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Woo S, Andrieu PC, Abu-Rustum NR, Broach V, Zivanovic O, Sonoda Y, Chi DS, Aviki E, Ellis A, Carayon P, Hricak H, Vargas HA. Bridging Communication Gaps Between Radiologists, Referring Physicians, and Patients Through Standardized Structured Cancer Imaging Reporting: The Experience with Female Pelvic MRI Assessment Using O-RADS and a Simulated Cohort Patient Group. Acad Radiol 2024; 31:1388-1397. [PMID: 37661555 PMCID: PMC11206174 DOI: 10.1016/j.acra.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate whether implementing structured reporting based on Ovarian-Adnexal Reporting and Data System (O-RADS) magnetic resonance imaging (MRI) in women with sonographically indeterminate adnexal masses improves communication between radiologists, referrers, and patients/caregivers and enhances diagnostic performance for determining adnexal malignancy. MATERIALS AND METHODS We retrospectively analyzed prospectively issued MRI reports in 2019-2022 performed for characterizing adnexal masses before and after implementing O-RADS MRI; 56 patients/caregivers and nine gynecologic oncologists ("referrers") were surveyed about report interpretability/clarity/satisfaction; responses for pre- and post-implementation reports were compared using Fisher's exact and Chi-squared tests. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS A total of 123 reports from before and 119 reports from after O-RADS MRI implementation were included. Survey response rates were 35.7% (20/56) for patients/caregivers and 66.7% (6/9) for referrers. For patients/caregivers, O-RADS MRI reports were clearer (p < 0.001) and more satisfactory (p < 0.001) than unstructured reports, but interpretability did not differ significantly (p = 0.14), as 28.0% (28/100) of postimplementation and 38.0% (38/100) of preimplementation reports were considered difficult to interpret. For referrers, O-RADS MRI reports were clearer, more satisfactory, and easier to interpret (p < 0.001); only 1.3% (1/77) were considered difficult to interpret. For differentiating benign from malignant adnexal lesions, O-RADS MRI showed area under the curve of 0.92 (95% confidence interval [CI], 0.85-0.99), sensitivity of 0.81 (95% CI, 0.58-0.95), and specificity of 0.91 (95% CI, 0.83-0.96). Diagnostic performance of reports before implementation could not be calculated due to many different phrases used to describe the likelihood of malignancy. CONCLUSION Implementing standardized structured reporting using O-RADS MRI for characterizing adnexal masses improved clarity and satisfaction for patients/caregivers and referrers. Interpretability improved for referrers but remained limited for patients/caregivers.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.); Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016 (S.W., H.A.V.).
| | - Pamela Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.)
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.); Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (O.Z.)
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Emeline Aviki
- Department of Obstetrics and Gynecology, NYU Long Island School of Medicine, Mineola, New York (E.A.)
| | - Annie Ellis
- Patient Family Advisory Council for Quality (PFACQ), Memorial Sloan Kettering Cancer Center, New York, New York (A.E.)
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin (P.C.)
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.)
| | - Hebert A Vargas
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016 (S.W., H.A.V.)
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Yao S, Ye Z, Wei Y, Jiang HY, Song B. Radiomics in hepatocellular carcinoma: A state-of-the-art review. World J Gastrointest Oncol 2021; 13:1599-1615. [PMID: 34853638 PMCID: PMC8603458 DOI: 10.4251/wjgo.v13.i11.1599] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/02/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common cancer and the second major contributor to cancer-related mortality. Radiomics, a burgeoning technology that can provide invisible high-dimensional quantitative and mineable data derived from routine-acquired images, has enormous potential for HCC management from diagnosis to prognosis as well as providing contributions to the rapidly developing deep learning methodology. This article aims to review the radiomics approach and its current state-of-the-art clinical application scenario in HCC. The limitations, challenges, and thoughts on future directions are also summarized.
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Affiliation(s)
- Shan Yao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Han-Yu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Gomes Marin JF, Nunes RF, Coutinho AM, Zaniboni EC, Costa LB, Barbosa FG, Queiroz MA, Cerri GG, Buchpiguel CA. Theranostics in Nuclear Medicine: Emerging and Re-emerging Integrated Imaging and Therapies in the Era of Precision Oncology. Radiographics 2021; 40:1715-1740. [PMID: 33001789 DOI: 10.1148/rg.2020200021] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Theranostics refers to the pairing of diagnostic biomarkers with therapeutic agents that share a specific target in diseased cells or tissues. Nuclear medicine, particularly with regard to applications in oncology, is currently one of the greatest components of the theranostic concept in clinical and research scenarios. Theranostics in nuclear medicine, or nuclear theranostics, refers to the use of radioactive compounds to image biologic phenomena by means of expression of specific disease targets such as cell surface receptors or membrane transporters, and then to use specifically designed agents to deliver ionizing radiation to the tissues that express these targets. The nuclear theranostic approach has sparked increasing interest and gained importance in parallel to the growth in molecular imaging and personalized medicine, helping to provide customized management for various diseases; improving patient selection, prediction of response and toxicity, and determination of prognosis; and avoiding futile and costly diagnostic examinations and treatment of many diseases. The authors provide an overview of theranostic approaches in nuclear medicine, starting with a review of the main concepts and unique features of nuclear theranostics and aided by a retrospective discussion of the progress of theranostic agents since early applications, with illustrative cases emphasizing the imaging features. Advanced concepts regarding the role of fluorine 18-fluorodeoxyglucose PET in theranostics, as well as developments in and future directions of theranostics, are discussed. ©RSNA, 2020 See discussion on this article by Greenspan and Jadvar.
