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Goh V, Mallett S, Rodriguez-Justo M, Boulter V, Glynne-Jones R, Khan S, Lessels S, Patel D, Prezzi D, Taylor S, Halligan S. Evaluation of prognostic models to improve prediction of metastasis in patients following potentially curative treatment for primary colorectal cancer: the PROSPECT trial. Health Technol Assess 2025; 29:1-91. [PMID: 40230305 PMCID: PMC12010235 DOI: 10.3310/btmt7049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2025] Open
Abstract
Background Despite apparently curative treatment, many patients with colorectal cancer develop subsequent metastatic disease. Current prognostic models are criticised because they are based on standard staging and omit novel biomarkers. Improved prognostication is an unmet need. Objectives To improve prognostication for colorectal cancer by developing a baseline multivariable model of standard clinicopathological predictors, and to then improve prediction via addition of promising novel imaging, genetic and immunohistochemical biomarkers. Design Prospective multicentre cohort. Setting Thirteen National Health Service hospitals. Participants Consecutive adult patients with colorectal cancer. Interventions Collection of prespecified standard clinicopathological variables and more novel imaging, genetic and immunohistochemical biomarkers, followed by 3-year follow-up to identify postoperative metastasis. Main outcome Best multivariable prognostic model including perfusion computed tomography compared with tumour/node staging. Secondary outcomes: Additive benefit of perfusion computed tomography and other biomarkers to best baseline model comprising standard clinicopathological predictors; measurement variability between local and central review; biological relationships between perfusion computed tomography and pathology variables. Results Between 2011 and 2016, 448 participants were recruited; 122 (27%) were withdrawn, leaving 326 (226 male, 100 female; mean ± standard deviation 66 ± 10.7 years); 183 (56%) had rectal cancer. Most cancers were locally advanced [≥ T3 stage, 227 (70%)]; 151 (46%) were node-positive (≥ N1 stage); 306 (94%) had surgery; 79 (24%) had neoadjuvant therapy. The resection margin was positive in 15 (5%); 93 (28%) had venous invasion; 125 (38%) had postoperative adjuvant chemotherapy; 81 (25%, 57 male) developed recurrent disease. Prediction of recurrent disease by the baseline clinicopathological time-to-event Weibull multivariable model (age, sex, tumour/node stage, tumour size and location, treatment, venous invasion) was superior to tumour/node staging: sensitivity: 0.57 (95% confidence interval 0.45 to 0.68), specificity 0.74 (95% confidence interval 0.68 to 0.79) versus sensitivity 0.56 (95% confidence interval 0.44 to 0.67), specificity 0.58 (95% confidence interval 0.51 to 0.64), respectively. Addition of perfusion computed tomography variables did not improve prediction significantly: c-statistic: 0.77 (95% confidence interval 0.71 to 0.83) versus 0.76 (95% confidence interval 0.70 to 0.82). Perfusion computed tomography parameters did not differ significantly between patients with and without recurrence (e.g. mean ± standard deviation blood flow of 60.3 ± 24.2 vs. 61.7 ± 34.2 ml/minute/100 ml). Furthermore, baseline model prediction was not improved significantly by the addition of any novel genetic or immunohistochemical biomarkers. We observed variation between local and central computed tomography measurements but neither improved model prediction significantly. We found no clear association between perfusion computed tomography variables and any immunohistochemical measurement or genetic expression. Limitations The number of patients developing metastasis was lower than expected from historical data. Our findings should not be overinterpreted. While the baseline model was superior to tumour/node staging, any clinical utility needs definition in daily practice. Conclusions A prognostic model of standard clinicopathological variables outperformed tumour/node staging, but novel biomarkers did not improve prediction significantly. Biomarkers that appear promising in small single-centre studies may contribute nothing substantial to prognostication when evaluated rigorously. Future work It would be desirable for other researchers to externally evaluate the baseline model. Trial registration This trial is registered as ISRCTN95037515. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 09/22/49) and is published in full in Health Technology Assessment; Vol. 29, No. 8. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Vicky Goh
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | | | | | | | | | - Sarah Lessels
- Scottish Clinical Trials Research Unit (SCTRU), NHS National Services Scotland, Edinburgh, Scotland
| | - Dominic Patel
- Research Department of Pathology, UCL Cancer Institute, London, UK
| | - Davide Prezzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Aydin F, Yalcin A, Karaman A, Sade R, Ozturk G, Alper F. Diagnostic and Management Perspectives in Alveolar Echinococcosis: Review of Literature. Eurasian J Med 2022; 54:10-15. [PMID: 36655439 PMCID: PMC11163348 DOI: 10.5152/eurasianjmed.2022.22308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/27/2022] [Indexed: 01/19/2023] Open
Abstract
Alveolar echinococcosis is a life-threatening zoonotic disease caused by Echinococcus multilocularis. The disease usually primarily involves the liver and shows tumor-like growth. Early diagnosis of alveolar echinococcosis is difficult because the disease is usually asymptomatic in the early stages. Untreated cases are fatal and result in death within 10 years of liver involvement. In the diagnosis of alveolar echinococcosis, the patient's medical history, radiological imaging findings, and serological and histopathological tests are used together. Radiological imaging methods are very important for early diagnosis and differential diagnosis of the disease. In this article, we wanted to review the diagnosis and treatment of alveolar echinococcosis and emphasize the importance of keeping it in mind, especially in cystic lesions of the liver, and the importance of early diagnosis of the disease.
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Affiliation(s)
- Fahri Aydin
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Ahmet Yalcin
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Adem Karaman
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Recep Sade
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Gurkan Ozturk
- Ataturk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Fatih Alper
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
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Beaton L, Tregidgo HFJ, Znati SA, Forsyth S, Counsell N, Clarkson MJ, Bandula S, Chouhan M, Lowe HL, Thin MZ, Hague J, Sharma D, Pollok JM, Davidson BR, Raja J, Munneke G, Stuckey DJ, Bascal ZA, Wilde PE, Cooper S, Ryan S, Czuczman P, Boucher E, Hartley JA, Atkinson D, Lewis AL, Jansen M, Meyer T, Sharma RA. Phase 0 Study of Vandetanib-Eluting Radiopaque Embolics as a Preoperative Embolization Treatment in Patients with Resectable Liver Malignancies. J Vasc Interv Radiol 2022; 33:1034-1044.e29. [PMID: 35526675 DOI: 10.1016/j.jvir.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess the safety and tolerability of a vandetanib-eluting radiopaque embolic (BTG-002814) for transarterial chemoembolization (TACE) in patients with resectable liver malignancies. MATERIALS AND METHODS The VEROnA clinical trial was a first-in-human, phase 0, single-arm, window-of-opportunity study. Eligible patients were aged ≥18 years and had resectable hepatocellular carcinoma (HCC) (Child-Pugh A) or metastatic colorectal cancer (mCRC). Patients received 1 mL of BTG-002814 transarterially (containing 100 mg of vandetanib) 7-21 days prior to surgery. The primary objectives were to establish the safety and tolerability of BTG-002814 and determine the concentrations of vandetanib and the N-desmethyl vandetanib metabolite in the plasma and resected liver after treatment. Biomarker studies included circulating proangiogenic factors, perfusion computed tomography, and dynamic contrast-enhanced magnetic resonance imaging. RESULTS Eight patients were enrolled: 2 with HCC and 6 with mCRC. There was 1 grade 3 adverse event (AE) before surgery and 18 after surgery; 6 AEs were deemed to be related to BTG-002814. Surgical resection was not delayed. Vandetanib was present in the plasma of all patients 12 days after treatment, with a mean maximum concentration of 24.3 ng/mL (standard deviation ± 13.94 ng/mL), and in resected liver tissue up to 32 days after treatment (441-404,000 ng/g). The median percentage of tumor necrosis was 92.5% (range, 5%-100%). There were no significant changes in perfusion imaging parameters after TACE. CONCLUSIONS BTG-002814 has an acceptable safety profile in patients before surgery. The presence of vandetanib in the tumor specimens up to 32 days after treatment suggests sustained anticancer activity, while the low vandetanib levels in the plasma suggest minimal release into the systemic circulation. Further evaluation of this TACE combination is warranted in dose-finding and efficacy studies.
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Affiliation(s)
- Laura Beaton
- University College London Cancer Institute, University College London, London, United Kingdom.
| | - Henry F J Tregidgo
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sami A Znati
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Sharon Forsyth
- Cancer Research UK and University College London Cancer Trials Centre, University College London, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK and University College London Cancer Trials Centre, University College London, London, United Kingdom
| | - Matthew J Clarkson
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Steven Bandula
- University College London Centre for Medical Imaging, University College London, London, United Kingdom
| | - Manil Chouhan
- University College London Centre for Medical Imaging, University College London, London, United Kingdom
| | - Helen L Lowe
- University College London Experimental Cancer Medicine Centre Good Clinical Laboratory Practice Facility, University College London, London, United Kingdom
| | - May Zaw Thin
- Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Julian Hague
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Dinesh Sharma
- Division of Transplantation and Immunology, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Joerg-Matthias Pollok
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Hepatopancreatobiliary Surgery and Liver Transplantation, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Brian R Davidson
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Hepatopancreatobiliary Surgery and Liver Transplantation, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Jowad Raja
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Graham Munneke
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Daniel J Stuckey
- Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Zainab A Bascal
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Paul E Wilde
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Sarah Cooper
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Samantha Ryan
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Peter Czuczman
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Eveline Boucher
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - John A Hartley
- University College London Cancer Institute, University College London, London, United Kingdom; University College London Experimental Cancer Medicine Centre Good Clinical Laboratory Practice Facility, University College London, London, United Kingdom
| | - David Atkinson
- University College London Centre for Medical Imaging, University College London, London, United Kingdom
| | - Andrew L Lewis
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Marnix Jansen
- University College London Cancer Institute, University College London, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tim Meyer
- University College London Cancer Institute, University College London, London, United Kingdom; Department of Oncology, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Ricky A Sharma
- National Institute for Health Research University College London Hospitals Biomedical Centre, University College London Cancer Institute, London, United Kingdom
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Relative Perfusion Differences between Parathyroid Adenomas and the Thyroid on Multiphase 4DCT. Int J Biomed Imaging 2022; 2022:2984789. [PMID: 35646108 PMCID: PMC9142320 DOI: 10.1155/2022/2984789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/14/2022] [Accepted: 05/10/2022] [Indexed: 02/07/2023] Open
Abstract
A multiphase 4DCT technique can be useful for the detection of parathyroid adenomas. Up to 16 different phases can be obtained without significant increase of exposure dose using wide beam axial scanning. This technique also allows for the calculation of perfusion parameters in suspected lesions. We present data on 19 patients with histologically proven parathyroid adenomas. We find a strong correlation between 2 perfusion parameters when comparing parathyroid adenomas and thyroid tissue: parathyroid adenomas show a 55% increase in blood flow (BF) (p < 0.001) and a 50% increase in blood volume (BV) (p < 0.001) as compared to normal thyroid tissue. The analysis of the ROC curve for the different perfusion parameters demonstrates a significantly high area under the curve for BF and BV, confirming these two perfusion parameters to be a possible discriminating tool to discern between parathyroid adenomas and thyroid tissue. These findings can help to discern parathyroid from thyroid tissue and may aid in the detection of parathyroid adenomas.
