Early Response to Anti-Tumoral Treatment in Hepatocellular Carcinoma - Can Quantitative Contrast-Enhanced Ultrasound Predict Outcome?

Knieling, Ferdinand; Waldner, MJ; Goertz, Ruediger S.; Zopf, Steffen; Wildner, D; Bernatik, T.; Strobel, D

doi:10.1055/s-0032-1330387

“…Tissue perfusion may be quantified also by further evaluating the replenishment kinetics of the volume of microbubbles after their destruction in the imaged slice (using high mechanical index US), obtaining quantitative parameters related to local tissue perfusion [15, 19]. However, we believe that the first step, as already performed for other organs and in our previous study [34], is the qualitative and semiquantitative analysis; time-intensity curves providing quantitative data require very large cohorts of patients in order to achieve a statistical relevance, so we feel that a quantitative analysis would be of little value in this study [28, 29, 32, 33]. …”

Section: Discussionmentioning

confidence: 96%

Intraoperative Cerebral Glioma Characterization with Contrast Enhanced Ultrasound

Prada

¹

,

Mattei

²

,

Bene

³

et al. 2014

BioMed Research International

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Background. Contrast enhanced ultrasound (CEUS) is a dynamic and continuous modality providing real-time view of vascularization and flow distribution patterns of different organs and tumors. Nevertheless its intraoperative use for brain tumors visualization has been performed few times, and a thorough characterization of cerebral glioma had never been performed before. Aim. To perform the first characterization of cerebral glioma using CEUS and to possibly achieve an intraoperative differentiation of different gliomas. Methods. We performed CEUS in an off-label setting in 69 patients undergoing surgery for cerebral glioma. An intraoperative qualitative analysis was performed comparing iCEUS with B-mode imaging. A postprocedural semiquantitative analysis was then performed for each case, according to EFSUMB criteria. Results were related to histopathology. Results. We observed different CE patterns: LGG show a mild, dotted CE with diffuse appearance and slower, delayed arterial and venous phase. HGG have a high CE with a more nodular, nonhomogeneous appearance and fast perfusion patterns. Conclusion. Our study characterizes for the first time human brain glioma with CEUS, providing further insight regarding these tumors' biology. CEUS is a fast, safe, dynamic, real-time, and economic tool that might be helpful during surgery in differentiating malignant and benign gliomas and refining surgical strategy.

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“…However, TTP pre and TTP in were found to have no significant difference regarding the CR or PR lymph node response status. In a study by Knieling et al (22), hepatocellular carcinoma patients were treated with sorafenib and the TTP increased as early as 1 month after the initiation of the treatment in the responder group compared to the non-responder group. In the study by Schirin-Sokhan et al (23), non-primary resectable liver metastases from colorectal cancer were treated with bevacizumab-based chemotherapy and it was demonstrated that the baseline TTP was significantly lower in the responder group compared to the non-responders, suggesting that low baseline TTP significantly correlates with tumor response according to RECIST.…”

Section: Discussionmentioning

confidence: 99%

Parametric contrast-enhanced ultrasound as an early predictor of radiation-based therapeutic response for lymph node metastases of nasopharyngeal carcinoma

Ye

¹

,

Huang

²

,

Zhou

³

et al. 2014

Molecular and Clinical Oncology

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Abstract. Nasopharyngeal carcinoma (NPC) is a common type of cancer in South East Asia with peculiar epidemiology, pathology, clinical behavior and response to treatment characteristics. To the best of our knowledge, this is the first study to investigate the use of a contrast-enhanced ultrasound (CEUS) as a predictor for the therapeutic response in lymph node metastases of NPC patients treated with radiation-based therapy. Sixty-seven NPC patients with lymph node metastases underwent the lymph nodes CEUS examination twice; pre-and in-treatment (at the 5th fraction radiotherapy), respectively. The CEUS parameters were acquired through Qontrast_4.0 software and mainly included peak intensity (PI) and time to peak (TTP). The response assessment at the lymph nodes revealed a complete response (CR) in 48 patients and partial response (PR) in 19 patients. There was a significant difference in pre-treatment PI (PI pre ) between the patients who showed CR or PR, but the predicted sensitivity and specificity of PI pre was low. The mean in-treatment PI (PI in ) value of the lymph nodes that achieved a CR was 34.24±3.78%, which was significantly higher than the PI in value for PR, 25.62±2.30% (P<0.001). Furthermore, the PI ratio , a PI-quotient, was calculated by dividing the PI in by the corresponding PI pre . The higher PI ratio was also observed in CR lymph nodes (0.81±0.01 vs. 0.66±0.01; P=0.001), and the mean change in PI (PI Δ ; PI Δ = PI pre -PI in ) was smaller in the patients with CR nodes compared to the patients with PR nodes (7.79±3.28 vs. 13.77±1.90%; P=0.000). No difference was observed in TTP pre or TTP in between the CR or PR lymph nodes patients. A receiver operating characteristic curve was constructed to assess the accuracy of the parameters for the prediction of the therapeutic responses. The sensitivity and specificity of PI in in predicting the therapeutic response was 94.3 and 88.2%, and the corresponding figures of the PI ratio were 92.5 and 83.8%, respectively. The CEUS parameters during the early course of radiation-based therapy, PI in and PI ratio , are associated with the therapeutic response of NPC lymph node metastases, with a high predicted sensitivity and specificity, thus yielding the conceivable predictors with the potential to individualize treatment.

