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Miyazaki M, Yamamoto A, Malis V, Statum S, Chung CB, Sozanski J, Bae WC. Time-Resolved Noncontrast Magnetic Resonance Perfusion Imaging of Paraspinal Muscles. J Magn Reson Imaging 2022; 56:1591-1599. [PMID: 35191562 PMCID: PMC9393201 DOI: 10.1002/jmri.28123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While evaluation of blood perfusion in lumbar paraspinal muscles is of interest in low back pain, it has not been performed using noncontrast magnetic resonance (MR) techniques. PURPOSE To introduce a novel application of a time-resolved, noncontrast MR perfusion technique for paraspinal muscles and demonstrate effect of exercise on perfusion parameters. STUDY TYPE Longitudinal. SUBJECTS Six healthy subjects (27-48 years old, two females) and two subjects with acute low back pain (46 and 65 years old females, one with diabetes/obesity). FIELD STRENGTH/SEQUENCE 3-T, MR perfusion sequence. ASSESSMENT Lumbar spines of healthy subjects were imaged axially at L3 level with a tag-on and tag-off alternating inversion recovery arterial spin labeling technique that suppresses background signal and acquires signal increase ratio (SIR) from the in-flow blood at varying inversion times (TI) from 0.12 seconds to 3.5 seconds. SIR vs. TI data were fit to determine the perfusion metrics of peak height (PH), time to peak (TTP), mean transit time, apparent muscle blood volume (MBV), and apparent muscle blood flow (MBF) in iliocostal, longissimus, and multifidus. Imaging was repeated immediately after healthy subjects performed a 20-minute walk, to determine the effect of exercise. STATISTICAL TESTS Repeated measures analysis of variance. RESULTS SIR vs. TI data showed well-defined leading and trailing edges, with sharply increasing SIR to TI of approximately 500 msec subsiding quickly to near zero around TI of 1500 msec. After exercise, the mean SIR at every TI increased markedly, resulting in significantly higher PH, MBV, and MBF (each P < 0.001 and F > 28.9), and a lower TTP (P < 0.05, F = 4.5), regardless of the muscle. MBF increased 2- to 2.5-fold after exercise, similar to the expected increase in cardiac output, given the intensity of the exercise. DATA CONCLUSIONS Feasibility of an MR perfusion technique for muscle perfusion imaging was demonstrated, successfully detecting significantly increased perfusion after exercise. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Mitsue Miyazaki
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Asako Yamamoto
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Vadim Malis
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Sheronda Statum
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
- Department of Radiology, VA San Diego Healthcare System, San Diego, California, USA
| | - Christine B. Chung
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
- Department of Radiology, VA San Diego Healthcare System, San Diego, California, USA
| | - Jesse Sozanski
- Department of Family Medicine, University of California, San Diego, La Jolla, California, USA
| | - Won C. Bae
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
- Department of Radiology, VA San Diego Healthcare System, San Diego, California, USA
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Weber JPD, Spiro JE, Scheffler M, Wolf J, Nogova L, Tittgemeyer M, Maintz D, Laue H, Persigehl T. Reproducibility of dynamic contrast enhanced MRI derived transfer coefficient Ktrans in lung cancer. PLoS One 2022; 17:e0265056. [PMID: 35259199 PMCID: PMC8903254 DOI: 10.1371/journal.pone.0265056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/22/2022] [Indexed: 12/25/2022] Open
Abstract
Dynamic contrast enhanced MRI (DCE-MRI) is a useful method to monitor therapy assessment in malignancies but must be reliable and comparable for successful clinical use. The aim of this study was to evaluate the inter- and intrarater reproducibility of DCE-MRI in lung cancer. At this IRB approved single centre study 40 patients with lung cancer underwent up to 5 sequential DCE-MRI examinations. DCE-MRI were performed using a 3.0T system. The volume transfer constant Ktrans was assessed by three readers using the two-compartment Tofts model. Inter- and intrarater reliability and agreement was calculated by wCV, ICC and their 95% confident intervals. DCE-MRI allowed a quantitative measurement of Ktrans in 107 tumors where 91 were primary carcinomas or intrapulmonary metastases and 16 were extrapulmonary metastases. Ktrans showed moderate to good interrater reliability in overall measurements (ICC 0.716-0.841; wCV 30.3-38.4%). Ktrans in pulmonary lesions ≥ 3 cm showed a good to excellent reliability (ICC 0.773-0.907; wCV 23.0-29.4%) compared to pulmonary lesions < 3 cm showing a moderate to good reliability (ICC 0.710-0.889; wCV 31.6-48.7%). Ktrans in intrapulmonary lesions showed a good reliability (ICC 0.761-0.873; wCV 28.9-37.5%) compared to extrapulmonary lesions with a poor to moderate reliability (ICC 0.018-0.680; wCV 28.1-51.8%). The overall intrarater agreement was moderate to good (ICC 0.607-0.795; wCV 24.6-30.4%). With Ktrans, DCE MRI offers a reliable quantitative biomarker for early non-invasive therapy assessment in lung cancer patients, but with a coefficient of variation of up to 48.7% in smaller lung lesions.
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Affiliation(s)
| | - Judith Eva Spiro
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany
| | - Matthias Scheffler
- Lung Cancer Group, Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Jürgen Wolf
- Lung Cancer Group, Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Lucia Nogova
- Lung Cancer Group, Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | | | - David Maintz
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Hendrik Laue
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
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Assessing the reproducibility of high temporal and spatial resolution dynamic contrast-enhanced magnetic resonance imaging in patients with gliomas. Sci Rep 2021; 11:23217. [PMID: 34853347 PMCID: PMC8636480 DOI: 10.1038/s41598-021-02450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/23/2021] [Indexed: 11/11/2022] Open
Abstract
Temporal and spatial resolution of dynamic contrast-enhanced MR imaging (DCE-MRI) is critical to reproducibility, and the reproducibility of high-resolution (HR) DCE-MRI was evaluated. Thirty consecutive patients suspected to have brain tumors were prospectively enrolled with written informed consent. All patients underwent both HR-DCE (voxel size, 1.1 × 1.1 × 1.1 mm3; scan interval, 1.6 s) and conventional DCE (C-DCE; voxel size, 1.25 × 1.25 × 3.0 mm3; scan interval, 4.0 s) MRI. Regions of interests (ROIs) for enhancing lesions were segmented twice in each patient with glioblastoma (n = 7) to calculate DCE parameters (Ktrans, Vp, and Ve). Intraclass correlation coefficients (ICCs) of DCE parameters were obtained. In patients with gliomas (n = 25), arterial input functions (AIFs) and DCE parameters derived from T2 hyperintense lesions were obtained, and DCE parameters were compared according to WHO grades. ICCs of HR-DCE parameters were good to excellent (0.84–0.95), and ICCs of C-DCE parameters were moderate to excellent (0.66–0.96). Maximal signal intensity and wash-in slope of AIFs from HR-DCE MRI were significantly greater than those from C-DCE MRI (31.85 vs. 7.09 and 2.14 vs. 0.63; p < 0.001). Both 95th percentile Ktrans and Ve from HR-DCE and C-DCE MRI could differentiate grade 4 from grade 2 and 3 gliomas (p < 0.05). In conclusion, HR-DCE parameters generally showed better reproducibility than C-DCE parameters, and HR-DCE MRI provided better quality of AIFs.
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Free-Breathing Dynamic Contrast-Enhanced Imaging of the Upper Abdomen Using a Cartesian Compressed-Sensing Sequence With Hard-Gated and Motion-State-Resolved Reconstruction. Invest Radiol 2019; 54:728-736. [DOI: 10.1097/rli.0000000000000607] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Salem A, Little RA, Latif A, Featherstone AK, Babur M, Peset I, Cheung S, Watson Y, Tessyman V, Mistry H, Ashton G, Behan C, Matthews JC, Asselin MC, Bristow RG, Jackson A, Parker GJM, Faivre-Finn C, Williams KJ, O'Connor JPB. Oxygen-enhanced MRI Is Feasible, Repeatable, and Detects Radiotherapy-induced Change in Hypoxia in Xenograft Models and in Patients with Non-small Cell Lung Cancer. Clin Cancer Res 2019; 25:3818-3829. [PMID: 31053599 DOI: 10.1158/1078-0432.ccr-18-3932] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/04/2019] [Accepted: 03/14/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Hypoxia is associated with poor prognosis and is predictive of poor response to cancer treatments, including radiotherapy. Developing noninvasive biomarkers that both detect hypoxia prior to treatment and track change in tumor hypoxia following treatment is required urgently. EXPERIMENTAL DESIGN We evaluated the ability of oxygen-enhanced MRI (OE-MRI) to map and quantify therapy-induced changes in tumor hypoxia by measuring oxygen-refractory signals in perfused tissue (perfused Oxy-R). Clinical first-in-human study in patients with non-small cell lung cancer (NSCLC) was performed alongside preclinical experiments in two xenograft tumors (Calu6 NSCLC model and U87 glioma model). RESULTS MRI perfused Oxy-R tumor fraction measurement of hypoxia was validated with ex vivo tissue pathology in both xenograft models. Calu6 and U87 experiments showed that MRI perfused Oxy-R tumor volume was reduced relative to control following single fraction 10-Gy radiation and fractionated chemoradiotherapy (P < 0.001) due to both improved perfusion and reduced oxygen consumption rate. Next, evaluation of 23 patients with NSCLC showed that OE-MRI was clinically feasible and that tumor perfused Oxy-R volume is repeatable [interclass correlation coefficient: 0.961 (95% CI, 0.858-0.990); coefficient of variation: 25.880%]. Group-wise perfused Oxy-R volume was reduced at 14 days following start of radiotherapy (P = 0.015). OE-MRI detected between-subject variation in hypoxia modification in both xenograft and patient tumors. CONCLUSIONS These findings support applying OE-MRI biomarkers to monitor hypoxia modification, to stratify patients in clinical trials of hypoxia-modifying therapies, to identify patients with hypoxic tumors that may fail treatment with immunotherapy, and to guide adaptive radiotherapy by mapping regional hypoxia.
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Affiliation(s)
- Ahmed Salem
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
- Department of Clinical Oncology, The Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Ross A Little
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Ayşe Latif
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Adam K Featherstone
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Muhammad Babur
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Isabel Peset
- Imaging and Flow Cytometry, Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Susan Cheung
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Yvonne Watson
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Victoria Tessyman
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Hitesh Mistry
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Garry Ashton
- Histology, Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Caron Behan
- Histology, Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Julian C Matthews
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Marie-Claude Asselin
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Robert G Bristow
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Clinical Oncology, The Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Alan Jackson
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Geoff J M Parker
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
- Bioxydyn Limited, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Clinical Oncology, The Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Kaye J Williams
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - James P B O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom. James.O'
- Department of Radiology, The Christie Hospital NHS Trust, Manchester, United Kingdom
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Intra- and interobserver reproducibility of pancreatic perfusion by computed tomography. Sci Rep 2019; 9:6043. [PMID: 30988325 PMCID: PMC6465241 DOI: 10.1038/s41598-019-42519-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/02/2019] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to measure intra- and interobserver agreement among radiologists in the assessment of pancreatic perfusion by computed tomography (CT). Thirty-nine perfusion CT scans were analyzed. The following parameters were measured by three readers: blood flow (BF), blood volume (BV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was performed using the Bland-Altman method, linear mixed model analysis, and intraclass correlation coefficient (ICC). There was no significant intraobserver variability for the readers regarding BF, BV or TTP. There were session effects for BF in the pancreatic body and MTT in the pancreatic tail and whole pancreas. There were reader effects for BV in the pancreatic head, pancreatic body and whole pancreas. There were no effects for the interaction between session and reader for any perfusion parameter. ICCs showed substantial agreement for the interobserver measurements and moderate to substantial agreement for the intraobserver measurements, with the exception of MTT. In conclusion, satisfactory reproducibility of measurements was observed for TTP in all pancreatic regions, for BF in the head and BV in the tail, and these parameters seem to ensure a reasonable estimation of pancreatic perfusion.
