Current status and guidelines for the assessment of tumour vascular support with dynamic contrast-enhanced computed tomography
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Dynamic contrast-enhanced computed tomography (DCE-CT) assesses the vascular support of tumours through analysis of temporal changes in attenuation in blood vessels and tissues during a rapid series of images acquired with intravenous administration of iodinated contrast material. Commercial software for DCE-CT analysis allows pixel-by-pixel calculation of a range of validated physiological parameters and depiction as parametric maps. Clinical studies support the use of DCE-CT parameters as surrogates for physiological and molecular processes underlying tumour angiogenesis. DCE-CT has been used to provide biomarkers of drug action in early phase trials for the treatment of a range of cancers. DCE-CT can be appended to current imaging assessments of tumour response with the benefits of wide availability and low cost. This paper sets out guidelines for the use of DCE-CT in assessing tumour vascular support that were developed using a Delphi process. Recommendations encompass CT system requirements and quality assurance, radiation dosimetry, patient preparation, administration of contrast material, CT acquisition parameters, terminology and units, data processing and reporting. DCE-CT has reached technical maturity for use in therapeutic trials in oncology. The development of these consensus guidelines may promote broader application of DCE-CT for the evaluation of tumour vascularity.
• DCE-CT can robustly assess tumour vascular support
• DCE-CT has reached technical maturity for use in therapeutic trials in oncology
• This paper presents consensus guidelines for using DCE-CT in assessing tumour vascularity
KeywordsTomography X-ray computed Contrast media Neoplasms Blood supply Diagnostic imaging Methods Standards Guideline
The authors would like to thank Giuseppe Petralia, University of Milan, Italy, and Koh Tong San, Nanyang Technological University, Singapore for contributing to the Delphi process and Dushyant Sahani, Harvard Medical School, USA and Finn Rassmussen, University Hospital, Arhus, Denmark for their feedback on the recommendations. The authors would also like to thank the ECMC Imaging Steering Committee for their expertise and the Secretariat for supporting and organising the workshop. The Experimental Cancer Medicine Centre Initiative is jointly funded by Cancer Research UK, the National Institute for Health Research in England and the Departments of Health for Scotland, Wales and Northern Ireland.
T.Y. Lee has a licensing agreement with GE Healthcare with respect to the CT Perfusion software. V. Goh has a research agreement with Siemens Healthcare. K.A. Miles and M.P. Hayball are shareholders and directors of TexRAD Ltd, a company with an interest in CT image processing. M.P. Hayball is a shareholder and director of Cambridge Computed Imaging Ltd—a company that develops and markets medical imaging software.
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