Research Presentation Session: Oncologic Imaging

RPS 2316 - Innovation in cancer research

March 3, 09:30 - 11:00 CET

7 min
Clinical added value of MRI to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): an international multicentre prospective diagnostic accuracy trial
Burak Görgec, Amsterdam / Netherlands
Author Block: B. Görgec1, I. Schrøder-Hansen2, G. Kemmerich2, T. Syversveen2, J. P. Sijberden1, Å. Fretland2, C. Verhoef3, M. G. Besselink1, J. Stoker1; 1Amsterdam/NL, 2Oslo/NO, 3Rotterdam/NL
Purpose: Guidelines are inconclusive on whether contrast enhanced magnetic resonance imaging(ceMRI) should be added routinely to computed tomography(ceCT) in the workup of patients with colorectal liver metastases(CRLM) scheduled for curative liver resection and/or thermal ablation. Although ceMRI is reportedly superior in the detection and characterization of CRLM, its impact on actual clinical patient management is unknown and through this project, we aim to understand that.
Methods or Background: This was an international multicentre prospective incremental diagnostic accuracy trial in patients with primary or recurrent CRLM scheduled for local therapy based on ceCT. All patients had ceCT and liver ceMRI including gadoxetic acid as contrast agent and diffusion-weighted imaging(DWI). Primary outcome was change in the local clinical treatment plan based on liver ceMRI findings. A multidisciplinary blinded expert panel performed a post-hoc analysis.
Results or Findings: Between December 2019, and July 2021, we enrolled 298 patients with CRLM planned for local therapy based on ceCT. A change in the local clinical treatment plan based on liver ceMRI findings was observed in 92/298 patients(31%;95% CI: 26% to 36%). This concerned 40 patients(13%) requiring more extensive local therapy, 11 patients(3.7%) requiring less extensive local therapy, and 34 patients(11.4%) in whom the indication for curative-intent local therapy was revoked, including 26 patients(8.7%) with too extensive disease and 8 patients(2.7%) with benign lesions on liver ceMRI(confirmed by follow-up). Upon assessment by the expert panel, liver ceMRI changed clinical management in 101/297 patients(34%;95% CI: 29% to 40%).
Conclusion: Liver ceMRI changed the local treatment plan in one third of patients scheduled for intervention for CRLM based on ceCT imaging.
Limitations: First, primary outcome change in local treatment plan could not be blinded for physicians. Second, ceCT- and ceMRI-scan protocols were not completely standardized between participating centres.
Funding for this study: This study was funded by the The Dutch Cancer Society and Bayer AG – Pharmaceuticals.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The Medical Ethical Review Board (METc) of the Amsterdam UMC, location AMC, has assessed primarily that the CAMINO study was NOT subject to the Medical Research Involving Human Subjects Act (WMO).
7 min
Diagnostic value of very early diffusion weighted changes at MRI after single-dose ablative radiation therapy (SDART) for organ-confined prostate cancer
Cammillo Roberto Giovanni Leopoldo Oreste Massimiliano Talei Franzesi, Milan / Italy
Author Block: C. R. G. L. O. M. Talei Franzesi, D. G. Gandola, P. N. Franco, C. Maino, D. Panizza, R. Lucchini, S. Arcangeli, R. Corso, D. Ippolito; Milan/IT
Purpose: The objective of this study was to investigate diagnostic value of diffusion-weighted MRI early changes, an hour after treatment, in patients with organ confined unfavorable prostate cancer(PCa) treated with single-dose ablative radiation therapy(SDART), in comparison with biochemical markers(PSA and testosterone).
Methods or Background: Twenty-four patients treated with a single fraction of 24Gy to the whole prostate with urethra sparing in association with androgen deprivation therapy(ADT) were enrolled. MRI was performed before SDART(time0), one-hour post-SDART(time1), and 3-month after treatment(time2). All the patients were examined on a 3.0-T-MRI(Ingenia;Philips Healthcare) with a phased-array external coil, with bowel preparations and 20 mg of butyl-scopolamine(Buscopan); the bladder was filled with 120 cc of saline solution, to simulate the same conditions during irradiation. MRI was performed with axial T1-weighted TSE and high resolution multi-planar T2-weighted TSE sequences. DWI was acquired with six b-values (0,50,100,150,800,1600mm2/s) and Apparent Diffusion Coefficient(ADC) (0,800) maps were calculated. Finally, axial contrast-enhanced dynamic imaging was obtained during intravenous injection of gadobutrol. ADC values were calculated at time 0,1,and 2 by placing region-of-interests(ROI) on ADC maps and the results were compared with PSA and testosterone blood levels at time 0 and 2.
