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Pelvic malignancy: integrating form and function

Epix Pharmaceuticals, 161 First Street, Cambridge, MA 02142, USA

View larger version (185K): [in a new window]   Figure 1. Coronal T2 weighted image of a previously treated anal cancer in an adult female patient. The arrows indicate the extent of perianal fibrosis following chemoradiotherapy. Despite the exquisite sensitivity of MRI to soft-tissue anatomy this image reveals little about the underlying tumour biology.

View larger version (12K): [in a new window]   Figure 2. Cartoon depicting diffusion of water molecules in two alternative environments. (a) In a region of high cellularity the translational motion of individual water molecules is considerably impeded. (b) In an area with substantial cell loss such as occurs with necrosis and/or apoptosis the translational motion of water molecules is relatively unimpeded. The degree of restriction of molecular translational motion is manifest as contrast differences on a diffusion weighted image and can be quantified. Cartoon courtesy of Dr P Murphy, Pfizer, Inc.

View larger version (71K): [in a new window]   Figure 3. A 1H-MRS (a) short echo time and (b) long echo time spectrum from a locally advanced rectal cancer. The sensitivity of MRS to different local magnetic fields generated in the molecule's electron valency clouds results in chemical species resonating at different frequencies. This is the basis for the different peaks illustrated in this example and allows investigators to probe the metabolism of cancers in vivo. Reprinted from [35].

View larger version (70K): [in a new window]   Figure 4. Composite of images depicting the output of a multifunctional MRI and MRS study in locally advanced rectal cancer. (a) Axial T2 weighted anatomical image (yellow arrows), (b) a Ktrans map which depicts capillary permeability, (c) a relative blood volume map derived by exploiting the first pass T2* effect. Note this tumour has a low blood volume (the high signal intensity anteriorly is the high blood volume within the body of a recently gravid uterus). (d) A diffusion weighted image. This quantitative map permits pixel-by-pixel analysis of tumour ADC (apparent diffusion coefficient). (e) A 1H-MRS spectrum. 1H-MRS can be used to probe tumour metabolism.

View larger version (71K): [in a new window]   Figure 5. Composite set of images from a multifunctional MRI study of a T2 stage prostate cancer. (a) The T2 anatomic image (yellow arrow). (b) The Ktrans and (c) relative blood volume maps. (d) The diffusion ADC image depicts the cellularity of the prostate whilst (e) the T2* imaging module has been implemented to probe for possible sensitivity of MRI to hypoxia.

View larger version (52K): [in a new window]   Figure 6. Cartoon of the molecular structure of vascular endothelial growth factor (VEGF). VEGF is potent angiogenic peptide that induces endothelial cell growth as well as increasing the permeability of blood vessels. VEGF is typically over-expressed by tumours and is a principal factor in the altered vascularity of tumours. It is also the target of several molecularly targeted anti-angiogenic therapies. The image was obtained from http://www.rcsb.org/pdb/.