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Xing X, Cheng SP, Huang JB. Predicting angiogenesis in adrenal pheochromocytoma: the role of modified parameters from contrast-enhanced CT. Discov Oncol 2024; 15:497. [PMID: 39331234 DOI: 10.1007/s12672-024-01343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVE The aim of this study is to investigate the value of modified parameters derived from dual-phase contrast-enhanced computed tomography (CT) in predicting angiogenesis within pheochromocytoma. METHOD A total of 31 patients with pathologically confirmed pheochromocytoma underwent preoperative dual-phase contrast-enhanced CT scanning, wherein modified CT enhancement parameters, namely maximum enhancement difference (∆H) and maximum enhancement velocity (V), were quantified. Subsequently, postoperative specimens were evaluated by pathological section, while microvessel density (MVD) and vascular endothelial growth factor (VEGF) levels were counted. We conducted comparative analyses to assess disparities in maximum enhancement difference and enhancement velocity between groups characterized by high and low VEGF expression. Furthermore, correlations between maximum enhancement difference, enhancement velocity, and MVD were examined, along with an assessment of the association between maximum enhancement difference, VEGF expression, and MVD at the point of maximal enhancement difference occurrence. RESULTS In the study group, unilateral pheochromocytoma was observed in 31 cases, with 19 cases of arterial phase enhancement and 12 cases displaying venous phase enhancement. The range of maximum enhancement difference (ΔH) spanned from 24 to 102 HU, while the range of maximum enhancement velocity (V) extended from 0.40 HU/s to 4.08 HU/s. Analysis revealed a significant elevation in MVD value within the arterial phase enhancement group compared to the venous phase enhancement group. Additionally, a positive correlation was discerned between the maximum enhancement difference, V, and MVD. Notably, both ∆H and V exhibited statistically significant elevations in the high VEGF expression group relative to the low VEGF expression group. Furthermore, a positive correlation was observed between both ΔH and V and VEGF expression levels. CONCLUSION Increased values of ∆H and V are indicative of heightened MVD and VEGF expression. Consequently, the modified parameters derived from dual-phase contrast-enhanced CT scanning serve as predictive markers for angiogenesis in adrenal pheochromocytoma.
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Affiliation(s)
- Xing Xing
- Department of Urology, The First Affiliated Hospital of Yangtze University Jingzhou, No. 8 of HangKong Road, ShaShi District, Jingzhou, 434000, Hubei, People's Republic of China
| | - Shao-Ping Cheng
- Department of Urology, The First Affiliated Hospital of Yangtze University Jingzhou, No. 8 of HangKong Road, ShaShi District, Jingzhou, 434000, Hubei, People's Republic of China.
| | - Jin-Bai Huang
- Department of Radiology, The First Affiliated Hospital of Yangtze University Jingzhou, Jingzhou, 434000, Hubei, People's Republic of China
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Tunissen SAM, Smit EJ, Mikerov M, Prokop M, Sechopoulos I. Performance evaluation of a 4D similarity filter for dynamic CT angiography imaging of the liver. Med Phys 2024. [PMID: 39264288 DOI: 10.1002/mp.17394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Dynamic computed tomography (CT) angiography of the abdomen provides perfusion information and characteristics of the tissues present in the abdomen. This information could potentially help characterize liver metastases. However, radiation dose has to be relatively low for the patient, causing the images to have very high noise content. Denoising methods are needed to increase image quality. PURPOSE The purpose of this study was to investigate the performance, limitations, and behavior of a new 4D filtering method, called the 4D Similarity Filter (4DSF), to reduce image noise in temporal CT data. METHODS The 4DSF averages voxels with similar time-intensity curves (TICs). Each phase is filtered individually using the information of all phases except for the one being filtered. This approach minimizes the bias toward the noise initially present in this phase. Since the 4DSF does not base similarity on spatial proximity, loss of spatial resolution is avoided. The 4DSF was evaluated on a 12-phase liver dynamic CT angiography acquisition of 52 digital anthropomorphic phantoms, each containing one hypervascular 1 cm lesion with a small necrotic core. The metrics used for evaluation were noise reduction, lesion contrast-to-noise ratio (CNR), CT number accuracy using peak-time and peak-intensity of the TICs, and resolution loss. The results were compared to those obtained by the time-intensity profile similarity (TIPS) filter, which uses the whole TIC for determining similarity, and the combination 4DSF followed by TIPS filter (4DSF + TIPS). RESULTS The 4DSF alone resulted in a median noise reduction by a factor of 6.8, which is lower than that obtained by the TIPS filter at 8.1, and 4DSF + TIPS at 12.2. The 4DSF increased the median CNR from 0. 44 to 1.85, which is less than the TIPS filter at 2.59 and 4DSF + TIPS at 3.12. However, the peak-intensity accuracy in the TICs was superior for the 4DSF, with a median intensity decrease of -34 HU compared to -88 and -50 HU for the hepatic artery when using the TIPS filter and 4DSF + TIPS, respectively. The median peak-time accuracy was inferior for the 4DSF filter and 4DSF + TIPS, with a time shift of -1 phases for the portal vein TIC compared to no shift in time when using the TIPS. The analysis of the full-width-at-half-maximum (FWHM) of a small artery showed significantly less spatial resolution loss for the 4DSF at 3.2 pixels, compared to the TIPS filter at 4.3 pixels, and 3.4 pixels for the 4DSF + TIPS. CONCLUSION The 4DSF can reduce noise with almost no resolution loss, making the filter very suitable for denoising 4D CT data for detection tasks, even in very low dose, i.e., very high noise level, situations. In combination with the TIPS filter, the noise reduction can be increased even further.
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Affiliation(s)
- Sjoerd A M Tunissen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewoud J Smit
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mikhail Mikerov
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening (LRCB), Nijmegen, The Netherlands
- Technical Medicine Centre, University of Twente, Enschede, The Netherlands
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Zhou J, Zhou Y, Qian S, Li X, Lin H, Dong J, Zhou X. Computed Tomography Perfusion Combined With Preoperative Embolization for Reducing Intraoperative Blood Loss in Separation Surgery for Thoracolumbar Metastases. Spine (Phila Pa 1976) 2024; 49:E183-E190. [PMID: 37477335 DOI: 10.1097/brs.0000000000004780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/02/2023] [Indexed: 07/22/2023]
Abstract
STUDY DESIGN A prospective consecutive case study. OBJECTIVE This study aimed to assess the accuracy of computed tomography perfusion (CTP) in evaluating the vascularity of thoracolumbar metastases and to determine the impact of combining CTP with preoperative embolization on reducing intraoperative blood loss during separation surgery. SUMMARY OF BACKGROUND DATA Surgery for thoracolumbar metastases is a complex procedure with the potential for substantial blood loss. Therefore, assessing tumor vascularity before surgery and taking measures to minimize intraoperative blood loss is essential. METHODS A total of 62 patients with thoracolumbar metastases were prospectively enrolled. All patients underwent separation surgery using the posterior approach. Before surgery, the vascularity of the metastases was evaluated using CTP. On the basis of the CTP results, patients were categorized into hypervascular and hypovascular groups. Preoperative angiography and embolization were performed for the hypervascular group. Clinical data were abstracted, including intraoperative blood loss, perioperative complications, visual analog scale score, neurological status, and the accuracy of vascularity evaluation by CTP confirmed by angiography. χ 2 testing was used to compare categorical variables, whereas independent sample t tests were used to compare continuous variables, with paired t tests used to assess differences from preoperative to postoperative time points. RESULTS The mean intraoperative blood loss was 485±167 and 455±127.6 mL in the two groups, respectively. The accuracy of vascularity evaluation by CTP was 100%. In the hypervascular group, 80.6% of the patients experienced at least one level of improvement in neurological status, while the hypovascular group had 81.5% of patients with similar improvement. None of the patients experienced neurological deterioration. There was a significant reduction in visual analog scale scores in both groups after the operation. CONCLUSIONS The vascularity of thoracolumbar metastases could be accurately evaluated using noninvasive CTP. When combined with preoperative embolization, this approach effectively and safely reduced intraoperative blood loss in the setting of separation surgery.
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Affiliation(s)
- Jian Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Zhou
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sheng Qian
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xilei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaogang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Goh V, Mallett S, Boulter V, Glynne-Jones R, Khan S, Lessels S, Patel D, Prezzi D, Rodriguez-Justo M, Taylor SA, Beable R, Betts M, Breen DJ, Britton I, Brush J, Correa P, Dodds N, Dunlop J, Gourtsoyianni S, Griffin N, Higginson A, Lowe A, Slater A, Strugnell M, Tolan D, Zealley I, Halligan S. Multivariable prognostic modelling to improve prediction of colorectal cancer recurrence: the PROSPeCT trial. Eur Radiol 2024:10.1007/s00330-024-10803-7. [PMID: 38836939 DOI: 10.1007/s00330-024-10803-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/25/2024] [Accepted: 04/05/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Improving prognostication to direct personalised therapy remains an unmet need. This study prospectively investigated promising CT, genetic, and immunohistochemical markers to improve the prediction of colorectal cancer recurrence. MATERIAL AND METHODS This multicentre trial (ISRCTN 95037515) recruited patients with primary colorectal cancer undergoing CT staging from 13 hospitals. Follow-up identified cancer recurrence and death. A baseline model for cancer recurrence at 3 years was developed from pre-specified clinicopathological variables (age, sex, tumour-node stage, tumour size, location, extramural venous invasion, and treatment). Then, CT perfusion (blood flow, blood volume, transit time and permeability), genetic (RAS, RAF, and DNA mismatch repair), and immunohistochemical markers of angiogenesis and hypoxia (CD105, vascular endothelial growth factor, glucose transporter protein, and hypoxia-inducible factor) were added to assess whether prediction improved over tumour-node staging alone as the main outcome measure. RESULTS Three hundred twenty-six of 448 participants formed the final cohort (226 male; mean 66 ± 10 years. 227 (70%) had ≥ T3 stage cancers; 151 (46%) were node-positive; 81 (25%) developed subsequent recurrence. The sensitivity and specificity of staging alone for recurrence were 0.56 [95% CI: 0.44, 0.67] and 0.58 [0.51, 0.64], respectively. The baseline clinicopathologic model improved specificity (0.74 [0.68, 0.79], with equivalent sensitivity of 0.57 [0.45, 0.68] for high vs medium/low-risk participants. The addition of prespecified CT perfusion, genetic, and immunohistochemical markers did not improve prediction over and above the clinicopathologic model (sensitivity, 0.58-0.68; specificity, 0.75-0.76). CONCLUSION A multivariable clinicopathological model outperformed staging in identifying patients at high risk of recurrence. Promising CT, genetic, and immunohistochemical markers investigated did not further improve prognostication in rigorous prospective evaluation. CLINICAL RELEVANCE STATEMENT A prognostic model based on clinicopathological variables including age, sex, tumour-node stage, size, location, and extramural venous invasion better identifies colorectal cancer patients at high risk of recurrence for neoadjuvant/adjuvant therapy than stage alone. KEY POINTS Identification of colorectal cancer patients at high risk of recurrence is an unmet need for treatment personalisation. This model for recurrence, incorporating many patient variables, had higher specificity than staging alone. Continued optimisation of risk stratification schema will help individualise treatment plans and follow-up schedules.
