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Lu T, Wang L, Li M, Wang Y, Chen M, Xiao BH, Wáng YXJ. Diffusion-derived vessel density (DDVD) computed from a simple diffusion MRI protocol as a biomarker of placental blood circulation in patients with placenta accreta spectrum disorders: A proof-of-concept study. Magn Reson Imaging 2024; 109:180-186. [PMID: 38513786 DOI: 10.1016/j.mri.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Increasing trend of PAS (placenta accreta spectrum disorders) incidence is a major health concern as PAS is associated with high maternal morbidity and mortality during cesarean section. Prenatal identification of PAS is crucial for delivery planning and patients management. This study aims to explore whether diffusion-derived vessel density (DDVD) computed from a simple diffusion MRI protocol differs in PAS from normal placenta. METHODS We enrolled 86 patients with PAS disorders and 40 pregnant women without PAS disorders. Each patient underwent intravoxel incoherent motion (IVIM) MRI sequence with 11 b-values. Placenta diffusion-derived vessel density (DDVD-b0b50) was the signal difference between b = 0 and b = 50 s/mm2 images. DDVD(b0b50) A/N was calculated as [accreta lesion DDVD(b0b50)]/ [normal placenta DDVD(b0b50)]. The correlation between DDVD and gestational age was explored using Spearman rank correlation. Differences of DDVD(b0b50) A/N in patients with normal placentas and with PAS, and in patients with different subtypes of PAS were explored. RESULTS DDVD was negatively correlated with gestational age (p = 0.023, r = -0.359) in patients with normal placentas. DDVD(b0b50) A/N was significantly higher in patients with PAS (median:1.16, mean: 1.261) than normal placenta (median:1.02, mean: 1.032, p < 0.001) and especially higher in patients with placenta increta (median:1.14, mean: 1.278) and percreta (median: 1.20, mean: 1.396, p < 0.001). CONCLUSION As a higher DDVD indicates higher physiological volume of micro-vessels in PAS, this study suggests DDVD can be a potential biomarker to evaluate the placenta perfusion.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu 610072, China.
| | - Li Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu 610072, China
| | - Mou Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu 610072, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu 610072, China
| | - Meining Chen
- MR Research Collaboration, Siemens Healthineers Ltd., Area e, Tianfu Software Park, 1268 Tianfu Avenue Middle Section, Wuhou District, Chengdu 610041, China.
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region.
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Xu Z, Huang L, Yang Y, Cai Z, Chen M, Lu R, Ouyang Y, Hong Z, Huang W, Xu Z. Discriminating atypical parotid carcinoma and pleomorphic adenoma utilizing extracellular volume fraction and arterial enhancement fraction derived from contrast-enhanced CT imaging: A multicenter study. Cancer Med 2024; 13:e7407. [PMID: 38899534 PMCID: PMC11187748 DOI: 10.1002/cam4.7407] [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: 02/29/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES To investigate the added value of extracellular volume fraction (ECV) and arterial enhancement fraction (AEF) derived from enhanced CT to conventional image and clinical features for differentiating between pleomorphic adenoma (PA) and atypical parotid adenocarcinoma (PCA) pre-operation. METHODS From January 2010 to October 2023, a total of 187 cases of parotid tumors were recruited, and divided into training cohort (102 PAs and 51 PCAs) and testing cohort (24 PAs and 10 atypical PCAs). Clinical and CT image features of tumor were assessed. Both enhanced CT-derived ECV and AEF were calculated. Univariate analysis identified variables with statistically significant differences between the two subgroups in the training cohort. Multivariate logistic regression analysis with the forward variable selection method was used to build four models (clinical model, clinical model+ECV, clinical model+AEF, and combined model). Diagnostic performances were evaluated using receiver operating characteristic (ROC) curve analyses. Delong's test compared model differences, and calibration curve and decision curve analysis (DCA) assessed calibration and clinical application. RESULTS Age and boundary were chosen to build clinical model, and to construct its ROC curve. Amalgamating the clinical model, ECV, and AEF to establish a combined model demonstrated superior diagnostic effectiveness compared to the clinical model in both the training and test cohorts (AUC = 0.888, 0.867). There was a significant statistical difference between the combined model and the clinical model in the training cohort (p = 0.0145). CONCLUSIONS ECV and AEF are helpful in differentiating PA and atypical PCA, and integrating clinical and CT image features can further improve the diagnostic performance.
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Affiliation(s)
- Zhen‐Yu Xu
- Department of RadiologyThe First People's Hospital of FoshanFoshanChina
| | - Lin‐Wen Huang
- Department of RadiologyThe First People's Hospital of FoshanFoshanChina
| | - Yun‐Jun Yang
- Department of RadiologyThe First People's Hospital of FoshanFoshanChina
| | - Zhi‐Ping Cai
- Department of RadiologyShunde Hospital, Southern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Mei‐Lin Chen
- Department of RadiologyThe First People's Hospital of FoshanFoshanChina
| | - Rui‐Liang Lu
- Department of RadiologyThe First People's Hospital of FoshanFoshanChina
| | - Yong‐Xi Ouyang
- Department of RadiologyThe First People's Hospital of FoshanFoshanChina
| | - Zhen‐Kai Hong
- Department of RadiologyThe First People's Hospital of FoshanFoshanChina
| | - Wei‐Jun Huang
- Department of UltrasoundThe First People's Hospital of FoshanFoshanChina
| | - Zhi‐Feng Xu
- Department of RadiologyThe First People's Hospital of FoshanFoshanChina
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Corrias G, Lai E, Ziranu P, Mariani S, Donisi C, Liscia N, Saba G, Pretta A, Persano M, Fanni D, Spanu D, Balconi F, Loi F, Deidda S, Restivo A, Pusceddu V, Puzzoni M, Solinas C, Massa E, Madeddu C, Gerosa C, Zorcolo L, Faa G, Saba L, Scartozzi M. Prediction of Response to Anti-Angiogenic Treatment for Advanced Colorectal Cancer Patients: From Biological Factors to Functional Imaging. Cancers (Basel) 2024; 16:1364. [PMID: 38611042 PMCID: PMC11011199 DOI: 10.3390/cancers16071364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer (CRC) is a leading tumor worldwide. In CRC, the angiogenic pathway plays a crucial role in cancer development and the process of metastasis. Thus, anti-angiogenic drugs represent a milestone for metastatic CRC (mCRC) treatment and lead to significant improvement of clinical outcomes. Nevertheless, not all patients respond to treatment and some develop resistance. Therefore, the identification of predictive factors able to predict response to angiogenesis pathway blockade is required in order to identify the best candidates to receive these agents. Unfortunately, no predictive biomarkers have been prospectively validated to date. Over the years, research has focused on biologic factors such as genetic polymorphisms, circulating biomarkers, circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and microRNA. Moreover, research efforts have evaluated the potential correlation of molecular biomarkers with imaging techniques used for tumor assessment as well as the application of imaging tools in clinical practice. In addition to functional imaging, radiomics, a relatively newer technique, shows real promise in the setting of correlating molecular medicine to radiological phenotypes.
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Affiliation(s)
- Giuseppe Corrias
- Department of Radiology, University of Cagliari, 09042 Cagliari, Italy;
| | - Eleonora Lai
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Pina Ziranu
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Stefano Mariani
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Clelia Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Nicole Liscia
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Giorgio Saba
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Andrea Pretta
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Mara Persano
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Daniela Fanni
- Division of Pathology, Department of Medical Sciences and Public Health, AOU Cagliari, University of Cagliari, 09124 Cagliari, Italy; (D.F.); (C.G.); (G.F.)
| | - Dario Spanu
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Francesca Balconi
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Francesco Loi
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Simona Deidda
- Colorectal Surgery Unit, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, 09042 Cagliari, Italy; (S.D.); (A.R.); (L.Z.)
| | - Angelo Restivo
- Colorectal Surgery Unit, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, 09042 Cagliari, Italy; (S.D.); (A.R.); (L.Z.)
| | - Valeria Pusceddu
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Marco Puzzoni
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Cinzia Solinas
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Elena Massa
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Clelia Madeddu
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
| | - Clara Gerosa
- Division of Pathology, Department of Medical Sciences and Public Health, AOU Cagliari, University of Cagliari, 09124 Cagliari, Italy; (D.F.); (C.G.); (G.F.)
| | - Luigi Zorcolo
- Colorectal Surgery Unit, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, 09042 Cagliari, Italy; (S.D.); (A.R.); (L.Z.)
| | - Gavino Faa
- Division of Pathology, Department of Medical Sciences and Public Health, AOU Cagliari, University of Cagliari, 09124 Cagliari, Italy; (D.F.); (C.G.); (G.F.)
| | - Luca Saba
- Department of Radiology, University of Cagliari, 09042 Cagliari, Italy;
| | - Mario Scartozzi
- Medical Oncology Unit, University Hospital and University of Cagliari, 09042 Cagliari, Italy; (E.L.); (P.Z.); (S.M.); (C.D.); (G.S.); (A.P.); (M.P.); (D.S.); (F.B.); (F.L.); (V.P.); (M.P.); (C.S.); (E.M.); (C.M.); (M.S.)
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Notake T, Shimizu A, Kubota K, Sugenoya S, Umemura K, Goto T, Yamada A, Fujinaga Y, Soejima Y. Usefulness of intratumoral perfusion analysis for assessing biological features of non-functional pancreatic neuroendocrine neoplasm. Langenbecks Arch Surg 2024; 409:38. [PMID: 38221590 DOI: 10.1007/s00423-023-03219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Here, we evaluated the usefulness of intratumoral perfusion analysis using preoperative contrast-enhanced CT (E-CT) to assess biological features of non-functional pancreatic neuroendocrine neoplasms (NF-PanNENs). METHODS We retrospectively studied 44 patients who underwent curative surgery for NF-PanNENs. We used preoperative E-CT with compartment model analysis to calculate the tumor perfusion parameters K1 (inflow rate constant), 1/k2 (mean transit time), and K1/k2 (distribution volume). We assessed the association between perfusion parameters and biological features of NF-PanNENs, including the WHO classification tumor histopathological grade and prognosis after surgery. RESULTS Patients in this study had a neuroendocrine tumor (NET) G1 (n = 32) or NET G2 (n = 12). Neither NET G3 or NEC tumors were observed. Among perfusion parameters, K1 was the most accurate predictor of the high-grade tumor (AUC: 0.726). K1-low (< 0.028 s-1) was significantly associated with large tumors (≥ 20 mm) (p = 0.022), high mitotic index (p = 0.017), high Ki-67 index (p = 0.004), and lymphatic invasion (p = 0.025). Synchronous extra-pancreatic metastasis, including lymph node metastasis or liver metastasis, more frequently developed in K1-low patients than in K1-high patients (29% vs 4%, p = 0.025). Disease-free survival of patients with a K1-low tumor was poorer than that of patients with a K1-high tumor (p = 0.005). Furthermore, no patient with a K1-high tumor developed recurrence after initial surgery. CONCLUSION The perfusion parameters obtained using E-CT were significantly associated with biological features and prognosis of NF-PanNENs.
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Affiliation(s)
- Tsuyoshi Notake
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan.
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Koji Kubota
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Shinsuke Sugenoya
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Kentaro Umemura
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Takamune Goto
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
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Talakić E, Kaufmann-Bühler AK, Igrec J, Adelsmayr G, Janisch M, Döller C, Geyer E, Lackner K, Fuchsjäger M, Schöllnast H. Perfusion Computed Tomography in Rectal Carcinoma: Influence of Optimization of the Patlak Range on Calculation of Equivalent Blood Volume and Flow Extraction. J Comput Assist Tomogr 2023; 47:850-855. [PMID: 37948358 DOI: 10.1097/rct.0000000000001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
PURPOSE The aim of the study is to assess the influence of manual adjustment of the Patlak range in computed tomography (CT) perfusion analysis of rectal carcinoma compared with default range of the perfusion software. METHODS This study was approved by the institutional review board and informed consent was obtained. Twenty-one patients (12 male, 9 female; mean age ± SD, 59 ± 11 years) with rectal cancer were included and underwent perfusion CT before preoperative chemoradiotherapy. Equivalent blood volume (BV) and flow-extraction (FE) were calculated using the Patlak plot model. Two perfusion sets were calculated per patient, a perfusion set using the default setting as provided by the software (dBV, dFE) and an optimized perfusion set after manual adaption of the Patlak range (aBV, aFE), which was limited to the intravascular space clearance of contrast to the extravascular space. Perfusion values calculated with both methods were compared for significance in differences using the Wilcoxon test. A P value of 0.05 or less was defined as statistically significant. RESULTS Adjustment of the Patlak range statistically significantly influenced BV and FE calculation. Median dBV was 23.2 mL/100 mL (interquartile range [IQR], 12.1 mL/100 mL), whereas median aBV was 20.3 mL/100 mL (IQR, 10.9 mL/100 mL). The difference in BV was statistically significant ( P = 0.021). Median dFE was 8.3 mL/min/100 mL (IQR, 4.7 mL/min/100 mL), whereas median aFE was 15.4 mL/min/100 mL (IQR, 5.8 mL/min/100 mL). The difference in FE was statistically significant ( P < 0.001). CONCLUSIONS Our findings indicate that in perfusion CT of rectal carcinoma, adjustment of the Patlak range may significantly influence BV and FE compared with default setting of the software. This may contribute to standardization in the use of this technique for functional imaging of rectal cancer.