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Huang SHS, Pavenski K, Lee TY, Jurkiewicz MT, Bharatha A, Thiessen JD, St. Lawrence K, Théberge J, Mandzia J, Barth D, Licht C, Patriquin CJ. Blood-brain barrier permeability in survivors of immune-mediated thrombotic thrombocytopenic purpura: a pilot study. Blood Adv 2021; 5:4211-4218. [PMID: 34521110 PMCID: PMC8945621 DOI: 10.1182/bloodadvances.2021005317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/23/2021] [Indexed: 11/20/2022] Open
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening disorder of systemic microthrombosis and organ ischemia. The etiology of chronic cerebrovascular outcomes in iTTP survivors is largely unknown. In this pilot study, we measured blood-brain barrier (BBB) permeability in patients with iTTP at the start of remission and 6 months later. This prospective pilot study included 7 adult patients with incident iTTP. Eligibility criteria included ADAMTS13 activity < 10% and detectable inhibitor at diagnosis. Patients were recruited from London Health Sciences Centre in Canada (2017-2019) within 3 days of hospital admission and followed for 6 months after remission (defined as normalization of platelet count and lactate dehydrogenase with no clinical signs or symptoms of microvascular injury for more than 30 days after the last plasma exchange). All patients had cerebral computed tomography perfusion scans with BBB permeability surface product measurements. Patients (5 women, 2 men) had a mean age of 48 years (range, 21-77 years). At diagnosis, patients had a mean platelet count of 22 (standard deviation [SD], 25) × 109/L. At the start of remission, mean BBB permeability surface product was 0.91 (0.30) mL/min/100 g. Six months later, the mean permeability surface product was 0.56 (0.22) mL/min/100 g, with a mean difference of -0.312 mL/min/100 g (95% confidence interval: -0.4729 to -0.1510; P = .0032). In this pilot study of patients with iTTP, pathologically increased BBB permeability was evident, and although there was some improvement, this persisted 6 months after remission. Future work will explore the chronicity of these findings and their clinical implications.
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Affiliation(s)
| | | | - Ting-Yim Lee
- Department of Medical Biophysics, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Department of Medical Imaging, Western University, London, Canada
| | | | - Aditya Bharatha
- Department of Radiology, St. Michael’s Hospital, Toronto, Canada
| | - Jonathan Dale Thiessen
- Department of Medical Biophysics, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Department of Medical Imaging, Western University, London, Canada
| | - Keith St. Lawrence
- Department of Medical Biophysics, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Jean Théberge
- Department of Medical Biophysics, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Department of Medical Imaging, Western University, London, Canada
| | | | - David Barth
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Toronto, Canada; and
| | - Christoph Licht
- Department of Pediatric, Division of Nephrology, SickKids Hospital, Toronto, Canada
| | - Christopher Jordan Patriquin
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Toronto, Canada; and
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Koell M, Klauss M, Skornitzke S, Mayer P, Fritz F, Stiller W, Grenacher L. Computed Tomography Perfusion Analysis of Pancreatic Adenocarcinoma using Deconvolution, Maximum Slope, and Patlak Methods - Evaluation of Diagnostic Accuracy and Interchangeability of Cut-Off Values. ROFO-FORTSCHR RONTG 2021; 193:1062-1073. [PMID: 33772484 DOI: 10.1055/a-1401-0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The goal of this study was to evaluate the diagnostic accuracy of perfusion computed tomography (CT) parameters obtained by different mathematical-kinetic methods for distinguishing pancreatic adenocarcinoma from normal tissue. To determine cut-off values and to assess the interchangeability of cut-off values, which were determined by different methods. MATERIALS AND METHODS Perfusion CT imaging of the pancreas was prospectively performed in 23 patients. 19 patients with histopathologically confirmed pancreatic adenocarcinoma were included in the study. Blood flow (BF), blood volume (BV) and permeability-surface area product (PS) were measured in pancreatic adenocarcinoma and normal tissue with the deconvolution (BF, BV, PS), maximum slope (BF), and Patlak methods (BV, PS). The interchangeability of cut-off values was examined by assessing agreement between BF, BV, and PS measured with different mathematical-kinetic methods. RESULTS Bland-Altman analysis demonstrated poor agreement between perfusion parameters, measured with different mathematical-kinetic methods. According to receiver operating characteristic (ROC) analysis, PS measured with the Patlak method had the significantly lowest diagnostic accuracy (area under ROC curve = 0.748). All other parameters were of high diagnostic accuracy (area under ROC curve = 0.940-0.997), although differences in diagnostic accuracy were not statistically different. Cut-off values for BF of ≤ 91.83 ml/100 ml/min and for BV of ≤ 5.36 ml/100 ml, both measured with the deconvolution method, appear to be the most appropriate cut-off values to distinguish pancreatic adenocarcinoma from normal tissue. CONCLUSION Perfusion parameters obtained by different methods are not interchangeable. Therefore, cut-off values, which were determined using different methods, are not interchangeable either. Perfusion parameters can help to distinguish pancreatic adenocarcinoma from normal tissue with high diagnostic accuracy, except for PS measured with the Patlak method. KEY POINTS · Perfusion CT parameters showed high diagnostic accuracy in differentiating between pancreatic adenocarcinoma and normal tissue.. · Only PS measured with the Patlak method showed a significantly lower diagnostic accuracy.. · Perfusion parameters measured with different mathematical-kinetic methods are not interchangeable.. · A specific cut-off value must be determined for each method and each perfusion parameter.. CITATION FORMAT · Koell M, Klauss M, Skornitzke S et al. Computed Tomography Perfusion Analysis of Pancreatic Adenocarcinoma with the Deconvolution, Maximum Slope, and Patlak Methods - Evaluation of Diagnostic Accuracy and Interchangeability of Cut-Off Values. Fortschr Röntgenstr 2021; 193: 1062 - 1073.
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Affiliation(s)
- Marco Koell
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - Miriam Klauss
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - Stephan Skornitzke
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - Philipp Mayer
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | | | - Wolfram Stiller
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - Lars Grenacher
- Imaging and Prevention Center, Conradia Radiology Munich, Germany
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Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease? Gastroenterol Res Pract 2019; 2019:6590729. [PMID: 31485219 PMCID: PMC6710743 DOI: 10.1155/2019/6590729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/24/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to evaluate the prognostic properties of perfusion parameters of liver parenchyma based on computed tomography (CT) of patients with acute pancreatitis (AP) made on the first day of onset of symptoms, to assess their usefulness in identifying patients with increased risk of the development of severe AP. Methods 79 patients with clinical symptoms and biochemical criteria indicative of AP underwent perfusion computed tomography (p-CT) within 24 hours after onset of the symptoms. Perfusion parameters in 41 people who developed a severe form of AP were compared with parameters in 38 patients in whom the course of AP was mild. Results Statistical differences in the liver perfusion parameters between the group of patients with mild and severe AP were shown. The permeability-surface area product was significantly lower, and the hepatic arterial fraction was significantly higher in the group of patients with progression of AP. Conclusions Based on the results, it seems that p-CT performed on the first day from the onset of AP is a method that, by revealing disturbances in hepatic perfusion, can help in identifying patients with increased risk of the development of severe AP.
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8
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Walker-Samuel S, Roberts TA, Ramasawmy R, Burrell JS, Johnson SP, Siow BM, Richardson S, Gonçalves MR, Pendse D, Robinson SP, Pedley RB, Lythgoe MF. Investigating Low-Velocity Fluid Flow in Tumors with Convection-MRI. Cancer Res 2018; 78:1859-1872. [PMID: 29317434 PMCID: PMC6298581 DOI: 10.1158/0008-5472.can-17-1546] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/18/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023]
Abstract
Several distinct fluid flow phenomena occur in solid tumors, including intravascular blood flow and interstitial convection. Interstitial fluid pressure is often raised in solid tumors, which can limit drug delivery. To probe low-velocity flow in tumors resulting from raised interstitial fluid pressure, we developed a novel MRI technique named convection-MRI, which uses a phase-contrast acquisition with a dual-inversion vascular nulling preparation to separate intra- and extravascular flow. Here, we report the results of experiments in flow phantoms, numerical simulations, and tumor xenograft models to investigate the technical feasibility of convection-MRI. We observed a significant correlation between estimates of effective fluid pressure from convection-MRI with gold-standard, invasive measurements of interstitial fluid pressure in mouse models of human colorectal carcinoma. Our results show how convection-MRI can provide insights into the growth and responsiveness to vascular-targeting therapy in colorectal cancers.Significance: A noninvasive method for measuring low-velocity fluid flow caused by raised fluid pressure can be used to assess changes caused by therapy. Cancer Res; 78(7); 1859-72. ©2018 AACR.
