S o p h i e T a ï e b

C e n t r e O s c a r L a m b r e t

D é p a r t e m e n t d ’ I m a g e r i e

L i l l e - F r a n c e

F U N C T I O N A L A S P E C T C R I T E R I A

•  Critères Morphologiques •  Taille Tumorale / Identification aux critères cliniques.

•  Functional Criteria •  Signal (TDM, IRM)

•  Tumour Metabolism

•  Vascularization

• Common language to same decisions •  Reproducible criteria : Inter & Intra Observers.

•  Objectif criteria = quantitative.

Comment ? How ?

Functional Imaging

Technique Tumoral characteristics

MRI and CT and US Tumour volume

DCE-MRI, DCE-CT and DCE-US Vascularisation

DWI-MRI Cellular density

MRS Molecular component

TEP FDG Glucose Métabolism

TEP FES Hormonal Métabolism

Increase of the signal after contrast administration

•  DCE-IRM : Gadolinium chelates

•  TDM : Iodine contrast

•  US : Microbubbles

Jain RK. Nature Medicine 2001;7:987-989

Anti-angiogéniques Anti-Vasculaire

Dynamic acquisition after contrast administration (DOTAREM*)

7

CT emporal curves of contrast enhancement aorte / GG

LS Fournier , J Radiol 2007

CHI-Q Software Quantification / ROI

Raw Data

Modelisation

4

Woman, 57-year-old. Bilateral renal cell. Pancreas metastasis / Sunitinib

7

Woman, 57-year-old. Bilateral renal cell. Pancreas metastasis / Sunitinib

CT Baseline : 3 cm, HD : 67

D60: 3 cm, HD : 29.

SD with RECIST 1.1

RP with CHOI criteria.

M9 : CR

Ø  Peak intensity Ø  Time to peak Ø  Mean transit time Ø  Slope of wash in Ø  AUC, AUWI, AUWO.

flux F

veine artère

Volume V de tissus

Artere Q

artere 1

Capillaire Q

cap 2

Kep

Ve

Interstitium Q

inter 3

Ktrans

Blood flow

k(0,2)

flux F

veine artère

Volume V de tissus

MRI and CT

Analysis

Inte

nsit

é d

e s

ign

al

Temps

F

kep = Ktrans / Ve

Vp Ve

1.  Perfusion (BF)

2.  Blood volume

3.  Permeability

4.  Intersticiel volume

Ktrans

C.de Bazelaire – St Louis - Paris

Temporal resolution : High - Seconde

All parameters

n  Perfusion (BF)

n  Blood volume

n  Permeability

n  Intersticiel volume

Inte

nsit

é d

e s

ign

al

Temps

( ) ( ) ( ) ( )∫∫ ⎟⎟⎠

⎞⎜⎜⎝

⎛−−

−+−=

t

e

trans

ptrans

pptis duutKuCKduutCFtC00

exp τν

τ

C.de Bazelaire – St Louis - Paris

Only :

¨  Perfusion (BF)

¨  Blood volume

n  Permeability

n  Intersticiel vol Ktrans

Inte

nsit

é d

e s

ign

al

Temps

( ) ( ) ( )∫ ⎟⎟⎠

⎞⎜⎜⎝

⎛−

−=

t

e

trans

ptrans

tis duutKuCKtC0

expν

C.de Bazelaire – St Louis - Paris

Temporal resolution : low - mn

Perfusion MRI

n Diagnosis value –  K trans : Se 93%, Sp 96%

BL < DCIS < DIC

–  Kep : BL < DCIS < DIC

–  Fibroadenoma : K trans high with Kep low

Preim U et al. EJR 2011

Furman-Haran E et al. Cancer 2005

Ø  No Pre-treatment differences between responders and non-responders : Tumour diameter, volume, kinetic parameters.

§  Nor ADC (Woodhams R et al, Radiology 2010) – 398 pts §  ADC useful (Li X et al. Med Oncol 2012) – 32 pts Before NAC

Mean ADC of responders lower than in non-resp. p<0,001

Ø  Early response : ü  Tumor diameter AUC [0.73-0.9] ü  Kinetic parameters : Ktrans AUC [0.63-0.93] ü  ADC : Useful but ADC cut off depends : B[800-1000],

multiB, 1.5 or 3 T.

Perfusion MRI

n  Pb tumoral heterogeneity

98 patientes, > 1B1 : Corrélation avec CL, SSR, SG

To morrow : multiparametric imaging

•  Diagnosis •  Treatment response

•  Predictive before treatment

•  Earlier : 1 or 2 cycles

+ TEP ?

Conclusion

•  RECIST – En défaut •  Respecter les contraintes lors Mesure

•  Connaitre les dérives possibles

•  Imagerie Fonctionnelle •  Echo de contraste = Validée

•  Perfusion IRM/TDM = à valider > 2 ans

•  Diffusion, Spectroscopie = ??