Assessment of Sodium MRI at 7 Tesla as Predictor of Therapy Response and Survival in Glioblastoma Patients

The purpose of this work was to prospectively investigate sodium (²³Na) MRI at 7 Tesla (T) as predictor of therapy response and survival in patients with glioblastoma (GBM). Thus, 20 GBM patients underwent ²³Na MRI at 7T before, immediately after and 6 weeks after chemoradiotherapy (CRT). The median tissue sodium concentration (TSC) inside the whole tumor excluding necrosis was determined. Initial response to CRT was assessed employing the updated response assessment in neuro-oncology working group (RANO) criteria. Clinical parameters, baseline TSC and longitudinal TSC differences were compared between patients with initial progressive disease (PD) and patients with initial stable disease (SD) using Fisher’s exact tests and Mann-Whitney-U-tests. Univariate proportional hazard models for progression free survival (PFS) and overall survival (OS) were calculated using clinical parameters and TSC metrics as predictor variables. The analyses demonstrated that TSC developed heterogeneously over all patients following CRT. None of the TSC metrics differed significantly between cases of initial SD and initial PD. Furthermore, TSC metrics did not yield a significant association with PFS or OS. Conversely, the initial response according to the RANO criteria could significantly predict PFS [univariate HR (95%CI) = 0.02 (0.0001–0.21), p < 0.001] and OS [univariate HR = 0.17 (0.04–0.65), p = 0.005]. In conclusion, TSC showed treatment-related changes in GBM following CRT, but did not significantly correlate with the initial response according to the RANO criteria, PFS or OS. In contrast, the initial response according to the RANO criteria was a significant predictor of PFS and OS. Future investigations need to elucidate the reasons for treatment-related changes in TSC and their clinical value for response prediction in glioblastoma patients receiving CRT.

Towards accelerated quantitative sodium MRI at 7 T in the skeletal muscle: Comparison of anisotropic acquisition- and compressed sensing techniques

PURPOSE

To compare three anisotropic acquisition schemes and three compressed sensing (CS) approaches for accelerated tissue sodium concentration (TSC) quantification using ²³Na MRI at 7 T.

MATERIALS AND METHODS

Three anisotropic 3D-radial acquisition sequences were evaluated using simulations, phantom- and in vivo TSC measurements: An anisotropic density-adapted 3D-radial sequence (3DPR-C), a 3D acquisition-weighted density-adapted stack-of-stars sampling scheme (SOS) and a SOS approach with golden-ratio rotation (SOS-GR). Eight healthy volunteers were examined at a 7 Tesla MRI system. TSC measurements of the calf were conducted with a nominal spatial resolution of Δx = (3.0 × 3.0 × 15.0) mm³ and a field of view of (156.0 × 156.0 × 240.0) mm³ for multiple undersampling factors (USF). Three CS reconstructions were evaluated: Total variation CS (TV-CS), 3D dictionary-learning compressed sensing (3D-DLCS) and TV-CS with a block matching prior (TV-BL-CS). Results of the simulations and measurements were compared to a simulated ground truth (GT) or a fully sampled reference measurement (FS), respectively. The deviation of the mean TSC evaluated in multiple ROI (mE_GT/FS) and the normalized root-mean-squared error (NRMSE) for simulations were evaluated for CS and NUFFT reconstructions.

RESULTS

In simulations, the SOS-GR yielded the lowest NRMSE and mE_GT (< 4%) with NUFFT for an acquisition time (TA) of less than 2 min. CS further improved the results. In simulations and measurements, the best TSC quantification results were obtained with 3D-DLCS and SOS-GR (lowest NRMSE, mE_GT < 2.6% in simulations, mE_GT < 10.7% for phantom measurements and mE_FS < 6% in vivo) with an USF = 4.1 (TA < 2 min). TV-CS showed no or only slight improvements to NUFFT. The results of TV-BL-CS were similar to 3D-DLCS.

