1
|
Yamin G, Tranvinh E, Lanzman BA, Tong E, Hashmi SS, Patel CB, Iv M. Arterial Spin-Labeling and DSC Perfusion Metrics Improve Agreement in Neuroradiologists' Clinical Interpretations of Posttreatment High-Grade Glioma Surveillance MR Imaging-An Institutional Experience. AJNR Am J Neuroradiol 2024; 45:453-460. [PMID: 38453410 PMCID: PMC11288557 DOI: 10.3174/ajnr.a8190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/16/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE MR perfusion has shown value in the evaluation of posttreatment high-grade gliomas, but few studies have shown its impact on the consistency and confidence of neuroradiologists' interpretation in routine clinical practice. We evaluated the impact of adding MR perfusion metrics to conventional contrast-enhanced MR imaging in posttreatment high-grade glioma surveillance imaging. MATERIALS AND METHODS This retrospective study included 45 adults with high-grade gliomas who had posttreatment perfusion MR imaging. Four neuroradiologists assigned Brain Tumor Reporting and Data System scores for each examination on the basis of the interpretation of contrast-enhanced MR imaging and then after the addition of arterial spin-labeling-CBF, DSC-relative CBV, and DSC-fractional tumor burden. Interrater agreement and rater agreement with a multidisciplinary consensus group were assessed with κ statistics. Raters used a 5-point Likert scale to report confidence scores. The frequency of clinically meaningful score changes resulting from the addition of each perfusion metric was determined. RESULTS Interrater agreement was moderate for contrast-enhanced MR imaging alone (κ = 0.63) and higher with perfusion metrics (arterial spin-labeling-CBF, κ = 0.67; DSC-relative CBV, κ = 0.66; DSC-fractional tumor burden, κ = 0.70). Agreement between raters and consensus was highest with DSC-fractional tumor burden (κ = 0.66-0.80). Confidence scores were highest with DSC-fractional tumor burden. Across all raters, the addition of perfusion resulted in clinically meaningful interpretation changes in 2%-20% of patients compared with contrast-enhanced MR imaging alone. CONCLUSIONS Adding perfusion to contrast-enhanced MR imaging improved interrater agreement, rater agreement with consensus, and rater confidence in the interpretation of posttreatment high-grade glioma MR imaging, with the highest agreement and confidence scores seen with DSC-fractional tumor burden. Perfusion MR imaging also resulted in interpretation changes that could change therapeutic management in up to 20% of patients.
Collapse
Affiliation(s)
- Ghiam Yamin
- From the Department of Radiology (G.Y., E. Tranvinh, B.A.L., E. Tong, S.S.H., M.I.), Division of Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, California
| | - Eric Tranvinh
- From the Department of Radiology (G.Y., E. Tranvinh, B.A.L., E. Tong, S.S.H., M.I.), Division of Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, California
| | - Bryan A Lanzman
- From the Department of Radiology (G.Y., E. Tranvinh, B.A.L., E. Tong, S.S.H., M.I.), Division of Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, California
| | - Elizabeth Tong
- From the Department of Radiology (G.Y., E. Tranvinh, B.A.L., E. Tong, S.S.H., M.I.), Division of Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, California
| | - Syed S Hashmi
- From the Department of Radiology (G.Y., E. Tranvinh, B.A.L., E. Tong, S.S.H., M.I.), Division of Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, California
| | - Chirag B Patel
- Department of Neuro-Oncology (C.B.P.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Iv
- From the Department of Radiology (G.Y., E. Tranvinh, B.A.L., E. Tong, S.S.H., M.I.), Division of Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, California
| |
Collapse
|
2
|
Mannam SS, Nwagwu CD, Sumner C, Weinberg BD, Hoang KB. Perfusion-Weighted Imaging: The Use of a Novel Perfusion Scoring Criteria to Improve the Assessment of Brain Tumor Recurrence versus Treatment Effects. Tomography 2023; 9:1062-1070. [PMID: 37368539 DOI: 10.3390/tomography9030087] [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: 04/20/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Imaging surveillance of contrast-enhancing lesions after the treatment of malignant brain tumors with radiation is plagued by an inability to reliably distinguish between tumor recurrence and treatment effects. Magnetic resonance perfusion-weighted imaging (PWI)-among other advanced brain tumor imaging modalities-is a useful adjunctive tool for distinguishing between these two entities but can be clinically unreliable, leading to the need for tissue sampling to confirm diagnosis. This may be partially because clinical PWI interpretation is non-standardized and no grading criteria are used for assessment, leading to interpretation discrepancies. This variance in the interpretation of PWI and its subsequent effect on the predictive value has not been studied. Our objective is to propose structured perfusion scoring criteria and determine their effect on the clinical value of PWI. METHODS Patients treated at a single institution between 2012 and 2022 who had prior irradiated malignant brain tumors and subsequent progression of contrast-enhancing lesions determined by PWI were retrospectively studied from CTORE (CNS Tumor Outcomes Registry at Emory). PWI was given two separate qualitative scores (high, intermediate, or low perfusion). The first (control) was assigned by a neuroradiologist in the radiology report in the course of interpretation with no additional instruction. The second (experimental) was assigned by a neuroradiologist with additional experience in brain tumor interpretation using a novel perfusion scoring rubric. The perfusion assessments were divided into three categories, each directly corresponding to the pathology-reported classification of residual tumor content. The interpretation accuracy in predicting the true tumor percentage, our primary outcome, was assessed through Chi-squared analysis, and inter-rater reliability was assessed using Cohen's Kappa. RESULTS Our 55-patient cohort had a mean age of 53.5 ± 12.2 years. The percentage agreement between the two scores was 57.4% (κ: 0.271). Upon conducting the Chi-squared analysis, we found an association with the experimental group reads (p-value: 0.014) but no association with the control group reads (p-value: 0.734) in predicting tumor recurrence versus treatment effects. CONCLUSIONS With our study, we showed that having an objective perfusion scoring rubric aids in improved PWI interpretation. Although PWI is a powerful tool for CNS lesion diagnosis, methodological radiology evaluation greatly improves the accurate assessment and characterization of tumor recurrence versus treatment effects by all neuroradiologists. Further work should focus on standardizing and validating scoring rubrics for PWI evaluation in tumor patients to improve diagnostic accuracy.
Collapse
Affiliation(s)
- Sneha Sai Mannam
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chibueze D Nwagwu
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Christina Sumner
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Kimberly B Hoang
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA 30322, USA
| |
Collapse
|
3
|
Anil A, Stokes AM, Chao R, Hu LS, Alhilali L, Karis JP, Bell LC, Quarles CC. Identification of single-dose, dual-echo based CBV threshold for fractional tumor burden mapping in recurrent glioblastoma. Front Oncol 2023; 13:1046629. [PMID: 36733305 PMCID: PMC9887158 DOI: 10.3389/fonc.2023.1046629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Background Relative cerebral blood volume (rCBV) obtained from dynamic susceptibility contrast (DSC) MRI is widely used to distinguish high grade glioma recurrence from post treatment radiation effects (PTRE). Application of rCBV thresholds yield maps to distinguish between regional tumor burden and PTRE, a biomarker termed the fractional tumor burden (FTB). FTB is generally measured using conventional double-dose, single-echo DSC-MRI protocols; recently, a single-dose, dual-echo DSC-MRI protocol was clinically validated by direct comparison to the conventional double-dose, single-echo protocol. As the single-dose, dual-echo acquisition enables reduction in the contrast agent dose and provides greater pulse sequence parameter flexibility, there is a compelling need to establish dual-echo DSC-MRI based FTB mapping. In this study, we determine the optimum standardized rCBV threshold for the single-dose, dual-echo protocol to generate FTB maps that best match those derived from the reference standard, double-dose, single-echo protocol. Methods The study consisted of 23 high grade glioma patients undergoing perfusion scans to confirm suspected tumor recurrence. We sequentially acquired single dose, dual-echo and double dose, single-echo DSC-MRI data. For both protocols, we generated leakage-corrected standardized rCBV maps. Standardized rCBV (sRCBV) thresholds of 1.0 and 1.75 were used to compute single-echo FTB maps as the reference for delineating PTRE (sRCBV < 1.0), tumor with moderate angiogenesis (1.0 < sRCBV < 1.75), and tumor with high angiogenesis (sRCBV > 1.75) regions. To assess the sRCBV agreement between acquisition protocols, the concordance correlation coefficient (CCC) was computed between the mean tumor sRCBV values across the patients. A receiver operating characteristics (ROC) analysis was performed to determine the optimum dual-echo sRCBV threshold. The sensitivity, specificity, and accuracy were compared between the obtained optimized threshold (1.64) and the standard reference threshold (1.75) for the dual-echo sRCBV threshold. Results The mean tumor sRCBV values across the patients showed a strong correlation (CCC = 0.96) between the two protocols. The ROC analysis showed maximum accuracy at thresholds of 1.0 (delineate PTRE from tumor) and 1.64 (differentiate aggressive tumors). The reference threshold (1.75) and the obtained optimized threshold (1.64) yielded similar accuracy, with slight differences in sensitivity and specificity which were not statistically significant (1.75 threshold: Sensitivity = 81.94%; Specificity: 87.23%; Accuracy: 84.58% and 1.64 threshold: Sensitivity = 84.48%; Specificity: 84.97%; Accuracy: 84.73%). Conclusions The optimal sRCBV threshold for single-dose, dual-echo protocol was found to be 1.0 and 1.64 for distinguishing tumor recurrence from PTRE; however, minimal differences were observed when using the standard threshold (1.75) as the upper threshold, suggesting that the standard threshold could be used for both protocols. While the prior study validated the agreement of the mean sRCBV values between the protocols, this study confirmed that their voxel-wise agreement is suitable for reliable FTB mapping. Dual-echo DSC-MRI acquisitions enable robust single-dose sRCBV and FTB mapping, provide pulse sequence parameter flexibility and should improve reproducibility by mitigating variations in preload dose and incubation time.
