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Wang Q, Yu G, Qiu J, Lu W. Application of Intravoxel Incoherent Motion in Clinical Liver Imaging: A Literature Review. J Magn Reson Imaging 2024; 60:417-440. [PMID: 37908165 DOI: 10.1002/jmri.29086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Abstract
Intravoxel incoherent motion (IVIM) modeling is a widely used double-exponential model for describing diffusion-weighted imaging (DWI) signal, with a slow component related to pure molecular diffusion and a fast component associated with microcirculatory perfusion, which compensates for the limitations of traditional DWI. IVIM is a noninvasive technique for obtaining liver pathological information and characterizing liver lesions, and has potential applications in the initial diagnosis and treatment monitoring of liver diseases. Recent studies have demonstrated that IVIM-derived parameters are useful for evaluating liver lesions, including nonalcoholic fatty liver disease (NAFLD), liver fibrosis and liver tumors. However, the results are not stable. Therefore, it is necessary to summarize the current applications of IVIM in liver disease research, identify existing shortcomings, and point out the future development direction. In this review, we searched for studies related to hepatic IVIM-DWI applications over the past two decades in the PubMed database. We first introduce the fundamental principles and influential factors of IVIM, and then discuss its application in NAFLD, liver fibrosis, and focal hepatic lesions. It has been found that IVIM is still unstable in ensuring the robustness and reproducibility of measurements in the assessment of liver fibrosis grade and liver tumors differentiation, due to inconsistent and substantial overlap in the range of IVIM-derived parameters for different fibrotic stages. In the end, the future direction of IVIM-DWI in the assessment of liver diseases is discussed, emphasizing the need for further research on the stability of IVIM-derived parameters, particularly perfusion-related parameters, in order to promote the clinical practice of IVIM-DWI. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Qi Wang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Guanghui Yu
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Weizhao Lu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
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McDonald BA, Dal Bello R, Fuller CD, Balermpas P. The Use of MR-Guided Radiation Therapy for Head and Neck Cancer and Recommended Reporting Guidance. Semin Radiat Oncol 2024; 34:69-83. [PMID: 38105096 PMCID: PMC11372437 DOI: 10.1016/j.semradonc.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Although magnetic resonance imaging (MRI) has become standard diagnostic workup for head and neck malignancies and is currently recommended by most radiological societies for pharyngeal and oral carcinomas, its utilization in radiotherapy has been heterogeneous during the last decades. However, few would argue that implementing MRI for annotation of target volumes and organs at risk provides several advantages, so that implementation of the modality for this purpose is widely accepted. Today, the term MR-guidance has received a much broader meaning, including MRI for adaptive treatments, MR-gating and tracking during radiotherapy application, MR-features as biomarkers and finally MR-only workflows. First studies on treatment of head and neck cancer on commercially available dedicated hybrid-platforms (MR-linacs), with distinct common features but also differences amongst them, have also been recently reported, as well as "biological adaptation" based on evaluation of early treatment response via functional MRI-sequences such as diffusion weighted ones. Yet, all of these approaches towards head and neck treatment remain at their infancy, especially when compared to other radiotherapy indications. Moreover, the lack of standardization for reporting MR-guided radiotherapy is a major obstacle both to further progress in the field and to conduct and compare clinical trials. Goals of this article is to present and explain all different aspects of MR-guidance for radiotherapy of head and neck cancer, summarize evidence, as well as possible advantages and challenges of the method and finally provide a comprehensive reporting guidance for use in clinical routine and trials.
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Affiliation(s)
- Brigid A McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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Li T, Wang J, Yang Y, Glide-Hurst CK, Wen N, Cai J. Multi-parametric MRI for radiotherapy simulation. Med Phys 2023; 50:5273-5293. [PMID: 36710376 PMCID: PMC10382603 DOI: 10.1002/mp.16256] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 09/10/2022] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) has become an important imaging modality in the field of radiotherapy (RT) in the past decade, especially with the development of various novel MRI and image-guidance techniques. In this review article, we will describe recent developments and discuss the applications of multi-parametric MRI (mpMRI) in RT simulation. In this review, mpMRI refers to a general and loose definition which includes various multi-contrast MRI techniques. Specifically, we will focus on the implementation, challenges, and future directions of mpMRI techniques for RT simulation.
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Affiliation(s)
- Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jihong Wang
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingli Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Carri K Glide-Hurst
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Ning Wen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- The Global Institute of Future Technology, Shanghai Jiaotong University, Shanghai, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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Mohamed ASR, Abusaif A, He R, Wahid KA, Salama V, Youssef S, McDonald BA, Naser M, Ding Y, Salzillo TC, AboBakr MA, Wang J, Lai SY, Fuller CD. Prospective validation of diffusion-weighted MRI as a biomarker of tumor response and oncologic outcomes in head and neck cancer: Results from an observational biomarker pre-qualification study. Radiother Oncol 2023; 183:109641. [PMID: 36990394 PMCID: PMC10848569 DOI: 10.1016/j.radonc.2023.109641] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To determine DWI parameters associated with tumor response and oncologic outcomes in head and neck (HNC) patients treated with radiotherapy (RT). METHODS HNC patients in a prospective study were included. Patients had MRIs pre-, mid-, and post-RT completion. We used T2-weighted sequences for tumor segmentation which were co-registered to respective DWIs for extraction of apparent diffusion coefficient (ADC) measurements. Treatment response was assessed at mid- and post-RT and was defined as: complete response (CR) vs. non-complete response (non-CR). The Mann-Whitney U test was used to compare ADC between CR and non-CR. Recursive partitioning analysis (RPA) was performed to identify ADC threshold associated with relapse. Cox proportional hazards models were done for clinical vs. clinical and imaging parameters and internal validation was done using bootstrapping technique. RESULTS Eighty-one patients were included. Median follow-up was 31 months. For patients with post-RT CR, there was a significant increase in mean ADC at mid-RT compared to baseline ((1.8 ± 0.29) × 10-3 mm2/s vs. (1.37 ± 0.22) × 10-3 mm2/s, p < 0.0001), while patients with non-CR had no significant increase (p > 0.05). RPA identified GTV-P delta (Δ)ADCmean < 7% at mid-RT as the most significant parameter associated with worse LC and RFS (p = 0.01). Uni- and multi-variable analysis showed that GTV-P ΔADCmean at mid-RT ≥ 7% was significantly associated with better LC and RFS. The addition of ΔADCmean significantly improved the c-indices of LC and RFS models compared with standard clinical variables (0.85 vs. 0.77 and 0.74 vs. 0.68 for LC and RFS, respectively, p < 0.0001 for both). CONCLUSION ΔADCmean at mid-RT is a strong predictor of oncologic outcomes in HNC. Patients with no significant increase of primary tumor ADC at mid-RT are at high risk of disease relapse.
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Affiliation(s)
- Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Abdelrahman Abusaif
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Vivian Salama
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Sara Youssef
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Brigid A McDonald
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Mohamed Naser
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Ding
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Travis C Salzillo
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Moamen A AboBakr
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Wang
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
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Zhang Y, Liu L, Zhang K, Su R, Jia H, Qian L, Dong J. Nomograms Combining Clinical and Imaging Parameters to Predict Recurrence and Disease-free Survival After Concurrent Chemoradiotherapy in Patients With Locally Advanced Cervical Cancer. Acad Radiol 2023; 30:499-508. [PMID: 36050264 DOI: 10.1016/j.acra.2022.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/27/2023]
Abstract
PURPOSES To investigate the value of nomograms based on clinical prognostic factors (CPF), intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and MRI-derived radiomics in predicting recurrence and disease-free survival (DFS) after concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). METHODS Retrospective analysis of data from 115 patients with ⅠB-ⅣA cervical cancer who underwent CCRT and had been followed up consistently. All patients were randomized 2:1 into training and validation groups. Pre-treatment IVIM-DWI parameters (ADC-value, D-value, D*-value and f-value) and pre- and post-treatment three-dimensional radiomics parameters (from axial T2WI) of primary lesions were measured. The LASSO algorithm and Logistic regression analysis were used to filter texture features and calculate radiomics score (Rad-score). Multivariate Logistic and Cox regression analysis was used to construct nomograms to predict recurrence and DFS for patients with LACC after CCRT respectively, with internal and external validation. RESULTS External beam radiotherapy dose, f-value, pre-treatment and post-treatment Rad-score were independent prognostic factors for recurrence and DFS in patients with cervical cancer, forming Model1 and Model2, with OR values of 0.480, 1.318, 3.071, 3.200 and HR values of 0.322, 3.372, 5.138, 7.204. The area under the curve (AUC) of Model1 for predicting recurrence of cervical cancer was 0.977, with internal and external validation C-indexes of 0.977 and 0.962. The AUC for Model2 predicting disease-free survival (DFS) at 1, 3, and 5 years was 0.895, 0.888 and 0.916 respectively, with internal and external C-indexes of 0.860 and 0.892. The decision curves analysis and clinical impact curves further indicate the high predictive efficiency and stability of nomograms. CONCLUSION The nomograms based on clinical, IVIM-DWI and radiomics parameters have high clinical value in predicting recurrence and DFS of patients with LACC after CCRT and can provide a reference for prognostic assessment and individualized treatment of cervical cancer patients.
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Affiliation(s)
- Yu Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
| | - Long Liu
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang University, Taizhou, Zhejiang, China
| | - Kaiyue Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
| | - Rixin Su
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
| | - Haodong Jia
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China; Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Liting Qian
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
| | - Jiangning Dong
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China; Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China.
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Utility of mono-exponential, bi-exponential, and stretched exponential signal models of intravoxel incoherent motion (IVIM) to predict prognosis and survival risk in laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) patients after chemoradiotherapy. Jpn J Radiol 2023:10.1007/s11604-023-01399-x. [PMID: 36847996 DOI: 10.1007/s11604-023-01399-x] [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: 07/25/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To investigate the predictive power of mono-exponential, bi-exponential, and stretched exponential signal models of intravoxel incoherent motion (IVIM) in prognosis and survival risk of laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) patients after chemoradiotherapy. MATERIALS AND METHODS Forty-five patients with laryngeal or hypopharyngeal squamous cell carcinoma were retrospectively enrolled. All patients had undergone pretreatment IVIM examination, subsequently, mean apparent diffusion coefficient (ADCmean), maximum ADC (ADCmax), minimum ADC (ADCmin) and ADCrange (ADCmax - ADCmean) by mono-exponential model, true diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f) by bi-exponential model, distributed diffusion coefficient (DDC), and diffusion heterogeneity index (α) by stretched exponential model were measured. Survival data were collected for 5 years. RESULTS Thirty-one cases were in the treatment failure group and fourteen cases were in the local control group. Significantly lower ADCmean, ADCmax, ADCmin, D, f, and higher D* values were observed in the treatment failure group than in the local control group (p < 0.05). D* had the greatest AUC of 0.802, with sensitivity and specificity of 77.4 and 85.7% when D* was 38.85 × 10-3 mm2/s. Kaplan-Meier survival analysis showed that the curves of N stage, ADCmean, ADCmax, ADCmin, D, D*, f, DDC, and α values were significant. Multivariate Cox regression analysis showed ADCmean and D* were independently correlated with progression-free survival (PFS) (hazard ratio [HR] = 0.125, p = 0.001; HR = 1.008, p = 0.002, respectively). CONCLUSION The pretreatment parameters of mono-exponential and bi-exponential models were significantly correlated with prognosis of LHSCC, ADCmean and D* values were independent factors for survival risk prediction.
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Liao L, Liu T, Wei B. Prediction of short-term treatment outcome of nasopharyngeal carcinoma based on voxel incoherent motion imaging and arterial spin labeling quantitative parameters. Eur J Radiol Open 2022; 10:100466. [PMID: 36590328 PMCID: PMC9794885 DOI: 10.1016/j.ejro.2022.100466] [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: 06/13/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To evaluate the early response of chemoradiotherapy (CRT) in nasopharyngeal carcinoma (NPC) based on intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and three-dimensional pseudo-continuous arterial spin labeling (3D pCASL). Materials and methods Forty patients diagnosed with NPC were recruited and divided into complete remission (CR) and partial remission (PR) group after CRT. All patients underwent IVIM and ASL and the related parameters was obtained. These parameters include pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), average blood flow ( BFavg), minimum blood flow (BFmin), and maximum blood flow (BFmax). Student's t test was used to compare the difference in ASL and IVIM derived parameters between CR and PR. The Areas under curve (AUC) of the receiver operating characteristic (ROC) was used to analyze the diagnostic performance of each parameter of ASL and IVIM to the treatment outcome. Results the D value of IVIM in CR group was lower than that of the PR group ( P = 0.014),. Among the parameters of ASL, the BFavg and BFmax of the CR group were higher than those of the PR group(p = 0.004,0.013), but the BFmin had no statistical significance in the two groups（P = 0.54）. AUC of D, BFavg, and BFmax is about 0.731, 0.753, and 0.724, respectively, all of their combined AUC diagnosis was 0.812. Conclusion The early response of NPC after CRT can predict by IVIM's diffusion parameters and ASL-related blood flow parameters.
