Automated Voxel-Based Analysis of Volumetric Dynamic Contrast-Enhanced CT Data Improves Measurement of Serial Changes in Tumor Vascular Biomarkers

Coolens, Catherine; Driscoll, Brandon; Chung, Caroline; Shek, Tina; Gorjizadeh, Alborz; Ménard, Cynthia; Jaffray, David A.

doi:10.1016/j.ijrobp.2014.09.028

Cited by 16 publications

(20 citation statements)

References 16 publications

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“…Kinetic analysis was done on every voxel of the liver, tumor included, using an in-house 4-dimensional (4D) temporal dynamic analysis method, which enables automated parametric analysis based on patient-specific dynamic behavior of contrast flow 15 . This has been validated using a dynamic flow phantom capable of creating typical liver enhancement curves5, 16 and shown to improve sensitivity of perfusion CT as an imaging biomarker in a recent study of brain metastases treated with stereotactic radiosurgery 4 .…”

Section: Methodsmentioning

confidence: 99%

“…Dynamic contrast-enhanced (DCE) computed tomography (CT) of the liver, with high resolution and clinical convenience, is a key potential method in this regard 2 . Advances in perfusion imaging analysis techniques and scanner acquisition capabilities have brought voxel-based perfusion imaging of the liver into the realm of possibilities and it is now well-understood that the absence of 3-dimensional (3D) volumetric representation results in poor accuracy and robustness as well as a lack of heterogeneity information, which is much-needed to address and understand changes in tumor behavior and treatment response 4, 5, 6…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of 4D perfusion CT imaging for the assessment of liver treatment response following SBRT and sorafenib

Coolens

Driscoll

Moseley

et al. 2016

Advances in Radiation Oncology

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ObjectivesTo evaluate the feasibility of 4-dimensional perfusion computed tomography (CT) as an imaging biomarker for patients with hepatocellular carcinoma and metastatic liver disease.Methods and materialsPatients underwent volumetric dynamic contrast-enhanced CT on a 320-slice scanner before and during stereotactic body radiation therapy and sorafenib, and at 1 and 3 months after treatment. Quiet free breathing was used in the CT acquisition and multiple techniques (rigid or deformable registration as well as outlier removal) were applied to account for residual liver motion. Kinetic modeling was performed on a voxel-by-voxel basis in the gross tumor volume and normal liver resulting in 3-dimensional parameter maps of blood perfusion, capillary permeability, blood volume, and mean transit time. Perfusion characteristics in the tumor and adjacent liver were correlated with radiation dose distributions to evaluate dose-response. Paired t tests assessed change in spatial and histogram parameters from baseline to different time points during and after treatment. Technique reproducibility as well as the impact of arterial and portal vein input functions was also investigated using intra- and inter-subject variance and Bland-Altman analysis.ResultsQuantitative perfusion parameters were reproducible (±5.7%; range, 2%-10%) depending on tumor/normal liver type and kinetic parameter. Statistically significant reductions in tumor perfusion were measurable over the course of treatment and as early as 1 week after sorafenib administration (P < .05). Marked liver parenchyma perfusion reduction was seen with a strong dose-response effect (R2 = 0.95) that increased significantly over the course treatment.ConclusionsThe proposed methodology demonstrated feasibility of evaluating spatiotemporal changes in liver tumor perfusion and normal liver function following antiangiogenic therapy and radiation treatment warranting further evaluation of biomarker prognostication.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of 4D perfusion CT imaging for the assessment of liver treatment response following SBRT and sorafenib

Coolens

Driscoll

Moseley

et al. 2016

Advances in Radiation Oncology

Self Cite

View full text Add to dashboard Cite

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“…Larger cranio-caudal (CC) coverage allows for dynamic volume acquisition at high spatial and temporal resolution without the need to move the patient (Mori, Hara et al 2009;Coolens, Bracken et al 2012;Coolens, Driscoll et al 2014) and creates the possibility of detecting anatomical motion and performing (deformable) image registration between the dynamic CT volumes of the DCE sequence. (Coolens, Driscoll et al 2013;Coolens, Driscoll et al 2014) Larger coverage scanners are expected to suffer from cone-beam artifacts and elevated noise due to x-ray scatter.…”

Section: Dce-ct Measurement: Temporal Resolution and Fovmentioning

confidence: 99%

“…(Coolens, Driscoll et al 2013;Coolens, Driscoll et al 2014) Larger coverage scanners are expected to suffer from cone-beam artifacts and elevated noise due to x-ray scatter. (Kak and Slaney) While artifacts are indeed present, they are not expected to impact DCE-CT results and voxel-based SNR analysis did not show a statistically relevant impact.…”

Section: Dce-ct Measurement: Temporal Resolution and Fovmentioning

confidence: 99%

“…(Miles, Lee et al 2012) Such an automated temporal dynamic analysis (TDA) method was tested in metastatic brain cancer patients showing improved sensitivity to detect vascular changes with minimal user interaction after selection of the arterial input function (AIF). (Coolens, Driscoll et al 2014) Further automation is possible within this area such as the automated detection of the AIF as in DCE-MR (see below) to improve the automation of voxel-based analysis so that it becomes a practically feasible solution to be included into a clinical workflow. The use of function versus anatomical ROI definitions requires further investigation as it can lead to a bias in voxels included in the ROI analysis.…”

Section: From Regions Of Interest (Roi) To Voxel-based Analysismentioning

confidence: 99%

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Quantitative Imaging in Radiation Oncology: An Emerging Science and Clinical Service

Jaffray

Chung

Coolens

et al. 2015

Seminars in Radiation Oncology

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Magnetic resonance imaging of anal cancer: tumor characteristics and early prediction of treatment outcome

et al. 2023

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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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Automated Voxel-Based Analysis of Volumetric Dynamic Contrast-Enhanced CT Data Improves Measurement of Serial Changes in Tumor Vascular Biomarkers

Cited by 16 publications

References 16 publications

Feasibility of 4D perfusion CT imaging for the assessment of liver treatment response following SBRT and sorafenib

Feasibility of 4D perfusion CT imaging for the assessment of liver treatment response following SBRT and sorafenib

Quantitative Imaging in Radiation Oncology: An Emerging Science and Clinical Service

Magnetic resonance imaging of anal cancer: tumor characteristics and early prediction of treatment outcome

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