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Affiliation(s)
- Emina Talakić
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
| | | | - Jasminka Igrec
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
| | - Gabriel Adelsmayr
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
| | - Michael Janisch
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
| | - Carmen Döller
- Department of Therapeutic Radiology and Oncology, Medical University of Graz
| | - Edith Geyer
- Department of Therapeutic Radiology and Oncology, Medical University of Graz
| | - Karoline Lackner
- Diagnostic and Research Institute of Pathology, Medical University of Graz
| | - Michael Fuchsjäger
- From the Division of General Radiology, Department of Radiology, Medical University of Graz
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Li Q, Bao J, Zhang Y, Dou Y, Liu A, Liu M, Wu H, Wu J, Zhao L, Yang Z, Zhu L, Gao W, Zhao W, Wei M, Hao F. Predictive value of CT-based extracellular volume fraction in the preoperative pathologic grading of rectal adenocarcinoma: A preliminary study. Eur J Radiol 2023; 163:110811. [PMID: 37062204 DOI: 10.1016/j.ejrad.2023.110811] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE This study aimed to investigate whether the extracellular volume fraction (ECV) determined using enhanced computed tomography (CT) can predict the pathologic grade of rectal adenocarcinoma. METHODS We prospectively analyzed 43 patients with rectal adenocarcinoma confirmed surgically and pathologically and who had undergone preoperative enhanced CT imaging. The plain, arterial, venous, and balance phase values were recorded, and the absolute contrast-enhanced CT differences ΔS1 = HUarterial phase-HUplain scan, ΔS2 = HUvenous phase-HUplain scan, ΔS3 = HUbalance phase-HUplain scan were obtained. The ECV of the primary lesion was calculated by measuring the CT values of the regions of interest in the plain and balance phases. Patients were allocated to either a low-grade or a high-grade group based on the histologic grading standard for colorectal adenocarcinoma (nonspecial type, World Health Organization 2010 standard). The differences in the parameters between the two groups were evaluated for statistical significance. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency. RESULTS The 43 enrolled patients [12 in the high-grade group (27.9%) and 31 in the low-grade group (72.1%)] had an average age of 64.47 years. The arterial phase (P = 0.005) as well as ΔS1 (P = 0.006), ΔS3 (P = 0.021), and ECV (P< 0.001) differed significantly between the high-grade and low-grade groups, with ECV (P< 0.001) and ΔS3 (P = 0.042) being positively correlated with the pathologic grade and arterial phase (P = 0.025) and ΔS1 (P = 0.005) being negatively correlated. The ROC curve demonstrated that the best efficacy in evaluating the pathologic grade of rectal cancer was achieved by ECV, with an area under the curve of 0.892 (95% confidence interval: 0.757-1.000). The diagnostic threshold was 34.42%, sensitivity was 91.7%, and specificity was 83.9%. CONCLUSION The use of enhanced CT to obtain ECV is helpful in predicting the pathologic grade of rectal cancer; however, this result has to be confirmed in a study with a larger sample size.
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Affiliation(s)
- Qingyang Li
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Jiaqi Bao
- Department of Oncology, Inner Mongolia Autonomous Region People's Hospital, Hohhot 010020, China
| | - Yuqi Zhang
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Yana Dou
- Computed Tomography System Division, Siemens Medical Systems Ltd, Beijing 100102, China
| | - Aishi Liu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Miaomiao Liu
- Department of Radiology, Shaw Hospital Affiliated to Zhejiang University, Hangzhou 310016, China
| | - Hui Wu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Jing Wu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Lei Zhao
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Zhenxing Yang
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Lu Zhu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Wei Gao
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Wei Zhao
- Department of Radiology, Linfen People's Hospital, Shanxi 041000, China
| | - Mingjie Wei
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China
| | - Fene Hao
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China.
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Seth R, Gupta P, Debi U, Prasad KK, Singh H, Sharma V. Perfusion Computed Tomography May Help in Discriminating Gastrointestinal Tuberculosis and Crohn’s Disease. Diagnostics (Basel) 2023; 13:diagnostics13071255. [PMID: 37046473 PMCID: PMC10093202 DOI: 10.3390/diagnostics13071255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Gastrointestinal tuberculosis (GITB) and Crohn’s disease (CD) are close mimics. This prospective study aimed to evaluate the diagnostic performance of perfusion computed tomography (CT) in differentiating GITB from CD. Consecutive patients with ileocaecal thickening underwent perfusion CT of the ileocaecal region between January 2019 and July 2020. Two radiologists (blinded to the final diagnosis) independently assessed blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability at perfusion CT. These parameters were compared among the patients with GITB as well as active and inactive CD. Receiver operating characteristic curves were utilized for determining the diagnostic performance of perfusion CT. Interclass correlation coefficient and Bland–Altman analysis were performed to compare the observations of the two radiologists. During the study period, 34 patients underwent perfusion CT. Eight patients had diagnoses other than intestinal tuberculosis or CD. Thus, 26 patients (mean age 36 ± 14 years, 18 males) with GITB (n = 11), active CD (n = 6), and inactive CD (n = 9) were evaluated. BF, MTT, and permeability showed significant differences among the groups, while BV did not differ significantly among the groups. BF and permeability had 100% sensitivity and 100% specificity, while MTT had 61.5–100% sensitivity and 70–100% specificity for differentiating GITB from active CD and active from inactive CD. The interclass correlation coefficient for perfusion CT parameters was 0.88–1. Perfusion CT is a novel imaging technique that can improve the diagnostic performance of differentiating tuberculosis from CD.
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Affiliation(s)
- Raghav Seth
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (R.S.); (P.G.)
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (R.S.); (P.G.)
| | - Uma Debi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (R.S.); (P.G.)
- Correspondence: ; Tel.: +91-94-1752-6614
| | - Kaushal Kishore Prasad
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (K.K.P.); (V.S.)
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (K.K.P.); (V.S.)
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Perik TH, van Genugten EAJ, Aarntzen EHJG, Smit EJ, Huisman HJ, Hermans JJ. Quantitative CT perfusion imaging in patients with pancreatic cancer: a systematic review. Abdom Radiol (NY) 2022; 47:3101-3117. [PMID: 34223961 PMCID: PMC9388409 DOI: 10.1007/s00261-021-03190-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 01/18/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related death with a 5-year survival rate of 10%. Quantitative CT perfusion (CTP) can provide additional diagnostic information compared to the limited accuracy of the current standard, contrast-enhanced CT (CECT). This systematic review evaluates CTP for diagnosis, grading, and treatment assessment of PDAC. The secondary goal is to provide an overview of scan protocols and perfusion models used for CTP in PDAC. The search strategy combined synonyms for 'CTP' and 'PDAC.' Pubmed, Embase, and Web of Science were systematically searched from January 2000 to December 2020 for studies using CTP to evaluate PDAC. The risk of bias was assessed using QUADAS-2. 607 abstracts were screened, of which 29 were selected for full-text eligibility. 21 studies were included in the final analysis with a total of 760 patients. All studies comparing PDAC with non-tumorous parenchyma found significant CTP-based differences in blood flow (BF) and blood volume (BV). Two studies found significant differences between pathological grades. Two other studies showed that BF could predict neoadjuvant treatment response. A wide variety in kinetic models and acquisition protocol was found among included studies. Quantitative CTP shows a potential benefit in PDAC diagnosis and can serve as a tool for pathological grading and treatment assessment; however, clinical evidence is still limited. To improve clinical use, standardized acquisition and reconstruction parameters are necessary for interchangeability of the perfusion parameters.
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Affiliation(s)
- T H Perik
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - E A J van Genugten
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E J Smit
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - H J Huisman
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - J J Hermans
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Maehira H, Tsuji Y, Iida H, Mori H, Nitta N, Maekawa T, Kaida S, Miyake T, Tani M. Estimated tumor blood flow as a predictive imaging indicator of therapeutic response in pancreatic ductal adenocarcinoma: use of three-phase contrast-enhanced computed tomography. Int J Clin Oncol 2021; 27:373-382. [PMID: 34783936 DOI: 10.1007/s10147-021-02066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preoperative chemotherapy or chemoradiotherapy is a common strategy for treating pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the association between the therapeutic response in PDAC and tumor blood circulation. METHODS The medical records of patients who underwent chemotherapy or chemoradiotherapy prior to pancreatectomy for PDAC were reviewed. Of these, patient data that included three-phase contrast-enhanced computed tomography (CECT) findings before treatments were used in this study. We evaluated the estimated tumor blood flow (eTBF) using CECT. According to the therapeutic histopathological response defined by the Evans classification, patients were divided into poor (grade I/IIa) and good (grade IIb/III/IV) responder groups. The variables, including eTBF, were compared between the two groups. RESULTS Thirty patients were enrolled in this study. Of these, 13 (43.3%) (grade IIB/III/IV: 8/4/1 patients) were categorized into the good responder group and 17 patients (56.7%) (grade I/IIA: 4/13 patients) were categorized into the poor responder group. eTBF was significantly higher in the good responder group (0.39 s-1 vs. 0.32 s-1, p = 0.007). An eTBF ≥ 0.36 s-1 was found to be an independent predictive factor for the destruction of over 50% of tumor cells (p = 0.036; odds ratio, 9.71; 95% confidence interval, 1.16-81.30). CONCLUSIONS eTBF can be used to predict the therapeutic histopathological response in PDAC prior to treatment.
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Affiliation(s)
- Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yoshihisa Tsuji
- Department of Community and General Medicine, Sapporo Medical University, Chuo-ku, Sapporo, Hokkaido, S1 W17060-8556, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Nobuhito Nitta
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Takeru Maekawa
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
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Collins T, Maktabi M, Barberio M, Bencteux V, Jansen-Winkeln B, Chalopin C, Marescaux J, Hostettler A, Diana M, Gockel I. Automatic Recognition of Colon and Esophagogastric Cancer with Machine Learning and Hyperspectral Imaging. Diagnostics (Basel) 2021; 11:diagnostics11101810. [PMID: 34679508 PMCID: PMC8535008 DOI: 10.3390/diagnostics11101810] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023] Open
Abstract
There are approximately 1.8 million diagnoses of colorectal cancer, 1 million diagnoses of stomach cancer, and 0.6 million diagnoses of esophageal cancer each year globally. An automatic computer-assisted diagnostic (CAD) tool to rapidly detect colorectal and esophagogastric cancer tissue in optical images would be hugely valuable to a surgeon during an intervention. Based on a colon dataset with 12 patients and an esophagogastric dataset of 10 patients, several state-of-the-art machine learning methods have been trained to detect cancer tissue using hyperspectral imaging (HSI), including Support Vector Machines (SVM) with radial basis function kernels, Multi-Layer Perceptrons (MLP) and 3D Convolutional Neural Networks (3DCNN). A leave-one-patient-out cross-validation (LOPOCV) with and without combining these sets was performed. The ROC-AUC score of the 3DCNN was slightly higher than the MLP and SVM with a difference of 0.04 AUC. The best performance was achieved with the 3DCNN for colon cancer and esophagogastric cancer detection with a high ROC-AUC of 0.93. The 3DCNN also achieved the best DICE scores of 0.49 and 0.41 on the colon and esophagogastric datasets, respectively. These scores were significantly improved using a patient-specific decision threshold to 0.58 and 0.51, respectively. This indicates that, in practical use, an HSI-based CAD system using an interactive decision threshold is likely to be valuable. Experiments were also performed to measure the benefits of combining the colorectal and esophagogastric datasets (22 patients), and this yielded significantly better results with the MLP and SVM models.
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Affiliation(s)
- Toby Collins
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
- Correspondence:
| | - Marianne Maktabi
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (M.M.); (C.C.)
| | - Manuel Barberio
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
- General Surgery Department, Card. G. Panico, 73039 Tricase, Italy
| | - Valentin Bencteux
- ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, 67400 Strasbourg, France;
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (B.J.-W.); (I.G.)
| | - Claire Chalopin
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (M.M.); (C.C.)
| | - Jacques Marescaux
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
| | - Alexandre Hostettler
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
| | - Michele Diana
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
- ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, 67400 Strasbourg, France;
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 67091 Strasbourg, France
- INSERM, Institute of Viral and Liver Disease, 67091 Strasbourg, France
- Mitochondrion, Oxidative Stress and Muscle Protection (MSP)-EA 3072, Institute of Physiology, Faculty of Medicine, University of Strasbourg, 67085 Strasbourg, France
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (B.J.-W.); (I.G.)
