Skip to main content

Advertisement

SpringerLink
Log in

Treatment response classification of liver metastatic disease evaluated on imaging. Are RECIST unidimensional measurements accurate?

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study was to evaluate the accuracy of unidimensional measurements (response evaluation criteria in solid tumors, RECIST) compared with volumetric measurements in patients with liver metastases undergoing chemotherapy. Forty-four patients with newly diagnosed liver lesions underwent three MRI examinations at treatment initiation, during chemotherapy, and immediately post-treatment. Measurements based on RECIST guidelines and volume calculations were performed on the “target” lesions (TLs). The two methods were in agreement in 64/77 of patients and 253/301 of individual lesions classification in response categories (“good” agreement, Cohen kappa = 0.735 and 0.741, respectively). In 16.88% of the comparisons the two methods stratified patients to a different response category; 27.6% of TLs did not follow the response category of the patient in whom lesions were located. The actual volume of TLs differs from the calculated volume of a sphere with the same diameter. Our study supports the use of volumetric techniques that may overcome certain disadvantages of unidimensional measurements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Diagram 1
Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hopper KD, Kasales CJ, Eggli KD et al (1996) The impact of 2D versus 3D quantitation of tumor bulk determination on current methods of assessing response to treatment. J Comput Assist Tomogr 20:930–937

    Article  PubMed  CAS  Google Scholar 

  2. Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  PubMed  CAS  Google Scholar 

  3. Padhani AR, Ollivier L (2001) The RECIST (response evaluation criteria in solid tumors) criteria: implications for diagnostic radiologists. Br J Radiol 74:983–986

    PubMed  CAS  Google Scholar 

  4. Husband JE (1996) Monitoring tumour response. Eur Radiol 6:775–785

    PubMed  CAS  Google Scholar 

  5. World Health Organization (1979) WHO handbook for reporting results of cancer treatment. WHO Publications Centre USA, Albany, NY

  6. Prasad SR, Jhaveri KS, Saini S, Hahn PF, Halpern EF, Sumner JE (2002) CT tumor measurement for therapeutic response assessment: comparison of unidimensional, bidimensional, and volumetric techniques initial observations. Radiology 225:416–419

    Article  PubMed  Google Scholar 

  7. Tran LN, Brown MS, Goldin JG et al (2004) Comparison of treatment response classifications between unidimensional, bidimensional, and volumetric measurements of metastatic lung lesions on chest computed tomography. Acad Radiol 11:1355–1360. doi:10.1016/j.acra.2004.09.004

    Article  PubMed  Google Scholar 

  8. Heussel CP, Meier S, Wittelsberger S, Gotte H, Mildenberger P, Kauczor HU (2007) Follow-up CT measurement of liver malignoma according to RECIST and WHO vs. volumetry. Rofo 179:958–964. doi:10.1055/s-2007-963171

    PubMed  CAS  Google Scholar 

  9. Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:303–308. doi:10.1148/radiol.2282011860

    Article  PubMed  Google Scholar 

  10. Altman DG (1991) Practical statistics for medical research. Chapman and Hall, London

    Google Scholar 

  11. Streiner DL, Norman GR (2003) Health measurement scales: a practical guide to their development and use. Oxford University Press, Oxford

    Google Scholar 

  12. Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214

    Article  PubMed  CAS  Google Scholar 

  13. Gehan EA, Tefft MC (2000) Will there be resistance to the RECIST (response evaluation criteria in solid tumors)? J Natl Cancer Inst 92:179–181

    Article  PubMed  CAS  Google Scholar 

  14. Jaffe CC (2006) Measures of response: RECIST, WHO, and new alternatives. J Clin Oncol 24:3245–3251. doi:10.1200/JCO.2006.06.5599

    Article  PubMed  Google Scholar 

  15. Mazonakis M, Damilakis J, Maris T, Prassopoulos P, Gourtsoyiannis N (2002) Comparison of two volumetric techniques for estimating liver volume using magnetic resonance imaging. J Magn Reson Imaging 15:557–563. doi:10.1002/jmri.10109

    Article  PubMed  Google Scholar 

  16. Mazonakis M, Damilakis J, Mantatzis M et al (2004) Stereology versus planimetry to estimate the volume of malignant liver lesions on MR imaging. Magn Reson Imaging 22:1011–1016. doi:10.1016/j.mri.2004.02.012

    Article  PubMed  Google Scholar 

  17. Laghi A (2007) Multidetector CT (64 slices) of the liver: examination techniques. Eur Radiol 17:675–683. doi:10.1007/s00330-006-0405-0

    Article  PubMed  Google Scholar 

  18. Keil S, Behrendt FF, Stanzel S et al (2008) Semi-automated measurement of hyperdense, hypodense and heterogeneous hepatic metastasis on standard MDCT slices. comparison of semi-automated and manual measurement of RECIST and WHO criteria. Eur Radiol 18:2456–2465. doi:10.1007/s00330-008-1050-6

    Article  PubMed  Google Scholar 

  19. Mazumdar M, Smith A, Schwartz LH (2004) A statistical simulation study finds discordance between WHO criteria and RECIST guideline. J Clin Epidemiol 57:358–365. doi:10.1016/j.jclinepi.2003.07.015

    Article  PubMed  Google Scholar 

  20. Therasse P, Eisenhauer EA, Verweij J (2006) RECIST revisited: a review of validation studies on tumour assessment. Eur J Cancer 42:1031–1039. doi:10.1016/j.ejca.2006.01.026

