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RECIST revised: implications for the radiologist. A review article on the modified RECIST guideline.

van Persijn van Meerten EL, Gelderblom H, Bloem JL - Eur Radiol (2009)

Bottom Line: The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate.The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN >or=10 mm but <15 mm and target LN >or=15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a >or=20% increase in the sum of the longest diameter (SLD) from the nadir but also a >or=5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines.Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. epersijn@lumc.nl

ABSTRACT
The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate. The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN >or=10 mm but <15 mm and target LN >or=15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a >or=20% increase in the sum of the longest diameter (SLD) from the nadir but also a >or=5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines. Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.

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In this 40-year-old man with hepatocellular carcinoma, a CT image of the liver in the late arterial phase shows a hypervascular tumour in the hepatic dome (arrows in a) that is well delineated from the surrounding parenchyma, whereas the same lesion is barely discernible from the liver parenchyma in the portal-venous phase (arrows in b) due to early washout of contrast media
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Fig6: In this 40-year-old man with hepatocellular carcinoma, a CT image of the liver in the late arterial phase shows a hypervascular tumour in the hepatic dome (arrows in a) that is well delineated from the surrounding parenchyma, whereas the same lesion is barely discernible from the liver parenchyma in the portal-venous phase (arrows in b) due to early washout of contrast media

Mentions: Intravenous contrast media administration in CT is mandatory. Although no specific instructions are given on the type, dose and rate of intravenous contrast media and the timing of CT data acquisition, it is stated that typically, CT acquisition should be performed during the portal venous phase and that a single phase is usually sufficient. However, triphasic CT protocols are recommended for hepatocellular and neuroendocrine tumours (Fig. 6). A method of contrast media administration should be chosen to demonstrate metastases to best effect and the method should be used consistently on follow-up CT studies. In case of contra-indications to intravenous contrast media, the decision on whether to perform non-contrast enhanced CT or MRI should depend on the tumour type, the anatomic location of the disease and the findings on prior studies, to allow for optimal comparison and reproducibility of results. Non-contrast chest CT is preferred over MRI or chest X-ray.


RECIST revised: implications for the radiologist. A review article on the modified RECIST guideline.

van Persijn van Meerten EL, Gelderblom H, Bloem JL - Eur Radiol (2009)

In this 40-year-old man with hepatocellular carcinoma, a CT image of the liver in the late arterial phase shows a hypervascular tumour in the hepatic dome (arrows in a) that is well delineated from the surrounding parenchyma, whereas the same lesion is barely discernible from the liver parenchyma in the portal-venous phase (arrows in b) due to early washout of contrast media
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2872013&req=5

Fig6: In this 40-year-old man with hepatocellular carcinoma, a CT image of the liver in the late arterial phase shows a hypervascular tumour in the hepatic dome (arrows in a) that is well delineated from the surrounding parenchyma, whereas the same lesion is barely discernible from the liver parenchyma in the portal-venous phase (arrows in b) due to early washout of contrast media
Mentions: Intravenous contrast media administration in CT is mandatory. Although no specific instructions are given on the type, dose and rate of intravenous contrast media and the timing of CT data acquisition, it is stated that typically, CT acquisition should be performed during the portal venous phase and that a single phase is usually sufficient. However, triphasic CT protocols are recommended for hepatocellular and neuroendocrine tumours (Fig. 6). A method of contrast media administration should be chosen to demonstrate metastases to best effect and the method should be used consistently on follow-up CT studies. In case of contra-indications to intravenous contrast media, the decision on whether to perform non-contrast enhanced CT or MRI should depend on the tumour type, the anatomic location of the disease and the findings on prior studies, to allow for optimal comparison and reproducibility of results. Non-contrast chest CT is preferred over MRI or chest X-ray.

Bottom Line: The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate.The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN >or=10 mm but <15 mm and target LN >or=15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a >or=20% increase in the sum of the longest diameter (SLD) from the nadir but also a >or=5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines.Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. epersijn@lumc.nl

ABSTRACT
The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate. The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN >or=10 mm but <15 mm and target LN >or=15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a >or=20% increase in the sum of the longest diameter (SLD) from the nadir but also a >or=5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines. Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.

Show MeSH
Related in: MedlinePlus