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11
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Lu H, Wu Y, Liu X, Huang H, Jiang H, Zhu C, Man Y, Liu P, Li X, Chen Z, Long X, Pang Q, Deng S, Gu J. The Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Predicting Treatment Response for Cervical Cancer Treated with Concurrent Chemoradiotherapy. Cancer Manag Res 2021; 13:6065-6078. [PMID: 34377025 PMCID: PMC8349537 DOI: 10.2147/cmar.s314289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting early treatment response. Materials and Methods Patients with locally advanced cervical cancer (LACC) treated with concurrent chemoradiotherapy (CCRT) were enrolled. Pelvic DCE-MRI scans were performed before RT (pre-RT), in the middle of RT (mid-RT), and at the end of RT (post-RT), separately. Parameters (ie, Ktrans, Kep, and Ve) were measured. Pre-, mid-, and post-RT Ktrans were denoted as Ktrans-preTx, Ktrans-midTx, and Ktrans-postTx, respectively. And the same denoting rule also went for Kep and Ve. Difference for the same parameter such as Ktrans measured between two consecutive time points was calculated as second Ktrans value minus first Ktrans value. The differences in Ktrans between pre-RT and post-RT, between pre-RT and mid-RT, and between mid-RT and post-RT were denoted as ΔKtrans-post-preTx, ΔKtrans-mid-preTx, and ΔKtrans-post-midTx, respectively, and the same denoting rule was also applied to Kep and Ve. Results A total of 57 patients were enrolled. After the treatment, 31 patients had complete response (CR group). The remaining 26 patients had partial response (NCR group). Significant differences were found in Ktrans-postTx, Kep-postTx, Ve-midTx, ΔKtrans-post-preTx, ΔKtrans-post-midTx, ΔKep-post-preTx, ΔKep-mid-preTx and ΔKep-post-midTx between the two groups. Receiver operating characteristic (ROC) analysis for their performances in predicting treatment response showed an area under curve (AUC) of 0.656-0.849, sensitivity of 61.3-93.5%, specificity of 46.1-73.1%, and maximal Youden Index of 36.5-66.6. Among those parameters, Kep-postTx was the best, and its AUC, sensitivity, specificity, maximal Youden Index, and cutoff value were 0.849, 87.1%, 73.1%, 60.2, and 0.341, respectively. These combined parameters showed an AUC of 0.952, with sensitivity of 87.1%, specificity of 96.1%, and maximal Youden Index of 83.2. Conclusion DCE-MRI parameters can predict early treatment outcome. Among those parameters, Kep-postTx is the best predictor. The combination of multi-parameters can increase the predictive potency.
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Affiliation(s)
- Heming Lu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Yuying Wu
- Department of Gynecology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Xu Liu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Huixian Huang
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Hailan Jiang
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Chaohua Zhu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Yuping Man
- Department of Radiology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Pei Liu
- Department of Oncology, Youjiang Medical University for Nationalities, Baise, 533000, People's Republic of China
| | - Xianglong Li
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Zhaohong Chen
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Xianfeng Long
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Qiang Pang
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Shan Deng
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Junzhao Gu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
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Moody AS, Dayton PA, Zamboni WC. Imaging methods to evaluate tumor microenvironment factors affecting nanoparticle drug delivery and antitumor response. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2021; 4:382-413. [PMID: 34796317 PMCID: PMC8597952 DOI: 10.20517/cdr.2020.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/07/2021] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
Standard small molecule and nanoparticulate chemotherapies are used for cancer treatment; however, their effectiveness remains highly variable. One reason for this variable response is hypothesized to be due to nonspecific drug distribution and heterogeneity of the tumor microenvironment, which affect tumor delivery of the agents. Nanoparticle drugs have many theoretical advantages, but due to variability in tumor microenvironment (TME) factors, the overall drug delivery to tumors and associated antitumor response are low. The nanotechnology field would greatly benefit from a thorough analysis of the TME factors that create these physiological barriers to tumor delivery and treatment in preclinical models and in patients. Thus, there is a need to develop methods that can be used to reveal the content of the TME, determine how these TME factors affect drug delivery, and modulate TME factors to increase the tumor delivery and efficacy of nanoparticles. In this review, we will discuss TME factors involved in drug delivery, and how biomedical imaging tools can be used to evaluate tumor barriers and predict drug delivery to tumors and antitumor response.
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Affiliation(s)
- Amber S. Moody
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
- Carolina Institute for Nanomedicine, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC 27599, USA
| | - Paul A. Dayton
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC 27599, USA
| | - William C. Zamboni
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
- Carolina Institute for Nanomedicine, Chapel Hill, NC 27599, USA
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Ponnatapura J, Lalwani N. Imaging of Colorectal Cancer: Screening, Staging, and Surveillance. Semin Roentgenol 2020; 56:128-139. [PMID: 33858639 DOI: 10.1053/j.ro.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Janardhana Ponnatapura
- Department of Radiology, Wake Forest University Baptist Hospital Sciences, Medical Center Bovlevard, Winston-Salem, NC.
| | - Neeraj Lalwani
- Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, VA
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Ippolito D, Pecorelli A, Querques G, Drago SG, Maino C, Franzesi CT, Hatzidakis A, Sironi S. Dynamic Computed Tomography Perfusion Imaging: Complementary Diagnostic Tool in Hepatocellular Carcinoma Assessment From Diagnosis to Treatment Follow-up. Acad Radiol 2019; 26:1675-1685. [PMID: 30852079 DOI: 10.1016/j.acra.2019.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 02/05/2023]
Abstract
Early diagnosis of HCC is of paramount importance in order to enable the application of curative treatments. Among these, radiofrequency ablation (RFA) is actually considered the most effective ablative therapy for early stage hepatocellular carcinoma (HCC) not suitable for surgery. On the other hand, transarterial chemoembolization (TACE) represents the standard of care for intermediate stage HCC and compensated liver function. Finally, sorafenib, an oral antiangiogenic targeted drug, is the only approved systemic therapy for advanced HCC with vascular invasion, extrahepatic spread, and well-preserved liver function. Beside traditional radiological techniques, new functional imaging tools have been introduced in order to provide not only morphological information but also quantitative functional data. In this review, we analyze perfusion-CT (pCT) from a technical point of view, describing the main different mathematical analytical models for the quantification of tissue perfusion from acquired CT raw data, the most commonly acquired perfusion parameters, and the technical parameters required to perform a standard pCT examination. Moreover, a systematic review of the literature was performed to assess the role of pCT as an emerging imaging biomarker for HCC diagnosis, response evaluation to RFA, TACE, and sorafenib, and we examine its challenges in HCC management.
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Affiliation(s)
- Davide Ippolito
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Anna Pecorelli
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy.
| | - Giulia Querques
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Silvia Girolama Drago
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Cesare Maino
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Cammillo Talei Franzesi
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Adam Hatzidakis
- Department of Medical Imaging, University Hospital of Heraklion, Greece
| | - Sandro Sironi
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Badia S, Picchia S, Bellini D, Ferrari R, Caruso D, Paolantonio P, Carbone I, Laghi A, Rengo M. The Role of Contrast-Enhanced Imaging for Colorectal Cancer Management. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00443-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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A prospective feasibility study evaluating the role of multimodality imaging and liquid biopsy for response assessment in locally advanced rectal carcinoma. Abdom Radiol (NY) 2019; 44:3641-3651. [PMID: 31327041 DOI: 10.1007/s00261-019-02135-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Colorectal cancer is a commonly encountered disease that poses several diagnostic and therapeutic challenges. The inherent heterogeneity of tumor biology and propensity to relapse despite "curative" resection pose significant challenges with regard to response assessment. Although MR imaging already plays a key role in primary staging of patients with rectal carcinoma, its reliability in restaging after neoadjuvant therapy is debatable (Van der broek et al. in Dis Colon Rectum 60(3):274-283, 2017). Therefore, there is significant interest in developing additional methods which may improve diagnostic accuracy. This study aims to evaluate the role of multimodality imaging and liquid biopsy in therapeutic response assessment. METHODS Seventeen patients were enrolled into the study over a span of 24 months. All underwent hybrid PET-MRI and CT-perfusion (CT-P), prior to and following neoadjuvant therapy for locally advanced rectal carcinoma. Twelve of the 17 patients also underwent liquid biopsy, which consisted of blood sampling and analysis of circulating tumor cells (CTCs) and extracellular vesicles (EVs), including cell fragments and microparticles (MPs), using the Cell Search System (Menarini Silicon Biosystems). SUV, DWI, and ADC were calculated during PET-MRI, and several parameters were evaluated during CT-perfusion, including average perfusion, blood flow (BF), blood volume (BV), mean transit time (MTT), permeability-surface area product (PS), contrast extraction efficiency (E), and K-trans (K). Changes observed pre- and post-neoadjuvant therapy in each modality were compared to tumor response at histopathology using a modified Ryan tumor regression grading system. RESULTS Of the 17 patients included in the study, 14 were classified as non-responders, and 3 were classified as responders as determined by the modified Ryan Tumor Regression Grade (TRG) scoring system (Van der broek et al. in Dis Colon Rectum 60(3):274-283, 2017). When combined, blood markers and CT-P parameters (mean transit time (MTT), K-trans, and permeability-surface area product (PS)) produced the strongest models (p < 0.01). PET (SUV measurement) combined with CT-P-derived K-trans produced a marginally significant (p = 0.057) model for predicting response. MRI-derived ADC value did not provide a significant model for response prediction. CONCLUSION A model of CT-P parameters plus liquid biopsy more accurately predicts tumor response than PET-MRI, CT-P alone, or liquid biopsy alone. These results suggest that in the evaluation of treatment response, liquid biopsy could provide additional information to functional imaging modalities such as CT-P and should therefore be explored further in a trial with larger sample size.
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Mainenti PP, Stanzione A, Guarino S, Romeo V, Ugga L, Romano F, Storto G, Maurea S, Brunetti A. Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging. World J Gastroenterol 2019; 25:5233-5256. [PMID: 31558870 PMCID: PMC6761241 DOI: 10.3748/wjg.v25.i35.5233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the leading causes of tumor-related deaths worldwide. Among the various tools at physicians’ disposal for the diagnostic management of the disease, tomographic imaging (e.g., CT, MRI, and hybrid PET imaging) is considered essential. The qualitative and subjective evaluation of tomographic images is the main approach used to obtain valuable clinical information, although this strategy suffers from both intrinsic and operator-dependent limitations. More recently, advanced imaging techniques have been developed with the aim of overcoming these issues. Such techniques, such as diffusion-weighted MRI and perfusion imaging, were designed for the “in vivo” evaluation of specific biological tissue features in order to describe them in terms of quantitative parameters, which could answer questions difficult to address with conventional imaging alone (e.g., questions related to tissue characterization and prognosis). Furthermore, it has been observed that a large amount of numerical and statistical information is buried inside tomographic images, resulting in their invisibility during conventional assessment. This information can be extracted and represented in terms of quantitative parameters through different processes (e.g., texture analysis). Numerous researchers have focused their work on the significance of these quantitative imaging parameters for the management of CRC patients. In this review, we aimed to focus on evidence reported in the academic literature regarding the application of parametric imaging to the diagnosis, staging and prognosis of CRC while discussing future perspectives and present limitations. While the transition from purely anatomical to quantitative tomographic imaging appears achievable for CRC diagnostics, some essential milestones, such as scanning and analysis standardization and the definition of robust cut-off values, must be achieved before quantitative tomographic imaging can be incorporated into daily clinical practice.
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Affiliation(s)
- Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples 80145, Italy
| | - Arnaldo Stanzione
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Salvatore Guarino
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Valeria Romeo
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Lorenzo Ugga
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Federica Romano
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Giovanni Storto
- IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture 85028, Italy
| | - Simone Maurea
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Arturo Brunetti
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
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Schawkat K, Sah BR, Ter Voert EE, Delso G, Wurnig M, Becker AS, Leibl S, Schneider PM, Reiner CS, Huellner MW, Veit-Haibach P. Role of intravoxel incoherent motion parameters in gastroesophageal cancer: relationship with 18F-FDG-positron emission tomography, computed tomography perfusion and magnetic resonance perfusion imaging parameters. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 65:178-186. [PMID: 31496202 DOI: 10.23736/s1824-4785.19.03153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Identification of pretherapeutic predictive markers in gastro-esophageal cancer is essential for individual-oriented treatment. This study evaluated the relationship of multimodality parameters derived from intravoxel incoherent motion method (IVIM), 18F-FDG-positron emission tomography (PET), computed tomography (CT) perfusion and dynamic contrast enhanced magnetic resonance imaging (MRI) in patients with gastro-esophageal cancer and investigated their histopathological correlation. METHODS Thirty-one consecutive patients (28 males; median age 63.9 years; range 37-84 years) with gastro-esophageal adenocarcinoma (N.=22) and esophageal squamous cell carcinoma (N.=9) were analyzed. IVIM parameters: pseudodiffusion (D*), perfusion fraction (fp), true diffusion (D) and the threshold b-value (bval); PET-parameters: SUV<inf>max</inf>, metabolic tumor volume (MTV) and total lesion glycolysis (TLG); CT perfusion parameters: blood flow (BF), blood volume (BV) and mean transit time (MTT); and MR perfusion parameters: time to enhance, positive enhancement integral, time-to-peak (TTP), maximum-slope-of-increase, and maximum-slope-of-decrease were determined, and correlated to each other and to histopathology. RESULTS IVIM and PET parameters showed significant negative correlations: MTV and bval (r<inf>s</inf> =-0.643, P=0.002), TLG and bval (r<inf>s</inf>=-0.699, P<0.01) and TLG and fp (r<inf>s</inf>=-0.577, P=0.006). Positive correlation was found for TLG and D (r<inf>s</inf>=0.705, P=0.000). Negative correlation was found for bval and staging (r<inf>s</inf>=0.590, P=0.005). Positive correlation was found for positive enhancement interval and BV (r<inf>s</inf>=0.547, P=0.007), BF and regression index (r<inf>s</inf>=0.753, P=0.005) and for time-to-peak and staging (r<inf>s</inf>=0.557, P=0.005). CONCLUSIONS IVIM parameters (bval, fp, D) provide quantitative information and correlate with PET parameters (MTV, TLG) and staging. IVIM might be a useful tool for additional characterization of gastro-esophageal cancer.