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Affiliation(s)
- Vicky Goh
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
- Department of Radiology, Guys and St. Thomas' NHS Foundation Trust, London, UK.
| | - Susan Mallett
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Victor Boulter
- Patient Representative, Mount Vernon Cancer Centre, Northwood, UK
| | | | - Saif Khan
- Research Department of Pathology, UCL Cancer Institute, University College London, London, UK
| | - Sarah Lessels
- Scottish Clinical Trials Research Unit, Public Health Scotland, Edinburgh, UK
| | - Dominic Patel
- Research Department of Pathology, UCL Cancer Institute, University College London, London, UK
| | - Davide Prezzi
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guys and St. Thomas' NHS Foundation Trust, London, UK
| | - Manuel Rodriguez-Justo
- Research Department of Pathology, UCL Cancer Institute, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Richard Beable
- Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Margaret Betts
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David J Breen
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ingrid Britton
- Department of Radiology, University Hospitals North Midlands NHS Trust, Stoke-On-Trent, UK
| | - John Brush
- Department of Radiology, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Peter Correa
- Department of Oncology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nicholas Dodds
- Department of Radiology, Jersey General Hospital, St. Helier, Jersey
| | - Joanna Dunlop
- Scottish Clinical Trials Research Unit, Public Health Scotland, Edinburgh, UK
| | - Sofia Gourtsoyianni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Nyree Griffin
- Department of Radiology, Guys and St. Thomas' NHS Foundation Trust, London, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Andrew Lowe
- Department of Radiology, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
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Perik T, Alves N, Hermans JJ, Huisman H. Automated Quantitative Analysis of CT Perfusion to Classify Vascular Phenotypes of Pancreatic Ductal Adenocarcinoma. Cancers (Basel) 2024; 16:577. [PMID: 38339328 PMCID: PMC10854854 DOI: 10.3390/cancers16030577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
CT perfusion (CTP) analysis is difficult to implement in clinical practice. Therefore, we investigated a novel semi-automated CTP AI biomarker and applied it to identify vascular phenotypes of pancreatic ductal adenocarcinoma (PDAC) and evaluate their association with overall survival (OS). METHODS From January 2018 to November 2022, 107 PDAC patients were prospectively included, who needed to undergo CTP and a diagnostic contrast-enhanced CT (CECT). We developed a semi-automated CTP AI biomarker, through a process that involved deformable image registration, a deep learning segmentation model of tumor and pancreas parenchyma volume, and a trilinear non-parametric CTP curve model to extract the enhancement slope and peak enhancement in segmented tumors and pancreas. The biomarker was validated in terms of its use to predict vascular phenotypes and their association with OS. A receiver operating characteristic (ROC) analysis with five-fold cross-validation was performed. OS was assessed with Kaplan-Meier curves. Differences between phenotypes were tested using the Mann-Whitney U test. RESULTS The final analysis included 92 patients, in whom 20 tumors (21%) were visually isovascular. The AI biomarker effectively discriminated tumor types, and isovascular tumors showed higher enhancement slopes (2.9 Hounsfield unit HU/s vs. 2.0 HU/s, p < 0.001) and peak enhancement (70 HU vs. 47 HU, p < 0.001); the AUC was 0.86. The AI biomarker's vascular phenotype significantly differed in OS (p < 0.01). CONCLUSIONS The AI biomarker offers a promising tool for robust CTP analysis. In PDAC, it can distinguish vascular phenotypes with significant OS prognostication.
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Affiliation(s)
- Tom Perik
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands (J.J.H.); (H.H.)
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Wang X, Nai YH, Gan J, Lian CPL, Ryan FK, Tan FSL, Chan DYS, Ng JJ, Lo ZJ, Chong TT, Hausenloy DJ. Multi-Modality Imaging of Atheromatous Plaques in Peripheral Arterial Disease: Integrating Molecular and Imaging Markers. Int J Mol Sci 2023; 24:11123. [PMID: 37446302 DOI: 10.3390/ijms241311123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral artery disease (PAD) is a common and debilitating condition characterized by the narrowing of the limb arteries, primarily due to atherosclerosis. Non-invasive multi-modality imaging approaches using computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging have emerged as valuable tools for assessing PAD atheromatous plaques and vessel walls. This review provides an overview of these different imaging techniques, their advantages, limitations, and recent advancements. In addition, this review highlights the importance of molecular markers, including those related to inflammation, endothelial dysfunction, and oxidative stress, in PAD pathophysiology. The potential of integrating molecular and imaging markers for an improved understanding of PAD is also discussed. Despite the promise of this integrative approach, there remain several challenges, including technical limitations in imaging modalities and the need for novel molecular marker discovery and validation. Addressing these challenges and embracing future directions in the field will be essential for maximizing the potential of molecular and imaging markers for improving PAD patient outcomes.
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Affiliation(s)
- Xiaomeng Wang
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Ying-Hwey Nai
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Julian Gan
- Siemens Healthineers, Singapore 348615, Singapore
| | - Cheryl Pei Ling Lian
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Fraser Kirwan Ryan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Forest Su Lim Tan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Dexter Yak Seng Chan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Jun Jie Ng
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore 258499, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore 168752, Singapore
- Surgical Academic Clinical Programme, Singapore General Hospital, Singapore 169608, Singapore
- Vascular SingHealth Duke-NUS Disease Centre, Singapore 168752, Singapore
| | - Derek John Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore 117597, Singapore
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
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Ng CS, Chandler AG, Chen Y, Wei W, Tannir NM, Hobbs BP. Effect of scan duration on CT perfusion values in metastases from renal cell carcinoma. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2023; 6:100028. [PMID: 39077545 PMCID: PMC11265368 DOI: 10.1016/j.redii.2023.100028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/31/2023] [Indexed: 07/31/2024]
Abstract
Objective CT perfusion (CTp) values are affected by CT scan acquisition duration (tacq); their reproducibility is adversely affected by uncertainty in their measurement. The objectives were to assess the effects of tacq on CTp parameter values in metastases from renal cell carcinoma (mRCC) in thoracic and abdominal locations. Materials and Methods 131 CTp evaluations in 53 patients with mRCC were retrospectively analyzed by distributed parameter modeling to yield tissue blood flow (BF), blood volume (BV), mean transit time (MTT), permeability (PS), and also hepatic arterial perfusion (HAP) and hepatic arterial fraction (HAF) for liver metastases and normal liver, with tacq from 25 to 590 s. Penalized piecewise polynomial regression (SPLINE) characterized functional relationships between CTp parameters and acquisition duration, tacq. Evidence for time-invariance was evaluated for each parameter at multiple time points by conducting inference on the fitted derivative to assess its proximity to zero as a function of acquisition time. Equivalence testing was implemented with three levels of confidence (low (20%), moderate (70%), high (95%)). Results Systematic and non-systematic variability was observed for CTp parameter values with limited tacq. All parameters in all locations approached increasing stability with increasing tacq. PS, HAP and HAF required longer acquisition times than BF, BV and MTT to attain comparable levels of stability. Stabilization tended to require longer acquisition in liver than other tissues. tacq=380 s was required to obtain at least moderate level of confidence for all parameters and organs. Conclusion Increasing tacq yields increasingly more stable CT perfusion parameters, and thereby better reproducibility.
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Affiliation(s)
- Chaan S. Ng
- Department of Radiology, Unit 1473, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Adam G. Chandler
- Imaging Physics, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Yanwen Chen
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Wei Wei
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Nizar M. Tannir
- Department of Genitourinary Medicine, Unit 1374, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Brian P. Hobbs
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
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Chung A, Raman SS. Radiologist's Disease: Imaging for Renal Cancer. Urol Clin North Am 2023; 50:161-180. [PMID: 36948664 DOI: 10.1016/j.ucl.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
There is a clear benefit of imaging-based differentiation of small indeterminate masses to its subtypes of clear cell renal cell carcinoma (RCC), chromophobe RCC, papillary RCC, fat poor angiomyolipoma and oncocytoma because it helps determine the next step options for the patients. The work thus far in radiology has explored different parameters in computed tomography, MRI, and contrast-enhanced ultrasound with the discovery of many reliable imaging features that suggest certain tissue subtypes. Likert score-based risk stratification systems can help determine management, and new techniques such as perfusion, radiogenomics, single-photon emission tomography, and artificial intelligence can add to the imaging-based evaluation of indeterminate renal masses.
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Affiliation(s)
- Alex Chung
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Steven S Raman
- David Geffen School of Medicine at UCLA, 757 Westwood Bl, RRMC, Los Angeles, CA, USA.
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Kim HY, Bae MS, Seo BK, Lee JY, Cho KR, Woo OH, Song SE, Cha J. Comparison of CT- and MRI-Based Quantification of Tumor Heterogeneity and Vascularity for Correlations with Prognostic Biomarkers and Survival Outcomes: A Single-Center Prospective Cohort Study. Bioengineering (Basel) 2023; 10:bioengineering10050504. [PMID: 37237574 DOI: 10.3390/bioengineering10050504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Tumor heterogeneity and vascularity can be noninvasively quantified using histogram and perfusion analyses on computed tomography (CT) and magnetic resonance imaging (MRI). We compared the association of histogram and perfusion features with histological prognostic factors and progression-free survival (PFS) in breast cancer patients on low-dose CT and MRI. METHODS This prospective study enrolled 147 women diagnosed with invasive breast cancer who simultaneously underwent contrast-enhanced MRI and CT before treatment. We extracted histogram and perfusion parameters from each tumor on MRI and CT, assessed associations between imaging features and histological biomarkers, and estimated PFS using the Kaplan-Meier analysis. RESULTS Out of 54 histogram and perfusion parameters, entropy on T2- and postcontrast T1-weighted MRI and postcontrast CT, and perfusion (blood flow) on CT were significantly associated with the status of subtypes, hormone receptors, and human epidermal growth factor receptor 2 (p < 0.05). Patients with high entropy on postcontrast CT showed worse PFS than patients with low entropy (p = 0.053) and high entropy on postcontrast CT negatively affected PFS in the Ki67-positive group (p = 0.046). CONCLUSIONS Low-dose CT histogram and perfusion analysis were comparable to MRI, and the entropy of postcontrast CT could be a feasible parameter to predict PFS in breast cancer patients.
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Affiliation(s)
- Hyo-Young Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan City 15355, Republic of Korea
| | - Min-Sun Bae
- Department of Radiology, Inha University Hospital, Inha University College of Medicine, Inhang-ro 27, Jung-gu, Incheon 22332, Republic of Korea
| | - Bo-Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan City 15355, Republic of Korea
| | - Ji-Young Lee
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Republic of Korea
| | - Kyu-Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Ok-Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Sung-Eun Song
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan City 15355, Republic of Korea
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Agostini A, Borgheresi A, Mariotti F, Ottaviani L, Carotti M, Valenti M, Giovagnoni A. New frontiers in oncological imaging with Computed Tomography: from morphology to function. Semin Ultrasound CT MR 2023; 44:214-227. [PMID: 37245886 DOI: 10.1053/j.sult.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Perik TH, van Genugten EAJ, Aarntzen EHJG, Smit EJ, Huisman HJ, Hermans JJ. Quantitative CT perfusion imaging in patients with pancreatic cancer: a systematic review. Abdom Radiol (NY) 2022; 47:3101-3117. [PMID: 34223961 PMCID: PMC9388409 DOI: 10.1007/s00261-021-03190-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 01/18/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related death with a 5-year survival rate of 10%. Quantitative CT perfusion (CTP) can provide additional diagnostic information compared to the limited accuracy of the current standard, contrast-enhanced CT (CECT). This systematic review evaluates CTP for diagnosis, grading, and treatment assessment of PDAC. The secondary goal is to provide an overview of scan protocols and perfusion models used for CTP in PDAC. The search strategy combined synonyms for 'CTP' and 'PDAC.' Pubmed, Embase, and Web of Science were systematically searched from January 2000 to December 2020 for studies using CTP to evaluate PDAC. The risk of bias was assessed using QUADAS-2. 607 abstracts were screened, of which 29 were selected for full-text eligibility. 21 studies were included in the final analysis with a total of 760 patients. All studies comparing PDAC with non-tumorous parenchyma found significant CTP-based differences in blood flow (BF) and blood volume (BV). Two studies found significant differences between pathological grades. Two other studies showed that BF could predict neoadjuvant treatment response. A wide variety in kinetic models and acquisition protocol was found among included studies. Quantitative CTP shows a potential benefit in PDAC diagnosis and can serve as a tool for pathological grading and treatment assessment; however, clinical evidence is still limited. To improve clinical use, standardized acquisition and reconstruction parameters are necessary for interchangeability of the perfusion parameters.
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Affiliation(s)
- T H Perik
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - E A J van Genugten
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E J Smit
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - H J Huisman
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - J J Hermans
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Cressoni M, Cozzi A, Schiaffino S, Cadringher P, Vitali P, Basso G, Ippolito D, Sardanelli F. Computation of contrast-enhanced perfusion using only two CT scan phases: a proof-of-concept study on abdominal organs. Eur Radiol Exp 2022; 6:37. [PMID: 36031643 PMCID: PMC9420683 DOI: 10.1186/s41747-022-00292-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Computed tomography perfusion imaging (CTPI) by repeated scanning has clinical relevance but implies relatively high radiation exposure. We present a method to measure perfusion from two CT scan phases only, considering tissue enhancement, feeding vessel (aortic) peak enhancement, and bolus shape.
Methods
CTPI scans (each with 40 frames acquired every 1.5 s) of 11 patients with advanced hepatocellular carcinoma (HCC) enrolled between 2012 and 2016 were retrospectively analysed (aged 69 ± 9 years, 8/11 males). Perfusion was defined as the maximal slope of the time-enhancement curve divided by the peak enhancement of the feeding vessel (aorta). Perfusion was computed two times, first using the maximum slope derived from all data points and then using the peak tissue enhancement and the bolus shape obtained from the aortic curve.
Results
Perfusion values from the two methods were linearly related (r2 = 0.92, p < 0.001; Bland–Altman analysis bias -0.12). The mathematical model showed that the perfusion ratio of two ROIs with the same feeding vessel (aorta) corresponds to their peak enhancement ratio (r2 = 0.55, p < 0.001; Bland–Altman analysis bias -0.68). The relationship between perfusion and tissue enhancement is predicted to be linear in the clinical range of interest, being only function of perfusion, peak feeding vessel enhancement, and bolus shape.
Conclusions
This proof-of-concept study showed that perfusion values of HCC, kidney, and pancreas could be computed using enhancement measured only with two CT scan phases, if aortic peak enhancement and bolus shape are known.
