Intermodality comparison between 3D perfusion CT and 18F-FDG PET/CT imaging for predicting early tumor response in patients with liver metastasis after chemotherapy: Preliminary results of a prospective study

Kim, Dong Hyun; Kim, Se Hyung; Im, Seock Ah; Han, Sae Won; Goo, Jin Mo; Willmann, Jürgen K.; Lee, Eun Seong; Eo, Jae Seon; Paeng, Jin Chul; Han, Joon Koo; Choi, Byung Ihn

doi:10.1016/j.ejrad.2012.02.012

Cited by 21 publications

(32 citation statements)

References 17 publications

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“…Emerging functional and molecular imaging techniques using MR imaging, CT, US, positron emission tomography (PET), and optical-based technologies are being developed and have shown promising results for monitoring cancer more accurately than traditional morphologic imaging (11)(12)(13)(14)(15)(16)(17). Among these, CT is currently the most commonly used first-line imaging modality for staging and monitoring of diseases in oncology because of its wide availability and the availability of standardized CT protocols which yield reproducible imaging results.…”

Section: Accreditation and Designation Statementmentioning

confidence: 99%

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CT Perfusion of the Liver: Principles and Applications in Oncology

Kim¹,

Kamaya²,

Willmann³

2014

Radiology

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With the introduction of molecularly targeted chemotherapeutics, there is an increasing need for defining new response criteria for therapeutic success because use of morphologic imaging alone may not fully assess tumor response. Computed tomographic (CT) perfusion imaging of the liver provides functional information about the microcirculation of normal parenchyma and focal liver lesions and is a promising technique for assessing the efficacy of various anticancer treatments. CT perfusion also shows promising results for diagnosing primary or metastatic tumors, for predicting early response to anticancer treatments, and for monitoring tumor recurrence after therapy. Many of the limitations of early CT perfusion studies performed in the liver, such as limited coverage, motion artifacts, and high radiation dose of CT, are being addressed by recent technical advances. These include a wide area detector with or without volumetric spiral or shuttle modes, motion correction algorithms, and new CT reconstruction technologies such as iterative algorithms. Although several issues related to perfusion imagingsuch as paucity of large multicenter trials, limited accessibility of perfusion software, and lack of standardization in methods-remain unsolved, CT perfusion has now reached technical maturity, allowing for its use in assessing tumor vascularity in larger-scale prospective clinical trials. In this review, basic principles, current acquisition protocols, and pharmacokinetic models used for CT perfusion imaging of the liver are described. Various oncologic applications of CT perfusion of the liver are discussed and current challenges, as well as possible solutions, for CT perfusion are presented.q RSNA, 2014

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Section: Accreditation and Designation Statementmentioning

confidence: 99%

“…There are several reports to suggest that CT perfusion parameters of the liver are related to prognosis in patients with liver metastases (12,35,36,78). For example, in a study by Miles et al (78), the relationship between HPI and survival was evaluated in a series of 80 patients with colorectal cancer.…”

Section: Early Detection Of Liver Tumorsmentioning

confidence: 99%

CT Perfusion of the Liver: Principles and Applications in Oncology

Kim¹,

Kamaya²,

Willmann³

2014

Radiology

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171

135

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“…Functional radiological techniques have been tested for follow-up evaluations during systemic treatment of liver metastases; details are reported in Table 4. Kim et al [123] reported that pCT-derived BF and flow extraction product (FEP) could be used as early response predictors in patients with liver metastases from CRC, being both significantly different between responders and non-responders to XELOX, FOLFOX or FOLFIRI chemotherapy regimens. Schlemmer et al [124] reported that metastatic NETs with good response to tyrosine kinase inhibitors showed a significant tendency towards lower perfusion values assessed by pCT as compared to poor responders.…”

Section: Liver Metastasesmentioning

confidence: 99%

“…Hsu et al [109] 31 DCE-MRI Ktrans decrease HCC sorafenib+metronomic tegafur/uracil Yopp et al [111] 17 DCE-MRI AUC90/AUC180/K trans decrease HCC bevacizumab Jiang et al [112] 23 pCT BF/BV/PS decrease HCC bevacizumab + cytotoxic agents MTT increase Kim et al [113] 10 DCE-MRI/DWI K trans /Kep decrease HCC sunitinib ADC increase Sahani et al [114] 23 DCE-MRI/DWI K trans /Kep decrease HCC sunitinib ADC increase Kim et al [123] 35 pCT BF decrease CRC metastases XELOX, FOLFOX, FOLFIRI Schlemmer et al [124] 24…”

Section: Primary Liver Tumorsmentioning

confidence: 99%

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Robertis¹,

Martini²,

Demozzi³

et al. 2015

WJG

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Diffusion-weighted imaging (DWI), dynamic contrastenhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for posttreatment assessment, even at an early stage. or altered cellular membranes will present diffusion restriction, which is depicted as signal hyperintensity areas on high b-value DW images and hypointensity on the apparent diffusion coefficient (ADC) maps; ADC measurement can also quantify water molecules' diffusion. As dedifferentiation or therapies may induce microscopic changes in neoplastic tissues that could modify water molecules' diffusion, DWI can distinguish between different degrees of malignancy and can be also proposed for post-treatment monitoring. Moreover, DWI can be performed in a single session with DCE-MRI, thus providing a comprehensive "one-step" morphological and functional evaluation of hepatobilio-pancreatic tumors.Perfusion imaging techniques evaluate changes in signal intensity (DCE-MRI) or density (pCT) after contrast medium injection, being therefore able to assess microvascularization through the evaluation of the dynamics of contrast medium distribution from vessels to the neoplastic tissue. Perfusion parameters are therefore theoretically good candidates for the evaluation of microscopic vascular differences between lesions with different pathological grade and for the assessment of treatment response, especially after chemoembolization or during treatments with antiangiogenic drugs.This editorial analyzes up-to-date literature data regarding the application of functional imaging techniques, apart from molecular imaging, to hepatic and pancreatic tumors, with particular emphasis on correlations to pathological features, prognostic stratification and therapeutic response assessment. FUNCTIONAL IMAGING TECHNIQUES: TECHNICAL BASESIn 1965 Stejskal and Tanne...

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“…Although hepatic pCT is also used for nononcologic applications, it is mainly utilized for oncologic imaging and many studies showed that it could demonstrate perfusion changes of the tissue of interest or tumor before and after the therapy (3)(4)(5). Thus pCT has the potential for monitoring therapy response earlier than the conventional methods such as regular CT follow-ups using mRECIST criteria (6,7). Although it has the advantage of detecting perfusion changes, lack of standard for CT protocol and relatively limited experience in the literature with many studies of small sample size and various methods are the main limitations, which hamper its clinical application.…”

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confidence: 99%