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Affiliation(s)
- Simon Walker-Samuel
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK.
| | - Thomas A Roberts
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | - Rajiv Ramasawmy
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | - Jake S Burrell
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, UK
| | | | - Bernard M Siow
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | - Simon Richardson
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | - Miguel R Gonçalves
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | | | - Simon P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, UK
| | | | - Mark F Lythgoe
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
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Sade R, Kantarci M, Genc B, Ogul H, Gundogdu B, Yilmaz O. Computed Tomography Perfusion Imaging for the Diagnosis of Hepatic Alveolar Echinococcosis. Eurasian J Med 2018; 50:1-5. [PMID: 29531482 PMCID: PMC5843444 DOI: 10.5152/eurasianjmed.2017.17321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/11/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Alveolar echinococcosis (AE) is a rare life-threatening parasitic infection. Computed tomography perfusion (CTP) imaging has the potential to provide both quantitative and qualitative information about the tissue perfusion characteristics. The purpose of this study was the examination of the characteristic features and feasibility of CTP in AE liver lesions. MATERIAL AND METHODS CTP scanning was performed in 25 patients who had a total of 35 lesions identified as AE of the liver. Blood flow (BF), blood volume (BV), portal venous perfusion (PVP), arterial liver perfusion (ALP), and hepatic perfusion indexes (HPI) were computed for background liver parenchyma and each AE lesion. RESULTS Significant differences were detected between perfusion values of the AE lesions and background liver tissue. The BV, BF, ALP, and PVP values for all components of the AE liver lesions were significantly lower than the normal liver parenchyma (p<0.01). CONCLUSIONS We suggest that perfusion imaging can be used in AE of the liver. Thus, the quantitative knowledge of perfusion parameters are obtained via CT perfusion imaging.
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Affiliation(s)
- Recep Sade
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Berhan Genc
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
- Department of Radiology, Karataş Hospital, İzmir, Turkey
| | - Hayri Ogul
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Betul Gundogdu
- Department of Pathology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Omer Yilmaz
- Department of Gastroenterology, Atatürk University School of Medicine, Erzurum, Turkey
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Muenzel D, Daerr H, Proksa R, Fingerle AA, Kopp FK, Douek P, Herzen J, Pfeiffer F, Rummeny EJ, Noël PB. Simultaneous dual-contrast multi-phase liver imaging using spectral photon-counting computed tomography: a proof-of-concept study. Eur Radiol Exp 2017; 1:25. [PMID: 29708205 PMCID: PMC5909366 DOI: 10.1186/s41747-017-0030-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background To assess the feasibility of dual-contrast spectral photon-counting computed tomography (SPCCT) for liver imaging. Methods We present an SPCCT in-silico study for simultaneous mapping of the complementary distribution in the liver of two contrast agents (CAs) subsequently intravenously injected: a gadolinium-based contrast agent and an iodine-based contrast agent. Four types of simulated liver lesions with a characteristic arterial and portal venous pattern (haemangioma, hepatocellular carcinoma, cyst, and metastasis) are presented. A material decomposition was performed to reconstruct quantitative iodine and gadolinium maps. Finally, a multi-dimensional classification algorithm for automatic lesion detection is presented. Results Our simulations showed that with a single-scan SPCCT and an adapted contrast injection protocol, it was possible to reconstruct contrast-enhanced images of the liver with arterial distribution of the iodine-based CA and portal venous phase of the gadolinium-based CA. The characteristic patterns of contrast enhancement were visible in all liver lesions. The approach allowed for an automatic detection and classification of liver lesions using a multi-dimensional analysis. Conclusions Dual-contrast SPCCT should be able to visualise the characteristic arterial and portal venous enhancement with a single scan, allowing for an automatic lesion detection and characterisation, with a reduced radiation exposure.
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Affiliation(s)
- Daniela Muenzel
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Heiner Daerr
- 2Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Roland Proksa
- 2Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Alexander A Fingerle
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Felix K Kopp
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Philippe Douek
- 3Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
| | - Julia Herzen
- 4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Franz Pfeiffer
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany.,4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany.,5Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Ernst J Rummeny
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Peter B Noël
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany.,4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany
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11
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Nakamura Y, Kawaoka T, Higaki T, Fukumoto W, Honda Y, Iida M, Fujioka C, Kiguchi M, Aikata H, Chayama K, Awai K. Hepatocellular carcinoma treated with sorafenib: Arterial tumor perfusion in dynamic contrast-enhanced CT as early imaging biomarkers for survival. Eur J Radiol 2017; 98:41-49. [PMID: 29279169 DOI: 10.1016/j.ejrad.2017.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/27/2017] [Accepted: 10/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate whether hepatic perfusion CT yields early imaging biomarkers predictive of the prognosis of hepatocellular carcinoma (HCC) patients treated with sorafenib. METHODS We evaluated 36 HCC patients who underwent hepatic perfusion CT before- and one week after sorafenib therapy. We measured arterial and portal perfusion in the hepatic tumor and liver parenchyma [(AP)(PP)tumor], [(AP)(PP)liver]. The perfusion ratio was calculated by dividing the post- by the pre-sorafenib value. The effect of each value on the overall survival rate was analyzed with the Cox proportional hazards model; statistically significant parameters were subjected to receiver operating characteristic analysis based on median survival after sorafenib administration to determine the overall survival rate with the Kaplan-Meier method. RESULTS Pre-APtumor was significantly associated with the overall survival rate (hazard ratio (HR) and 95% confidence interval (CI), 0.16 and 0.02-0.84, p=0.03). The APtumor ratio tended to be associated with the overall survival rate (HR and 95% CI, 2.94 and 0.94-7.88, p=0.06). The overall survival rate was higher in patients with pre-APtumor>71.7mL/min/100mL, and with APtumor ratio≦1.1 (p<0.01 and 0.03, respectively, in Kaplan-Meier method with log-rank). CONCLUSION Hepatic perfusion CT yields early imaging biomarkers for predicting overall survival in HCC patients treated with sorafenib.
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Affiliation(s)
| | - Tomokazu Kawaoka
- Department of Medicine and Molecular Science, Hiroshima University, Japan; Hiroshima Liver Research Project Center, Japan.
| | - Toru Higaki
- Diagnostic Radiology, Hiroshima University, Japan.
| | | | - Yukiko Honda
- Diagnostic Radiology, Hiroshima University, Japan.
| | - Makoto Iida
- Diagnostic Radiology, Hiroshima University, Japan.
| | - Chikako Fujioka
- Department of Radiology, Hiroshima University Hospital, Japan.
| | - Masao Kiguchi
- Department of Radiology, Hiroshima University Hospital, Japan.
| | - Hiroshi Aikata
- Department of Medicine and Molecular Science, Hiroshima University, Japan; Hiroshima Liver Research Project Center, Japan.
| | - Kazuaki Chayama
- Department of Medicine and Molecular Science, Hiroshima University, Japan; Hiroshima Liver Research Project Center, Japan.
| | - Kazuo Awai
- Diagnostic Radiology, Hiroshima University, Japan.
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12
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Gill AB, Hilliard NJ, Hilliard ST, Graves MJ, Lomas DJ, Shaw A. A semi-automatic method for the extraction of the portal venous input function in quantitative dynamic contrast-enhanced CT of the liver. Br J Radiol 2017; 90:20160875. [PMID: 28511589 DOI: 10.1259/bjr.20160875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To aid the extraction of the portal venous input function (PVIF) from axial dynamic contrast-enhanced CT images of the liver, eliminating the need for full manual outlining of the vessel across time points. METHODS A cohort of 20 patients undergoing perfusion CT imaging of the liver was examined. Dynamic images of the liver were reformatted into contiguous thin slices. A region of interest was defined within a transverse section of the portal vein on a single contrast-enhanced image. This region of interest was then computationally projected across all thin slices for all time points to yield a semi-automated PVIF curve. This was compared against the "gold-standard" PVIF curve obtained by conventional manual outlining. RESULTS Bland-Altman plots of curve characteristics indicated no substantial difference between automated and manual PVIF curves [concordance correlation coefficient in the range (0.66, 0.98)]. No substantial differences were shown by Bland-Altman plots of derived pharmacokinetic parameters when a suitable kinetic model was applied in each case [concordance correlation coefficient in range (0.92, 0.95)]. CONCLUSION This semi-automated method of extracting the PVIF performed equivalently to a "gold-standard" manual method for assessing liver function. Advances in knowledge: This technique provides a quick, simple and effective solution to the problems incurred by respiration motion and partial volume factors in the determination of the PVIF in liver dynamic contrast-enhanced CT.
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Affiliation(s)
- Andrew B Gill
- 1 Department of Radiology, University of Cambridge, Cambridge, UK.,2 Department of Medical Physics, Cambridge University Hospitals, Cambridge, UK
| | | | - Simon T Hilliard
- 3 Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Martin J Graves
- 1 Department of Radiology, University of Cambridge, Cambridge, UK.,2 Department of Medical Physics, Cambridge University Hospitals, Cambridge, UK
| | - David J Lomas
- 1 Department of Radiology, University of Cambridge, Cambridge, UK.,3 Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Ashley Shaw
- 3 Department of Radiology, Cambridge University Hospitals, Cambridge, UK
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13
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Topcuoğlu OM, Karçaaltıncaba M, Akata D, Özmen MN. Reproducibility and variability of very low dose hepatic perfusion CT in metastatic liver disease. Diagn Interv Radiol 2017; 22:495-500. [PMID: 27759566 DOI: 10.5152/dir.2016.16612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE We aimed to determine the intra- and interobserver agreement on the software analysis of very low dose hepatic perfusion CT (pCT). METHODS A total of 53 pCT examinations were obtained from 21 patients (16 men, 5 women; mean age, 60.4 years) with proven liver metastasis from various primary cancers. The pCT examinations were analyzed by two readers independently and perfusion parameters were noted for whole liver, whole metastasis, metastasis wall, and normal-looking liver (liver tissue without metastasis) in regions of interest (ROIs). Readers repeated the analysis after an interval of one month. Intra- and interobserver agreements were assessed with intraclass correlation coefficients (ICC) and Bland-Altman statistics. RESULTS The mean ICCs of all ROIs between readers were 0.91, 0.93, 0.86, 0.45, 0.53, and 0.66 for blood flow (BF), blood volume (BV), permeability, arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic perfusion index (HPI), respectively. The mean ICCs of all ROIs between readings were 0.86, 0.91, 0.81, 0.53, 0.56, and 0.71 for BF, BV, permeability, ALP, PVP, and HPI, respectively. There was greater agreement on the parameters measured for the whole metastasis than on the parameters measured for the metastasis wall. The effective dose of all perfusion CT studies was 2.9 mSv. CONCLUSION There is greater intra- and interobserver agreement for BF and BV than for permeability, ALP, PVP, and HPI at very low dose hepatic pCT. Permeability, ALP, PVP, and HPI parameters cannot be used in clinical practice for hepatic pCT with an effective dose of 2.9 mSv.
