Diffusion-Weighted MRI of Advanced Hepatocellular Carcinoma During Sorafenib Treatment: Initial Results

Schraml, Christina; Schwenzer, Nina F.; Martirosian, Petros; Bitzer, Michael; Lauer, Ulrich M.; Claussen, Claus D.; Horger, Marius

doi:10.2214/ajr.08.2289

Cited by 90 publications

(63 citation statements)

References 16 publications

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“…Therefore, many recent studies have examined its clinical applications, especially for oncologic imaging. In terms of HCC, DWI can improve lesion detection [79][80][81], predict the histological grade of HCC [82][83][84][85], and assess treatment response and recurrence [86][87][88][89][90].…”

Section: Dual Energy Ctmentioning

confidence: 99%

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

Joo

Choi

2012

Liver Cancer

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Based on recent clinical practice guidelines, imaging is largely replacing pathology as the preferred diagnostic method for determination of hepatocellular carcinoma (HCC). A variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography, are currently used to examine patients with chronic liver disease and suspected HCC. Advancements in imaging techniques such as perfusion imaging, diffusion imaging, and elastography along with the development of new contrast media will further improve the ability to detect and characterize HCC. Early diagnosis of HCC is essential for prompt treatment, which may in turn improve prognosis. Considering the process of hepatocarcinogenesis, it is important to evaluate sequential changes via imaging which would help to differentiate HCC from premalignant or benign lesions. Recent innovations including multiphasic examinations, high-resolution imaging, and the increased functional capabilities available with contrast-enhanced US, multidetector row CT, and MRI have raised the standards for HCC diagnosis. Although hemodynamic features of nodules in the cirrhotic liver remain the main diagnostic criterion, newly developed cell-specific contrast agents have shown great possibilities for improved HCC diagnosis and may overcome the diagnostic dilemma associated with small or borderline hepatocellular lesions. In the 20th century paradigm of medical imaging, radiological diagnosis was based on morphological characteristics, but in the 21st century, a paradigm shift to include biomedical, physiological, functional, and genetic imaging is needed. A multidisciplinary team approach is necessary to foster an integrated approach to HCC imaging. By developing and combining new imaging modalities, all phases of HCC patient care, including screening, diagnosis, treatment, and therapy, can be dramatically improved.

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Section: Dual Energy Ctmentioning

confidence: 99%

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

Joo

Choi

2012

Liver Cancer

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“…The underlying mechanism associating changes in ADC to therapeutic response is a decreased cellularity resulting from necrosis and apoptosis (7). In some cases, an initial decrease in ADC, attributed to cellular swelling or reduced blood flow (8), is attributed to treatment response. 18 F-FDG uptake in lung cancers has been associated not only with glucose transporter 1 and hexokinase activity, biologic components directly related to glucose metabolism, but also with hypoxia-inducible factor 1-a, vascular endothelial growth factor, its receptor, and microvessels (9).…”

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confidence: 99%

A Population-Based Gaussian Mixture Model Incorporating ¹⁸F-FDG PET and Diffusion-Weighted MRI Quantifies Tumor Tissue Classes

et al. 2015

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The aim of our study was to create a novel Gaussian mixture modeling (GMM) pipeline to model the complementary information derived from 18 F-FDG PET and diffusion-weighted MRI (DW-MRI) to separate the tumor microenvironment into relevant tissue compartments and follow the development of these compartments longitudinally. Methods: Serial 18 F-FDG PET and apparent diffusion coefficient (ADC) maps derived from DW-MR images of NCI-H460 xenograft tumors were coregistered, and a population-based GMM was implemented on the complementary imaging data. The tumor microenvironment was segmented into 3 distinct regions and correlated with histology. ANCOVA was applied to gauge how well the total tumor volume was a predictor for the ADC and 18 F-FDG, or if ADC was a good predictor of 18 F-FDG for average values in the whole tumor or average necrotic and viable tissues. Results: The coregistered PET/MR images were in excellent agreement with histology, both visually and quantitatively, and allowed for validation of the last-time-point measurements. Strong correlations were found for the necrotic (r 5 0.88) and viable fractions (r 5 0.87) between histology and clustering. The GMM provided probabilities for each compartment with uncertainties expressed as a mixture of tissues in which the resolution of scans was inadequate to accurately separate tissues. The ANCOVA suggested that both ADC and 18 F-FDG in the whole tumor (P 5 0.0009, P 5 0.02) as well as necrotic (P 5 0.008, P 5 0.02) and viable (P 5 0.003, P 5 0.01) tissues were a positive, linear function of total tumor volume. ADC proved to be a positive predictor of 18 F-FDG in the whole tumor (P 5 0.001) and necrotic (P 5 0.02) and viable (P 5 0.0001) tissues. Conclusion: The complementary information of 18 F-FDG and ADC longitudinal measurements in xenograft tumors allows for segmentation into distinct tissues when using the novel GMM pipeline. Leveraging the power of multiparametric PET/MRI in this manner has the potential to take the assessment of disease outcome beyond RECIST and could provide an important impact to the field of precision medicine.

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“…This technique enables the detection of early cellular necrosis [53]. DWI has been reported to be useful in monitoring treatment responses after chemotherapy, radioembolization, and chemoembolization [54][55][56][57][58][59][60][61][62]. The maximal lesion-to-parenchyma enhancement ratio of the iodine map can be achieved by subtraction of the background water density.…”

Section: Diffusion-weighted Imagingmentioning

confidence: 99%

Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma

et al. 2012

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Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Accurate diagnosis and assessment of disease extent are crucial for proper management of patients with HCC. Imaging plays a crucial role in early detection, accurate staging, and the planning of management strategies. A variety of imaging modalities are currently used in evaluating patients with suspected HCC; these include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography. Among these modalities, dynamic MRI and CT are regarded as the best imaging techniques available for the noninvasive diagnosis of HCC. Recent improvements in CT and MRI technology have made noninvasive and reliable diagnostic assessment of hepatocellular nodules possible in the cirrhotic liver, and biopsy is frequently not required prior to treatment. Until now, the major challenge for radiologists in imaging cirrhosis has been the characterization of small cirrhotic nodules smaller than 2 cm in diameter. Further technological advancement will undoubtedly have a major impact on liver tumor imaging. The increased speed of data acquisition in CT and MRI has allowed improvements in both spatial and temporal resolution, which have made possible a more precise evaluation of the hemodynamics of liver nodules. Furthermore, the development of new, tissue-specific contrast agents such as gadoxetic acid has improved HCC detection on MRI. In this review, we discuss the role of CT and MRI in the diagnosis and staging of HCC, recent technological advances, and the strengths and limitations of these imaging modalities.

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Diffusion-Weighted MRI of Advanced Hepatocellular Carcinoma During Sorafenib Treatment: Initial Results

Cited by 90 publications

References 16 publications

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

A Population-Based Gaussian Mixture Model Incorporating ¹⁸F-FDG PET and Diffusion-Weighted MRI Quantifies Tumor Tissue Classes

Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma

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Diffusion-Weighted MRI of Advanced Hepatocellular Carcinoma During Sorafenib Treatment: Initial Results

Cited by 90 publications

References 16 publications

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

A Population-Based Gaussian Mixture Model Incorporating 18F-FDG PET and Diffusion-Weighted MRI Quantifies Tumor Tissue Classes

Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma

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A Population-Based Gaussian Mixture Model Incorporating ¹⁸F-FDG PET and Diffusion-Weighted MRI Quantifies Tumor Tissue Classes