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Veikutis V, Brazdziunas M, Keleras E, Basevicius A, Grib A, Skaudickas D, Lukosevicius S. Diagnostic Approaches to Adult-Type Diffuse Glial Tumors: Comparative Literature and Clinical Practice Study. Curr Oncol 2023; 30:7818-7835. [PMID: 37754483 PMCID: PMC10528153 DOI: 10.3390/curroncol30090568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/28/2023] Open
Abstract
Gliomas are the most frequent intrinsic central nervous system tumors. The new 2021 WHO Classification of Central Nervous System Tumors brought significant changes into the classification of gliomas, that underline the role of molecular diagnostics, with the adult-type diffuse glial tumors now identified primarily by their biomarkers rather than histology. The status of the isocitrate dehydrogenase (IDH) 1 or 2 describes tumors at their molecular level and together with the presence or absence of 1p/19q codeletion are the most important biomarkers used for the classification of adult-type diffuse glial tumors. In recent years terminology has also changed. IDH-mutant, as previously known, is diagnostically used as astrocytoma and IDH-wildtype is used as glioblastoma. A comprehensive understanding of these tumors not only gives patients a more proper treatment and better prognosis but also highlights new difficulties. MR imaging is of the utmost importance for diagnosing and supervising the response to treatment. By monitoring the tumor on followup exams better results can be achieved. Correlations are seen between tumor diagnostic and clinical manifestation and surgical administration, followup care, oncologic treatment, and outcomes. Minimal resection site use of functional imaging (fMRI) and diffusion tensor imaging (DTI) have become indispensable tools in invasive treatment. Perfusion imaging provides insightful information about the vascularity of the tumor, spectroscopy shows metabolic activity, and nuclear medicine imaging displays tumor metabolism. To accommodate better treatment the differentiation of pseudoprogression, pseudoresponse, or radiation necrosis is needed. In this report, we present a literature review of diagnostics of gliomas, the differences in their imaging features, and our radiology's departments accumulated experience concerning gliomas.
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Affiliation(s)
- Vincentas Veikutis
- Medical Academy, Lithuanian University of Health Sciences, LT50161 Kaunas, Lithuania; (M.B.); (E.K.); (A.B.); (D.S.); (S.L.)
| | - Mindaugas Brazdziunas
- Medical Academy, Lithuanian University of Health Sciences, LT50161 Kaunas, Lithuania; (M.B.); (E.K.); (A.B.); (D.S.); (S.L.)
- Faculty of Medicine, Kaunas University of Applied Sciences, LT44162 Kaunas, Lithuania
| | - Evaldas Keleras
- Medical Academy, Lithuanian University of Health Sciences, LT50161 Kaunas, Lithuania; (M.B.); (E.K.); (A.B.); (D.S.); (S.L.)
| | - Algidas Basevicius
- Medical Academy, Lithuanian University of Health Sciences, LT50161 Kaunas, Lithuania; (M.B.); (E.K.); (A.B.); (D.S.); (S.L.)
| | - Andrei Grib
- Department of Internal Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD2004 Chisinau, Moldova;
| | - Darijus Skaudickas
- Medical Academy, Lithuanian University of Health Sciences, LT50161 Kaunas, Lithuania; (M.B.); (E.K.); (A.B.); (D.S.); (S.L.)
| | - Saulius Lukosevicius
- Medical Academy, Lithuanian University of Health Sciences, LT50161 Kaunas, Lithuania; (M.B.); (E.K.); (A.B.); (D.S.); (S.L.)
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Maiter A, Butteriss D, English P, Lewis J, Hassani A, Bhatnagar P. Assessing the diagnostic accuracy and interobserver agreement of MRI perfusion in differentiating disease progression and pseudoprogression following treatment for glioblastoma in a tertiary UK centre. Clin Radiol 2022; 77:e568-e575. [DOI: 10.1016/j.crad.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
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Park JE, Kim HS, Lee J, Cheong EN, Shin I, Ahn SS, Shim WH. Deep-learned time-signal intensity pattern analysis using an autoencoder captures magnetic resonance perfusion heterogeneity for brain tumor differentiation. Sci Rep 2020; 10:21485. [PMID: 33293590 PMCID: PMC7723041 DOI: 10.1038/s41598-020-78485-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
Current image processing methods for dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) do not capture complex dynamic information of time-signal intensity curves. We investigated whether an autoencoder-based pattern analysis of DSC MRI captured representative temporal features that improves tissue characterization and tumor diagnosis in a multicenter setting. The autoencoder was applied to the time-signal intensity curves to obtain representative temporal patterns, which were subsequently learned by a convolutional neural network. This network was trained with 216 preoperative DSC MRI acquisitions and validated using external data (n = 43) collected with different DSC acquisition protocols. The autoencoder applied to time-signal intensity curves and clustering obtained nine representative clusters of temporal patterns, which accurately identified tumor and non-tumoral tissues. The dominant clusters of temporal patterns distinguished primary central nervous system lymphoma (PCNSL) from glioblastoma (AUC 0.89) and metastasis from glioblastoma (AUC 0.95). The autoencoder captured DSC time-signal intensity patterns that improved identification of tumoral tissues and differentiation of tumor type and was generalizable across centers.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea.
