Fulvio Zaccagna

Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound

ObjectivesThe objectives of this study were to evaluate the efficacy in pain management of magnetic resonance (MR)–guided focused ultrasound for the primary treatment of painful bone metastases and to assess its potential for local control of bone metastases. Materials and MethodsThis was a prospective, single-arm research study with approval from the institutional review board. Eighteen consecutive patients (female, 8; male, 10; mean [SD] age, 62.7 [11.5] years) with painful bone metastases were enrolled. The patients were examined clinically for pain severity and pain interference in accordance with the Brief Pain Inventory-Quality of Life criteria before and at each follow-up visit. Computed tomography and MR imaging were performed before and at 1 and 3 months after the magnetic resonance–guided focused ultrasound treatment. The nonperfused volume (NPV) was calculated to correlate the extension of the ablated pathological tissue in the responder and nonresponder patients. ResultsNo treatment-related adverse events were recorded during the study. The evaluation of pain palliation revealed a statistically significant difference between baseline and follow-up values for pain severity and pain interference (P = 0.001, both evaluations). In the evaluation of local tumor control, we observed increased bone density with restoration of cortical borders in 5 of the 18 patients (27.7%). In accordance with the MD Anderson criteria, complete and partial responses were obtained in 2 of the 18 patients (11.1%) and 4 of the 18 patients (22.2%), respectively. Nonperfused volume values ranged between 20% and 93%. Mean NPV values remained substantially stable after the treatment (P = 0.08). There was no difference in the NPV values between the responder and nonresponder patients (46.7% [24.2%] [25%–90%] versus 45% [24.9%] [20%–93%]; P = 0.7). ConclusionsMagnetic resonance–guided focused ultrasound can be safely and effectively used as the primary treatment of pain palliation in patients with bone metastases and has a potential role in local tumor control.

Whole-Tumor Perfusion CT in Patients with Advanced Lung Adenocarcinoma Treated with Conventional and Antiangiogenetic Chemotherapy: Initial Experience

PURPOSE To determine whether wide-volume perfusion computed tomography (CT) performed with a new generation scanner can allow evaluation of the effects of chemotherapy combined with antiangiogenetic treatment on the whole tumor mass in patients with locally advanced lung adenocarcinoma and to determine if changes in CT numbers correlate with the response to therapy as assessed by conventional response evaluation criteria in solid tumors (RECIST). MATERIALS AND METHODS Forty-five patients with unresectable lung adenocarcinoma underwent perfusion CT before and 40 and 90 days after chemotherapy and antiangiogenetic treatment. RECIST measurements and calculations of blood flow, blood volume, time to peak, and permeability were performed by two independent blinded radiologists. Pearson correlation coefficient was used to assess the correlation between baseline CT numbers. Baseline and follow-up perfusion parameters of the neoplastic lesions were tested overall for statistically significant differences by using the repeated-measures analysis of variance and then were also compared on the basis of the therapy response assessed according to the RECIST criteria. RESULTS Pearson correlation coefficient showed a significant correlation between baseline values of blood flow and blood volume (ρ = 0.48; P = .001), time to peak and permeability (ρ = 0.31; P = .04), time to peak and blood flow (ρ = -0.66; P < .001), and time to peak and blood volume (ρ = -0.39; P = .007). Blood flow, blood volume, and permeability values were higher in responding patients than in the other patients, with a significant difference at second follow-up for blood flow (P = .0001), blood volume (P = .02), and permeability (P = .0001); time to peak was higher in nonresponding patients (P = .012). CONCLUSION Perfusion CT imaging may allow evaluation of lung cancer angiogenesis demonstrating alterations in vascularity following treatment.

