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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleAdult Brain

Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making

M. Iv, X. Liu, J. Lavezo, A.J. Gentles, R. Ghanem, S. Lummus, D.E. Born, S.G. Soltys, S. Nagpal, R. Thomas, L. Recht and N. Fischbein
American Journal of Neuroradiology October 2019, 40 (10) 1649-1657; DOI: https://doi.org/10.3174/ajnr.A6211
M. Iv
aFrom the Departments of Neuroimaging and Neurointervention (M.I., N.F.)
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X. Liu
fDepartment of Neurosurgery (X.L.), Shengjing Hospital of China Medical University, Shenyang, China.
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J. Lavezo
bPathology (J.L., R.G., S.L., D.E.B.)
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A.J. Gentles
cMedicine (Biomedical Informatics Research) (A.J.G.)
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R. Ghanem
bPathology (J.L., R.G., S.L., D.E.B.)
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S. Lummus
bPathology (J.L., R.G., S.L., D.E.B.)
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D.E. Born
bPathology (J.L., R.G., S.L., D.E.B.)
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S.G. Soltys
dRadiation Oncology (S.G.S.)
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S. Nagpal
eNeurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
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R. Thomas
eNeurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
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L. Recht
eNeurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
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N. Fischbein
aFrom the Departments of Neuroimaging and Neurointervention (M.I., N.F.)
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    Fig 1.

    Representative examples of treatment effect (upper row) and recurrent tumor (lower row) in 2 patients with previously resected and irradiated glioblastomas. Contrast-enhancing lesions on postcontrast T1-weighted (A and E) and ΔT1 (B and F) images. Output FTB maps superimposed on the contrast-enhanced T1-weighted images (C and G). Blue represents areas of low blood volume (FTBlow), and red represents areas of high blood volume (FTBhigh). Histograms (D and H) show all voxels of the contrast-enhancing volume classified into the respective FTBlow, FTBmid (yellow), and FTBhigh classes, which is based on the rCBV thresholds of 1.0 and 1.75.

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    Fig 2.

    Boxplots of the relationship between FTB and normalized rCBV in 2 histopathologically defined groups: treatment effect and recurrent tumor. Open circles and squares represent individual measurements. The upper and lower limits of the whiskers represent the minimum and maximum of all of the data. Double asterisks indicate P < .01; triple asterisks, P < .001.

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    Fig 3.

    Receiver operating characteristic curves for the use of fractional tumor burden classes and normalized rCBV to differentiate tumor from treatment effect.

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    Fig 4.

    Agreement between the consensus (among 5 physician raters) qualitative interpretation of imaging and the actual histopathologic diagnosis (A). Agreement between the hypothetic consensus decision to change treatment plans and the actual (real-time) management plans (B and C).

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    Table 1:

    Patient demographics and clinicopathologic informationa

    TE (n = 17)Tumor (n = 30)Total (n = 47)
    Age (yr)
    Mean (SD)56 (10)55 (13)55 (12)
    Range38-7720-8020-80
    Sex
    Male11 (65%)18 (60%)29 (62%)
    Female6 (35%)12 (40%)18 (38%)
    Interval time between end or radiation therapy and surgery (mo)
    Median (range)11.4 (0.6-60.4)10.7 (1.3-101.5)10.9 (0.6-101.5)
    Bevacizumab at time of surgeryb2 (12%)3 (10%)5 (11%)
    Surgical procedure
    Biopsy3 (18%)4 (13%)7 (15%)
    >90% resection3 (18%)9 (30%)12 (25%)
    Gross total resection11 (64%)17 (57%)28 (60%)
    HGG histopathology
    Anaplastic astrocytoma, WHO grade III2 (12%)02 (4%)
    Glioblastoma, WHO grade IV15 (88%)29 (97%)44 (94%)
    Gliosarcoma, WHO grade IV01 (3%)1 (2%)
    HGG molecular features
    IDH wild type11 (65%)11 (37%)22 (47%)
    IDH mutant02 (7%)2 (4%)
    Unknown IDH status6 (35%)17 (56%)23 (49%)
    MGMT-unmethylated6 (35%)15 (50%)21 (45%)
    MGMT-methylated6 (35%)8 (27%)14 (30%)
    Unknown MGMT status5 (30%)7 (23%)12 (25%)
    • Note:—IDH indicates isocitrate dehydrogenase; MGMT, O-6-methylguanine-DNA methyltransferase; WHO, World Health Organization.

    • ↵a Percentage values in parentheses for sex, bevacizumab at time of the operation, surgical procedure, HGG histopathology, and HGG molecular features are percentages relative to the number of patients in each column.

    • ↵b Patient received a dose of bevacizumab within 1 month of the surgical procedure for suspected recurrence.

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    Table 2:

    Mean values of FTB classes and normalized rCBV in histopathologically defined treatment effect and tumor groupsa

    TETumorP Values
    FTBlow54.8 (22.3)33.1 (20.8).002
    FTBmid27.0 (15.4)21.3 (11.3).16
    FTBhigh18.2 (14.4)45.5 (22.6)<.001
    rCBV1.2 (0.6)2.1 (1.0)<.001
    • ↵a Values are reported as mean (SD), except for P values.

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American Journal of Neuroradiology: 40 (10)
American Journal of Neuroradiology
Vol. 40, Issue 10
1 Oct 2019
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M. Iv, X. Liu, J. Lavezo, A.J. Gentles, R. Ghanem, S. Lummus, D.E. Born, S.G. Soltys, S. Nagpal, R. Thomas, L. Recht, N. Fischbein
Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making
American Journal of Neuroradiology Oct 2019, 40 (10) 1649-1657; DOI: 10.3174/ajnr.A6211

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Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making
M. Iv, X. Liu, J. Lavezo, A.J. Gentles, R. Ghanem, S. Lummus, D.E. Born, S.G. Soltys, S. Nagpal, R. Thomas, L. Recht, N. Fischbein
American Journal of Neuroradiology Oct 2019, 40 (10) 1649-1657; DOI: 10.3174/ajnr.A6211
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Cited By...

  • Multisite Benchmark Study for Standardized Relative CBV in Untreated Brain Metastases Using the DSC-MRI Consensus Acquisition Protocol
  • Identification of a Single-Dose, Low-Flip-Angle-Based CBV Threshold for Fractional Tumor Burden Mapping in Recurrent Glioblastoma
  • Arterial Spin-Labeling and DSC Perfusion Metrics Improve Agreement in Neuroradiologists Clinical Interpretations of Posttreatment High-Grade Glioma Surveillance MR Imaging--An Institutional Experience
  • DSC Perfusion MRI-Derived Fractional Tumor Burden and Relative CBV Differentiate Tumor Progression and Radiation Necrosis in Brain Metastases Treated with Stereotactic Radiosurgery
  • 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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