Restriction spectrum imaging predicts response to bevacizumab in patients with high-grade glioma

McDonald, Carrie R.; Delfanti, Rachel L.; Krishnan, Anitha Priya; Leyden, Kelly M.; Hattangadi‐Gluth, Jona A.; Seibert, Tyler M.; Karunamuni, Roshan; Elbe, P; Kuperman, Joshua; Bartsch, Hauke; Piccioni, David; White, Nathan S.; Dale, Anders M.; Farid, Nikdokht

doi:10.1093/neuonc/now063

Cited by 25 publications

(48 citation statements)

References 42 publications

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“…In contrast to mean values that can be diluted by tissue and microenviromental heterogeneity, the lowest 10th percentile value was chosen to represent regions of tumor with the highest cellular density and proliferation. This is consistent with prior reports showing that the lowest representation of ADC using fifth percentile 20 or 10th percentile ADC values 21,22 has a higher correlation with tumor grade and cellular density in comparison with ADC mean values. One limitation of this study was the small sample size, and a larger cohort would be needed to further validate our results.…”

Section: Discussionsupporting

confidence: 92%

Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma

Chen¹,

Swinburne²,

Tsankova³

et al. 2018

AJNR Am J Neuroradiol

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Section: Discussionsupporting

confidence: 92%

Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma

Chen¹,

Swinburne²,

Tsankova³

et al. 2018

AJNR Am J Neuroradiol

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“…Thus, RSI’s ability to probe both the scale and geometry of tissue microstructure positions it well to determine whether regional reductions in DTI-derived FA values are due to axonal loss/demyelination versus extracellular changes (e.g., CSF-filled spaces; inflammation) or CFs. We have previously shown the advantage of RSI over standard DTI for reconstructing fiber tracts in regions of peritumoral edema 8 , identifying regions of high cellularity in patients with high grade glioma 16 , and evaluating response to therapy in patients treated with bevacizumab 17 . We now extend the application of RSI to unveiling the complex cytoarchitecture of white matter injury in patients with TLE.…”

Section: Introductionmentioning

confidence: 99%

Restriction spectrum imaging reveals decreased neurite density in patients with temporal lobe epilepsy

et al. 2016

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Objective Diffusion tensor imaging (DTI) has become a popular tool for delineating the location and extent of white matter injury in temporal lobe epilepsy (TLE). However, DTI yields nonspecific measures that are confounded by changes occurring within both the intracellular and extracellular environments. This study investigated whether an advanced diffusion method, restriction spectrum imaging (RSI) could provide a more robust measure of white matter injury in TLE relative to DTI due to RSI’s ability to separate intra-axonal diffusion (i.e., neurite density; ND) from diffusion associated with extra-axonal factors (e.g., inflammation; crossing fibers). Methods RSI and DTI scans were obtained on 21 patients with TLE and 11 age-matched controls. RSI-derived maps of ND, isotropic hindered (IH) and free (IF) water, and crossing fibers (CF) were compared to DTI-derived fractional anisotropy (FA) maps. Voxelwise and tract-based analyses were performed comparing patients with TLE to controls on each diffusion metric. Results Reductions in FA were seen primarily in frontotemporal white matter in TLE and were most pronounced proximal to the seizure focus. Reductions in ND corresponded to those seen in the FA maps; however, ND reductions were greater in magnitude, more lateralized to the epileptogenic hemisphere, and showed a broader pattern. Increases in IF/IH and effects from CFs also contributed to reduced FA in the ipsilateral parahippocampal cingulum and fornix, with decreases in IH extending into extratemporal regions. Reduced ND of the uncinate fasciculus was associated with longer disease duration, whereas FA was not associated with any clinical variables. Significance RSI may provide a more specific measure of white matter pathology in TLE, distinguishing regions primarily affected by axonal/myelin loss from those where CFs and increases in extracellular water also play a role. By providing a more specific measure of axonal/myelin loss, RSI-derived ND may better reflect overall white matter burden in epilepsy.

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“…These findings are in line with previous research suggesting that neither FLAIR nor CE volumes are significant predictors of PFS/OS following bevacizumab. 25,31 Rather, quantitative estimates of FLAIR border patterns may have the potential to serve as a reliable biomarker for non-enhancing tumor progression in HGG patients following treatment with bevacizumab.…”

Section: Discussionmentioning

confidence: 99%

“…The patients included in this study represent a subset (33 of 40) of the patients reported in a previous publication that examined the utility of advanced diffusion imaging (i.e., restriction spectrum imaging) for the evaluation of response to bevacizumab. 25 …”

Section: Methodsmentioning

confidence: 99%

Edge Contrast of the FLAIR Hyperintense Region Predicts Survival in Patients with High-Grade Gliomas following Treatment with Bevacizumab

Bahrami

Piccioni

Karunamuni

et al. 2018

AJNR Am J Neuroradiol

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Background and Purpose Treatment with bevacizumab is standard of care for recurrent high grade gliomas (HGGs); However, monitoring response to treatment following bevacizumab remains a challenge. The purpose of this study is to determine whether quantifying the sharpness of the fluid-attenuated inversion recovery (FLAIR) hyperintense border using a measure derived from texture analysis—edge contrast (EC)—improves the evaluation of response to bevacizumab in patients with HGG. Materials and Methods MRIs were evaluated in 33 patients with HGG before and after the initiation of bevacizumab. Volumes of interest (VOIs) within the FLAIR hyperintense region were segmented. EC magnitude for each VOI was extracted using gradients of the 3D FLAIR images. Cox proportional hazard models were generated to determine the relationship between EC and PFS/OS using age and the extent of surgical resection as covariates. Results After bevacizumab, lower EC of the FLAIR hyperintense region was associated with poorer PFS (p=0.009) and OS (p = 0.022) among HGG patients. Kaplan-Meier curves revealed that EC cutoff significantly stratified patients for both PFS (log rank χ2 = 8.3, p = 0.003) and OS (log rank χ2 = 5.5, p = 0.019). Conclusion Texture analysis using EC of the FLAIR hyperintense region may be an important predictive indicator in HGG patients following treatment with bevacizumab. Specifically, low FLAIR EC may partially reflect areas of early tumor infiltration. This study adds to a growing body of literature proposing that quantifying features may be important for determining outcomes in patients with HGG.

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Restriction spectrum imaging predicts response to bevacizumab in patients with high-grade glioma

Abstract: RSI is less influenced by changes in edema, conferring an advantage of RSI over ADC for evaluating response to anti-angiogenic therapy in patients with HGG.

Cited by 25 publications

References 42 publications

Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma

Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma

Restriction spectrum imaging reveals decreased neurite density in patients with temporal lobe epilepsy

Edge Contrast of the FLAIR Hyperintense Region Predicts Survival in Patients with High-Grade Gliomas following Treatment with Bevacizumab

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