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Affiliation(s)
- José Flávio Gomes Marin
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
| | - Rafael F Nunes
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
| | - Artur M Coutinho
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
| | - Elaine C Zaniboni
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
| | - Larissa B Costa
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
| | - Felipe G Barbosa
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
| | - Marcelo A Queiroz
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
| | - Giovanni G Cerri
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
| | - Carlos A Buchpiguel
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil (J.F.G.M., R.F.N., A.M.C., E.C.Z., L.B.C., F.G.B., M.A.Q., G.G.C., C.A.B.); and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (J.F.G.M., A.M.C., M.A.Q., G.G.C., C.A.B.)
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Advani D, Sharma S, Kumari S, Ambasta RK, Kumar P. Precision Oncology, Signaling and Anticancer Agents in Cancer Therapeutics. Anticancer Agents Med Chem 2021; 22:433-468. [PMID: 33687887 DOI: 10.2174/1871520621666210308101029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The global alliance for genomics and healthcare facilities provides innovational solutions to expedite research and clinical practices for complex and incurable health conditions. Precision oncology is an emerging field explicitly tailored to facilitate cancer diagnosis, prevention and treatment based on patients' genetic profile. Advancements in "omics" techniques, next-generation sequencing, artificial intelligence and clinical trial designs provide a platform for assessing the efficacy and safety of combination therapies and diagnostic procedures. METHOD Data were collected from Pubmed and Google scholar using keywords: "Precision medicine", "precision medicine and cancer", "anticancer agents in precision medicine" and reviewed comprehensively. RESULTS Personalized therapeutics including immunotherapy, cancer vaccines, serve as a groundbreaking solution for cancer treatment. Herein, we take a measurable view of precision therapies and novel diagnostic approaches targeting cancer treatment. The contemporary applications of precision medicine have also been described along with various hurdles identified in the successful establishment of precision therapeutics. CONCLUSION This review highlights the key breakthroughs related to immunotherapies, targeted anticancer agents, and target interventions related to cancer signaling mechanisms. The success story of this field in context to drug resistance, safety, patient survival and in improving quality of life is yet to be elucidated. We conclude that, in the near future, the field of individualized treatments may truly revolutionize the nature of cancer patient care.
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Affiliation(s)
- Dia Advani
- Molecular Neuroscience and Functional Genomics Laboratory Shahbad Daulatpur, Bawana Road, Delhi 110042. India
| | - Sudhanshu Sharma
- Molecular Neuroscience and Functional Genomics Laboratory Shahbad Daulatpur, Bawana Road, Delhi 110042. India
| | - Smita Kumari
- Molecular Neuroscience and Functional Genomics Laboratory Shahbad Daulatpur, Bawana Road, Delhi 110042. India
| | - Rashmi K Ambasta
- Molecular Neuroscience and Functional Genomics Laboratory Shahbad Daulatpur, Bawana Road, Delhi 110042. India
| | - Pravir Kumar
- Molecular Neuroscience and Functional Genomics Laboratory Shahbad Daulatpur, Bawana Road, Delhi 110042. India
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Abstract
Radiomics is an emerging field which extracts quantitative radiology data from medical images and explores their correlation with clinical outcomes in a non-invasive manner. This review aims to assess whether radiomics is a useful and reproducible method for clinical management of hepatocellular carcinoma (HCC) by reviewing the strengths and weaknesses of current radiomics literature pertaining specifically to HCC. From an initial set of 48 articles recovered through database searches, 23 articles were retained to be included in this review after full screening. Among these 23 studies, 7 used a radiomics approach in magnetic resonance imaging (MRI). Only two studies applied radiomics to positron emission tomography-computed tomography (PET-CT). In the remaining 14 articles, a radiomics analysis was performed on computed tomography (CT). Eight studies dealt with the relationship between biological signatures and imaging findings, and can be classified as radiogenomic studies. For each study included in our review, we computed a Radiomics Quality Score (RQS) as proposed by Lambin et al. We found that the RQS (mean ± standard deviation) was 8.35 ± 5.38 (out of a possible maximum value of 36). Although these scores are fairly low, and radiomics has not yet reached clinical utility in HCC, it is important to underscore the fact that these early studies pave the way for the radiomics field with a focus on HCC. Radiomics is still a very young field, and is far from being mature, but it remains a very promising technology for the future for developing adequate personalized treatment as a non-invasive approach, for complementing or replacing tumor biopsies, as well as for developing novel prognostic biomarkers in HCC patients.
