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- Title
Early response assessment of glioma patients to definitive chemoradiotherapy using chemical exchange saturation transfer imaging at 7 T.
- Authors
Meissner, Jan‐Eric; Korzowski, Andreas; Regnery, Sebastian; Goerke, Steffen; Breitling, Johannes; Floca, Ralf Omar; Debus, Jürgen; Schlemmer, Heinz‐Peter; Ladd, Mark Edward; Bachert, Peter; Adeberg, Sebastian; Paech, Daniel; Meissner, Jan-Eric; Schlemmer, Heinz-Peter
- Abstract
<bold>Background: </bold>Patients with newly diagnosed inoperable glioma receive chemoradiotherapy (CRT). Standard Response Assessment in Neuro-Oncology (RANO) takes a minimum of 4 weeks after the end of treatment.<bold>Purpose/hypothesis: </bold>To investigate whether chemical exchange saturation transfer (CEST) MRI enables earlier assessment of response to CRT in glioma patients.<bold>Study Type: </bold>Longitudinal prospective study.<bold>Population: </bold>Twelve brain tumor patients who underwent definitive CRT were included in this study. Three longitudinal CEST MRI measurements were performed for each patient at 7T: first before, second immediately after completion of CRT, and a third measurement as a 6-week follow-up.<bold>Field Strength/sequence: </bold>Conventional MRI (contrast-enhanced, T2 w and diffusion-weighted imaging) at 3T and T2 w and CEST MRI at 7T was performed for all patients.<bold>Assessment: </bold>The mean relaxation-compensated relayed nuclear-Overhauser-effect CEST signal (rNOE) and the mean downfield-rNOE-suppressed amide proton transfer (dns-APT) CEST signal were investigated. Additionally, choline-to-N-acetyl-aspartate ratios (Cho/NAA) were evaluated using single-voxel 1 H-MRS in six of these patients. Performance of obtained contrasts was analyzed in assessing treatment response as classified according to the updated RANO criteria.<bold>Statistical Test: </bold>Unpaired Student's t-test.<bold>Results: </bold>The rNOE signal significantly separated stable and progressive disease directly after the end of therapy (post-treatment normalized to pre-treatment mean ± SD: rNOEresponder = 1.090 ± 0.110, rNOEnon-responder = 0.808 ± 0.155, P = 0.015). In contrast, no significant difference was observed between either group when assessing the normalized dns-APT (dns-APTresponder = 0.953 ± 0.384, dns-APTnon-responder = 0.972 ± 0.477, P = 0.95). In the smaller MRS subcohort, normalized Cho/NAA decreased in therapy responders (Cho/NAAresponder = 0.632 ± 0.007, Cho/NAAnon-responder = 0.946 ± 0.124, P = 0.070). DATA CONCLUSION: rNOE mediated CEST imaging at 7T allowed for discrimination of responders and non-responders immediately after the end of CRT, additionally supported by 1 H-MRS data. This is at least 4 weeks earlier than the standard clinical evaluation according to RANO. Therefore, CEST MRI may enable early response assessment in glioma patients.<bold>Level Of Evidence: </bold>1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:1268-1277.
- Subjects
MAGNETIZATION transfer; CHEMORADIOTHERAPY; DIFFUSION magnetic resonance imaging; BRAIN tumors; GLIOMAS; COMPUTERS in medicine; BRAIN; MAGNETIC resonance imaging; CONTRAST media; DIAGNOSTIC imaging; TREATMENT effectiveness; LONGITUDINAL method
- Publication
Journal of Magnetic Resonance Imaging, 2019, Vol 50, Issue 4, p1268
- ISSN
1053-1807
- Publication type
journal article
- DOI
10.1002/jmri.26702