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Affiliation(s)
- Khoschy Schawkat
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland - .,University of Zurich, Zurich, Switzerland -
| | - Bert-Ram Sah
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Edwin E Ter Voert
- University of Zurich, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Gaspar Delso
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Moritz Wurnig
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Anton S Becker
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Sebastian Leibl
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Paul M Schneider
- Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
| | - Cäcilia S Reiner
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Martin W Huellner
- University of Zurich, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Veit-Haibach
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Toronto, Toronto, ON, Canada.,Toronto Joint Department of Medical Imaging, University Hospital of Zurich, Toronto General Hospital, Zurich, Switzerland
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19
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Ren XJ. CT and MRI assessment of intestinal blood flow. Shijie Huaren Xiaohua Zazhi 2019; 27:851-856. [DOI: 10.11569/wcjd.v27.i14.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The accuracy of multi-slice computed tomography (CT) in the diagnosis of acute mesenteric ischemia is very high, however, it cannot demonstrate the small embolus of blood vessels and abnormal intestinal blood flow. The intestinal blood flow in chronic mesenteric ischemia decreases whereas there are few morphology changes, which leads to a high misdiagnosis rate of CT and CT angiography. In addition, inflammatory bowel disease, intestinal tumors, and portal hypertension can be diagnosed definitely by conventional CT, but the hemodynamics and microcirculation in these conditions cannot be assessed, which affects the accuracy of clinical staging and the assessment of therapeutic effect. For intestinal diseases, especially mesenteric ischemia, therefore, it is needed not only to make CT morphologic diagnosis but also to further assess the abnormal intestinal blood flow. In recent years, more and more CT and magnetic resonance imaging (MRI)-related new techniques for assessing blood flow have emerged, including CT perfusion, spectral CT imaging, magnetic resonance perfusion imaging, and phase contrast MRI. This paper reviews the clinical application and progress of these techniques for assessing intestinal blood flow.
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Affiliation(s)
- Xiao-Jun Ren
- Department of Radiology, Xidian Group Hospital Affiliated Shaanxi University of Chinese Medicine, Xi'an 710077, Shaanxi Province, China
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20
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Dercle L, Lu L, Lichtenstein P, Yang H, Wang D, Zhu J, Wu F, Piessevaux H, Schwartz LH, Zhao B. Impact of Variability in Portal Venous Phase Acquisition Timing in Tumor Density Measurement and Treatment Response Assessment: Metastatic Colorectal Cancer as a Paradigm. JCO Clin Cancer Inform 2019; 1:1-8. [PMID: 30657405 DOI: 10.1200/cci.17.00108] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE New response patterns to anticancer drugs have led tumor size-based response criteria to shift to also include density measurements. Choi criteria, for instance, categorize antiangiogenic therapy response as a decrease in tumor density > 15% at the portal venous phase (PVP). We studied the effect that PVP timing has on measurement of the density of liver metastases (LM) from colorectal cancer (CRC). METHODS Pretreatment PVP computed tomography images from 291 patients with LM-CRC from the CRYSTAL trial (Cetuximab Combined With Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer; ClinicalTrials.gov identifier: NCT00154102) were included. Four radiologists independently scored the scans' timing according to a three-point scoring system: early, optimal, late PVP. Using this, we developed, by machine learning, a proprietary computer-aided quality-control algorithm to grade PVP timing. The reference standard was a computer-refined consensus. For each patient, we contoured target liver lesions and calculated their mean density. RESULTS Contrast-product administration data were not recorded in the digital imaging and communications in medicine headers for injection volume (94%), type (93%), and route (76%). The PVP timing was early, optimal, and late in 52, 194, and 45 patients, respectively. The mean (95% CI) accuracy of the radiologists for detection of optimal PVP timing was 81.7% (78.3 to 85.2) and was outperformed by the 88.6% (84.8 to 92.4) computer accuracy. The mean ± standard deviation of LM-CRC density was 68 ± 15 Hounsfield units (HU) overall and 59.5 ± 14.9 HU, 71.4 ± 14.1 HU, 62.4 ± 12.5 HU at early, optimal, and late PVP timing, respectively. LM-CRC density was thus decreased at nonoptimal PVP timing by 14.8%: 16.7% at early PVP ( P < .001) and 12.6% at late PVP ( P < .001). CONCLUSION Nonoptimal PVP timing should be identified because it significantly decreased tumor density by 14.8%. Our computer-aided quality-control system outperformed the accuracy, reproducibility, and speed of radiologists' visual scoring. PVP-timing scoring could improve the extraction of tumor quantitative imaging biomarkers and the monitoring of anticancer therapy efficacy at the patient and clinical trial levels.
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Affiliation(s)
- Laurent Dercle
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Lin Lu
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philip Lichtenstein
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hao Yang
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Deling Wang
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jianguo Zhu
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Feiyun Wu
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hubert Piessevaux
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Lawrence H Schwartz
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Binsheng Zhao
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Hamdy A, Ichikawa Y, Toyomasu Y, Nagata M, Nagasawa N, Nomoto Y, Sami H, Sakuma H. Perfusion CT to Assess Response to Neoadjuvant Chemotherapy and Radiation Therapy in Pancreatic Ductal Adenocarcinoma: Initial Experience. Radiology 2019; 292:628-635. [PMID: 31287389 DOI: 10.1148/radiol.2019182561] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundChange in tumor size at CT is insufficient for reliable assessment of treatment response after neoadjuvant chemotherapy and radiation therapy (CRT) and shows poor correlation with histologic grading of response.PurposeTo investigate the use of perfusion CT to predict the response of pancreatic ductal adenocarcinoma (PDA) to CRT.Materials and MethodsBetween June 2016 and May 2018, study participants with biopsy-proven PDA were prospectively recruited to undergo perfusion CT before and after planned CRT. Blood flow (BF), blood volume (BV), and permeability-surface area product (PSP) were quantified from CT images. Participants were categorized into responders and nonresponders according to therapy response. The Mann-Whitney test was used to compare the baseline perfusion values between responders and nonresponders, and the Wilcoxon matched-pairs signed rank test was used to compare perfusion values before and after CRT.ResultsThe final cohort of 21 participants (median age, 68 years; interquartile range [IQR], 65-72 years; eight men) underwent dynamic perfusion (dual-source) CT before neoadjuvant CRT. All participants underwent pancreatectomy. Eighteen participants underwent post-CRT perfusion CT. Baseline BF was higher in responders (n = 10) than in nonresponders (n = 11) (median, 44 [IQR, 39-56] vs 28 [IQR, 16-52] mL/100 g/min; P = .04), while BV and PSP were similar between groups (median BV, 4.3 [IQR, 3.5-6.9] vs 2.0 [IQR, 1.6-6.5] mL/100 g, P = .15; median PSP, 25 [IQR, 21-30] vs 20 [IQR, 10-34] mL/100 g/min, P = .31). Response Evaluation Criteria in Solid Tumors (RECIST) and carbohydrate antigen (CA) 19-9 showed no correlation with perfusion parameters (eg, RECIST and BF: r = 0.05, P = .84, 95% confidence interval [CI]: -0.40, 0.48; CA 19-9 and BF: r = 0.06, P = .78, 95% CI: -0.39, 0.49) or histopathologic response (r = 0.16, P = .47, 95% CI: -0.3, 0.57 and r = 0.09, P = .71, 95% CI: -0.37, 0.51, respectively). For responders, perfusion parameters increased after CRT (eg, median BF, 54 [IQR, 42-73] vs 43 [IQR, 28-53] mL/100 g/min; P = .04). The perfusion change in nonresponders was not significant (median BF, 43 [IQR, 28-53] vs 33 [IQR, 16-52] mL/100 g/min; P = .06).ConclusionPerfusion CT may be useful in helping predict the histopathologic response to therapy in pancreatic ductal adenocarcinoma.© RSNA, 2019See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Ahmed Hamdy
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Yasutaka Ichikawa
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Yutaka Toyomasu
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Motonori Nagata
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Naoki Nagasawa
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Yoshihito Nomoto
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Haney Sami
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Hajime Sakuma
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
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Trinidad López C, De La Fuente Aguado J, Oca Pernas R, Delgado Sánchez-Gracián C, Santos Armentia E, Vaamonde Liste A, Prada González R, Souto Bayarri M. Evaluation of response to conventional chemotherapy and radiotherapy by perfusion computed tomography in non-small cell lung cancer (NSCLC). Eur Radiol Exp 2019; 3:23. [PMID: 31197486 PMCID: PMC6565789 DOI: 10.1186/s41747-019-0101-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To evaluate changes in perfusion computed tomography (PCT) parameters induced by treatment with conventional chemotherapy (CCT) alone or with CCT and radiation therapy (RT) in patients with non-small cell lung cancer (NSCLC) and to determine whether these changes correlate with response as defined by the response evaluation criteria in solid tumours version 1.1 (RECIST-1.1). METHODS Fifty-three patients with a histological diagnosis of NSCLC prospectively underwent PCT of the whole tumour, before/after CCT or before/after CCT and RT. Blood flow (BF), blood volume (BV), permeability (PMB), and mean transit time (MTT) were compared before and after treatment and with the response as defined by RECIST-1.1. The relationship between changes in the perfusion parameters and in tumour size was also evaluated. RESULTS PCT parameters decreased after treatment, significantly for BV (p = 0.002) and MTT (p = 0.027). The 30 patients with partial response had a significant decrease of 21% for BV (p = 0.006) and 17% for MTT (p = 0.031). A non-significant decrease in all perfusion parameters was found in patients with stable disease (p > 0.137). In patients with progressive disease, MTT decreased by 10% (p = 0.465) and the other parameters did not significantly vary (p > 0.809). No significant correlation was found between changes in size and PCT parameters (p > 0.145). CONCLUSIONS Treatment of NSCLC with platinum derivatives, with or without RT, induces changes in PCT parameters. Partial response is associated with a significant decrease in BV and MTT, attributable to the effect of the treatment on tumour vascularisation.
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Affiliation(s)
- Carmen Trinidad López
- Department of Radiology, POVISA Hospital, 5 Salamanca st, 36208, Vigo, Pontevedra, Spain.
| | | | - Roque Oca Pernas
- Department of Radiology, Osatek, Urduliz Hospital, Vizcaya, Spain
| | | | - Eloisa Santos Armentia
- Department of Radiology, POVISA Hospital, 5 Salamanca st, 36208, Vigo, Pontevedra, Spain
| | - Antonio Vaamonde Liste
- Department of Statistics and Operational Research, Faculty of Economic and Business Sciences, Vigo University Spain, Vigo, Spain
| | - Raquel Prada González
- Department of Radiology, POVISA Hospital, 5 Salamanca st, 36208, Vigo, Pontevedra, Spain
| | - Miguel Souto Bayarri
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Shi L, Zhou XL, Sun JJ, Huang JH, Wang X, Li K, Pang PP, Xu YJ, Chen M, Zhang MM. Whole-tumor perfusion CT using texture analysis in unresectable stage IIIA/B non-small cell lung cancer treated with recombinant human endostatin. Quant Imaging Med Surg 2019; 9:968-975. [PMID: 31367551 DOI: 10.21037/qims.2019.06.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background To observe the dynamic changes of blood perfusion with whole-tumor computed tomography (CT) perfusion imaging using texture analysis in patients with unresectable stage IIIA/B non-small cell lung cancer (NSCLC) treated with recombinant human endostatin (Endostar). Methods This phase II clinical trial recruited 11 patients diagnosed with stage IIIA/B NSCLC. Histological examination prior to treatment revealed squamous cell carcinoma in 4 cases and adenocarcinoma in 7 cases. All patients underwent contrast-enhanced perfusion CT at baseline and a second CT scan 1 week after treatment initiation with Endostar. CT perfusion images including blood flow (BF), blood volume (BV), and permeability (PMB) were imported into OmniKinetics software to quantitatively assess the texture features. Skewness, kurtosis, and entropy were calculated at baseline and after anti-angiogenic therapy. Changes in tumor were analyzed using Wilcoxon signed-rank test. The association of parameters with survival was evaluated using Cox proportional hazards regression model. Results There were no statistical differences in the mean values of BF, BV, and PMB before and after treatment (P=0.594, 0.477 and 0.328, respectively). The skewness on BF images demonstrated significant differences at baseline and after treatment (0.6±2.7 vs. 1.0±2.6, P=0.010), while skewness of BV and PMB showed no significant variation (P=0.477 and 0.213, respectively). The kurtosis and entropy for BF, BV and PMB showed no significant differences (all P>0.05). In adenocarcinoma, the mean BF showed no significant differences at baseline and after treatment (76.5±25.7 vs. 101.2±46.4, P=0.398), while skewness for BF was significantly higher after treatment than at baseline (-0.19±3.3 vs. 0.59±3.2, P=0.028). No significant associations were found between perfusion CT imaging parameters and progression-free survival. Conclusions These results suggested that blood perfusion showed improvement with whole-tumor perfusion CT using texture analysis in patients with stage IIIA/B NSCLC treated by Endostar.
