Research Presentation Session: Oncologic Imaging

RPS 2416 - Imaging advances in oncology: from diagnosis to therapy

March 3, 11:30 - 12:30 CET

7 min
An external validation study of the Birmingham atypical cartilage tumour imaging protocol for the management of solitary central cartilage tumours of the proximal humerus and around the knee
Thomas Van Den Berghe, Lochristi / Belgium
Author Block: T. Van Den Berghe, F. Delbare, E. Candries, M. Lejoly, C. Algoet, F. Laloo, W. Huysse, D. Creytens, K. Verstraete; Ghent/BE
Purpose: This study aimed to externally validate the Birmingham atypical cartilage tumour imaging protocol (BACTIP) recommendations for differentiation and follow-up of central cartilage tumours (CCTs) of the proximal humerus, distal femur and proximal tibia and to recommend BACTIP adaptations to reduce diagnostic delay in high-risk CCTs.
Methods or Background: MRIs of 123 patients (45±11 years, 37 men) with an untreated CCT with MRI follow-up (n=62) or histopathological confirmation (n=61) were retrospectively and consecutively included and categorised following the BACTIP (2003-2020/Ghent University Hospital/Belgium). Tumour length and endosteal scalloping differences between enchondroma, atypical cartilaginous tumour (ACT) and high-grade chondrosarcoma (CS II/III/dedifferentiated) were evaluated. ROC-curve analysis for differentiating benign from malignant CCTs and for evaluating the BACTIP was performed.
Results or Findings: For lesion length and endosteal scalloping, ROC-AUCs were poor and fair-excellent, respectively, for differentiating between different CCT groups (0.59-0.69 versus 0.73-0.91). The diagnostic performance of endosteal scalloping and the BACTIP was higher than that of lesion length. A 1° endosteal scalloping angle cut-off differentiated the enchondroma group from the ACT/high-grade CS group with a sensitivity of 90%, reducing diagnostic delay. However, the specificity was only 29%, inducing overmedicalisation with excessive follow-up. ROC-AUC of the BACTIP was poor for differentiating enchondroma from ACT (ROC-AUC=0.69; 95%CI=0.51-0.87; p=0.041) and fair-good for differentiation between other CCT groups (ROC-AUC=0.72-0.81). BACTIP recommendations were incorrect/unsafe in five ACTs and one CS II which were all discharged from follow-up, inducing diagnostic delay. Eleven enchondromas received unnecessary referral and/or follow-up.
Conclusion: Although promising as a useful tool for the management and follow-up of CCTs of the proximal humerus, distal femur and proximal tibia, five ACTs and one CS grade II were discharged, inducing diagnostic delay, which could be reduced by adapting BACTIP cut-off values.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the IRB (BC-08631).
7 min
Evaluation of the value of (dynamic) contrast-enhanced MRI for the diagnosis and follow-up of central cartilaginous tumours
Thomas Van Den Berghe, Lochristi / Belgium
Author Block: T. Van Den Berghe, M. Lejoly, F. Delbare, W. Huysse, D. Creytens, G. M. Sys, K. Verstraete; Ghent/BE
Purpose: The objective of this study was to evaluate the value of (dynamic) contrast-enhanced MRI for the diagnosis and follow-up of central cartilaginous tumours of the proximal humerus, distal femur and proximal tibia.
Methods or Background: Ninety-seven patients (44±11 years, 31 men) with a central cartilaginous tumour (histopathologically proven or more than two years follow-up (5±3 years)) were retrospectively and consecutively included. Thickness of the enhancing rim and dynamic contrast-enhanced MRI parameters were calculated. Tumour volumes were calculated for the assessment of tumour growth. Significant differences between enchondromas, atypical cartilaginous tumours, high-grade chondrosarcomas, tumours with and without growth at follow-up were searched for and ROC-curves were analysed.
