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Three-Dimensional MRI Scans May Offer More Accurate Way to Predict Survival After Chemotherapy for Liver Tumors

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Key Points

  • Specialized 3D MRI  scans were able to precisely measure living and dying tumor tissue and quickly show whether chemotherapy is working.
  • Researchers said that their results are evidence that using 3D MRI before and after treatment is a faster and better tool for predicting patient survival after chemoembolization.

In a series of studies involving 140 American men and women with liver tumors, researchers at Johns Hopkins have used specialized three-dimensional (3D) MRI scans to precisely measure living and dying tumor tissue to quickly show whether highly toxic chemotherapy is working.

The investigators said their findings, presented in San Diego at the Society of Interventional Radiology Annual Scientific Meeting, are the first “proof of principle” that this technology can show tumors in three dimensions and accurately measure tumor viability and death. Early data was also presented at the Radiological Society of North America annual meeting in December 2013.

They also say their results—in patients with either primary liver cancers or metastatic tumors from cancers originating elsewhere in 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, or chemoembolization.

3D MRI

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

The new technology builds on standard 2D methods and uses computer analytics to evaluate the amount of contrast dye absorbed by tumor tissue. The dye is injected into patients before their MRI scan to enhance image production. 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,” said senior investigator Jean-Francois Geschwind, MD, Professor in the Russell H. Morgan Department of Radiology at the Johns Hopkins University School of Medicine and is Kimmel Cancer Center.

Dr. Geschwind said that knowing the true extent of a tumor’s response to chemoembolization is particularly important for patients with moderate to advanced stages of the disease, whose liver tumors might initially be too large or too numerous to surgically remove.

Study Details

In the first study, researchers compared the standard imaging method and the newly developed technology in 17 Baltimore men and women with advanced liver cancer. All patients were treated with surgery or liver transplantation after chemoembolization. The research team used existing MR analysis techniques, as well as the new 3D method to compare the radiologists’ analyses with pathologic review of tumor samples after therapy and surgical removal. According to the researchers , the error margin of the new 3D image analysis was low (≤ 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.

In a series of additional studies, Dr. Geschwind and his team used the standard and new imaging techniques to analyze 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 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 method method, the researchers found that patients who responded well to therapy lived 19 months longer (an average of 42 months) than patients who did not respond well (average, 23-month survival). Standard methods showed slightly less difference in survival (average, 18 months longer) between patients who responded to therapy and those who did not respond.

Faster, More Accurate Way to Assess Outcomes

Dr. Geschwind said the 3D technology’s improved accuracy removes much of the guesswork that now goes into evaluating treatment outcomes. The new assessment takes seconds to perform, he adds, so radiologists can provide faster, almost instantaneous treatment advice.

Funding support for this study was provided by the French Society of Radiology and Philips Research North America, the National Cancer Institute, and the National Center for Research Resources, and the Rolf W. Günther Foundation for Radiology and Radiological Sciences. The software used in the MRI scans was developed at Johns Hopkins and at Philips Research North America, which manufactured some of the MRI devices used in the study.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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