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Barboriak DP, Zhang Z, Desai P, Snyder BS, Safriel Y, McKinstry RC, Bokstein F, Sorensen G, Gilbert MR, Boxerman JL. Interreader Variability of Dynamic Contrast-enhanced MRI of Recurrent Glioblastoma: The Multicenter ACRIN 6677/RTOG 0625 Study. Radiology 2019; 290:467-476. [PMID: 30480488 PMCID: PMC6358054 DOI: 10.1148/radiol.2019181296] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate factors contributing to interreader variation (IRV) in parameters measured at dynamic contrast material-enhanced (DCE) MRI in patients with glioblastoma who were participating in a multicenter trial. Materials and Methods A total of 18 patients (mean age, 57 years ± 13 [standard deviation]; 10 men) who volunteered for the advanced imaging arm of ACRIN 6677, a substudy of the RTOG 0625 clinical trial for recurrent glioblastoma treatment, underwent analyzable DCE MRI at one of four centers. The 78 imaging studies were analyzed centrally to derive the volume transfer constant (Ktrans) for gadolinium between blood plasma and tissue extravascular extracellular space, fractional volume of the extracellular extravascular space (ve), and initial area under the gadolinium concentration curve (IAUGC). Two independently trained teams consisting of a neuroradiologist and a technologist segmented the enhancing tumor on three-dimensional spoiled gradient-recalled acquisition in the steady-state images. Mean and median parameter values in the enhancing tumor were extracted after registering segmentations to parameter maps. The effect of imaging time relative to treatment, map quality, imager magnet and sequence, average tumor volume, and reader variability in tumor volume on IRV was studied by using intraclass correlation coefficients (ICCs) and linear mixed models. Results Mean interreader variations (± standard deviation) (difference as a percentage of the mean) for mean and median IAUGC, mean and median Ktrans, and median ve were 18% ± 24, 17% ± 23, 27% ± 34, 16% ± 27, and 27% ± 34, respectively. ICCs for these metrics ranged from 0.90 to 1.0 for baseline and from 0.48 to 0.76 for posttreatment examinations. Variability in reader-derived tumor volume was significantly related to IRV for all parameters. Conclusion Differences in reader tumor segmentations are a significant source of interreader variation for all dynamic contrast-enhanced MRI parameters. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Wolf in this issue.
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Affiliation(s)
- Daniel P. Barboriak
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Zheng Zhang
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Pratikkumar Desai
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Bradley S. Snyder
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Yair Safriel
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Robert C. McKinstry
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Felix Bokstein
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Gregory Sorensen
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Mark R. Gilbert
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
| | - Jerrold L. Boxerman
- From the Department of Radiology, Duke University Medical Center,
2301 Erwin Rd, Durham, NC 27710 (D.P.B.); Department of Biostatistics and Center
for Statistical Sciences, Brown University, Providence, RI (Z.Z.); Department of
Psychiatry and Behavioral Sciences, University of Texas Health Science Center,
Houston, Tex (P.D.); Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI (B.S.S.); Pharmascan Clinical Trials and Radiology
Associates of Clearwater, University of South Florida, Clearwater, Fla (Y.S.);
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St Louis, Mo (R.C.M.); Neuro-Oncology Service, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel (F.B.); A.A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass
(G.S.); Siemens Healthcare, Malvern, Pa (G.S.); Department of Neuro-Oncology,
The University of Texas MD Anderson Cancer Center, Houston, Tex (M.R.G.); and
Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical
School of Brown University, Providence, RI (J.L.B.)
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Klawer EME, van Houdt PJ, Simonis FFJ, van den Berg CAT, Pos FJ, Heijmink SWTPJ, Isebaert S, Haustermans K, van der Heide UA. Improved repeatability of dynamic contrast-enhanced MRI using the complex MRI signal to derive arterial input functions: a test-retest study in prostate cancer patients. Magn Reson Med 2019; 81:3358-3369. [PMID: 30656738 PMCID: PMC6590420 DOI: 10.1002/mrm.27646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/07/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022]
Abstract
Purpose The arterial input function (AIF) is a major source of uncertainty in tracer kinetic (TK) analysis of dynamic contrast‐enhanced (DCE)‐MRI data. The aim of this study was to investigate the repeatability of AIFs extracted from the complex signal and of the resulting TK parameters in prostate cancer patients. Methods Twenty‐two patients with biopsy‐proven prostate cancer underwent a 3T MRI exam twice. DCE‐MRI data were acquired with a 3D spoiled gradient echo sequence. AIFs were extracted from the magnitude of the signal (AIFMAGN), phase (AIFPHASE), and complex signal (AIFCOMPLEX). The Tofts model was applied to extract Ktrans, kep and ve. Repeatability of AIF curve characteristics and TK parameters was assessed with the within‐subject coefficient of variation (wCV). Results The wCV for peak height and full width at half maximum for AIFCOMPLEX (7% and 8%) indicated an improved repeatability compared to AIFMAGN (12% and 12%) and AIFPHASE (12% and 7%). This translated in lower wCV values for Ktrans (11%) with AIFCOMPLEX in comparison to AIFMAGN (24%) and AIFPHASE (15%). For kep, the wCV was 16% with AIFMAGN, 13% with AIFPHASE, and 13% with AIFCOMPLEX. Conclusion Repeatability of AIFPHASE and AIFCOMPLEX is higher than for AIFMAGN, resulting in a better repeatability of TK parameters. Thus, use of either AIFPHASE or AIFCOMPLEX improves the robustness of quantitative analysis of DCE‐MRI in prostate cancer.
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Affiliation(s)
- Edzo M E Klawer
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petra J van Houdt
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frank F J Simonis
- Department of Radiation Oncology, Imaging Division, University Medical Center, Utrecht, The Netherlands
| | - Cornelis A T van den Berg
- Department of Radiation Oncology, Imaging Division, University Medical Center, Utrecht, The Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Sofie Isebaert
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Uulke A van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
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9
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Shukla-Dave A, Obuchowski NA, Chenevert TL, Jambawalikar S, Schwartz LH, Malyarenko D, Huang W, Noworolski SM, Young RJ, Shiroishi MS, Kim H, Coolens C, Laue H, Chung C, Rosen M, Boss M, Jackson EF. Quantitative imaging biomarkers alliance (QIBA) recommendations for improved precision of DWI and DCE-MRI derived biomarkers in multicenter oncology trials. J Magn Reson Imaging 2018; 49:e101-e121. [PMID: 30451345 DOI: 10.1002/jmri.26518] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/14/2022] Open
Abstract
Physiological properties of tumors can be measured both in vivo and noninvasively by diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging. Although these techniques have been used for more than two decades to study tumor diffusion, perfusion, and/or permeability, the methods and studies on how to reduce measurement error and bias in the derived imaging metrics is still lacking in the literature. This is of paramount importance because the objective is to translate these quantitative imaging biomarkers (QIBs) into clinical trials, and ultimately in clinical practice. Standardization of the image acquisition using appropriate phantoms is the first step from a technical performance standpoint. The next step is to assess whether the imaging metrics have clinical value and meet the requirements for being a QIB as defined by the Radiological Society of North America's Quantitative Imaging Biomarkers Alliance (QIBA). The goal and mission of QIBA and the National Cancer Institute Quantitative Imaging Network (QIN) initiatives are to provide technical performance standards (QIBA profiles) and QIN tools for producing reliable QIBs for use in the clinical imaging community. Some of QIBA's development of quantitative diffusion-weighted imaging and dynamic contrast-enhanced QIB profiles has been hampered by the lack of literature for repeatability and reproducibility of the derived QIBs. The available research on this topic is scant and is not in sync with improvements or upgrades in MRI technology over the years. This review focuses on the need for QIBs in oncology applications and emphasizes the importance of the assessment of their reproducibility and repeatability. Level of Evidence: 5 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;49:e101-e121.
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Affiliation(s)
- Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dariya Malyarenko
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Wei Huang
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Susan M Noworolski
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark S Shiroishi
- Division of Neuroradiology, Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Harrison Kim
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine Coolens
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Boss
- Applied Physics Division, National Institute of Standards and Technology, Boulder, Colorado, USA
| | - Edward F Jackson
- Departments of Medical Physics, Radiology, and Human Oncology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
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10
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MacKay JW, Low SBL, Smith TO, Toms AP, McCaskie AW, Gilbert FJ. Systematic review and meta-analysis of the reliability and discriminative validity of cartilage compositional MRI in knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:1140-1152. [PMID: 29550400 DOI: 10.1016/j.joca.2017.11.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 11/14/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess reliability and discriminative validity of cartilage compositional magnetic resonance imaging (MRI) in knee osteoarthritis (OA). DESIGN The study was carried out per PRISMA recommendations. We searched MEDLINE and EMBASE (1974 - present) for eligible studies. We performed qualitative synthesis of reliability data. Where data from at least two discrimination studies were available, we estimated pooled standardized mean difference (SMD) between subjects with and without OA. Discrimination analyses compared controls and subjects with mild OA (Kellgren-Lawrence (KL) grade 1-2), severe OA (KL grade 3-4) and OA not otherwise specified (NOS) where not possible to stratify. We assessed quality of the evidence using Quality Appraisal of Diagnostic Reliability (QAREL) and Quality Assessment of Diagnostic Accuracy (QUADAS-2) tools. RESULTS Fifty-eight studies were included in the reliability analysis and 26 studies were included in the discrimination analysis, with data from a total of 2,007 knees. Intra-observer, inter-observer and test-retest reliability of compositional techniques were excellent with most intraclass correlation coefficients >0.8 and coefficients of variation <10%. T1rho and T2 relaxometry were significant discriminators between subjects with mild OA and controls, and between subjects with OA (NOS) and controls (P < 0.001). T1rho showed best discrimination for mild OA (SMD [95% CI] = 0.73 [0.40 to 1.06], P < 0.001) and OA (NOS) (0.60 [0.41 to 0.80], P < 0.001). Quality of evidence was moderate for both parts of the review. CONCLUSIONS Cartilage compositional MRI techniques are reliable and, in the case of T1rho and T2 relaxometry, can discriminate between subjects with OA and controls.
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Affiliation(s)
- J W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK.
| | - S B L Low
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
| | - A W McCaskie
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge UK.
| | - F J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK.
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11
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Weekes CD, Rosen LS, Capasso A, Wong KM, Ye W, Anderson M, McCall B, Fredrickson J, Wakshull E, Eppler S, Shon-Nguyen Q, Desai R, Huseni M, Hegde PS, Pourmohamad T, Rhee I, Bessudo A. Phase I study of the anti-α5β1 monoclonal antibody MINT1526A with or without bevacizumab in patients with advanced solid tumors. Cancer Chemother Pharmacol 2018; 82:339-351. [PMID: 29905898 DOI: 10.1007/s00280-018-3622-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/08/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE MINT1526A is a monoclonal antibody that blocks the interaction of integrin alpha 5 beta 1 (α5β1) with its extracellular matrix ligands. This phase I study evaluated the safety and pharmacokinetics of MINT1526A with or without bevacizumab in patients with advanced solid tumors. METHODS MINT1526A was administered every 3 weeks (Q3W) as monotherapy (arm 1) or in combination with bevacizumab 15 mg/kg, Q3W (arm 2). Each arm included a 3 + 3 dose-escalation stage and a dose-expansion stage. RESULTS Twenty-four patients were enrolled in arm 1 (dose range 2-30 mg/kg) and 30 patients were enrolled in arm 2 (dose range 3-15 mg/kg). Monocyte α5β1 receptor occupancy was saturated at a dose of 15 mg/kg. No dose-limiting toxicities were observed, and the maximum tolerated dose was not reached in either arm. The most common adverse events, regardless of causality, included abdominal pain (25%), diarrhea (25%), nausea (21%), vomiting (21%), and fatigue (21%) in arm 1 and nausea (40%), fatigue (33%), vomiting (30%), dehydration (30%), headache (30%), and hypertension (30%) in arm 2. No grade ≥ 3 bleeding events were observed in either arm. No confirmed partial responses (PR) were observed in arm 1. In arm 2, one patient with thymic carcinoma experienced a confirmed PR and two patients with hepatocellular carcinoma (HCC) experienced durable minor radiographic responses. CONCLUSIONS MINT1526A, with or without bevacizumab, was well-tolerated. Preliminary evidence of combination efficacy, including in patients with HCC, was observed, but cannot be distinguished from bevacizumab monotherapy in this phase I study.
