Repeatability and reproducibility of relative cerebral blood volume measurement of recurrent glioma in a multicentre trial setting

Smits, Marion; Bendszus, Martin; Collette, Sandra; Postma, Linda A.; Dhermain, Frédéric; Hagenbeek, Rogier E.; Clément, Paul M.; Liu, Yan; Wick, Wolfgang; Bent, Martin J. van den; Heiland, Sabine

doi:10.1016/j.ejca.2019.03.007

Cited by 21 publications

(29 citation statements)

References 19 publications

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“…Automatically segmented NAWM ROI can also reduce the time it takes to manually draw ROIs. Furthermore, studies have shown interrater variability when ROIs are manually drawn . In our study, the AUROC of rCBV for a manually drawn NAWM was 0.78, and is similar to ROC results published by Tietze et al, where their AUROC for rCBV was 0.78 .…”

Section: Discussionsupporting

confidence: 90%

“…Additionally, the choice of NAWM ROI had the biggest impact on the optimal thresholds from the ROC analysis (whereas application of leakage correction did not alter the optimal threshold dramatically), suggesting that careful consideration is needed when reporting optimal thresholds. Prior studies also found differences in optimal thresholds for GBM progression depending on the software used, and recommended against specific thresholds for rCBV unless the same postprocessing was applied . Lastly, a recent publication demonstrated poor repeatability and reproducibility across normalized CBV when three radiologists were asked to manually select NAWM .…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies also found differences in optimal thresholds for GBM progression depending on the software used, and recommended against specific thresholds for rCBV unless the same postprocessing was applied. 25,27 Lastly, a recent publication demonstrated poor repeatability and reproducibility across normalized CBV when three radiologists were asked to manually select NAWM. 25 The results from our study indicate that biomarkers normalized to automatically segmented NAWM regions perform just as well or better than the manually drawn regions, supporting future work into determining the reproducibility of automatic segmentation methods.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of postprocessing steps for residue function dependent dynamic susceptibility contrast (DSC)‐MRI biomarkers and their clinical impact on glioma grading for both 1.5 and 3T

Bell

Stokes

Quarles

2019

Magnetic Resonance Imaging

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Background Dynamic susceptibility contrast (DSC)‐MRI analysis pipelines differ across studies and sites, potentially confounding the clinical value and use of the derived biomarkers. Purpose/Hypothesis To investigate how postprocessing steps for computation of cerebral blood volume (CBV) and residue function dependent parameters (cerebral blood flow [CBF], mean transit time [MTT], capillary transit heterogeneity [CTH]) impact glioma grading. Study Type Retrospective study from The Cancer Imaging Archive (TCIA). Population Forty‐nine subjects with low‐ and high‐grade gliomas. Field Strength/Sequence 1.5 and 3.0T clinical systems using a single‐echo echo planar imaging (EPI) acquisition. Assessment Manual regions of interest (ROIs) were provided by TCIA and automatically segmented ROIs were generated by k‐means clustering. CBV was calculated based on conventional equations. Residue function dependent biomarkers (CBF, MTT, CTH) were found by two deconvolution methods: circular discretization followed by a signal‐to‐noise ratio (SNR)‐adapted eigenvalue thresholding (Method 1) and Volterra discretization with L‐curve‐based Tikhonov regularization (Method 2). Statistical Tests Analysis of variance, receiver operating characteristics (ROC), and logistic regression tests. Results MTT alone was unable to statistically differentiate glioma grade (P > 0.139). When normalized, tumor CBF, CTH, and CBV did not differ across field strengths (P > 0.141). Biomarkers normalized to automatically segmented regions performed equally (rCTH AUROC is 0.73 compared with 0.74) or better (rCBF AUROC increases from 0.74–0.84; rCBV AUROC increases 0.78–0.86) than manually drawn ROIs. By updating the current deconvolution steps (Method 2), rCTH can act as a classifier for glioma grade (P < 0.007), but not if processed by current conventional DSC methods (Method 1) (P > 0.577). Lastly, higher‐order biomarkers (eg, rCBF and rCTH) along with rCBV increases AUROC to 0.92 for differentiating tumor grade as compared with 0.78 and 0.86 (manual and automatic reference regions, respectively) for rCBV alone. Data Conclusion With optimized analysis pipelines, higher‐order perfusion biomarkers (rCBF and rCTH) improve glioma grading as compared with CBV alone. Additionally, postprocessing steps impact thresholds needed for glioma grading. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:547–553.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Analysis of postprocessing steps for residue function dependent dynamic susceptibility contrast (DSC)‐MRI biomarkers and their clinical impact on glioma grading for both 1.5 and 3T

Bell

Stokes

Quarles

2019

Magnetic Resonance Imaging

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“…30,31 Based on BA analysis, APTw max showed less observer dependence than rCBV max , which has been reported to vary not only with ROI placement, but also with variations in the choice of reference tissue used for normalization. 32,33 Even though APTw and rCBV appear to be positively correlated, the techniques represent different contrast mechanisms, reflecting two hallmarks of tumor activity. The APTw effect is considered to originate from hypercellularity and increased concentration of amide protons in the cytoplasm of proliferating glioma cells, whereas rCBV is a marker of neovascularization.…”

