scholarly journals Dynamic contrast-enhanced magnetic resonance imaging of osseous spine metastasis before and 1 hour after high-dose image-guided radiation therapy

2017 ◽  
Vol 42 (1) ◽  
pp. E9 ◽  
Author(s):  
Eric Lis ◽  
Atin Saha ◽  
Kyung K. Peck ◽  
Joan Zatcky ◽  
Michael J. Zelefsky ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
High Dose ◽  
Dce Mri ◽  
Image Guided Radiation Therapy ◽  
Image Guided ◽  
Dynamic Contrast Enhanced ◽  
Spine Metastases ◽  
Contrast Enhanced ◽  
Recent Emergence ◽  
Significant Difference

OBJECTIVE High-dose image-guided radiation therapy (HD IGRT) has been instrumental in mitigating some limitations of conventional RT. The recent emergence of dynamic contrast-enhanced (DCE) MRI to investigate tumor physiology can be used to verify the response of human tumors to HD IGRT. The purpose of this study was to evaluate the near-immediate effects of HD IGRT on spine metastases through the use of DCE MRI perfusion studies. METHODS Six patients with spine metastases from prostate, thyroid, and renal cell carcinoma who underwent HD IGRT were studied using DCE MRI prior to and 1 hour after HD IGRT. The DCE perfusion parameters plasma volume (Vp) and vascular permeability (Ktrans) were measured to assess the near-immediate and long-term tumor response. A Mann-Whitney U-test was performed to compare significant changes (at p ≤ 0.05) in perfusion parameters before and after RT. RESULTS The authors observed a precipitous drop in Vp within 1 hour of HD IGRT, with a mean decrease of 65.2%. A significant difference was found between Vp values for before and 1 hour after RT (p ≤ 0.05). No significant change was seen in Vp (p = 0.31) and Ktrans (p = 0.1) from 1 hour after RT to the first follow-up. CONCLUSIONS The data suggest that there is an immediate effect of HD IGRT on the vascularity of spine metastases, as demonstrated by a precipitous decrease in Vp. The DCE MRI studies can detect such changes within 1 hour after RT, and findings are concordant with existing animal models.

scholarly journals DCE-MRI of esophageal carcinoma using star-VIBE compared with conventional 3D-VIBE

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
He-Ping Deng ◽  
Xue-Ming Li ◽  
Liu Yang ◽  
Yi Wang ◽  
Shao-Yu Wang ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Free Breathing ◽  
Sequence Group ◽  
Resonance Imaging ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Group A ◽  
Group B

AbstractTo investigate the value of the star-VIBE sequence in dynamic contrast-enhanced magnetic resonance imaging of esophageal carcinoma under free breathing conditions. From February 2019 to June 2020, 60 patients with esophageal carcinoma were prospectively enrolled to undergo dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with the K-space golden-angle radial stack-of-star acquisition scheme (star-VIBE) sequence (Group A) or conventional 3D volumetric-interpolated breath-hold examination (3D-VIBE) sequence (Group B), completely randomized grouping. The image quality of DCE-MRI was subjectively evaluated at five levels and objectively evaluated according to the image signal-to-noise ratio (SNR) and contrast-noise ratio (CNR). The DCE-MRI parameters of volume transfer constant (Ktrans), rate constant (Kep) and vascular extracellular volume fraction (Ve) were calculated using the standard Tofts double-compartment model in the post-perfusion treatment software TISSUE 4D (Siemens). Each group included 30 randomly selected cases. There was a significant difference in subjective classification between the groups (35.90 vs 25.10, p = 0.009). The study showed that both the SNR and CNR of group A were significantly higher than those of group B (p = 0.004 and < 0.001, respectively). There was no significant difference in Ktrans, Kep or Ve between the groups (all p > 0.05). The star-VIBE sequence can be applied in DCE-MRI examination of esophageal carcinoma, which can provide higher image quality than the conventional 3D-VIBE sequence in the free breathing state.

Differential diagnosis of central lymphoma and high-grade glioma: dynamic contrast-enhanced histogram

2020 ◽  
Vol 61 (9) ◽  
pp. 1221-1227
Author(s):  
Han-wen Zhang ◽  
Gui-wen Lyu ◽  
Wen-jie He ◽  
Yi Lei ◽  
Fan Lin ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Histogram Analysis ◽  
High Grade ◽  
Diagnostic Efficiency ◽  
Roc Curve Analysis ◽  
Diagnostic Efficacy ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Significant Difference

