Role of the Apparent Diffusion Coefficient as a Predictor of Tumor Progression in Patients with Chordoma

Sasaki, Takeshi; Moritani, Toshio; Belay, Abel A.; Capizzano, Arístides A.; Sato, Shuhei; Sato, Yoshitaka; Kirby, Patricia; Ishitoya, Shunta; Oya, Akiko; Toda, Masahiro; Takahashi, Koji

doi:10.3174/ajnr.a5664

Cited by 11 publications

(11 citation statements)

References 37 publications

(47 reference statements)

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“…In this study, cases with mean and minimum ADC values that were higher than the cutoff values showed significantly improved OS and PFS compared to those with lower values. Previous studies also correlated with our findings as cases with mean ADC values higher than 1494 (10 –6 mm 2 /s) were significantly associated with longer OS ( P = 0.006) 15 . In terms of PFS, the predictive value of preoperative ADC imaging is high considering the notoriously high recurrence rates of clival chordomas.…”

Section: Discussionsupporting

confidence: 91%

“…Recently, Yeom et al reported that poorly de-differentiated chordomas have a lower mean, maximum, and minimum ADC values compared to classic and chondroid chordomas 27 . A lower mean ADC value has also been reported to predict OS for craniospinal axis chordomas 15 . Our results were consistent with the findings of previous reports that preoperative ADC values could be used to infer to the characteristics of tumor components and predict the behavior of clival chordoma.…”

Section: Discussionmentioning

confidence: 89%

“…Regardless of these limitations, our results suggest that preoperative ADC values could be useful in predicting the prognosis of patients with clival chordomas. Previously, there have been a study highlighting the importance of ADC values in predicting aggressive of craniospinal axis chordomas 15 . However, sacral chordomas can have different www.nature.com/scientificreports/ ADC values compared to clival chordoma and higher ADC values may predict non-responsiveness to carbon ion radiotherapy 36 .…”

Section: Discussionmentioning

confidence: 99%

“…A recent study revealed that apparent diffusion coefficient (ADC) values could be used to predict tumor progression for craniospinal axis chordomas 15 . The study, however, covered both clival and sacral chordomas, included only a small number of patients, and did not take EOR into consideration, which is still, the most reliable prognostic factor for clival chordoma.…”

Section: Introductionmentioning

confidence: 99%

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Apparent diffusion coefficient as a prognostic factor in clival chordoma

Hong

Lee

et al. 2021

Sci Rep

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Clival chordoma is a rare disease with high recurrence rates even after a combination of surgical resection and radiotherapy. Apparent diffusion coefficient (ADC) has been used to evaluate aggressive features of chordoma, but its utility for clival chordoma has not been explored specifically. In this study, the utility of preoperative ADC values was analyzed for predicting tumor progression and recurrence in patients with clival chordoma. Between 2012 and 2019, a total of 30 operated cases were analyzed with available preoperative ADC data. Receiver operating characteristic (ROC) analysis was used to obtain ADC cutoff values for predicting tumor aggressiveness. The mean and minimum ADC values were significantly lower in the aggressive tumor group than in the stable tumor group (both P < 0.001). ROC analysis showed that a mean cutoff ADC value of 1198 × 10−6 mm2/s and minimum ADC value of 895.5 × 10–6 mm2/s could be used to predict aggressive features of clival chordoma. Subtotal resection, partial resection, and mean and minimum ADC values that were lower than cutoff values were negative predictors of overall survival and progression-free survival. In conclusion, mean and minimum ADC values could be useful in predicting aggressiveness of clival chordoma.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Apparent diffusion coefficient as a prognostic factor in clival chordoma

Hong

Lee

et al. 2021

Sci Rep

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“…Another limitation is that this is a retrospective study for which some clinical information was missing; for example, the tumor blood supply of 3 tumors was not recorded in the archives. A study showed that lower ADC values may predict tumor progression in postsurgery chordomas 27 and may also predict tumor-control probability in skull base chordomas treated with carbon ion therapy. 28 This probability suggests that the relationship between ADC values and electronic microscopic characteristics will also be worth investigating.…”