Results or Findings: Median patient’s age was 78 years. Median prostate volume was 36.2 cc. An increase of ADC value of tumour lesion of 27%(range 7%-69%) and 54%(range 20%-83%) was registered at time 1 and time 2 respectively, compared to the baseline. Median prostate volume was found unchanged at time 1, while decreased by about 25%(range 9%-59%) at time 2. At 3-months follow-up,all patients were found bNED with PSA and testosterone levels of<0.01 ng/ml and<0.20 ng/ml, respectively, and nine of them obtained a complete response.
Conclusion: Our findings demonstrated high diagnostic value of DWI imaging with good correlation between very early changes (one-hour after treatment) in ADC values after SDART and later tumour response (biochemical and imaging) in patients with unfavorable PCa.
Limitations: One limitation was that this was a single-centre study.
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: This study utilised retrospective anonymous data analysis.
7 min
Comparison between MRI and conventional CT scans in the prediction of peritoneal cancer index
Michela Polici, Rome / Italy
Author Block: M. Polici, B. Masci, F. Palmeri, P. Sammartino, A. Del Gaudio, M. Zerunian, D. De Santis, D. Caruso, A. Laghi; Rome/IT
Purpose: Peritoneal cancer index (PCI) has been recognised as an independent prognostic indicator for long-term outcomes, however the preoperative assessment represents a clinical challenge. So, the aim of the study was to compare the performance of MRI to CT having the surgery as reference standard.
Methods or Background: Twenty-three patients affected by peritoneal carcinomatosis with availability of pre-operative MRI and CT scans of abdomen and pelvis, were prospectively enrolled, between July 2021 and May 2023. All CT and MRI scans were performed in the same day, within one week from the surgery. Two expert abdominal radiologists blinded, with two different experience levels (expert and inexperienced), evaluated PCI in both MRI and CT scans. The agreements between the radiologists' assessment with surgical results, sensitivity, and specificity were evaluated in total and per site.
Results or Findings: In total PCI, for the expert radiologist the assessment was quite better for MRI (kappa=0.89) than CT (kappa = 0.73). Similarly, for the inexperienced radiologist MRI was better (kappa = 0.79) than CT (kappa = 0.69). In the sub analysis of per site, both expert and inexperienced radiologists showed higher agreement for MRI (kappa = 0.83 and 0.75, respectively) than for CT (kappa=0.68 and 0.63, respectively). Overall, MRI showed higher value of per-site sensitivity and specificity compared to CT (0.95 vs 0.65 and 0.79 vs 0.75, respectively).
Conclusion: MRI shows better results in terms of PCI assessment performance compared to CT, with quite higher agreement for the expert radiologist.
Limitations: This study was performed on a small population; it was of retrospective nature; it lacks survival analysis.
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: Written informed consent was acquired for all patients and Institutional Review Board approval was obtained
7 min
CT morphological phenotype of a tumour is influenced more by the host tissue environment than tumour type
Sajjad Rostami, Amsterdam / Netherlands
Author Block: S. Rostami, C. Guerendel, S. H. Benson, Z. Bodalal, R. G. H. Beets-Tan; Amsterdam/NL
Purpose: Tumour morphology is influenced by numerous genetic and environmental factors. Tumour type and origin, oncogenic mutational processes, and host tissue (micro)environment all impact how a tumour grows. In this study, we aimed to assess the effects of the tumour type and the host tissue (micro)environment on tumour morphology, using radiomics and unsupervised clustering techniques.
Methods or Background: Manually segmented baseline CT scans of 1659 cancer patients of various tumour types were used to extract the radiomic features of 11,164 lesions. TSNE, an unsupervised clustering approach, was used to derive the components that encapsulated the entire tumour morphology, as measured by radiomics. We visualised all the lesions on a TSNE plot to explore the presence of morphological clustering. To assess the association between the observed morphological clusters and our endpoints, we applied the labels of tumour type and host tissue (micro)environment (e.g., liver, lung, bone, lymphatics, etc.) to the plot.
Results or Findings: On the basis of morphology, TSNE identified several distinct clusters. Tumour type failed to explain the clustering pattern observed, when all the lesions (primary and metastases) were included. Looking at only primary lesions, lung cancer formed a distinct morphological cluster apart from non-lung cancers. We observed that the morphological clusters identified could be largely explained by the host tissue (micro)environment.
