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Zhou J, Zhou Y, Qian S, Li X, Lin H, Dong J, Zhou X. Computed Tomography Perfusion Combined With Preoperative Embolization for Reducing Intraoperative Blood Loss in Separation Surgery for Thoracolumbar Metastases. Spine (Phila Pa 1976) 2024; 49:E183-E190. [PMID: 37477335 DOI: 10.1097/brs.0000000000004780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/02/2023] [Indexed: 07/22/2023]
Abstract
STUDY DESIGN A prospective consecutive case study. OBJECTIVE This study aimed to assess the accuracy of computed tomography perfusion (CTP) in evaluating the vascularity of thoracolumbar metastases and to determine the impact of combining CTP with preoperative embolization on reducing intraoperative blood loss during separation surgery. SUMMARY OF BACKGROUND DATA Surgery for thoracolumbar metastases is a complex procedure with the potential for substantial blood loss. Therefore, assessing tumor vascularity before surgery and taking measures to minimize intraoperative blood loss is essential. METHODS A total of 62 patients with thoracolumbar metastases were prospectively enrolled. All patients underwent separation surgery using the posterior approach. Before surgery, the vascularity of the metastases was evaluated using CTP. On the basis of the CTP results, patients were categorized into hypervascular and hypovascular groups. Preoperative angiography and embolization were performed for the hypervascular group. Clinical data were abstracted, including intraoperative blood loss, perioperative complications, visual analog scale score, neurological status, and the accuracy of vascularity evaluation by CTP confirmed by angiography. χ 2 testing was used to compare categorical variables, whereas independent sample t tests were used to compare continuous variables, with paired t tests used to assess differences from preoperative to postoperative time points. RESULTS The mean intraoperative blood loss was 485±167 and 455±127.6 mL in the two groups, respectively. The accuracy of vascularity evaluation by CTP was 100%. In the hypervascular group, 80.6% of the patients experienced at least one level of improvement in neurological status, while the hypovascular group had 81.5% of patients with similar improvement. None of the patients experienced neurological deterioration. There was a significant reduction in visual analog scale scores in both groups after the operation. CONCLUSIONS The vascularity of thoracolumbar metastases could be accurately evaluated using noninvasive CTP. When combined with preoperative embolization, this approach effectively and safely reduced intraoperative blood loss in the setting of separation surgery.
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Affiliation(s)
- Jian Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Zhou
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sheng Qian
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xilei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaogang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Ferda J, Frölich M, Ferdová E, Heidenreich F, Charvát R, Mírka H. Neovascularization, vascular mimicry and molecular exchange: The imaging of tumorous tissue aggressiveness based on tissue perfusion. Eur J Radiol 2023; 163:110797. [PMID: 37018901 DOI: 10.1016/j.ejrad.2023.110797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
Angiogenesis in healthy tissue and within malignant tumors differs on many levels, which may partly be explained by vascular mimicry formation resulting in altered contrast material or different radiopharmaceuticals distributions. Failed remodulation results in changes in the molecular exchange through the capillary wall and those consequences affect the behavior of contrast agents and radiopharmaceuticals. One of the most indicative signs of malignant tissue is the increased permeability and the faster molecular exchange that occurs between the extracellular and intravascular spaces. Dynamic imaging can help to assess the changed microenvironment. The fast-distribution of molecules reflects newly developed conditions in blood-flow redistribution inside a tumor and within the affected organ during the early stages of tumor formation. Tumor development, as well as aggressiveness, can be assessed based on the change to the vascular bed development, the level of molecular exchange within the tissue, and/or indicative distribution within the organ. The study of the vascular network organization and its impact on the distribution of molecules is important to our understanding of the image pattern in several imaging methods, which in turn influences our interpretation of the findings. A hybrid imaging approach (including PET/MRI) allows the quantification of vascularization and/or its pathophysiological impressions in structural and metabolic images. It might optimize the evaluation of the pretreatment imaging, as well as help assess the effect of therapy targeting neovascularization; antiVEGF drugs and embolization-based therapies, for example.
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Affiliation(s)
- Jiří Ferda
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic.
| | - Matthias Frölich
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic; Klinik für Radiologie und Nuklearmedizin, Universitäts Klinikum Mannheim
| | - Eva Ferdová
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic
| | - Filip Heidenreich
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic
| | - Radim Charvát
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic
| | - Hynek Mírka
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic
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Löhr CV, Stieger-Vanegas SM, Terry JL, Milovancev M, Medlock J. Targeting Peritumoral Lesions Identified by Computed Tomography and Magnetic Resonance Imaging in Feline Injection-Site Sarcomas for Microscopic Examination. Vet Pathol 2021; 58:923-934. [PMID: 33969752 DOI: 10.1177/03009858211012949] [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: 11/16/2022]
Abstract
Peritumoral lesions identified during in vivo imaging of feline injection-site sarcoma (FISS) are frequently interpreted as neoplastic. We recently showed that most peritumoral imaging-identified lesions (PTIILs) in FISS are non-neoplastic. In this article, we describe a protocol to target PTIIL for microscopic examination and report on the protocol's performance. Ten client-owned cats with FISS were prospectively enrolled. A fiducial marker sutured onto the skin, centered on the palpable mass, served as reference point throughout the study. Each FISS and surrounding tissue was imaged in vivo by dual phase computed tomography angiography and multiple magnetic resonance imaging pulse sequences and each PTIIL documented. Subgross measurements obtained during trimming aided localization and identification of PTIIL during microscopy. Histologic findings were categorized by descending clinical relevance: neoplastic, equivocal, non-neoplastic, within normal limits (WNL). Based on in vivo imaging resolution limits, histologic findings were ≥3 mm in at least one dimension and ≥3 mm apart. Surgical margins served as control tissue for PTIILs. Eighty-one of 87 PTIIL were examined histologically; 13 were neoplastic, 16 equivocal, and 28 non-neoplastic; 24 had no identified histologic correlate. Two neoplastic and 10 equivocal findings were located outside of PTIILs but none of them were located in sections of surgical margins. Computation of a simple confusion matrix yielded fair sensitivity (70.4%) and low specificity (59.7%) for prediction of PTIIL by histologic findings. After combining instances of normal microanatomy with non-neoplastic histologic findings, specificity increased (85.1%) and sensitivity decreased (35.8%). The protocol is a blueprint for targeting PTIIL for microscopic examination but may benefit from further refinement.
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Affiliation(s)
| | | | - Jesse L Terry
- 2694Oregon State University, Corvallis, OR, USA.,Dr Terry is now at MedVet Northern Utah, Sunset, UT, USA
| | | | - Jan Medlock
- 2694Oregon State University, Corvallis, OR, USA
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Kumar P, Kumar V. Role of NMR Metabolomics and MR Imaging in Colon Cancer. COLON CANCER DIAGNOSIS AND THERAPY 2021:43-66. [DOI: 10.1007/978-3-030-63369-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Kim B, Kim HK, Kim J, Ki Y, Joo JH, Jeon H, Park D, Kim W, Nam J, Kim DH. Adaptive Image Rescaling for Weakly Contrast-Enhanced Lesions in Dedicated Breast CT: A Phantom Study. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1477-1492. [PMID: 36238889 PMCID: PMC9431963 DOI: 10.3348/jksr.2020.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/31/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
Purpose Dedicated breast CT is an emerging volumetric X-ray imaging modality for diagnosis that does not require any painful breast compression. To improve the detection rate of weakly enhanced lesions, an adaptive image rescaling (AIR) technique was proposed. Materials and Methods Two disks containing five identical holes and five holes of different diameters were scanned using 60/100 kVp to obtain single-energy CT (SECT), dual-energy CT (DECT), and AIR images. A piece of pork was also scanned as a subclinical trial. The image quality was evaluated using image contrast and contrast-to-noise ratio (CNR). The difference of imaging performances was confirmed using student's t test. Results Total mean image contrast of AIR (0.70) reached 74.5% of that of DECT (0.94) and was higher than that of SECT (0.22) by 318.2%. Total mean CNR of AIR (5.08) was 35.5% of that of SECT (14.30) and was higher than that of DECT (2.28) by 222.8%. A similar trend was observed in the subclinical study. Conclusion The results demonstrated superior image contrast of AIR over SECT, and its higher overall image quality compared to DECT with half the exposure. Therefore, AIR seems to have the potential to improve the detectability of lesions with dedicated breast CT.
