MRI perfusion measurements calculated using advanced deconvolution techniques predict survival in recurrent glioblastoma treated with bevacizumab

Harris, Robert J.; Cloughesy, Timothy F.; Hardy, Anthony J.; Liau, Linda M.; Pope, Whitney B.; Nghiemphu, Phioanh L.; Lai, Albert; Ellingson, Benjamin M.

doi:10.1007/s11060-015-1755-8

Cited by 37 publications

(17 citation statements)

References 26 publications

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“…In our study we used DSC-MRI to identify lesions with increased relative cerebral blood volume. Studies have shown that patients with hyper-perfused tumor prior to treatment with BEV have longer survival following BEV treatment [ 16 , 36 ]. Following treatment with BEV, increased perfusion as measured by high relative cerebral blood volume values on DSC-MRI correlated with poor OS and progression-free survival.…”

Section: Discussionmentioning

confidence: 99%

Radiographic patterns of recurrence and pathologic correlation in malignant gliomas treated with bevacizumab

et al. 2018

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Interpretation of MRI abnormalities in patients with malignant gliomas (MG) treated with bevacizumab is challenging. Recent reports describe quantitative analyses of diffusion-weighted imaging abnormalities not available in standard clinical settings, to differentiate tumor recurrence from treatment necrosis. We retrospectively reviewed bevacizumab treated MG patients who underwent surgery or autopsy to correlate radiographic recurrence patterns with pathologic findings. 32 patients with MG (26 glioblastoma, three anaplastic astrocytoma and three anaplastic oligodendroglioma) were identified. Recurrence patterns: local enhancing (n = 23), distant enhancing (n = 1), nonenhancing (n = 7) and leptomeningeal (n = 1). Histology: tumor (n = 25), mixed tumor/necrosis (n = 5) and all necrosis (n = 2). On diffusion-weighted imaging, 5/32 had restricted diffusion (three mixed and two necrosis). Irrespective of radiographic recurrence pattern, tumor was found in 94% of cases. Restricted diffusion correlated with necrosis.

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Section: Discussionmentioning

confidence: 99%

Radiographic patterns of recurrence and pathologic correlation in malignant gliomas treated with bevacizumab

et al. 2018

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“…With DSC-MRI, T2 or T2*-weighted images are acquired with high temporal resolution during a bolus administration of a gadolinium (Gd) contrast agent [7]. The derived rCBV (relative cerebral blood volume) maps have demonstrated the ability to predict tumor grade [8, 9], survival [10], distinguish treatment effects from recurrent tumor [11, 12] and predict response to anti-angiogenic therapy more reliably than standard MRI [13–15]. …”

Section: Introductionmentioning

confidence: 99%

Multisite Concordance of DSC-MRI Analysis for Brain Tumors: Results of a National Cancer Institute Quantitative Imaging Network Collaborative Project

Schmainda¹,

Prah²,

Rand

et al. 2018

AJNR Am J Neuroradiol

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Background and Purpose Standard assessment criteria for brain tumors that only includes anatomic imaging, continues to be insufficient. While numerous studies have demonstrated the value of DSC-MRI perfusion metrics for this purpose, they have not been incorporated due to a lack of confidence in the consistency of DSC-MRI metrics across sites and platforms. This study addresses this limitation with a comparison of multi-site/multi-platform analyses of a shared brain tumor patient DSC-MRI dataset. Methods DSC-MRI data was collected, after a preload and during a bolus injection of gadolinium contrast agent using a GRE-EPI sequence (TE/TR=30/1200ms; flip angle=72°). Forty-nine low-grade (LG:n=13) and high-grade (HG:n=36) glioma datasets were uploaded to the cancer imaging archive (TCIA). Datasets included a predetermined AIF (arterial input function), enhancing tumor ROIs and ROIs necessary to create normalized relative cerebral blood volume (nRCBV) and cerebral blood flow (nCBF) maps. Seven sites computed 20 different perfusion metrics. Pair-wise agreement between sites was assessed with Linn’s-Concordance-Correlation-Coefficient (LCCC). Distinction of LG from HG tumor was evaluated with the Wilcoxon-rank-sum test followed by ROC analysis to identify the optimal threshold(s) based on sensitivity(SN) and specificity(SP). Results For nRCBV and nCBF 93% and 94% of entries showed good or excellent cross-site agreement (0.8≤LCCC≤1.0). All metrics could distinguish LG from HG tumor. Optimum thresholds were determined for pooled data (nRCBV=1.4, SN:SP=90%:77%; nCBF=1.58, SN:SP=86%:77%). Conclusion Using DSC-MRI data, obtained after a preload of contrast agent, substantial consistency resulted across sites for brain tumor perfusion metrics with a common threshold discoverable for distinguishing LG from HG tumor.