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Affiliation(s)
- Colin D Weekes
- Division of Hematology/Oncology, Massachusetts General Hospital, 55 Fruit St, Yawkey 7E, Boston, MA, 02114, USA.
| | - Lee S Rosen
- Division of Hematology-Oncology, University of California-Los Angeles, Santa Monica, CA, USA
| | - Anna Capasso
- Division of Medical Oncology, University of Colorado School of Medicine and Developmental Therapeutics Program, University of Colorado Cancer Center, Aurora, CO, USA
| | - Kit Man Wong
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Weilan Ye
- Genentech, Inc., South San Francisco, CA, USA
| | | | | | | | | | | | | | - Rupal Desai
- Genentech, Inc., South San Francisco, CA, USA
| | | | | | | | - Ina Rhee
- Genentech, Inc., South San Francisco, CA, USA
| | - Alberto Bessudo
- California Cancer Associates for Research & Excellence, Encinitas, CA, USA
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12
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Benz MR, Bongartz G, Froehlich JM, Winkel D, Boll DT, Heye T. Acceleration techniques and their impact on arterial input function sampling: Non-accelerated versus view-sharing and compressed sensing sequences. Eur J Radiol 2018; 104:8-13. [PMID: 29857871 DOI: 10.1016/j.ejrad.2018.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim was to investigate the variation of the arterial input function (AIF) within and between various DCE MRI sequences. MATERIAL AND METHODS A dynamic flow-phantom and steady signal reference were scanned on a 3T MRI using fast low angle shot (FLASH) 2d, FLASH3d (parallel imaging factor (P) = P0, P2, P4), volumetric interpolated breath-hold examination (VIBE) (P = P0, P3, P2 × 2, P2 × 3, P3 × 2), golden-angle radial sparse parallel imaging (GRASP), and time-resolved imaging with stochastic trajectories (TWIST). Signal over time curves were normalized and quantitatively analyzed by full width half maximum (FWHM) measurements to assess variation within and between sequences. RESULTS The coefficient of variation (CV) for the steady signal reference ranged from 0.07-0.8%. The non-accelerated gradient echo FLASH2d, FLASH3d, and VIBE sequences showed low within sequence variation with 2.1%, 1.0%, and 1.6%. The maximum FWHM CV was 3.2% for parallel imaging acceleration (VIBE P2 × 3), 2.7% for GRASP and 9.1% for TWIST. The FWHM CV between sequences ranged from 8.5-14.4% for most non-accelerated/accelerated gradient echo sequences except 6.2% for FLASH3d P0 and 0.3% for FLASH3d P2; GRASP FWHM CV was 9.9% versus 28% for TWIST. CONCLUSION MRI acceleration techniques vary in reproducibility and quantification of the AIF. Incomplete coverage of the k-space with TWIST as a representative of view-sharing techniques showed the highest variation within sequences and might be less suited for reproducible quantification of the AIF.
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Affiliation(s)
- Matthias R Benz
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
| | - Georg Bongartz
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | | | - David Winkel
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Daniel T Boll
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Heye
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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13
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Wagner M, Hectors S, Bane O, Gordic S, Kennedy P, Besa C, Schiano TD, Thung S, Fischman A, Taouli B. Noninvasive prediction of portal pressure with MR elastography and DCE-MRI of the liver and spleen: Preliminary results. J Magn Reson Imaging 2018; 48:1091-1103. [PMID: 29638020 DOI: 10.1002/jmri.26026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/09/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Portal hypertension (PH), defined by hepatic venous pressure gradient (HVPG) ≥5 mmHg and clinically significant PH, defined by HVPG ≥10 mmHg, are complications of chronic liver disease. PURPOSE To assess the diagnostic performance of MR elastography (MRE) and dynamic contrast-enhanced MRI (DCE-MRI) of the liver and spleen for the prediction of PH and clinically significant PH, in comparison with a qualitative PH imaging scoring system. STUDY TYPE IRB-approved prospective study. POPULATION In all, 34 patients with chronic liver disease who underwent HVPG measurement. FIELD STRENGTH/SEQUENCE 1.5/3T examination including 2D-GRE MRE (n = 33) and DCE-MRI of the liver/spleen (n = 28). ASSESSMENT Liver and spleen stiffness were calculated from elastogram maps. DCE-MRI was analyzed using model-free parameters and pharmacokinetic modeling. Two observers calculated qualitative PH imaging scores based on routine images. STATISTICAL TESTS Imaging parameters were correlated with HVPG. Receiver operating characteristic (ROC) analysis was performed for prediction of PH and clinically significant PH. RESULTS There were significant correlations between DCE-MRI parameters (liver time-to-peak, r = 0.517 / P = 0.006, liver distribution volume, r = 0.494 / P = 0.009, liver upslope, r = -0.567 / P = 0.002), liver stiffness (r = 0.478 / P = 0.016), PH imaging score (r = 0.441 / P = 0.009), and HVPG. ROC analysis provided significant area under the ROC (AUROCs) for PH (liver upslope 0.765, liver stiffness 0.809, spleen volume/diameter 0.746-0.731, PH imaging score 0.756) and for clinically significant PH (liver and spleen perfusion parameters 0.733-0.776, liver stiffness 0.742, PH imaging score 0.742). The ratio of liver stiffness to liver upslope had the highest AUROC for diagnosing PH (0.903) and clinically significant PH (0.785). DATA CONCLUSION These preliminary results suggest that the combination of liver stiffness and perfusion metrics provide excellent accuracy for diagnosing PH, and fair accuracy for clinically significant PH. Combined MRE and DCE-MRI outperformed qualitative imaging scores for prediction of PH. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1091-1103.
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Affiliation(s)
- Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Sorbonne Universités, CNRS, INSERM, LIB, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stefanie Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Kennedy
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cecilia Besa
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Thomas D Schiano
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Swan Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aaron Fischman
- Department of Radiology, Section of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Study of Intrapatient Variability and Reproducibility of Quantitative Tumor Perfusion Parameters Evaluated With Dynamic Contrast-Enhanced Ultrasonography. Invest Radiol 2017; 52:148-154. [DOI: 10.1097/rli.0000000000000324] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Kumar V, Boucher Y, Liu H, Ferreira D, Hooker J, Catana C, Hoover AJ, Ritter T, Jain RK, Guimaraes AR. Noninvasive Assessment of Losartan-Induced Increase in Functional Microvasculature and Drug Delivery in Pancreatic Ductal Adenocarcinoma. Transl Oncol 2016; 9:431-437. [PMID: 27751347 PMCID: PMC5067928 DOI: 10.1016/j.tranon.2016.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023] Open
Abstract
PURPOSE: Losartan, an angiotensin II receptor blocker, can reduce desmoplasia and enhance drug delivery and efficacy through improving interstitial transport and vascular perfusion in pancreatic ductal adenocarcinoma (PDAC) models in mice. The purpose of this study was to determine whether magnetic resonance imaging (MRI) of magnetic iron oxide nanoparticles (MNPs) and micro–positron emission tomography (PET) measurements could respectively detect improvements in tumor vascular parameters and drug uptake in orthotopic PDAC in mice treated with losartan. METHOD AND MATERIALS: All experiments were approved by the local Institutional Animal Care and Use Committee. FVB mice with orthotopic PDAC were treated daily with an i.p. injection of losartan (70 mg/kg) or saline (control vehicle) for 5 days. In order to calculate the fractional blood volume, vessel size index, and vessel density index, MRI was performed at 4.7 T following the injection of 3 mg/kg iron ferumoxytol (i.v.). Dynamic PET images were also acquired for 60 minutes using an 18F-5FU tracer dose of 200 μCi and analyzed for time activity curves normalized to muscle. Statistical analyses compared both cohorts using an unpaired two-tailed t test. RESULTS: In comparison to the control treatment, the losartan administration significantly increased the fractional blood volume (mean ± SEM) [12.1 ± 1.7 (n = 19) vs 6.7 ± 1.1 (n = 20); P < .02] and vessel size index (128.2 ± 35.6 vs 57.5 ± 18; P < .05). Losartan also induced a significant increase in the intratumoral uptake of 18F-5FU by 53% (P < .0001). CONCLUSION: MRI using FDA-approved MNPs provides a noninvasive, translatable means of assaying microvascular parameters induced by losartan in pancreatic cancer. PET measurements demonstrated that losartan significantly increased the uptake of 18F-5FU.
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Affiliation(s)
- Vidhya Kumar
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Yves Boucher
- E.L. Steele Laboratories Department of Radiation Oncology Harvard Medical School and Massachusetts General Hospital 100 Blossom Street, Cox 7 Boston, MA 02114
- Address all correspondence to: Alexander R. Guimaraes, MD, PhD, Associate Professor of Radiology, Section Chief, Body Imaging, Department of Diagnostic Radiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Mail Code L340, Office SJH 10B77, Portland, OR, 97239, or Yves Boucher, PhD, Steele Lab for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, 149 13th St., Charlestown, MA, 02129.Department of Diagnostic RadiologyOregon Health Sciences UniversitySteele Lab for Tumor Biology, Department of Radiation OncologyMassachusetts General Hospital3181 SW Sam Jackson Park Road, Mail Code L340, Office SJH 10B77PortlandOR97239
| | - Hao Liu
- E.L. Steele Laboratories Department of Radiation Oncology Harvard Medical School and Massachusetts General Hospital 100 Blossom Street, Cox 7 Boston, MA 02114
| | - Diego Ferreira
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Jacob Hooker
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Ciprian Catana
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Andrew J. Hoover
- Department of Chemistry and Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, Massachusetts 02138, United States
| | - Tobias Ritter
- Department of Chemistry and Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, Massachusetts 02138, United States
- Max-Planck-Institut fü r Kohlenforschung, Kaiser-Wilhelm-Platz 1, D-45470 Mü lheim an der Ruhr, Germany
| | - Rakesh K. Jain
- E.L. Steele Laboratories Department of Radiation Oncology Harvard Medical School and Massachusetts General Hospital 100 Blossom Street, Cox 7 Boston, MA 02114
| | - Alexander R. Guimaraes
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA
- Division of Body Imaging, Department of Diagnostic Radiology, Oregon Health Sciences University, Portland, OR
- Address all correspondence to: Alexander R. Guimaraes, MD, PhD, Associate Professor of Radiology, Section Chief, Body Imaging, Department of Diagnostic Radiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Mail Code L340, Office SJH 10B77, Portland, OR, 97239, or Yves Boucher, PhD, Steele Lab for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, 149 13th St., Charlestown, MA, 02129.Department of Diagnostic RadiologyOregon Health Sciences UniversitySteele Lab for Tumor Biology, Department of Radiation OncologyMassachusetts General Hospital3181 SW Sam Jackson Park Road, Mail Code L340, Office SJH 10B77PortlandOR97239
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16
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Imaging approaches to assess the therapeutic response of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): current perspectives and future trends of an exciting field in development. Cancer Metastasis Rev 2016; 34:823-42. [PMID: 26433592 PMCID: PMC4661203 DOI: 10.1007/s10555-015-9598-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a family of neoplasms with a complex spectrum of clinical behavior. Although generally more indolent than carcinomas, once they progress beyond surgical resectability, they are essentially incurable. Systemic treatment options have substantially expanded in recent years for the management of advanced disease. Imaging plays a major role in new drug development, as it is the main tool used to objectively evaluate response to novel agents. However, current standard response criteria have proven suboptimal for the assessment of the antiproliferative effect of many targeted agents, particularly in the context of slow-growing tumors such as well-differentiated NETs. The aims of this article are to discuss the advantages and limitations of conventional radiological techniques and standard response assessment criteria and to review novel imaging modalities in development as well as alternative cancer- and therapy-specific criteria to assess drug efficacy in the field of GEP-NETs.