Results or Findings: There was a significant difference (p=0.015) in enhancing rim thickness between high-grade chondrosarcomas and other diagnostic central cartilaginous tumour groups. A ROC-curve with an AUC of 0.89 and cut-off value of 1.2 mm had a sensitivity of 100% and a specificity of 64% to identify high-grade chondrosarcomas. A significant correlation was found between the relative maximal enhancement of the whole tumour on dynamic contrast-enhanced MRI and the absolute growth rate (ml/year) (ρ=0.75; p<0.001). Lesions with a relative maximal enhancement <1 compared to muscle remained stable or showed regression during follow-up (mean -0.1±0.3 ml/year). Lesions with a relative maximal enhancement between one and two showed little growth (mean +0.2±0.2 ml/year), and lesions with a relative maximal enhancement >2 had the highest growth rate (mean +0.4±0.2 ml/year).
Conclusion: A thick enhancing rim of more than 1.2 mm has a high sensitivity to detect high-grade chondrosarcomas. The higher the relative maximal enhancement of the whole tumour on dynamic contrast-enhanced MRI, the higher the growth rate of a central cartilaginous tumour.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the IRB (BC-08631).
7 min
Changes in Deauville scores on delayed imaging with total-body 18F-FDG PET/CT scans: any association with outcome?
Yasser Gaber Abdelhafez, Sacramento / United States
Author Block: Y. G. Abdelhafez, C. Mingels, H. Nalbant, M. Rokni, F. Sen, R. Badawi, N. S. Esteghamat, J. Tuscano, L. Nardo; Sacramento, CA/US
Purpose: Deauville score (DS) relies on comparing lesion uptake to reference tissues (liver and blood pool) that demonstrate tracer washout over time. We aimed to evaluate DS changes for 18F-FDG total-body PET/CT scans acquired at 2-hr compared to 1-hr post-injection and the association of these changes with clinical outcome data.
Methods or Background: Forty-five patients (54.3±19.1 years; 25 females) with lymphoma (Hodgkin's lymphoma=12; non-Hodgkin's=33 [11 DLBCL, 13 follicular, and 9 marginal-zone]) underwent a total of 64 18F-FDG total-body PET/CT studies (36 staging/restaging, 22 interim, and 6 end-of-treatment [EOT] scans). All studies were acquired as dual-timepoint total-body scans at 1- and 2-hr post-injection. Changes in scan-based DSs between the two timepoints were recorded by a single radiologist blinded to clinical notes. Interim and EOT scans were evaluated for therapy response according to Lugano criteria. Follow-up data (progression and/or all-cause mortality) was collected.
Results or Findings: The median follow-up from diagnosis was 32.6 months. A total of 15 out of 45 patients progressed, seven of them died. One patient (2%) was upstaged from DS3 on 1-hr to DS4 on 2-hr interim PET scan. This upstaging would have changed the response category from complete to partial metabolic response. Subsequent follow-up revealed complete response.
Conclusion: DSs assessed on delayed 2-hr 18F-FDG total-body PET/CT scans may potentially change the response category of a small fraction (~2%) of lymphoma patients. Further validation of these initial findings in a larger cohort, with multiple readers, and stratification according to the pathologic subtypes is ongoing.
Limitations: Small cohort limits this study.
Funding for this study: US National Institutes of Health R01-CA249422; R01-CA206187 funded with this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This single-centre study was approved by the Institutional Review Board at University of California Davis (IRB#1470016) and all included subjects signed an informed consent form.
7 min
Relaxation-compensated CEST imaging of the APT has greater predictive value in patients with glioma at baseline before radiotherapy, compared to imaging of the APTw and ssMT at 3T
Nikolaus von Knebel Doeberitz, Heidelberg / Germany
Author Block: N. von Knebel Doeberitz, F. Kroh, S. Graß, L. König, C. Bauspieß, M. E. Ladd, H-P. Schlemmer, A. Korzowski, D. Paech; Heidelberg/DE
Purpose: Chemical exchange saturation transfer (CEST) MRI can be applied to use endogenous compounds as peptides and semi-solid macromolecules as imaging contrasts. However, CEST-contrasts are heavily dependent on the field strength and the applied metrics for contrast reconstruction from the Z-spectrum. Therefore, for the purpose of this study was to compare the predictive value of different CEST contrast of the amid proton transfer (APT) and semi-solid magnetization transfer (ssMT) in a larger clinical cohort of patients with glioma before radiotherapy at 3T.