Osteoid Osteoma: MR-guided Focused Ultrasound for Entirely Noninvasive Treatment

PURPOSE To determine the preliminary feasibility, safety, and clinical efficacy of magnetic resonance (MR)-guided focused ultrasound for the treatment of painful osteoid osteoma. MATERIALS AND METHODS This prospective institutional review board-approved study involved six consecutive patients (five males and one female; mean age, 21 years) with a diagnosis of osteoid osteoma based on clinical and imaging findings. All patients underwent MR-guided focused ultrasound ablation after providing informed consent. Lesions located in the vertebral body were excluded. The number of sonications and the energy deposition were recorded. Treatment success was determined at 1, 3, and 6 months after treatment. A visual analog scale (VAS) score for pain was used to assess changes in symptoms. MR imaging features of osteoid osteoma (edema, hyperemia, and nidus vascularization) were considered at baseline and at imaging follow-up. RESULTS Treatment was performed with a mean of 4 sonications ± 1.8 (standard deviation), with a mean energy deposition of 866 J ± 211. No treatment- or anesthesia-related complications occurred. The pre- and posttreatment mean VAS scores significantly differed (7.9 ± 1.4 and 0.0 ± 0.0, respectively). At imaging, the edema and hyperemia associated with osteoid osteoma gradually disappeared in all lesions. However, nidus vascularization still persisted after treatment in four of six patients. CONCLUSION This limited series demonstrated that MR-guided focused ultrasound treatment of osteoid osteoma can be performed safely with a high rate of success and without apparent treatment-related morbidity.

Diagnostic accuracy of colour Doppler ultrasonography, CT angiography and blood-pool-enhanced MR angiography in assessing carotid stenosis: a comparative study with DSA in 170 patients