| | - Junkyu Lee
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 43 Olympic-ro 88, Songpa-Gu, Seoul, Korea
| | - E-Nae Cheong
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 43 Olympic-ro 88, Songpa-Gu, Seoul, Korea
| | - Ilah Shin
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Ahn
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea.,Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 43 Olympic-ro 88, Songpa-Gu, Seoul, Korea
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Choi KS, Choi SH, Jeong B. Prediction of IDH genotype in gliomas with dynamic susceptibility contrast perfusion MR imaging using an explainable recurrent neural network. Neuro Oncol 2020; 21:1197-1209. [PMID: 31127834 DOI: 10.1093/neuonc/noz095] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of this study was to predict isocitrate dehydrogenase (IDH) genotypes of gliomas using an interpretable deep learning application for dynamic susceptibility contrast (DSC) perfusion MRI. METHODS Four hundred sixty-three patients with gliomas who underwent preoperative MRI were enrolled in the study. All the patients had immunohistopathologic diagnoses of either IDH-wildtype or IDH-mutant gliomas. Tumor subregions were segmented using a convolutional neural network followed by manual correction. DSC perfusion MRI was performed to obtain T2* susceptibility signal intensity-time curves from each subregion of the tumors: enhancing tumor, non-enhancing tumor, peritumoral edema, and whole tumor. These, with arterial input functions, were fed into a neural network as multidimensional inputs. A convolutional long short-term memory model with an attention mechanism was developed to predict IDH genotypes. Receiver operating characteristics analysis was performed to evaluate the model. RESULTS The IDH genotype predictions had an accuracy, sensitivity, and specificity of 92.8%, 92.6%, and 93.1%, respectively, in the validation set (area under the curve [AUC], 0.98; 95% confidence interval [CI], 0.969-0.991) and 91.7%, 92.1%, and 91.5%, respectively, in the test set (AUC, 0.95; 95% CI, 0.898-0.982). In temporal feature analysis, T2* susceptibility signal intensity-time curves obtained from DSC perfusion MRI with attention weights demonstrated high attention on the combination of the end of the pre-contrast baseline, up/downslopes of signal drops, and/or post-bolus plateaus for the curves used to predict IDH genotype. CONCLUSIONS We developed an explainable recurrent neural network model based on DSC perfusion MRI to predict IDH genotypes in gliomas.
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Affiliation(s)
- Kyu Sung Choi
- Graduate School of Medical Science and Engineering, Korea Advanced Institute for Science and Technology (KAIST), Daejeon, Republic of Korea.,KAIST Institute for Health Science and Technology, Korea Advanced Institute for Science and Technology (KAIST), Daejeon, Republic of Korea.,KAIST Institute for Artificial Intelligence, Korea Advanced Institute for Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul, Republic of Korea
| | - Bumseok Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute for Science and Technology (KAIST), Daejeon, Republic of Korea.,KAIST Institute for Health Science and Technology, Korea Advanced Institute for Science and Technology (KAIST), Daejeon, Republic of Korea.,KAIST Institute for Artificial Intelligence, Korea Advanced Institute for Science and Technology (KAIST), Daejeon, Republic of Korea
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Delacoste EL, Delattre BMA, Wanyanga P, Vargas MI. Comparing dynamic susceptibility contrast perfusion post-processing with different clinically available software among patients affected of a high-grade glioma. J Neuroradiol 2020; 49:412-420. [PMID: 33065197 DOI: 10.1016/j.neurad.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/03/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE The main purpose of this retrospective study was to evaluate inter-software variability in patients affected of a high-grade glioma for the post-processing of dynamic susceptibility contrast (DSC1) perfusion imaging in MRI.2 MATERIALS AND METHODS: The included patients were either anaplastic astrocytoma (WHO3 grade III) or glioblastoma (WHO grade IV) located in the cerebral parenchyma. The postprocessing of 54 MRI-DSC imaging from 46 patients using both Intellispace© (Philips) and Olea© (Olea Medical) software was performed. The hemodynamic parameter studied was the normalised relative cerebral blood volume corrected for the T1 leakage effect (nrCBVc4). The inter-operator variabilities were also evaluated. RESULTS Regarding inter-software reproducibility, Cohen's Kappa from therapeutic follow-up obtained were 0.61, close to the recommended limit (0.60). Subgroups were created to complete the analysis and to evaluate the partial volume effect. Even if necrosis or vascular structures from regions of interest (ROI5) were avoided, results did not improve. ROI of a minimum area of 250 mm2 yielded a Cohen's Kappa of 0.65. The inter-operator reproducibility on Intellispace and Olea were 0.90 and 0.73 respectively, which is satisfactory. CONCLUSION The reproducibility between Intellispace and Olea was below recommended threshold in a clinical context. This discrepancy can be explained by the partial volume effect and the models used. ROI with an area of at least 250 mm2 improves this reproducibility and becomes acceptable.
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Affiliation(s)
- Eloïse L Delacoste
- HES-SO Master Conjoint Avec l'UNIL, Avenue de Provence 6, 1007 Lausanne Vaud, Suisse.
| | - Bénédicte M A Delattre
- Unité de Neuroradiologie Diagnostique, Hôpitaux Universitaires de Genève, Faculté de Médecine de Genève, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Suisse.
| | - Pierre Wanyanga
- Hôpital Fribourgeois, Chemin des Pensionnats 2-6, 1752 Villars-sur-Glâne, Vaud, Suisse.
| | - Maria I Vargas
- Unité de Neuroradiologie Diagnostique, Hôpitaux Universitaires de Genève, Faculté de Médecine de Genève, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Suisse.