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Affiliation(s)
- Lei Shi
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Hangzhou YITU Healthcare Technology Co., Ltd., Hangzhou 310000, China
| | - Xiang-Lan Zhou
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jing-Jing Sun
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jie-Hui Huang
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Xu Wang
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Kai Li
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | | | - Yu-Jin Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Min-Ming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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Emerging Functional Imaging Biomarkers of Tumour Responses to Radiotherapy. Cancers (Basel) 2019; 11:cancers11020131. [PMID: 30678055 PMCID: PMC6407112 DOI: 10.3390/cancers11020131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 12/11/2022] Open
Abstract
Tumour responses to radiotherapy are currently primarily assessed by changes in size. Imaging permits non-invasive, whole-body assessment of tumour burden and guides treatment options for most tumours. However, in most tumours, changes in size are slow to manifest and can sometimes be difficult to interpret or misleading, potentially leading to prolonged durations of ineffective treatment and delays in changing therapy. Functional imaging techniques that monitor biological processes have the potential to detect tumour responses to treatment earlier and refine treatment options based on tumour biology rather than solely on size and staging. By considering the biological effects of radiotherapy, this review focusses on emerging functional imaging techniques with the potential to augment morphological imaging and serve as biomarkers of early response to radiotherapy.
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MRI-Based Apparent Diffusion Coefficient for Predicting Pathologic Response of Rectal Cancer After Neoadjuvant Therapy: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:W205-W216. [PMID: 30240291 DOI: 10.2214/ajr.17.19135] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the use of apparent diffusion coefficient (ADC) during DWI for predicting complete pathologic response of rectal cancer after neoadjuvant therapy. MATERIALS AND METHODS A systematic review of available literature was conducted to retrieve studies focused on the identification of complete pathologic response of locally advanced rectal cancer after neoadjuvant chemoradiation, through the assessment of ADC evaluated before, after, or both before and after treatment, as well as in terms of the difference between pretreatment and posttreatment ADC. Pooled mean pretreatment ADC, posttreatment ADC, and Δ-ADC (calculated as posttreatment ADC minus pretreatment ADC divided by pretreatment ADC and multiplied by 100) in complete responders versus incomplete responders were calculated. For each parameter, we also pooled sensitivity and specificity and calculated the area under the summary ROC curve. RESULTS We found 10 prospective and eight retrospective studies. Overall, pathologic complete response was observed in 22.2% of patients. Pooled mean pretreatment ADC in complete responders was 0.84 × 10-3 mm2/s versus 0.89 × 10-3 mm2/s in incomplete responders (p = 0.33). Posttreatment ADC values were 1.51 × 10-3 mm2/s and 1.29 × 10-3 mm2/s, in complete and incomplete responders, respectively (p = 0.00001). The Δ-ADC percentages were also significantly higher in complete responders than in incomplete responders (59.7% vs 29.7%, respectively, p = 0.016). Pooled sensitivity, specificity, and AUC were 0.743, 0.755, and 0.841 for pretreatment ADC; 0.800, 0.737, and 0.782 for posttreatment ADC; and 0.832, 0.806, and 0.895 for Δ-ADC. CONCLUSION Use of ADC during DWI is a promising technique for assessment of results of neoadjuvant treatment of rectal cancer.
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Niu T, Yang P, Sun X, Mao T, Xu L, Yue N, Kuang Y, Shi L, Nie K. Variations of quantitative perfusion measurement on dynamic contrast enhanced CT for colorectal cancer: implication of standardized image protocol. Phys Med Biol 2018; 63:165009. [PMID: 29889046 DOI: 10.1088/1361-6560/aacb99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Tumor angiogenesis is considered an important prognostic factor. With an increasing emphasis on imaging evaluation of the tumor microenvironment, dynamic contrast enhanced-computed tomography (DCE-CT) has evolved as an important functional technique in this setting. Yet many questions remain as to how and when these functional measurements should be performed for each agent and tumor type, and what quantitative models should be used in the fitting process. In this study, we evaluated the variations of perfusion measurement on DCE-CT for rectal cancer patients from (1) different tracer kinetic models, (2) different scan acquisition lengths, and (3) different scan intervals. A total of seven commonly used models were studied: the adiabatic approximation to the tissue homogeneity (AATH) model, adiabatic approximation to the homogeneity tissue with fixed transit time (AATHFT) model, the Tofts model (TM), the extended Tofts model (ETM), Patlak model, Logan model, and the model-free deconvolution method. Akaike's information criterion was used to identify the best fitting model. The interchangeability of different models was further evaluated using Bland-Altman analysis. All models gave comparable blood volume (BV) measurements except the Patlak method. While for the volume transfer constant (Ktrans) estimation, AATHFT, AATH, and ETM generated reasonable agreement among each other but not for the other models. Regarding the blood flow (BF) measurement, no two models were interchangeable. In addition, the perfusion parameters were compared with four acquisition times (45, 65, 85, and 105 s) and four temporal intervals (1, 2, 3, and 4 s). No significant difference was observed in the volume transfer constant (Ktrans), BV, and BF measurements when comparing data acquired over 65 s with data acquired over 105 s using any of the DCE models in this study. Yet increasing the temporal interval led to a significant overestimation of BF in the deconvolution method. In conclusion, the perfusion measurement is indeed model dependent and the image acquisition/processing technique is dependent. The radiation dose of DCE-CT was an average of 1.5-2 times an abdomen/pelvic CT, which is not insubstantial. To take the DCE-CT forward as a biomarker in oncology, prospective studies should be carefully designed with the optimal image acquisition and analysis technique.
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Affiliation(s)
- Tianye Niu
- Institute of Translational Medicine, Zhejiang University, Hangzhou 310013, People's Republic of China. Department of Radiation Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310019, People's Republic of China. Both authors contribute equally
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Armstrong G, Croft J, Corrigan N, Brown JM, Goh V, Quirke P, Hulme C, Tolan D, Kirby A, Cahill R, O'Connell PR, Miskovic D, Coleman M, Jayne D. IntAct: intra-operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial. Colorectal Dis 2018; 20:O226-O234. [PMID: 29751360 PMCID: PMC6099475 DOI: 10.1111/codi.14257] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/02/2018] [Indexed: 02/06/2023]
Abstract
AIM Anastomotic leak (AL) is a major complication of rectal cancer surgery. Despite advances in surgical practice, the rates of AL have remained static, at around 10-15%. The aetiology of AL is multifactorial, but one of the most crucial risk factors, which is mostly under the control of the surgeon, is blood supply to the anastomosis. The MRC/NIHR IntAct study will determine whether assessment of anastomotic perfusion using a fluorescent dye (indocyanine green) and near-infrared laparoscopy can minimize the rate of AL leak compared with conventional white-light laparoscopy. Two mechanistic sub-studies will explore the role of the rectal microbiome in AL and the predictive value of CT angiography/perfusion studies. METHOD IntAct is a prospective, unblinded, parallel-group, multicentre, European, randomized controlled trial comparing surgery with intra-operative fluorescence angiography (IFA) against standard care (surgery with no IFA). The primary end-point is rate of clinical AL at 90 days following surgery. Secondary end-points include all AL (clinical and radiological), change in planned anastomosis, complications and re-interventions, use of stoma, cost-effectiveness of the intervention and quality of life. Patients should have a diagnosis of adenocarcinoma of the rectum suitable for potentially curative surgery by anterior resection. Over 3 years, 880 patients from 25 European centres will be recruited and followed up for 90 days. DISCUSSION IntAct will rigorously evaluate the use of IFA in rectal cancer surgery and explore the role of the microbiome in AL and the predictive value of preoperative CT angiography/perfusion scanning.
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Affiliation(s)
| | - J. Croft
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - N. Corrigan
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - J. M. Brown
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - V. Goh
- School of Biomedical Engineering and Imaging SciencesKing's College London and Honorary Consultant RadiologistGuy's and St Thomas’ Hospitals NHS Foundation TrustLondonUK
| | | | - C. Hulme
- Academic Unit of Health EconomicsLeeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - D. Tolan
- Leeds Teaching Hospital TrustLeedsUK
| | | | - R. Cahill
- University College DublinDublinIreland
| | | | | | - M. Coleman
- Derriford HospitalPlymouth NHS TrustPlymouthUK
| | - D. Jayne
- Leeds Institute of Biological and Clinical SciencesSt James's University HospitalLeedsUK
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Kang HJ, Kim SH, Bae JS, Jeon SK, Han JK. Can quantitative iodine parameters on DECT replace perfusion CT parameters in colorectal cancers? Eur Radiol 2018; 28:4775-4782. [PMID: 29789907 DOI: 10.1007/s00330-018-5502-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/18/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine the correlation between iodine concentrations derived from dual-energy CT (DECT) and perfusion CT (PCT) parameters in patients with pathologically proven colorectal cancers (CRC) and to evaluate their reproducibility and respective radiation exposures. METHODS Institutional review board approval and written informed consents were obtained for this study. Forty-one patients with CRCs who underwent same-day DECT and PCT were prospectively enrolled. Three radiologists independently analyzed the iodine concentration of the tumors and iodine ratios [ratio of lesion to aorta (IRa) or to infrarenal IVC (IRv)] from DECT as well as blood flow (BF), blood volume (BV), permeability (PMB), and mean transit time (MTT) from PCT. Pearson R and linear correlation, paired t-test, and intraclass correlation coefficients (ICCs) were used. RESULTS Significant correlations were found between iodine parameters from DECT and PCT parameters: iodine concentration of tumors and BV (r = 0.32, p = 0.04), PMB (r = 0.34, p = 0.03), and MTT (r = -0.38, p = 0.02); iodine ratio (IRa) and MTT (r = -0.32, p = 0.04); iodine ratio (IRv) and BF (r = 0.32, p = 0.04) and PMB (r = 0.44, p = <0.01). DECT showed better intra- and interobserver agreements (ICC = 0.98, 0.90 in iodine concentration; 0.98, 0.91 in IRa; and 0.91, 0.93 in IRv, respectively) than PCT (ICC = 0.90, 0.78 in BF; 0.82, 0.76 in BV; 0.75, 0.75 in PMB; 0.64, 0.79 in MTT, respectively). As for radiation dosage, CTDIvol and DLP in DECT (10.48 ± 1.84 mGy and 519.7 ± 116.7 mGy·cm) were significantly lower than those of PCT (75.76 mGy and 911 mGy·cm) (p < 0.01). CONCLUSION Iodine parameters from DECT are significantly correlated with PCT parameters, but have higher intra- and interobserver agreements and lower radiation exposure. KEY POINTS • Quantitative iodine concentrations from DECT are significantly correlated with perfusion CT parameters. • Intra- and interobserver agreements of DECT are better than those of perfusion CT. • Effective radiation doses of DECT are significantly lower than those of perfusion CT. • DECT can be used as an alternative to perfusion CT with lower radiation doses.
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Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Seyyedi S, Liapi E, Lasser T, Ivkov R, Hatwar R, Stayman JW. Low-Dose CT Perfusion of the Liver using Reconstruction of Difference. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2018; 2:205-214. [PMID: 29785411 DOI: 10.1109/trpms.2018.2812360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Liver CT perfusion (CTP) is used in the detection, staging, and treatment response analysis of hepatic diseases. Unfortunately, CTP radiation exposures is significant, limiting more widespread use. Traditional CTP data processing reconstructs individual temporal samples, ignoring a large amount of shared anatomical information between temporal samples, suggesting opportunities for improved data processing. We adopt a prior-image-based reconstruction approach called Reconstruction of Difference (RoD) to enable low-exposure CTP acquisition. RoD differs from many algorithms by directly estimating the attenuation changes between the current patient state and a prior CT volume. We propose to use a high-fidelity unenhanced baseline CT image to integrate prior anatomical knowledge into subsequent data reconstructions. Using simulation studies based on a 4D digital anthropomorphic phantom with realistic time-attenuation curves, we compare RoD with conventional filtered-backprojection, penalized-likelihood estimation, and prior image penalized-likelihood estimation. We evaluate each method in comparisons of reconstructions at individual time points, accuracy of estimated time-attenuation curves, and in an analysis of common perfusion metric maps including hepatic arterial perfusion, hepatic portal perfusion, perfusion index, and time-to-peak. Results suggest that RoD enables significant exposure reductions, outperforming standard and more sophisticated model-based reconstruction, making RoD a potentially important tool to enable low-dose liver CTP.
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Affiliation(s)
- Saeed Seyyedi
- Computer Aided Medical Procedures and Chair of Biomedical Physics, Technical University of Munich, Munich, 85748 Germany
| | - Eleni Liapi
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21205 USA
| | - Tobias Lasser
- Computer Aided Medical Procedures, Technical University of Munich, Munich, 85748 Germany
| | - Robert Ivkov
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD 21205 USA
| | - Rajeev Hatwar
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA
| | - J Webster Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA
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Kawamoto S, Fuld MK, Laheru D, Huang P, Fishman EK. Assessment of iodine uptake by pancreatic cancer following chemotherapy using dual-energy CT. Abdom Radiol (NY) 2018; 43:445-456. [PMID: 29473093 PMCID: PMC7385923 DOI: 10.1007/s00261-017-1338-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pancreatic cancer remains a major health problem, and only less than 20% of patients have resectable disease at the time of initial diagnosis. Systemic chemotherapy is often used in the patients with borderline resectable, locally advanced unresectable disease and metastatic disease. CT is often used to assess for therapeutic response; however, conventional imaging including CT may not correctly reflect treatment response after chemotherapy. Dual-energy (DE) CT can acquire datasets at two different photon spectra in a single CT acquisition, and permits separating materials and extract iodine by applying a material decomposition algorithm. Quantitative iodine mapping may have an added value over conventional CT imaging for monitoring the treatment effects in patients with pancreatic cancer and potentially serve as a unique biomarker for treatment response. In this pictorial essay, we will review the technique for iodine quantification of pancreatic cancer by DECT and discuss our observations of iodine quantification at baseline and after systemic chemotherapy with conventional cytotoxic agents, and illustrate example cases.