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Dynamic contrast-enhanced MRI detects acute radiotherapy-induced alterations in mandibular microvasculature: prospective assessment of imaging biomarkers of normal tissue injury. Sci Rep 2016; 6:29864. [PMID: 27499209 PMCID: PMC4976364 DOI: 10.1038/srep29864] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/27/2016] [Indexed: 11/28/2022] Open
Abstract
Normal tissue toxicity is an important consideration in the continued development of more effective external beam radiotherapy (EBRT) regimens for head and neck tumors. The ability to detect EBRT-induced changes in mandibular bone vascularity represents a crucial step in decreasing potential toxicity. To date, no imaging modality has been shown to detect changes in bone vascularity in real time during treatment. Based on our institutional experience with multi-parametric MRI, we hypothesized that DCE-MRI can provide in-treatment information regarding EBRT-induced changes in mandibular vascularity. Thirty-two patients undergoing EBRT treatment for head and neck cancer were prospectively imaged prior to, mid-course, and following treatment. DCE-MRI scans were co-registered to dosimetric maps to correlate EBRT dose and change in mandibular bone vascularity as measured by Ktrans and Ve. DCE-MRI was able to detect dose-dependent changes in both Ktrans and Ve in a subset of patients. One patient who developed ORN during the study period demonstrated decreases in Ktrans and Ve following treatment completion. We demonstrate, in a prospective imaging trial, that DCE-MRI can detect dose-dependent alterations in mandibular bone vascularity during chemoradiotherapy, providing biomarkers that are physiological correlates of acute of acute mandibular vascular injury and recovery temporal kinetics.
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Weller A, O'Brien MER, Ahmed M, Popat S, Bhosle J, McDonald F, Yap TA, Du Y, Vlahos I, deSouza NM. Mechanism and non-mechanism based imaging biomarkers for assessing biological response to treatment in non-small cell lung cancer. Eur J Cancer 2016; 59:65-78. [PMID: 27016624 DOI: 10.1016/j.ejca.2016.02.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Abstract
Therapeutic options in locally advanced non-small cell lung cancer (NSCLC) have expanded in the past decade to include a palate of targeted interventions such as high dose targeted thermal ablations, radiotherapy and growing platform of antibody and small molecule therapies and immunotherapies. Although these therapies have varied mechanisms of action, they often induce changes in tumour architecture and microenvironment such that response is not always accompanied by early reduction in tumour mass, and evaluation by criteria other than size is needed to report more effectively on response. Functional imaging techniques, which probe the tumour and its microenvironment through novel positron emission tomography and magnetic resonance imaging techniques, offer more detailed insights into and quantitation of tumour response than is available on anatomical imaging alone. Use of these biomarkers, or other rational combinations as readouts of pathological response in NSCLC have potential to provide more accurate predictors of treatment outcomes. In this article, the robustness of the more commonly available positron emission tomography and magnetic resonance imaging biomarker indices is examined and the evidence for their application in NSCLC is reviewed.
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Affiliation(s)
- A Weller
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK.
| | - M E R O'Brien
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - M Ahmed
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - S Popat
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - J Bhosle
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - F McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - T A Yap
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Y Du
- Department of Nuclear Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - I Vlahos
- Radiology Department, St George's Hospital NHS Trust, London, SW17 0QT, UK
| | - N M deSouza
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK
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van den Boogaart VEM, de Lussanet QG, Houben RMA, de Ruysscher D, Groen HJM, Marcus JT, Smit EF, Dingemans AMC, Backes WH. Inter-reader reproducibility of dynamic contrast-enhanced magnetic resonance imaging in patients with non-small cell lung cancer treated with bevacizumab and erlotinib. Lung Cancer 2016; 93:20-7. [PMID: 26898610 DOI: 10.1016/j.lungcan.2015.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/16/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Objectives When evaluating anti-tumor treatment response by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) it is necessary to assure its validity and reproducibility. This has not been well addressed in lung tumors. Therefore we have evaluated the inter-reader reproducibility of response classification by DCE-MRI in patients with non-small cell lung cancer (NSCLC) treated with bevacizumab and erlotinib enrolled in a multicenter trial. MATERIALS AND METHODS Twenty-one patients were scanned before and 3 weeks after start of treatment with DCE-MRI in a multicenter trial. The scans were evaluated by two independent readers. The primary lung tumor was used for response assessment. Responses were assessed in terms of relative changes in tumor mean trans endothelial transfer rate (K(trans)) and its heterogeneity in terms of the spatial standard deviation. Reproducibility was expressed by the inter-reader variability, intra-class correlation coefficient (ICC) and dichotomous response classification. RESULTS The inter-reader variability and ICC for the relative K(trans) were 5.8% and 0.930, respectively. For tumor heterogeneity the inter-reader variability and ICC were 0.017 and 0.656, respectively. For the two readers the response classification for relative K(trans) was concordant in 20 of 21 patients (k=0.90, p<0.0001) and for tumor heterogeneity in 19 of 21 patients (k=0.80, p<0.0001). CONCLUSIONS Strong agreement was seen with regard to the inter-reader variability and reproducibility of response classification by the two readers of lung cancer DCE-MRI scans.
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Affiliation(s)
- Vivian E M van den Boogaart
- Department of Pulmonary Diseases, Viecuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands; Department of Pulmonary Diseases, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Quido G de Lussanet
- Department of Radiology, Medical Center Zuiderzee, Ziekenhuisweg 100, 8233AA Lelystad, The Netherlands.
| | - Ruud M A Houben
- Department of Radiation-Oncology (Maastro), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 3035, 6202 NA Maastricht, The Netherlands.
| | - Dirk de Ruysscher
- Department of Radiation-Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Harry J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - J Tim Marcus
- Physics and Medical Technology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Egbert F Smit
- Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Walter H Backes
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
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Metabolic Heterogeneity in Human Lung Tumors. Cell 2016; 164:681-94. [PMID: 26853473 DOI: 10.1016/j.cell.2015.12.034] [Citation(s) in RCA: 764] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/05/2015] [Accepted: 12/14/2015] [Indexed: 12/31/2022]
Abstract
Non-small cell lung cancer (NSCLC) is heterogeneous in the genetic and environmental parameters that influence cell metabolism in culture. Here, we assessed the impact of these factors on human NSCLC metabolism in vivo using intraoperative (13)C-glucose infusions in nine NSCLC patients to compare metabolism between tumors and benign lung. While enhanced glycolysis and glucose oxidation were common among these tumors, we observed evidence for oxidation of multiple nutrients in each of them, including lactate as a potential carbon source. Moreover, metabolically heterogeneous regions were identified within and between tumors, and surprisingly, our data suggested potential contributions of non-glucose nutrients in well-perfused tumor areas. Our findings not only demonstrate the heterogeneity in tumor metabolism in vivo but also highlight the strong influence of the microenvironment on this feature.
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Simonis FF, Sbrizzi A, Beld E, Lagendijk JJ, van den Berg CA. Improving the arterial input function in dynamic contrast enhanced MRI by fitting the signal in the complex plane. Magn Reson Med 2015; 76:1236-45. [DOI: 10.1002/mrm.26023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Frank F.J. Simonis
- Department of Radiotherapy; Imaging Division, University Medical Center Utrecht; Utrecht the Netherlands
| | - Alessandro Sbrizzi
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Ellis Beld
- Department of Radiotherapy; Imaging Division, University Medical Center Utrecht; Utrecht the Netherlands
| | - Jan J.W. Lagendijk
- Department of Radiotherapy; Imaging Division, University Medical Center Utrecht; Utrecht the Netherlands
| | - Cornelis A.T. van den Berg
- Department of Radiotherapy; Imaging Division, University Medical Center Utrecht; Utrecht the Netherlands
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Abstract
Newly developed or advanced methods of ultrasonography and MR imaging provide combined anatomical and quantitative functional information about diffuse and focal liver diseases. Ultrasound elastography has a central role for staging liver fibrosis and an increasing role in grading portal hypertension; dynamic contrast-enhanced ultrasonography may improve tumor characterization. In clinical practice, MR imaging examinations currently include diffusion-weighted and dynamic MR imaging, enhanced with extracellular or hepatobiliary contrast agents. Moreover, quantitative parameters obtained with diffusion-weighted MR imaging, dynamic contrast-enhanced MR imaging and MR elastography have the potential to characterize further diffuse and focal liver diseases, by adding information about tissue cellularity, perfusion, hepatocyte transport function and visco-elasticity. The multiparametric capability of ultrasonography and more markedly of MR imaging gives the opportunity for high diagnostic performance by combining imaging biomarkers. However, image acquisition and post-processing methods should be further standardized and validated in multicenter trials.
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Lassen U, Chinot OL, McBain C, Mau-Sørensen M, Larsen VA, Barrie M, Roth P, Krieter O, Wang K, Habben K, Tessier J, Lahr A, Weller M. Phase 1 dose-escalation study of the antiplacental growth factor monoclonal antibody RO5323441 combined with bevacizumab in patients with recurrent glioblastoma. Neuro Oncol 2015; 17:1007-15. [PMID: 25665807 DOI: 10.1093/neuonc/nov019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/21/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We conducted a phase 1 dose-escalation study of RO5323441, a novel antiplacental growth factor (PlGF) monoclonal antibody, to establish the recommended dose for use with bevacizumab and to investigate the pharmacokinetics, pharmacodynamics, safety/tolerability, and preliminary clinical efficacy of the combination. METHODS Twenty-two participants with histologically confirmed glioblastoma in first relapse were treated every 2 weeks with RO5323441 (625 mg, 1250 mg, or 2500 mg) plus bevacizumab (10 mg/kg). A standard 3 + 3 dose-escalation trial design was used. RESULTS RO5323441 combined with bevacizumab was generally well tolerated, and the maximum tolerated dose was not reached. Two participants experienced dose-limiting toxicities (grade 3 meningitis associated with spinal fluid leak [1250 mg] and grade 3 cerebral infarction [2500 mg]). Common adverse events included hypertension (14 participants, 64%), headache (12 participants, 55%), dysphonia (11 participants, 50%) and fatigue (6 participants, 27%).The pharmacokinetics of RO5323441 were linear, over-the-dose range, and bevacizumab exposure was unaffected by RO5323441 coadministration. Modulation of plasmatic angiogenic proteins, with increases in VEGFA and decreases in FLT4, was observed. Dynamic contrast-enhanced/diffusion-weighted MRI revealed large decreases in vascular parameters that were maintained through the dosing period. Combination therapy achieved an overall response rate of 22.7%, including one complete response, and median progression-free and overall survival of 3.5 and 8.5 months, respectively. CONCLUSION The toxicity profile of RO5323441 plus bevacizumab was acceptable and manageable. The observed clinical activity of the combination does not appear to improve on that obtained with single-agent bevacizumab in patients with recurrent glioblastoma.