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Wang X, Henzler T, Gawlitza J, Diehl S, Wilhelm T, Schoenberg S, Jin Z, Xue H, Smakic A. Image quality of mean temporal arterial and mean temporal portal venous phase images calculated from low dose dynamic volume perfusion CT datasets in patients with hepatocellular carcinoma and pancreatic cancer. Eur J Radiol 2016; 85:2104-2110. [DOI: 10.1016/j.ejrad.2016.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/22/2016] [Accepted: 09/24/2016] [Indexed: 01/28/2023]
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15
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Fronczyk KM, Guindani M, Hobbs BP, Ng CS, Vannucci M. A Bayesian Nonparametric Approach for Functional Data Classification with Application to Hepatic Tissue Characterization. Cancer Inform 2016; 14:151-62. [PMID: 27279730 PMCID: PMC4886897 DOI: 10.4137/cin.s31933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/20/2016] [Accepted: 03/20/2016] [Indexed: 11/05/2022] Open
Abstract
Computed tomography perfusion (CTp) is an emerging functional imaging technology that provides a quantitative assessment of the passage of fluid through blood vessels. Tissue perfusion plays a critical role in oncology due to the proliferation of networks of new blood vessels typical of cancer angiogenesis, which triggers modifications to the vasculature of the surrounding host tissue. In this article, we consider a Bayesian semiparametric model for the analysis of functional data. This method is applied to a study of four interdependent hepatic perfusion CT characteristics that were acquired under the administration of contrast using a sequence of repeated scans over a period of 590 seconds. More specifically, our modeling framework facilitates borrowing of information across patients and tissues. Additionally, the approach enables flexible estimation of temporal correlation structures exhibited by mappings of the correlated perfusion biomarkers and thus accounts for the heteroskedasticity typically observed in those measurements, by incorporating change-points in the covariance estimation. This method is applied to measurements obtained from regions of liver surrounding malignant and benign tissues, for each perfusion biomarker. We demonstrate how to cluster the liver regions on the basis of their CTp profiles, which can be used in a prediction context to classify regions of interest provided by future patients, and thereby assist in discriminating malignant from healthy tissue regions in diagnostic settings.
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Affiliation(s)
- Kassandra M. Fronczyk
- Research Staff Member, Operational Evaluation Division, Institute for Defense Analyses, Alexandria, VA, USA
| | - Michele Guindani
- Assistant Professor, Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian P. Hobbs
- Assistant Professor, Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chaan S. Ng
- Professor, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Vannucci
- Professor, Department of Statistics, Rice University, Houston, TX, USA
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16
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Bevilacqua A, Barone D, Malavasi S, Gavelli G. Automatic detection of misleading blood flow values in CT perfusion studies of lung cancer. Biomed Signal Process Control 2016. [DOI: 10.1016/j.bspc.2016.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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17
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Ippolito D, Casiraghi AS, Talei Franzesi C, Bonaffini PA, Fior D, Sironi S. Intraobserver and Interobserver Agreement in the Evaluation of Tumor Vascularization With Computed Tomography Perfusion in Cirrhotic Patients With Hepatocellular Carcinoma. J Comput Assist Tomogr 2016; 40:152-159. [PMID: 26484957 DOI: 10.1097/rct.0000000000000331] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate intrareader and inter-reader agreement in CT perfusion (Perf) measurements in cirrhotic patients with hepatocellular carcinoma (HCC) lesions. METHODS Sixteen patients with HCC (9 untreated, 5 recurrence/residual disease after transarterial chemoembolization, and 2 after radiofrequency ablation treatment) underwent standard CT examination and a Perf study; a quantitative map of arterial and portal Perf by means of a color scale was generated. With dedicated Perf software, the following parameters were calculated on untreated and treated HCC lesions and on cirrhotic parenchyma: hepatic Perf, tissue blood volume, hepatic perfusion index, arterial perfusion, and time to peak. Intraobserver and interobserver agreements were assessed for 2 readers with Bland-Altman plots, intraclass correlation coefficients (ICCs), coefficients of variation, and repeatability. RESULTS In HCC lesions, agreement analysis demonstrated higher intra-agreement values in comparison with interagreement (range of ICC values, 0.26-0.59 between readers and 0.67-0.94 between readings). Lower interagreement was found for treated HCC lesions in comparison with untreated lesions (range of ICC values, respectively, 0.12-0.54 and 0.31-0.89). CONCLUSIONS For all Perf parameters intra-agreement was higher than interagreement, even though a relatively wide range of 95% limits of agreement was found in both cases.
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Affiliation(s)
- Davide Ippolito
- From the Department of Diagnostic Radiology, "San Gerardo" Hospital; and School of Medicine, University of Milano-Bicocca, Monza, Milan, Italy
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Thaiss WM, Sauter AW, Bongers M, Horger M, Nikolaou K. Clinical applications for dual energy CT versus dynamic contrast enhanced CT in oncology. Eur J Radiol 2015; 84:2368-79. [DOI: 10.1016/j.ejrad.2015.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022]
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Ch'ang HJ. Optimal combination of antiangiogenic therapy for hepatocellular carcinoma. World J Hepatol 2015; 7:2029-40. [PMID: 26261692 PMCID: PMC4528276 DOI: 10.4254/wjh.v7.i16.2029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 07/21/2015] [Accepted: 07/24/2015] [Indexed: 02/06/2023] Open
Abstract
The success of sorafenib in prolonging survival of patients with hepatocellular carcinoma (HCC) makes therapeutic inhibition of angiogenesis a component of treatment for HCC. To enhance therapeutic efficacy, overcome drug resistance and reduce toxicity, combination of antiangiogenic agents with chemotherapy, radiotherapy or other targeted agents were evaluated. Nevertheless, the use of antiangiogenic therapy remains suboptimal regarding dosage, schedule and duration of therapy. The issue is further complicated by combination antiangiogenesis to other cytotoxic or biologic agents. There is no way to determine which patients are most likely respond to a given form of antiangiogenic therapy. Activation of alternative pathways associated with disease progression in patients undergoing antiangiogenic therapy has also been recognized. There is increasing importance in identifying, validating and standardizing potential response biomarkers for antiangiogenesis therapy for HCC patients. In this review, biomarkers for antiangiogenesis therapy including systemic, circulating, tissue and imaging ones are summarized. The strength and deficit of circulating and imaging biomarkers were further demonstrated by a series of studies in HCC patients receiving radiotherapy with or without thalidomide.
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Affiliation(s)
- Hui-Ju Ch'ang
- Hui-Ju Ch'ang, National Institute of Cancer Research, National Health Research Institutes, Miaoli 35053, Taiwan
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20
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Lv WF, Han JK, Cheng DL, Zhou CZ, Ni M, Lu D. CT Perfusion Imaging Can Predict Patients' Survival and Early Response to Transarterial Chemo-Lipiodol Infusion for Liver Metastases from Colorectal Cancers. Korean J Radiol 2015; 16:810-20. [PMID: 26175580 PMCID: PMC4499545 DOI: 10.3348/kjr.2015.16.4.810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/13/2015] [Indexed: 02/06/2023] Open
Abstract
Objective To prospectively evaluate the performance of computed tomography perfusion imaging (CTPI) in predicting the early response to transarterial chemo-lipiodol infusion (TACLI) and survival of patients with colorectal cancer liver metastases (CRLM). Materials and Methods Computed tomography perfusion imaging was performed before and 1 month after TACLI in 61 consecutive patients. Therapeutic response was evaluated on CT scans 1 month and 4 months after TACLI; the patients were classified as responders and non-responders based on 4-month CT scans after TACLI. The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI. The optimal parameter and cutoff value were determined. The patients were divided into 2 subgroups according to the cutoff value. The log-rank test was used to compare the survival rates of the 2 subgroups. Results Four-month images were obtained from 58 patients, of which 39.7% were responders and 60.3% were non-responders. The percentage change in hepatic arterial perfusion (HAP) 1 month after TACLI was the optimal predicting parameter (p = 0.003). The best cut-off value was -21.5% and patients who exhibited a ≥ 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001). Conclusion Computed tomography perfusion imaging can predict the early response to TACLI and survival of patients with CRLM. The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.
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Affiliation(s)
- Wei-Fu Lv
- PET/CT Center, Qilu Hospital, First Affiliated Hospital of Shandong University, Jinan 250012, China. ; Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Jian-Kui Han
- PET/CT Center, Qilu Hospital, First Affiliated Hospital of Shandong University, Jinan 250012, China
| | - De-Lei Cheng
- Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Chun-Ze Zhou
- Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Ming Ni
- Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Dong Lu
- Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230001, China
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Intraprocedural blood volume measurement using C-arm CT as a predictor for treatment response of malignant liver tumours undergoing repetitive transarterial chemoembolization (TACE). Eur Radiol 2015; 26:755-63. [PMID: 26123407 DOI: 10.1007/s00330-015-3869-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/24/2015] [Accepted: 06/01/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate feasibility of measuring parenchymal blood volume (PBV) of malignant hepatic tumours using C-arm CT, test the changes in PBV following repeated transarterial chemoembolization (TACE) and correlate these changes with the change in tumour size in MRI. METHODS 111 patients with liver malignancy were included. Patients underwent MRI and TACE in a 4- to 6-week interval. During intervention C-arm CT was performed. Images were post-processed to generate PBV maps. Blood volume data in C-arm CT and change in size in MRI were evaluated. The correlation between PBV and size was tested using Spearman rank test. RESULTS Pre-interventional PBV maps showed a mean blood volume of 84.5 ml/1000 ml ± 62.0, follow-up PBV maps after multiple TACE demonstrated 61.1 ml/1000 ml ± 57.5. The change in PBV was statistically significant (p = 0.02). Patients with initial tumour blood volume >100 ml/1000 ml dropped 7.1% in size and 47.2% in blood volume; 50-100 ml/1000 ml dropped 4.6% in size and 25.7% in blood volume; and <50 ml/1000 ml decreased 2.8% in size and increased 82.2% in blood volume. CONCLUSION PBV measurement of malignant liver tumours using C-arm CT is feasible. Following TACE PBV decreased significantly. Patients with low initial PBV show low local response rates and further increase in blood volume, whereas high initial tumour PBV showed better response to TACE. KEY POINTS Parenchymal blood volume assessment of malignant hepatic lesions using C-arm CT is feasible. The parenchymal blood volume is reduced significantly following transarterial chemoembolization. Parenchymal blood volume can monitor the response of tumours after transarterial chemoembolization. Although not significant, high initial parenchymal blood volume yields better response to TACE.