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“…[7][8][9] In particular, relative cerebral blood volume (rCBV), a parameter computed by integrating the dynamic susceptibility contrast (DSC)-MRI relaxivity-time curve following the principles of indicator dilution theory, 10 is the most common MRI-based perfusion measurement used in neurooncology. 11 It is generally accepted that rCBV is elevated in tumors and decreases with successful chemoradiation-induced reduction in tumor-area blood vessels.…”

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confidence: 99%

“…Because antiangiogenic therapy may decrease the contrast-enhancing lesion volume on conventional T 1 -weighted postcontrast MRI, despite the absence of cytotoxic effect, 5,6 there is growing interest in using perfusion magnetic resonance imaging (MRI) to evaluate changes in blood volume as a noninvasive method of assessing the efficacy of anti-VEGF therapies. [7][8][9] In particular, relative cerebral blood volume (rCBV), a parameter computed by integrating the dynamic susceptibility contrast (DSC)-MRI relaxivity-time curve following the principles of indicator dilution theory, 10 is the most common MRI-based perfusion measurement used in neurooncology. 11 It is generally accepted that rCBV is elevated in tumors and decreases with successful chemoradiation-induced reduction in tumor-area blood vessels.…”

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confidence: 99%

Bidirectional Contrast agent leakage correction of dynamic susceptibility contrast (DSC)‐MRI improves cerebral blood volume estimation and survival prediction in recurrent glioblastoma treated with bevacizumab

Leu

Boxerman

Lai

et al. 2016

Magnetic Resonance Imaging

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Purpose To evaluate a leakage correction algorithm for T1 and T2* artifacts arising from contrast agent extravasation in dynamic susceptibility contrast magnetic resonance imaging (DSC‐MRI) that accounts for bidirectional contrast agent flux and compare relative cerebral blood volume (CBV) estimates and overall survival (OS) stratification from this model to those made with the unidirectional and uncorrected models in patients with recurrent glioblastoma (GBM). Materials and Methods We determined median rCBV within contrast‐enhancing tumor before and after bevacizumab treatment in patients (75 scans on 1.5T, 19 scans on 3.0T) with recurrent GBM without leakage correction and with application of the unidirectional and bidirectional leakage correction algorithms to determine whether rCBV stratifies OS. Results Decreased post‐bevacizumab rCBV from baseline using the bidirectional leakage correction algorithm significantly correlated with longer OS (Cox, P = 0.01), whereas rCBV change using the unidirectional model (P = 0.43) or the uncorrected rCBV values (P = 0.28) did not. Estimates of rCBV computed with the two leakage correction algorithms differed on average by 14.9%. Conclusion Accounting for T1 and T2* leakage contamination in DSC‐MRI using a two‐compartment, bidirectional rather than unidirectional exchange model might improve post‐bevacizumab survival stratification in patients with recurrent GBM. J. Magn. Reson. Imaging 2016;44:1229–1237.

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MRI perfusion measurements calculated using advanced deconvolution techniques predict survival in recurrent glioblastoma treated with bevacizumab

Cited by 37 publications

References 26 publications

Radiographic patterns of recurrence and pathologic correlation in malignant gliomas treated with bevacizumab

Radiographic patterns of recurrence and pathologic correlation in malignant gliomas treated with bevacizumab

Multisite Concordance of DSC-MRI Analysis for Brain Tumors: Results of a National Cancer Institute Quantitative Imaging Network Collaborative Project

Bidirectional Contrast agent leakage correction of dynamic susceptibility contrast (DSC)‐MRI improves cerebral blood volume estimation and survival prediction in recurrent glioblastoma treated with bevacizumab

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