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Tang S, Yen A, Wang K, Albuquerque K, Wang J. Progression-Free Survival Prediction for Locally Advanced Cervical Cancer After Chemoradiotherapy With MRI-based Radiomics. Clin Oncol (R Coll Radiol) 2025; 38:103702. [PMID: 39706142 DOI: 10.1016/j.clon.2024.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 11/15/2024] [Accepted: 11/25/2024] [Indexed: 12/23/2024]
Abstract
AIMS A significant proportion of locally advanced cervical cancer (LACC) patients experience disease progression post chemoradiotherapy (CRT). Currently existing clinical variables are suboptimal predictors of treatment response. This study reported a radiomics-based model leveraging information extracted from magnetic resonance (MR) T2-weighted image (T2WI) to predict the progression-free survival (PFS) for LACC following CRT. MATERIALS AND METHODS Radiomics features were extracted from pre-treatment MR T2WI in 105 LACC patients. Following pre-feature selection and a step forward feature selection method, an optimal feature set was determined with a Cox proportional hazard (CPH) model. The PFS predictions were generated through a radiomics-clinical combined model utilized five repeated nested 5-fold cross-validation (5-fold CV). Disease progression risk was stratified into high- and low-risk groups based on the predicted PFS and assessed by Kaplan-Meier analysis. RESULTS The radiomics texture feature extracted from MR T2WI significantly predict PFS in LACC after CRT. In comparison with the model using clinical variables alone, the radiomics-clinical combined model achieves significantly improved performance in testing patient cohort, achieving higher C-index (0.748 vs 0.655) and area under the curve (0.798 vs 0.660 for 2-year PFS). Meanwhile, the proposed method significantly differentiated the high- and low-risk patients groups for disease progression (P < 0.001). CONCLUSION An MR T2WI-based radiomics and clinical combined model provided improved prognostic capabilities in predicting the PFS for LACC patients treated with CRT, outperforming a model using clinical variables alone. The incorporation of MR T2WI-based radiomics is promising in assisting in personalized management in LACC, indicating the potential of MR T2WI radiomics as imaging biomarker.
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Affiliation(s)
- S Tang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging and Informatics for Radiation Therapy Laboratory and Medical Artificial Intelligence and Automation Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A Yen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging and Informatics for Radiation Therapy Laboratory and Medical Artificial Intelligence and Automation Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging and Informatics for Radiation Therapy Laboratory and Medical Artificial Intelligence and Automation Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Hanekamp BA, Virdee PS, Goh V, Jones M, Hvass Hansen R, Hjorth Johannesen H, Schulz A, Serup-Hansen E, Guren MG, Muirhead R. Diffusion-weighted magnetic resonance imaging as an early prognostic marker of chemoradiotherapy response in squamous cell carcinoma of the anus: An individual patient data meta-analysis. Phys Imaging Radiat Oncol 2024; 31:100618. [PMID: 39188809 PMCID: PMC11345337 DOI: 10.1016/j.phro.2024.100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/28/2024] Open
Abstract
Background and purpose Squamous cell carcinoma of the anus (SCCA) can recur after chemoradiotherapy (CRT). Early prediction of treatment response is crucial for individualising treatment. Existing data on radiological biomarkers is limited and contradictory. We performed an individual patient data meta-analysis (IPM) of four prospective trials investigating whether diffusion-weighted (DW) magnetic resonance imaging (MRI) in weeks two to three of CRT predicts treatment failure in SCCA. Material and methods Individual patient data from four trials, including paired DW-MRI at baseline and during CRT, were combined into one dataset. The association between ADC volume histogram parameters and treatment failure (locoregional and any failure) was assessed using logistic regression. Pre-defined analysis included categorising patients into a change in the mean ADC of the delineated tumour volume above and below 20%. Results The study found that among all included 142 patients, 11.3 % (n = 16) had a locoregional treatment failure. An ADC mean change of <20 % and >20 % resulted in a locoregional failure rate of 16.7 % and 8.0 %, respectively. However, no other ADC-based histogram parameter was associated with locoregional or any treatment failure. Conclusions DW-MRI standard parameters, as an isolated biomarker, were not found to be associated with increased odds of treatment failure in SCCA in this IPM. Radiological biomarker investigations involve multiple steps and can result in heterogeneous data. In future, it is crucial to include radiological biomarkers in large prospective trials to minimize heterogeneity and maximize learning.
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Affiliation(s)
- Bettina A. Hanekamp
- Department of Radiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pradeep S. Virdee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Rasmus Hvass Hansen
- Section for Radiation Therapy, Department of Oncology, Copenhagen University Hospital, Rigs-hospitalet, Copenhagen, Denmark
| | - Helle Hjorth Johannesen
- Department of Clinical Physiology and Nuclear Medicin, Copenhagen University Hospital, Rigs-hospitalet, Copenhagen, Denmark
| | - Anselm Schulz
- Department of Radiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Serup-Hansen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Marianne G. Guren
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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Hanekamp BA, Viktil E, Slørdahl KS, Dormagen JB, Kløw NE, Malinen E, Brunborg C, Guren MG, Schulz A. Magnetic resonance imaging of anal cancer: tumor characteristics and early prediction of treatment outcome. Strahlenther Onkol 2024; 200:19-27. [PMID: 37429949 PMCID: PMC10784345 DOI: 10.1007/s00066-023-02114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE To analyze tumor characteristics derived from pelvic magnetic resonance imaging (MRI) of patients with squamous cell carcinoma of the anus (SCCA) before and during chemoradiotherapy (CRT), and to compare the changes in these characteristics between scans of responders vs. nonresponders to CRT. METHODS We included 52 patients with a pelvic 3T MRI scan prior to CRT (baseline scan); 39 of these patients received an additional scan during week 2 of CRT (second scan). Volume, diameter, extramural tumor depth (EMTD), and external anal sphincter infiltration (EASI) of the tumor were assessed. Mean, kurtosis, skewness, standard deviation (SD), and entropy values were extracted from apparent diffusion coefficient (ADC) histograms. The main outcome was locoregional treatment failure. Correlations were evaluated with Wilcoxon's signed rank-sum test and Pearson's correlation coefficient, quantile regression, univariate logistic regression, and area under the ROC curve (AUC) analyses. RESULTS In isolated analyses of the baseline and second MRI scans, none of the characteristics were associated with outcome. Comparison between the scans showed significant changes in several characteristics: volume, diameter, EMTD, and ADC skewness decreased in the second scan, although the mean ADC increased. Small decreases in volume and diameter were associated with treatment failure, and these variables had the highest AUC values (0.73 and 0.76, respectively) among the analyzed characteristics. CONCLUSION Changes in tumor volume and diameter in an early scan during CRT could represent easily assessable imaging-based biomarkers to eliminate the need for analysis of more complex MRI characteristics.
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Affiliation(s)
- Bettina A Hanekamp
- Department of Radiology, Oslo University Hospital Ullevål, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ellen Viktil
- Department of Radiology, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kathinka S Slørdahl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Nils E Kløw
- Department of Radiology, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eirik Malinen
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Marianne G Guren
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anselm Schulz
- Department of Radiology, Oslo University Hospital Ullevål, Oslo, Norway
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Li T, Wang J, Yang Y, Glide-Hurst CK, Wen N, Cai J. Multi-parametric MRI for radiotherapy simulation. Med Phys 2023; 50:5273-5293. [PMID: 36710376 PMCID: PMC10382603 DOI: 10.1002/mp.16256] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 09/10/2022] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) has become an important imaging modality in the field of radiotherapy (RT) in the past decade, especially with the development of various novel MRI and image-guidance techniques. In this review article, we will describe recent developments and discuss the applications of multi-parametric MRI (mpMRI) in RT simulation. In this review, mpMRI refers to a general and loose definition which includes various multi-contrast MRI techniques. Specifically, we will focus on the implementation, challenges, and future directions of mpMRI techniques for RT simulation.
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Affiliation(s)
- Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jihong Wang
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingli Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Carri K Glide-Hurst
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Ning Wen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- The Global Institute of Future Technology, Shanghai Jiaotong University, Shanghai, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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Hafeez S, Koh M, Jones K, Ghzal AE, D’Arcy J, Kumar P, Khoo V, Lalondrelle S, McDonald F, Thompson A, Scurr E, Sohaib A, Huddart RA. Diffusion-weighted MRI to determine response and long-term clinical outcomes in muscle-invasive bladder cancer following neoadjuvant chemotherapy. Front Oncol 2022; 12:961393. [PMID: 36452501 PMCID: PMC9702046 DOI: 10.3389/fonc.2022.961393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/29/2022] [Indexed: 09/05/2023] Open
Abstract
Objective This study aims to determine local treatment response and long-term survival outcomes in patients with localised muscle-invasive bladder cancer (MIBC) patients receiving neoadjuvant chemotherapy (NAC) using diffusion-weighted MRI (DWI) and apparent diffusion coefficient (ADC) analysis. Methods Patients with T2-T4aN0-3M0 bladder cancer suitable for NAC were recruited prospectively. DWI was performed prior to NAC and was repeated following NAC completion. Conventional response assessment was performed with cystoscopy and tumour site biopsy. Response was dichotomised into response ( Results Forty-eight patients (96 DWI) were evaluated. NAC response was associated with significant increase in mean ΔADC and %ΔADC compared to poor response (ΔADCall 0.32×10-3 versus 0.11×10-3 mm2/s; p=0.009, and %ΔADCall 21.70% versus 8.23%; p=0.013). Highest specificity predicting response was seen at 75th percentile ADC (AUC, 0.8; p=0.01). Sensitivity, specificity, positive predictive power, and negative predictive power of %ΔADCb100 75th percentile was 73.7%, 90.0%, 96.6%, and 52.9%, respectively. %ΔADCb100 75th percentile >15.5% was associated with significant improvement in OS (HR, 0.40; 95% CI, 0.19-0.86; p=0.0179), bCSS (HR, 0.26; 95% CI, 0.08-0.82; p=0.0214), PFS (HR, 0.16; 95% CI, 0.05-0.48; p=0.0012), and time to cystectomy (HR, 0.19; 95% CI, 0.07-0.47; p=0.0004). Conclusions Quantitative ADC analysis can successfully identify NAC response and improved long-term clinical outcomes. Multi-centre validation to assess reproducibility and repeatability is required before testing within clinical trials to inform MIBC treatment decision making. Advances in knowledge We successfully demonstrated that measured change in DWI can successfully identify NAC response and improved long-term survival outcomes.
