Tumor vascularity: evaluation in a murine model with contrast-enhanced color Doppler US effect of angiogenesis inhibitors

Clinical diagnostic value of contrast-enhanced ultrasonography in the diagnosis of cardiac masses: A pilot study

OBJECTIVES

To assess the qualitative and quantitative characteristics of suspected cardiac masses by contrast-enhanced ultrasonography (CEUS) and to evaluate its usefulness.

METHODS

Twenty-eight adult patients with suspected cardiac masses were selected for this study. All of them were examined by conventional transthoracic echocardiography (TTE) and CEUS. The location, attachment point, basement, morphology, size, boundary, internal echo, shape change, range of motion, length, area, effect on hemodynamics, and peak enhancement of the masses (A1), and adjacent normal myocardium (A2) were measured. Then, the A1 to A2 ratio was calculated and the above parameters were analyzed.

RESULTS

The benign lesions showed regular morphology and clear-boundary uniform enhancement of the contrast agent. Malignant lesions showed an irregular shape, unclear boundary with surrounding tissue, and uneven enhancement of the contrast agent. The normal myocardial perfusion intensity was the same; there was no enhancement inside a simple thrombus, and the A1 of the benign lesion was lower than that of the normal myocardium (mean value [dB] ± SD, 0.63 ± 0.42); the A2 of the malignant lesion was higher than that of the normal myocardium (mean value [dB] ± SD, 1.49 ± 0.09). The difference in the ratio of A1 to A2 between groups was statistically significant (P < .05).

CONCLUSIONS

Contrast-enhanced ultrasonography can assess the basic biological characteristics and properties of cardiac masses and has a high diagnostic accuracy for differentiation of a thrombus from a tumor or a benign tumor from a malignant tumor.

Evaluation of cardiac masses by real-time perfusion imaging echocardiography

Background

Diagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization.

Methods

We prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (β), and microvascular blood flow (A x β) were determined by quantitative RTPE.

Results

Logistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1–7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x β values were 0.0 dB/s⁻¹ (0.01–0.14), 2.00 dB/s⁻¹ (1–6), and 1.18 dB/s⁻¹ (0.52–3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Axβ = 2.46 dB/s⁻¹ (1.42–4.59) versus Axβ = 1.55 dB/s [1] (0.51-4.08); p = NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT.

Conclusion

RTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.

Non-invasive imaging for studying anti-angiogenic therapy effects

Noninvasive imaging plays an emerging role in preclinical and clinical cancer research and has high potential to improve clinical translation of new drugs. This article summarises and discusses tools and methods to image tumour angiogenesis and monitor anti-angiogenic therapy effects. In this context, micro-computed tomography (µCT) is recommended to visualise and quantify the micro-architecture of functional tumour vessels. Contrast-enhanced ultrasound (US) and magnetic resonance imaging (MRI) are favourable tools to assess functional vascular parameters, such as perfusion and relative blood volume. These functional parameters have been shown to indicate anti-angiogenic therapy response at an early stage, before changes in tumour size appear. For tumour characterisation, the imaging of the molecular characteristics of tumour blood vessels, such as receptor expression, might have an even higher diagnostic potential and has been shown to be highly suitable for therapy monitoring as well. In this context, US using targeted microbubbles is currently evaluated in clinical trials as an important tool for the molecular characterisation of the angiogenic endothelium. Other modalities, being preferably used for molecular imaging of vessels and their surrounding stroma, are photoacoustic imaging (PAI), near-infrared fluorescence optical imaging (OI), MRI, positron emission tomography (PET) and single photon emission computed tomography (SPECT). The latter two are particularly useful if very high sensitivity is needed, and/or if the molecular target is difficult to access. Carefully considering the pros and cons of different imaging modalities in a multimodal imaging setup enables a comprehensive longitudinal assessment of the (micro)morphology, function and molecular regulation of tumour vessels.

New noninvasive ultrasound techniques: can they predict liver cirrhosis?

OBJECTIVE

This study aimed to determine the threshold values and accuracy of 2 noninvasive techniques, contrast-enhanced ultrasound with maximum-intensity projection (MIP) imaging and ultrasound elastography, acoustic radiation force impulse (ARFI), to differentiate a normal from a cirrhotic liver.

MATERIALS AND METHODS

One hundred thirty-two patients were predicted clinically as having a normal liver (n = 60) or cirrhosis (n = 72). All had MIP liver vessel evaluation on an Acuson Sequoia and 90 of them had ARFI on an S2000 (Siemens, Mountain View, Calif). Two readers reviewed 4 parameters on MIP data and predicted cirrhosis (n = 65) or normal (n = 67) outcome. They were considered as having cirrhosis when more than 1 MIP parameter was positive. Acoustic radiation force impulse values above 1.36 m/s suggested cirrhosis. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic accuracy of the ARFI measurement and to extract the optimal cutoff value in the differentiation of a cirrhotic liver from a noncirrhotic liver.

RESULTS

Sixty-four patients (64/65, 98.5%) with abnormal and 8 (8/59, 13.6%) with normal vessels on MIP imaging were clinically cirrhosis (P < 0.001). Forty-five patients (45/49, 91.8%) with abnormal ARFI (≥ 1.36 m/s) and 6 (6/41, 14.6%) with normal ARFI (<1.36 m/s) had a clinical cirrhotic liver (P < 0.001). Sensitivity and specificity of MIP of vessel morphology to predict cirrhosis were 89% (64/72) and 98% (59/60), respectively. Acoustic radiation force impulse showed a sensitivity of 88% (45/51) and a specificity of 90% (35/39), and the area under the receiver operating characteristic curve was 0.932, suggesting very good accuracy. The combination of ARFI and MIP showed increased sensitivity and specificity to 95.8% and 100%.

CONCLUSIONS

Liver evaluation with MIP and ARFI contributes to a noninvasive prediction of cirrhosis.

Quantitative evaluation of viable tissue perfusion changes with contrast-enhanced greyscale ultrasound in a mouse hepatoma model following treatment with different doses of thalidomide

OBJECTIVE

This study aimed to quantify intratumoural viable tissue perfusion with contrast-enhanced greyscale ultrasound to evaluate tumour response to anti-angiogenic treatment.

METHODS

H22 hepatoma-bearing mice were treated with low-dose thalidomide (Group B), high-dose thalidomide (Group C) or 0.5% carboxylmethylcellulose (Group A). Contrast-enhanced greyscale ultrasound was performed after 7 days of treatments to evaluate the percentage of non-enhanced area for each tumour; regions of interest within the enhanced area were analysed offline to determine the area under the curve (AUC), maximum intensity (IMAX), perfusion index (PI), mean transit time (MTT), time to peak (TTP) and quality of fit (QOF). Immunohistochemical analysis was performed for evaluation of microvascular density (MVD).