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Sudre CH, Panovska-Griffiths J, Sanverdi E, Brandner S, Katsaros VK, Stranjalis G, Pizzini FB, Ghimenton C, Surlan-Popovic K, Avsenik J, Spampinato MV, Nigro M, Chatterjee AR, Attye A, Grand S, Krainik A, Anzalone N, Conte GM, Romeo V, Ugga L, Elefante A, Ciceri EF, Guadagno E, Kapsalaki E, Roettger D, Gonzalez J, Boutelier T, Cardoso MJ, Bisdas S. Machine learning assisted DSC-MRI radiomics as a tool for glioma classification by grade and mutation status. BMC Med Inform Decis Mak 2020; 20:149. [PMID: 32631306 PMCID: PMC7336404 DOI: 10.1186/s12911-020-01163-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Combining MRI techniques with machine learning methodology is rapidly gaining attention as a promising method for staging of brain gliomas. This study assesses the diagnostic value of such a framework applied to dynamic susceptibility contrast (DSC)-MRI in classifying treatment-naïve gliomas from a multi-center patients into WHO grades II-IV and across their isocitrate dehydrogenase (IDH) mutation status. METHODS Three hundred thirty-three patients from 6 tertiary centres, diagnosed histologically and molecularly with primary gliomas (IDH-mutant = 151 or IDH-wildtype = 182) were retrospectively identified. Raw DSC-MRI data was post-processed for normalised leakage-corrected relative cerebral blood volume (rCBV) maps. Shape, intensity distribution (histogram) and rotational invariant Haralick texture features over the tumour mask were extracted. Differences in extracted features across glioma grades and mutation status were tested using the Wilcoxon two-sample test. A random-forest algorithm was employed (2-fold cross-validation, 250 repeats) to predict grades or mutation status using the extracted features. RESULTS Shape, distribution and texture features showed significant differences across mutation status. WHO grade II-III differentiation was mostly driven by shape features while texture and intensity feature were more relevant for the III-IV separation. Increased number of features became significant when differentiating grades further apart from one another. Gliomas were correctly stratified by mutation status in 71% and by grade in 53% of the cases (87% of the gliomas grades predicted with distance less than 1). CONCLUSIONS Despite large heterogeneity in the multi-center dataset, machine learning assisted DSC-MRI radiomics hold potential to address the inherent variability and presents a promising approach for non-invasive glioma molecular subtyping and grading.
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Affiliation(s)
- Carole H Sudre
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College, London, UK
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Jasmina Panovska-Griffiths
- Department of Applied Health Research, Institute of Epidemiology & Health Care, University College London, London, UK.
- Institute for Global Health, University College London, London, UK.
- The Queen's College, Oxford University, Oxford, UK.
| | - Eser Sanverdi
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
| | - Sebastian Brandner
- Division of Neuropathology, UCL Queen Square Institute of Neurology, London, UK
| | - Vasileios K Katsaros
- Department of Advanced Imaging Modalities, MRI Unit, General Anti-Cancer and Oncological Hospital of Athens "St. Savvas", Athens, Greece
- Department of Neurosurgery, General Hospital Evangelismos, Medical School, University of Athens, Athens, Greece
| | - George Stranjalis
- Department of Neurosurgery, General Hospital Evangelismos, Medical School, University of Athens, Athens, Greece
| | - Francesca B Pizzini
- Neuroradiology, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - Claudio Ghimenton
- Neuropathology, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - Katarina Surlan-Popovic
- Department of Neuroradiology, University Medical Centre, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Avsenik
- Department of Neuroradiology, University Medical Centre, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maria Vittoria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Mario Nigro
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Arindam R Chatterjee
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Arnaud Attye
- Grenoble Institute of Neurosciences, INSERM, University Grenoble Alpes, Grenoble, France
| | - Sylvie Grand
- Grenoble Institute of Neurosciences, INSERM, University Grenoble Alpes, Grenoble, France
| | - Alexandre Krainik
- Grenoble Institute of Neurosciences, INSERM, University Grenoble Alpes, Grenoble, France
| | - Nicoletta Anzalone
- Department of Neuroradiology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Gian Marco Conte
- Department of Neuroradiology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, Diagnostic Imaging Section, University of Naples Federico II, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Diagnostic Imaging Section, University of Naples Federico II, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, Diagnostic Imaging Section, University of Naples Federico II, Naples, Italy
| | - Elisa Francesca Ciceri
- Neuropathology, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
- Department of Advanced Biomedical Sciences, Diagnostic Imaging Section, University of Naples Federico II, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples Federico II, Naples, Italy
| | - Eftychia Kapsalaki
- Department of Radiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | | | | | | | - M Jorge Cardoso
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College, London, UK
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sotirios Bisdas
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
- Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, UCL, London, UK
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Hoxworth JM, Eschbacher JM, Gonzales AC, Singleton KW, Leon GD, Smith KA, Stokes AM, Zhou Y, Mazza GL, Porter AB, Mrugala MM, Zimmerman RS, Bendok BR, Patra DP, Krishna C, Boxerman JL, Baxter LC, Swanson KR, Quarles CC, Schmainda KM, Hu LS. Performance of Standardized Relative CBV for Quantifying Regional Histologic Tumor Burden in Recurrent High-Grade Glioma: Comparison against Normalized Relative CBV Using Image-Localized Stereotactic Biopsies. AJNR Am J Neuroradiol 2020; 41:408-415. [PMID: 32165359 DOI: 10.3174/ajnr.a6486] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Perfusion MR imaging measures of relative CBV can distinguish recurrent tumor from posttreatment radiation effects in high-grade gliomas. Currently, relative CBV measurement requires normalization based on user-defined reference tissues. A recently proposed method of relative CBV standardization eliminates the need for user input. This study compares the predictive performance of relative CBV standardization against relative CBV normalization for quantifying recurrent tumor burden in high-grade gliomas relative to posttreatment radiation effects. MATERIALS AND METHODS We recruited 38 previously treated patients with high-grade gliomas (World Health Organization grades III or IV) undergoing surgical re-resection for new contrast-enhancing lesions concerning for recurrent tumor versus posttreatment radiation effects. We recovered 112 image-localized biopsies and quantified the percentage of histologic tumor content versus posttreatment radiation effects for each sample. We measured spatially matched normalized and standardized relative CBV metrics (mean, median) and fractional tumor burden for each biopsy. We compared relative CBV performance to predict tumor content, including the Pearson correlation (r), against histologic tumor content (0%-100%) and the receiver operating characteristic area under the curve for predicting high-versus-low tumor content using binary histologic cutoffs (≥50%; ≥80% tumor). RESULTS Across relative CBV metrics, fractional tumor burden showed the highest correlations with tumor content (0%-100%) for normalized (r = 0.63, P < .001) and standardized (r = 0.66, P < .001) values. With binary cutoffs (ie, ≥50%; ≥80% tumor), predictive accuracies were similar for both standardized and normalized metrics and across relative CBV metrics. Median relative CBV achieved the highest area under the curve (normalized = 0.87, standardized = 0.86) for predicting ≥50% tumor, while fractional tumor burden achieved the highest area under the curve (normalized = 0.77, standardized = 0.80) for predicting ≥80% tumor. CONCLUSIONS Standardization of relative CBV achieves similar performance compared with normalized relative CBV and offers an important step toward workflow optimization and consensus methodology.
