Quantitating whole lesion tumor biology in rectal cancer MRI: taking a lesson from FDG-PET tumor metrics

Gollub, Marc J.; Hötker, Andreas M.; Woo, Kaitlin M.; Mazaheri, Yousef; Gönen, Mithat

doi:10.1007/s00261-017-1389-8

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…Furthermore, PET/MRI permits the assessment of cellular density with diffusion-weighted imaging (DWI). In studies of MRI alone, quantitative metrics such as the apparent diffusion coefficient (ADC) have been used to track response to treatment or predict clinical outcomes (6,7). The repeatability of ADC metrics for integrated PET/MRI systems is unknown and might be different from MRI-only systems.…”

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confidence: 99%

Measurement Repeatability of ¹⁸F-FDG PET/CT Versus ¹⁸F-FDG PET/MRI in Solid Tumors of the Pelvis

et al. 2019

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Knowledge of the within-subject variability of 18 F-FDG PET/MRI measurements is necessary for proper interpretation of quantitative PET or MRI metrics in the context of therapeutic efficacy assessments with integrated PET/MRI scanners. The goal of this study was to determine the test–retest repeatability of these metrics on PET/MRI, with comparison to similar metrics acquired by PET/CT. Methods: This prospective study enrolled subjects with pathology-proven pelvic malignancies. Baseline imaging consisted of PET/CT immediately followed by PET/MRI, using a single 370-MBq 18 F-FDG dose. Repeat imaging was performed within 7 d using an identical imaging protocol, with no oncologic therapy between sessions. PET imaging on both scanners consisted of a list-mode acquisition at a single pelvic station. The MRI consisted of 2-point Dixon imaging for attenuation correction, standard sequences for anatomic correlation, and diffusion-weighted imaging. PET data were statically reconstructed using various frame durations and minimizing uptake time differences between sessions. SUV metrics were extracted for both PET/CT and PET/MRI in each imaging session. Apparent diffusion coefficient (ADC) metrics were extracted for both PET/MRI sessions. Results: The study cohort consisted of 14 subjects (13 female, 1 male) with various pelvic cancers (11 cervical, 2 rectal, 1 endometrial). For SUV max , the within-subject coefficient of variation (wCV) appeared higher for PET/CT (8.5%–12.8%) than PET/MRI (6.6%–8.7%) across all PET reconstructions, though with no significant repeatability differences (all P values ≥ 0.08) between modalities. For lean body mass-adjusted SUV peak , the wCVs appeared similar for PET/CT (9.9%–11.5%) and PET/MRI (9.2%–11.3%) across all PET reconstructions, again with no significant repeatability differences (all P values ≥ 0.14) between modalities. For PET/MRI, the wCV for ADC median of 3.5% appeared lower than the wCVs for SUV max (6.6%–8.7%) and SUL peak (9.2%–11.3%), though without significant repeatability differences (all P values ≥ 0.23). Conclusion: For solid tumors of the pelvis, the repeatability of the evaluated SUV and ADC metrics on 18 F-FDG PET/MRI is both acceptably high and similar to previously published values for 18 F-FDG PET/CT and MRI, supporting the use of 18 F-FDG PET/MRI for quantitative oncologic treatment response assessments.

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confidence: 99%

Measurement Repeatability of ¹⁸F-FDG PET/CT Versus ¹⁸F-FDG PET/MRI in Solid Tumors of the Pelvis

et al. 2019

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“…78 In another study, the authors evaluated tumor volume based on DWI (defining total lesion diffusion as the total DWI tumor volume multiplied by mean volumetric ADC), demonstrating that tumor volume based on DWI was correlated with pathological tumor regression and was comparable to DWI-and DCE-based volumetry. 79 Pooled analysis demonstrated the superiority of DWI over T2WI volumetry, wherein volumetric DWI measurements after neoadjuvant therapy were able to predict pCR with a sensitivity and an overall accuracy of 65% and 90%, respectively. 80 Functional Imaging DWI may provide functional information on the microstructure of the tumor environment through the assessment of differences in water proton mobility.…”

Section: Tumor Volumetrymentioning

confidence: 91%

“…One study demonstrated that tumor volume on T2WI and its reduction correlated with the ypT stage, although MRI overestimated the volume of residual tumor 78 . In another study, the authors evaluated tumor volume based on DWI (defining total lesion diffusion as the total DWI tumor volume multiplied by mean volumetric ADC), demonstrating that tumor volume based on DWI was correlated with pathological tumor regression and was comparable to DWI‐ and DCE‐based volumetry 79 …”

