The emerging potential of quantitative MRI biomarkers for the early prediction of brain metastasis response after stereotactic radiosurgery: a scoping review

Abstract

Background: At present, the simple prognostic models based on clinical information for predicting the treatment outcomes of brain metastases (BMs) are subjective and delayed. Thus, we performed this systematic review of multiple studies to assess the potential of quantitative magnetic resonance imaging (MRI) biomarkers for the early prediction of treatment outcomes of brain metastases with stereotactic radiosurgery (SRS). Methods:We systematically searched the PubMed, Embase, Cochrane, Web of Science, and Clinical Trials.gov databases for articles published between February 1, 1991, and April 11, 2022, with no language restrictions. We included studies involving patients with BMs receiving SRS; the included patients were required to have definite pathology of a primary tumor and complete imaging data (pre-and post-SRS).We excluded the articles that included patients who had undergone previous surgery and those that did not include regular follow-up or corresponding MRI scans.Results: We identified 2,162 studies, of which 26 were included in our analysis, involving a total of 1,362 participants. All 26 studies explored the relevant MRI parameters to predict the prognosis of patients with BMs who received SRS. The outcomes were generalized according to the relationships between the anatomical/morphological, microstructural, vascular, and metabolic changes and SRS. Generally, with traditional MRI, there are several quantitative prognostic models based on preradiosurgical radiomics that predict the outcome of SRS treatment in local BM control. With the implementation of advanced MRI, the relative apparent diffusion coefficient (ADC), perfusion fraction (f), relative cerebral blood volume (rCBV), relative regional cerebral blood flow (rrCBF), interstitial fluid (IFP), quadratic of time-dependent leakage (K trans 2 ), extracellular extravascular volume (v e ), choline/creatine (Cho/Cr), nuclear Overhauser effect (NOE) peak, and intraextracellular water exchange rate constant (k IE ) were confirmed to be indicative of the therapeutic effect of SRS for BMs. Conclusion:Quantitative MRI biomarkers extracted from traditional or advanced MRI at different time points, which can represent the anatomical/morphological, microstructural, vascular, and metabolic changes, respectively, have been proposed as promising markers for the early prediction of SRS response in those with BMs. There are some limitations in this review, including the risk of selection bias, the limited number of study objects, the incomparability of the total data, and the subjectivity of the review process.

A systematic review of brain metastases from lung cancer using magnetic resonance neuroimaging: Clinical and technical aspects

“…17,18 By applying these techniques to MRI data from BMs of patients with LC, we may gain new insights into tumour biology, treatment response and clinical outcomes. 19 However, the available literature on the role of MRI in the management of BMs from LC is heterogeneous and lacks a comprehensive evaluation. Therefore, the present systematic review aims to investigate the role of MRI techniques in the diagnosis and management of BMs from LC with a particular focus on clinical and technical aspects.…”

“…Radiomics extracts quantitative imaging features from MRI scans that can reveal information about the tumour phenotype, while DL methods (DLMs) can analyse raw imaging data directly to make inferences 17,18 . By applying these techniques to MRI data from BMs of patients with LC, we may gain new insights into tumour biology, treatment response and clinical outcomes 19 …”

“… 17 , 18 By applying these techniques to MRI data from BMs of patients with LC, we may gain new insights into tumour biology, treatment response and clinical outcomes. 19 …”

Development and validation of a fully automatic tissue delineation model for brain metastasis using a deep neural network

“…Among all patients with newly diagnosed brain metastases, 49–53% have single metastasis ( 4 , 5 ). Stereotactic radiosurgery (SRS) is now a primary treatment option for patients with brain metastases, particularly those with a limited number of lesions (i.e., 1–3) ( 6 , 7 ). Various treatment units can perform SRS, including Gamma Knife (GK), CyberKnife, linear accelerator (LINAC)-based radiosurgery, and TomoTherapy ( 8 ).…”