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Key Words
- 3DpCASL, three-dimensional quasi-continuous arterial spin labeling
- ADC, apparent diffusion coefficient
- AUC, area under the curve
- Arterial spin labeling
- BFavg, average of blood flow
- BFmax, maximum blood flow
- BFmin, minimum blood flow
- CR, complete remission
- CRT, chemoradiotherapy
- Chemoradiotherapy
- D*, pseudo-diffusion coefficient
- D, pure diffusion coefficient
- DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging
- IVIM-DWI, intravoxel incoherent motion diffusion-weighted imaging
- Intravoxel incoherent motion diffusion-weighted imaging
- NPC, nasopharyngeal carcinoma
- Nasopharyngeal carcinoma
- PR, partial remission
- f, perfusion fraction
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Affiliation(s)
- Liping Liao
- Department of Radiology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Clinical Medical Research Center of Imaging Medicine, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Key Clinical Specialties, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Medical University Cancer Hospital Superiority Cultivation Discipline, 71 Hedi Road, Nanning, Guangxi, People's Republic of China
| | - Teng Liu
- Department of Radiology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Clinical Medical Research Center of Imaging Medicine, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Key Clinical Specialties, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Medical University Cancer Hospital Superiority Cultivation Discipline, 71 Hedi Road, Nanning, Guangxi, People's Republic of China
| | - Bo Wei
- Department of Radiology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Clinical Medical Research Center of Imaging Medicine, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Key Clinical Specialties, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Department of Radiology, Guangxi Medical University Cancer Hospital Superiority Cultivation Discipline, 71 Hedi Road, Nanning, Guangxi, People's Republic of China,Corresponding author at: Department of Radiology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, People's Republic of China.
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Prospective Investigation of 18FDG-PET/MRI with Intravoxel Incoherent Motion Diffusion-Weighted Imaging to Assess Survival in Patients with Oropharyngeal or Hypopharyngeal Carcinoma. Cancers (Basel) 2022; 14:cancers14246104. [PMID: 36551590 PMCID: PMC9775681 DOI: 10.3390/cancers14246104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
To prospectively investigate the prognostic value of 18F-FDG PET/MRI in patients with oropharyngeal or hypopharyngeal squamous cell carcinomas (OHSCC) treated by chemoradiotherapy. The study cohort consisted of patients with OHSCC who had undergone integrated PET/MRI prior to chemoradiotherapy or radiotherapy. Imaging parameters derived from intravoxel incoherent motion (IVIM), dynamic contrast-enhanced MRI (DCE-MRI), and 18F-FDG PET were analyzed in relation to overall survival (OS) and recurrence-free survival (RFS). In multivariable analysis, T classification (p < 0.001), metabolic tumor volume (p = 0.013), and pseudo-diffusion coefficient (p = 0.008) were identified as independent risk factors for OS. The volume transfer rate constant (p = 0.015), initial area under the curve (p = 0.043), T classification (p = 0.018), and N classification (p = 0.018) were significant predictors for RFS. The Harrell’s c-indices of OS and RFS obtained from prognostic models incorporating clinical and PET/MRI predictors were significantly higher than those derived from the traditional TNM staging system (p = 0.001). The combination of clinical risk factors with functional parameters derived from IVIM and DCE-MRI plus metabolic PET parameters derived from 18F-FDG PET in integrated PET/MRI outperformed the information provided by traditional TNM staging in predicting the survival of patients with OHSCC.
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Kong X, Zhang Q, Wu X, Zou T, Duan J, Song S, Nie J, Tao C, Tang M, Wang M, Zou J, Xie Y, Li Z, Li Z. Advances in Imaging in Evaluating the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer. Front Oncol 2022; 12:816297. [PMID: 35669440 PMCID: PMC9163342 DOI: 10.3389/fonc.2022.816297] [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: 11/16/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC) is increasingly widely used in breast cancer treatment, and accurate evaluation of its response provides essential information for treatment and prognosis. Thus, the imaging tools used to quantify the disease response are critical in evaluating and managing patients treated with NAC. We discussed the recent progress, advantages, and disadvantages of common imaging methods in assessing the efficacy of NAC for breast cancer.
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Affiliation(s)
- Xianshu Kong
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Qian Zhang
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Xuemei Wu
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Tianning Zou
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jiajun Duan
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Shujie Song
- Department of Pathology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jianyun Nie
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Chu Tao
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Mi Tang
- Department of Pathology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Maohua Wang
- First Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jieya Zou
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yu Xie
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Zhenhui Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Zhen Li
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
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von der Grün J, Winkelmann R, Burck I, Martin D, Rödel F, Wild PJ, Bankov K, Weigert A, Kur IM, Brandts C, Filmann N, Issing C, Thönissen P, Tanneberger AM, Rödel C, Ghanaati S, Balermpas P. Neoadjuvant Chemoradiotherapy for Oral Cavity Cancer: Predictive Factors for Response and Interim Analysis of the Prospective INVERT-Trial. Front Oncol 2022; 12:817692. [PMID: 35402268 PMCID: PMC8988145 DOI: 10.3389/fonc.2022.817692] [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: 11/18/2021] [Accepted: 03/02/2022] [Indexed: 01/10/2023] Open
Abstract
Background To study neoadjuvant chemoradiotherapy (nCRT) and potential predictive factors for response in locally advanced oral cavity cancer (LA-OCC). Methods The INVERT trial is an ongoing single-center, prospective phase 2, proof-of-principle trial. Operable patients with stage III-IVA squamous cell carcinomas of the oral cavity were eligible and received nCRT consisting of 60 Gy with concomitant cisplatin and 5-fluorouracil. Surgery was scheduled 6-8 weeks after completion of nCRT. Explorative, multiplex immunohistochemistry (IHC) was performed on pretreatment tumor specimen, and diffusion-weighted magnetic resonance imaging (DW-MRI) was conducted prior to, during nCRT (day 15), and before surgery to identify potential predictive biomarkers and imaging features. Primary endpoint was the pathological complete response (pCR) rate. Results Seventeen patients with stage IVA OCC were included in this interim analysis. All patients completed nCRT. One patient died from pneumonia 10 weeks after nCRT before surgery. Complete tumor resection (R0) was achieved in 16/17 patients, of whom 7 (41%, 95% CI: 18-67%) showed pCR. According to the Clavien-Dindo classification, grade 3a and 3b complications were found in 4 (25%) and 5 (31%) patients, respectively; grade 4-5 complications did not occur. Increased changes in the apparent diffusion coefficient signal intensities between MRI at day 15 of nCRT and before surgery were associated with better response (p=0.022). Higher abundances of programmed cell death protein 1 (PD1) positive cytotoxic T-cells (p=0.012), PD1+ macrophages (p=0.046), and cancer-associated fibroblasts (CAFs, p=0.036) were associated with incomplete response to nCRT. Conclusion nCRT for LA-OCC followed by radical surgery is feasible and shows high response rates. Larger patient cohorts from randomized trials are needed to further investigate nCRT and predictive biomarkers such as changes in DW-MRI signal intensities, tumor infiltrating immune cells, and CAFs.
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Affiliation(s)
- Jens von der Grün
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Ria Winkelmann
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Iris Burck
- Department of Diagnostic and Interventional Radiology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Daniel Martin
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Peter Johannes Wild
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Katrin Bankov
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Andreas Weigert
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ivan-Maximiliano Kur
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Brandts
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Medicine, Hematology/Oncology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Issing
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Otorhinolaryngology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Philipp Thönissen
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Anna Maria Tanneberger
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Shahram Ghanaati
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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11
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Papoutsaki MV, Sidhu HS, Dikaios N, Singh S, Atkinson D, Kanber B, Beale T, Morley S, Forster M, Carnell D, Mendes R, Punwani S. Utility of diffusion MRI characteristics of cervical lymph nodes as disease classifier between patients with head and neck squamous cell carcinoma and healthy volunteers. NMR IN BIOMEDICINE 2021; 34:e4587. [PMID: 34240782 DOI: 10.1002/nbm.4587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
Diffusion MRI characteristics assessed by apparent diffusion coefficient (ADC) histogram analysis in head and neck squamous cell carcinoma (HNSCC) have been reported as helpful in classifying tumours based on diffusion characteristics. There is little reported on HNSCC lymph nodes classification by diffusion characteristics. The aim of this study was to determine whether pretreatment nodal microstructural diffusion MRI characteristics can classify diseased nodes of patients with HNSCC from normal nodes of healthy volunteers. Seventy-nine patients with histologically confirmed HNSCC prior to chemoradiotherapy, and eight healthy volunteers, underwent diffusion-weighted (DW) MRI at a 1.5-T MR scanner. Two radiologists contoured lymph nodes on DW (b = 300 s/m2 ) images. ADC, distributed diffusion coefficient (DDC) and alpha (α) values were calculated by monoexponential and stretched exponential models. Histogram analysis metrics of drawn volume were compared between patients and volunteers using a Mann-Whitney test. The classification performance of each metric between the normal and diseased nodes was determined by receiver operating characteristic (ROC) analysis. Intraclass correlation coefficients determined interobserver reproducibility of each metric based on differently drawn ROIs by two radiologists. Sixty cancerous and 40 normal nodes were analysed. ADC histogram analysis revealed significant differences between patients and volunteers (p ≤0.0001 to 0.0046), presenting ADC distributions that were more skewed (1.49 for patients, 1.03 for volunteers; p = 0.0114) and 'peaked' (6.82 for patients, 4.20 for volunteers; p = 0.0021) in patients. Maximum ADC values exhibited the highest area under the curve ([AUC] 0.892). Significant differences were revealed between patients and volunteers for DDC and α value histogram metrics (p ≤0.0001 to 0.0044); the highest AUC were exhibited by maximum DDC (0.772) and the 25th percentile α value (0.761). Interobserver repeatability was excellent for mean ADC (ICC = 0.88) and the 25th percentile α value (ICC = 0.78), but poor for all other metrics. These results suggest that pretreatment microstructural diffusion MRI characteristics in lymph nodes, assessed by ADC and α value histogram analysis, can identify nodal disease.
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Affiliation(s)
| | | | - Nikolaos Dikaios
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK
| | - Saurabh Singh
- Centre for Medical Imaging, University College London, London, UK
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, UK
| | - Baris Kanber
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Timothy Beale
- Department of Radiology, University College London Hospital, London, UK
| | - Simon Morley
- Department of Radiology, University College London Hospital, London, UK
| | - Martin Forster
- Department of Oncology, University College London, Cancer Institute, London, UK
- Department of Oncology, University College London Hospital, London, UK
| | - Dawn Carnell
- Department of Oncology, University College London Hospital, London, UK
| | - Ruheena Mendes
- Department of Oncology, University College London Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
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12
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Riva G, Imparato S, Savietto G, Pecorilla M, Iannalfi A, Barcellini A, Ronchi S, Fiore MR, Paganelli C, Buizza G, Ciocca M, Baroni G, Preda L, Orlandi E. Potential role of functional imaging in predicting outcome for patients treated with carbon ion therapy: a review. Br J Radiol 2021; 94:20210524. [PMID: 34520670 DOI: 10.1259/bjr.20210524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Carbon ion radiation therapy (CIRT) is an emerging radiation technique with advantageous physical and radiobiologic properties compared to conventional radiotherapy (RT) providing better response in case of radioresistant and hypoxic tumors. Our aim is to critically review if functional imaging techniques could play a role in predicting outcome of CIRT-treated tumors, as already proven for conventional RT. METHODS 14 studies, concerning Magnetic resonance imaging (MRI) and Positron Emission Tomography (PET), were selected after a comprehensive search on multiple electronic databases from January 2000 to March 2020. RESULTS MRI studies (n = 5) focused on diffusion-weighted MRI and, even though quantitative parameters were the same in all studies (apparent diffusion coefficient, ADC), results were not univocal, probably due to different imaging acquisition protocols and tumoral histology. For PET studies (n = 9), different tracers were used such as [18F]FDG and other uncommon tracers ([11C]MET, [18F]FLT), with a relevant heterogeneity regarding parameters used for outcome assessment. CONCLUSION No conclusion can be drawn on the predictive value of functional imaging in CIRT-treated tumors. A standardization of image acquisition, multi-institutional large trials and external validations are needed in order to establish the prognostic value of functional imaging in CIRT and to guide clinical practice. ADVANCES IN KNOWLEDGE Emerging studies focused on functional imaging's role in predicting CIRT outcome. Due to the heterogeneity of images acquisition and studies, results are conflicting and prospective large studies with imaging standardized protocol are needed.