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Affiliation(s)
- J M Hoxworth
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
| | | | | | - K W Singleton
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - G D Leon
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - K A Smith
- Keller Center for Imaging Innovation (A.M.S.), Barrow Neurological Institute, Phoenix, Arizona
| | - A M Stokes
- Keller Center for Imaging Innovation (A.M.S.), Barrow Neurological Institute, Phoenix, Arizona
| | - Y Zhou
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
| | - G L Mazza
- Department of Health Sciences Research (G.L.M.), Division of Biomedical Statistics and Informatics, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | | | | | | | - B R Bendok
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - D P Patra
- Departments of Neurosurgery (D.P.P.)
| | | | - J L Boxerman
- Department of Diagnostic Imaging (J.L.B.), Rhode Island Hospital, Providence, Rhode Island
| | - L C Baxter
- Neuropsychology (L.C.B.), Mayo Clinic Hospital, Phoenix, Arizona
| | - K R Swanson
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | | | - K M Schmainda
- Department of Radiology (K.M.S.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L S Hu
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
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8
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Bell LC, Stokes AM, Quarles CC. Analysis of postprocessing steps for residue function dependent dynamic susceptibility contrast (DSC)-MRI biomarkers and their clinical impact on glioma grading for both 1.5 and 3T. J Magn Reson Imaging 2019; 51:547-553. [PMID: 31206948 DOI: 10.1002/jmri.26837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dynamic susceptibility contrast (DSC)-MRI analysis pipelines differ across studies and sites, potentially confounding the clinical value and use of the derived biomarkers. PURPOSE/HYPOTHESIS To investigate how postprocessing steps for computation of cerebral blood volume (CBV) and residue function dependent parameters (cerebral blood flow [CBF], mean transit time [MTT], capillary transit heterogeneity [CTH]) impact glioma grading. STUDY TYPE Retrospective study from The Cancer Imaging Archive (TCIA). POPULATION Forty-nine subjects with low- and high-grade gliomas. FIELD STRENGTH/SEQUENCE 1.5 and 3.0T clinical systems using a single-echo echo planar imaging (EPI) acquisition. ASSESSMENT Manual regions of interest (ROIs) were provided by TCIA and automatically segmented ROIs were generated by k-means clustering. CBV was calculated based on conventional equations. Residue function dependent biomarkers (CBF, MTT, CTH) were found by two deconvolution methods: circular discretization followed by a signal-to-noise ratio (SNR)-adapted eigenvalue thresholding (Method 1) and Volterra discretization with L-curve-based Tikhonov regularization (Method 2). STATISTICAL TESTS Analysis of variance, receiver operating characteristics (ROC), and logistic regression tests. RESULTS MTT alone was unable to statistically differentiate glioma grade (P > 0.139). When normalized, tumor CBF, CTH, and CBV did not differ across field strengths (P > 0.141). Biomarkers normalized to automatically segmented regions performed equally (rCTH AUROC is 0.73 compared with 0.74) or better (rCBF AUROC increases from 0.74-0.84; rCBV AUROC increases 0.78-0.86) than manually drawn ROIs. By updating the current deconvolution steps (Method 2), rCTH can act as a classifier for glioma grade (P < 0.007), but not if processed by current conventional DSC methods (Method 1) (P > 0.577). Lastly, higher-order biomarkers (eg, rCBF and rCTH) along with rCBV increases AUROC to 0.92 for differentiating tumor grade as compared with 0.78 and 0.86 (manual and automatic reference regions, respectively) for rCBV alone. DATA CONCLUSION With optimized analysis pipelines, higher-order perfusion biomarkers (rCBF and rCTH) improve glioma grading as compared with CBV alone. Additionally, postprocessing steps impact thresholds needed for glioma grading. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:547-553.
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Affiliation(s)
- Laura C Bell
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ashley M Stokes
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - C Chad Quarles
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, Arizona, USA
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9
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Bell LC, Semmineh N, An H, Eldeniz C, Wahl R, Schmainda KM, Prah MA, Erickson BJ, Korfiatis P, Wu C, Sorace AG, Yankeelov TE, Rutledge N, Chenevert TL, Malyarenko D, Liu Y, Brenner A, Hu LS, Zhou Y, Boxerman JL, Yen YF, Kalpathy-Cramer J, Beers AL, Muzi M, Madhuranthakam AJ, Pinho M, Johnson B, Quarles CC. Evaluating Multisite rCBV Consistency from DSC-MRI Imaging Protocols and Postprocessing Software Across the NCI Quantitative Imaging Network Sites Using a Digital Reference Object (DRO). Tomography 2019; 5:110-117. [PMID: 30854448 PMCID: PMC6403027 DOI: 10.18383/j.tom.2018.00041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Relative cerebral blood volume (rCBV) cannot be used as a response metric in clinical trials, in part, because of variations in biomarker consistency and associated interpretation across sites, stemming from differences in image acquisition and postprocessing methods (PMs). This study leveraged a dynamic susceptibility contrast magnetic resonance imaging digital reference object to characterize rCBV consistency across 12 sites participating in the Quantitative Imaging Network (QIN), specifically focusing on differences in site-specific imaging protocols (IPs; n = 17), and PMs (n = 19) and differences due to site-specific IPs and PMs (n = 25). Thus, high agreement across sites occurs when 1 managing center processes rCBV despite slight variations in the IP. This result is most likely supported by current initiatives to standardize IPs. However, marked intersite disagreement was observed when site-specific software was applied for rCBV measurements. This study's results have important implications for comparing rCBV values across sites and trials, where variability in PMs could confound the comparison of therapeutic effectiveness and/or any attempts to establish thresholds for categorical response to therapy. To overcome these challenges and ensure the successful use of rCBV as a clinical trial biomarker, we recommend the establishment of qualifying and validating site- and trial-specific criteria for scanners and acquisition methods (eg, using a validated phantom) and the software tools used for dynamic susceptibility contrast magnetic resonance imaging analysis (eg, using a digital reference object where the ground truth is known).