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Affiliation(s)
- Bitbyeol Kim
- School of Mechanical Engineering and the Center for Advanced Medical Engineering Research, Pusan National University, Busan, Korea
| | - Ho Kyung Kim
- School of Mechanical Engineering and the Center for Advanced Medical Engineering Research, Pusan National University, Busan, Korea
| | - Jinsung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yongkan Ki
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Hyeon Joo
- Department of Radiation Oncology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hosang Jeon
- Department of Radiation Oncology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dahl Park
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
| | - Wontaek Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
| | - Jiho Nam
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
| | - Dong Hyeon Kim
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
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Franklin JM, Irving B, Papiez BW, Kallehauge JF, Wang LM, Goldin RD, Harris AL, Anderson EM, Schnabel JA, Chappell MA, Brady M, Sharma RA, Gleeson FV. Tumour subregion analysis of colorectal liver metastases using semi-automated clustering based on DCE-MRI: Comparison with histological subregions and impact on pharmacokinetic parameter analysis. Eur J Radiol 2020; 126:108934. [PMID: 32217426 DOI: 10.1016/j.ejrad.2020.108934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/21/2020] [Accepted: 03/01/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To use a novel segmentation methodology based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to define tumour subregions of liver metastases from colorectal cancer (CRC), to compare these with histology, and to use these to compare extracted pharmacokinetic (PK) parameters between tumour subregions. MATERIALS AND METHODS This ethically-approved prospective study recruited patients with CRC and ≥1 hepatic metastases scheduled for hepatic resection. Patients underwent DCE-MRI pre-metastasectomy. Histological sections of resection specimens were spatially matched to DCE-MRI acquisitions and used to define histological subregions of viable and non-viable tumour. A semi-automated voxel-wise image segmentation algorithm based on the DCE-MRI contrast-uptake curves was used to define imaging subregions of viable and non-viable tumour. Overlap of histologically-defined and imaging subregions was compared using the Dice similarity coefficient (DSC). DCE-MRI PK parameters were compared for the whole tumour and histology-defined and imaging-derived subregions. RESULTS Fourteen patients were included in the analysis. Direct histological comparison with imaging was possible in nine patients. Mean DSC for viable tumour subregions defined by imaging and histology was 0.738 (range 0.540-0.930). There were significant differences between Ktrans and kep for viable and non-viable subregions (p < 0.001) and between whole lesions and viable subregions (p < 0.001). CONCLUSION We demonstrate good concordance of viable tumour segmentation based on pre-operative DCE-MRI with a post-operative histological gold-standard. This can be used to extract viable tumour-specific values from quantitative image analysis, and could improve treatment response assessment in clinical practice.
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Affiliation(s)
- James M Franklin
- Institute of Medical Imaging and Visualisation, Bournemouth University, UK; Radiology Department, Royal Bournemouth and Christchurch Hospitals NS Foundation Trust, UK.
| | - Benjamin Irving
- Institute of Biomedical Engineering (Department of Engineering Science), University of Oxford, UK
| | - Bartlomiej W Papiez
- Institute of Biomedical Engineering (Department of Engineering Science), University of Oxford, UK
| | - Jesper F Kallehauge
- Institute of Biomedical Engineering (Department of Engineering Science), University of Oxford, UK
| | - Lai Mun Wang
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, UK
| | | | | | - Ewan M Anderson
- Radiology Department, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Julia A Schnabel
- Institute of Biomedical Engineering (Department of Engineering Science), University of Oxford, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Michael A Chappell
- Institute of Biomedical Engineering (Department of Engineering Science), University of Oxford, UK
| | | | - Ricky A Sharma
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK
| | - Fergus V Gleeson
- Radiology Department, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
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Ippolito D, Pecorelli A, Querques G, Drago SG, Maino C, Franzesi CT, Hatzidakis A, Sironi S. Dynamic Computed Tomography Perfusion Imaging: Complementary Diagnostic Tool in Hepatocellular Carcinoma Assessment From Diagnosis to Treatment Follow-up. Acad Radiol 2019; 26:1675-1685. [PMID: 30852079 DOI: 10.1016/j.acra.2019.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 02/05/2023]
Abstract
Early diagnosis of HCC is of paramount importance in order to enable the application of curative treatments. Among these, radiofrequency ablation (RFA) is actually considered the most effective ablative therapy for early stage hepatocellular carcinoma (HCC) not suitable for surgery. On the other hand, transarterial chemoembolization (TACE) represents the standard of care for intermediate stage HCC and compensated liver function. Finally, sorafenib, an oral antiangiogenic targeted drug, is the only approved systemic therapy for advanced HCC with vascular invasion, extrahepatic spread, and well-preserved liver function. Beside traditional radiological techniques, new functional imaging tools have been introduced in order to provide not only morphological information but also quantitative functional data. In this review, we analyze perfusion-CT (pCT) from a technical point of view, describing the main different mathematical analytical models for the quantification of tissue perfusion from acquired CT raw data, the most commonly acquired perfusion parameters, and the technical parameters required to perform a standard pCT examination. Moreover, a systematic review of the literature was performed to assess the role of pCT as an emerging imaging biomarker for HCC diagnosis, response evaluation to RFA, TACE, and sorafenib, and we examine its challenges in HCC management.
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Affiliation(s)
- Davide Ippolito
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Anna Pecorelli
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy.
| | - Giulia Querques
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Silvia Girolama Drago
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Cesare Maino
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Cammillo Talei Franzesi
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Adam Hatzidakis
- Department of Medical Imaging, University Hospital of Heraklion, Greece
| | - Sandro Sironi
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Caballo M, Mann R, Sechopoulos I. Patient-based 4D digital breast phantom for perfusion contrast-enhanced breast CT imaging. Med Phys 2018; 45:4448-4460. [PMID: 30151857 PMCID: PMC6181787 DOI: 10.1002/mp.13156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/17/2018] [Accepted: 08/19/2018] [Indexed: 11/06/2022] Open
Abstract
Purpose The purpose of this study was to develop a realistic patient‐based 4D digital breast phantom including time‐varying contrast enhancement for simulation of dedicated breast CT perfusion imaging. Methods A 3D static phantom is first created by segmenting a breast CT image from a healthy patient into skin, fibroglandular tissue, adipose tissue, and vasculature. For the creation of abnormal cases, a breast lesion model was developed and can be added to the phantom. After defining the necessary perfusion parameters for each tissue (e.g., arterial input function for vasculature, blood volume and blood flow for the other normal tissues) based on contrast‐enhanced dynamic breast MRI data, the corresponding time‐enhancement curves are computed for each voxel in the phantom, according to tissue type. These curves are calculated by convolution between the arterial input function and a shifted exponential function. This exponential depends on the perfusion parameters associated with each tissue voxel, and, to incorporate normal biological variability, a uniform random distribution is used to vary the perfusion parameters on a voxel‐basis. Finally, a 4D array is produced by sampling the continuous time‐enhancement curves at the desired sampling rate. Beside modeling different enhancement dynamics according to the given input perfusion parameters, the phantom also includes the possibility to realistically simulate different spatial enhancement patterns for the breast parenchyma, taking into account the arterial sources supplying the breast. Finally, different patterns of contrast medium uptake can also be simulated for the tumor models (homogeneous and rim enhancement). Results As an example, a typical 4D phantom has dimensions of 426 × 421 × 260 × 559 (x, y, z, t), with a voxel size of 273 μm and a sampling time of 1 s. The characteristics of the tumor model can be modified at will to evaluate perfusion in different types of breast lesions. Results show the expected enhancement of tissues, consistent with the given input parameters. Moreover, the tumor models evaluated in this work show different enhancement dynamics according to the tumor type (defined by different input perfusion parameters), and also present a higher enhancement compared to the other healthy tissues, as expected. Conclusions The proposed digital phantom can model the breast tissue perfusion during 4D breast CT image acquisition, displaying the different enhancement dynamics that could be found in a real patient breast. This phantom can be used during the development of dynamic contrast‐enhanced dedicated breast CT imaging, for optimization of image acquisition, image reconstruction, and image analysis. This modality could provide functional information of the breast, resulting in detection, diagnosis, and treatment improvements of breast cancer with breast CT.