Collapse
Affiliation(s)
- Aliya Anil
- Division of Neuroimaging Research and Barrow Neuroimaging Innovation Center, Barrow Neuroimaging Institute, Phoenix, AZ, United States
| | - Ashley M. Stokes
- Division of Neuroimaging Research and Barrow Neuroimaging Innovation Center, Barrow Neuroimaging Institute, Phoenix, AZ, United States
| | - Renee Chao
- Division of Neuroimaging Research and Barrow Neuroimaging Innovation Center, Barrow Neuroimaging Institute, Phoenix, AZ, United States
| | - Leland S. Hu
- Department of Radiology, Division of Neuroradiology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Lea Alhilali
- Neuroradiology, Southwest Neuroimaging at Barrow Neurological Institute, Phoenix, AZ, United States
| | - John P. Karis
- Neuroradiology, Southwest Neuroimaging at Barrow Neurological Institute, Phoenix, AZ, United States
| | - Laura C. Bell
- Early Clinical Development, Genentech, San Francisco, CA, United States
| | - C. Chad Quarles
- Cancer System Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: C. Chad Quarles,
| |
Collapse
|
4
|
Li AY, Iv M. Conventional and Advanced Imaging Techniques in Post-treatment Glioma Imaging. FRONTIERS IN RADIOLOGY 2022; 2:883293. [PMID: 37492665 PMCID: PMC10365131 DOI: 10.3389/fradi.2022.883293] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/06/2022] [Indexed: 07/27/2023]
Abstract
Despite decades of advancement in the diagnosis and therapy of gliomas, the most malignant primary brain tumors, the overall survival rate is still dismal, and their post-treatment imaging appearance remains very challenging to interpret. Since the limitations of conventional magnetic resonance imaging (MRI) in the distinction between recurrence and treatment effect have been recognized, a variety of advanced MR and functional imaging techniques including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), MR spectroscopy (MRS), as well as a variety of radiotracers for single photon emission computed tomography (SPECT) and positron emission tomography (PET) have been investigated for this indication along with voxel-based and more quantitative analytical methods in recent years. Machine learning and radiomics approaches in recent years have shown promise in distinguishing between recurrence and treatment effect as well as improving prognostication in a malignancy with a very short life expectancy. This review provides a comprehensive overview of the conventional and advanced imaging techniques with the potential to differentiate recurrence from treatment effect and includes updates in the state-of-the-art in advanced imaging with a brief overview of emerging experimental techniques. A series of representative cases are provided to illustrate the synthesis of conventional and advanced imaging with the clinical context which informs the radiologic evaluation of gliomas in the post-treatment setting.
Collapse
Affiliation(s)
- Anna Y. Li
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael Iv
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
5
|
Scola E, Desideri I, Bianchi A, Gadda D, Busto G, Fiorenza A, Amadori T, Mancini S, Miele V, Fainardi E. Assessment of brain tumors by magnetic resonance dynamic susceptibility contrast perfusion-weighted imaging and computed tomography perfusion: a comparison study. LA RADIOLOGIA MEDICA 2022; 127:664-672. [PMID: 35441970 DOI: 10.1007/s11547-022-01470-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/11/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the association and agreement between magnetic resonance dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) and computed tomography perfusion (CTP) in determining vascularity and permeability of primary and secondary brain tumors. MATERIAL AND METHODS DSC-PWI and CTP studies from 97 patients with high-grade glioma, low-grade glioma and solitary brain metastasis were retrospectively reviewed. Normalized cerebral blood flow (nCBF), cerebral blood volume (nCBV), capillary transfer constant (nK2) and permeability surface area product (nPS) values were obtained. Variables among groups were compared, and correlation and agreement between DSC-PWI and CTP were tested. RESULTS All DSC-PWI and CTP parameters were higher in high-grade than in low-grade gliomas (p < 0.01 and p < 0.001). Metastases had greater DSC-PWI nCBV (p < 0.05), nCTP-CBF (p < 0.05), nCTP-CBV (p < 0.01) and nCTP-PS (p < 0.0001) than low-grade gliomas and more elevated nCTP-PS (p < 0.01) than high-grade gliomas. The correlation was strong between DSC-PWI nCBF and CTP nCBF (r = 0.79; p < 0.00001) and between DSC-PWI nCBV and CTP nCBV (r = 0.83; p < 0.00001), weaker between DSC-PWI nK2 and CTP nPS (r = 0.29; p < 0.01). Bland-Altman plots indicated that the agreement was strong between DSC-PWI nCBF and CTP nCBF, good between DSC-PWI nCBV and CTP nCBV and poorer between DSC-PWI nK2 and CTP nPS. CONCLUSION DSC-PWI and CTP CBF and CBV maps were comparable and interchangeable in the assessment of tumor vascularity, unlike DSC-PWI K2 and CTP PS maps that were more discordant in the analysis of tumor permeability. CTP could be an alternative method to quantify tumor neoangiogenesis when MRI is not available or when the patient does not tolerate it.
Collapse
Affiliation(s)
- Elisa Scola
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Ilaria Desideri
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Bianchi
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Davide Gadda
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Giorgio Busto
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alessandro Fiorenza
- Radiodiagnostic Unit N. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Amadori
- Radiodiagnostic Unit N. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Sara Mancini
- Radiodiagnostic Unit N. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy.,Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| |
Collapse
|
6
|
Li Y, Ma Y, Wu Z, Xie R, Zeng F, Cai H, Lui S, Song B, Chen L, Wu M. Advanced Imaging Techniques for Differentiating Pseudoprogression and Tumor Recurrence After Immunotherapy for Glioblastoma. Front Immunol 2021; 12:790674. [PMID: 34899760 PMCID: PMC8656432 DOI: 10.3389/fimmu.2021.790674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Glioblastoma (GBM) is the most common malignant tumor of the central nervous system with poor prognosis. Although the field of immunotherapy in glioma is developing rapidly, glioblastoma is still prone to recurrence under strong immune intervention. The major challenges in the process of immunotherapy are evaluating the curative effect, accurately distinguishing between treatment-related reactions and tumor recurrence, and providing guidance for clinical decision-making. Since the conventional magnetic resonance imaging (MRI) is usually difficult to distinguish between pseudoprogression and the true tumor progression, many studies have used various advanced imaging techniques to evaluate treatment-related responses. Meanwhile, criteria for efficacy evaluation of immunotherapy are constantly updated and improved. A standard imaging scheme to evaluate immunotherapeutic response will benefit patients finally. This review mainly summarizes the application status and future trend of several advanced imaging techniques in evaluating the efficacy of GBM immunotherapy.