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Ou-Yang L, Lu GM. Decrease with aging of the microcirculatory function of the lumbar vertebral marrow preceding the loss of bone material density and the onset of intervertebral discal degeneration: A study about the potential cause. Chronic Dis Transl Med 2015; 1:96-104. [PMID: 29062993 PMCID: PMC5643569 DOI: 10.1016/j.cdtm.2015.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Indexed: 01/13/2023] Open
Abstract
Objective Using a dynamic computed tomographic perfusion (CTP) imaging method to explore the age-related distribution of the microcirculation perfusion function in the vertebral marrow, the bone material density (BMD), and the intervertebral discal degeneration (IDD). Further, to discuss a possible causation relationship between them. Methods One hundred and eighty-six people were randomly enrolled by stratified sampling and grouped by age: ≤15, 16–25, 26–35, 36–45, 46–55, 56–65, 66–75, and ≥76 years old. The average CTP and BMD of the third and fourth lumbar vertebrae marrow were measured and the IDD incidence of the third-fourth vertebrae was assessed. The temporal–spatial distribution patterns of the age-related changes of the CTP, BMD, and IDD were described, and the correlations between them were calculated. Results The microcirculatory perfusion function of the vertebral marrow develops to maturity by 25 years and is maintained until age 35, then declines with aging. The BMD grew to a peak from 26 to 45 years old, then decreased yearly. The IDD showed a sudden increase after 45 years of age. The CTP [BF (r = 0.806, P = 0.000), BV (r = 0.685, P = 0.005) and PMB (r = 0.619, P = 0.001)] showed strong positive correlations and CTP [TTP (r = −0.211, P = 0.322) and MTT (r = −0.598, P = 0.002)] showed negative correlations with BMD. The CTP [BF (r = −0.815, P = 0.000), BV (r = −0.753, P = 0.000) and PMB (r = −0.690, P = 0.000)] had strong negative correlations, and CTP [TTP (r = 0.323, P = 0.126) and MTT (r = 0.628, P = 0.001)] had positive correlations with the incidence of IDD. Conclusion The decrease with aging of the microcirculatory perfusion in the lumbar vertebral marrow preceded, and is a potential causative factor for the loss of BMD and the onset of IDD.
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Affiliation(s)
- Lin Ou-Yang
- Department of Medical Imaging, PLA 175th Hospital, Southeast Hospital, Clinical School of Medical College, Xiamen University, Zhangzhou, Fujian, China
| | - Guang-Ming Lu
- Department of Medical Imaging, Nanjing General Hospital, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
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Dysfunctional microcirculation of the lumbar vertebral marrow prior to the bone loss and intervertebral discal degeneration. Spine (Phila Pa 1976) 2015; 40:E593-600. [PMID: 25955095 PMCID: PMC4431500 DOI: 10.1097/brs.0000000000000834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Descriptive study, stratified sampling. OBJECTIVE Using dynamic computed tomographic perfusion (CTP) to explore the age-related distribution patterns of the microcirculation perfusion in the vertebral marrow, the vertebral bone mineral density (BMD), and the intervertebral discal degeneration (IDD) further to discuss the possible causation between them. SUMMARY OF BACKGROUND DATA A latest viewpoint deemed that reduced blood supply of the vertebral marrow was correlated with an increased incidence of IDD and loss of BMD. However, the causative relationship between them needs more investigation. METHODS One hundred eighty-six general people were randomly enrolled by stratified sampling and grouped by age: 15 years or less, 16 to 25 years, 26 to 35 years, 36 to 45 years, 46 to 55 years, 56 to 65 years, 66 to 75 years, and 76 years or more. Both CTP and BMD of the third and fourth lumbar vertebral marrow were measured, and the IDD incidence of the third-fourth vertebrae was assessed. The temporal-spatial distribution patterns of the age-related changes of CTP, BMD, and IDD were described, and the correlations between them were calculated. RESULTS Microcirculatory perfusion of the vertebral marrow developed to maturate by 25 years, maintained stable at 35 years, and then declined by age after 35 years. BMD grew to a peak phase in 26 to 45 years and then dropped by years. However, IDD presented a sudden increase after 45 years of age. CTP (blood flow [r=0.806], blood volume [r=0.685], and permeability [r=0.619]) showed strong positive correlations and CTP (time to peak [r=-0.211], mean transit time [r=-0.598]) showed negative correlations with BMD. Meanwhile, CTP (blood flow [r=-0.815], blood volume [r=-0.753], and permeability [r=-0.690]) had strong negative correlations and CTP (time to peak [r=0.323] and mean transit time [r=0.628]) had positive correlations with the incidence of IDD. CONCLUSION Aging-related decrease of the microcirculatory perfusion of the lumbar vertebral marrow preceded the loss of BMD and the onset of IDD, indicating their possible causal relationship. LEVEL OF EVIDENCE 3.
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Hayano K, Lee SH, Sahani DV. Imaging for assessment of treatment response in hepatocellular carcinoma: Current update. Indian J Radiol Imaging 2015; 25:121-128. [PMID: 25969635 PMCID: PMC4419421 DOI: 10.4103/0971-3026.155835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Morphologic methods such as the Response Evaluation Criteria in Solid Tumors (RECIST) are considered as the gold standard for response assessment in the management of cancer. However, with the increasing clinical use of antineoplastic cytostatic agents and locoregional interventional therapies in hepatocellular carcinoma (HCC), conventional morphologic methods are confronting limitations in response assessment. Thus, there is an increasing interest in new imaging methods for response assessment, which can evaluate tumor biology such as vascular physiology, fibrosis, necrosis, and metabolism. In this review, we discuss various novel imaging methods for response assessment and compare them with the conventional ones in HCC.
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Affiliation(s)
- Koichi Hayano
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sang Ho Lee
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Quantitative assessment of effects of motion compensation for liver and lung tumors in CT perfusion. Acad Radiol 2014; 21:1416-26. [PMID: 25300721 DOI: 10.1016/j.acra.2014.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 04/24/2014] [Accepted: 06/17/2014] [Indexed: 01/23/2023]
Abstract
RATIONALE AND OBJECTIVES To study the effects of four different rigid alignment approaches on both time-concentration curves (TCCs) and perfusion maps in computed tomography perfusion (CTp) studies of liver and lung tumors. MATERIALS AND METHODS Eleven data sets in patients who were subjected to axial CTp after contrast agent administration were assessed. Each data set consists of four different sequences, according to the different rigid alignment configurations considered to compute blood flow perfusion maps: no alignment, translational, craniocaudal, and three dimensional (3D). The color maps were built on TCCs according to the maximum slope method. The effects of motion correction procedures on the reliability of TCCs and perfusion maps were assessed both quantitatively and visually. RESULTS TCCs built after 3D alignments show the best indices as well as producing the most reliable maps. We show examinations in which the translational alignment only yields more accurate TCCs, but less reliable perfusion maps, than those achieved with no alignment. Furthermore, we show color maps with two different perfusion patterns, both considered reliable by radiologists, achieved with different motion correction approaches. CONCLUSIONS The quantitative index we conceived allows relating quality of 3D alignment and reliability of perfusion maps. A better alignment does not necessarily yield more reliable perfusion values: color maps resulting from either alignment procedure must be critically assessed by radiologists. This achievement will hopefully represent a step forward for the clinical use of CTp studies for staging, prognosis, and monitoring values of therapeutic regimens.
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Kim SH, Kamaya A, Willmann JK. CT perfusion of the liver: principles and applications in oncology. Radiology 2014; 272:322-44. [PMID: 25058132 DOI: 10.1148/radiol.14130091] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the introduction of molecularly targeted chemotherapeutics, there is an increasing need for defining new response criteria for therapeutic success because use of morphologic imaging alone may not fully assess tumor response. Computed tomographic (CT) perfusion imaging of the liver provides functional information about the microcirculation of normal parenchyma and focal liver lesions and is a promising technique for assessing the efficacy of various anticancer treatments. CT perfusion also shows promising results for diagnosing primary or metastatic tumors, for predicting early response to anticancer treatments, and for monitoring tumor recurrence after therapy. Many of the limitations of early CT perfusion studies performed in the liver, such as limited coverage, motion artifacts, and high radiation dose of CT, are being addressed by recent technical advances. These include a wide area detector with or without volumetric spiral or shuttle modes, motion correction algorithms, and new CT reconstruction technologies such as iterative algorithms. Although several issues related to perfusion imaging-such as paucity of large multicenter trials, limited accessibility of perfusion software, and lack of standardization in methods-remain unsolved, CT perfusion has now reached technical maturity, allowing for its use in assessing tumor vascularity in larger-scale prospective clinical trials. In this review, basic principles, current acquisition protocols, and pharmacokinetic models used for CT perfusion imaging of the liver are described. Various oncologic applications of CT perfusion of the liver are discussed and current challenges, as well as possible solutions, for CT perfusion are presented.
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Affiliation(s)
- Se Hyung Kim
- From the Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, 300 Pasteur Dr, Room H1307, Stanford, CA 94305-5621 (S.H.K., A.K., J.K.W.); and Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (S.H.K.)