PurposeThis study was undertaken to prospectively evaluate the diagnostic performance of colour Doppler ultrasonography (CDUS), first-pass (FP) and steady-state (SS) contrast-enhanced magnetic resonance angiography (MRA) and computed tomography angiography (CTA) of the carotid arteries using digital subtraction angiography (DSA) as the reference standard.Materials and methodsA total of 170 patients with previous cerebrovascular events and suspected carotid artery stenoses underwent CDUS, blood-pool MRA, CTA and DSA. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for CDUS, FP MRA, SS MRA and CTA. The McNemar and Wilcoxon tests and receiver operating characteristic (ROC) curve analysis were used to determine significant differences (p<0.05) between the diagnostic performances of the four modalities, and the degree of stenosis was compared using linear regression.ResultsA total of 336 carotid bifurcations were studied. The area under the curve (AUC) for degree of stenosis was: CDUS 0.85±0.02, FP MRA 0.982±0.005, SS MRA 0.994±0.002 and CTA 0.997±0.001. AUC analysis showed no statistically significant difference between CTA and MRA (p=0.0174) and a statistically significant difference between CDUS and the other techniques (p<0.001). Plaque morphology analysis showed no significant difference between CTA and SS MRA; a significant difference was seen between CTA and SS MRA versus FP MRA (p=0.04) and CDUS (p=0.038). Plaque ulceration analysis showed a statistically significant difference between MRA and CTA (0.04< p<0.046) versus CDUS (p=0.019).ConclusionsCTA is the most accurate technique for evaluating carotid stenoses, with a slightly better performance than MRA (97% vs. 95% for SS MRA and 92% for FP MRA) and a greater accuracy than CDUS (97% vs. 76%). Blood-pool contrast-enhanced SS sequences offer improved evaluation of degree of stenosis and plaque morphology with accuracy substantially identical to CTA.RiassuntoObiettivoL’obiettivo di questo studio è stato di valutare prospetticamente l’accuratezza dell’eco-color Doppler (ECD), dell’angiografia con risonanza magnetica (angio-RM), ottenuta con sequenze di primo passaggio (PP) ed allo stato stazionario (SS) e dell’angiografia con tomografia computerizzata (angio-TC) nella diagnostica della stenosi carotidea utilizzando l’angiografia con sottrazione digitale (DSA) come metodica di riferimento.Materiali e metodiCentosettanta pazienti sintomatici e con sospetta stenosi carotidea sono stati sottoposti ad ECD, angio-RM, angio-TC e DSA. Accuratezza, sensibilità, specificità, valore predittivo positivo (VPP) e valore predittivo negativo (VPN) sono stati calcolati per ECD, angio-RM ed angio-TC. Le differenze di performance tra le metodiche sono state valutate utilizzando il test di McNemar, il test di Wilcoxon e l’analisi delle curve receiver operating characteristic (ROC) (p<0,05). Inoltre il valore di stenosi attribuito dalla valutazione dell’ECD, dell’angio-RM e dell’angio-TC è stato confrontato con il valore della DSA tramite regressioni lineari.RisultatiSono state valutate 336 biforcazioni carotidee. Per la valutazione del grado di stenosi è stata calcolata l’area sotto la curva (AUC) delle quattro metodiche che è risultata: ECD 0,85±0,02, angio-RM PP=0,982±0,005, angio-RM SS=0,994±0,002 ed angio-TC=0,997±0,001 con sostanziale equivalenza tra angio-TC ed angio-RM (p=0,0174) ed una differenza statisticamente significativatra l’ECD e le altre metodiche (p<0,001). Per la valutazione della morfologia di placca l’analisi delle AUC delle quattro metodiche ha evidenziato una sostanziale equivalenza tra angio-TC ed angio-RM con SS, ma ha evidenziato una lieve differenza di entrambe le metodiche nei confronti dell’angio-RM con PP (p=0,04) e dell’ECD (p=0,038). La valutazione delle ulcere ha evidenziato una differenza statisticamente significativa tra l’angio-RM e l’angio-TC (p=0,04–0,046) e l’ECD (p=0,019).ConclusioniL’angio-TC è la metodica più affidabile con una leggera superiorità diagnostica rispetto all’angio-RM (97% vs. 95% per le sequenze SS e 92% per le sequenze PP) ed una superiorità molto marcata rispetto all’ECD (97% vs. 76%). L’angio-RM con l’utilizzo delle sequenze allo stato stazionario ottenute con mezzo di contrasto intravascolare ad alta relassività tende sostanzialmente ad eguagliare l’accuratezza dell’angio-TC.Purpose. This study was undertaken to prospectively evaluate the diagnostic performance of colour Doppler ultrasonography (CDUS), first-pass (FP) and steady-state (SS) contrast-enhanced magnetic resonance angiography (MRA) and computed tomography angiography (CTA) of the carotid arteries using digital subtraction angiography (DSA) as the reference standard. Materials and methods. A total of 170 patients with previous cerebrovascular events and suspected carotid artery stenoses underwent CDUS, blood-pool MRA, CTA and DSA. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for CDUS, FP MRA, SS MRA and CTA. The McNemar and Wilcoxon tests and receiver operating characteristic (ROC) curve analysis were used to determine significant differences (p<0.05) between the diagnostic performances of the four modalities, and the degree of stenosis was compared using linear regression. Results. A total of 336 carotid bifurcations were studied. The area under the curve (AUC) for degree of stenosis was: CDUS 0.85±0.02, FP MRA 0.982±0.005, SS MRA 0.994±0.002 and CTA 0.997±0.001. AUC analysis showed no statistically significant difference between CTA and MRA (p=0.0174) and a statistically significant difference between CDUS and the other techniques (p<0.001). Plaque morphology analysis showed no significant difference between CTA and SS MRA; a significant difference was Riassunto Obiettivo. L’obiettivo di questo studio e stato di valutare prospetticamente l’accuratezza dell’eco-color Doppler (ECD), dell’angiografia con risonanza magnetica (angio-RM), ottenuta con sequenze di primo passaggio (PP) ed allo stato stazionario (SS) e dell’angiografia con tomografia computerizzata (angio-TC) nella diagnostica della stenosi carotidea utilizzando l’angiografia con sottrazione digitale (DSA) come metodica di riferimento. Materiali e metodi. Centosettanta pazienti sintomatici e con sospetta stenosi carotidea sono stati sottoposti ad ECD, angio-RM, angio-TC e DSA. Accuratezza, sensibilita, specificita, valore predittivo positivo (VPP) e valore predittivo negativo (VPN) sono stati calcolati per ECD, angio-RM ed angio-TC. Le differenze di performance tra le metodiche sono state valutate utilizzando il test di McNemar, il test di Wilcoxon e l’analisi delle curve receiver operating characteristic (ROC) (p<0,05). Inoltre il valore di stenosi attribuito dalla valutazione dell’ECD, dell’angio-RM e dell’angio-TC e stato confrontato con il valore della DSA tramite regressioni lineari. Risultati. Sono state valutate 336 biforcazioni carotidee. Per la valutazione del grado di stenosi e stata calcolata l’area sotto la curva (AUC) delle quattro metodiche che e risultata: ECD 0,85±0,02, angio-RM PP=0,982±0,005, angio-RM SS=0,994±0,002 ed angio-TC=0,997±0,001 con sostanziale equivalenza tra angio-TC ed angio-RM (p=0,0174) ed una differenza statisticamente significativa VASCULAR AND INTERVENTIONAL RADIOLOGY RADIOLOGIA VASCOLARE E INTERVENTISTICA Diagnostic accuracy of colour Doppler ultrasonography, CT angiography and blood-pool-enhanced MR angiography in assessing carotid stenosis: a comparative study with DSA in 170 patients Accuratezza diagnostica nella valutazione della stenosi carotidea di eco-color Doppler, angio-TC ed angio-RM con mezzo di contrasto intravascolare: valutazione comparativa dell’accuratezza diagnostica con DSA in 170 pazienti M. Anzidei1 • A. Napoli1 • F. Zaccagna1 • P. Di Paolo1 • L. Saba2 • B. Cavallo Marincola2 • C. Zini1 G. Cartocci1 • L. Di Mare1 • C. Catalano1 • R. Passariello1 1 Department of Radiological Sciences, University of Rome “La Sapienza”, Viale Regina Elena 324, 00161 Rome, Italy 2 Department of Radiology, Azienda Ospedaliera Universitaria (A.O.U.) Cagliari, Polo di Monserrato, Italy Correspondence to: M. Anzidei, Tel.: +39-06-4455602, Fax: +39-06-490243, e-mail: michele.anzidei@gmail.com Received: 27 July 2010 / Accepted: 7 September 2010 / Published online: 19 March 2011