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Affiliation(s)
- Laura C. Bell
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
| | - Natenael Semmineh
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Richard Wahl
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Kathleen M. Schmainda
- Departments of Radiology and Biophysics, Medical College of Wisconsin, Wauwatosa, WI
| | - Melissa A. Prah
- Departments of Radiology and Biophysics, Medical College of Wisconsin, Wauwatosa, WI
| | | | | | - Chengyue Wu
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX
| | - Anna G. Sorace
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX
| | - Thomas E. Yankeelov
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX
| | - Neal Rutledge
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX
| | | | | | - Yichu Liu
- UT Health San Antonio, San Antonio, TX
| | | | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Yuxiang Zhou
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Jerrold L. Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI;,Alpert Medical School of Brown University, Providence, RI
| | - Yi-Fen Yen
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | | - Andrew L. Beers
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Marco Pinho
- UT Southwestern Medical Center, Dallas, TX; and
| | - Brian Johnson
- UT Southwestern Medical Center, Dallas, TX; and,Philips Healthcare, Gainesville, FL
| | - C. Chad Quarles
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
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10
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Huber T, Rotkopf L, Wiestler B, Kunz WG, Bette S, Gempt J, Preibisch C, Ricke J, Zimmer C, Kirschke JS, Sommer WH, Thierfelder KM. Wavelet-based reconstruction of dynamic susceptibility MR-perfusion: a new method to visualize hypervascular brain tumors. Eur Radiol 2018; 29:2669-2676. [PMID: 30552476 DOI: 10.1007/s00330-018-5892-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/16/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Parameter maps based on wavelet-transform post-processing of dynamic perfusion data offer an innovative way of visualizing blood vessels in a fully automated, user-independent way. The aims of this study were (i) a proof of concept regarding wavelet-based analysis of dynamic susceptibility contrast (DSC) MRI data and (ii) to demonstrate advantages of wavelet-based measures compared to standard cerebral blood volume (CBV) maps in patients with the initial diagnosis of glioblastoma (GBM). METHODS Consecutive 3-T DSC MRI datasets of 46 subjects with GBM (mean age 63.0 ± 13.1 years, 28 m) were retrospectively included in this feasibility study. Vessel-specific wavelet magnetic resonance perfusion (wavelet-MRP) maps were calculated using the wavelet transform (Paul wavelet, order 1) of each voxel time course. Five different aspects of image quality and tumor delineation were each qualitatively rated on a 5-point Likert scale. Quantitative analysis included image contrast and contrast-to-noise ratio. RESULTS Vessel-specific wavelet-MRP maps could be calculated within a mean time of 2:27 min. Wavelet-MRP achieved higher scores compared to CBV in all qualitative ratings: tumor depiction (4.02 vs. 2.33), contrast enhancement (3.93 vs. 2.23), central necrosis (3.86 vs. 2.40), morphologic correlation (3.87 vs. 2.24), and overall impression (4.00 vs. 2.41); all p < .001. Quantitative image analysis showed a better image contrast and higher contrast-to-noise ratios for wavelet-MRP compared to conventional perfusion maps (all p < .001). CONCLUSIONS wavelet-MRP is a fast and fully automated post-processing technique that yields reproducible perfusion maps with a clearer vascular depiction of GBM compared to standard CBV maps. KEY POINTS • Wavelet-MRP offers high-contrast perfusion maps with a clear delineation of focal perfusion alterations. • Both image contrast and visual image quality were beneficial for wavelet-MRP compared to standard perfusion maps like CBV. • Wavelet-MRP can be automatically calculated from existing dynamic susceptibility contrast (DSC) perfusion data.
