Jie Liu1, Cong Li2, Yinsheng Chen2, Xiaofei Lv3, Yanchun Lv3, Jian Zhou3, Shaoyan Xi4, Weiqiang Dou5, Long Qian5, Hairong Zheng1, Yin Wu1, Zhongping Chen2. 1. Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China. 2. Department of Neurosurgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China. 3. Department of Medical Imaging, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China. 4. Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China. 5. GE Healthcare, Beijing, China.
Abstract
BACKGROUND: MRI is one of the most important techniques to assess the treatment response of gliomas. However, differentiating tumor recurrence (TuR) from treatment effects (TrE) remains challenging. PURPOSE: To compare the diagnostic performance of MR diffusion-weighted imaging (DWI), arterial spin labeling (ASL), proton MR spectroscopy (MRS), and amide proton transfer (APT) imaging in differentiating between TuR and TrE in posttreatment glioma patients. STUDY TYPE: Prospective. POPULATION: Thirty patients with suspected tumor progression. FIELD STRENGTH/SEQUENCE: DWI, ASL, proton MRS, and APT imaging were performed at 3T MR. ASSESSMENT: MR indices, including ADC, relative cerebral blood flow (rCBF), ratios of Cho/Cr, Cho/NAA, and NAA/Cr and APT-weighted (APTw) effect were obtained from DWI, ASL, proton MRS, and APT imaging, respectively. Indices were measured in the contralateral normal-appearing white matter and lesions defined on the Gd-enhanced T1 w image. TuR or TrE was either determined histologically or clinically from longitudinal MRI follow-up for at least 6 months. STATISTICAL TESTS: The diagnostic performance of the indices was evaluated using Student's t-test, receiver operating characteristic (ROC) curve, and multivariate logistic regression analyses. RESULTS: Among the 30 patients, 16 were diagnosed as having TuR and the rest having TrE. The recurrent tumors showed a significantly higher APTw effect (1.56 ± 1.14%) and rCBF (1.44 ± 0.61) compared with lesions representing treatment effects (-0.44 ± 1.34% and 0.72 ± 0.25, respectively, with P < 0.001). The areas under the curve (AUCs) were 0.87 and 0.90 for APTw and rCBF, respectively, in differentiating between TuR and TrE. Combining APTw and rCBF achieved a higher AUC of 0.93. MRS index ratios of Cho/Cr (P = 0.25), Cho/NAA (P = 0.16), and NAA/Cr (P = 0.86) and ADC (P = 0.37) showed no significant differences between TuR and TrE lesions, with AUCs lower than 0.70. DATA CONCLUSION: Compared with DWI and MRS, ASL and APT imaging techniques showed better diagnostic capability in distinguishing TuR from TrE. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2020;51:1154-1161.
BACKGROUND: MRI is one of the most important techniques to assess the treatment response of gliomas. However, differentiating tumor recurrence (TuR) from treatment effects (TrE) remains challenging. PURPOSE: To compare the diagnostic performance of MR diffusion-weighted imaging (DWI), arterial spin labeling (ASL), proton MR spectroscopy (MRS), and amide proton transfer (APT) imaging in differentiating between TuR and TrE in posttreatment gliomapatients. STUDY TYPE: Prospective. POPULATION: Thirty patients with suspected tumor progression. FIELD STRENGTH/SEQUENCE: DWI, ASL, proton MRS, and APT imaging were performed at 3T MR. ASSESSMENT: MR indices, including ADC, relative cerebral blood flow (rCBF), ratios of Cho/Cr, Cho/NAA, and NAA/Cr and APT-weighted (APTw) effect were obtained from DWI, ASL, proton MRS, and APT imaging, respectively. Indices were measured in the contralateral normal-appearing white matter and lesions defined on the Gd-enhanced T1 w image. TuR or TrE was either determined histologically or clinically from longitudinal MRI follow-up for at least 6 months. STATISTICAL TESTS: The diagnostic performance of the indices was evaluated using Student's t-test, receiver operating characteristic (ROC) curve, and multivariate logistic regression analyses. RESULTS: Among the 30 patients, 16 were diagnosed as having TuR and the rest having TrE. The recurrent tumors showed a significantly higher APTw effect (1.56 ± 1.14%) and rCBF (1.44 ± 0.61) compared with lesions representing treatment effects (-0.44 ± 1.34% and 0.72 ± 0.25, respectively, with P < 0.001). The areas under the curve (AUCs) were 0.87 and 0.90 for APTw and rCBF, respectively, in differentiating between TuR and TrE. Combining APTw and rCBF achieved a higher AUC of 0.93. MRS index ratios of Cho/Cr (P = 0.25), Cho/NAA (P = 0.16), and NAA/Cr (P = 0.86) and ADC (P = 0.37) showed no significant differences between TuR and TrE lesions, with AUCs lower than 0.70. DATA CONCLUSION: Compared with DWI and MRS, ASL and APT imaging techniques showed better diagnostic capability in distinguishing TuR from TrE. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2020;51:1154-1161.
Authors: Thomas C Booth; Evita C Wiegers; Esther A H Warnert; Kathleen M Schmainda; Frank Riemer; Ruben E Nechifor; Vera C Keil; Gilbert Hangel; Patrícia Figueiredo; Maria Del Mar Álvarez-Torres; Otto M Henriksen Journal: Front Oncol Date: 2022-02-28 Impact factor: 5.738
Authors: Jinyuan Zhou; Moritz Zaiss; Linda Knutsson; Phillip Zhe Sun; Sung Soo Ahn; Silvio Aime; Peter Bachert; Jaishri O Blakeley; Kejia Cai; Michael A Chappell; Min Chen; Daniel F Gochberg; Steffen Goerke; Hye-Young Heo; Shanshan Jiang; Tao Jin; Seong-Gi Kim; John Laterra; Daniel Paech; Mark D Pagel; Ji Eun Park; Ravinder Reddy; Akihiko Sakata; Sabine Sartoretti-Schefer; A Dean Sherry; Seth A Smith; Greg J Stanisz; Pia C Sundgren; Osamu Togao; Moriel Vandsburger; Zhibo Wen; Yin Wu; Yi Zhang; Wenzhen Zhu; Zhongliang Zu; Peter C M van Zijl Journal: Magn Reson Med Date: 2022-04-22 Impact factor: 3.737