title: Blood vessel morphologic changes depicted with MR angiography during treatment of brain metastases: a feasibility study.
abstract: OBJECTIVE
  To prospectively determine if magnetic resonance (MR) angiography can depict intracranial vascular morphologic changes during treatment of brain metastases from breast cancer and if serial quantitative vessel tortuosity measurements can be used to predict tumor treatment response sooner than traditional methods.
  
  
  METHODS
  Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Twenty-two women aged 31-61 years underwent brain MR angiography prior to and 2 months after initiation of lapatinib therapy for brain metastases from breast cancer. Vessels were extracted from MR angiograms with a computer program. Changes in vessel number, radius, and tortuosity were calculated mathematically, normalized with values obtained in 34 healthy control subjects (19 women, 15 men; age range, 19-72 years), and compared with subsequent assessments of tumor volume and clinical course.
  
  
  RESULTS
  All patients exhibited abnormal vessel tortuosity at baseline. Nineteen (86%) patients did not exhibit improvement in vessel tortuosity at 2-month follow-up, and all patients demonstrated tumor growth at 4-month follow-up. Vessel tortuosity measurements enabled us to correctly predict treatment failure 1-2 months earlier than did traditional methods. Three (14%) patients had quantitative improvement in vessel tortuosity at 2-month follow-up, with drop out of small abnormal vessels and straightening of large vessels. Each of the two patients for whom further follow-up data were available responded to treatment for more than 6 months.
  
  
  CONCLUSIONS
  Study results established the feasibility of using MR angiography to quantify vessel shape changes during therapy. Although further research is required, results suggest that changes in vessel tortuosity might enable early prediction of tumor treatment response.
authors.affiliation: Computer Assisted Surgery and Imaging Laboratory, University of North Carolina, 247 Wing E, CB 7062, Chapel Hill, NC 27599, USA. bullitt@med.unc.edu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bullitt
authors.forename: Nancy U
authors.initials: NU
authors.lastname: Lin
authors.forename: J Keith
authors.initials: JK
authors.lastname: Smith
authors.forename: Donglin
authors.initials: D
authors.lastname: Zeng
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Carey
authors.forename: Weili
authors.initials: W
authors.lastname: Lin
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Ewend
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000098:blood supply* / Q000188:drug therapy / Q000473:pathology / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies