Injection rate of contrast medium affects diagnostic ability of dynamic contrast-enhanced magnetic resonance imaging for endometrial carcinoma: a prospective cohort study.

BACKGROUND: Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) can obtain semi-quantitative or quantitative parameters of tumors by capturing the images before and after injection of contrast medium. However, there has been no further research on the effect of flow rate of contrast medium on image quality and parameter sensitivity of DCE-MRI in endometrial carcinoma (EC). METHODS: This was a prospective cohort study enrolling patients who were suspected of EC between January 2018 and June 2020. The baseline data of participants were collected. Post-surgical histological examination acted as the gold standard of EC diagnosis and some characteristics of tumors were recorded. We calculated 3 important parameters of DCE-MRI, including volume transfer constant (Ktrans), flux rate constant (Kep), and extravascular extracellular volume fraction (Ve), according to the MRI system. The image quality in DCE-MRI imaging was evaluated according to contrast, resolution, artifact, signal-to-noise ratio, and scanning time. To evaluate the diagnostic ability of DCE-MRI with different injection rate, receiver operating characteristic (ROC) curve was generated and the area under curve (AUC) was calculated. RESULTS: According to the different injection rate of contrast medium, participants were divided into three groups, including 2, 3, and 4 mL/s group. It was found that there were more grade 1 EC in the 3 mL/s group (52.4%) than other two groups (34.3% and 23.3%, respectively), and the difference was significant (P=0.021). No other significant differences were found among all other variables. It was found that Ktrans was much higher in the 4 mL/s group than in other two groups (P<0.001). Also, Ve was much higher in the 4 mL/s group than in other two groups (P<0.001). However, no significant difference was found in Kep between three groups (P=0.633). Besides, the 4 mL/s group had the highest quality of all three groups (P<0.001). The sensitivity, specificity, and accuracy were highest in 4 mL/s group. The AUC in three groups were 0.822, 0.832, and 0.888 in the 2, 3, and 4 mL/s group, respectively. CONCLUSIONS: The DCE-MRI measurement is useful for the diagnosis of EC, and faster injection rate may be beneficial to improve diagnostic accuracy and image quality.

Pilot study of huachansu in patients with hepatocellular carcinoma, nonsmall-cell lung cancer, or pancreatic cancer.

BACKGROUND: Huachansu, a Chinese medicine that comes from dried toad venom from the skin glands of Bufo gargarizans or B. melanostictus, has been used in the treatment of various cancers in China. The authors conducted a pilot study, using a phase 1 trial design, of huachansu in patients with advanced cancer. METHODS: Huachansu was administered intravenously for 14 days followed by 7 days off (1 cycle). Without significant adverse events or progressive disease, treatment continued beyond 2 cycles. The dose of huachansu was escalated as follows with 3 patients per cohort: 10 (level 1), 20 (level 2), 40 (level 3), 60 (level 4), and 90 (level 5) mL/m(2). RESULTS: Fifteen patients (hepatocellular cancer, n = 11; nonsmall cell lung cancer, n = 2; pancreatic cancer, n = 2) were enrolled in the trial, and no dose-limiting toxicities (DLTs) were found. Eleven patients had no drug-related toxicity greater than grade 1. Six (40%) had stable disease (median duration, 6.0 months; range, 3.5-11.1 months). One of these patients (with hepatocellular cancer) had 20% regression (duration, 11 months) (dose level 1). Quality of life improved for patients with stable disease. Plasma bufalin concentration reached maximal levels at the end of the 2-hour infusion and was proportional to the amount of drug being administered (0.81-3.38 ng/mL). CONCLUSIONS: No DLT was observed with the use of huachansu at doses up to 8x higher than typically used in China. Six patients had prolonged stable disease or minor tumor shrinkage.

Concentration change of chemotherapeutic agents in plasma and tissue after intraarterial and intravenous injection.

OBJECTIVE: To study the concentration change of chemotherapeutic agents in plasma and tissue after intraarterial and intravenous injection. METHODS: Ten mature female New Zealand rabbits were divided randomly into two groups. Fluorouracil, etopiside, and cisplatin were injected into the rabbits through the ear vein in one group and through the internal iliac artery in the other group. Blood samples and the uterus tissue specimens were collected at various time points after injection. Drug concentration in plasma and tissue was determined by high performance liquid chromatography (HPLC) method. The data were analyzed by the pharmacokinetic program 3P97. RESULTS: Regular concentration change of the three drugs in plasma and tissue was observed after the intravenous and intraarterial injection, which met the two - compartment model. The pharmacokinetic parameters of the three drugs after intravenous and intraarterial injection were different. The peak concentration in plasma after intraarterial injection was lower than that after intravenous injection and the peak concentration and area under curve (AUC) value in tissue after intraarterial injections were higher than those after intravenous injection. CONCLUSION: Intraarterial chemotherapy has advantages to intravenous chemotherapy in fluorouracil, etopiside and cisplatin. These advantages depend on the drug pharmacological properties.