Peripheral Arterial Occlusive Disease: Diagnostic Performance and Effect on Therapeutic Management of 64-Section CT Angiography

PURPOSE To evaluate the diagnostic performance and effect on therapeutic management of 64-section computed tomographic (CT) angiography in the assessment of steno-occlusive disease in patients with peripheral arterial disease (PAD), with conventional digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS The study protocol was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 212 patients with symptomatic PAD underwent CT angiography and subsequent DSA. For stenosis analysis (≥ 70% stenosis), the arterial bed was divided into 35 segments and evaluated by three readers. Interobserver agreement was determined with generalized κ statistics. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated. In addition, according to the TransAtlantic Inter-Society Consensus (TASC) Document on Management of Peripheral Arterial Disease guidelines, treatment recommendations based on CT angiographic and DSA findings were compared. McNemar test was used to prove significant differences between CT angiographic and DSA findings. RESULTS A total of 7420 arterial segments were evaluated, with excellent agreement between readers (κ ≥ 0.928). On a segmental basis, both sensitivity and specificity for stenosis of 70% or more were at least 96% (3072 of 3113 segments and 4141 of 4279 segments, respectively), with an accuracy of 98% (7213 of 7392 segments), a PPV of 96% (3072 of 3187 segments), an NPV of 99% (3141 of 3187 segments), a PLR of 36.7, and an NLR of 0.013. There was no significant difference between CT angiographic and DSA findings (P = .62-.87). In accordance with TASC II guidelines, 49 patients were referred for conservative treatment, 87 underwent endovascular procedures, 38 underwent surgery, and 17 received hybrid treatment. Therapy recommendations based on CT angiographic findings alone were identical to those based on DSA findings in all but one patient. CONCLUSION The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD. The results can be used to effectively guide therapeutic decision making in these patients.

Liver metastases from colorectal cancer treated with conventional and antiangiogenetic chemotherapy: evaluation with liver computed tomography perfusion and magnetic resonance diffusion-weighted imaging.

