Document Detail

Pancreatic cancer: utility of dynamic contrast-enhanced MR imaging in assessment of antiangiogenic therapy.
MedLine Citation:
PMID:  20515976     Owner:  NLM     Status:  MEDLINE    
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.
M Fatih Akisik; Kumaresan Sandrasegaran; Guixue Bu; Chen Lin; Gary D Hutchins; Elena G Chiorean
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-06-01
Journal Detail:
Title:  Radiology     Volume:  256     ISSN:  1527-1315     ISO Abbreviation:  Radiology     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-26     Completed Date:  2010-09-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  441-9     Citation Subset:  AIM; IM    
Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, Room 0279, Indianapolis, IN 46202, USA.
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MeSH Terms
Angiogenesis Inhibitors / administration & dosage*
Antineoplastic Agents / administration & dosage
Benzenesulfonates / administration & dosage*
Contrast Media
Gadolinium DTPA / diagnostic use*
Image Enhancement / methods
Magnetic Resonance Imaging / methods*
Middle Aged
Pancreatic Neoplasms / diagnosis*,  drug therapy*
Pyridines / administration & dosage*
Reproducibility of Results
Sensitivity and Specificity
Treatment Outcome
Reg. No./Substance:
0/Angiogenesis Inhibitors; 0/Antineoplastic Agents; 0/Benzenesulfonates; 0/Contrast Media; 0/Pyridines; 0/sorafenib; 80529-93-7/Gadolinium DTPA

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