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Abstract
OBJECTIVE. The purpose of this study is to assess the frequency of atypical response patterns in oncology patients treated with the programmed cell death protein-1 inhibitor nivolumab. MATERIALS AND METHODS. This retrospective study included 254 patients treated with nivolumab alone or in combination, from January 2013 through August 2017. A blinded reader prospectively assessed treatment response. Among 166 patients (65%) who experienced a clinical benefit (defined as stable disease, partial response, or complete response as the best response), four response patterns were identified: pattern 1 is a decrease or less than 20% increase in the sum of the longest dimension (SLD) without a return to below the nadir, pattern 2 is a 10-19% increase in SLD with a return to below the nadir, pattern 3 is a 20% or greater increase in SLD with a return to below the nadir (classic pseudoprogression), and pattern 4 is the development of new lesions with a decrease in SLD lasting through at least two consecutive scans. Patterns 2, 3, and 4 were defined as atypical response patterns. RESULTS. Of 166 patients who experienced a clinical benefit, pattern 1 was seen in 133 (80%), pattern 2 was seen in 15 (9%), pattern 3 was seen in two (1%), and pattern 4 was seen in 16 (10%) patients. Thus, atypical response patterns were seen in 33 (20%) patients who experienced a clinical benefit, including 25 of 91 (27%) taking nivolumab and ipilimumab combined, six of 46 (13%) taking nivolumab alone, and two of 29 (7%) taking a combination of nivolumab and another chemotherapeutic agent (p = 0.02). CONCLUSION. Although classic pseudoprogression was rare, an atypical response was seen in 20% of patients who experienced a clinical benefit, and a delayed response up to 24 months of therapy may be seen. Radiologists should be aware of these atypical patterns to avoid errors in response assessment.
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Bustos Fiore A, Banguero Gutiérrez A, Guerrero Acosta L, Segura Cros C, Ramos de la Rosa R. Immunotherapy in oncology: A new challenge for radiologists. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fan W, Tang W, Lau J, Shen Z, Xie J, Shi J, Chen X. Breaking the Depth Dependence by Nanotechnology-Enhanced X-Ray-Excited Deep Cancer Theranostics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1806381. [PMID: 30698854 DOI: 10.1002/adma.201806381] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/26/2018] [Indexed: 05/12/2023]
Abstract
The advancements in nanotechnology have created multifunctional nanomaterials aimed at enhancing diagnostic accuracy and treatment efficacy for cancer. However, the ability to target deep-seated tumors remains one of the most critical challenges for certain nanomedicine applications. To this end, X-ray-excited theranostic techniques provide a means of overcoming the limits of light penetration and tissue attenuation. Herein, a comprehensive overview of the recent advances in nanotechnology-enhanced X-ray-excited imaging and therapeutic methodologies is presented, with an emphasis on the design of multifunctional nanomaterials for contrast-enhanced computed tomography (CT) imaging, X-ray-excited optical luminescence (XEOL) imaging, and X-ray-excited multimodal synchronous/synergistic therapy. The latter is based on the concurrent use of radiotherapy with chemotherapy, gas therapy, photodynamic therapy, or immunotherapy. Moreover, the featured biomedical applications of X-ray-excited deep theranostics are discussed to highlight the advantages of X-ray in high-sensitivity detection and efficient elimination of malignant tumors. Finally, key issues and technical challenges associated with this deep theranostic technology are identified, with the intention of advancing its translation into the clinic.
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Affiliation(s)
- Wenpei Fan
- Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Wei Tang
- Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Joseph Lau
- Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Zheyu Shen
- Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Jin Xie
- Department of Chemistry, University of Georgia, Athens, GA, 30602, USA
| | - Jianlin Shi
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Xiaoyuan Chen
- Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
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Bustos Fiore A, Gutiérrez AB, Acosta LG, Segura Cros C, Ramos de la Rosa R. Immunotherapy in oncology: a new challenge for radiologists. RADIOLOGIA 2018; 61:134-142. [PMID: 30580817 DOI: 10.1016/j.rx.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/20/2018] [Accepted: 10/21/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In patients with oncologic disease, immunotherapy has become established as an alternative or complementary therapy to traditional treatment options (surgery, radiotherapy, and chemotherapy). Currently available immunotherapy modes can be divided into two types: passive and active. The active type strengthens the immune system's response to tumor cells by activating both humoral immunity and cell-mediated immunity, using the adaptive response. This article aims to analyze the radiologic patterns of the response to immunotherapy through immune-response-related criteria and to describe the main adverse effects associated with this treatment approach. CONCLUSION Imaging tests play a fundamental role in the follow-up of oncologic patients and in the assessment of their response to treatment. Immunotherapy represents a challenge for radiologists both in the evaluation of the response to immunotherapy and in the detection of the adverse effects associated with this treatment approach.
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Affiliation(s)
- A Bustos Fiore
- Hospital Universitario Quirón Dexeus, Barcelona, España.
