3D MRI Offers Improved Prediction of Survival After Chemotherapy for Liver Tumors

Researchers are using specialized three-dimensional (3D) magnetic resonance imaging (MRI) scanning technology to accurately measure living and dying liver tumor tissue in order to quickly show whether very toxic chemotherapy, delivered right through a tumor’s blood supply, is working.

The Johns Hopkins University (Baltimore, MD, USA) investigators noted that their findings, presented on March 22–27, 2014, in San Diego (CA, USA), at the annual meeting of the Society of Interventional Radiology, are the first “proof of principle” that this technology can show tumors in three dimensions and effectively measure tumor viability and death. Early data of a series of studies involving 140 US men and women with liver tumors were also presented at the Radiological Society of North America (RSNA) annual meeting, December 1–6, 2013, in Chicago (IL, USA).

The researchers also reported that their findings in patients with either primary liver cancers or metastatic tumors from cancers beginning in other areas of the body are evidence that using this technology before and after treatment is a faster and better tool for predicting patient survival after chemotherapy targeted directly at tumors, called chemoembolization.

Unlike standard methods to assess tumor response after chemoembolization, which are based on two-dimensional images and tumor size, the Johns Hopkins-developed 3D technology also distinguishes between dead and live tissue, giving an accurate evaluation of tumor cell death.

The new technology builds on conventional 2D techniques and uses computer analytics to evaluate the amount of so-called contrast dye absorbed by tumor tissue. The dye is injected into patients before their MRI scan to enhance image production. Researchers say live tissue will absorb more dye than dead tissue, affecting image brightness, which can also be measured for size and intensity. "Our high-precision, 3D images of tumors provide better information to patients about whether chemoembolization has started to kill their tumors so that physicians can make more well-informed treatment recommendations,” stated Johns Hopkins interventional radiologist Jean-Francois Geschwind, MD, senior investigator on the studies.

Dr. Geschwind, a professor in the department of radiology at the Johns Hopkins University School of Medicine and its Kimmel Cancer Center, stated that determining the real degree of a tumor’s response to chemoembolization is especially important for patients with moderate to advanced stages of the disease, whose liver tumors might at first be too large or too many to surgically remove.

In the first study, researchers compared the conventional imaging technology and the newly developed technology in 17 Baltimore men and women with advanced liver cancer. All were treated with surgery or liver transplantation after chemoembolization. The research team used existing MR analysis techniques, as well as the new 3D technology to compare the radiologists’ studies with pathologic review of tumor samples after therapy and surgical removal. The error margin of the new 3D image analysis, they reported, was low (at up to 10%) when predicting the amount of dead tumor tissue found by pathologists whereas the standard, 2D method deviated by as much as 40% from actual values.

Dr. Geschwind and his colleagues, in further studies, used the conventional and new imaging techniques to study the MRI scans of more than 300 liver tumors in some 123 other men and women, also from the Baltimore region. All patients were treated at The Johns Hopkins Hospital between 2003 and 2012, and each received pre- and post-chemoembolization MRI scans to assess the effects of therapy on the tumors.

Using the new 3D technique, Dr. Geschwind’s team discovered that patients who responded well to therapy lived 19 months longer (a median of 42 months) than patients who did not respond well (average 23 month survival). Standard techniques revealed slightly less disparity in survival (average 18 months longer) between patients who responded to therapy and those who did not respond.

Dr. Geschwind reported that the 3D technology’s improved accuracy removes a lot of the guesswork that now goes into evaluating treatment outcomes. The new assessment takes seconds to perform, he added, so radiologists can provide faster, nearly instantaneous treatment guidance. The investigators plan additional software modifications to the new application before training more physicians to use it. He also has plans to study how it can affect treatment decisions, and whether these therapy choices help individuals lead a longer life.

The software used in the MRI scans was developed at Johns Hopkins and at Philips Research North America (Briarcliff Manor, NY, USA). Philips Healthcare, whose parent company is based in the Netherlands, manufactures some of the MRI scanners used in the study.

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