Objective The objectives of the study were to determine whether perfusion computed tomography (CT-p) and magnetic resonance diffusion-weighted imaging (MR-DWI) can allow evaluation of the effects of chemotherapy combined with antiangiogenetic treatment on liver metastases in patients with advanced colorectal cancer and to determine if changes in CT-p and MR-DWI correlate with the response to therapy as assessed by conventional Response Evaluation Criteria in Solid Tumors (RECIST). Methods Eighteen patients with liver metastases from colorectal cancer underwent CT-p and MR-DWI before and 6 months after chemotherapy and antiangiogenetic treatment. Lesions were classified according to RECIST criteria (complete response [CR], partial response [PR], stable disease [SD], and progressive disease) and calculations of CT-p parameters including blood flow (BF), blood volume (BV), capillary permeability (CP), and MR-DWI apparent diffusion coefficient (ADC) values were performed; RECIST, CT-p, and MR-DWI measurements at baseline and follow-up were tested for statistically significant differences using the paired-samples t test. Baseline and follow-up perfusion parameters of the lesions were also compared on the basis of therapy response assessed by RECIST criteria using independent-samples t test. P < 0.05 was considered indicative of a statistically significant difference for all statistical test. Results Six patients (6/18; 33.3%) were classified as PR (Fig. 1), and the remaining 12 (12/18; 66.7%) were classified as SD. On a per-lesion basis, 2 (2/32; 6.3%) cannot be identified at follow-up, 6 (6/32; 18.8%) showed a decrease in size of more than 30%, and 24 (24/32; 75%) were substantially stable in size. No cases of progressive disease were demonstrated at follow-up. No statistically significant differences were demonstrated between PR, CR, and SD lesions for BF (P = 0.19), BV (P = 0.14), and ADC (P = 0.68) measurements, whereas CP was significantly higher in CR and PR lesions (P = 0.038). Considering differences between baseline and follow-up values, no statistically significant differences were noted between PR and CR lesions versus SD lesions for CT-p values (BF: P = 0.77; BV: P = 0.15; CP: P = 0.64). A statistically significant difference between PR and CR lesions and SD lesions was noted for ADC values (P = 0.047). Conclusion Both CT-p and MR-DWI can detect therapy-induced modifications in lesion vascularization before significant changes in size are evident.

High-resolution steady state magnetic resonance angiography of the carotid arteries: Are intravascular agents necessary?: Feasibility and preliminary experience with gadobenate dimeglumine

Purpose:To prospectively evaluate the potential of gadobenate dimeglumine for high-resolution steady-state (SS) contrast-enhanced magnetic resonance angiography (CE-MRA) of the carotid arteries as an adjunct to conventional first-pass (FP) MRA, with computed tomography angiography (CTA) and digital subtraction angiography (DSA) as reference. Materials and Methods:Institutional ethics committee approval and written informed consent were obtained. Forty consecutive patients underwent conventional FP MRA with 15 mL gadobenate dimeglumine, using a conventional 3D FLASH sequence (14 sec acquisition time). Immediately afterward, SS images were obtained using a high resolution coronal 3D FLASH sequence (240 sec acquisition time). All patients also underwent CTA and conventional DSA within 8 ± 3 days. Three experienced radiologists assessed FP and SS image quality and calculated sensitivity, specificity, accuracy, and predictive values for stenosis grade and length, plaque morphology, and tandem lesions using DSA as reference. Detected stenoses were quantified and compared (Spearman rank correlation coefficient, [R(s)]; McNemar test) with DSA and CTA findings. Inter-read variability was assessed using kappa (&kgr;) statistics. The impact of SS acquisitions on diagnostic confidence and patient management was assessed. Results:MRA FP and SS image quality was excellent in 63 (78.8%) and 46 (57.5%) vessels, adequate in 11 (13.8%) and 20 (25.0%) vessels, and poor in 6 (7.5%) and 14 (17.5%) vessels, respectively. Area under the curve analysis revealed no significant differences between MRA FP, MRA FP + SS, and CTA for the grading of stenoses (P = 0.838; accuracy values of 97.4%, 97.4%, and 98.7%, respectively). Greater accuracy (P < 0.001) was noted for FP + SS images over FP images alone for the assessment of plaque morphology (96.1% for FP + SS images vs. 83.3% for FP). Increased diagnostic confidence was noted for 49 (61.3%) vessels because of additional SS images whereas an impact on final diagnosis was noted in 8 (10%) cases. Good correlation was noted between SS image quality and impact on final diagnosis (R(s) = 0.7; P < 0.0001). Conclusion:SS imaging of the carotid arteries is feasible with gadobenate dimeglumine. The increased spatial resolution attainable allows improved evaluation of stenoses and plaque irregularity, yielding comparable diagnostic performance to that of CTA and DSA.