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Affiliation(s)
- Satomi Kawamoto
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- , JHOC 3140E, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
| | - Matthew K Fuld
- The Russell H. Morgan Department of Radiology and Radiological Science, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Siemens Medical Solutions USA, Inc, Malvern, PA, USA
| | - Daniel Laheru
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Peng Huang
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Biostatistics, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Detsky JS, Milot L, Ko YJ, Munoz-Schuffenegger P, Chu W, Czarnota G, Chung HT. Perfusion imaging of colorectal liver metastases treated with bevacizumab and stereotactic body radiotherapy. Phys Imaging Radiat Oncol 2018; 5:9-12. [PMID: 33458362 PMCID: PMC7807608 DOI: 10.1016/j.phro.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 01/18/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) and bevacizumab are used in the treatment of colorectal liver metastases. This study prospectively evaluated changes in perfusion of liver metastases in seven patients treated with both bevacizumab and SBRT. Functional imaging using dynamic contrast-enhanced CT perfusion and contrast-enhanced ultrasound were performed at baseline, after bevacizumab, and after SBRT. After bevacizumab, a significant decrease was found in permeability (−28%, p < .05) and blood volume (−47%, p < .05), while SBRT led to a significant reduction in permeability (−22%, p < .05) and blood flow (−37%, p < .05). This study demonstrates that changes in perfusion can be detected after bevacizumab and SBRT.
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Affiliation(s)
- Jay S Detsky
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Laurent Milot
- Department of Medical Imaging, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Yoo-Joung Ko
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Munoz-Schuffenegger
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - William Chu
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Czarnota
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Chuang-bo Y, Tai-ping H, Hai-feng D, Yong-jun J, Xi-rong Z, Guang-ming M, Chenglong R, Jun W, Yong Y. Quantitative assessment of the degree of differentiation in colon cancer with dual-energy spectral CT. Abdom Radiol (NY) 2017; 42:2591-2596. [PMID: 28500383 DOI: 10.1007/s00261-017-1176-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate dual-energy spectral CT imaging in evaluating the degree of differentiation in colon cancer. METHODS Forty-seven colon cancer patients underwent spectral CT during arterial phase (AP) and portal venous phase (PP), and were characterized pathologically differentiated to well-differentiated (A, n = 18) and poorly differentiated or undifferentiated carcinoma group (B, n = 29). Lesion iodine concentration (IC) was measured and normalized to that of aorta (NIC). CT numbers were measured and the slope (λ HU) of the spectral HU curve was calculated. These parameters were statistically compared between the two groups. ROC curves were used to evaluate their diagnostic efficacies. RESULTS There were significant differences in IC (1.01 ± 0.20 vs. 1.59 ± 0.57 mg/ml), NIC (0.12 ± 0.03 vs. 0.19 ± 0.09), λ HU (1.41 ± 0.29 vs. 2.03 ± 0.85), and CT number at 70 keV (48.61 ± 9.03HU vs. 63.97 ± 15.86HU) between groups A and B in AP (p < 0.05), but no difference in PP. Using IC = 1.13 mg/ml in AP as the threshold, one obtained a sensitivity of 81.8% and a specificity of 71.4% for differentiating well-differentiated from poorly differentiated or undifferentiated carcinoma. These values were statistically higher than those (64.7% and 62.3%) using CT number at 70 keV. CONCLUSION Spectral CT imaging parameters (IC, NIC, and λ HU) in AP provide improved accuracy for evaluating the degrees of differentiation in colon cancer than CT number at 70 keV.
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Kruk-Bachonko J, Krupski W, Czechowski M, Kurys-Denis E, Mądro P, Sierocińska-Sawa J, Dąbrowski A, Wallner G, Skoczylas T. Perfusion CT - A novel quantitative and qualitative imaging biomarker in gastric cancer. Eur J Radiol 2017; 95:399-408. [PMID: 28987697 DOI: 10.1016/j.ejrad.2017.08.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/22/2017] [Accepted: 08/28/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this research was to examine whether Perfusion Computed Tomography (P-CT) can qualitatively and quantitatively help detect gastric cancer neoangiogenesis in vivo as well as treatment response evaluation. We attempted to explore which P-CT parameters are best used in neoangiogenesis and neoadjuvant therapy for most effective evaluation. We also tried to recognize a positive prediction value of P-CT in early responders and non-responders patients identification. MATERIALS AND METHODS Twenty-four patients with positive biopsy results and/or clinically proven gastric cancer were enrolled in the P-CT exam. Patients were qualified for systemic treatment (16 patients received chemotherapy and 8 patients received radiochemotherapy). The baseline Perfusion-CT exam and after neoadjuvant treatment Perfusion-CT exam were conducted using a 64-row GE tomograph based on a deconvolution model in first-pass protocol perfusion. The P-CT examined the following parameters: Blood Flow (BF), Blood Volume (BV), Mean Transit Time (MTT) and Permeability Surface (PS). Positive clinical response to neoadjuvant treatment (CHT and RCT) was defined as tumor size reduction 25% or more. RESULTS Tumor dimension reduction after neoadjuvant therapy was significantly correlated with the BF and the PS. Neoadjuvant therapy was more effective for patients with higher output BF and PS values. We did not register a significant relationship between BV and MTT parameters and tumor dimension reduction. Patients with a positive treatment response showed a decrease in BF, BV and PS perfusion parameters with an increase in MTT. CONCLUSIONS P-CT examination allows a noninvasive neoangiogenesis assessment in vivo, leading to early identification of responding and non-responding patients. As a standard procedure, a full evaluation of treatment response should include a P-CT exam assessing neoangiogenesis.
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Affiliation(s)
- Joanna Kruk-Bachonko
- Department of Radiology, Medical University of Lublin, Staszica 16, Lublin 20-081, Poland.
| | - Witold Krupski
- Department of Radiology, Medical University of Lublin, Staszica 16, Lublin 20-081, Poland.
| | - Michał Czechowski
- Department of Radiology, Medical University of Lublin, Staszica 16, Lublin 20-081, Poland.
| | - Ewa Kurys-Denis
- Department of Radiology, Medical University of Lublin, Staszica 16, Lublin 20-081, Poland.
| | - Przemysław Mądro
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Digestive Tract, Medical University of Lublin, Staszica 16, Lublin 20-081, Poland.
| | | | - Andrzej Dąbrowski
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Digestive Tract, Medical University of Lublin, Staszica 16, Lublin 20-081, Poland.
| | - Grzegorz Wallner
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Digestive Tract, Medical University of Lublin, Staszica 16, Lublin 20-081, Poland.
| | - Tomasz Skoczylas
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Digestive Tract, Medical University of Lublin, Staszica 16, Lublin 20-081, Poland.
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Gaa T, Neumann W, Sudarski S, Attenberger UI, Schönberg SO, Schad LR, Zöllner FG. Comparison of perfusion models for quantitative T1 weighted DCE-MRI of rectal cancer. Sci Rep 2017; 7:12036. [PMID: 28931946 PMCID: PMC5607266 DOI: 10.1038/s41598-017-12194-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/05/2017] [Indexed: 12/17/2022] Open
Abstract
In this work, the two compartment exchange model and two compartment uptake model were applied to obtain quantitative perfusion parameters in rectum carcinoma and the results were compared to those obtained by the deconvolution algorithm. Eighteen patients with newly diagnosed rectal carcinoma underwent 3 T MRI of the pelvis including a T1 weighted dynamic contrastenhanced (DCE) protocol before treatment. Mean values for Plasma Flow (PF), Plasma Volume (PV) and Mean Transit Time (MTT) were obtained for all three approaches and visualized in parameter cards. For the two compartment models, Akaike Information Criterion (AIC) and [Formula: see text] were calculated. Perfusion parameters determined with the compartment models show results in accordance with previous studies focusing on rectal cancer DCE-CT (PF2CX = 68 ± 44 ml/100 ml/min, PF2CU = 55 ± 36 ml/100 ml/min) with similar fit quality (AIC:169 ± 81/179 ± 77, [Formula: see text]:10 ± 12/9 ± 10). Values for PF are overestimated whereas PV and MTT are underestimated compared to results of the deconvolution algorithm. Significant differences were found among all models for perfusion parameters as well as between the AIC and [Formula: see text] values. Quantitative perfusion parameters are dependent on the chosen tracer kinetic model. According to the obtained parameters, all approaches seem capable of providing quantitative perfusion values in DCE-MRI of rectal cancer.
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Affiliation(s)
- Tanja Gaa
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
| | - Wiebke Neumann
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sonja Sudarski
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Ulrike I Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Stefan O Schönberg
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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Parameters Affecting the Enhanced Permeability and Retention Effect: The Need for Patient Selection. J Pharm Sci 2017; 106:3179-3187. [PMID: 28669714 DOI: 10.1016/j.xphs.2017.06.019] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/03/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023]
Abstract
The enhanced permeability and retention (EPR) effect constitutes the rationale by which nanotechnologies selectively target drugs to tumors. Despite promising preclinical and clinical results, these technologies have, in our view, underachieved compared to their potential, possibly due to a suboptimal exploitation of the EPR effect. Here, we have systematically analyzed clinical data to identify key parameters affecting the extent of the EPR effect. An analysis of 17 clinical studies showed that the magnitude of the EPR effect was varied and was influenced by tumor type and size. Pancreatic, colon, breast, and stomach cancers showed the highest levels of accumulation of nanomedicines. Tumor size also had an effect on the accumulation of nanomedicines, with large-size tumors having higher accumulation than both medium- and very large-sized tumors. However, medium tumors had the highest percentage of cases (100% of patients) with evidence of the EPR effect. Moreover, tumor perfusion, angiogenesis, inflammation in tumor tissues, and other factors also emerged as additional parameters that might affect the accumulation of nanomedicines into tumors. At the end of the commentary, we propose 2 strategies for identification of suitable patient subpopulations, with respect to the EPR effect, in order to maximize therapeutic outcome.
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Volny O, Cimflova P, Lee TY, Menon BK, d'Esterre CD. Permeability surface area product analysis in malignant brain edema prediction - A pilot study. J Neurol Sci 2017; 376:206-210. [PMID: 28431614 DOI: 10.1016/j.jns.2017.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Using an extended CT perfusion acquisition (150s), we sought to determine the association between perfusion parameters and malignant edema after ischemic stroke. METHODS Patients (from prospective study PROVE-IT, NCT02184936) with terminal internal carotid artery±proximal middle cerebral occlusion were involved. CTA was assessed for clot location and status of leptomeningeal collaterals. The following CTP parameters were calculated within the ischemic territory and contralaterally: permeability surface area product (PS), cerebral blood flow (CBF) and cerebral blood volume (CBV). PS was calculated using the adiabatic approximation to the Johnson and Wilson model. Outcome was evaluated by midline shift and infarction volume on follow-up imaging. RESULTS Of 200 patients enrolled, 7 patients (3.5%) had midline shift≥5mm (2 excluded for poor-quality scans). Five patients with midline shift and 5 matched controls were analysed. There was no significant difference in mean PS, CBF and CBV within the ischemic territory between the two groups. A CBV threshold of 1.7ml/100g had the highest AUC=0.72, 95% CI=0.54-0.90 for early midline shift prediction, sensitivity and specificity were 0.83 and 0.67 respectively. CONCLUSION Our preliminary results did not show significant differences in permeability surface area analysis if analysed for complete ischemic region. CBV parameter had the highest accuracy and there was a trend for the mean PS values for midline shift prediction.
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Affiliation(s)
- O Volny
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; First Department of Neurology, Medical Faculty of Masaryk University, St. Anne's University Hospital, Brno, Czech Republic.
| | - P Cimflova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Medical Imaging, Medical Faculty of Masaryk University, St. Anne's University Hospital, Brno, Czech Republic
| | - T-Y Lee
- Imaging Research Labs, Robarts Research Institute, Ontario, Canada
| | - B K Menon
- Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada
| | - C D d'Esterre
- Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada
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Lee HY, Kim N, Goo JM, Chie EK, Song HJ. Perfusion parameters as potential imaging biomarkers for the early prediction of radiotherapy response in a rat tumor model. Diagn Interv Radiol 2017; 22:231-40. [PMID: 27023149 DOI: 10.5152/dir.2015.15171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to compare various tumor-related radiologic morphometric changes and computed tomography (CT) perfusion parameters before and after treatment, and to determine the optimal imaging assessment technique for the prediction of early response in a rat tumor model treated with radiotherapy. METHODS Among paired tumors of FN13762 murine breast cancer cells implanted bilaterally in the necks of eight Fischer rats, tumors on the right side were treated with a single 20 Gy dose of radiotherapy. Perfusion CT studies were performed on day 0 before radiotherapy, and on days 1 and 5 after radiotherapy. Variables based on the size, including the longest diameter, tumor area, and volume, were measured. Quantitative perfusion analysis was performed for the whole tumor volume and permeabilities and blood volumes (BVs) were obtained. The area under the curve (AUC) difference in the histograms of perfusion parameters and texture analyses of uniformity and entropy were quantified. Apoptotic cell density was measured on pathology specimens immediately after perfusion imaging on day 5. RESULTS On day 1 after radiotherapy, differences in size between the irradiated and nonirradiated tumors were not significant. In terms of percent changes in the uniformity of permeabilities between tumors before irradiation and on day 1 after radiotherapy, the changes were significantly higher in the irradiated tumors than in the nonirradiated tumors (0.085 [-0.417, 0.331] vs. -0.131 [-0.536, 0.261], respectively; P = 0.042). The differences in AUCs of the histogram of voxel-by-voxel vascular permeability and BV in tumors between day 0 and day 1 were significantly higher in treated tumors compared with the control group (permeability, 21.4 [-2.2, 37.5] vs. 9.5 [-8.9, 33.8], respectively, P = 0.030; BV, 52.9 [-6186.0, 419.2] vs. 11.9 [-198.3, 346.7], respectively, P = 0.049). Apoptotic cell density showed a significantly positive correlation with the AUC difference of BV, the percent change of uniformity in permeability and BV (r=0.202, r=0.644, and r=0.706, respectively). CONCLUSION By enabling earlier tumor response prediction than morphometric evaluation, the histogram analysis of CT perfusion parameters appears to have a potential in providing prognostic predictive information in an irradiated rat model.
