Dynamic contrast enhanced MRI of pulmonary adenocarcinomas for early risk stratification: higher contrast uptake associated with response and better prognosis

• Published in: BMC medical imaging 2022-12, Vol.22 (1), p.215-215, Article 215
• Main Authors: Rheinheimer, Stephan, Christopoulos, Petros, Erdmann, Stella, Saupe, Julia, Golpon, Heiko, Vogel-Claussen, Jens, Dinkel, Julien, Thomas, Michael, Heussel, Claus Peter, Kauczor, Hans-Ulrich, Heussel, Gudula
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Biology; Biomarkers; Breast cancer; Cancer therapies; Chemotherapy; Contrast agents; Contrast Media; Documentation; Early response; Humans; Image contrast; Kinases; Liver Neoplasms; Lung cancer; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical prognosis; Medical records; Metastases; Non-small-cell lung carcinoma; Parameters; Patients; Perfusion; Platinum; Pretreatment; Prognosis; Regression analysis; Response evaluation criteria in solid tumors; Survival; Treatment Outcome; Tumors; Tyrosine; Variables
• ISSN: 1471-2342; 1471-2342
• DOI: 10.1186/s12880-022-00943-x

To explore the prognostic value of serial dynamic contrast-enhanced (DCE) MRI in patients with advanced pulmonary adenocarcinoma undergoing first-line therapy with either tyrosine-kinase inhibitors (TKI) or platinum-based chemotherapy (PBC). Patients underwent baseline (day 0, n = 98), and post-therapeutic DCE MRI (PBC: day + 1, n = 52); TKI: day + 7, n = 46) at 1.5T. Perfusion curves were acquired at 10, 40, and 70 s after contrast application and analysed semiquantitatively. Treatment response was evaluated at 6 weeks by CT (RECIST 1.1); progression-free survival (PFS) and overall survival  were analysed with respect to clinical and perfusion parameters. Relative uptake was defined as signal difference between contrast and non-contrast images, divided by the non-contrast signal. Predictors of survival were selected using Cox regression analysis. Median follow-up was 825 days. In pre-therapeutic and early post-therapeutic MRI, treatment responders (n = 27) showed significantly higher relative contrast uptake within the tumor at 70 s after application as compared to non-responders (n = 71, p ≤ 0.02), response defined as PR by RECIST 1.1 at 6 weeks. There was no significant change of perfusion at early MRI after treatment. In multivariate regression analysis of selected parameters, the strongest association with PFS were relative uptake at 40 s in the early post-treatment MRI and pre-treatment clinical data (presence of liver metastases, ECOG performance status). Higher contrast uptake within the tumor at pre-treatment and early post-treatment MRI was associated with treatment response and better prognosis. DCE MRI of pulmonary adenocarcinoma may provide important prognostic information.