Collapse
Affiliation(s)
- Yan Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqi Ma
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zijun Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Ruoxi Xie
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Fanxin Zeng
- Department of Clinic Medical Center, Dazhou Central Hospital, Dazhou, China
| | - Huawei Cai
- Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.,Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Min Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.,Department of Clinic Medical Center, Dazhou Central Hospital, Dazhou, China
| |
Collapse
|
7
|
Boxerman JL, Quarles CC, Hu LS, Erickson BJ, Gerstner ER, Smits M, Kaufmann TJ, Barboriak DP, Huang RH, Wick W, Weller M, Galanis E, Kalpathy-Cramer J, Shankar L, Jacobs P, Chung C, van den Bent MJ, Chang S, Al Yung WK, Cloughesy TF, Wen PY, Gilbert MR, Rosen BR, Ellingson BM, Schmainda KM. Consensus recommendations for a dynamic susceptibility contrast MRI protocol for use in high-grade gliomas. Neuro Oncol 2020; 22:1262-1275. [PMID: 32516388 PMCID: PMC7523451 DOI: 10.1093/neuonc/noaa141] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Despite the widespread clinical use of dynamic susceptibility contrast (DSC) MRI, DSC-MRI methodology has not been standardized, hindering its utilization for response assessment in multicenter trials. Recently, the DSC-MRI Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition issued an updated consensus DSC-MRI protocol compatible with the standardized brain tumor imaging protocol (BTIP) for high-grade gliomas that is increasingly used in the clinical setting and is the default MRI protocol for the National Clinical Trials Network. After reviewing the basis for controversy over DSC-MRI protocols, this paper provides evidence-based best practices for clinical DSC-MRI as determined by the Committee, including pulse sequence (gradient echo vs spin echo), BTIP-compliant contrast agent dosing (preload and bolus), flip angle (FA), echo time (TE), and post-processing leakage correction. In summary, full-dose preload, full-dose bolus dosing using intermediate (60°) FA and field strength-dependent TE (40-50 ms at 1.5 T, 20-35 ms at 3 T) provides overall best accuracy and precision for cerebral blood volume estimates. When single-dose contrast agent usage is desired, no-preload, full-dose bolus dosing using low FA (30°) and field strength-dependent TE provides excellent performance, with reduced contrast agent usage and elimination of potential systematic errors introduced by variations in preload dose and incubation time.
Collapse
Affiliation(s)
- Jerrold L Boxerman
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Representative of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group
- Representative of the American Society of Neuroradiology (ASNR)
- Representative of the American Society of Functional Neuroradiology (ASFNR)
| | - Chad C Quarles
- Department of Neuroimaging Research and Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Leland S Hu
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
- Representative of the Alliance for Clinical Trials in Oncology
- Representative of the American Society of Neuroradiology (ASNR)
| | - Bradley J Erickson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Representative of the Alliance for Clinical Trials in Oncology
- Representative of the RSNA Quantitative Imaging Biomarker Alliance (QIBA)
- Representative of the American Society of Neuroradiology (ASNR)
| | - Elizabeth R Gerstner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Representative of the Adult Brain Tumor Consortium (ABTC)
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, Netherlands
- Representative of the European Organisation for Research and Treatment of Cancer (EORTC)
| | - Timothy J Kaufmann
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Representative of the Alliance for Clinical Trials in Oncology
| | - Daniel P Barboriak
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
- Representative of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group
- Representative of the RSNA Quantitative Imaging Biomarker Alliance (QIBA)
- Representative of the American Society of Neuroradiology (ASNR)
| | - Raymond H Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Wolfgang Wick
- Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany
- Representative of the European Organisation for Research and Treatment of Cancer (EORTC)
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- Representative of the European Organisation for Research and Treatment of Cancer (EORTC)
| | - Evanthia Galanis
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Representative of the Alliance for Clinical Trials in Oncology
| | - Jayashree Kalpathy-Cramer
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lalitha Shankar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA
| | - Paula Jacobs
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Representative of the Alliance for Clinical Trials in Oncology
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Representative of the European Organisation for Research and Treatment of Cancer (EORTC)
| | - Susan Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - W K Al Yung
- Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
- Representative of the Adult Brain Tumor Consortium (ABTC)
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute (NCI), Bethesda, Maryland, USA
- Representative of the Radiation Therapy Oncology Group (RTOG)
| | - Bruce R Rosen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin M Ellingson
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Departments of Radiological Sciences, Psychiatry, and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Representative of the Adult Brain Tumor Consortium (ABTC)
- Representative of the Ivy Consortium for Early Phase Clinical Trials
- Representative of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group
- Representative of the RSNA Quantitative Imaging Biomarker Alliance (QIBA)
- Representative of the American Society of Neuroradiology (ASNR)
| | - Kathleen M Schmainda
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Representative of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group
| |
Collapse
|
8
|
The Impact of MRI Features and Observer Confidence on the Treatment Decision-Making for Patients with Untreated Glioma. Sci Rep 2019; 9:19898. [PMID: 31882644 PMCID: PMC6934740 DOI: 10.1038/s41598-019-56333-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/02/2019] [Indexed: 12/02/2022] Open
Abstract
In a blind, dual-center, multi-observer setting, we here identify the pre-treatment radiologic features by Magnetic Resonance Imaging (MRI) associated with subsequent treatment options in patients with glioma. Study included 220 previously untreated adult patients from two institutions (94 + 126 patients) with a histopathologically confirmed diagnosis of glioma after surgery. Using a blind, cross-institutional and randomized setup, four expert neuroradiologists recorded radiologic features, suggested glioma grade and corresponding confidence. The radiologic features were scored using the Visually AcceSAble Rembrandt Images (VASARI) standard. Results were retrospectively compared to patient treatment outcomes. Our findings show that patients receiving a biopsy or a subtotal resection were more likely to have a tumor with pathological MRI-signal (by T2-weighted Fluid-Attenuated Inversion Recovery) crossing the midline (Hazard Ratio; HR = 1.30 [1.21–1.87], P < 0.001), and those receiving a biopsy sampling more often had multifocal lesions (HR = 1.30 [1.16–1.64], P < 0.001). For low-grade gliomas (N = 50), low observer confidence in the radiographic readings was associated with less chance of a total resection (P = 0.002) and correlated with the use of a more comprehensive adjuvant treatment protocol (Spearman = 0.48, P < 0.001). This study may serve as a guide to the treating physician by identifying the key radiologic determinants most likely to influence the treatment decision-making process.
Collapse
|
9
|
Abstract
BACKGROUND Clinical practice guidelines suggest that magnetic resonance imaging (MRI) of the brain should be performed at certain time points or intervals distant from diagnosis (interval or surveillance imaging) of cerebral glioma, to monitor or follow up the disease; it is not known, however, whether these imaging strategies lead to better outcomes among patients than triggered imaging in response to new or worsening symptoms. OBJECTIVES To determine the effect of different imaging strategies (in particular, pre-specified interval or surveillance imaging, and symptomatic or triggered imaging) on health and economic outcomes for adults with glioma (grades 2 to 4) in the brain. SEARCH METHODS The Cochrane Gynaecological, Neuro-oncology and Orphan Cancers (CGNOC) Group Information Specialist searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase up to 18 June 2019 and the NHS Economic Evaluation Database (EED) up to December 2014 (database closure). SELECTION CRITERIA We included randomised controlled trials, non-randomised controlled trials, and controlled before-after studies with concurrent comparison groups comparing the effect of different imaging strategies on survival and other health outcomes in adults with cerebral glioma; and full economic evaluations (cost-effectiveness analyses, cost-utility analyses and cost-benefit analyses) conducted alongside any study design, and any model-based economic evaluations on pre- and post-treatment imaging in adults with cerebral glioma. DATA COLLECTION AND ANALYSIS We used standard Cochrane review methodology with two authors independently performing study selection and data collection, and resolving disagreements through discussion. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included one retrospective, single-institution study that compared post-operative imaging within 48 hours (early post-operative imaging) with no early post-operative imaging among 125 people who had surgery for glioblastoma (GBM: World Health Organization (WHO) grade 4 glioma). Most patients in the study underwent maximal surgical resection followed by combined radiotherapy and temozolomide treatment. Although patient characteristics in the study arms were comparable, the study was at high risk of bias overall. Evidence from this study suggested little or no difference between early and no early post-operative imaging with respect to overall survival (deaths) at one year after diagnosis of GBM (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.61 to 1.21; 48% vs 55% died, respectively; very low certainty evidence) and little or no difference in overall survival (deaths) at two years after diagnosis of GBM (RR 1.06, 95% CI 0.91 to 1.25; 86% vs 81% died, respectively; very low certainty evidence). No other review outcomes were reported. We found no evidence on the effectiveness of other imaging schedules. In addition, we identified no relevant economic evaluations assessing the efficiency of the different imaging strategies. AUTHORS' CONCLUSIONS The effect of different imaging strategies on survival and other health outcomes remains largely unknown. Existing imaging schedules in glioma seem to be pragmatic rather than evidence-based. The limited evidence suggesting that early post-operative brain imaging among GBM patients who will receive combined chemoradiation treatment may make little or no difference to survival needs to be further researched, particularly as early post-operative imaging also serves as a quality control measure that may lead to early re-operation if residual tumour is identified. Mathematical modelling of a large glioma patient database could help to distinguish the optimal timing of surveillance imaging for different types of glioma, with stratification of patients facilitated by assessment of individual tumour growth rates, molecular biomarkers and other prognostic factors. In addition, paediatric glioma study designs could be used to inform future research of imaging strategies among adults with glioma.
