Pancreatic Cancer: Utility of Dynamic Contrast-enhanced MR Imaging in Assessment of Antiangiogenic Therapy
Pancreatic Cancer: Utility of Dynamic Contrast-enhanced MR Imaging in Assessment of Antiangiogenic Therapy
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DOI：
10.1148/radiol.10091733
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发表时间：
2010-08-01
期刊：
影响因子：
19.7
通讯作者：
Chiorean, Elena G.
中科院分区：
文献类型：
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作者：
Akisik, M. Fatih;Sandrasegaran, Kumaresan;Chiorean, Elena G.
目的：前瞻性评价动态对比剂增强磁共振（MR）成像在预测局部晚期胰腺癌对联合化疗和抗血管生成治疗的反应中的作用。材料和方法：这项前瞻性、机构审查委员会批准的、符合健康保险和财产保护法（HIPAA）的研究在知情同意的情况下评估了11例患者的动态对比剂增强MR成像（平均年龄，54.3岁; 6名男性和5名女性）在联合化疗和抗血管生成治疗之前和之后28天患有局部浸润性胰腺癌。每公斤体重注射0.1 mmol钆喷酸葡胺后获得轴向灌注图像。获取上腹主动脉的血管造影图像用于动脉输入函数计算。使用二室动力学模型计算灌注参数K-transs（代表造影剂从动脉血转移到血管外细胞外间隙的速率常数）、K-ep（代表造影剂从血管外细胞外间隙转移到血浆的速率常数）和分布容积（v（e））。还计算了半定量测量值、峰值组织钆浓度（C峰）、钆增加的最大斜率（斜率）和60秒时钆曲线下面积（AUC（60））。灌注参数和肿瘤大小的变化与碳水化合物抗原19-9水平相关。治疗前和治疗后研究之间的比较采用Wilcoxon符号秩和检验，应答者和无应答者之间的比较采用Mann-Whitney检验。结果：治疗后，K-transs、v（e）、C-peak、slope和AUC（60）显著降低（分别为P = 0.02、0.001、0.002、0.007和0.01）。肿瘤大小和K-ep无显著变化。治疗前K-transs和K-ep在显示标志物应答的肿瘤中显著高于未显示标志物应答的肿瘤（分别为P = 0.02和0.006）。治疗前K-transs值（每毫升组织的血液毫升数乘以分钟数）大于0.78 mL/mL。min对后续肿瘤反应的敏感性为100%，特异性为71%。半定量参数和肿瘤大小组间无差异。结论：胰腺肿瘤治疗前K-transm测量可预测抗血管生成治疗的反应。联合化疗和抗血管生成治疗28天后，所有灌注参数均显著降低。(C)RSNA，2010年
Purpose: To prospectively evaluate the utility of dynamic contrast material-enhanced magnetic resonance (MR) imaging in predicting the response of locally advanced pancreatic cancer to combined chemotherapy and antiangiogenic therapy.Materials and Methods: This prospective, institutional review board-approved, HIPAA-compliant study with informed consent assessed dynamic contrast-enhanced MR imaging in 11 patients (mean age, 54.3 years; six men and five women) with locally invasive pancreatic cancer before and 28 days after combined chemotherapy and antiangiogenic therapy. Axial perfusion images were obtained after injection of 0.1 mmol gadopentetate dimeglumine per kilogram of body weight. Sagittal images of the upper abdominal aorta were obtained for arterial input function calculation. A two-compartment kinetic model was used to calculate the perfusion parameters K-trans (the rate constant that represents transfer of contrast agent from the arterial blood into the extravascular extracellular space), K-ep (the rate constant that represents transfer of contrast agent from the extravascular extracellular space to the blood plasma), and volume of distribution (v(e)). Semiquantitative measurements, peak tissue gadolinium concentration (C-peak), maximum slope of gadolinium increase (slope), and area under the gadolinium curve at 60 seconds (AUC(60)) were also calculated. Perfusion parameters and tumor size changes were correlated with carbohydrate antigen 19-9 levels. Comparisons between pre- and posttreatment studies were performed by using the Wilcoxon signed rank test, and comparisons between responders and nonresponders were performed by using the Mann-Whitney test.Results: After therapy, K-trans, v(e), C-peak, slope, and AUC(60) decreased significantly (P = .02, .001, .002, .007, and .01, respectively). Tumor size and K-ep were not significantly changed. Pretreatment K-trans and K-ep were significantly higher (P = .02 and .006, respectively) in tumors that showed marker response than in those that did not. A pretreatment K-trans value (milliliters of blood per milliliter of tissue times minutes) of more than 0.78 mL/mL . min was 100% sensitive and 71% specific for subsequent tumor response. Semiquantative parameters and tumor size were not different between the groups.Conclusion: Pretreatment K-trans measurement in pancreatic tumors can predict response to antiangiogenic therapy. All perfusion parameters showed substantial reduction after 28 days of combined chemotherapy and antiangiogenic therapy. (C) RSNA, 2010