Methods or Background: Seventy-nine patients who had received biopsy or surgery for diffuse glioma prospectively underwent CEST imaging of the APT and ssMT at the baseline MRI before radiotherapy, applying Lorentzian-fit- and asymmetry-based reconstruction metrics first described by Zou et al. (APTw_asym), Mehrabian et al. (MTconst) and Zaiß et al. (APT_MTRRex and MT_MTRRex). Contrast-enhancing (CE) and whole tumour (WT) volumes were segmented on contrast-enhanced T1w-CE and T2w-FLAIR images. Therapy response at the first follow-up four to six weeks after the completion of radiotherapy and progression-free survival (PFS) were assessed by longitudinal follow-up according to the response assessment in neuro-oncology (RANO) criteria. Statistical testing included receiver-operator-characteristic (ROC) and Kaplan-Meier analyses.
Results or Findings: Imaging of the APT_MTRRex (CE: AUC=0.73, p=0.01) and MT_MTRRex (CE: AUC=0.67, p=0.05) was associated with therapy response. The APT_MTRRex (WT: HR=2.75, p<0.01) was furthermore associated with PFS. Imaging of the APTw_asym and MTconst were not associated with any outcome.
Conclusion: Relaxation-compensated CEST imaging of the APT has great predictive value in patients with glioma at the baseline MRI at 3T, and might help to inform clinical decision making in the future.
Limitations: Single centre study. Median overall survival was not reached at the time of data analysis (05/07/2023), leading to limitations.
Funding for this study: German Cancer Research Foundation (Grant No. 445704496) funded this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The local institutional review board committee approved this prospective study. Written informed consent was obtained from each participant prior to study inclusion.
7 min
Therapeutic application of single-atom iron nanozymes in magnetic resonance imaging, synergistic chemodynamic therapy, and photothermal therapy in colorectal carcinoma
Jun Zhang, Shanghai / China
Author Block: J. Zhang, L. Wang; Shanghai/CN
Purpose: This study was aimed at designing a nanotherapeutic strategy that incorporates nanoscale chemodynamic therapy while integrating efficient photothermal conversion performance in colorectal cancer treatment.
Methods or Background: We constructed a novel and simple Fe single-atom coordinated N-doped porous carbon nanozyme (FeCA SAzyme) at the atomic level for catalytic anti-tumour treatment coupled with photothermal therapy. The catalytic performance of FeCA SAzyme was verified by cell experiment and animal experiment.
Results or Findings: The FeCA SAzymes exhibited a superior catalytic kinetic Km value (4.62 mM) compared with natural catalase and other reported nanozymes. In addition, the dual-mode strategy of chemodynamic therapy in combination with photothermal therapy further increased the tumour treatment effect. Moreover, the FeCA SAzymes exhibited favourable performance in magnetic resonance imaging. The r2 value of FeCA SAzymes was approximately 149.8 mM-1S-1, which highlighting their potential as negative-contrast media for imaging purposes.
Conclusion: Our study shows that single-atom nanozymes can increase the Fenton reaction at the atomic level, which provides a new research direction for exploring multi-modal biological applications in tumour therapy and diagnosis.
Limitations: No limitations identified for this study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Fudan University Ethics committee approved this study.
7 min
The value of DLSCT-based multi-parameters for assessment of VETC and MVI in hepatocellular carcinoma
Anqi Li, Guangzhou / China
Author Block: A. Li1, M. Luo1, M. Li1, H. You1, J. Zhou1, W. Deng2, X. Yu2, Z. Zhang2, J. Wang1; 1Guangzhou/CN, 2Shanghai/CN
Purpose: The objective of this study was to explore the diagnostic performance of multi-parameters derived from dual-layer spectral detector CT (DLSCT) to preoperatively identify vessels encapsulating tumour clusters (VETC) and microvascular invasion (MVI) of hepatocellular carcinoma (HCC).
Methods or Background: Patients with histopathology-confirmed HCC who preoperatively underwent dual-phase contrast-enhanced DLSCT were enrolled between May 2020 and June 2022 in this retrospective single-center study. Multi-parameters, including effective atomic number (Zeff), electron density (ED), iodine density (ID), and the slope of the spectral attenuation curve (λ) were obtained from DLSCT in arterial-phase (AP) and portal-venous-phase (PVP). The parameters of Zeff, ID and ED were then normalised with three different normalization approaches, N1=tumor-to-aorta ratio; N2=tumor-to-liver parenchyma; N3=[tumourPVP-tumourAP]-to-tumourAP ratio. The diagnostic performance of multi-parameters was analyzed by the area under the receiver operating characteristic curve (AUC), and was compared using the Delong test.
Results or Findings: There were 122 HCC patients (positive/negative VETC, n=57/65; positive/negative MVI, n=54/68). Compared with ZeffAP (AUC:0.64) and IDAP (AUC:0.64), the performance of N1-ZeffAP (AUC:0.77) and N1-IDAP (AUC:0.70) for VETC diagnosis of HCC had been significantly improved, respectively (both p<0.05), and N1-ZeffAP had very high sensitivity (98.2%). The AUCs of N1-ZeffPVP (0.68) and N1-IDPVP (0.70), N2-ZeffPVP (0.71) and N2-IDPVP (0.71) for MVI diagnosis of HCC non-significantly increased compared with ZeffPVP (0.65) and IDPVP (0.65) (all p>0.05). N1-EDPVP showed high sensitivity (88.2%) and N1-IDPVP showed high specificity (88.9%) for identifying MVI. λAP was used to diagnose VETC with good sensitivity (84.2%), and λPVP was used to diagnose MVI with good specificity (79.6%).
Conclusion: Multi-parameters derived from dual-phase contrast-enhanced DLSCT could be the promising biomarkers for noninvasively identifying VETC and MVI of HCC, and the tumour-to-aorta ratio is recommended for the normalization of parameters to improve the diagnostic performance.
Limitations: Not applicable for this study.
Funding for this study: This work was supported by the National Natural Science Foundation of China grant (82271973, JW; 91959118, Jin Wang), Guangdong Basic and Applied Research Foundation (2021A1515010582, Jin Wang), Key Research and Development Program of Guangdong Province (2019B020235002, Jin Wang), China International Medical Foundation SKY Research Fund for Medical Imaging (Z-2014-07-2101 and Z-2014-07-1912-15, Jin Wang) and Clinical Research Foundation of the 3rd Affiliated Hospital of Sun Yat-Sen University (YHJH201901, Jin Wang)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Not applicable for this study.
7 min
Node reporting and data system 1.0 (Node-RADS): validation on abdominal lymph nodes
Elena Grimaldi, Milan / Italy
Author Block: E. Grimaldi1, F. Rigiroli2, O. Hamam2, B. Aslan2, A. Brook2, B. Siewert2, S. Nougaret2, O. R. Brook2; 1Milan/IT, 2Boston, MA/US
Purpose: The aim of the study is to validate the Node Reporting and Data System 1.0 (Node-RADS) by assigning biopsied abdominal lymph nodes to one of the Node-RADS categories and calculating malignancy rates for each.