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Affiliation(s)
- Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giovanni Savietto
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Pecorilla
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Lorenzo Preda
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Pavia, Italy
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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13
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Boeke S, Mönnich D, van Timmeren JE, Balermpas P. MR-Guided Radiotherapy for Head and Neck Cancer: Current Developments, Perspectives, and Challenges. Front Oncol 2021; 11:616156. [PMID: 33816247 PMCID: PMC8017313 DOI: 10.3389/fonc.2021.616156] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Based on the development of new hybrid machines consisting of an MRI and a linear accelerator, magnetic resonance image guided radiotherapy (MRgRT) has revolutionized the field of adaptive treatment in recent years. Although an increasing number of studies have been published, investigating technical and clinical aspects of this technique for various indications, utilizations of MRgRT for adaptive treatment of head and neck cancer (HNC) remains in its infancy. Yet, the possible benefits of this novel technology for HNC patients, allowing for better soft-tissue delineation, intra- and interfractional treatment monitoring and more frequent plan adaptations appear more than obvious. At the same time, new technical, clinical, and logistic challenges emerge. The purpose of this article is to summarize and discuss the rationale, recent developments, and future perspectives of this promising radiotherapy modality for treating HNC.
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Affiliation(s)
- Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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14
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Song Q, Li F, Chen X, Wang J, Liu H, Cheng Y. Early detection treatment response for head and neck carcinomas using intravoxel incoherent motion-magnetic resonance imaging: a meta-analysis. Dentomaxillofac Radiol 2021; 50:20190507. [PMID: 32286860 DOI: 10.1259/dmfr.20190507] [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: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of intravoxel incoherent motion-MRI (IVIM-MRI) for predicting the treatment response in head and neck squamous cell carcinomas (HNSCC) patients. METHODS A comprehensive literature search was performed to identify original articles on diagnostic performance of IVIM in predicting treatment response in HNSCC patients receiving chemoradiotherapy. The IVIM parameters studied were diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient. Summary estimates of diagnostic accuracy were obtained by using a random-effects model. Of 65 studies screened, 8 studies with 347 patients were finally included. RESULTS The pooled sensitivities and specificities were 76% [95% confidence interval (CI) 69-82%] and 81% (95% CI 70-89%) for pre-treatment D, and 70% (95% CI 58-80%) and 82% (95% CI 66-92%) for △D, respectively. In addition, the sensitivities and specificities ranged from 41.7 to 94% and 67 to 100% for pre-treatment f, and from 55.7 to 76.5% and 72.2 to 93.3% for pre-treatment apparent diffusion coefficient, respectively. CONCLUSIONS The diffusion-related coefficients pre-treatment D and △D demonstrated good accuracy in predicting early treatment response in HNSCC patients. However, because of the variability in reference test and other limitations of included literature, further investigation is needed before implementing any IVIM strategy into clinical practice.
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Affiliation(s)
- Qingxu Song
- Department of Radiation Oncology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, P.R. China
| | - Fang Li
- Second Department of Internal Medicine, Laiwu People's Hospital, 79 Fengchengxi Street, Jinan, Shandong, 271100, P.R. China
| | - Xin Chen
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Road, Jinan, Shandong, 250021, P.R. China
| | - Jianbo Wang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, P.R. China
| | - Hong Liu
- Department of Radiation Oncology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, P.R. China
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, P.R. China
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15
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Song T, Yao Q, Qu J, Zhang H, Zhao Y, Qin J, Feng W, Zhang S, Han X, Wang S, Yan X, Li H. The value of intravoxel incoherent motion diffusion-weighted imaging in predicting the pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma. Eur Radiol 2020; 31:1391-1400. [PMID: 32901300 DOI: 10.1007/s00330-020-07248-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/05/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the prediction of pathologic response to neoadjuvant chemotherapy (NAC) in locally advanced esophageal squamous cell carcinoma (ESCC). MATERIAL AND METHODS Forty patients with locally advanced ESCC who were treated with NAC followed by radical resection were prospectively enrolled from September 2015 to May 2018. MRI and IVIM were performed within 1 week before and 2-3 weeks after NAC, prior to surgery. Parameters including apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), and pseudodiffusion fraction (f) before and after NAC were measured. Pathologic response was evaluated according to the AJCC tumor regression grade (TRG) system. The changes in IVIM values before and after therapy in different TRG groups were assessed. Receiver operating characteristic (ROC) curves analysis was used to determine the best cutoff value for predicting the pathologic response to NAC. RESULTS Twenty-two patients were identified as TRG 2 (responders), and eighteen as TRG 3 (non-responders) in pathologic evaluation. The ADC, D, and f values increased significantly after NAC. The post-NAC D and ΔD values of responders were significantly higher than those of non-responders. The area under the curve (AUC) was 0.722 for post-NAC D and 0.859 for ΔD in predicting pathologic response. The cutoff values of post-NAC D and ΔD were 1.685 × 10-3 mm2/s and 0.350 × 10-3 mm2/s, respectively. CONCLUSION IVIM-DWI may be used as an effective functional imaging technique to predict pathologic response to NAC in locally advanced ESCC. KEY POINTS • The optimal cutoff values of post-NAC D and ΔD for predicting pathologic response to NAC in locally advanced ESCC were 1.685 × 10-3 mm2/s and 0.350 × 10-3 mm2/s, respectively. • Pathologic response to NAC in locally advanced ESCC was favorable in patients with post-NAC D and ΔD values that were higher than the optimal cutoff values. • IVIM-DWI can potentially be used to preoperatively predict pathologic response to NAC in esophageal carcinoma. Accurate quantification of the D value derived from IVIM-DWI may eventually translate into an effective and non-invasive marker to predict therapeutic efficacy.
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Affiliation(s)
- Tao Song
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Qi Yao
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Jinrong Qu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China.
| | - Hongkai Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Yan Zhao
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Jianjun Qin
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Wen Feng
- Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Shouning Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Xianhua Han
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, XI'an, 710065, China
| | - Xu Yan
- MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China
| | - Hailiang Li
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China
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16
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Li J, Li W, Niu J, Song X, Wu W, Gong T, Zheng R, Ting-Fang Shih T, Li W, Zhou XJ. Intravoxel Incoherent Motion Diffusion-weighted MRI of Infiltrated Marrow for Predicting Overall Survival in Newly Diagnosed Acute Myeloid Leukemia. Radiology 2020; 295:155-161. [PMID: 32068504 DOI: 10.1148/radiol.2020191693] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Acute myeloid leukemia (AML) features relatively low overall survival (OS). Intravoxel incoherent motion (IVIM) diffusion-weighted MRI separates tissue microcapillary perfusion and diffusivity and may have potential for helping to assess prognosis in infiltrated marrow disease apart from solid tumor. Thus, a study of overall survival would contribute to clarifying the value of IVIM for assessing long-term prognosis in AML. Purpose To determine whether the IVIM-derived parameters of infiltrated bone marrow may be associated with OS in newly diagnosed AML. Materials and Methods This prospective study enrolled participants with newly diagnosed AML between July 2014 to March 2016 consecutively. Participants underwent MRI of the lumbar spine by using an IVIM sequence. Participant clinical characteristics and OS were collected. The median of follow-up period was 20 months (range, 1-56 months). The IVIM parameters (pseudoperfusion fraction, f; diffusion coefficient, D; and pseudodiffusion coefficient, D*) were obtained. A nonparametric log-rank test was used to identify the threshold of IVIM parameters for OS. Univariable Kaplan-Meier and multivariable Cox proportional hazards regression analyses were performed to investigate prognostic significance of possible indicators. Results Fifty-three participants (mean age, 42 years ± 17; 30 men) were evaluated. Nonparametric log-rank test results showed that the thresholds of f and D values for OS were 31.0% and 0.2 × 10-3 mm2/sec, respectively. Univariable analyses indicated that high f value (>31.0%) and low D value (≤0.2 × 10-3 mm2/sec) were associated with shorter OS (P = .003 and .01, respectively). An f value greater than 31.0% (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.6; P = .046) was associated with OS, independent of clinical confounders (age, karyotype, and white blood cell counts) in a multivariable analysis. Conclusion Pseudoperfusion fraction and diffusion coefficient from intravoxel incoherent motion diffusion-weighted MRI may be viable prognosis predictors of newly diagnosed acute myeloid leukemia. © RSNA, 2020.
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Affiliation(s)
- Jianting Li
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Wenjin Li
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Jinliang Niu
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Xiaoli Song
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Wenqi Wu
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Tong Gong
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Rong Zheng
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Tiffany Ting-Fang Shih
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Weiguo Li
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Xiaohong Joe Zhou
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
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Chung SR, Choi YJ, Suh CH, Lee JH, Baek JH. Diffusion-weighted Magnetic Resonance Imaging for Predicting Response to Chemoradiation Therapy for Head and Neck Squamous Cell Carcinoma: A Systematic Review. Korean J Radiol 2020; 20:649-661. [PMID: 30887747 PMCID: PMC6424826 DOI: 10.3348/kjr.2018.0446] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To systematically review the evaluation of the diagnostic accuracy of pre-treatment apparent diffusion coefficient (ADC) and change in ADC during the intra- or post-treatment period, for the prediction of locoregional failure in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Ovid-MEDLINE and Embase databases were searched up to September 8, 2018, for studies on the use of diffusion-weighted magnetic resonance imaging for the prediction of locoregional treatment response in patients with HNSCC treated with chemoradiation or radiation therapy. Risk of bias was assessed by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS Twelve studies were included in the systematic review, and diagnostic accuracy assessment was performed using seven studies. High pre-treatment ADC showed inconsistent results with the tendency for locoregional failure, whereas all studies evaluating changes in ADC showed consistent results of a lower rise in ADC in patients with locoregional failure compared to those with locoregional control. The sensitivities and specificities of pre-treatment ADC and change in ADC for predicting locoregional failure were relatively high (range: 50-100% and 79-96%, 75-100% and 69-95%, respectively). Meta-analytic pooling was not performed due to the apparent heterogeneity in these values. CONCLUSION High pre-treatment ADC and low rise in early intra-treatment or post-treatment ADC with chemoradiation, could be indicators of locoregional failure in patients with HNSCC. However, as the studies are few, heterogeneous, and at high risk for bias, the sensitivity and specificity of these parameters for predicting the treatment response are yet to be determined.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,Department of Radiology, Namwon Medical Center, Namwon, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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18
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Bian H, Liu F, Chen S, Li G, Song Y, Sun M, Dong H. Intravoxel incoherent motion diffusion-weighted imaging evaluated the response to concurrent chemoradiotherapy in patients with cervical cancer. Medicine (Baltimore) 2019; 98:e17943. [PMID: 31725650 PMCID: PMC6867768 DOI: 10.1097/md.0000000000017943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To evaluate the application of multiple b values diffusion-weighted imaging based on biexponential signal decay model to predict the response to concurrent chemoradiotherapy in cervical cancer patients.This prospective study enrolled 28 patients (mean age: 50.89 ± 10.70 years) with cervical cancer confirmed by biopsy who received concurrent chemoradiotherapy. Pelvic magnetic resonance scans were performed 2 weeks before, 7 days and 21 days after the initiation of therapy, and 1 month after the end of the treatment. Diffusion-weighted imaging with b values of 0, 50, 450, and 850 s/mm were performed, and tumor volume, means of tumor apparent diffusion coefficient (ADC)min, ADCmean, ADCslow, ADCfast, and Ffast were measured.Pretreatment ADCmin and ADCslow of good outcome group were significantly higher than those of poor outcome group (P < .05). At the 7th day of the treatment, Ffast and its change rate of good outcome group were significantly higher than those of poor outcome group (P < .05). At the 7th day and 21st day of the treatment, Ffast showed a slowly increasing tendency with no significant difference compared with pretreatment value in poor outcome group (P < .05). One month post-treatment, only ADCslow change rate was significantly higher in good outcome group than that in poor outcome group.Intravoxel incoherent motion-related ADC values could be utilized to better predict the outcome of cervical cancer chemoradiotherapy.
