3D MRI predicts survival after chemotherapy for liver tumors

3D MRI predicts survival after chemotherapy for liver tumors
3D MRI predicts survival after chemotherapy for liver tumors

In a series of studies involving 140 American men and women with liver tumors, researchers used specialized three-dimensional (3D) magnetic resonance imaging (MRI) scans to precisely measure living and dying tumor tissue to quickly show whether highly toxic chemotherapy, delivered directly through a tumor's blood supply, is working. The findings were presented at the annual meeting of the Society of Interventional Radiology, in San Diego, California.

The investigators, from Johns Hopkins Medicine in Baltimore, Maryland, stated that their findings are the first proof of principle that this technology can show tumors in three dimensions and accurately measure tumor viability and death.

They also stated that their results, in patients with either primary liver cancers or metastatic tumors from cancers originating elsewhere in the body, are evidence that using this technology before and after treatment is a faster and better tool for predicting patient survival after chemotherapy targeted directly at tumors, called chemoembolization.

Unlike standard methods to assess tumor response after chemoembolization, which are based on two-dimensional images and tumor size, the 3D technology also distinguishes between dead and live tissue, giving an accurate assessment of tumor cell death.

The new technology builds on standard two-dimensional methods and uses computer analytics to evaluate the amount of so-called contrast dye absorbed by tumor tissue. The dye is injected into patients before their MRI scan to enhance image production. Researchers say live tissue will absorb more dye than dead tissue, affecting image brightness, which can also be measured for size and intensity.

"Our high-precision, 3D images of tumors provide better information to patients about whether chemoembolization has started to kill their tumors so that physicians can make more well-informed treatment recommendations," said senior investigator Jean-Francois Geschwind, MD, of Johns Hopkins. He explained that knowing the true extent of a tumor's response to chemoembolization is particularly important for patients with moderate to advanced stages of the disease, whose liver tumors might initially be too large or too numerous to surgically remove.

Geschwind stated that the improved accuracy of the 3D technology removes a lot of the guesswork that now goes into evaluating treatment outcomes. The new assessment takes seconds to perform, so radiologists can provide almost instantaneous treatment advice.

In a series of studies, Geschwind and his team used the standard and new imaging techniques to analyze the MRI scans of more than 300 liver tumors in some 123 men and women. All patients were treated at The Johns Hopkins Hospital between 2003 and 2012, and each received pre- and postchemoembolization MRI scans to assess the effects of therapy on the tumors.

Using the new 3D method, Geschwind's team found that patients who responded well to therapy lived 19 months longer (an average of 42 months) than patients who did not respond well (average 23 month). Standard methods showed slightly less difference in survival (average 18 months longer) between patients who responded to therapy and those who did not respond.

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