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Published on: December 28, 2017
Microvascular Perfusion MRI Improves Therapy Monitoring and Detects Early Recurrences of Gliomas: A Large-Scale Trial
Andreas Stadlbauer1,2,3, Katarina Nikolic4,5, Franz Marhold4,6
1From the Institute of Medical Radiology (A.S., K.N., F.M., A.Ö., G.H., S.O.), Karl Landsteiner University of Health Sciences, Krems, Austria andi@nmr.at.
Background And Purpose:
Detecting glioma recurrence is fundamental for clinical patient outcomes; however, conventional MRI (cMRI) techniques may be limited, leading to diagnostic uncertainty relevant for therapeutic intervention. This study aimed to evaluate whether a microvascular perfusion (µPerf) imaging technique based on spin-echo DSC perfusion MRI could support the early detection of glioma recurrence compared with cMRI by characterizing subtle vascular changes preceding macroscopic tumor growth.
Materials And Methods:
A total of 351 patients with gliomas who underwent 2003 follow-up MRI examinations were retrospectively evaluated, with 422 of these examinations subjected to detailed quantitative analysis. The standard cMRI protocol was extended by applying the µPerf approach, with an additional 2 minutes for data acquisition. Custom-made Matlab software was used to generate imaging biomarker maps for microvascular CBV and microvascular type indicator. The clinical utility of µPerf was assessed by comparing its findings with radiologic interpretations of cMRI data, which were reviewed in consensus by at least 2 board-certified radiologists. Statistical analyses included the calculation of diagnostic performance metrics and the area under the receiver operating characteristic curve (AUROC) to evaluate glioma recurrence detection.
Results:
The µPerf technique exhibited superior diagnostic performance, achieving an accuracy of 97.4% and AUROC values of 0.987 (95% CI, 0.976-0.999) for microvascular type indicator and 0.982 (95% CI, 0.965-0.998) for microvascular CBV, significantly surpassing cMRI (accuracy: 85.1%; AUROC: 0.941; 95% CI, 0.918-0.965 for CBV). µPerf identified glioma recurrence earlier than cMRI in 13.5% of cases, with the time interval ranging from 41 to 353 days (mean, 137 days). During this time, tumor volume increased by 38% to as much as 155-fold (mean, 9.1-fold). Notably, early recurrences of high-grade malignant gliomas were predominantly characterized by microvascular changes compared with later-stage recurrences.
Conclusions:
µPerf improves early detection of glioma recurrence and shows a higher sensitivity of microvascular changes compared with cMRI. µPerf has significant potential to promote more timely and personalized treatment strategies, which, in turn, could improve patient outcomes. Notably, µPerf works with standard clinical follow-up protocols, but its integration into clinical practice requires further validation through multicenter studies and long-term outcome analyses.
Insights
Microvascular perfusion (µPerf) MRI detects glioma recurrence earlier and more accurately than conventional MRI (cMRI). This advanced technique identifies subtle vascular changes, improving patient treatment strategies and outcomes.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- Detecting glioma recurrence is critical for patient outcomes but often limited by conventional MRI (cMRI) techniques.
- Diagnostic uncertainty in glioma recurrence impacts therapeutic intervention decisions.
- Subtle vascular changes preceding macroscopic tumor growth are key indicators of early recurrence.
Purpose of the Study:
- To evaluate the efficacy of a microvascular perfusion (µPerf) imaging technique in detecting glioma recurrence.
- To compare the diagnostic performance of µPerf with conventional MRI (cMRI) for early glioma recurrence detection.
- To characterize subtle vascular changes indicative of early glioma recurrence using µPerf.
Main Methods:
- Retrospective analysis of 351 patients with gliomas, with 422 follow-up MRI examinations undergoing quantitative analysis.
- Standard cMRI protocol augmented with a 2-minute µPerf acquisition using spin-echo DSC perfusion MRI.
- Generation of microvascular cerebral blood volume (CBV) and type indicator maps using custom Matlab software.
- Comparison of µPerf findings with consensus radiologic interpretations of cMRI data by board-certified radiologists.
- Statistical analysis including diagnostic performance metrics and AUROC for recurrence detection.
Main Results:
- µPerf demonstrated superior diagnostic performance with 97.4% accuracy and AUROC values of 0.987 (type indicator) and 0.982 (CBV), significantly outperforming cMRI (85.1% accuracy, 0.941 AUROC).
- µPerf identified glioma recurrence 41-353 days earlier than cMRI in 13.5% of cases, with a mean lead time of 137 days.
- Early recurrences, particularly in high-grade gliomas, were primarily characterized by microvascular changes detected by µPerf.
Conclusions:
- µPerf significantly improves the early detection of glioma recurrence compared to cMRI, showing higher sensitivity to microvascular changes.
- The technique holds potential for more timely and personalized treatment strategies, potentially improving patient outcomes.
- Further validation through multicenter studies and long-term outcome analyses is required for clinical integration.
