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Diagnostic Performance of Fast Brain MRI Compared with Routine Clinical MRI in Patients with Glioma Grades 3 and 4: A
Francesca De Luca1,2, Annika Suneson3, Annika Kits4,3
1From the Department of Clinical Neuroscience (F.D.L., A.K., S.S., A.F.D.), Karolinska Institutet, Stockholm, Sweden francesca.de.luca@ki.se.
Background And Purpose:
EPIMix is a fast brain MRI technique not previously investigated in patients with grade 3 and 4 gliomas. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with grade 3 and 4 gliomas compared with routine clinical MRI (rcMRI).
Materials And Methods:
Patients with grade 3 and 4 gliomas investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1-R3) participated in the radiological assessment applying the Response Assessment for Neuro-Oncology (RANO 2.0) criteria, of whom two (R1 and R2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrast-enhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix versus rcMRI) were performed using the weighted Cohen κ. The sensitivity and specificity to progressive disease (PD) on a follow-up scan were calculated for EPIMix compared with rcMRI with receiver operating characteristic curves (ROC) to assess the area under the curve (AUC).
Results:
Of 35 patients (mean age, 53 years; 31% women), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at a blinded reading in 33% of EPIMix (19/58, R1-2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 versus rcMRIR1 κ = 0.96; EPIMixR2 versus rcMRIR2 κ = 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81-1.00) for R1 and 0.90 (0.68-0.99) for R2, while the specificity was 0.97 (0.86-1.00) for R1 and R2. The AUC for PD was 0.99 for R1 (EPIMixR1 versus rcMRIR1) and 0.94 for R2 (EPIMixR2 versus rcMRIR2). The P value of the DeLong test AUCR1 versus AUCR2 was P = .20 (R1-R2).
Conclusions:
In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high but slightly lower diagnostic performance than rcMRI.
Insights
This pilot study shows that fast brain MRI (EPIMix) is a viable alternative for evaluating treatment response in high-grade gliomas. EPIMix demonstrated high diagnostic performance, comparable to routine clinical MRI, for detecting progressive disease.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- High-grade gliomas (grades 3 and 4) require accurate treatment monitoring.
- Routine clinical MRI (rcMRI) is standard for radiological treatment evaluation.
- EPIMix is a fast MRI technique not previously studied in this patient group.
Purpose of the Study:
- To assess the diagnostic performance of EPIMix in treatment evaluation for adult patients with grade 3 and 4 gliomas.
- To compare EPIMix directly against routine clinical MRI (rcMRI).
Main Methods:
- Retrospective study including patients with grade 3 and 4 gliomas who underwent both rcMRI and EPIMix.
- Three radiologists assessed tumor response using Response Assessment for Neuro-Oncology (RANO 2.0) criteria.
- Inter-reader agreement and diagnostic performance (sensitivity, specificity, AUC) were calculated for EPIMix versus rcMRI.
Main Results:
- EPIMix showed almost perfect agreement with rcMRI for tumor category assessment (κ = 0.96 for R1, 0.89 for R2).
- High sensitivity (0.90-1.00) and specificity (0.97) for detecting progressive disease (PD) were observed with EPIMix.
- Area under the curve (AUC) for PD detection was high for EPIMix (0.99 for R1, 0.94 for R2).
Conclusions:
- EPIMix is a promising fast MRI technique for treatment evaluation in high-grade gliomas.
- EPIMix offers high diagnostic performance, slightly lower than rcMRI, but as a faster alternative.
