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S o p h i e T a ï e b
C e n t r e O s c a r L a m b r e t
D é p a r t e m e n t d ’ I m a g e r i e
L i l l e - F r a n c e
F U N C T I O N A L A S P E C T C R I T E R I A
• Critères Morphologiques • Taille Tumorale / Identification aux critères cliniques.
• Functional Criteria • Signal (TDM, IRM)
• Tumour Metabolism
• Vascularization
• Common language to same decisions • Reproducible criteria : Inter & Intra Observers.
• Objectif criteria = quantitative.
Comment ? How ?
Functional Imaging
Technique Tumoral characteristics
MRI and CT and US Tumour volume
DCE-MRI, DCE-CT and DCE-US Vascularisation
DWI-MRI Cellular density
MRS Molecular component
TEP FDG Glucose Métabolism
TEP FES Hormonal Métabolism
Increase of the signal after contrast administration
• DCE-IRM : Gadolinium chelates
• TDM : Iodine contrast
• US : Microbubbles
Jain RK. Nature Medicine 2001;7:987-989
Anti-angiogéniques Anti-Vasculaire
Dynamic acquisition after contrast administration (DOTAREM*)
7
CT emporal curves of contrast enhancement aorte / GG
LS Fournier , J Radiol 2007
CHI-Q Software Quantification / ROI
Raw Data
Modelisation
4
Woman, 57-year-old. Bilateral renal cell. Pancreas metastasis / Sunitinib
7
Woman, 57-year-old. Bilateral renal cell. Pancreas metastasis / Sunitinib
CT Baseline : 3 cm, HD : 67
D60: 3 cm, HD : 29.
SD with RECIST 1.1
RP with CHOI criteria.
M9 : CR
Ø Peak intensity Ø Time to peak Ø Mean transit time Ø Slope of wash in Ø AUC, AUWI, AUWO.
flux F
veine artère
Volume V de tissus
Artere Q
artere 1
Capillaire Q
cap 2
Kep
Ve
Interstitium Q
inter 3
Ktrans
Blood flow
k(0,2)
flux F
veine artère
Volume V de tissus
MRI and CT
Analysis
Inte
nsit
é d
e s
ign
al
Temps
F
kep = Ktrans / Ve
Vp Ve
1. Perfusion (BF)
2. Blood volume
3. Permeability
4. Intersticiel volume
Ktrans
C.de Bazelaire – St Louis - Paris
Temporal resolution : High - Seconde
All parameters
n Perfusion (BF)
n Blood volume
n Permeability
n Intersticiel volume
Inte
nsit
é d
e s
ign
al
Temps
( ) ( ) ( ) ( )∫∫ ⎟⎟⎠
⎞⎜⎜⎝
⎛−−
−+−=
t
e
trans
ptrans
pptis duutKuCKduutCFtC00
exp τν
τ
C.de Bazelaire – St Louis - Paris
Only :
¨ Perfusion (BF)
¨ Blood volume
n Permeability
n Intersticiel vol Ktrans
Inte
nsit
é d
e s
ign
al
Temps
( ) ( ) ( )∫ ⎟⎟⎠
⎞⎜⎜⎝
⎛−
−=
t
e
trans
ptrans
tis duutKuCKtC0
expν
C.de Bazelaire – St Louis - Paris
Temporal resolution : low - mn
Perfusion MRI
n Diagnosis value – K trans : Se 93%, Sp 96%
BL < DCIS < DIC
– Kep : BL < DCIS < DIC
– Fibroadenoma : K trans high with Kep low
Preim U et al. EJR 2011
Furman-Haran E et al. Cancer 2005
Ø No Pre-treatment differences between responders and non-responders : Tumour diameter, volume, kinetic parameters.
§ Nor ADC (Woodhams R et al, Radiology 2010) – 398 pts § ADC useful (Li X et al. Med Oncol 2012) – 32 pts Before NAC
Mean ADC of responders lower than in non-resp. p<0,001
Ø Early response : ü Tumor diameter AUC [0.73-0.9] ü Kinetic parameters : Ktrans AUC [0.63-0.93] ü ADC : Useful but ADC cut off depends : B[800-1000],
multiB, 1.5 or 3 T.
Perfusion MRI
n Pb tumoral heterogeneity
98 patientes, > 1B1 : Corrélation avec CL, SSR, SG
To morrow : multiparametric imaging
• Diagnosis • Treatment response
• Predictive before treatment
• Earlier : 1 or 2 cycles
+ TEP ?
Conclusion
• RECIST – En défaut • Respecter les contraintes lors Mesure
• Connaitre les dérives possibles
• Imagerie Fonctionnelle • Echo de contraste = Validée
• Perfusion IRM/TDM = à valider > 2 ans
• Diffusion, Spectroscopie = ??