Collapse
Affiliation(s)
- Gerard Thompson
- University of EdinburghCentre for Clinical Brain SciencesChancellor’s Building FU201a49 Little France CrescentEdinburghScotlandUKEH16 4SB
| | - Theresa A Lawrie
- The Evidence‐Based Medicine Consultancy Ltd3rd Floor Northgate HouseUpper Borough WallsBathUKBA1 1RG
| | - Ashleigh Kernohan
- Newcastle UniversityInstitute of Health & SocietyBaddiley‐Clark Building, Richardson RoadNewcastle upon TyneUKNE2 4AA
| | - Michael D Jenkinson
- Institute of Translational MedicineUniversity of Liverpool & Department of NeurosurgeryThe Walton Centre NHS Foundation TrustLiverpoolMerseysideUK
| | | |
Collapse
|
10
|
Iv M, Liu X, Lavezo J, Gentles AJ, Ghanem R, Lummus S, Born DE, Soltys SG, Nagpal S, Thomas R, Recht L, Fischbein N. Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making. AJNR Am J Neuroradiol 2019; 40:1649-1657. [PMID: 31515215 DOI: 10.3174/ajnr.a6211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Fractional tumor burden better correlates with histologic tumor volume fraction in treated glioblastoma than other perfusion metrics such as relative CBV. We defined fractional tumor burden classes with low and high blood volume to distinguish tumor from treatment effect and to determine whether fractional tumor burden can inform treatment-related decision-making. MATERIALS AND METHODS Forty-seven patients with high-grade gliomas (primarily glioblastoma) with recurrent contrast-enhancing lesions on DSC-MR imaging were retrospectively evaluated after surgical sampling. Histopathologic examination defined treatment effect versus tumor. Normalized relative CBV thresholds of 1.0 and 1.75 were used to define low, intermediate, and high fractional tumor burden classes in each histopathologically defined group. Performance was assessed with an area under the receiver operating characteristic curve. Consensus agreement among physician raters reporting hypothetic changes in treatment-related decisions based on fractional tumor burden was compared with actual real-time treatment decisions. RESULTS Mean lower fractional tumor burden, high fractional tumor burden, and relative CBV of the contrast-enhancing volume were significantly different between treatment effect and tumor (P = .002, P < .001, and P < .001), with tumor having significantly higher fractional tumor burden and relative CBV and lower fractional tumor burden. No significance was found with intermediate fractional tumor burden. Performance of the area under the receiver operating characteristic curve was the following: high fractional tumor burden, 0.85; low fractional tumor burden, 0.7; and relative CBV, 0.81. In comparing treatment decisions, there were disagreements in 7% of tumor and 44% of treatment effect cases; in the latter, all disagreements were in cases with scattered atypical cells. CONCLUSIONS High fractional tumor burden and low fractional tumor burden define fractions of the contrast-enhancing lesion volume with high and low blood volume, respectively, and can differentiate treatment effect from tumor in recurrent glioblastomas. Fractional tumor burden maps can also help to inform clinical decision-making.
Collapse
Affiliation(s)
- M Iv
- From the Departments of Neuroimaging and Neurointervention (M.I., N.F.)
| | - X Liu
- Department of Neurosurgery (X.L.), Shengjing Hospital of China Medical University, Shenyang, China
| | - J Lavezo
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - A J Gentles
- Medicine (Biomedical Informatics Research) (A.J.G.)
| | - R Ghanem
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - S Lummus
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - D E Born
- Pathology (J.L., R.G., S.L., D.E.B.)
| | | | - S Nagpal
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - R Thomas
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - L Recht
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - N Fischbein
- From the Departments of Neuroimaging and Neurointervention (M.I., N.F.)
| |
Collapse
|
11
|
Using Magnetic Resonance Perfusion to Stratify Overall Survival in Treated High-Grade Gliomas. Can J Neurol Sci 2019; 46:533-539. [PMID: 31284880 DOI: 10.1017/cjn.2019.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND MR perfusion imaging is a relatively new technique that may aid in identifying recurrent tumor (RT) in those with radically treated high-grade gliomas (HGG). We aim to assess the relationship between dynamic susceptibility contrast-enhanced MR perfusion (DSC-MRP) and overall survival to establish a baseline for future research and to determine the utility of DSC-MRP as a clinical decision-making and prognostic tool. METHODS We conducted a retrospective cohort study. Adults with pathologically confirmed HGG at the Juravinski Cancer Centre, Ontario between January 2011 and April 2014 with at least one post-treatment DSC-MRP were included. DSC-MRP was interpreted as positive or negative for tumor recurrence by experienced radiologists. The primary outcome was overall survival. RESULTS Sixty-one patients were enrolled. Median survival for patients with a positive DSC-MRP scan was 4.5 months compared with 10.2 months for those with a negative DSC-MRP scan (hazard ratio [unadjusted] = 2.51; 95% confidence interval = 1.10-5.67; p-value = 0.03). Multivariable modeling (adjusted) that included all pre-selected variables showed similar results. CONCLUSION Survival time in patients with HGG is generally low, and almost all patients will demonstrate RT. Our data suggest a positive DSC-MRP correlates with lower overall survival and may signify the presence of highly active RT. These results generate a hypothesis that there may be a prognostic role for the use of serial DSC-MRP for tumor surveillance. More importantly, this biomarker may aid in decision making for treatment plans and palliation.
Collapse
|
12
|
Vallatos A, Al-Mubarak HFI, Birch JL, Galllagher L, Mullin JM, Gilmour L, Holmes WM, Chalmers AJ. Quantitative histopathologic assessment of perfusion MRI as a marker of glioblastoma cell infiltration in and beyond the peritumoral edema region. J Magn Reson Imaging 2018; 50:529-540. [PMID: 30569620 DOI: 10.1002/jmri.26580] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Conventional MRI fails to detect regions of glioblastoma cell infiltration beyond the contrast-enhanced T1 solid tumor region, with infiltrating tumor cells often migrating along host blood vessels. PURPOSE To quantitatively and qualitatively analyze the correlation between perfusion MRI signal and tumor cell density in order to assess whether local perfusion perturbation could provide a useful biomarker of glioblastoma cell infiltration. STUDY TYPE Animal model. SUBJECTS Mice bearing orthotopic glioblastoma xenografts generated from a patient-derived glioblastoma cell line. FIELD STRENGTH/SEQUENCES 7T perfusion images acquired using a high signal-to-noise ratio (SNR) multiple boli arterial spin labeling sequence were compared with conventional MRI (T1 /T2 weighted, contrast-enhanced T1 , diffusion-weighted, and apparent diffusion coefficient). ASSESSMENT Immunohistochemistry sections were stained for human leukocyte antigen (probing human-derived tumor cells). To achieve quantitative MRI-tissue comparison, multiple histological slices cut in the MRI plane were stacked to produce tumor cell density maps acting as a "ground truth." STATISTICAL TESTS Sensitivity, specificity, accuracy, and Dice similarity indices were calculated and a two-tailed, paired t-test used for statistical analysis. RESULTS High comparison test results (Dice 0.62-0.72, Accuracy 0.86-0.88, Sensitivity 0.51-0.7, and Specificity 0.92-0.97) indicate a good segmentation for all imaging modalities and highlight the quality of the MRI tissue assessment protocol. Perfusion imaging exhibits higher sensitivity (0.7) than conventional MRI (0.51-0.61). MRI/histology voxel-to-voxel comparison revealed a negative correlation between tumor cell infiltration and perfusion at the tumor margins (P = 0.0004). DATA CONCLUSION These results demonstrate the ability of perfusion imaging to probe regions of low tumor cell infiltration while confirming the sensitivity limitations of conventional imaging modalities. The quantitative relationship between tumor cell density and perfusion identified in and beyond the edematous T2 hyperintensity region surrounding macroscopic tumor could be used to detect marginal tumor cell infiltration with greater accuracy. LEVEL OF EVIDENCE 1 Technical stage: 2 J. Magn. Reson. Imaging 2019;50:529-540.