Methods or Background: This IRB-approved, HIPAA-compliant study included 505 consecutive patients who underwent CT-guided biopsy of abdominal lymph nodes between May 2016 and July 2023 at a single tertiary institution. A third-year radiology resident, blinded to pathology results, reviewed the lymph node’s size and configuration on a pre-procedure contrast-enhanced CT or MRI study acquired within 30 days prior to biopsy. This resulted in a malignancy suspicion score summarized in five Node-RADS categories: “1-very low”; “2-low”; “3-equivocal”; “4-high”; “5-very high”. This score was then compared to the pathology result. Clinical or imaging follow-up was used as the reference standard for inconclusive pathology results.
Results or Findings: Five hundred and five consecutive CT-guided abdominal lymph node biopsies were included (median age 66 years, IQR 58-75 years), of which 326/505 (65%) were retroperitoneal, 123/505 (24%) pelvic and 56/505 (11%) mesenteric lymph nodes. 10/505 (2%) lymph nodes were classified as Node-RADS 2, 61/505 (12%) Node-RADS 3, 66/505 (13%) Node-RADS 4 and 367/505 (73%) Node-RADS 5. Pathology was the reference standard in 476/505 (94%) patients, imaging follow-up in 25/505 (5%), and clinical follow-up in 4/505 (1%). Malignancy rates were 1/10 (10%, 95% CI: 0%-31%) of Node-RADS 2, 26/61 (43%, 95%CI: 30%-55%) of Node-RADS 3, 53/66 (80%, 95%CI: 71%-90%) of Node-RADS 4, and 332/367 (90%, 95% CI: 87%-93%) of Node-RADS 5.
Conclusion: Node-RADS categories were validated in the largest cohort of abdominal lymphadenopathies with pathology. This system can provide a numeric risk score for malignant involvement of abdominal lymph nodes.
Limitations: The limitation is that the inter-reader agreement is still under evaluation.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by IRB (reference number: 2018P000099).
7 min
Evaluation of sarcopenia as predicting factor of perioperative chemotherapy toxicity and response to treatment in patients with locally advanced gastric cancer
Stefano Nardacci, Rome / Italy
Author Block: S. Nardacci, M. Zerunian, G. Arrivi, C. Santangeli, F. Mazzuca, D. De Santis, D. Caruso, A. Laghi; Rome/IT
Purpose: In the management of patients with locally advanced gastric cancer, treatment is gastrectomy with perioperative chemotherapy (p-ChT). Not all patients tolerate chemotherapy, therefore it would be useful to identify a non-invasive biomarker to predict the outcome of p-CHT. Thus, we aimed to test the role of sarcopenia in predicting p-ChT toxicity and treatment response in patients with gastric cancer.
Methods or Background: Patients with advanced gastric cancer who underwent contrast-enhanced CT both before and after the p-ChT and had images available were retrospectively enrolled. Twenty-nine patients were enrolled, six excluded for CT unavailability. Skeletal muscle mass (SMM) was assessed by manually segmented specific abdominal body region on unenhanced CT at L3 lumbar vertebra level with a dedicated software (ImageJ). Skeletal muscle index was obtained by normalizing SMM for patient height in metres squared. SMI<52.4 and 38.5 cm2/m2 was considered as sarcopenic for male and female respectively. Data on haematological, gastrointestinal and neurological toxicity and response to treatment were recorded. Rank correlation and receiver operating characteristics (ROC) curve were obtained to assess sarcopenia status performance for p-Cht toxicity and response to treatment prediction; P<0.05 considered significant.
Results or Findings: Among the toxicities of p-Cht, sarcopenia showed significant ability to predict both haematologic and neurologic toxicity (AUC=0.929 and 0.972 respectively, all P<0.001). In addition, sarcopenia was shown to be a significant predictor of postoperative complications in the sarcopenic population (p=0.033). Gastrointestinal toxicity and response therapy did not show significant results (P>0.05).
Conclusion: Evaluation of sarcopenia might represent an important non-invasive imaging biomarker to predict haematologic and neurologic toxicity in patients with gastric cancer before the beginning of chemotherapy to allow a personalised treatment management.
Limitations: The limitations of the study are the poor population and the manual segmentation method.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study is retrospective hence, no ethical approval was required.

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