| | | | | | - C Segura Cros
- Hospital Universitario Quirón Dexeus, Barcelona, España
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Collantes M, Martínez-Vélez N, Zalacain M, Marrodán L, Ecay M, García-Velloso MJ, Alonso MM, Patiño-García A, Peñuelas I. Assessment of metabolic patterns and new antitumoral treatment in osteosarcoma xenograft models by [ 18F]FDG and sodium [ 18F]fluoride PET. BMC Cancer 2018; 18:1193. [PMID: 30497448 PMCID: PMC6267920 DOI: 10.1186/s12885-018-5122-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Osteosarcoma is the most common malignant bone tumor in children and young adults that produces aberrant osteoid. The aim of this study was to assess the utility of 2-deoxy-2-[18F-] fluoro-D-glucose ([18F] FDG) and sodium [18F] Fluoride (Na [18F] F) PET scans in orthotopic murine models of osteosarcoma to describe the metabolic pattern of the tumors, to detect and diagnose tumors and to evaluate the efficacy of a new treatment based in oncolytic adenoviruses. METHODS Orthotopic osteosarcoma murine models were created by the injection of 143B and 531MII cell lines. [18F]FDG and Na [18F] F PET scans were performed 30 days (143B) and 90 days (531MII) post-injection. The antitumor effect of two doses (107 and 108 pfu) of the oncolytic adenovirus VCN-01 was evaluated in 531 MII model by [18F] FDG PET studies. [18F] FDG uptake was quantified by SUVmax and Total Lesion Glycolysis (TLG) indexes. For Na [18F] F, the ratio tumor SUVmax/hip SUVmax was calculated. PET findings were confirmed by histopathological techniques. RESULTS The metabolic pattern of tumors was different between both orthotopic models. All tumors showed [18F] FDG uptake, with a sensitivity and specificity of 100%. The [18F] FDG uptake was significantly higher for the 143B model (p < 0.001). Sensitivity for Na [18F] F was around 70% in both models, with a specificity of 100%. 531MII tumors showed a heterogeneous Na [18F] F uptake, significantly higher than 143B tumors (p < 0.01). Importantly, [18F] FDG and Na [18F] F uptake corresponded to highly cellular or osteoid-rich tumors in the histopathological analysis, respectively. [18F] FDG data confirmed that the oncolytic treatment of 531MII tumors produced a significant reduction in growth even with the 107 pfu dose. CONCLUSIONS PET studies demonstrated that the different osteosarcoma xenograft models developed tumors with diverse metabolic patterns that can be described by multitracer PET studies. Since not all tumors produced abundant osteoid, [18F] FDG demonstrated a better sensitivity for tumor detection and was able to quantitatively monitor in vivo response to the oncolytic adenovirus VCN-01.
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Affiliation(s)
- María Collantes
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Avenida Pío XII, 36 31008 Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Naiara Martínez-Vélez
- Departamento de Pediatría, Clínica Universidad de Navarra, Avenida Pío XII, 31008 Pamplona, Spain
| | - Marta Zalacain
- Departamento de Pediatría, Clínica Universidad de Navarra, Avenida Pío XII, 31008 Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Lucia Marrodán
- Departamento de Pediatría, Clínica Universidad de Navarra, Avenida Pío XII, 31008 Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Margarita Ecay
- Small Animal Imaging Research Unit, CIMA, Universidad de Navarra, Avenida Pío XII, 31008 Pamplona, Spain
| | - María José García-Velloso
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Avenida Pío XII, 36 31008 Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Marta María Alonso
- Departamento de Pediatría, Clínica Universidad de Navarra, Avenida Pío XII, 31008 Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Ana Patiño-García
- Departamento de Pediatría, Clínica Universidad de Navarra, Avenida Pío XII, 31008 Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Iván Peñuelas
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Avenida Pío XII, 36 31008 Pamplona, Spain
- Small Animal Imaging Research Unit, CIMA, Universidad de Navarra, Avenida Pío XII, 31008 Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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11
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Jeong WK, Jamshidi N, Felker ER, Raman SS, Lu DS. Radiomics and radiogenomics of primary liver cancers. Clin Mol Hepatol 2018; 25:21-29. [PMID: 30441889 PMCID: PMC6435966 DOI: 10.3350/cmh.2018.1007] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 02/07/2023] Open
Abstract
Concurrent advancements in imaging and genomic biomarkers have created opportunities to identify non-invasive imaging surrogates of molecular phenotypes. In order to develop such imaging surrogates radiomics and radiogenomics/imaging genomics will be necessary; there has been consistent progress in these fields for primary liver cancers. In this article we evaluate the current status of the field specifically with regards to hepatocellular carcinoma and intrahepatic cholangiocarcinoma, highlighting some of the up and coming results that were presented at the annual Radiological Society of North America Conference in 2017. There are an increasing number of studies in this area with a bias towards quantitative feature measurement, which is expected to benefit reproducibility of the findings and portends well for the future development of biomarkers for diagnosis, prognosis, and treatment response assessment. We review some of the advancements and look forward to some of the exciting future applications that are anticipated as the field develops.
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Affiliation(s)
- Woo Kyoung Jeong
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Neema Jamshidi
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ely Richard Felker
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Steven Satish Raman
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - David Shinkuo Lu
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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12
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Katsila T, Liontos M, Patrinos GP, Bamias A, Kardamakis D. The New Age of -omics in Urothelial Cancer - Re-wording Its Diagnosis and Treatment. EBioMedicine 2018; 28:43-50. [PMID: 29428524 PMCID: PMC5835572 DOI: 10.1016/j.ebiom.2018.01.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 02/06/2023] Open
Abstract
Unmet needs in urothelial cancer management represent an important challenge in our effort to improve long-term overall and disease-free survival rates with no significant compromise in quality of life. Radical cystectomy with pelvic lymph node dissection is the standard for the management of muscle-invasive, non-metastatic cancers. In spite of a 90% local disease control, up to 50% of patients ultimately die of distant metastasis. Bladder preservation using chemo-radiation is an acceptable alternative, but optimal patient selection remains elusive. Recent research is focused on the employment of tailored-made strategies in urothelial cancer exploiting the potential of theranostics in patient selection for specific therapies. Herein, we review the current knowledge on molecular theranostics in urothelial cancer and we suggest that this is the time to move toward imaging theranostics, if tailored-made disease management and patient stratification is envisaged. Urothelial cancer management represents an important challenge. Optimum patient stratification and tailored-made theranostics remain elusive. Imaging theranostics is envisaged as a cancer roadmap.
