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Perfusion CT measurements predict tumor response in rectal carcinoma

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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the capacity of perfusion CT imaging to distinguish between complete and incomplete responders after neoadjuvant chemoradiation therapy for rectal carcinoma, with particular attention to segmentation technique.

Materials and methods

17 patients were evaluated in this prospective IRB-approved study. For each patient, a perfusion CT acquisition was obtained prior to the initiation of chemoradiation, at 1–2 weeks after the start of chemoradiation, and at 12 weeks after the start of chemoradiation therapy. From each dataset, three perfusion parameters were measured, each in two different ways: a region of interest incorporating only “hot spots” of greatest enhancement and whole-tumor measurements.

Results

In univariate analysis, blood volume and permeability differed significantly between responders and non-responders. In logistic regression analysis evaluating predictors of the “complete response” outcome, only two predictors were retained as statistically significant: peak hot spot blood volume 1–2 weeks into therapy (OR 10.25, p = 0.0026) and hot spot permeability decline at 12 weeks after the initiation of therapy (OR 5.62, p = 0.03). The overall likelihood ratio test for this model supported the conclusion that hot spot blood volume and hot spot permeability decline were significant predictors of the complete pathologic response outcome (p < 0.0001).

Conclusion

In this pilot study, peak tumor blood volume and decline in tumor permeability, when measured in “hot spots” of greatest enhancement, were strong predictors of complete therapeutic response in rectal cancer after neoadjuvant therapy.

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Acknowledgements

The authors would like to thank Ulrike Haberland, PhD for technical input and Robert Berger, RT for image acquisition.

Author information

Authors and Affiliations

  1. Stanford University Medical Center, 300 Pasteur Drive, R354, Stanford, CA, 94305, USA

    Aya Kino

  2. Department of Radiation Oncology, Stanford University Medical Center, 875 Blake Wilbur Drive, Stanford, CA, 94305-5152, USA

    Jenny Shaffer, Albert C. Koong & Daniel T. Chang

  3. University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48104, USA

    Katherine E. Maturen

  4. Siemens Medical Solutions USA, Inc., 40 Liberty Blvd, Malvern, PA, 19355, USA

    Heiko Schmiedeskamp

  5. Stanford University Medical Center, 300 Pasteur Drive, S072, Stanford, CA, 94305, USA

    Dominik Fleischmann

  6. Stanford University Medical Center, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA

    Aya Kamaya

Authors
  1. Aya Kino
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  2. Jenny Shaffer
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  3. Katherine E. Maturen
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  4. Heiko Schmiedeskamp
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  5. Albert C. Koong
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  7. Dominik Fleischmann
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  8. Aya Kamaya
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Corresponding author

Correspondence to Aya Kamaya.

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Funding

This study was partially funded by the Society of Abdominal Radiology Wylie J. Dodds Research Award and by the Developmental Cancer Research Award, Stanford Cancer Center Translational Research.

Conflict of interest

Heiko Schmiedeskamp, PhD, is employee of Siemens Healthcare, Dominik Fleischmann, MD, received research support from General Electric Healthcare and Siemens Medical Solutions. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB approval was obtained for this study (IRB protocol #19224, Stanford University).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Kino, A., Shaffer, J., Maturen, K.E. et al. Perfusion CT measurements predict tumor response in rectal carcinoma. Abdom Radiol 42, 1132–1140 (2017). https://doi.org/10.1007/s00261-016-0983-5

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  • DOI: https://doi.org/10.1007/s00261-016-0983-5

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