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Affiliation(s)
- Ulrik Lassen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Olivier L Chinot
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Catherine McBain
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Morten Mau-Sørensen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Vibeke Andrée Larsen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Maryline Barrie
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Patrick Roth
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Oliver Krieter
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Ka Wang
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Kai Habben
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Jean Tessier
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Angelika Lahr
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
| | - Michael Weller
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark (U.L., M.M.-S.); Department of Radiology, Rigshospitalet, Copenhagen, Denmark (V.A.L.); Aix-Marseille University A.P.-H.M., Department of Neuro-Oncology, University Hospital Timone, Marseille, France (O.L.C., M.B.); Department of Clinical Oncology, The Christie Hospital N.H.S Foundation Trust, Manchester, England (C.M.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.R., M.W.); Roche Diagnostics GmbH, Penzberg, Germany (O.K., K.H., A.L.); Hoffmann La Roche Pharmaceuticals, Nutley, NewJersey (K.W.); F. Hoffmann-La Roche Ltd, Basel, Switzerland (J.T.)
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Bodei L, Sundin A, Kidd M, Prasad V, Modlin IM. The status of neuroendocrine tumor imaging: from darkness to light? Neuroendocrinology 2015; 101:1-17. [PMID: 25228173 DOI: 10.1159/000367850] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/23/2014] [Indexed: 11/19/2022]
Abstract
Diagnostic imaging plays a pivotal role in the diagnosis, staging, treatment selection and follow-up for neuroendocrine tumors. The available diagnostic strategies are morphologic imaging, including computed tomography, magnetic resonance imaging (MRI) and ultrasound techniques, and molecular imaging, including scintigraphy with (111)In-pentetreotide and positron emission tomography with (68)Ga-DOTA-peptides, (18)F-DOPA and (11)C-5-HTP. A combination of anatomic and functional techniques is routinely performed to optimize sensitivity and specificity. The introduction of diffusion-weighted MRI and dynamic contrast-enhanced techniques represents a promising advance in radiologic imaging, whereas new receptor-binding peptides, including somatostatin agonists and antagonists, represent the recent most favorable innovation in molecular imaging. Future development includes the short-term validation of these techniques, but in extension also a more comprehensive multilevel integration of biologic information pertaining to a specific tumor and patient, possibly encompassing genomic considerations, currently evolving as a new entity denoted 'precision medicine'. The ideal is a diagnostic sequence that captures the global status of an individual's tumor and encompasses a multidimensional characterization of tumor location, metabolic performance and target identification. To date, advances in imagery have focused on increasing resolution, discrimination and functional characterization. In the future, the fusion of imagery with the parallel analysis of biological and genomic information has the potential to considerably amplify diagnosis.
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Affiliation(s)
- Lisa Bodei
- Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy
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Chen J, Yin HB. Dynamic contrast-enhanced magnetic resonance imaging of the liver: Applications in treatment of hepatic malignancies with vascular targeting agents. Shijie Huaren Xiaohua Zazhi 2014; 22:4928-4933. [DOI: 10.11569/wcjd.v22.i32.4928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging of the liver as a trendy technique can be applied in various kinds of liver diseases to evaluate perfusion and vascular characteristics of liver tissue and tumor. It has been proved that DCE-MR imaging plays an important role in the treatment of liver malignancies with vascular targeting agents. This review aims to give an overview of DCE-MR imaging of the liver in terms of semi-quantitative analysis methods, common quantitative analysis models and contrast agents and discuss its application value in the treatment of liver malignancies with vascular targeting agents.
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Emblem KE, Farrar CT, Gerstner ER, Batchelor TT, Borra RJH, Rosen BR, Sorensen AG, Jain RK. Vessel caliber--a potential MRI biomarker of tumour response in clinical trials. Nat Rev Clin Oncol 2014; 11:566-84. [PMID: 25113840 PMCID: PMC4445139 DOI: 10.1038/nrclinonc.2014.126] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Our understanding of the importance of blood vessels and angiogenesis in cancer has increased considerably over the past decades, and the assessment of tumour vessel calibre and structure has become increasingly important for in vivo monitoring of therapeutic response. The preferred method for in vivo imaging of most solid cancers is MRI, and the concept of vessel-calibre MRI has evolved since its initial inception in the early 1990s. Almost a quarter of a century later, unlike traditional contrast-enhanced MRI techniques, vessel-calibre MRI remains widely inaccessible to the general clinical community. The narrow availability of the technique is, in part, attributable to limited awareness and a lack of imaging standardization. Thus, the role of vessel-calibre MRI in early phase clinical trials remains to be determined. By contrast, regulatory approvals of antiangiogenic agents that are not directly cytotoxic have created an urgent need for clinical trials incorporating advanced imaging analyses, going beyond traditional assessments of tumour volume. To this end, we review the field of vessel-calibre MRI and summarize the emerging evidence supporting the use of this technique to monitor response to anticancer therapy. We also discuss the potential use of this biomarker assessment in clinical imaging trials and highlight relevant avenues for future research.
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Affiliation(s)
- Kyrre E Emblem
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Christian T Farrar
- Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Elizabeth R Gerstner
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA
| | - Tracy T Batchelor
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA
| | - Ronald J H Borra
- Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Bruce R Rosen
- Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - A Gregory Sorensen
- Siemens Healthcare Health Services, 51 Valley Stream Parkway, Malvern, PA 19355, USA
| | - Rakesh K Jain
- Edwin L. Steele Laboratory of Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA
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Kim SH, Kamaya A, Willmann JK. CT perfusion of the liver: principles and applications in oncology. Radiology 2014; 272:322-44. [PMID: 25058132 DOI: 10.1148/radiol.14130091] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the introduction of molecularly targeted chemotherapeutics, there is an increasing need for defining new response criteria for therapeutic success because use of morphologic imaging alone may not fully assess tumor response. Computed tomographic (CT) perfusion imaging of the liver provides functional information about the microcirculation of normal parenchyma and focal liver lesions and is a promising technique for assessing the efficacy of various anticancer treatments. CT perfusion also shows promising results for diagnosing primary or metastatic tumors, for predicting early response to anticancer treatments, and for monitoring tumor recurrence after therapy. Many of the limitations of early CT perfusion studies performed in the liver, such as limited coverage, motion artifacts, and high radiation dose of CT, are being addressed by recent technical advances. These include a wide area detector with or without volumetric spiral or shuttle modes, motion correction algorithms, and new CT reconstruction technologies such as iterative algorithms. Although several issues related to perfusion imaging-such as paucity of large multicenter trials, limited accessibility of perfusion software, and lack of standardization in methods-remain unsolved, CT perfusion has now reached technical maturity, allowing for its use in assessing tumor vascularity in larger-scale prospective clinical trials. In this review, basic principles, current acquisition protocols, and pharmacokinetic models used for CT perfusion imaging of the liver are described. Various oncologic applications of CT perfusion of the liver are discussed and current challenges, as well as possible solutions, for CT perfusion are presented.
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Affiliation(s)
- Se Hyung Kim
- From the Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, 300 Pasteur Dr, Room H1307, Stanford, CA 94305-5621 (S.H.K., A.K., J.K.W.); and Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (S.H.K.)
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Abstract
In this article, functional magnetic resonance (MR) imaging techniques in the abdomen are discussed. Diffusion-weighted imaging (DWI) increases the confidence in detecting and characterizing focal hepatic lesions. The potential uses of DWI in kidneys, adrenal glands, bowel, and pancreas are outlined. Studies have shown potential use of quantitative dynamic contrast-enhanced MR imaging parameters, such as K(trans), in predicting outcomes in cancer therapy. MR elastography is considered to be a useful tool in staging liver fibrosis. A major issue with all functional MR imaging techniques is the lack of standardization of the protocol.
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Affiliation(s)
- Kumar Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202, USA.
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Nensa F, Stattaus J, Morgan B, Horsfield MA, Soria JC, Besse B, Gounant V, Khalil A, Seng K, Fischer B, Krissel H, Laurent D, Christoph D, Eberhardt WEE, Gauler TC. Dynamic contrast-enhanced MRI parameters as biomarkers for the effect of vatalanib in patients with non-small-cell lung cancer. Future Oncol 2014; 10:823-33. [PMID: 24799063 DOI: 10.2217/fon.13.248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT: Aims: To assess the utility of dynamic contrast-enhanced MRI parameters in the demonstration of early antiangiogenic effects and as prognostic biomarkers in second-line treatment of advanced-stage non-small-cell lung cancer with vatalanib. Patients & methods: The transfer constant (Ktrans) and the initial area under the contrast concentration–time curve at 60 s (AUC60) were assessed in 46 patients. Changes were compared with response evaluation from computed tomography imaging and Response Evaluation Criteria In Solid Tumors guidelines. Results: Statistically significant mean reductions in Ktrans (38.4%; p < 0.0001) and AUC60 (24.9%; p < 0.0001) were found at day 2. After 12 weeks, 16 patients (35%) demonstrated stable disease and 30 (65%) demonstrated progressive disease. No statistically significant differences in day 2 Ktrans and AUC60 reductions between stable disease and progressive disease patients were found. Conclusion: Dynamic contrast-enhanced MRI can demonstrate a statistically significant reduction in vascular parameters of non-small-cell lung cancer, but does not predict patient outcome.
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Affiliation(s)
- Felix Nensa
- Department of Diagnostic & Interventional Radiology & Neuroradiology, University Hospital of University Duisburg-Essen, Essen, Germany
| | - Jörg Stattaus
- Department of Radiology & Nuclear Medicine, Bergmannsheil und KinderklinikBuer GmbH, Gelsenkirchen, Germany
| | - Bruno Morgan
- Department of Cancer Studies & Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - Mark A Horsfield
- Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | | | - Benjamin Besse
- Département de Médecine, Institut Gustave Roussy, Villejuif, France
| | - Valerie Gounant
- Unité Fonctionnelle de Pneumologie (Orientation Oncologique), Hôpital Tenon, Paris, France
| | - Antoine Khalil
- Unité Fonctionnelle de Pneumologie (Orientation Oncologique), Hôpital Tenon, Paris, France
| | - Katja Seng
- Department of Diagnostic & Interventional Radiology & Neuroradiology, University Hospital of University Duisburg-Essen, Essen, Germany
| | - Berthold Fischer
- Department of Respiratory Diseases III, Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Heiko Krissel
- Global Clinical Development Oncology, Bayer Pharma AG, Berlin, Germany
| | - Dirk Laurent
- Global Clinical Development Oncology, Bayer Pharma AG, Berlin, Germany
| | - Daniel Christoph
- Department of Medicine (Cancer Research), West German Tumor Center, University Hospital of University Duisburg-Essen, Essen, Germany
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, CO, USA
| | - Wilfried EE Eberhardt
- Department of Medicine (Cancer Research), West German Tumor Center, University Hospital of University Duisburg-Essen, Essen, Germany
| | - Thomas C Gauler
- Department of Medicine (Cancer Research), West German Tumor Center, University Hospital of University Duisburg-Essen, Essen, Germany
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Chen BB, Shih TTF. DCE-MRI in hepatocellular carcinoma-clinical and therapeutic image biomarker. World J Gastroenterol 2014; 20:3125-3134. [PMID: 24695624 PMCID: PMC3964384 DOI: 10.3748/wjg.v20.i12.3125] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/26/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables tumor vascular physiology to be assessed. Within the tumor tissue, contrast agents (gadolinium chelates) extravasate from intravascular into the extravascular extracellular space (EES), which results in a signal increase on T1-weighted MRI. The rate of contrast agents extravasation to EES in the tumor tissue is determined by vessel leakiness and blood flow. Thus, the signal measured on DCE-MRI represents a combination of permeability and perfusion. The semi-quantitative analysis is based on the calculation of heuristic parameters that can be extracted from signal intensity-time curves. These enhancing curves can also be deconvoluted by mathematical modeling to extract quantitative parameters that may reflect tumor perfusion, vascular volume, vessel permeability and angiogenesis. Because hepatocellular carcinoma (HCC) is a hypervascular tumor, many emerging therapies focused on the inhibition of angiogenesis. DCE-MRI combined with a pharmacokinetic model allows us to produce highly reproducible and reliable parametric maps of quantitative parameters in HCC. Successful therapies change quantitative parameters of DCE-MRI, which may be used as early indicators of tumor response to anti-angiogenesis agents that modulate tumor vasculature. In the setting of clinical trials, DCE-MRI may provide relevant clinical information on the pharmacodynamic and biologic effects of novel drugs, monitor treatment response and predict survival outcome in HCC patients.
