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Rofo 2012; 184(4): 340-344
DOI: 10.1055/s-0031-1299277
Rapid Communication
© Georg Thieme Verlag KG Stuttgart · New York

Imaging of Tumor Viability in Lung Cancer: Initial Results Using 23Na-MRI

Bildgebung der Tumor-Vitalität von Lungenkrebs: erste Ergebnisse der 23Na-MRT
T. Henzler
1   Institut of Clinical Radiology and Nuclear Medicine, University medical Center Mannheim, Medical Faculty Heidelberg University
,
S. Konstandin
2   Computer Assisted Clinical Medicine, Heidelberg University, Medical Faculty Mannheim
,
G. Schmid-Bindert
3   University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Interdisciplinary Thoracic Oncology, Department of Surgery
,
P. Apfaltrer
4   Institut of Clinical Radiology and Nuclear Medicine Mannheim, Germany, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
,
S. Haneder
4   Institut of Clinical Radiology and Nuclear Medicine Mannheim, Germany, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
,
F. Wenz
5   Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
,
L. Schad
6   Computer Assisted Clinical Medicine Mannheim, Germany, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
,
C. Manegold
7   Interdisciplinary Thoracic Oncology, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
,
S. O. Schoenberg
8   Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim
,
C. Fink
9   Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Universität Heidelberg
› Author Affiliations
Further Information

Publication History

28 November 2011

17 January 2012

Publication Date:
20 February 2012 (online)

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Abstract

Purpose: 23Na-MRI has been proposed as a potential imaging biomarker for the assessment of tumor viability and the evaluation of therapy response but has not yet been evaluated in patients with lung cancer. We aimed to assess the feasibility of 23Na-MRI in patients with lung cancer.

Materials and Methods: Three patients with stage IV adenocarcinoma of the lung were examined on a clinical 3 Tesla MRI system (Magnetom TimTrio, Siemens Healthcare, Erlangen, Germany). Feasibility of 23Na-MRI images was proven by comparison and fusion of 23Na-MRI with 1H-MR, CT and FDG-PET-CT images. 23Na signal intensities (SI) of tumor and cerebrospinal fluid (CSF) of the spinal canal were measured and the SI ratio in tumor and CSF was calculated. One chemonaive patient was examined before and after the initiation of combination therapy (Carboplatin, Gemcitabin, Cetuximab).

Results: All 23Na-MRI examinations were successfully completed and were of diagnostic quality. Fusion of 23Na-MRI images with 1H-MRI, CT and FDG-PET-CT was feasible in all patients and showed differences in solid and necrotic tumor areas. The mean tumor SI and the tumor/CSF SI ratio were 13.3 ± 1.8 × 103 and 0.83 ± 0.14, respectively. In necrotic tumors, as suggested by central non-FDG-avid areas, the mean tumor SI and the tumor/CSF ratio were 19.4 × 103 and 1.10, respectively.

Conclusion: 23Na-MRI is feasible in patients with lung cancer and could provide valuable functional molecular information regarding tumor viability, and potentially treatment response.

Zusammenfassung

Ziel: Die 23Na-MRT wurde als ein potenzieller Bildgebungs-Biomarker für die Beurteilung der Tumorvitalität oder die Beurteilung des Therapieansprechens beschrieben. Bislang gibt es keine Publikation über den Einsatz der 23Na-MRT bei Patienten mit Lungenkarzinom.

Material und Methoden: 3 Patienten mit Stadium IV Adenokarzinom der Lunge wurden an einem klinischen 3 Tesla-MRT (Magnetom TimTrio, Siemens Healthcare, Erlangen, Deutschland) untersucht. Die Machbarkeit der 23Na-MRT wurde durch den Vergleich bzw. die Fusion mit Bilddaten der 1H-MRT, CT und FDG-PET-CT beurteilt. Die Signalintensität der 23Na-MRT (SI) im Tumor und Liquor des Spinalkanals wurden gemessen und das Verhältnis der SI im Tumor und Liquor berechnet. Ein chemonaiver Patient wurde vor und nach Einleitung einer Kombinationschemotherapie (Carboplatin, Gemcitabin, Cetuximab) untersucht.

Ergebnisse: Alle 23Na-MRT-Untersuchungen wurden erfolgreich und mit diagnostischer Bildqualität durchgeführt. Die Fusion der 23Na-MRT mit der 1H-MR, CT und FDG-PET-CT war bei allen Patienten durchführbar und zeigte Unterschiede zwischen soliden und nekrotischen Tumoranteilen. Die mittlere SI der Tumoren und das Verhältnis der SI im Tumor und Liquor betrugen 13,3 ± 1,8 × 103 und 0,83 ± 0,14. Im nekrotischen Tumor, der durch nicht FDG-avide Tumoranteile definiert wurde, betrugen die mittlere SI der Tumoren und das Verhältnis der SI im Tumor und Liquor 19,4 × 103 und 1,10.

Schlussfolgerung: Die 23Na-MRT ist bei Patienten mit Lungenkarzinom klinisch einsetzbar und kann funktionelle bzw. molekulare Informationen über die Vitalität von Tumoren liefern. Damit steht ein potenzieller bildegebender Biomarker für die Responsebeurteilung zur Verfügung.

Key words

thorax - MR functional imaging - technical aspects - staging
 

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