Dual Energy CT for Monitoring Targeted Therapies in Patients with Advanced Gastrointestinal Stromal Tumor: Initial Results

Schramm, Nicolai; Schlemmer, M.; Englhart, E.; Hittinger, M.; Becker, Conny; Reiser, M.; Berger, Frank

doi:10.2174/138920111795164066

Cited by 23 publications

(13 citation statements)

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“…In the case of gastrointestinal stromal tumors, DECT has proven a useful supplement to RECIST and CHOI [21,22] for monitoring therapy within the framework of studies.…”

Section: Discussionmentioning

confidence: 99%

Staging of pulmonary metastases using dual-energy computed tomography after anti-angiogenic therapy

Altenbernd

Wetter

Umutlu

et al. 2017

IJDI

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Objective: The aim of this study was the evaluation of dual-energy computed tomography (DECT) for the assessment of pulmonary metastases (PM) after antiangiogentic therapy (AT). Material and methodology: A total of 82 patients with non-small cell lung carcinoma (NSCLC), colorectal cancer (CRC), gastrointestinal stromal tumors (GIST) and hepatocellular carcinoma (HCC) were examined before and after AT with DECT of the lung. The number, size, CT densities (HU) of the PM were determined by 2 radiologists in consens in both DECT. The Wilcoxon sign rank test was applied (SPSS, version 21, SPSS, IBM, Chicago, USA). Results: The 82 patients (NSCLC: 32/82; CRC: 34/82; GIST: 10/82; HCC: 6/82) with a total of 201 PM were included. DECT were produced with a time interval of 4 ± 1 months. Size changes of the metastases: PM total 23 mm vs. 24 mm; p = .1/ NSCLC 22 mm vs. 23 mm; p = .2/ CRC 23 mm vs. 23 mm; p = .3/ GIST 24 mm vs. 25 mm; p = .1/ HCC 22 mm vs. 21 mm; p = .1. Contrast media in the course: PM total 45 HU vs. 25 HU; -44%; p < .05/ NSCLC 43 HU vs. 22 HU; -49%; p < .05/CRC 33 HU vs. 15 HU; -55%; p < .05/ GIST 45 HU vs. 24 HU; 47%; p < .05/HCC 62 HU vs. 43 HU; -31%, p < .05. Conclusions: The quantification of the contrast medium uptake of pulmonary metastases is valid by using dual-energy imaging. In this way, the therapy response according to antiangiogenetic therapy with regard to the contrast medium uptake can be assessed more precisely without native imaging in addition to changes in the size of the metastases.

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“…In the case of gastrointestinal stromal tumors, DECT has proven a useful supplement to RECIST and CHOI [21,22] for monitoring therapy within the framework of studies.…”

Section: Discussionmentioning

confidence: 99%

Staging of pulmonary metastases using dual-energy computed tomography after anti-angiogenic therapy

Altenbernd

Wetter

Umutlu

et al. 2017

IJDI

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“…In contrast to our study, they used a non-standardized two-dimensional ROI. A similar approach for semi-quantitative iodine measurements in GIST using a manually driven ROI around the margin of the entire tumor describes an inconclusive relationship between RECIST/Choi criteria and IU [ 32 ] .…”

Section: Discussionmentioning

confidence: 99%

“…Contrast agent dose and injection rate for an individual were not altered between FU examinations, but normalization as proposed in other studies [ 32 ] , for example, using an ROI placed in the aorta [ 33 ] , was not performed in our evaluation. In addition to the contrast agent injection parameter, there are other influencing factors not investigated in our study such as varying cardiac output or permeability of vessels.…”

Section: Discussionmentioning

confidence: 99%

Monitoring targeted therapy using dual-energy CT: semi-automatic RECIST plus supplementary functional information by quantifying iodine uptake of melanoma metastases

Uhrig

Sedlmair

Schlemmer³

et al. 2013

Cancer Imaging

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Aim: Supplementary functional information can contribute to assess response in targeted therapies. The aim of this study was to evaluate semi-automatic RECIST plus iodine uptake (IU) determination in melanoma metastases under BRAF inhibitor (vemurafenib) therapy using dual-energy computed tomography (DECT). Methods: Nine patients with stage IV melanoma treated with a BRAF inhibitor were included. Contrast-enhanced DECT was performed before and twice after treatment onset. Changes in tumor size were assessed according to RECIST. Quantification of IU (absolute value for total IU (mg) and volume-normalized IU (mg/ml)) was based on semi-automatic tumor volume segmentation. The decrease compared with baseline was calculated. Results: The mean change of RECIST diameter sum per patient was −47% at the first follow-up (FU), −56% at the second FU (P < 0.01). The mean normalized IU per patient was −21% at the first FU (P < 0.2) and −45% at the second FU (P < 0.01). Total IU per patient, combining both normalized IU and volume, showed the most pronounced decrease: −89% at the first FU and −90% at the second FU (P < 0.01). Conclusion: Semi-automatic RECIST plus IU quantification in DECT enables objective, easy and fast parameterization of tumor size and contrast medium uptake, thus providing 2 complementary pieces of information for response monitoring applicable in daily routine.

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“…These substances rather result in cytostatic than cytoreductive effects in case of therapeutic response [33]. In the course of response, cystic formation, central necrosis and even pseudo-growth have been reported as well, which can be misinterpreted as progression when assessed with conventional response criteria like Response Evaluation Criteria in Solid Tumors (RECIST), in greatest detail evaluated in patients with metastatic GIST [31,[53][54][55]. As a consequence, new DECT-derived response criteria have been proposed also in patients with lung cancer treated with anti-angiogenic substances with the goal to improve therapeutic response evaluation [56]: in 2012, a small cohort of ten NSCLC patients treated with bevacizumab underwent DECT for evaluation of response assessment.…”

Section: Dect and Therapeutic Response Assessmentmentioning

confidence: 99%

Dual-energy snap-shot perfusion CT in suspect pulmonary nodules and masses and for lung cancer staging

Sudarski

Hagelstein

Weis

et al. 2015

European Journal of Radiology

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Dual Energy CT for Monitoring Targeted Therapies in Patients with Advanced Gastrointestinal Stromal Tumor: Initial Results

Cited by 23 publications

References 0 publications

Staging of pulmonary metastases using dual-energy computed tomography after anti-angiogenic therapy

Staging of pulmonary metastases using dual-energy computed tomography after anti-angiogenic therapy

Monitoring targeted therapy using dual-energy CT: semi-automatic RECIST plus supplementary functional information by quantifying iodine uptake of melanoma metastases

Dual-energy snap-shot perfusion CT in suspect pulmonary nodules and masses and for lung cancer staging

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