Research ArticleCLINICAL INVESTIGATIONS

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

Dennis Vriens, Hanneke W.M. van Laarhoven, Jack J.A. van Asten, Paul F.M. Krabbe, Eric P. Visser, Arend Heerschap, Cornelis J.A. Punt, Lioe-Fee de Geus-Oei and Wim J.G. Oyen
Journal of Nuclear Medicine November 2009, 50 (11) 1777-1784; DOI: https://doi.org/10.2967/jnumed.109.064790

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Example of 78-y-old man with intermediately differentiated adenocarcinoma of sigmoid (T3N1M1) with metachronous liver metastases. (Left, top to bottom) Conventional T1-weighted MR image (before Gd-DTPA) and fused parametric image of kep values with T1-weighted MR image. (Right, top to bottom) 18F-FDG PET uptake image (20–50 min after injection) and parametric image of MRglc.

Tables

  • TABLE 1

    Patient Characteristics

    CharacteristicValue
    No. of patients23
    Demographic
     Mean age (y)61.5
     Range (y)44.8–78.9
     No. of men17 (74%)
    Matched lesions per patient
     Mean1.3
     Range1–5
     Patients > 1 matched lesion5 (22%)
     Median lesion MAD (mm)56
     IQR (mm)38–75
    Histology
     Adenocarcinoma22 (96%)
     Mucinous adenocarcinoma1 (4%)
    Location of primary tumor
     Sigmoid9 (39%)
     Rectum6 (26%)
     Colon5 (22%)
     Colon and rectum3 (13%)
    Presenting stage
     Stage II3 (13%)
     Stage III4 (17%)
     Stage IV16 (70%)
  • TABLE 2

    Predictive Value of Pretreatment Parameters to Survival Assessed by Cox Regression Analysis

    OSPFS
    ParameterHRCIPHRCIP
    Univariate
     MRglc*3.611.58–8.260.002†3.111.41–6.860.005†
     MAD‡1.031.00–1.060.032†1.031.00–1.070.039†
     Chemotherapy line§2.190.87–5.510.0972.400.96–6.030.062
    Multivariate
     MRglc*4.291.72–10.670.002†3.191.39–7.350.006†
     MAD‡1.041.01–1.070.020†1.031.00–1.070.059
     Chemotherapy line§——————

    • ↵* Per 0.1 μmol·mL−1·min−1 change.

    • ↵† Significant (P > 0.05) assessed by Wald's χ2 test.

    • ↵‡ Per 5-mm change.

    • ↵§ First-line vs. higher lines.

    • CI = 95% confidence interval.

  • TABLE 3

    Baseline and Follow-up Values of Vascular and Metabolic Parameters (n = 23 Patients)

    BaselineFollow-up
    ParameterMedianIQRMedianIQRP
    DCE-MRI
     kep (s−1)0.0140.005–0.0340.0220.012–0.0490.056
     Ktrans (s−1)0.0090.003–0.0200.0160.008–0.0330.035*
     ve0.6380.516–0.6980.6140.566–0.7440.893
    18F-FDG PET
     MRglc (μmol·mL−1·min−1)0.1280.108–0.1600.0540.041–0.122<0.001*
    T1-weighted MRI
     MAD (mm)5650–925447–1090.268

    • ↵* P < 0.05 (Wilcoxon signed rank test for paired samples).

  • TABLE 4

    Predictive Value of Therapy-Induced Parameter Changes for Early Response Evaluation, Assessed by Cox Regression Analysis

    OSPFS
    ParameterHRCIP*HRCIP*
    Univariate
     ΔMRglc (all in FOV)†1.151.01–1.320.041———
     ΔMAD†1.401.06–1.850.0231.341.04–1.740.026
     Chemotherapy line‡——————
    Multivariate
     ΔMRglc (all in FOV)†1.221.05–1.410.008———
     Δkep†0.990.98–1.000.100———
     ΔMAD†———1.481.10–1.990.010
     Chemotherapy line‡———3.151.17–8.490.023

    • ↵* Significance assessed by Wald χ2 test.

    • ↵† Per 10% change.

    • ↵‡ First line vs. higher lines.

    • CI = 95% confidence interval; all in FOV = estimated including all lesions in FOV of PET scanner.

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