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Konstantinidis IT, Do RKG, Gultekin DH, Gönen M, Schwartz LH, Fong Y, Allen PJ, D'Angelica MI, DeMatteo RP, Klimstra DS, Kemeny NE, Jarnagin WR. Regional chemotherapy for unresectable intrahepatic cholangiocarcinoma: a potential role for dynamic magnetic resonance imaging as an imaging biomarker and a survival update from two prospective clinical trials. Ann Surg Oncol 2014; 21:2675-83. [PMID: 24664624 DOI: 10.1245/s10434-014-3649-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND For patients with unresectable intrahepatic cholangiocarcinoma (ICC), treatment options are limited and survival is poor. This study summarizes the long-term outcome of two previously reported clinical trials using hepatic arterial infusion (HAI) with floxuridine and dexamethasone (with or without bevacizumab) in advanced ICC. METHODS Prospectively collected clinicopathologic and survival data were retrospectively reviewed. Response was based on Response Evaluation Criteria in Solid Tumors (RECIST). Pre-HAI dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) images were reviewed, and tumor perfusion data correlated with outcome. RESULTS Forty-four patients were analyzed (floxuridine, 26; floxuridine/bevacizumab, 18). At a median follow-up of 29.3 months, 41 patients had died of disease. Partial response by RECIST was observed in 48 %, and 50 % had stable disease. Three patients underwent resection after response, and 82 % received additional HAI after removal from the trials. Median survival was similar in both trials (floxuridine 29.3 months vs. floxuridine/bevacizumab 28.5 months; p = 0.96). Ten (23 %) patients survived ≥3 years, including 5 (11 %) who survived ≥5 years. Tumor perfusion measured on pre-treatment DCE-MRI [area under the gadolinium concentration curve at 90 and 180 s (AUC90 and AUC180, respectively)] was significantly higher in ≥3-year survivors and was the only factor that distinguished this group from <3-year survivors (mean AUC90 22.6 vs. 15.9 mM s, p = 0.025, and mean AUC180 48.9 vs. 32.3 mM s, p = 0.003, respectively). Median hepatic progression-free survival was longer in ≥3-year survivors (12.9 vs. 9.3 months, respectively; p = 0.008). CONCLUSIONS HAI chemotherapy can result in prolonged survival in unresectable ICC. Pre-HAI DCE-MRI may predict treatment outcome.
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Czernin J, Herrmann K. The potential of PET/MRI imaging in oncology: a comment to a summary report of the First PET/MRI Workshop in Tuebingen in 2012. Mol Imaging Biol 2014; 15:372-3. [PMID: 23689984 PMCID: PMC3708288 DOI: 10.1007/s11307-013-0642-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Johannes Czernin
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Room 2-222 CHS, Los Angeles, CA 90095-1782 USA
| | - Ken Herrmann
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Room 2-222 CHS, Los Angeles, CA 90095-1782 USA
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Comparison of magnetic resonance elastography and gadoxetate disodium-enhanced magnetic resonance imaging for the evaluation of hepatic fibrosis. Invest Radiol 2014; 48:607-13. [PMID: 23538889 DOI: 10.1097/rli.0b013e318289ff8f] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The objective of this study was to compare the diagnostic performance of magnetic resonance elastography (MRE) and gadoxetate disodium-enhanced magnetic resonance imaging (MRI) in the staging of hepatic fibrosis (HF) in patients with liver diseases. MATERIALS AND METHODS This retrospective study was approved by our institutional review board, and the informed consent was waived. One hundred and sixty-eight patients with chronic liver disease or suspected focal hepatic lesions underwent MRE and gadoxetate disodium-enhanced MRI at 1.5 T. Liver stiffness values were measured on quantitative shear-stiffness maps. The contrast enhancement index (CEI) was calculated as SIpost / SIpre, where SIpost and SIpre are, respectively, the liver-to-muscle signal intensity (SI) ratio on hepatobiliary phase images and on unenhanced images. The diagnostic performance of MRE and CEI for staging HF was compared using the receiver operating characteristic curve analysis on the basis of the histopathologic analysis of HF. RESULTS The liver stiffness values measured on MRE (r = 0.802; P < 0.0001) were more strongly correlated with the HF stage than with the CEI (r = -0.378; P < 0.0001). The areas under the receiver operating characteristic curve values of the liver stiffness values were significantly larger than those of CEI were for discriminating all stages of HF (P < 0.001 for ≥ F1, ≥ F2, ≥ F3, and ≥ F4). Magnetic resonance elastography showed higher sensitivity and specificity for predicting HF ≥ F1 (91% and 87%), ≥ F2 (87% and 91%), ≥ F3 (80% and 89%), and F4 (81% and 85%) compared with CEI (46% and 85%, 46% and 82%, 63% and 68%, and 76% and 65%, respectively). CONCLUSIONS Magnetic resonance elastography was superior to the gadoxetate disodium-enhancement MRI for HF staging.
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Esposito A, Palmisano A, Maffi P, Malosio ML, Nano R, Canu T, De Cobelli F, Piemonti L, Ironi G, Secchi A, Del Maschio A. Liver perfusion changes occurring during pancreatic islet engraftment: a dynamic contrast-enhanced magnetic resonance study. Am J Transplant 2014; 14:202-9. [PMID: 24219129 DOI: 10.1111/ajt.12501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/26/2013] [Accepted: 09/07/2013] [Indexed: 01/25/2023]
Abstract
The aim of this study was to investigate liver microvascular adaptation following the intraportal infusion of pancreatic islets (pancreatic islet transplantation [islet-tx]) in diabetic patients using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). DCE-MRI was performed before and 7 days after islet-tx in six diabetic patients. Initial area under curve (AUC60) and volume transfer coefficient (Ktrans) were assessed as markers of liver perfusion. Clinical and metabolic monthly follow-up was performed in all patients, considering fasting C-peptide and β-score as main indices of graft function. High variability in the response of liver microvasculature to islet infusion was observed: two patients showed a significant reduction in liver perfusion after transplantation (pt.2: AUC60 = -23.4%, Ktrans = -31.7%; pt.4: AUC60 = -23.7%, Ktrans = -27.9%); three patients did not show any significant variation of liver perfusion and one patient showed a significant increase (pt.3: AUC60 = +31%, Ktrans = +42.8%). Interestingly, a correlation between DCE-MRI parameters and indices of graft function was observed and, in particular, both patients with DCE-MRI evidence of posttransplantation liver perfusion reduction experienced premature graft failure. Our preliminary study demonstrated that DCE-MRI may identify different adaptive responses of liver microvasculature in patients submitted to islet-tx. These different responses could have an impact on islet engraftment, although reported findings need confirmation from larger studies.
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Affiliation(s)
- A Esposito
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Aronhime S, Calcagno C, Jajamovich GH, Dyvorne HA, Robson P, Dieterich D, Fiel MI, Martel-Laferriere V, Chatterji M, Rusinek H, Taouli B. DCE-MRI of the liver: effect of linear and nonlinear conversions on hepatic perfusion quantification and reproducibility. J Magn Reson Imaging 2013; 40:90-8. [PMID: 24923476 DOI: 10.1002/jmri.24341] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 07/12/2013] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate the effect of different methods to convert magnetic resonance (MR) signal intensity (SI) to gadolinium concentration ([Gd]) on estimation and reproducibility of model-free and modeled hepatic perfusion parameters measured with dynamic contrast-enhanced (DCE)-MRI. MATERIALS AND METHODS In this Institutional Review Board (IRB)-approved prospective study, 23 DCE-MRI examinations of the liver were performed on 17 patients. SI was converted to [Gd] using linearity vs. nonlinearity assumptions (using spoiled gradient recalled echo [SPGR] signal equations). The [Gd] vs. time curves were analyzed using model-free parameters and a dual-input single compartment model. Perfusion parameters obtained with the two conversion methods were compared using paired Wilcoxon test. Test-retest and interobserver reproducibility of perfusion parameters were assessed in six patients. RESULTS There were significant differences between the two conversion methods for the following parameters: AUC60 (area under the curve at 60 s, P < 0.001), peak gadolinium concentration (Cpeak, P < 0.001), upslope (P < 0.001), Fp (portal flow, P = 0.04), total hepatic flow (Ft, P = 0.007), and MTT (mean transit time, P < 0.001). Our preliminary results showed acceptable to good reproducibility for all model-free parameters for both methods (mean coefficient of variation [CV] range, 11.87-23.7%), except for upslope (CV = 37%). Among modeled parameters, DV (distribution volume) had CV <22% with both methods, PV and MTT showed CV <21% and <29% using SPGR equations, respectively. Other modeled parameters had CV >30% with both methods. CONCLUSION Linearity assumption is acceptable for quantification of model-free hepatic perfusion parameters while the use of SPGR equations and T1 mapping may be recommended for the quantification of modeled hepatic perfusion parameters.
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Affiliation(s)
- Shimon Aronhime
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Hötker AM, Schmidtmann I, Oberholzer K, Düber C. Dynamic contrast enhanced-MRI in rectal cancer: Inter- and intraobserver reproducibility and the effect of slice selection on pharmacokinetic analysis. J Magn Reson Imaging 2013; 40:715-22. [DOI: 10.1002/jmri.24385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 08/07/2013] [Indexed: 12/11/2022] Open
Affiliation(s)
- Andreas M. Hötker
- Department of Diagnostic and Interventional Radiology; Universitätsmedizin Mainz; Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics; Universitätsmedizin Mainz; Germany
| | - Katja Oberholzer
- Department of Diagnostic and Interventional Radiology; Universitätsmedizin Mainz; Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology; Universitätsmedizin Mainz; Germany
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Sugimoto K, Moriyasu F, Saito K, Rognin N, Kamiyama N, Furuichi Y, Imai Y. Hepatocellular carcinoma treated with sorafenib: early detection of treatment response and major adverse events by contrast-enhanced US. Liver Int 2013; 33:605-15. [PMID: 23305331 DOI: 10.1111/liv.12098] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 11/22/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Early prediction of tumour response and major adverse events (AEs), especially liver failure, in patients with hepatocellular carcinoma (HCC) is essential for maximizing the clinical benefits of sorafenib. To evaluate the usefulness of dynamic contrast-enhanced ultrasound (DCE-US) for the early prediction of tumour response and major AEs in HCC patients. METHODS Thirty-seven HCC patients were started on a reduced dosage of sorafenib, subsequently increased to the standard dosage. Tumour response at 1 month was assessed by CT using the Response Evaluation Criteria in Solid Tumors (RECIST). Major AEs were defined as grade 3 or higher. DCE-US was performed before treatment (day 0) and on days 7, 14 and 28. Changes in perfusion parameters in the tumour and liver parenchyma between day 0 and later time points were compared between treatment responders and nonresponders based on RECIST and between patients who experienced major AEs and those who did not. Tumour results were also compared with progression-free survival (PFS) and overall survival (OS). RESULTS Tumour perfusion parameters based on the area under the time-intensity curve (AUC) were statistically significant, with AUC during washin on day 14, the most relevant for tumour response (P = 0.0016) and AUC during washin on day 7, the most relevant for both PFS (P = 0.009) and OS (P = 0.037). A decrease in total AUC between days 0 and 7 in the liver parenchyma was strongly correlated with major AEs (P = 0.0002). CONCLUSION DCE-US may be useful for the early prediction of tumour response and major AEs in patients with HCC.