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Affiliation(s)
- Marco Caballo
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ritse Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Dutch Expert Center for Screening (LRCB), PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
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Ippolito D, Querques G, Okolicsanyi S, Franzesi CT, Strazzabosco M, Sironi S. Diagnostic value of dynamic contrast-enhanced CT with perfusion imaging in the quantitative assessment of tumor response to sorafenib in patients with advanced hepatocellular carcinoma: A feasibility study. Eur J Radiol 2017; 90:34-41. [PMID: 28583645 DOI: 10.1016/j.ejrad.2017.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the feasibility of perfusion-CT (p-CT) measurements in quantitative assessment of hemodynamic changes related to sorafenib in patients with advanced hepatocellular carcinoma (HCC). MATERIALS AND METHODS Twenty-two patients with advanced HCC underwent p-CT study (256-MDCT scanner) before and 2 months after sorafenib administration. Dedicated perfusion software generated a quantitative map of arterial and portal perfusion and calculated the following perfusion parameters in target liver lesion: hepatic perfusion (HP), time-to-peak (TTP), blood volume (BV), arterial perfusion (AP), and hepatic perfusion index (HPI). After the follow-up scan, patients were categorized as responders and non-responders, according to mRECIST. Perfusion values were analyzed and compared in HCC lesions and in the cirrhotic parenchyma (n=22), such as between baseline and follow-up in progressors and non-progressors. RESULTS Before treatment, all mean perfusion values were significantly higher in HCC lesions than in the cirrhotic parenchyma (HP 47.8±17.2 vs 13.3±6.3mL/s per 100g; AP 47.9±18.1 vs 12.9±10.7mL/s; p<0.001). The group that responded to sorafenib (n=17) showed a significant reduction of values in HCC target lesions after therapy (HP 29.2±23.3 vs 48.1±15.1; AP 29.4±24.6 vs 49.2±17.4; p<0.01), in comparison with the non-responder group (n=5) that demonstrated no significant variation before and after treatment of HP (46.9±25.1 vs 46.7±24.1) and AP (43.4±21.7 vs 43.5±24.6). Among the responder group, HP percentage variation (Δ) in target lesions, during treatment, showed a significantly different (p=0.04) ΔHP in the group with complete response (79%) compared to the group with partial response or stable disease (16%). CONCLUSIONS p-CT technique can be used for HCC quantitative assessment of changes related to anti-angiogenic therapy. Identification of response predictors might help clinicians in selection of patients who may benefit from targeted-therapy allowing for optimization of individualized treatment.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy.
| | - Giulia Querques
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy
| | - Stefano Okolicsanyi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cammillo Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy
| | - Mario Strazzabosco
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy; Liver Center Section of Digestive Diseases, Yale University, New Haven, CTUSA
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy
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Kontopodis N, Galanakis N, Tsetis D, Ioannou CV. Perfusion computed tomography imaging of abdominal aortic aneurysms may be of value for patient specific rupture risk estimation. Med Hypotheses 2017; 101:6-10. [DOI: 10.1016/j.mehy.2017.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/27/2016] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
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Chen BB, Hsu CY, Yu CW, Liang PC, Hsu C, Hsu CH, Cheng AL, Shih TTF. Early perfusion changes within 1 week of systemic treatment measured by dynamic contrast-enhanced MRI may predict survival in patients with advanced hepatocellular carcinoma. Eur Radiol 2016; 27:3069-3079. [PMID: 27957638 DOI: 10.1007/s00330-016-4670-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To correlate early changes in the parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) within 1 week of systemic therapy with overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC). METHODS Eighty-nine patients with advanced HCC underwent DCE-MRI before and within 1 week following systemic therapy. The relative changes of six DCE-MRI parameters (Peak, Slope, AUC, Ktrans, Kep and Ve) of the tumours were correlated with OS using the Kaplan-Meier model and the double-sided log-rank test. RESULTS All patients died and the median survival was 174 days. Among the six DCE-MRI parameters, reductions in Peak, AUC, and Ktrans, were significantly correlated with one another. In addition, patients with a high Peak reduction following treatment had longer OS (P = 0.023) compared with those with a low Peak reduction. In multivariate analysis, a high Peak reduction was an independent favourable prognostic factor in all patients [hazard ratio (HR), 0.622; P = 0.038] after controlling for age, sex, treatment methods, tumour size and stage, and Eastern Cooperative Oncology Group performance status. CONCLUSIONS Early perfusion changes within 1 week following systemic therapy measured by DCE-MRI may aid in the prediction of the clinical outcome in patients with advanced HCC. KEY POINTS • DCE-MRI is helpful to evaluate perfusion changes of HCC after systemic treatment. • Early perfusion changes within 1 week after treatment may predict overall survival. • High Peak reduction was an independent favourable prognostic factor after systemic treatment.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Chao-Yu Hsu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan.,Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chih-Wei Yu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Chiun Hsu
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Chih-Hung Hsu
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan. .,Department of Medical Imaging, Taipei City Hospital, Taipei City, Taiwan. .,Department of Medical Imaging, National Taiwan University Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
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Turco S, Wijkstra H, Mischi M. Mathematical Models of Contrast Transport Kinetics for Cancer Diagnostic Imaging: A Review. IEEE Rev Biomed Eng 2016; 9:121-47. [PMID: 27337725 DOI: 10.1109/rbme.2016.2583541] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Angiogenesis plays a fundamental role in cancer growth and the formation of metastasis. Novel cancer therapies aimed at inhibiting angiogenic processes and/or disrupting angiogenic tumor vasculature are currently being developed and clinically tested. The need for earlier and improved cancer diagnosis, and for early evaluation and monitoring of therapeutic response to angiogenic treatment, have led to the development of several imaging methods for in vivo noninvasive assessment of angiogenesis. The combination of dynamic contrast-enhanced imaging with mathematical modeling of the contrast agent kinetics enables quantitative assessment of the structural and functional changes in the microvasculature that are associated with tumor angiogenesis. In this paper, we review quantitative imaging of angiogenesis with dynamic contrast-enhanced magnetic resonance imaging, computed tomography, and ultrasound.
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Musculoskeletal wide detector CT: Principles, techniques and applications in clinical practice and research. Eur J Radiol 2015; 84:892-900. [DOI: 10.1016/j.ejrad.2014.12.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/15/2014] [Accepted: 12/31/2014] [Indexed: 11/21/2022]
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Li MH, Shang DP, Chen C, Xu L, Huang Y, Kong L, Yu JM. Perfusion Computed Tomography in Predicting Treatment Response of Advanced Esophageal Squamous Cell Carcinomas. Asian Pac J Cancer Prev 2015; 16:797-802. [DOI: 10.7314/apjcp.2015.16.2.797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ippolito D, Fior D, Franzesi CT, Capraro C, Casiraghi A, Leni D, Vacirca F, Corso R, Sironi S. Tumour-related neoangiogenesis: functional dynamic perfusion computed tomography for diagnosis and treatment efficacy assessment in hepatocellular carcinoma. Dig Liver Dis 2014; 46:916-922. [PMID: 25023006 DOI: 10.1016/j.dld.2014.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/24/2014] [Accepted: 06/02/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Aim of the study was to determine the value of perfusion computed tomography in the quantitative assessment of tumour-related neoangiogenesis for the diagnosis and treatment of hepatocellular carcinoma lesions. METHODS Overall, 47 consecutive patients with cirrhotic liver disease, with a high risk of hepatocellular carcinoma, and undergoing standard surveillance (six-month intervals) were eligible for inclusion in this prospective study; based on Barcelona Clinic Liver Cancer guidelines, 27 patients were enrolled. Perfusion computed tomography was performed in 29 biopsy-proven hepatocellular carcinoma lesions before and after treatment with transarterial chemoembolization or radiofrequency ablation. The dynamic study was performed with a 256-slice multidetector-computed tomography scanner; the following parameters were measured: hepatic perfusion, arterial perfusion, blood volume, hepatic perfusion index, and time-to-peak in all patients. RESULTS Hepatocellular carcinoma lesions had the following median perfusion values: perfusion 46.3mL/min/100g; blood volume 20.4mL/100mg; arterial perfusion 42.9mL/min; hepatic perfusion index 92.5%; time to peak 18.7s. Significantly lower perfusion values were obtained in correctly treated lesions or surrounding parenchyma than in viable hepatocellular carcinoma tissue. CONCLUSIONS In hepatocellular carcinoma, perfusion computed tomography could contribute to a non-invasive quantification of tumour blood supply related to the formation of new arterial structures, and enable the assessment of therapeutic response.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy.