RESULTS

The percentage of non-enhanced area was significantly larger in Group C than in Groups A and B (p<0.05); however, there was no significant difference between Groups A and B. Treatment with thalidomide resulted in a significant decrease in AUC, PI and IMAX compared with Group A (p<0.05). Immunohistochemistry showed significant decreases in MVD in Groups B and C compared with Group A (p<0.05); however, there was no significant difference in MVD between Groups B and C. MVD was positively correlated with IMAX (r = 0.419, p = 0.023) and PI (r = 0.455, p = 0.013).

CONCLUSION

Quantitatively analysing intratumoural viable tissue perfusion enables early evaluation of tumour response to anti-angiogenic therapy before apparent changes in tumour necrosis.

Diagnostic and therapeutic imaging for cancer: therapeutic considerations and future directions

As cancer treatment cost soar and the mantra for "personalized medicine" grows louder, we will increasingly be searching for solutions to these diametrically opposed forces. In this review we highlight several exciting novel imaging strategies including MRI, CT, PET SPECT, sentinel node, and ultrasound imaging that hold great promise for improving outcomes through detection of lymph node involvement. We provide clinical data that demonstrate how these evolving strategies have the potential to transform treatment paradigms.

Contrast enhanced maximum intensity projection ultrasound imaging for assessing angiogenesis in murine glioma and breast tumor models: A comparative study

The purpose of this study was to prospectively compare noninvasive, quantitative measures of vascularity obtained from four contrast enhanced ultrasound (US) techniques to four invasive immunohistochemical markers of tumor angiogenesis in a large group of murine xenografts. Glioma (C6) or breast cancer (NMU) cells were implanted in 144 rats. The contrast agent Optison (GE Healthcare, Princeton, NJ) was injected in a tail vein (dose: 0.4ml/kg). Power Doppler imaging (PDI), pulse-subtraction harmonic imaging (PSHI), flash-echo imaging (FEI), and Microflow imaging (MFI; a technique creating maximum intensity projection images over time) was performed with an Aplio scanner (Toshiba America Medical Systems, Tustin, CA) and a 7.5MHz linear array. Fractional tumor neovascularity was calculated from digital clips of contrast US, while the relative area stained was calculated from specimens. Results were compared using a factorial, repeated measures ANOVA, linear regression and z-tests. The tortuous morphology of tumor neovessels was visualized better with MFI than with the other US modes. Cell line, implantation method and contrast US imaging technique were significant parameters in the ANOVA model (p<0.05). The strongest correlation determined by linear regression in the C6 model was between PSHI and percent area stained with CD31 (r=0.37, p<0.0001). In the NMU model the strongest correlation was between FEI and COX-2 (r=0.46, p<0.0001). There were no statistically significant differences between correlations obtained with the various US methods (p>0.05). In conclusion, the largest study of contrast US of murine xenografts to date has been conducted and quantitative contrast enhanced US measures of tumor neovascularity in glioma and breast cancer xenograft models appear to provide a noninvasive marker for angiogenesis; although the best method for monitoring angiogenesis was not conclusively established.

Contrast-enhanced ultrasonic parametric perfusion imaging in the evaluation of antiangiogenic tumor treatment

PURPOSE

To assess the validity of contrast-enhanced ultrasonic parametric perfusion imaging in the evaluation of antiangiogenic tumor treatment by using histology as the reference standard.

MATERIALS AND METHODS

H22 hepatoma-bearing mice were treated with thalidomide or placebo by intraperitoneal injection. Contrast-enhanced ultrasound was performed on day 8 after bolus injection of SonoVue. Three different parametric perfusion images were calculated based on the following parameters: area under the curve (AUC), maximum intensity (IMAX) and perfusion index (PI). A score from 1 to 5 (1 = low, 5 = excellent) was used for analysis of parametric perfusion images by two independent readers. Immunohistochemical analysis was performed for evaluation of microvascular density (MVD).

RESULTS

Treatment with thalidomide resulted in a significant decrease in perfusion scores assigned to AUC, IMAX and PI parametric images as compared with control tumors (P < 0.001). Immunohistochemistry showed significant decreases of MVD in treated tumors as compared with control tumors (P = 0.002). MVD was positively correlated with the perfusion scores assigned to AUC parametric images (r = 0.568, P = 0.009), IMAX parametric images (r = 0.614, P = 0.004) and PI parametric images (r = 0.636, P = 0.003).

CONCLUSION

Contrast-enhanced ultrasonic parametric perfusion imaging provides a noninvasive tool to directly visualize tumor perfusion changes after antiangiogenic tumor treatment.

Contrast-enhanced ultrasound for molecular imaging of angiogenesis

INTRODUCTION

Molecular imaging of angiogenesis using contrast-enhanced ultrasound allows for functional, real-time, inexpensive imaging of angiogenesis. The addition of stabilized microbubbles as contrast agents greatly improves ultrasound signal to noise ratio/signal strength/image quality (up to 25 dB) and allows for imaging of angiogenic vasculature.

METHODS

In this article recent advances in the usage of contrast-enhanced ultrasound for molecular imaging of angiogenesis are reviewed.

RESULTS

The usage of commercially available agents and correlations between their imaging parameters and molecular markers of angiogenesis are reviewed. Recent developments in ultrasound contrast agents targeted to angiogenic markers for both diagnosis and monitoring are discussed. Finally, a brief overview of the emerging field of chemotherapeutic-loaded agents, which can be used with ultrasound-triggered drug delivery, is provided.

Antiangiogenic tumor treatment: noninvasive monitoring with contrast pulse sequence imaging for contrast-enhanced grayscale ultrasound

RATIONALE AND OBJECTIVES

This study was designed to test the feasibility of contrast pulse sequencing imaging for contrast-enhanced grayscale ultrasound in assessing the effects of antiangiogenic therapy.

MATERIALS AND METHODS

Mice with subcutaneously implanted H22 mouse hepatoma were treated with thalidomide or placebo by oral gavage over 7 days, starting at 24 hours after implantation. Contrast pulse sequencing ultrasound imaging was performed on day 8 to evaluate maximal cross-sectional area and nonenhanced area. Immediately after imaging, mice were euthanized, and tumor tissue was removed for fixation in a 10% formalin solution. The section equivalent to the ultrasound imaging plane was stained with hematoxylin and eosin to allow for the assessment of the largest cross-sectional area and necrotic area.

