Inter-patient variations of radiation-induced normal-tissue changes in Gd-EOB-DTPA-enhanced hepatic MRI scans during fractionated proton therapy

Christian Richter, Ovidiu C. Andronesi, Ronald J.H. Borra, Felix Voigt, Steffen Löck, Dan G. Duda, Alexander Guimaraes, Theodore S. Hong, Thomas R. Bortfeld, Joao Seco

Research output: Contribution to journalArticle

Abstract

Background and purpose: Previous MRI studies have shown a substantial decrease in normal-tissue uptake of a hepatobiliary-directed contrast agent 6–9 weeks after liver irradiation. In this prospective clinical study, we investigated whether this effect is detectable during the course of proton therapy. Material and methods: Gd-EOB-DTPA enhanced MRI was performed twice during hypo-fractionated proton therapy of liver lesions in 9 patients (plus two patients with only one scan available). Dose-correlated signal changes were qualitatively scored based on difference images from the two scans. We evaluated the correlation between the MRI signal change with the planned dose map. The GTV was excluded from all analyses. In addition, were examined timing, irradiated liver volume, changes in liver function parameters as well as circulating biomarkers of inflammation. Results: Strong, moderate or no dose-correlated signal changes were detected for 2, 3 and 5 patients, respectively. Qualitative scoring was consistent with the quantitative dose to signal change correlation. In an exploratory analysis, the strongest correlation was found between the qualitative scoring and pretreatment IL-6 concentration. For all patients, a clear dose-correlated signal decrease was seen in late follow-up scans. Conclusion: Radiation-induced effects can be detected with Gd-EOB-DTPA enhanced MRI in a subgroup of patients within a few days after proton irradiation. The reason for the large inter-patient variations is not yet understood and will require validation in larger studies.

Original languageEnglish (US)
Pages (from-to)113-119
Number of pages7
JournalClinical and Translational Radiation Oncology
Volume18
DOIs
StatePublished - Sep 1 2019

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Proton Therapy
Magnetic Resonance Imaging
Radiation
Liver
Radiation Effects
Contrast Media
gadolinium ethoxybenzyl DTPA
Protons
Interleukin-6
Biomarkers
Prospective Studies
Inflammation

Keywords

  • Gd-EOB-DTPA
  • In vivo verification
  • Inflammatory response
  • Liver
  • MRI
  • Radiation-induced changes

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Inter-patient variations of radiation-induced normal-tissue changes in Gd-EOB-DTPA-enhanced hepatic MRI scans during fractionated proton therapy. / Richter, Christian; Andronesi, Ovidiu C.; Borra, Ronald J.H.; Voigt, Felix; Löck, Steffen; Duda, Dan G.; Guimaraes, Alexander; Hong, Theodore S.; Bortfeld, Thomas R.; Seco, Joao.

In: Clinical and Translational Radiation Oncology, Vol. 18, 01.09.2019, p. 113-119.

Research output: Contribution to journalArticle

Richter, Christian ; Andronesi, Ovidiu C. ; Borra, Ronald J.H. ; Voigt, Felix ; Löck, Steffen ; Duda, Dan G. ; Guimaraes, Alexander ; Hong, Theodore S. ; Bortfeld, Thomas R. ; Seco, Joao. / Inter-patient variations of radiation-induced normal-tissue changes in Gd-EOB-DTPA-enhanced hepatic MRI scans during fractionated proton therapy. In: Clinical and Translational Radiation Oncology. 2019 ; Vol. 18. pp. 113-119.
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AU - Andronesi, Ovidiu C.

AU - Borra, Ronald J.H.

AU - Voigt, Felix

AU - Löck, Steffen

AU - Duda, Dan G.

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AB - Background and purpose: Previous MRI studies have shown a substantial decrease in normal-tissue uptake of a hepatobiliary-directed contrast agent 6–9 weeks after liver irradiation. In this prospective clinical study, we investigated whether this effect is detectable during the course of proton therapy. Material and methods: Gd-EOB-DTPA enhanced MRI was performed twice during hypo-fractionated proton therapy of liver lesions in 9 patients (plus two patients with only one scan available). Dose-correlated signal changes were qualitatively scored based on difference images from the two scans. We evaluated the correlation between the MRI signal change with the planned dose map. The GTV was excluded from all analyses. In addition, were examined timing, irradiated liver volume, changes in liver function parameters as well as circulating biomarkers of inflammation. Results: Strong, moderate or no dose-correlated signal changes were detected for 2, 3 and 5 patients, respectively. Qualitative scoring was consistent with the quantitative dose to signal change correlation. In an exploratory analysis, the strongest correlation was found between the qualitative scoring and pretreatment IL-6 concentration. For all patients, a clear dose-correlated signal decrease was seen in late follow-up scans. Conclusion: Radiation-induced effects can be detected with Gd-EOB-DTPA enhanced MRI in a subgroup of patients within a few days after proton irradiation. The reason for the large inter-patient variations is not yet understood and will require validation in larger studies.

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