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    Islet Cell Liver Metastases: Assessment of Volumetric Early Response with Functional MR Imaging after Transarterial Chemoembolization

    Zhen Li, MD, PhD,
    Susanne Bonekamp, DVM, PhD,
    Vivek Gowdra Halappa, MD,
    Celia Pamela Corona-Villalobos, MD, PhD,
    Timothy Pawlik, MD,
    Nik Bhagat, MD,
    Diane Reyes, BS,
    Hong Lai, PhD,
    Jean F. Geschwind, MD and
    Ihab R. Kamel, MD, PhD

    + Author Affiliations

    From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.L.); and Russell H. Morgan Department of Radiology and Radiological Science (S.B., V.G.H., C.P.C., N.B., D.R., H.L., J.F.G., I.R.K.) and Department of Surgery (T.P.), the Johns Hopkins Medical Institutions, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287.

    Address correspondence to
    I.R.K. (e-mail: ikamel@jhmi.edu).

    Author contributions: Guarantors of integrity of entire study, Z.L., C.P.C., T.P., I.R.K.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; literature research, Z.L., V.G.H., C.P.C., H.L., I.R.K.; clinical studies, Z.L., S.B., V.G.H., J.F.G., I.R.K.; statistical analysis, Z.L., S.B., C.P.C., H.L., J.F.G., I.R.K.; and manuscript editing, all authors

    Abstract

    Purpose: To assess early response to transarterial chemoembolization by using volumetric functional magnetic resonance (MR) imaging in patients with islet cell liver metastases (ICLMs).

    Materials and Methods: This retrospective institutional review board–approved HIPAA-compliant study included 215 ICLMs in 26 patients (15 men, 11 women; mean age, 59.7 years; age range, 37–79 years). Volumetric measurements were performed by an experienced radiologist on diffusion-weighted and contrast material–enhanced MR images at baseline and 1-month follow-up. Measurements included mean change (three-dimensional [3D] mean apparent diffusion coefficient [ADC], 3D mean enhancement) and percentage of tumor with change above a predetermined threshold (3D threshold ADC, 3D threshold enhancement). Response by volumetric measurements at 1-month follow-up was compared with Response Evaluation Criteria in Solid Tumors (RECIST) at 6-month follow-up. Lesions that had complete or partial response were considered responders, while those with stable or progressive disease were considered nonresponders. Statistical analysis included the t test, receiver operating characteristic (ROC) curve analysis, and logistic regression analysis.

    Results: RECIST criteria at 6-month follow-up indicated 78 (36.3%) lesions responded, while 137 (63.7%) did not. The increase in 3D mean ADC was significantly higher in responders than in nonresponders (median, 26.2% vs 10.9%; P < .001). The 3D threshold ADC was 71.1% in responders and 47.6% in nonresponders (P < .001). Decrease in 3D mean arterial enhancement (AE) was significantly higher in responders than in nonresponders (median, 40.5% vs 18.0%; P < .001). Decrease in 3D mean venous enhancement (VE) was significantly higher in responders than in nonresponders (median, 28.0% vs 10.0%; P < .001). The 3D threshold VE and 3D threshold AE did not differ between responders and nonresponders. In unadjusted logistic regression analyses, 3D mean ADC and 3D threshold ADC had the highest odds ratio (1.02 and 1.03, respectively) and the largest area under the ROC curve (0.698 and 0.695, respectively).

    Conclusion: Volumetric functional MR imaging could be used to predict early response of hepatic ICLMs to therapy and to distinguish between responders and nonresponders.

    © RSNA, 2012

    Footnotes

    Received October 10, 2011; revision requested November 14; revision received January 9, 2012; accepted January 19; final version accepted February 7.

    S.B. and I.R.K. supported by Bracco Diagnostics, Bayer Healthcare, and Siemens Medical Solutions.