RESULTS

There was no significant difference in tumor volume between the two groups. The difference of largest cross-sectional area determined by the two methods was not significant between control and treated tumors (P > .05). The nonenhanced area and its percentage evaluated by ultrasound were significantly larger in treated tumors than in control tumors (P < .05). The necrotic area and its percentage estimated by pathology slice were also significantly larger in treated tumors than in control tumors (P < .05). The largest cross-sectional area determined by the two methods was well correlated (r = 0.815, P < .001). There was good correlation between the nonenhanced area on ultrasound and the necrotic area on pathology slides (r = 0.909, P < .001). The percentage of nonenhanced area was well correlated with the percentage of necrotic area (r = 0.910, P < .001).

CONCLUSION

Contrast-enhanced grayscale ultrasound with contrast pulse sequencing imaging provides a tool for early monitoring of antiangiogenic treatment of tumors, before apparent change in tumor size.

Correlation of quantified contrast-enhanced sonography with in vivo tumor response

OBJECTIVE

The purpose of our study was to establish in vivo criteria for monitoring tumor treatment response using 3-dimensional (3D) volumetric gray scale, power Doppler, and contrast-enhanced sonography.

METHODS

Twelve mice were implanted with Lewis lung carcinoma cells on their hind limbs and categorized to 4 groups: control, chemotherapy, radiation therapy, and chemoradiation. A high-frequency ultrasound system with a 40-MHz probe was used to image the tumors. Follow-up contrast-enhanced sonography was performed on days 7 and 14 of treatment with two 50-microL boluses of a perflutren microbubble contrast agent injected into the tail vein. The following contrast-enhanced sonographic criteria were quantified: time to peak, peak intensity, alpha (microvessel cross-sectional area), and beta (microbubble velocity). Three-dimensional power Doppler images were also obtained after the acquisition of contrast data. On day 15, the tumors were excised for immunohistochemical analysis with CD31 fluorescent staining.

RESULTS

The tumor size and 3D power Doppler vascular index showed no statistically significant correlation with microvascular density in all examined groups. Among all of the analyzed contrast-enhanced sonographic parameters, relative alpha showed the strongest correlation with the histologic microvessel density (Pearson r = 0.93; P < .01) and an independent association with the histologic data in a multiple regression model (beta = .93; R(2) = 0.86; P < .01).

CONCLUSIONS

Of the various examined sonographic parameters, alpha has the strongest correlation with histologic microvessel density and may be the parameter of choice for the noninvasive monitoring of tumor angiogenic response in vivo.

Delta-projection imaging on contrast-enhanced ultrasound to quantify tumor microvasculature and perfusion

RATIONALE AND OBJECTIVES

The aim of this study was to assess the Delta-projection image processing technique for visualizing tumor microvessels and for quantifying the area of tissue perfused by them on contrast-enhanced ultrasound images.

MATERIALS AND METHODS

The Delta-projection algorithm was implemented to quantify perfusion by tracking the running maximum of the difference (Delta) between the contrast-enhanced ultrasound image sequence and a baseline image. Twenty-five mice with subcutaneous K1735 melanomas were first imaged with contrast-enhanced grayscale and then with minimum-exposure contrast-enhanced power Doppler (minexCPD) ultrasound. Delta-projection images were reconstructed from the grayscale images and then used to evaluate the evolution of tumor vascularity during the course of contrast enhancement. The extent of vascularity (ratio of the perfused area to the tumor area) for each tumor was determined quantitatively from Delta-projection images and compared to the extent of vascularity determined from contrast-enhanced power Doppler images. Delta-projection and minexCPD measurements were compared using linear regression analysis.

RESULTS

Delta-projection was successfully performed in all 25 cases. The technique allowed the dynamic visualization of individual blood vessels as they filled in real time. Individual tumor blood vessels were distinctly visible during early image enhancement. Later, as an increasing number of blood vessels were filled with the contrast agent, clusters of vessels appeared as regions of perfusion, and the identification of individual vessels became difficult. Comparisons were made between the perfused area of tumors in Delta-projections and in minexCPD images. The Delta-projection perfusion measurements were correlated linearly with minexCPD.

CONCLUSION

Delta-projection visualized tumor vessels and enabled the quantitative assessment of the tumor area perfused by the contrast agent.

Monitoring angiogenesis in human melanoma xenograft model using contrast-enhanced ultrasound imaging

The potential for noninvasive monitoring and quantification of tumor angiogenesis with contrast-enhanced ultrasound imaging has been investigated in a murine cancer model. Seventy athymic nude mice were implanted with the human melanoma cell line DB-1 but only 30 of these were available for the final study. The 30 mice were divided into three groups (10 mice/group), which were studied with contrast-enhanced ultrasound imaging 4, 5 or 6 weeks post-implantation. Power Doppler and pulse inversion harmonic imaging (PIHI) were performed (in real time and intermittently) with a Sonoline Elegra scanner (Siemens Medical Solutions, Issaquah, WA) following injection of Optison (dose: 0.4-0.6 ml/kg; GE Healthcare, Princeton, NJ). Ultrasound results were compared to immunohistochemical stains for endothelial cells (CD31), vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2). Linear regression analysis indicated statistically significant correlations between the percent area stained with VEGF and ultrasound measures of tumor neovascularity obtained with all three techniques (p < 0.01). Contrast-enhanced ultrasound imaging of tumor neovascularity appears to provide a noninvasive marker of angiogenesis corresponding to the expression of VEGF in the DB-1 model and may become a useful tool for monitoring clinical anti-angiogenic therapies.

Contrast-enhanced ultrasound imaging of intraplaque neovascularization in carotid arteries: correlation with histology and plaque echogenicity

OBJECTIVES

This study was designed to evaluate contrast-enhanced ultrasound imaging of carotid atherosclerosis as a clinical tool to study intraplaque neovascularization.

BACKGROUND

Plaque neovascularization is associated with plaque vulnerability and symptomatic disease; therefore, imaging of neovascularization in carotid atherosclerosis may represent a useful tool for clinical risk stratification and monitoring the efficacy of antiatherosclerotic therapies.

METHODS

Thirty-two patients with 52 carotid plaques were studied by standard and contrast-enhanced ultrasound imaging. In 17 of these patients who underwent endarterectomy, the surgical specimen was available for histological determination of microvessel density by CD31/CD34 double staining. Plaque echogenicity and degree of stenosis at standard ultrasound imaging were evaluated for each lesion. Contrast-agent enhancement within the plaque was categorized as absent/peripheral (grade 1) and extensive/internal (grade 2).

