The Evaluation of Esophageal Adenocarcinoma Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Chang, Eugene; Li, Xin; Jerosch‐Herold, Michael; Priest, Ryan; Enestvedt, C. Kristian; Xu, Jingang; Springer, Charles S.; Jobe, Blair A.

doi:10.1007/s11605-007-0253-5

Cited by 37 publications

(21 citation statements)

References 55 publications

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“…Therefore, DCE-MRI could detect the variation in esophageal carcinoma at the microcirculation level. These results were in agreement with those found by Chang et al (20). This study suggested that DCE-MRI quantitative imaging could distinguish between normal esophageal carcinoma and malignant carcinoma, and the K trans values of the mass declined markedly prior to and following chemoradiotherapy.…”

Section: Discussionsupporting

confidence: 93%

Assessment of esophageal carcinoma undergoing concurrent chemoradiotherapy with quantitative dynamic contrast-enhanced magnetic resonance imaging

et al. 2015

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Abstract. The aim of the present study was to investigate whether quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can predict an early response in primary esophageal carcinoma patients undergoing concurrent chemoradiotherapy. A total of 25 patients with who were pathologically confirmed stage II-III esophageal carcinoma underwent quantitative DCE-MRI prior to chemoradiotherapy, and at 3 weeks post-treatment, the quantitative parameters [K trans (volume transfer constant; the rate at which contrast agent distributes from the plasma to the EES), K ep (rate contrast; the rate at which the contrast agent that has diffused to the EES returns to the plasma) and V e (the contrast agent percentage in the space of the extracellular fluid)] were analyzed respectively. The 25 cases were categorized as a complete response (CR) or a partial response (PR). An independent samples Mann-Whitney U test was used to compare the quantitative parameters between CR and PR. A receiver operating characteristic curve (ROC) was used to determine the best predictor. In total, 17 patients were in the CR group and 8 patients were in the PR group. Pretreatment K trans , K ep and V e values were 0.54±0.17/min, 1.12±0.46/min and 0.37±0.14, respectively, in the CR group, and 0.40±0.21/min, 1.07±0.37/min and 0.40±0.22, respectively, in the PR group. There was a significant difference between the two groups for K trans , but there were no significant differences between the two groups for K ep and V e .The K trans , K ep and V e values at 3 weeks post-treatment were 0.33±0.11/min, 0.86±0.31/min and 0.66±0.05, respectively, in the CR group, and 0.62±0.22/min, 1.19±0.39/min and 0.45±0.19, respectively, in the PR group. The corresponding U values were -3.319, -1.719 and -2.628, respectively, and the P-values were 0.006, 0.119 and 0.021, respectively. The areas under the ROC curve of K trans prior to chemoradiotherapy, and of K trans and K ep at 3 weeks post-treatment were 0.648, 0.741 and 0.796, respectively. In conclusion, DCE-MRI can predict an early response in primary esophageal carcinoma following 3 weeks of concurrent chemoradiotherapy. K trans prior to chemoradiotherapy, and K trans and K ep at 3 weeks post-treatment are sensitive prediction parameters. IntroductionEsophageal carcinoma is a common disease, and >80% of cases occur in developing countries. In 2008, esophageal cancer was the eighth most common cancer worldwide and China was ranked with the fourth highest morbidity rate for esophageal cancer worldwide with a five-year survival rate of <40% (1). The early symptoms of the disease, which include difficulty swallowing and esophageal foreign body sensation, are not obvious, and thus the majority of patients are diagnosed at an advanced stage (2). At present, the most common diagnostic techniques involve the examination of esophageal function, and include imaging analysis and esophagoscopy (3). The current treatment methods for esophageal carcinoma include surgery, radiation therapy, chemotherapy, endoscopic ...

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Section: Discussionsupporting

confidence: 93%

Assessment of esophageal carcinoma undergoing concurrent chemoradiotherapy with quantitative dynamic contrast-enhanced magnetic resonance imaging

et al. 2015

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“…This far outweighs the tiny incidence [0.00045% of the Ͼ30 million patients who have received a particular, suspect CR (34)] of serious reaction to CR administration, and which correlates with preexisting kidney compromise. We expect the SSM to also significantly quantify the proven DCE-MRI ability to detect very early responses to anticancer therapeutic interventions with approved drugs (16) and in drug discovery (35,36). And the SSM has much more to teach us.…”

Section: Discussionmentioning

confidence: 99%

“…And the SSM has much more to teach us. Besides smaller studies of a number of other malignant tumors in animal and human hosts (12,13,15,16), we have applied the SSM to data from normal skeletal (8,15), nonskeletal (9,15), and myocardial (17) musculature, myocardium in hyperemia (17), multiple sclerosis lesions in cerebral white matter (15), and the normal blood-brain barrier. We think the SSM offers the opportunity for general quantitative vascular phenotyping in vivo.…”

Section: Discussionmentioning

confidence: 99%

“…This corollary is not valid (5,6), and its assumption can effectively ''short circuit'' MRI determination of CR compartmentalization (5,7), the pharmacokinetic essence. In a series of papers (5,6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), we have examined the significance of this implication. We refer to the incorporation of equilibrium water exchange MR effects into the pharmacokinetic derivation as yielding the shutter-speed model (SSM) family.…”

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confidence: 99%

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The magnetic resonance shutter speed discriminates vascular properties of malignant and benign breast tumors in vivo

Huang

Morris

et al. 2008

Proc. Natl. Acad. Sci. U.S.A.

