Lung Cancer Perfusion at Multi–Detector Row CT: Reproducibility of Whole Tumor Quantitative Measurements

Ng, Quan‐Sing; Goh, Vicky; Fichte, Heinz; Klotz, Ernst; Fernie, Pat; Saunders, Michele I.; Hoskin, Peter; Padhani, Anwar R.

doi:10.1148/radiol.2392050568

Cited by 123 publications

(84 citation statements)

References 23 publications

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“…We also show that it is a significant independent predictor of survival. However, the disadvantage of this approach is that the dynamic CT protocol required is yet to be routinely adopted in clinical practice and there are technical challenges that need to be overcome (31,32). DCE CT also entails an additional radiation dose that may need to be as high as 30 mSv for reliable wholetumor assessments (32).…”

Section: Discussionmentioning

confidence: 99%

Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

Win

Miles

Janes

et al. 2013

Clinical Cancer Research

188

152

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Purpose: We prospectively examined the role of tumor textural heterogeneity on positron emission tomography/computed tomography (PET/CT) in predicting survival compared with other clinical and imaging parameters in patients with non-small cell lung cancer (NSCLC).Experimental Design: The feasibility study consisted of 56 assessed consecutive patients with NSCLC (32 males, 24 females; mean age 67 AE 9.7 years) who underwent combined fluorodeoxyglucose (FDG) PET/ CT. The validation study population consisted of 66 prospectively recruited consecutive consenting patients with NSCLC (37 males, 29 females; mean age, 67.5 AE 7.8 years) who successfully underwent combined FDG PET/CT-dynamic contrast-enhanced (DCE) CT. Images were used to derive tumoral PET/CT textural heterogeneity, DCE CT permeability, and FDG uptake (SUV max ). The mean follow-up periods were 22.6 AE 13.3 months and 28.5AE 13.2 months for the feasibility and validation studies, respectively. Optimum threshold was determined for clinical stage and each of the above biomarkers (where available) from the feasibility study population. Kaplan-Meier analysis was used to assess the ability of the biomarkers to predict survival in the validation study. Cox regression determined survival factor independence.Results: Univariate analysis revealed that tumor CT-derived heterogeneity (P < 0.001), PET-derived heterogeneity (P ¼ 0.003), CT-derived permeability (P ¼ 0.002), and stage (P < 0Á001) were all significant survival predictors. The thresholds used in this study were derived from a previously conducted feasibility study. Tumor SUV max did not predict survival. Using multivariable analysis, tumor CT textural heterogeneity (P ¼ 0.021), stage (P ¼ 0.001), and permeability (P < 0.001) were independent survival predictors. These predictors were independent of patient treatment.Conclusions: Tumor stage and CT-derived textural heterogeneity were the best predictors of survival in NSCLC. The use of CT-derived textural heterogeneity should assist the management of many patients with NSCLC.

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Section: Discussionmentioning

confidence: 99%

Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

Win

Miles

Janes

et al. 2013

Clinical Cancer Research

188

152

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“…Functional imaging has been claimed to provide more relevant information on tissue viability during treatment monitoring than the standard therapeutic response assessment (RECIST) based on tumour size changes [6][7][8], which is currently used. Among other imaging modalities, CT perfusion (CT-p) recently experienced a progressive increase in interest and acceptance in the radiological community for oncological applications [9][10][11][12][13], including both the diagnostic process and follow-up of lung cancer [14][15][16]. Substantial differences between treatment response to conventional and anti-angiogenic drugs assessed by RECIST criteria and CT-p in patients with lung adenocarcinoma have been evidenced [17].…”

