title: Bone marrow angiogenesis magnetic resonance imaging in patients with acute myeloid leukemia: peak enhancement ratio is an independent predictor for overall survival.
abstract: Emerging evidence suggests that progression of hematologic malignancies is associated with angiogenesis. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can provide global and functional imaging of tumor angiogenesis. In this study, we performed bone marrow DCE-MRI prospectively at diagnosis and after induction chemotherapy in 78 de novo acute myeloid leukemia (AML) patients and correlated it with treatment outcome. An algorithm to assess bone marrow angiogenesis by measuring the DCE-MRI time-intensity curve pixel by pixel was developed using 3 distinct parameters: peak enhancement ratio (Peak) to indicate tissue blood perfusion; amplitude (Amp) to reflect vascularity; and volume transfer constant (K trans) to indicate vascular permeability. The Peak and Amp decreased significantly at remission status after induction chemotherapy. Patients with higher Peak or Amp at diagnosis had shorter overall survival and disease-free survival than others. Cox multivariate analysis identified higher Peak value (hazard ratio, 9.181; 95% confidence interval, 1.740-48.437; P = .009) as an independent predictor for overall survival in addition to unfavorable karyotype and old age. Our findings provide evidence that increased bone marrow angiogenesis measured by DCE-MRI can predict adverse clinical outcome in AML patients. DCE-MRI may help to select high-risk phenotype AML patients for tailored antiangiogenic therapy and to monitor treatment response.
authors.affiliation: Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Tiffany Ting-Fang
authors.initials: TT
authors.lastname: Shih
authors.forename: Hsin-An
authors.initials: HA
authors.lastname: Hou
authors.forename: Chieh-Yu
authors.initials: CY
authors.lastname: Liu
authors.forename: Bang-Bin
authors.initials: BB
authors.lastname: Chen
authors.forename: Jih-Luh
authors.initials: JL
authors.lastname: Tang
authors.forename: Hsuan-Yu
authors.initials: HY
authors.lastname: Chen
authors.forename: Shwu-Yuan
authors.initials: SY
authors.lastname: Wei
authors.forename: Ming
authors.initials: M
authors.lastname: Yao
authors.forename: Shang-Yi
authors.initials: SY
authors.lastname: Huang
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Chou
authors.forename: Szu-Chun
authors.initials: SC
authors.lastname: Hsu
authors.forename: Woei
authors.initials: W
authors.lastname: Tsay
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yu
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Hsu
authors.forename: Hwei-Fang
authors.initials: HF
authors.lastname: Tien
authors.forename: Pan-Chyr
authors.initials: PC
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011379:Prognosis; D011859:Radiography; D016019:Survival Analysis; D015854:Up-Regulation / Q000502:physiology; D055815:Young Adult