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Affiliation(s)
- Shaista Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Diagnostic Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Kelly Jones
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Amir El Ghzal
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - James D’Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Pardeep Kumar
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Vincent Khoo
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Susan Lalondrelle
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Fiona McDonald
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alan Thompson
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Erica Scurr
- Department of Diagnostic Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Aslam Sohaib
- Department of Diagnostic Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Robert Anthony Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Ghani M, Liau J, Eskander R, Mell L, Yusufaly T, Obrzut S. Imaging Biomarkers and Liquid Biopsy in Assessment of Cervical Cancer. J Comput Assist Tomogr 2022; 46:707-715. [PMID: 35995483 PMCID: PMC9474655 DOI: 10.1097/rct.0000000000001358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The role of imaging has been increasing in pretherapy planning and response assessment in cervical cancer, particularly in high-resource settings that provide access to computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). In 2018, imaging was incorporated into the International Federation of Gynecology and Obstetrics staging system for cervical cancer. Magnetic resonance imaging is advantageous over CT for evaluation of the primary cervical cancer size and extent, because of superior contrast resolution. Furthermore, quantitative methods, including diffusion-weighted and dynamic contrast-enhanced MRI, show promise in improving treatment response and prognosis evaluation. Molecular imaging with fluorodeoxyglucose-PET/CT and PET/MRI can be particularly helpful in the detection of nodal disease and distant metastases. Semiautomated delineation of 3-dimensional tumor regions of interest has facilitated the development of novel PET-derived biomarkers that include metabolic volume and radiomics textural analysis features for prediction of outcomes. However, posttreatment inflammatory changes can be a confounder and lymph node evaluation is challenging, even with the use of PET/CT. Liquid biopsy has emerged as a promising tool that may be able to overcome some of the drawbacks inherent with imaging, such as limited ability to detect microscopic metastases or to distinguish between postchemoradiotherapy changes and residual tumor. Preliminary evidence suggests that liquid biopsy may be able to identify cervical cancer treatment response and resistance earlier than traditional methods. Future work should prioritize how to best synergize imaging and liquid biopsy as an integrated approach for optimal cervical cancer management.
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Affiliation(s)
- Mansur Ghani
- Department of Radiology, University of California San Diego, CA, USA
| | - Joy Liau
- Department of Radiology, University of California San Diego, CA, USA
| | - Ramez Eskander
- Division of Hematology/Oncology, University of California San Diego, CA, USA
| | - Loren Mell
- Department of Radiation Oncology, University of California San Diego, CA, USA
| | - Tahir Yusufaly
- Department of Radiology, Johns Hopkins University, MD, USA
| | - Sebastian Obrzut
- Department of Radiology, University of California San Diego, CA, USA
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Valladares A, Beyer T, Papp L, Salomon E, Rausch I. A multi-modality physical phantom for mimicking tumour heterogeneity patterns in PET/CT and PET/MRI. Med Phys 2022; 49:5819-5829. [PMID: 35838056 PMCID: PMC9543355 DOI: 10.1002/mp.15853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/12/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Hybrid imaging (e.g., positron emission tomography [PET]/computed tomography [CT], PET/magnetic resonance imaging [MRI]) helps one to visualize and quantify morphological and physiological tumor characteristics in a single study. The noninvasive characterization of tumor heterogeneity is essential for grading, treatment planning, and following‐up oncological patients. However, conventional (CONV) image‐based parameters, such as tumor diameter, tumor volume, and radiotracer activity uptake, are insufficient to describe tumor heterogeneities. Here, radiomics shows promise for a better characterization of tumors. Nevertheless, the validation of such methods demands imaging objects capable of reflecting heterogeneities in multi‐modality imaging. We propose a phantom to simulate tumor heterogeneity repeatably in PET, CT, and MRI. Methods The phantom consists of three 50‐ml plastic tubes filled partially with acrylic spheres of S1: 1.6 mm, S2: 50%(1.6 mm)/50%(6.3 mm), or S3: 6.3‐mm diameter. The spheres were fixed to the bottom of each tube by a plastic grid, yielding one sphere free homogeneous region and one heterogeneous (S1, S2, or S3) region per tube. A 3‐tube phantom and its replica were filled with a fluorodeoxyglucose (18F) solution for test–retest measurements in a PET/CT Siemens TPTV and a PET/MR Siemens Biograph mMR system. A number of 42 radiomic features (10 first order and 32 texture features) were calculated for each phantom region and imaging modality. Radiomic features stability was evaluated through coefficients of variation (COV) across phantoms and scans for PET, CT, and MRI. Further, the Wilcoxon test was used to assess the capability of stable features to discriminate the simulated phantom regions. Results The different patterns (S1–S3) did present visible heterogeneity in all imaging modalities. However, only for CT and MRI, a clear visual difference was present between the different patterns. Across all phantom regions in PET, CT, and MR images, 10, 16, and 21 features out of 42 evaluated features in total had a COV of 10% or less. In particular, CONV, histogram, and gray‐level run length matrix features showed high repeatability for all the phantom regions and imaging modalities. Several of repeatable texture features allowed the image‐based discrimination of the different phantom regions (p < 0.05). However, depending on the feature, different pattern discrimination capabilities were found for the different imaging modalities. Conclusion The proposed phantom appears suitable for simulating heterogeneities in PET, CT, and MRI. We demonstrate that it is possible to select radiomic features for the readout of the phantom. Most of these features had been shown to be relevant in previous clinical studies.
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Affiliation(s)
- Alejandra Valladares
- QIMP Team, Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- QIMP Team, Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Laszlo Papp
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Salomon
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ivo Rausch
- QIMP Team, Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Sun C, Wang S, Ye W, Wang R, Tan M, Zhang H, Zhou J, Li M, Wei L, Xu P, Zhu G, Lang J, Lu S. The Prognostic Value of Tumor Size, Volume and Tumor Volume Reduction Rate During Concurrent Chemoradiotherapy in Patients With Cervical Cancer. Front Oncol 2022; 12:934110. [PMID: 35912169 PMCID: PMC9329537 DOI: 10.3389/fonc.2022.934110] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to investigate the relationship between prognostic and tumor parameters of cervical cancer patients, such as tumor size (TS), tumor volume (TV), and tumor volume reduction rate (TVRR) after external beam radiotherapy. Methods A total of 217 patients with advanced cervical cancer, classified as Federation of Gynecology and Obstetrics (FIGO) IIa–IVa, were enrolled in the study. Pre- and mid-RT pelvic magnetic resonance imaging (MRI) were performed twice, during RT and just before brachytherapy. Results The median follow-up time was 51 months (range, 7–111 months). The 5-year overall survival (OS), progression-free survival (PFS), and local failure-free survival (LFFS) rates were 81.3, 85.1, and 92.9%, respectively. Multivariate analysis revealed that tumor parameters including FIGO stage >II (Hazard Ratio, 2.377 and 95% confidence interval [CI], 1.091–5.182; P = 0.029), pre-RT TV >61.6 cm3 (HR, 0.417 and 95% CI, 0.188–0.926; P = 0.032), and mid-RT TV >11.38 cm3 (HR, 3.192 and 95% CI, 1.094–9.316; P = 0.034) were observably associated with OS. Univariate analysis showed that the tumor volume reduction rate (TVRR) was dramatically associated with overall survival (HR, 0.204 and 95% CI 0.033–1.282; P <0.001) and local failure-free survival (P = 0.050). Conclusions In this retrospective study, TVRR and mid-radiotherapy tumor volume are independent and strong prognostic parameters for patients with local advanced cervical cancer receiving CCRT.
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Affiliation(s)
- Chang Sun
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shubin Wang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenjing Ye
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - RanLin Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingyu Tan
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hanyi Zhang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Zhou
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Peng Xu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guiquan Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
- *Correspondence: Shun Lu, ; Jinyi Lang,
| | - Shun Lu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
- *Correspondence: Shun Lu, ; Jinyi Lang,
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Prisciandaro J, Zoberi JE, Cohen G, Kim Y, Johnson P, Paulson E, Song W, Hwang KP, Erickson B, Beriwal S, Kirisits C, Mourtada F. AAPM Task Group Report 303 endorsed by the ABS: MRI Implementation in HDR Brachytherapy-Considerations from Simulation to Treatment. Med Phys 2022; 49:e983-e1023. [PMID: 35662032 DOI: 10.1002/mp.15713] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
Abstract
The Task Group (TG) on Magnetic Resonance Imaging (MRI) Implementation in High Dose Rate (HDR) Brachytherapy - Considerations from Simulation to Treatment, TG 303, was constituted by the American Association of Physicists in Medicine's (AAPM's) Science Council under the direction of the Therapy Physics Committee, the Brachytherapy Subcommittee, and the Working Group on Brachytherapy Clinical Applications. The TG was charged with developing recommendations for commissioning, clinical implementation, and on-going quality assurance (QA). Additionally, the TG was charged with describing HDR brachytherapy (BT) workflows and evaluating practical consideration that arise when implementing MR imaging. For brevity, the report is focused on the treatment of gynecologic and prostate cancer. The TG report provides an introduction and rationale for MRI implementation in BT, a review of previous publications on topics including available applicators, clinical trials, previously published BT related TG reports, and new image guided recommendations beyond CT based practices. The report describes MRI protocols and methodologies, including recommendations for the clinical implementation and logical considerations for MR imaging for HDR BT. Given the evolution from prescriptive to risk-based QA,1 an example of a risk-based analysis using MRI-based, prostate HDR BT is presented. In summary, the TG report is intended to provide clear and comprehensive guidelines and recommendations for commissioning, clinical implementation, and QA for MRI-based HDR BT that may be utilized by the medical physics community to streamline this process. This report is endorsed by the American Brachytherapy Society (ABS). This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Gil'ad Cohen
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Perry Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | | | | | - Ken-Pin Hwang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sushil Beriwal
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | | | - Firas Mourtada
- Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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10
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Gagliardi T, Adejolu M, deSouza NM. Diffusion-Weighted Magnetic Resonance Imaging in Ovarian Cancer: Exploiting Strengths and Understanding Limitations. J Clin Med 2022; 11:1524. [PMID: 35329850 PMCID: PMC8949455 DOI: 10.3390/jcm11061524] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
Detection, characterization, staging, and response assessment are key steps in the imaging pathway of ovarian cancer. The most common type, high grade serous ovarian cancer, often presents late, so that accurate disease staging and response assessment are required through imaging in order to improve patient management. Currently, computerized tomography (CT) is the most common method for these tasks, but due to its poor soft-tissue contrast, it is unable to quantify early response within lesions before shrinkage is observed by size criteria. Therefore, quantifiable techniques, such as diffusion-weighted magnetic resonance imaging (DW-MRI), which generates high contrast between tumor and healthy tissue, are increasingly being explored. This article discusses the basis of diffusion-weighted contrast and the technical issues that must be addressed in order to achieve optimal implementation and robust quantifiable diffusion-weighted metrics in the abdomen and pelvis. The role of DW-MRI in characterizing adnexal masses in order to distinguish benign from malignant disease, and to differentiate borderline from frankly invasive malignancy is discussed, emphasizing the importance of morphological imaging over diffusion-weighted metrics in this regard. Its key role in disease staging and predicting resectability in comparison to CT is addressed, including its valuable use as a biomarker for following response within individual lesions, where early changes in the apparent diffusion coefficient in peritoneal metastases may be detected. Finally, the task of implementing DW-MRI into clinical trials in order to validate this biomarker for clinical use are discussed, along with the trials that include it within their protocols.