    Article  PubMed  CAS  Google Scholar 

  21. Marten K, Auer F, Schmidt S, Kohl G, Rummeny EJ, Engelke C (2006) Inadequacy of manual measurements compared to automated CT volumetry in assessment of treatment response of pulmonary metastases using RECIST criteria. Eur Radiol 16:781–790. doi:10.1007/s00330-005-0036-x

    Article  PubMed  Google Scholar 

  22. Wormanns D, Kohl G, Klotz E et al (2004) Volumetric measurements of pulmonary nodules at multi-row detector CT: in vivo reproducibility. Eur Radiol 14:86–92. doi:10.1007/s00330-003-2132-0

    Article  PubMed  Google Scholar 

  23. Goldie JH, Coldman AJ (1979) A mathematic model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep 63:1727–1733

    PubMed  CAS  Google Scholar 

  24. Marten K, Auer F, Schmidt S, Rummeny EJ, Engelke C (2007) Automated CT volumetry of pulmonary metastases: the effect of a reduced growth threshold and target lesion number on the reliability of therapy response assessment using RECIST criteria. Eur Radiol 17:2561–2571. doi:10.1007/s00330-007-0642-x

    Article  PubMed  Google Scholar 

  25. Sohaib SA, Turner B, Hanson JA, Farquharson M, Oliver RT, Reznek RH (2000) CT assessment of tumour response to treatment: comparison of linear, cross-sectional and volumetric measures of tumour size. Br J Radiol 73:1178–1184

    PubMed  CAS  Google Scholar 

  26. Gurland J, Johnson RO (1966) Case for using only maximum diameter in measuring tumors. Cancer Chemother Rep 50:119–124

    PubMed  CAS  Google Scholar 

  27. Kamel IR, Bluemke DA (2002) Magnetic resonance imaging of the liver: assessing response to treatment. Top Magn Reson Imaging 13:191–200

    Article  PubMed  Google Scholar 

  28. del Frate C, Bazzocchi M, Mortele KJ et al (2002) Detection of liver metastases: comparison of gadobenate dimeglumine-enhanced and ferumoxides-enhanced MR imaging examinations. Radiology 225:766–772

    Article  PubMed  Google Scholar 

  29. Bipat S, van Leeuwen MS, Comans EF et al (2005) Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology 237:123–131. doi:10.1148/radiol.2371042060

    Article  PubMed  Google Scholar 

  30. Kim YK, Ko SW, Hwang SB, Kim CS, Yu HC (2006) Detection and characterization of liver metastases: 16-slice multidetector computed tomography versus superparamagnetic iron oxide-enhanced magnetic resonance imaging. Eur Radiol 16:1337–1345. doi:10.1007/s00330-005-0140-y

    Article  PubMed  Google Scholar 

  31. Tanimoto A, Wakabayashi G, Shinmoto H, Nakatsuka S, Okuda S, Kuribayashi S (2005) Superparamagnetic iron oxide-enhanced MR imaging for focal hepatic lesions: a comparison with CT during arterioportography plus CT during hepatic arteriography. J Gastroenterol 40:371–380. doi:10.1007/s00535-005-1553-8

    Article  PubMed  Google Scholar 

  32. Kubaska S, Sahani DV, Saini S, Hahn PF, Halpern E (2001) Dual contrast enhanced magnetic resonance imaging of the liver with superparamagnetic iron oxide followed by gadolinium for lesion detection and characterization. Clin Radiol 56:410–415. doi:10.1053/crad.2000.0673

    Article  PubMed  CAS  Google Scholar 

  33. Kim MJ, Kim JH, Chung JJ, Park MS, Lim JS, Oh YT (2003) Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced MR imaging. Radiology 228:719–726. doi:10.1148/radiol.2283020735

    Article  PubMed  Google Scholar 

  34. Ward J, Robinson PJ, Guthrie JA et al (2005) Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 237:170–180. doi:10.1148/radiol.2371041444

    Article  PubMed  Google Scholar 

  35. Blakeborough A, Ward J, Wilson D et al (1997) Hepatic lesion detection at MR imaging: a comparative study with four sequences. Radiology 203:759–765

    PubMed  CAS  Google Scholar 

  36. Takahama K, Amano Y, Hayashi H, Ishihara M, Kumazaki T (2003) Detection and characterization of focal liver lesions using superparamagnetic iron oxide-enhanced magnetic resonance imaging: comparison between ferumoxides-enhanced T1-weighted imaging and delayed-phase gadolinium-enhanced T1-weighted imaging. Abdom Imaging 28:525–530

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University Hospital of Alexandroupolis, Opsikiou 1, 681 00, Alexandroupolis, Greece

    Michael Mantatzis

  2. Department of Oncology, University Hospital of Alexandroupolis, 681 00, Dragana, Alexandroupolis, Greece

    Stylianos Kakolyris & Kyriakos Amarantidis

  3. Second Department of Surgery, University Hospital of Alexandroupolis, 681 00, Dragana, Alexandroupolis, Greece

    Anastasios Karayiannakis

  4. Medical School of Thrace, Department of Radiology, University Hospital of Alexandroupolis, 681 00, Dragana, Alexandroupolis, Greece

    Panos Prassopoulos

Authors
  1. Michael Mantatzis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stylianos Kakolyris
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyriakos Amarantidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anastasios Karayiannakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Panos Prassopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Panos Prassopoulos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mantatzis, M., Kakolyris, S., Amarantidis, K. et al. Treatment response classification of liver metastatic disease evaluated on imaging. Are RECIST unidimensional measurements accurate?. Eur Radiol 19, 1809–1816 (2009). https://doi.org/10.1007/s00330-009-1327-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-009-1327-4

Keywords

Search

Navigation