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Jahn M, Layer G. [Multiparametric MRI in hepatocellular carcinoma, part 2 : Diffusion-weighted imaging in the primary diagnostics and treatment monitoring]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:587-596. [PMID: 38884639 DOI: 10.1007/s00117-024-01323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/18/2024]
Abstract
In addition to morphology and tissue perfusion, diffusion-weighted imaging (DWI) is the third pillar of multiparametric diagnostics in oncology. Due to the strong correlation between the apparent diffusion coefficient (ADC) and cell count in hepatocellular carcinoma (HCC), it can be used as a surrogate marker for tumor cell quantity. Therefore, ADC effectively reflects the effects of cytoreductive treatment, such as transarterial chemoembolization (TACE) and systemic chemotherapy and becomes an important clinical marker for treatment response. The DWI should remain an integral part of a magnetic resonance imaging (MRI) protocol in primary HCC diagnostics and treatment monitoring but is of secondary clinical importance compared to contrast-enhanced MRI perfusion sequences and the use of liver-specific contrast agents. For the future, standardization of DWI sequences for better comparability of various study protocols would be desirable.
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Affiliation(s)
- Mona Jahn
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstraße 79, 67063, Ludwigshafen, Deutschland.
| | - Günter Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstraße 79, 67063, Ludwigshafen, Deutschland
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Svecic A, Mansour R, Tang A, Kadoury S. Prediction of post transarterial chemoembolization MR images of hepatocellular carcinoma using spatio-temporal graph convolutional networks. PLoS One 2021; 16:e0259692. [PMID: 34874934 PMCID: PMC8651128 DOI: 10.1371/journal.pone.0259692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/24/2021] [Indexed: 11/25/2022] Open
Abstract
Magnetic resonance imaging (MRI) plays a critical role in the planning and monitoring of hepatocellular carcinomas (HCC) treated with locoregional therapies, in order to assess disease progression or recurrence. Dynamic contrast-enhanced (DCE)-MRI sequences offer temporal data on tumor enhancement characteristics which has strong prognostic value. Yet, predicting follow-up DCE-MR images from which tumor enhancement and viability can be measured, before treatment of HCC actually begins, remains an unsolved problem given the complexity of spatial and temporal information. We propose an approach to predict future DCE-MRI examinations following transarterial chemoembolization (TACE) by learning the spatio-temporal features related to HCC response from pre-TACE images. A novel Spatial-Temporal Discriminant Graph Neural Network (STDGNN) based on graph convolutional networks is presented. First, embeddings of viable, equivocal and non-viable HCCs are separated within a joint low-dimensional latent space, which is created using a discriminant neural network representing tumor-specific features. Spatial tumoral features from independent MRI volumes are then extracted with a structural branch, while dynamic features are extracted from the multi-phase sequence with a separate temporal branch. The model extracts spatio-temporal features by a joint minimization of the network branches. At testing, a pre-TACE diagnostic DCE-MRI is embedded on the discriminant spatio-temporal latent space, which is then translated to the follow-up domain space, thus allowing to predict the post-TACE DCE-MRI describing HCC treatment response. A dataset of 366 HCC's from liver cancer patients was used to train and test the model using DCE-MRI examinations with associated pathological outcomes, with the spatio-temporal framework yielding 93.5% classification accuracy in response identification, and generating follow-up images yielding insignificant differences in perfusion parameters compared to ground-truth post-TACE examinations.
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Affiliation(s)
- Andrei Svecic
- Department of Computer Engineering, MedICAL, Polytechnique Montréal, Montréal, Québec, Canada
| | | | - An Tang
- CHUM Research Center, Montréal, Québec, Canada
- Department of Radiology, CHUM, Montréal, Québec, Canada
| | - Samuel Kadoury
- Department of Computer Engineering, MedICAL, Polytechnique Montréal, Montréal, Québec, Canada
- CHUM Research Center, Montréal, Québec, Canada
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Bo J, Peng H, LianHua Z, Xiang F, YuKun L. Intraarterial contrast-enhanced ultrasound to predict the short-term tumour response of hepatocellular carcinoma to Transarterial chemoembolization with Lipiodol. BMC Cancer 2021; 21:1171. [PMID: 34727882 PMCID: PMC8565038 DOI: 10.1186/s12885-021-08867-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is an effective locoregional therapy in hepatocellular carcinoma (HCC). However, it is difficult to predict the tumour response (TR) of TACE intraprocedurally. The aim of this study was to predict the TR after TACE (1-3 months) in HCC patients using intraprocedural intraarterial contrast enhanced ultrasound (IA-CEUS). METHODS In this case-control study, consecutive patients who received TACE in our hospital from September 2018 to May 2019 were enrolled. IA-CEUS was performed before and after TACE. Postoperative contrast-enhanced liver MRI was performed 1-3 months after TACE as the gold standard. According to the modified Response Evaluation Criteria in Solid Tumours (mRECIST), ultrasonic manifestations were compared between the complete remission (CR) group and non-CR group by univariate and multivariate analyses. A logistic predictive model was established and validated, and its diagnostic efficiency was evaluated. RESULTS Forty-four patients with sixty-one lesions were enrolled in the study. Multivariate analysis identified, the risk factors as a large lesion diameter (OR: 1.84; 95% confidence interval [CI]: 1.009, 3.080; P = 0.020), a larger dimension of non-enhancing area in superior mesenteric artery (SMA)-CEUS than the size in B-mode ultrasound preoperatively (OR: 3.379; 95% CI: 1.346,8.484; P = 0.010), presence of corona enhancement in hepatic artery (HA)-CEUS postoperatively (OR: 6.642; 95% CI: 1.214, 36.331; P = 0.029), and decreased corona enhancement thickness (per centimetre) postoperatively (OR: 0.025; 95% CI: 0.006,0.718; P = 0.025). The area under the receiver operating characteristic curve (AUROC) of the predictive model was 0.904 (95% CI: 0.804, 0.966; P < 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 81.08, 91.67, 85.25, 93.75, and 75.86%, respectively. Leave-one-out cross-validation (LOOCV) showed that the accuracy was 77.05%. CONCLUSIONS Intraprocedural IA-CEUS can be used to predict the TR in HCC patients after TACE.