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“…Tissue perfusion may be quantified also by further evaluating the replenishment kinetics of the volume of microbubbles after their destruction in the imaged slice (using high mechanical index US), obtaining quantitative parameters related to local tissue perfusion [15,19]. However, we believe that the first step, as already performed for other organs and in our previous study [34], is the qualitative and semiquantitative analysis; timeintensity curves providing quantitative data require very large cohorts of patients in order to achieve a statistical relevance, so we feel that a quantitative analysis would be of little value in this study [28,29,32,33].…”

Section: Discussionmentioning

confidence: 91%

“…Comparison with other imaging modalities (such as MRI imaging T1 weighted GD) will be necessary for defining further advantages or limitations of this technique when compared with other imaging standards in actual practice. Moreover, further studies aimed at quantitative data analysis are mandatory for a rigorous validation of the method: these results will further improve CEUS characterization of cerebral gliomas and will also enhance knowledge of tumor biology, possibly leading to prediction of the responsiveness to therapy of a specific individual tumor, or to orientation during the choice of the best therapeutic option [32,33].…”

Section: Discussionmentioning

confidence: 99%

201 Intraoperative Cerebral Glioma Characterization With Contrast Enhanced Ultrasound

Prada¹,

Mattei²,

Filippini³

et al. 2014

Neurosurgery

1

0

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Background. Contrast enhanced ultrasound (CEUS) is a dynamic and continuous modality providing real-time view of vascularization and flow distribution patterns of different organs and tumors. Nevertheless its intraoperative use for brain tumors visualization has been performed few times, and a thorough characterization of cerebral glioma had never been performed before. Aim. To perform the first characterization of cerebral glioma using CEUS and to possibly achieve an intraoperative differentiation of different gliomas. Methods. We performed CEUS in an off-label setting in 69 patients undergoing surgery for cerebral glioma. An intraoperative qualitative analysis was performed comparing iCEUS with B-mode imaging. A postprocedural semiquantitative analysis was then performed for each case, according to EFSUMB criteria. Results were related to histopathology. Results. We observed different CE patterns: LGG show a mild, dotted CE with diffuse appearance and slower, delayed arterial and venous phase. HGG have a high CE with a more nodular, nonhomogeneous appearance and fast perfusion patterns. Conclusion. Our study characterizes for the first time human brain glioma with CEUS, providing further insight regarding these tumors' biology. CEUS is a fast, safe, dynamic, real-time, and economic tool that might be helpful during surgery in differentiating malignant and benign gliomas and refining surgical strategy.

show abstract

Early Response to Anti-Tumoral Treatment in Hepatocellular Carcinoma - Can Quantitative Contrast-Enhanced Ultrasound Predict Outcome?

Abstract: Quantitative CEUS reveals variations of dynamic parameters of blood flow during anti-tumoral therapy in liver cancer patients. Further investigations and clinical trails have to confirm that the TTP is a promising parameter in the prediction of early response to sorafenib-based therapy.

Cited by 21 publications

References 26 publications

Intraoperative Cerebral Glioma Characterization with Contrast Enhanced Ultrasound

Intraoperative Cerebral Glioma Characterization with Contrast Enhanced Ultrasound

Parametric contrast-enhanced ultrasound as an early predictor of radiation-based therapeutic response for lymph node metastases of nasopharyngeal carcinoma

201 Intraoperative Cerebral Glioma Characterization With Contrast Enhanced Ultrasound

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