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First published online October 16, 2009, 10.2967/jnumed.109.064790
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Journal of Nuclear Medicine Vol. 50 No. 11 1777-1784
© 2009 by Society of Nuclear Medicine
doi: 10.2967/jnumed.109.064790

Clinical Investigation

Chemotherapy Response Monitoring of Colorectal Liver Metastases by Dynamic Gd-DTPA–Enhanced MRI Perfusion Parameters and 18F-FDG PET Metabolic Rate

Dennis Vriens1, Hanneke W.M. van Laarhoven2, Jack J.A. van Asten3, Paul F.M. Krabbe4, Eric P. Visser1, Arend Heerschap3, Cornelis J.A. Punt2, Lioe-Fee de Geus-Oei1 and Wim J.G. Oyen1

1 Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; 2 Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; 3 Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and 4 Department of Epidemiology, Biostatistics, and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Correspondence: For correspondence or reprints contact: Dennis Vriens, Department of Nuclear Medicine, Internal Postal Code 444, Radboud University, Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: D.Vriens{at}nucmed.umcn.nl

In this study, we examined the in vivo relationship between functional tumor vasculature, determined by dynamic contrast-enhanced (DCE-) MRI, and tumor metabolism, determined by dynamic 18F-FDG PET, during cytotoxic treatment of patients with colorectal liver metastases. Methods: Twenty-three patients underwent DCE-MRI (using gadolinium dimeglumine) and dynamic 18F-FDG PET at baseline and after 3 treatment cycles, unless treatment was terminated because of toxicity. Parameters for vasculature (rate constant between extravascular extracellular space and blood plasma [kep] and volume transfer constant [Ktrans]), extracellular space (ve), tumor size (the maximal axial diameter of each included lesion [MAD]), and metabolism (glucose metabolic rates [MRglc]) were derived, and changes during treatment were correlated. Overall survival (OS) and progression-free survival (PFS) served as outcome measures for the predictive abilities of pretreatment parameters and of treatment-related parameter changes. Results: Pretreatment MRglc and MAD were individually predictive for OS and PFS. During treatment, Ktrans increased significantly, but this increase could not be confirmed in a lesion-by-lesion analysis. MRglc decreased significantly (P < 0.001). No correlations were found for changes in DCE-MRI parameters and {Delta}MRglc. No relationship was found between changes in DCE-MRI parameters and OS or PFS. {Delta}MRglc was able to predict OS (P = 0.008) after correction for confounders. Conclusion: The efficacy of cytotoxic chemotherapy assessed by reduction in tumor metabolism does not depend on pretreatment properties of the tumor vasculature determined by DCE-MRI. Cytotoxic chemotherapy does not alter DCE-MRI–derived properties of tumor vasculature but decreases glucose consumption of tumor cells.

Key Words: colorectal carcinoma • DCE-MRI • 18F-FDG • PET • chemotherapy • therapy monitoring • survival

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.


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