DISCUSSION

The TA for TSC measurements could be reduced to less than 2 min by using adapted sequences such as SOS-GR and CS reconstruction approaches such as 3D-DLCS or TV-BL-CS, while the quantitative accuracy stays comparable to a fully sampled NUFFT reconstruction (approx. 8 min TA). In future, the lower TA could improve clinical applicability of TSC measurements.

Ultra-high-field sodium MRI as biomarker for tumor extent, grade and IDH mutation status in glioma patients

PURPOSE

This prospective clinical trial investigated sodium (23Na) MRI at 7 Tesla (T) field strength as biomarker for tumor extent, isocitrate dehydrogenase (IDH) mutation and O6-methylguanine DNA methyltransferase (MGMT) promotor methylation in glioma patients.

METHODS

28 glioma patients underwent 23Na MRI on a 7T scanner (Siemens Healthcare, Erlangen, Germany) parallel to standard 3T MRI before chemoradiation. Areas of Gadolinium-contrast enhancement (gdce), non-enhancing T2-hyperintensity (regarded as edema), necrosis, and normal-appearing white matter (nawm) were segmented on 3T MRI imaging and were co-registered with the 23Na images. The median total 23Na concentrations of all areas were compared by pairwise t-tests. Furthermore, areas of gdce and edema were merged to yield the whole tumor area without necrosis. Subsequently, the difference in median of the 23Na concentration of this whole tumor area was compared between IDH-mutated and IDH wild-type gliomas as well as MGMT methylated and MGMT not-methylated glioblastomas using Whitney-Mann U-tests. All p-values were corrected after the Bonferroni-Holm procedure.

RESULTS

The 23Na concentration increased successively from nawm to necrotic areas (mean ± sd: nawm = 37.84 ± 5.87 mM, edema = 54.69 ± 10.64 mM, gdce = 61.72 ± 12.95 mM, necrosis = 81.88 ± 17.53 mM) and the concentrations differed statistically significantly between all regarded areas (adjusted p-values for all pairwise comparisons < 0.05). Furthermore, IDH-mutated gliomas showed significantly higher 23Na concentrations than IDH wild-type gliomas (median [interquartile range]: IDH wild-type = 52.37 mM [45.98 - 58.56 mM], IDH mutated = 65.02 mM [58.87-67.05 mM], p = 0.039). Among the glioblastomas, there was a trend towards increased 23Na concentration in MGMT methylated tumors that did not reach statistical significance (median [interquartile range]: MGMT methylated = 57.59 mM [50.70 - 59.17 mM], MGMT not methylated = 48.78 mM [45.88 - 53.91 mM], p = 1.0).

CONCLUSIONS

23Na MRI correlates with the IDH mutation status and could therefore enhance image guidance towards biopsy sites as wells as image-guided surgery and radiotherapy. Furthermore, the successive decrease of 23Na concentration from central necrosis to normal-appearing white matter suggests a correlation with tumor infiltration.

Amide proton transfer of carnosine in aqueous solution studied in vitro by WEX and CEST experiments

Amide protons of peptide bonds induce an important chemical exchange saturation transfer (CEST) contrast in vivo. As a simple in vitro model for a peptide amide proton CEST effect, we suggest herein the dipeptide carnosine. We show that the metabolite carnosine creates a CEST effect and we study the properties of the exchange of the amide proton (-NH) of the carnosine peptide bond (NHCPB) in model solutions for a pH range from 6 to 8.3 and a temperature range from T = 5 °C to 43 °C by means of CEST and water exchange spectroscopy (WEX) experiments on a 3 T whole-body MR tomograph. The dependence of the NHCPB chemical exchange rate k(sw) on pH and temperature T was determined using WEX. For physiological conditions (T = 37 °C, pH = 7.10) we obtained k(sw) = (47.07 ± 7.90)/s. With similar chemical shift and exchange properties to amide protons in vivo, carnosine forms a simple model system for optimization of CEST pulse sequences in vitro. The potential for direct detection of the metabolite carnosine in vivo is discussed.