A pilot study evaluating the use of dynamic contrast-enhanced perfusion MRI to predict local recurrence after radiosurgery on spinal metastases Journal Article


Authors: Kumar, K. A.; Peck, K. K.; Karimi, S.; Lis, E.; Holodny, A. I.; Bilsky, M. H.; Yamada, Y.
Article Title: A pilot study evaluating the use of dynamic contrast-enhanced perfusion MRI to predict local recurrence after radiosurgery on spinal metastases
Abstract: Purpose: Dynamic contrast-enhanced magnetic resonance imaging offers noninvasive characterization of the vascular microenvironment and hemodynamics. Stereotactic radiosurgery, or stereotactic body radiation therapy, engages a vascular component of the tumor response which may be detectable using dynamic contrast-enhanced magnetic resonance imaging. The purpose of this study is to examine whether dynamic contrast-enhanced magnetic resonance imaging can be used to predict local tumor recurrence in patients with spinal bone metastases who undergo high-dose radiotherapy with stereotactic radiosurgery. Materials and Methods: We conducted a study of 30 patients with spinal metastases who underwent dynamic contrast-enhanced magnetic resonance imaging before and after radiotherapy. Twenty patients received single-fraction stereotactic radiosurgery (24 Gy), while 10 received hypofractionated stereotactic radiosurgery (3-5 fractions, 27-30 Gy total). Kaplan-Meier analysis was used to estimate the actuarial local recurrence rates. Two perfusion parameters (Ktrans: permeability and Vp: plasma volume) were measured for each metastasis. Percentage change in parameter values from pre- to posttreatment was calculated and compared. Results: At 20-month median follow-up, 5 of the 30 patients had pathological evidence of local recurrence. One- and 3-year actuarial local recurrence rates were 24% and 44% for the hypofractionated stereotactic radiosurgery cohort versus 5% and 16% for the single-fraction stereotactic radiosurgery cohort (P =.20). The average change in Vp and Ktrans for patients without local recurrence versus those with local recurrence was −76% and −66% versus +28% and −14% (P <.01 for both). With a cutoff point of −20%, Vp had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 98%, 91%, and 100%, respectively, for the detection of local recurrence following high-dose radiotherapy. Using this definition, dynamic contrast-enhanced magnetic resonance imaging identified local recurrence up to 18 months (mean [standard deviation], 6.6 [6.8] months) earlier than standard magnetic resonance imaging. Conclusions: We demonstrated that changes in perfusion parameters, particularly Vp, after high-dose radiotherapy to spinal bone metastases were predictive of local tumor recurrence. These changes predicted local recurrence on average >6 months earlier than standard imaging did. © The Author(s) 2017.
Keywords: adult; clinical article; aged; positron emission tomography; sensitivity and specificity; cohort analysis; retrospective study; pilot study; tumor recurrence; stereotactic radiosurgery; dynamic contrast-enhanced magnetic resonance imaging; dce-mri; predictive value; spinal cord metastasis; sbrt; receiver operating characteristic; srs; spine metastases; plasma volume; human; male; female; article; high-dose rt
Journal Title: Technology in Cancer Research & Treatment
Volume: 16
Issue: 6
ISSN: 1533-0346
Publisher: Sage Publications, Inc.  
Date Published: 2017-12-01
Start Page: 857
End Page: 865
Language: English
DOI: 10.1177/1533034617705715
PROVIDER: scopus
PMCID: PMC5762041
PUBMED: 28449626
DOI/URL:
Notes: Article -- Export Date: 1 February 2018 -- Source: Scopus
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MSK Authors
  1. Eric Lis
    130 Lis
  2. Yoshiya Yamada
    453 Yamada
  3. Mark H Bilsky
    303 Bilsky
  4. Sasan Karimi
    113 Karimi
  5. Kyung Peck
    109 Peck
  6. Andrei Holodny
    196 Holodny