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Affiliation(s)
- Ho Yun Lee
- Departments of Radiology and Center for Imaging Science Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Ippolito D, Querques G, Okolicsanyi S, Franzesi CT, Strazzabosco M, Sironi S. Diagnostic value of dynamic contrast-enhanced CT with perfusion imaging in the quantitative assessment of tumor response to sorafenib in patients with advanced hepatocellular carcinoma: A feasibility study. Eur J Radiol 2017; 90:34-41. [PMID: 28583645 DOI: 10.1016/j.ejrad.2017.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the feasibility of perfusion-CT (p-CT) measurements in quantitative assessment of hemodynamic changes related to sorafenib in patients with advanced hepatocellular carcinoma (HCC). MATERIALS AND METHODS Twenty-two patients with advanced HCC underwent p-CT study (256-MDCT scanner) before and 2 months after sorafenib administration. Dedicated perfusion software generated a quantitative map of arterial and portal perfusion and calculated the following perfusion parameters in target liver lesion: hepatic perfusion (HP), time-to-peak (TTP), blood volume (BV), arterial perfusion (AP), and hepatic perfusion index (HPI). After the follow-up scan, patients were categorized as responders and non-responders, according to mRECIST. Perfusion values were analyzed and compared in HCC lesions and in the cirrhotic parenchyma (n=22), such as between baseline and follow-up in progressors and non-progressors. RESULTS Before treatment, all mean perfusion values were significantly higher in HCC lesions than in the cirrhotic parenchyma (HP 47.8±17.2 vs 13.3±6.3mL/s per 100g; AP 47.9±18.1 vs 12.9±10.7mL/s; p<0.001). The group that responded to sorafenib (n=17) showed a significant reduction of values in HCC target lesions after therapy (HP 29.2±23.3 vs 48.1±15.1; AP 29.4±24.6 vs 49.2±17.4; p<0.01), in comparison with the non-responder group (n=5) that demonstrated no significant variation before and after treatment of HP (46.9±25.1 vs 46.7±24.1) and AP (43.4±21.7 vs 43.5±24.6). Among the responder group, HP percentage variation (Δ) in target lesions, during treatment, showed a significantly different (p=0.04) ΔHP in the group with complete response (79%) compared to the group with partial response or stable disease (16%). CONCLUSIONS p-CT technique can be used for HCC quantitative assessment of changes related to anti-angiogenic therapy. Identification of response predictors might help clinicians in selection of patients who may benefit from targeted-therapy allowing for optimization of individualized treatment.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy.
| | - Giulia Querques
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy
| | - Stefano Okolicsanyi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cammillo Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy
| | - Mario Strazzabosco
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy; Liver Center Section of Digestive Diseases, Yale University, New Haven, CTUSA
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy
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Abstract
PURPOSE To evaluate the capacity of perfusion CT imaging to distinguish between complete and incomplete responders after neoadjuvant chemoradiation therapy for rectal carcinoma, with particular attention to segmentation technique. MATERIALS AND METHODS 17 patients were evaluated in this prospective IRB-approved study. For each patient, a perfusion CT acquisition was obtained prior to the initiation of chemoradiation, at 1-2 weeks after the start of chemoradiation, and at 12 weeks after the start of chemoradiation therapy. From each dataset, three perfusion parameters were measured, each in two different ways: a region of interest incorporating only "hot spots" of greatest enhancement and whole-tumor measurements. RESULTS In univariate analysis, blood volume and permeability differed significantly between responders and non-responders. In logistic regression analysis evaluating predictors of the "complete response" outcome, only two predictors were retained as statistically significant: peak hot spot blood volume 1-2 weeks into therapy (OR 10.25, p = 0.0026) and hot spot permeability decline at 12 weeks after the initiation of therapy (OR 5.62, p = 0.03). The overall likelihood ratio test for this model supported the conclusion that hot spot blood volume and hot spot permeability decline were significant predictors of the complete pathologic response outcome (p < 0.0001). CONCLUSION In this pilot study, peak tumor blood volume and decline in tumor permeability, when measured in "hot spots" of greatest enhancement, were strong predictors of complete therapeutic response in rectal cancer after neoadjuvant therapy.
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Rahnemai-Azar AA, Pandey P, Kamel I, Pawlik TM. Monitoring outcomes in intrahepatic cholangiocarcinoma patients following hepatic resection. Hepat Oncol 2017; 3:223-239. [PMID: 30191045 DOI: 10.2217/hep-2016-0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/04/2016] [Indexed: 02/07/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is one of the fatal gastrointestinal cancers with increasing incidence and mortality. Although surgery offers the only potential for cure in iCCA patients, the prognosis is not optimal with low overall survival rate and high disease recurrence. Hence, adjuvant therapy is generally recommended in the management of high-risk patients. Identifying factors associated with disease recurrence and survival of the iCCA patients after resection will improve understanding of disease prognosis and help in selecting patients who will benefit from surgical resection or stratifying them for clinical trials. Despite development of new methods for early detection of tumor recurrence, effective prognostic models and nomograms, and recent advances in management, significant challenges remain in improving the prognosis of iCCA patients.
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Affiliation(s)
- Amir A Rahnemai-Azar
- Department of Surgery, University of Washington Medical Center, University of Washington School of Medicine, Seattle, WA, USA.,Department of Surgery, University of Washington Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Pallavi Pandey
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab Kamel
- Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA.,Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
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Parameter estimation of perfusion models in dynamic contrast-enhanced imaging: a unified framework for model comparison. Med Image Anal 2017; 35:360-374. [DOI: 10.1016/j.media.2016.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 05/21/2016] [Accepted: 07/20/2016] [Indexed: 01/03/2023]
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Schneeweiß S, Horger M, Grözinger A, Nikolaou K, Ketelsen D, Syha R, Grözinger G. CT-perfusion measurements in pancreatic carcinoma with different kinetic models: Is there a chance for tumour grading based on functional parameters? Cancer Imaging 2016; 16:43. [PMID: 27978850 PMCID: PMC5159980 DOI: 10.1186/s40644-016-0100-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To evaluate the interchangeability of perfusion parameters obtained with help of models used for post-processing of perfusion-CT images in pancreatic adenocarcinoma and to determine the mean values and ranges of perfusion in different tumour gradings. METHODS Perfusion-CT imaging was performed prospectively in 48 consecutive patients with pancreatic adenocarcinoma. In 42 patients biopsy-proven tumor grading was available (4 × G1/24 × G2/14 × G3/6× unknown). Images were post-processed using a model based on the maximum-slope (MS) approach (blood flow-BFMS) + Patlak analysis (P) (blood volume [BVP] and permeability [k-transP]), as well as a model with deconvolution-based (D) analysis (BFD, BVD and k-transD). 50 mL contrast agent were applied with a delay time of 7 s. Perfusion parameters were compared using intraclass correlation coefficient (ICC), the Wilcoxon matched-pairs test and Bland-Altman plots. RESULTS Forty eight VOIs of tumours were outlined and analysed. Moderate to good ICC values were found for the perfusion parameters (ICC = 0.62-0.75). Wilcoxon matched-pairs revealed significantly lower values (P < .001 and 0.008), for the BF and BV values obtained using the maximum-slope approach + Patlak analysis compared to deconvolution based analysis. For k-trans measurement, deconvolution revealed significantly lower values (P < 0.001). Different histologic subgroups (G1-G3) did not show significantly different functional parameters. CONCLUSION There were significant differences in the perfusion parameters obtained using the different calculation methods, and therefore these parameters are not directly interchangeable. However, the magnitude of pairs of parametric values is in constant relation to each other enabling the use of any of these methods. VPCT parameters did not allow for histologic classification.
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Affiliation(s)
- Sven Schneeweiß
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Anja Grözinger
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Roland Syha
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Gerd Grözinger
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
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Gollub MJ, Tong T, Weiser M, Zheng J, Gonen M, Zakian KL. Limited accuracy of DCE-MRI in identification of pathological complete responders after chemoradiotherapy treatment for rectal cancer. Eur Radiol 2016; 27:1605-1612. [PMID: 27436029 DOI: 10.1007/s00330-016-4493-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 05/23/2016] [Accepted: 06/27/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To examine whether post-chemoradiotherapy (CRT) DCE-MRI can identify rectal cancer patients with pathologic complete response (pCR). METHODS From a rectal cancer surgery database 2007-2014, 61 consecutive patients that met the following inclusion criteria were selected for analysis: (1) stage II/III primary rectal adenocarcinoma; (2) received CRT; (3) underwent surgery (4); underwent rectal DCE-MRI on a 1.5-T MRI scanner. Two experienced radiologists, in consensus, drew regions of interest (ROI) on the sagittal DCE-MRI image in the tumour bed. These were exported from ImageJ to in-house Matlab code for modelling using the Tofts model. K trans, K ep and v e values were compared to pathological response. RESULTS Of the 61 initial patients, 37 had data considered adequate for fitting to obtain perfusion parameters. Among the 13 men and 24 women, median age 53 years, there were 8 pCR (22 %). K trans could not distinguish patients with pCR. For patients with 90 % or greater response, mean K trans and K ep values were statistically significant (p = 0.032 and 0.027, respectively). Using a cutoff value of K trans = 0.25 min-1, the AUC was 0.71. CONCLUSION K trans could be used to identify patients with 90 % or more response to chemoradiotherapy for rectal cancer with an AUC of 0.7. KEY POINTS • Chemoradiotherapy for rectal cancer causes decreased blood flow and permeability in the tumour bed. • Lower values of blood flow and permeability correlate with good tumour response. • K trans of 0.25min -1 best identifies patients with ≥90 % response with AUC 0.71.
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Affiliation(s)
- Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Tong Tong
- Department of Radiology, Fudan University Medical Center, Shanghai, China
| | - Martin Weiser
- Department of Surgery, Divison of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Kristen L Zakian
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Kim JI, Lee HJ, Goo JM, Kim MA, Chung DH. Correlation of volumetric perfusion CT parameters with hypoxia inducible factor-1 alpha expression in a rabbit VX2 tumor model. Acta Radiol 2016; 57:708-15. [PMID: 26339038 DOI: 10.1177/0284185115603243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 08/01/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hypoxia inducible factor-1 alpha (HIF-1α) plays a critical role in tumoral angiogenesis and HIF-1α overexpression is associated with an increased risk of patient mortality in many cancers. A number of studies have introduced perfusion computed tomography (CT) as a monitoring modality for antiangiogenic therapy. PURPOSE To investigate significance of volumetric perfusion CT parameters in relationship to HIF-1α expression in VX2 tumor rabbit models. MATERIAL AND METHODS Twenty VX2 carcinoma tumors of bilateral back muscles of 10 rabbits were evaluated with serial volumetric perfusion CT in 7, 10, and 14 days after tumor implantation. CT perfusion data were analyzed to calculate blood flow (BF), blood volume (BV), and permeability surface area product (PS) of whole tumor and non-necrotic peripheral area (periphery). Immunohistochemical analysis of HIF-1α expression and microvessel density (MVD) was performed. RESULTS HIF-1α was expressed in 12 tumors; two, three, and seven tumors classified as scores 1, 2 and 3, respectively. Mean MVD was 24.85 ± 13.7. PS of both the whole tumor and periphery showed positive correlations with HIF-1α score (r = 0.41, P = 0.046; r = 0.43, P = 0.002, respectively). BV of periphery showed a negative correlation with HIF-1α (r = -0.48, P = 0.040). There was strong positive correlation between HIF-1α expression and MVD (r = 0.82, P < 0.001). CONCLUSION In VX2 tumors, volumetric perfusion CT parameters were of limited value for the prediction of HIF-1α activity although HIF-1α expression was found to be weakly positively correlated with PS and negatively correlated with BV.
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Affiliation(s)
- Jung Im Kim
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Ju Lee
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Min A Kim
- Department of Pathology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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García-Figueiras R, Baleato-González S, Padhani AR, Marhuenda A, Luna A, Alcalá L, Carballo-Castro A, Álvarez-Castro A. Advanced imaging of colorectal cancer: From anatomy to molecular imaging. Insights Imaging 2016; 7:285-309. [PMID: 27136925 PMCID: PMC4877344 DOI: 10.1007/s13244-016-0465-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Imaging techniques play a key role in the management of patients with colorectal cancer. The introduction of new advanced anatomical, functional, and molecular imaging techniques may improve the assessment of diagnosis, prognosis, planning therapy, and assessment of response to treatment of these patients. Functional and molecular imaging techniques in clinical practice may allow the assessment of tumour-specific characteristics and tumour heterogeneity. This paper will review recent developments in imaging technologies and the evolving roles for these techniques in colorectal cancer. TEACHING POINTS • Imaging techniques play a key role in the management of patients with colorectal cancer. • Advanced imaging techniques improve the evaluation of these patients. • Functional and molecular imaging allows assessment of tumour hallmarks and tumour heterogeneity.
