Quantifying radiation therapy response using apparent diffusion coefficient (ADC) parametric mapping of pediatric diffuse intrinsic pontine glioma: a report from the pediatric brain tumor consortium

Ceschin, Rafael; Koçak, Mehmet; Vajapeyam, Sridhar; Pollack, Ian F.; Onar‐Thomas, Arzu; Dunkel, Ira J.; Poussaint, Tina Young; Panigrahy, Ashok

doi:10.1007/s11060-019-03133-y

Cited by 13 publications

(10 citation statements)

References 25 publications

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“…Advanced MR imaging techniques such as DSC and DCE-MR perfusion imaging, [22][23][24] arterial spin-labeling, 8 diffusion imaging including ADC histograms and functional diffusion maps, 6,22,25 MR spectroscopy, 26 and PET 27 have proved increasingly useful in characterizing the heterogeneity in DIPG for predicting survival and may even provide insight into molecular subgroups. 28,29 Our DCE-MR imaging findings show that increased baseline mean K trans was associated with shorter survival, which again suggests that greater perfusion in enhancing tumors indicates a worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

Advanced ADC Histogram, Perfusion, and Permeability Metrics Show an Association with Survival and Pseudoprogression in Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Vajapeyam

Brown

Billups³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Diffuse intrinsic pontine glioma is a lethal childhood brain cancer with dismal prognosis and MR imaging is the primary methodology used for diagnosis and monitoring. Our aim was to determine whether advanced diffusion, perfusion, and permeability MR imaging metrics predict survival and pseudoprogression in children with newly diagnosed diffuse intrinsic pontine glioma. MATERIALS AND METHODS: A clinical trial using the poly (adenosine diphosphate ribose) polymerase (PARP) inhibitor veliparib concurrently with radiation therapy, followed by maintenance therapy with veliparib + temozolomide, in children with diffuse intrinsic pontine glioma was conducted by the Pediatric Brain Tumor Consortium. Standard MR imaging, DWI, dynamic contrast-enhanced perfusion, and DSC perfusion were performed at baseline and approximately every 2 months throughout treatment. ADC histogram metrics of T2-weighted FLAIR and enhancing tumor volume, dynamic contrast-enhanced permeability metrics for enhancing tumors, and tumor relative CBV from DSC perfusion MR imaging were calculated. Baseline values, post-radiation therapy changes, and longitudinal trends for all metrics were evaluated for associations with survival and pseudoprogression. RESULTS: Fifty children were evaluable for survival analyses. Higher baseline relative CBV was associated with shorter progression-free survival (P ¼ .02, Q ¼ 0.089) and overall survival (P ¼ .006, Q ¼ 0.055). Associations of higher baseline mean transfer constant from the blood plasma into the extravascular extracellular space with shorter progression-free survival (P ¼ .03, Q ¼ 0.105) and overall survival (P ¼ .03, Q ¼ 0.102) trended toward significance. An increase in relative CBV with time was associated with shorter progression-free survival (P , .001, Q , 0.001) and overall survival (P ¼ .004, Q ¼ 0.043). Associations of longitudinal mean extravascular extracellular volume fraction with progression-free survival (P ¼ .03, Q ¼ 0.104) and overall survival (P ¼ .03, Q ¼ 0.105) and maximum transfer constant from the blood plasma into the extravascular extracellular space with progression-free survival (P ¼ .03, Q ¼ 0.102) trended toward significance. Greater increases with time were associated with worse outcomes. True radiologic progression showed greater post-radiation therapy decreases in mode_ADC_FLAIR compared with pseudoprogression (means, À268.15 versus À26.11, P ¼ .01.) CONCLUSIONS: ADC histogram, perfusion, and permeability MR imaging metrics in diffuse intrinsic pontine glioma are useful in predicting survival and pseudoprogression. ABBREVIATIONS: DCE ¼ dynamic contrast-enhanced; DIPG ¼ diffuse intrinsic pontine glioma; K ep ¼ rate constant from extravascular extracellular space back into blood plasma; K trans ¼ transfer constant from blood plasma into extravascular extracellular space; OS ¼ overall survival; PBTC ¼ Pediatric Brain Tumor Consortium; PFS ¼ progression-free survival; rCBV ¼ relative CBV; RT ¼ radiation therapy; TMZ ¼ temozolomide; v e ¼ extravascular ext...

