Identification of a candidate biomarker from perfusion MRI to anticipate glioblastoma progression after chemoradiation

• Published in: European radiology Vol. 26; no. 11; pp. 4194 - 4203
• Main Authors: Khalifa, J., Tensaouti, F., Chaltiel, L., Lotterie, J.-A., Catalaa, I., Sunyach, M. P., Ibarrola, D., Noël, G., Truc, G., Walker, P., Magné, N., Charissoux, M., Ken, S., Peran, P., Berry, I., Moyal, E. Cohen-Jonathan, Laprie, A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2016; Springer Nature B.V; Springer Verlag
• Subjects: Adult; Aged; Bioengineering; Biomarkers; Biomarkers - metabolism; Blood; Blood Volume; Brain cancer; Brain Neoplasms - pathology; Brain Neoplasms - physiopathology; Brain Neoplasms - therapy; Chemoradiotherapy - methods; Contrast Media; Diagnostic Radiology; Disease Progression; Female; Glioblastoma - pathology; Glioblastoma - physiopathology; Glioblastoma - therapy; Humans; Imaging; Internal Medicine; Interventional Radiology; Life Sciences; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - pathology; Neuro; Neuroradiology; Nuclear medicine; Oncology; Prospective Studies; Radiation; Radiology; ROC Curve; Ultrasound; France; rCBV; Biomarker; Perfusion weighted magnetic resonance imaging; Radiotherapy; Glioblastoma; Brain-Tumor Recurrence; Contrast-Enhanced Mr; Radiation-Injury; Adc Histogram Analysis; Imaging Biomarker; High-Grade Gliomas; Cerebral Blood-Volume; True Progression; Apparent Diffusion-Coefficient; Bevacizumab Treatment
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-016-4234-5

Objective
To identify relevant relative cerebral blood volume biomarkers from T2* dynamic-susceptibility contrast magnetic resonance imaging to anticipate glioblastoma progression after chemoradiation.
Methods
Twenty-five patients from a prospective study with glioblastoma, primarily treated by chemoradiation, were included. According to the last follow-up MRI confirmed status, patients were divided into: relapse group (n = 13) and control group (n = 12). The time of last MR acquisition was t
end
; MR acquisitions performed at t
end-2M
, t
end-4M
and t
end-6M
(respectively 2, 4 and 6 months before t
end
) were analyzed to extract relevant variations among eleven perfusion biomarkers (B). These variations were assessed through R(B), as the absolute value of the ratio between ∆B from t
end-4M
to t
end-2M
and ∆B from t
end-6M
to t
end-4M
. The optimal cut-off for R(B) was determined using receiver-operating-characteristic curve analysis.
Results
The fraction of hypoperfused tumor volume (F_hP
g
) was a relevant biomarker. A ratio R(F_hP
g
) ≥ 0.61 would have been able to anticipate relapse at the next follow-up with a sensitivity/specificity/accuracy of 92.3 %/63.6 %/79.2 %. High R(F_hPg) (≥0.61) was associated with more relapse at t
end
compared to low R(F_hPg) (75 % vs 12.5 %, p = 0.008).
Conclusion
Iterative analysis of F_hP
g
from consecutive examinations could provide surrogate markers to predict progression at the next follow-up.
Key Points
•
Related rCBV biomarkers from DSC were assessed to anticipate GBM progression.
•
Biomarkers were assessed through their patterns of variation during the follow-up.
•
The fraction of hypoperfused tumour volume (F_hP
g
) seemed to be a relevant biomarker.
•
An innovative ratio R(F_hP
g
) could be an early surrogate marker of relapse.
•
A significant time gain could be achieved in the management of GBM patients.