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Affiliation(s)
- Thomas Huber
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Lukas Rotkopf
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefanie Bette
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christine Preibisch
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wieland H Sommer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kolja M Thierfelder
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany
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11
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Anzalone N, Castellano A, Cadioli M, Conte GM, Cuccarini V, Bizzi A, Grimaldi M, Costa A, Grillea G, Vitali P, Aquino D, Terreni MR, Torri V, Erickson BJ, Caulo M. Brain Gliomas: Multicenter Standardized Assessment of Dynamic Contrast-enhanced and Dynamic Susceptibility Contrast MR Images. Radiology 2018; 287:933-943. [DOI: 10.1148/radiol.2017170362] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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12
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Schmainda KM, Prah MA, Rand SD, Liu Y, Logan B, Muzi M, Rane SD, Da X, Yen YF, Kalpathy-Cramer J, Chenevert TL, Hoff B, Ross B, Cao Y, Aryal MP, Erickson B, Korfiatis P, Dondlinger T, Bell L, Hu L, Kinahan PE, Quarles CC. Multisite Concordance of DSC-MRI Analysis for Brain Tumors: Results of a National Cancer Institute Quantitative Imaging Network Collaborative Project. AJNR Am J Neuroradiol 2018; 39:1008-1016. [PMID: 29794239 DOI: 10.3174/ajnr.a5675] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Standard assessment criteria for brain tumors that only include anatomic imaging continue to be insufficient. While numerous studies have demonstrated the value of DSC-MR imaging perfusion metrics for this purpose, they have not been incorporated due to a lack of confidence in the consistency of DSC-MR imaging metrics across sites and platforms. This study addresses this limitation with a comparison of multisite/multiplatform analyses of shared DSC-MR imaging datasets of patients with brain tumors. MATERIALS AND METHODS DSC-MR imaging data were collected after a preload and during a bolus injection of gadolinium contrast agent using a gradient recalled-echo-EPI sequence (TE/TR = 30/1200 ms; flip angle = 72°). Forty-nine low-grade (n = 13) and high-grade (n = 36) glioma datasets were uploaded to The Cancer Imaging Archive. Datasets included a predetermined arterial input function, enhancing tumor ROIs, and ROIs necessary to create normalized relative CBV and CBF maps. Seven sites computed 20 different perfusion metrics. Pair-wise agreement among sites was assessed with the Lin concordance correlation coefficient. Distinction of low- from high-grade tumors was evaluated with the Wilcoxon rank sum test followed by receiver operating characteristic analysis to identify the optimal thresholds based on sensitivity and specificity. RESULTS For normalized relative CBV and normalized CBF, 93% and 94% of entries showed good or excellent cross-site agreement (0.8 ≤ Lin concordance correlation coefficient ≤ 1.0). All metrics could distinguish low- from high-grade tumors. Optimum thresholds were determined for pooled data (normalized relative CBV = 1.4, sensitivity/specificity = 90%:77%; normalized CBF = 1.58, sensitivity/specificity = 86%:77%). CONCLUSIONS By means of DSC-MR imaging data obtained after a preload of contrast agent, substantial consistency resulted across sites for brain tumor perfusion metrics with a common threshold discoverable for distinguishing low- from high-grade tumors.
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Affiliation(s)
- K M Schmainda
- From the Department of Radiology (K.M.S., M.A.P., S.D.R.)
| | - M A Prah
- From the Department of Radiology (K.M.S., M.A.P., S.D.R.)
| | - S D Rand
- From the Department of Radiology (K.M.S., M.A.P., S.D.R.).,Department of Radiology (M.M., S.D.R., P.E.K.), University of Washington, Seattle, Washington
| | - Y Liu
- Division of Biostatistics (Y.L., B.L.), Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B Logan
- Division of Biostatistics (Y.L., B.L.), Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - M Muzi
- Department of Radiology (M.M., S.D.R., P.E.K.), University of Washington, Seattle, Washington
| | - S D Rane
- From the Department of Radiology (K.M.S., M.A.P., S.D.R.)
| | - X Da
- Department of Radiology (X.D.), Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Y-F Yen
- Athinoula A. Martinos Center for Biomedical Imaging (Y.-F.Y., J.K.-C.), Department of Radiology, Harvard Medical School/Massachusetts General Hospital, Charlestown, Massachusetts
| | - J Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging (Y.-F.Y., J.K.-C.), Department of Radiology, Harvard Medical School/Massachusetts General Hospital, Charlestown, Massachusetts
| | | | - B Hoff
- Department of Radiology (T.L.C., B.H., B.R.)
| | - B Ross
- Department of Radiology (T.L.C., B.H., B.R.)
| | - Y Cao
- Departments of Radiation Oncology, Radiology, and Biomedical Engineering (Y.C., M.P.A.), University of Michigan, Ann Arbor, Michigan
| | - M P Aryal
- Departments of Radiation Oncology, Radiology, and Biomedical Engineering (Y.C., M.P.A.), University of Michigan, Ann Arbor, Michigan
| | - B Erickson
- Department of Radiology (B.E., P.K.), Mayo Clinic, Rochester, Minnesota
| | - P Korfiatis
- Department of Radiology (B.E., P.K.), Mayo Clinic, Rochester, Minnesota
| | - T Dondlinger
- Imaging Biometrics LLC (T.D.), Elm Grove, Wisconsin
| | - L Bell
- Division of Imaging Research (L.B., C.C.Q.), Barrow Neurological Institute, Phoenix, Arizona
| | - L Hu
- Department of Radiology (L.H.), Mayo Clinic, Scottsdale, Arizona
| | - P E Kinahan
- Department of Radiology (M.M., S.D.R., P.E.K.), University of Washington, Seattle, Washington
| | - C C Quarles
- Division of Imaging Research (L.B., C.C.Q.), Barrow Neurological Institute, Phoenix, Arizona
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13
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Dongas J, Asahina AT, Bacchi S, Patel S. Magnetic Resonance Perfusion Imaging in the Diagnosis of High-Grade Glioma Progression and Treatment-Related Changes: A Systematic Review. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojmn.2018.83024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Calmon R, Puget S, Varlet P, Beccaria K, Blauwblomme T, Grevent D, Sainte-Rose C, Castel D, Dufour C, Dhermain F, Bolle S, Saitovitch A, Zilbovicius M, Brunelle F, Grill J, Boddaert N. Multimodal Magnetic Resonance Imaging of Treatment-Induced Changes to Diffuse Infiltrating Pontine Gliomas in Children and Correlation to Patient Progression-Free Survival. Int J Radiat Oncol Biol Phys 2017; 99:476-485. [PMID: 28871999 DOI: 10.1016/j.ijrobp.2017.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/30/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To use multimodal magnetic resonance imaging (MRI) to quantify treatment-induced changes in the whole volume of diffuse infiltrating pontine gliomas and correlate them with progression-free survival (PFS). METHODS AND MATERIALS This prospective study included 22 children aged 3.3 to 14.7 years (median, 5.9 years). Multimodal MRI was performed at 3 distinct time points: before treatment, the first week following radiation therapy (RT), and 2 months after RT. The imaging protocol included morphologic, multi b-value diffusion; arterial spin labeling; and dynamic susceptibility contrast-enhanced perfusion. Morphologic and multimodal data-lesion volume, diffusion coefficients, relative cerebral blood flow, and relative cerebral blood volume (rCBV)-were recorded at the 3 aforementioned time points. The Wilcoxon test was used to compare each individual parameter variation between time points, and its correlation with PFS was assessed by the Spearman test. RESULTS Following RT, the tumors' solid component volume decreased by 40% (P<.001). Their median diffusion coefficients decreased by 20% to 40% (P<.001), while median relative cerebral blood flow increased by 60% to 80% (P<.001) and median rCBV increased by 70% (P<.001). PFS was positively correlated with rCBV measured immediately after RT (P=.003), and in patients whose rCBV was above the cutoff value of 2.46, the median PFS was 4.6 months longer (P=.001). These indexes tended to return to baseline 2 months after RT. Lesion volume before or after RT was not correlated with survival. CONCLUSIONS Multimodal MRI provides useful information about diffuse infiltrating pontine gliomas' response to treatment; rCBV increases following RT, and higher values are correlated with better PFS. High rCBV values following RT should not be mistaken for progression and could be an indicator of response to therapy.
