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Hatzoglou V, Yang TJ, Omuro A, Gavrilovic I, Ulaner G, Rubel J, Schneider T, Woo KM, Zhang Z, Peck KK, Beal K, Young RJ. A prospective trial of dynamic contrast-enhanced MRI perfusion and fluorine-18 FDG PET-CT in differentiating brain tumor progression from radiation injury after cranial irradiation. Neuro Oncol 2015; 18:873-80. [PMID: 26688076 DOI: 10.1093/neuonc/nov301] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/06/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the effectiveness of fluorine-18 fluorodeoxyglucose (FDG) PET-CT and dynamic contrast-enhanced (DCE) MRI in differentiating tumor progression and radiation injury in patients with indeterminate enhancing lesions after radiation therapy (RT) for brain malignancies. METHODS Patients with indeterminate enhancing brain lesions on conventional MRI after RT underwent brain DCE-MRI and PET-CT in a prospective trial. Informed consent was obtained. Lesion outcomes were determined by histopathology and/or clinical and imaging follow-up. Metrics obtained included plasma volume (Vp) and volume transfer coefficient (K(trans)) from DCE-MRI, and maximum standardized uptake value (SUVmax) from PET-CT; lesion-to-normal brain ratios of all metrics were calculated. The Wilcoxon rank sum test and receiver operating characteristic analysis were performed. RESULTS The study included 53 patients (29 treated for 29 gliomas and 24 treated for 26 brain metastases). Progression was determined in 38/55 (69%) indeterminate lesions and radiation injury in 17 (31%). Vpratio (VP lesion/VP normal brain, P < .001), K(trans) ratio (P = .002), and SUVratio (P = .002) correlated significantly with diagnosis of progression versus radiation injury. Progressing lesions exhibited higher values of all 3 metrics compared with radiation injury. Vpratio had the highest accuracy in determining progression (area under the curve = 0.87), with 92% sensitivity and 77% specificity using the optimal, retrospectively determined threshold of 2.1. When Vpratio was combined with K(trans) ratio (optimal threshold 3.6), accuracy increased to 94%. CONCLUSIONS Vpratio was the most effective metric for distinguishing progression from radiation injury. Adding K(trans) ratio to Vpratio further improved accuracy. DCE-MRI is an effective imaging technique for evaluating nonspecific enhancing intracranial lesions after RT.
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Affiliation(s)
- Vaios Hatzoglou
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - T Jonathan Yang
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Antonio Omuro
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Igor Gavrilovic
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Gary Ulaner
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Jennifer Rubel
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Taylor Schneider
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Kaitlin M Woo
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Zhigang Zhang
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Kyung K Peck
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Kathryn Beal
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Robert J Young
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
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