Section: Limitationsmentioning

confidence: 99%

MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas

Bai

Shi

Zhang

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: MR imaging is a useful and widely used evaluation for chordomas. Prior studies have classified chordomas into cell-dense type and matrix-rich type according to the ultrastructural features. However, the relationship between the MR imaging signal intensity and ultrastructural classification is unknown. We hypothesized that MR imaging signal intensity may predict both tumor ultrastructural classification and prognosis.MATERIALS AND METHODS: Seventy-nine patients with skull base chordomas who underwent 95 operations were included in this retrospective single-center series. Preoperative tumor-to-pons MR imaging signal intensity ratios were calculated and designated as ratio on T1 FLAIR sequence (R T1 ), ratio on T2 sequence (R T2 ), and ratio on enhanced T1 FLAIR sequence (R EN ), respectively. We assessed the relationships among signal intensity ratios, ultrastructural classification, and survival. RESULTS:Compared with the matrix-rich type group, the cell-dense type chordomas showed lower R T2 (cell-dense type: 1.90 6 0.38; matrix-rich type: 2.61 6 0.60 P , .001). The model of predicting cell-dense type based on R T2 had an area under the curve of 0.83 (95% CI, 0.75-0.92). In patients without radiation therapy, both progression-free survival (P ¼ .003) and overall survival (P ¼ .002) were longer in the matrix-rich type group than in the cell-dense type group. R EN was a risk factor for progression-free survival (hazard ratio ¼ 10.24; 95% CI, 1.73-60.79); R T2 was a protective factor for overall survival (hazard ratio ¼ 0.33; 95% CI, 0.12-0.87); and R EN was a risk factor for overall survival (hazard ratio ¼ 4.76; 95% CI, 1.51-15.01). CONCLUSIONS:The difference in MR imaging signal intensity in chordomas can be explained by electron microscopic features. Both signal intensity ratios and electron microscopic features may be prognostic factors.

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Microstructural parameters from DW‐MRI for tumour characterization and local recurrence prediction in particle therapy of skull‐base chordoma

et al. 2023

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Background Quantitative imaging such as Diffusion‐Weighted MRI (DW‐MRI) can be exploited to non‐invasively derive patient‐specific tumor microstructure information for tumor characterization and local recurrence risk prediction in radiotherapy. Purpose To characterize tumor microstructure according to proliferative capacity and predict local recurrence through microstructural markers derived from pre‐treatment conventional DW‐MRI, in skull‐base chordoma (SBC) patients treated with proton (PT) and carbon ion (CIRT) radiotherapy. Methods Forty‐eight patients affected by SBC, who underwent conventional DW‐MRI before treatment and were enrolled for CIRT (n = 25) or PT (n = 23), were retrospectively selected. Clinically verified local recurrence information (LR) and histological information (Ki‐67, proliferation index) were collected. Apparent diffusion coefficient (ADC) maps were calculated from pre‐treatment DW‐MRI and, from these, a set of microstructural parameters (cellular radius R, volume fraction vf, diffusion D) were derived by applying a fine‐tuning procedure to a framework employing Monte Carlo simulations on synthetic cell substrates. In addition, apparent cellularity (ρapp) was estimated from vf and R for an easier clinical interpretation. Histogram‐based metrics (mean, median, variance, entropy) from estimated parameters were considered to investigate differences (Mann‐Whitney U‐test, α = 0.05) in estimated tumor microstructure in SBCs characterized by low or high cell proliferation (Ki‐67). Recurrence‐free survival analyses were also performed to assess the ability of the microstructural parameters to stratify patients according to the risk of local recurrence (Kaplan‐Meier curves, log‐rank test α = 0.05). Results Refined microstructural markers revealed optimal capabilities in discriminating patients according to cell proliferation, achieving best results with mean values (p‐values were 0.0383, 0.0284, 0.0284, 0.0468, and 0.0088 for ADC, R, vf, D, and ρapp, respectively). Recurrence‐free survival analyses showed significant differences between populations at high and low risk of local recurrence as stratified by entropy values of estimated microstructural parameters (p = 0.0110). Conclusion Patient‐specific microstructural information was non‐invasively derived providing potentially useful tools for SBC treatment personalization and optimization in particle therapy.

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Role of the Apparent Diffusion Coefficient as a Predictor of Tumor Progression in Patients with Chordoma

Abstract: BACKGROUND AND PURPOSE: Diffusion-weighted imaging may aid in distinguishing aggressive chordoma from nonaggressive chordoma. This study explores the prognostic role of the apparent diffusion coefficient in chordomas.

Cited by 11 publications

References 37 publications

Apparent diffusion coefficient as a prognostic factor in clival chordoma

Apparent diffusion coefficient as a prognostic factor in clival chordoma

MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas

Microstructural parameters from DW‐MRI for tumour characterization and local recurrence prediction in particle therapy of skull‐base chordoma

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