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13
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Bhatt S, Mandal S, Mehrotra G, Arora V, Singh U. Multidetector Computed Tomography Perfusion in Head and Neck Squamous Cell Carcinomas: Evaluation of a Dose Reduction Strategy. Indian J Radiol Imaging 2022; 32:451-459. [DOI: 10.1055/s-0042-1753469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Abstract
Background Computed tomography perfusion (CTp), a useful technique in oncology, is not widely utilized due to the high radiation dose delivered from it. It involves scanning the region of interest every second for 50 seconds following intravenous contrast administration. Doubling sampling interval (SI) to 2 seconds will half the radiation dose, but may impact its effectiveness, which needs to be evaluated.
Objectives To evaluate a dose reduction strategy in CTp by determining agreement between standard dose (SD) CTp (acquisition with SI 1 second) and low-dose CTp techniques with SI of 2 seconds (achieved either by reconstruction only or true low-dose acquisition).
Materials and methods This cross-sectional study was conducted on histopathology-proven head and neck squamous cell carcinoma (HNSCC) patients who underwent CTp on 64 slice multidetector CT. A total of 56 patients had SD and 24 patients underwent true low dose (LD) acquisition. SD data were also reconstructed at SI 2 seconds to obtain a dataset simulating low dose (low-dose reconstruction [LDr]). Paired t-test was applied to compare CTp in SD and LDr groups and the Bland–Altman plot drawn to calculate 95% confidence limit of agreement. The Kolmogorov–Smirnov test compared CTp parameters for LDr and LD groups.
Results There was no statistical difference in CTp parameters (except blood flow in malignant) in SD and LDr groups for both malignant and normal tissues. CTp of malignant tissue was not statistically different in LDr and LD groups but the radiation dose was half in the LD group.
Conclusion Reduction of radiation dose to half achieved by doubling the SI does not affect the CTp parameters significantly. So LD acquisitions will increase the use of CTp in HNSCC.
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Affiliation(s)
- Shuchi Bhatt
- Department of Radio-diagnosis, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Samrat Mandal
- Department of Radio-diagnosis, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Gopesh Mehrotra
- Department of Radio-diagnosis, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Vipin Arora
- Department of Otorhinolaryngology, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Usharani Singh
- Department of Pathology, University College of Medical Sciences, University of Delhi, Delhi, India
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14
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Galanakis N, Maris TG, Kontopodis N, Tsetis K, Kehagias E, Tsetis D. Perfusion imaging techniques in lower extremity peripheral arterial disease. Br J Radiol 2022; 95:20211203. [PMID: 35522774 PMCID: PMC10996332 DOI: 10.1259/bjr.20211203] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
Abstract
Lower limb peripheral arterial disease (PAD) characterizes the impairment of blood flow to extremities caused by arterial stenoses or occlusions. Evaluation of PAD is based on clinical examination, calculation of ankle-brachial index and imaging studies such as ultrasound, CT, MRI and digital subtraction angiography. These modalities provide significant information about location, extension and severity of macrovasular lesions in lower extremity arterial system. However, they can be also used to evaluate limb perfusion, using appropriate techniques and protocols. This information may be valuable for assessment of the severity of ischemia and detection of hypoperfused areas. Moreover, they can be used for planning of revascularization strategy in patients with severe PAD and evaluation of therapeutic outcome. These techniques may also determine prognosis and amputation risk in patients with PAD. This review gives a basic overview of the perfusion techniques for lower limbs provided by imaging modalities such as ultrasound, CT, MRI, digital subtraction angiography and scintigraphy and their clinical applications for evaluation of PAD and revascularization outcome.
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Affiliation(s)
- Nikolaos Galanakis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and
Vascular Surgery, University Hospital Heraklion, University of Crete
Medical School, Heraklion,
Greece
| | - Konstantinos Tsetis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Elias Kehagias
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Dimitrios Tsetis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
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15
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Gao JF, Pan Y, Lin XC, Lu FC, Qiu DS, Liu JJ, Huang HG. Prognostic value of preoperative enhanced computed tomography as a quantitative imaging biomarker in pancreatic cancer. World J Gastroenterol 2022; 28:2468-2481. [PMID: 35979266 PMCID: PMC9258279 DOI: 10.3748/wjg.v28.i22.2468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/31/2021] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies with high mortality and short survival time. Computed tomography (CT) plays an important role in the diagnosis, staging and treatment of pancreatic tumour. Pancreatic cancer generally shows a low enhancement pattern compared with normal pancreatic tissue.
AIM To analyse whether preoperative enhanced CT could be used to predict postoperative overall survival in patients with PDAC.
METHODS Sixty-seven patients with PDAC undergoing pancreatic resection were enrolled retrospectively. All patients underwent preoperative unenhanced and enhanced CT examination, the CT values of which were measured. The ratio of the preoperative CT value increase from the nonenhancement phase to the portal venous phase between pancreatic tumour and normal pancreatic tissue was calculated. The cut-off value of ratios was obtained by the receiver operating characteristic (ROC) curve of the tumour relative enhancement ratio (TRER), according to which patients were divided into low- and high-enhancement groups. Univariate and multivariate analyses were performed using Cox regression based on TRER grouping. Finally, the correlation between TRER and clinicopathological characteristics was analysed.
RESULTS The area under the curve of the ROC curve was 0.768 (P < 0.05), and the cut-off value of the ROC curve was calculated as 0.7. TRER ≤ 0.7 was defined as the low-enhancement group, and TRER > 0.7 was defined as the high-enhancement group. According to the TRER grouping, the Kaplan-Meier survival curve analysis results showed that the median survival (10.0 mo) with TRER ≤ 0.7 was significantly shorter than that (22.0 mo) with TRER > 0.7 (P < 0.05). In the univariate and multivariate analyses, the prognosis of patients with TRER ≤ 0.7 was significantly worse than that of patients with TRER > 0.7 (P < 0.05). Our results demonstrated that patients in the low TRER group were more likely to have higher American Joint Committee on Cancer stage, tumour stage and lymph node stage (all P < 0.05), and TRER was significantly negatively correlated with tumour size (P < 0.05).
CONCLUSION TRER ≤ 0.7 in patients with PDAC may represent a tumour with higher clinical stage and result in a shorter overall survival.
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Affiliation(s)
- Jian-Feng Gao
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Yu Pan
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Xian-Chao Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Feng-Chun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ding-Shen Qiu
- Department of Radiology, The Hospital of Changle, Fuzhou 350200, Fujian Province, China
| | - Jun-Jun Liu
- Department of Radiology, The Hospital of Changle, Fuzhou 350200, Fujian Province, China
| | - He-Guang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
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16
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Lewin M, Laurent-Bellue A, Desterke C, Radu A, Feghali JA, Farah J, Agostini H, Nault JC, Vibert E, Guettier C. Evaluation of perfusion CT and dual-energy CT for predicting microvascular invasion of hepatocellular carcinoma. Abdom Radiol (NY) 2022; 47:2115-2127. [PMID: 35419748 DOI: 10.1007/s00261-022-03511-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Evaluation of perfusion CT and dual-energy CT (DECT) quantitative parameters for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) prior to surgery. METHODS This prospective single-center study included fifty-six patients (44 men; median age 67; range 31-84) who provided written informed consent. Inclusion criteria were (1) treatment-naïve patients with a diagnosis of HCC, (2) an indication for hepatic resection, and (3) available arterial DECT phase and perfusion CT (GE revolution HD-GSI). Iodine concentrations (IC), arterial density (AD), and 9 quantitative perfusion parameters for HCC were correlated to pathological results. Radiological parameters based principal component analysis (PCA), corroborated by unsupervised heatmap classification, was meant to deliver a model for predicting MVI in HCC. Survival analysis was performed using univariable log-rank test and multivariable Cox model, both censored at time of relapse. RESULTS 58 HCC lesions were analyzed (median size 42.3 mm; range of 20-140). PCA showed that the radiological model was predictive of tumor grade (p = 0.01), intratumoral MVI (p = 0.004), peritumoral MVI (p = 0.04), MTM (macrotrabecular-massive) subtype (p = 0.02), and capsular invasion (p = 0.02) in HCC. Heatmap classification of HCC showed tumor heterogeneity, stratified into three main clusters according to the risk of relapse. Survival analysis confirmed that permeability surface-area product (PS) was the only significant independent parameter, among all quantitative tumoral CT parameters, for predicting a risk of relapse (Cox p value = 0.004). CONCLUSION A perfusion CT and DECT-based quantitative imaging profile can provide a diagnosis of histological MVI in HCC. PS is an independent parameter for relapse. CLINICAL TRIALS ClinicalTrials.gov: NCT03754192.
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Affiliation(s)
- Maïté Lewin
- Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France.
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France.
| | - Astrid Laurent-Bellue
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomopathologie, AP-HP-Université Paris Saclay Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
| | - Christophe Desterke
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France
- Service de Bio-informatique, INSERM UA9, Hôpital Paul Brousse, 94800, Villejuif, France
| | - Adina Radu
- Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Joëlle Ann Feghali
- Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Jad Farah
- Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Hélène Agostini
- Service d'Epidémiologie et de Santé Publique, AP-HP-Université Paris Saclay Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
| | - Jean-Charles Nault
- Service d'Hépatologie, AP-HP, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Hôpital Avicenne, 93000, Bobigny, France
- Functional Genomics of Solid Tumors Laboratory, Centre de Recherche Des Cordeliers, Sorbonne Université, Inserm, USPC, Université Paris Descartes, Université Paris Diderot, Université Paris 13, 75006, Paris, France
- Université Paris 13, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, 93000, Bobigny, France
| | - Eric Vibert
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France
- AP-HP-Université Paris Saclay, Hôpital Paul Brousse, 94800, Villejuif, France
- Centre Hépato-Biliaire, INSERM U1193 Hôpital Paul Brousse, 94800, Villejuif, France
| | - Catherine Guettier
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomopathologie, AP-HP-Université Paris Saclay Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Centre Hépato-Biliaire, INSERM U1193 Hôpital Paul Brousse, 94800, Villejuif, France
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Bajaj G, Callan AK, Weinschenk RC, Chhabra A. Multiparametric Evaluation of Soft Tissue Sarcoma: Current Perspectives and Future Directions. Semin Roentgenol 2022; 57:212-231. [DOI: 10.1053/j.ro.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
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García-Figueiras R, Baleato-González S, Canedo-Antelo M, Alcalá L, Marhuenda A. Imaging Advances on CT and MRI in Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2021. [DOI: 10.1007/s11888-021-00468-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Garbino N, Brancato V, Salvatore M, Cavaliere C. A Systematic Review on the Role of the Perfusion Computed Tomography in Abdominal Cancer. Dose Response 2021; 19:15593258211056199. [PMID: 34880716 PMCID: PMC8647276 DOI: 10.1177/15593258211056199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background and purpose Perfusion Computed Tomography (CTp) is an imaging technique which allows
quantitative and qualitative evaluation of tissue perfusion through dynamic
CT acquisitions. Since CTp is still considered a research tool in the field
of abdominal imaging, the aim of this work is to provide a systematic
summary of the current literature on CTp in the abdominal region to clarify
the role of this technique for abdominal cancer applications. Materials and Methods A systematic literature search of PubMed, Web of Science, and Scopus was
performed to identify original articles involving the use of CTp for
clinical applications in abdominal cancer since 2011. Studies were included
if they reported original data on CTp and investigated the clinical
applications of CTp in abdominal cancer. Results Fifty-seven studies were finally included in the study. Most of the included
articles (33/57) dealt with CTp at the level of the liver, while a low
number of studies investigated CTp for oncologic diseases involving UGI
tract (8/57), pancreas (8/57), kidneys (3/57), and colon–rectum (5/57). Conclusions Our study revealed that CTp could be a valuable functional imaging tool in
the field of abdominal oncology, particularly as a biomarker for monitoring
the response to anti-tumoral treatment.