Background In clinical diagnosis, some central nervous system lymphomas (CNSL) are difficult to distinguish from high-grade gliomas (HGG). Purpose To evaluate the diagnostic efficacy of the histogram analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in the identification of CNSL and HGG. Material and Methods In all, 43 patients diagnosed with HGG (n = 28) and CNSL (n = 15) by histopathology underwent DCE-MRI scanning. Differences in histogram parameters based on DCE-MRI between HGG and CNSL were analyzed by Mann–Whitney U test. In addition, receiver operating characteristic (ROC) analysis was performed. Short-term follow-up of patients was performed using Kaplan–Meier analysis to explore the survival rates of HGG and CNSL. Results For the ROC curve analysis, we demonstrate that the 10th percentile of Ktrans (area under the curve [AUC] = 0.912, sensitivity = 86.7%, specificity = 92.9%), Kep (AUC = 0.940, sensitivity = 93.3%, specificity = 79.6%), Ve (AUC = 0.907, sensitivity = 86.7%, specificity = 89.3%), and AUC (AUC = 0.904, sensitivity = 86.7%, specificity = 92.9%) were significantly different between the CNSL and HGG groups ( P < 0.001), with high diagnostic efficiency. Table 2 shows that the histogram features based on AUC maps (10th, 25th, median, 75th, 90th, and mean) were always significantly higher in the CNSL group than in the HGG group ( P < 0.001). There was no significant difference in Vp or in the 75th, 90th and mean of Ktrans, Kep, and Ve between the CNSL and HGG groups ( P > 0.05). Conclusion A histogram analysis of DCE-MRI identified significant differences between HGG and CNSL, and this will help in the clinical differential diagnosis of these conditions.

NEAR-COMPLETE PATHOLOGICAL RESPONSE OF CHORDOMA TO HIGH-DOSE SINGLE-FRACTION RADIOTHERAPY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. E389-E390 ◽  
Author(s):  
Abraham J. Wu ◽  
Mark H. Bilsky ◽  
Mark A. Edgar ◽  
Yoshiya Yamada
Keyword(s):  
Radiation Therapy ◽  
Pathological Response ◽  
High Dose ◽  
Recurrent Pain ◽  
Mechanical Instability ◽  
Complete Pathological Response ◽  
En Bloc ◽  
Single Fraction ◽  
Image Guided Radiation Therapy ◽  
Image Guided

Abstract OBJECTIVE High-dose, single-fraction radiotherapy, also known as radiosurgery, has theoretical advantages for the treatment of chordoma, which is considered resistant to conventional radiation therapy. Demonstration of biological effectiveness, as indicated by pathological response of a chordoma specimen after such radiotherapy, has not previously been reported. CLINICAL PRESENTATION A 72-year-old man presented with lower back pain and was found to have an L3 vertebral mass. Open biopsy yielded chordoma. He was considered for en bloc resection, but definitive radiation therapy was preferred owing to medical comorbidities and concern for field contamination from the previous biopsy. INTERVENTION The patient underwent single-fraction, high-dose, image-guided radiation therapy to the tumor. Two months later, he underwent kyphoplasty because of recurrent pain. A core biopsy performed at that time showed viable chordoma. Four months after treatment, he underwent L3 corpectomy because of symptoms of mechanical instability. Pathology now showed near-complete necrosis of the resected chordoma. CONCLUSION Preoperative, single-fraction radiotherapy for chordoma induced a near-complete pathological response in this patient. That the effect was seen at 4 months but not 2 months after treatment suggests a time-dependent effect. This case suggests a promising role for single-fraction, image-guided radiation therapy in the treatment of chordoma.

scholarly journals Breast dynamic contrast enhanced MRI: fibrocystic changes presenting as a non-mass enhancement mimicking malignancy

2017 ◽  
Vol 51 (2) ◽  
pp. 130-136 ◽  
Author(s):  
Zorica C. Milosevic ◽  
Mirjan M. Nadrljanski ◽  
Zorka M. Milovanovic ◽  
Nina Z. Gusic ◽  
Slavko S. Vucicevic ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Time Intensity Curve ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Mri Examination ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Plateau Time ◽  
Diffuse Distribution ◽  
Mass Enhancement

Abstract Background We aimed to analyse the morphokinetic features of breast fibrocystic changes (nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia) presenting as a non-mass enhancement (NME)in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examination. Patients and methods Forty-six patients with histologically proven fibrocystic changes (FCCs) were retrospectively reviewed, according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Prior to DCE-MRI examination, a unilateral breast lesion suspicious of malignancy was detected clinically, on mammography or breast ultrasonography. Results The predominant features of FCCs presenting as NME in DCE-MRI examination were: unilateral regional or diffuse distribution (in 35 patients or 76.1%), heterogeneous or clumped internal pattern of enhancement (in 36 patients or 78.3%), plateau time-intensity curve (in 25 patients or 54.3%), moderate or fast wash-in (in 31 patients or 67.4%).Nonproliferative lesions were found in 11 patients (24%), proliferative lesions without atypia in 29 patients (63%) and lesions with atypia in six patients (13%), without statistically significant difference of morphokinetic features, except of the association of clustered microcysts with proliferative dysplasia without atypia. Conclusions FCCs presenting as NME in DCE-MRI examination have several morphokinetic features suspicious of malignancy, therefore requiring biopsy (BI-RADS 4). Nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia predominantly share the same predefined DCE-MRI morphokinetic features.

scholarly journals Characterization of Pure Ductal Carcinoma In Situ on Dynamic Contrast-Enhanced MR Imaging: Do Nonhigh Grade and High Grade Show Different Imaging Features?