Collapse
Affiliation(s)
- A Vallatos
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - H F I Al-Mubarak
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK.,University of Misan, Iraq
| | - J L Birch
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Galllagher
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - J M Mullin
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - L Gilmour
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
| | - W M Holmes
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - A J Chalmers
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
| |
Collapse
|
13
|
Glioblastoma radiomics: can genomic and molecular characteristics correlate with imaging response patterns? Neuroradiology 2018; 60:1043-1051. [PMID: 30094640 DOI: 10.1007/s00234-018-2060-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE For glioblastoma (GBM), imaging response (IR) or pseudoprogression (PSP) is frequently observed after chemoradiation and may connote a favorable prognosis. With tumors categorized by the Cancer Genome Atlas Project (mesenchymal, classical, neural, and proneural) and by methylguanine-methyltransferase (MGMT) methylation status, we attempted to determine if certain genomic or molecular subtypes of GBM were specifically associated with IR or PSP. METHODS Patients with GBM treated at two institutions were reviewed. Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Mantel-cox test determined effect of IR and PSP on OS and PFS. Fisher's exact test was utilized to correlate IR and PSP with genomic subtypes and MGMT status. RESULTS Eighty-two patients with GBM were reviewed. The median OS and PFS were 17.9 months and 8.9 months. IR was observed in 28 (40%) and was associated with improved OS (median 29.4 vs 14.5 months p < 0.01) and PFS (median 17.7 vs 5.5 months, p < 0.01). PSP was observed in 14 (19.2%) and trended towards improved PFS (15.0 vs 7.7 months p = 0.08). Tumors with a proneural component had a higher rate of IR compared to those without a proneural component (IR 60% vs 28%; p = 0.03). MGMT methylation was associated with IR (58% vs 24%, p = 0.032), but not PSP (34%, p = 0.10). CONCLUSION IR is associated with improved OS and PFS. The proneural subtype and MGMT methylated tumors had higher rates of IR.
Collapse
|
14
|
Pope WB, Brandal G. Conventional and advanced magnetic resonance imaging in patients with high-grade glioma. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:239-253. [PMID: 29696946 DOI: 10.23736/s1824-4785.18.03086-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Magnetic resonance imaging is integral to the care of patients with high-grade gliomas. Anatomic detail can be acquired with conventional structural imaging, but newer approaches also add capabilities to interrogate image-derived physiologic and molecular characteristics of central nervous system neoplasms. These advanced imaging techniques are increasingly employed to generate biomarkers that better reflect tumor burden and therapy response. The following is an overview of current strategies based on advanced magnetic resonance imaging that are used in the assessment of high-grade glioma patients with an emphasis on how novel imaging biomarkers can potentially advance patient care.
Collapse
Affiliation(s)
- Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA -
| | - Garth Brandal
- Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
15
|
Liu X, Mangla R, Tian W, Qiu X, Li D, Walter KA, Ekholm S, Johnson MD. The preliminary radiogenomics association between MR perfusion imaging parameters and genomic biomarkers, and their predictive performance of overall survival in patients with glioblastoma. J Neurooncol 2017; 135:553-560. [PMID: 28889246 DOI: 10.1007/s11060-017-2602-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/20/2017] [Indexed: 12/20/2022]
Abstract
The radiogenomics association of neovascularization is important for overall survival (OS) in glioblastoma patients and remains unclear. The purpose of this study is to assess the association between MR perfusion imaging derived parameters and genomic biomarkers of glioblastoma, and to evaluate their prognostic value. This retrospective study enrolled 41 patients with newly diagnosed glioblastoma. The mean and maximal relative cerebral blood volume (rCBV) ratio (rCBVmean and rCBVmax), derived from MR perfusion weighted imaging, of the enhancing tumor, as well as maximal rCBV ratio of peri-enhancing tumor area (rCBVperi-tumor) were measured. The ki-67 labeling index, mammalian target of rapamycin (mTOR) activation, epidermal growth factor receptor (EGFR) amplification, isocitrate dehydrogenase (IDH) mutation and TP53 were assessed. There was a significant correlation between rCBVmax and mTOR based on Pearson's correlations with Benjamini-Hochberg adjustment for controlling false discovery rate, p = 0.047. The rCBVperi-tumor showed significant correlation with mTOR (p = 0.0183) after adjustment of gender and EGFR status. The mean rCBVperi-tumor value of the patients with OS shorter than 14 months was significantly higher than patients with OS longer than 14 months, p = 0.002. The rCBVperi-tumor and age were the two strongest predictors of OS (hazard ratio = 1.29 and 1.063 respectively) by Cox regression analysis. This study showed that hemodynamic abnormalities of glioblastoma were associated with genomics activation status of mTOR-EGFR pathway, however, the radiogenomics associations are different in enhancing and peri-enhancing area of glioblastoma. The rCBVperi-tumor has better prognostic value than genomic biomarkers alone.
Collapse
Affiliation(s)
- Xiang Liu
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 648, Rochester, NY, 14642-8638, USA.
| | - Rajiv Mangla
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 648, Rochester, NY, 14642-8638, USA
| | - Wei Tian
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 648, Rochester, NY, 14642-8638, USA
| | - Xing Qiu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Dongmei Li
- Clinical and Translational Research and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin A Walter
- Department of Neurosurgey, University of Rochester Medical Center, Rochester, NY, USA
| | - Sven Ekholm
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 648, Rochester, NY, 14642-8638, USA
| | - Mahlon D Johnson
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
16
|
The evolving role for re-irradiation in the management of recurrent grade 4 glioma. J Neurooncol 2017; 134:523-530. [PMID: 28386661 DOI: 10.1007/s11060-017-2392-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/24/2017] [Indexed: 01/14/2023]
Abstract
Although significant gains have been realized in the management of grade 4 glioma, the majority of these patients will ultimately suffer local recurrence within the prior field of treatment. Clearly, novel local treatment strategies are required to improve patient outcomes. Concerns of toxicity have limited enthusiasm for the utilization of re-irradiation as a treatment option. However, using modern imaging technology and precision radiotherapy delivery techniques re-irradiation has proven a feasible option achieving both a palliative benefit and prolongation of survival with low toxicity rates. The evolution of re-irradiation as a treatment modality for recurrent grade 4 glioma is reviewed. In addition, potential targeted radiosensitizers to be used in conjunction with re-irradiation are also discussed.
Collapse
|
17
|
Tong E, Sugrue L, Wintermark M. Understanding the Neurophysiology and Quantification of Brain Perfusion. Top Magn Reson Imaging 2017; 26:57-65. [PMID: 28277465 DOI: 10.1097/rmr.0000000000000128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Newer neuroimaging technology has moved beyond pure anatomical imaging and ventured into functional and physiological imaging. Perfusion magnetic resonance imaging (PWI), which depicts hemodynamic conditions of the brain at the microvascular level, has an increasingly important role in clinical central nervous system applications. This review provides an overview of the established role of PWI in brain tumor and cerebrovascular imaging, as well as some emerging applications in neuroimaging. PWI allows better characterization of brain tumors, grading, and monitoring. In acute stroke imaging, PWI is utilized to distinguish penumbra from infarcted tissue. PWI is a promising tool in the assessment of neurodegenerative and neuropsychiatric diseases, although its clinical role is not yet defined.
