1. Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma
- Author
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Saba Rahimi, Benjamin M. Ellingson, Julia Keith, Angus Z. Lau, Chris Heyn, Sten Myrehaug, Hany Soliman, David G. Munoz, Shadi Daghighi, Chia-Lin Tseng, Greg J. Stanisz, Pejman Jabehdar Maralani, Arjun Sahgal, Jay Detsky, Eshetu G. Atenafu, Hatef Mehrabian, Sunit Das, James Perry, Nir Lipsman, Aimee K.M. Chan, John Conklin, and Max Wintermark
- Subjects
Oncology ,medicine.medical_specialty ,Survival ,medicine.medical_treatment ,Intravoxel incoherent motion imaging ,Article ,Diffusion MRI ,030218 nuclear medicine & medical imaging ,Motion ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Effective diffusion coefficient ,Radiology, Nuclear Medicine and imaging ,Progression-free survival ,Intravoxel incoherent motion ,Radiotherapy ,business.industry ,Chemoradiotherapy ,Hematology ,Odds ratio ,medicine.disease ,Magnetic Resonance Imaging ,Progression-free Survival ,Radiation therapy ,Diffusion Magnetic Resonance Imaging ,030220 oncology & carcinogenesis ,Glioblastoma ,business ,Perfusion - Abstract
Background Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome. Methods 38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADCT1C, ADCT2-FLAIR) and perfusion fraction (fT1C, fT2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated. Results Higher ADCT2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95% CI 1.01–1.15, p = 0.025], lower fT2-FLAIR at fraction 10 (OR = 2.11, 95% CI 1.04–4.27, p = 0.018), and lack of increase in ADCT2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95% CI 1.02–1.22, p = 0.02) were associated with early progression. Combining ADCT2-FLAIR at baseline, fT2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher fT2-FLAIR at fraction 10 (HR = 0.72, 95% CI 0.56–0.95, p = 0.018) was associated with longer PFS. Conclusion ADCT2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or fT2-FLAIR at fraction 10 significantly predicted early progression. fT2-FLAIR at fraction 10 was associated with PFS.
- Published
- 2021