Conclusion: In this study, we utilised routinely available clinical imaging data to explore the biological influence on tumour morphology. Considering that tumour morphology is a multifactorial attribute, the host tissue (micro)environment might substantially affect how a tumour appears, more than its very own origin.
Limitations: External validation of the results is not done yet, limiting 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: This study was ethically approved by the IRB Code: IRBd20-213.
7 min
Patient eligibility for trials with imaging response assessment at the time of molecular tumour board presentation
Nabeel Mansour, Munich / Germany
Author Block: N. Mansour, B. Westphalen, M. Bergwelt-Baildon, W. G. Kunz; Munich/DE
Purpose: The goal of this study was to assess the eligibility of patients with advanced or recurrent solid malignancies presented in a molecular tumour board (MTB) at a large precision oncology centre for inclusion in trials with the endpoints objective response rate (ORR) or duration of response (DOR) based on Response Evaluation Criteria in Solid Tumours (RECIST 1.1).
Methods or Background: Prospective patients with available imaging at the time of presentation in the MTB were included. Imaging data was reviewed for objectifiable measurable disease (MD) according to RECIST version 1.1. Additionally, we evaluated the patients with MD for representativeness of the identified measurable lesion(s) in relation to the overall tumour burden.
Results or Findings: Two hundred and sixty-two patients with different solid malignancies were included. 177 patients (68%) had MD and 85 (32%) had non-measurable disease (NMD) at the timepoint of MTB presentation in accordance with RECIST 1.1. MD was not representative of the overall tumour burden in eleven patients (6%). The main reasons for NMD were lesions with longest diameter shorter than 10 mm (22%) and non-measurable peritoneal carcinomatosis (18%). Colorectal cancer and malignant melanoma displayed the highest rates of MD (>75%). In contrast, gastric cancer, head and neck malignancies, and ovarian carcinoma had the lowest rates of MD (<55%).
Conclusion: Approximately a third of cancer patients with advanced solid malignancies are not eligible for treatment response assessment in trials with endpoints ORR or DOR at the time of MTB presentation. The rate of patients eligible for trials with imaging endpoints differs significantly based on the underlying malignancy and should be taken under consideration in the planning stages of new basket trials.
Limitations: The data is limited as a single-center study with a limited sample size, hence the representation of tumour entities may differ in larger cohorts.
Funding for this study: This study was not supported by any funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board. Informed consent was waived due to the retrospective character of the study.
7 min
Iodine maps concentration and LI-RADS classification: to a quantitative evaluation of HCC
Alessandro Barbaro, Concorezzo / Italy
Author Block: A. Barbaro, P. A. Bonaffini, A. Celestino, G. Muscogiuri, P. Marra, S. Sironi; 24127 Bergamo/IT
Purpose: The LI-RADS classification is universally recognized as a valid instrument for evaluating hepatocellular carcinoma (HCC), but it is a qualitative evaluation. This study aims to investigate the possibility of having a quantitative assessment of HCC, by using the Iodine maps of dual-energy CT (DECT).
Methods or Background: This retrospective study included 75 patients with HCC who underwent DECT between March 2022 and April 2023. Some of them underwent more than one DECT in that period, for a total of 90 exams. We included all those lesions classified as LI-RADS 5 and all those classified as LI-RADS 3 and 4 that were subsequently confirmed as HCC by other exams such as MRI or CEUS.
We measured the Iodine Concentration in the arterial phase (ICa), in the venous phase (ICv) and normalized them for iodine concentration in a non-pathologic part of liver parenchyma (NICa and NICv). We calculated the ratio between NICa and NICv, and performed a Kruskal-Willis test.
Results or Findings: The median of ICa was 2.95 mg/ml for LI-RADS 3, 3.40 mg/ml for LI-RADS 4 and 3.30 mg/ml for LI-RADS 5. The median of ICv was 2.55 mg/ml for LI-RADS 3, 2.90 mg/ml for LI-RADS 4, and 2.40 mg/ml for LI-RADS 5.
The median of the NICa/NICv ratio was 1.793 for LI-RADS 3, 3.495 for LI-RADS 4, and 2.611 for LI-RADS 5 (P = 0,000429), demonstrating that the NICa/NICv ratio is significantly lower in the LI-RADS 3 sample.
Conclusion: Quantitative assessment of wash-in/was-out for HCC nodules on iodine concentration maps and, particularly, the NICa/NICv ratio may increase radiologists’ confidence in LI-RADS class allocation.
Limitations: The main limitations are the small sample size and the selection bias due to the retrospective design of this study.
