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Published on: December 28, 2017
Tensor-Valued Diffusion MRI for Microstructural Assessment During Stereotactic Radiotherapy of Brain Metastases: A
Minna Lerner1,2, Patrik Brynolfsson1,2,3, Filip Szczepankiewicz4
1Department of Translational Medicine, Medical Radiation Physics, Lund University, Skåne University Hospital Malmö, SE-205 02 Malmö, Sweden.
Objectives:
Early identification of treatment response in brain metastases remains clinically challenging. This study explores tensor-valued diffusion MRI (dMRI), specifically q-space trajectory imaging (QTI), as a novel source of early imaging biomarkers during stereotactic radiotherapy (SRT).
Methods:
Twenty-six patients with brain metastases were enrolled; thirteen met quality and completeness criteria for QTI analysis (10 responders, three non-responders). MRI was acquired at four time points: before SRT, before final SRT fraction, and at 3 and 6 months post-SRT. QTI-derived metrics included mean diffusivity (MD), fractional anisotropy (FA), microscopic FA (µFA), and isotropic (MKI) and anisotropic (MKA) diffusional variance. Parameter values within the tumour volume were compared pre- and during SRT and correlated with treatment response from standard MRI follow-up. Overall survival was assessed using Kaplan-Meier analysis.
Results:
Median survival was 12 months. QTI analysis was feasible with visible changes in the tumour tissue parameter maps over time. Statistically significant differences (p < 0.05) were found between responders and non-responders in FA before treatment. MKI in responders was significantly lower (p < 0.05) during SRT than before.
Conclusions:
This study presents a first exploration of QTI-derived parameters in a cohort of patients with brain metastases. We demonstrate feasibility and a scalable workflow, supporting further investigation in larger cohorts and in patients with larger or more stable lesions.
