Recurrent tumor and treatment-induced effects have different MR signatures in contrast enhancing and non-enhancing lesions of high-grade gliomas

Abstract

Background Differentiating treatment-induced injury from recurrent high-grade glioma is an ongoing challenge in neuro-oncology, in part due to lesion heterogeneity. This study aimed to determine whether different MR features were relevant for distinguishing recurrent tumor from the effects of treatment in contrast-enhancing lesions (CEL) and non-enhancing lesions (NEL). Methods This prospective study analyzed 291 tissue samples (222 recurrent tumor, 69 treatment-effect) with known coordinates on imaging from 139 patients who underwent preoperative 3T MRI and surgery for a suspected recurrence. 8 MR parameter values were tested from perfusion-weighted, diffusion-weighted, and MR spectroscopic imaging at each tissue sample location for association with histopathological outcome using generalized estimating equation models for CEL and NEL tissue samples. Individual cutoff values were evaluated using receiver operating characteristic curve analysis with 5-fold cross-validation. Results In tissue samples obtained from CEL, elevated relative cerebral blood volume (rCBV) was associated with the presence of recurrent tumor pathology (P < 0.03), while increases in normalized choline (nCho) and choline-to-NAA index (CNI) were associated with the presence of recurrent tumor pathology in NEL tissue samples (P < 0.008). A mean CNI cutoff value of 2.7 had the highest performance, resulting in mean sensitivity and specificity of 0.61 and 0.81 for distinguishing treatment-effect from recurrent tumor within the NEL. Conclusion Although our results support prior work that underscores the utility of rCBV in distinguishing the effects of treatment from recurrent tumor within the contrast enhancing lesion, we found that metabolic parameters may be better at differentiating recurrent tumor from treatment-related changes in the NEL of high-grade gliomas. Key Points 1. MR signatures that distinguish treatment effect and high-grade tumor vary spatially. 2. MR spectroscopic metrics within nonenhancing regions are the most predictive.

Complications of Cancer Therapy in Children: A Comprehensive Review of Neuroimaging Findings

“…Elevated choline-to-NAA ratio and choline-to-Cr ratio may indicate tumor recurrence, whereas elevated lipid-lactate peak may indicate radiation necrosis. 42,[47][48][49][50][51][52] Elevated target-to-background ratios on positron emission tomographic imaging may also suggest recurrent tumor. 42 Use of a multiparametric approach using multiple quantitative measures may be necessary to increase diagnostic accuracy and confidence.…”

“…6). Elevated choline-to-NAA ratio and choline-to-Cr ratio may indicate tumor recurrence, whereas elevated lipid-lactate peak may indicate radiation necrosis 42,47–52 . Elevated target-to-background ratios on positron emission tomographic imaging may also suggest recurrent tumor 42 .…”

Improving the Automatic Classification of Brain MRI Acquisition Contrast with Machine Learning

“…Four MRI datasets were included in this analysis: 1) an MS research (MSR) dataset consisting of 1731 exams [17]; 2) a glioma research (GR) dataset consisting of 1 3 179 newly diagnosed and recurrent glioma exams [18,19]; 3) a post-traumatic stress disorder research dataset (ADNIR) consisting of 116 exams from the publicly available ADNIDOD dataset [20]; and 4) a clinical MS (MSC) dataset consisting of 311 exams that are representative of typical real-world institutional PACS data acquired on multiple scanners and external sites (Table 1). The ADNIR data used in this article were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu) designed to test whether serial magnetic resonance imaging (MRI), positron emission tomography, other biological markers, and clinical and neuropsychological assessment can be combined to measure the progression of mild cognitive impairment and early Alzheimer's disease.…”

Current evidence and challenges of systematic therapies for adult recurrent glioblastoma: Results from clinical trials

“…With the development of immunotherapy, immunotherapy-induced pseudoprogression is gradually being recognized, and the Immunotherapy Response Assessment in Neuro-Oncology (iRANO) criteria further improve the evaluation accuracy. It has also been suggested that elevated relative cerebral blood volume indicates a high possibility of recurrence in contrast-enhancing lesions but has not been included in the diagnostic criteria ( 7 ).…”