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Affiliation(s)
- Jiang Bo
- Department of ultrasound, The First Medical Centre, Chinese PLA General Hospital, No. 28 of Fuxing Road, Haidian District, Beijing, 100853 China
| | - Han Peng
- Department of ultrasound, The First Medical Centre, Chinese PLA General Hospital, No. 28 of Fuxing Road, Haidian District, Beijing, 100853 China
| | - Zhu LianHua
- Department of ultrasound, The First Medical Centre, Chinese PLA General Hospital, No. 28 of Fuxing Road, Haidian District, Beijing, 100853 China
| | - Fei Xiang
- Department of ultrasound, The First Medical Centre, Chinese PLA General Hospital, No. 28 of Fuxing Road, Haidian District, Beijing, 100853 China
| | - Luo YuKun
- Department of ultrasound, The First Medical Centre, Chinese PLA General Hospital, No. 28 of Fuxing Road, Haidian District, Beijing, 100853 China
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Cannella R, Sartoris R, Grégory J, Garzelli L, Vilgrain V, Ronot M, Dioguardi Burgio M. Quantitative magnetic resonance imaging for focal liver lesions: bridging the gap between research and clinical practice. Br J Radiol 2021; 94:20210220. [PMID: 33989042 PMCID: PMC8173689 DOI: 10.1259/bjr.20210220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) is highly important for the detection, characterization, and follow-up of focal liver lesions. Several quantitative MRI-based methods have been proposed in addition to qualitative imaging interpretation to improve the diagnostic work-up and prognostics in patients with focal liver lesions. This includes DWI with apparent diffusion coefficient measurements, intravoxel incoherent motion, perfusion imaging, MR elastography, and radiomics. Multiple research studies have reported promising results with quantitative MRI methods in various clinical settings. Nevertheless, applications in everyday clinical practice are limited. This review describes the basic principles of quantitative MRI-based techniques and discusses the main current applications and limitations for the assessment of focal liver lesions.
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Affiliation(s)
- Roberto Cannella
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Section of Radiology - BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127 Palermo, Italy.,Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | | | - Jules Grégory
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - Lorenzo Garzelli
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - Valérie Vilgrain
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Marco Dioguardi Burgio
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,INSERM U1149, CRI, Paris, France
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5
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Cancer Detection and Quantification of Treatment Response Using Diffusion-Weighted MRI. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gregory J, Dioguardi Burgio M, Corrias G, Vilgrain V, Ronot M. Evaluation of liver tumour response by imaging. JHEP Rep 2020; 2:100100. [PMID: 32514496 PMCID: PMC7267412 DOI: 10.1016/j.jhepr.2020.100100] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
The goal of assessing tumour response on imaging is to identify patients who are likely to benefit - or not - from anticancer treatment, especially in relation to survival. The World Health Organization was the first to develop assessment criteria. This early score, which assessed tumour burden by standardising lesion size measurements, laid the groundwork for many of the criteria that followed. This was then improved by the Response Evaluation Criteria in Solid Tumours (RECIST) which was quickly adopted by the oncology community. At the same time, many interventional oncology treatments were developed to target specific features of liver tumours that result in significant changes in tumours but have little effect on tumour size. New criteria focusing on the viable part of tumours were therefore designed to provide more appropriate feedback to guide patient management. Targeted therapy has resulted in a breakthrough that challenges conventional response criteria due to the non-linear relationship between response and tumour size, requiring the development of methods that emphasize the appearance of tumours. More recently, research into functional and quantitative imaging has created new opportunities in liver imaging. These results have suggested that certain parameters could serve as early predictors of response or could predict later tumour response at baseline. These approaches have now been extended by machine learning and deep learning. This clinical review focuses on the progress made in the evaluation of liver tumours on imaging, discussing the rationale for this approach, addressing challenges and controversies in the field, and suggesting possible future developments.
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Key Words
- (c)TACE, (conventional) transarterial chemoembolisation
- (m)RECIST, (modified) Response Evaluation Criteria in Solid Tumours
- 18F-FDG, 18F-fluorodeoxyglucose
- 90Y, yttrium-90
- ADC, apparent diffusion coefficient
- APHE, arterial phase hyperenhancement
- CEUS, contrast-enhanced ultrasound
- CRLM, colorectal liver metastases
- DWI, diffusion-weighted imaging
- EASL
- EASL, European Association for the Study of the Liver criteria
- GIST, gastrointestinal stromal tumours
- HCC, hepatocellular carcinoma
- HU, Hounsfield unit
- Imaging
- LI-RADS
- LI-RADS, Liver Imaging Reporting And Data System
- Liver
- Metastases
- PD, progressive disease
- PET, positron emission tomography
- PR, partial response
- RECIST
- SD, stable disease
- SIRT, selective internal radiotherapy
- TR, treatment response
- Tumours
- WHO, World Health Organization
- mRECIST
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Affiliation(s)
- Jules Gregory
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Giuseppe Corrias
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
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Hussein RS, Tantawy W, Abbas YA. MRI assessment of hepatocellular carcinoma after locoregional therapy. Insights Imaging 2019; 10:8. [PMID: 30694398 PMCID: PMC6352610 DOI: 10.1186/s13244-019-0690-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022] Open
Abstract
Liver cirrhosis and hepatocellular carcinoma (HCC) constitute one of the major causes of morbidity, mortality, and high health care costs worldwide. Multiple treatment options are available for HCC depending on the clinical status of the patient, size and location of the tumor, and available techniques and expertise. Locoregional treatment options are multiple. The most challenging part is how to assess the treatment response by different imaging modalities, but our scope will be assessing the response to locoregional therapy for HCC by MRI. This will be addressed by conventional MR methods using LI-RADS v2018 and by functional MR using diffusion-weighted imaging, perfusion, and highlighting the value of the novel intravoxel incoherent motion (IVIM).
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Affiliation(s)
- Rasha S Hussein
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt.
| | - Wahid Tantawy
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
| | - Yasser A Abbas
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
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8
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Hepatic pseudolymphoma: imaging features on dynamic contrast-enhanced MRI and diffusion-weighted imaging. Abdom Radiol (NY) 2018; 43:2288-2294. [PMID: 29392361 DOI: 10.1007/s00261-018-1468-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate dynamic contrast-enhanced (DCE) MR findings and diffusion-weighted imaging (DWI) characteristics of hepatic pseudolymphoma. MATERIALS AND METHODS The MR data of 20 lesions in 14 patients with histopathologically proven hepatic pseudolymphoma were retrospectively analyzed. All patients underwent dynamic gadopentetate dimeglumine-enhanced MR imaging and DWI. Morphologic characteristics and signal features on T1- and T2-weighted images (T1WI, T2WI), and DCE pattern were qualitatively evaluated. The quantitative analysis was performed for the size, the degree of enhancement on arterial phase, signal intensity (SI) of DWI, and apparent diffusion coefficient (ADC) values. The Wilcoxon signed ranks test was used for statistical analysis. RESULTS The contour of all lesions was round. The lesion size was 0.7-2.8 cm (mean 1.3 ± 0.5 cm). All lesions manifested as homogeneous hypointensity on T1WI and hyperintensity on T2WI. All lesions were shown as hypervascular with various enhancement patterns on DCE MR imaging. The presence of peripheral enhancement and pseudocapsule was observed in 7 and 4 lesions, respectively. SI of the hepatic pseudolymphoma was significantly lower than that of portal vein on arterial phase (P < 0.001) and the ADC was significantly lower than that of spleen (P = 0.012). CONCLUSION A homogeneous nodule with small size (<2 cm), manifestation of hypervascular with lower SI than that of portal vein on arterial phase and lower ADC values than that of spleen are the common MR features of hepatic pseudolymphoma.
