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Imaging findings and value of CT and (DCE-)MRI in monitoring denosumab therapy of giant cell tumors of bone

Thomas Van Den Berghe (UGent) , Maryse Lejoly (UGent) , Lore Lapeire (UGent) , Wouter Huysse (UGent) , David Creytens (UGent) and Koenraad Verstraete (UGent)
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Abstract
Purpose or Learning Objective To determine the value of CT and (DCE-)MRI for monitoring denosumab therapy of giant cell tumors of bone (GCTB). Methods or Background Twelve patients (8 males, 4 females) with GCTB (4 spine, 8 limbs) were monitored six-monthly alternately with CT and (DCE-)MRI imaging studies and (semi-)quantitative measurements to assess response, relapse and complications. Results or Findings On CT, good responders showed progressive re-ossification of osteolysis, cortical remodelling and tumor and soft tissue volume reduction. On MRI, first a reduction in contrast enhancement, surrounding bone marrow oedema and volume were observed. Next, focal necrosis, fatty infiltration and progressive re-ossification of the osteolysis appeared. On DCE-MRI, the time-intensity curve evolved from a type IV curve with high first pass, high amplitude and steep wash-out rate over an intermediate type III or V to a slow type I or II curve. A reduction in wash-in slope, maximum signal intensity, area under the curve and amplitude of wash-in was observed, along with an increase in arrival time and time to peak. A decrease in Ktrans, initial area under curve and amplitude A was observed, along with increased Ve and Kep (extended Tofts/Brix models). Patients with poor response or relapse showed the inverse findings of good responders. Three patients showed relapse after initial good response when denosumab was stopped for pregnancy or dental surgery. Regarding evolution in time, one patient with initial good response showed a new cortical breakthrough and extensive bone marrow oedema. Biopsy revealed a highly cellular high-grade conventional osteosarcoma with small interstitial space. Conclusion Denosumab is effective in inoperable GCTB and in operable cases with large morbidity. CT and (DCE-)MRI allow adequate evaluation of early/late response and detection of therapy failure and malignant transformation. Limitations None. Ethics committee approval Approved, ICF obtained. Funding for this study None.
Keywords
CT, MRI, denosumab, giant cell tumor of bone

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MLA
Van Den Berghe, Thomas, et al. “Imaging Findings and Value of CT and (DCE-)MRI in Monitoring Denosumab Therapy of Giant Cell Tumors of Bone.” European Congress of Radiology 2022, Abstracts, European Congress of Radiology 2022, 2022.
APA
Van Den Berghe, T., Lejoly, M., Lapeire, L., Huysse, W., Creytens, D., & Verstraete, K. (2022). Imaging findings and value of CT and (DCE-)MRI in monitoring denosumab therapy of giant cell tumors of bone. European Congress of Radiology 2022, Abstracts. Presented at the European Congress of Radiology 2022; ECR 2022, Vienna, Austria.
Chicago author-date
Van Den Berghe, Thomas, Maryse Lejoly, Lore Lapeire, Wouter Huysse, David Creytens, and Koenraad Verstraete. 2022. “Imaging Findings and Value of CT and (DCE-)MRI in Monitoring Denosumab Therapy of Giant Cell Tumors of Bone.” In European Congress of Radiology 2022, Abstracts. Vienna: European Congress of Radiology 2022.
Chicago author-date (all authors)
Van Den Berghe, Thomas, Maryse Lejoly, Lore Lapeire, Wouter Huysse, David Creytens, and Koenraad Verstraete. 2022. “Imaging Findings and Value of CT and (DCE-)MRI in Monitoring Denosumab Therapy of Giant Cell Tumors of Bone.” In European Congress of Radiology 2022, Abstracts. Vienna: European Congress of Radiology 2022.
Vancouver
1.
Van Den Berghe T, Lejoly M, Lapeire L, Huysse W, Creytens D, Verstraete K. Imaging findings and value of CT and (DCE-)MRI in monitoring denosumab therapy of giant cell tumors of bone. In: European Congress of Radiology 2022, Abstracts. Vienna: European Congress of Radiology 2022; 2022.
IEEE
[1]
T. Van Den Berghe, M. Lejoly, L. Lapeire, W. Huysse, D. Creytens, and K. Verstraete, “Imaging findings and value of CT and (DCE-)MRI in monitoring denosumab therapy of giant cell tumors of bone,” in European Congress of Radiology 2022, Abstracts, Vienna, Austria, 2022.
@inproceedings{8768377,
  abstract     = {{Purpose or Learning Objective
To determine the value of CT and (DCE-)MRI for monitoring denosumab therapy of giant cell tumors of bone (GCTB). 

Methods or Background
Twelve patients (8 males, 4 females) with GCTB (4 spine, 8 limbs) were monitored six-monthly alternately with CT and (DCE-)MRI imaging studies and (semi-)quantitative measurements to assess response, relapse and complications.

Results or Findings
On CT, good responders showed progressive re-ossification of osteolysis, cortical remodelling and  tumor and soft tissue volume reduction. On MRI, first a reduction in contrast enhancement, surrounding bone marrow oedema and volume were observed. Next, focal necrosis, fatty infiltration and progressive re-ossification of the osteolysis appeared. On DCE-MRI, the time-intensity curve evolved from a type IV curve with high first pass, high amplitude and steep wash-out rate over an intermediate type III or V to a slow type I or II curve. A reduction in wash-in slope, maximum signal intensity, area under the curve and amplitude of wash-in was observed, along with an increase in arrival time and time to peak. A decrease in Ktrans, initial area under curve and amplitude A was observed, along with increased Ve and Kep (extended Tofts/Brix models). 
Patients with poor response or relapse showed the inverse findings of good responders. Three patients showed relapse after initial good response when denosumab was stopped for pregnancy or dental surgery.
Regarding evolution in time, one patient with initial good response showed a new cortical breakthrough and extensive bone marrow oedema. Biopsy revealed a highly cellular high-grade conventional osteosarcoma with small interstitial space. 
Conclusion
Denosumab is effective in inoperable GCTB and in operable cases with large morbidity. CT and 
(DCE-)MRI allow adequate evaluation of early/late response and detection of therapy failure and malignant transformation.

Limitations
None.

Ethics committee approval
Approved, ICF obtained.

Funding for this study
None.}},
  author       = {{Van Den Berghe, Thomas and Lejoly, Maryse and Lapeire, Lore and Huysse, Wouter and Creytens, David and Verstraete, Koenraad}},
  booktitle    = {{European Congress of Radiology 2022, Abstracts}},
  keywords     = {{CT,MRI,denosumab,giant cell tumor of bone}},
  language     = {{eng}},
  location     = {{Vienna, Austria}},
  publisher    = {{European Congress of Radiology 2022}},
  title        = {{Imaging findings and value of CT and (DCE-)MRI in monitoring denosumab therapy of giant cell tumors of bone}},
  year         = {{2022}},
}