| | - Davide Fior
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Cristina Capraro
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Alessandra Casiraghi
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Davide Leni
- Department of Interventional Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Francesco Vacirca
- Department of Interventional Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Rocco Corso
- Department of Interventional Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
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Ippolito D, Fior D, Bonaffini PA, Capraro C, Leni D, Corso R, Sironi S. Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients. Eur J Radiol 2014; 83:1665-1671. [PMID: 24962900 DOI: 10.1016/j.ejrad.2014.05.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/11/2014] [Accepted: 05/23/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess if radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may influence the evaluation of perfusion parameters obtained with CT-perfusion (CT-p) in HCC treated patients. MATERIALS AND METHODS Thirty-three consecutive cirrhotic patients with biopsy-proven diagnosis of HCC lesions and candidates to TACE or RFA were included. The CT-p study of hepatic parenchyma and of treated lesions was performed about 1 month after treatment on 16 multidetector CT after injection of 50mL of non ionic contrast agent (350mg I/mL) at a flow rate of 6mL/s acquiring 40 dynamic scans. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed.The following perfusion parameters were assessed before and after RFA or TACE treatment: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), time to peak (TTP), hepatic perfusion index (HPI). RESULTS A complete treatment was obtained in 16 cases and incomplete treatment in the 17 remaining cases. The perfusion data of completely treated lesions were: HP 10.2±6.3; AP 10.4±7; BV 4.05±4.8; TTP 38.9±4.2; HPI 9.9±9.2, whereas in partially treated lesions were: HP 43.2±15.1mL/s/100g; AP 38.7±8.8mL/min; BV 20.7±9.5mL/100mg; TTP 24±3.7s; HPI 61.7±7.5%. In adjacent cirrhotic parenchyma, the parameters of all evaluated patients were: HP 13.2±4; AP 12.3±3.4; BV 11.8±2.8; TTP 43.9±2.9; and HPI 17.1±9.8. A significant difference (P<0.001) was found for all parameters between residual viable tumor tissue (P<0.001) compared to successfully treated lesion due to the presence of residual arterial vascular structure in viable portion of treated HCC. CONCLUSION According to our results, CT-p evaluation is not influenced by TACE or RFA treatments, thus representing a feasible technique that allows a reproducible quantitative evaluation of treatment response in HCC patients.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
| | - Davide Fior
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Cristina Capraro
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Davide Leni
- Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Rocco Corso
- Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
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Hayano K, Fuentes-Orrego JM, Sahani DV. New approaches for precise response evaluation in hepatocellular carcinoma. World J Gastroenterol 2014; 20:3059-3068. [PMID: 24696594 PMCID: PMC3964378 DOI: 10.3748/wjg.v20.i12.3059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/26/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023] Open
Abstract
With the increasing clinical use of cytostatic and novel biologic targeted agents, conventional morphologic tumor burden assessments, including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors, are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue. Therefore, the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired. In this review, we will discuss the conventional and new approaches to assess tumor burden. Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes, these functional tumor burden analyses are very promising. However, some of them have not gone thorough all steps for standardization and validation. Nevertheless, these new techniques and criteria will play an important role in the cancer management, and provide each patient more tailored therapy.
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Perfusion CT: A biomarker for soft tissue tumors of extremities. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Narunsky L, Oren R, Bochner F, Neeman M. Imaging aspects of the tumor stroma with therapeutic implications. Pharmacol Ther 2013; 141:192-208. [PMID: 24134903 DOI: 10.1016/j.pharmthera.2013.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 09/13/2013] [Indexed: 12/25/2022]
Abstract
Cancer cells rely on extensive support from the stroma in order to survive, proliferate and invade. The tumor stroma is thus an important potential target for anti-cancer therapy. Typical changes in the stroma include a shift from the quiescence promoting-antiangiogenic extracellular matrix to a provisional matrix that promotes invasion and angiogenesis. These changes in the extracellular matrix are induced by changes in the secretion of extracellular matrix proteins and glucose amino glycans, extravasation of plasma proteins from hyperpermeable vessels and release of matrix modifying enzymes resulting in cleavage and cross-linking of matrix macromolecules. These in turn alter the rigidity of the matrix and the exposure and release of cytokines. Changes in matrix rigidity and vessel permeability affect drug delivery and mediate resistance to cytotoxic therapy. These stroma changes are brought about not only by the cancer cells, but also through the action of many cell types that are recruited by tumors including immune cells, fibroblasts and endothelial cells. Within the tumor, these normal host cells are activated resulting in loss of inhibitory and induction of cancer promoting activities. Key to the development of stroma-targeted therapies, selective biomarkers were developed for specific imaging of key aspects of the tumor stroma.
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Affiliation(s)
- Lian Narunsky
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Roni Oren
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Filip Bochner
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Michal Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 76100, Israel.
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Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A. CT dose optimisation and reduction in osteoarticular disease. Diagn Interv Imaging 2013; 94:371-88. [DOI: 10.1016/j.diii.2012.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moding EJ, Clark DP, Qi Y, Li Y, Ma Y, Ghaghada K, Johnson GA, Kirsch DG, Badea CT. Dual-energy micro-computed tomography imaging of radiation-induced vascular changes in primary mouse sarcomas. Int J Radiat Oncol Biol Phys 2013; 85:1353-9. [PMID: 23122984 PMCID: PMC3625949 DOI: 10.1016/j.ijrobp.2012.09.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the effects of radiation therapy on primary tumor vasculature using dual-energy (DE) micro-computed tomography (micro-CT). METHODS AND MATERIALS Primary sarcomas were generated with mutant Kras and p53. Unirradiated tumors were compared with tumors irradiated with 20 Gy. A liposomal-iodinated contrast agent was administered 1 day after treatment, and mice were imaged immediately after injection (day 1) and 3 days later (day 4) with DE micro-CT. CT-derived tumor sizes were used to assess tumor growth. After DE decomposition, iodine maps were used to assess tumor fractional blood volume (FBV) at day 1 and tumor vascular permeability at day 4. For comparison, tumor vascularity and vascular permeability were also evaluated histologically by use of CD31 immunofluorescence and fluorescently-labeled dextrans. RESULTS Radiation treatment significantly decreased tumor growth from day 1 to day 4 (P<.05). There was a positive correlation between CT measurement of tumor FBV on day 1 and extravasated iodine on day 4 with microvascular density (MVD) on day 4 (R(2)=0.53) and dextran accumulation (R(2)=0.63) on day 4, respectively. Despite no change in MVD measured by histology, tumor FBV significantly increased after irradiation as measured by DE micro-CT (0.070 vs 0.091, P<.05). Both dextran and liposomal-iodine accumulation in tumors increased significantly after irradiation, with dextran fractional area increasing 5.2-fold and liposomal-iodine concentration increasing 4.0-fold. CONCLUSIONS DE micro-CT is an effective tool for noninvasive assessment of vascular changes in primary tumors. Tumor blood volume and vascular permeability increased after a single therapeutic dose of radiation treatment.
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Affiliation(s)
- Everett J. Moding
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA 27710
| | - Darin P. Clark
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC, USA 27710
| | - Yi Qi
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC, USA 27710
| | - Yifan Li
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA 27710
| | - Yan Ma
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA 27710
| | - Ketan Ghaghada
- The Edward B. Singleton Department of Pediatric Radiology, Texas Children’s Hospital, Houston, TX, USA 77030
| | - G. Allan Johnson
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC, USA 27710
| | - David G. Kirsch
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA 27710
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA 27710
| | - Cristian T. Badea
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC, USA 27710
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Peungjesada S, Chuang HH, Prasad SR, Choi H, Loyer EM, Bronstein Y. Evaluation of cancer treatment in the abdomen: Trends and advances. World J Radiol 2013; 5:126-42. [PMID: 23671749 PMCID: PMC3650203 DOI: 10.4329/wjr.v5.i3.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 01/24/2013] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Response evaluation in Oncology has relied primarily on change in tumor size. Inconsistent results in the prediction of clinical outcome when size based criteria are used and the increasing role of targeted and loco-regional therapies have led to the development of new methods of response evaluation that are unrelated to change in tumor size. The goals of this review are to expose briefly the size based criteria and to present the non-size based approaches that are currently applicable in the clinical setting. Other paths that are still being explored are not discussed in details.
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Abstract
Based on recent clinical practice guidelines, imaging is largely replacing pathology as the preferred diagnostic method for determination of hepatocellular carcinoma (HCC). A variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography, are currently used to examine patients with chronic liver disease and suspected HCC. Advancements in imaging techniques such as perfusion imaging, diffusion imaging, and elastography along with the development of new contrast media will further improve the ability to detect and characterize HCC. Early diagnosis of HCC is essential for prompt treatment, which may in turn improve prognosis. Considering the process of hepatocarcinogenesis, it is important to evaluate sequential changes via imaging which would help to differentiate HCC from premalignant or benign lesions. Recent innovations including multiphasic examinations, high-resolution imaging, and the increased functional capabilities available with contrast-enhanced US, multidetector row CT, and MRI have raised the standards for HCC diagnosis. Although hemodynamic features of nodules in the cirrhotic liver remain the main diagnostic criterion, newly developed cellspecific contrast agents have shown great possibilities for improved HCC diagnosis and may overcome the diagnostic dilemma associated with small or borderline hepatocellular lesions. In the 20th century paradigm of medical imaging, radiological diagnosis was based on morphological characteristics, but in the 21st century, a paradigm shift to include biomedical, physiological, functional, and genetic imaging is needed. A multidisciplinary team approach is necessary to foster an integrated approach to HCC imaging. By developing and combining new imaging modalities, all phases of HCC patient care, including screening, diagnosis, treatment, and therapy, can be dramatically improved.
