Barentsz J O, Berger-Hartog O, Witjes J A, Hulsbergen-van der Kaa C, Oosterhof G O, VanderLaak J A, Kondacki H, Ruijs S H
Department of Radiology, University Hospital Nijmegen, The Netherlands.
Radiology. 1998 Jun;207(3):791-7. doi: 10.1148/radiology.207.3.9609906.
To evaluate if the failure of chemotherapy in patients with advanced urinary bladder cancer can be predicted early in the course of chemotherapy with fast dynamic contrast material-enhanced magnetic resonance (MR) imaging.
In this prospective study, 22 consecutive patients with histologically proved advanced urinary bladder cancer underwent MR imaging before and after two, four, and six cycles of chemotherapy with methotrexate, vinblastine, adriamycin, and cisplatin (MVAC). The response after two chemotherapy cycles was evaluated by using conventional tumor size parameters at unenhanced MR imaging and with changes in the time to the start of tumor or lymph node enhancement at fast dynamic contrast-enhanced MR imaging. The results obtained with these techniques were compared with the findings at histopathology in cystectomy (n = 9) or multiple transurethral resection (n = 13) specimens obtained after completion of chemotherapy.
After two MVAC cycles, the accuracy, sensitivity, and specificity in distinguishing responders from nonresponders with conventional MR imaging were 73%, 79%, and 63%, respectively. With the dynamic technique, these were 95%, 93%, and 100%, respectively. Although the differences between these values are not significant (P = .48 for sensitivity, .25 for specificity, and .07 for accuracy), the data indicate that dynamic enhanced MR imaging performed better than unenhanced MR imaging. Dynamic imaging yielded correct results after two MVAC cycles in 21 cases, and in all cases after four cycles. After four MVAC cycles, the accuracy of dynamic MR imaging was significantly better (P < .05). Persisting early enhancement after four MVAC cycles correctly corresponded with lack of response in all nine cases, and after two cycles in eight of these cases. The unenhanced MR technique showed initial tumor size reduction in three of these cases.
Conventional and dynamic enhanced MR imaging were used to evaluate chemotherapy after two, four, and six cycles of MVAC in 22 patients with bladder cancer. After two cycles, dynamic MR imaging helped detect 13 of 14 responders and eight of eight nonresponders. It helped detect five of seven lymph node responders and two of two nonresponders. Thus, it may be possible to predict after two MVAC cycles whether a patient will respond to chemotherapy.
评估在晚期膀胱癌患者化疗过程中，能否通过快速动态对比剂增强磁共振（MR）成像在化疗早期预测化疗失败情况。
在这项前瞻性研究中，22例经组织学证实的晚期膀胱癌患者在接受甲氨蝶呤、长春碱、阿霉素和顺铂（MVAC）化疗的两个、四个和六个周期前后接受了MR成像检查。通过在未增强MR成像时使用传统肿瘤大小参数以及在快速动态对比增强MR成像时观察肿瘤或淋巴结开始强化时间的变化，评估两个化疗周期后的反应。将这些技术获得的结果与化疗完成后膀胱切除术（n = 9）或多次经尿道切除术（n = 13）标本的组织病理学结果进行比较。
在两个MVAC周期后，使用传统MR成像区分反应者与无反应者的准确性、敏感性和特异性分别为73%、79%和63%。使用动态技术时，这些指标分别为95%、93%和100%。虽然这些值之间的差异不显著（敏感性P = 0.48，特异性P = 0.25，准确性P = 0.07），但数据表明动态增强MR成像比未增强MR成像表现更好。动态成像在两个MVAC周期后对21例患者得出了正确结果，在四个周期后对所有病例都得出了正确结果。在四个MVAC周期后，动态MR成像的准确性显著更高（P < 0.05）。在四个MVAC周期后持续早期强化在所有9例病例中均与无反应情况相符，在其中8例病例中在两个周期后也是如此。未增强MR技术在其中3例病例中显示初始肿瘤大小缩小。
对22例膀胱癌患者在MVAC化疗的两个、四个和六个周期后，使用传统和动态增强MR成像评估化疗情况。在两个周期后，动态MR成像帮助检测出14例反应者中的13例和8例无反应者中的8例。它帮助检测出7例淋巴结反应者中的5例和2例无反应者中的2例。因此，在两个MVAC周期后有可能预测患者是否对化疗有反应。