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Zou M, Zhao Z, Zhang B, Mao H, Huang Y, Wang C. Pulmonary lesions: correlative study of dynamic triple-phase enhanced CT perfusion imaging with tumor angiogenesis and vascular endothelial growth factor expression. BMC Med Imaging 2021; 21:158. [PMID: 34717573 PMCID: PMC8556962 DOI: 10.1186/s12880-021-00692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background To investigate value of the quantitative perfusion parameters of dynamic triple-phase enhanced CT in differential diagnosis of pulmonary lesions, and explore the correlation between perfusion parameters of lung cancer with microvessel density (MVD) and vascular endothelial growth factor (VEGF). Methods 73 consecutive patients with lung lesions who successfully underwent pre-operative CT perfusion examination with dynamic triple-phase enhanced CT and received a final diagnosis by postoperative pathology or a clinical follow-up. The cases were divided into malignant and benign groups according to the pathological results. CT perfusion parameters, such as Median, Mean, Standard deviation (Std), Q10, Q25, Q50, Q75, Q90 of pulmonary artery perfusion (PAP), bronchial artery perfusion (BAP), perfusion index (PI) and arterial enhancement fraction (AEF) were obtained by performing computed tomography perfusion imaging (CTPI). Computed tomography perfusion (CTP) parameters were compared between malignant and benign lesions. The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CTP parameters in diagnosing malignant lesions. The correlations between CTP parameters with MVD and VEGF were analysed in 36 lung cancer patients who had extra sections be used for immunohistochemistry staining of CD34 and VEGF. Results BAP (Mean, Std, Q90) and PI Std of benign lesions were higher than malignant lesions (p < 0.05), and PAP (Q10, Q25), PI (Median, Mean, Q10, Q25, Q50) of malignant lesions were higher than the benign (p < 0.05). The area under the ROC curve of PI Mean, PI Q10 and PI Std was 0.722 (95% CI = [0.595–0.845]), 0.728 (95% CI = [0.612–0.844]) and 0.717 (95% CI = [0.598–0.835]) respectively. Partial perfusion parameters of BAP and AEF Q10 were positively correlated with MVD (p value range is < 0.001–0.037, ρ value range is 0.483–0.683), and partial perfusion parameters of PI were negatively correlated with MVD (p value range is 0.001–0.041,ρvalue range is − 0.523–− 0.343). Partial perfusion parameters of BAP and AEF Q10 were positively correlated with VEGF (p value range is 0.001–0.016, ρvalue range is 0.398–0.570), meanwhile some perfusion parameters of PAP and PI were negatively correlated with VEGF (p value range is 0.001–0.040, ρ value range is − 0.657–0.343). Conclusions Quantitative parameters of dynamic triple-phase enhanced CT can provide diagnostic basis for the differentiation of lung lesions, and there were connection with tumor angiogenesis and vascular endothelial growth factor expression.
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Affiliation(s)
- Mingyue Zou
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China.
| | - Bingqian Zhang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Haijia Mao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Yanan Huang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Cheng Wang
- Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
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Spek A, Graser A, Casuscelli J, Szabados B, Rodler S, Marcon J, Stief C, Staehler M. Dynamic contrast-enhanced CT-derived blood flow measurements enable early prediction of long term outcome in metastatic renal cell cancer patients on antiangiogenic treatment. Urol Oncol 2021; 40:13.e1-13.e8. [PMID: 34535355 DOI: 10.1016/j.urolonc.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/11/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the role of dynamic contrast-enhanced CT (DCE-CT) as an independent non-invasive biomarker in predicting long term outcome in patients with metastatic renal cell carcinoma (mRCC) on antiangiogenic treatment. MATERIAL AND METHODS Eighty two mRCC patients were prospectively enrolled from 09/2011 to 04/2015, out of which 71 were included in the final data analysis; the population was observed until 12/2020 to obtain complete overall survival data. DCE-CT imaging was performed at baseline and 10 to 12 weeks after start of treatment with targeted therapy. DCE-CT included a dynamic acquisition after injection of 50 ml of nonionic contrast agent at 6 ml/s using a 4D spiral mode (10 cm z-axis coverage, acquisition time 43 sec, 100 kVp (abdomen), 80 kVp (chest), 80-100 mAs) on a dual source scanner (Definition FLASH, Siemens). Blood flow (BF) was calculated for target tumor volumes using a deconvolution model. Progression free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier statistics (SPSS version 24). RESULTS Patients were treated with either sunitinib, pazopanib, sorafenib, tivozanib, axitinib, or cabozantinib. A cut-off value of 50% blood flow reduction at follow-up allowed for identification of patients with favorable long-term outcome: Median OS in n = 42 patients with an average blood flow reduction of >50% (mean, 79%) was 34 (range, 14-54) months, while n = 21 patients with an average reduction of less than 50% (mean, 28%) showed a median OS of 12 (range, 6-18) months, and n = 8 patients with an increase in blood flow survived for a median of 7 (range, 3-11) months. CONCLUSION Blood flow in metastases measured with DCE-CT at first follow-up is a strong predictor of overall survival in mRCC patients on antiangiogenic treatment.
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Affiliation(s)
- Annabel Spek
- Department of Urology, University Hospital, LMU Munich, Munich, Germany.
| | | | | | | | - Severin Rodler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Staehler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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22
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Guerraty M, Bhargava A, Senarathna J, Mendelson AA, Pathak AP. Advances in translational imaging of the microcirculation. Microcirculation 2021; 28:e12683. [PMID: 33524206 PMCID: PMC8647298 DOI: 10.1111/micc.12683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
The past few decades have seen an explosion in the development and use of methods for imaging the human microcirculation during health and disease. The confluence of innovative imaging technologies, affordable computing power, and economies of scale have ushered in a new era of "translational" imaging that permit us to peer into blood vessels of various organs in the human body. These imaging techniques include near-infrared spectroscopy (NIRS), positron emission tomography (PET), and magnetic resonance imaging (MRI) that are sensitive to microvascular-derived signals, as well as computed tomography (CT), optical imaging, and ultrasound (US) imaging that are capable of directly acquiring images at, or close to microvascular spatial resolution. Collectively, these imaging modalities enable us to characterize the morphological and functional changes in a tissue's microcirculation that are known to accompany the initiation and progression of numerous pathologies. Although there have been significant advances for imaging the microcirculation in preclinical models, this review focuses on developments in the assessment of the microcirculation in patients with optical imaging, NIRS, PET, US, MRI, and CT, to name a few. The goal of this review is to serve as a springboard for exploring the burgeoning role of translational imaging technologies for interrogating the structural and functional status of the microcirculation in humans, and highlight the breadth of current clinical applications. Making the human microcirculation "visible" in vivo to clinicians and researchers alike will facilitate bench-to-bedside discoveries and enhance the diagnosis and management of disease.
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Affiliation(s)
- Marie Guerraty
- Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
USA
| | - Akanksha Bhargava
- Russell H. Morgan Department of Radiology and Radiological
Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janaka Senarathna
- Russell H. Morgan Department of Radiology and Radiological
Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asher A. Mendelson
- Department of Medicine, Section of Critical Care, Rady
Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Arvind P. Pathak
- Russell H. Morgan Department of Radiology and Radiological
Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, The Johns Hopkins
University School of Medicine, Baltimore, MD, USA
- Department of Electrical Engineering, Johns Hopkins
University, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, The Johns
Hopkins University School of Medicine, Baltimore, MD, USA
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23
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Suryavanshi S, Kumar J, Manchanda A, Singh I, Khurana N. Comparison of CECT and CT perfusion in differentiating benign from malignant neck nodes in oral cavity cancers. Eur J Radiol Open 2021; 8:100339. [PMID: 33850970 PMCID: PMC8039829 DOI: 10.1016/j.ejro.2021.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
Aim The objective of the study was to assess the performance of CT Perfusion in comparison to CECT for preoperative detection of metastases to lymph nodes in squamous cell cancers of oral cavity. Methods Twenty-five patients with squamous cell cancers of oral cavity underwent CECT and CTP. Two radiologists evaluated CECT and CTP parameters independently. Surgery and post-operative histopathology was performed in all patients. Results Level wise analysis of the largest node was done. 102 lymph nodes on CECT and 82 lymph nodes on CTP were correlated with post-operative histopathological findings. CECT had a sensitivity, specificity and accuracy of 75 %, 98.6 % and 91.2 %(p-value <0.001) respectively in differentiating benign from metastatic nodes. Mean transit time[MTT] was significantly the most accurate CTP parameter and carried a sensitivity, specificity, accuracy and AUC of 90.5 %, 93.4 %, 92.7 % and 0.96 (p < 0.001). The sensitivity of MTT was higher than the sensitivity of overall CECT. Conclusions CTP is a promising tool for detection of metastatic cervical nodes in squamous cell cancers of the oral cavity.
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Affiliation(s)
- Shubham Suryavanshi
- Department of Radiodiagnosis, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi, India
| | - Jyoti Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi, India
- Corresponding author at: Maulana Azad Medical College & Associated Hospitals, Bahadurshah Zafar Marg, 110002, New Delhi-Central, Delhi, India.
| | - Alpana Manchanda
- Department of Radiodiagnosis, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi, India
| | - Ishwar Singh
- Department of Otorhinolaryngology Head and Neck Surgery, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi, India
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Igrec J, Fuchsjäger MH. Imaging of Bone Sarcomas and Soft-Tissue Sarcomas. ROFO-FORTSCHR RONTG 2021; 193:1171-1182. [PMID: 33772487 DOI: 10.1055/a-1401-0215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the diagnosis of bone and soft-tissue sarcomas, the continuous advancement of various imaging modalities has improved the detection of small lesions, surgical planning, assessment of chemotherapeutic effects, and, importantly, guidance for surgery or biopsy. METHOD This review was composed based on a PubMed literature search for the terms "bone sarcoma," "bone cancer" and "soft tissue sarcoma," "imaging," "magnetic resonance imaging", "computed tomography", "ultrasound", "radiography", and "radiomics" covering the publication period 2005-2020. RESULTS AND CONCLUSION As discussed in this review, radiography, ultrasound, CT, and MRI all play key roles in the imaging evaluation of bone and soft-tissue sarcomas. In daily practice, advanced MRI techniques complement standard MRI but remain underused, as they are considered time-consuming, technically challenging, and not reliable enough to replace biopsy and histology. PET/MRI and radiomics have shown promise regarding the imaging of sarcomas in the future. KEY POINTS · Radiographs remain crucial in diagnostic imaging algorithms for sarcomas.. · US is an initial imaging study for the evaluation of superficial soft-tissue tumors.. · The role of CT continues to evolve as new techniques emerge.. · MRI allows the noninvasive evaluation of soft-tissue, osseous, and articular structures.. · Machine learning methods could improve personalized selection of therapy for patients with sarcoma.. CITATION FORMAT · Igrec J, Fuchsjäger MH. Imaging of Bone and Soft-Tissue Sarcomas. Fortschr Röntgenstr 2021; 193: 1171 - 1182.
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Affiliation(s)
- Jasminka Igrec
- Division of General Radiological Diagnostics, Department of Radiology, Hospital of the Federal State of Styria and University Hospital Graz, Austria
| | - Michael H Fuchsjäger
- Division of General Radiological Diagnostics, Department of Radiology, Hospital of the Federal State of Styria and University Hospital Graz, Austria
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25
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van Amerongen MJ, Vos AM, van der Woude W, Nagtegaal ID, de Wilt JHW, Fütterer JJ, Hermans JJ. Does perfusion computed tomography correlate to pathology in colorectal liver metastases? PLoS One 2021; 16:e0245764. [PMID: 33497385 PMCID: PMC7837475 DOI: 10.1371/journal.pone.0245764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Targeted therapy against tumor angiogenesis is widely used in clinical practice for patients with colorectal liver metastases (CRLM). Possible predictive biomarkers for tumor angiogenesis, such as, microvessel density (MVD), hypoxia and cell proliferation, can be determined using immunohistochemical staining. However, patients ineligible for surgical treatment need to undergo invasive diagnostic interventions in order to determine these biomarkers. CT perfusion (CTP) is an emerging functional imaging technique, which can non-invasively determine vascular properties of solid tumors. The purpose of this study was to evaluate CTP with histological biomarkers in CRLM. Material and methods Patients with CRLM underwent CTP one day before liver surgery. CTP analysis was performed on the entire volume of the largest metastases in each patient. Dual-input maximum slope analysis was used and data concerning arterial flow (AF), portal flow (PF) and perfusion index (PI) were recorded. Immunohistochemical staining with CD34, M75/CA-IX and MIB-1 was performed on the rim in the midsection of the tumor to determine respectively MVD, hypoxia and cell proliferation. Results Twenty CRLM in 20 patients were studied. Mean size of the largest CRLM was 37 mm (95% CI 21–54 mm). Mean AF and PF were respectively 64 ml/min/100ml (95% CI 48–79) and 30 ml/min/100ml (95% CI 22–38). Mean PI was 68% (95% CI 62–73). No significant correlation was found between tumor growth patterns and CTP (p = 0.95). MVD did not significantly correlate to AF (r = 0.05; p = 0.84), PF (r = 0.17; p = 0.47) and PI (r = -0.12; p = 0.63). Cell proliferation also did not significantly correlate to AF (r = 0.07; p = 0.78), PF (r = -0.01; p = 0.95) and PI (r = 0.15; p = 0.52). Hypoxia did not significantly correlate to AF (r = -0.05; p = 0.83), however, significantly to PF (r = 0.51; p = 0.02) and a trend to negative correlation with PF (r = -0.43; p = 0.06). However, after controlling the false discovery rate, no significant correlation between CTP and used immunohistochemical biomarkers was found. Conclusion In conclusion, this feasibility study found a trend to negative correlation between PI and hypoxia, CTP might therefore possibly evaluate this prognostic marker in CRLM non-invasively. However, CTP is not an appropriate technique for the assessment of microvessels or cell proliferation in CRLM.
