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Diagnosis and monitoring denosumab therapy of giant cell tumors of bone : radiologic-pathologic correlation

Maryse Lejoly (UGent) , Thomas Van Den Berghe (UGent) , David Creytens (UGent) , Wouter Huysse (UGent) , Lore Lapeire (UGent) , Gwen Sys (UGent) and Koenraad Verstraete (UGent)
(2024) SKELETAL RADIOLOGY. 53. p.353-364
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Abstract
ObjectiveTo determine the value of CT and dynamic contrast-enhanced (DCE-)MRI for monitoring denosumab therapy of giant cell tumors of bone (GCTB) by correlating it to histopathology.Materials and methodsPatients with GCTB under denosumab treatment and monitored with CT and (DCE-)MRI (2012-2021) were retrospectively included. Imaging and (semi-)quantitative measurements were used to assess response/relapse. Tissue samples were analyzed using computerized segmentation for vascularization and number of neoplastic and giant cells. Pearson's correlation/Spearman's rank coefficient and Kruskal-Wallis tests were used to assess correlations between histopathology and radiology.ResultsSix patients (28 & PLUSMN; 8years; five men) were evaluated. On CT, good responders showed progressive re-ossification (+7.8HU/month) and cortical remodeling (woven bone). MRI showed an SI decrease relative to muscle on T1-weighted (-0.01 A.U./month) and on fat-saturated T2-weighted sequences (-0.03 A.U./month). Time-intensity-curves evolved from a type IV with high first pass, high amplitude, and steep wash-out to a slow type II. An increase in time-to-peak (+100%) and a decrease in Ktrans (-71%) were observed. This is consistent with microscopic examination, showing a decrease of giant cells (-76%), neoplastic cells (-63%), and blood vessels (-28%). There was a strong statistical significant inverse correlation between time-to-peak and microvessel density (& rho; = -0.9, p = 0.01). Significantly less neoplastic (p = 0.03) and giant cells (p = 0.04) were found with a time-intensity curve type II, compared to a type IV. Two patients showed relapse after initial good response when stopping denosumab. Inverse imaging and pathological findings were observed.ConclusionCT and (DCE-)MRI show a good correlation with pathology and allow adequate evaluation of response to denosumab and detection of therapy failure.
Keywords
Radiology, Nuclear Medicine and imaging, Microvessel density, CT, Time-to-peak, Ktrans, Correlation, Vascularization, Histopathology, (DCE-)MRI, Denosumab, Giant cell tumor of bone

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MLA
Lejoly, Maryse, et al. “Diagnosis and Monitoring Denosumab Therapy of Giant Cell Tumors of Bone : Radiologic-Pathologic Correlation.” SKELETAL RADIOLOGY, vol. 53, Springer Science and Business Media LLC, 2024, pp. 353–64, doi:10.1007/s00256-023-04403-7.
APA
Lejoly, M., Van Den Berghe, T., Creytens, D., Huysse, W., Lapeire, L., Sys, G., & Verstraete, K. (2024). Diagnosis and monitoring denosumab therapy of giant cell tumors of bone : radiologic-pathologic correlation. SKELETAL RADIOLOGY, 53, 353–364. https://doi.org/10.1007/s00256-023-04403-7
Chicago author-date
Lejoly, Maryse, Thomas Van Den Berghe, David Creytens, Wouter Huysse, Lore Lapeire, Gwen Sys, and Koenraad Verstraete. 2024. “Diagnosis and Monitoring Denosumab Therapy of Giant Cell Tumors of Bone : Radiologic-Pathologic Correlation.” SKELETAL RADIOLOGY 53: 353–64. https://doi.org/10.1007/s00256-023-04403-7.
Chicago author-date (all authors)
Lejoly, Maryse, Thomas Van Den Berghe, David Creytens, Wouter Huysse, Lore Lapeire, Gwen Sys, and Koenraad Verstraete. 2024. “Diagnosis and Monitoring Denosumab Therapy of Giant Cell Tumors of Bone : Radiologic-Pathologic Correlation.” SKELETAL RADIOLOGY 53: 353–364. doi:10.1007/s00256-023-04403-7.
Vancouver
1.
Lejoly M, Van Den Berghe T, Creytens D, Huysse W, Lapeire L, Sys G, et al. Diagnosis and monitoring denosumab therapy of giant cell tumors of bone : radiologic-pathologic correlation. SKELETAL RADIOLOGY. 2024;53:353–64.
IEEE
[1]
M. Lejoly et al., “Diagnosis and monitoring denosumab therapy of giant cell tumors of bone : radiologic-pathologic correlation,” SKELETAL RADIOLOGY, vol. 53, pp. 353–364, 2024.
@article{01H6P1MFSGQJGGQCM9B9FKVQ4V,
  abstract     = {{ObjectiveTo determine the value of CT and dynamic contrast-enhanced (DCE-)MRI for monitoring denosumab therapy of giant cell tumors of bone (GCTB) by correlating it to histopathology.Materials and methodsPatients with GCTB under denosumab treatment and monitored with CT and (DCE-)MRI (2012-2021) were retrospectively included. Imaging and (semi-)quantitative measurements were used to assess response/relapse. Tissue samples were analyzed using computerized segmentation for vascularization and number of neoplastic and giant cells. Pearson's correlation/Spearman's rank coefficient and Kruskal-Wallis tests were used to assess correlations between histopathology and radiology.ResultsSix patients (28 & PLUSMN; 8years; five men) were evaluated. On CT, good responders showed progressive re-ossification (+7.8HU/month) and cortical remodeling (woven bone). MRI showed an SI decrease relative to muscle on T1-weighted (-0.01 A.U./month) and on fat-saturated T2-weighted sequences (-0.03 A.U./month). Time-intensity-curves evolved from a type IV with high first pass, high amplitude, and steep wash-out to a slow type II. An increase in time-to-peak (+100%) and a decrease in Ktrans (-71%) were observed. This is consistent with microscopic examination, showing a decrease of giant cells (-76%), neoplastic cells (-63%), and blood vessels (-28%). There was a strong statistical significant inverse correlation between time-to-peak and microvessel density (& rho; = -0.9, p = 0.01). Significantly less neoplastic (p = 0.03) and giant cells (p = 0.04) were found with a time-intensity curve type II, compared to a type IV. Two patients showed relapse after initial good response when stopping denosumab. Inverse imaging and pathological findings were observed.ConclusionCT and (DCE-)MRI show a good correlation with pathology and allow adequate evaluation of response to denosumab and detection of therapy failure.}},
  author       = {{Lejoly, Maryse and Van Den Berghe, Thomas and Creytens, David and Huysse, Wouter and Lapeire, Lore and Sys, Gwen and Verstraete, Koenraad}},
  issn         = {{0364-2348}},
  journal      = {{SKELETAL RADIOLOGY}},
  keywords     = {{Radiology, Nuclear Medicine and imaging,Microvessel density,CT,Time-to-peak,Ktrans,Correlation,Vascularization,Histopathology,(DCE-)MRI,Denosumab,Giant cell tumor of bone}},
  language     = {{eng}},
  pages        = {{353--364}},
  publisher    = {{Springer Science and Business Media LLC}},
  title        = {{Diagnosis and monitoring denosumab therapy of giant cell tumors of bone : radiologic-pathologic correlation}},
  url          = {{http://doi.org/10.1007/s00256-023-04403-7}},
  volume       = {{53}},
  year         = {{2024}},
}
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