Institute of Cancer Research, Cancer Research UK and EPSRC Cancer Imaging Centre, Sutton, Surrey SM2 5NG, England.
Radiology. 2012 Apr;263(1):139-48. doi: 10.1148/radiol.12110770. Epub 2012 Feb 17.
To evaluate dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for monitoring and assessing treatment response in patients with neuroendocrine liver metastases treated using yttrium 90 ((90)Y)-labeled octreotide ((90)Y-DOTATOC).
The study was approved by the local research and ethics committee and patient informed consent was obtained. Twenty patients with liver metastases from neuroendocrine tumors underwent T1-weighted DCE MR imaging of the liver before and at 2 months after intravenous (90)Y-DOTATOC treatment. Regions of interest were drawn around target lesions, as well as along liver outlines for each patient. A dual-input single-compartment model was used to compute parameters including fractional distribution volume and the arterial flow fraction. Pre- and posttreatment values were compared using Wilcoxon signed rank test. Treatment response was defined as showing a greater than 50% reduction in the nadir chromogranin A level within the 1st year after treatment. Pretreatment values of responders and nonresponders were compared using the Mann-Whitney test. A two-tailed P value of .008 or less, which accounts for multiple testing, was considered to indicate a significant difference.
In responders, tumor and whole liver distribution volume significantly increased after treatment (median tumor distribution volume, 0.182 vs 0.244; median whole liver distribution volume, 0.175 vs 0.207; P = .008). The pretreatment whole liver distribution volume was significantly lower in responders (median, 0.175 vs 0.248; P = .003), while pretreatment tumor arterial flow fraction was significantly higher in responders (median, 1.000 vs 0.7 ± 1, P = .006).
DCE MR imaging may be used to monitor the effects of peptide receptor radiolabeled targeted therapy in patients with neuroendocrine tumors liver metastases; a lower pretreatment distribution volume and high arterial flow fraction was associated with a better response to treatment.
评估钇 90（90Y）标记奥曲肽（90Y-DOTATOC）治疗神经内分泌肝脏转移瘤患者的动态对比增强（DCE）磁共振成像（MR）监测和评估治疗反应。
本研究经当地研究和伦理委员会批准，并获得了患者的知情同意。20 例神经内分泌肿瘤肝脏转移患者在静脉注射 90Y-DOTATOC 治疗前和治疗后 2 个月进行肝脏 T1 加权 DCE-MRI 检查。为每位患者绘制目标病变的感兴趣区以及肝轮廓的感兴趣区。采用双输入单室模型计算包括分容积分数和动脉血流分数在内的参数。使用 Wilcoxon 符号秩检验比较治疗前后的值。治疗反应定义为治疗后 1 年内嗜铬粒蛋白 A 水平降低 50%以上。使用 Mann-Whitney 检验比较有反应者和无反应者的治疗前值。考虑到多次检验，双侧 P 值<.008 被认为具有统计学意义。
在有反应者中，肿瘤和全肝分布容积在治疗后显著增加（肿瘤分布容积中位数，0.182 比 0.244；全肝分布容积中位数，0.175 比 0.207；P =.008）。有反应者的治疗前全肝分布容积明显较低（中位数，0.175 比 0.248；P =.003），而有反应者的肿瘤动脉血流分数明显较高（中位数，1.000 比 0.7±1，P =.006）。
DCE-MRI 可用于监测神经内分泌肿瘤肝脏转移患者肽受体放射性标记靶向治疗的效果；较低的治疗前分布容积和较高的动脉血流分数与更好的治疗反应相关。