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129

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The pharmacokinetic analysis of dynamic-contrast-enhanced (DCE) MRI data yields K trans and kep, two parameters independently measuring the capillary wall contrast reagent transfer rate. The almost universally used standard model (SM) embeds the implicit assumption that equilibrium transcytolemmal water exchange is effectively infinitely fast. In analyses of routine DCE-MRI data from 22 patients with suspicious breast lesions initially ruled positive by institutional screening protocols, the SM K trans values for benign and malignant lesions exhibit considerable overlap. A form of the shutter-speed model (SSM), which allows for finite exchange kinetics, agrees with the SM K trans value for each of the 15 benign lesions. However, it reveals that the SM underestimates K trans for each of the seven malignant tumors in this population. The fact that this phenomenon is unique to malignant tumors allows their complete discrimination from the benign lesions, as validated by comparison with gold-standard pathology analyses of subsequent biopsy tissue samples. Likewise, the SM overestimates k ep, particularly for the benign tumors. Thus, incorporation of the SSM into the screening protocols would have precluded all 68% of the biopsy/pathology procedures that yielded benign findings. The SM/SSM difference is well understood from molecular first principles.cancer ͉ water exchange ͉ MRI ͉ screening ͉ DCE S creening for breast cancer represents one of modern medicine's success stories. However, the continued large fraction of false positives in current diagnostic protocols (1) often leads to biopsy/ pathology procedures that append considerable pain, anxiety, healthcare cost, and possibly increased malignancy risk, but that are potentially avoidable. To address this problem, there have been recent calls for the increased use of magnetic resonance imaging (MRI) in breast screening (2, 3).Early in the development of medical MRI, it was realized that hydrophilic paramagnetic molecules could enhance image contrast, and that the shape of the water proton ( 1 H 2 O) signal intensity time course after a bolus injection of such a contrast reagent (CR) contained considerable patho-physiological information, promising even possible quantitative vascular phenotyping.Major efforts have been mounted for the pharmacokinetic analyses of such time-course data (4). It was natural that mathematical models for these were taken from the field of nuclear medicine, where such algorithms have matured. However, these were developed for tracer pharmacokinetics, with the intrinsic feature of direct radiotracer detection. Although the MRI CR plays the tracer role, the signal molecule remains water: the CR is detected only indirectly, via its effect on the nature of tissue 1 H 2 O relaxation. Affecting the recovery of longitudinal 1 H 2 O magnetization (i.e., in the magnetic field direction) requires (transient) water CR molecular interaction, as depicted in Fig. 1. The three major loci for tissue water, the cytoplasmae, the interstitium, and the bloo...

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“…This corollary is not valid (2,6), and its assumption can effectively short circuit MRI determination of CR compartmentalization (2, 7)-the pharmacokinetic essence. In a series of papers (2,5,6,(8)(9)(10)(11)(12)(13)(14)(15)(16), we have examined the significance of this implication. We refer to models incorporating equilibrium exchange effects in the pharmacokinetic derivation as belonging to the shutter-speed model (SSM) family.…”

Section: Dynamic Nuclear Magnetic Resonance (Dnmr)mentioning

confidence: 99%

Dynamic NMR effects in breast cancer dynamic-contrast-enhanced MRI

Huang

Morris

et al. 2008

Proc. Natl. Acad. Sci. U.S.A.

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147

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The passage of a vascular-injected paramagnetic contrast reagent (CR) bolus through a region-of-interest affects tissue 1 H2O relaxation and thus MR image intensity. For longitudinal relaxation [R1 ϵ (T1) ؊1 ], the CR must have transient molecular interactions with water. Because the CR and water molecules are never uniformly distributed in the histological-scale tissue compartments, the kinetics of equilibrium water compartmental interchange are competitive. In particular, the condition of the equilibrium transcytolemmal water exchange NMR system sorties through different domains as the interstitial CR concentration, [CRo], waxes and wanes. Before CR, the system is in the fast-exchange-limit (FXL). Very soon after CRo arrival, it enters the fast-exchange-regime (FXR). Near maximal [CRo], the system could enter even the slowexchange-regime (SXR). These conditions are defined herein, and a comprehensive description of how they affect quantitative pharmacokinetic analyses is presented. Data are analyzed from a population of 22 patients initially screened suspicious for breast cancer. After participating in our study, the subjects underwent biopsy/pathology procedures and only 7 (32%) were found to have malignancies. The transient departure from FXL to FXR (and apparently not SXR) is significant in only the malignant tumors, presumably because of angiogenic capillary leakiness. Thus, if accepted, this analysis would have prevented the 68% of the biopsies that proved benign.water exchange ͉ screening ͉ shutter speed

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The Evaluation of Esophageal Adenocarcinoma Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Cited by 37 publications

References 55 publications

Assessment of esophageal carcinoma undergoing concurrent chemoradiotherapy with quantitative dynamic contrast-enhanced magnetic resonance imaging

Assessment of esophageal carcinoma undergoing concurrent chemoradiotherapy with quantitative dynamic contrast-enhanced magnetic resonance imaging

The magnetic resonance shutter speed discriminates vascular properties of malignant and benign breast tumors in vivo

Dynamic NMR effects in breast cancer dynamic-contrast-enhanced MRI

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