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Affiliation(s)
| | - Byung Ihn Choi
- *Byung Ihn Choi, MD, Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul 110-744 (Korea), Tel. +82 2 2072 2515, E-Mail
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Nakano S, Ohtsuka M, Mibu A, Karikomi M, Sakata H, Yamamoto M. Diagnostic imaging strategy for MDCT- or MRI-detected breast lesions: use of targeted sonography. BMC Med Imaging 2012; 12:13. [PMID: 22691539 PMCID: PMC3427136 DOI: 10.1186/1471-2342-12-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 05/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leading-edge technology such as magnetic resonance imaging (MRI) or computed tomography (CT) often reveals mammographically and ultrasonographically occult lesions. MRI is a well-documented, effective tool to evaluate these lesions; however, the detection rate of targeted sonography varies for MRI detected lesions, and its significance is not well established in diagnostic strategy of MRI detected lesions. We assessed the utility of targeted sonography for multidetector-row CT (MDCT)- or MRI-detected lesions in practice. METHODS We retrospectively reviewed 695 patients with newly diagnosed breast cancer who were candidates for breast conserving surgery and underwent MDCT or MRI in our hospital between January 2004 and March 2011. Targeted sonography was performed in all MDCT- or MRI-detected lesions followed by imaging-guided biopsy. Patient background, histopathology features and the sizes of the lesions were compared among benign, malignant and follow-up groups. RESULTS Of the 695 patients, 61 lesions in 56 patients were detected by MDCT or MRI. The MDCT- or MRI-detected lesions were identified by targeted sonography in 58 out of 61 lesions (95.1%). Patients with pathological diagnoses were significantly older and more likely to be postmenopausal than the follow-up patients. Pathological diagnosis proved to be benign in 20 cases and malignant in 25. The remaining 16 lesions have been followed up.Lesion size and shape were not significantly different among the benign, malignant and follow-up groups. CONCLUSIONS Approximately 95% of MDCT- or MRI-detected lesions were identified by targeted sonography, and nearly half of these lesions were pathologically proven malignancies in this study. Targeted sonography is a useful modality for MDCT- or MRI-detected breast lesions.
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Affiliation(s)
- Satoko Nakano
- Department of Surgery, Kawaguchi Municipal Medical Center, 180 Nishi-araijyuku, Kawaguchi-city, Saitama, 333-0833, Japan.
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Lee JM, Yoon JH, Joo I, Woo HS. Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma. Liver Cancer 2012; 1:22-40. [PMID: 24159569 PMCID: PMC3747553 DOI: 10.1159/000339018] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Accurate diagnosis and assessment of disease extent are crucial for proper management of patients with HCC. Imaging plays a crucial role in early detection, accurate staging, and the planning of management strategies. A variety of imaging modalities are currently used in evaluating patients with suspected HCC; these include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography. Among these modalities, dynamic MRI and CT are regarded as the best imaging techniques available for the noninvasive diagnosis of HCC. Recent improvements in CT and MRI technology have made noninvasive and reliable diagnostic assessment of hepatocellular nodules possible in the cirrhotic liver, and biopsy is frequently not required prior to treatment. Until now, the major challenge for radiologists in imaging cirrhosis has been the characterization of small cirrhotic nodules smaller than 2 cm in diameter. Further technological advancement will undoubtedly have a major impact on liver tumor imaging. The increased speed of data acquisition in CT and MRI has allowed improvements in both spatial and temporal resolution, which have made possible a more precise evaluation of the hemodynamics of liver nodules. Furthermore, the development of new, tissue-specific contrast agents such as gadoxetic acid has improved HCC detection on MRI. In this review, we discuss the role of CT and MRI in the diagnosis and staging of HCC, recent technological advances, and the strengths and limitations of these imaging modalities.
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Affiliation(s)
| | - Jeong-Hee Yoon
- *Jeong Min Lee, MD, Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744 (South Korea), Tel. +82 2 2072 3154, E-Mail
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Zerizer I, Al-Nahhas A, Towey D, Tait P, Ariff B, Wasan H, Hatice G, Habib N, Barwick T. The role of early ¹⁸F-FDG PET/CT in prediction of progression-free survival after ⁹⁰Y radioembolization: comparison with RECIST and tumour density criteria. Eur J Nucl Med Mol Imaging 2012; 39:1391-9. [PMID: 22644713 DOI: 10.1007/s00259-012-2149-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/30/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE This study evaluated the ability of (18)F-FDG PET/CT imaging to predict early response to (90)Y-radioembolization in comparison with contrast-enhanced CT (CECT) using RECIST and lesion density (Choi) criteria. Progression-free survival (PFS) in patients with liver metastases at 2 years and decline in tumour markers were the primary end-points of the study. METHODS A total of 121 liver lesions were evaluated in 25 patients (14 men, 11 women) with liver-dominant metastatic colorectal cancer who underwent (18)F-FDG PET/CT and CECT before and 6-8 weeks after treatment. Changes in SUV(max), tumour density measured in terms of Hounsfield units and the sum of the longest diameters (LD) were calculated for the target liver lesions in each patient. The patient responses to treatment were categorized using EORTC PET criteria, tumour density criteria (Hounsfield units) and RECIST, and were correlated with the responses of tumour markers and 2-year PFS using Kaplan-Meier plots and the log-rank test for comparison. Multivariate proportional hazards (Cox) regression analysis was performed to assess the effect of relevant prognostic factors on PFS. RESULTS Using (18)F-FDG PET/CT response criteria, 15 patients had a partial response (PR) and 10 patients had stable disease (SD), while using RECIST only 2 patients had a PR and 23 had SD. Two patients had a PR, 21 SD and 2 progressive disease using tumour density criteria. The mean changes in SUV(max), sum of the LDs and tumour density after treatment were 2.9 ± 2.6, 7.3 ± 14.4 mm and 1.9 ± 13.18 HU, respectively. Patients who had a PR on (18)F-FDG PET/CT had a mean decrease of 44.5 % in SUV(max) compared to those with SD who had a decrease of only 10.3 %. The decreases in SUV(max) and sum of the LDs were significant (p < 0.0001, p < 0.05, respectively) while the decrease in tumour density was not (p > 0.1065). The responses on the (18)F-FDG PET/CT studies were highly correlated with the responses of tumour markers (p < 0.0001 for LDH, p = 0.01 for CEA and p = 0.02 for Ca19-9), while the responses on the CECT studies using both RECIST and tumour density criteria were not significantly correlated with the responses of tumour markers. The responses on (18)F-FDG PET/CT studies also significantly predicted PFS (the median PFS in those with a PR was 12.0 months and in those with SD was 5 months, p < 0.0001), while RECIST and tumour density did not significantly predict PFS. Multivariate analysis demonstrated that responses on (18)F-FDG PET/CT studies and decreases in SUV(max) of ≤ 2.0 were the strongest predictors of PFS. CONCLUSION Early response assessment to (90)Y-radioembolization using (18)F-FDG PET/CT is superior to RECIST and tumour density, demonstrating a correlation with tumour markers and significantly predicting PFS in patients with liver metastases. This could enable early response-adapted treatment strategies to be employed.
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Affiliation(s)
- I Zerizer
- Department of Radiology/Nuclear Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
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Figueiras RG, Padhani AR, Goh VJ, Vilanova JC, González SB, Martín CV, Caamaño AG, Naveira AB, Choyke PL. Novel oncologic drugs: what they do and how they affect images. Radiographics 2012; 31:2059-91. [PMID: 22084189 DOI: 10.1148/rg.317115108] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Targeted therapies are designed to interfere with specific aberrant biologic pathways involved in tumor development. The main classes of novel oncologic drugs include antiangiogenic drugs, antivascular agents, drugs interfering with EGFR-HER2 or KIT receptors, inhibitors of the PI3K/Akt/mTOR pathway, and hormonal therapies. Cancer cells usurp normal signal transduction pathways used by growth factors to stimulate proliferation and sustain viability. The interaction of growth factors with their receptors activates different intracellular pathways affecting key tumor biologic processes such as neoangiogenesis, tumor metabolism, and tumor proliferation. The response of tumors to anticancer therapy can be evaluated with anatomic response assessment, qualitative response assessment, and response assessment with functional and molecular imaging. Angiogenesis can be measured by means of perfusion imaging with computed tomography and magnetic resonance (MR) imaging. Diffusion-weighted MR imaging allows imaging evaluation of tumor cellularity. The main imaging techniques for studying tumor metabolism in vivo are positron emission tomography and MR spectroscopy. Familiarity with imaging findings secondary to tumor response to targeted therapies may help the radiologist better assist the clinician in accurate evaluation of tumor response to these anticancer treatments. Functional and molecular imaging techniques may provide valuable data and augment conventional assessment of tumor response to targeted therapies. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.317115108/-/DC1.
