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Published on: August 18, 2016
Fractional tumor burden maps increase the confidence of reading brain MR perfusion
Siem D A Herings1, Marte W van der Wijk1, Victoria von Beckerath2
1Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Center of Expertise Neuro-Oncology, Nijmegen, The Netherlands.
Rationale And Objectives:
Various methods exist to perform and post-process perfusion weighted MR imaging in the post-treatment imaging of glioma patients to differentiate tumor progression from tumor-related abnormalities. One of these post-processing methods produces 'fractional tumor burden' maps. This multi-reader study investigated the clinical feasibility of fractional tumor burden maps on real world data from radiological follow-up of high-grade astrocytoma patients.
Methods:
Five readers with background in radiology and varying levels of experience were tasked with assessing 30 astrocytoma and glioblastoma patients during one reader session. First, they were provided with a dataset of conventional MRI sequences, including perfusion MRI with regional cerebral blood volume maps. Then the dataset was expanded with a corresponding fractional tumor burden maps. Diagnostic accuracy, duration of post-processing, duration of the assessment of the fractional tumor burden maps, the diagnostic confidence reported by the readers and their diagnoses were recorded. Final diagnosis was determined by clinical and radiological follow-up and/or histopathological data used as gold standard.
Results:
A mean sensitivity of 83.3 % and mean specificity of 55.1 % was obtained without the use of fractional tumor burden maps, whereas their additional of fractional tumor burden maps resulted in a mean sensitivity and specificity of 79.5 % and 54.2 %, respectively. Diagnostic accuracies with and without fractional tumor burden maps were not significantly different (Z = 0.76, p = 0.450). The median time spent post-processing was 313 s, while the median duration of the assessment of the FTB maps was 19 s. Interestingly, reader confidence increased significantly after adding the fractional tumor burden-maps to the assessment (Z = 454, p < 0.01).
Conclusions:
While the use of fractional tumor burden maps does not carry additional value in the radiological follow-up of post-operative high-grade astrocytoma and glioblastoma patients, it does give readers more confidence in their diagnosis.
Insights
Fractional tumor burden maps did not improve diagnostic accuracy for glioma patients but significantly increased reader confidence. This study assessed their clinical feasibility in radiological follow-up.
Area of Science:
- Neuroradiology
- Oncology
- Medical Imaging
Background:
- Differentiating tumor progression from treatment-related abnormalities in glioma patients post-treatment is crucial.
- Perfusion-weighted MRI (PWI) and its post-processing methods, like fractional tumor burden (FTB) maps, are used for this assessment.
Purpose of the Study:
- To investigate the clinical feasibility of FTB maps in the radiological follow-up of high-grade astrocytoma and glioblastoma patients.
- To evaluate the impact of FTB maps on diagnostic accuracy, reader confidence, and assessment time.
Main Methods:
- Five radiologists assessed 30 astrocytoma and glioblastoma patients using conventional MRI and PWI with regional cerebral blood volume maps.
- The dataset was subsequently augmented with FTB maps for a second assessment.
- Diagnostic accuracy, post-processing time, FTB map assessment duration, and reader confidence were recorded.
Main Results:
- No significant difference in diagnostic accuracy was found with or without FTB maps (p=0.450).
- Reader confidence significantly increased after incorporating FTB maps (p<0.01).
- The median time for FTB map assessment was only 19 seconds.
Conclusions:
- FTB maps do not offer additional diagnostic value for the radiological follow-up of post-operative high-grade astrocytoma and glioblastoma.
- However, FTB maps enhance reader confidence in their diagnostic assessments.