    Abbreviations:ADC = apparent diffusion coefficientAE = arterial enhancementDW = diffusion weightedICLM = islet cell liver metastasisICT = islet cell tumorIQR = interquartile rangePD = progressive diseasePR = partial responseRECIST = Response Evaluation Criteria in Solid TumorsSD = stable diseaseTACE = transarterial chemoembolizationVE = venous enhancement

    MRT News said:
    June 21, 2012 at 4:55 am

    Prostate Cancer: Feasibility and Preliminary Experience of a Diffusional Kurtosis Model for Detection and Assessment of Aggressiveness of Peripheral Zone Cancer

    Andrew B. Rosenkrantz, MD,
    Eric E. Sigmund, PhD,
    Glyn Johnson, PhD,
    James S. Babb, PhD,
    Thais C. Mussi, MD1,
    Jonathan Melamed, MD,
    Samir S. Taneja, MD,
    Vivian S. Lee, MD, PhD, MBA2 and
    Jens H. Jensen, PhD3

    + Author Affiliations

    From the Department of Radiology (A.B.R., E.E.S., G.J., J.S.B., T.C.M., V.S.L., J.H.J.), Department of Pathology (J.M.), and Division of Urologic Oncology, Department of Urology (S.S.T.), New York University Langone Medical Center, 550 First Ave, TCH-HW202, New York, NY 10016.

    Address correspondence to
    A.B.R. (e-mail: Andrew.Rosenkrantz@nyumc.org).

    Author contributions: Guarantor of integrity of entire study, A.B.R.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, A.B.R., E.E.S., J.H.J.; clinical studies, A.B.R., E.E.S., G.J., T.C.M., J.M., S.S.T., J.H.J.; statistical analysis, J.S.B.; and manuscript editing, A.B.R., E.E.S., G.J., J.S.B., T.C.M., S.S.T., V.S.L., J.H.J.

    Abstract

    Purpose: To assess the feasibility of diffusional kurtosis (DK) imaging for distinguishing benign from malignant regions, as well as low- from high-grade malignant regions, within the peripheral zone (PZ) of the prostate in comparison with standard diffusion-weighted (DW) imaging.

    Materials and Methods: The institutional review board approved this retrospective HIPAA-compliant study and waived informed consent. Forty-seven patients with prostate cancer underwent 3-T magnetic resonance imaging by using a pelvic phased-array coil and DW imaging (maximum b value, 2000 sec/mm2). Parametric maps were obtained for apparent diffusion coefficient (ADC); the metric DK (K), which represents non-Gaussian diffusion behavior; and corrected diffusion (D) that accounts for this non-Gaussianity. Two radiologists reviewed these maps and measured ADC, D, and K in sextants positive for cancer at biopsy. Data were analyzed by using mixed-model analysis of variance and receiver operating characteristic curves.

    Results: Seventy sextants exhibited a Gleason score of 6; 51 exhibited a Gleason score of 7 or 8. K was significantly greater in cancerous sextants than in benign PZ (0.96 ± 0.24 vs 0.57 ± 0.07, P < .001), as well as in cancerous sextants with higher rather than lower Gleason score (1.05 ± 0.26 vs 0.89 ± 0.20, P < .001). K showed significantly greater sensitivity for differentiating cancerous sextants from benign PZ than ADC or D (93.3% vs 78.5% and 83.5%, respectively; P .99). K exhibited significantly greater sensitivity for differentiating sextants with low- and high-grade cancer than ADC or D (68.6% vs 51.0% and 49.0%, respectively; P ≤ .004) but with decreased specificity (70.0% vs 81.4% and 82.9%, respectively; P ≤ .023). K had significantly greater area under the curve for differentiating sextants with low- and high-grade cancer than ADC (0.70 vs 0.62, P = .010). Relative contrast between cancerous sextants and benign PZ was significantly greater for D or K than ADC (0.25 ± 0.14 and 0.24 ± 0.13, respectively, vs 0.18 ± 0.10; P < .001).

    Conclusion: Preliminary findings suggest increased value for DK imaging compared with standard DW imaging in prostate cancer assessment.

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