Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, Room 0279, Indianapolis, IN 46202, USA.
Radiology. 2010 Aug;256(2):441-9. doi: 10.1148/radiol.10091733. Epub 2010 Jun 1.
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.
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.
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.
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.
前瞻性评估动态对比增强磁共振成像（MR）预测局部进展期胰腺癌对联合化疗和抗血管生成治疗反应的作用。
本研究为前瞻性研究，已获得机构审查委员会批准，符合 HIPAA 规定并获得患者知情同意。共纳入 11 例局部侵袭性胰腺癌患者（平均年龄 54.3 岁；男 6 例，女 5 例），在接受联合化疗和抗血管生成治疗前及治疗后 28 天行动态对比增强 MR 成像检查。经静脉团注 0.1mmol/kg 钆喷酸葡甲胺后，行轴位灌注成像，获取上腹部主动脉矢状位图像以计算动脉输入函数。采用双室动力学模型计算灌注参数 K(trans)（表示对比剂从动脉血向血管外细胞外间隙转移的速率常数）、K(ep)（表示对比剂从血管外细胞外间隙向血浆转移的速率常数）和分布容积（v(e)）。还计算半定量指标：峰值组织钆浓度（C(peak)）、最大钆浓度上升斜率（slope）和 60 秒时的钆廓清曲线下面积（AUC(60)）。采用 Wilcoxon 符号秩检验比较治疗前后各参数变化，采用 Mann-Whitney 检验比较有反应者和无反应者之间的差异。
治疗后，K(trans)、v(e)、C(peak)、slope 和 AUC(60)显著降低（P 值分别为.02、.001、.002、.007 和.01），而肿瘤大小和 K(ep)无显著变化。与无反应者相比，有反应者治疗前的 K(trans)和 K(ep)更高（P 值分别为.02 和.006）。治疗前 K(trans)值（毫升/毫升组织. 分钟）大于 0.78mL/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在有反应者和无反应者之间无差异。
胰腺肿瘤治疗前 K(trans)值可预测抗血管生成治疗的反应。所有灌注参数在联合化疗和抗血管生成治疗 28 天后均显著降低。
