Contents I
MEDICAL RADIOLOGY Diagnostic Imaging
Editors:
A. L. Baert, Leuven K. Sartor, Heidelberg
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Contents III
A. Jackson · D. L. Buckley · G. J. M. Parker (Eds.)
Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Oncology
With Contributions by
M. W. Ah-See · R. C. Brasch · D. L. Buckley · F. Calamante · J. L. Evelhoch · L. S. Fournier I. S. Gribbestad · K. I. Gjesdal · M. H. B. Hjelstuen · A. Jackson · G. C. Jayson
M. W. Knopp · M. O. Leach · K. L. Li · S. Lundgreen · N. A. Mayr · D. S. McMeekin J. F. Montebello · C. T. W. Moonen · D. A. Nicholson · G. Nilsen · M. D. Noseworthy A. R. Padhani · G. J. M. Parker · M. Pedersen · W. E. Reddick · T. P. L. Roberts J. S. Taylor · P. van Gelderen · J. C. Waterton · D. H. Wu · W. T. C. Yuh · X. P. Zhu
Foreword by
A. L. Baert
With 110 Figures in 295 Separate Illustrations, 85 in Color and 20 Tables
123
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IV Contents
Alan Jackson, MBChB (Hons), PhD, FRCP FRCR Professor, Imaging Science and
Biomedical Engineering The Medical School University of Manchester Stopford Building Oxford Road
Manchester M13 9PT UK
David L. Buckley, PhD Lecturer in Image Science
Imaging Science and Biomedical Engineering University of Manchester
Stopford Building Oxford Road
Manchester M13 9PT UK
Medical Radiology · Diagnostic Imaging and Radiation Oncology
Series Editors: A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Molls · K. Sartor Continuation of Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
ISBN 3-540-42322-2 Springer Berlin Heidelberg New York
Library of Congress Cataloging-in-Publication Data
Dynamic contrast-enhanced magnetic resonance imaging in oncology / A. Jackson, D.
Buckley, G.J.M. Parker, eds. ; with contributions by R.C. Brasch ... [et al.] ; foreword by A. L. Baert.
p. ; cm. -- (Medical radiology)
Includes bibliographical references and index.
ISBN 3-540-42322-2 (hard: alk. paper)
1. Cancer--Magnetic resonance imaging. I. Jackson, Alan, Ph.D. II. Buckley, D.
(David), 1969- III. Parker, G. J. M. (Geoffrey J. M.) 1971- IV. Series.
[DNLM: 1. Magnetic Resonance Imaging--methods. 2. Neoplasms--diagnosis. 3.
Contrast Media. QZ 241 D997 2003]
RC270.3.M33D96 2003
616.99’407548--dc22 2003067408
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi - cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law.
Springer-Verlag is part of Springer Science+Business Media http//www.springeronline.com
쏘 Springer-Verlag Berlin Heidelberg 2005 Printed in Germany
The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every case the user must check such information by consulting the relevant literature.
Medical Editor: Dr. Ute Heilmann, Heidelberg Desk Editor: Ursula N. Davis, Heidelberg Production Editor: Kurt Teichmann, Mauer
Cover-Design and Typesetting: Verlagsservice Teichmann, 69256 Mauer 21/3150xq – 5 4 3 2 1 0 – Printed on acid-free paper
Geoffrey J. M. Parker, PhD Research Fellow in Imaging Science
Imaging Science and Biomedical Engineering University of Manchester
Stopford Building Oxford Road
Manchester M13 9PT UK
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Contents V
To our wifes
Anna and Susan
and our children
Joseph and Jessica
Theodore and Alexandra
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Contents VII
Dynamic contrast enhancement techniques using iodinated contrast media have been employed routinely in computed tomography for many years and can help the radiolo- gist considerably in narrowing down the differential diagnosis of tumors by adding functional information to the anatomically detailed morphological images.
One of the many advantages of magnetic resonance imaging is the possibility to use not one but several types of contrast media, each with its specifi c composition and par- ticular properties.
The functional imaging capabilities of dynamic contrast-enhanced MRI are for that reason substantially greater than those of dynamic contrast-enhanced CT.