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Abstract
Liver-directed intra-arterial therapies are palliative treatment options for patients with unresectable liver cancer; their use has also resulted in patients being downstaged leading to curative resection and transplantation. These intra-arterial therapies include transarterial embolization, conventional transarterial chemoembolization (TACE), drug-eluting bead TACE and radioembolization. Assessment of imaging response following these liver-directed intra-arterial therapies is challenging but pivotal for patient management. Size measurements based on computed tomography or magnetic resonance imaging (MRI) have been traditionally used to assess tumor response to therapy. However, these anatomic changes lag behind functional changes and may require months to occur. Further, these intra-arterial therapies cause acute tumor necrosis, which may result in a paradoxical increase in tumor size on early follow-up imaging despite complete cell death or necrosis. This concept is unique comparing to changes seen following systemic chemotherapy. The recent development of functional imaging techniques including diffusion-weighted MRI (DW MRI) and positron emission tomography (PET) allow for early assessment of treatment response and even prediction of overall tumor response to intra-arterial therapies. Although the results of DW MRI and PET studies are promising, the impact of these imaging modalities to assess treatment response has been limited without standardized protocols. The aim of this review article is to delineate the best practice for assessing tumor response in patients with primary or secondary hepatic malignancies undergoing intra-arterial therapies.
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Brufau BP, Cerqueda CS, Villalba LB, Izquierdo RS, González BM, Molina CN. Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted antiangiogenic therapy by using multidetector CT. Radiographics 2014; 33:1691-716. [PMID: 24108558 DOI: 10.1148/rg.336125110] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances in treatment of metastatic renal cell carcinoma (RCC), such as new molecular therapies that use novel antiangiogenic agents, have led to revision of the most frequently used guideline to evaluate tumor response to therapy: Response Evaluation Criteria in Solid Tumors (RECIST 1.1). Assessment of the response of metastatic RCC to therapy has traditionally been based on changes in target lesion size. However, the mechanism of action of newer antiangiogenic therapies is more cytostatic than cytotoxic, which leads to disease stabilization rather than to tumor regression. This change in tumor response makes RECIST 1.1--a system whose criteria are based exclusively on tumor size--inadequate to discriminate patients with early tumor progression from those with more progression-free disease and prolonged survival. New criteria such as changes in attenuation, morphology, and structure, as seen at contrast-enhanced multidetector computed tomography (CT), are being incorporated into new classifications used to assess response of metastatic RCC to antiangiogenic therapies. The new classifications provide better assessments of tumor response to the new therapies, but they have some limitations. The authors provide a practical review of these systems--the Choi, modified Choi, and Morphology, Attenuation, Size, and Structure (MASS) criteria--by explaining their differences and limitations that may influence the feasibility and reproducibility of these classifications. The authors review the use of multidetector CT in the detection of metastatic RCC and the different appearances and locations of these lesions. They also provide an overview of the new antiangiogenic therapies and their mechanisms of action and a brief introduction to functional imaging techniques. Functional imaging techniques, especially dynamic contrast-enhanced CT, seem promising for assessing response of metastatic RCC to treatment. Nonetheless, further studies are needed before functional imaging can be used in routine clinical practice.
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Affiliation(s)
- Blanca Paño Brufau
- CDIC and ICMHO, Hospital Clínic de Barcelona, C/Villarroel n° 170, 08036 Barcelona, Spain
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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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Jensen NKG, Mulder D, Lock M, Fisher B, Zener R, Beech B, Kozak R, Chen J, Lee TY, Wong E. Dynamic contrast enhanced CT aiding gross tumor volume delineation of liver tumors: an interobserver variability study. Radiother Oncol 2014; 111:153-7. [PMID: 24631143 DOI: 10.1016/j.radonc.2014.01.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/02/2014] [Accepted: 01/25/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the application of perfusion CT for gross tumor volume (GTV) delineation for radiotherapy of intrahepatic tumors. MATERIALS AND METHODS 15 radiotherapy patients with confirmed liver tumors underwent contrast enhanced 4D-CT (Philips Brilliance Big-bore) as well as dynamic contrast enhanced (DCE) CT (GE 750HD). Perfusion maps were generated with CT perfusion v5 from GE. Five observers delineated GTVs of all intrahepatic foci on the 4D-CT, time-averaged DCE-CT and perfusion CT for every patient. STAPLE consensus contours were generated. Dice's coefficients were compared between GTVs generated by observers on each image set and the corresponding consensus GTVs. Comparisons were also performed with patients stratified by hepatocellular carcinoma (HCC) metastatic tumors, and by tumor volume. RESULTS Overall, mean Dice's coefficients were 0.81±0.14, 0.84±0.10, and 0.81±0.14 for 4D-CT, DCECT and perfusion. DCE-CT performed significantly better than 4D-CT and perfusion (p=0.005 and p=0.01 respectively). For patients with HCC, DCE-CT reduced interobserver variability significantly compared to 4D-CT (Dice's coefficients 0.87 vs. 0.84, p<0.05). For patients with metastatic disease time-averaged DCE-CT images decreased variability compared to 4D-CT (Dice's coefficient 0.81 vs. 0.76, p<0.05), especially true for tumors<100cc. The smaller tumors results are important to be included here. CONCLUSIONS DCE-CT imaging of liver perfusion reduced interobserver variability in GTV delineation for both HCC and metastatic liver tumors.
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Affiliation(s)
| | - Danielle Mulder
- Physics & Engineering, London Regional Cancer Program, Canada
| | - Michael Lock
- Radiation Oncology, London Regional Cancer Program, Canada; Department of Oncology, University of Western Ontario, London, Canada
| | - Barbara Fisher
- Radiation Oncology, London Regional Cancer Program, Canada; Department of Oncology, University of Western Ontario, London, Canada
| | | | - Ben Beech
- Physics & Engineering, London Regional Cancer Program, Canada
| | - Roman Kozak
- Radiology, St. Joseph's Health Care, London, Canada
| | - Jeff Chen
- Physics & Engineering, London Regional Cancer Program, Canada; Department of Oncology, University of Western Ontario, London, Canada; Department of Medical Biophysics, University of Western Ontario, London, Canada
| | - Ting-Yim Lee
- Department of Oncology, University of Western Ontario, London, Canada; Radiology, St. Joseph's Health Care, London, Canada; Imaging Research Lab, Robarts Research Institute, London, Canada; Department of Medical Biophysics, University of Western Ontario, London, Canada; Imaging Program, Lawson Health Research Institute, London, Canada
| | - Eugene Wong
- Physics & Engineering, London Regional Cancer Program, Canada; Department of Oncology, University of Western Ontario, London, Canada; Department of Medical Biophysics, University of Western Ontario, London, Canada; Department of Physics & Astronomy, University of Western Ontario, London, Canada.
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FUJISHIRO TAKESHI, SHUTO KIYOHIKO, HAYANO KOICHI, SATOH ASAMI, KONO TSUGUAKI, OHIRA GAKU, TOHMA TAKAYUKI, GUNJI HISASHI, NARUSHIMA KAZUO, TOCHIGI TORU, HANAOKA TOSHIHARU, ISHII SAYAKA, YANAGAWA NORIYUKI, MATSUBARA HISAHIRO. Preoperative hepatic CT perfusion as an early predictor for the recurrence of esophageal squamous cell carcinoma: initial clinical results. Oncol Rep 2014; 31:1083-1088. [PMID: 24452736 PMCID: PMC3926648 DOI: 10.3892/or.2014.2992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 12/27/2013] [Indexed: 12/13/2022] Open
Abstract
Reports suggest that hepatic blood flow may have an association with cancer progression. The aim of the present study was to evaluate whether the hepatic blood flow measured by CT perfusion (CTP) may identify patients at high‑risk for postoperative recurrence of esophageal squamous cell carcinoma (ESCC). Prior to surgery, hepatic CTP images were obtained using a 320-row area detector CT. The data were analyzed by a commercially available software based on the dual input maximum slope method, and arterial blood flow (AF, ml/min/100 ml tissue), portal blood flow (PF, ml/min/100 ml tissue) and perfusion index [PI (%) = AF/AF + PF x 100] were measured. These parameters were compared with the pathological stage and outcome of the ESCC patients. Forty-five patients with ESCC were eligible for this study. The median follow-up period was 17 months, and recurrences were observed in 9 patients (20%). The preoperative PI values of the 9 patients with recurrence were significantly higher than those of the 36 patients without recurrence (23.9 vs. 15.9, P=0.0022). Patients were categorized into the following two groups; high PI (>20) and low PI (<20). The recurrence-free survival of the low PI group was significantly better than that of the high PI group (P<0.0001). A multivariate analysis showed that a high PI was an independent risk factor for recurrence (odds ratio, 19.1; P=0.0369).Therefore, the preoperative PI of the liver may be a useful imaging biomarker for predicting the recurrence of patients with esophageal cancer.
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Affiliation(s)
- TAKESHI FUJISHIRO
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - KIYOHIKO SHUTO
- Department of Surgery, Teikyo University Medical Center, Ichihara, Chiba 299-0111, Japan
| | - KOICHI HAYANO
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - ASAMI SATOH
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - TSUGUAKI KONO
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - GAKU OHIRA
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - TAKAYUKI TOHMA
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - HISASHI GUNJI
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - KAZUO NARUSHIMA
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - TORU TOCHIGI
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - TOSHIHARU HANAOKA
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - SAYAKA ISHII
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - NORIYUKI YANAGAWA
- Department of Radiological Technology, Chiba University Hospital, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - HISAHIRO MATSUBARA
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba 260-8677, Japan
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Hayano K, Desai GS, Kambadakone AR, Fuentes JM, Tanabe KK, Sahani DV. Quantitative characterization of hepatocellular carcinoma and metastatic liver tumor by CT perfusion. Cancer Imaging 2013; 13:512-519. [PMID: 24334461 PMCID: PMC3864227 DOI: 10.1102/1470-7330.2013.0040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the diagnostic value of computed tomography perfusion (CTP) in the distinction of hepatocellular carcinomas (HCCs) from metastatic liver tumors. MATERIALS AND METHODS CTP data from 90 liver tumors (HCC 38, metastasis 52) in 31 patients (16 men and 15 women; mean age 60.3 years) were studied. CTP was performed on a 16/64 multidetector-row CT scanner using a 30-s duration cine acquisition after rapid bolus injection (5-7 ml/s) of 50-70 ml of iodinated contrast medium. The CTP data were analyzed using a deconvolution model. Metastatic tumors were grouped into hypovascular (n = 36) and hypervascular (n = 16) tumors. RESULTS AND CONCLUSION The hypovascular metastases showed a significantly lower blood flow (BF) and blood volume (BV), and higher mean transit time (MTT) than HCC (all P < 0.0001). BF, BV, and MTT of HCCs were substantially lower than those of hypervascular metastases (P = 0.02, P < 0.0001, P = 0.03, respectively). A receiver-operating characteristic analysis showed that BV was a useful marker to distinguish HCCs from hypervascular metastases.