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Affiliation(s)
- Roberto García Figueiras
- Department of Radiology, Grupo de Imagen Molecular, Fundación IDICHUS/IDIS, Complexo Hospitalario Universitario de Santiago de Compostela, Choupana s/n, 15702 Santiago de Compostela, Spain.
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Ippolito D, Capraro C, Casiraghi A, Cestari C, Sironi S. Quantitative assessment of tumour associated neovascularisation in patients with liver cirrhosis and hepatocellular carcinoma: role of dynamic-CT perfusion imaging. Eur Radiol 2012; 22:803-811. [PMID: 22086560 DOI: 10.1007/s00330-011-2307-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 09/27/2011] [Accepted: 09/28/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the value of perfusion computed tomography (CT-p) in the quantitative assessment of tumour-related neoangiogenesis processes in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Fifty-two biopsy proven HCC lesions were examined with dynamic CT investigations during injection of 50 mL of contrast agent (350 mgI/mL). A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of a colour scale was employed. The following parameters related to the blood microcirculation and tissue perfusion were calculated: hepatic perfusion (Perf), tissue blood volume (BV), hepatic perfusion index (HPI), arterial perfusion (AP), portal perfusion (PP), and time to peak (TTP). Perfusion parameters were statistically analysed, comparing neoplastic lesions with cirrhotic parenchyma. RESULTS Perf, BV, HPI and AP values were higher (P < 0.001), whereas PP and TTP were lower (P < 0.001) in HCC relative to the surrounding liver. No significant correlation was found between perfusion parameters and HCC grade. Values of perfusion parameters in the cirrhotic liver of patients with and without HCC were not significantly different. CONCLUSIONS Our results suggest that CT-p can help in non-invasive quantification of tumour blood supply, related to the formation of new arterial structures (neoangiogenesis), which are essential for tumour growth. KEY POINTS Perfusion computed tomography (CT) enables depiction of tumour vascular physiology. Perfusion CT is non-invasive and is now quick to perform and analyse. Quantitative measurements of hepatic perfusion provide important information about hepatocellular carcinoma (HCC). Such perfusion CT data may help in the determination of the outcome of HCC. Perfusion CT can act as an in-vivo biomarker of tumour-related angiogenesis.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
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Gay F, Pierucci F, Zimmerman V, Lecocq-Teixeira S, Teixeira P, Baumann C, Blum A. Contrast-enhanced ultrasonography of peripheral soft-tissue tumors: Feasibility study and preliminary results. Diagn Interv Imaging 2011; 93:37-46. [PMID: 22277709 DOI: 10.1016/j.diii.2011.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the diagnostic value of contrast-enhanced ultrasonography, to differentiate benign and malignant soft-tissue tumors and to assess the feasibility and interest of modelling enhancement curves. PATIENTS AND METHODS This retrospective study includes 118 patients with soft-tissue tumors, examined with ultrasound after injection of SonoVue(®), a contrast product. The raw data were treated with CHI-Q acquisition software to model the enhancement curves. We analyzed tumor uptake of the contrast product visually and studied the enhancement curves, characterized by five parameters: peak intensity, time to peak, mean transit time, initial slope, and area under the curve. RESULTS There were 81 benign and 37 malignant tumors. For a diagnosis of benign tumor, the absence of contrast uptake had a sensitivity of 60%, a specificity of 68%, a positive predictive value of 50% and a negative predictive of 83%. Study of the 70 curves obtained (48 benign and 22 malignant tumors) showed that the parameters of area under the curve (Chi(2)=8.6 and P<0.005), slope (Chi(2)=8.12 and P=0.004), and peak intensity (Chi(2)=7.55, P=0.005) differed significantly between the two populations. CONCLUSION Absence of contrast uptake suggests a benign lesion. The study of enhancement curves showed significant differences between the different tumor populations.
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Affiliation(s)
- F Gay
- Guilloz Imaging Department, Nancy University Hospital-Central Hospital, Nancy, France.
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Abstract
Cancer treatment strategies have changed considerably over the past two decades, with increasing emphasis on cancer-specific biological therapies. This situation has led to the incorporation of biomarkers, including those obtained by medical imaging, into trial designs to better understand mechanisms of action and, hopefully, to provide early evidence of treatment efficacy at a molecular or physiological level. Unlike blood tests and tissue samples, an imaging biomarker allows assessment of treatment in the whole tumor, in all tumors in the body, and at multiple time points. This situation has increased the complexity of clinical trials, as each imaging modality has issues related to cost, ease of use, patient compatibility, data analysis, and interpretation. This article reviews strengths and limitations of the current imaging methods available in clinical cancer trials, including MRI, CT, PET, and ultrasonography. The information gained by each test, and the difficulties in acquiring the data and interpreting it are also discussed in order to help researchers plan imaging in clinical trials and interpret data from such studies.
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Contrast enhanced MR imaging of female pelvic cancers: Established methods and emerging applications. Eur J Radiol 2011; 78:2-11. [DOI: 10.1016/j.ejrad.2010.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/11/2010] [Indexed: 01/30/2023]
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González Hernando C, Esteban L, Cañas T, Van den Brule E, Pastrana M. The role of magnetic resonance imaging in oncology. Clin Transl Oncol 2011; 12:606-13. [PMID: 20851801 DOI: 10.1007/s12094-010-0565-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Conventional diagnostic magnetic resonance imaging (MRI) techniques have focused on improving the spatial resolution and image acquisition speed (whole-body MRI) or on new contrast agents. Most advances in MRI go beyond morphologic study to obtain functional and structural information in vivo about different physiological processes of tumor microenvironment, such as oxygenation levels, cellular proliferation, or tumor vascularization through MRI analysis of some characteristics: angiogenesis (perfusion MRI), metabolism (MRI spectroscopy), cellularity (diffusion-weighted MRI), lymph node function, or hypoxia [blood-oxygen-level-dependent (BOLD) MRI]. We discuss the contributions of different MRI techniques than must be integrated in oncologic patients to substantially advance tumor detection and characterization risk stratification, prognosis, predicting and monitoring response to treatment, and development of new drugs.
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Lei Z, Ma H, Xu N, Xi H. The evaluation of anti-angiogenic treatment effects for implanted rabbit VX2 breast tumors using functional multi-slice spiral computed tomography (f-MSCT). Eur J Radiol 2011; 78:277-81. [PMID: 21310569 DOI: 10.1016/j.ejrad.2011.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 01/03/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Investigate the benefit of functional multi-slice spiral computed tomography (f-MSCT) perfusion imaging in the non-invasive assessment of targeted anti-angiogenesis therapy on an implanted rabbit VX2 breast tumor model. METHOD 69 female pure New Zealand white rabbits were randomly assigned to one of the 4 groups and received treatment accordingly: control (saline), Endostar, neoadjuvant chemotherapy (Cyclophosphamide, Epirubicin and 5-Fluorouracil, CEF), combination therapy (Endostar and CEF). After 2 weeks of treatment, f-MSCT perfusion scannings were performed for all rabbits and information about blood flow (BF), blood volume (BV), mean transit time (MTT) and surface permeability (SP) was collected. After perfusion imaging, tumor tissues were sampled for immunohistochemistry and the Western blot test of VEGF protein expression. RESULTS (1) The VEGF expression level, measured by immunohistochemistry and Western blot, decreased by treatment group (control > Endostar > CEF > combination therapy). The same was true for the mean BF, BV, MTT and PS, which decreased from the control group to the combination therapy group gradually. The mean MTT level increased in reverse order from the control to the combination therapy group. The difference between any 2 groups on these measures was statistically significant (P < 0.05). (2) There was moderate positive correlation between VEGF expression and BE, BV, or PS level (P < 0.05) and a negative correlation between VEGF expression and MTT level for all 4 groups (P < 0.05). CONCLUSION Therefore, f-MSCT can be used as a non-invasive approach to evaluate the effect of anti-angiogenic therapy for implanted rabbit VX2 breast tumors.
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Affiliation(s)
- Zhen Lei
- Department of Anatomy, Chinese Medical University, No. 92, Beiermalu Road, Heping District, Shenyang, 110001, China.