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Affiliation(s)
- Tanja Gagliardi
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
| | - Margaret Adejolu
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
| | - Nandita M. deSouza
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK
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11
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Value of Diffusion Imaging in Prognosticating Outcomes Among Patients of Cervix Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00614-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Yoo JG, Kim SI, Yeo SG, Park DC. Usefulness of Short-Term Imaging and Squamous Cell Carcinoma Antigen to Early Predict Response to Concurrent Chemoradiotherapy in Patients With Cervical Cancer. Cancer Control 2022; 29:10732748221074530. [PMID: 35196888 PMCID: PMC8883373 DOI: 10.1177/10732748221074530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective is to investigate the factors that can predict early treatment response in patients receiving concurrent chemoradiotherapy (CCRT) for cervical cancer. METHODS We assessed clinical factors and treatment response in patients who underwent CCRT for cervical cancer at four time points: initial, 2.5 weeks, 6 weeks after starting CCRT, and 3 months after completing CCRT. The final treatment response was determined by positron emission tomography-computed tomography (PET-CT) 3 months after completion of CCRT. Patients were divided into two groups according to the final treatment response: complete response (CR) group or non-CR group. And the early CCRT response prediction model was developed using stepwise multivariate logistic regression analysis. RESULTS Of the 62 patients who underwent CCRT for cervical cancer, 57 patients who completed all 4 time points examinations were included in the analyses and classified as CR (n = 32) and non-CR (n = 25) group. Tumor volume and serum squamous cell carcinoma antigen (SCC Ag) of the initial, 2.5 weeks, and 6 weeks after CCRT were significantly associated with the final treatment response. For the early treatment response prediction model, we selected patient age, tumor volume, and SCC Ag measured at initial and 2.5 weeks of CCRT as variables, and the equation of the final model was yielded. Using a cutoff of 0.433, this model had a sensitivity of 72.0%, a specificity of 84.4%, and a probability of 0.8225 (P < .0001). CONCLUSION Short-term (at 2.5 weeks after starting CCRT) measurements of tumor volume and serum SCC Ag were significant predictors of response to CCRT in patients with cervical cancer.
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Affiliation(s)
- Ji Geun Yoo
- Department of Obstetrics and Gynecology, Daejeon St Mary’s Hospital, The Catholic University of Korea, Daejeon, South Korea
| | - Sang Il Kim
- Department of Obstetrics and Gynecology, St Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Seung Geun Yeo
- Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University, Seoul, South Korea
| | - Dong Choon Park
- Department of Obstetrics and Gynecology, St Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
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13
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Harry VN, Persad S, Bassaw B, Parkin D. Diffusion-weighted MRI to detect early response to chemoradiation in cervical cancer: A systematic review and meta-analysis. Gynecol Oncol Rep 2021; 38:100883. [PMID: 34926764 PMCID: PMC8651768 DOI: 10.1016/j.gore.2021.100883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/26/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Diffusion-weighted magnetic resonance imaging (DWI) has shown promise in predicting response to therapy in several malignancies. This systematic review and meta-analysis aimed to evaluate DWI in the prediction of response to treatment in patients with cervical cancer. METHODS A systematic search was conducted on PubMed, Web of Science, Cochrane and Google Scholar databases Studies that evaluated DWI and apparent diffusion coefficient (ADC) for response evaluation before, during and after treatment with a correlation to conventional response criteria were included. The primary endpoint was the mean ADC values of cervical cancer at these timepoints. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of the studies. RESULTS Nine studies, comprising 270 patients, were included. Pre-treatment ADC values showed no correlation with eventual response. However, in our meta-analysis, there was a significant correlation with early treatment ADC values obtained within the first 3 weeks of therapy and response, as well as a significant correlation with the percentage change in ADC (ΔADC) and response. In addition, the pooled mean ΔADC percentage was also significantly higher in responders than in non-responders (49.7% vs 19.7%, respectively, p = 0.016). CONCLUSION DWI shows potential as a biomarker of early treatment response in patients with cervical carcinoma. Use of the change in ADC particularly within the first 3 weeks of therapy seems to be predictive of response and may serve as a suitable marker in the determination of early response.
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Affiliation(s)
- Vanessa N Harry
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Sunil Persad
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Bharat Bassaw
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - David Parkin
- Department of Gynecological Oncology, NHS Grampian, UK
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14
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Hernando D, Zhang Y, Pirasteh A. Quantitative diffusion MRI of the abdomen and pelvis. Med Phys 2021; 49:2774-2793. [PMID: 34554579 DOI: 10.1002/mp.15246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver, prostate, and other organs. Quantitative diffusion MRI is based on acquisitions with multiple diffusion encodings followed by quantitative mapping of diffusion parameters that are sensitive to tissue microstructure. Compared to qualitative diffusion-weighted MRI, quantitative diffusion MRI can improve standardization of tissue characterization as needed for disease detection, staging, and treatment monitoring. However, similar to many other quantitative MRI methods, diffusion MRI faces multiple challenges including acquisition artifacts, signal modeling limitations, and biological variability. In abdominal and pelvic diffusion MRI, technical acquisition challenges include physiologic motion (respiratory, peristaltic, and pulsatile), image distortions, and low signal-to-noise ratio. If unaddressed, these challenges lead to poor technical performance (bias and precision) and clinical outcomes of quantitative diffusion MRI. Emerging and novel technical developments seek to address these challenges and may enable reliable quantitative diffusion MRI of the abdomen and pelvis. Through systematic validation in phantoms, volunteers, and patients, including multicenter studies to assess reproducibility, these emerging techniques may finally demonstrate the potential of quantitative diffusion MRI for abdominal and pelvic imaging applications.
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Affiliation(s)
- Diego Hernando
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yuxin Zhang
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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15
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Min LA, Ackermans LLGC, Nowee ME, Griethuysen JJWV, Roberti S, Maas M, Vogel WV, Beets-Tan RGH, Lambregts DMJ. Pre-treatment prediction of early response to chemoradiotherapy by quantitative analysis of baseline staging FDG-PET/CT and MRI in locally advanced cervical cancer. Acta Radiol 2021; 62:940-948. [PMID: 32722967 DOI: 10.1177/0284185120943046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early prediction of response to concurrent chemoradiotherapy (cCRT) could aid to further optimize treatment regimens for locally advanced cervical cancer (LACC) in the future. PURPOSE To explore whether quantitative parameters from baseline (pre-therapy) magnetic resonance imaging (MRI) and FDG-PET/computed tomography (CT) have potential as predictors of early response to cCRT. MATERIAL AND METHODS Forty-six patients with LACC undergoing cCRT after staging with FDG-PET/CT and MRI were retrospectively analyzed. Primary tumor volumes were delineated on FDG-PET/CT, T2-weighted (T2W)-MRI and diffusion-weighted MRI (DWI) to extract the following quantitative parameters: T2W volume; T2W signalmean; DWI volume; ADCmean; ADCSD; MTV42%; and SUVmax. Outcome was the early treatment response, defined as the residual tumor volume on MRI 3-4 weeks after start of external beam radiotherapy with chemotherapy (before the start of brachytherapy): patients with a residual tumor volume <10 cm3 were classified as early responders. Imaging parameters were analyzed together with FIGO stage to assess their performance to predict early response, using multivariable logistic regression analysis with bi-directional variable selection. Leave-one-out cross-validation with bootstrapping was used to simulate performance in a new, independent dataset. RESULTS T2W volume (OR 0.94, P = 0.003) and SUVmax (OR 1.15, P = 0.18) were identified as independent predictors in multivariable analysis, rendering a model with an AUC of 0.82 in the original dataset, and AUC of 0.68 (95% CI 0.41-0.81) from cross-validation. CONCLUSION Although the predictive performance achieved in this small exploratory dataset was limited, these preliminary data suggest that parameters from baseline MRI and FDG-PET/CT (in particular pre-therapy tumor volume) may contribute to prediction of early response to cCRT in cervical cancer.
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Affiliation(s)
- Lisa A Min
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology – University of Maastricht, Maastricht, The Netherlands
| | - Leanne LGC Ackermans
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marlies E Nowee
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost JW van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology – University of Maastricht, Maastricht, The Netherlands
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina GH Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology – University of Maastricht, Maastricht, The Netherlands
| | - Doenja MJ Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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16
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Kido A, Nakamoto Y. Implications of the new FIGO staging and the role of imaging in cervical cancer. Br J Radiol 2021; 94:20201342. [PMID: 33989030 DOI: 10.1259/bjr.20201342] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
International Federation of Gynecology and Obstetrics (FIGO) staging, which is the fundamentally important cancer staging system for cervical cancer, has changed in 2018. New FIGO staging includes considerable progress in the incorporation of imaging findings for tumour size measurement and evaluating lymph node (LN) metastasis in addition to tumour extent evaluation. MRI with high spatial resolution is expected for tumour size measurements and the high accuracy of positron emmision tomography/CT for LN evaluation. The purpose of this review is firstly review the diagnostic ability of each imaging modality with the clinical background of those two factors newly added and the current state for LN evaluation. Secondly, we overview the fundamental imaging findings with characteristics of modalities and sequences in MRI for accurate diagnosis depending on the focus to be evaluated and for early detection of recurrent tumour. In addition, the role of images in treatment response and prognosis prediction is given with the development of recent technique of image analysis including radiomics and deep learning.
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Affiliation(s)
- Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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17
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Tavakoli F, Khatami SS, Momeni F, Azadbakht J, Ghasemi F. Cervical Cancer Diagnosis: Insights into Biochemical Biomarkers and Imaging Techniques. Comb Chem High Throughput Screen 2021; 24:605-623. [PMID: 32875976 DOI: 10.2174/1386207323666200901101955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 11/22/2022]
Abstract
Cervical malignancy is known as one of the important cancers which is originated from cervix. This malignancy has been observed in women infected with papillomavirus who had regular oral contraceptives, multiple pregnancies, and sexual relations. Early and fast cervical cancer diagnosis is known as two important aspects of cervical cancer therapy. Several investigations indicated that early and fast detection of cervical cancer could be associated with better treatment process and increasing survival rate of patients with this malignancy. Imaging techniques are very important diagnosis tools that could be employed for diagnosis and following responses to therapy in various cervical cancer stages. Multiple lines of evidence indicated that utilization of imaging techniques is related to some limitations (i.e. high cost, and invasive effects). Hence, it seems that along with using imaging techniques, finding and developing new biomarkers could be useful in the diagnosis and treatment of subjects with cervical cancer. Taken together, many studies showed that a variety of biomarkers including, several proteins, mRNAs, microRNAs, exosomes and polymorphisms might be introduced as prognostic, diagnostic and therapeutic biomarkers in cervical cancer therapy. In this review article, we highlighted imaging techniques as well as novel biomarkers for the diagnosis of cervical cancer.