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Affiliation(s)
- M. J. van Amerongen
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - A. M. Vos
- Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - W. van der Woude
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I. D. Nagtegaal
- Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J. H. W. de Wilt
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J. J. Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J. J. Hermans
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Assessment of tissue perfusion of pancreatic cancer as potential imaging biomarker by means of Intravoxel incoherent motion MRI and CT perfusion: correlation with histological microvessel density as ground truth. Cancer Imaging 2021; 21:13. [PMID: 33468259 PMCID: PMC7816417 DOI: 10.1186/s40644-021-00382-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background/objectives The aim of this study was to compare intravoxel incoherent motion (IVIM) diffusion weighted (DW) MRI and CT perfusion to assess tumor perfusion of pancreatic ductal adenocarcinoma (PDAC). Methods In this prospective study, DW-MRI and CT perfusion were conducted in nineteen patients with PDAC on the day before surgery. IVIM analysis of DW-MRI was performed and the parameters perfusion fraction f, pseudodiffusion coefficient D*, and diffusion coefficient D were extracted for tumors, upstream, and downstream parenchyma. With a deconvolution-based analysis, the CT perfusion parameters blood flow (BF) and blood volume (BV) were estimated for tumors, upstream, and downstream parenchyma. In ten patients, intratumoral microvessel density (MVDtumor) and microvessel area (MVAtumor) were analyzed microscopically in resection specimens. Correlation coefficients between IVIM parameters, CT perfusion parameters, and histological microvessel parameters in tumors were calculated. Receiver operating characteristic (ROC) analysis was performed for differentiation of tumors and upstream parenchyma. Results ftumor significantly positively correlated with BFtumor (r = 0.668, p = 0.002) and BVtumor (r = 0.672, p = 0.002). There were significant positive correlations between ftumor and MVDtumor/ MVAtumor (r ≥ 0.770, p ≤ 0.009) as well as between BFtumor and MVDtumor/ MVAtumor (r ≥ 0.697, p ≤ 0.025). Correlation coefficients between ftumor and MVDtumor/ MVAtumor were not significantly different from correlation coefficients between BFtumor and MVDtumor/ MVAtumor (p ≥ 0.400). Moreover, f, BF, BV, and permeability values (PEM) showed excellent performance in distinguishing tumors from upstream parenchyma (area under the ROC curve ≥0.874). Conclusions The study shows that IVIM derived ftumor and CT perfusion derived BFtumor similarly reflect vascularity of PDAC and seem to be comparably applicable for the evaluation of tumor perfusion for tumor characterization and as potential quantitative imaging biomarker. Trial registration DRKS, DRKS00022227, Registered 26 June 2020, retrospectively registered. https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID=DRKS00022227. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-021-00382-x.
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Agostini A, Borgheresi A, Bruno F, Natella R, Floridi C, Carotti M, Giovagnoni A. New advances in CT imaging of pancreas diseases: a narrative review. Gland Surg 2021; 9:2283-2294. [PMID: 33447580 DOI: 10.21037/gs-20-551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Computed tomography (CT) plays a pivotal role as a diagnostic tool in many diagnostic and diffuse pancreatic diseases. One of the major limits of CT is related to the radiation exposure of young patients undergoing repeated examinations. Besides the standard CT protocol, the most recent technological advances, such as low-voltage acquisitions with high performance X-ray tubes and iterative reconstructions, allow for significant optimization of the protocol with dose reduction. The variety of CT tools are further expanded by the introduction of dual energy: the production of energy-selective images (i.e., virtual monochromatic images) improves the image contrast and lesion detection while the material-selective images (e.g., iodine maps or virtual unenhanced images) are valuable for lesion detection and dose reduction. The perfusion techniques provide diagnostic and prognostic information lesion and parenchymal vascularization and interstitium. Both dual energy and perfusion CT have the potential for pushing the limits of conventional CT from morphological evaluation to quantitative imaging applied to inflammatory and oncological diseases. Advances in post-processing of CT images, such as pancreatic volumetry, texture analysis and radiomics provide relevant information for pancreatic function but also for the diagnosis, management and prognosis of pancreatic neoplasms. Artificial intelligence is promising for optimization of the workflow in qualitative and quantitative analyses. Finally, basic concepts on the role of imaging on screening of pancreatic diseases will be provided.
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Affiliation(s)
- Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Natella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Marina Carotti
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
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Soliman MA, Guccione J, Reiter AM, Moawad AW, Etchison A, Kamel S, Khatchikian AD, Elsayes KM. Current Concepts in Multi-Modality Imaging of Solid Tumor Angiogenesis. Cancers (Basel) 2020; 12:cancers12113239. [PMID: 33153067 PMCID: PMC7692820 DOI: 10.3390/cancers12113239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary The recent increase in the use of targeted molecular therapy including anti-angiogenetic agents in cancer treatment necessitate the use of robust tools to assess and guide treatment. Angiogenesis, the formation of new disorganized blood vessels, is used by tumor cells to grow and spread using different mechanisms that could be targeted by anti-angiogenetic agents. In this review, we discuss the biological principles of tumor angiogenesis and the imaging modalities that could provide information beyond gross tumor size and morphology to capture the efficacy of anti-angiogenetic therapeutic response. Abstract There have been rapid advancements in cancer treatment in recent years, including targeted molecular therapy and the emergence of anti-angiogenic agents, which necessitate the need to quickly and accurately assess treatment response. The ideal tool is robust and non-invasive so that the treatment can be rapidly adjusted or discontinued based on efficacy. Since targeted therapies primarily affect tumor angiogenesis, morphological assessment based on tumor size alone may be insufficient, and other imaging modalities and features may be more helpful in assessing response. This review aims to discuss the biological principles of tumor angiogenesis and the multi-modality imaging evaluation of anti-angiogenic therapeutic responses.
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Affiliation(s)
- Moataz A. Soliman
- Department of Diagnostic Radiology, Northwestern University, Evanston, IL 60201, USA;
| | - Jeffrey Guccione
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA;
| | - Anna M. Reiter
- School of Medicine, University of Texas Southwestern, Dallas, TX 75390, USA;
| | - Ahmed W. Moawad
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA;
| | - Ashley Etchison
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX 76798, USA;
| | - Serageldin Kamel
- Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA;
| | - Aline D. Khatchikian
- Department of Diagnostic Radiology, McGill University, Montreal, QC H3G 1A4, Canada;
| | - Khaled M. Elsayes
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA;
- Correspondence:
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Normalized Dual-Energy Iodine Ratio Best Differentiates Renal Cell Carcinoma Subtypes Among Quantitative Imaging Biomarkers From Perfusion CT and Dual-Energy CT. AJR Am J Roentgenol 2020; 215:1389-1397. [PMID: 33052738 DOI: 10.2214/ajr.19.22612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. The objective of our study was to assess and compare the diagnostic accuracy of perfusion CT (PCT) and dual-energy CT (DECT) in differentiating clear cell renal cell carcinoma (ccRCC) from non-ccRCC. MATERIALS AND METHODS. This retrospective study included 51 patients with 52 renal cell carcinomas (RCCs) (36 ccRCCs and 16 non-ccRCCs) who underwent both PCT and DECT before surgery or biopsy between January 2014 and December 2018. Three independent readers measured blood flow, blood volume (BV), and permeability using PCT and iodine concentration (IC) and iodine ratio using DECT. Interreader agreement was calculated using the intraclass correlation coefficient (ICC). Multivariable logistic regression analysis was performed to assess PCT and DECT models. Size-specific dose estimates of the two methods were compared. RESULTS. BV (ICC, 0.93) and iodine ratio (ICC, 0.85) were the most reproducible parameters. Both PCT and DECT were significant models (p < 0.05, all readers) for differentiating ccRCC from non-ccRCC. There was no significant difference in diagnostic accuracy between PCT and DECT (p > 0.05). BV and iodine ratio were independent predictors of nonccRCC (p < 0.05). However, the mean size-specific dose estimate was 16 times lower with DECT than with PCT (p < 0.001). The AUC of iodine ratio was 0.95, and sensitivity, specificity, and accuracy with an iodine ratio cutoff of 63.72% was 0.90, 0.86, and 0.87, respectively. CONCLUSION. PCT and DECT had comparable and high diagnostic accuracy in differentiating RCC subtypes; however, because of the significantly lower radiation dose of DECT, iodine ratio may be used as the best independent predictor.
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Huang T, Sun H, Luo X, Zhang X, Jin K, Wang F, Sun L, Cheng N, Wu S, Lou Q, Li B. Correlation study between flash dual source CT perfusion imaging and regional lymph node metastasis of non-small cell lung cancer. BMC Cancer 2020; 20:547. [PMID: 32532248 PMCID: PMC7291763 DOI: 10.1186/s12885-020-07032-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/03/2020] [Indexed: 01/06/2023] Open
Abstract
Background To explore the correlation of flash dual source computed tomography perfusion imaging (CTPI) and regional lymph node metastasis of non-small cell lung cancer (NSCLC), and to evaluate the value of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC. Methods 120 consecutive patients with NSCLC confirmed by postoperative histopathology were underwent flash dual source CT perfusion imaging in pre-operation. The CT perfusion parameters of NSCLC, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability (PMB) were obtained by the image post-processing. Then microvessel density (MVD), luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP) of NSCLC were counted by immunohistochemistry. These cases were divided into group A (patients with lymph node metastasis, 58 cases) and group B (patients without lymph node metastasis, 62 cases) according to their pathological results. The CT perfusion parameters and the microvessel parameters were contrastively analysed between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC in pre-operation. Results Group A presented significantly lower LVA, BF and higher MTT, PMB than Group B (P < 0.05), while BV, LVN, LVP and MVD were no significant difference (P > 0.05). Correlation analysis showed that BF was correlated with LVA and LVP (P < 0.05), while BV, MTT and PMB were not correlated with LVN, LVA and LVP (P > 0.05). All the perfusion parameters were not correlated with MVD. According to the ROC curve analysis, when BF < 85.16 ml/100 ml/min as a cutoff point to predict regional lymph node metastasis of NSCLC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 60.8, 81.7, 71.5, 75.6 and 69.5% respectively. Conclusion Flash dual source CT perfusion imaging can non-invasively indicate the luminal vascular structure of tumor and BF can be used as one of the important indexes in predicting regional lymph node metastasis of NSCLC in pre-operation.
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Affiliation(s)
- Tingting Huang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
| | - Hui Sun
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Xianli Luo
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Xuemei Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, China
| | - Kaiyuan Jin
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Feng Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Lv Sun
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Nianlan Cheng
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Shuo Wu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Qin Lou
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Bangguo Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.
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Combination of diffusion-weighted imaging and arterial spin labeling at 3.0 T for the clinical staging of nasopharyngeal carcinoma. Clin Imaging 2020; 66:127-132. [PMID: 32480267 DOI: 10.1016/j.clinimag.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To probe the utility of diffusion-weighted imaging (DWI) and 3D arterial spin labeling (ASL) in assessing the clinical stage of nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS This prospective study included sixty-five newly diagnosed NPC patients who underwent DWI and 3D ASL scans on a 3.0-T magnetic resonance imaging (MRI) system. The apparent diffusion coefficient (ADC) and the tumor blood flow (TBF) of NPC were measured. Tumors were classified as low or high T, N and American Joint Committee on Cancer (AJCC) stages. Student's t-test was used to evaluate the differences between tumors with low and high clinical stages. Pearson correlation analyses were performed to determine the correlation between MRI parameters and clinical stages. Receiver operating characteristic (ROC) curves were then used to evaluate diagnostic capability. RESULTS High T stage (T3/4) NPC showed significantly lower ADCmin (P = 0.000) and higher TBFmax (P = 0.003) and TBFmean (P = 0.008) values than low T stage (T1/2) NPC. High N stage (N2/3) NPC showed significantly lower ADCmin values (P = 0.023) than low N stage (N0/1) NPC. High AJCC stage (III/IV) NPC showed significantly lower ADCmin (P = 0.000) and higher TBFmax (P = 0.005) and TBFmean (P = 0.011) values than low AJCC stage (I/II) NPC. ADCmin values showed moderate negative correlations with T stage (r = -0.512, P = 0.000), N stage (r = -0.281, P = 0.023), and AJCC stage (r = -0.494, P = 0.000). TBFmax values showed moderate positive correlations with T stage (r = 0.369, P = 0.003) and AJCC stage (r = 0.346, P = 0.005). Compared with ADCmin and TBFmax alone, the combination of ADCmin and TBFmax improved the accuracy from 72.3% and 75.4% to 78.5%, respectively, for T staging, as well as from 72.3% and 69.2% to 83.1% for AJCC staging. CONCLUSIONS ADCmin and TBFmax values in patients with NPC could help evaluate clinical stages. ADCmin and TBFmax values combined could clearly improve the accuracy in the assessment of AJCC stage.