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9
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Transarterial Radioembolization Following Chemoembolization for Unresectable Hepatocellular Carcinoma: Response Based on Apparent Diffusion Coefficient Change is an Independent Predictor for Survival. Cardiovasc Intervent Radiol 2018; 41:1716-1726. [DOI: 10.1007/s00270-018-1991-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/19/2018] [Indexed: 12/22/2022]
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10
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Predicting Treatment Response of Colorectal Cancer Liver Metastases to Conventional Lipiodol-Based Transarterial Chemoembolization Using Diffusion-Weighted MR Imaging: Value of Pretreatment Apparent Diffusion Coefficients (ADC) and ADC Changes Under Therapy. Cardiovasc Intervent Radiol 2017; 40:852-859. [PMID: 28357571 DOI: 10.1007/s00270-017-1634-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/21/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To use absolute pretreatment apparent diffusion coefficients (ADC) derived from diffusion-weighted MR imaging (DWI) to predict response to repetitive cTACE for unresectable liver metastases of colorectal carcinoma (CRLM) at 1 and 3 months after start of treatment. MATERIALS AND METHODS Fifty-five metastases in 34 patients were examined with DWI prior to treatment and 1 month after initial cTACE. Treatment was performed in 4-week intervals. Response was evaluated at 1 and 3 months after start of therapy. Metastases showing a decrease of ≥30% in axial diameter were classified as responding lesions. RESULTS One month after initial cTACE, seven lesions showed early response. There was no significant difference in absolute pretreatment ADC values between responding and non-responding lesions (p = 0.94). Three months after initial cTACE, 17 metastases showed response. There was a significant difference (p = 0.021) between absolute pretreatment ADC values of lesions showing response (median 1.08 × 10-3 mm2/s) and no response (median 1.30 × 10-3 mm2/s). Pretreatment ADC showed fair diagnostic value to predict response (AUC 0.7). Lesions showing response at 3 months also revealed a significant increase in ADC between measurements before treatment and at one month after initial cTACE (p < 0.001). Applying an increase in ADC of 12.17%, response at 3 months after initial cTACE could be predicted with a sensitivity and specificity of 77 and 74%, respectively (AUC 0.817). Furthermore, there was a strong and significant correlation (r = 0.651, p < 0.001) between percentage change in size after third cTACE and percentage change in ADC. CONCLUSION In patients with CRLM, ADC measurements are potential biomarkers for assessing response to cTACE.
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Galbán CJ, Hoff BA, Chenevert TL, Ross BD. Diffusion MRI in early cancer therapeutic response assessment. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3458. [PMID: 26773848 PMCID: PMC4947029 DOI: 10.1002/nbm.3458] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 05/05/2023]
Abstract
Imaging biomarkers for the predictive assessment of treatment response in patients with cancer earlier than standard tumor volumetric metrics would provide new opportunities to individualize therapy. Diffusion-weighted MRI (DW-MRI), highly sensitive to microenvironmental alterations at the cellular level, has been evaluated extensively as a technique for the generation of quantitative and early imaging biomarkers of therapeutic response and clinical outcome. First demonstrated in a rodent tumor model, subsequent studies have shown that DW-MRI can be applied to many different solid tumors for the detection of changes in cellularity as measured indirectly by an increase in the apparent diffusion coefficient (ADC) of water molecules within the lesion. The introduction of quantitative DW-MRI into the treatment management of patients with cancer may aid physicians to individualize therapy, thereby minimizing unnecessary systemic toxicity associated with ineffective therapies, saving valuable time, reducing patient care costs and ultimately improving clinical outcome. This review covers the theoretical basis behind the application of DW-MRI to monitor therapeutic response in cancer, the analytical techniques used and the results obtained from various clinical studies that have demonstrated the efficacy of DW-MRI for the prediction of cancer treatment response. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - B. D. Ross
- Correspondence to: B. D. Ross, University of Michigan School of Medicine, Center for Molecular Imaging and Department of Radiology, Biomedical Sciences Research Building, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA.
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12
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Ye XD, Yuan Z, Zhang J, Yuan Z. Radiological biomarkers for assessing response to locoregional therapies in hepatocellular carcinoma: From morphological to functional imaging (Review). Oncol Rep 2017; 37:1337-1346. [PMID: 28184942 DOI: 10.3892/or.2017.5420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/16/2017] [Indexed: 11/05/2022] Open
Abstract
Many hepatocellular carcinoma (HCC) patients do not qualify for curative surgical intervention and are instead treated with locoregional therapies (LRTs) including ablative and endovascular therapies. Assessment of imaging response is essential in the management of HCC for determining efficacy of therapy and as a surrogate marker for improved survival. The established morphological image biomarkers for tumor burden measurement continue to be applied, as size measurement can easily be used in clinical practice. However, in the setting of liver-directed LRTs for HCC, simple tumor morphological changes can be less informative and usually appear later than biologic changes. Functional imaging (such as perfusion and diffusion imaging, PET-CT/MR and MR spectroscopy) has the potential to be a promising technique for assessment of HCC response to LRTs. Although promising, none of these functional imaging biomarkers have gone through all the required steps of standardization and validation and established accepted criteria for clinical practice.
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Affiliation(s)
- Xiao-Dan Ye
- Department of Radiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, P.R. China
| | - Zuguo Yuan
- Radiation Oncology Center, The 1st Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Jian Zhang
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Zheng Yuan
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
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13
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Diffusion weighted and dynamic contrast enhanced magnetic resonance imaging in assessment of malignant liver tumors after percutaneous radiofrequency ablation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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14
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Ronot M, Clift AK, Vilgrain V, Frilling A. Functional imaging in liver tumours. J Hepatol 2016; 65:1017-1030. [PMID: 27395013 DOI: 10.1016/j.jhep.2016.06.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 02/08/2023]
Abstract
Functional imaging encompasses techniques capable of assessing physiological parameters of tissues, and offers useful clinical information in addition to that obtained from morphological imaging. Such techniques may include magnetic resonance imaging with diffusion-weighted sequences or hepatobiliary contrast agents, perfusion imaging, or molecular imaging with radiolabelled tracers. The liver is of major importance in oncological practice; not only is hepatocellular carcinoma one of the malignancies with steadily rising incidence worldwide, but hepatic metastases are regularly observed with a range of solid neoplasms. Within the realm of hepatic oncology, different functional imaging modalities may occupy pivotal roles in lesion characterisation, treatment selection and follow-up, depending on tumour size and type. In this review, we characterise the major forms of functional imaging, discuss their current application to the management of patients with common primary and secondary liver tumours, and anticipate future developments within this field.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | | | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
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Kokabi N, Ludwig JM, Camacho JC, Xing M, Mittal PK, Kim HS. Baseline and Early MR Apparent Diffusion Coefficient Quantification as a Predictor of Response of Unresectable Hepatocellular Carcinoma to Doxorubicin Drug-Eluting Bead Chemoembolization. J Vasc Interv Radiol 2016; 26:1777-86. [PMID: 26603497 DOI: 10.1016/j.jvir.2015.08.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate baseline and early apparent diffusion coefficients (ADC) derived from diffusion-weighted imaging (DWI) as a predictor of objective response (OR) and survival in unresectable hepatocellular carcinoma (HCC) treated with doxorubicin drug-eluting bead (DEB) transcatheter arterial chemoembolization. MATERIALS AND METHODS In a prospective study, 57 patients underwent DEB chemoembolization. Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed at baseline and 1 and 3 months after DEB chemoembolization. OR was evaluated per modified Response Evaluation Criteria In Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) guidelines. Baseline ADCs of tumors that showed OR at 1 and 3 months were compared with nonresponding tumor ADCs by two-sample t test and receiver operating characteristic curves. Additionally, ADC changes at 30 days were correlated with OR. Finally, Kaplan–Meier analysis was used to compare survival between patients with lesions demonstrating more restricted baseline diffusion and others. RESULTS At 1 month, 33 patients (60%) showed OR (21 complete responses and 12 partial responses). At baseline, tumors with OR at 1 month showed significantly more restricted diffusion (0.731 × 10(−3) mm2/s) compared with others (1.057 × 10(−3) mm2/s; P = .031). No difference between response rates at 1 and 3 months according to mRECIST and EASL was observed. For an area under the curve of 0.965, the sensitivity and specificity of predicting objective tumor response at 1 month using a baseline HCC ADC of 0.83 × 10(−3) mm2/s were 91% and 96%, respectively. In addition, patients with lesions with a baseline ADC < 0.83 × 10(−3) mm2/s showed prolonged survival compared with others (P < .001). CONCLUSIONS In unresectable HCC, a baseline ADC < 0.83 × 10(−3) mm2/s is a predictor of survival and treatment response at 1 and 3 months after DEB chemoembolization with high sensitivity and specificity.
