soft tissue sarcomas received either a phase I trial regimen of sorafenib + chemoradiotherapy (n = 8) or chemoradiotherapy only (n = 12), and underwent DCE-MRI at baseline, after 2 weeks of treatment with sorafenib or after the first chemotherapy cycle, and after therapy completion. MRI tumor size in the longest diameter (LD) was measured according to the RECIST (Response Evaluation Criteria In Solid Tumors) guidelines. Pharmacokinetic analyses of DCE-MRI data were performed using the Shutter-Speed model. After only 2 weeks of treatment with sorafenib or after 1 chemotherapy cycle, Ktrans (rate constant for plasma/interstitium contrast agent transfer) and its percent change were good early predictors of optimal versus suboptimal pathological response with univariate logistic regression C statistics values of 0.90 and 0.80, respectively, whereas RECIST LD percent change was only a fair predictor (C = 0.72). Post-therapy Ktrans, ve (extravascular and extracellular volume fraction), and kep (intravasation rate constant), not RECIST LD, were excellent (C > 0.90) markers of therapy response. Several DCE-MRI parameters before, during, and after therapy showed significant (P < .05) correlations with percent necrosis of resected tumor specimens. In conclusion, absolute values and percent changes of quantitative DCE-MRI parameters provide better early prediction and evaluation of the pathological response of soft tissue sarcoma to preoperative chemoradiotherapy than the conventional measurement of imaging tumor size change.
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Affiliation(s)
- Wei Huang
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon; Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Brooke R Beckett
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Alina Tudorica
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Janelle M Meyer
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon
| | - Aneela Afzal
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon
| | - Yiyi Chen
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Atiya Mansoor
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - James B Hayden
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Yee-Cheen Doung
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Arthur Y Hung
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Megan L Holtorf
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Torrie J Aston
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Christopher W Ryan
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon; Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon
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