Transcript
So I'd like to introduce you the Contrast Clearance Analysis to differentiate between Treatment Response and Tumor Progression. This is still a problem and a challenge every day for us radiologists to see this followup after treatment. So we see the first one after treatment, then, two months later. And then another month later, this very high enhancement in this area after treatment.
So what is it? And looking at the T1 on the first line, you see it's just the same to recruitment. But two weeks later, you see this blue area on this side. So with Contrast Clearance Analysis, there is now a possibility to differentiate it much better than with Perfusion until today.
So this is a very important function you see here, showed by this model from Israel. So it shows the T1 signal intensity. There's this time. So she saw that the tumor, the tumor lesions make a clearance of gadolinium. So you have, at the first time, at the five minutes after gado application, you have, in T1 signal intensity increasing. And then you have this decreasing after the time. And necrosis makes just the opposite of it. The T1 signal intensity at the beginning, it's very small. And at the cut off at 55 minutes, you have this increasing of the signal intensity. So the best time to make the second acquisition is at 75 minutes. So you have the good discrimination between the red, the necrosis, and the blue curve for tumor progression.
And this is how it works. You make the first T1 sequence normally after five minutes after gado application and you make the second one about 75 minutes later, plus/minus 20 minutes and you make a subtraction. So you can differentiate the red areas like showed in this example with necrosis and you have the blue areas with tumor.
And this is how it works. The second one, you subtract from it the first one, and it's just simple. You get a really crisp Contrast Clearance Analysis, the blue and the red areas.
So, the Contrast Clearance Analysis has new, a very high specificity and sensitivity. It's just better than the Perfusion which will make it because it's very often after treatment, falls negative. And the Contrast Clearance Analysis had very accurate and identification of the active tumor, the high resolution, and it even can show new small brain metastasis better than the Perfusion.
So let me show two patients from our institute. You see here a woman after breast cancer with this metastasis on this side. She get first resection. This is the T1 without gado and the T1 after gado, after resection. So, there is no enhancement. There is no lesion left. And this is even what we see with the Perfusion. There is no pathological CVV.
So what has happened after VMAT? We see the first one at the end of VMAT, it looks wonderful. And this is even the followup one month later. Five months later, it even looks very good.
But what happens another month later? You see this very intensity and huge enhancement on this area and we don't know what it is. We make a Perfusion and we see some small, very small pathological perfusion at that side, but we even don't know...we can't differentiate. Is it now a recurrence or is it treatment effect? So we made a Contrast Clearance Analysis, and we see now this blue area which is as high as the first one. You see it on the T1 with gado and just a little bit of necrosis at the periphery.
So, she got another surgery. This is the T1 without gado, this is the T1 with gado after surgery. And we see on this side here, a very small enhancement. So we made, after surgery, this Contrast Clearance Analysis and we can say what you see here with T1 gado, this is no tumor. Whereas, this is just the necrosis.
Now the patient with lung cancer, we can see here, he came with a headache, and we see here the metastasis on the parietal lobe. And this is the T1 after gado.
So, first, he get radiotherapy. You see here this area of the radiotherapy and the followup. And two months later, looking at the first metastasis he had, this is the response. Two months later, sorry, at this time, on this area. And then, we have another lesion here literally from the first one. So, what is it? We didn't know. And look at the images after biopsy and we see here the trajectory of the biopsy he had first. And so, we thought this may be a second metastasis on this biopsy trajectory.
So, this was the first one and this is the second one we see here. We made a Perfusion and yes, we have the confirmation. This may be a metastasis because that area, he never had treatment.
So, we made even Contrast Clearance Analysis. And you see here, the first metastasis, which was radiotherapy. And this second one, on the trajectory analysis, this is real metastasis. So he get the second radiotherapy. You see here the first one and you see here the second one, and you see here now on coronary reconstructions at the second one and the first one. And we saw him two months later only with headache but no edema and no recurrence at that area.
So, what can we see about Contrast Clearance Analysis? It's a radiology focused procedure so we don't need nuclear medicine, we don't need another CT or whatever. You have only the first and the normal gado dose, weight-adapted gado dose, and you make the first MRI. You see this enhancement on this side and you have time to make the decision. Do you need the second acquisition or not? And if you see this enhancement, you can say, "Okay." Say other patients, "Please make one hour and go take a coffee or whatever, and please return one hour later. And then we make the second scan." You don't need a second Contrast medium so it's just the first one you gave. And you make the Contrast Clearance Analysis and have this high specificity and sensitivity to differentiate tumor for tumor [inaudible 00:08:47.588]. Thank you very much.