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Section: Discussionmentioning

confidence: 99%

Advanced ADC Histogram, Perfusion, and Permeability Metrics Show an Association with Survival and Pseudoprogression in Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Vajapeyam

Brown

Billups³

et al. 2020

AJNR Am J Neuroradiol

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“…Diffusion weighted imaging (DWI) has become widely used clinically for cancer detection, diagnostics and therapeutic response evaluation [1][2][3][4][5]. The apparent diffusion coefficient (ADC) derived from the monoexponential model of DWI signal decay with increasing b-value (diffusion weighting strength) is considered as a quantitative imaging biomarker of cancerous tissue cellularity [2,3,5,6].…”

Section: Introductionmentioning

confidence: 99%

Empirical validation of gradient field models for an accurate ADC measured on clinical 3T MR systems in body oncologic applications

et al. 2021

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“…It was reported that less neurologic impairments of pediatric gliomas were observed when tumors located at cerebral hemispheres compared with ones at midline, optic pathway, posterior fossa, and brainstem (8). Besides the advantages in the determination of symptom and diagnosis, the tumor location in radiology promotes the accuracy of surgical resection and the efficacy of outcome evaluation (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Immune Checkpoint-Associated Locations of Diffuse Gliomas Comparing Pediatric With Adult Patients Based on Voxel-Wise Analysis

Zhang

Dou

et al. 2021

Front. Immunol.

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Objective: Pediatric diffuse gliomas (pDGs) are relatively rare and molecularly distinct from pediatric pilocytic astrocytoma and adult DGs. Immunotherapy is a promising therapeutic strategy, requiring a deep understanding of tumor immune profiles. The spatial locations of brain tumors might be related to the molecular profiles. We aimed to analyze the relationship between the immune checkpoint molecules with the locations of DGs comparing pediatric with adult patients.Method: We studied 20 pDGs patients (age ≤ 21 years old), and 20 paired adult patients according to gender and histological types selected from 641 adult patients with DGs. Immune checkpoint molecules including B7-H3, CD47, and PD-L1, as well as tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs), were manifested by immunohistochemical staining. Expression difference analyses and Spearman's correlation were performed. MRI data were voxel-wise normalized, segmented, and analyzed by Fisher's exact test to construct the tumor frequency and p value heatmaps. Survival analyses were conducted by Log-rank tests.Result: The median age of pediatric patients was 16 years. 55% and 30% of patients were WHO II and III grades, respectively. The left frontal lobe and right cerebellum were the statistically significant locations for pDGs, while the anterior horn of ventricles for adult DGs. A potential association between the expression of PD-L1 and TAMs was found in pDGs (p = 0.002, R = 0.670). The right posterior external capsule and the lateral side of the anterior horn of the left ventricle were predominant locations for the adult patients with high expression of B7-H3 and low expression of PD-L1 compared to pediatric ones, respectively. Pediatric patients showed significantly improved overall survival compared with adults. The prognostic roles of immune checkpoint molecules and TILs/TAMs were not significantly different between the two groups.Conclusion: Immune checkpoint-associated locations of diffuse gliomas comparing pediatric with adult patients could be helpful for the immunotherapy decisions and design of clinical trials.

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Quantifying radiation therapy response using apparent diffusion coefficient (ADC) parametric mapping of pediatric diffuse intrinsic pontine glioma: a report from the pediatric brain tumor consortium

Cited by 13 publications

References 25 publications

Advanced ADC Histogram, Perfusion, and Permeability Metrics Show an Association with Survival and Pseudoprogression in Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Advanced ADC Histogram, Perfusion, and Permeability Metrics Show an Association with Survival and Pseudoprogression in Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Empirical validation of gradient field models for an accurate ADC measured on clinical 3T MR systems in body oncologic applications

Immune Checkpoint-Associated Locations of Diffuse Gliomas Comparing Pediatric With Adult Patients Based on Voxel-Wise Analysis

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