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confidence: 99%

Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

Fraioli

Anzidei

Serra

et al. 2013

BJR

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Objective: To determine whether CT-perfusion (CT-p) can be used to evaluate the effects of chemotherapy and anti-angiogenic treatment in patients with non-small-cell lung carcinoma (NSCLC) and whether CT-p and standard therapeutic response assessment (RECIST) data obtained before and after therapy correlate. Methods: 55 patients with unresectable NSCLC underwent CT-p before the beginning of therapy and 50 of them repeated CT-p 90 days after it. Therapeutic protocol included platinum-based doublets plus bevacizumab for non-squamous carcinoma and platinum-based doublets for squamous carcinoma. RECIST measurements and calculations of blood flow (BF), blood volume (BV), time to peak (TTP) and permeability surface (PS) were performed, and baseline and post-treatment measurements were tested for statistically significant differences. Baseline and follow-up perfusion parameters were also compared based on histopathological subclassification (2004 World Health Organization Classification of Tumours) and therapy response assessed by RECIST. Results: Tumour histology was consistent with large cell carcinoma in 14/50 (28%) cases, adenocarcinoma in 22/50 (44%) cases and squamous cell carcinoma in the remaining 14/50 (28%) cases. BF and PS differences for all tumours between baseline and post-therapy measurements were significant (p50.001); no significant changes were found for BV (p50.3) and TTP (p50.1). The highest increase of BV was demonstrated in adenocarcinoma (5.2634.1%), whereas the highest increase of TTP was shown in large cell carcinoma (6.9622.4%), and the highest decrease of PS was shown in squamous cell carcinoma (221.5618.5%). A significant difference between the three histological subtypes was demonstrated only for BV (p,0.007). On the basis of RECIST criteria, 8 (16%) patients were classified as partial response (PR), 2 (4%) as progressive disease (PD) and the remaining 40 (80%) as stable disease (SD). Among PR, a decrease of both BF (1869.6%) and BV (12.669.2%) were observed; TTP increased in 3 (37.5%) cases, and PS decreased in 6 (75%) cases. SD patients showed an increase of BF, BV, TTP and PS in 6

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“…RSNA, 2009 Supplemental C urrent computed tomographic (CT) perfusion techniques require the acquisition of 30 seconds or more of serial stationary scans. The timeattenuation curve (TAC) over the tissue or organ of interest is used, with various models of single-and multiple-compartment flow, to estimate parameters such as absolute blood flow and volume and vascular permeability (1)(2)(3). For oncologic applications, increased tissue perfusion has been studied to assess tumor malignancy and potential response to therapy, while in ischemic disease applications, blood flow is correlated to tissue viability (1,(4)(5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

Renal Perfusion and Hemodynamics: Accurate in Vivo Determination at CT with a 10-Fold Decrease in Radiation Dose and HYPR Noise Reduction

Liu

Primak²,

Krier

et al. 2009

Radiology

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Purpose:To prospectively evaluate the accuracy of computed tomographic (CT) perfusion measurements of renal hemodynamics and function obtained by using images acquired with one-tenth the typical radiation dose and postprocessed with a highly constrained back-projection (HYPR)-local reconstruction (LR) noise-reduction technique. Materials and Methods:This study was approved by the institutional Animal Care and Use Committee. Two consecutive CT perfusion acquisitions were performed in 10 anesthetized pigs over 180 seconds by using routine (80 kV, 160 mAs) and one-tenth (80 kV, 16 mAs) dose levels. Images obtained with each acquisition were reconstructed with identical parameters, and the one-tenth dose images were also processed with a HYPR-LR algorithm. Attenuation changes in kidneys were determined as a function of time to form time-attenuation curves (TACs). Extended gamma-variate curve-fitting was performed, and regional perfusion, glomerular filtration rate, and renal blood flow were calculated. Image quality was evaluated (in 10 pigs), and the agreement for renal perfusion and function between the routine dose and the one-tenth dose HYPR-LR images was determined (for 20 kidneys) by using statistical methods. Statistical analysis was performed by using the paired t test, linear regression, and Bland-Altman analysis. Results:TACs obtained with the one-tenth dose were similar to those obtained with the routine dose. Statistical analysis showed that there were no significant differences between the routine dose and the one-tenth dose acquisitions in renal perfusion and hemodynamic values and that there were slight but statistically significant differences in some values with the one-tenth dose HYPR-LR-processed acquisition. The image quality of the one-tenth dose acquisition was improved by using the HYPR-LR algorithm. Linear regression and BlandAltman plots showed agreement between the images acquired by using the routine dose and those acquired by using the one-tenth dose with HYPR-LR processing. Conclusion:A 10-fold dose reduction at renal perfusion CT imaging can be achieved in vivo, without loss of accuracy. The image quality of the one-tenth dose images could be improved to be near that of the routine dose images by using the HYPR-LR noise-reduction algorithm. RSNA, 2009 Supplemental Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.C urrent computed tomographic (CT) perfusion techniques require the acquisition of 30 seconds or more of serial stationary scans. The timeattenuation curve (TAC) over the tissue or organ of interest is used, with various models of single-and multiple-compartment flow, to estimate parameters such as absolute blood flow and volume and vascular permeability (1-3). For oncologic applications, increased tissue perfusion has been studied to assess tumor malignancy and potential response to therapy, while in ischemic disease appl...

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Lung Cancer Perfusion at Multi–Detector Row CT: Reproducibility of Whole Tumor Quantitative Measurements

Cited by 123 publications

References 23 publications

Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

Renal Perfusion and Hemodynamics: Accurate in Vivo Determination at CT with a 10-Fold Decrease in Radiation Dose and HYPR Noise Reduction

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