PROS & CONS OF USING MRI, CT, US, PET/CT TO ASSESS RESPONSE & PROGRESSION

KLINIK UND POLIKLINIK FÜR RADIOLOGIE PROS & CONS OF USING MRI, CT, US, PET/CT TO ASSESS RESPONSE & PROGRESSION JENS RICKE & FREDERIK STROBL

RESPONSE ASSESSMENT: IMPLICATIONS For the Patients How long do I live? For the physician Do I have to modify my therapy? Study endpoints Is the drug active? The problem: imaging is just a surrogate The only answer is the fate of the patient ( Survival ) KLINIK UND POLIKLINIK FÜR RADIOLOGIE

TECHNOLOGIES FOR RESPONSE ASSESSMENT Morphological imaging and functional imaging KLINIK UND POLIKLINIK FÜR RADIOLOGIE

RESPONSE CRITERIA (SOLID TUMORS) WHO (1981) RECIST (2000) Target lesions: 5 per organ, 10 max RECIST 1.1 (2009) Target lesions: 2 per organ, 5 max KLINIK UND POLIKLINIK FÜR RADIOLOGIE

BEST RESPONSE WHO/RECIST Therasse J NCI 2000 KLINIK UND POLIKLINIK FÜR RADIOLOGIE

The measurement of tumor to define response 16 experienced oncologist randomly measuring 12 spheres (1.8-14.5 cm) by palpation 0.5 inches rubber skin cover for lymph nodes 1.5 inches rubber skin cover for abdominal masses < 50% reduction to > 25% increase 50% reduction 25% increase (6.8% false positive) (17.8% false negatives) The basis for the seminal WHO criteria and RECIST Slide courtesy of J. Bruix, Barcelona CG Moertel and JA Hanley. Cancer 1976;38:388-394

KLINIK UND POLIKLINIK FÜR RADIOLOGIE

Diffusion Sequenz TR TE Flip FS Vo x e l Matrix SD n Ze it RL/AP (F OV 350 x 320) DWI-EPI 1600 ms 60 ms 90 SPIR 2.5 x 2.5 140 x 128 6 mm 30 1.30 min 4.30 min b = 0/50/500 [ x 10-3 mm 2 /sec] [Magnete, Fluss und Artefakte, Siemens Manual ]

Diffusion b=0 b=50 b=500

Diffusion ADC & T2 shine through ln S m = ADC ] b-wert ln [S b /S o ] = - b x ADC [2.6 x10-3 ]

DWI and therapy monitoring INSTITUT FÜR KLINISCHE RADIOLOGIE CAMPUS GROßHADERN Wilhelm et al. 2014

Case 1 Ovarian carcinoma 42 yo female with ovarian carcinoma and increasing CA125 18 F-FDG PET/CT Lymph node metastasis adjacent to sternum on the left INSTITUT FÜR KLINISCHE RADIOLOGIE

ENDOMETRIAL CANCER 22 PROJEKTGRUPPE ZERTIFIZIERUNG DER KD

DIAGNOSTIC VALUE OF 18F-FDG PET/CT IN RECURRENCE OF ENDOMETRIAL CANCER INSTITUT FÜR KLINISCHE RADIOLOGIE

BASELINE PROGNOSTIC FACTORS: DIFFUSION- WEIGHTED-IMAGING PREOPERATIVELY INSTITUT FÜR KLINISCHE RADIOLOGIE

CERVICAL CANCER 29 PROJEKTGRUPPE ZERTIFIZIERUNG DER KD

METAANALYSIS INSTITUT FÜR KLINISCHE RADIOLOGIE

INSTITUT FÜR KLINISCHE RADIOLOGIE

MRI FOR FOLLOW-UP OF CHEMORADIOTHERAPY IN LOCALLY ADVANCED CERVICAL CANCER INSTITUT FÜR KLINISCHE RADIOLOGIE

METAANALYSIS INSTITUT FÜR KLINISCHE RADIOLOGIE

MRI FOR FOLLOW-UP OF CHEMORADIOTHERAPY IN LOCALLY ADVANCED CERVICAL CANCER INSTITUT FÜR KLINISCHE RADIOLOGIE

ANALYSES OF PRETREATMENT ADC VALUES INSTITUT FÜR KLINISCHE RADIOLOGIE

OVARIAN CANCER 41 PROJEKTGRUPPE ZERTIFIZIERUNG DER KD

J Comput Assist Tomogr. 2007 Nov-Dec;31(6):868-75 INSTITUT FÜR KLINISCHE RADIOLOGIE

OVARIAN CANCER: PERITONEAL RECURRENCE J Comput Assist Tomogr. 2007 Nov-Dec;31(6):868-75 INSTITUT FÜR KLINISCHE RADIOLOGIE

RADIOMICS Dania Daye, RSNA 2017 KLINIK UND POLIKLINIK FÜR Deutsche RADIOLOGIE Akademie für Mikrotherapie

Dania Daye, RSNA 2017 KLINIK UND POLIKLINIK FÜR Deutsche RADIOLOGIE Akademie für Mikrotherapie

TAKE HOME Technologies and therapy monitoring Recurrence in (most) solid tumors: PET-CT Ovarian: include DWI-MRI Therapy monitoring: Morphologic imaging (standard) + DWI-MRI Immunotherapy and Pseudoprogression: irecist Do you tell your Radiologist about the true baseline and course of therapy? Morphological imaging will go in the [far] future To be replaced by functional imaging and data science Diffusion MRI include in future trials! and Radiomics KLINIK UND POLIKLINIK FÜR RADIOLOGIE

DANKE! jens.ricke@med.lmu.de Radiologie LMU