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Affiliation(s)
| | | | - Sha Chen
- Department of Ultrasound, Cangzhou Central Hospital, Cangzhou, Hebei, China
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19
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Liao CC, Qin YY, Tang Q, Tan XH, Ke Q, Rong Y, Zhong JH, Li LQ, Cen H. Multi-b value diffusion-weighted magnetic resonance imaging and intravoxel incoherent motion modeling: Differentiation of aggressive lymphoma lesions on initial treatment and activity assessment after chemotherapy. Medicine (Baltimore) 2019; 98:e14459. [PMID: 30732212 PMCID: PMC6380798 DOI: 10.1097/md.0000000000014459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/18/2018] [Accepted: 01/18/2019] [Indexed: 11/26/2022] Open
Abstract
The diagnostic efficiency of diffusion-weighted magnetic resonance imaging with different b-values and application of an intravoxel incoherent motion (IVIM) model for differentiating disease states of lymphoma was investigated.Thirty-six patients at initial diagnosis and 69 after chemotherapy underwent diffusion-weighted magnetic resonance imaging (DW-MRI) with multiple b-values. Analysis parameters included the apparent diffusion coefficient (ADC) for each b-value. Standard ADC, D, D*, and f were calculated using an IVIM model.For patients at initial diagnosis, compared with aggressive lymphomas, the benign lymph nodes exhibited higher mean ADC (2.34 vs 0.66 × 10 mm/s, P < .01) for b = 200 s/mm. The AUC, sensitivity, specificity, and the cutoff value were 0.992, 96%, 100%, and 1.09 ×10 mm/s, respectively. For patients who had finished chemotherapy, the f-values of IVIM for those with partial remission (PR) were higher than those of complete remission (CR) (56.22 vs 21.81%, P < .01). The AUC, sensitivity, specificity, and the cutoff value were 0.937, 94%, 82%, 42.10%, respectively.For b = 200 s/mm, ADC values are most helpful for characterizing benign lymph nodes and malignant lymphomas. The f-value of the IVIM is most valuable in the identification of residual lesions of lymphomas after chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University
| | - Le-qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, P.R. China
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20
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Martens RM, Noij DP, Ali M, Koopman T, Marcus JT, Vergeer MR, de Vet H, de Jong MC, Leemans CR, Hoekstra OS, de Bree R, de Graaf P, Boellaard R, Castelijns JA. Functional imaging early during (chemo)radiotherapy for response prediction in head and neck squamous cell carcinoma; a systematic review. Oral Oncol 2018; 88:75-83. [PMID: 30616800 DOI: 10.1016/j.oraloncology.2018.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
This systematic review gives an extensive overview of the current state of functional imaging during (chemo)radiotherapy to predict locoregional control (LRC) and overall survival (OS) for head and neck squamous cell carcinoma. MEDLINE and EMBASE were searched for literature until April 2018 assessing the predictive performance of functional imaging (computed tomography perfusion (CTp), MRI and positron-emission tomography (PET)) within 4 weeks after (chemo)radiotherapy initiation. Fifty-two studies (CTp: n = 4, MRI: n = 19, PET: n = 26, MRI/PET: n = 3) were included involving 1623 patients. Prognostic information was extracted according the PRISMA protocol. Pooled estimation and subgroup analyses were performed for comparable parameters and outcome. However, the heterogeneity of included studies limited the possibility for comparison. Early tumoral changes from (chemo)radiotherapy can be captured by functional MRI and 18F-FDG-PET and could allow for personalized treatment adaptation. Lesions showed potentially prognostic intratreatment changes in perfusion, diffusion and metabolic activity. Intratreatment ADCmean increase (decrease of diffusion restriction) and low SUVmax (persistent low or decrease of 18F-FDG uptake) were most predictive of LRC. Intratreatment persistent high or increase of perfusion on CT/MRI (i.e. blood flow, volume, permeability) also predicted LRC. Low SUVmax and total lesion glycolysis (TLG) predicted favorable OS. The optimal timing to perform functional imaging to predict LRC or OS was 2-3 weeks after treatment initiation.
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Affiliation(s)
- Roland M Martens
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
| | - Daniel P Noij
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Meedie Ali
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Thomas Koopman
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - J Tim Marcus
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Marije R Vergeer
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Henrica de Vet
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Marcus C de Jong
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Jonas A Castelijns
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
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Leibfarth S, Winter RM, Lyng H, Zips D, Thorwarth D. Potentials and challenges of diffusion-weighted magnetic resonance imaging in radiotherapy. Clin Transl Radiat Oncol 2018; 13:29-37. [PMID: 30294681 PMCID: PMC6169338 DOI: 10.1016/j.ctro.2018.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/20/2018] [Accepted: 09/03/2018] [Indexed: 02/09/2023] Open
Abstract
Discussion of DW imaging protocols and imaging setup. Discussion of mono- and bi-exponential models for quantitative parameter extraction. Review of recent publications investigating potential benefits of using DWI in RT, including detailed synoptic table. Detailed discussion of geometric and quantitative accuracy of DW imaging and DW-derived parameters. Purpose To review the potential and challenges of integrating diffusion weighted magnetic resonance imaging (DWI) into radiotherapy (RT). Content Details related to image acquisition of DWI for RT purposes are discussed, along with the challenges with respect to geometric accuracy and the robustness of quantitative parameter extraction. An overview of diffusion- and perfusion-related parameters derived from mono- and bi-exponential models is provided, and their role as potential RT biomarkers is discussed. Recent studies demonstrating potential of DWI in different tumor sites such as the head and neck, rectum, cervix, prostate, and brain, are reviewed in detail. Conclusion DWI has shown promise for RT outcome prediction, response assessment, as well as for tumor delineation and characterization in several cancer types. Geometric and quantification robustness is challenging and has to be addressed adequately. Evaluation in larger clinical trials with well designed imaging protocol and advanced analysis models is needed to develop the optimal strategy for integrating DWI in RT.
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Affiliation(s)
- Sara Leibfarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Germany
| | - René M Winter
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Germany
| | - Heidi Lyng
- Department of Radiation Biology, Norwegian Radium Hospital, Oslo University Hospital, Norway
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Germany
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22
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Zheng H, Ren W, Pan X, Zhang Q, Liu B, Liu S, He J, Zhou Z. Role of intravoxel incoherent motion MRI in early assessment of the response of esophageal squamous cell carcinoma to chemoradiotherapy: A pilot study. J Magn Reson Imaging 2018; 48:349-358. [PMID: 29297204 DOI: 10.1002/jmri.25934] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/07/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Since definitive concurrent chemoradiotherapy (CRT) is standard therapy for inoperable esophageal squamous cell carcinoma (ESCC), early evaluation of treatment response is crucial for patients and would be useful in assessing response, especially in patients with severe side effects. PURPOSE To explore the feasibility of intravoxel incoherent motion (IVIM) MRI in the early assessment of treatment response to CRT. STUDY TYPE Prospective. POPULATION Twenty-three inoperable ESCC patients. SEQUENCE IVIM 3T MRI of nine b values (0, 25, 50, 75, 100, 150, 200, 500 and 800 s/mm2 ) was performed at four timepoints: pre-CRT (within 5 days before CRT), mid-CRT (2-3 weeks after the start of CRT), end-CRT (within 5 days after the end of CRT), and post-CRT (1 month after the end of CRT). ASSESSMENT IVIM-based parameters and ADC were analyzed independently by two radiologists and treatment response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). STATISTICAL TESTS Analyses of variance for repeated measurements were conducted to observe dynamic changes of IVIM-based parameters (D, f, and D*) and ADC during CRT. The parameters and their change percentages (Δ%) were compared between complete response (CR) and partial response (PR) by Mann-Whitney U-test. Diagnostic performance of parameters in predicting response was tested with receiver-operating characteristic curve analysis. RESULTS ADC, D, and f increased significantly during CRT (P < 0.001, < 0.001, and 0.001, respectively). ADC, f, Δ%ADC, and Δ%D at mid-CRT in CR group were significantly higher than those in the PR group (P = 0.002, 0.013, 0.005, and 0.011, respectively). D combined with f and ADC had highest area under curve (0.917) in identifying CR from PR. DATA CONCLUSION IVIM parameters proved useful in assessing response to definitive concurrent CRT for inoperable ESCC and combined with ADC at an early stage of treatment was a good predictor of response. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 4 J. MAGN. RESON. IMAGING 2018;48:349-358.
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Affiliation(s)
- Huanhuan Zheng
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wei Ren
- Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Xia Pan
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qinglei Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Baorui Liu
- Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Li F, Wang H, Hou J, Tang J, Lu Q, Wang L, Yu X. Utility of intravoxel incoherent motion diffusion-weighted imaging in predicting early response to concurrent chemoradiotherapy in oesophageal squamous cell carcinoma. Clin Radiol 2018; 73:756.e17-756.e26. [DOI: 10.1016/j.crad.2018.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
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Zhu Y, Li X, Wang F, Zhang J, Li W, Ma Y, Qi J, Ren S, Ye Z. Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging in characterization of axillary lymph nodes: Preliminary animal experience. Magn Reson Imaging 2018; 52:46-52. [PMID: 29852212 DOI: 10.1016/j.mri.2018.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 05/27/2018] [Accepted: 05/27/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the diagnostic value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for discriminating axillary metastatic from non-metastatic lymph nodes (LNs) in rabbit models. MATERIALS AND METHODS The institutional animal care and use committee approved this study. Forty New Zealand white rabbits were randomly divided into two groups. The axillary LN models were created by inoculating VX2 cell suspension and complete Freund's adjuvant in the mammary glands of 20 female rabbits of each group, respectively. Conventional MRI and IVIM DWI were performed after animal models successfully established. Images of axillary LNs were analyzed with regard to long-axis diameter (L), short-axis diameter (S), apparent diffusion coefficient (ADC) and IVIM parameters (D, D*, f). Receiver operating characteristic analyses were conducted to determine the diagnostic performance of aforementioned criteria. RESULTS A total of 42 metastatic and 30 non-metastatic LNs were successfully isolated. ADC and D of metastatic LNs were significantly lower than those of non-metastatic ones (all P < 0.001), whereas D* was statistically higher (P = 0.033). L, S, and f showed no significant difference between the two groups (P = 0.089, 0.058, 0.054, respectively). Optimal cutoff values, area under the curve, sensitivity, and specificity for differentiation were as follows: ADC = 1.101 × 10-3 mm2/s, 0.886, 78.6%, 90.0%; D = 0.938 × 10-3 mm2/s, 0.927, 83.3%, 93.3%; and D* = 12.635 × 10-3 mm2/s, 0.657, 52.4%, 80.0%. CONCLUSION IVIM DWI is useful to distinguish metastatic from non-metastatic LNs in axilla. D was the most discriminative variable for predicting metastatic LNs.
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Affiliation(s)
- Yueqiang Zhu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Xubin Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Fengkui Wang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Jun Zhang
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Wei Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yan Ma
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Jin Qi
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Song Ren
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
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Non-invasive prediction of the tumor growth rate using advanced diffusion models in head and neck squamous cell carcinoma patients. Oncotarget 2018; 8:33631-33643. [PMID: 28430583 PMCID: PMC5464896 DOI: 10.18632/oncotarget.16851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/28/2017] [Indexed: 12/19/2022] Open
Abstract
We assessed parameters of advanced diffusion weighted imaging (DWI) models for the prediction of the tumor growth rate in 55 head and neck squamous cell carcinoma (HNSCC) patients. The DWI acquisition used single-shot spin-echo echo-planar imaging with 12 b-values (0−2000). We calculated 14 DWI parameters using mono-exponential, bi-exponential, tri-exponential, stretched exponential and diffusion kurtosis imaging models. We directly measured the tumor growth rate from two sets of different-date imaging data. We divided the patients into a discovery group (n = 40) and validation group (n = 15) based on their MR acquisition dates. In the discovery group, we performed univariate and multivariate regression analyses to establish the multiple regression equation for the prediction of the tumor growth rate using diffusion parameters. The equation obtained with the discovery group was applied to the validation group for the confirmation of the equation's accuracy. After the univariate and multivariate regression analyses in the discovery-group patients, the estimated tumor growth rate equation was established by using the significant parameters of intermediate diffusion coefficient D2 and slow diffusion coefficient D3 obtained by the tri-exponential model. The discovery group's correlation coefficient between the estimated and directly measured tumor growth rates was 0.74. In the validation group, the correlation coefficient (r = 0.66) and intra-class correlation coefficient (0.65) between the estimated and directly measured tumor growth rates were respectively good. In conclusion, advanced DWI model parameters can be a predictor for determining HNSCC patients’ tumor growth rate.