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Diffusion weighted magnetic resonance imaging in assessment of hepatocellular carcinoma after chemoembolization. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Luna A, Pahwa S, Bonini C, Alcalá-Mata L, Wright KL, Gulani V. Multiparametric MR Imaging in Abdominal Malignancies. Magn Reson Imaging Clin N Am 2016; 24:157-186. [PMID: 26613880 PMCID: PMC4974463 DOI: 10.1016/j.mric.2015.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Modern MR imaging protocols can yield both anatomic and functional information for the assessment of hepatobiliary and pancreatic malignancies. Diffusion-weighted imaging is fully integrated into state-of-the-art protocols for tumor detection, characterization, and therapy monitoring. Hepatobiliary contrast agents have gained ground in the evaluation of focal liver lesions during the last years. Perfusion MR imaging is expected to have a central role for monitoring therapy in body tumors treated with antivascular drugs. Approaches such as Magnetic resonance (MR) elastography and (1)H-MR spectroscopy are still confined to research centers, but with the potential to grow in a short time frame.
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Affiliation(s)
- Antonio Luna
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain; Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.
| | - Shivani Pahwa
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lidia Alcalá-Mata
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain
| | - Katherine L Wright
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Gulani
- Department of Radiology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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Favelier S, Estivalet L, Pottecher P, Loffroy R. Novel imaging biomarkers of response to transcatheter arterial chemoembolization in hepatocellular carcinoma patients. Chin J Cancer Res 2015; 27:611-26. [PMID: 26752936 PMCID: PMC4697100 DOI: 10.3978/j.issn.1000-9604.2015.07.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Sylvain Favelier
- Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon Cedex, France
| | - Louis Estivalet
- Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon Cedex, France
| | - Pierre Pottecher
- Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon Cedex, France
| | - Romaric Loffroy
- Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon Cedex, France
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Chemoembolization follow-up of hepatocellular carcinoma with diffusion-weighted MR imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Ludwig JM, Camacho JC, Kokabi N, Xing M, Kim HS. The Role of Diffusion-Weighted Imaging (DWI) in Locoregional Therapy Outcome Prediction and Response Assessment for Hepatocellular Carcinoma (HCC): The New Era of Functional Imaging Biomarkers. Diagnostics (Basel) 2015; 5:546-63. [PMID: 26854170 PMCID: PMC4728474 DOI: 10.3390/diagnostics5040546] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 12/12/2022] Open
Abstract
Reliable response criteria are critical for the evaluation of therapeutic response in hepatocellular carcinoma (HCC). Current response assessment is mainly based on: (1) changes in size, which is at times unreliable and lag behind the result of therapy; and (2) contrast enhancement, which can be difficult to quantify in the presence of benign post-procedural changes and in tumors presenting with a heterogeneous pattern of enhancement. Given these challenges, functional magnetic resonance imaging (MRI) techniques, such as diffusion-weighted imaging (DWI) have been recently investigated, aiding specificity to locoregional therapy response assessment and outcome prediction. Briefly, DWI quantifies diffusion of water occurring naturally at a cellular level (Brownian movement), which is restricted in multiple neoplasms because of high cellularity. Disruption of cellular integrity secondary to therapy results in increased water diffusion across the injured membranes. This review will provide an overview of the current literature on DWI therapy response assessment and outcome prediction in HCC following treatment with locoregional therapies.
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Affiliation(s)
- Johannes M Ludwig
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
| | - Juan C Camacho
- Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Nima Kokabi
- Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Minzhi Xing
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
| | - Hyun S Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
- Yale Cancer Center, Yale School of Medicine, New Haven, CT 06519, USA.
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Yuan Z, Zhang J, Yang H, Ye XD, Xu LC, Li WT. Diffusion-Weighted MR Imaging of Hepatocellular Carcinoma: Current Value in Clinical Evaluation of Tumor Response to Locoregional Treatment. J Vasc Interv Radiol 2015; 27:20-30; quiz 31. [PMID: 26621785 DOI: 10.1016/j.jvir.2015.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 02/07/2023] Open
Abstract
The established size-based image biomarkers for tumor burden measurement continue to be applied to solid tumors, as size measurement can easily be used in clinical practice. However, in the setting of novel targeted therapies and liver-directed locoregional treatments for hepatocellular carcinoma (HCC), simple tumor anatomic changes can be less informative and usually appear later than biologic changes. Functional magnetic resonance (MR) imaging has the potential to be a promising technique for assessment of HCC response to therapy. Diffusion-weighted MR imaging is now widely used as a standard imaging modality to evaluate the liver. This review discusses the current clinical value of diffusion-weighted MR imaging in the evaluation of tumor response after nonsurgical locoregional treatment of HCC.