So what is it? And looking at the T1 on the first line, you see it's just the same to recruitment. But two weeks later, you see this blue area on this side. So with Contrast Clearance Analysis, there is now a possibility to differentiate it much better than with Perfusion until today.
So this is a very important function you see here, showed by this model from Israel. So it shows the T1 signal intensity. There's this time. So she saw that the tumor, the tumor lesions make a clearance of gadolinium. So you have, at the first time, at the five minutes after gado application, you have, in T1 signal intensity increasing. And then you have this decreasing after the time. And necrosis makes just the opposite of it. The T1 signal intensity at the beginning, it's very small. And at the cut off at 55 minutes, you have this increasing of the signal intensity. So the best time to make the second acquisition is at 75 minutes. So you have the good discrimination between the red, the necrosis, and the blue curve for tumor progression.
And this is how it works. You make the first T1 sequence normally after five minutes after gado application and you make the second one about 75 minutes later, plus/minus 20 minutes and you make a subtraction. So you can differentiate the red areas like showed in this example with necrosis and you have the blue areas with tumor.
And this is how it works. The second one, you subtract from it the first one, and it's just simple. You get a really crisp Contrast Clearance Analysis, the blue and the red areas.
So, the Contrast Clearance Analysis has new, a very high specificity and sensitivity. It's just better than the Perfusion which will make it because it's very often after treatment, falls negative. And the Contrast Clearance Analysis had very accurate and identification of the active tumor, the high resolution, and it even can show new small brain metastasis better than the Perfusion.
So let me show two patients from our institute. You see here a woman after breast cancer with this metastasis on this side. She get first resection. This is the T1 without gado and the T1 after gado, after resection. So, there is no enhancement. There is no lesion left. And this is even what we see with the Perfusion. There is no pathological CVV.
So what has happened after VMAT? We see the first one at the end of VMAT, it looks wonderful. And this is even the followup one month later. Five months later, it even looks very good.
But what happens another month later? You see this very intensity and huge enhancement on this area and we don't know what it is. We make a Perfusion and we see some small, very small pathological perfusion at that side, but we even don't know...we can't differentiate. Is it now a recurrence or is it treatment effect? So we made a Contrast Clearance Analysis, and we see now this blue area which is as high as the first one. You see it on the T1 with gado and just a little bit of necrosis at the periphery.
So, she got another surgery. This is the T1 without gado, this is the T1 with gado after surgery. And we see on this side here, a very small enhancement. So we made, after surgery, this Contrast Clearance Analysis and we can say what you see here with T1 gado, this is no tumor. Whereas, this is just the necrosis.
Now the patient with lung cancer, we can see here, he came with a headache, and we see here the metastasis on the parietal lobe. And this is the T1 after gado.
So, first, he get radiotherapy. You see here this area of the radiotherapy and the followup. And two months later, looking at the first metastasis he had, this is the response. Two months later, sorry, at this time, on this area. And then, we have another lesion here literally from the first one. So, what is it? We didn't know. And look at the images after biopsy and we see here the trajectory of the biopsy he had first. And so, we thought this may be a second metastasis on this biopsy trajectory.
So, this was the first one and this is the second one we see here. We made a Perfusion and yes, we have the confirmation. This may be a metastasis because that area, he never had treatment.
So, we made even Contrast Clearance Analysis. And you see here, the first metastasis, which was radiotherapy. And this second one, on the trajectory analysis, this is real metastasis. So he get the second radiotherapy. You see here the first one and you see here the second one, and you see here now on coronary reconstructions at the second one and the first one. And we saw him two months later only with headache but no edema and no recurrence at that area.
So, what can we see about Contrast Clearance Analysis? It's a radiology focused procedure so we don't need nuclear medicine, we don't need another CT or whatever. You have only the first and the normal gado dose, weight-adapted gado dose, and you make the first MRI. You see this enhancement on this side and you have time to make the decision. Do you need the second acquisition or not? And if you see this enhancement, you can say, "Okay." Say other patients, "Please make one hour and go take a coffee or whatever, and please return one hour later. And then we make the second scan." You don't need a second Contrast medium so it's just the first one you gave. And you make the Contrast Clearance Analysis and have this high specificity and sensitivity to differentiate tumor for tumor [inaudible 00:08:47.588]. Thank you very much.