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deSouza NM, Winfield JM, Waterton JC, Weller A, Papoutsaki MV, Doran SJ, Collins DJ, Fournier L, Sullivan D, Chenevert T, Jackson A, Boss M, Trattnig S, Liu Y. Implementing diffusion-weighted MRI for body imaging in prospective multicentre trials: current considerations and future perspectives. Eur Radiol 2018; 28:1118-1131. [PMID: 28956113 PMCID: PMC5811587 DOI: 10.1007/s00330-017-4972-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/24/2017] [Accepted: 06/28/2017] [Indexed: 12/18/2022]
Abstract
For body imaging, diffusion-weighted MRI may be used for tumour detection, staging, prognostic information, assessing response and follow-up. Disease detection and staging involve qualitative, subjective assessment of images, whereas for prognosis, progression or response, quantitative evaluation of the apparent diffusion coefficient (ADC) is required. Validation and qualification of ADC in multicentre trials involves examination of i) technical performance to determine biomarker bias and reproducibility and ii) biological performance to interrogate a specific aspect of biology or to forecast outcome. Unfortunately, the variety of acquisition and analysis methodologies employed at different centres make ADC values non-comparable between them. This invalidates implementation in multicentre trials and limits utility of ADC as a biomarker. This article reviews the factors contributing to ADC variability in terms of data acquisition and analysis. Hardware and software considerations are discussed when implementing standardised protocols across multi-vendor platforms together with methods for quality assurance and quality control. Processes of data collection, archiving, curation, analysis, central reading and handling incidental findings are considered in the conduct of multicentre trials. Data protection and good clinical practice are essential prerequisites. Developing international consensus of procedures is critical to successful validation if ADC is to become a useful biomarker in oncology. KEY POINTS • Standardised acquisition/analysis allows quantification of imaging biomarkers in multicentre trials. • Establishing "precision" of the measurement in the multicentre context is essential. • A repository with traceable data of known provenance promotes further research.
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Affiliation(s)
- N. M. deSouza
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT UK
| | - J. M. Winfield
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT UK
| | - J. C. Waterton
- Manchester Academic Health Sciences Institute, University of Manchester, Manchester, UK
| | - A. Weller
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT UK
| | - M.-V. Papoutsaki
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT UK
| | - S. J. Doran
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT UK
| | - D. J. Collins
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT UK
| | - L. Fournier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Radiology Department, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - D. Sullivan
- Duke Comprehensive Cancer Institute, Durham, NC USA
| | - T. Chenevert
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI USA
| | - A. Jackson
- Manchester Academic Health Sciences Institute, University of Manchester, Manchester, UK
| | - M. Boss
- Applied Physics Division, National Institute of Standards and Technology (NIST), Boulder, CO USA
| | - S. Trattnig
- Department of Biomedical Imaging and Image guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Y. Liu
- European Organisation for Research and Treatment of Cancer, Headquarters, Brussels, Belgium
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Surer E, Rossi C, Becker AS, Finkenstaedt T, Wurnig MC, Valavanis A, Winklhofer S. Cardiac-gated intravoxel incoherent motion diffusion-weighted magnetic resonance imaging for the investigation of intracranial cerebrospinal fluid dynamics in the lateral ventricle: a feasibility study. Neuroradiology 2018; 60:413-419. [PMID: 29470603 DOI: 10.1007/s00234-018-1995-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/12/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Intravoxel incoherent motion (IVIM) in diffusion-weighted magnetic resonance imaging (DW-MRI) attributes the signal attenuation to the molecular diffusion and to a faster pseudo-diffusion. Purpose of the study was to demonstrate the feasibility of IVIM for the investigation of intracranial cerebrospinal fluid (CSF) dynamics. METHODS Cardiac-gated DW-MRI images with fifteen b-values (0-1300s/mm2) along three orthogonal directions (mediolateral (ML), anteroposterior (AP), and craniocaudal (CC)) were acquired during maximum systole and diastole in 10 healthy volunteers (6 males, mean age 36 ± 15 years). A pixel-wise bi-exponential fitting with an iterative nonparametric algorithm was carried out to calculate the following parameters: diffusion coefficient (D), fast diffusion coefficient (D*), and fraction of fast diffusion (f). Region of interest measurements were performed in both lateral ventricles. Comparison of IVIM parameters was performed among two cardiac cycle acquisitions and among the diffusion-encoding directions using a paired Student's t test. RESULTS f significantly (p < 0.05) depended on the diffusion-encoding direction and on the cardiac cycle (diastole AP 0.30 ± 0.13, ML 0.22 ± 0.12, CC 0.26 ± 0.17; systole AP 0.45 ± 0.17, ML 0.34 ± 0.15, CC 0.40 ± 0.21). Neither a cardiac cycle nor a direction dependency was found among mean D values (which is in line with the expected intraventricular isotropic diffusion) and D* values (p > 0.05 each). CONCLUSION The fraction of fast diffusion from IVIM is feasible to detect a direction-dependent and cardiac-dependent pulsatile CSF flow within the lateral ventricles allowing for quantitative monitoring of CSF dynamics. This technique might provide opportunities to further investigate the pathophysiology of various neurological disorders involving altered CSF dynamics.
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Affiliation(s)
- Eddie Surer
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cristina Rossi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology, School of Medicine, University of California, San Diego, California, USA
| | - Moritz C Wurnig
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonios Valavanis
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Xu Q, Xu Y, Sun H, Chan Q, Shi K, Song A, Wang W. Quantitative intravoxel incoherent motion parameters derived from whole-tumor volume for assessing pathological complete response to neoadjuvant chemotherapy in locally advanced rectal cancer. J Magn Reson Imaging 2017; 48:248-258. [PMID: 29281151 DOI: 10.1002/jmri.25931] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many locally advanced rectal cancer (LARC) patients can benefit from neoadjuvant chemotherapy (NACT), with some achieving a pathological complete response (pCR). However, there is limited research reporting on the value of intravoxel incoherent motion (IVIM) in monitoring pCR in patients with LARC. PURPOSE To identify whether IVIM parameters derived from whole-tumor volume (WTV) before and after NACT could accurately assess pCR in patients with LARC. STUDY TYPE Prospective patient control study. POPULATION Fifty-one patients with LARC before and after NACT, prior to surgery. FIELD STRENGTH/SEQUENCE IVIM-diffusion imaging at 3T. ASSESSMENT Apparent diffusion coefficient (ADC), slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion-related diffusion fraction (f) values were obtained on diffusion-weighted magnetic resonance images (DW-MRI) using WTV methods and calculated using a biexponential model before and after NACT. STATISTICAL TESTS DWI-derived ADC and IVIM-derived parameters and their percentage changes (ΔADC%, ΔD%, ΔD*%, and Δf%) were compared using independent-samples t-test and Mann-Whitney U-test between the pCR and non-pCR groups. The diagnostic performance of IVIM parameters and their percentage changes were evaluated using receiver operating characteristic curves. RESULTS Compared with the non-pCR group, the pCR group exhibited significantly lower pre-ADCmean (P = 0.003) and pre-D values (P = 0.024), and significantly higher post-f (P = 0.002), ΔADCmean % (P = 0.002), ΔD% (P = 0.001), and Δf% values (P = 0.017). Receiver operating characteristic curves showed that the pre-D value had the best specificity (95.12%) and accuracy (86.27%) in predicting the pCR status, and ΔD% had the highest area under the curve (0.832) in assessing the pCR response to NACT. DATA CONCLUSIONS The IVIM-derived D value is a promising tool in predicting the pCR status before therapy. The percentage changes in D values after therapy may help assess the pCR status prior to surgery. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
- Qiaoyu Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Queenie Chan
- Philips Healthcare, Shatin, New Territories, Hong Kong, China
| | | | - Aiping Song
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Wu Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Federau C. Intravoxel incoherent motion MRI as a means to measure in vivo perfusion: A review of the evidence. NMR IN BIOMEDICINE 2017; 30. [PMID: 28885745 DOI: 10.1002/nbm.3780] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/19/2017] [Accepted: 07/07/2017] [Indexed: 05/07/2023]
Abstract
The idea that in vivo intravoxel incoherent motion magnetic resonance signal is influenced by blood motion in the microvasculature is exciting, because it suggests that local and quantitative perfusion information can be obtained in a simple and elegant way from a few diffusion-weighted images, without contrast injection. When the method was proposed in the late 1980s some doubts appeared as to its feasibility, and, probably because the signal to noise and image quality at the time was not sufficient, no obvious experimental evidence could be produced to alleviate them. Helped by the tremendous improvements seen in the last three decades in MR hardware, pulse design, and post-processing capabilities, an increasing number of encouraging reports on the value of intravoxel incoherent motion perfusion imaging have emerged. The aim of this article is to review the current published evidence on the feasibility of in vivo perfusion imaging with intravoxel incoherent motion MRI.
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Affiliation(s)
- Christian Federau
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, Petersgraben, Basle, Switzerland
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Hejduk B, Bobek-Billewicz B, Rutkowski T, Hebda A, Zawadzka A, Jurkowski MK. Application of Intravoxel Incoherent Motion (IVIM) Model for Differentiation Between Metastatic and Non-Metastatic Head and Neck Lymph Nodes. Pol J Radiol 2017; 82:506-510. [PMID: 29662580 PMCID: PMC5894025 DOI: 10.12659/pjr.902275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/11/2016] [Indexed: 11/18/2022] Open
Abstract
Background Application of intravoxel incoherent motion (IVIM) model parameters, including: true diffusion (D), pseudodiffusion (D*), and perfusion fraction (Fp), for differentiation between metastatic and non-metastatic head and neck lymph nodes. Material/Methods Diffusion-weighted images/apparent diffusion coefficient (DWI/ADC) images of 86 lymph nodes from 31 cancer patients were analyzed. DWI images were obtained with a 1.5T MRI scanner (Magnetom Avanto); b=0,50, 150, 300, 500, 750, 1000, 1200 s/mm2. Results In the study group, there were 32 (37%) and 54 (67%) metastatic and non-metastatic lymph nodes, respectively. The mean values of D, D*, and Fp did not differ significantly between metastatic and non-metastatic lymph nodes. Conclusions IVIM parameters are not useful for differentiation between metastatic and non-metastatic head and neck lymph nodes.
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Affiliation(s)
- Beata Hejduk
- Department of Radiology and Diagnostic Imaging, Center of Oncology - M. Skłodowska-Curie Memorial Institute, Branch in Gliwice, Gliwice, Poland
| | - Barbara Bobek-Billewicz
- Department of Radiology and Diagnostic Imaging, Center of Oncology - M. Skłodowska-Curie Memorial Institute, Branch in Gliwice, Gliwice, Poland
| | - Tomasz Rutkowski
- I Clinic of Radiotherapy and Chemotherapy, Center of Oncology - M. Skłodowska-Curie Memorial Institute, Branch in Gliwice, Gliwice, Poland
| | - Anna Hebda
- Department of Radiology and Diagnostic Imaging, Center of Oncology - M. Skłodowska-Curie Memorial Institute, Branch in Gliwice, Gliwice, Poland
| | - Agata Zawadzka
- Department of Radiology and Diagnostic Imaging, Center of Oncology - M. Skłodowska-Curie Memorial Institute, Branch in Gliwice, Gliwice, Poland
| | - Marek K Jurkowski
- Department of Medical Physics, Center of Oncology - M. Skłodowska-Curie Memorial Institute, Branch in Gliwice, Gliwice, Poland.,Department of Medical Analytics, University of Warmia and Mazury, Olsztyn, Poland
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Comparison of intravoxel incoherent motion diffusion-weighted imaging between turbo spin-echo and echo-planar imaging of the head and neck. Eur Radiol 2017; 28:316-324. [DOI: 10.1007/s00330-017-4990-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/25/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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Reischauer C, Patzwahl R, Koh DM, Froehlich JM, Gutzeit A. Non-Mono-Exponential Analysis of Diffusion-Weighted Imaging for Treatment Monitoring in Prostate Cancer Bone Metastases. Sci Rep 2017; 7:5809. [PMID: 28724944 PMCID: PMC5517576 DOI: 10.1038/s41598-017-06246-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/27/2017] [Indexed: 01/14/2023] Open
Abstract
Diffusion-weighted imaging quantified using the mono-exponential model has shown great promise for monitoring treatment response in prostate cancer bone metastases. The aim of this prospective study is to evaluate whether non-mono-exponential diffusion models better describe the water diffusion properties and may improve treatment response assessment. Diffusion-weighted imaging data of 12 treatment-naïve patients with 34 metastases acquired before and at one, two, and three months after initiation of antiandrogen treatment are analysed using the mono-exponential, the intravoxel incoherent motion, the stretched exponential, and the statistical model. Repeatability of the fitted parameters and changes under therapy are quantified. Model preference is assessed and correlation coefficients across times are calculated to delineate the relationship between the prostate-specific antigen levels and the diffusion parameters as well as between the diffusion parameters within each model. There is a clear preference for non-mono-exponential diffusion models at all time points. Particularly the stretched exponential is favoured in approximately 60% of the lesions. Its parameters increase significantly in response to treatment and are highly repeatable. Thus, the stretched exponential may be utilized as a potential optimal model for monitoring treatment response. Compared with the mono-exponential model, it may provide complementary information on tissue properties and improve response assessment.