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Affiliation(s)
- Raphael Calmon
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France; Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France.
| | - Stephanie Puget
- Pediatric Neurosurgery Department, Hôpital Necker Enfants Malades, Paris, France
| | - Pascale Varlet
- Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Centre Hospitalier Sainte-Anne, Laboratoire de Neuropathologie, Paris, France
| | - Kevin Beccaria
- Pediatric Neurosurgery Department, Hôpital Necker Enfants Malades, Paris, France
| | - Thomas Blauwblomme
- Pediatric Neurosurgery Department, Hôpital Necker Enfants Malades, Paris, France
| | - David Grevent
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France; Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
| | | | - David Castel
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8203, Gustave Roussy et Université Paris-Saclay, Villejuif, France
| | - Christelle Dufour
- Département de Cancerologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Villejuif, France
| | - Frédéric Dhermain
- Département de Radiothérapie, Institut Gustave Roussy, Villejuif, France
| | - Stéphanie Bolle
- Département de Radiothérapie, Institut Gustave Roussy, Villejuif, France
| | - Ana Saitovitch
- Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France
| | - Monica Zilbovicius
- Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France
| | - Francis Brunelle
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France; Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
| | - Jacques Grill
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8203, Gustave Roussy et Université Paris-Saclay, Villejuif, France; Département de Cancerologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Villejuif, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France; Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
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Abstract
OPINION STATEMENT With advances in treatments and survival of patients with glioblastoma (GBM), it has become apparent that conventional imaging sequences have significant limitations both in terms of assessing response to treatment and monitoring disease progression. Both 'pseudoprogression' after chemoradiation for newly diagnosed GBM and 'pseudoresponse' after anti-angiogenesis treatment for relapsed GBM are well-recognised radiological entities. This in turn has led to revision of response criteria away from the standard MacDonald criteria, which depend on the two-dimensional measurement of contrast-enhancing tumour, and which have been the primary measure of radiological response for over three decades. A working party of experts published RANO (Response Assessment in Neuro-oncology Working Group) criteria in 2010 which take into account signal change on T2/FLAIR sequences as well as the contrast-enhancing component of the tumour. These have recently been modified for immune therapies, which are associated with specific issues related to the timing of radiological response. There has been increasing interest in quantification and validation of physiological and metabolic parameters in GBM over the last 10 years utilising the wide range of advanced imaging techniques available on standard MRI platforms. Previously, MRI would provide structural information only on the anatomical location of the tumour and the presence or absence of a disrupted blood-brain barrier. Advanced MRI sequences include proton magnetic resonance spectroscopy (MRS), vascular imaging (perfusion/permeability) and diffusion imaging (diffusion weighted imaging/diffusion tensor imaging) and are now routinely available. They provide biologically relevant functional, haemodynamic, cellular, metabolic and cytoarchitectural information and are being evaluated in clinical trials to determine whether they offer superior biomarkers of early treatment response than conventional imaging, when correlated with hard survival endpoints. Multiparametric imaging, incorporating different combinations of these modalities, improves accuracy over single imaging modalities but has not been widely adopted due to the amount of post-processing analysis required, lack of clinical trial data, lack of radiology training and wide variations in threshold values. New techniques including diffusion kurtosis and radiomics will offer a higher level of quantification but will require validation in clinical trial settings. Given all these considerations, it is clear that there is an urgent need to incorporate advanced techniques into clinical trial design to avoid the problems of under or over assessment of treatment response.
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16
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Conte GM, Castellano A, Altabella L, Iadanza A, Cadioli M, Falini A, Anzalone N. Reproducibility of dynamic contrast-enhanced MRI and dynamic susceptibility contrast MRI in the study of brain gliomas: a comparison of data obtained using different commercial software. Radiol Med 2017; 122:294-302. [PMID: 28070841 DOI: 10.1007/s11547-016-0720-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Dynamic susceptibility contrast MRI (DSC) and dynamic contrast-enhanced MRI (DCE) are useful tools in the diagnosis and follow-up of brain gliomas; nevertheless, both techniques leave the open issue of data reproducibility. We evaluated the reproducibility of data obtained using two different commercial software for perfusion maps calculation and analysis, as one of the potential sources of variability can be the software itself. METHODS DSC and DCE analyses from 20 patients with gliomas were tested for both the intrasoftware (as intraobserver and interobserver reproducibility) and the intersoftware reproducibility, as well as the impact of different postprocessing choices [vascular input function (VIF) selection and deconvolution algorithms] on the quantification of perfusion biomarkers plasma volume (Vp), volume transfer constant (K trans) and rCBV. Data reproducibility was evaluated with the intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS For all the biomarkers, the intra- and interobserver reproducibility resulted in almost perfect agreement in each software, whereas for the intersoftware reproducibility the value ranged from 0.311 to 0.577, suggesting fair to moderate agreement; Bland-Altman analysis showed high dispersion of data, thus confirming these findings. Comparisons of different VIF estimation methods for DCE biomarkers resulted in ICC of 0.636 for K trans and 0.662 for Vp; comparison of two deconvolution algorithms in DSC resulted in an ICC of 0.999. CONCLUSIONS The use of single software ensures very good intraobserver and interobservers reproducibility. Caution should be taken when comparing data obtained using different software or different postprocessing within the same software, as reproducibility is not guaranteed anymore.