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Affiliation(s)
- Zheng Yuan
- Department of Radiology, Shanghai 85 Hospital; Department of Interventional Radiology, Shanghai Cancer Hospital, Fudan University.
| | - Jian Zhang
- Department of Nuclear Medicine, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Huan Yang
- Department of Interventional Radiology, Shanghai Cancer Hospital, Fudan University
| | - Xiao-Dan Ye
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Li-Chao Xu
- Department of Interventional Radiology, Shanghai Cancer Hospital, Fudan University
| | - Wen-Tao Li
- Department of Interventional Radiology, Shanghai Cancer Hospital, Fudan University
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Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2015; 38:1548-56. [PMID: 26001366 DOI: 10.1007/s00270-015-1129-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/26/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate whether intraprocedural 3D quantification of Lipiodol deposition on cone-beam computed tomography (CBCT) can predict tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). MATERIALS AND METHODS This IRB approved, retrospective analysis included 36 patients with 51 HCC target lesions, who underwent cTACE with CBCT. CE-MRI was acquired at baseline and 1 month after cTACE. Overall tumor volumes as well as intratumoral Lipiodol volumes on CBCT were measured and compared with the overall and necrotic (non-enhancing) tumor volumes on CE-MRI using the paired student's t test. Tumor response on CE-MRI was assessed using modified response evaluation criteria in solid tumors (mRECIST). A linear regression model was used to correlate tumor volumes, Lipiodol volumes, and the percentage of Lipiodol deposition on CBCT with the corresponding parameters on CE-MRI. Nonparametric spearman rank-order correlation and trend test were used to correlate the percentage of Lipiodol deposition in the tumor with tumor response. RESULT A strong correlation between overall tumor volumes on CBCT and CE-MRI was observed (R(2) = 0.986). In addition, a strong correlation was obtained between the volume of Lipiodol deposition on CBCT and tumor necrosis (in cm(3)) on CE-MRI (R(2) = 0.960), and between the percentage of Lipiodol deposition and tumor necrosis (R(2) = 0.979). Importantly, the extent of Lipiodol deposition (in percentage of total tumor volume) correlated strongly with tumor response on CE-MRI (Spearman rho = 0.84, p < 0.001). CONCLUSIONS Intraprocedural 3D quantification of Lipiodol deposition on CBCT can be used to predict tumor response on follow-up CE-MRI.
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Wang Z, Qu K, Huang Z, Xu X, Zhang J, Zhang L, Liu S, Chang H, Lin T, Liu Y, Niu W, Liu C. Glutathione S-transferase O2 gene rs157077 polymorphism predicts response to transarterial chemoembolization in hepatocellular carcinoma. Tumour Biol 2015; 36:6463-9. [DOI: 10.1007/s13277-015-3336-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/12/2015] [Indexed: 12/21/2022] Open
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Kokabi N, Camacho JC, Xing M, Edalat F, Mittal PK, Kim HS. Immediate post-doxorubicin drug-eluting beads chemoembolization Mr Apparent diffusion coefficient quantification predicts response in unresectable hepatocellular carcinoma: A pilot study. J Magn Reson Imaging 2015; 42:981-9. [PMID: 25683022 DOI: 10.1002/jmri.24845] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/18/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To investigate magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) of hepatocellular carcinoma (HCC) immediately post-doxorubicin drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) therapy as an early imaging biomarker of therapy response. MATERIALS AND METHODS In a single-center prospective correlative study, 12 consecutive patients, median age 64 years, underwent DEB-TACE and dynamic contrast-enhanced (DCE) and DWI (b = 50,400,800 s/mm(2)) MRI at baseline with respect to first DEB-TACE, within 3 hours, and at 1 and 3 months posttherapy. DCE imaging response was evaluated according to target mRECIST and EASL. Relative change (RC) in apparent diffusion coefficient (ADC) of treated lesions was measured on follow-ups. Correlation between ADC RC in tumors and anatomical response were evaluated with paired t-test and receiver operator characteristic (ROC) curve. Survival from first DEB-TACE was estimated using Kaplan-Meier and log-rank analysis. RESULTS Compared to baseline, mean ADC increased significantly for responders within 3 hours post-DEB-TACE (0.73 ± 0.20 mm(2) /s vs. 0.99 ± 0.28 mm(2) /s × 10(-3) (P = 0.001)). There was no significant change in ADC within 3 hours for nonresponders. ADC RC threshold of 20% immediately post-DEB-TACE showed 100% sensitivity and specificity in predicting anatomical response at 1 and 3 months with patients with ≥20% ADC increase demonstrated significantly prolonged mean overall survival compared to others (25.4 vs. 13.3 months (P = 0.017)). CONCLUSION ADC relative change of ≥20% immediately post-DEB-TACE is an accurate predictor of objective and quantitative treatment response and prolonged survival in unresectable HCC.
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Affiliation(s)
- Nima Kokabi
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Juan C Camacho
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Abdominal Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Minzhi Xing
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Faramarz Edalat
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pardeep K Mittal
- Division of Abdominal Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hyun S Kim
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Magnetic resonance-imaging of the effect of targeted antiangiogenic gene delivery in a melanoma tumour model. Eur Radiol 2014; 25:1107-18. [PMID: 25432291 DOI: 10.1007/s00330-014-3492-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 10/24/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We investigated the effect of targeted gene therapy to melanoma tumours (M21) by MR-imaging. METHODS M21 and M21-L tumours were grown to a size of 850 mm(3). M21 and M21-L tumours were intravenously treated with an αvβ3-integrin-ligand-coupled nanoparticle (RGDNP)/RAF(-) complex five times every 72 hours. MRI was performed at set time intervals 24h and 72h after the i.v. injection of the complex. The MRI protocol was T1-wt-SE±CM, T2-wt-FSE, DCE-MRI, Diffusion-wt-STEAM-sequence, T2-time obtained on a 1.5-T-GE-MRI device. RESULTS The size of the treated M21 tumours kept nearly constant during the treatment phase (847.8±31.4 mm(3) versus 904.8±44.4 mm(3)). The SNR value (T2-weighted images) of the tumours was 36.7±0.6 and dropped down to 30.6±1.9 (p=0.004). At the beginning the SNR value (T1-weighted images) of the tumours after contrast medium application was 42.3±1.9 and dropped down to 28.5±3.0 (p<0.001). In the treatment group the diffusion coefficient increased significantly under therapy (0.54±0.01x10(-3) mm(2)/s versus 0.67±0.04x10(-3) mm(2)/s). The DCE-MRI showed a reduction of the slope and of the Akep of 67.8±4.3 % respectively 64.8±3.3 % compared to baseline. CONCLUSIONS Targeted gene delivery therapy induces significant changes in MR-imaging. MRI showed a significant reduction of contrast medium uptake parameters and increase of the diffusion coefficient of the tumours. KEY POINT • Treatment with targeted gene-delivery therapy can be monitored by MR imaging • DCE and diffusion-weighted imaging are appropriate methods for monitoring this therapy • Functional changes are significant prior to any morphological changes.
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Abstract
In this article, functional magnetic resonance (MR) imaging techniques in the abdomen are discussed. Diffusion-weighted imaging (DWI) increases the confidence in detecting and characterizing focal hepatic lesions. The potential uses of DWI in kidneys, adrenal glands, bowel, and pancreas are outlined. Studies have shown potential use of quantitative dynamic contrast-enhanced MR imaging parameters, such as K(trans), in predicting outcomes in cancer therapy. MR elastography is considered to be a useful tool in staging liver fibrosis. A major issue with all functional MR imaging techniques is the lack of standardization of the protocol.
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Affiliation(s)
- Kumar Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202, USA.
