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Perfusion MDCT Enables Early Detection of Therapeutic Response to Antiangiogenic Therapy

¹ Minimally Invasive Tumor Therapy Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
² Renal Cancer Program, Dana Farber/Harvard Cancer Center, Boston, MA.
³ Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd., WCC 308-B, Boston, MA 02215.
⁴ Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
⁵ Department of Pathology, Brigham and Women's Hospital, Boston, MA.

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Perfusion MDCT maps of control group tumors (outlined regions and arrows) show progressive increase in size, volume, and blood flow from days 0–14. Images obtained at days 0 (A), 4, (B), 9 (C), and 14 (D). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion.

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Perfusion MDCT maps of control group tumors (outlined regions and arrows) show progressive increase in size, volume, and blood flow from days 0–14. Images obtained at days 0 (A), 4, (B), 9 (C), and 14 (D). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Perfusion MDCT maps of control group tumors (outlined regions and arrows) show progressive increase in size, volume, and blood flow from days 0–14. Images obtained at days 0 (A), 4, (B), 9 (C), and 14 (D). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Perfusion MDCT maps of control group tumors (outlined regions and arrows) show progressive increase in size, volume, and blood flow from days 0–14. Images obtained at days 0 (A), 4, (B), 9 (C), and 14 (D). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Perfusion CT maps of two rats from sorafenib-treated group show decrease in tumor volume and blood flow from days 0–9. Maps of rat 1 (A–C) and rat 2 (D–F) at days 0 (A and D), 4 (B and E), and 9 (C and F). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion. In addition, these figures show development of rim of increased perfusion (arrows, C and F) in sorafenib-treated tumors despite continued decrease in tumor volume. This could possibly represent early development of tumor resistance to antiangiogenic therapy.

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Perfusion CT maps of two rats from sorafenib-treated group show decrease in tumor volume and blood flow from days 0–9. Maps of rat 1 (A–C) and rat 2 (D–F) at days 0 (A and D), 4 (B and E), and 9 (C and F). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion. In addition, these figures show development of rim of increased perfusion (arrows, C and F) in sorafenib-treated tumors despite continued decrease in tumor volume. This could possibly represent early development of tumor resistance to antiangiogenic therapy.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Perfusion CT maps of two rats from sorafenib-treated group show decrease in tumor volume and blood flow from days 0–9. Maps of rat 1 (A–C) and rat 2 (D–F) at days 0 (A and D), 4 (B and E), and 9 (C and F). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion. In addition, these figures show development of rim of increased perfusion (arrows, C and F) in sorafenib-treated tumors despite continued decrease in tumor volume. This could possibly represent early development of tumor resistance to antiangiogenic therapy.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Perfusion CT maps of two rats from sorafenib-treated group show decrease in tumor volume and blood flow from days 0–9. Maps of rat 1 (A–C) and rat 2 (D–F) at days 0 (A and D), 4 (B and E), and 9 (C and F). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion. In addition, these figures show development of rim of increased perfusion (arrows, C and F) in sorafenib-treated tumors despite continued decrease in tumor volume. This could possibly represent early development of tumor resistance to antiangiogenic therapy.

View larger version (55K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —Perfusion CT maps of two rats from sorafenib-treated group show decrease in tumor volume and blood flow from days 0–9. Maps of rat 1 (A–C) and rat 2 (D–F) at days 0 (A and D), 4 (B and E), and 9 (C and F). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion. In addition, these figures show development of rim of increased perfusion (arrows, C and F) in sorafenib-treated tumors despite continued decrease in tumor volume. This could possibly represent early development of tumor resistance to antiangiogenic therapy.

View larger version (61K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —Perfusion CT maps of two rats from sorafenib-treated group show decrease in tumor volume and blood flow from days 0–9. Maps of rat 1 (A–C) and rat 2 (D–F) at days 0 (A and D), 4 (B and E), and 9 (C and F). Blood flow in each perfusion map is represented in color-coding scheme in rainbow format such that flow of 0 mL/min/100 g is shown in black and maximal blood flow (50 mL/min/100 g) is shown in bright red. Flow values between 0 and 50 mL/min/100 g are represented as varying shades of blue, green, yellow, and red in order of increasing perfusion. In addition, these figures show development of rim of increased perfusion (arrows, C and F) in sorafenib-treated tumors despite continued decrease in tumor volume. This could possibly represent early development of tumor resistance to antiangiogenic therapy.

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Histopathologic correlation (right) of sorafenib-treated tumor with CT map (left). Areas of increased and decreased or absent blood flow (yellow arrows) on perfusion images correspond to viable and nonviable tumor areas (black arrows), respectively, on tissue section.

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