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Lung cancer therapy response calls for new thinking
CT multitasks in the lungs, serving as a tool for cancer screening, disease diagnosis, lesion characterization, and lung cancer treatment response. In a talk at the 2008 Stanford International Symposium on Multidetector-Row CT in Las Vegas, Michael McNitt-Gray, Ph.D., posited that CT can be used more effectively to assess treatment response in lung cancer patients, but clinicians must look beyond current response parameters.
CT multitasks in the lungs, serving as a tool for cancer screening, disease diagnosis, lesion characterization, and lung cancer treatment response. In a talk at the 2008 Stanford International Symposium on Multidetector-Row CT in Las Vegas, Michael McNitt-Gray, Ph.D., posited that CT can be used more effectively to assess treatment response in lung cancer patients, but clinicians must look beyond current response parameters.
The Response Evaluation Criteria in Solid Tumors (RECIST) is the standard for treatment evaluation, said McNitt-Gray, director of the Biomedical Physics Graduate Program at the Thoracic Imaging Research Group, based at the University of California, Los Angeles.
RECIST relies on changes to the interdimensional diameter of a lesion. Measurements can be taken on five lesions at a time and done directly on the film. McNitt-Gray pointed out several issues, however, that compromise RECIST's reliability to offer the most accurate information.
"It's difficult to estimate the diameter of irregular lesions. How do we know that the (diameter) change we're seeing is real change and not just measurement variability?" he said. "When a patient comes back for follow-up, he or she isn't always imaged in the same scan plane. There is also intra- and interobserver variability. How long do we have to wait for a response- a few weeks, a month?"
While tumor size is important, McNitt-Gray suggested other parameters for measuring response. Changes in tumor volume can be assessed with segmentation on thin-slice CT, he said. PET/CT has value for measuring tumor function.
At his institution, McNitt-Gray performs 4D mapping of contrast enhancement through the nodule. These contrast uptake patterns can be measured at multiple time points with low-dose CT, offering rapid information on nodule perfusion and permeability, he said.
"Ultimately, what is the minimum amount of change that we can detect?" McNitt-Gray said. "And how long would it take to see this minimally detectable change?"
Patient survival influences new lung cancer staging system
May 21st 2009Based on on a database with more than 100,000 submitted cases, modifications to the international system for staging non-small cell lung cancer promise to more closely reflect the connection between disease progression and the patient's prospects for survival.
Advantages of wide CT detectors outweigh disadvantages
May 19th 2009The new generation of wide CT detectors provides expanded coverage, allowing faster scans and even dynamic imaging of organs, including heart and brain. There are disadvantages, said Dr. Mathias Prokop, speaking May 19 at the 11th International Symposium on Multidetector Row CT, but these are minor in comparison.
Glazer calls 'invisible radiologist' to task, encourages molecular understanding
May 19th 2009A smorgasbord of challenges face radiology but few present a greater threat than the “invisible radiologist,” said Dr. Gary Glazer, chairman of the Stanford University radiology department, who kicked off the 11th International Symposium on Multidetector-Row CT.