Contrast-enhanced MR is now well established as a high-performance imaging modality for the diagnosis and management of patients with solid tumors.
This book is the fi rst volume to cover comprehensively these new and fascinating techniques and represents an excellent up-to-date review of our knowledge in this fi eld.
It deals with the theoretical and technical principles of the methods, their practical implementation and their application in tumors of the brain, the breast, the muscu- loskeletal system, the liver, the prostate and the cervix. It also discusses the actual and possible future applications of the method in assessing tumor treatment including anti- angiogenesis.
The editors are world-renowned experts in the fi eld with a long-standing interest in functional MRI. The authors of the individual chapters were invited to contribute because of their outstanding experience and their major contributions to the literature.
I would like to thank both the editors and the authors and congratulate them sin- cerely for their innovative approach and their superb efforts in compiling this excellent volume.
This book will be of great interest to radiologists, oncologists and oncological sur- geons but also to scientists involved in more basic research. I am confi dent that it will meet the same success with readers as the previous volumes published in this series.
Leuven Albert L. Baert
Foreword
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Contents IX
Preface
Radiologists have long been interested in imaging and measuring blood fl ow and in characterising the structure of blood vessels within pathological tissues. In 1927 Egas Moniz described the technique of cerebral angiography using injection of radio-opaque contrast agent combined with conventional radiology. His earlier published work had focused on the physiology of sex, so the fact that dynamic contrast imaging was able to divert him is a testament to the excitement intrinsic to the topic. Perhaps it is worrying that he later went on to invent the technique of prefrontal lobotomy – one can only hope that it was not his frustration with dynamic contrast imaging that drove him to it.
More seriously, it soon became obvious that dynamic contrast imaging using con- ventional radiography (i.e. angiography) was an enormously powerful clinical tool for the identifi cation, localisation and characterisation of a wide range of pathological tis- sues. This was especially true in the head, where alternative radiological tools were not available, and in vascular and malignant lesions. The angiographer became a mainstay in many areas of diagnosis, and numerous articles were subsequently published on the characterisation of tumours based on their angiographic appearances. Even in these early days before the Second World War it was clear that classifying tumours based on the number of blood vessels, the density of capillaries, the rate of blood fl ow and the extent of contrast leakage provided valuable, and at the time unique, information, although these classifi cation methods remained purely subjective.
The development of axial imaging techniques, particularly CT and SPECT, in the second half of the twentieth century offered a range of alternative imaging approaches for lesion diagnosis and classifi cation, and the usage of diagnostic angiography for tissue classifi cation declined. With the widespread adoption of CT in neuroradiology and in oncological diagnosis and grading, the use of vascular patterns for tissue clas- sifi cation became of principally historical interest. In retrospect, the obvious biological importance of vascular structure in pathology meant that it was inevitable this situ- ation would change. This book refl ects the change that has occurred over the past 10 years due to the convergence of a number of important factors. First, and probably most important, was the realisation less than 20 years ago that the development of tumours is entirely dependent on the induction of growth of new blood vessels from existing host vasculature, a process known as angiogenesis. One important concomitant of this was the realisation that histological estimates of vascular structure, such as microvascular density, could provide prognostic information over and above formal histological grad- ing strategies in a number of tumours. Even more important was the gradual elucidation of mechanisms controlling the angiogenic process and the demonstration, in animal models, that anti-angiogenic therapies that target the mechanism or the endothelial cell itself can be highly effective in a wide range of tumours. This led to a demand for sur-
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X Contents
rogate markers of the angiogenic process that could be used in drug development trials, and the use of imaging to characterise the angiogenic vasculature was a clear candidate.
At the same time as this revolution in the understanding of tumour biology there were dramatic leaps in the technology of MRI that made it ideal for this type of study. The ability of MRI to produce images without radiation, using a selectable range of contrast mechanisms and in any arbitrary plane were already providing it with a high profi le in clinical practice. The development of strategies for faster image acquisition offered the opportunity to study time-course changes in vascular beds. This convergence of demand and capability has provided fertile soil for the growth of a virtual subspecialty of angio- genic imaging, of which dynamic contrast-enhanced MRI has become the mainstay.