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Abstract
Liver-directed intra-arterial therapies are palliative treatment options for patients with unresectable liver cancer; their use has also resulted in patients being downstaged leading to curative resection and transplantation. These intra-arterial therapies include transarterial embolization, conventional transarterial chemoembolization (TACE), drug-eluting bead TACE and radioembolization. Assessment of imaging response following these liver-directed intra-arterial therapies is challenging but pivotal for patient management. Size measurements based on computed tomography or magnetic resonance imaging (MRI) have been traditionally used to assess tumor response to therapy. However, these anatomic changes lag behind functional changes and may require months to occur. Further, these intra-arterial therapies cause acute tumor necrosis, which may result in a paradoxical increase in tumor size on early follow-up imaging despite complete cell death or necrosis. This concept is unique comparing to changes seen following systemic chemotherapy. The recent development of functional imaging techniques including diffusion-weighted MRI (DW MRI) and positron emission tomography (PET) allow for early assessment of treatment response and even prediction of overall tumor response to intra-arterial therapies. Although the results of DW MRI and PET studies are promising, the impact of these imaging modalities to assess treatment response has been limited without standardized protocols. The aim of this review article is to delineate the best practice for assessing tumor response in patients with primary or secondary hepatic malignancies undergoing intra-arterial therapies.
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Functional Volumetric MRI in Assessing Treatment Response to Intra-Arterial Therapy of Primary and Secondary Liver Tumors. J Comput Assist Tomogr 2014; 38:513-7. [DOI: 10.1097/rct.0000000000000072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Loffroy R, Favelier S, Cherblanc V, Estivalet L. C-arm dual-phase cone-beam CT: a revolutionary real-time imaging modality to assess drug-eluting beads TACE success in liver cancer patients. Quant Imaging Med Surg 2013; 3:196-9. [PMID: 24040615 DOI: 10.3978/j.issn.2223-4292.2013.08.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/27/2013] [Indexed: 11/14/2022]
Abstract
The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensions (3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transcatheter arterial chemoembolization (TACE) treatment of liver cancer especially with the recent introduction of dual-phase CBCT (DP-CBCT) for unresectable hepatocellular carcinoma (HCC) treatment. Loffroy and colleagues proposed the use of intraprocedural C-arm DP-CBCT immediately after TACE with doxorubicin-eluting beads to predict HCC tumor response at 1-month magnetic resonance (MR) imaging follow-up. They reported a significant relationship between tumor enhancement seen at DP-CBCT after TACE and objective MR imaging response at 1-month follow-up, suggesting that DP-CBCT can be used to predict tumor response after TACE. If confirmed in larger studies, this imaging modality may play a key role in the improvement of treatment planning, especially with regard to the need for repeat treatment. More important, a potential clinical implication of using intraprocedural DP-CBCT in these patients might be elimination of 1-month follow-up MR imaging.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular, Oncologic and Interventional Radiology, Le2i, UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon Cedex, France
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Role of C-Arm CT for Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma: Diagnostic Performance and Predictive Value for Therapeutic Response Compared With Gadoxetic Acid–Enhanced MRI. AJR Am J Roentgenol 2013; 201:675-83. [DOI: 10.2214/ajr.12.10445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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31
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Sahani DV, Jiang T, Hayano K, Duda DG, Catalano OA, Ancukiewicz M, Jain RK, Zhu AX. Magnetic resonance imaging biomarkers in hepatocellular carcinoma: association with response and circulating biomarkers after sunitinib therapy. J Hematol Oncol 2013; 6:51. [PMID: 23842041 PMCID: PMC3722053 DOI: 10.1186/1756-8722-6-51] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/26/2013] [Indexed: 12/18/2022] Open
Abstract
Background To investigate the hypothesis that MRI derived diffusion-weighted imaging (DWI) and perfusion (MRP) parameters are sensitive image biomarkers for monitoring early antiangiogenic effects and predicting progression free survival (PFS) in advanced hepatocellular carcinoma (HCC). Methods In this phase II clinical trial, 23 of 34 patients were included in the imaging and circulating biomarker study. DWI and MRP were performed at the baseline and at 2-weeks after initiation of sunitinib. The imaging protocol included an axial DWI sequence using b values of 50, 400 and 800 sec/mm2, and MRP using a series of coronal 3D-VIBE following 20 ml of Gd-DTPA at 2 ml/sec. These parameters were compared with clinical outcome and PFS at 6-months. Correlation between changes in MRI parameters and plasma biomarkers was also evaluated. Results After 2-week of sunitinib, substantial Ktrans changes in HCC were observed from median baseline value 2.15 min−1 to 0.94 min−1 (P = 0.0001) with increases in median apparent diffusion coefficient (ADC) from 0.88 × 10-3 mm2/s to 0.98 × 10-3 mm2/s (P = 0.0001). Tumor size remained unchanged by RECIST and mRECIST (both P > 0.05). Patients who showed larger drop in Ktrans and Kep at 2 weeks correlated with favorable clinical outcome, and higher baseline Ktrans and larger drop in EVF correlated with longer PFS (all P < 0.05). There was a significant association between a decrease in sVEGFR2 and the drop in Ktrans and Kep (P = 0.044, P = 0.030), and a significant and borderline association between decrease in TNF-α and the drop in Ktrans and Kep, respectively (P = 0.051, P = 0.035). Conclusion In HCC, MRP may be a more sensitive biomarker in predicting early response and PFS following sunitinib than RECIST and mRECIST. Trial registration ClinicalTrials.gov: NCT00361309
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Affiliation(s)
- Dushyant V Sahani
- Division of Abdominal Imaging and Intervention, Harvard Medical School and Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
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Bonekamp S, Halappa VG, Geschwind JFH, Li Z, Corona-Villalobos CP, Reyes D, Bhagat N, Cosgrove DP, Pawlik TM, Mezey E, Eng J, Kamel IR. Unresectable hepatocellular carcinoma: MR imaging after intraarterial therapy. Part II. Response stratification using volumetric functional criteria after intraarterial therapy. Radiology 2013; 268:431-9. [PMID: 23616632 DOI: 10.1148/radiol.13121637] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess whether volumetric functional magnetic resonance (MR) results 3-4 weeks after initial intraarterial therapy can aid accurate distinction between responders and nonresponders, to determine whether overall survival (OS) is improved, and to compare volumetric functional MR response with anatomic response criteria (Response Evaluation Criteria in Solid Tumors [RECIST], modified RECIST [mRECIST], European Association for the Study of the Liver [EASL]), as well as α1-fetoprotein [AFP] level. MATERIALS AND METHODS In this single-institution HIPAA-compliant retrospective, institutional review board-approved study, informed consent was waived; 143 patients with hepatocellular carcinoma underwent intraarterial therapy between October 2005 and February 2011. Volumetric functional MR response (25% or more increase in apparent diffusion coefficient, 65% or more decrease in enhancement) was stratified as follows: Dual-parameter responders fulfilled both criteria, single-parameter responders fulfilled one criterion, and those with stable disease (SD) fulfilled neither. RECIST, mRECIST, EASL, and AFP response criteria were determined. Kaplan-Meier technique, log-rank tests, and the Cox proportional hazards model were used to test whether OS was different per response. RESULTS OS differed significantly between single-parameter responders and dual-parameter responders (P = .01) and between single-parameter responders and those with SD (P = .001). Dual-parameter responders' response improved OS compared with single-parameter responders; risk of death decreased (hazard ratio [HR] = 0.28, P = .01). In those with SD compared with single-parameter responders, risk of death increased (HR = 2.09, P = .001). RECIST, mRECIST, and EASL stratification was short of significant; most lesions were classified as SD. Baseline AFP level increased in 55 patients; AFP responders versus AFP nonresponders had decreased risk of death (HR = 0.36, P = .002). Agreement between anatomic response criteria and volumetric functional MR findings (κ = 0.06-0.12) and between AFP response and imaging criteria (κ = -0.04 to 0.14) was low. CONCLUSION Volumetric functional MR response 3-4 weeks after initial intraarterial therapy showed improved OS. Volumetric functional MR was superior to current imaging (RECIST, mRECIST, and EASL) and biochemical (AFP level) response criteria.
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Affiliation(s)
- Susanne Bonekamp
- Department of Radiology, Johns Hopkins School of Medicine, the Johns Hopkins Hospital, 600 N Wolfe St, MRI 143, Baltimore, MD 21287, USA
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Steiner K, Papadopoulou A, Yu D. The role of interventional radiology in the treatment of hepatocellular carcinoma. Semin Ultrasound CT MR 2013; 34:89-101. [PMID: 23395321 DOI: 10.1053/j.sult.2012.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The incidence of hepatocellular carcinoma (HCC) in the UK is increasing. The role of interventional radiology in the treatment of HCC is well established. We discuss the minimally invasive treatment options that are available. It is important that procedures are undertaken in and postprocedure imaging is reviewed by centers with accredited hepatobiliary units. This is when the best outcomes are achieved. Advances in tumor biology and in technology will continue to expand the role of interventional radiology in the treatment of HCC in the future.
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Affiliation(s)
- Kate Steiner
- Department of Radiology, The Royal Free Hospital, Pond St, London NW3 2QG, UK.
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Loffroy R, Lin M, Yenokyan G, Rao PP, Bhagat N, Noordhoek N, Radaelli A, Blijd J, Liapi E, Geschwind JF. Intraprocedural C-arm dual-phase cone-beam CT: can it be used to predict short-term response to TACE with drug-eluting beads in patients with hepatocellular carcinoma? Radiology 2012; 266:636-48. [PMID: 23143027 DOI: 10.1148/radiol.12112316] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate whether C-arm dual-phase cone-beam computed tomography (CT) performed during transcatheter arterial chemoembolization (TACE) with doxorubicin-eluting beads can help predict tumor response at 1-month follow-up in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS This prospective study was compliant with HIPAA and approved by the institutional review board and animal care and use committee. Analysis was performed retrospectively on 50 targeted HCC lesions in 29 patients (16 men, 13 women; mean age, 61.9 years ± 10.7) treated with TACE with drug-eluting beads. Magnetic resonance (MR) imaging was performed at baseline and 1 month after TACE. Dual-phase cone-beam CT was performed before and after TACE. Tumor enhancement at dual-phase cone-beam CT in early arterial and delayed venous phases was assessed retrospectively with blinding to MR findings. Tumor response at MR imaging was assessed according to European Association for the Study of the Liver (EASL) guidelines. Two patients were excluded from analysis because dual-phase cone-beam CT scans were not interpretable. Logistic regression models for correlated data were used to compare changes in tumor enhancement between modalities. The radiation dose with dual-phase cone-beam CT was measured in one pig. RESULTS At 1-month MR imaging follow-up, complete and/or partial tumor response was seen in 74% and 76% of lesions in the arterial and venous phases, respectively. Paired t tests used to compare images obtained before and after TACE showed a significant reduction in tumor enhancement with both modalities (P < .0001). The decrease in tumor enhancement seen with dual-phase cone-beam CT after TACE showed a linear correlation with MR findings. Estimated correlation coefficients were excellent for first (R = 0.89) and second (R = 0.82) phases. A significant relationship between tumor enhancement at cone-beam CT after TACE and complete and/or partial tumor response at MR imaging was found for arterial (odds ratio, 0.95; 95% confidence interval [CI]: 0.91, 0.99; P = .023) and venous (odds ratio, 0.96; 95% CI: 0.93, 0.99; P = .035) phases with the multivariate logistic regression model. Radiation dose for two dual-phase cone-beam CT scans was 3.08 mSv. CONCLUSION Intraprocedural C-arm dual-phase cone-beam CT can be used immediately after TACE with doxorubicin-eluting beads to predict HCC tumor response at 1-month MR imaging follow-up.
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Affiliation(s)
- Romaric Loffroy
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287, USA
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Fidelman N, Qayyum A. Pretransplant prediction of microvascular invasion in patients with hepatocellular carcinoma: added value of diffusion-weighted magnetic resonance imaging. Liver Transpl 2012; 18:1131-3. [PMID: 22899661 DOI: 10.1002/lt.23536] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Hundt W, Steinbach S, O'Connell-Rodwell CE, Mayer D, Burbelko M, Guccione S. In vivo monitoring of antiangiogenic therapy by magnetic resonance and bioluminescence imaging in an M21 tumor model through activation of an hsp70 promoter-luciferase reporter construct. CONTRAST MEDIA & MOLECULAR IMAGING 2012; 7:450-9. [PMID: 22821879 DOI: 10.1002/cmmi.1472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We have investigated the effect of targeted gene therapy on the melanoma cell line M21, using a combination of bioluminescence imaging (BLI) and magnetic resonance imaging (MRI). M21 cells transfected with a plasmid containing either an hsp70 (Hspa1b) or a CMV promoter fragment, along with the luciferase reporter gene, were grown to a tumor size of 900 mm(3) . Five mice in each group were intravenously treated every 72 h with a complex consisting of a nanoparticle, an Arg-Gly-Asp-peptide, and a dominant negative mutant protein kinase inhibitor gene. BLI and MRI were performed at specific time intervals. The MRI scan protocol included T(1) -weighted-spin-echo ± contrast medium, T(2) -weighted-fast-spin-echo, dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted-stimulated-echo-acquisition-mode-sequence. The T(2) times were obtained using a 1.5 T GE MRI scanner. The size of the treated M21 tumors remained almost constant during the treatment phase (837.8 ± 133.4 vs 914.8 ± 134.4 mm(3) ). BLI showed that, if transcription was controlled by the CMV promoter, the luciferase activity decreased to 51.1 ± 8.3%. After transcription was controlled by the hsp70 promoter, the highest luciferase activity (4.4 ± 0.3 fold) was seen after 24 h. The signal-to-noise ratio (SNR; T(2) -weighted images) of the tumors was 36.7 ± 0.6 and subsequently dropped to 31.2 ± 4.4 (p=0.004). DCE-MRI showed a reduction of the slope and the Ak(ep) of 67.8% ± 4.3 and 64.8% ± 3.3%, respectively, compared with the baseline. The SNR value (T(1) -weighted images) of the tumors was 42.3 ± 1.9 immediately following contrast medium application and subsequently dropped to 28.5 ± 3.0 (p<0.001). In the treatment group, the diffusion coefficient increased significantly under therapy (0.66 ± 0.05 vs the pretreatment value of 0.54 ± 0.009 p<0.01). Thus, we observed that targeted antiangiogenic therapy can induce activation of the hsp70 promoter through a heat shock/luciferase reporter system. Moreover, MRI showed a significant reduction of the contrast medium uptake parameters and an increase in the diffusion coefficient of the tumors.