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Zhang Z, Zou H, Yuan A, Jiang F, Zhao B, Liu Y, Chen J, Zuo M, Gong L. A Single Enhanced Dual-Energy CT Scan May Distinguish Lung Squamous Cell Carcinoma From Adenocarcinoma During the Venous phase. Acad Radiol 2020; 27:624-629. [PMID: 31447258 DOI: 10.1016/j.acra.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate whether iodine quantification extracted from enhanced dual energy-computed tomography (DE-CT) is useful for distinguishing lung squamous cell carcinoma from adenocarcinoma and to evaluate whether a single scan evaluated during the venous phase (VP) can be substituted for scans evaluated during other phases. MATERIALS AND METHODS Sixty-two patients with lung cancer (32 squamous cell carcinomas; 30 adenocarcinomas) underwent enhanced dual-phase DE-CT scans, including an arterial phase and VP. The iodine concentration (IC), normalized iodine concentration (NIC), and slope of the curve (K) in lesions were measured during two scanning phases in two different pathological types of lung cancers. The differences in parameters (IC, NIC, and K) between these two types of lung cancers were statistically analyzed. In addition, the receiver operating characteristic curves of these parameters were performed to discriminate squamous cell carcinoma from adenocarcinoma. RESULTS The mean IC, NIC, and K in adenocarcinomas were all higher than those in squamous cell carcinomas during the two scanning phases. However, the differences in these parameters between the two types of cancers were significant only during the VP, not during the arterial phase. Receiver operating characteristic analysis demonstrated that the optimal thresholds of the IC, NIC, and K for discriminating squamous cell carcinoma from adenocarcinoma were 1.550, 0.227, and 1.608, respectively. In addition, the sensitivity, specificity, and area under the curve were 81.2%, 83.3%, and 0.871 for the IC; 56.2%, 93.3%, and 0.800 for the NIC; and 65.6%, 80%, and 0.720 for the K; 81.3%, 83.3%, and 0.874 for the IC + NIC; 68.8%, 93.3%, and 0.891 for the IC + NIC + K, respectively. The "IC + NIC + K" had the highest diagnostic efficiency for discriminating two types of lung cancers, but with low sensitivity. Whereas, "IC"and "IC + NIC" had the similar lower diagnostic efficiency, but with high sensitivity and specificity. CONCLUSION The iodine quantification parameters derived from enhanced DE-CT during the VP may be useful for distinguishing lung squamous cell carcinoma from adenocarcinoma.
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Mouawad M, Biernaski H, Brackstone M, Lock M, Yaremko B, Shmuilovich O, Kornecki A, Ben Nachum I, Muscedere G, Lynn K, Prato FS, Thompson RT, Gaede S, Gelman N. DCE-MRI assessment of response to neoadjuvant SABR in early stage breast cancer: Comparisons of single versus three fraction schemes and two different imaging time delays post-SABR. Clin Transl Radiat Oncol 2020; 21:25-31. [PMID: 32021911 PMCID: PMC6993055 DOI: 10.1016/j.ctro.2019.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To determine the effect of dose fractionation and time delay post-neoadjuvant stereotactic ablative radiotherapy (SABR) on dynamic contrast-enhanced (DCE)-MRI parameters in early stage breast cancer patients. MATERIALS AND METHODS DCE-MRI was acquired in 17 patients pre- and post-SABR. Five patients were imaged 6-7 days post-21 Gy/1fraction (group 1), six 16-19 days post-21 Gy/1fraction (group 2), and six 16-18 days post-30 Gy/3 fractions every other day (group 3). DCE-MRI scans were performed using half the clinical dose of contrast agent. Changes in the surrounding tissue were quantified using a signal-enhancement threshold metric that characterizes changes in signal-enhancement volume (SEV). Tumour response was quantified using Ktrans and ve (Tofts model) pre- and post-SABR. Significance was assessed using a Wilcoxin signed-rank test. RESULTS All group 1 and 4/6 group 2 patients' SEV increased post-SABR. All group 3 patients' SEV decreased. The mean Ktrans increased for group 1 by 76% (p = 0.043) while group 2 and 3 decreased 15% (p = 0.028) and 34% (p = 0.028), respectively. For ve, there was no significant change in Group 1 (p = 0.35). Groups 2 showed an increase of 24% (p = 0.043), and Group 3 trended toward an increase (23%, p = 0.08). CONCLUSION Kinetic parameters measured 2.5 weeks post-SABR in both single fraction and three fraction groups were indicative of response but only the single fraction protocol led to enhancement in the surrounding tissue. Our results also suggest that DCE-MRI one-week post-SABR may be too early for response assessment, at least for single fraction SABR, whereas 2.5 weeks appears sufficiently long to minimize confounding acute effects.
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Affiliation(s)
- Matthew Mouawad
- Medical Biophysics, Western University, London, Ontario, Canada
| | | | - Muriel Brackstone
- Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- St. Joseph’s Health Care, London, Ontario, Canada
| | - Michael Lock
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Brian Yaremko
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Olga Shmuilovich
- Lawson Health Research Institute, London, Ontario, Canada
- St. Joseph’s Health Care, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Anat Kornecki
- Lawson Health Research Institute, London, Ontario, Canada
- St. Joseph’s Health Care, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Ilanit Ben Nachum
- Lawson Health Research Institute, London, Ontario, Canada
- St. Joseph’s Health Care, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Giulio Muscedere
- Lawson Health Research Institute, London, Ontario, Canada
- St. Joseph’s Health Care, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Kalan Lynn
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- St. Joseph’s Health Care, London, Ontario, Canada
| | - Frank S. Prato
- Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- St. Joseph’s Health Care, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - R. Terry Thompson
- Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Stewart Gaede
- Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Neil Gelman
- Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
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Li S, Zhang Q, Hong Y. Tumor Vessel Normalization: A Window to Enhancing Cancer Immunotherapy. Technol Cancer Res Treat 2020; 19:1533033820980116. [PMID: 33287656 PMCID: PMC7727091 DOI: 10.1177/1533033820980116] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/13/2020] [Accepted: 10/30/2020] [Indexed: 01/05/2023] Open
Abstract
Hostile microenvironment produced by abnormal blood vessels, which is characterized by hypoxia, low pH value and increasing interstitial fluid pressure, would facilitate tumor progression, metastasis, immunosuppression and anticancer treatments resistance. These abnormalities are the result of the imbalance of pro-angiogenic and anti-angiogenic factors (such as VEGF and angiopoietin 2, ANG2). Prudent use of anti-angiogenesis drugs would normalize these aberrant tumor vessels, resulting in a transient window of vessel normalization. In addition, use of cancer immunotherapy including immune checkpoint blockers when vessel normalization is achieved brings better outcomes. In this review, we sum up the advances in the field of understanding and application of the concept of tumor vessels normalization window to treat cancer. Moreover, we also outline some challenges and opportunities ahead to optimize the combination of anti-angiogenic agents and immunotherapy, leading to improve patients' outcomes.
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Affiliation(s)
- Sai Li
- Department of gynecologic oncology, Women’s hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yupeng Hong
- Department of Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
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Low-Dose Perfusion Computed Tomography for Breast Cancer to Quantify Tumor Vascularity: Correlation With Prognostic Biomarkers. Invest Radiol 2019; 54:273-281. [PMID: 30570503 DOI: 10.1097/rli.0000000000000538] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the feasibility of using low-dose perfusion computed tomography (CT) in breast cancers for quantification of tumor vascularity and to correlate perfusion indexes with prognostic biomarkers. MATERIALS AND METHODS This preliminary study was approved by our institutional review board. Signed informed consent was obtained from all 70 enrolled patients with invasive breast cancers. Low-dose perfusion CT was performed with the patient in the prone position using a spectral CT device set at 80 kVp and 30 mAs (1.30-1.40 mSv). Images were analyzed using commercial software applying the maximum slope algorithm. On CT perfusion maps, perfusion (mL/min per 100 mL), blood volume (mL/100 g), time-to-peak enhancement (second), and peak enhancement intensity (HU) were measured in the tumor, normal breast glandular tissues, and fat. Tumor grade, estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2), and Ki67 level were evaluated using histopathology. Statistically, CT perfusion indexes of the tumor and normal glandular tissues or fat were compared using the Wilcoxon signed-rank test, and CT indexes were correlated with histological characteristics using the Mann-Whitney U or Kruskal-Wallis tests. We also correlated CT indexes with magnetic resonance imaging enhancement characteristics. RESULTS In breast cancers, perfusion, blood volume, and peak enhancement intensity values were significantly higher, and time to peak was shorter than in normal glandular tissues and fat (P < 0.001). Perfusion increased significantly in high-grade, ER-, or HER2+ cancers (P < 0.05). Time to peak decreased in ER-, HER2+, and high-grade cancers or in those with high Ki67 levels (P < 0.05). Peak enhancement intensity significantly increased in high-grade cancers (P < 0.05). HER2 overexpressing cancers showed significantly higher perfusion and shorter time to peak than luminal-type cancers (P < 0.05). Perfusion increased and time to peak decreased significantly in cancers with washout enhancement patterns on magnetic resonance imaging. CONCLUSIONS Low-dose perfusion CT in the prone position is feasible to quantify tumor vascularity in breast cancers, and CT perfusion indexes are significantly correlated with prognostic biomarkers and molecular subtypes of breast cancer.
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Tognarelli A, Faggioni L, Manassero F, Gadducci A, Selli C. A case report of endorectal displacement of a right ureteral stent following radiochemotherapy and Bevacizumab. BMC Urol 2019; 19:128. [PMID: 31818277 PMCID: PMC6902463 DOI: 10.1186/s12894-019-0566-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background The angiogenesis inhibitor monoclonal antibody Bevacizumab is presently the standard treatment for numerous neoplasms but particular toxicities are emerging, such as hypertension, haemorrhage, thromboembolism, gastrointestinal perforation, fistulae, and delayed wound healing. The addition of Bevacizumab to radio and chemotherapy has improved the overall survival rate in patients with metastatic, persistent or recurrent cervical carcinoma. However an increased risk of enteric or urinary fistula formation has been documented, related to hypoxia which is induced by the inhibition of angiogenesis. Moreover, previous pelvic surgery, repeated ureteral stenting and radiation are additional risk factors. Case presentation We describe the remarkable case of a right ureteral stent displacement inside the rectum lumen in a patient treated with Bevacizumab for pelvic recurrence of cervical cancer. The patient was referred to our Urology Department with urinary sepsis and bilateral hydronephrosis. Right ureteral stent substitution was planned; at cystoscopy the distal loop of the stent was not visualized inside the bladder. The presence of the distal loop of the right ureteral inside the rectum was clearly demonstrated with a CT scan. Conclusions Since Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers.
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Affiliation(s)
- Alessio Tognarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Sections of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy.
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Francesca Manassero
- Department of Translational Research and New Technologies in Medicine and Surgery, Sections of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Section of Gynecologic Oncology, University of Pisa, Pisa, Italy
| | - Cesare Selli
- Department of Translational Research and New Technologies in Medicine and Surgery, Sections of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
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Baseline perfusion CT parameters as potential biomarkers in predicting long-term prognosis of localized clear cell renal cell carcinoma. Abdom Radiol (NY) 2019; 44:3370-3376. [PMID: 31399787 DOI: 10.1007/s00261-019-02087-z] [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] [Indexed: 01/17/2023]
Abstract
PURPOSE We aimed to explore the relationship among baseline perfusion CT parameters, clinical, and pathological factors with post-nephrectomy long-term progression-free survival in localized clear cell renal cell carcinoma. MATERIALS AND METHODS This study retrospectively collected 127 patients from March 2005 to May 2007 who undertook perfusion CT. 61 patients were confirmed of pT1N0M0 or pT2N0M0 ccRCC. The mean follow-up time is 118.8 months (± 13.1 m, range 72-135 m). We compared clinical, pathological factors (gender, T stage, age, Fuhrmann grade, VEGF level, and MVD), and perfusion parameters before treatment [blood flow (BF), blood volume, mean transition time, and permeability surface-area product] between groups with post-nephrectomy metastasis and without metastasis. Association between covariates and progression-free survival (PFS) were analyzed using Cox proportional regression. RESULTS Among 61 patients, 11 developed distant metastasis (10 in the lung, one in the bone). BF in metastatic group [429.1 (233.8, 570.1) ml/min/100 g] was significantly higher than non-metastatic group [214.3 (153.3, 376.5) ml/min/100 g] (p = 0.011). Metastatic group also had more patients with higher Fuhrmann grade. Multi-covariant Cox regression demonstrated T staging, Fuhrmann grade, and BF were significantly associated with PFS [hazard ratio (HR) 3.35, 3.08, and 1.006]. In another model, BF > 230 ml/min/100 g was associated with PFS (HR 12.90), along with T staging and Fuhrmann grade (HR 4.73, 3.69). CONCLUSION Baseline tumor BF is a potential biomarker in prediction long-term metastasis of localized ccRCC and may help screening for higher risk localized ccRCC patients who need personalized surveillance strategy after nephrectomy.
