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Tumour-specific disease response criteria
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Imaging assessments are at the core of personalized management of oncological patients. Imaging response biomarkers provide surrogate endpoint data to support marketing applications to regulatory agencies, thus facilitating a timely translation of novel drugs from clinical trials into clinical practice. In the clinical setting, imaging biomarkers could help in early identification of response/progression to a particular treatment and thus maximize the effectiveness of patient care. Despite their shortcomings, RECIST 1.1 criteria have been paramount to oncological drug development. With the ongoing increase of novel therapies and emergence of combination therapies, there will be an increased need for the radiological community to embrace and actively engage in the validation of disease-adapted RECIST criteria (modified RECIST).
Looking ahead Opportunities and challenges in radiomics and radiogenomics
Published in Ruijiang Li, Lei Xing, Sandy Napel, Daniel L. Rubin, Radiomics and Radiogenomics, 2019
Ruijiang Li, Yan Wu, Michael Gensheimer, Masoud Badiei Khuzani, Lei Xing
Radiomics and radiogenomics have been widely investigated for noninvasive acquisition of quantitative textural information from medical imaging data and correlate them to various clinical findings or genomics data. The field has shown a great promise for the discovery of clinically useful imaging markers having diagnostic and prognostic values for variety of clinical applications. It is important to emphasize that, despite the enthusiasm and excitement around this, many radiomics and radiogenomics studies so far are limited by their hypothesis-generating nature, as rigorous validation in independent cohorts has been lacking. Another caveat is that existing biologic knowledge about a certain disease is often not taken into account in many studies. To be of practical value, any new imaging biomarkers should be complementary and add predictive value to known clinical and pathologic factors. It is also useful to point out that an under-explored area of investigation is how radiomics/radiogenomics can be applied to longitudinal imaging scans to better evaluate therapeutic response and monitor disease given the increasing availability of treatment regimens.105 Although initial studies on simple delta-radiomics are encouraging,106 alternative approaches to characterizing longitudinal change should also be explored to maximize the information extracted from serial imaging scans.
Structural and Molecular Imaging in Cancer Therapy Clinical Trials
Published in John Crowley, Antje Hoering, Handbook of Statisticsin Clinical Oncology, 2012
Brenda F. Kurland, David A. Mankoff
The use of imaging to help direct and evaluate cancer therapy falls under the general category of use as a cancer biomarker. The aims for the use of qualitative and quantitative imaging biomarkers are similar to the aims for biomarkers from tissue and serum. To develop and apply appropriate statistical methods for analysis of these markers, it is important to understand the similarities and differences between tissue and imaging biomarkers (Table 24.1). It is also important to acknowledge that in many circumstances for clinical application and for design of clinical trials, information from both modalities (tissue and imaging biomarkers) may be available. Depending on the nature of overlap between tissue and imaging biomarkers, they may be used as confirmatory or complementary.
Long term outcomes following anti-VEGF therapy for diabetic macular edema
Published in Expert Review of Ophthalmology, 2022
Christopher M. Maatouk, Resya Sastry, Rishi P. Singh
In summary, this review of 21 studies of the long-term outcomes of anti-VEGF treatment for DME found that anti-VEGF treatment produces long-term VA and CRT benefits. Anti-VEGF agents provide longer periods of improved vision than laser or sham with fewer adverse effects and may be more cost-effective than laser treatments for individuals with center-involving DME causing vision loss. However, this review highlights a concern with anti-VEGF treatment, in that patients in real-world settings may not perform as well as their counterparts participating in clinical trials. Emphasis should be placed on the development of more efficient anti-VEGF agents and delivery methods which reduce the number of follow-up visits and treatments that patients require. In conjunction, further exploration of imaging biomarkers for treatment responses and outcomes may lead to more effective monitoring and assist with guiding treatment strategies.
Nonalcoholic fatty liver disease: use of diagnostic biomarkers and modalities in clinical practice
Published in Expert Review of Molecular Diagnostics, 2021
Saleh A Alqahtani, Jörn M Schattenberg
Hepatic steatosis, the key feature of NAFLD, is defined by the presence of >5% liver fat evidenced by histology or imaging techniques in individuals who consume little to no alcohol and in the absence of other chronic liver conditions. Patients with 'simple steatosis' have a low risk of disease progression, but early diagnosis would help provide appropriate and effective prevention measures to obviate progression to advanced fibrosis. Related to its asymptomatic nature, it is difficult to diagnose on clinical grounds, and the use of liver biopsy is not feasible. Several simple and reproducible biomarker panels and scores were developed to diagnose hepatic steatosis. Biomarker panels can be categorized into serum and imaging biomarkers. Importantly, not all serum proteins measured are strictly specific to the liver compartment and thus overlap with other conditions have to be taken into consideration. Therefore, the pretest probability of the target condition in the developmental cohort of a score is of importance to place sensitivity and specificity into context and understand potential confounders. These limitations can be partly overcome by imaging techniques for hepatic steatosis such as ultrasound- and magnetic resonance-based diagnostic tools as they reflect the intrinsic property of the liver texture or stiffness directly []. Both approaches have their limitations, and here we discuss in detail the available noninvasive diagnostic modalities in detecting NAFLD.
What do we know about the variability in survival of patients with amyotrophic lateral sclerosis?
Published in Expert Review of Neurotherapeutics, 2020
Pamela A. McCombe, Fleur C Garton, Matthew Katz, Naomi R Wray, Robert D Henderson
Imaging biomarkers are ideal for use as they represent a noninvasive tool that can be repetitively applied. The association of some imaging biomarkers with survival is summarized in Table 6. Ultrasound appears to have a role in the diagnosis of ALS with assessment of fasciculations and denervation [218] but has not been evaluated as a marker of progression or predictor of survival. MRI scans in ALS demonstrate loss of gray matter and loss of white matter tracts using morphometry and diffusion tractography [219,220]. It appears that changes in white matter are substantial by the time of diagnosis, with limited further change as disease progresses, but gray matter loss continues to be demonstrable as disease progresses [221,222]. Severity of MRI abnormalities is predictive of survival [223,224]. A model that incorporated clinical, cognitive, and MRI measures has also been found to predict survival [115].