Early posttreatment assessment of MRI perfusion biomarkers can predict long-term response of lung cancer brain metastases to stereotactic radiosurgery

Taunk, Neil K.; Oh, Jung Hun; Shukla–Dave, Amita; Beal, Kathryn; Vachha, Behroze; Holodny, Andrei I.; Hatzoglou, Vaios

doi:10.1093/neuonc/nox159

Cited by 30 publications

(33 citation statements)

References 37 publications

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“…On the contrary, Winter et al [36] found significant decreases in v e at 20 days post stereotactic radiosurgery for brain metastases. Furthermore, most studies do not find a significant change in v e following therapy [34][35][36]39,41]. These variable results may be due to the long scan times required for precise measurement of v e [5,46].…”

Section: Discussionmentioning

confidence: 99%

“…A recent early stage breast cancer study [13] found significant increases in the initial area under an enhancement curve for the entire GTV at one-week post-single dose SABR. However, when assessing response at later times (>1month) in other cancer sites, decreases in K trans were associated with pathologically complete response [39][40][41]. Two of these reports [39,41] also indicated that decreases in rK trans was indicative of response.…”

Section: Discussionmentioning

confidence: 99%

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DCE-MRI assessment of response to neoadjuvant SABR in early stage breast cancer: Comparisons of single versus three fraction schemes and two different imaging time delays post-SABR

Mouawad

Biernaski

Brackstone

et al. 2020

Clinical and Translational Radiation Oncology

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To determine the effect of dose fractionation and time delay post-neoadjuvant stereotactic ablative radiotherapy (SABR) on dynamic contrast-enhanced (DCE)-MRI parameters in early stage breast cancer patients. Materials and methods: DCE-MRI was acquired in 17 patients pre-and post-SABR. Five patients were imaged 6-7 days post-21 Gy/1fraction (group 1), six 16-19 days post-21 Gy/1fraction (group 2), and six 16-18 days post-30 Gy/3 fractions every other day (group 3). DCE-MRI scans were performed using half the clinical dose of contrast agent. Changes in the surrounding tissue were quantified using a signalenhancement threshold metric that characterizes changes in signal-enhancement volume (SEV). Tumour response was quantified using K trans and v e (Tofts model) pre-and post-SABR. Significance was assessed using a Wilcoxin signed-rank test. Results: All group 1 and 4/6 group 2 patients' SEV increased post-SABR. All group 3 patients' SEV decreased. The mean K trans increased for group 1 by 76% (p = 0.043) while group 2 and 3 decreased 15% (p = 0.028) and 34% (p = 0.028), respectively. For v e , there was no significant change in Group 1 (p = 0.35). Groups 2 showed an increase of 24% (p = 0.043), and Group 3 trended toward an increase (23%, p = 0.08). Conclusion: Kinetic parameters measured 2.5 weeks post-SABR in both single fraction and three fraction groups were indicative of response but only the single fraction protocol led to enhancement in the surrounding tissue. Our results also suggest that DCE-MRI one-week post-SABR may be too early for response assessment, at least for single fraction SABR, whereas 2.5 weeks appears sufficiently long to minimize confounding acute effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

DCE-MRI assessment of response to neoadjuvant SABR in early stage breast cancer: Comparisons of single versus three fraction schemes and two different imaging time delays post-SABR

Mouawad

Biernaski

Brackstone

et al. 2020

Clinical and Translational Radiation Oncology

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“…v e and K trans are derived from DCE-MRI, which has been extensively utilized to evaluate brain tumors. 9,19,20,[30][31][32] For example, Taunk et al found that post-SRS K trans standard deviation within 12 weeks of treatment was a significant predictive biomarker for lung cancer brain metastases. Almeida-Freitas et al found that an increase of 15% in K trans 4-8 weeks after SRS was predictive of tumor progression.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, early apoptotic changes may precede tumor shrinkage; these changes cannot be assessed with conventional imaging and typically require follow-up over months to years. 5 Multiple studies have assessed the predictive capabilities of conventional and advanced MRI features weeks to months after SRS [5][6][7][8][9] with mixed results using mainly retrospective analysis. Advanced MRI hours after treatment may better predict long-term treatment response.…”

Section: Introductionmentioning

confidence: 99%

Diffusion and Perfusion MRI Predicts Response Preceding and Shortly After Radiosurgery to Brain Metastases: A Pilot Study

