Magnetic Resonance Imaging Mapping of Brain Tumor Burden: Clinical Implications for Neurosurgical Management: Case Report

Connelly, Jennifer; Prah, Melissa; Santos-Pinheiro, Fernando; Mueller, Wade; Cochran, Elizabeth J.; Schmainda, Kathleen M.

doi:10.1093/neuopn/okab029

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Brain tumor rCBV has been shown helpful in identifying such cases retrospectively, 25 or, preferably, both can be avoided altogether by identifying the best sites for surgical biopsy 28 . In a more recent case report, 29 rCBV class maps (referred to as fractional tumor burden maps), which delineate regions of low, intermediate, and high vascularity (Fig. 2), confirmed that tissue obtained from areas of zero to low rCBV received a histopathologic diagnosis of non‐tumor while the remaining unresectable tissue, with a high pre‐operative rCBV, was the site of early and aggressive recurrence.…”

Section: Resultsmentioning

confidence: 99%

Advanced MR Techniques for Preoperative Glioma Characterization: Part 1

Hirschler

Sollmann

Schmitz-Abecassis

et al. 2023

Magnetic Resonance Imaging

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Preoperative clinical magnetic resonance imaging (MRI) protocols for gliomas, brain tumors with dismal outcomes due to their infiltrative properties, still rely on conventional structural MRI, which does not deliver information on tumor genotype and is limited in the delineation of diffuse gliomas. The GliMR COST action wants to raise awareness about the state of the art of advanced MRI techniques in gliomas and their possible clinical translation or lack thereof. This review describes current methods, limits, and applications of advanced MRI for the preoperative assessment of glioma, summarizing the level of clinical validation of different techniques. In this first part, we discuss dynamic susceptibility contrast and dynamic contrast‐enhanced MRI, arterial spin labeling, diffusion‐weighted MRI, vessel imaging, and magnetic resonance fingerprinting. The second part of this review addresses magnetic resonance spectroscopy, chemical exchange saturation transfer, susceptibility‐weighted imaging, MRI‐PET, MR elastography, and MR‐based radiomics applications. Evidence Level: 3 Technical Efficacy: Stage 2

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Section: Resultsmentioning

confidence: 99%

Advanced MR Techniques for Preoperative Glioma Characterization: Part 1

Hirschler

Sollmann

Schmitz-Abecassis

et al. 2023

Magnetic Resonance Imaging

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“…A standardized rCBV value of 1.56 was used as the higher threshold for tumor prediction considering our own clinical experience and a prior report of this value indicating .88% probability of tumor. 17 Mean and median rCBV values of the contrast-enhancing volumes were generated for each patient. Volumetric images of the contrast-enhancing lesion superimposed on the FTB map containing colored voxels of each class (FTB low ¼ blue; FTB mid ¼ yellow; FTB high ¼ red) and a histogram displaying voxels for the entire contrast-enhancing volume were also produced.…”

Section: Dsc Image Processingmentioning

confidence: 99%

Arterial Spin-Labeling and DSC Perfusion Metrics Improve Agreement in Neuroradiologists’ Clinical Interpretations of Posttreatment High-Grade Glioma Surveillance MR Imaging—An Institutional Experience

Yamin,

Tranvinh,

Lanzman

et al. 2024

AJNR Am J Neuroradiol

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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 k 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 (k ¼ 0.63) and higher with perfusion metrics (arterial spin-labeling-CBF, k ¼ 0.67; DSC-relative CBV, k ¼ 0.66; DSC-fractional tumor burden, k ¼ 0.70). Agreement between raters and consensus was highest with DSC-fractional tumor burden (k ¼ 0.66-0.80). Confidence scores were highest with DSCfractional 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.ABBREVIATIONS: ASL ¼ arterial spin-labeling; BT-RADS ¼ Brain Tumor Reporting and Data System; CE ¼ contrast-enhanced; CRT ¼ chemoradiotherapy; FTB ¼ fractional tumor burden; GBM ¼ glioblastoma; HGG ¼ high-grade glioma; IRA ¼ interrater agreement; rCBV ¼ relative CBV S urveillance MR imaging following surgery and chemoradiotherapy (CRT) is integral to the care of patients with highgrade gliomas (HGGs). In the Response Assessment in Neuro-Oncology criteria, the assessment of tumor status is based on

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“…These studies have found that when DSC-MRI data is acquired and analyzed using uniform methodology, common rCBV thresholds can be employed to identify, and regionally map, PTRE and recurrence. The application of these thresholds enables computation of images called fractional tumor burden (FTB) maps ( 15 , 18 , 19 ). Previous studies have used rCBV threshold of 1.0 to differentiate tumor from PTRE ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

Identification of single-dose, dual-echo based CBV threshold for fractional tumor burden mapping in recurrent glioblastoma

Anil¹,

Stokes²,

Chao³

et al. 2023

Front. Oncol.

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BackgroundRelative 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.MethodsThe 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.ResultsThe 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%).ConclusionsThe 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.

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Magnetic Resonance Imaging Mapping of Brain Tumor Burden: Clinical Implications for Neurosurgical Management: Case Report

Cited by 7 publications

References 8 publications

Advanced MR Techniques for Preoperative Glioma Characterization: Part 1

Advanced MR Techniques for Preoperative Glioma Characterization: Part 1

Arterial Spin-Labeling and DSC Perfusion Metrics Improve Agreement in Neuroradiologists’ Clinical Interpretations of Posttreatment High-Grade Glioma Surveillance MR Imaging—An Institutional Experience

Identification of single-dose, dual-echo based CBV threshold for fractional tumor burden mapping in recurrent glioblastoma

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