Section: Research Directions On Response Assessmentmentioning

confidence: 99%

Rectal MRI Interpretation After Neoadjuvant Therapy

Horvat

Homsi

Miranda

et al. 2022

Magnetic Resonance Imaging

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In recent years, several key advances in the management of locally advanced rectal cancer have been made, including the implementation of total mesorectal excision as the standard surgical approach; use of neoadjuvant chemoradiotherapy in selected patients with a high risk of local recurrence, and finally, adoption of organ preservation strategies, through either local excision or nonoperative management in selected patients with clinical complete response following neoadjuvant chemoradiotherapy. This review aims to shed light on the role of rectal MRI in the assessment of treatment response after neoadjuvant therapy, which is especially important given the growing feasibility of nonoperative management. First, an overview of current neoadjuvant therapies and response assessment based on digital rectal examination, endoscopy, and MRI will be provided. Second, the use of a high‐quality restaging rectal MRI protocol will be presented. Third, a step‐by‐step approach to assessing treatment response on restaging rectal MRI following neoadjuvant treatment will be outlined, acknowledging challenges faced by radiologists during MRI interpretation. Finally, research related to response assessment will be discussed. Level of Evidence 4 Technical Efficacy Stage 3

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“…T2-weighted signal intensity-selected volumetry of post-CRT MRI performed better than visual qualitative T2 volumetry in predicting pCR in patients with LARC[151]. Posttreatment total lesion diffusion (TLD = total DWI tumor volume x mean volumetric ADC) was better correlated than the total DWI tumor volume with histopathological tumor responses after CRT in patients with LARC[152].…”

Section: Quantitative Image Analysis Methodsmentioning

confidence: 99%

Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging

Mainenti

Stanzione

Guarino

et al. 2019

WJG

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Colorectal cancer (CRC) represents one of the leading causes of tumor-related deaths worldwide. Among the various tools at physicians’ disposal for the diagnostic management of the disease, tomographic imaging (e.g., CT, MRI, and hybrid PET imaging) is considered essential. The qualitative and subjective evaluation of tomographic images is the main approach used to obtain valuable clinical information, although this strategy suffers from both intrinsic and operator-dependent limitations. More recently, advanced imaging techniques have been developed with the aim of overcoming these issues. Such techniques, such as diffusion-weighted MRI and perfusion imaging, were designed for the “in vivo” evaluation of specific biological tissue features in order to describe them in terms of quantitative parameters, which could answer questions difficult to address with conventional imaging alone (e.g., questions related to tissue characterization and prognosis). Furthermore, it has been observed that a large amount of numerical and statistical information is buried inside tomographic images, resulting in their invisibility during conventional assessment. This information can be extracted and represented in terms of quantitative parameters through different processes (e.g., texture analysis). Numerous researchers have focused their work on the significance of these quantitative imaging parameters for the management of CRC patients. In this review, we aimed to focus on evidence reported in the academic literature regarding the application of parametric imaging to the diagnosis, staging and prognosis of CRC while discussing future perspectives and present limitations. While the transition from purely anatomical to quantitative tomographic imaging appears achievable for CRC diagnostics, some essential milestones, such as scanning and analysis standardization and the definition of robust cut-off values, must be achieved before quantitative tomographic imaging can be incorporated into daily clinical practice.

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Quantitating whole lesion tumor biology in rectal cancer MRI: taking a lesson from FDG-PET tumor metrics

Abstract: The novel tumor metrics TLD and TLP revealed similar results to established metrics for correlation with tumor response with equivalent or superior inter-reader agreements and we recommend that these be studied in larger trials.

Cited by 5 publications

References 30 publications

Measurement Repeatability of ¹⁸F-FDG PET/CT Versus ¹⁸F-FDG PET/MRI in Solid Tumors of the Pelvis

Measurement Repeatability of ¹⁸F-FDG PET/CT Versus ¹⁸F-FDG PET/MRI in Solid Tumors of the Pelvis

Rectal MRI Interpretation After Neoadjuvant Therapy

Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging

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Quantitating whole lesion tumor biology in rectal cancer MRI: taking a lesson from FDG-PET tumor metrics

Abstract: The novel tumor metrics TLD and TLP revealed similar results to established metrics for correlation with tumor response with equivalent or superior inter-reader agreements and we recommend that these be studied in larger trials.

Cited by 5 publications

References 30 publications

Measurement Repeatability of 18F-FDG PET/CT Versus 18F-FDG PET/MRI in Solid Tumors of the Pelvis

Measurement Repeatability of 18F-FDG PET/CT Versus 18F-FDG PET/MRI in Solid Tumors of the Pelvis

Rectal MRI Interpretation After Neoadjuvant Therapy

Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging

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Product

Resources

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Measurement Repeatability of ¹⁸F-FDG PET/CT Versus ¹⁸F-FDG PET/MRI in Solid Tumors of the Pelvis

Measurement Repeatability of ¹⁸F-FDG PET/CT Versus ¹⁸F-FDG PET/MRI in Solid Tumors of the Pelvis