Collapse
Affiliation(s)
- Elizabeth Tong
- *Department of Radiology & Biomedical Imaging, University of California, San Francisco †Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA
| | | | | |
Collapse
|
18
|
Chae SY, Suh S, Ryoo I, Park A, Noh KJ, Shim H, Seol HY. A semi-automated volumetric software for segmentation and perfusion parameter quantification of brain tumors using 320-row multidetector computed tomography: a validation study. Neuroradiology 2017; 59:461-469. [PMID: 28341992 DOI: 10.1007/s00234-017-1790-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/18/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE We developed a semi-automated volumetric software, NPerfusion, to segment brain tumors and quantify perfusion parameters on whole-brain CT perfusion (WBCTP) images. The purpose of this study was to assess the feasibility of the software and to validate its performance compared with manual segmentation. METHODS Twenty-nine patients with pathologically proven brain tumors who underwent preoperative WBCTP between August 2012 and February 2015 were included. Three perfusion parameters, arterial flow (AF), equivalent blood volume (EBV), and Patlak flow (PF, which is a measure of permeability of capillaries), of brain tumors were generated by a commercial software and then quantified volumetrically by NPerfusion, which also semi-automatically segmented tumor boundaries. The quantification was validated by comparison with that of manual segmentation in terms of the concordance correlation coefficient and Bland-Altman analysis. RESULTS With NPerfusion, we successfully performed segmentation and quantified whole volumetric perfusion parameters of all 29 brain tumors that showed consistent perfusion trends with previous studies. The validation of the perfusion parameter quantification exhibited almost perfect agreement with manual segmentation, with Lin concordance correlation coefficients (ρ c) for AF, EBV, and PF of 0.9988, 0.9994, and 0.9976, respectively. On Bland-Altman analysis, most differences between this software and manual segmentation on the commercial software were within the limit of agreement. CONCLUSIONS NPerfusion successfully performs segmentation of brain tumors and calculates perfusion parameters of brain tumors. We validated this semi-automated segmentation software by comparing it with manual segmentation. NPerfusion can be used to calculate volumetric perfusion parameters of brain tumors from WBCTP.
Collapse
Affiliation(s)
- Soo Young Chae
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea.
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea
| | - Arim Park
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea
| | - Kyoung Jin Noh
- Department of Electronic Engineering, Soonchunhyang University, Asan, South Korea
| | - Hackjoon Shim
- Toshiba Medical Systems Korea Co., Seoul, South Korea
| | - Hae Young Seol
- Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea
| |
Collapse
|
19
|
Nyberg E, Honce J, Kleinschmidt-DeMasters BK, Shukri B, Kreidler S, Nagae L. Arterial spin labeling: Pathologically proven superiority over conventional MRI for detection of high-grade glioma progression after treatment. Neuroradiol J 2016; 29:377-83. [PMID: 27542895 DOI: 10.1177/1971400916665375] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Standard of care for high-grade gliomas (HGGs) includes surgical debulking and adjuvant chemotherapy and radiation. Patients under treatment require frequent clinical and imaging monitoring for therapy modulation. Differentiating tumor progression from treatment-related changes can be challenging on conventional MRI, resulting in delayed recognition of tumor progression. Arterial spin labeling (ASL) may be more sensitive for tumor progression. MATERIALS AND METHODS ASL and associated conventional MR images obtained in patients previously treated for HGGs and before biopsy or re-resection were reviewed by three neuroradiologists who were blinded to the histopathologic results. Regions of interest (ROIs) of greatest perfusion were chosen by consensus, and mirror-image contralateral ROIs were also placed. Sensitivity of ASL for tumor progression was compared with those of contrast-enhanced T1-weighted (T1W-CE) and fluid-attenuated inversion recovery (FLAIR) images using McNemar's test. We tested for an association between cerebral blood flow (CBF) and apparent diffusion correlation (ADC) using a Hotelling-Lawley trace. Finally, we used a Pearson's analysis to test for a correlation between CBF and percentage of tumor within each resection. RESULTS Twenty-two patients were studied. ASL demonstrated hyperperfusion in all cases with mean CBF ratio 3.37 (±1.71). T1W-CE and FLAIR images were positive in 15 (p = 0.0233) and 16 (p = 0.0412) cases, respectively. There was no association between ADC and CBF (p = 0.687). There was a correlation between CBF and percentage of tumor (p = 0.048). CONCLUSION ASL may be more sensitive than conventional MR sequences for the detection of tumor progression in patients treated for HGGs.
Collapse
Affiliation(s)
- Eric Nyberg
- Department of Radiology, University of Colorado Hospital, USA
| | - Justin Honce
- Department of Radiology, University of Colorado Hospital, USA
| | | | - Brian Shukri
- Department of Radiology, University of Colorado Hospital, USA
| | | | - Lidia Nagae
- Department of Radiology, University of Colorado Hospital, USA
| |
Collapse
|
20
|
Kerkhof M, Hagenbeek RE, van der Kallen BFW, Lycklama À Nijeholt GJ, Dirven L, Taphoorn MJB, Vos MJ. Interobserver variability in the radiological assessment of magnetic resonance imaging (MRI) including perfusion MRI in glioblastoma multiforme. Eur J Neurol 2016; 23:1528-33. [PMID: 27424939 DOI: 10.1111/ene.13070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 05/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Conventional magnetic resonance imaging (MRI) has limited value for differentiation of true tumor progression and pseudoprogression in treated glioblastoma multiforme (GBM). Perfusion weighted imaging (PWI) may be helpful in the differentiation of these two phenomena. Here interobserver variability in routine radiological evaluation of GBM patients is assessed using MRI, including PWI. METHODS Three experienced neuroradiologists evaluated MR scans of 28 GBM patients during temozolomide chemoradiotherapy at three time points: preoperative (MR1) and postoperative (MR2) MR scan and the follow-up MR scan after three cycles of adjuvant temozolomide (MR3). Tumor size was measured both on T1 post-contrast and T2 weighted images according to the Response Assessment in Neuro-Oncology criteria. PW images of MR3 were evaluated by visual inspection of relative cerebral blood volume (rCBV) color maps and by quantitative rCBV measurements of enhancing areas with highest rCBV. Image interpretability of PW images was also scored. Finally, the neuroradiologists gave a conclusion on tumor status, based on the interpretation of both T1 and T2 weighted images (MR1, MR2 and MR3) in combination with PWI (MR3). RESULTS Interobserver agreement on visual interpretation of rCBV maps was good (κ = 0.63) but poor on quantitative rCBV measurements and on interpretability of perfusion images (intraclass correlation coefficient 0.37 and κ = 0.23, respectively). Interobserver agreement on the overall conclusion of tumor status was moderate (κ = 0.48). CONCLUSIONS Interobserver agreement on the visual interpretation of PWI color maps was good. However, overall interpretation of MR scans (using both conventional and PW images) showed considerable interobserver variability. Therefore, caution should be applied when interpreting MRI results during chemoradiation therapy.
Collapse
Affiliation(s)
- M Kerkhof
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
| | - R E Hagenbeek
- Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands
| | | | | | - L Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Vos
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
| |
Collapse
|
21
|
Liu X, Tian W, Chen H, LoStracco TA, Zhang J, Li MY, Germin B, Wang HZ. Advanced Neuroimaging in the Evaluation of Spinal Cord Tumors and Tumor Mimics: Diffusion Tensor and Perfusion-Weighted Imaging. Semin Ultrasound CT MR 2016; 38:163-175. [PMID: 28347419 DOI: 10.1053/j.sult.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Spinal cord tumors are an important component of pathologic diseases involving the spinal cord. Conventional magnetic resonance (MR) imaging only provides anatomical information. MR diffusion tensor imaging (DTI) and MR perfusion-weighted imaging (PWI) may detect microstructure diffusion and hemodynamic changes in these tumors. We review recent application studies of MR DTI and PWI in spinal cord tumors. Overall, MR DTI and MR PWI are promising imaging tools that are especially useful in improving differential diagnosis between spinal cord tumors and tumor mimics, preoperative evaluation of resectability, and providing assistance in surgical navigation.