RESULTS

In the surgical subgroup, plaques with higher contrast-agent enhancement showed a greater neovascularization at histology (grade 2 vs. grade 1 contrast-agent enhancement: median vasa vasorum density: 3.24/mm(2) vs. 1.82/mm(2), respectively, p = 0.005). In the whole series of 52 lesions, echolucent plaques showed a higher degree of contrast-agent enhancement (p < 0.001). Stenosis degree was not associated with neovascularization at histology or with the grade of contrast-agent enhancement.

CONCLUSIONS

Carotid plaque contrast-agent enhancement with sonographic agents correlates with histological density of neovessels and is associated with plaque echolucency, a well-accepted marker of high risk lesions, but it is unrelated to the degree of stenosis. Contrast-enhanced carotid ultrasound imaging may provide valuable information for plaque risk stratification and for assessing the response to antiatherosclerotic therapies, beyond that provided by standard ultrasound imaging.

Molecular imaging in drug development

Molecular imaging can allow the non-invasive assessment of biological and biochemical processes in living subjects. Such technologies therefore have the potential to enhance our understanding of disease and drug activity during preclinical and clinical drug development, which could aid decisions to select candidates that seem most likely to be successful or to halt the development of drugs that seem likely to ultimately fail. Here, with an emphasis on oncology, we review the applications of molecular imaging in drug development, highlighting successes and identifying key challenges that need to be addressed for successful integration of molecular imaging into the drug development process.

Dose-response relationship of ultrasound contrast agent in an in vivo murine melanoma model

Many factors affect the sensitivity and reliability of tumor vasculature assessment at the small doses of contrast agent necessary for imaging mice. In this study we investigate the dose-response relationship of ultrasound contrast agent for a minimal exposure power Doppler technique (minexPD) in a murine melanoma model. K1735 murine melanomas grown in 25 C3H/HeN mice were imaged by power Doppler ultrasound using different doses of contrast agents, Optison(R) and Definity(R). Six mice were treated with an antivascular agent, combretastatin A4-phosphate (CA4P), and imaged before and after treatment. The color-weighted fractional area (CWFA) of the peak-enhanced image was measured to assess tumor perfusion on a relative scale of 0 to 100. CWFA increased logarithmically with dose (R(2)=0.97). Treatment with CA4P resulted in pronounced reduction in tumor perfusion 2 h after contrast injection, but perfusion recovered in the tumor periphery after 2 days. CWFA was significantly different between pre- and post-treatment for all doses at 2 h and 2 days (p < 0.05, respectively). There was no significant difference detectable between the two contrast agents, Optison(R) and Definity(R) (p = 0.46). In vivo tumor enhancement in mice increases as logarithmic function with dose. Although the extent of enhancement is dose dependent, the difference between pre- and post-therapy enhancement is relatively unchanged and uniform at varying doses. The two contrast agents tested in this study performed equally well. These results suggest that quantitative contrast-enhanced power Doppler imaging is an effective method for monitoring therapy response of tumors in mice.

Detecting vascular changes in tumour xenografts using micro-ultrasound and micro-ct following treatment with VEGFR-2 blocking antibodies

Blockade of vascular endothelial growth factor (VEGF) binding to its receptors on endothelial cells has been shown preclinically to induce tumour growth inhibition. Using ultrasound biomicroscopy (UBM) or micro-ultrasound imaging and micro-computed tomography (micro-CT) analysis, we have examined the effects of DC101, a highly specific vascular endothelial growth factor receptor-2 (VEGFR-2)-targeting antibody, in inducing growth inhibition and functional vascular changes in established melanoma (MeWo) xenografts in mice. Postprocessing of UBM imaging loops for speckle variance was introduced to estimate the level of functional blood flow in tumours. Perfused tumour area visualized by speckle variance revealed decreased blood flow within 48 h after DC101 injection (control versus DC101: 1.90 +/- 0.25% versus 1.01 +/- 0.11%, p < 0.01) and following a 3-wk DC101 therapy (control versus DC101: 0.76 +/- 0.14% versus 0.45 +/- 0.05%, p = 0.04), suggesting that VEGFR-2 blockade mediates both early and long-term effects on tumour blood flow. The growth of xenografts was significantly inhibited after treating with DC101 for 3 wk compared with controls. In addition to UBM, we examined the tumour vasculature in three-dimension (3D) using contrast-enhanced Micro-CT imaging, which displayed a reduction in the number of tumour vessels following extended VEGFR-2 blockade (vascular density of control versus DC101: 48.4 +/- 5.4% versus 20.6 +/- 1.8%). Lastly, decreased microvessel density (MVD) was noted in DC101-treated xenografts (3 wk) by performing immunohistochemical staining of endothelial marker CD34. Our study investigates tumour response to DC101 using complementing micro-ultrasound and micro-CT imaging tools.

Parametric imaging of contrast ultrasound for the evaluation of neovascularization in liver tumors

AIM

To assess the efficacy of parametric imaging for the diagnosis of neovascularization in liver tumors.

METHODS

The subjects were 17 rabbits (five with normal liver and 12 with VX2 tumor implanted in the liver). The contrast agents used were SonoVue (Bracco, Milan, Italy). A diagnostic ultrasound system was used with a programmable replenishment sequence. The images obtained between the initial frame after the high mechanical index (MI) scan, which diminishes microbubbles in the scan volume, and the current frame were coded in color according to the arrival and peak times. After the experiment, the tumors were excised and sectioned. Sections were prepared for light microscopy with hematoxylin-eosin (HE) staining and CD31 staining to evaluate vascular density.

RESULTS

Arrival time imaging (ATI) delineated the fine blood vessels (100-200 mum in diameter) in all of the rabbits. Tortuous and meandering tumor vessels were visualized in the VX2 tumors. Differences of perfusion velocity between tumor tissue and tumor-free areas were shown in peak time imaging (PTI). Vascularity evaluated on the ATI and perfusion speed recognized on the ATI and PTI were related to the vascular density measured by pathological investigation.

CONCLUSION

Parametric imaging is a promising new method for the visualization of perfusion and the estimation of tumor blood vessels.