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Affiliation(s)
- Fatemeh Tavakoli
- Department of Biotechnology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sara Sadat Khatami
- Department of Biotechnology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Momeni
- Isfahan Research Committee of Multiple Sclerosis, Alzahra Research Institute, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javid Azadbakht
- Department of Radiology and Imaging, Kashan University of Medical Science, Kashan, Iran
| | - Faezeh Ghasemi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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18
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van Houdt PJ, Yang Y, van der Heide UA. Quantitative Magnetic Resonance Imaging for Biological Image-Guided Adaptive Radiotherapy. Front Oncol 2021; 10:615643. [PMID: 33585242 PMCID: PMC7878523 DOI: 10.3389/fonc.2020.615643] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
MRI-guided radiotherapy systems have the potential to bring two important concepts in modern radiotherapy together: adaptive radiotherapy and biological targeting. Based on frequent anatomical and functional imaging, monitoring the changes that occur in volume, shape as well as biological characteristics, a treatment plan can be updated regularly to accommodate the observed treatment response. For this purpose, quantitative imaging biomarkers need to be identified that show changes early during treatment and predict treatment outcome. This review provides an overview of the current evidence on quantitative MRI measurements during radiotherapy and their potential as an imaging biomarker on MRI-guided radiotherapy systems.
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Affiliation(s)
- Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Yingli Yang
- Department of Radiation Oncology, University of California, Los Angeles, CA, United States
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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19
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Cancer Detection and Quantification of Treatment Response Using Diffusion-Weighted MRI. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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20
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A prospective comparative dosimetric study between diffusion weighted MRI (DWI) & T2-weighted MRI (T2W) for target delineation and planning in cervical cancer brachytherapy. Rep Pract Oncol Radiother 2020; 25:1011-1016. [PMID: 33299382 DOI: 10.1016/j.rpor.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 11/21/2022] Open
Abstract
Aim To evaluate the difference between GTVBT (Gross Tumor Volume at Brachytherapy) and HR CTV (High Risk Clinical Tumor Volume) delineated with DWI and T2W MRI. To evaluate doses to organs at risk and targets from plans generated using T2W and DWI. Background Functional imaging with DWI can improve cervical tumor distinction as it is more sensitive than T2W MRI even in detecting parametrial invasion. This study does a dosimetric comparison between a T2W and DWI based plan. Methods Fifty carcinoma cervix patients were subjected to MRI based brachytherapy. T2W and a diffusion weighted sequence were acquired. Target delineation and brachytherapy planning was done on both T2W and DWI. Standard DVH parameters were recorded and the treatment was given using the plan generated from T2W images. Results GTVBT and HRCTV contours on DWI were different when compared with T2W. Mean GTVBT volume on T2W and DWI was 5.25 and 5.23, respectively (p value 0.8). Mean HRCTV on T2W and DWI was 28.3 and 27 cc, respectively (p value 0.003). Planning on the above volumes resulted in a superior coverage in terms of HRCTV D90 and D100 for DWI based plan, HRCTV D90 - 735.1 and 741 cGy for T2W and DWI, respectively (p value 0.006), HRCTV D100 - 441.05 and 444.5 for T2W and DWI plans, respectively (p value = 0.006). Doses to the OAR were not significantly increased. Conclusion GEC ESTRO based contouring guidelines cover all the functionally abnormal areas on DWI. DWI should only be used as a supplement to T2W for contouring target volumes.
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21
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Prognosis impact of posttreatment pelvic MRI in patients treated for stage IB2-IIB cervical cancer with chemoradiation therapy. Eur J Surg Oncol 2020; 47:1103-1110. [PMID: 33160780 DOI: 10.1016/j.ejso.2020.10.009] [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: 06/28/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the performances of systematic posttreatment pelvic magnetic resonance imaging (PPMRI) in predicting prognosis of patients treated with chemoradiation therapy (CRT) for locally advanced cervical cancer (LACC). MATERIALS AND METHODS Multi-institutional data from 216 patients presenting FIGO IB2-IIB cervical cancer for which PPMRI was performed following CRT were retrospectively reviewed. Incomplete response was defined as the identification of persistent lesion on PPMRI. Primary endpoints were patients' 5-year recurrence free (RFS) and overall (OS) survivals. Secondary endpoint was the identification of residual histologic disease on hysterectomy specimens when completion surgery was performed. RESULTS PPMRI identified an incomplete response in 102 (47.2%) cases. A 70% or more reduction in tumor size on PPMRI was identified as the best predictive cut-off for recurrence (37.7% sensitivity and 78.7% specificity) and death (50% sensitivity and 77.9% specificity) with significant impact on those risks (HRa: 0.42; 95%CI: 0.23-0.77 and HRa: 0.18; 95%CI: 0.06-0.50, respectively). Completion hysterectomy was performed in 117 (54.4%) cases, with histologic residual disease in 55 (47.4%). PPMRI demonstrated 74.5% sensitivity and 50.8% specificity in predicting residual disease. Although survival of patients with complete response at PPMRI was not impacted by completion hysterectomy, it significantly increased 5-year RFS and OS of those with incomplete response: 38.7% vs. 65.3% (p < 0.001) and 63% vs. 82.9% (p = 0.038), respectively. CONCLUSION A 70% or more reduction of in tumor size on PPMRI following CRT in patients with LACC is predictive of RFS and OS. PPMRI could help triaging patients who could benefit from completion hysterectomy.
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22
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Muirhead R, Bulte D, Cooke R, Chu KY, Durrant L, Goh V, Jacobs C, Ng SM, Strauss VY, Virdee PS, Qi C, Hawkins MA. A Prospective Study of Diffusion-weighted Magnetic Resonance Imaging as an Early Prognostic Biomarker in Chemoradiotherapy in Squamous Cell Carcinomas of the Anus. Clin Oncol (R Coll Radiol) 2020; 32:874-883. [PMID: 33023818 DOI: 10.1016/j.clon.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/15/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
AIMS The use of diffusion-weighted magnetic resonance imaging (DW-MRI) as a prognostic marker of treatment response would enable early individualisation of treatment. We aimed to quantify the changes in mean apparent diffusion coefficient (ΔADCmean) between a DW-MRI at diagnosis and on fraction 8-10 of chemoradiotherapy (CRT) as a biomarker for cellularity, and correlate these with anal squamous cell carcinoma recurrence. MATERIALS AND METHODS This prospective study recruited patients with localised anal cancer between October 2014 and November 2017. DW-MRI was carried out at diagnosis and after fraction 8-10 of radical CRT. A region of interest was delineated for all primary tumours and any lymph nodes >2 cm on high-resolution T2-weighted images and propagated to the ADC map. Routine clinical follow-up was collected from Nation Health Service electronic systems. RESULTS Twenty-three of 29 recruited patients underwent paired DW-MRI scans. Twenty-six regions of interest were delineated among the 23 evaluable patients. The median (range) tumour volume was 13.6 cm3 (2.8-84.9 cm3). Ten of 23 patients had lesions with ΔADCmean ≤ 20%. With a median follow-up of 41.2 months, four patients either failed to have a complete response to CRT or subsequently relapsed. Three of four patients with disease relapse had lesions demonstrating ΔADCmean <20%, the other patient with persistent disease had ΔADCmean of 20.3%. CONCLUSIONS We demonstrated a potential correlation between patients with ΔADCmean <20% and disease relapse. Further investigation of the prognostic merit of DW-MRI change is needed in larger, prospective cohorts.
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Affiliation(s)
- R Muirhead
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - D Bulte
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - R Cooke
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K-Y Chu
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - L Durrant
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - V Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - C Jacobs
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S M Ng
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, UK
| | - V Y Strauss
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - P S Virdee
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - C Qi
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M A Hawkins
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Incorporating Magnetic Resonance Imaging (MRI) Based Radiation Therapy Response Prediction into Clinical Practice for Locally Advanced Cervical Cancer Patients. Semin Radiat Oncol 2020; 30:291-299. [DOI: 10.1016/j.semradonc.2020.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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24
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Kumar R, Kala P, Narayanan GS, Vishwanathan B, Narayanan S, Mandal S, Rao A, Gowda G. Evaluation and evolution of apparent diffusion coefficient (ADC) in image-guided adaptive brachytherapy (IGABT) for cervical cancer. Brachytherapy 2020; 20:112-117. [PMID: 32928683 DOI: 10.1016/j.brachy.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Image-guided adaptive brachytherapy (IGABT) recently has shown excellent clinical outcomes with superior local control and less toxicity. For IGABT, T2W (T2-weighted) MRI is the gold standard. However, studies have shown that target delineation with the same results in uncertainties, poor interobserver variabilities, and low conformity indices for high-risk clinical target volume contours. In this study, we investigate the role of diffusion-weighted imaging-derived apparent diffusion coefficient (ADC) maps to aid in IGABT. We also evaluated ADC from the baseline to brachytherapy. METHODS AND MATERIALS Thirty selected patients were enrolled for this study, and two MRIs were taken at diagnosis and before brachytherapy. Patients were divided into two groups, Group 1 being patients with parametrial involvement before external beam radiotherapy and no parametrial involvement before brachytherapy. Group 2 included patients with parametrial involvement before external beam radiotherapy and persistent parametrial involvement before brachytherapy. ADC was measured at the center, edge, and 1 cm from the edge. RESULTS The measured ADC increased from diagnosis to brachytherapy, and this increase was more for the patients in Group 1 than in Group 2. The mean TDadc (diagnosis ADC, center), TEadc (tumor edge ADC diagnosis), and T1cmDadc (1 cm from edge at diagnosis) were 0.884, 1.45, and 1.9 × 10-3 mm2/s, respectively. The TBadc (ADC at brachytherapy, center), TEBadc (tumor edge ADC at brachytherapy), and TE1cmBadc (1 cm from edge brachytherapy) were 1.2, 1.8, and 2.3 × 10-3 mm2/s, respectively, p-value <0.00001. No abnormal ADC was present outside the high-risk clinical target volume contours. CONCLUSION MRI-based IGABT using T2W imaging essentially covers all functionally abnormal zones at brachytherapy. Diffusion-weighted imaging, along with ADC maps, should only be used as a supplement for target delineation.