Shah

Konar

Paudyal

et al. 2020

Journal of Neuroimaging

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To determine the ability of diffusion-weighted imaging (DWI) and dynamic contrastenhanced magnetic resonance imaging (DCE-MRI) to predict long-term response of brain metastases prior to and within 72 hours of stereotactic radiosurgery (SRS). METHODS: In this prospective pilot study, multiple b-value DWI and T1-weighted DCE-MRI were performed in patients with brain metastases before and within 72 hours following SRS. Diffusion-weighted images were analyzed using the monoexponential and intravoxel incoherent motion (IVIM) models. DCE-MRI data were analyzed using the extended Tofts pharmacokinetic model. The parameters obtained with these methods were correlated with brain metastasis outcomes according to modified Response Assessment in Neuro-Oncology Brain Metastases criteria. RESULTS: We included 25 lesions from 16 patients; 16 patients underwent pre-SRS MRI and 12 of 16 patients underwent both pre-and early (within 72 hours) post-SRS MRI. The perfusion fraction (f) derived from IVIM early post-SRS was higher in lesions demonstrating progressive disease than in lesions demonstrating stable disease, partial response, or complete response (q = .041). Pre-SRS extracellular extravascular volume fraction, v e , and volume transfer coefficient, K trans , derived from DCE-MRI were higher in nonresponders versus responders (q = .041). CONCLUSIONS: Quantitative DWI and DCE-MRI are feasible imaging methods in the pre-and early (within 72 hours) post-SRS evaluation of brain metastases. DWI-and DCE-MRI-derived parameters demonstrated physiologic changes (tumor cellularity and vascularity) and offer potentially useful biomarkers that can predict treatment response. This allows for initiation of alternate therapies within an effective time window that may help prevent disease progression.

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“…Previous work showed that a DCE-MRI permeability decrease within brain metastases at 1 week post-SRS was predictive of treatment response [ 7 ], although differences in permeability quantification make direct comparisons with the cited study challenging. Another study, investigating predictive value of DCE-MRI metrics < 12 weeks post-SRS, demonstrated decreased K trans and v e measures post-SRS in non-progressing metastases, although their key result was demonstrating predictive value of post-contrast K trans standard deviation for distinguishing progressing versus non-progressing metastases [ 20 ]. Both increases [ 21 ] and decreases [ 7 ] in DSC measures of rCBV have been observed in progressive disease versus non-progressive disease after 4–6 weeks post-RT.…”

Section: Discussionmentioning

confidence: 99%

Detectability of radiation-induced changes in magnetic resonance biomarkers following stereotactic radiosurgery: A pilot study

et al. 2018

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Our objective was to investigate direct voxel-wise relationship between dose and early MR biomarker changes both within and in the high-dose region surrounding brain metastases following stereotactic radiosurgery (SRS). Specifically, we examined the apparent diffusion coefficient (ADC) from diffusion-weighted imaging and the contrast transfer coefficient (Ktrans) and volume of extracellular extravascular space (ve) derived from dynamic contrast-enhanced (DCE) MRI data. We investigated 29 brain metastases in 18 patients using 3 T MRI to collect imaging data at day 0, day 3 and day 20 following SRS. The ADC maps were generated by the scanner and Ktrans and ve maps were generated using in-house software for dynamic tracer-kinetic analysis. To enable spatially-correlated voxel-wise analysis, we developed a registration pipeline to register all ADC, Ktrans and ve maps to the planning MRI scan. To interrogate longitudinal changes, we computed absolute ΔADC, ΔKtrans and Δve for day 3 and 20 post-SRS relative to day 0. We performed a Kruskall-Wallice test on each biomarker between time points and investigated dose correlations within the gross tumour volume (GTV) and surrounding high dose region > 12 Gy via Spearman’s rho. Only ve exhibited significant differences between day 0 and 20 (p < 0.005) and day 3 and 20 (p < 0.05) within the GTV following SRS. Strongest dose correlations were observed for ADC within the GTV (rho = 0.17 to 0.20) and weak correlations were observed for ADC and Ktrans in the surrounding > 12 Gy region. Both ΔKtrans and Δve showed a trend with dose at day 20 within the GTV and > 12 Gy region (rho = -0.04 to -0.16). Weak dose-related decreases in Ktrans and ve within the GTV and high dose region at day 20 most likely reflect underlying vascular responses to radiation. Our study also provides a voxel-wise analysis schema for future MR biomarker studies with the goal of elucidating surrogates for radionecrosis.

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Early posttreatment assessment of MRI perfusion biomarkers can predict long-term response of lung cancer brain metastases to stereotactic radiosurgery

Cited by 30 publications

References 37 publications

DCE-MRI assessment of response to neoadjuvant SABR in early stage breast cancer: Comparisons of single versus three fraction schemes and two different imaging time delays post-SABR

DCE-MRI assessment of response to neoadjuvant SABR in early stage breast cancer: Comparisons of single versus three fraction schemes and two different imaging time delays post-SABR

Diffusion and Perfusion MRI Predicts Response Preceding and Shortly After Radiosurgery to Brain Metastases: A Pilot Study

Detectability of radiation-induced changes in magnetic resonance biomarkers following stereotactic radiosurgery: A pilot study

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