Ultrasonic assessment of hepatic blood flow as a marker of mouse hepatocarcinoma

Two-dimensional color-coded pulsed Doppler ultrasonography (US) with a 12-MHz linear transducer was used to follow tumor growth and neoangiogenesis development in 12 transgenic mice developing a whole liver hepatocellular carcinoma (HCC) induced by the expression of SV40-T antigen. In this model, male mice developed HCC at various temporal and histologic stages (hyperplastic, four-eight wk; nodular, 12 wk; diffuse carcinoma, 16-20 wk), whereas female mice remained tumor free. Seven age-matched tumor-free mice were used as controls. Liver volume was calculated from B-mode images of the abdomen. Blood flow waveforms were recorded from the hepatic tumor-feeding artery upstream from the tumor vessels, allowing quantitative blood flow velocity measurements. Measurements were performed every four weeks from four to 20 weeks. As early as the hyperplastic stage (eight weeks), liver volume was increased by 2.7-fold, hepatic artery peak-systolic blood flow velocities (BFV) by 1.5-fold, end-diastolic BFV by 1.6-fold and mean BFV by 2.0-fold compared with control values (p < 0.001). Differences increased until 20 weeks and peak-systolic reached 90 +/- 6, end-diastolic 54 +/- 5 and mean BFV 48 +/- 5 cm s(-1). Successive measurements of BFV were reproducible and intraobserver repeatability coefficient values were <3 cm s(-1). In contrast, mesenteric artery BFV, which did not supply tumor region, did not show any significant difference with respect to control values. Thus, an increase in BFV constitutes a functional evaluation of tumor vascularity. In preclinical studies in small animals, measurements of liver volume and blood flow velocities in hepatic tumor-feeding artery provide a useful, reproducible, noninvasive, easy-to-repeat tool to monitor tumor growth and neoangiogenesis in hepatocellular carcinoma in mice.

L’échographie haute résolution de la souris

Small-animal ultrasound imaging has been made possible using high-resolution imaging devices. The spatial resolution is therefore sufficient to accurately measure anatomical parameters in mice. This paper reviews some of the main applications of high-resolution ultrasound imaging of the mouse and highlights what could be the forthcoming advances.

Dynamic assessment of antiangiogenic therapy by monitoring both tumoral vascularization and tissue degeneration

Tumor growth is dependent both on endothelial and tumor cells. The aim of this study was to investigate dynamically whether changes in tumor vasculature implicate tumor tissue degeneration during antiangiogenic therapies. In order to quantify intra-tumor vascularization and necrosis, we have used ultrasound technology. This study has identified essential parameters needed to quantify specifically and sensitively the number of microvessels and the extent of necrosis in xenografted human carcinomas during natural tumor evolution, using contrast-enhanced high-frequency ultrasonography with (HFCDUS) or without (HFUS) color Doppler. We showed that quantification of intra-tumor microvessels between HFCDUS and immunohistochemistry is correlated using an anti-CD31 antibody. Furthermore, quantification of tumor necrosis with HFUS was confirmed by histological examination of hematoxylin-eosin-saffranin-stained sections over the observation period. Subsequently, for the assessment of novel angiogenic inhibitors, HFCDUS and HFUS were used to elucidate the underlying dynamics linking vessel inhibition and tumor eradication. We describe a novel application for HFCDUS/HFUS that constitutes an effective, convenient, and non-invasive method for clinical assessment of angiogenic inhibitors. In conclusion, we showed that tumor cells abruptly became necrotic following an antivascular therapy, whereas untreated tumors were protected from degeneration by a significant blood supply.

Angiogenesis inhibitors in a murine neuroblastoma model: quantitative assessment of intratumoral blood flow with contrast-enhanced gray-scale US

PURPOSE

To quantify intratumoral ultrasonographic (US) contrast agent flow at gray-scale imaging as a measure of functional tumor vascularity in an orthotopic murine neuroblastoma model treated with angiogenesis inhibitors.

MATERIALS AND METHODS

After Institutional Animal Care and Use Committee approval, retroperitoneal neuroblastomas were established in mice with unmodified NXS2 cells (n = 13) or with cells engineered to overexpress an angiogenesis inhibitor--either tissue inhibitor of matrix metalloproteinase-3 (n = 22) or a truncated soluble form of the vascular endothelial growth factor receptor-2 (truncated soluble fetal liver kinase-1; n = 13). When tumors were approximately 600 mm3, contrast material-enhanced gray-scale US was performed, and the imaging was recorded on cine clips. Regions of interest within tumors were analyzed off-line to determine postcontrast change in signal intensity (SI) from baseline to initial peak (deltaSI), rate of SI increase from baseline to initial peak (RSI), and contrast material washout. The Mann-Whitney test was used to evaluate potential differences in these US parameters between treatment groups. The mean intratumoral endothelial cell (CD34) and pericyte (smooth muscle actin [SMA]) counts at immunohistochemical analysis were also evaluated. Spearman correlation test was used to investigate the relation between US parameters and these histologic markers.

RESULTS

The deltaSI and RSI were lower in tumors overexpressing an angiogenesis inhibitor than in control tumors (all P < .03). Contrast material washout did not differ between groups. For the entire cohort, the RSI correlated with the immunohistochemical assessment of tumor vascularity (SMA and CD34 counts) (P < .003).

CONCLUSION

Quantification of intratumoral flow of a US contrast agent at gray-scale imaging shows promise for monitoring tumor vascular response to antiangiogenic therapy.

New technologies and directed agents for applications of cancer imaging

Molecular imaging represents tissue-specific imaging and quantification of physiologic (functional) and molecular events in tumors utilizing new noninvasive imaging modalities, radioligands, and contrast agents. It combines anatomic, physiologic, and metabolic information in a single imaging session. Molecular imaging relies on the ability to target genes and proteins that are linked directly or indirectly to human disease. New imaging biomarkers are being developed. In addition, functional and molecular imaging can potentially replace anatomic longitudinal studies by assessing treatment response earlier. Vascular targeting agents can be evaluated by imaging of tumor angiogenesis using magnetic resonance imaging (MRI), computed tomography and ultrasound, and positron emission tomography (PET). Targeted contrast agents can accomplish site-directed imaging or therapy by a variety of active and passive mechanisms. Furthermore, there is the possibility of combining different modalities such as ultrasonic imaging and MRI or MRI and PET to increase the flexibility unachievable with either modality alone. However, there is a need to standardize these techniques so that longitudinal evaluation of tumor response to treatment is feasible.

Angiogenesis: noninvasive quantitative assessment with contrast-enhanced functional US in murine model

PURPOSE

To evaluate quantitative functional ultrasonography (US) in a murine gel model by using microbubble destruction kinetics to determine whether parametric indices provided with US could help assess angiogenesis.

MATERIALS AND METHODS

Institutional Animal Subjects Committee approved experiments and procedures. In 36 normal mice, two 0.4-mL gel implants were placed subcutaneously on either side of spine. One implant contained 0.5, 1.0, or 1.5 microg human basic fibroblast growth factor (bFGF) per milliliter of gel. Functional US quantitative analysis of angiogenesis with microbubble contrast agent was performed on days 3, 6, 9, and 12; histologic data were collected. Time-intensity curve of implant was fitted to mathematic decay model to calculate fractional blood volume and fraction of blood replaced per unit of time. Microvascular density (MVD) and percentage of microvascular area (MVA) were measured after anti-CD31 staining. Spearman rank order correlation was used in analyses.

