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Stumpo V, Guida L, Bellomo J, Van Niftrik CHB, Sebök M, Berhouma M, Bink A, Weller M, Kulcsar Z, Regli L, Fierstra J. Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions. Cancers (Basel) 2022; 14:cancers14051342. [PMID: 35267650 PMCID: PMC8909110 DOI: 10.3390/cancers14051342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Gliomas, and glioblastoma in particular, exhibit an extensive intra- and inter-tumoral molecular heterogeneity which represents complex biological features correlating to the efficacy of treatment response and survival. From a neuroimaging point of view, these specific molecular and histopathological features may be used to yield imaging biomarkers as surrogates for distinct tumor genotypes and phenotypes. The development of comprehensive glioma imaging markers has potential for improved glioma characterization that would assist in the clinical work-up of preoperative treatment planning and treatment effect monitoring. In particular, the differentiation of tumor recurrence or true progression from pseudoprogression, pseudoresponse, and radiation-induced necrosis can still not reliably be made through standard neuroimaging only. Given the abundant vascular and hemodynamic alterations present in diffuse glioma, advanced hemodynamic imaging approaches constitute an attractive area of clinical imaging development. In this context, the inclusion of objective measurable glioma imaging features may have the potential to enhance the individualized care of diffuse glioma patients, better informing of standard-of-care treatment efficacy and of novel therapies, such as the immunotherapies that are currently increasingly investigated. In Part B of this two-review series, we assess the available evidence pertaining to hemodynamic imaging for molecular feature prediction, in particular focusing on isocitrate dehydrogenase (IDH) mutation status, MGMT promoter methylation, 1p19q codeletion, and EGFR alterations. The results for the differentiation of tumor progression/recurrence from treatment effects have also been the focus of active research and are presented together with the prognostic correlations identified by advanced hemodynamic imaging studies. Finally, the state-of-the-art concepts and advancements of hemodynamic imaging modalities are reviewed together with the advantages derived from the implementation of radiomics and machine learning analyses pipelines.
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Affiliation(s)
- Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Correspondence:
| | - Lelio Guida
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Jacopo Bellomo
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Christiaan Hendrik Bas Van Niftrik
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Moncef Berhouma
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, 69500 Lyon, France;
| | - Andrea Bink
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
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Macyszyn L, Akbari H, Pisapia JM, Da X, Attiah M, Pigrish V, Bi Y, Pal S, Davuluri RV, Roccograndi L, Dahmane N, Martinez-Lage M, Biros G, Wolf RL, Bilello M, O'Rourke DM, Davatzikos C. Imaging patterns predict patient survival and molecular subtype in glioblastoma via machine learning techniques. Neuro Oncol 2015; 18:417-25. [PMID: 26188015 DOI: 10.1093/neuonc/nov127] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/12/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND MRI characteristics of brain gliomas have been used to predict clinical outcome and molecular tumor characteristics. However, previously reported imaging biomarkers have not been sufficiently accurate or reproducible to enter routine clinical practice and often rely on relatively simple MRI measures. The current study leverages advanced image analysis and machine learning algorithms to identify complex and reproducible imaging patterns predictive of overall survival and molecular subtype in glioblastoma (GB). METHODS One hundred five patients with GB were first used to extract approximately 60 diverse features from preoperative multiparametric MRIs. These imaging features were used by a machine learning algorithm to derive imaging predictors of patient survival and molecular subtype. Cross-validation ensured generalizability of these predictors to new patients. Subsequently, the predictors were evaluated in a prospective cohort of 29 new patients. RESULTS Survival curves yielded a hazard ratio of 10.64 for predicted long versus short survivors. The overall, 3-way (long/medium/short survival) accuracy in the prospective cohort approached 80%. Classification of patients into the 4 molecular subtypes of GB achieved 76% accuracy. CONCLUSIONS By employing machine learning techniques, we were able to demonstrate that imaging patterns are highly predictive of patient survival. Additionally, we found that GB subtypes have distinctive imaging phenotypes. These results reveal that when imaging markers related to infiltration, cell density, microvascularity, and blood-brain barrier compromise are integrated via advanced pattern analysis methods, they form very accurate predictive biomarkers. These predictive markers used solely preoperative images, hence they can significantly augment diagnosis and treatment of GB patients.
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Affiliation(s)
- Luke Macyszyn
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Hamed Akbari
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Jared M Pisapia
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Xiao Da
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Mark Attiah
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Vadim Pigrish
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Yingtao Bi
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Sharmistha Pal
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Ramana V Davuluri
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Laura Roccograndi
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Nadia Dahmane
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Maria Martinez-Lage
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - George Biros
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Ronald L Wolf
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Michel Bilello
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Donald M O'Rourke
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
| | - Christos Davatzikos
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (L.M., J.M.P., M.A., L.R., N.D., D.M.O.); Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., R.L.W., M.B., C.D.); Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania (H.A., X.D., V.P., M.B., C.D.); Department of Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Y.B., S.P., R.V.D.); Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas (G.B.); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (M.M.-L., D.M.O.)
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