Collapse
Affiliation(s)
- Xiang Liu
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY.
| | - Wei Tian
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Hongyan Chen
- Department of Radiology, Beijing TiantanHospital, Beijing, China
| | - Thomas A LoStracco
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Jing Zhang
- GE Healthcare MR research center, Beijing, China
| | - Michael Yan Li
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY
| | - Barbara Germin
- (║)Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
22
|
Wen PY, Cloughesy TF, Ellingson BM, Reardon DA, Fine HA, Abrey L, Ballman K, Bendszuz M, Buckner J, Chang SM, Prados MD, Pope WB, Gregory Sorensen A, van den Bent M, Yung WKA. Report of the Jumpstarting Brain Tumor Drug Development Coalition and FDA clinical trials neuroimaging endpoint workshop (January 30, 2014, Bethesda MD). Neuro Oncol 2015; 16 Suppl 7:vii36-47. [PMID: 25313237 DOI: 10.1093/neuonc/nou226] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
On January 30, 2014, a workshop was held on neuroimaging endpoints in high-grade glioma. This workshop was sponsored by the Jumpstarting Brain Tumor Drug Development Coalition, consisting of the National Brain Tumor Society, the Society for Neuro-Oncology, Accelerate Brain Cancer Cure, and the Musella Foundation for Research and Information, and conducted in collaboration with the Food and Drug Administration. The workshop included neuro-oncologists, neuroradiologists, radiation oncologists, neurosurgeons, biostatisticians, patient advocates, and representatives from industry, clinical research organizations, and the National Cancer Institute. This report summarizes the presentations and discussions of that workshop and the proposals that emerged to improve the Response Assessment in Neuro-Oncology (RANO) criteria and standardize neuroimaging parameters.
Collapse
Affiliation(s)
- Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Timothy F Cloughesy
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Benjamin M Ellingson
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Howard A Fine
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Lauren Abrey
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Karla Ballman
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Martin Bendszuz
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Jan Buckner
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Susan M Chang
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Michael D Prados
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Whitney B Pope
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Alma Gregory Sorensen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Martin van den Bent
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Wai-Kwan Alfred Yung
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| |
Collapse
|
23
|
Welker K, Boxerman J, Kalnin A, Kaufmann T, Shiroishi M, Wintermark M. ASFNR recommendations for clinical performance of MR dynamic susceptibility contrast perfusion imaging of the brain. AJNR Am J Neuroradiol 2015; 36:E41-51. [PMID: 25907520 DOI: 10.3174/ajnr.a4341] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/20/2015] [Indexed: 11/07/2022]
Abstract
MR perfusion imaging is becoming an increasingly common means of evaluating a variety of cerebral pathologies, including tumors and ischemia. In particular, there has been great interest in the use of MR perfusion imaging for both assessing brain tumor grade and for monitoring for tumor recurrence in previously treated patients. Of the various techniques devised for evaluating cerebral perfusion imaging, the dynamic susceptibility contrast method has been employed most widely among clinical MR imaging practitioners. However, when implementing DSC MR perfusion imaging in a contemporary radiology practice, a neuroradiologist is confronted with a large number of decisions. These include choices surrounding appropriate patient selection, scan-acquisition parameters, data-postprocessing methods, image interpretation, and reporting. Throughout the imaging literature, there is conflicting advice on these issues. In an effort to provide guidance to neuroradiologists struggling to implement DSC perfusion imaging in their MR imaging practice, the Clinical Practice Committee of the American Society of Functional Neuroradiology has provided the following recommendations. This guidance is based on review of the literature coupled with the practice experience of the authors. While the ASFNR acknowledges that alternate means of carrying out DSC perfusion imaging may yield clinically acceptable results, the following recommendations should provide a framework for achieving routine success in this complicated-but-rewarding aspect of neuroradiology MR imaging practice.
Collapse
Affiliation(s)
- K Welker
- From the Department of Radiology (K.W., T.K.), Mayo Clinic, Rochester, Minnesota
| | - J Boxerman
- Department of Diagnostic Imaging (J.B.), Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - A Kalnin
- Department of Radiology (A.K.), Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - T Kaufmann
- From the Department of Radiology (K.W., T.K.), Mayo Clinic, Rochester, Minnesota
| | - M Shiroishi
- Division of Neuroradiology, Department of Radiology (M.S.), Keck School of Medicine, University of Southern California, Los Angeles, California
| | - M Wintermark
- Department of Radiology, Neuroradiology Section (M.W.), Stanford University, Stanford, California
| | | |
Collapse
|
24
|
Neagu MR, Huang RY, Reardon DA, Wen PY. How treatment monitoring is influencing treatment decisions in glioblastomas. Curr Treat Options Neurol 2015; 17:343. [PMID: 25749847 DOI: 10.1007/s11940-015-0343-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT Glioblastoma (GBM), the most common malignant primary tumor in adults, carries a dismal prognosis with an average median survival of 14-16 months. The current standard of care for newly diagnosed GBM consists of maximal safe resection followed by fractionated radiotherapy combined with concurrent temozolomide and 6 to 12 cycles of adjuvant temozolomide. The determination of treatment response and clinical decision-making in the treatment of GBM depends on accurate radiographic assessment. Differentiating treatment response from tumor progression is challenging and combines long-term follow-up using standard MRI, with assessing clinical status and corticosteroid dependency. At progression, bevacizumab is the mainstay of treatment. Incorporation of antiangiogenic therapies leads to rapid blood-brain barrier normalization with remarkable radiographic response often not accompanied by the expected survival benefit, further complicating imaging assessment. Improved radiographic interpretation criteria, such as the Response Assessment in Neuro-Oncology (RANO) criteria, incorporate non-enhancing disease but still fall short of definitely distinguishing tumor progression, pseudoresponse, and pseudoprogression. With new evolving treatment modalities for this devastating disease, advanced imaging modalities are increasingly becoming part of routine clinical care in a field where neuroimaging has such essential role in guiding treatment decisions and defining clinical trial eligibility and efficacy.
Collapse
Affiliation(s)
- Martha R Neagu
- Dana Farber Cancer Institute, G4200, 44 Binney St, Boston, MA, 02115, USA
| | | | | | | |
Collapse
|
25
|
Huang RY, Neagu MR, Reardon DA, Wen PY. Pitfalls in the neuroimaging of glioblastoma in the era of antiangiogenic and immuno/targeted therapy - detecting illusive disease, defining response. Front Neurol 2015; 6:33. [PMID: 25755649 PMCID: PMC4337341 DOI: 10.3389/fneur.2015.00033] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/09/2015] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma, the most common malignant primary brain tumor in adults is a devastating diagnosis with an average survival of 14–16 months using the current standard of care treatment. The determination of treatment response and clinical decision making is based on the accuracy of radiographic assessment. Notwithstanding, challenges exist in the neuroimaging evaluation of patients undergoing treatment for malignant glioma. Differentiating treatment response from tumor progression is problematic and currently combines long-term follow-up using standard magnetic resonance imaging (MRI), with clinical status and corticosteroid-dependency assessments. In the clinical trial setting, treatment with gene therapy, vaccines, immunotherapy, and targeted biologicals similarly produces MRI changes mimicking disease progression. A neuroimaging method to clearly distinguish between pseudoprogression and tumor progression has unfortunately not been found to date. With the incorporation of antiangiogenic therapies, a further pitfall in imaging interpretation is pseudoresponse. The Macdonald criteria that correlate tumor burden with contrast-enhanced imaging proved insufficient and misleading in the context of rapid blood–brain barrier normalization following antiangiogenic treatment that is not accompanied by expected survival benefit. Even improved criteria, such as the RANO criteria, which incorporate non-enhancing disease, clinical status, and need for corticosteroid use, fall short of definitively distinguishing tumor progression, pseudoresponse, and pseudoprogression. This review focuses on advanced imaging techniques including perfusion MRI, diffusion MRI, MR spectroscopy, and new positron emission tomography imaging tracers. The relevant image analysis algorithms and interpretation methods of these promising techniques are discussed in the context of determining response and progression during treatment of glioblastoma both in the standard of care and in clinical trial context.
Collapse
Affiliation(s)
- Raymond Y Huang
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - Martha R Neagu
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - David A Reardon
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - Patrick Y Wen
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| |
Collapse
|
26
|
Abstract
The use of radiotherapy in low-grade glioma has been a topic of controversy over the past 2 decades. Although earlier studies showed no overall survival benefit and no dose response, recent studies demonstrate a possible synergism between radiotherapy and chemotherapy. However, many questions remained unanswered regarding the proper management including the potential roles of biological imaging in treatment planning, the role of reirradiation after recurrence, the role of intensity-modulated radiation therapy and proton beam radiotherapy, and the proper choice of chemotherapy agents. Further clinical trials are necessary to help integrate these new therapies and technologies into clinical practice.
