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Parametric Response Mapping of FLAIR MRI Provides an Early Indication of Progression Risk in Glioblastoma
Benjamin A Hoff1, Benjamin Lemasson2, Thomas L Chenevert1
1Department of Radiology, the Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan.
Rationale And Objectives:
Glioblastoma image evaluation utilizes Magnetic Resonance Imaging contrast-enhanced, T1-weighted, and noncontrast T2-weighted fluid-attenuated inversion recovery (FLAIR) acquisitions. Disease progression assessment relies on changes in tumor diameter, which correlate poorly with survival. To improve treatment monitoring in glioblastoma, we investigated serial voxel-wise comparison of anatomically-aligned FLAIR signal as an early predictor of GBM progression.
Materials And Methods:
We analyzed longitudinal normalized FLAIR images (rFLAIR) from 52 subjects using voxel-wise Parametric Response Mapping (PRM) to monitor volume fractions of increased (PRMrFLAIR+), decreased (PRMrFLAIR-), or unchanged (PRMrFLAIR0) rFLAIR intensity. We determined response by rFLAIR between pretreatment and 10 weeks posttreatment. Risk of disease progression in a subset of subjects (N = 26) with stable disease or partial response as defined by Response Assessment in Neuro-Oncology (RANO) criteria was assessed by PRMrFLAIR between weeks 10 and 20 and continuously until the PRMrFLAIR+ exceeded a defined threshold. RANO defined criteria were compared with PRM-derived outcomes for tumor progression detection.
Results:
Patient stratification for progression-free survival (PFS) and overall survival (OS) was achieved at week 10 using RANO criteria (PFS: p <0.0001; OS: p <0.0001), relative change in FLAIR-hyperintense volume (PFS: p = 0.0011; OS: p <0.0001), and PRMrFLAIR+ (PFS: p <0.01; OS: p <0.001). PRMrFLAIR+ also stratified responding patients' progression between weeks 10 and 20 (PFS: p <0.05; OS: p = 0.01) while changes in FLAIR-volume measurements were not predictive. As a continuous evaluation, PRMrFLAIR+ exceeding 10% stratified patients for PFA after 5.6 months (p<0.0001), while RANO criteria did not stratify patients until 15.4 months (p <0.0001).
Conclusion:
PRMrFLAIR may provide an early biomarker of disease progression in glioblastoma.
Insights
Parametric Response Mapping (PRM) of fluid-attenuated inversion recovery (FLAIR) images offers an early biomarker for glioblastoma (GBM) progression. This novel imaging analysis method improves upon traditional tumor diameter measurements for predicting patient survival.
Area of Science:
- Neuro-oncology
- Radiology
- Medical Imaging Analysis
Background:
- Glioblastoma (GBM) diagnosis and treatment monitoring traditionally rely on Magnetic Resonance Imaging (MRI) metrics like tumor diameter, which show poor correlation with survival outcomes.
- Assessing disease progression in GBM is challenging, necessitating improved methods for early detection and treatment response evaluation.
Purpose of the Study:
- To investigate the utility of serial voxel-wise comparison of anatomically-aligned FLAIR signal using Parametric Response Mapping (PRM) as an early predictor of GBM progression.
- To compare the efficacy of PRM-derived outcomes with Response Assessment in Neuro-Oncology (RANO) criteria for detecting tumor progression and stratifying patient survival.
Main Methods:
- Longitudinal normalized FLAIR (rFLAIR) images from 52 subjects were analyzed using voxel-wise PRM to quantify volume fractions of increased (PRMrFLAIR+), decreased (PRMrFLAIR-), and unchanged (PRMrFLAIR0) rFLAIR intensity.
- Response was determined between pre-treatment and 10-week post-treatment scans. Disease progression risk was assessed in a subset (N=26) between weeks 10-20 and continuously until PRMrFLAIR+ exceeded a threshold.
- PRM-derived outcomes were compared against RANO criteria for tumor progression detection and patient survival stratification.
Main Results:
- PRMrFLAIR+ significantly stratified patients for progression-free survival (PFS) and overall survival (OS) at week 10 (PFS: p <0.01; OS: p <0.001), outperforming changes in FLAIR-hyperintense volume.
- PRMrFLAIR+ also stratified progression between weeks 10 and 20 (PFS: p <0.05; OS: p = 0.01), whereas FLAIR-volume changes were not predictive.
- Continuous PRMrFLAIR+ evaluation exceeding 10% stratified patients for progression-free survival (PFA) significantly earlier (5.6 months) compared to RANO criteria (15.4 months).
Conclusions:
- Parametric Response Mapping (PRM) of FLAIR images demonstrates potential as an early and sensitive biomarker for glioblastoma disease progression.
- PRMrFLAIR offers a more effective method for early treatment monitoring and patient stratification compared to traditional RANO criteria and volumetric measurements.
- This imaging analysis technique may significantly improve clinical decision-making and patient management in glioblastoma.
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