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Affiliation(s)
- Rishabh Kumar
- Department Radiation Oncology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India.
| | - Prachi Kala
- Department of Radiology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Geeta S Narayanan
- Department Radiation Oncology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Bhaskar Vishwanathan
- Department Radiation Oncology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Sowmya Narayanan
- Department of Radiation Oncology and Radiation Physics, Chief Medical Physicist, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Sanjeet Mandal
- Department Radiation Oncology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Arpitha Rao
- Department Radiation Oncology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Gangadharappa Gowda
- Department of Radiology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
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Fournier LS, Bats AS, Durdux C. Diffusion MRI: Technical principles and application to uterine cervical cancer. Cancer Radiother 2020; 24:368-373. [PMID: 32360093 DOI: 10.1016/j.canrad.2020.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 01/15/2023]
Abstract
Imaging is involved in the management of uterine cervical cancer with several objectives: 1/to assess local and lymph node extension of the initial disease; 2/evaluate treatment response to conservative therapy; 3/detect recurrences. Pelvic MRI is the first-line examination in all these indications. It is the key element for delineation after image fusion when the indication of chemoradiation therapy is made. It is also essential for guiding the placement of applicators and optimising the dosimetry of brachytherapy. The diffusion-weighted acquisition is a sequence sensitive to the motion of water molecules. It allows distinguishing water molecules with free diffusion from water molecules with diffusion restricted by obstacles such as cell membranes or the cytoskeleton. The diffusion is thus connected to the cellularity of the explored tissue, and the cancers, being hypercellular, will present a high signal. It thus provides additional information thanks to a high contrast between the tumour and the surrounding tissues, facilitating detection, evaluation of the volume and extent of the disease.
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Affiliation(s)
- L S Fournier
- Radiology Department, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Inserm, 56, rue Leblanc, 75015 Paris, France.
| | - A-S Bats
- Oncological and Gynaecological Surgery Department, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - C Durdux
- Radiation Oncology Department, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Intravoxel incoherent motion magnetic resonance imaging for predicting the long-term efficacy of immune checkpoint inhibitors in patients with non-small-cell lung cancer. Lung Cancer 2020; 143:47-54. [PMID: 32203770 DOI: 10.1016/j.lungcan.2020.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Conventional evaluation of anti-tumor activity on the basis of tumor size is inadequate for immune checkpoint inhibitors (ICIs). We therefore aimed to assess the usefulness of intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) for evaluation of the therapeutic efficacy of ICIs. MATERIALS AND METHODS A chest IVIM-MRI was performed before and 2, 4, and 8 weeks after administration of ICIs in patients with advanced non-small-cell lung cancer. Apparent diffusion coefficient (ADC), skewness of ADC (ADCskew), kurtosis of ADC (ADCkurt), true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were evaluated at each evaluation point and changes from the baseline (Δ). RESULTS Twenty patients were enrolled in this study. An increased ADC 8 weeks and decreased ADCkurt and ΔADCkurt 4 weeks after ICIs was associated with objective responses and longer progression-free survival (PFS). A decreased ΔADCskew at 4 weeks was associated with objective responses, disease control, and longer PFS and overall survival. There was no correlation between the efficacy of ICIs and D, D* and f. All of three patients who had pseudoprogression had decreased ΔADCskew at 4 weeks and two of them had decreased ΔADCkurt at 4 weeks. Inversely, all five patients who had progressive disease (PD) did not have increased ΔADCskew at 4 weeks and only one of them had decreased ΔADCkurt at 4 weeks. CONCLUSIONS Changes in histograms of ADC may be useful for predicting long-term efficacy and distinguishing between pseudoprogression and actual PD after ICIs.
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Vogl TJ, Hoppe AT, Gruber-Rouh T, Basten L, Dewes P, Hammerstingl RM, Balaban Ü, Mastrodicasa D, Thompson ZM, Albrecht MH. Diffusion-Weighted MR Imaging of Primary and Secondary Lung Cancer: Predictive Value for Response to Transpulmonary Chemoembolization and Transarterial Chemoperfusion. J Vasc Interv Radiol 2020; 31:301-310. [PMID: 31899107 DOI: 10.1016/j.jvir.2019.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To examine predictive value of apparent diffusion coefficient (ADC) in diffusion-weighted imaging (DWI) for response of patients with primary and secondary lung neoplasms undergoing transpulmonary chemoembolization (TPCE) and transarterial chemoperfusion (TACP) treatment. MATERIALS AND METHODS Thirty-one patients (mean age ± SD 64 ± 12.4 y) with 42 lung target lesions (13 primary and 29 secondary) underwent DWI and subsequent ADC analysis on a 1.5T MR imaging scanner before and 30.3 days ± 6.4 after first session of TPCE or TACP. After 3.1 treatment sessions ± 1.4 performed in 2- to 4-week intervals, morphologic response was analyzed by comparing tumor diameter and volume before and after treatment on unenhanced T1-weighted MR images. On a per-lesion basis, response was classified according to Response Evaluation Criteria In Solid Tumors. RESULTS Threshold ADC increase of 20.7% indicated volume response with 88% sensitivity and 78% specificity (area under the curve [AUC] = 0.84). Differences between ADC changes in volume response groups were significant (P = .002). AUC for volume response predicted by ADC before treatment was 0.77. Median ADC before treatment and mean ADC change were 1.09 × 10-3 mm2/second and 0.36 × 10-3 mm2/second ± 0.23, 1.45 × 10-3 mm2/second and 0.14 × 10-3 mm2/second ± 0.16, and 1.30 × 10-3 mm2/second and 0.06 × 10-3 mm2/second ± 0.19 in partial response, stable disease, and progressive disease groups. In primary lung cancer lesions, strong negative correlation of ADC change with change in diameter (ρ = -.87, P < .001) and volume (ρ = -.66, P = .016) was found. In metastases, respective correlation coefficients were ρ = -.18 (P = .356) and ρ = -.35 (P = .061). CONCLUSIONS ADC quantification shows considerable diagnostic value for predicting response and monitoring TPCE and TACP treatment of patients with primary and secondary lung neoplasms.
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Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany.
| | - Alexander T Hoppe
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Lajos Basten
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Patricia Dewes
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Renate M Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Ümniye Balaban
- Department of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Domenico Mastrodicasa
- Section of Diagnostic Imaging and Therapy-Radiology Division, Department of Neuroscience and Imaging, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy
| | - Zachary M Thompson
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
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Perucho JAU, Chang HCC, Vardhanabhuti V, Wang M, Becker AS, Wurnig MC, Lee EYP. B-Value Optimization in the Estimation of Intravoxel Incoherent Motion Parameters in Patients with Cervical Cancer. Korean J Radiol 2020; 21:218-227. [PMID: 31997597 PMCID: PMC6992446 DOI: 10.3348/kjr.2019.0232] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 10/30/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study aimed to find the optimal number of b-values for intravoxel incoherent motion (IVIM) imaging analysis, using simulated and in vivo data from cervical cancer patients. MATERIALS AND METHODS Simulated data were generated using literature pooled means, which served as reference values for simulations. In vivo data from 100 treatment-naïve cervical cancer patients with IVIM imaging (13 b-values, scan time, 436 seconds) were retrospectively reviewed. A stepwise b-value fitting algorithm calculated optimal thresholds. Feed forward selection determined the optimal subsampled b-value distribution for biexponential IVIM fitting, and simplified IVIM modeling using monoexponential fitting was attempted. IVIM parameters computed using all b-values served as reference values for in vivo data. RESULTS In simulations, parameters were accurately estimated with six b-values, or three b-values for simplified IVIM, respectively. In vivo data showed that the optimal threshold was 40 s/mm² for patients with squamous cell carcinoma and a subsampled acquisition of six b-values (scan time, 198 seconds) estimated parameters were not significantly different from reference parameters (individual parameter error rates of less than 5%). In patients with adenocarcinoma, the optimal threshold was 100 s/mm², but an optimal subsample could not be identified. Irrespective of the histological subtype, only three b-values were needed for simplified IVIM, but these parameters did not retain their discriminative ability. CONCLUSION Subsampling of six b-values halved the IVIM scan time without significant losses in accuracy and discriminative ability. Simplified IVIM is possible with only three b-values, at the risk of losing diagnostic information.
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Affiliation(s)
| | | | | | - Mandi Wang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | - Anton Sebastian Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Switzerland
| | - Moritz Christoph Wurnig
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Switzerland
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Jajodia A, Mahawar V, Chaturvedi AK, Rao A, Singla R, Mitra S, Goyal S, Kesan S, Pasricha S, Maheshwari U, Tripathi R, Babu Koyyala VP. Role of ADC values in assessing clinical response and identifying residual disease post-chemo radiation in uterine cervix cancer. Indian J Radiol Imaging 2020; 29:404-411. [PMID: 31949343 PMCID: PMC6958886 DOI: 10.4103/ijri.ijri_339_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/08/2019] [Accepted: 11/26/2019] [Indexed: 01/31/2023] Open
Abstract
Objectives: To evaluate the role of apparent diffusion coefficient (ADC) values in assessing response after chemo-radiotherapy in cervix cancer and investigate the utility of ADC as a tool to identify residual disease, after the treatment completion. Methods: A prospective study was done in 100 patients with histopathologically proven cancer of uterine cervix who were classified as either complete response (CR) or residual disease posttreatment. MRI was done pretreatment and after 6 weeks post-treatment with chemo-radiation. 53 patients among the cohort also underwent a fluoro-deoxy glucose positron-emission computed tomography (FDG-PET CT). ADC values, change in ADC values, and metabolic activity obtained from FDG-PET CT were correlated with clinical outcome, and statistical analysis was done to determine the better tool for assessing response evaluation between ADC and PET-CT. Results: Residual lesions have notably lower ADC value than that of posttreatment changes. The mean ADC values of residual tumors: 1.26 ± 0.238 × 10−3 mm2/s and mean ADC values of lesions due to posttreatment changes: 1.540 ± 0.218 × 10−3 mm2/s (statistically significant difference between malignant and posttreatment lesions, P < 0.05). ADC has 67% sensitivity, 83% specificity, 35% positive predictive values (PPV), 95% negative predictive values (NPV), and 81% accuracy in differentiating residual disease from post treatment changes. PPV, NPV, sensitivity, and specificity with PET-CT were 93%, 89%, 98%, and 73%, respectively. PPV, NPV, sensitivity, and specificity of contrast MRI were 16%, 91%, 58%, and 59%, respectively. Conclusion: Diffusion imaging differentiates residual cervix malignancies from post treatment changes based on ADC values and can be a promising and evocative biomarker. Complimentary use of ADC and PET/CT may increase diagnostic confidence.
