CT and MRI in monitoring response: state-of-the-art and future developments.
The present review is aimed at updating the reader with the current role of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of tumor response, contextualizing the imaging methods advantages and limitations. CT has been the most frequent and widely adopted diagnostic tool. The main advantages of such method include wide availability, high reproducibility, capability to contemporarily evaluate soft tissues, bone and lung parenchyma, besides being easy to perform. Its main limitation is related to the use of ionizing radiation. MRI has emerged as a feasible alternative to CT, particularly in patients with contraindications to the use of iodinated contrast agents, with advantages related to its high soft tissues contrast. The disadvantages are based on its operational complexity and the many technical variables involved which may influence and compromise the reproducibility and broad implementation of the method. New criteria for evaluation of tumor response have recently been proposed, contemplating lately developed drugs and therapeutic strategies that demand the utilization of functional parameters. In this context, the technological developments incorporated in the CT and MRI imaging techniques, such as perfusion analysis, diffusion studies (DW-RM) and MR spectroscopy (MRS), among others, have provided relevant information regarding the tumor response to targeted therapies, anticipating dimensional alterations and guiding physicians in the course of the treatment. Despite such developments, further efforts are needed to establish reproducible protocols, functional response criteria and time intervals for response evaluation in order to allow a definitive incorporation of these new technologies in the assessment of tumor response.
Department of Diagnostic Imaging, Escola Paulista de Medicina, São Paulo Federal University, São Paulo, Brazil. giuseppe_dr@uol.com.br
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D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D057054:Molecular Imaging / Q000639:trends*; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000639:trends*; D013382:Subtraction Technique / Q000639:trends*; D014057:Tomography, X-Ray Computed / Q000639:trends*; D016896:Treatment Outcome