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Hamdy A, Ichikawa Y, Toyomasu Y, Nagata M, Nagasawa N, Nomoto Y, Sami H, Sakuma H. Perfusion CT to Assess Response to Neoadjuvant Chemotherapy and Radiation Therapy in Pancreatic Ductal Adenocarcinoma: Initial Experience. Radiology 2019; 292:628-635. [PMID: 31287389 DOI: 10.1148/radiol.2019182561] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundChange in tumor size at CT is insufficient for reliable assessment of treatment response after neoadjuvant chemotherapy and radiation therapy (CRT) and shows poor correlation with histologic grading of response.PurposeTo investigate the use of perfusion CT to predict the response of pancreatic ductal adenocarcinoma (PDA) to CRT.Materials and MethodsBetween June 2016 and May 2018, study participants with biopsy-proven PDA were prospectively recruited to undergo perfusion CT before and after planned CRT. Blood flow (BF), blood volume (BV), and permeability-surface area product (PSP) were quantified from CT images. Participants were categorized into responders and nonresponders according to therapy response. The Mann-Whitney test was used to compare the baseline perfusion values between responders and nonresponders, and the Wilcoxon matched-pairs signed rank test was used to compare perfusion values before and after CRT.ResultsThe final cohort of 21 participants (median age, 68 years; interquartile range [IQR], 65-72 years; eight men) underwent dynamic perfusion (dual-source) CT before neoadjuvant CRT. All participants underwent pancreatectomy. Eighteen participants underwent post-CRT perfusion CT. Baseline BF was higher in responders (n = 10) than in nonresponders (n = 11) (median, 44 [IQR, 39-56] vs 28 [IQR, 16-52] mL/100 g/min; P = .04), while BV and PSP were similar between groups (median BV, 4.3 [IQR, 3.5-6.9] vs 2.0 [IQR, 1.6-6.5] mL/100 g, P = .15; median PSP, 25 [IQR, 21-30] vs 20 [IQR, 10-34] mL/100 g/min, P = .31). Response Evaluation Criteria in Solid Tumors (RECIST) and carbohydrate antigen (CA) 19-9 showed no correlation with perfusion parameters (eg, RECIST and BF: r = 0.05, P = .84, 95% confidence interval [CI]: -0.40, 0.48; CA 19-9 and BF: r = 0.06, P = .78, 95% CI: -0.39, 0.49) or histopathologic response (r = 0.16, P = .47, 95% CI: -0.3, 0.57 and r = 0.09, P = .71, 95% CI: -0.37, 0.51, respectively). For responders, perfusion parameters increased after CRT (eg, median BF, 54 [IQR, 42-73] vs 43 [IQR, 28-53] mL/100 g/min; P = .04). The perfusion change in nonresponders was not significant (median BF, 43 [IQR, 28-53] vs 33 [IQR, 16-52] mL/100 g/min; P = .06).ConclusionPerfusion CT may be useful in helping predict the histopathologic response to therapy in pancreatic ductal adenocarcinoma.© RSNA, 2019See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Ahmed Hamdy
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Yasutaka Ichikawa
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Yutaka Toyomasu
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Motonori Nagata
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Naoki Nagasawa
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Yoshihito Nomoto
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Haney Sami
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
| | - Hajime Sakuma
- From the Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (A.H., Y.I., Y.T., M.N., N.N., Y.N., H. Sakuma); and Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt (A.H., H. Sami)
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Abstract
OBJECTIVE Imaging plays a key role in the assessment of patients before, during, and after percutaneous cryoablation of hepatic tumors. Intra-procedural and early post-procedure imaging with CT and MRI is vital to the assessment of technical success including adequacy of ablation zone coverage. Recognition of the normal expected post-procedure findings of hepatic cryoablation such as ice ball formation, hydrodissection, and the normal appearance of the ablation zone is crucial to be able to differentiate from complications including vascular, biliary, or non-target organ injury. Delayed imaging is essential for determination of clinical effectiveness and detection of unexpected findings such as residual unablated tumor and local tumor progression. The purpose of this article is to review the spectrum of expected and unexpected imaging findings that may occur during or after percutaneous cryoablation of hepatic tumors. CONCLUSION Differentiating expected from unexpected findings during and after hepatic cryoablation helps radiologists identify residual or recurrent tumor and detect procedure-related complications.
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Seo JH, Lee SM, Yu SN, Lee JW, Lee JE. Clinical usefulness of two-phase 18F-sodium-fluoride (18F-NaF) bone PET/CT for evaluating treatment response of bone metastases from breast cancer: Case report. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Trinidad López C, De La Fuente Aguado J, Oca Pernas R, Delgado Sánchez-Gracián C, Santos Armentia E, Vaamonde Liste A, Prada González R, Souto Bayarri M. Evaluation of response to conventional chemotherapy and radiotherapy by perfusion computed tomography in non-small cell lung cancer (NSCLC). Eur Radiol Exp 2019; 3:23. [PMID: 31197486 PMCID: PMC6565789 DOI: 10.1186/s41747-019-0101-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To evaluate changes in perfusion computed tomography (PCT) parameters induced by treatment with conventional chemotherapy (CCT) alone or with CCT and radiation therapy (RT) in patients with non-small cell lung cancer (NSCLC) and to determine whether these changes correlate with response as defined by the response evaluation criteria in solid tumours version 1.1 (RECIST-1.1). METHODS Fifty-three patients with a histological diagnosis of NSCLC prospectively underwent PCT of the whole tumour, before/after CCT or before/after CCT and RT. Blood flow (BF), blood volume (BV), permeability (PMB), and mean transit time (MTT) were compared before and after treatment and with the response as defined by RECIST-1.1. The relationship between changes in the perfusion parameters and in tumour size was also evaluated. RESULTS PCT parameters decreased after treatment, significantly for BV (p = 0.002) and MTT (p = 0.027). The 30 patients with partial response had a significant decrease of 21% for BV (p = 0.006) and 17% for MTT (p = 0.031). A non-significant decrease in all perfusion parameters was found in patients with stable disease (p > 0.137). In patients with progressive disease, MTT decreased by 10% (p = 0.465) and the other parameters did not significantly vary (p > 0.809). No significant correlation was found between changes in size and PCT parameters (p > 0.145). CONCLUSIONS Treatment of NSCLC with platinum derivatives, with or without RT, induces changes in PCT parameters. Partial response is associated with a significant decrease in BV and MTT, attributable to the effect of the treatment on tumour vascularisation.
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Affiliation(s)
- Carmen Trinidad López
- Department of Radiology, POVISA Hospital, 5 Salamanca st, 36208, Vigo, Pontevedra, Spain.
| | | | - Roque Oca Pernas
- Department of Radiology, Osatek, Urduliz Hospital, Vizcaya, Spain
| | | | - Eloisa Santos Armentia
- Department of Radiology, POVISA Hospital, 5 Salamanca st, 36208, Vigo, Pontevedra, Spain
| | - Antonio Vaamonde Liste
- Department of Statistics and Operational Research, Faculty of Economic and Business Sciences, Vigo University Spain, Vigo, Spain
| | - Raquel Prada González
- Department of Radiology, POVISA Hospital, 5 Salamanca st, 36208, Vigo, Pontevedra, Spain
| | - Miguel Souto Bayarri
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Volume Computed Tomography Perfusion Imaging: Evaluation of the Significance in Oncologic Follow-up of Metastasizing Renal Cell Carcinoma in the Early Period of Targeted Therapy - Preliminary Results. J Comput Assist Tomogr 2019; 43:493-498. [PMID: 30762651 DOI: 10.1097/rct.0000000000000848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to assess the significance of volume computed tomography perfusion imaging of metastasizing renal cell carcinoma (mRCC) in the early period after the initiation of targeted therapy. METHODS Blood flow (BF), blood volume, and clearance (CL) were calculated in 10 patients with histologically verified mRCC before and 1 month after initiation of targeted therapy using compartmental analysis algorithms. In addition, the longest diameter of tumor was measured for both time points and compared. Correlation test was performed between perfusion parameters and size changes with time to progression (TTP). RESULTS Blood flow and CL were significantly lower after therapy initiation, whereas blood volume and the long diameter remained unchanged. Median values before and after 4 weeks of therapy were 144.2 versus 99.4 mL/min/100 mL for BF (P = 0.009) and 115.5 versus 46.8 mL/min/100 mL for CL (P = 0.007). Changes in BF and CL showed very strong negative correlation with TTP (r = -0.838, P = 0.009 and r = -0.826, P = 0.011, respectively). CONCLUSIONS Our preliminary study results indicate that volume computed tomography perfusion may assess targeted therapy response of mRCC earlier than the currently used Response Evaluation Criteria in Solid Tumors. In addition, changes in BF and CL may be a promising parameter for prediction of TTP.
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Computed Tomography Perfusion Measurements in Renal Lesions Obtained by Bayesian Estimation, Advanced Singular-Value Decomposition Deconvolution, Maximum Slope, and Patlak Models: Intermodel Agreement and Diagnostic Accuracy of Tumor Classification. Invest Radiol 2019; 53:477-485. [PMID: 29762256 DOI: 10.1097/rli.0000000000000477] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the agreement of computed tomography (CT)-perfusion parameter values of the normal renal cortex and various renal tumors, which were obtained by different mathematical models, and to evaluate their diagnostic accuracy. MATERIALS AND METHODS Perfusion imaging was performed prospectively in 35 patients to analyze 144 regions of interest of the normal renal cortex and 144 regions of interest of renal tumors, including 21 clear-cell renal cell carcinomas (RCC), 6 papillary RCCs, 5 oncocytomas, 1 chromophobe RCC, 1 angiomyolipoma with minimal fat, and 1 tubulocystic RCC. Identical source data were postprocessed and analyzed on 2 commercial software applications with the following implemented mathematical models: maximum slope, Patlak plot, standard singular-value decomposition (SVD), block-circulant SVD, oscillation-limited block-circulant SVD, and Bayesian estimation technique. Results for blood flow (BF), blood volume (BV), and mean transit time (MTT) were recorded. Agreement and correlation between pairs of models and perfusion parameters were assessed. Diagnostic accuracy was evaluated by receiver operating characteristic (ROC) analysis. RESULTS Significant differences and poor agreement of BF, BV, and MTT values were noted for most of model comparisons in both the normal renal cortex and different renal tumors. The correlations between most model pairs and perfusion parameters ranged between good and perfect (Spearman ρ = 0.79-1.00), except for BV values obtained by Patlak method (ρ = 0.61-0.72). All mathematical models computed BF and BV values, which differed significantly between clear cell RCCs, papillary RCCs, and oncocytomas, which introduces them as useful diagnostic tests to differentiate between different histologic subgroups (areas under ROC curve, 0.83-0.99). The diagnostic accuracy to discriminate between clear-cell RCCs and the renal cortex was the lowest based on the Patlak plot model (area under ROC curve, 0.76); BF and BV values obtained by other algorithms did not differ significantly in their diagnostic accuracy. CONCLUSIONS Quantitative perfusion parameters obtained from different mathematical models cannot be used interchangeably. Based on BF and BV estimates, all models are a useful tool in the differential diagnosis of kidney tumors, with the Patlak plot model yielding a significantly lower diagnostic accuracy.
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Hatzidakis A, Perisinakis K, Kalarakis G, Papadakis A, Savva E, Ippolito D, Karantanas A. Perfusion-CT analysis for assessment of hepatocellular carcinoma lesions: diagnostic value of different perfusion maps. Acta Radiol 2019; 60:561-568. [PMID: 30114926 DOI: 10.1177/0284185118791200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Computed tomography liver perfusion (CTLP) has been improved in recent years, offering a variety of perfusion-parametric maps. A map that better discriminates hepatocellular carcinoma (HCC) is still to be found. PURPOSE To compare different CTLP maps, regarding their ability to differentiate cirrhotic or non-cirrhotic parenchyma from malignant HCC. MATERIAL AND METHODS Twenty-six patients (11 cirrhotic) with 50 diagnosed HCC lesions, underwent CTLP on a 128-row dual-energy CT system. Nine different maps were generated. Regions of interest (ROIs) were positioned on non-tumorous parenchyma and on HCCs found on previous magnetic resonance imaging. Perfusion parameters for non-cirrhotic and cirrhotic livers were compared. Receiver operating characteristic (ROC) analysis was employed to evaluate each map's ability to discriminate HCCs from non-tumorous livers. Comparison of ROC curves was performed to evaluate statistical significance of differences in the discriminating efficiency of derived perfusion maps. RESULTS Perfusion parameters for non-tumorous liver and HCCs recorded in cirrhotic patients did not significantly differ from corresponding values recorded in non-cirrhotic patients ( P > 0.05). The highest power for HCC discrimination was found for the maximum-slope-of-increase (MSI) parametric map, with estimated the area under ROC curve of 0.997. An MSI cut-off criterion of 2.2 HU/s was found to provide 96% sensitivity and 100% specificity. Time to peak, blood flow, and transit time to peak were also found to have high discriminating power. CONCLUSION Among available CTLP-derived perfusion parameters, MSI was found to provide the highest diagnostic accuracy in discriminating HCCs from non-tumorous parenchyma. Perfusion parameters for non-tumorous livers and HCCs were not found to significantly differ between cirrhotic and non-cirrhotic patients.