Diagnostic performance of 64-MDCT and 1.5-T MRI with highresolution sequences in the T staging of gastric cancer: a comparative analysis with histopathology

PurposeThis study was undertaken to compare the accuracy of magnetic resonance (MR) imaging and 64-slice multidetector computed tomography (64-MDCT) in the T staging of gastric carcinoma in comparison with histopathology.Materials and methodsForty patients with an endoscopic diagnosis of gastric carcinoma underwent preoperative MR imaging and 64-MDCT, both of which were performed after i.v. injection of scopolamine and water distension of the stomach. In the MR imaging protocol, we acquired T2-weighted turbo spin-echo (TSE) sequences, true fast imaging steady-state free precession (true-FISP) and gadolinium-enhanced T1-weighted volumetric interpolated breath-hold examination (VIBE) 3D sequences. Contrastenhanced CT scans were obtained in the arterial and venous phases. Two groups of radiologists independently reviewed the MR and 64-MDCT images. The results were compared with pathology findings.ResultsIn the evaluation of T stage, 64-MDCT had 82.5% and MR imaging had 80% sensitivity. Accuracy of MR imaging was slightly higher than that of 64-MDCT in identifying T1 lesions (50% vs 37.5%), whereas the accuracy of 64-MDCT was higher in differentiating T2 lesions (81.2% vs 68.7%). The accuracy of MR imaging and 64-MDCT did not differ significantly in the evaluation of T3-T4 lesions (p>0.05). Understaging was observed in 20% of cases with MR imaging and in 17.5% with 64-MDCT.ConclusionsMR imaging and 64-MDCT accuracy levels did not differ in advanced stages of disease, whereas MR imaging was superior in identifying early stages of gastric cancer and can be considered a valid alternative to MDCT in clinical practice.RiassuntoObiettivoScopo di questo studio è stato valutare l7’accuratezza diagnostica della RM e della TC nella stadiazione locale del carcinoma gastrico rispetto ai rilievi istologici.Materiali e metodiQuaranta pazienti con diagnosi gastroscopica di carcinoma gastrico sono stati sottoposti a RM e TC per la stadiazione pre-operatoria. Sia la RM che la TC sono state eseguite dopo somministrazione ev di scopolamina e dopo aver disteso lo stomaco con acqua. Le immagini RM sono state acquisite con sequenze turbo spin echo (TSE) T2 pesate ad alta risoluzione, true fast imaging with steady state precession (trueFISP) e volumetric interpolated breath hold examination (VIBE) 3D T1 pesate dopo somministrazione ev di chelati del gadolinio (Gd-BOPTA). Le immagini TC sono state acquisite in fase postcontrastografica artero-portale e venosa e sono state analizzate da due gruppi di radiologi; i risultati sono stati successivamente comparati con l’esame istopatologico.RisultatiNella valutazione globale del parametro T la sensibilità della TC è stata dell’82,5% e quella della RM è stata dell’80%. La RM si è rivelata più accurata della TC nella valutazione delle lesioni T1 (50% vs 37,5%), mentre la TC è risultata più affidabile nella valutazione delle lesioni T2 (81,2% vs 68,7%). L’accuratezza diagnostica delle due metodiche nella valutazione delle lesioni T3–T4 non ha dimostrato differenze statisticamente significative (p>0,05). I casi sottostadiati sono stati il 20% con la RM ed il 17,5% con la TC.ConclusioniI valori di accuratezza della RM e della TC nella stadiazione del carcinoma gastrico non presentano differenze significative. La RM è risultata maggiormente accurata nell’individuazione delle lesioni precoci e del tutto comparabile alla TC nella stadiazione delle lesioni in stadio avanzato, proponendosi quindi come valida alternativa alla TC nella pratica clinica.

Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

OBJECTIVE To determine whether CT-perfusion (CT-p) can be used to evaluate the effects of chemotherapy and anti-angiogenic treatment in patients with non-small-cell lung carcinoma (NSCLC) and whether CT-p and standard therapeutic response assessment (RECIST) data obtained before and after therapy correlate. METHODS 55 patients with unresectable NSCLC underwent CT-p before the beginning of therapy and 50 of them repeated CT-p 90 days after it. Therapeutic protocol included platinum-based doublets plus bevacizumab for non-squamous carcinoma and platinum-based doublets for squamous carcinoma. RECIST measurements and calculations of blood flow (BF), blood volume (BV), time to peak (TTP) and permeability surface (PS) were performed, and baseline and post-treatment measurements were tested for statistically significant differences. Baseline and follow-up perfusion parameters were also compared based on histopathological subclassification (2004 World Health Organization Classification of Tumours) and therapy response assessed by RECIST. RESULTS Tumour histology was consistent with large cell carcinoma in 14/50 (28%) cases, adenocarcinoma in 22/50 (44%) cases and squamous cell carcinoma in the remaining 14/50 (28%) cases. BF and PS differences for all tumours between baseline and post-therapy measurements were significant (p=0.001); no significant changes were found for BV (p=0.3) and TTP (p=0.1). The highest increase of BV was demonstrated in adenocarcinoma (5.2±34.1%), whereas the highest increase of TTP was shown in large cell carcinoma (6.9±22.4%), and the highest decrease of PS was shown in squamous cell carcinoma (-21.5±18.5%). A significant difference between the three histological subtypes was demonstrated only for BV (p<0.007). On the basis of RECIST criteria, 8 (16%) patients were classified as partial response (PR), 2 (4%) as progressive disease (PD) and the remaining 40 (80%) as stable disease (SD). Among PR, a decrease of both BF (18±9.6%) and BV (12.6±9.2%) were observed; TTP increased in 3 (37.5%) cases, and PS decreased in 6 (75%) cases. SD patients showed an increase of BF, BV, TTP and PS in 6 (15%), 21 (52.5%), 23 (57.5%) and 2 (5%) cases, respectively. PD patients demonstrated an increase of BF (26±0.2%), BV (2.7±0.1%) and TTP (3.1±0.8%) while only PS decreased (23±0.2%). CONCLUSION CT-p can adequately evaluate therapy-induced alterations in NSCLC, and perfusion parameters correlate with therapy response assessment performed with RECIST criteria. ADVANCES IN KNOWLEDGE Evaluating perfusional parameters, CT-p can demonstrate therapy-induced changes in patients with different types of lung cancer and identify response to treatment with excellent agreement to RECIST measurements.

First-pass and high-resolution steady-state magnetic resonance angiography of the peripheral arteries with gadobenate dimeglumine: an assessment of feasibility and diagnostic performance.

Purpose:To assess the feasibility of combined first-pass (FP) and steady-state (SS) contrast-enhanced magnetic resonance angiography (MRA) of the peripheral arteries with gadobenate dimeglumine (MultiHance) and to evaluate diagnostic performance relative to digital subtraction angiography (DSA). Materials and Methods:A total of 35 patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent FP MRA (repetition time [TR]/echo time [TE]/flip angle [FA]/acquisition time [TA] = 3.5/1.2/30°/14s) at 1.5T after intravenous injection of 10 mL of gadobenate dimeglumine. Thereafter, SS imaging of the calf (TR/TE/FA/TA = 7.5/2.3/20°/40–130s) and femoropopliteal (TR/TE/FA/TA = 7.5/2.3/18°/130–240s) regions was performed after a second injection of 5 mL of gadobenate dimeglumine. All patients underwent conventional DSA. Three readers reviewed separate FP and FP+SS MRA datasets for image quality and presence/absence of clinically relevant PAOD. A fourth independent observer evaluated DSA images. The diagnostic performance (sensitivity, specificity, positive and negative predictive values) achieved with each dataset was determined and compared. Inter-reader agreement was assessed using kappa statistics. Results:The image quality of 134 of 140 vascular regions was optimal or adequate on SS MRA. Inter-reader agreement was good to very good for assessments of FP (&kgr; = 0.725) and combined FP+SS images (&kgr; = 0.866). SS images improved diagnostic confidence in 34 (48.6%) femoropoliteal and 46 (65.7%) crural regions and altered final diagnosis in 8 (11.4%) and 10 (14.3%) regions, respectively. Global diagnostic accuracy increased from 92.9% on FP images to 95.9% on FP+SS images, with significant (P = 0.0384) improvement in the crural region. Conclusion:SS MRA of the peripheral arteries is feasible with gadobenate dimeglumine and potentially improves diagnostic performance in patients with symptomatic PAOD.