MRI

On the Cutting Edge: Dynamic Contrast-Enhanced MRI
Inroads in Oncology Care
Mortality and Medical Imaging

On the Cutting Edge: Dynamic Contrast-Enhanced MRI

The American College of Radiology Image Metrix, which specializes in imaging trial design, techniques, data extraction, management, and analysis, recently discussed the expertise it has developed in the subject of dynamic contrast-enhanced MRI. A noninvasive imaging method, DCE-MRI enables clinical trials to assess the status of tumor microcirculation repeatedly over a period of time. This allows researchers to evaluate the effectiveness of developmental drug activity, according to the ACR Image Metrix. Furthermore, the group explains that there is a difference between true DCE-MRI and routine contrast MRI imaging, which is performed either in the steady-state or in a semidynamic manner.

The ACR Image Metrix notes that DCE-MRI aims to determine the pharmacodynamics of tumor contrast enhancement, such as the degree and rate of early tumor enhancement a reflection of tumor vascularity. To capture this pharmacodynamic information, DCE-MRI imaging must occur at a much faster rate—2 to 10 seconds—than the rate traditionally performed in clinical MRI. The ACR Image Metrix also notes that using existing MRI equipment, imaging at these rates limits image quality, image resolution, and volume of coverage. In order to bring about minimal variability between and within patients, trials using DCE-MRI require rigorous standardization.”Despite the hurdles one must overcome in DCE-MRI, many clinical studies have demonstrated the efficacy of DCE-MRI for tumor vascular evaluation during vascular targeted therapy,” said Mark Rosen, assistant professor of radiology at the University of Pennsylvania Medical Center and scientific director of the ACR Image Metrix MRI Core Labs.

The ACR Image Metrix says DCE-MRI is useful as an adjunctive study in late phase 1 or phase 2 drug trials identifying in vivo tumor vascular responsiveness to the study drug. Specifically, in phase 1 studies, the imaging technique may be employed to identify a dose-response curve or to determine the longevity of antitumor effect. Meanwhile, the technique’s response may be tracked and compared to downstream clinical markers of efficacy, like progression-free survival, in phase 2 studies that focus on a smaller number of tumor types.

“ACR Image Metrix offers its clients an unusually strong scientific perspective, matching the imaging approach to clients’ imaging needs,” said Bruce Hillman, ACR Image Metrix chief scientific officer. “We are proud to offer world-class DCE-MRI to our clients with drug development programs addressing vascular pathways.”

According to the ACR Image Metrix, it successfully implemented the use of DCE-MRI in clinical research for drug trials. Additionally, the group says it can aid pharmaceutical and biotech companies to include the technique into their clinical research programs in an appropriate manner. Lastly, the ACR Image Metrix maintains that it is on the forefront of newer imaging techniques used in drug discovery and development.

—Elaine Sanchez

Inroads in Oncology Care

Radiologists who diagnose and follow systemic diseases like cancer face extreme challenges. Current imaging technology, while powerful, can add to the challenge. While MRI offers the ability to scan multiple times and over multiple regions with less radiation concern, scans can be long and uncomfortable, and require readjustments. CT scanners can remove these problems with continuous movement, but can be limited with imaging scope.  

Fusing the benefits of both tools, the syngo® TimCT Oncology tool from Siemens promises remarkable advances for radiologists and oncologists. The tool utilizes the Tim (Total imaging matrix) technology for oncology, making scanning more efficient and CT-like over a larger field of view.  

“With the Tim technology, we’re bringing the capability of CT to MRI, with patients traveling through the field of view on a continuously moving table for a very efficient use of the scanner,” said Jeffrey Bundy, vice president of magnetic resonance, Siemens Healthcare. “Bringing this to oncology means radiologists can look more easily for metastases without repeated exams, scanning over larger regions more efficiently.”  

The syngo TimCT Oncology tool offers significant operational advantages. Patients are on and off the table in minutes, and the processing of data can be done separately, saving time and energy for both radiologists and patients. The speed and comprehensive scanning ability reduce the need for rescheduling multiple exams. At the same time, the tool still offers the power for tumor characterization, staging, presurgical planning, therapy monitoring, and follow-up.   

The syngo tools are available for general oncology use, with a few specific solutions offered for prostate cancer and breast cancer. From here, Siemens is looking forward, eyeing other systemic diseases and big killers, and hopes to offer TimCT solutions for fields like neurology and cardiology.

Siemens believes that in the hands of current users of TimCT solutions and early adopters of the oncology tools, the syngo tools could ultimately push oncology diagnosis in new directions.

“When we make new technology like this, it is because our customers have asked,” said Bundy. “They are looking for ways to increase quality and lower costs, and we respond with technology that is operationally better and more cost-efficient and provides better quality of care for patients. In terms of oncology diagnosis in radiology, we work closely with our customers to see how we can keep improving the process for oncology diagnosis. With these tools, radiologists could make a new path in the field.”  

—Amy Lillard

Women’s Imaging

Mortality and Medical Imaging

Increased utilization of advanced medical imaging, such as MRI and CT, between 1991 and 2004 improved life expectancy rates by a factor greater than the mortality rates caused by obesity over the same time frame, according to a recent study.

The work of Columbia University professor Frank Lichtenberg, PhD, prompted a statement from Medical Imaging and Technology Alliance (MITA), which praised his paper, “The Quality of Medical Care, Behavioral Risk Factors, and Longevity Growth.” Results of the study were released through the National Bureau of Economic Research.

Specifically, life expectancy increased by 0.62 to 0.71 years (out of a total 2.37-year increase) attributed to advanced medical imaging techniques over the 14-year period. This is comparable to the 0.58 to 0.68 year decrease in life expectancy as a result of increased prevalence of obesity.

“As health care reform moves forward, and we work to identify the best ways to improve outcomes while reducing costs, this research provides helpful insights on some of the key influencers that can help us to do just that,” said Ilyse Schuman, managing director, MITA, a member of the Access to Medical Imaging Coalition. “MITA applauds the work of Dr Lichtenberg, whose thorough and detailed analysis has shown that with life expectancy varying so greatly from state to state, and countless variables to be taken into consideration, there is an undeniable correlation between increases in advanced medical imaging and increases in life expectancy.”

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Lichtenberg looked to measure the significance of a number of variables on life expectancy, including the effect of the quality of medical care, behavioral risk factors (obesity, smoking, AIDS incidence), education, income, and health insurance coverage. In order to examine the quality of care, Lichtenberg looked at average quality of diagnostic imaging procedures, average quality of practicing physicians, and the mean vintage (FDA approval year) of outpatient and inpatient prescription drugs.

According to his study, across the board, life expectancy increased more rapidly in states that experienced larger increases in utilization of advanced medical imaging. The report noted that those same states did not have larger increases in per capita medical expenditure.  

Lichtenberg concluded, “This may be the case because, while newer diagnostic procedures and drugs are more expensive than their older counterparts, they may reduce the need for costly additional medical treatment. The absence of a correlation across states between medical innovation and expenditure growth is inconsistent with the view that advances in medical technology have contributed to rising overall US health care spending.”

To read the full paper by Lichtenberg, visit: www.nber.org/papers/w15068.

—Elaine Sanchez