Program Information
Inclusion of Cavernous Sinus Drainage and Standardized DCE-MRI Models for Pituitary Tumors
D Wu1*, J Modi2 , M Gumerlock3 , (1) University of Oklahoma Health Sciences Center, Oklahoma City, Ok, (2) Yale Medical Center, New Haven, CT, (3) Neurosurgery, Oklahoma City, Ok
Presentations
TH-CD-207-4 (Thursday, July 16, 2015) 10:00 AM - 12:00 PM Room: 207
Purpose:
The pituitary gland regulates major body functions through the endocrine system. However, its function is susceptible to be adversely affected by the presence of cancer. Currently, DCE-MRI has now emerged as a potentially prognostic clinical tool for the evaluation of tumors and there has been much effort to standardize its use through the QIBA initiative. Recently, it has been reported that the hypothalamic-pituitary-thyroid axis can be particularly sensitive to ionizing radiation. Additionally, upon extensive literature search, we believe that this report is the first in pituitary tumors in humans that applies full/detailed pharmacokinetic models. We also report significant differences between a conventional two-compartmental model and our newly included cavernous sinus compartment in pituitary cancer models.
Methods: Six patients with microadenomas and six controls were used to evaluate our pharmacokinetic models. We have built pharmacokinetic models in QT/C++/Matlab. A Toft-Kermode model, which implemented a Marquart-Levenberg regression, was applied. Image segmentation was used to identify the three compartments around the pituitary (body, stalk and sinus). We have also supplied both omnibus/descriptive statistics for each population using SAS/R packages.
Results: On twelve subjects, we were able to discern differences on a MANOVA across patients/controls on the dependent variables of KTrans and VE with a p=.0072 [ F=10.8282,DOF=(2,7) ]. Illustrating that the choice between including drainage and without is both significant in patients and controls for the pituitary.
Conclusion: To our knowledge, this is the first report that provides the pharmacokinetic KTrans and VE values for the pituitary. Additionally, we have determined it is significant to include the venous drainage of the pituitary (a visible effect of contrast uptake in the cavernous sinus was strongly noted by radiologists). We suggest recognizing drainage to play a larger role for accurate tumor perfusion monitoring and should be incorporated into pharmacokinetic models whenever possible.
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