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Affiliation(s)
- Carolin Reischauer
- Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Hirslanden Hospital St. Anna, Lucerne, Switzerland.
- Institute for Biomedical Engineering, ETH and University of Zurich, Zurich, Switzerland.
| | - René Patzwahl
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Dow-Mu Koh
- Academic Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
- CR-UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research, Sutton, Surrey, UK
| | - Johannes M Froehlich
- Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Hirslanden Hospital St. Anna, Lucerne, Switzerland
| | - Andreas Gutzeit
- Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Hirslanden Hospital St. Anna, Lucerne, Switzerland
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
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Fujima N, Sakashita T, Homma A, Yoshida D, Kudo K, Shirato H. Utility of a Hybrid IVIM-DKI Model to Predict the Development of Distant Metastasis in Head and Neck Squamous Cell Carcinoma Patients. Magn Reson Med Sci 2017; 17:21-27. [PMID: 28515412 PMCID: PMC5760229 DOI: 10.2463/mrms.mp.2016-0136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate the diagnostic power of hybrid intravoxel incoherent motion (IVIM)-diffusion kurtosis imaging (DKI) model parameters in pretreatment for the prediction of future distant metastasis in head and neck squamous cell carcinoma (HNSCC) patients. Materials and Methods: We retrospectively evaluated 49 HNSCC patients who underwent curative chemoradiation therapy. Diffusion-weighted image (DWI) acquired by single-shot spin-echo echo-planar imaging with 12 b-values (0–2000) was performed in all patients before any treatment. We calculated the IVIM-DKI parameters and the conventional apparent diffusion coefficient (ADC) in the ROI placed on the primary lesion. The presence of future distant metastasis was determined by histological findings or clinical follow-up. Results: A univariate analysis revealed significant differences between the patients with distant metastasis and those without in slow diffusion coefficient (D) and kurtosis value (K). Highest diagnostic accuracy was obtained by the D value. In addition, a multivariate analysis revealed that the D value was an independent predictor of future distant metastasis. Conclusion: The D and K values obtained by this hybrid IVIM-DKI model can be one of the diagnostic tools for the prediction of future distant metastasis in HNSCC patients.
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Affiliation(s)
- Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Tomohiro Sakashita
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine
| | - Daisuke Yoshida
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine.,The Global Station for Quantum Medical Science and Engineering, Global Institution for collaborative research and education
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Noij DP, Martens RM, Marcus JT, de Bree R, Leemans CR, Castelijns JA, de Jong MC, de Graaf P. Intravoxel incoherent motion magnetic resonance imaging in head and neck cancer: A systematic review of the diagnostic and prognostic value. Oral Oncol 2017; 68:81-91. [DOI: 10.1016/j.oraloncology.2017.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/12/2017] [Accepted: 03/25/2017] [Indexed: 12/20/2022]
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Cheng J, Wang Y, Zhang CF, Wang H, Wu WZ, Pan F, Hong N, Deng J. Chemotherapy response evaluation in a mouse model of gastric cancer using intravoxel incoherent motion diffusion-weighted MRI and histopathology. World J Gastroenterol 2017; 23:1990-2001. [PMID: 28373765 PMCID: PMC5360640 DOI: 10.3748/wjg.v23.i11.1990] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/19/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the role of intravoxel incoherent motion (IVIM) diffusion-weighted (DW) magnetic resonance imaging (MRI) using a bi-exponential model in chemotherapy response evaluation in a gastric cancer mouse model.
METHODS Mice bearing MKN-45 human gastric adenocarcinoma xenografts were divided into four treated groups (TG1, 2, 3 and 4, n = 5 in each group) which received Fluorouracil and Calcium Folinate and a control group (CG, n = 7). DW-MRI scans with 14 b-values (0-1500 s/mm2) were performed before and after treatment on days 3, 7, 14 and 21. Fast diffusion component (presumably pseudo-perfusion) parameters including the fast diffusion coefficient (D*) and fraction volume (fp), slow diffusion coefficient (D) and the conventional apparent diffusion coefficients (ADC) were calculated by fitting the IVIM model to the measured DW signals. The median changes from the baseline to each post-treatment time point for each measurement (ΔADC, ΔD* and Δfp) were calculated. The differences in the median changes between the two groups were compared using the mixed linear regression model by the restricted maximum likelihood method shown as z values. Histopathological analyses including Ki-67, CD31, TUNEL and H&E were conducted in conjunction with the MRI scans. The median percentage changes were compared with the histopathological analyses between the pre- and post-treatment for each measurement.
RESULTS Compared with the control group, D* in the treated group decreased significantly (ΔD*treated% = -30%, -34% and -20%, with z = -5.40, -4.18 and -1.95. P = 0.0001, 0.0001 and 0.0244) and fp increased significantly (Δfptreated% = 93%, 113% and 181%, with z = 4.63, 5.52, and 2.12, P = 0.001, 0.0001 and 0.0336) on day 3, 7 and 14, respectively. Increases in ADC in the treated group were higher than those in the control group on days 3 and 14 (z = 2.44 and 2.40, P = 0.0147 and P = 0.0164).
CONCLUSION Fast diffusion measurements derived from the bi-exponential IVIM model may be more sensitive imaging biomarkers than ADC to assess chemotherapy response in gastric adenocarcinoma.
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Winfield JM, Orton MR, Collins DJ, Ind TEJ, Attygalle A, Hazell S, Morgan VA, deSouza NM. Separation of type and grade in cervical tumours using non-mono-exponential models of diffusion-weighted MRI. Eur Radiol 2017; 27:627-636. [PMID: 27221560 PMCID: PMC5209433 DOI: 10.1007/s00330-016-4417-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/15/2016] [Accepted: 05/13/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Assessment of empirical diffusion-weighted MRI (DW-MRI) models in cervical tumours to investigate whether fitted parameters distinguish between types and grades of tumours. METHODS Forty-two patients (24 squamous cell carcinomas, 14 well/moderately differentiated, 10 poorly differentiated; 15 adenocarcinomas, 13 well/moderately differentiated, two poorly differentiated; three rare types) were imaged at 3 T using nine b-values (0 to 800 s mm-2). Mono-exponential, stretched exponential, kurtosis, statistical, and bi-exponential models were fitted. Model preference was assessed using Bayesian Information Criterion analysis. Differences in fitted parameters between tumour types/grades and correlation between fitted parameters were assessed using two-way analysis of variance and Pearson's linear correlation coefficient, respectively. RESULTS Non-mono-exponential models were preferred by 83 % of tumours with bi-exponential and stretched exponential models preferred by the largest numbers of tumours. Apparent diffusion coefficient (ADC) and diffusion coefficients from non-mono-exponential models were significantly lower in poorly differentiated tumours than well/moderately differentiated tumours. α (stretched exponential), K (kurtosis), f and D* (bi-exponential) were significantly different between tumour types. Strong correlation was observed between ADC and diffusion coefficients from other models. CONCLUSIONS Non-mono-exponential models were preferred to the mono-exponential model in DW-MRI data from cervical tumours. Parameters of non-mono-exponential models showed significant differences between types and grades of tumours. KEY POINTS • Non-mono-exponential DW-MRI models are preferred in the majority of cervical tumours. • Poorly differentiated cervical tumours exhibit lower diffusion coefficients than well/moderately differentiated tumours. • Non-mono-exponential model parameters α, K, f, and D* differ between tumour types. • Micro-structural features are likely to affect parameters in non-mono-exponential models differently.
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Affiliation(s)
- Jessica M Winfield
- MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
| | - Matthew R Orton
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - David J Collins
- MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Thomas E J Ind
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Ayoma Attygalle
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Steve Hazell
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Veronica A Morgan
- MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Nandita M deSouza
- MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
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Zhu L, Zhu L, Wang H, Yan J, Liu B, Chen W, He J, Zhou Z, Yang X. Predicting and Early Monitoring Treatment Efficiency of Cervical Cancer Under Concurrent Chemoradiotherapy by Intravoxel Incoherent Motion Magnetic Resonance Imaging. J Comput Assist Tomogr 2017; 41:422-429. [PMID: 27824669 DOI: 10.1097/rct.0000000000000550] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to explore the potential of intravoxel incoherent motion magnetic resonance (MR) imaging in predicting and measuring responses to concurrent chemoradiotherapy (CCRT) in advanced cervical cancers. METHODS Thirty-seven patients with advanced cervical cancers scheduled for CCRT underwent MR examinations including intravoxel incoherent motion sequence with 9 b values (0-800 s/mm) before CCRT, 2 and 4 weeks after the initiation of CCRT, and immediately after CCRT. Apparent diffusion coefficient, f, D, and D* values were obtained during the course. The maximum diameter of the tumor was measured to determine the treatment efficiency. RESULTS At the end of CCRT, 25 patients were classified as complete response and 12 as partial response. The pretreatment f of cervical cancer showed its efficiency in predicting partial response and complete response with an area under receiver operating characteristic curve of 0.768. During CCRT, the apparent diffusion coefficient, D, and D* values kept on rising, whereas f increased first and then decreased after 4 weeks of CCRT. CONCLUSIONS Intravoxel incoherent motion MR imaging held great potential in both predicting and early monitoring treatment efficiency of advanced cervical cancer under CCRT.
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Affiliation(s)
- Li Zhu
- From the *Department of Radiology, Nanjing Drum Tower Hospital, and †The Comprehensive Cancer Centre of Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing; and ‡Philips Healthcare, Shanghai, China; and §Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA
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Pekçevik Y, Çukurova İ, Arslan İB. Apparent diffusion coefficient for discriminating metastatic lymph nodes in patients with squamous cell carcinoma of the head and neck. Diagn Interv Radiol 2016. [PMID: 26200481 DOI: 10.5152/dir.2015.14468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the apparent diffusion coefficient (ADC) values of metastatic lymph nodes in patients with squamous cell carcinoma (SCC) of the head and neck. METHODS Patients with metastatic lymph nodes underwent 1.5 Tesla diffusion-weighted magnetic resonance imaging (MRI). The ADC values of the histologically proven metastases were evaluated retrospectively and mean ADC values were compared using one-way analysis of variance test. Receiver operating characteristic analysis was performed to identify ADC threshold values. RESULTS We included 33 patients (27 males, 6 females; mean age, 60.7 years) with 53 metastatic lymph nodes in the study. Mean ADC values for nodal metastases of nasopharyngeal carcinoma (NPC) (n=7), oropharyngeal (n=12), laryngeal (n=27), and hypopharyngeal (n=7) carcinoma were (0.810±0.158)×10-3 mm2/s, (0.985±0.099)×10-3 mm2/s, (1.037±0.150)×10-3 mm2/s, and (0.948±0.081)×10-3 mm2/s, respectively. The mean ADC values of nodal metastases of NPC were significantly lower than ADC values of laryngeal carcinoma (LSCC) (P = 0.002). An ADC value less than 0.890×10-3 mm2/s was found to facilitate differentiation of NPC from LSCC with a sensitivity of 71% and specificity of 85% (area under the curve, 0.852). CONCLUSION The mean ADC values showed significant differences between nodal metastases of NPC and LSCC. Considering SCCs as a single group may affect the accuracy of ADC-based differentiation. Location of the primary tumor should be taken into account and cutoff values should be determined separately for each anatomical location.
