The Promise of Dynamic Contrast-Enhanced Imaging in Radiation Therapy
Section snippets
Prognostic and Predictive Indicators for Tumor Response Assessment
Malignant gliomas, particularly GBM, exhibit neovascularity characterized as abnormally rapid growth of vasculature with high density, great vessel leakage, abnormal perfusion, and prolonged mean transit time, which is possibly mediated by angiogenesis and has become the target of antiangiogenic therapy.32, 33 Cerebral blood volume (CBV), cerebral blood flow (CBF), and vascular permeability in gliomas mapped by DCE or DSc MRI before radiation have been shown to be prognostic factors for
DCE Imaging for Assessment of Normal Tissue and Organ Response to Radiation Dose
Radiation-induced vascular injury in normal tissue and organs can pose a risk for organ function. Radiation can cause vascular damage, such as vessel dilation, endothelial cell death and apoptosis, microvessel hemorrhage, and eventually vessel occlusion.51, 52, 53, 54, 55 Vascular damage can subsequently affect organ function (eg, in the brain, liver, and rectum).56, 57, 58, 59 This risk hinders the attempt to increase radiation dose to achieve a better tumor control or even cure the cancer.
DCE MRI for Radiation Target Selection and Delineation
Because technological dose delivery has changed dramatically, target volume definition based on CT scanning is increasingly becoming an obvious limiting factor in advanced precision treatment. The role of functional imaging for target volume definition has been discussed by several authors.1, 76 It has been suggested that a tumor target volume could be defined and segmented as multiple biological target subvolumes, which could be defined based on multiple functional imaging examinations, each
Issues Related to DCE Imaging in Radiation Therapy
Issues related to the use of DCE imaging in radiation oncology perhaps depend on the attempted usage. There are some common issues related to all types of cancer therapy but others uniquely to radiation therapy. These common issues include the standardization of imaging protocols; the PK models; and quantitative metrics derived from the DCE imaging data, quality control/assurance of imaging acquisition, and reproducibility and accuracy of the method as a whole. Currently, there are several
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2020, Radiotherapy and OncologyCitation Excerpt :While local granularity of Hounsfield units has a negligible impact on macroscopic dose calculations, it can provide clues to the underlying tumour biology, potentially indicating tissue radiosensitivity for instance, or helping to demarcate between recurrence and radiation-induced lung injury following radiotherapy [45–47]. Furthermore, DCE images can be obtained on a CT scanner, typically using iodine as contrast agent [48,49]. A drawback with DCE CT compared to DCE MRI is the high radiation dose associated with the repeated imaging during DCE CT acquisition.
DCE-MRI assessment of response to neoadjuvant SABR in early stage breast cancer: Comparisons of single versus three fraction schemes and two different imaging time delays post-SABR
2020, Clinical and Translational Radiation OncologyCitation Excerpt :We speculate that the absence of increased enhancement for the three fraction group is related to reduced radiation damage to the surrounding tissue due to repair mechanisms as per radiobiological theory. We suspect that this differential effect on surrounding tissue is related to an endothelial cell death dose threshold which has been hypothesized to be on the order of 8–12 Gy delivered in a single dose [6,9,10,42–45]. With endothelial cell death, gadolinium contrast would be freer to diffuse into the extra-cellular, extra-vascular space and result in enhancement outside the tumour.
Contrast-agent-based perfusion MRI code repository and testing framework: ISMRM Open Science Initiative for Perfusion Imaging (OSIPI)
2024, Magnetic Resonance in Medicine
Supported in part by NIH P01 CA59827, NCI RO1 CA132834, RO1 NS064973 and R21 CA126137.