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: No ethical approval was sought for this study.
7 min
Stage IIIN2 NSCLC undergoing induction chemotherapy and subsequent surgery: preliminary results of CT morphologic prognostic factors
Nunzia Di Meglio, Siena / Italy
Author Block: N. Di Meglio, A. Perrella, G. Bagnacci, V. Di Martino, L. Volterrani, L. Luzzi, M. A. Mazzei; Siena/IT
Purpose: Patients diagnosed with stage IIIN2 Non-Small Cell Lung Carcinoma (NSCLC) have various treatment options, including surgery following induction chemotherapy (CHT) or concurrent chemoradiotherapy followed by immunotherapy. This study aimed to identify radiological prognostic factors in a cohort of stage IIIN2-NSCLC patients who received induction CHT and subsequent surgery.
Methods or Background: Among 93 patients with locally advanced NSCLC who underwent surgical resection following induction CHT between 2013 and 2020, we retrospectively selected 72 patients. We assessed histological parameters (pTNM stage, pathological regression grade, mutational profile) and radiological features (tumour size, margin characteristics, location, presence of necrosis or carcinomatous lymphangitis for T-stage, and lymph node size, location, structure, and enhancement pattern for N-stage) from staging and restaging CT scans. We correlated these parameters with overall survival (OS) to determine their prognostic significance. We also evaluated the performance of different radiological analysis methods
Results or Findings: The mean OS was 65.54±6.170 months, with disease recurrence occurring in 32 out of 72 cases (44.5%). Among clinical, histological, and radiological factors, a significant correlation with OS was observed only for the presence of the KRAS mutation (p<0.001), regression of clinical nodal stage after CHT (cN2 to ypN0/1; p 0.02), and nodal stage regression based on multiparametric criteria (p 0.001). Multiparametric criteria exhibited high sensitivity (95%), specificity (85%), positive predictive value (PPV) (91%), negative predictive value (NPV) (92%), and an overall accuracy of 91%.
Conclusion: Nodal downstaging after induction CHT result to be a good prognostic factor. Radiological nodal involvement could be established with high accuracy by the multiparametric criteria at CT examination.
Limitations: The main limitation of this study is that it is of retrospective design.
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No ethical approval was sought for this study.
7 min
Dynamic contrast-enhanced ultrasound analysis in preoperative diagnosis between hepatocellular carcinoma and intrahepatic cholangiocarcinoma in non-cirrhotic liver
Yi Dong, Shanghai / China
Author Block: Y. Dong, S. Chen, Y. Huang, J. Chen, Y. Wang, W-p. Wang; Shanghai/CN
Purpose: The purpose of this study was to investigate the value of dynamic contrast-enhanced ultrasound (DCE-US) and quantitative analysis in preoperative differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) in non-cirrhotic liver.
Methods or Background: In this retrospective study, patients with histopathologically proven ICC and HCC lesions in non-cirrhotic liver were included. All patients underwent contrast enhanced ultrasound (CEUS) examinations within one week before surgery. B mode ultrasound (BMUS) features and CEUS enhancement patterns were analysed. DCE-US analysis was performed by VueBox® software (Bracco, Italy). Time intensity curves (TICs) were generated, and quantitative perfusion parameters were obtained and compared between ICC and HCC groups using the Student t test or Mann-Whitney U test.
Results or Findings: From November 2020 to February 2022, patients with histopathologically confirmed ICC (n = 30) and HCC (n = 24) lesions in non-cirrhotic liver were included. Compared with HCC lesions, TICs of ICCs showed earlier and lower enhancement during the AP, faster decline during the PVP, and reduced area under the curve (AUC). The combined area under the receiver operating characteristic curve (AUROC) of all significant parameters was 0.946, with 86.7 % sensitivity, 95.8 % specificity, and 90.7 % accuracy in differential diagnosis between ICC and HCC lesions in non-cirrhotic liver, which improved the diagnostic efficacy of CEUS (58.3 % sensitivity, 90.0 % specificity, and 75.9 % accuracy).
Conclusion: ICC and HCC lesions in non-cirrhotic liver might show some overlap of CEUS features in diagnosis. DCE-US with quantitative analysis is helpful for preoperative differential diagnosis.
Limitations: Single centre study with relatively small sample size and retrospective nature of the study were predominant limitations.
Funding for this study: This study was supported by National Natural Science Foundation of China (Grant No. 82071942).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This was a retrospective observational study approved by the institutional review board of our university hospital (ID: B2020-424R). The informed consent was waived. All aspects of this study were performed in accordance with the Declaration of Helsinki.
