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Which is the best advanced MR imaging protocol for predicting recurrent metastatic brain tumor following gamma-knife
Myeong Ju Koh1, Ho Sung Kim, Choong Gon Choi
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, South Korea.
Introduction:
High spatial resolution of dynamic contrast-enhanced (DCE) MR imaging allows characterization of heterogenous tumor microenvironment. Our purpose was to determine which is the best advanced MR imaging protocol, focused on additional MR perfusion method, for predicting recurrent metastatic brain tumor following gamma-knife radiosurgery (GKRS).
Methods:
Seventy-two consecutive patients with post-GKRS metastatic brain tumor were enrolled. Two readers independently calculated the percentile histogram cutoffs for normalized cerebral blood volume (nCBV) from dynamic susceptibility contrast (DSC) imaging and initial area under the time signal-intensity curve (IAUC) from DCE imaging, respectively. Area under the receiver operating characteristic curve (AUC) and interreader agreement were assessed.
Results:
For differentiating tumor recurrence from therapy effect, adding DCE imaging to diffusion-weighted imaging (DWI) significantly improved AUC from 0.79 to 0.95 for reader 1 and from 0.80 to 0.96 for reader 2, respectively. There was no significant difference of AUC between the combination of DWI with DSC imaging and the combination of DWI with DCE imaging for both readers. With the combination of DWI and DCE imaging, the sensitivity and specificity were 86.7 and 88.1% for reader 1 and 90.0 and 85.7% for reader 2, respectively. The intraclass correlation coefficient (ICC) between readers was highest for calculation of the 90th percentile histogram cutoffs for IAUC (ICC, 0.87).
Conclusion:
Adding perfusion MR imaging to DWI significantly improves the prediction of recurrent metastatic tumor; however, the diagnostic performance is not affected by selection of either DSC or DCE MR perfusion method.
Insights
Adding advanced MR perfusion imaging, such as dynamic susceptibility contrast (DSC) or dynamic contrast-enhanced (DCE) imaging, to diffusion-weighted imaging (DWI) significantly improves the prediction of recurrent metastatic brain tumors after gamma-knife radiosurgery (GKRS). The choice between DSC and DCE does not impact diagnostic performance.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Dynamic contrast-enhanced (DCE) MR imaging offers high spatial resolution for characterizing heterogeneous tumor microenvironments.
- Predicting recurrent metastatic brain tumors after gamma-knife radiosurgery (GKRS) is crucial for patient management.
Purpose of the Study:
- To determine the optimal advanced MR imaging protocol for predicting recurrent metastatic brain tumors post-GKRS.
- To compare the efficacy of different MR perfusion methods when added to diffusion-weighted imaging (DWI).
Main Methods:
- Seventy-two patients with post-GKRS metastatic brain tumors were analyzed.
- Normalized cerebral blood volume (nCBV) from dynamic susceptibility contrast (DSC) and initial area under the curve (IAUC) from DCE imaging were calculated.
- Area under the receiver operating characteristic curve (AUC) and interreader agreement were assessed.
Main Results:
- Adding DCE imaging to DWI significantly improved AUC for differentiating tumor recurrence (0.79-0.95 for reader 1, 0.80-0.96 for reader 2).
- No significant difference in AUC was observed between DWI combined with DSC versus DWI combined with DCE.
- DWI and DCE combination achieved high sensitivity (86.7-90.0%) and specificity (85.7-88.1%).
Conclusions:
- Perfusion MR imaging, when added to DWI, substantially enhances the prediction of recurrent metastatic tumors.
- The diagnostic performance for predicting recurrence is not significantly influenced by the choice between DSC and DCE MR perfusion techniques.
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