Elwira Szychot1, Adam Youssef2, Balaji Ganeshan3, Raymond Endozo4, Harpreet Hyare5, Jenny Gains6, Kshitij Mankad7, Ananth Shankar8. 1. The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK. Electronic address: e.szychot@nhs.net. 2. Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK. Electronic address: adam.youssef@nhs.net. 3. University College London Hospital, 235 Euston Road, Bloomsbury, London NW1 2BU, UK. 4. University College London Hospital, 235 Euston Road, Bloomsbury, London NW1 2BU, UK. Electronic address: raymond.endozo@nhs.net. 5. University College London Hospital, 235 Euston Road, Bloomsbury, London NW1 2BU, UK. Electronic address: harpreet.hyare@nhs.net. 6. University College London Hospital, 235 Euston Road, Bloomsbury, London NW1 2BU, UK. Electronic address: jenny.gains@nhs.net. 7. Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK. Electronic address: kshitij.mankad@gosh.nhs.uk. 8. University College London Hospital, 235 Euston Road, Bloomsbury, London NW1 2BU, UK. Electronic address: ananth.shankar@nhs.net.
Abstract
BACKGROUND: Diffuse midline gliomas (DMG) are aggressive brain tumours, previously known as diffuse intrinsic pontine gliomas (DIPG), with 10% overall survival (OS) at 18 months. Predicting OS will help refine treatment strategy in this patient group. MRI based texture analysis (MRTA) is novel image analysis technique that provides objective information about spatial arrangement of MRI signal intensity (heterogeneity) and has potential to be imaging biomarker. OBJECTIVES: To investigate MRTA in predicting OS in childhood DMG. METHODS: Retrospective study of patients diagnosed with DMG, based on radiological features, treated at our institution 2007-2017. MRIs were acquired at diagnosis and 6 weeks after radiotherapy (54Gy in 30 fractions). MRTA was performed using commercial available TexRAD research software on T2W sequence and Apparent Diffusion Coefficient (ADC) maps encapsulating tumour in the largest single axial plane. MRTA comprised filtration-histogram technique using statistical and histogram metrics for quantification of texture. Kaplan-Meier survival analysis determined association of MRI texture parameters with OS. RESULTS: In all, 32 children 2-14 years (median 7 years) were included. MRTA was undertaken on T2W (n=32) and ADC (n=22). T2W-MRTA parameters were better at prognosticating than ADC-MRTA. Children with homogenous tumour texture, at medium scale on diagnostic T2W MRI, had worse prognosis (Mean of Positive Pixels (MPP): P=0.005, mean: P=0.009, SD: P=0.011, kurtosis: P=0.037, entropy: P=0.042). Best predictor MPP was able to stratify patients into poor and good prognostic groups with median survival of 7.5 months versus 17.5 months, respectively. CONCLUSIONS: DMG with more homogeneous texture on diagnostic MRI is associated with worse prognosis. Texture parameter MPP is the most predictive marker of OS in childhood DMG.
BACKGROUND: Diffuse midline gliomas (DMG) are aggressive brain tumours, previously known as diffuse intrinsic pontine gliomas (DIPG), with 10% overall survival (OS) at 18 months. Predicting OS will help refine treatment strategy in this patient group. MRI based texture analysis (MRTA) is novel image analysis technique that provides objective information about spatial arrangement of MRI signal intensity (heterogeneity) and has potential to be imaging biomarker. OBJECTIVES: To investigate MRTA in predicting OS in childhood DMG. METHODS: Retrospective study of patients diagnosed with DMG, based on radiological features, treated at our institution 2007-2017. MRIs were acquired at diagnosis and 6 weeks after radiotherapy (54Gy in 30 fractions). MRTA was performed using commercial available TexRAD research software on T2W sequence and Apparent Diffusion Coefficient (ADC) maps encapsulating tumour in the largest single axial plane. MRTA comprised filtration-histogram technique using statistical and histogram metrics for quantification of texture. Kaplan-Meier survival analysis determined association of MRI texture parameters with OS. RESULTS: In all, 32 children 2-14 years (median 7 years) were included. MRTA was undertaken on T2W (n=32) and ADC (n=22). T2W-MRTA parameters were better at prognosticating than ADC-MRTA. Children with homogenous tumour texture, at medium scale on diagnostic T2W MRI, had worse prognosis (Mean of Positive Pixels (MPP): P=0.005, mean: P=0.009, SD: P=0.011, kurtosis: P=0.037, entropy: P=0.042). Best predictor MPP was able to stratify patients into poor and good prognostic groups with median survival of 7.5 months versus 17.5 months, respectively. CONCLUSIONS:DMG with more homogeneous texture on diagnostic MRI is associated with worse prognosis. Texture parameter MPP is the most predictive marker of OS in childhood DMG.
Authors: Lydia T Tam; Kristen W Yeom; Jason N Wright; Alok Jaju; Alireza Radmanesh; Michelle Han; Sebastian Toescu; Maryam Maleki; Eric Chen; Andrew Campion; Hollie A Lai; Azam A Eghbal; Ozgur Oztekin; Kshitij Mankad; Darren Hargrave; Thomas S Jacques; Robert Goetti; Robert M Lober; Samuel H Cheshier; Sandy Napel; Mourad Said; Kristian Aquilina; Chang Y Ho; Michelle Monje; Nicholas A Vitanza; Sarah A Mattonen Journal: Neurooncol Adv Date: 2021-03-05
Authors: Peter Raab; Rouzbeh Banan; Arash Akbarian; Majid Esmaeilzadeh; Madjid Samii; Amir Samii; Helmut Bertalanffy; Ulrich Lehmann; Joachim K Krauss; Heinrich Lanfermann; Christian Hartmann; Roland Brüning Journal: Cancers (Basel) Date: 2022-03-09 Impact factor: 6.639