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Affiliation(s)
- Theodora Katsila
- Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece; Department of Radiation Oncology, University of Patras Medical School, Patras, Greece.
| | - Michalis Liontos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Patrinos
- Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece; Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University of Patras Medical School, Patras, Greece
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13
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Abstract
OBJECTIVE The goals of this review are to provide background information on the definitions and applications of the general term "biomarker" and to highlight the specific roles of breast imaging biomarkers in research and clinical breast cancer care. A search was conducted of the main electronic biomedical databases (PubMed, Cochrane, Embase, MEDLINE [Ovid], Scopus, and Web of Science). The search was focused on review literature in general radiology and biomedical sciences and on reviews and primary research articles on biomarkers in breast imaging over the 15 years ending in June 2017. The keywords included "biomarker," "trial endpoints," "breast imaging," "breast cancer," "radiomics," and "precision medicine" in the titles and abstracts of the papers. CONCLUSION Clinical breast care and breast cancer-related research rely on imaging biomarkers for decision support. In the era of precision medicine and big data, the practice of radiology is likely to change. A closer integration of breast imaging with related biomedical fields and the creation of large integrated and shareable databases of clinical, molecular, and imaging biomarkers should allow the field to continue guiding breast cancer care and research.
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Giardino A, Gupta S, Olson E, Sepulveda K, Lenchik L, Ivanidze J, Rakow-Penner R, Patel MJ, Subramaniam RM, Ganeshan D. Role of Imaging in the Era of Precision Medicine. Acad Radiol 2017; 24:639-649. [PMID: 28131497 DOI: 10.1016/j.acra.2016.11.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/07/2016] [Accepted: 11/29/2016] [Indexed: 12/17/2022]
Abstract
Precision medicine is an emerging approach for treating medical disorders, which takes into account individual variability in genetic and environmental factors. Preventive or therapeutic interventions can then be directed to those who will benefit most from targeted interventions, thereby maximizing benefits and minimizing costs and complications. Precision medicine is gaining increasing recognition by clinicians, healthcare systems, pharmaceutical companies, patients, and the government. Imaging plays a critical role in precision medicine including screening, early diagnosis, guiding treatment, evaluating response to therapy, and assessing likelihood of disease recurrence. The Association of University Radiologists Radiology Research Alliance Precision Imaging Task Force convened to explore the current and future role of imaging in the era of precision medicine and summarized its finding in this article. We review the increasingly important role of imaging in various oncological and non-oncological disorders. We also highlight the challenges for radiology in the era of precision medicine.
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Affiliation(s)
- Angela Giardino
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Supriya Gupta
- Department of Radiology and Imaging, Medical College of Georgia, 1120 15th St, Augusta, GA 30912.
| | - Emmi Olson
- Radiology Resident, University of California San Diego, San Diego, California
| | | | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jana Ivanidze
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, New York
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, San Diego, California
| | - Midhir J Patel
- Department of Radiology, University of South Florida, Tampa, Florida
| | - Rathan M Subramaniam
- Cyclotron and Molecular Imaging Program, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
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Yasaka K, Akai H, Mackin D, Court L, Moros E, Ohtomo K, Kiryu S. Precision of quantitative computed tomography texture analysis using image filtering: A phantom study for scanner variability. Medicine (Baltimore) 2017; 96:e6993. [PMID: 28538408 PMCID: PMC5457888 DOI: 10.1097/md.0000000000006993] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Quantitative computed tomography (CT) texture analyses for images with and without filtration are gaining attention to capture the heterogeneity of tumors. The aim of this study was to investigate how quantitative texture parameters using image filtering vary among different computed tomography (CT) scanners using a phantom developed for radiomics studies.A phantom, consisting of 10 different cartridges with various textures, was scanned under 6 different scanning protocols using four CT scanners from four different vendors. CT texture analyses were performed for both unfiltered images and filtered images (using a Laplacian of Gaussian spatial band-pass filter) featuring fine, medium, and coarse textures. Forty-five regions of interest were placed for each cartridge (x) in a specific scan image set (y), and the average of the texture values (T(x,y)) was calculated. The interquartile range (IQR) of T(x,y) among the 6 scans was calculated for a specific cartridge (IQR(x)), while the IQR of T(x,y) among the 10 cartridges was calculated for a specific scan (IQR(y)), and the median IQR(y) was then calculated for the 6 scans (as the control IQR, IQRc). The median of their quotient (IQR(x)/IQRc) among the 10 cartridges was defined as the variability index (VI).The VI was relatively small for the mean in unfiltered images (0.011) and for standard deviation (0.020-0.044) and entropy (0.040-0.044) in filtered images. Skewness and kurtosis in filtered images featuring medium and coarse textures were relatively variable across different CT scanners, with VIs of 0.638-0.692 and 0.430-0.437, respectively.Various quantitative CT texture parameters are robust and variable among different scanners, and the behavior of these parameters should be taken into consideration.