Section: Discussionmentioning

confidence: 99%

Amide proton transfer-weighted MRI in the clinical setting – correlation with dynamic susceptibility contrast perfusion in the post-treatment imaging of adult glioma patients at 3T

et al. 2022

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Introduction: We investigated the correlation between amide proton transfer-weighted magnetic resonance imaging (APTw MRI) and dynamic susceptibility contrast (DSC) perfusion in order to assess the potential of APTw MRI as an alternative to DSC in adult brain tumor (glioma) imaging. Methods: After Ethical Committee approval, forty adult patients, treated for histopathologically confirmed glioma (World Health Organization (WHO) grade II-IV), were prospectively imaged at 3 Tesla (3 T) with DSC perfusion and a commercially available three-dimensional (3D) APTw sequence. Two consultant neuroradiologists independently performed region of interest (ROI) measurements on relative cerebral blood volume (rCBV) and APTw maps, co-registered with anatomical images. The correlation APTw MRI-DSC perfusion was assessed using Spearman's rank-order test. Inter-observer agreement was evaluated by the intraclass correlation coefficient (ICC) and Bland-Altman (BA) plots. Results: A statistically significant moderately strong positive correlation was observed between maximum rCBV (rCBV max ) and maximum APTw (APTw max ) values (observer 1: r ¼ 0.73; p < 0.01; observer 2: r ¼ 0.62; p < 0.01). We found good inter-observer agreement for APTw max (ICC ¼ 0.82; 95% confidence interval (CI) 0.66e0.90), with somewhat broad outer 95% CI for the BA Limits of Agreement (LoA) (À1.6 to 1.9). ICC for APTw max was higher than ICC for rCBV max (ICC ¼ 0.74; 95%; CI 0.50e0.86), but the difference was not statistically significant. Conclusion: APTw max values correlate positively with rCBV max in patients treated for brain glioma. APTw imaging is a reproducible technique, with some observer dependence. Results need to be confirmed by a larger population analysis. Implications for practice: APTw MRI can be a useful addition to glioma follow-up imaging and a potential alternative to DSC perfusion, especially in patients where contrast agent is contraindicated.

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“…15 Of the various methodologic factors that can impact rCBV measurement (eg, software modeling, 18,19 preload dose, 16,17,20,21 pulse sequence parameters 16,17 ), the process of rCBV normalization is arguably the most fundamental. [22][23][24] While quantitative measurements of rCBV are not possible given the poor reliability of arterial input functions on DSC-MR imaging and unknown voxelwise contrast agent T2* relaxivity, rCBV normalization provides a means of semiquantification against internal reference tissue in each patient. By convention, users define ROIs within the contralateral normal-appearing white matter (NAWM) and/or normal gray matter.…”

mentioning

confidence: 99%

Performance of Standardized Relative CBV for Quantifying Regional Histologic Tumor Burden in Recurrent High-Grade Glioma: Comparison against Normalized Relative CBV Using Image-Localized Stereotactic Biopsies

Hoxworth

Eschbacher²,

Gonzáles³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Perfusion MR imaging measures of relative CBV can distinguish recurrent tumor from posttreatment radiation effects in high-grade gliomas. Currently, relative CBV measurement requires normalization based on user-defined reference tissues. A recently proposed method of relative CBV standardization eliminates the need for user input. This study compares the predictive performance of relative CBV standardization against relative CBV normalization for quantifying recurrent tumor burden in high-grade gliomas relative to posttreatment radiation effects. MATERIALS AND METHODS: We recruited 38 previously treated patients with high-grade gliomas (World Health Organization grades III or IV) undergoing surgical re-resection for new contrast-enhancing lesions concerning for recurrent tumor versus posttreatment radiation effects. We recovered 112 image-localized biopsies and quantified the percentage of histologic tumor content versus posttreatment radiation effects for each sample. We measured spatially matched normalized and standardized relative CBV metrics (mean, median) and fractional tumor burden for each biopsy. We compared relative CBV performance to predict tumor content, including the Pearson correlation (r), against histologic tumor content (0%-100%) and the receiver operating characteristic area under the curve for predicting high-versus-low tumor content using binary histologic cutoffs

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Repeatability and reproducibility of relative cerebral blood volume measurement of recurrent glioma in a multicentre trial setting

Cited by 21 publications

References 19 publications

Analysis of postprocessing steps for residue function dependent dynamic susceptibility contrast (DSC)‐MRI biomarkers and their clinical impact on glioma grading for both 1.5 and 3T

Analysis of postprocessing steps for residue function dependent dynamic susceptibility contrast (DSC)‐MRI biomarkers and their clinical impact on glioma grading for both 1.5 and 3T

Amide proton transfer-weighted MRI in the clinical setting – correlation with dynamic susceptibility contrast perfusion in the post-treatment imaging of adult glioma patients at 3T

Performance of Standardized Relative CBV for Quantifying Regional Histologic Tumor Burden in Recurrent High-Grade Glioma: Comparison against Normalized Relative CBV Using Image-Localized Stereotactic Biopsies

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