7 min
Body CT scan for oncologic patients: the impact of subspecialty radiology in the clinical practice: a quality care study
Luca Bonomo, Massagno / Switzerland
Author Block: S. Rizzo1, L. Bellesi2, A. D'Ermo2, L. Bonomo1, O. D'Ecclesiis3, S. Presilla2, E. Rezzonico1, M. Del Grande2, F. Del Grande1; 1Lugano/CH, 2Bellinzona/CH, 3Milan/IT
Purpose: The primary objective of this study was to assess if the CT dose delivered to oncological patients was different in a subspecialty radiology department, compared to a general radiology department. Secondary explorative objective was to assess if the objective image quality of CT examinations was different in the two settings.
Methods or Background: Chest and abdomen CT scans performed for oncological indications were selected from a general radiology department and a subspecialty radiology department. By using a radiation dose management platform, we extracted and compared CT dose index (CTDIvol) and dose length product (DLP) both for each phase and for the entire CT exams. For objective image quality evaluation, we calculated the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) at the level of the liver and of the aorta. Appropriate statistical analysis was performed. P-value < 0.05 was considered significant. The statistical analyses were performed with R software, version 4.2.3.
Results or Findings: Sven thousand and ninety-eight CT examinations were included. CTDIvol was evaluated in 12804 phases; DLP in 10713 phases and in 6714 examinations. The CTDIvol and DLP overall as well as in the native, arterial and portal venous phases were significantly lower in the subspecialty radiology department. The objective image quality showed no significant difference in the general and subspecialty radiology departments.
Conclusion: In a subspecialty radiology department, CT protocols are optimized compared to general radiology department leading to lower dose to oncologic patients without significant objective image quality degradation.
Limitations: We did not evaluate the patients’ exposure through the effective dose; we cannot exclude that other factors may have influenced the difference in radiation dose; we did not evaluate the effects of the reduction of radiation dose and the effects of the choice of a different imaging.
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 present study was considered a quality care control study by our Ethical Committee and did not fall under the Swiss law of the human research. As such, specific approval and informed consent were waived.
7 min
Comparison of iRECIST and RECIST 1.1 for response assessment of immune checkpoint inhibitor therapy
Christian Nelles, Cologne / Germany
Author Block: C. Nelles, P. Bernard, N. Große Hokamp, M. Gräf, T. Persigehl, P. J. Bröckelmann, S. Lennartz; Cologne/DE
Purpose: To compare response assessment of patients undergoing immune checkpoint inhibitor (ICI) therapy between iRECIST and RECIST 1.1 in a clinical cohort of patients with non-small cell lung cancer (NSCLC) or melanoma.
Methods or Background: 216 patients with NSCLC or melanoma who received PD-1 inhibitors (Nivolumab or Pembrolizumab) or CTLA-4 inhibitor Ipilimumab between January 2015 and May 2020 and who underwent oncologic staging and follow-up CT of the chest and abdomen were included in this retrospective analysis. Treatment response assessment in compliance with the RECIST 1.1 and iRECIST guidelines was performed for all patients for the time period of ICI therapy. Response patterns as well as overall response rate (ORR) and progression-free survival time (PFS) were compared between iRECIST and RECIST 1.1.
Results or Findings: Out of 110 (50.9%) patients with progressive disease (PD) according to RECIST 1.1, 34 did not reach confirmation of progression (iCPD) in iRECIST and for 9 patients, iCPD was reached at a later point in time compared to RECIST 1.1, with a resulting difference of mean PFS (225.3 ± 92.8 days for RECIST 1.1 vs. 270.7 ± 91.9 days for iRECIST). In iRECIST, unconfirmed progressive disease (iUPD) transitioned to stable disease (iSD) in the subsequent follow-up in 17 patients and to partial response (iPR) in 12 patients, leading to a difference in ORR (31.0% for RECIST 1.1 and 35.2% for iRECIST).
Conclusion: Our analysis suggests that iRECIST is more suitable than RECIST 1.1 for correctly capturing atypical response to ICI therapy in patients with melanoma and NSCLC outside of clinical trials, resulting in differences in clinical outcome evaluation.
Limitations: This was a retrospective and a monocentre study design, we did not assess response patterns separately for melanoma and NSCLC.
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: After reviewing the study design, the institutional review board waived the need for informed patient consent and approved this retrospective monocentre study.

This session will not be streamed, nor will it be available on-demand!