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Affiliation(s)
- Roberto García-Figueiras
- />Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Sandra Baleato-González
- />Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Anwar R. Padhani
- />Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England, HA6 2RN UK
| | - Ana Marhuenda
- />Department of Radiology, IVO (Instituto Valenciano de Oncología), C/ Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Antonio Luna
- />Department of Radiology, Advanced Medical Imaging, Clinica Las Nieves, SERCOSA, Grupo Health Time, C/ Carmelo Torres 2, 23007 Jaén, Spain
- />Case Western Reserve University, Cleveland, OH USA
| | - Lidia Alcalá
- />Department of Radiology, Advanced Medical Imaging, Clinica Las Nieves, SERCOSA, Grupo Health Time, C/ Carmelo Torres 2, 23007 Jaén, Spain
| | - Ana Carballo-Castro
- />Department of Radiotherapy, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Ana Álvarez-Castro
- />Department of Gastroenterology, Colorectal Cancer Group, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, Santiago de Compostela, 15706 Spain
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Hill EJ, Roberts C, Franklin JM, Enescu M, West N, MacGregor TP, Chu KY, Boyle L, Blesing C, Wang LM, Mukherjee S, Anderson EM, Brown G, Dutton S, Love SB, Schnabel JA, Quirke P, Muschel R, McKenna WG, Partridge M, Sharma RA. Clinical Trial of Oral Nelfinavir before and during Radiation Therapy for Advanced Rectal Cancer. Clin Cancer Res 2016; 22:1922-31. [PMID: 26861457 PMCID: PMC4835023 DOI: 10.1158/1078-0432.ccr-15-1489] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/28/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Nelfinavir, a PI3K pathway inhibitor, is a radiosensitizer that increases tumor blood flow in preclinical models. We conducted an early-phase study to demonstrate the safety of nelfinavir combined with hypofractionated radiotherapy (RT) and to develop biomarkers of tumor perfusion and radiosensitization for this combinatorial approach. EXPERIMENTAL DESIGN Ten patients with T3-4 N0-2 M1 rectal cancer received 7 days of oral nelfinavir (1,250 mg b.i.d.) and a further 7 days of nelfinavir during pelvic RT (25 Gy/5 fractions/7 days). Perfusion CT (p-CT) and DCE-MRI scans were performed pretreatment, after 7 days of nelfinavir and prior to the last fraction of RT. Biopsies taken pretreatment and 7 days after the last fraction of RT were analyzed for tumor cell density (TCD). RESULTS There were 3 drug-related grade 3 adverse events: diarrhea, rash, and lymphopenia. On DCE-MRI, there was a mean 42% increase in medianKtrans, and a corresponding median 30% increase in mean blood flow on p-CT during RT in combination with nelfinavir. Median TCD decreased from 24.3% at baseline to 9.2% in biopsies taken 7 days after RT (P= 0.01). Overall, 5 of 9 evaluable patients exhibited good tumor regression on MRI assessed by tumor regression grade (mrTRG). CONCLUSIONS This is the first study to evaluate nelfinavir in combination with RT without concurrent chemotherapy. It has shown that nelfinavir-RT is well tolerated and is associated with increased blood flow to rectal tumors. The efficacy of nelfinavir-RT versus RT alone merits clinical evaluation, including measurement of tumor blood flow.
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Affiliation(s)
- Esme J Hill
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Corran Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie M Franklin
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Monica Enescu
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Nicholas West
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Thomas P MacGregor
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Kwun-Ye Chu
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Lucy Boyle
- Oncology Clinical Trials Office (OCTO), Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Claire Blesing
- Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, United Kingdom
| | - Lai-Mun Wang
- Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, United Kingdom
| | - Somnath Mukherjee
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Ewan M Anderson
- Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, United Kingdom
| | - Gina Brown
- Radiology Department, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Susan Dutton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sharon B Love
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Julia A Schnabel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Phil Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Ruth Muschel
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - William G McKenna
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Michael Partridge
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Ricky A Sharma
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom.
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Wang J, Tang Z, Wang S, Zeng W, Qian W, Wu L, Wang W, Luo J. Differential diagnostic value of computed tomography perfusion combined with vascular endothelial growth factor expression in head and neck lesions. Oncol Lett 2016; 11:3342-3348. [PMID: 27123114 PMCID: PMC4840932 DOI: 10.3892/ol.2016.4413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/08/2016] [Indexed: 12/22/2022] Open
Abstract
There are numerous types of head and neck lesions (HNLs), and conventional computed tomography (CT) has low specificity and sensitivity in the definitive and differential diagnosis of HNLs. The aim of the present study was to evaluate the value of perfusion CT (CTP) combined with vascular endothelial growth factor (VEGF) expression in the differentiation between malignant and benign HNLs. In total, 41 HNLs, which were pathologically confirmed, underwent CTP and VEGF expression analysis. All lesions were divided into three groups: Group A, benign hypovascular lesions; Group B, benign hypervascular lesions; and Group C, malignant lesions. Time density curve (TDC) and CTP parameters [maximum intensity projection (MIP), blood volume (BV), blood flow (BF), mean transit time and capillary permeability] were analyzed. The association between perfusion measurements and VEGF was assessed using Pearson's correlation. TDCs were classified into three types, and type I was more frequently identified in benign tumors (Groups A and B) compared with malignant tumors (Group C) (P=0.003). Malignant tumors primarily had a TDC of type II and III. MIP, BF and BV were all significantly higher in Groups B and C compared to Group A (P<0.01). VEGF expression of malignant tumors was significantly higher than benign tumors (P=0.007). No correlation was identified between VEGF and any CTP parameter. The present findings suggest that CTP combined with VEGF may differentiate between malignant and benign HNLs, and between benign hypovascular and hypervascular lesions.
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Affiliation(s)
- Jie Wang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Zuohua Tang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Shuyi Wang
- Department of Pathology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Wenjiao Zeng
- Department of Pathology, Shanghai Medical School of Fudan University, Shanghai 200032, P.R. China
| | - Wen Qian
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Lingjie Wu
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Wenzhong Wang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Jianfeng Luo
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai 200032, P.R. China
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Pogue BW, Elliott JT, Kanick SC, Davis SC, Samkoe KS, Maytin EV, Pereira SP, Hasan T. Revisiting photodynamic therapy dosimetry: reductionist & surrogate approaches to facilitate clinical success. Phys Med Biol 2016; 61:R57-89. [PMID: 26961864 DOI: 10.1088/0031-9155/61/7/r57] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Photodynamic therapy (PDT) can be a highly complex treatment, with many parameters influencing treatment efficacy. The extent to which dosimetry is used to monitor and standardize treatment delivery varies widely, ranging from measurement of a single surrogate marker to comprehensive approaches that aim to measure or estimate as many relevant parameters as possible. Today, most clinical PDT treatments are still administered with little more than application of a prescribed drug dose and timed light delivery, and thus the role of patient-specific dosimetry has not reached widespread clinical adoption. This disconnect is at least partly due to the inherent conflict between the need to measure and understand multiple parameters in vivo in order to optimize treatment, and the need for expedience in the clinic and in the regulatory and commercialization process. Thus, a methodical approach to selecting primary dosimetry metrics is required at each stage of translation of a treatment procedure, moving from complex measurements to understand PDT mechanisms in pre-clinical and early phase I trials, towards the identification and application of essential dose-limiting and/or surrogate measurements in phase II/III trials. If successful, identifying the essential and/or reliable surrogate dosimetry measurements should help facilitate increased adoption of clinical PDT. In this paper, examples of essential dosimetry points and surrogate dosimetry tools that may be implemented in phase II/III trials are discussed. For example, the treatment efficacy as limited by light penetration in interstitial PDT may be predicted by the amount of contrast uptake in CT, and so this could be utilized as a surrogate dosimetry measurement to prescribe light doses based upon pre-treatment contrast. Success of clinical ALA-based skin lesion treatment is predicted almost uniquely by the explicit or implicit measurements of photosensitizer and photobleaching, yet the individualization of treatment based upon each patients measured bleaching needs to be attempted. In the case of ALA, lack of PpIX is more likely an indicator that alternative PpIX production methods must be implemented. Parsimonious dosimetry, using surrogate measurements that are clinically acceptable, might strategically help to advance PDT in a medical world that is increasingly cost and time sensitive. Careful attention to methodologies that can identify and advance the most critical dosimetric measurements, either direct or surrogate, are needed to ensure successful incorporation of PDT into niche clinical procedures.
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Affiliation(s)
- Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA. Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
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Lundsgaard Hansen M, Fallentin E, Axelsen T, Lauridsen C, Norling R, Svendsen LB, Nielsen MB. Interobserver and Intraobserver Reproducibility with Volume Dynamic Contrast Enhanced Computed Tomography (DCE-CT) in Gastroesophageal Junction Cancer. Diagnostics (Basel) 2016; 6:diagnostics6010008. [PMID: 26838804 PMCID: PMC4808823 DOI: 10.3390/diagnostics6010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/20/2016] [Accepted: 01/26/2016] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to assess inter- and intra-observer reproducibility of three different analytic methods to evaluate quantitative dynamic contrast-enhanced computed tomography (DCE-CT) measures from gastroesophageal junctional cancer. Twenty-five DCE-CT studies with gastroesophageal junction cancer were selected from a previous longitudinal study. Three radiologists independently reviewed all scans, and one repeated the analysis eight months later for intraobserver analysis. Review of the scans consisted of three analysis methods: (I) Four, fixed small sized regions of interest (2-dimensional (2D) fixed ROIs) placed in the tumor periphery, (II) 2-dimensional regions of interest (2D-ROI) along the tumor border in the tumor center, and (III) 3-dimensional volumes of interest (3D-VOI) containing the entire tumor volume. Arterial flow, blood volume and permeability (ktrans) were recorded for each observation. Inter- and intra-observer variability were assessed by Intraclass Correlation Coefficient (ICC) and Bland-Altman statistics. Interobserver ICC was excellent for arterial flow (0.88), for blood volume (0.89) and for permeability (0.91) with 3D-VOI analysis. The 95% limits of agreement were narrower for 3D analysis compared to 2D analysis. Three-dimensional volume DCE-CT analysis of gastroesophageal junction cancer provides higher inter- and intra-observer reproducibility with narrower limits of agreement between readers compared to 2D analysis.
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Affiliation(s)
- Martin Lundsgaard Hansen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
- Department of Radiology, Koege and Roskilde Hospital, DK-4000 Roskilde, Denmark.
| | - Eva Fallentin
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Thomas Axelsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Carsten Lauridsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
- Metropolitan University College, Radiography Education, Copenhagen, DK-2200 Copenhagen, Denmark.
| | - Rikke Norling
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Lars Bo Svendsen
- Department of Surgery, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Michael Bachmann Nielsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
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50
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Gordic S, Puippe GD, Krauss B, Klotz E, Desbiolles L, Lesurtel M, Müllhaupt B, Pfammatter T, Alkadhi H. Correlation between Dual-Energy and Perfusion CT in Patients with Hepatocellular Carcinoma. Radiology 2016; 280:78-87. [PMID: 26824712 DOI: 10.1148/radiol.2015151560] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To develop a dual-energy contrast media-enhanced computed tomographic (CT) protocol by using time-attenuation curves from previously acquired perfusion CT data and to evaluate prospectively the relationship between iodine enhancement metrics at dual-energy CT and perfusion CT parameters in patients with hepatocellular carcinoma (HCC). Materials and Methods Institutional review board and local ethics committee approval and written informed consent were obtained. The retrospective part of this study included the development of a dual-energy CT contrast-enhanced protocol to evaluate peak arterial enhancement of HCC in the liver on the basis of time-attenuation curves from previously acquired perfusion CT data in 20 patients. The prospective part of the study consisted of an intraindividual comparison of dual-energy CT and perfusion CT data in another 20 consecutive patients with HCC. Iodine density and iodine ratio (iodine attenuation of the lesion divided by iodine attenuation in the aorta) from dual-energy CT and arterial perfusion (AP), portal venous perfusion, and total perfusion (TP) from perfusion CT were compared. Pearson R and linear correlation coefficients were calculated for AP and iodine density, AP and iodine ratio, TP and iodine density, and TP and iodine ratio. Results The dual-energy CT protocol consisted of bolus tracking in the abdominal aorta (threshold, 150 HU; scan delay, 9 seconds). The strongest intraindividual correlations in HCCs were found between iodine density and AP (r = 0.75, P = .0001). Moderate correlations were found between iodine ratio and AP (r = 0.50, P = .023) and between iodine density and TP (r = 0.56, P = .011). No further significant correlations were found. The volume CT dose index (11.4 mGy) and dose-length product (228.0 mGy · cm) of dual-energy CT was lower than those of the arterial phase of perfusion CT (36.1 mGy and 682.3 mGy · cm, respectively). Conclusion A contrast-enhanced dual-energy CT protocol developed by using time-attenuation curves from previously acquired perfusion CT data sets in patients with HCC could show good correlation between iodine density from dual-energy CT with AP from perfusion CT. (©) RSNA, 2016.
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Affiliation(s)
- Sonja Gordic
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Gilbert D Puippe
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Bernhard Krauss
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Ernst Klotz
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Lotus Desbiolles
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Mickaël Lesurtel
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Beat Müllhaupt
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Thomas Pfammatter
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
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