Dynamic Contrast-enhanced MR Imaging Measurement of Vertebral Bone Marrow Perfusion May Be Indicator of Outcome of Acute Myeloid Leukemia Patients in Remission

Chen, Bang-Bin; Hsu, Chih-Wei; Yu, Chih‐Wei; Hou, Hsin‐An; Liu, Chieh‐Yu; Wei, Shih-Chung; Chou, Wen‐Chien; Tien, Hwei‐Fang; Shih, Tiffany Ting-Fang

doi:10.1148/radiol.10100995

Cited by 42 publications

(23 citation statements)

References 50 publications

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“…For example, the universally over-expressed WT1 antigen in AML has been used successfully to determine chemosensitive disease using a PCR approach [27]. Similarly, the use of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) to measure changes in bone marrow microvascular density as an indicator of active disease, has been effectively employed as a noninvasive interim monitoring tool [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia: Can we do better?

et al. 2016

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The presence of >5% blasts at "day 14" (D14), in patients undergoing induction chemotherapy for acute myeloid leukemia (AML) is problematic. It is unclear if a second course of chemotherapy for early persistent disease will alter outcome in these patients. We conducted a retrospective study of AML patients undergoing induction chemotherapy where diagnostic, interim (around day 14), and recovery (days 21-42) bone marrow (BM) evaluations were available for review. Of the 113 patients included in the final analysis, 99 (87.6%) achieved CR at hematologic recovery. At D14, 90 patients (79.6%) had <5% blasts and of these, 87 (96.7%) ultimately achieved CR. At D14, Twenty-three (20.4%) patients had residual leukemia (>5% blasts). Of these, 11 (47.8%) received a second course of chemotherapy (double induction [DI]) and 12 (52.2%) were observed until count recovery (single induction [SI]). No significant difference in CR rates was observed between these two groups (58.3% DI group vs. 45.5% SI group, P value 5 0.684). In our analysis, D14 BM evaluation did not uniformly identify patients with primary induction failure. To unequivocally determine the value of a D14 marrow assessment in AML, prospective studies in the context of large cooperative group trials are required. Considering our findings and similar reports from others, we propose that D14 marrow assessment should be individualized, and that other factors, such as cytogenetics and early peripheral blood blast clearance should be considered, to identify patients most likely to benefit from interim disease assessment during AML induction therapy.

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Section: Discussionmentioning

confidence: 99%

Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia: Can we do better?

et al. 2016

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“…Also, several studies have applied DCE-MRI to monitor treatment-induced changes using different therapies, for example, chemotherapy (17), radiation therapy (20), angiogenic therapy (19), and stem cell transplantation (16). DCE-MRI parameters have been shown to be associated with prognosis and survival of patients, which might be related to the angiogenesis of the disease (14–18,33). It was found that a higher microvessel density was correlated with higher tumor grade, worse prognosis, and shorter survival in myeloma patients (34–36).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Spinal Lesions Using Heuristic and Pharmacokinetic Parameters Measured by Dynamic Contrast-Enhanced MRI

Yuan

et al. 2017

Academic Radiology

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Rationale and Objectives: This study aimed to evaluate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiation of four spinal lesions by using heuristic and pharmacokinetic parameters analyzed from DCE signal intensity time course. Materials and Methods: DCE-MRI of 62 subjects with confirmed myeloma (n=9), metastatic cancer (n= 22), lymphoma (n= 7), and inflammatory tuberculosis (TB) (n= 24) in the spine were analyzed retrospectively. The region of interest was placed on strongly enhanced tissues. The DCE time course was categorized as the “wash-out,” “plateau,” or “persistent enhancement” pattern. The maximum enhancement, steepest wash-in enhancement, and wash-out slope using the signal intensity at 67 seconds after contrast injection as reference were measured. The Tofts 2-compartmental pharmacokinetic model was applied to obtain Ktrans and kep. Pearson correlation between heuristic and pharmacokinetic parameters was evaluated, and receiver operating characteristic curve analysis was performed for pairwise group differentiation. Results: The mean wash-out slope was −22% ± 10% for myeloma, 1% ± 0.4% for metastatic cancer, 3% ± 3% for lymphoma, and 7% ± 10% for TB, and it could significantly distinguish myeloma from metastasis (area under the curve [AUC] = 0.884), lymphoma (AUC = 1.0), and TB (AUC = 1.0) with P = .001, and distinguish metastasis from TB (AUC = 0.741) with P = .005. The kep and wash-out slope were highly correlated (r = 0.92), and they showed a similar diagnostic performance. The Ktrans was significantly correlated with the maximum enhancement (r = 0.71) and the steepest wash-in enhancement (r = 0.85), but they had inferior diagnostic performance compared to the wash-out slope. Conclusions: DCE-MRI may provide additional diagnostic information, and a simple wash-out slope had the best diagnostic performance. The heuristic and pharmacokinetic parameters were highly correlated.

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“…Moreover, the risks of a contrast (gadolinium) toxicity is lower than with CT scans. Recently, two groups have shown early data that dynamic contrast enhanced- (DCE-) MRI can be used to assess bone marrow vascular perfusion and predict for response to chemotherapy [51, 52]. …”

Section: Summary and Future Directionsmentioning

confidence: 99%

Angiogenesis in Acute Myeloid Leukemia and Opportunities for Novel Therapies

Trujillo

McGee

Cogle

2012

Journal of Oncology

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Acute myeloid leukemia (AML) arises from neoplastic transformation of hematopoietic stem and progenitor cells, and relapsed disease remains one of the greater challenges in treating this hematologic malignancy. This paper focuses on angiogenic aspects of AML including the significance and prognostic value of bone marrow microvessel density and circulating cytokine levels. We show three general mechanisms whereby AML exploits angiogenic pathways, including direct induction of angiogenesis, paracrine regulation, and autocrine stimulation. We also present early evidence that leukemia cells contribute directly to vascular endothelia. Novel treatment strategies are proposed, and a review of relevant antiangiogenic clinical trials is presented. By understanding how blood vessels can serve as a reservoir for refractory and relapsed AML, new diagnostics and promising treatment strategies can be developed.

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Dynamic Contrast-enhanced MR Imaging Measurement of Vertebral Bone Marrow Perfusion May Be Indicator of Outcome of Acute Myeloid Leukemia Patients in Remission

Abstract: Bone marrow perfusion measured with DCE MR imaging in AML patients in CR can be an indicator of outcome and survival. K(ep) measured with kinetic modeling was useful and significantly associated with RFS, while heuristic parameters (peak and slope) were not.

Cited by 42 publications

References 50 publications

Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia: Can we do better?

Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia: Can we do better?

Diagnosis of Spinal Lesions Using Heuristic and Pharmacokinetic Parameters Measured by Dynamic Contrast-Enhanced MRI

Angiogenesis in Acute Myeloid Leukemia and Opportunities for Novel Therapies

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