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Affiliation(s)
- Ankush Jajodia
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Vivek Mahawar
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Arvind K Chaturvedi
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Avinash Rao
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Rishu Singla
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Swarupa Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Sumit Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Sikha Kesan
- Department of Obstetrics and Gynecology, KEM Hospital, Mumbai, Maharashtra, India
| | - Sunil Pasricha
- Department of Histopathology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Udip Maheshwari
- Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Rupal Tripathi
- Department of Research, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Venkata Pradeep Babu Koyyala
- Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
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Kalampokas E, Macdonald G, Young H, Bednarek A, Kennedy AM, Cairns M, Parkin DE. Definitive chemoradiotherapy for cervical cancer: A 11-year population-based study. Eur J Cancer Care (Engl) 2020; 29:e13223. [PMID: 31944444 DOI: 10.1111/ecc.13223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/07/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the recurrence pattern and survival in women treated with definitive chemoradiotherapy for cervical cancer. METHODS A retrospective cohort study of women FIGO (2012) stage IB2 to IVA from the Grampian region of Scotland between February 2000 and March 2011. These women were followed up until April 2018. RESULTS A total of 121 eligible women allocated with mean age at treatment 50.59 years (SD = 13.98, range 22-82). Tumours staged: IB2: n = 24 (19.8%), II: n = 45 (37.2%), III: n = 43 (35.5%) and IVA: n = 7 (5.8%). Two (1.7%) women had no available data. Fifty-five (45.5%) women had recurrence after treatment, and 51 (42.15%) women died from the disease. The sites of recurrence were as follows: central pelvic only (n = 4, 7.27%), pelvic and distant (n = 39, 70.91%) and distant only (n = 12, 21.82%) with median time from end of treatment to first recurrence 44 months (range 2-98), 26 months (range 1-146) and 22 months (range 3-66) respectively. 5-and 8-year overall survival was 76.0% (95% CI: 68.8%-84.0%) and 64.4% (95% CI: 56.4%-73.5%) respectively. CONCLUSIONS Though overall survival is better than with radiotherapy alone, recurrence occurs up to 10 years after treatment. This raises the issues of how to reduce late recurrence and the appropriateness of current follow-up protocols.
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Affiliation(s)
| | - Graham Macdonald
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Antonina Bednarek
- Department of Obstetrics and Gynecology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ann-Marie Kennedy
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Mary Cairns
- Department of Gynecologic Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - David E Parkin
- Department of Gynecologic Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
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31
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Kido A. Therapy Response Imaging in Gynecologic Malignancies. MEDICAL RADIOLOGY 2020:159-176. [DOI: 10.1007/978-3-030-31171-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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El-Husseiny NG, Mehana SM, El Zawawy SF. Assessment of the percentage of apparent diffusion coefficient value changes as an early indicator of the response of colorectal hepatic metastases to chemotherapy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Colorectal cancer is considered one of the most common causes of cancer-related deaths worldwide. We aim to evaluate the efficacy of DWI-MRI in predicting response to chemotherapy in this cohort.
The study included 30 lesions in 20 biopsy proven-colorectal cancer patients with hepatic metastasis larger than 1 cm. All patients underwent both triphasic CT with intravenous contrast, pre-chemotherapy MRI (axial T2 and DW sequences) which was repeated 21 days following chemotherapy. A follow-up CT was done 2 months later. The response of the lesions was evaluated using the RESCIST criteria. On MRI, the lesions corresponding to the ones chosen on CT were identified and the apparent diffusion coefficient (ADC) values of pre- and post-chemotherapy images were recorded and correlated with the CT results.
Results
In the study, 17 (56.7%) of the lesions showed response to chemotherapy while 13 (43.3%) were non-responding. There was no significant difference in pretreatment ADC values between responding and non-responding lesions (p = 0.14). The mean percentage increase in ADC values in responding lesions was 42% compared to 18% in non-responding lesions (p < 0.001). Lesions that showed less than 18% increase were all found to be non-responsive
Conclusion
DWI-MRI has an emerging role in early assessment of early treatment response that can be detected before morphological response for patients with hepatic metastasis from colorectal cancer. Based on our study, the use of 25 % as the cutoff point of percent difference in ADC for detection of non-responding lesions proved to be successful only 21 days after the 1st chemotherapy cycle.
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Feng Y, Liu H, Ding Y, Zhang Y, Liao C, Jin Y, Ai C. Combined dynamic DCE-MRI and diffusion-weighted imaging to evaluate the effect of neoadjuvant chemotherapy in cervical cancer. TUMORI JOURNAL 2019; 106:155-164. [PMID: 31736439 DOI: 10.1177/0300891619886656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To prospectively investigate changes in quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in patients with cervical cancer before and after neoadjuvant chemotherapy (NACT). METHODS Thirty-eight patients with cervical cancer underwent DCE-MRI and DWI 1 week before and 4 weeks after NACT. The patients were classified into 2 groups: significant reaction (sCR) group and the non-sCR group. DCE-MRI parameters and ADC values were measured and compared between the 2 groups. RESULTS Before NACT, the mean Ktrans value was higher, but the mean Ve was lower, in the sCR group compared with the non-sCR group; these differences were statistically significant (p<0.05). After NACT, the mean Ktrans value and the delta (i.e., changed) value of Ktrans were significantly lower in the sCR group compared with the non-sCR group (p<0.05). However, the mean ADC and the delta value of the mean ADC between the 2 groups were slightly higher in the sCR group compared with the non-sCR group (p<0.05). The area under the curve of pre-mean Ktrans, DKtrans, and pre-mean Ktrans combined with post-mean ADC values were 0.801, 0.955, and 0.878, respectively (p<0.05). The optimal cutoff values for distinguishing sCR from non-sCR were pretreatment Ktrans (0.7020 min-1) and DKtrans (0.0437 min-1). CONCLUSIONS Quantitative parameters (pre-mean Ktrans, DKtrans, and pre-mean Ktrans) combined with post-mean ADC could predict treatment efficacy more precisely. However, quantitative DCE-MRI combined with DWI could not significantly improve prognostic efficacy.
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Affiliation(s)
- Yusen Feng
- Department of Radiology, Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Kunming Yan'an Hospital, Kunming, China
| | - Hui Liu
- Department of Radiology, Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Kunming Yan'an Hospital, Kunming, China
| | - Yingying Ding
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ya Zhang
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chengde Liao
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yan Jin
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Conghui Ai
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
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Prognostic Significance of Apparent Diffusion Coefficient in Hepatocellular Carcinoma Patients treated with Stereotactic Ablative Radiotherapy. Sci Rep 2019; 9:14157. [PMID: 31578433 PMCID: PMC6775098 DOI: 10.1038/s41598-019-50503-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/15/2019] [Indexed: 01/06/2023] Open
Abstract
The role of diffusion-weighted magnetic resonance imaging (DW MRI) in assessing durable tumor control for patients with hepatocellular carcinoma (HCC) treated with stereotactic ablative radiotherapy (SABR) was not defined. This retrospective study included 34 HCC patients with 45 lesions who had DW MRI data at baseline and within 6 months post-SABR. On the first post-SABR MRI, 13 lesions (28.9%) had a complete response (CR), 12 (26.7%) had a partial response (PR), 17 (37.8%) had stable disease, and 3 (6.7%) had progressive disease by modified Response Evaluation Criteria in Solid Tumors (mRECIST). On subsequent imaging, the response rate improved from 55.6% to 75.6%. The apparent diffusion coefficients (ADCs) (mean ± standard deviation) pre- and post-SABR were 1.43 ± 0.28 and 1.72 ± 0.34 (×10−3 mm2/s), respectively (p < 0.001). An ADC change ≥25% (DW[+]) was identified as a predictor of favorable in-field control (IFC) (1-year IFC, 93.3% vs. 50.0% for DW[−], p = 0.004), but an mRECIST-based positive response (CR and PR) at the first MRI was not (p = 0.130). In conclusion, ADC change on early MRI is closely related to IFC in HCCs treated with SABR. Standardization of the DW MRI protocol, as well as prospective validation studies, are warranted.
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Kumar T, Achkar S, Haie-Meder C, Chargari C. Curiethérapie guidée par imagerie multimodale : l’exemple du cancer du col utérin. Cancer Radiother 2019; 23:765-772. [DOI: 10.1016/j.canrad.2019.07.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
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Sun C, Tian X, Liu Z, Li W, Li P, Chen J, Zhang W, Fang Z, Du P, Duan H, Liu P, Wang L, Chen C, Tian J. Radiomic analysis for pretreatment prediction of response to neoadjuvant chemotherapy in locally advanced cervical cancer: A multicentre study. EBioMedicine 2019; 46:160-169. [PMID: 31395503 PMCID: PMC6712288 DOI: 10.1016/j.ebiom.2019.07.049] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/05/2019] [Accepted: 07/18/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We aimed to investigate whether pre-therapeutic radiomic features based on magnetic resonance imaging (MRI) can predict the clinical response to neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC). METHODS A total of 275 patients with LACC receiving NACT were enrolled in this study from eight hospitals, and allocated to training and testing sets (2:1 ratio). Three radiomic feature sets were extracted from the intratumoural region of T1-weighted images, intratumoural region of T2-weighted images, and peritumoural region of T2-weighted images before NACT for each patient. With a feature selection strategy, three single sequence radiomic models were constructed, and three additional combined models were constructed by combining the features of different regions or sequences. The performance of all models was assessed using receiver operating characteristic curve. FINDINGS The combined model of the intratumoural zone of T1-weighted images, intratumoural zone of T2-weighted images,and peritumoural zone of T2-weighted images achieved an AUC of 0.998 in training set and 0.999 in testing set, which was significantly better (p < .05) than the other radiomic models. Moreover, no significant variation in performance was found if different training sets were used. INTERPRETATION This study demonstrated that MRI-based radiomic features hold potential in the pretreatment prediction of response to NACT in LACC, which could be used to identify rightful patients for receiving NACT avoiding unnecessary treatment.
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Affiliation(s)
- Caixia Sun
- Key Laboratory of Intelligent Medical Image Analysis and Precise Diagnosis of Guizhou Province, School of Computer Science and Technology, Guizhou University, Guiyang, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Xin Tian
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Weili Li
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pengfei Li
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiaming Chen
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weifeng Zhang
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ziyu Fang
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Peiyan Du
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Duan
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lihui Wang
- Key Laboratory of Intelligent Medical Image Analysis and Precise Diagnosis of Guizhou Province, School of Computer Science and Technology, Guizhou University, Guiyang, China.
| | - Chunlin Chen
- Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China; Engineering Research Center of Molecular and NeSuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China.
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Song SH, Jeong WK, Choi D, Kim YK, Park HC, Yu JI. Evaluation of early treatment response to radiotherapy for HCC using pre- and post-treatment MRI. Acta Radiol 2019; 60:826-835. [PMID: 30282483 DOI: 10.1177/0284185118805253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- So Hee Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongil Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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White IM, Scurr E, Wetscherek A, Brown G, Sohaib A, Nill S, Oelfke U, Dearnaley D, Lalondrelle S, Bhide S. Realizing the potential of magnetic resonance image guided radiotherapy in gynaecological and rectal cancer. Br J Radiol 2019; 92:20180670. [PMID: 30933550 PMCID: PMC6592079 DOI: 10.1259/bjr.20180670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/24/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
CT-based radiotherapy workflow is limited by poor soft tissue definition in the pelvis and reliance on rigid registration methods. Current image-guided radiotherapy and adaptive radiotherapy models therefore have limited ability to improve clinical outcomes. The advent of MRI-guided radiotherapy solutions provides the opportunity to overcome these limitations with the potential to deliver online real-time MRI-based plan adaptation on a daily basis, a true "plan of the day." This review describes the application of MRI guided radiotherapy in two pelvic tumour sites likely to benefit from this approach.