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Affiliation(s)
- Yeliz Pekçevik
- Department of Radiology, Tepecik Training and Research Hospital, İzmir, Turkey.
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Freitag MT, Bickelhaupt S, Ziener C, Meier-Hein K, Radtke JP, Mosebach J, Kuder TA, Schlemmer HP, Laun FB. [Selected clinically established and scientific techniques of diffusion-weighted MRI. In the context of imaging in oncology]. Radiologe 2016; 56:137-47. [PMID: 26801187 DOI: 10.1007/s00117-015-0066-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that was established in the clinical routine primarily for the detection of brain ischemia. In the past 15 years its clinical use has been extended to oncological radiology, as tumor and metastases can be depicted in DWI due to their hypercellular nature. PRINCIPLES The basis of DWI is the Stejskal-Tanner experiment. The diffusion properties of tissue can be visualized after acquisition of at least two diffusion-weighted series using echo planar imaging and a specific sequence of gradient pulses. CLINICAL APPLICATIONS The use of DWI in prostate MRI was reported to be one of the first established applications that found its way into internationally recognized clinical guidelines of the European Society of Urological Radiology (ESUR) and the prostate imaging reporting and data system (PI-RADS) scale. Due to recently reported high specificity and negative predictive values of 94% and 92%, respectively, its regular use for breast MRI is expected in the near future. Furthermore, DWI can also reliably be used for whole-body imaging in patients with multiple myeloma or for measuring the extent of bone metastases. OUTLOOK New techniques in DWI, such as intravoxel incoherent motion imaging, diffusion kurtosis imaging and histogram-based analyses represent promising approaches to achieve a more quantitative evaluation for tumor detection and therapy response.
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Affiliation(s)
- M T Freitag
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.
| | - S Bickelhaupt
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - C Ziener
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - K Meier-Hein
- Abteilung für medizinische Informatik, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - J P Radtke
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.,Abteilung für Urologie, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - J Mosebach
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - T-A Kuder
- Abteilung für Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - H-P Schlemmer
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - F B Laun
- Abteilung für Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
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Pan F, Den J, Zhang C, Wang H, Cheng J, Wu W, Hong N, Wang Y. The Therapeutic Response of Gastrointestinal Stromal Tumors to Imatinib Treatment Assessed by Intravoxel Incoherent Motion Diffusion-Weighted Magnetic Resonance Imaging with Histopathological Correlation. PLoS One 2016; 11:e0167720. [PMID: 27911930 PMCID: PMC5135126 DOI: 10.1371/journal.pone.0167720] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023] Open
Abstract
Purpose To exploit the intravoxel incoherent motion (IVIM) diffusion-weighted (DW) MRI when evaluating the therapeutic response of gastrointestinal stromal tumors (GIST) to Imatinib in a mouse model. Materials and Methods Mice with xenografts bearing cells from the GIST-T1 cell line were randomly divided into a treated group receiving Imatinib and a control group. DWMRI scans with 14 b-values (0–1500 s/mm2) were performed before and after treatment (days 1, 3 and 7). IVIM related parameters perfusion fractions (fp) and perfusion-related diffusion coefficients (D*) and the conventional apparent diffusion coefficients (ADC) were calculated by fitting the DWMRI signal decay. The mean changes from baseline to each post-treatment time point for each measurement (ΔADC, Δfp and ΔD*) were calculated. The differences of mean changes between the two groups were tested for statistical significance. Histopathological analyses including Ki-67, CD31, TUNEL and H&E were conducted in conjunction with the MRI scans. Results Increases in ADC of the treated group were higher than those of the control group after treatment, whereas statistical significances were not observed. Compared to the control group, D* in the treated group decreased significantly (ΔD*treated = -41%, -49%, and -49% with P = 0.0001, 0.0001 and 0.0001), and fp increased significantly (Δfptreated = 79%, 82% and 110%, with P = 0.001, 0.0001 and P = 0.0007) on days 1, 3 and 7 after treatment. Histopathological analyses demonstrated different tumor tissue characteristics between the treated and control groups. Conclusion IVIM measurements may serve as more sensitive imaging biomarkers than ADC when assessing GIST response to Imatinib as early as one day after treatment.
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Affiliation(s)
- Feng Pan
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
| | - Jie Den
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Chunfang Zhang
- People’s Hospital, Peking University, Clinical Epidemiology and Medical Statistics, Beijing, China
| | - He Wang
- GE Healthcare, Shanghai, China
| | - Jin Cheng
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
| | - Weizhen Wu
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
| | - Nan Hong
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
| | - Yi Wang
- Department of Radiology, People’s Hospital, Peking University, Beijing, China
- * E-mail:
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Lin M, Tian MM, Zhang WP, Xu L, Jin P. Predictive values of diffusion-weighted imaging and perfusion-weighted imaging in evaluating the efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma. Onco Targets Ther 2016; 9:7029-7037. [PMID: 27895495 PMCID: PMC5117880 DOI: 10.2147/ott.s112555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study explored the predictive values of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in evaluating the efficacy of transcatheter arterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC). A total of 118 HCC patients treated with TACE were selected from April 2013 to November 2015. T1-weighted imaging (T1WI)/T2-weighted imaging (T2WI), DWI, and PWI were performed on all patients before and after TACE. Efficacy was evaluated according to modified Response Evaluation Criteria in Solid Tumors 1.1. Receiver operating characteristic curve was used to evaluate the diagnostic power of quantitative DWI and PWI parameters in evaluating the efficacy of TACE for HCC patients. Among the 118 HCC patients, there were 17 cases (14.4%) with complete response, 50 cases (42.4%) with partial response, 28 cases (23.7%) with stable disease, and 23 cases (19.5%) with progressive disease. There were 67 patients in the effective group (complete response + partial response) and 51 patients in the ineffective group (stable disease + progressive disease). Before TACE, there were significant differences in maximum tumor diameter (MTD), apparent diffusion coefficient (ADC), slow ADC (Dslow), fast ADC (Dfast), transfer constant of vessel at the maximum level (Ktrans), and rate constant of backflux (Kep) between the effective and ineffective groups (all P<0.05). After TACE, the effective group exhibited lower MTD, Dfast, and Kep and higher ADC and Dslow than the ineffective group (all P<0.05). Tumor regression rate negatively correlated with MTD, Ktrans, Kep, and Dfast but positively correlated with ADC and Dslow. Receiver operating characteristic curve analysis suggested that the area under the curve of ADC, Dslow, Dfast, Ktrans, and Kep were 0.869, 0.833, 0.812, 0.802, and 0.809, respectively. In conclusion, these results suggest that quantitative DWI and PWI parameters might be useful in evaluating the efficacy of TACE in the treatment of HCC patients.
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Affiliation(s)
| | | | - Wei-Ping Zhang
- Department of Oncology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
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Kang KM, Choi SH, Kim DE, Yun TJ, Kim JH, Sohn CH, Park SW. Application of Cardiac Gating to Improve the Reproducibility of Intravoxel Incoherent Motion Measurements in the Head and Neck. Magn Reson Med Sci 2016; 16:190-202. [PMID: 27818467 PMCID: PMC5600025 DOI: 10.2463/mrms.mp.2016-0051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: To prospectively evaluate whether cardiac gating can improve the reproducibility of intravoxel incoherent motion (IVIM) parameters in the head and neck, we performed IVIM diffusion-weighted imaging (DWI) using 4 b values (4b), 4 b values with cardiac gating (4b gating) and 17 b values (17b). Methods: We performed IVIM DWI twice per person on nine healthy volunteers using 4b, 4b gating and 17b and five patients with head and neck masses using 4b gating and 17b. The ADC, perfusion fraction (f), diffusion coefficient (D) and perfusion-related diffusion coefficient (D*) were calculated in the brain, masticator muscle, parotid gland, submandibular gland, tonsil and masses. Intraclass coefficient (ICC), Bland-Altman analysis (BAA) and coefficient of variation (CV) were used to assess short-term test-retest reproducibility. Kruskal-Wallis test and Mann-Whitney test were used to investigate whether 4b, 4b gating or 17b had significant influences on the parameters. Results: For normal tissues and masses, ICC was excellent for all maps except the D* map. All parameters showed the lowest CV in the 4b gating. BAA also revealed the narrowest 95% limits of agreement using 4b gating for all parameters. In the subgroup analysis, almost all parameters in brain, muscle, parotid gland and submandibular gland showed the best reproducibility using 4b gating. In the muscle, parotid gland and submandibular gland, the values of ADC, f and D were not significantly different between among the three methods. Conclusion: 4b gating was more reproducible with respect to measurements of IVIM parameters in comparison with 4b or 17b.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology, Seoul National University Hospital.,Department of Radiology, Seoul National University College of Medicine
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital.,School of Chemical and Biological Engineering, Seoul National University
| | | | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital.,Department of Radiology, Seoul National University College of Medicine
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital.,Department of Radiology, Seoul National University College of Medicine
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital.,Center for Nanoparticle Research, Institute for Basic Science (IBS)
| | - Sun-Won Park
- Department of Radiology, Seoul National University Boramae Hospital
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Hou J, Yu X, Hu Y, Li F, Xiang W, Wang L, Wang H, Lu Q, Zhang Z, Zeng W. Value of intravoxel incoherent motion and dynamic contrast-enhanced MRI for predicting the early and short-term responses to chemoradiotherapy in nasopharyngeal carcinoma. Medicine (Baltimore) 2016; 95:e4320. [PMID: 27583847 PMCID: PMC5008531 DOI: 10.1097/md.0000000000004320] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of the study was to investigate the value of intravoxel incoherent motion diffusion-weighted magnetic resonance imaging (IVIM-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the early and short-term responses to chemoradiotherapy (CRT) in patients with nasopharyngeal carcinoma (NPC).Forty-three NPC patients underwent IVIM-DWI and DCE-MRI at baseline (pretreatment) and after the first cycle of induction chemotherapy (posttreatment). Based on whether locoregional lesions were identified, patients were divided into the residual and nonresidual groups at the end of CRT and into the good-responder and poor-responder groups 6 months after the end of CRT. The pretreatment and posttreatment IVIM-DWI parameters (ADC, D, D*, and f) and DCE-MRI parameters (K, Kep, and Ve) values and their percentage changes (Δ%) were compared between the residual and nonresidual groups and between the good-responder and poor-responder groups.None of perfusion-related parametric values derived from either DCE-MRI or IVIM-DWI showed significant differences either between the residual and nonresidual groups or between the good-responder and poor-responder groups. The nonresidual group exhibited lower pre-ADC, lower pre-D, and higher Δ%D values than did the residual group (all P <0.05). The good-responder group had lower pre-D and pre-ADC values than did the poor-responder group (both P <0.05). Based on receiver operating characteristic (ROC) curve analysis, pre-D had the highest area under the curve in predicting both the early and short-term responses to CRT for NPC patients (0.817 and 0.854, respectively).IVIM-DWI is more valuable than DCE-MRI in predicting the early and short-term response to CRT for NPC, and furthermore diffusion-related IVIM-DWI parameters (pre-ADC, pre-D, and Δ%D) are more powerful than perfusion-related parameters derived from both IVIM-DWI and DCE-MRI.
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Affiliation(s)
- Jing Hou
- School of Pharmaceutical Sciences, Central South University
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
| | - Xiaoping Yu
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
- Hunan Provincial Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, Changsha, Hunan
- Correspondence: Xiaoping Yu, 283 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, People's Republic of China (e-mail: ); Wenbin Zeng, 172 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, People's Republic of China (e-mail: )
| | - Yin Hu
- Hunan Provincial Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, Changsha, Hunan
| | - Feiping Li
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
| | - Wang Xiang
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
| | - Lanlan Wang
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
| | - Hui Wang
- Hunan Provincial Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, Changsha, Hunan
| | - Qiang Lu
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
| | | | - Wenbin Zeng
- School of Pharmaceutical Sciences, Central South University
- Correspondence: Xiaoping Yu, 283 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, People's Republic of China (e-mail: ); Wenbin Zeng, 172 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, People's Republic of China (e-mail: )
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The Role of Intravoxel Incoherent Motion MRI in Predicting Early Treatment Response to Chemoradiation for Metastatic Lymph Nodes in Nasopharyngeal Carcinoma. Adv Ther 2016; 33:1158-68. [PMID: 27294489 DOI: 10.1007/s12325-016-0352-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pilot studies have suggested potential clinical applications for intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in head and neck cancers. This study aimed to characterize metastatic lymph nodes using IVIM MRI, and to evaluate the role of IVIM MRI in the prediction of the early treatment response of lymph node metastasis from nasopharyngeal carcinoma (NPC). METHODS A total of 122 patients with metastatic lymph nodes from NPC underwent two MRI examinations, pre-treatment and post-treatment (at 4 weeks and at ≥2 years from the end of chemoradiotherapy). Treatment response was assessed using the Response Evaluation Criteria in Solid Tumors version 1.1. Differences in the initial IVIM parameters [pure molecular diffusion (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f)] between nodes with a partial response (PR) and a complete response (CR) were analyzed in 102 patients after the exclusion of 20. RESULTS The initial D*, D, and apparent diffusion coefficient (ADC) did not reveal a significant difference between nodes showing a PR or a CR. The mean initial f value was significantly higher in patients with a PR relative to patients with a CR (p = 0.003), and its sensitivity and specificity in predicting treatment response to chemoradiotherapy were 86.7% and 100%, respectively. CONCLUSIONS The present study indicated that the initial f value may be more accurate than the initial D*, D, and ADC in the early prediction of treatment response to chemoradiotherapy for metastatic lymph nodes in patients with NPC.