RESULTS

bFGF-containing implants induced MVD of eight, 35, 42, and 42 vessels per square millimeter on days 3, 6, 9, and 12, respectively; in controls, MVD was four vessels/mm2 (P<.05 on days 6, 9, and 12). bFGF-containing implants induced percentage MVA of 2%, 5%, 20%, and 27%, respectively; in controls, it was 0.5% (P<.05). Maximum enhancement was significantly increased in bFGF implants (23.3 gray level+/-14.1 [standard deviation]) compared with controls (11.0+/-5.5, P<.001). Implants containing bFGF showed poor correlations between fractional blood volume and MVD (r2=0.42) or percentage MVA (r2=0.51) at US. There was no correlation between microbubble velocity and MVD (r2<0.05) or percentage MVA (r2<0.13).

CONCLUSION

Functional US perfusion parameters do not correlate with current histologic indices for quantifying angiogenesis. MVD, as a histologic quantitative measurement of angiogenesis, may not be an appropriate standard for contrast-enhanced imaging that relies on perfused neovessels.

Assessment of cyclic changes of microvessels in ovine ovaries using Sonovue contrast-enhanced ultrasound

Our objective was to detect variations of ovarian vascularization that occur in the estrus cycle of the ewe using an IV contrast agent. Five ewes were investigated using contrast-enhanced power Doppler after Sonovue injection at day 0, 3, 5, 10 and 13 of the cycle in two successive estrus cycles. Transvaginal ultrasound monitoring of each ewe was performed after a dose of Sonovue. Parameters derived from the time-intensity curves were compared. Quantification of the enhancement and wash-in period parameters changed significantly between ovaries and between the follicular and luteal periods of the cycle. Uptake time, wash-out time, total time of enhancement and area under the curve were the parameters with the smallest variation between ovaries. Wash-out time and area under the curve are two contrast parameters that did not change with cyclic changes. Thus, using these parameters in premenopausal women will allow more accurate detection of vascular modifications that may be associated with ovarian cancer.

Vaskuläre Bildgebung mittels kontrastverstärkter Sonographie in der experimentellen Anwendung

The possibility of employing contrast-enhanced ultrasound for sensitive detection of perfusion has resulted in new forms of application in fundamental medical biological research that go far beyond mere preclinical evaluation of these techniques. This contribution explains the methods for visualization and quantification of perfusion with contrast-enhanced sonography and provides an overview of how these functional examinations have been used to date. The procedure is generally considered indicated when information on tissue perfusion using ultrasound is required. This topic is also gaining increasing clinical interest, e.g., for assessment of myocardial, cerebral, and renal perfusion or for monitoring therapy. Among the various new treatment procedures that have been investigated in animal models with ultrasound, particularly pro-angiogenic and antiangiogenic therapy approaches predict promising new fields for application of contrast-enhanced ultrasound.

Echo contrast-enhanced power Doppler ultrasonography for assessment of angiogenesis in renal cell carcinoma

OBJECTIVE

Tumoral growth is an angiogenesis-dependent event. Although there are studies about the importance of histopathologic angiogenesis in various malignancies, the assessment of the angiogenesis by radiologic techniques is not well established. The aim of this study was to investigate the efficacy of echo contrast-enhanced power Doppler ultrasonography (PDUS) in determining the angiogenic status of renal cell carcinoma (RCC).

METHODS

Power Doppler ultrasonography was performed before and after intravenous administration of an echo contrast agent in 42 patients with renal masses. Twenty-one of these renal masses were diagnosed as RCC histopathologically, and these 21 patients were reevaluated retrospectively. The color pixel ratios of selected images were calculated as the ratio of the number of pixels showing power Doppler signals to the total number of pixels within the lesion. The results were compared with the histopathologic microvessel density (MVD).

RESULTS

A significant correlation was found between color pixel ratio and MVD values in both PDUS techniques. The use of the echo contrast agent improved this correlation and P values (Spearman rho from 0.436 to 0.551; P from .048 to .01).

CONCLUSIONS

Color pixel ratio values reflect the MVD in RCC. Therefore, these results suggest that preoperative quantification of angiogenesis can be possible with the help of PDUS in RCC.

Property and contrast-enhancement effects of lipid ultrasound contrast agent: a preliminary experimental study

This work investigated the influence of some factors on the property in vitro of a self-made lipid ultrasound (US) contrast agent (LCA) and evaluated the relationship of acoustic pressure and enhancement effect in normal rabbit kidney parenchyma. In the in vitro studies, filling gas, solvent and concentration of LCA solution were investigated. Morphologic characteristics, concentration and mean diameter of microbubbles were considered as indices. In the in vivo studies, contrast-tuned imaging (CnTi) technique was used to investigate the enhancement effects in kidney parenchyma under nine acoustic pressure levels. Among the samples saturated with different filling gases, perfluoropropane (C(3)F(8)) resulted in the highest concentration of microbubbles and air, the lowest. Microbubbles filled with C(3)F(8) or sulfur hexafluoride (SF(6)) were quite stable and remained at a high level of concentration (above 2 x 10(9) microbubbles per mL) much longer than did air-filled microbubbles. Among the four solutions tested, 5% glucose solution and 0.9% saline solution showed higher initial concentrations and greater longevity than dextran 40 glucose solution (6%) or distilled water. The concentration of LCA solution had a positive correlation with the microbubble concentration. All microbubble samples under different test conditions remained shape-complete and no aggregation or fusion was observed. The mean diameter of microbubble samples was about 3.4 microm. Contrast intensity and longevity of CnTi enhancement in vivo showed an acoustic-pressure-dependent decrease. At 1 kPa, contrast intensity increased 224-fold (4.47/0.02) and the longevity of CnTi enhancement in the kidney parenchyma remained longer.

Sonographic depiction of microvessel perfusion: principles and potential

OBJECTIVE

To provide an overview of the technical aspects and potential clinical applications of microvessel perfusion as depicted by microbubble-enhanced sonography.

METHODS

Sonographic depiction of microvessel perfusion was obtained by microbubble-enhanced sonography. This technique was used for imaging in vivo murine tumors and was correlated with magnetic resonance and fluorodeoxyglucose autoradiography. Sonographic estimation of microvessel perfusion used parameters derived from time-activity curves.

RESULTS

Preliminary data indicate that accurate and reproducible quantification of microvessel perfusion is possible with the use of microbubble-enhanced sonography.