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Affiliation(s)
- Ingrid M White
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Erica Scurr
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Andreas Wetscherek
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Gina Brown
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Aslam Sohaib
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Simeon Nill
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Uwe Oelfke
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - David Dearnaley
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Susan Lalondrelle
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Shreerang Bhide
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
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Gu KW, Kim CK, Choi CH, Yoon YC, Park W. Prognostic value of ADC quantification for clinical outcome in uterine cervical cancer treated with concurrent chemoradiotherapy. Eur Radiol 2019; 29:6236-6244. [PMID: 30980126 DOI: 10.1007/s00330-019-06204-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/15/2019] [Accepted: 03/26/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To investigate the prognostic value of diffusion-weighted imaging (DWI) in predicting clinical outcome in patients with cervical cancer after concurrent chemoradiotherapy (CCRT). METHODS We enrolled 124 cervical cancer patients who received definitive CCRT and underwent 3 T-MRI before and 1 month after initiating treatment. The mean apparent diffusion coefficient (ADC) value was measured on the tumor and the changes in ADC percentage (ΔADCmean) between the two time points were calculated. The Cox proportion hazard model was used to evaluate the associations between imaging or clinical variables and progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS In multivariate analysis, ΔADCmean was the only independent predictor of PFS (hazard ratio [HR] = 0.2379, p = 0.005), CSS (HR = 0.310, p = 0.024), and OS (HR = 0.217, p = 0.002). Squamous cell carcinoma antigen, histology, and pretreatment tumor size were significantly independent predictors of PFS. Tumor size response was significantly independent predictor of CSS and OS. Using the cutoff values of ΔADCmean, the PFS was significantly lower for ΔADCmean < 27.8% (p = 0.001). The CSS and OS were significantly lower for ΔADCmean < 16.1% (p = 0.002 and p < 0.001, respectively). CONCLUSION The percentage change in tumor ADC may be a useful predictor of disease progression and survival in patients with cervical cancer treated with CCRT. KEY POINTS • DWI is widely used as a potential marker of tumor viability. • Percentage change in tumor ADC (ΔADC mean ) was an independent marker of PFS, CSS, and OS. • Survival was better in patients with ≥ ΔADC mean cutoff value than with < the cutoff value.
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Affiliation(s)
- Kyo-Won Gu
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea. .,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Chel Hun Choi
- Departments of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Cheol Yoon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ye ZM, Dai SJ, Yan FQ, Wang L, Fang J, Fu ZF, Wang YZ. DCE-MRI-Derived Volume Transfer Constant (K trans) and DWI Apparent Diffusion Coefficient as Predictive Markers of Short- and Long-Term Efficacy of Chemoradiotherapy in Patients With Esophageal Cancer. Technol Cancer Res Treat 2019; 17:1533034618765254. [PMID: 29642773 PMCID: PMC5900808 DOI: 10.1177/1533034618765254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This study aimed to evaluate both the short- and long-term efficacies of chemoradiotherapy in relation to the treatment of esophageal cancer . This was achieved through the use of dynamic contrast-enhanced magnetic resonance imaging–derived volume transfer constant and diffusion weighted imaging–derived apparent diffusion coefficient . Patients with esophageal cancer were assigned into the sensitive and resistant groups based on respective efficacies in chemoradiotherapy. Dynamic contrast-enhanced magnetic resonance imaging and diffusion weighted imaging were used to measure volume transfer constant and apparent diffusion coefficient, while computed tomography was used to calculate tumor size reduction rate. Pearson correlation analyses were conducted to analyze correlation between volume transfer constant, apparent diffusion coefficient, and the tumor size reduction rate. Receiver operating characteristic curve was constructed to analyze the short-term efficacy of volume transfer constant and apparent diffusion coefficient, while Kaplan-Meier curve was employed for survival rate analysis. Cox proportional hazard model was used for the risk factors for prognosis of patients with esophageal cancer. Our results indicated reduced levels of volume transfer constant, while increased levels were observed in ADCmin, ADCmean, and ADCmax following chemoradiotherapy. A negative correlation was determined between ADCmin, ADCmean, and ADCmax, as well as in the tumor size reduction rate prior to chemoradiotherapy, whereas a positive correlation was uncovered postchemoradiotherapy. Volume transfer constant was positively correlated with tumor size reduction rate both before and after chemoradiotherapy. The 5-year survival rate of patients with esophageal cancer having high ADCmin, ADCmean, and ADCmax and volume transfer constant before chemoradiotherapy was greater than those with respectively lower values. According to the Cox proportional hazard model, ADCmean, clinical stage, degree of differentiation, and tumor stage were all confirmed as being independent risk factors in regard to the prognosis of patients with EC. The findings of this study provide evidence suggesting that volume transfer constant and apparent diffusion coefficient as being tools allowing for the evaluation of both the short- and long-term efficacies of chemoradiotherapy esophageal cancer treatment.
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Affiliation(s)
- Zhi-Min Ye
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Shu-Jun Dai
- 2 Department of Intense Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Feng-Qin Yan
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Lei Wang
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Jun Fang
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Zhen-Fu Fu
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
| | - Yue-Zhen Wang
- 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Repbulic of China
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Vandecasteele K, Tummers P, Van Bockstal M, De Visschere P, Vercauteren T, De Gersem W, Denys H, Naert E, Makar A, De Neve W. EXclusion of non-Involved uterus from the Target Volume (EXIT-trial): an individualized treatment for locally advanced cervical cancer using modern radiotherapy and imaging techniques. BMC Cancer 2018; 18:898. [PMID: 30223802 PMCID: PMC6142314 DOI: 10.1186/s12885-018-4800-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Definitive chemoradiotherapy is standard of care in locally advanced cervical cancer (LACC). Both toxicity and local relapse remain major concerns in this treatment. We hypothesize that a magnetic resonance imaging (MRI) based redefining of the radiotherapeutic target volume will lead to a reduction of acute and late toxicity. In our center, chemoradiotherapy followed by hysterectomy was implemented successfully in the past. This enables us to assess the safety of reducing the target volume but also to explore the biological effects of chemoradiation on the resected hysterectomy specimen. Methods The EXIT-trial is a phase II, single arm study aimed at LACC patients. This study evaluates whether a MRI-based exclusion of the non-tumor-bearing parts of the uterus out of the target volume results in absence of tumor in the non-high doses irradiated part of the uterus in the hysterectomy specimen. Secondary endpoints include a dosimetric comparison of dose on normal tissue when comparing study treatment plans compared to treatment of the whole uterus at high doses; acute and chronic toxicity, overall survival, local relapse- and progression-free survival. In the translational part of the study, we will evaluate the hypothesis that the baseline apparent diffusion coefficient (ADC) values of diffusion weighted MRI and its evolution 2 weeks after start of CRT, for the whole tumor as well as for intra-tumoral regions, is prognostic for residual tumor on the hysterectomy specimen. Discussion Although MRI is already used to guide target delineation in brachytherapy, the EXIT-trial is the first to use this information to guide target delineation in external beam radiotherapy. Early therapy resistance prediction using DW-MRI opens a window for early treatment adaptation or further dose-escalation on tumors/intratumoral regions at risk for treatment failure. Trial registration Belgian Registration: B670201526181 (prospectively registered, 26/11/2015); ClinicalTrials.gov Identifier: NCT03542942 (retrospectively registered, 17/5/2018).
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Affiliation(s)
- Katrien Vandecasteele
- Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Philippe Tummers
- Gynaecologic Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Mieke Van Bockstal
- Pathology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.,Pathology, Erasmus Medical Center, s-Gravendijkwal 230, 3015, Rotterdam, The Netherlands
| | - Pieter De Visschere
- Radiology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Tom Vercauteren
- Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Werner De Gersem
- Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Hannelore Denys
- Medical Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Eline Naert
- Medical Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Amin Makar
- Gynaecologic Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Wilfried De Neve
- Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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Chen J, Hua H, Pang J, Shi X, Bi W, Li Y, Xu W. The Value of Diffusion-Weighted Magnetic Resonance Imaging in Predicting the Efficacy of Radiation and Chemotherapy in Cervical Cancer. Open Life Sci 2018; 13:305-311. [PMID: 33817097 PMCID: PMC7874687 DOI: 10.1515/biol-2018-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/08/2018] [Indexed: 01/22/2023] Open
Abstract
Background To analyze the application value of apparent diffusion coefficient (ADC) and exponent apparent diffusion coefficient (EADC) in evaluating the efficacy of radiation and chemotherapy in cervical cancer using pre- and posttreatment diffusion-weighted magnetic resonance imaging (DW-MRI) scans. Methods 52 patients with cervical cancer were administered radiation and chemotherapy. Both MRI and DW-MRI were obtained at different stages. The ADC and EADC values, as well as the maximum tumor diameter, were measured and analyzed. Results We found that the ADC value increased after treatment, and the EADC value decreased. Changes in the calculated ADC occurred earlier than the morphologic changes of the tumors. A negative correlation was detected between reduced rates in the maximum tumor diameter two months after treatment and pretreatment ADC value (r = –0.658, P < 0.05). An ROC curve and nonlinear regression analysis showed that the formula, y = (1525500.122x2 – 4689.962x + 3.482) × 100%, can be used to calculate the percentage of complete remission after treatment according to the pretreatment ADC value. Conclusion Our data suggest that pretreatment ADC and EADC values are predictive of the efficacy of radiation and chemotherapy. Both ADC and EADC values during treatment were instrumental in early monitoring and dynamic observation.