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Affiliation(s)
- Koichi Hayano
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gaurav S. Desai
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Avinash R. Kambadakone
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jorge M. Fuentes
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kenneth K. Tanabe
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dushyant V. Sahani
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Aronhime S, Calcagno C, Jajamovich GH, Dyvorne HA, Robson P, Dieterich D, Fiel MI, Martel-Laferriere V, Chatterji M, Rusinek H, Taouli B. DCE-MRI of the liver: effect of linear and nonlinear conversions on hepatic perfusion quantification and reproducibility. J Magn Reson Imaging 2013; 40:90-8. [PMID: 24923476 DOI: 10.1002/jmri.24341] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 07/12/2013] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate the effect of different methods to convert magnetic resonance (MR) signal intensity (SI) to gadolinium concentration ([Gd]) on estimation and reproducibility of model-free and modeled hepatic perfusion parameters measured with dynamic contrast-enhanced (DCE)-MRI. MATERIALS AND METHODS In this Institutional Review Board (IRB)-approved prospective study, 23 DCE-MRI examinations of the liver were performed on 17 patients. SI was converted to [Gd] using linearity vs. nonlinearity assumptions (using spoiled gradient recalled echo [SPGR] signal equations). The [Gd] vs. time curves were analyzed using model-free parameters and a dual-input single compartment model. Perfusion parameters obtained with the two conversion methods were compared using paired Wilcoxon test. Test-retest and interobserver reproducibility of perfusion parameters were assessed in six patients. RESULTS There were significant differences between the two conversion methods for the following parameters: AUC60 (area under the curve at 60 s, P < 0.001), peak gadolinium concentration (Cpeak, P < 0.001), upslope (P < 0.001), Fp (portal flow, P = 0.04), total hepatic flow (Ft, P = 0.007), and MTT (mean transit time, P < 0.001). Our preliminary results showed acceptable to good reproducibility for all model-free parameters for both methods (mean coefficient of variation [CV] range, 11.87-23.7%), except for upslope (CV = 37%). Among modeled parameters, DV (distribution volume) had CV <22% with both methods, PV and MTT showed CV <21% and <29% using SPGR equations, respectively. Other modeled parameters had CV >30% with both methods. CONCLUSION Linearity assumption is acceptable for quantification of model-free hepatic perfusion parameters while the use of SPGR equations and T1 mapping may be recommended for the quantification of modeled hepatic perfusion parameters.
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Affiliation(s)
- Shimon Aronhime
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gonzalez-Guindalini FD, Botelho MPF, Harmath CB, Sandrasegaran K, Miller FH, Salem R, Yaghmai V. Assessment of Liver Tumor Response to Therapy: Role of Quantitative Imaging. Radiographics 2013; 33:1781-800. [DOI: 10.1148/rg.336135511] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Adaptive 4D Volume Perfusion CT of Lung Cancer: Effects of Computerized Motion Correction and the Range of Volume Coverage on Measurement Reproducibility. AJR Am J Roentgenol 2013; 200:W603-9. [DOI: 10.2214/ajr.12.9458] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Effect of sampling frequency on perfusion values in perfusion CT of lung tumors. AJR Am J Roentgenol 2013; 200:W155-62. [PMID: 23345379 DOI: 10.2214/ajr.12.8664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of this study was to assess as a potential means of limiting radiation exposure the effect on perfusion CT values of increasing sampling intervals in lung perfusion CT acquisition. SUBJECTS AND METHODS Lung perfusion CT datasets in patients with lung tumors (> 2.5 cm diameter) were analyzed by distributed parameter modeling to yield tumor blood flow, blood volume, mean transit time, and permeability values. Scans were obtained 2-7 days apart with a 16-MDCT scanner without intervening therapy. Linear mixed-model analyses were used to compare perfusion CT values for the reference standard sampling interval of 0.5 second with those of datasets obtained at sampling intervals of 1, 2, and 3 seconds, which included relative shifts to account for uncertainty in preenhancement set points. Scan-rescan reproducibility was assessed by between-visit coefficient of variation. RESULTS Twenty-four lung perfusion CT datasets in 12 patients were analyzed. With increasing sampling interval, mean and 95% CI blood flow and blood volume values were increasingly overestimated by up to 14% (95% CI, 11-18%) and 8% (95% CI, 5-11%) at the 3-second sampling interval, and mean transit time and permeability values were underestimated by up to 11% (95% CI, 9-13%) and 3% (95% CI, 1-6%) compared with the results in the standard sampling interval of 0.5 second. The differences were significant for blood flow, blood volume, and mean transit time for sampling intervals of 2 and 3 seconds (p ≤ 0.0002) but not for the 1-second sampling interval. The between-visit coefficient of variation increased with subsampling for blood flow (32.9-34.2%), blood volume (27.1-33.5%), and permeability (39.0-42.4%) compared with the values in the 0.5-second sampling interval (21.3%, 23.6%, and 32.2%). CONCLUSION Increasing sampling intervals beyond 1 second yields significantly different perfusion CT parameter values compared with the reference standard (up to 18% for 3 seconds of sampling). Scan-rescan reproducibility is also adversely affected.
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Computed Tomography (CT) Perfusion in Abdominal Cancer: Technical Aspects. Diagnostics (Basel) 2013; 3:261-70. [PMID: 26835679 PMCID: PMC4665537 DOI: 10.3390/diagnostics3020261] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 12/22/2022] Open
Abstract
Computed Tomography (CT) Perfusion is an evolving method to visualize perfusion in organs and tissue. With the introduction of multidetector CT scanners, it is now possible to cover up to 16 cm in one rotation, and thereby making it possible to scan entire organs such as the liver with a fixed table position. Advances in reconstruction algorithms make it possible to reduce the radiation dose for each examination to acceptable levels. Regarding abdominal imaging, CT perfusion is still considered a research tool, but several studies have proven it as a reliable non-invasive technique for assessment of vascularity. CT perfusion has also been used for tumor characterization, staging of disease, response evaluation of newer drugs targeted towards angiogenesis and as a method for early detection of recurrence after radiation and embolization. There are several software solutions available on the market today based on different perfusion algorithms. However, there is no consensus on which protocol and algorithm to use for specific organs. In this article, the authors give an introduction to CT perfusion in abdominal imaging introducing technical aspects for calculation of perfusion parameters, and considerations on patient preparation. This article also contains clinical cases to illustrate the use of CT perfusion in abdominal imaging.
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Jensen NKG, Lock M, Fisher B, Kozak R, Chen X, Chen J, Wong E, Lee TY. Prediction and reduction of motion artifacts in free-breathing dynamic contrast enhanced CT perfusion imaging of primary and metastatic intrahepatic tumors. Acad Radiol 2013; 20:414-22. [PMID: 23498981 DOI: 10.1016/j.acra.2012.09.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVE To develop and evaluate a method for predicting and reducing motion artifacts in free-breathing liver perfusion computed tomography (CT) scanning with couch shuttling and to compare tumor and liver parenchyma perfusion values. MATERIALS AND METHODS Thirty patients (23 males, 7 females, median age of 74 years) with primary or metastatic intrahepatic tumors underwent dynamic contrast enhanced CT scans with axial shuttling. A semiautomatic respiratory motion correction algorithm was applied to align the acquired images along the z-axis. Perfusion maps were generated using the dual-input Johnson-Wilson model. Root mean squared deviation (RMSD) maps of the model fit to the pixel time-density curves were calculated. RESULTS Precorrection RMSD correlated positively with magnitude of change in functional values resulting from motion. Blood flow, arterial blood flow, and permeability surface product were significantly increased in tumor compared to normal tissue (P < .05), blood volume was significantly reduced in tumor compared to normal tissue (P < .05). In a subgroup of patients with high-amplitude motion significant difference was observed between uncorrected and motion correction blood flow maps. CONCLUSIONS Patients can breathe freely during hepatic perfusion imaging if retrospective motion correction is applied to reduce motion artifacts. RMSD provides a regional assessment of motion induced artifacts in liver perfusion maps.
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Affiliation(s)
- Nikolaj K G Jensen
- Department of Physics & Astronomy, University of Western Ontario, 1151 Richmond Street, London, ON, Canada, N6A 3K7.
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Rao SX, Chen CZ, Liu H, Zeng MS, Qu XD. Three-dimensional whole-liver perfusion magnetic resonance imaging in patients with hepatocellular carcinomas and colorectal hepatic metastases. BMC Gastroenterol 2013; 13:53. [PMID: 23530688 PMCID: PMC3626859 DOI: 10.1186/1471-230x-13-53] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 03/21/2013] [Indexed: 01/17/2023] Open
Abstract
Background Three-dimensional (3D) whole-liver perfusion magnetic resonance(MR) imaging with parallel imaging, a novel imaging method to characterize tumor vascularization in vivo, has recently been applied to comprehensively image perfusion changes in large tumors. Coupled with new perfusion software, this technique enables motion correction, registration, and evaluation of perfusion MR parameters. The purpose of this study was to assess the feasibility of 3D whole-liver perfusion MR, for imaging hepatocellular carcinoma (HCC) and colorectal hepatic metastases (CRHM). Methods 26 patients with hepatic tumors (10 HCC; 16 CRHM) were subjected to 3D whole-liver perfusion MR with a temporal resolution of 3.7 seconds. The following estimated perfusion parameters were measured: the volume transfer constant Ktrans (min-1); the volume (Ve) of extravascular extracellular space (EES) per volume unit of tissue; and the flux rate constant between EES and plasma Kep (min-1). Statistical analysis was conducted to investigate inter-observer characteristics and significance of the measured parameters. Results Inter-observer agreement analysis (95% limits of agreement) yielded a mean difference of −0.0048 min-1 (−0.0598 ~ 0.0502) for Ktrans , -0.0630 ml (−0.5405 ~ 0.4145) for Ve, and −0.0031 min-1 (−0.0771 ~ 0.0709) for Kep respectively. When comparing images from patients with HCC vs. CRHM, significant differences were seen for the mean Ktrans (p = 0.017), but not for Ve(p = 0.117) or Kep(p = 0.595). Conclusion Herein we show that 3D whole-liver MR perfusion imaging with semi-automatic data analysis is feasible and enables the reliable quantitative evaluation of the perfusion parameters for HCCs and CRHMs.