2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Siwa Chan ◽  
Jeon-Hor Chen ◽  
Garima Agrawal ◽  
Muqing Lin ◽  
Rita S. Mehta ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Kinetic Curve ◽  
Imaging Features ◽  
High Grade ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Mass Lesions ◽  
Grade Iii

To characterize imaging features of pure DCIS on dynamic contrast-enhanced MR imaging (DCE-MRI), 31 consecutive patients (37-81 years old, mean 56), including 2 Grade I, 16 Grade II, and 13 Grade III, were studied. MR images were reviewed retrospectively and the morphological appearances and kinetic features of breast lesions were categorized according to the ACR BI-RADS breast MRI lexicon. DCE-MRI was a sensitive imaging modality in detecting pure DCIS. MR imaging showed enhancing lesions in 29/31 (94%) cases. Pure DCIS appeared as mass type or non-mass lesions on MRI with nearly equal frequency. The 29 MR detected lesions include 15 mass lesions (52%), and 14 lesions showing non-mass-like lesions (48%). For the mass lesions, the most frequent presentations were irregular shape (50%), irregular margin (50%) and heterogeneous enhancement (67%). For the non-mass-like lesions, the clumped internal enhancement pattern was the dominate feature, seen in 9/14 cases (64%). Regarding enhancement kinetic curve, 21/29 (78%) lesions showed suspicious malignant type kinetics. No significant difference was found in morphology (), tumor size (P= 0.21), and kinetic characteristics () between non-high grade (I+II) and high-grade (III) pure DCIS.

No association between excessive wound complications and preoperative high-dose, hypofractionated, image-guided radiation therapy for spine metastasis

2014 ◽  
Vol 20 (4) ◽  
pp. 411-420 ◽  
Author(s):  
Jennifer Keam ◽  
Mark H. Bilsky ◽  
Ilya Laufer ◽  
Weiji Shi ◽  
Zhigang Zhang ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Total Dose ◽  
Wound Complication ◽  
Wound Complications ◽  
High Dose ◽  
Image Guided Radiation Therapy ◽  
Image Guided ◽  
Vertebral Bodies ◽  
Univariate Analyses ◽  
Dose Per Fraction

Object Radiation therapy is known to impair wound healing. Higher dose per fraction is believed to increase this risk. This study sought to quantify rates of wound complication in patients receiving preoperative conventionally fractionated radiotherapy (XRT) or high-dose hypofractionated image-guided radiation therapy (IGRT) for spinal metastasis, and to identify predictors of wound complication. Methods The records of 165 consecutive patients who underwent spine surgery for metastasis at Memorial Sloan–Kettering Cancer Center between 1999 and 2010, with a history of prior radiation therapy, were reviewed. Patients with primary spine tumors, 2 courses of prior radiation therapy to the surgical site, total dose < 9 Gy, or radiation therapy adjacent to or partially overlapping the surgical site, were excluded. One hundred thirty patients received XRT (≤ 3 Gy/fraction) and 35 received IGRT (> 3 Gy/fraction). The total dose prescribed to the 100% isodose line to treat the planning target volume was 18–30 Gy in 1–5 fractions. Clinical factors evaluated included age, Karnofsky Performance Scale score, body mass index, presence of diabetes, smoking, ambulatory status, prior surgery at same spinal site, preoperative laboratory results (hemoglobin, lymphocyte count, and albumin), perioperative chemotherapy or steroids, estimated blood loss, extent of stabilization hardware, time between radiation therapy and surgery, number of vertebral bodies irradiated, total radiation dose, and dose per fraction of radiation therapy. Wound complication was defined as poor healing, dehiscence, or infection. Potential predictors of wound complication were assessed by univariate analyses using competing-risk methods to adjust for risk of death. Results For XRT patients, median dose was 30 Gy (range 11.5–70 Gy) with 72% of them receiving 3 Gy × 10 fractions. For IGRT patients, 66% received 18–24 Gy × 1 fraction and 23% received 6 Gy × 5 fractions. Groups differed only by the mean number of vertebral bodies treated (4.6 XRT and 1.8 IGRT, p < 0.0001). Wound complications occurred at a median of 0.95 months (range 0.4–3.9 months). A total of 22 wound events occurred in the XRT group and 2 in the IGRT group. The 6-month cumulative incidence of wound complications for XRT was 17% and for IGRT was 6%. There was no significant difference in wound complications between groups (IGRT vs XRT: hazard ratio 0.31, 95% CI 0.08–1.3; p = 0.11). Higher dose per fraction appeared to be associated with a lower risk of wound complication (hazard ratio 0.27, 95% CI 0.06–1.15; p = 0.08), which trended toward significance. Univariate analyses did not reveal any significant predictors of wound complications. Conclusions Patients who underwent XRT or IGRT did not have significantly different rates of postoperative wound complications. This finding may be explained by the treatment of fewer vertebral bodies in IGRT patients, or by the low overall number of total events. With a wound complication rate of 6%, preoperative IGRT, a highly conformal treatment, resulted in a very low rate of surgical wound complication.

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