Craciunescu O.I., Yoo D.S., Cleland E., Muradyan N., Carroll M.D., MacFall J.R., Barboriak D.P., Brizel D.M.
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States; GECAD Ghana Ltd., Acra, Ghana; ICAD Inc., Nashua, NH, United States; Department of Radiology, Duke University Medical Center, Durham, NC, United States; Department of Surgery, Duke University Medical Center, Durham, NC, United States
Craciunescu, O.I., Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States; Yoo, D.S., Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States; Cleland, E., GECAD Ghana Ltd., Acra, Ghana; Muradyan, N., ICAD Inc., Nashua, NH, United States; Carroll, M.D., Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States; MacFall, J.R., Department of Radiology, Duke University Medical Center, Durham, NC, United States; Barboriak, D.P., Department of Radiology, Duke University Medical Center, Durham, NC, United States; Brizel, D.M., Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States, Department of Surgery, Duke University Medical Center, Durham, NC, United States
Purpose: Dynamic contrast-enhanced (DCE) MRI-extracted parameters measure tumor microvascular physiology and are usually calculated from an intratumor region of interest (ROI). Optimal ROI delineation is not established. The valid clinical use of DCE-MRI requires that the variation for any given parameter measured within a tumor be less than that observed between tumors in different patients. This work evaluates the impact of tumor ROI selection on the assessment of intra- and interpatient variability. Method and Materials: Head and neck cancer patients received initial targeted therapy (TT) treatment with erlotinib and/or bevacizumab, followed by radiotherapy and concurrent cisplatin with synchronous TT. DCE-MRI data from Baseline and the end of the TT regimen (Lead-In) were analyzed to generate the vascular transfer function (K trans), the extracellular volume fraction (v e), and the initial area under the concentration time curve (iAUC 1 min). Four ROI sampling strategies were used: whole tumor or lymph node (Whole), the slice containing the most enhancing voxels (SliceMax), three slices centered in SliceMax (Partial), and the 5% most enhancing contiguous voxels within SliceMax (95Max). The average coefficient of variation (aCV) was calculated to establish intrapatient variability among ROI sets and interpatient variability for each ROI type. The average ratio between each intrapatient CV and the interpatient CV was calculated (aRCV). Results: Baseline primary/nodes aRCVs for different ROIs not including 95Max were, for all three MR parameters, in the range of 0.14-0.24, with Lead-In values between 0.09 and 0.2, meaning a low intrapatient vs. interpatient variation. For 95Max, intrapatient CVs approximated interpatient CVs, meaning similar data dispersion and higher aRCVs (0.6-1.27 for baseline) and 0.54-0.95 for Lead-In. Conclusion: Distinction between different patient's primary tumors and/or nodes cannot be made using 95Max ROIs. The other three strategies are viable and equivalent for using DCE-MRI to measure head and neck cancer physiology. © 2012 Elsevier Inc.
Bevacizumab; Clinical use; Coefficient of variation; Concentration-time; Concurrent cisplatin; Contrast-enhanced; Data dispersion; DCE-MRI; Dynamic contrast enhanced MRI; Erlotinib; Extracellular volumes; Head-and-neck cancer; Lymph node; Microvascular; Pharmacokinetic analysis; Pharmacokinetic parameters; Region of interest; ROI; Sampling strategies; Diseases; Patient treatment; Pharmacokinetics; Physiology; Platinum compounds; Tumors; bevacizumab; cisplatin; erlotinib; tarceval; unclassified drug; add on therapy; adjuvant therapy; article; chemoradiotherapy; clinical trial; contrast enhancement; dynamic contrast enhanced magnetic resonance imaging; head and neck cancer; human; molecularly targeted therapy; nuclear magnetic resonance imaging; parameters; physiology; priority journal; Angiogenesis Inhibitors; Antibodies, Monoclonal, Humanized; Area Under Curve; Chemoradiotherapy; Cisplatin; Contrast Media; Gadolinium DTPA; Head and Neck Neoplasms; Humans; Image Enhancement; Lymphatic Metastasis; Magnetic Resonance Imaging; Microcirculation; Molecular Targeted Therapy; North Carolina; Quinazolines
