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Monitoring of Tumor Microcirculation during Fractionated Radiation Therapy in Patients with Rectal Carcinoma: Preliminary Results and Implications for Therapy¹

¹ From the Departments of Radiotherapy and Radio-oncology (A.d.V., J.G., P.L.), Magnetic Resonance (C.K., W.J., T.K.), Biostatistics (K.P.P.), and Radiodiagnostic 1 (W.B.) and the Institute of Histology and Embryology (P.D.), Leopold-Franzens-Universität Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria; and the GSF Research Center for Environment and Health, Institute for Radiation Biology, Neuherberg, Germany (T.G.). From the 1998 RSNA scientific assembly. Received November 29, 1999; revision requested January 28, 2000; revision received March 20; accepted April 4. Supported in part by grants from Schering Germany and Schering Austria. Address correspondence to A.d.V. (e-mail: alexander.devries@uibk.ac.at).

PURPOSE: To measure microcirculatory changes during chemoirradiation and to correlate perfusion index (PI) values with therapy outcome.

MATERIALS AND METHODS: Perfusion data in 11 patients with cT3 (clinical staging, tumor invaded the perirectal tissue) rectal carcinoma who underwent preoperative chemoirradiation were analyzed. Perfusion data were acquired by using a T1 mapping sequence with a whole-body magnetic resonance (MR) imager. After contrast medium was intravenously infused at a constant rate, concentration-and-time curves were evaluated for arterial blood and tumor. All patients underwent MR imaging before and at constant intervals during chemoirradiation. Clinical stages before therapy were compared with surgical stages after therapy.

RESULTS: Spatial and temporal resolution on dynamic T1 maps were sufficient to reveal changes in contrast medium accumulation in the tumor. Comparison of PI values and radiation dose showed a significant increase in the 1st (P = .003) and 2nd weeks (P = .01) of treatment; values subsequently returned to pretreatment levels or showed a renewed increase. High initial PI values correlated with greater lymph node downstaging (P = .042).

CONCLUSION: Dynamic T1 mapping provides a suitable tool for monitoring tumor microcirculation during chemoirradiation and offers the potential for individual optimization of therapeutic procedures. Furthermore, these results indicate that the PI map may serve as a prognostic factor.

Index terms: Magnetic resonance (MR), contrast enhancement, 757.12143 • Magnetic resonance (MR), inversion recovery, 757.121413 • Magnetic resonance (MR), perfusion study • Pelvic organs, MR, 757.121411, 757.121413, 757.12143 • Pelvic organs, therapeutic radiology, 757.1269 • Rectum, neoplasms, 757.321 • Rectum, therapeutic radiology, 757.1266, 757.1269

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