Mains Jill Rachel, Donskov Frede, Pedersen Erik Morre, Madsen Hans Henrik Torp, Thygesen Jesper, Thorup Kennet, Rasmussen Finn
1 Department of Radiology, Aarhus University Hospital , Aarhus , Denmark.
2 Department of Oncology, Aarhus University Hospital , Aarhus , Denmark.
Br J Radiol. 2018 Feb;91(1082):20160795. doi: 10.1259/bjr.20160795. Epub 2018 Jan 2.
To use the patient outcome endpoints overall survival and progression-free survival to evaluate functional parameters derived from dynamic contrast-enhanced CT.
69 patients with metastatic renal cell carcinoma had dynamic contrast-enhanced CT scans at baseline and after 5 and 10 weeks of treatment. Blood volume, blood flow and standardized perfusion values were calculated using deconvolution (BV, BF and SPV), blood flow and standardized perfusion values using maximum slope (BF and SPV) and blood volume and permeability surface area product using the Patlak model (BV and PS). Histogram data for each were extracted and associated to patient outcomes. Correlations and agreements were also assessed.
The strongest associations were observed between patient outcome and medians and modes for BV, BV and BF at baseline and during the early ontreatment period (p < 0.05 for all). For the relative changes in median and mode between baseline and weeks 5 and 10, PS seemed to have opposite associations dependent on treatment. Interobserver correlations were excellent (r ≥ 0.9, p < 0.001) with good agreement for BF, BF, SPV and SPV and moderate to good (0.5 < r < 0.7, p < 0.001) for BV and BV. Medians had a better reproducibility than modes.
Patient outcome was used to identify the best functional imaging parameters in patients with metastatic renal cell carcinoma. Taking patient outcome and reproducibility into account, BV, BV and BF provide the most clinically meaningful information, whereas PS seems to be treatment dependent. Standardization of acquisition protocols and post-processing software is necessary for future clinical utilization. Advances in knowledge: Taking patient outcome and reproducibility into account, BV, BV and BF provide the most clinically meaningful information. PS seems to be treatment dependent.
采用患者预后终点指标总生存期和无进展生存期来评估动态对比增强CT得出的功能参数。
69例转移性肾细胞癌患者在基线期、治疗5周和10周后进行了动态对比增强CT扫描。使用去卷积法计算血容量、血流量和标准化灌注值（BV、BF和SPV），使用最大斜率法计算血流量和标准化灌注值（BF和SPV），使用Patlak模型计算血容量和通透表面积乘积（BV和PS）。提取各参数的直方图数据并与患者预后相关联。还评估了相关性和一致性。
在基线期和治疗早期，观察到患者预后与BV、BV和BF的中位数及众数之间存在最强的关联（所有p值均<0.05）。对于基线期与第5周和第10周之间中位数和众数的相对变化，PS似乎根据治疗情况有相反的关联。观察者间相关性极佳（r≥0.9，p<0.001），BF、BF、SPV和SPV的一致性良好，BV和BV的一致性为中度至良好（0.5<r<0.7，p<0.001）。中位数的可重复性优于众数。
利用患者预后确定转移性肾细胞癌患者最佳的功能成像参数。综合考虑患者预后和可重复性，BV、BV和BF提供了最具临床意义的信息，而PS似乎依赖于治疗。采集方案和后处理软件的标准化对于未来的临床应用是必要的。知识进展：综合考虑患者预后和可重复性，BV、BV和BF提供了最具临床意义的信息。PS似乎依赖于治疗。