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Affiliation(s)
- Gian Marco Conte
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Mi, Italy
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Mi, Italy
| | - Luisa Altabella
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Mi, Italy.,Department of Medical Physics, San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Mi, Italy
| | - Antonella Iadanza
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Mi, Italy
| | - Marcello Cadioli
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Mi, Italy.,Philips Healthcare, via Gaetano Casati 23, 20900, Monza, MB, Italy
| | - Andrea Falini
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Mi, Italy
| | - Nicoletta Anzalone
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Mi, Italy.
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17
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Korfiatis P, Kline TL, Kelm ZS, Carter RE, Hu LS, Erickson BJ. Dynamic Susceptibility Contrast-MRI Quantification Software Tool: Development and Evaluation. ACTA ACUST UNITED AC 2016; 2:448-456. [PMID: 28066810 PMCID: PMC5217187 DOI: 10.18383/j.tom.2016.00172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Relative cerebral blood volume (rCBV) is a magnetic resonance imaging biomarker that is used to differentiate progression from pseudoprogression in patients with glioblastoma multiforme, the most common primary brain tumor. However, calculated rCBV depends considerably on the software used. Automating all steps required for rCBV calculation is important, as user interaction can lead to increased variability and possible inaccuracies in clinical decision-making. Here, we present an automated tool for computing rCBV from dynamic susceptibility contrast-magnetic resonance imaging that includes leakage correction. The entrance and exit bolus time points are automatically calculated using wavelet-based detection. The proposed tool is compared with 3 Food and Drug Administration-approved software packages, 1 automatic and 2 requiring user interaction, on a data set of 43 patients. We also evaluate manual and automated white matter (WM) selection for normalization of the cerebral blood volume maps. Our system showed good agreement with 2 of the 3 software packages. The intraclass correlation coefficient for all comparisons between the same software operated by different people was >0.880, except for FuncTool when operated by user 1 versus user 2. Little variability in agreement between software tools was observed when using different WM selection techniques. Our algorithm for automatic rCBV calculation with leakage correction and automated WM selection agrees well with 2 out of the 3 FDA-approved software packages.
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Affiliation(s)
| | | | - Zachary S Kelm
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Leland S Hu
- Department of Radiology, Mayo Clinic, Scottsdale, Arizona
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Patel P, Baradaran H, Delgado D, Askin G, Christos P, John Tsiouris A, Gupta A. MR perfusion-weighted imaging in the evaluation of high-grade gliomas after treatment: a systematic review and meta-analysis. Neuro Oncol 2016; 19:118-127. [PMID: 27502247 DOI: 10.1093/neuonc/now148] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Distinction between tumor and treatment related changes is crucial for clinical management of patients with high-grade gliomas. Our purpose was to evaluate whether dynamic susceptibility contrast-enhanced (DSC) and dynamic contrast enhanced (DCE) perfusion-weighted imaging (PWI) metrics can effectively differentiate between recurrent tumor and posttreatment changes within the enhancing signal abnormality on conventional MRI. METHODS A comprehensive literature search was performed for studies evaluating PWI-based differentiation of recurrent tumor and posttreatment changes in patients with high-grade gliomas (World Health Organization grades III and IV). Only studies published in the "temozolomide era" beginning in 2005 were included. Summary estimates of diagnostic accuracy were obtained by using a random-effects model. RESULTS Of 1581 abstracts screened, 28 articles were included. The pooled sensitivities and specificities of each study's best performing parameter were 90% and 88% (95% CI: 0.85-0.94; 0.83-0.92) and 89% and 85% (95% CI: 0.78-0.96; 0.77-0.91) for DSC and DCE, respectively. The pooled sensitivities and specificities for detecting tumor recurrence using the 2 most commonly evaluated parameters, mean relative cerebral blood volume (rCBV) (threshold range, 0.9-2.15) and maximum rCBV (threshold range, 1.49-3.1), were 88% and 88% (95% CI: 0.81-0.94; 0.78-0.95) and 93% and 76% (95% CI: 0.86-0.98; 0.66-0.85), respectively. CONCLUSIONS PWI-derived thresholds separating viable tumor from treatment changes demonstrate relatively good accuracy in individual studies. However, because of significant variability in optimal reported thresholds and other limitations in the existing body of literature, further investigation and standardization is needed before implementing any particular quantitative PWI strategy across institutions.
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Affiliation(s)
- Praneil Patel
- Department of Radiology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York (P.P., H.B., A.J.T., A.G.); Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York (D.D.); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (G.A., P.C.)
| | - Hediyeh Baradaran
- Department of Radiology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York (P.P., H.B., A.J.T., A.G.); Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York (D.D.); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (G.A., P.C.)
| | - Diana Delgado
- Department of Radiology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York (P.P., H.B., A.J.T., A.G.); Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York (D.D.); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (G.A., P.C.)
| | - Gulce Askin
- Department of Radiology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York (P.P., H.B., A.J.T., A.G.); Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York (D.D.); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (G.A., P.C.)
| | - Paul Christos
- Department of Radiology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York (P.P., H.B., A.J.T., A.G.); Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York (D.D.); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (G.A., P.C.)
| | - Apostolos John Tsiouris
- Department of Radiology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York (P.P., H.B., A.J.T., A.G.); Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York (D.D.); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (G.A., P.C.)
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York (P.P., H.B., A.J.T., A.G.); Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York (D.D.); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (G.A., P.C.)
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Wu A, Lim M. Issues to Consider in Designing Immunotherapy Clinical Trials for Glioblastoma Management. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jct.2016.78060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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