CONCLUSIONS

Microbubble-enhanced sonography can depict microvessel perfusion. This technique has several potential clinical applications, including assessment of tumor blood flow and changes that occur with treatment.

Correlation of power Doppler with microvessel density in assessing prostate needle biopsy

AIM

To correlate hypervascular power Doppler ultrasonography with the histological evaluation of microvasculature in the prostate using trans-rectal ultrasound (TRUS)-guided needle biopsy.

MATERIALS AND METHODS

Ninety-six patients with a lower urinary tract symptoms (LUTS) and prostate specific antigen (PSA) value more than 4 ng/ml were evaluated using power Doppler ultrasonography before biopsy. The vascularity of the peripheral zone was graded on a scale of PZ0 to PZ2. Core needle biopsies were immunostained with CD31(DAKO) and counting was performed manually on separate high power fields (HPF; x 400) in areas containing the highest number of vessels.

RESULTS

There was a significant correlation between the grading system used for power Doppler and the microvessel density (MVD; PZ0 28.61 +/- 8.97,PZ1 36.00 +/- 12.11 & PZ2 64.008 +/- 15.86; p < 0.001). There was also a significant difference in MVD between benign, malignant and tissue cores with atypia and prostatic intra-epithelial neoplasia (PIN; p < 0.001 and p < 0.018 respectively). There was a significant correlation between malignant tissue having a higher Gleason score and increased MVD (p < 0.001) Furthermore, cancer biopsies having a high flow PZ2 are nearly twice as likely (63.2%) to have a Gleason score of 7 or more when compared those having a Gleason score of less than 7 (36.8%).

CONCLUSION

The grading system of assessing the power Doppler flow signals appears to be of value as an indicator of MVD. It also correlates with a higher Gleason score and this may reflect the clinical outcome in prostate cancer. It deserves further study and evaluation as a prognostic indicator.

In vivo mapping of spontaneous mammary tumors in transgenic mice using MRI and ultrasonography

PURPOSE

To compare T1- or T2-weighted magnetic resonance imaging (MRI) and ultrasonography (US) as tools for in vivo mapping of different tissue components in spontaneous tumors of transgenic mice.

MATERIALS AND METHODS

Human-like mammary adenocarcinomas from FVB/neuT transgenic mice were analyzed by T2-weighted and T1-weighted MRI at 4.7 Tesla and US and then, after excision, were paraffin-embedded for histologic analysis. The histologic samples were prepared taking care to obtain sections that spatially matched the MRI and US images as precisely as possible.

RESULTS

US can obtain basic information such as the size of developing tumors in experimental animals and can identify necrotic areas. T2-weighted MRI, especially if compared to T1-weighted MRI and/or US, allows advanced analysis of morphologic aspects, with high resolution in the differentiation of details of necrotic areas such as coagulation, liquefaction, biphasic splitting of cysts, and fibrotic and lipidic infiltration.

CONCLUSION

Of the three methods, T2-weighted MRI provides the most information about the anatomy of tumors. However, when distinctions between the different types of necrosis are not needed, US analysis is to be preferred for its practicality.

Color and power Doppler sonography in the diagnosis of prostate cancer: comparison between vascular density and total vascularity

OBJECTIVE

Advances in color flow Doppler (CFD) and power Doppler imaging (PDI) have potential for prostate cancer diagnosis. Previous reports based on qualitative assessment suggest that hypervascularity increases likelihood of prostate cancer. Our objective was to compare 2 methods of vascularity assessment using PDI: total vascularity (TV) and vascular density (VD). The goal was to determine whether quantitative Doppler vascularity correlates with the likelihood of prostate cancer. Quantitative measurements were compared with subjective visual analysis of images.

METHODS

Ninety patients before biopsy had gray scale sonography, CFD, and PDI. Histologic analysis showed adenocarcinoma, prostate intraepithelial neoplasia, benign prostatic hypertrophy/prostatitis, and benign findings. The CFD and PDI images were analyzed for vascularity by (1) integrating the number of blood vessels over an imaged area (TV) and (2) integrating the number of vessels over a unit area of tissue (VD). Images were also assessed visually. VD, TV, and visual assessment were compared with one another and histologic findings.

RESULTS

Mean volume was not different. In each pathologic group, vascularity extent measured by TV and VD ranged from low to high. Disease groups did not exhibit a substantial difference in vascularity by either quantitative or qualitative analyses. Regionally, central gland TV was not significantly more vascular than peripheral gland TV except in benign prostatic hypertrophy. However, peripheral gland VD was 2.5 times greater than central gland VD. Seventy-one percent of the 31 focal hypoechoic lesions were hypervascular. Only 23% were carcinoma.

CONCLUSIONS

Pathologic categories were not separable by apparent vascular measurement. All pathologic categories showed low, moderate, or high vascularity; thus vascular areas by themselves did not distinguish cancer types, nor did focal hypervascular hypoechoic areas increase the likelihood of cancer. These imaging techniques provided no further resolution of tumor discrimination over multiple biopsies of the prostate.

Quantification of tumor vascularity with contrast-enhanced sonography: correlation with magnetic resonance imaging and fluorodeoxyglucose autoradiography in an implanted tumor

OBJECTIVE

To correlate the quantitated tumor vascularity of implanted murine tumors as depicted by contrast-enhanced sonography with estimates made with magnetic resonance imaging and with estimates of the percentage of viable (metabolically active) tumor as depicted by fluorodeoxyglucose autoradiography.

METHODS

Implanted tumors in 10 mice were imaged with contrast-enhanced sonography, magnetic resonance imaging, and fluorodeoxyglucose autoradiography. Tumor vascularity was estimated with each modality and compared with the percentage of viable tumor.

RESULTS

Quantitated estimates of tumor vascularity with contrast-enhanced sonography closely correlated (r = 0.95) with estimates made by magnetic resonance imaging and with the percentage of viable tumor (r = 0.93) as depicted by fluorodeoxyglucose autoradiography.

CONCLUSIONS

Contrast-enhanced sonography accurately depicts tumor vascularity in these implanted tumors. Tumor vascularity correlated with the amount of metabolically active tumor.

Evaluation of the effect of protamine on human prostate carcinoma PC-3m using contrast enhanced Doppler ultrasound

PURPOSE

We evaluated the ability of contrast enhanced Doppler ultrasound (CEDU) to demonstrate changes in tumor vascularity during angiogenesis inhibitive therapy in PC-3m human prostate carcinoma.