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Affiliation(s)
- Walter Hundt
- Department of Radiology, Lucas MRS Research Center, Stanford School of Medicine, Stanford, CA 94305, USA.
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Chen J, Sheng J, Xing W, Aoun H, Chen M, Bi HL, Tian JM, Dai YM. Monitoring early response of lymph node metastases to radiotherapy in animal models: diffusion-weighted imaging vs. morphological MR imaging. Acta Radiol 2011; 52:989-94. [PMID: 22006987 DOI: 10.1258/ar.2011.110254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) offers a non-invasive technique that can reveal microscopic details about the architecture of both normal and anomalous tissues. Some studies have confirmed DWI can detect the early changes of tumors that have originated from various organs, even after treatment. PURPOSE To compare the usefulness of apparent diffusion coefficient (ADC) and morphologic magnetic resonance (MR) imaging for monitoring the therapeutic response of metastatic disease in lymph nodes to radiotherapy. MATERIAL AND METHODS Twenty-six rabbits (metastatic, n = 17; non-metastatic, n = 9) were divided into group A (metastatic, n = 10), group B (metastatic, n = 7) and group C (non-metastatic, n = 9). Groups A and C underwent irradiation, whereas group B was set as a reference. Standard MR imaging and DWI were performed before and 1, 3, and 7 days after radiotherapy for all rabbits. The lymph node volumes and ADCs were measured and evaluated with repeated measures ANOVA. The difference between group A and B was analyzed using Student's t-test. RESULTS In all rabbits, a total of 35 lymph nodes were found, including 16 nodes in group A, 10 in group B and nine in group C. In group A, 3 and 7 days after therapy ADCs were significantly higher than pre-treatment and 1 day after therapy (P < 0.05). For groups A and B, a significant difference of ADCs was present 7 days after therapy. A significant difference of variation of ADCs among the three groups was also present (P < 0.001). CONCLUSION DWI is superior to morphological MRI in monitoring early radiation response in animal models.
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Affiliation(s)
- Jie Chen
- Department of Radiology, Third Affiliated Hospital of SooChow University, Changzhou First Hospital, Jiangsu Province, Changzhou, China
| | - Jing Sheng
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of SooChow University, Changzhou First Hospital, Jiangsu Province, Changzhou, China
| | | | - Ming Chen
- Department of Radiology, Third Affiliated Hospital of SooChow University, Changzhou First Hospital, Jiangsu Province, Changzhou, China
| | - Heng-Liang Bi
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian-Ming Tian
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Chiaradia M, Baranes L, Pigneur F, Djabbari M, Zegai B, Brugières P, Zerbib P, Decaens T, Deux JF, Kobeiter H, Rahmouni A, Luciani A. Liver magnetic resonance diffusion weighted imaging: 2011 update. Clin Res Hepatol Gastroenterol 2011; 35:539-48. [PMID: 21700529 DOI: 10.1016/j.clinre.2011.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 02/04/2023]
Abstract
Diffusion-Weighted-Imaging (DWI) assesses proton motion on a cellular scale. Owing to recent instrumentation developments, diffusion sequences are now routinely used for liver imaging. This review will go through the physical principles that underlie this technique, and then highlight up-to-date liver applications including quantification of liver fibrosis, focal lesions detection and characterization, and therapy response monitoring.
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Affiliation(s)
- Mélanie Chiaradia
- Imagerie medicale, AP-HP, groupe Henri-Mondor Albert-Chenevier, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Creteil, France
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Intraprocedural transcatheter intra-arterial perfusion MRI as a predictor of tumor response to chemoembolization for hepatocellular carcinoma. Acad Radiol 2011; 18:828-36. [PMID: 21669349 DOI: 10.1016/j.acra.2011.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES To prospectively test the hypothesis that transcatheter intraarterial perfusion magnetic resonance imaging (TRIP-MRI) measured semiquantitative perfusion reductions during transcatheter arterial chemoembolization of hepatocellular carcinoma (HCC) are associated with tumor response. MATERIALS AND METHODS Twenty-eight patients (mean age 63 years; range 47-87 years) with 29 tumors underwent chemoembolization in a combined magnetic resonance interventional radiology suite. Intraprocedural tumor perfusion reductions during chemoembolization were monitored using TRIP-MRI. Pre- and postchemoembolization semiquantitative area under the time-signal enhancement curve (AUC) tumor perfusion was measured. Mean tumor perfusion pre- and postchemoembolization were compared using a paired t-test. Imaging follow-up was performed 1-3 months after chemoembolization. We studied the relationship between short-term tumor imaging response and intraprocedural perfusion reductions using univariate and multivariate analysis. RESULTS Intraprocedural AUC perfusion value decreased significantly after chemoembolization (342.1 vs. 158.6 arbitrary unit, P < .001). Twenty-six patients with 27 HCCs (n = 27) had follow-up imaging at mean 39 days postchemoembolization. Favorable response was present in 67% of these treated tumors according to necrosis criteria. Fifteen of 16 (94%) tumors with 25%-75% perfusion reductions showed necrosis treatment response compared to only 3 of 11 (27%) tumors with perfusion reductions outside the above range (P = .001). Multivariate logistic regression indicated that intraprocedural tumor perfusion reduction and Child-Pugh class were independent factors associated significantly with tumor response (P = .012 and .047, respectively). CONCLUSION TRIP-MRI can successfully measure semiquantitative changes in HCC perfusion during chemoembolization. Intraprocedural tumor perfusion reductions are associated with future tumor response.
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Delumeau S, Lebigot J, Ridereau-Zins C, Bouvier A, Boursier J, Aubé C. Aspects et évaluation post-thérapeutiques des lésions du foie après traitement non chirurgical. ACTA ACUST UNITED AC 2011; 92:632-58. [DOI: 10.1016/j.jradio.2011.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 01/04/2011] [Accepted: 04/15/2011] [Indexed: 12/31/2022]
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Edeline J, Boucher E, Rolland Y, Vauléon E, Pracht M, Perrin C, Le Roux C, Raoul JL. Comparison of tumor response by Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST in patients treated with sorafenib for hepatocellular carcinoma. Cancer 2011; 118:147-56. [DOI: 10.1002/cncr.26255] [Citation(s) in RCA: 228] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/11/2011] [Accepted: 04/19/2011] [Indexed: 12/17/2022]
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