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Affiliation(s)
- Koichiro Yasaka
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Akai
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Dennis Mackin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Moros
- Departments of Radiation Oncology, Diagnostic Imaging, and Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeru Kiryu
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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16
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Affiliation(s)
- Herbert Y Kressel
- From the Radiology Editorial Office, 800 Boylston St, 15th Floor, Boston, MA 02119
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17
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Dunnick NR. Introduction to the special focus section: kidney. Abdom Radiol (NY) 2016; 41:1005-6. [PMID: 27145769 DOI: 10.1007/s00261-016-0760-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- N Reed Dunnick
- University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
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18
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The Role of Radiology in Personalized Medicine. Per Med 2016. [DOI: 10.1007/978-3-319-39349-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Herold CJ, Lewin JS, Wibmer AG, Thrall JH, Krestin GP, Dixon AK, Schoenberg SO, Geckle RJ, Muellner A, Hricak H. Imaging in the Age of Precision Medicine: Summary of the Proceedings of the 10th Biannual Symposium of the International Society for Strategic Studies in Radiology. Radiology 2015; 279:226-38. [PMID: 26465058 DOI: 10.1148/radiol.2015150709] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
During the past decade, with its breakthroughs in systems biology, precision medicine (PM) has emerged as a novel health-care paradigm. Challenging reductionism and broad-based approaches in medicine, PM is an approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle. It involves integrating information from multiple sources in a holistic manner to achieve a definitive diagnosis, focused treatment, and adequate response assessment. Biomedical imaging and imaging-guided interventions, which provide multiparametric morphologic and functional information and enable focused, minimally invasive treatments, are key elements in the infrastructure needed for PM. The emerging discipline of radiogenomics, which links genotypic information to phenotypic disease manifestations at imaging, should also greatly contribute to patient-tailored care. Because of the growing volume and complexity of imaging data, decision-support algorithms will be required to help physicians apply the most essential patient data for optimal management. These innovations will challenge traditional concepts of health care and business models. Reimbursement policies and quality assurance measures will have to be reconsidered and adapted. In their 10th biannual symposium, which was held in August 2013, the members of the International Society for Strategic Studies in Radiology discussed the opportunities and challenges arising for the imaging community with the transition to PM. This article summarizes the discussions and central messages of the symposium.
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Affiliation(s)
- Christian J Herold
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Jonathan S Lewin
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Andreas G Wibmer
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - James H Thrall
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Gabriel P Krestin
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Adrian K Dixon
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Stefan O Schoenberg
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Rena J Geckle
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Ada Muellner
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Hedvig Hricak
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
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Affiliation(s)
- N Reed Dunnick
- From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, University Hospital, Room B1G503, Box 0030, Ann Arbor, MI 48109-0030
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Medical imaging in personalised medicine: a white paper of the research committee of the European Society of Radiology (ESR). Insights Imaging 2015; 6:141-55. [PMID: 25763994 PMCID: PMC4376812 DOI: 10.1007/s13244-015-0394-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
The future of medicine lies in early diagnosis and individually tailored treatments, a concept that has been designated 'personalised medicine' (PM), which aims to deliver the right treatment to the right patient at the right time. Medical imaging has always been personalised and is fundamental to almost all aspects of PM. It is instrumental in solving clinical differential diagnoses. Imaging procedures are tailored to the clinical problem and patient characteristics. Screening for preclinical disease is done with imaging. Stratification based on imaging biomarkers can help identify individuals suited for preventive intervention. Treatment decisions are based on the in vivo visualisation of the location and extent of an abnormality, as well as the loco-regional physiological, biochemical and biological processes using structural and molecular imaging. Image-guided biopsy provides relevant tissue specimens for genetic/molecular characterisation. In addition, radiogenomics relate imaging biomarkers to these genetic and molecular features. Furthermore, imaging is essential to patient-tailored therapy planning, therapy monitoring and follow-up of disease, as well as targeting non-invasive or minimally invasive treatments, especially with the rise of theranostics. Radiologists need to be prepared for this new paradigm as it will mean changes in training, clinical practice and in research. Key Points • Medical imaging is a key component in personalised medicine • Personalised prevention will rely on image-based screening programmes • Anatomical, functional and molecular imaging biomarkers affect decisions on the type and intensity of treatment • Treatment response assessment with imaging will improve personalised treatment • Image-based invasive intervention integrates personalised diagnosis and personalised treatment.
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Arosio P, Orsini F, Piras AM, Sandreschi S, Chiellini F, Corti M, Masa M, Múčková M, Schmidtová Ľ, Ravagli C, Baldi G, Nicolato E, Conti G, Marzola P, Lascialfari A. MR imaging and targeting of human breast cancer cells with folate decorated nanoparticles. RSC Adv 2015. [DOI: 10.1039/c5ra04880j] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Folate decorated organic nanocarriers loaded with magnetite nanoparticles and paclitaxel provide a specific and prolonged negative contrast of breast cancers on T2-weighted MR images.
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Abstract
Steroid hormone receptor (SHR) expression and changes in SHR expression compared to basal levels, whether upregulated, downregulated, or mutated, form a distinguishing feature of some breast, ovarian, and prostate cancers. These receptors act to induce tumor proliferation. In the imaging context, total expression together with modulation of expression can yield predictive and prognostic information. Currently, biopsy for histologic assessment of SHR expression is routine for breast and prostate cancer; however, the technique is not well suited to the heterogeneous tumor environment and can lead to incorrect receptor expression assignment, which precludes effective treatment. The development of positron emission tomography (PET) radioligands to image receptor expression may overcome the difficulties associated with tumor heterogeneity and facilitate the assessment of metastatic disease.