MATERIALS AND METHODS

Pieces of human prostate carcinoma PC-3m tumor (Institute of Urology, Beijing University, Beijing, People's Republic of China) were transplanted subcutaneously into 48 male BALB/C nude mice (Center of Animal Quarantine, Beijing, People's Republic of China). Protamine (Shanghai Biochemistry Pharmaceutical Co., People's Republic of China) was injected subcutaneously as an angiogenesis inhibitor. The animals were randomly divided into 3 groups according to protamine dose. The color flow signal-pixel rate (SPR) of the images was calculated using the number of pixels showing color Doppler signals as a ratio of the total number of pixels covering the lesion.

RESULTS

The SPR of the high and low dose groups were significantly lower than that of the control group (p <0.01). Mean SPR +/- SD in the 3 groups was 0.09 +/- 0.05, 0.11 +/- 0.05 and 0.22 +/- 0.10, respectively. SPR correlated significantly with microvessel density (r = 0.86 to 0.94, p <0.01).

CONCLUSIONS

CEDU can effectively reveal the change in vascularity in a tumor that was treated with protamine. In addition to microvessel density, CEDU may become one of several independent prognostic indexes of angiogenesis inhibitor therapy.

Comparison of intermittent-bolus contrast imaging with conventional power Doppler sonography: quantification of tumour perfusion in small animals

Replenishment kinetics of microbubbles were adapted to a single bolus injection to investigate tumour angiogenesis in small animals with intermittent imaging, and to compare vascularisation parameters from this new approach with conventional power Doppler ultrasound (US). A reformulation of the imaging protocol and the derivation of perfusion parameters was necessary, taking into account the time-dependence of the systemic microbubble concentration after single bolus injection. Using this new method, tumour vascularisation was evaluated in 13 experimental murine tumours. Furthermore, parameters calculated with intermittent imaging after bolus injection of 100 microl Levovist were compared with parameters from the signal intensity-time curve. The results showed that quantifying tumour perfusion, blood volume and flow, as well as the assessment of the mean blood velocity (in m/s), is possible in tumours with a volume of more than 0.1 mL. In larger tumours, a lower perfusion was calculated than in smaller ones (k = -0.88; p < 0.001). Only limited correlations were found between conventional power Doppler US quantities and parameters of intermittent sonography: Perfusion correlated with the maximum signal intensity (k = 0.61, p < 0.05) and the gradient to maximum (k = 0.82, p < 0.01), full width-half maximum was associated with blood volume (k = 0.62, p < 0.05). We conclude that intermittent bolus contrast sonography allows the quantification of tumour perfusion, even in small animals, and the monitoring of basic antiangiogenic studies with perfusion parameters shows a higher significance than conventional power Doppler US.

Imaging tumor angiogenesis with contrast ultrasound and microbubbles targeted to alpha(v)beta3

BACKGROUND

Angiogenesis is a critical determinant of tumor growth and metastasis. We hypothesized that contrast-enhanced ultrasound (CEU) with microbubbles targeted to alpha(v)-integrins expressed on the neovascular endothelium could be used to image angiogenesis.

METHODS AND RESULTS

Malignant gliomas were produced in 14 athymic rats by intracerebral implantation of U87MG human glioma cells. On day 14 or day 28 after implantation, CEU was performed with microbubbles targeted to alpha(v)beta3 by surface conjugation of echistatin. CEU perfusion imaging with nontargeted microbubbles was used to derive tumor microvascular blood volume and blood velocity. Vascular alpha(v)-integrin expression was assessed by immunohistochemistry, and microbubble adhesion was characterized by confocal microscopy. Mean tumor size increased markedly from 14 to 28 days (2+/-1 versus 35+/-14 mm2, P<0.001). Tumor blood volume increased by approximately 35% from day 14 to day 28, whereas microvascular blood velocity decreased, especially at the central portions of the tumors. On confocal microscopy, alpha(v)beta3-targeted but not control microbubbles were retained preferentially within the tumor microcirculation. CEU signal from alpha(v)beta3-targeted microbubbles in tumors increased significantly from 14 to 28 days (1.7+/-0.4 versus 3.3+/-1.0 relative units, P<0.05). CEU signal from alpha(v)beta3-targeted microbubbles was greatest at the periphery of tumors, where alpha(v)-integrin expression was most prominent, and correlated well with tumor microvascular blood volume (r=0.86).

CONCLUSIONS

CEU with microbubbles targeted to alpha(v)beta3 can noninvasively detect early tumor angiogenesis. This technique, when coupled with changes in blood volume and velocity, may provide insights into the biology of tumor angiogenesis and be used for diagnostic applications.

Experimental microcomputed tomography study of the 3D microangioarchitecture of tumors

Differences between soft X-ray imaging and microcomputed tomography (micro-CT) in the microangiographic depiction of small vessels in tumors were compared to evaluate the tumors' 3D microangioarchitecture and the progress of growth-related neovascularization. VX2 carcinomas transplanted to the auricles of 24 rabbits randomly assigned to three groups were examined after 1, 3, and 7 days. Eight rabbits without transplants were the controls. Barium sulfate was injected into the auricular artery, and conventional soft X-ray images and micro-CT microangiograms of auricle specimens were studied. Micro-CT detected vessels with diameters of less than 50 microm, and imaging from several angles clearly showed the network of tumor vessels. Moreover, micro-CT confirmed the 3D process of growth-related neovascularization. There were no significant differences between the present findings and those of our previously published microscopic study. Micro-CT should prove useful for evaluating the 3D microarchitecture of tumors and for clear imaging of tumor angiogenesis.

Imaging of angiogenesis: from microscope to clinic

Advances in imaging are transforming our understanding of angiogenesis and the evaluation of drugs that stimulate or inhibit angiogenesis in preclinical models and human disease. Vascular imaging makes it possible to quantify the number and spacing of blood vessels, measure blood flow and vascular permeability, and analyze cellular and molecular abnormalities in blood vessel walls. Microscopic methods ranging from fluorescence, confocal and multiphoton microscopy to electron microscopic imaging are particularly useful for elucidating structural and functional abnormalities of angiogenic blood vessels. Magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), ultrasonography and optical imaging provide noninvasive, functionally relevant images of angiogenesis in animals and humans. An ongoing dilemma is, however, that microscopic methods provide their highest resolution on preserved tissue specimens, whereas clinical methods give images of living tissues deep within the body but at much lower resolution and specificity and generally cannot resolve vessels of the microcirculation. Future challenges include developing new imaging methods that can bridge this resolution gap and specifically identify angiogenic vessels. Another goal is to determine which microscopic techniques are the best benchmarks for interpreting clinical images. The importance of angiogenesis in cancer, chronic inflammatory diseases, age-related macular degeneration and reversal of ischemic heart and limb disease provides incentive for meeting these challenges.