The technique of dynamic contrast-enhanced MRI is now fi rmly established in drug development, clinical research and clinical practice. Despite this there is a wide choice of image-acquisition protocols, contrast agents and analysis methods which can be over- whelming to the newcomer. In the main this refl ects the fact that, as with so many things in life, all dynamic contrast-enhanced MRI studies represent a series of compromises.
The contrasting demands of the clinical or biological study and the limitations of the image-acquisition equipment and analysis techniques can lead to the use of study proto- cols that seem incompatible or contradictory to the uninitiated. This book is designed to provide the reader with the insight to understand this range of techniques and to allow them to tackle dynamic contrast-enhanced MRI studies with confi dence.
The contributors to this book are an outstanding sample of clinicians and scientists working with dynamic contrast-enhanced MRI and all have international reputations in their fi eld. We feel fortunate that they agreed to contribute to this work and would like to offer our thanks for their efforts and dedication. Finally, we hope that our readers will fi nd this fi eld as exciting as we all do. We look forward to meeting many of you and read- ing your work over the coming years.
Manchester Alan Jackson
David L. Buckley Geoffrey J. M. Parker
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Contents XI
Principles of Dynamic Contrast-Enhanced MRI. . . 1 1 An Introduction to Dynamic Contrast-Enhanced MRI in Oncology
Ingrid S. Gribbestad, Kjell I. Gjesdal, Gunnar Nilsen, Steinar Lundgren, Mari H. B. Hjelstuen, and Alan Jackson . . . 3 2 Contrast Agents for Magnetic Resonance Imaging
Timothy P. L. Roberts and Michael D. Noseworthy . . . 23 3 The Role of Blood Pool Contrast Media in the Study of Tumor Pathophysiology
Laure S. Fournier and Robert C. Brasch. . . 39 4 Quantifi cation of Dynamic Susceptibility Contrast T2* MRI in Oncology
Fernando Calamante . . . 53 5 Measuring Contrast Agent Concentration in T1-Weighted Dynamic
Contrast-Enhanced MRI
David L. Buckley and Geoffrey J. M. Parker. . . 69 6 Tracer Kinetic Modelling for T1-Weighted DCE-MRI
Geoffrey J. M. Parker and David L. Buckley. . . 81 Imaging Techniques. . . 93 7 Imaging Techniques for Dynamic Susceptibility Contrast-Enhanced MRI
Michael Pedersen, Peter van Gelderen, and Chrit T. W. Moonen . . . 95 8 Consensus Recommendations for Aquisition of Dynamic Contrast-Enhanced
MRI Data in Oncology
Jeffrey L. Evelhoch . . . 109 Clinical Applications . . . 115 9 Dynamic Contrast-Enhanced MRI in Cerebral Tumours
Xiao Ping Zhu, Kah Loh Li, and Alan Jackson . . . 117 10 Dynamic Magnetic Resonance Imaging in Breast Tumours
Mei-Lin W. Ah-See and Anwar R. Padhani . . . 145 11 Dynamic Contrast Enhancemed MR Imaging for Predicting Tumor Control
in Patients with Cervical Cancer
Joseph F. Montebello, Nina A. Mayr, William T. C. Yuh, D. Scott McMeekin, Dee H. Wu, and Michael W. Knopp . . . 175
Contents
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XII Contents
12 Dynamic Contrast-Enhanced MRI of Prostate Cancer
Anwar R. Padhani . . . 191 13 Dynamic Contrast-Enhanced MR Imaging in Musculoskeletal Tumors
June S. Taylor and Wilburn E. Reddick . . . 215 14 Dynamic Contrast-Enhanced MRI in the Liver
Alan Jackson and David A. Nicholson . . . 239 Applications. . . 263 15 Use of Dynamic Contrast-Enhanced MRI in Multi-Centre Trials with Particular Reference to Breast Cancer Screening in Women at Genetic Risk
Martin O. Leach . . . 265 16 Applications of Dynamic Contrast-Enhanced MRI in Oncology Drug
Development
Gordon C. Jayson and John C.Waterton. . . 281 Subject Index . . . 299 List of Contributors. . . 309
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An Introduction to Dynamic Contrast Enhanced MRI in Oncology 1
Principles of Dynamic Contrast-Enhanced MRI
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