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Tumor volume decrease at 8 weeks is associated with longer survival in EGFR-mutant advanced non-small-cell lung cancer patients treated with EGFR TKI. J Thorac Oncol 2014; 8:1059-68. [PMID: 23787800 DOI: 10.1097/jto.0b013e318294c909] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The study investigated whether tumor volume changes at 8 weeks of therapy is associated with outcomes in advanced non-small-cell lung cancer (NSCLC) patients harboring sensitizing epidermal growth factor receptor (EGFR) mutations treated with EGFR tyrosine kinase inhibitors (TKIs). METHODS In 56 advanced NSCLC patients with sensitizing EGFR mutations treated with first-line erlotinib or gefitinib, tumor volumes of dominant lung lesions were measured on baseline and follow-up computed tomography, and were analyzed for association with survival. RESULTS Among 56 eligible patients, the median tumor volume was 17.8 cm (range, 1.3-172.7 cm) on the baseline scans. Forty-nine patients had follow-up computed tomography at approximately 8 weeks; the median tumor volume at 8 weeks was 7.1 cm (range, 0.4-62.3 cm), with the median proportional volume change of -59% (range, -90% to +91%) from baseline. The proportional volume change at 8 weeks was associated with survival (p = 0.02). Using the cutoff value of 38% volume decrease (75th percentile) at 8 weeks, patients with volume decrease more than 38% (n = 37) had a median overall survival of 43.5 months compared with 16.3 months among those with volume decrease of 38% or less (n = 12; p = 0.01). The median progression-free survival for patients with more than 38% volume decrease was 12.6 months, compared with 5.5 months for those with 38% or lesser volume decrease (p = 0.2). CONCLUSION The proportional volume change at 8 weeks is associated with overall survival in EGFR-mutant advanced NSCLC patients treated with first-line EGFR-TKIs. The observation of the study, if confirmed in larger study cohorts, indicates that tumor volume analysis at 8 weeks may provide an early marker for survival, and contribute to therapeutic decision making by identifying patients who may benefit from additional anticancer therapy after 8 weeks of EGFR-TKI therapy.
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Hussain T, Nguyen QT. Molecular imaging for cancer diagnosis and surgery. Adv Drug Deliv Rev 2014; 66:90-100. [PMID: 24064465 DOI: 10.1016/j.addr.2013.09.007] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/07/2013] [Accepted: 09/13/2013] [Indexed: 12/11/2022]
Abstract
Novel molecular imaging techniques have the potential to significantly enhance the diagnostic and therapeutic approaches for cancer treatment. For solid tumors in particular, novel molecular enhancers for imaging modalities such as US, CT, MRI and PET may facilitate earlier and more accurate diagnosis and staging which are prerequisites for successful surgical therapy. Enzymatically activatable "smart" molecular MRI probes seem particularly promising because of their potential to image tumors before and after surgical removal without re-administration of the probe to evaluate completeness of surgical resection. Furthermore, the use of "smart" MR probes as part of screening programs may enable detection of small tumors throughout the body in at-risk patient populations. Dual labeling of molecular MR probes with fluorescent dyes can add real time intraoperative guidance facilitating complete tumor resection and preservation of important structures. A truly theranostic approach with the further addition of therapeutic agents to the molecular probe for adjuvant therapy is conceivable for the future.
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Persigehl T, Ring J, Budny T, Hahnenkamp A, Stoeppeler S, Schwartz LH, Spiegel HU, Heindel W, Remmele S, Bremer C. Vessel Size Imaging (VSI) by Robust Magnetic Resonance (MR) Relaxometry: MR-VSI of Solid Tumors in Correlation with Immunohistology and Intravital Microscopy. Mol Imaging 2013. [DOI: 10.2310/7290.2013.00059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Thorsten Persigehl
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Janine Ring
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Tymoteusz Budny
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Anke Hahnenkamp
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Sandra Stoeppeler
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Lawrence H. Schwartz
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Hans-Ullrich Spiegel
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Walter Heindel
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Stefanie Remmele
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
| | - Christoph Bremer
- From the Department of Radiology, University Hospital Cologne, Cologne, Germany; Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Department of Radiology, Columbia University Medical Center, New York, NY; Department of General Surgery, Surgical Research, University Hospital Muenster, Muenster, Germany; Philips Research Europe, Hamburg, Germany; and Department of Radiology, St. Franziskus Hospital, Muenster, Germany
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Primary Pain Palliation and Local Tumor Control in Bone Metastases Treated With Magnetic Resonance-Guided Focused Ultrasound. Invest Radiol 2013; 48:351-8. [DOI: 10.1097/rli.0b013e318285bbab] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Brader P, Menu Y, Kreuzer S, Polanec S, Mayerhoefer M, Herold C. Onkologische Bildgebung. Radiologe 2013; 53:303-12. [DOI: 10.1007/s00117-012-2431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Progress in using circulating tumor cell information to improve metastatic breast cancer therapy. JOURNAL OF ONCOLOGY 2013; 2013:702732. [PMID: 23589716 PMCID: PMC3621388 DOI: 10.1155/2013/702732] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/20/2013] [Indexed: 12/17/2022]
Abstract
Circulating tumor cells (CTCs) were discovered nearly 150 years ago but have only recently been recognized as a feature of most solid tumors due to their extremely low concentration in the peripheral circulation. Several technologies have been developed to isolate and analyze CTCs, which can now be routinely accessed for clinical information. The most mature of these (the CELLSEARCH system) uses immunomagnetic selection of epithelial cell adhesion molecule to isolate CTCs for analysis. Studies using this system have demonstrated that categorization of patients into high and low CTC groups using a validated decision point is prognostic in patients with metastatic breast, colorectal, or prostate cancer. Initial attempts to use CTC counts to guide therapeutic decisions appeared to yield positive results and key concepts in clinical application of CTC information, including the CTC cutoff, predictive value in disease subtypes, and comparison to current evaluation methods, have been demonstrated. Clinical studies of the impact of CTC counts in routine clinical practice are ongoing; however, recent published evidence on the clinical use of CTCs in metastatic breast cancer continues to support these concepts, and experience in the community oncology setting also suggests that CTC enumeration can be useful for therapy management.