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Affiliation(s)
- Adam Hatzidakis
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
| | - Kostas Perisinakis
- 2 University Hospital of Heraklion, Department of Medical Physics, Heraklion, Greece
| | - Georgios Kalarakis
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
| | - Antonis Papadakis
- 2 University Hospital of Heraklion, Department of Medical Physics, Heraklion, Greece
| | - Eirini Savva
- 3 University Hospital of Heraklion, Department of Internal Medicine, Heraklion, Greece
| | - Davide Ippolito
- 4 Azienda Ospedaliera San Gerardo, Department of Diagnostic Radiology, Monza, Lombardia, Italy
| | - Apostolos Karantanas
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
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Joo I, Kim SH, Lee DH, Han JK. Dynamic Contrast-Enhanced Ultrasound of Gastric Cancer: Correlation with Perfusion CT and Histopathology. Korean J Radiol 2019; 20:781-790. [PMID: 30993929 PMCID: PMC6470092 DOI: 10.3348/kjr.2018.0273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To assess the relationship between contrast-enhanced ultrasound (CEUS) parameters and perfusion CT (PCT) parameters of gastric cancers and their correlation with histologic features. Materials and Methods This prospective study was approved by our Institutional Review Board. We included 43 patients with pathologically-proven gastric cancers undergoing CEUS using SonoVue® (Bracco) and PCT on the same day. Correlation between the CEUS parameters (peak intensity [PI], area under the curve [AUC], rise time [RT] from 10% to 90% of PI, time to peak [TTPUS], and mean transit time [MTTUS]) and PCT parameters (blood flow, blood volume, TTPCT, MTTCT, and permeability surface product) of gastric cancers were analyzed using Spearman's rank correlation test. In cases of surgical resection, the CEUS and PCT parameters were compared according to histologic features using Mann-Whitney test. Results CEUS studies were of diagnostic quality in 88.4% (38/43) of patients. Among the CEUS parameters of gastric cancers, RT and TTPUS showed significant positive correlations with TTPCT (rho = 0.327 and 0.374, p = 0.045 and 0.021, respectively); PI and AUC were significantly higher in well-differentiated or moderately-differentiated tumors (n = 4) than poorly-differentiated tumors (n = 18) (p = 0.026 and 0.033, respectively), whereas MTTCT showed significant differences according to histologic types (poorly cohesive carcinoma [PCC] vs. non-PCC), T-staging (≤ T2 vs. ≥ T3), N-staging (N0 vs. N-positive), and epidermal growth factor receptor expression (≤ faint vs. ≥ moderate staining) (p values < 0.05). Conclusion In patients with gastric cancers, CEUS is technically feasible for the quantification of tumor perfusion and may provide correlative and complementary information to that of PCT, which may allow prediction of histologic features.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
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García-Figueiras R, Baleato-González S, Padhani AR, Luna-Alcalá A, Vallejo-Casas JA, Sala E, Vilanova JC, Koh DM, Herranz-Carnero M, Vargas HA. How clinical imaging can assess cancer biology. Insights Imaging 2019; 10:28. [PMID: 30830470 PMCID: PMC6399375 DOI: 10.1186/s13244-019-0703-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
Human cancers represent complex structures, which display substantial inter- and intratumor heterogeneity in their genetic expression and phenotypic features. However, cancers usually exhibit characteristic structural, physiologic, and molecular features and display specific biological capabilities named hallmarks. Many of these tumor traits are imageable through different imaging techniques. Imaging is able to spatially map key cancer features and tumor heterogeneity improving tumor diagnosis, characterization, and management. This paper aims to summarize the current and emerging applications of imaging in tumor biology assessment.
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Affiliation(s)
- Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Spain.
| | - Sandra Baleato-González
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England, HA6 2RN, UK
| | - Antonio Luna-Alcalá
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
- MRI Unit, Clínica Las Nieves, Health Time, Jaén, Spain
| | - Juan Antonio Vallejo-Casas
- Unidad de Gestión Clínica de Medicina Nuclear. IMIBIC. Hospital Reina Sofía. Universidad de Córdoba, Córdoba, Spain
| | - Evis Sala
- Department of Radiology and Cancer Research UK Cambridge Center, Cambridge, CB2 0QQ, UK
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona and IDI, Lorenzana 36, 17002, Girona, Spain
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital & Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - Michel Herranz-Carnero
- Nuclear Medicine Department, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706, Santiago de Compostela, Galicia, Spain
- Molecular Imaging Program, IDIS, USC, Santiago de Compostela, Galicia, Spain
| | - Herbert Alberto Vargas
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Radiology, 1275 York Av. Radiology Academic Offices C-278, New York, NY, 10065, USA
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Shuto K, Mori M, Kosugi C, Narushima K, Nakabayashi S, Fujisiro T, Sato A, Hayano K, Shimizu H, Koda K. Hepatic blood flow by perfusion computed tomography as an imaging biomarker for patients with gastric cancer. Oncol Lett 2019; 17:3267-3276. [PMID: 30867759 PMCID: PMC6396202 DOI: 10.3892/ol.2019.9969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/17/2019] [Indexed: 11/19/2022] Open
Abstract
Perfusion computed tomography (PCT) is a less invasive imaging modality that provides information about tissue hemodynamics at the capillary level. The present study aimed to investigate the correlation between hepatic perfusion and gastric cancer progression. A total of 136 patients with gastric adenocarcinoma were evaluated in the present study. Prior to initial treatment, liver PCT was performed across the hepatic hilar plane and the hepatic blood flow (HBF) was measured using the dual-input deconvolution method. HBF was compared with clinicopathological factors, patient prognosis and circulating serum proangiogenic cytokines. The median HBF was 217 ml/min/100 g tissue. Patients with high HBF had larger tumors (43 mm vs. 71, P<0.001) and more advanced tumor-node stages (P<0.001 for both). When both patient groups of operable and inoperable were compared by their respective median HBF values, each high-HBF group had a significantly worse prognosis (P=0.002 and P=0.024), notably in the inoperable group, with <1-year survival. In 17 postoperative recurrent patients, the high-HBF at recurrence group also had a significantly worse postrecurrent prognosis (P=0.019). HBF was an independent prognostic factor (hazard ratio, 2.019; P=0.048) and was strongly associated with serum vascular endothelial growth factor level (R=0.607, P<0.001). HBF was significantly correlated with gastric cancer progression, and is an easily measured imaging biomarker reflecting patient survival.
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Affiliation(s)
- Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan
| | - Mikito Mori
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan
| | - Kazuo Narushima
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan
| | - Satoko Nakabayashi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan
| | - Takeshi Fujisiro
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Asami Sato
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Hiroaki Shimizu
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan
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Wang M, Li B, Sun H, Huang T, Zhang X, Jin K, Wang F, Luo X. Correlation study between dual source CT perfusion imaging and the microvascular composition of solitary pulmonary nodules. Lung Cancer 2019; 130:115-120. [PMID: 30885331 DOI: 10.1016/j.lungcan.2019.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To explore the correlation between dual source computed tomography perfusion imaging (CTPI) and microvascular parameters, and evaluate the value of CTPI in the differential diagnosis of solitary pulmonary nodule (SPN). METHODS 65 consecutive patients with SPN who successfully underwent pre-operative CT perfusion imaging with dual source CT and received a final diagnosis by postoperative pathology. The cases were divided into malignant, benign and inflammatory groups according to the pathological results. CT perfusion parameters, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface (PMB) were obtained by performing CTPI of SPNs. The postoperative specimens of SPNs were immunohistochemically stained for CD34 and SMA to detect microvessel density (MVD) and luminal vascular parameters, such as luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP). The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameter in diagnosing malignant SPNs. RESULTS In these 65 cases, malignant, benign and inflammatory SPNs were respectively 39, 14 and 12 cases. Significant difference was observed in LVN/MVD, LVA and LVP among the three groups (P < 0.05). The correlation between CT perfusion parameters (BF, BV and PMB) and the luminal vascular parameters was stronger than that with MVD (P < 0.05). PMB has the strongest correlation with LVN/MVD. Using BF≥60ml/100ml/min, BV≥6.34ml/100ml and PMB≥13.35ml/100 ml/min for the diagnosis, the area under the curve (AUC) of the ROC curve was 0.760, the sensitivity was 82% and the specificity was 61%. CONCLUSIONS The main indicators reflecting blood perfusion of SPN are the degree of lumen or maturity of microvessels (LVN, LVA and LVP), not just the number of microvessels (e.g. MVD). CT perfusion imaging can be used as an important method to non-invasively evaluate tumour angiogenesis and help to distinguish malignant SPNs from benign and inflammatory SPNs.
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Affiliation(s)
- Meng Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China; Department of Radiology, The First People's Hospital of Xinxiang, Xinxiang, Henan Province, China.
| | - Bangguo Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China.
| | - Hui Sun
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China; Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China.
| | - Tingting Huang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China; Department of Radiology, The Third Affiliated Hospital, Qiqihar Medical University, Qiqihar, Heilongjiang Province, China.
| | - Xuemei Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China.
| | - Kaiyuan Jin
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China.
| | - Feng Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China.
| | - Xianli Luo
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China.
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Seo JH, Lee SM, Yu SN, Lee JW, Lee JE. Clinical usefulness of two-phase 18F-sodium-fluoride ( 18F-NaF) bone PET/CT for evaluating treatment response of bone metastases from breast cancer: Case report. Rev Esp Med Nucl Imagen Mol 2019; 38:238-242. [PMID: 30665751 DOI: 10.1016/j.remn.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/09/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
Abstract
We report the case of a breast cancer patient in whom a two-phase 18F-sodium-fluoride (18F-NaF) bone PET/CT was useful for detecting hidden bone metastases and assessing treatment response. The patient underwent a two-phase bone PET/CT to evaluate a newly developed lesion found on bone scintigraphy following surgery. In the perfusion and bone phase PET/CT images, focally increased perfusion and bony uptake were found in the sacrum and L5 vertebra, suggesting bone metastases of breast cancer. Therefore, the patient subsequently underwent palliative treatment. In another twoPET/CT studies (each including two-phase bone images) performed after 3and 6months of follow-up, the perfusion phase images showed an improvement of the lesion uptake more clearly than in the bone phase images in the visual and semi-quantitative analyses, and thus the perfusion phase images were more useful for clarifying the treatment response earlier than the bone phase images. This is the first case showing the clinical usefulness of 18F-NaF bone PET/CT with the perfusion imaging technique for evaluating bone metastases and the therapeutic response of metastatic bone lesions.
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Affiliation(s)
- J H Seo
- Department of Radiology, Soonchunhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, República de Corea
| | - S M Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, 31151, República de Corea.
| | - S N Yu
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, República de Corea
| | - J W Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Simgok-ro 100 Gil 25, Seo-gu, Incheon 22711, República de Corea
| | - J E Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, República de Corea
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Lee D, Park S, Ang MJC, Park JG, Yoon S, Kim C, Lee SK, Cho KO, Choi J. Evaluation of liver lesions by use of shear wave elastography and computed tomography perfusion imaging after radiofrequency ablation in clinically normal dogs. Am J Vet Res 2019; 79:1140-1149. [PMID: 30372151 DOI: 10.2460/ajvr.79.11.1140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate acute changes of the liver by use of shear wave elastography (SWE) and CT perfusion after radiofrequency ablation (RFA). ANIMALS 7 healthy Beagles. PROCEDURES RFA was performed on the liver (day 0). Stiffness of the ablation lesion, transitional zone, and normal parenchyma were evaluated by use of SWE, and blood flow, blood volume, and arterial liver perfusion of those regions were evaluated by use of CT perfusion on days 0 and 4. All RFA lesions were histologically examined on day 4. RESULTS Examination of the SWE color-coded map distinctly revealed stiffness of the liver tissue, which increased from the normal parenchyma to the transitional zone and then to the ablation zone. For CT perfusion, blood flow, blood volume, and arterial liver perfusion decreased from the transitional zone to the normal parenchyma and then to the ablation zone. Tissue stiffness and CT perfusion variables did not differ significantly between days 0 and 4. Histologic examination revealed central diffuse necrosis and peripheral hyperemia with infiltration of lymphoid cells and macrophages. CONCLUSIONS AND CLINICAL RELEVANCE Coagulation necrosis induced a loss of blood perfusion and caused tissue hardening (stiffness) in the ablation zone. Hyperemic and inflammatory changes of the transitional zone resulted in increased blood perfusion. Acute changes in stiffness and perfusion of liver tissue after RFA could be determined by use of SWE and CT perfusion. These results can be used to predict the clinical efficacy of RFA and to support further studies, including those involving hepatic neoplasia.
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