Collapse
|
27
|
Hochberg FH, Atai NA, Gonda D, Hughes MS, Mawejje B, Balaj L, Carter RS. Glioma diagnostics and biomarkers: an ongoing challenge in the field of medicine and science. Expert Rev Mol Diagn 2014; 14:439-52. [PMID: 24746164 DOI: 10.1586/14737159.2014.905202] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Glioma is the most common brain tumor. For the more aggressive form, glioblastoma, standard treatment includes surgical resection, irradiation with adjuvant temozolomide and, on recurrence, experimental chemotherapy. However, the survival of patients remains poor. There is a critical need for minimally invasive biomarkers for diagnosis and as measures of response to therapeutic interventions. Glioma shed extracellular vesicles (EVs), which invade the surrounding tissue and circulate within both the cerebrospinal fluid and the systemic circulation. These tumor-derived EVs and their content serve as an attractive source of biomarkers. In this review, we discuss the current state of the art of biomarkers for glioma with emphasis on their EV derivation.
Collapse
Affiliation(s)
- Fred H Hochberg
- Department of Neurology and Program in Neuroscience, Massachusetts General Hospital and Harvard Medical School, Suite 340, 175 Cambridge Street, Boston, MA 02114, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Soffietti R, Pope W, Schiff D, Wick W. Highlights from the Literature. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
29
|
Milchenko MV, Rajderkar D, LaMontagne P, Massoumzadeh P, Bogdasarian R, Schweitzer G, Benzinger T, Marcus D, Shimony JS, Fouke SJ. Comparison of perfusion- and diffusion-weighted imaging parameters in brain tumor studies processed using different software platforms. Acad Radiol 2014; 21:1294-303. [PMID: 25088833 PMCID: PMC4607045 DOI: 10.1016/j.acra.2014.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/06/2014] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES To compare quantitative imaging parameter measures from diffusion- and perfusion-weighted imaging magnetic resonance imaging (MRI) sequences in subjects with brain tumors that have been processed with different software platforms. MATERIALS AND METHODS Scans from 20 subjects with primary brain tumors were selected from the Comprehensive Neuro-oncology Data Repository at Washington University School of Medicine (WUSM) and the Swedish Neuroscience Institute. MR images were coregistered, and each subject's data set was processed by three software packages: 1) vendor-specific scanner software, 2) research software developed at WUSM, and 3) a commercially available, Food and Drug Administration-approved, processing platform (Nordic Ice). Regions of interest (ROIs) were chosen within the brain tumor and normal nontumor tissue. The results obtained using these methods were compared. RESULTS For diffusion parameters, including mean diffusivity and fractional anisotropy, concordance was high when comparing different processing methods. For perfusion-imaging parameters, a significant variance in cerebral blood volume, cerebral blood flow, and mean transit time (MTT) values was seen when comparing the same raw data processed using different software platforms. Correlation was better with larger ROIs (radii ≥ 5 mm). Greatest variance was observed in MTT. CONCLUSIONS Diffusion parameter values were consistent across different software processing platforms. Perfusion parameter values were more variable and were influenced by the software used. Variation in the MTT was especially large suggesting that MTT estimation may be unreliable in tumor tissues using current MRI perfusion methods.
Collapse
Affiliation(s)
- Mikhail V Milchenko
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Dhanashree Rajderkar
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Pamela LaMontagne
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Parinaz Massoumzadeh
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Ronald Bogdasarian
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Gordon Schweitzer
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Tammie Benzinger
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Dan Marcus
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S Shimony
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Sarah Jost Fouke
- Department of Neurological Surgery, Swedish Medical Center, Seattle, Washington
| |
Collapse
|
30
|
Fouke SJ, Benzinger TL, Milchenko M, LaMontagne P, Shimony JS, Chicoine MR, Rich KM, Kim AH, Leuthardt EC, Keogh B, Marcus DS. The comprehensive neuro-oncology data repository (CONDR): a research infrastructure to develop and validate imaging biomarkers. Neurosurgery 2014; 74:88-98. [PMID: 24089052 DOI: 10.1227/neu.0000000000000201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Advanced imaging methods have the potential to serve as quantitative biomarkers in neuro-oncology research. However, a lack of standardization of image acquisition, processing, and analysis limits their application in clinical research. Standardization of these methods and an organized archival platform are required to better validate and apply these markers in research settings and, ultimately, in clinical practice. OBJECTIVE The primary objective of the Comprehensive Neuro-oncology Data Repository (CONDR) is to develop a data set for assessing and validating advanced imaging methods in patients diagnosed with brain tumors. As a secondary objective, informatics resources will be developed to facilitate the integrated collection, processing, and analysis of imaging, tissue, and clinical data in multicenter clinical trials. Finally, CONDR data and informatics resources will be shared with the research community for further analysis. METHODS CONDR will enroll 200 patients diagnosed with primary brain tumors. Clinical, imaging, and tissue-based data are obtained from patients serially, beginning with diagnosis and continuing over the course of their treatment. The CONDR imaging protocol includes structural and functional sequences, including diffusion- and perfusion-weighted imaging. All data are managed within an XNAT-based informatics platform. Imaging markers are assessed by correlating image and spatially aligned pathological markers and a variety of clinical markers. EXPECTED OUTCOMES CONDR will generate data for developing and validating imaging markers of primary brain tumors, including multispectral and probabilistic maps. DISCUSSION CONDR implements a novel, open-research model that will provide the research community with both open-access data and open-source informatics resources.
Collapse
Affiliation(s)
- Sarah Jost Fouke
- *Department of Neurological Surgery, Swedish Medical Center, Seattle, Washington; ‡Department of Radiology, Washington University School of Medicine, St. Louis, Missouri; §Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; ‖Swedish Neuroscience Institute, Seattle, Washington, Radia PS, Everett, Washington
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Shiroishi MS, Castellazzi G, Boxerman JL, D'Amore F, Essig M, Nguyen TB, Provenzale JM, Enterline DS, Anzalone N, Dörfler A, Rovira À, Wintermark M, Law M. Principles of T2*-weighted dynamic susceptibility contrast MRI technique in brain tumor imaging. J Magn Reson Imaging 2014; 41:296-313. [DOI: 10.1002/jmri.24648] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/03/2014] [Indexed: 01/17/2023] Open
Affiliation(s)
- Mark S. Shiroishi
- Keck School of Medicine; University of Southern California; Los Angeles California USA
| | - Gloria Castellazzi
- Department of Industrial and Information Engineering; University of Pavia; Pavia Italy
- Brain Connectivity Center, IRCCS “C. Mondino Foundation,”; Pavia Italy
| | - Jerrold L. Boxerman
- Warren Alpert Medical School of Brown University; Providence Rhode Island USA
| | - Francesco D'Amore
- Keck School of Medicine; University of Southern California; Los Angeles California USA
- Department of Neuroradiology; IRCCS “C. Mondino Foundation,” University of Pavia; Pavia Italy
| | - Marco Essig
- University of Manitoba's Faculty of Medicine; Winnipeg Manitoba Canada
| | - Thanh B. Nguyen
- Faculty of Medicine, Ottawa University; Ottawa Ontario Canada
| | - James M. Provenzale
- Duke University Medical Center; Durham North Carolina USA
- Emory University School of Medicine; Atlanta Georgia USA
| | | | | | - Arnd Dörfler
- University of Erlangen-Nuremberg, Erlangen; Germany
| | - Àlex Rovira
- Vall d'Hebron University Hospital; Barcelona Spain
| | - Max Wintermark
- School of Medicine; University of Virginia; Charlottesville Virginia USA
| | - Meng Law
- Keck School of Medicine; University of Southern California; Los Angeles California USA
| |
Collapse
|
32
|
Abstract
OBJECTIVE This article addresses questions that radiologists frequently ask when planning, performing, processing, and interpreting MRI perfusion studies in CNS imaging. CONCLUSION Perfusion MRI is a promising tool in assessing stroke, brain tumors, and neurodegenerative diseases. Most of the impediments that have limited the use of per-fusion MRI can be overcome to allow integration of these methods into modern neuroimaging protocols.
Collapse
|