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Abstract
Personalized oncology is evidence-based, individualized medicine that delivers the right care to the right cancer patient at the right time and results in measurable improvements in outcomes and a reduction on health care costs. Evolving topics in personalized oncology such as genomic analysis, targeted drugs, cancer therapeutics and molecular diagnostics will be discussed in this review. Biomarkers and molecular individualized medicine are replacing the traditional "one size fits all" medicine. In the next decade the treatment of cancer will move from a reactive to a proactive discipline. The essence of personalized oncology lies in the use of biomarkers. These biomarkers can be from tissue, serum, urine or imaging and must be validated. Personalized oncology based on biomarkers is already having a remarkable impact. Three different types of biomarkers are of particular importance: predictive, prognostic and early response biomarkers. Tools for implementing preemptive medicine based on genetic and molecular diagnostic and interventions will improve cancer prevention. Imaging technologies such as Computed Tomography (CT) and Positron Emitted Tomography (PET) are already influencing the early detection and management of the cancer patient. Future advances in imaging are expected to be in the field of molecular imaging, integrated diagnostics, biology driven interventional radiology and theranostics. Molecular diagnostics identify individual cancer patients who are more likely to respond positively to targeted chemotherapies. Molecular diagnostics include testing for genes, gene expression, proteins and metabolites. The use of companion molecular diagnostics is expected to grow significantly in the future and will be integrated into new cancer therapies a single (bundled) package which will provide greater efficiency, value and cost savings. This approach represents a unique opportunity for integration, increased value in personalized oncology.
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Affiliation(s)
- Madhu Kalia
- Department of Biochemistry, Jefferson Medical College of Thomas Jefferson University, Suite 520, 1020 Walnut Street, Philadelphia, PA 19107, USA.
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31
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Kircher MF, Hricak H, Larson SM. Molecular imaging for personalized cancer care. Mol Oncol 2012; 6:182-95. [PMID: 22469618 PMCID: PMC5528375 DOI: 10.1016/j.molonc.2012.02.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 12/19/2022] Open
Abstract
Molecular imaging is rapidly gaining recognition as a tool with the capacity to improve every facet of cancer care. Molecular imaging in oncology can be defined as in vivo characterization and measurement of the key biomolecules and molecularly based events that are fundamental to the malignant state. This article outlines the basic principles of molecular imaging as applied in oncology with both established and emerging techniques. It provides examples of the advantages that current molecular imaging techniques offer for improving clinical cancer care as well as drug development. It also discusses the importance of molecular imaging for the emerging field of theranostics and offers a vision of how molecular imaging may one day be integrated with other diagnostic techniques to dramatically increase the efficiency and effectiveness of cancer care.
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Affiliation(s)
- Moritz F. Kircher
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
| | - Steven M. Larson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
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Medical imaging in personalised medicine: a white paper of the research committee of the European Society of Radiology (ESR). Insights Imaging 2011; 2:621-630. [PMID: 22347981 PMCID: PMC3259336 DOI: 10.1007/s13244-011-0125-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/04/2011] [Indexed: 11/07/2022] Open
Abstract
The future of medicine lies in early diagnosis and individually tailored treatments, a concept that has been designated ‘personalised medicine’ (PM), i.e. delivering the right treatment to the right patient at the right time. However, the value of medical imaging in PM is frequently underestimated, as many policy makers forget the all-important right location in the PM paradigm. Medical imaging has always been personalised as it provides individual assessment of the location and extent of an abnormality, and in the future it will prove fundamental to almost all aspects of PM. Stratification based on imaging biomarkers can help identify individuals suited for preventive intervention and can improve disease staging. In vivo visualisation of locoregional physiological, biochemical and biological processes using molecular imaging can detect diseases in pre-symptomatic phases or facilitate individualised drug delivery. Furthermore, imaging is essential to patient-tailored therapy planning, therapy monitoring and follow-up of disease progression, as well as targeting non-invasive or minimally invasive treatments, especially with the rise of theranostics. For PM to reach its full potential, medical imaging must be an integral part. Radiologists need to be prepared for this new paradigm as it will mean changes in training, in research and in clinical practice.
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