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Fujima N, Yoshida D, Sakashita T, Homma A, Tsukahara A, Shimizu Y, Tha KK, Kudo K, Shirato H. Prediction of the treatment outcome using intravoxel incoherent motion and diffusional kurtosis imaging in nasal or sinonasal squamous cell carcinoma patients. Eur Radiol 2016; 27:956-965. [DOI: 10.1007/s00330-016-4440-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/10/2016] [Accepted: 05/23/2016] [Indexed: 12/11/2022]
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Yang K, Zhang XM, Yang L, Xu H, Peng J. Advanced imaging techniques in the therapeutic response of transarterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol 2016; 22:4835-4847. [PMID: 27239110 PMCID: PMC4873876 DOI: 10.3748/wjg.v22.i20.4835] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/29/2016] [Accepted: 04/20/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity and mortality in patients with chronic liver disease. Transarterial chemoembolization (TACE) can significantly improve the survival rate of patients with HCC and is the first treatment choice for patients who are not suitable for surgical resections. The evaluation of the response to TACE treatment affects not only the assessment of the therapy efficacy but also the development of the next step in the treatment plan. The use of imaging to examine changes in tumor volume to assess the response of solid tumors to treatment has been controversial. In recent years, the emergence of new imaging technology has made it possible to observe the response of tumors to treatment prior to any morphological changes. In this article, the advances in studies reporting the use of computed tomography perfusion imaging, diffusion-weighted magnetic resonance imaging (MRI), intravoxel incoherent motion, diffusion kurtosis imaging, magnetic resonance spectroscopy, magnetic resonance perfusion-weighted imaging, blood oxygen level-dependent MRI, positron emission tomography (PET)/computed tomography and PET/MRI to assess the TACE treatment response are reviewed.
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Yan C, Xu J, Xiong W, Wei Q, Feng R, Wu Y, Liu Q, Li C, Chan Q, Xu Y. Use of intravoxel incoherent motion diffusion-weighted MR imaging for assessment of treatment response to invasive fungal infection in the lung. Eur Radiol 2016; 27:212-221. [PMID: 27180185 DOI: 10.1007/s00330-016-4380-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 03/16/2016] [Accepted: 04/22/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether intravoxel incoherent motion (IVIM) -derived parameters and apparent diffusion coefficient (ADC) could act as imaging biomarkers for predicting antifungal treatment response. METHODS Forty-six consecutive patients (mean age, 33.9 ± 13.0 y) with newly diagnosed invasive fungal infection (IFI) in the lung according to EORTC/MSG criteria were prospectively enrolled. All patients underwent diffusion-weighted magnetic resonance (MR) imaging at 3.0 T using 11 b values (0-1000 sec/mm2). ADC, pseudodiffusion coffiecient D*, perfusion fraction f, and the diffusion coefficient D were compared between patients with favourable (n=32) and unfavourable response (n=14). RESULTS f values were significantly lower in the unfavourable response group (12.6%±4.4%) than in the favourable response group (30.2%±8.6%) (Z=4.989, P<0.001). However, the ADC, D, and D* were not significantly different between the two groups (P>0.05). Receiver operating characteristic curve analyses showed f to be a significant predictor for differentiation, with a sensitivity of 93.8% and a specificity of 92.9%. CONCLUSIONS IVIM-MRI is potentially useful in the prediction of antifungal treatment response to patients with IFI in the lung. Our results indicate that a low perfusion fraction f may be a noninvasive imaging biomarker for unfavourable response. KEY POINTS • Recognition of IFI indicating clinical outcome is important for treatment decision-making. • IVIM can reflect diffusion and perfusion information of IFI lesions separately. • Perfusion characteristics of IFI lesions could help differentiate treatment response. • An initial low f may predict unfavourable response in IFI.
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Affiliation(s)
- Chenggong Yan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Jun Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Wei Xiong
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Qi Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Ru Feng
- Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Yuankui Wu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Caixia Li
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Queenie Chan
- Philips Healthcare, Science Park East Avenue, Hong Kong Science Park, New Territories, Hong Kong
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China.
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Orton MR, Messiou C, Collins D, Morgan VA, Tessier J, Young H, deSouza N, Leach MO. Diffusion-weighted MR imaging of metastatic abdominal and pelvic tumours is sensitive to early changes induced by a VEGF inhibitor using alternative diffusion attenuation models. Eur Radiol 2016; 26:1412-9. [PMID: 26253255 PMCID: PMC4820470 DOI: 10.1007/s00330-015-3933-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/16/2015] [Accepted: 07/20/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To assess the utility of diffusion weighted imaging for monitoring early treatment effects associated with a VEGF inhibitor. MATERIALS AND METHODS Twenty-nine patients with metastatic abdominal and pelvic tumours were recruited and imaged with DW-MRI: twice at baseline, and after 7 and 28 days of treatment with cediranib. Tumour measures were derived using mono-exponential, bi-exponential and stretched-exponential models, and parameter repeatability and treatment effects seen after 7 and 28 days were assessed. Correlations with volume changes and DCE-MRI metrics were also assessed. RESULTS Diffusion coefficient repeatabilities from all models were < 6%; f and D* (bi-exponential) were 22% and 44%; α (stretched-exponential) was 4.2%. Significant increases in the diffusion coefficients from all models were observed at day 28 but not day 7. Significant decreases in D* and f.D* were observed at day 7 and in f at day 28; significant increases in α were observed at both time-points. Weak correlations between DW-MRI changes and volume changes and DCE-MRI changes were observed. CONCLUSION DW-MRI is sensitive to early and late treatment changes caused by a VEGF inhibitor using non-mono-exponential models. Evidence of over-fitting using the bi-exponential model suggests that the stretched-exponential model is best suited to monitor such changes. KEY POINTS • Non-mono-exponential diffusion models widen sensitivity to a broader class of tissue properties. • A stretched-exponential model robustly detects changes after 7 days of VEGF-inhibitor treatment. • There are very weak correlations between DWI-IVIM perfusion and similar DCE-MRI measures. • Diffusion-weighted MRI is a highly informative technique for assessing novel tumour therapies.
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Affiliation(s)
- Matthew R Orton
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
- Institute of Cancer Research, 15 Cotswold Road, Belmont, Sutton, Surrey, SM2 5MG, UK.
| | - Christina Messiou
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - David Collins
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Veronica A Morgan
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Jean Tessier
- Early Clinical Development, AstraZeneca, Macclesfield, UK
| | - Helen Young
- Early Clinical Development, AstraZeneca, Macclesfield, UK
| | - Nandita deSouza
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Martin O Leach
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
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Guo W, Luo D, Lin M, Wu B, Li L, Zhao Y, Yang L, Zhou C. Pretreatment Intra-Voxel Incoherent Motion Diffusion-Weighted Imaging (IVIM-DWI) in Predicting Induction Chemotherapy Response in Locally Advanced Hypopharyngeal Carcinoma. Medicine (Baltimore) 2016; 95:e3039. [PMID: 26962824 PMCID: PMC4998905 DOI: 10.1097/md.0000000000003039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to predict response to induction chemotherapy in patients with locally advanced hypopharyngeal carcinoma by IVIM values.Twenty-eight patients with locally advanced hypopharyngeal carcinoma underwent IVIM studies using 12 different b values (b = 0, 10, 20, 30, 50, 70 100, 150, 200, 400, 800, and 1000 s/ mm). All patients underwent 2 MRI studies: a baseline exam before any treatment and a mid-treatment exam 3 weeks after induction chemotherapy. In the IVIM approach, D, f, and D were extracted from a bi-exponential fit. For comparison, the ADC map were extracted from a mono-exponential fit. At the end of induction chemotherapy, patients were classified as responders or nonresponders group according to the Response Evaluation Criteria in Solid Tumors criteria (RECIST), based on their MRI measurement. The patients were classified into high grade group (G1), moderate grade group (G2), and low grade group (G3) according to the tumor pathological grading. The predictive value of IVIM parameters were examined with Student's t test, analysis of variance (ANOVA), and receiver operating characteristic (ROC) curves.After 2 cycles of induction chemotherapy, 18 patients were categorized into the responder group whereas the other 10 patients were considered nonresponders. Compared with the pretreatment value, the post-treatment ADC value and D value was significantly higher and the posttreatment D value was significantly lower (all P < 0.05). In contrast, post-treatment f parameter only changed slightly (P > 0.05). Compared with nonresponders, a notably lower pretreatment ADC value, D value, posttreatment D value, and higher posttreatment ADC value, D value, ΔADC, ΔD, and ΔD were observed in responders (all P < 0.05), but no significant change in Δ f among the 2 group (P > 0.05). The ROC curve analysis indicated that the cutoff of pretreatment D value in best predicting tumor's chemotherapeutic response was 0.847 × 10 mm/s, and the corresponding AUC, sensitivity, and specificity were 0.806, 75.0%, and 88.9%, respectively. Although pretreatment IVIM-derived parameters had no significant differences between high grade, moderate grade, and low grade group, a trend towards lower D was observed with increasing tumor grading from G3 to G1.IVIM-DWI can potentially predict the treatment response to induction chemotherapy for hypopharyngeal carcinoma.
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Affiliation(s)
- Wei Guo
- From the Department of Diagnostic Radiology, Peking Union Medical College, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China
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Zhu L, Zhu L, Shi H, Wang H, Yan J, Liu B, Chen W, He J, Zhou Z, Yang X, Liu T. Evaluating early response of cervical cancer under concurrent chemo-radiotherapy by intravoxel incoherent motion MR imaging. BMC Cancer 2016; 16:79. [PMID: 26860361 PMCID: PMC4748551 DOI: 10.1186/s12885-016-2116-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/03/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Intravoxel incoherent motion (IVIM) MR imaging has been applied in researches of various diseases, however its potential in cervical cancer patients has not been fully explored. The purpose of this study was to investigate the feasibility of IVIM MR imaging to monitor early treatment response in patients receiving concurrent chemo-radiotherapy (CCRT) for advanced cervical cancers. METHODS Twenty-one patients receiving CCRT for advanced cervical cancer were prospectively enrolled. MR examinations including IVIM imaging (with 14 b values, 0 ~ 1000 s/mm(2)) were performed at 4 time points: 1-week prior to, 2-week and 4-week during, as well as immediately post CCRT (within 1 week). The apparent diffusion coefficient (ADC) maps were derived from the mono-exponential model, while the diffusion coefficient (D), perfusion fraction (f) and pseudo-diffusion coefficient (D*) maps were calculated from the bi-exponential model. Dynamic changes of ADC, D, f and D* in cervical cancers were investigated as early surrogate markers for treatment response. RESULTS ADC and D values increased throughout the CCRT course. Both f and D* increased in the first 2 to 3 weeks of CCRT and started to decrease around 4 weeks of CCRT. Significant increase of f value was observed from prior to CCRT (f 1 = 0.12 ± 0.52) to two-week during CCRT (f2 = 0.20 ± 0.90, p = 0.002). CONCLUSIONS IVIM MR imaging has the potential in monitoring early tumor response induced by CCRT in patients with cervical cancers.
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Affiliation(s)
- Li Zhu
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Lijing Zhu
- The Comprehensive Cancer Centre of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Hua Shi
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Huanhuan Wang
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Jing Yan
- The Comprehensive Cancer Centre of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Baorui Liu
- The Comprehensive Cancer Centre of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | | | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA.
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA.
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