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Affiliation(s)
- Jingjing Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Hui Hua
- Department of Thyroid Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jing Pang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xianglong Shi
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Weiqun Bi
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Yingduan Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Wenjian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 266000, Shandong Province, China
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Valdes-Devesa V, Jimenez MDM, Sanz-Rosa D, Espada Vaquero M, Alvarez Moreno E, Sainz de la Cuesta Abbad R. Preoperative diagnosis of atypical pelvic leiomyoma and sarcoma: the potential role of diffusion-weighted imaging. J OBSTET GYNAECOL 2018; 39:98-104. [DOI: 10.1080/01443615.2018.1466110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Victoria Valdes-Devesa
- Department of Obstetrics and Gynecology, Hospital Universitario Quiron Madrid, Madrid, Spain
| | | | - David Sanz-Rosa
- Clinical Department, Faculty of Biomedical and Health Sciences, Universidad Europea, Madrid, Spain
| | - Mercedes Espada Vaquero
- Department of Obstetrics and Gynecology, Hospital Universitario Quiron Madrid, Madrid, Spain
| | | | - Ricardo Sainz de la Cuesta Abbad
- Department of Radiology, Hospital Universitario Quiron Madrid, Madrid, Spain
- Clinical Department, Faculty of Biomedical and Health Sciences, Universidad Europea, Madrid, Spain
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Keriakos NN, Darwish E. Diffusion weighted imaging in suspicious uterine tumors; how efficient is it? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zhao S, Zhang Y, Wang L, Yang L, Zou L, Gao F. Adeno-associated virus 2 mediated gene transfer of vascular endothelial growth factor Trap: a new treatment option for glioma. Cancer Biol Ther 2018; 20:65-72. [PMID: 30136881 PMCID: PMC6343700 DOI: 10.1080/15384047.2018.1504725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Adeno-associated virus 2 mediated gene transfer of vascular endothelial growth factor Trap (AAV2-VEGF-Trap) has been reported to inhibit the growth of primary tumor as well as distant metastasis in 4T1 metastatic breast cancer models. The aim of this study was to investigate the inhibiting efficacy of AAV2-VEGF-Trap for glioma. Methods: The intracranial transplanted model of glioma in rats was established. They were treated with AAV2-VEGF-Trap, bevacizumab (BEV), temozolomide (TMZ), TMZ combined with AAV2-VEGF-Trap, TMZ combined with BEV and the control group, respectively. A 7.0 Tesla magnetic resonance (MR) was used to assess the tumor volumes and obtain the apparent diffusion coefficient (ADC) values. Immunohistochemical and terminal dexynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) staining were used to evaluate the effects on tumor angiogenesis, proliferation and apoptosis. Results: The combination of TMZ with AAV2-VEGF-Trap or BEV showed greater tumor growth inhibition than the other groups, and the ADC values in these two groups were larger than that of the control group. The decreased microvessel density in treatment groups which contain AAV2-VEGF-Trap or BEV was observed. The reduced proliferation activity in groups containing TMZ and increased apoptotic tumor cells in TMZ combined with AAV2-VEGF-Trap group and TMZ combined with BEV group were detected. In addition, there were no differences in antitumor effect, ADC values, Ki-67 and CD31 staining and apoptosis analysis between the two combined therapy groups. Conclusion: AAV2-VEGF-Trap has an obvious anti-angiogenic effect and inhibits the growth of glioma just by a single intravenous injection, which is similar to BEV. Moreover, there is a synergistic antitumor effect between AAV2-VEGF-Trap and TMZ.
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Affiliation(s)
- Shengnan Zhao
- a Department of Medical Oncology , Cancer Center , West China Hospital of Sichuan University , Chengdu, China
| | - Yakun Zhang
- a Department of Medical Oncology , Cancer Center , West China Hospital of Sichuan University , Chengdu, China.,b Department of Oncology , the Affiliated Hospital of North Sichuan Medical College , Nanchong , China
| | - Lei Wang
- c Department of Radiology , West China Hospital of Sichuan University , Chengdu , China
| | - Li Yang
- d State Key Laboratory of Biotherapy , West China Hospital of Sichuan University , Chengdu , China
| | - Liqun Zou
- a Department of Medical Oncology , Cancer Center , West China Hospital of Sichuan University , Chengdu, China
| | - Fabao Gao
- c Department of Radiology , West China Hospital of Sichuan University , Chengdu , China
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Dregely I, Prezzi D, Kelly‐Morland C, Roccia E, Neji R, Goh V. Imaging biomarkers in oncology: Basics and application to MRI. J Magn Reson Imaging 2018; 48:13-26. [PMID: 29969192 PMCID: PMC6587121 DOI: 10.1002/jmri.26058] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/26/2018] [Indexed: 12/12/2022] Open
Abstract
Cancer remains a global killer alongside cardiovascular disease. A better understanding of cancer biology has transformed its management with an increasing emphasis on a personalized approach, so-called "precision cancer medicine." Imaging has a key role to play in the management of cancer patients. Imaging biomarkers that objectively inform on tumor biology, the tumor environment, and tumor changes in response to an intervention complement genomic and molecular diagnostics. In this review we describe the key principles for imaging biomarker development and discuss the current status with respect to magnetic resonance imaging (MRI). LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 5 J. Magn. Reson. Imaging 2018;48:13-26.
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Affiliation(s)
- Isabel Dregely
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
| | - Davide Prezzi
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
| | - Christian Kelly‐Morland
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
| | - Elisa Roccia
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
| | - Radhouene Neji
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
- MR Research CollaborationsSiemens HealthcareFrimleyUK
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
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Wu C, Huang J, Xu WB, Guan YJ, Ling HW, Mi JQ, Yan H. Discriminating Depth of Response to Therapy in Multiple Myeloma Using Whole-body Diffusion-weighted MRI with Apparent Diffusion Coefficient: Preliminary Results From a Single-center Study. Acad Radiol 2018; 25:904-914. [PMID: 29373210 DOI: 10.1016/j.acra.2017.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to measure apparent diffusion coefficient (ADC) in Chinese patients with newly diagnosed multiple myeloma by whole-body diffusion-weighted magnetic resonance imaging (WB-DWI MRI) and assess the diagnostic accuracy of ADC in the discrimination of deep response to induction chemotherapy. MATERIALS AND METHODS Seventeen patients underwent WB-DWI MRI before and after induction chemotherapy (week 20). DWI images and ADC maps were produced and 89 regions of interest were chosen. ADC percent changes were compared between deep (complete response or very good partial response) and non-deep responders (partial response, minimal response, stable disease, or progressive disease) as International Myeloma Working Group criteria. Diagnostic accuracy of ADC was calculated using specific cut offs. Predictive positive value of ADC was calculated to predict deep response to consolidation therapy. RESULTS Lesions reduced in size and number and signal intensity decreased in follow-up DWI, which did not differ between deep and non-deep responders. ADC percent changes were significantly higher in deep responders (36.79%) than in non-deep responders (11.50%) after induction therapy (P = .02) in per lesion analysis. ADC percent increases by 46.96%, 78.0% yielded specificity at 81.4%, 90.7% in discriminating deep response to induction therapy. Predictive positive value predicting deep response to consolidation therapy was 60.5% by using ADC cutoff >1.00 × 10-3 mm2/s at week 20. CONCLUSIONS ADC from WB-DWI MRI increased remarkably in patients who achieved deep response at the end of induction chemotherapy, which represented a confirmatory diagnostic tool to discriminate deep response to induction therapy for patients with multiple myeloma. ADC may have a potential to predict deep response to consolidation therapy.
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DCE-MRI for Early Prediction of Response in Hepatocellular Carcinoma after TACE and Sorafenib Therapy: A Pilot Study. J Belg Soc Radiol 2018; 102:40. [PMID: 30039052 PMCID: PMC6032464 DOI: 10.5334/jbsr.1278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: Dynamic contrast-enhanced MRI (DCE-MRI) can measure the changes in tumor blood flow, vascular permeability and interstitial and intravascular volume. The objective was to evaluate the efficacy of DCE-MRI in prediction of Barcelona Clinic Liver Cancer (BCLC) staging B or C hepatocellular carcinoma (HCC) response after treatment with transcatheter arterial chemoembolization (TACE) followed by sorafenib therapy. Methods: Sorafenib was administered four days after TACE of BCLC staging B or C HCC in 11 patients (21 lesions). DCE-MRI was performed with Gd-EOB-DTPA contrast before TACE and three and 10 days after TACE. DCE-MRI acquisitions were taken pre-contrast, hepatic arterial-dominant phase and 60, 120, 180, 240, 330, 420, 510 and 600 seconds post-contrast. Distribution volume of contrast agent (DV) and transfer constant Ktrans were calculated. Patients were grouped by mRECIST after one month or more post-TACE into responders (complete response, partial response) and non-responders (stable disease, progressive disease). Results: DV was reduced in responders at three and 10 days post-TACE (p = 0.008 and p = 0.008 respectively). DV fell in non-responders at three days (p = 0.025) but was not significantly changed from pre-TACE values after sorafenib. Sensitivity and specificity for DV 10 days post-TACE were 88% and 77% respectively. Conclusion: DV may be a useful biomarker for early prediction of therapeutic outcome in intermediate HCC.
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Hwang J, Hong SS, Kim HJ, Chang YW, Nam BD, Oh E, Lee E, Cha H. Reduced field-of-view diffusion-weighted MRI in patients with cervical cancer. Br J Radiol 2018; 91:20170864. [PMID: 29630391 DOI: 10.1259/bjr.20170864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Diffusion-weighted imaging (DWI) with reduced field-of-view (FOV) has been shown to provide high spatial resolution with reduced distorsion in the spinal cord, breast, pancreas, and prostate gland. Therefore, we performed this study to evaluate the qualitative image quality and quantitative ADC value of reduced FOV DWI in patients with cervical cancer in comparison with conventional DWI. METHODS This study retrospectively included 22 patients (mean age, 53.9 years) with biopsy-proven cervical cancer who underwent pelvic MR imaging including conventional DWI and reduced FOV DWI before therapy. Two observers independently rated image quality for reduced FOV DWI and conventional DWI regarding anatomic detail, lesion conspicuity, presence of artifacts, and overall image quality using the following 4-point scale. Quantitative analysis was performed by measuring the ADC value of the tumor. The Wilcoxon signed-rank test was used to compare qualitative scores and mean ADC value between two DWI sequences. RESULTS Reduced FOV DWI achieved significantly better anatomic detail, lesion conspicuity, presence of artifacts, and overall image quality compared to conventional DWI (p < 0.05). There was no significant difference in mean tumor ADC value between the two DWI sequences (0.990 × 10-3 mm2 s-1 ± 0.364 at reduced FOV DWI vs 1.253 × 10-3 mm2 s-1 ± 0.387 at conventional DWI) (p = 0.067). CONCLUSION Reduced FOV DWI shows better image quality in terms of anatomic detail and lesion conspicuity with fewer artifacts compared to conventional DWI. Advance in knowledge: Reduced FOV DWI may enhance diagnostic performance for evaluation of cervical cancer.
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Affiliation(s)
- Jiyoung Hwang
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital , Seoul , Republic of Korea
| | - Seong Sook Hong
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital , Seoul , Republic of Korea
| | - Hyun-Joo Kim
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital , Seoul , Republic of Korea
| | - Yun-Woo Chang
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital , Seoul , Republic of Korea
| | - Bo Da Nam
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital , Seoul , Republic of Korea
| | - Eunsun Oh
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital , Seoul , Republic of Korea
| | - EunJi Lee
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital , Seoul , Republic of Korea
| | - Hwajin Cha
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital , Seoul , Republic of Korea
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The PRICE study: The role of conventional and diffusion-weighted magnetic resonance imaging in assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. Eur Radiol 2018; 28:2425-2435. [DOI: 10.1007/s00330-017-5233-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/08/2017] [Accepted: 12/01/2017] [Indexed: 01/10/2023]
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