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Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
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Rao SX, Chen CZ, Liu H, Zeng MS, Qu XD. Three-dimensional whole-liver perfusion magnetic resonance imaging in patients with hepatocellular carcinomas and colorectal hepatic metastases. BMC Gastroenterol 2013; 13:53. [PMID: 23530688 PMCID: PMC3626859 DOI: 10.1186/1471-230x-13-53] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 03/21/2013] [Indexed: 01/17/2023] Open
Abstract
Background Three-dimensional (3D) whole-liver perfusion magnetic resonance(MR) imaging with parallel imaging, a novel imaging method to characterize tumor vascularization in vivo, has recently been applied to comprehensively image perfusion changes in large tumors. Coupled with new perfusion software, this technique enables motion correction, registration, and evaluation of perfusion MR parameters. The purpose of this study was to assess the feasibility of 3D whole-liver perfusion MR, for imaging hepatocellular carcinoma (HCC) and colorectal hepatic metastases (CRHM). Methods 26 patients with hepatic tumors (10 HCC; 16 CRHM) were subjected to 3D whole-liver perfusion MR with a temporal resolution of 3.7 seconds. The following estimated perfusion parameters were measured: the volume transfer constant Ktrans (min-1); the volume (Ve) of extravascular extracellular space (EES) per volume unit of tissue; and the flux rate constant between EES and plasma Kep (min-1). Statistical analysis was conducted to investigate inter-observer characteristics and significance of the measured parameters. Results Inter-observer agreement analysis (95% limits of agreement) yielded a mean difference of −0.0048 min-1 (−0.0598 ~ 0.0502) for Ktrans , -0.0630 ml (−0.5405 ~ 0.4145) for Ve, and −0.0031 min-1 (−0.0771 ~ 0.0709) for Kep respectively. When comparing images from patients with HCC vs. CRHM, significant differences were seen for the mean Ktrans (p = 0.017), but not for Ve(p = 0.117) or Kep(p = 0.595). Conclusion Herein we show that 3D whole-liver MR perfusion imaging with semi-automatic data analysis is feasible and enables the reliable quantitative evaluation of the perfusion parameters for HCCs and CRHMs.
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Affiliation(s)
- Sheng-Xiang Rao
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute, Shanghai, People's Republic of China
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Heye T, Davenport MS, Horvath JJ, Feuerlein S, Breault SR, Bashir MR, Merkle EM, Boll DT. Reproducibility of Dynamic Contrast-enhanced MR Imaging. Part I. Perfusion Characteristics in the Female Pelvis by Using Multiple Computer-aided Diagnosis Perfusion Analysis Solutions. Radiology 2013; 266:801-11. [DOI: 10.1148/radiol.12120278] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Davenport MS, Heye T, Dale BM, Horvath JJ, Breault SR, Feuerlein S, Bashir MR, Boll DT, Merkle EM. Inter- and intra-rater reproducibility of quantitative dynamic contrast enhanced MRI using TWIST perfusion data in a uterine fibroid model. J Magn Reson Imaging 2012; 38:329-35. [DOI: 10.1002/jmri.23974] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 11/02/2012] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Tobias Heye
- Duke University Medical Center; Durham; North Carolina; USA
| | - Brian M. Dale
- Duke University Medical Center; Durham; North Carolina; USA
| | | | | | | | | | - Daniel T. Boll
- Duke University Medical Center; Durham; North Carolina; USA
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Heye T, Merkle EM, Reiner CS, Davenport MS, Horvath JJ, Feuerlein S, Breault SR, Gall P, Bashir MR, Dale BM, Kiraly AP, Boll DT. Reproducibility of dynamic contrast-enhanced MR imaging. Part II. Comparison of intra- and interobserver variability with manual region of interest placement versus semiautomatic lesion segmentation and histogram analysis. Radiology 2012; 266:812-21. [PMID: 23220891 DOI: 10.1148/radiol.12120255] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To compare the inter- and intraobserver variability with manual region of interest (ROI) placement versus that with software-assisted semiautomatic lesion segmentation and histogram analysis with respect to quantitative dynamic contrast material-enhanced (DCE) MR imaging determinations of the volume transfer constant (K(trans)). MATERIALS AND METHODS The study was approved by the institutional review board and compliant with HIPAA. The requirement to obtain informed consent was waived. Fifteen DCE MR imaging studies of the female pelvis defined the study group. Uterine fibroids were used as a perfusion model. Three varying types of lesion measurements were performed by five readers on each study by using DCE MR imaging perfusion analysis software with manual ROI placement and a semiautomatic lesion segmentation and histogram analysis solution. Intra- and interreader variability of measurements of K(trans) with the different measurement types was calculated. RESULTS The overall interobserver variability of K(trans) with manual ROI placement (mean, 28.5% ± 9.3) was reduced by 42.5% when the semiautomatic, software-assisted lesion measurement method was used (16.4% ± 6.2). Whole-lesion measurement showed the lowest interobserver variability with both measurement methods (20.1% ± 4.3 with the manual method vs 10.8% ± 2.6 with the semiautomatic method). The overall intrareader variability with the manual ROI method (7.6% ± 10.6) was not significantly different from that with the semiautomatic method (7.3% ± 10.8), but the intraclass correlation coefficient for intrareader reproducibility improved from 0.86 overall with the manual method to 0.99 with the semiautomatic method. CONCLUSION A semiautomatic lesion segmentation and histogram analysis approach can provide a significant reduction in interobserver variability for DCE MR imaging measurements of K(trans) when compared with manual ROI methods, whereas intraobserver reproducibility is improved to some extent.
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Affiliation(s)
- Tobias Heye
- Department of Radiology and Duke Multi-Dimensional Image Processing Laboratory, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
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Messiou C, Orton M, Ang JE, Collins DJ, Morgan VA, Mears D, Castellano I, Papadatos-Pastos D, Brunetto A, Tunariu N, Mann H, Tessier J, Young H, Ghiorghiu D, Marley S, Kaye SB, deBono JS, Leach MO, deSouza NM. Advanced solid tumors treated with cediranib: comparison of dynamic contrast-enhanced MR imaging and CT as markers of vascular activity. Radiology 2012; 265:426-36. [PMID: 22891356 DOI: 10.1148/radiol.12112565] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess baseline reproducibility and compare performance of dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging versus DCE computed tomographic (CT) measures of early vascular response in the same patients treated with cediranib (30 or 45 mg daily). MATERIALS AND METHODS After institutional review board approval, written informed consent was obtained from 29 patients with advanced solid tumors who had lesions 3 cm or larger and in whom simultaneous imaging of an adjacent artery was possible. Two baseline DCE MR acquisitions and two baseline DCE CT acquisitions 7 days or fewer apart (within 14 days of starting treatment) and two posttreatment acquisitions with each modality at day 7 and 28 (±3 days) were obtained. Nonmodeled and modeled parameters were derived (measured arterial input function [AIF] for CT, population-based AIF for MR imaging; temporal sampling rate of 0.5 second for CT, 3-6 seconds for MR imaging). Baseline variability was assessed by using intra- and intersubject analysis of variance and Bland-Altman analysis; a paired t test assessed change from baseline to after treatment. RESULTS The most reproducible parameters were DCE MR imaging enhancement fraction (baseline intrapatient coefficient of variation [CV]=8.6%), volume transfer constant (CV=13.9%), and integrated area under the contrast agent uptake curve at 60 seconds (CV=15.5%) and DCE CT positive enhancement integral (CV=16.0%). Blood plasma volume was highly variable and the only parameter with CV greater than 30%. Average reductions (percentage change) from baseline were consistently observed for all DCE MR imaging and DCE CT parameters at day 7 and 28 for both starting-dose groups (45 and 30 mg), except for DCE CT mean transit time. Percentage change from baseline for parameters reflecting blood flow and permeability were comparable, and reductions from baseline at day 7 were maintained at day 28. CONCLUSION DCE MR imaging and DCE CT can depict vascular response to antiangiogenic agents with response evident at day 7. Improved reproducibility with MR imaging favors its use in trials with small patient numbers.
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Affiliation(s)
- Christina Messiou
- Cancer Research UK and EPSRC Imaging Centre and Drug Development Unit of Section of Medicine, Institute of Cancer Research and Royal Marsden Hospital, MRI Unit, Downs Road, Sutton, Surrey SM2 5PT, England
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Contrast agents as a biological marker in magnetic resonance imaging of the liver: conventional and new approaches. ACTA ACUST UNITED AC 2012; 37:164-79. [PMID: 21516381 DOI: 10.1007/s00261-011-9734-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Liver imaging is an important clinical area in everyday practice. The clinical meaning of different lesion types in the liver can be quite different. Therefore, the result of imaging studies of the liver can change therapeutic concepts fundamentally. Contrast agents are used in the majority of MR examinations of the liver parenchyma-despite the already good soft-tissue contrast in plain MRI. This can be explained by the advantages in lesion detection and characterization of contrast-enhanced MRI of the liver. Beyond the qualitative evaluation of contrast-enhanced liver MR examinations, quantification of parameters will be the demand of the future. This can be achieved by perfusion MRI, also called dynamic contrast-enhanced MRI (DCE-MRI) of the liver. Its basic principles and different clinical applications will be discussed in this article. Definite cut-off values to determine disease or therapeutic response will help to increase the objectivity and reliability of liver MRI in future. This is especially important in the oncological setting, where modern therapies cannot be assessed based on changes in size only.
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Gauthier M, Pitre-Champagnat S, Tabarout F, Leguerney I, Polrot M, Lassau N. Impact of the arterial input function on microvascularization parameter measurements using dynamic contrast-enhanced ultrasonography. World J Radiol 2012; 4:291-301. [PMID: 22900130 PMCID: PMC3419865 DOI: 10.4329/wjr.v4.i7.291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 06/05/2012] [Accepted: 06/12/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the sources of variation influencing the microvascularization parameters measured by dynamic contrast-enhanced ultrasonography (DCE-US).
METHODS: Firstly, we evaluated, in vitro, the impact of the manual repositioning of the ultrasound probe and the variations in flow rates. Experiments were conducted using a custom-made phantom setup simulating a tumor and its associated arterial input. Secondly, we evaluated, in vivo, the impact of multiple contrast agent injections and of examination day, as well as the influence of the size of region of interest (ROI) associated with the arterial input function (AIF). Experiments were conducted on xenografted B16F10 female nude mice. For all of the experiments, an ultrasound scanner along with a linear transducer was used to perform pulse inversion imaging based on linear raw data throughout the experiments. Semi-quantitative and quantitative analyses were performed using two signal-processing methods.
RESULTS: In vitro, no microvascularization parameters, whether semi-quantitative or quantitative, were significantly correlated (P values from 0.059 to 0.860) with the repositioning of the probe. In addition, all semi-quantitative microvascularization parameters were correlated with the flow variation while only one quantitative parameter, the tumor blood flow, exhibited P value lower than 0.05 (P = 0.004). In vivo, multiple contrast agent injections had no significant impact (P values from 0.060 to 0.885) on microvascularization parameters. In addition, it was demonstrated that semi-quantitative microvascularization parameters were correlated with the tumor growth while among the quantitative parameters, only the tissue blood flow exhibited P value lower than 0.05 (P = 0.015). Based on these results, it was demonstrated that the ROI size of the AIF had significant influence on microvascularization parameters: in the context of larger arterial ROI (from 1.17 ± 0.6 mm3 to 3.65 ± 0.3 mm3), tumor blood flow and tumor blood volume were correlated with the tumor growth, exhibiting P values lower than 0.001.
CONCLUSION: AIF selection is an essential aspect of the deconvolution process to validate the quantitative DCE-US method.