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Functional and structural characteristics of tumor angiogenesis in lung cancers overexpressing different VEGF isoforms assessed by DCE- and SSCE-MRI. PLoS One 2011; 6:e16062. [PMID: 21283766 PMCID: PMC3024413 DOI: 10.1371/journal.pone.0016062] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 12/07/2010] [Indexed: 12/27/2022] Open
Abstract
The expressions of different vascular endothelial growth factor (VEGF) isoforms are associated with the degree of tumor invasiveness and the patient's prognosis in human cancers. We hypothesized that different VEGF isoforms can exert different effects on the functional and structural characteristics of tumor angiogenesis. We used dynamic contrast-enhanced MRI (DCE-MRI) and steady-state contrast-enhanced MRI (SSCE-MRI) to evaluate in vivo vascular functions (e.g., perfusion and permeability) and structural characteristics (e.g., vascular size and vessel density) of the tumor angiogenesis induced by different VEGF isoforms (VEGF121, VEGF165, and VEGF189) in a murine xenograft model of human lung cancer. Tumors overexpressing VEGF189 were larger than those overexpressing the other two VEGF isoforms. The K(trans) map obtained from DCE-MRI revealed that the perfusion and permeability functions of tumor microvessels was highest in both the rim and core regions of VEGF189-overexpressing tumors (p<0.001 for both tumor rim and core). The relative vessel density and relative vessel size indexes derived from SSCE-MRI revealed that VEGF189-overexpressing tumors had the smallest (p<0.05) and the most-dense (p<0.01) microvessels, which penetrated deeply from the tumor rim into the core, followed by the VEGF165-overepxressing tumor, whose microvessels were located mainly in the tumor rim. The lowest-density microvessels were found in the VEGF121-overexpressing tumor; these microvessels had a relatively large lumen and were found mainly in the tumor rim. We conclude that among the three VEGF isoforms evaluated, VEGF189 induces the most densely sprouting and smallest tumor microvessels with the highest in vivo perfusion and permeability functions. These characteristics of tumor microvessels may contribute to the reported adverse effects of VEGF189 overexpression on tumor progression, metastasis, and patient survival in several human cancers, including non-small cell lung cancer, and suggest that applying aggressive therapy may be necessary in human cancers in which VEGF189 is overexpressed.
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Protocol modifications for CT perfusion (CTp) examinations of abdomen-pelvic tumors: impact on radiation dose and data processing time. Eur Radiol 2011; 21:1293-300. [PMID: 21246200 DOI: 10.1007/s00330-010-2048-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 11/08/2010] [Accepted: 11/12/2010] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the effect of CT perfusion (CTp) protocol modifications on quantitative perfusion parameters, radiation dose and data processing time. MATERIALS & METHODS CTp datasets of 30 patients (21M:9F) with rectal (n = 24) or retroperitoneal (n = 6) tumours were studied. Standard CTp protocol included 50 sec cine-phase (0.5 sec/rotation) and delayed-phase after 70 ml contrast bolus at 5-7 ml/sec. CTp-data was sub-sampled to generate modified datasets (n = 105) with cine-phase(n = 15) alone, varying cine-phase duration (20-40 sec, n = 45) and varying temporal sampling-interval (1-3 sec, n = 45). The estimated CTp parameters (BF,BV,MTT&PS) and radiation dose of standard CTp served as reference for comparison. RESULTS CTp with 50 sec cine-phase showed moderate to high correlation with standard CTp for BF&MTT (r = 0.96&0.85) and low correlation for BV (0.75, p = 0.04). Limiting cine-phase duration to 30 sec demonstrated comparable results for BF&MTT, while considerable variation in CTp values existed at 20 sec. There was moderate-to-high correlation of CTp parameters with sampling interval of 1&2 sec (r = 0.83-0.97, p > 0.05), while at 3 sec only BF showed high correlation (r = 0.96, p = 0.05). Increasing sampling interval (47-60%) and reducing cine-phase duration substantially reduced dose(30.8-65%) which paralleled reduced data processing time (3-10 min). CONCLUSION Limiting CTp cine-phase to 30 sec results in comparable BF&MTT values and increasing cine-phase sampling interval to 2 sec provides good correlation for all CTp parameters with substantial dose reduction and improved computational efficiency.
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Soyer P, Boudiaf M, Fishman EK, Hoeffel C, Dray X, Manfredi R, Marteau P. Imaging of malignant neoplasms of the mesenteric small bowel: new trends and perspectives. Crit Rev Oncol Hematol 2010; 80:10-30. [PMID: 21035353 DOI: 10.1016/j.critrevonc.2010.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 12/13/2022] Open
Abstract
This article describes the recent advances in radiological imaging of malignant neoplasms of the mesenteric small bowel and provides an outline of new trends and perspectives that can be anticipated. The introduction of multidetector row technology, which allows the acquisition of submillimeter and isotropic voxels, has dramatically improved the capabilities of computed tomography in the investigation of the mesenteric small bowel. This technology combined with optimal filling of small bowel loops through the use of appropriate enteral contrast agents has markedly changed small bowel imaging. Computed tomography-enteroclysis, which is based on direct infusion of enteral contrast agent into the mesenteric small bowel through a naso-jejunal tube, provides optimal luminal distension. By contrast, computed tomography-enterography is based on oral administration of enteral contrast agent. These two techniques are now well-established ones for the detection and the characterization of small bowel neoplasms. During the same time, combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging has gained wide acceptance for the evaluation of patients with suspected small bowel neoplasms. Rapid magnetic resonance imaging sequences used in combination with specific enteral contrast agents generate superb images of the mesenteric small bowel so that magnetic resonance-enteroclysis and magnetic resonance-enterography are now considered as effective diagnostic tools for both the detection and the characterization of neoplasms of the mesenteric small bowel. Recent improvements in image post-processing capabilities help obtain realistic three-dimensional representations of tumors and virtual enteroscopic views of the small bowel that are useful for the surgeon and the gastroenteroenteologist to plan surgical or endoscopic interventions. Along with a better knowledge of the potential and limitations of wireless capsule endoscopy and new endoscopic techniques, these recent developments in radiological imaging reasonably suggest that substantial changes in the investigation of small bowel tumors may be anticipated in a near future, thus potentially create a new paradigm shift after standard small bowel follow-through study has been universally abandoned.
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Affiliation(s)
- Philippe Soyer
- Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP and Université Diderot-Paris, France.
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Morgan B, Kennedy AS, Lewington V, Jones B, Sharma RA. Intra-arterial brachytherapy of hepatic malignancies: watch the flow. Nat Rev Clin Oncol 2010; 8:115-20. [PMID: 20924355 DOI: 10.1038/nrclinonc.2010.153] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although the liver possesses a dual blood supply, arterial vessels deliver only a small proportion of blood to normal parenchyma, but they deliver the vast majority of blood to primary and secondary cancers of the liver. This anatomical discrepancy is the basis for intra-arterial brachytherapy of liver cancers using radioactive microspheres, termed radio-embolization (RE). Radioactive microspheres implant preferentially in the terminal arterioles of tumors. Although biological models of the flow dynamics and distribution of microspheres are currently in development, there is a need to improve the imaging biomarkers of flow dynamics used to plan RE. Since a direct consequence of RE is vascular disruption and necrosis, we suggest that imaging protocols sensitive to changes in vasculature are highly likely to represent useful early biomarkers for treatment efficacy. We propose dynamic contrast-enhanced CT as the most appropriate imaging modality for studying vascular parameters in clinical trials of RE treatment.
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Affiliation(s)
- Bruno Morgan
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK
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Prionas ND, Lindfors KK, Ray S, Huang SY, Beckett LA, Monsky WL, Boone JM. Contrast-enhanced dedicated breast CT: initial clinical experience. Radiology 2010; 256:714-23. [PMID: 20720067 DOI: 10.1148/radiol.10092311] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To quantify contrast material enhancement of breast lesions scanned with dedicated breast computed tomography (CT) and to compare their conspicuity with that at unenhanced breast CT and mammography. MATERIALS AND METHODS Approval of the institutional review board and the Radiation Use Committee and written informed consent were obtained for this HIPAA-compliant study. Between September 2006 and April 2009, 46 women (mean age, 53.2 years; age range, 35-72 years) with Breast Imaging Reporting and Data System category 4 or 5 lesions underwent unenhanced breast CT and contrast material-enhanced breast CT before biopsy. Two radiologists independently scored lesion conspicuity for contrast-enhanced breast CT versus mammography and for contrast-enhanced breast CT versus unenhanced breast CT. Mean lesion voxel intensity was measured in Hounsfield units and normalized to adipose tissue intensity on manually segmented images obtained before and after administration of contrast material. Regression models focused on conspicuity and quantified enhancement were used to estimate the effect of pathologic diagnosis (benign vs malignant), lesion type (mass vs calcifications), breast density, and interradiologist variability. RESULTS Fifty-four lesions (25 benign, 29 malignant) in 46 subjects were analyzed. Malignant lesions were seen significantly better at contrast-enhanced breast CT than at unenhanced breast CT (P < .001) or mammography (P < .001). Malignant calcifications (malignant lesions manifested mammographically as microcalcifications only, n = 7) were seen better at contrast-enhanced breast CT than at unenhanced breast CT (P < .001) and were seen similarly at contrast-enhanced breast CT and mammography. Malignant lesions enhanced 55.9 HU +/- 4.0 (standard error), whereas benign lesions enhanced 17.6 HU +/- 6.1 (P < .001). Ductal carcinoma in situ (n = 5) enhanced a mean of 59.6 HU +/- 2.8. Receiver operating characteristic curve analysis of lesion enhancement yielded an area under the receiver operating characteristic curve of 0.876. CONCLUSION Conspicuity of malignant breast lesions, including ductal carcinoma in situ, is significantly improved at contrast-enhanced breast CT. Quantifying lesion enhancement may aid in the detection and diagnosis of breast cancer.