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Affiliation(s)
- Sheng-Xiang Rao
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute, Shanghai, People's Republic of China
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CT Dynamics: The Shift from Morphology to Function. CURRENT RADIOLOGY REPORTS 2013. [DOI: 10.1007/s40134-012-0004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Grimm LJ, Feuerlein S, Bashir M, Nelson RC. Effectiveness of a breath-hold monitoring system in improving the reproducibility of different breath-hold positions in multiphasic CT imaging. Clin Imaging 2012; 36:754-7. [PMID: 23154005 DOI: 10.1016/j.clinimag.2012.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 01/29/2012] [Accepted: 01/30/2012] [Indexed: 11/28/2022]
Abstract
This study tests whether the utilization of an electronic breath-hold monitoring device improves breath-hold reproducibility during computed tomographic (CT) scanning. Two cohorts of 40 patients underwent dual-phase abdominal CT scans, either with a breath-hold monitoring device or with the standard breath-holding technique. Two blinded readers measured the differences in diaphragmatic position between phases. There was no statistical difference in diaphragmatic position (P=.14) between the monitored (8.5±11.5 mm) and control (5.6±5.2 mm) cohorts. Ten percent of patients from the monitored cohort had greater than 20 mm of deviation, versus 0%-2.5% for the control cohort. Reproduction of breath-holding position remains challenging, even with a monitoring system.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
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Ng CS, Chandler AG, Wei W, Anderson EF, Herron DH, Kurzrock R, Charnsangavej C. Effect of dual vascular input functions on CT perfusion parameter values and reproducibility in liver tumors and normal liver. J Comput Assist Tomogr 2012; 36:388-93. [PMID: 22805665 DOI: 10.1097/rct.0b013e318256b1e2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the impact on absolute values and reproducibility of adding portal venous (PV) to arterial input functions in computed tomographic perfusion (CTp) evaluations of liver tumors and normal liver. METHODS Institutional review board approval and written informed consent were obtained; the study complied with Health Insurance Portability and Accountability Act regulations. Computed tomographic perfusion source data sets, obtained from 7 patients (containing 9 liver tumors) on 2 occasions, 2 to 7 days apart, were analyzed by deconvolution modeling using dual ("Liver" protocol: PV and aorta) and single ("Body" protocol: aorta only) vascular inputs. Identical tumor, normal liver, aortic and, where applicable, PV regions of interest were used in corresponding analyses to generate tissue blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability (PS) values. Test-retest variability was assessed by within-patient coefficients of variation. RESULTS For liver tumor and normal liver, median BF, BV, and PS were significantly higher for the Liver protocol than for the Body protocol: 171.3 to 177.8 vs 39.4 to 42.0 mL/min per 100 g, 17.2 to 18.7 vs 3.1 to 4.2 mL/100 g, and 65.1 to 78.9 vs 50.4 to 66.1 mL/min per 100 g, respectively (P < 0.01 for all). There were no differences in MTT between protocols. Within-patient coefficients of variation were lower for all parameters with the Liver protocol than with the Body protocol: BF, 7.5% to 11.2% vs 11.7% to 20.8%; BV, 10.1% to 14.4% vs 16.6% to 30.1%; MTT, 4.2% to 5.5% vs 10.4% to 12.9%; and PS, 7.3% to 12.1% vs 12.6% to 20.3%, respectively. CONCLUSION Utilization of dual vascular input CTp liver analyses has substantial impact on absolute CTp parameter values and test-retest variability. Incorporation of the PV inputs may yield more precise results; however, it imposes substantial practical constraints on acquiring the necessary data.
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Affiliation(s)
- Chaan S Ng
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Petralia G, Summers P, Viotti S, Montefrancesco R, Raimondi S, Bellomi M. Quantification of variability in breath-hold perfusion CT of hepatocellular carcinoma: a step toward clinical use. Radiology 2012; 265:448-56. [PMID: 22996748 DOI: 10.1148/radiol.12111232] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To assess the variability of breath-hold perfusion computed tomography (CT) parameters and to investigate whether these measurements are affected by a commercial software upgrade in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Written informed consent was obtained from all participants in this institutional ethics committee-approved study. Perfusion CT examinations in HCC patients were prospectively analyzed by three readers. Two readers repeated their analysis after an interval of at least 4 weeks. Inter- and intraobserver agreement, as well as intersoftware agreement, were assessed with intraclass correlation coefficients (ICCs) and Bland-Altman limits of agreement (LoA), with adjustment for correlation between repeated measures. RESULTS Ninety-three breath-hold perfusion CT examinations were included from 23 HCC patients. The ICC between readers was very high (>0.91) for blood flow (BF), high (>0.84) for blood volume (BV), and lower (>0.30 and >0.39) for mean transit time (MTT) and permeability surface area product (PS), respectively, while ICC between readings was high (>0.80) for BF and BV, good (>0.75) for PS, and lower (>0.38) for MTT, irrespective of software version. By using the current software, the clinically relevant percentage of LoA between readers for BF were -33%; for BV, -39%; for MTT, 55%; and for PS, -93%. Between readings by the most expert reader, the clinically relevant LoA were -35% for BF,-43% for BV, 33% for MTT, and -79% for PS. BF, BV, and PS values were significantly higher and MTT values were significantly lower (P<.01) with the current software version relative to the previous version. CONCLUSION With the current CT perfusion software, only decreases between scans of HCC lesions of more than 35% for BF and 43% for BV, or an increase of more than 55% for MTT, could be considered beyond the analysis variability. The perfusion parameters obtained with the current and previous software versions were not exchangeable. The results of this study are specific for breath-hold perfusion CT of HCC and may not apply to different acquisition protocols and tumors.
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Affiliation(s)
- Giuseppe Petralia
- Department of Radiology and Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Sourbron S, Sommer WH, Reiser MF, Zech CJ. Combined quantification of liver perfusion and function with dynamic gadoxetic acid-enhanced MR imaging. Radiology 2012; 263:874-83. [PMID: 22623698 DOI: 10.1148/radiol.12110337] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the feasibility of quantifying hepatic perfusion and function by using dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging with the hepatobiliary contrast agent gadoxetic acid and a dual-inlet two-compartment uptake model. MATERIALS AND METHODS The study was approved by the local institutional review board, and written informed consent was obtained from all patients. Data were acquired between October 2008 and November 2009 in 24 patients with hepatic metastases from neuroendocrine tumors (13 men, 11 women; mean age, 59.8 years). DCE MR imaging was performed at 3.0 T with a standard dose of gadoxetic acid and a three-dimensional sequence, with 48 sections of data acquired every 2.2 seconds for 5 minutes. For each patient, a plasma flow map was calculated by means of deconvolution and the model was fitted to six region-of-interest curves. Results were evaluated with goodness-of-fit analysis and, in normal-appearing liver tissue, by comparing perfusion parameters with those reported in the literature. Interobserver effects in the selection of arterial and venous input functions were assessed. RESULTS With an arterial delay parameter, the model provided a good fit to all data. Values for arterial and venous plasma flow and extracellular volume in normal-appearing liver tissue were comparable to those in the literature. The mean intracellular uptake rate is 3.4/100/min with a standard deviation of 1.9/100/min The model also provided a good fit in all tumor data, producing high arterial flow fraction (87%) and lower uptake (1.7/100/min) . Bias due to observer-dependent differences in the selection of the input functions was negligible. CONCLUSION The analysis of dynamic gadoxetic acid-enhanced MR images with the dual-inlet two-compartment uptake model presents a new and practical approach for measuring arterial and venous perfusion and hepatic function in a single acquisition.
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Affiliation(s)
- Steven Sourbron
- Division of Medical Physics, University of Leeds, Worsley Building, Clarendon Way, Leeds LS2 9JT, England.
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Wang H, Zheng LF, Feng Y, Xie XQ, Yang XM, Zhang GX. CTA combined with CT perfusion for assessing the efficacy of anti-angiogenic therapy in rabbit VX2 tumors. Acad Radiol 2012; 19:358-65. [PMID: 22310524 DOI: 10.1016/j.acra.2011.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 01/30/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to validate the feasibility of assessing the efficacy of antiangiogenic therapy on VX2 tumors using three-dimensional computed tomographic (CT) angiography (CTA) combined with CT perfusion. MATERIALS AND METHODS Forty rabbits with VX2 tumors were randomly assigned to four groups according to different doses of antiangiogenic drug, which were administered intraperitoneally daily for 14 days. In each group, 10 animals were scanned using three-dimensional CTA and CT perfusion on days 1 and 2 after the latest administration of the drug. Tumor masses were sectioned, stained by immunohistochemistry, and processed for correlation between CT imaging and histology. RESULTS The numbers of new tumor vessels from CTA were significantly different among the four groups (P < .001). As the dose of the drug increased, blood flow and blood volume on CT perfusion increased linearly, but the mean transit time and permeability surface-area product decreased linearly (P < .001). Immunohistochemical analyses showed that microvascular density decreased, while both luminal vascular number and mature vessel number increased linearly as the drug dose increased (P < .001). CT manifestations were correlated well with histologic findings (P < .05). CONCLUSIONS It is feasible to assess the efficacy of antiangiogenic therapy on VX2 tumors using three-dimensional CTA combined with CT perfusion. Three-dimensional CTA can display the morphologic changes of tumor vessels, while CT perfusion can predict the functional changes of tumor vessels after antiangiogenic therapy.
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