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Ng CS, Waterton JC, Kundra V, Brammer D, Ravoori M, Han L, Wei W, Klumpp S, Johnson VE, Jackson EF. Reproducibility and comparison of DCE-MRI and DCE-CT perfusion parameters in a rat tumor model. Technol Cancer Res Treat 2012; 11:279-88. [PMID: 22417064 DOI: 10.7785/tcrt.2012.500296] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and computed tomography (DCE-CT) provide independent measures of biomarkers related to tumor perfusion. We compared the reproducibilities and absolute values of DCE-MRI and DCE-CT biomarkers in the same tumors in an animal model, to investigate the physiologic validity of both approaches. DCE-MRI and DCE-CT were each performed sequentially on three consecutive days in each of twelve rats bearing C6 glioma xenografts. DCE-MRI yielded endothelial transfer constant (K(trans)), extracellular, extravascular space volume fraction (v(e)), and contrast agent reflux rate constant (k(ep)); and DCE-CT, blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability-surface area product (PS) using Tofts and deconvolution physiological models, with 6.6 and 0.4 seconds temporal resolutions, respectively. Variability in DCE-CT and DCE-MRI were evaluated by variance components analysis. Intra-rat coefficients of variation for DCE-CT parameters BF, BV, MTT and PS were 25%, 22%, 18% and 23%; and for DCE-MRI parameters K(trans), k(ep) and v(e) were 23%, 16% and 20%, respectively. Mean (±SD) BF, BV, MTT and PS were: 44.6 (±13.7) ml min(-1) 100 g(-1), 5.7 (±1.5) ml 100 g(-1), 10.8 (±2.3) seconds, and 14.6 (±4.7) ml min(-1) 100 g(-1), respectively. Mean (±SD) K(trans), k(ep) and v(e) were: 0.21 (±0.05) min(-1), 0.68 (±0.14) min(-1), and 0.29 (±0.06), respectively. Permeability estimates from DCE-MRI (K(trans)) were 44% higher than from DCE-CT (PS), despite application of appropriate corrections. DCE-MRI and DCE-CT biomarkers of tumor perfusion have similar reproducibilities suggesting that they may have comparable utility, but their derived parameter values are not equivalent.
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Affiliation(s)
- Chaan S Ng
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
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Monitoring response to antiangiogenic treatment and predicting outcomes in advanced hepatocellular carcinoma using image biomarkers, CT perfusion, tumor density, and tumor size (RECIST). Invest Radiol 2012; 47:11-7. [PMID: 21512396 DOI: 10.1097/rli.0b013e3182199bb5] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Our aim was to investigate the hypothesis that the CT perfusion (CTP) is a more sensitive image biomarker when compared with tumor burden (Response Evaluation Criteria in Solid Tumors [RECIST]) and tumor density (HU) for monitoring treatment changes and for predicting long-term outcome in advanced hepatocellular carcinoma (HCC) treated with a combination of antiangiogenic treatment and chemotherapy. MATERIAL AND METHODS In this phase II clinical trial, 33 patients with advanced HCC were enrolled and 23 were included in the current study. A diagnostic dual-phase contrast-enhanced CT and perfusion CT was performed at baseline and days 10 to 12 after initiation of antiangiogenic treatment (Bevacizumab). The patients subsequently received bevacizumab in combination with gemcitabine and oxaliplatin (GEMOX-B) and contrast-enhanced CT was performed at the end of treatment (after completing 3 cycles of GEMOX-B chemotherapy) and after every 8 week until there was evidence of disease progression or intolerable toxicity. The CTP protocol included a targeted dynamic cine acquisition for 25 to 30 seconds after 50 to 70 mL of iodinated contrast media injection at 5 to 7 mL/s. The CTP parameters were compared with tumor size (according to Response Evaluation Criteria in Solid Tumors, RECIST 1.1) and density measurements (HU) before and after treatment and correlated with patient's outcome in groups with and without tumor thrombus. A one-sided P value was calculated and the Bonferroni correction was used to address the issue of multiple comparisons. RESULTS On days 10 to 12 after initiation of bevacizumab, significant decrease in CTP parameters was noted (P < 0.005). There was a mild reduction in mean tumor density (P = 0.016) without any significant change in mean tumor size. Tumors with higher baseline mean transit time values on CTP correlated with favorable clinical outcome (partial response and stable disease) and had better 6 months progression-free survival (P = 0.002 and P = 0.005, respectively). The baseline transfer constant (Ktrans) of responders (1425.19 ± 609.47 mL/1000 mL/min) was significantly higher than that of nonresponders (935.96 ± 189.47 mL/1000 mL/min). The tumor thrombus in the portal vein demonstrated baseline perfusion values and post-treatment change values similar to the HCC. CONCLUSION In advanced HCC, CTP is a more sensitive image biomarker for monitoring early antiangiogenic treatment effects as well as in predicting outcome at the end of treatment and progression-free survival as compared with RECIST and tumor density.
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Figueiras RG, Padhani AR, Goh VJ, Vilanova JC, González SB, Martín CV, Caamaño AG, Naveira AB, Choyke PL. Novel oncologic drugs: what they do and how they affect images. Radiographics 2012; 31:2059-91. [PMID: 22084189 DOI: 10.1148/rg.317115108] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Targeted therapies are designed to interfere with specific aberrant biologic pathways involved in tumor development. The main classes of novel oncologic drugs include antiangiogenic drugs, antivascular agents, drugs interfering with EGFR-HER2 or KIT receptors, inhibitors of the PI3K/Akt/mTOR pathway, and hormonal therapies. Cancer cells usurp normal signal transduction pathways used by growth factors to stimulate proliferation and sustain viability. The interaction of growth factors with their receptors activates different intracellular pathways affecting key tumor biologic processes such as neoangiogenesis, tumor metabolism, and tumor proliferation. The response of tumors to anticancer therapy can be evaluated with anatomic response assessment, qualitative response assessment, and response assessment with functional and molecular imaging. Angiogenesis can be measured by means of perfusion imaging with computed tomography and magnetic resonance (MR) imaging. Diffusion-weighted MR imaging allows imaging evaluation of tumor cellularity. The main imaging techniques for studying tumor metabolism in vivo are positron emission tomography and MR spectroscopy. Familiarity with imaging findings secondary to tumor response to targeted therapies may help the radiologist better assist the clinician in accurate evaluation of tumor response to these anticancer treatments. Functional and molecular imaging techniques may provide valuable data and augment conventional assessment of tumor response to targeted therapies. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.317115108/-/DC1.
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Affiliation(s)
- Roberto García Figueiras
- Department of Radiology, Grupo de Imagen Molecular, Fundación IDICHUS/IDIS, Complexo Hospitalario Universitario de Santiago de Compostela, Choupana s/n, 15702 Santiago de Compostela, Spain.
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Alexandraki KI, Kaltsas G. Gastroenteropancreatic neuroendocrine tumors: new insights in the diagnosis and therapy. Endocrine 2012; 41:40-52. [PMID: 22124940 DOI: 10.1007/s12020-011-9562-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 10/12/2011] [Indexed: 01/22/2023]
Abstract
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are relatively rare and heterogenous malignancies. Recent advances in histopathological classification according to the anatomical site of origin, proliferation rate, and extend of the disease have created a valid and powerful tool for the prognostic stratification of GEP-NETs. Chromogranin A is still the best available marker used for the biochemical confirmation of these tumors, but new more sensitive markers are urgently required. Although scintigraphy with (111)In-octreotide has widely been applied for the localization and staging of GEP-NETs, newer imaging modalities based on the functional characteristics of these tumors are evolving aiming not only to facilitate the diagnosis but also prognosis and evaluation of treatment. Somatostatin receptors are the primary therapeutic targets through somatostatin analogs and peptide receptor radionuclide therapy (PRRT) producing symptomatic, biochemical and to a lesser extent antiproliferative effects. Due to the relatively limited and erratic response to chemotherapy, new molecular targeted therapies exploiting some of the biological properties of GEP-NETs such as increased vascularity and inhibition of pathways involved in downstream signal transduction have evolved. Some of these therapies, the mTOR inhibitor everolimus and the tyrosine kinase inhibitor sunitinib, have been recently validated in phase III studies producing practice changing outcomes. In addition, two oral chemotherapeutic agents temozolomide and capecitabine, show promising effects and may replace streptozotocin-based regimens whereas combination therapies with the angiogenesis inhibitor bevacizumab are being investigated. Although progression free survival is used as a feasible primary end point due to the long survival of patients even in the presence of extensive disease prolongation of overall survival following the introduction of new therapies needs to be established.
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Mamata H, Tokuda J, Gill RR, Padera RF, Lenkinski RE, Sugarbaker DJ, Butler JP, Hatabu H. Clinical application of pharmacokinetic analysis as a biomarker of solitary pulmonary nodules: dynamic contrast-enhanced MR imaging. Magn Reson Med 2012; 68:1614-22. [PMID: 22231729 DOI: 10.1002/mrm.24150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/22/2011] [Accepted: 12/14/2011] [Indexed: 12/21/2022]
Abstract
The purpose of this study is to evaluate perfusion indices and pharmacokinetic parameters in solitary pulmonary nodules (SPNs). Thirty patients of 34 enrolled with SPNs (15-30 mm) were evaluated in this study. T1 and T2-weighted structural images and 2D turbo FLASH perfusion images were acquired with shallow free breathing. B-spline nonrigid image registration and optimization by χ² test against pharmacokinetic model curve were performed on dynamic contrast-enhanced MRI. This allowed voxel-by-voxel calculation of k(ep) , the rate constant for tracer transport to and from plasma and the extravascular extracellular space. Mean transit time, time-to-peak, initial slope, and maximum enhancement (E(max) ) were calculated from time-intensity curves fitted to a gamma variate function. After blinded data analysis, correlation with tissue histology from surgical resection or biopsy samples was performed. Histologic evaluation revealed 25 malignant and five benign SPNs. All benign SPNs had k(ep) < 1.0 min⁻¹. Nineteen of 25 (76%) malignant SPNs showed k(ep) > 1.0 min⁻¹. Sensitivity to diagnose malignant SPNs at a cutoff of k(ep) = 1.0 min⁻¹ was 76%, specificity was 100%, positive predictive value was 100%, negative predictive value was 45%, and accuracy was 80%. Of all indices studied, k(ep) was the most significant in differentiating malignant from benign SPNs.
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Affiliation(s)
- Hatsuho Mamata
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Sundin A, Rockall A. Therapeutic monitoring of gastroenteropancreatic neuroendocrine tumors: the challenges ahead. Neuroendocrinology 2012; 96:261-71. [PMID: 22907438 DOI: 10.1159/000342270] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 08/01/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gastroenteropancreatic neuroendocrine tumors (NETs), a heterogeneous family of tumors arising in a variety of anatomic sites, are generally well differentiated and often metastatic at diagnosis. Morphologic and functional imaging modalities have vastly improved the understanding and diagnosis of NETs. However, use of conventional imaging techniques and response criteria to assess treatment response is often complicated by the clinical course and cytostatic nature of oncologic treatments for NETs. MATERIALS AND METHODS The means of therapeutic monitoring discussed in this review were based on a PubMed search of the medical literature and on the clinical expertise of the authors. RESULTS Morphology-based criteria for assessing tumor response in general oncology are presented, along with their limitations for assessing response in gastrointestinal and pancreatic NETs. Functional imaging and preliminary response criteria incorporating functional imaging are presented as possible solutions to monitoring treatment response in NETs. CONCLUSIONS Morphology-based criteria to assess tumor response have limitations for NETs, which are often slow growing and frequently demonstrate low response rates when based on conventional radiological criteria. Furthermore, many NET treatments do not induce cytotoxic effects despite demonstrated clinical benefit. Novel imaging techniques are available which have the potential to measure changes in tumor physiology and metabolism. These include (68)Ga-labelled somatostatin analogs for PET/CT-based monitoring of NET, molecular imaging with PET tracers that are not based on somatostatin receptor targeting, and functional MRI. These techniques should be explored as options for monitoring treatment in patients with NET.
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Affiliation(s)
- Anders Sundin
- Department of Radiology, Karolinska University Hospital, Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. anders.sundin @ ki.se
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