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Affiliation(s)
- Nicolas D Prionas
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA 95817, USA
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Dessouky BAM, El Abd OL, El Gowily AG, El Khawalka YM. Functional diffusion map of malignant brain tumors: A surrogate imaging biomarker for early prediction of therapeutic response and patient survival. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2010. [DOI: 10.1016/j.ejrnm.2010.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Wang L. Morphological and functional MDCT: problem-solving tool and surrogate biomarker for hepatic disease clinical care and drug discovery in the era of personalized medicine. Hepat Med 2010; 2:111-24. [PMID: 24367211 PMCID: PMC3846718 DOI: 10.2147/hmer.s9052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This article explains the significant role of morphological and functional multidetector computer tomography (MDCT) in combination with imaging postprocessing algorithms served as a problem-solving tool and noninvasive surrogate biomarker to effectively improve hepatic diseases characterization, detection, tumor staging and prognosis, therapy response assessment, and novel drug discovery programs, partial liver resection and transplantation, and MDCT-guided interventions in the era of personalized medicine. State-of-the-art MDCT depicts and quantifies hepatic disease over conventional CT for not only depicting lesion location, size, and extent but also detecting changes in tumor biologic behavior caused by therapy or tumor progression before morphologic changes. Color-encoded parameter display provides important functional information on blood flow, permeability, leakage space, and blood volume. Together with other relevant biomarkers and genomics, the imaging modality is being developed and validated as a biomarker to early response to novel, targeted anti-VEGF(R)/PDGFR or antivascular/angiogenesis agents as its parameters correlate with immunohistochemical surrogates of tumor angiogenesis and molecular features of malignancies. MDCT holds incremental value to World Health Organization response criteria and Response Evaluation Criteria in Solid Tumors in liver disease management. MDCT volumetric measurement of future remnant liver is the most important factor influencing the outcome of patients who underwent partial liver resection and transplantation. MDCT-guided interventional methods deliver personalized therapies locally in the human body. MDCT will hold more scientific impact when it is fused with other imaging probes to yield comprehensive information regarding changes in liver disease at different levels (anatomic, metabolic, molecular, histologic, and other levels).
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Affiliation(s)
- Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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64-row MDCT perfusion of head and neck squamous cell carcinoma: technical feasibility and quantitative analysis of perfusion parameters. Eur Radiol 2010; 21:113-21. [DOI: 10.1007/s00330-010-1898-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 06/06/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
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Tumor perfusion assessed by dynamic contrast-enhanced MRI correlates to the grading of renal cell carcinoma: Initial results. Eur J Radiol 2010; 74:e176-80. [DOI: 10.1016/j.ejrad.2009.05.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 04/28/2009] [Accepted: 05/25/2009] [Indexed: 02/06/2023]
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Li MM, Rybalov M, Haider MA, de Jong IJ. Does computed tomography or positron emission tomography/computed tomography contribute to detection of small focal cancers in the prostate? J Endourol 2010; 24:693-700. [PMID: 20367444 DOI: 10.1089/end.2009.0470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Prostate cancer is considered to be a multifocal tumor in the majority of patients. Based on histologic data after prostatectomy, there is a growing insight that a considerable number of men who receive a diagnosis in the contemporary setting of prostate-specific antigen screening have unilateral or unifocal disease. With this, the current concept of whole-gland therapy has come into discussion. The need for improvement of intraprostatic tumor characterization is clear. Molecular imaging is one of the areas of research on this aspect. The clinical indications for positron emission tomography (PET)/CT have increased rapidly in the field of oncology and are largely based on fluorodeoxyglucose (FDG) PET. Both conventional CT and FDG PET, however, cannot detect prostate cancer foci <5 mm within the prostate. Dynamic contrast-enhanced CT involves imaging a region of interest rapidly (usually <10 seconds between images) during a bolus intravenous injection of a contrast agent. Through analysis of the contrast enhancement time curves, it is possible to distinguish tissues with different microvascular properties such as cancer. The technologic aspects of both imaging techniques and the clinical results of 11C-choline PET/CT for intraprostatic tumor characterization are discussed. Based on preliminary studies, dynamic contrast-enhanced (DCE)-CT may be a useful tool for localization of prostate tumors and, perhaps more importantly, quantification of therapeutic response in prostate cancer. Validation work is necessary, however, to define its accuracy and role in therapeutic paradigms such as focal therapies, particularly given the current accuracy of MRI. In the future, combining DCE-CT with CT or (11)C-choline PET/CT may be an alternative to MRI, offering a combination of quantitative parameters that may correlate to tumor prognosis as well as cancer localization for focal therapy.
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Affiliation(s)
- Michael M Li
- Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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García Figueiras R, Padhani A, Vilanova J, Goh V, Villalba Martín C. Imagen funcional tumoral. Parte 1. RADIOLOGIA 2010; 52:115-25. [DOI: 10.1016/j.rx.2009.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 12/09/2009] [Accepted: 12/27/2009] [Indexed: 02/06/2023]
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Kinetic Models for Cancer Imaging. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 680:549-57. [DOI: 10.1007/978-1-4419-5913-3_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Functional imaging of tumors. Part 1. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abramyuk A, Tokalov SV. Distribution of fluorescent microspheres in vascular space and parenchymal organs of intact nude rats. Int J Radiat Biol 2009; 85:781-6. [PMID: 19657864 DOI: 10.1080/09553000903090035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess kinetics of elimination of different sized microspheres (MS) from the blood pool and tendency of their distribution in parenchymal organs of intact nude rats. MATERIALS AND METHODS A mixture of 1 microm and 3 microm MS in phosphate-buffered saline was injected intravenously into eight rats under intraperitoneal anaesthesia. Blood samples were collected before, just after and in 2, 5 and 10 min after MS injection. Dynamics of MS elimination from blood pool was evaluated with flow cytometry. After euthanasia, histological sections were prepared and distributions of MS through the liver, spleen, kidney and lung were analysed with fluorescence microscopy and flow cytometry. RESULTS The number of microspheres registered in the intravascular space showed a marked exponential decrease over time independent of MS size. Different amounts and proportions of 1 microm and 3 microm MS were revealed in lung, liver, spleen and kidneys of the rats. Most of 1 microm MS were localised in liver and spleen. In contrast, 3 microm MS were detected predominantly in lung. CONCLUSION 1 microm and 3 microm MS may be assumed as free circulating particles only for a short period of time after injection. Their elimination kinetics seems to be tightly linked to specific tissue properties such a pulmonary vasoconstriction and phagocytosis.
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Affiliation(s)
- Andrij Abramyuk
- OncoRay-Center for Radiation Research in Oncology, Dresden University of Technology, Dresden, Germany.
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Kambadakone AR, Sahani DV. Body perfusion CT: technique, clinical applications, and advances. Radiol Clin North Am 2009; 47:161-78. [PMID: 19195541 DOI: 10.1016/j.rcl.2008.11.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perfusion CT has made tremendous progress since its inception and is gradually broadening its applications from the research realm into routine clinical care. This has been particularly noteworthy in the oncological setting, where perfusion CT is emerging as a valuable tool in tissue characterization, risk stratification and monitoring treatment effects especially assessing early response to novel targeted therapies. Recent technological advancements in CT have paved ways to overcome the initial limitations of restricted tissue coverage and radiation dose concerns. In this article, the authors review the basic principles and technique of perfusion CT and discuss its various oncologic and non-oncological clinical applications in body imaging.
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Affiliation(s)
- Avinash R Kambadakone
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
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