Imaging of Tumor Angiogenesis for Radiologists—Part 2: Clinical Utility
Introduction
Tumor angiogenesis is a fundamental biological feature whereby new blood vessels are formed to supply nutrients and oxygen for growing tumors, which is a crucial prerequisite for tumor development and dissemination.1 This article reviews the role of imaging techniques in the assessment of angiogenesis in vivo in clinical practice and correlates imaging findings with the corresponding biological features before, during, and after treatment.
Section snippets
Imaging of Angiogenesis in Clinical Practice
Imaging techniques have a critical role in cancer management. These techniques are extremely useful tools in the management of oncologic patients, including diagnosis, prognosis, planning therapy, and assessment of response to treatment. In addition, the specific assessment of angiogenesis status may provide critical data for patients. Most published studies using imaging to probe the structure, characteristics, and function of tumor microvasculature have used dynamic contrast-enhanced (DCE)
Multiparametric Approach
Because cancers are characterized by profound spatial and temporal heterogeneity in a variety of biological characteristics that are exacerbated by therapy effects, a multiparametric imaging assessment that maps the tumor biology is desirable for enabling improved biological understanding. Combinations of multiple modalities can yield complementary information offering advantages that go beyond what can be achieved by any modality used alone (Fig 9).
Multiparametric functional-molecular imaging
Future Challenges for Imaging of Angiogenesis
There are several challenges that imaging of angiogenesis needs to address before its clinical application. First, there is often a lack of standard approaches to data collection and analysis. The range of reported methodologies and analyses between studies has made identification of best technique difficult. In general, specialist research groups are the main users of these imaging techniques. Second, measurements of reproducibility are needed. Biological parameters are subject to random and
Conclusion
Noninvasive imaging plays a key role in cancer evaluation. To date, anatomical imaging remains the mainstay for tumor evaluation. However, new functional and molecular imaging techniques offer insights into tumor hallmarks, including angiogenesis, beyond conventional imaging capabilities. Although a quantitative imaging approach is only at the beginning of its possible incorporation into clinical imaging protocols, these advanced imaging techniques may answer key questions relating to tumor
References (62)
Contrast enhanced MR imaging of female pelvic cancers: Established methods and emerging applications
Eur J Radiol
(2011)- et al.
Brain tumors: A multimodality approach with diffusion-weighted imaging, diffusion tensor imaging, magnetic resonance spectroscopy, dynamic susceptibility contrast and dynamic contrast-enhanced magnetic resonance imaging
Magn Reson Imaging Clin N Am
(2013) - et al.
Perfusion patterns of metastatic gastrointestinal stromal tumor lesions under specific molecular therapy
Eur J Radiol
(2011) The promise of dynamic contrast-enhanced imaging in radiation therapy
Semin Radiat Oncol
(2011)- et al.
Functional MRI for radiotherapy dose painting
Magn Reson Imaging
(2012) - et al.
Arterial spin labeling blood flow magnetic resonance imaging for the characterization of metastatic renal cell carcinoma
Acad Radiol
(2005) - et al.
Tumor antivascular effects of radiotherapy combined with combretastatin a4 phosphate in human non-small-cell lung cancer
Int J Radiat Oncol Biol Phys
(2007) - et al.
Molecular mechanisms and clinical applications of angiogenesis
Nature
(2011) - et al.
BI-RADS-MRI: A primer
AJR Am J Roentgenol
(2006) - PI‐RADS v2. Prostate Imaging and Reporting and Data System: Version 2. Available at:...
Endometrial cancer: Diagnostic value of quantitative measurements of microvascular changes with DCE-MR imaging
MAGMA
USANZ. The role of magnetic resonance imaging in the diagnosis and management of prostate cancer
BJU Int
CT perfusion in oncologic imaging: A useful tool?
AJR Am J Roentgenol
Perfusion MRI: The five most frequently asked technical questions
AJR Am J Roentgenol
Vascular characterisation of triple negative breast carcinomas using dynamic MRI
Eur Radiol
Early changes in liver perfusion caused by occult metastases in rats: Detection with quantitative CT
Radiology
Contrast-enhanced M.R. imaging of lymph nodes in cancer patients
Korean J Radiol
Does volume perfusion computed tomography enable differentiation of metastatic and non-metastatic mediastinal lymph nodes in lung cancer patients? A feasibility study
Cancer Imaging
Do imaging biomarkers relate to outcome in patients treated with VEGF inhibitors?
Clin Cancer Res
Imaging biomarkers of angiogenesis and the microvascular environment in cerebral tumours
Br J Radiol
Advances in MRI assessment of gliomas and response to anti-VEGF therapy
Curr Neurol Neurosci Rep
Advanced hepatocellular carcinoma: CT perfusion of liver and tumor tissue-initial experience
Radiology
Evaluation with DCE-US of antiangiogenic treatments in 539 patients allowing the selection of one surrogate marker correlated to overall survival
J Clin Oncol
Perfusion CT can predict response to chemoradiation therapy and survival in oesophageal squamous cell carcinoma: Initial results
Oncol Rep
Quantitative measurement of blood flow using perfusion CT for assessing clinicopathological features and prognosis in patients with rectal cancer
Dis Colon Rectum
The safety and efficacy of sunitinib prior to planned nephrectomy in metastatic clear cell renal cancer
J Clin Oncol
The potential for an enhanced role for MRI in radiation-therapy treatment planning
Technol Cancer Res Treat
New therapies and functional-molecular Imaging
Novel oncologic drugs: What they do and how they affect images
Radiographics
Dynamic contrast-enhanced ultrasonography (DCE-US) with quantification of tumor perfusion: A new diagnostic tool to evaluate the early effects of antiangiogenic treatment
Eur Radiol
DCE-MRI biomarkers in the clinical evaluation of antiangiogenic and vascular disrupting agents
Br J Cancer
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Investigating the correlation of arterial spin labeling and dynamic contrast enhanced perfusion in primary tumor of nasopharyngeal carcinoma
2018, European Journal of RadiologyCitation Excerpt :The semi-quantitative parameters were calculated by TIC without the requirement of a specific model. Despite the simplistic nature, they have been reported for clinical significance [42,43]. It was previously reported that IAUGC was related to blood flow, blood volume, permeability, extravascular-extracellular space volume, and MVD [43,44].
Specific criteria for tumor response
2018, RadiologiaAdvanced imaging to predict response to chemotherapy in colorectal liver metastases – a systematic review
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2016, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :On DCE imaging, a favorable tumor response to CTP results in decreases in the rate and magnitude of enhancement in several tumor types. The magnitude of antiangiogenic response to neoadjuvant CTP demonstrated by DCE-MR imaging can be predictive of overall and disease-free survival in some solid cancers but also in hematologic malignancies.7,8 In this setting, a change in signal intensity-time curves shape of 1 or more points was significant for overall 5-year survival in patients with breast cancer (BC) scored using a 5-curve–type classification schema encompassing wash-in and wash-out phases.18