A prospective trial of dynamic contrast-enhanced MRI perfusion and fluorine-18 FDG PET-CT in differentiating brain tumor progression from radiation injury after cranial irradiation Journal Article


Authors: Hatzoglou, V.; Yang, T. J.; Omuro, A.; Gavrilovic, I.; Ulaner, G.; Rubel, J.; Schneider, T.; Woo, K. M.; Zhang, Z.; Peck, K. K.; Beal, K.; Young, R. J.
Article Title: A prospective trial of dynamic contrast-enhanced MRI perfusion and fluorine-18 FDG PET-CT in differentiating brain tumor progression from radiation injury after cranial irradiation
Abstract: Background The aim of this study was to assess the effectiveness of fluorine-18 fluorodeoxyglucose (FDG) PET-CT and dynamic contrast-enhanced (DCE) MRI in differentiating tumor progression and radiation injury in patients with indeterminate enhancing lesions after radiation therapy (RT) for brain malignancies. Methods Patients with indeterminate enhancing brain lesions on conventional MRI after RT underwent brain DCE-MRI and PET-CT in a prospective trial. Informed consent was obtained. Lesion outcomes were determined by histopathology and/or clinical and imaging follow-up. Metrics obtained included plasma volume (Vp) and volume transfer coefficient (Ktrans) from DCE-MRI, and maximum standardized uptake value (SUVmax) from PET-CT; lesion-to-normal brain ratios of all metrics were calculated. The Wilcoxon rank sum test and receiver operating characteristic analysis were performed. Results The study included 53 patients (29 treated for 29 gliomas and 24 treated for 26 brain metastases). Progression was determined in 38/55 (69%) indeterminate lesions and radiation injury in 17 (31%). Vpratio (VP lesion/VP normal brain, P <. 001), Ktrans ratio (P =. 002), and SUVratio (P =. 002) correlated significantly with diagnosis of progression versus radiation injury. Progressing lesions exhibited higher values of all 3 metrics compared with radiation injury. Vpratio had the highest accuracy in determining progression (area under the curve = 0.87), with 92% sensitivity and 77% specificity using the optimal, retrospectively determined threshold of 2.1. When Vpratio was combined with Ktrans ratio (optimal threshold 3.6), accuracy increased to 94%. Conclusions Vpratio was the most effective metric for distinguishing progression from radiation injury. Adding Ktrans ratio to Vpratio further improved accuracy. DCE-MRI is an effective imaging technique for evaluating nonspecific enhancing intracranial lesions after RT. © 2015 The Author(s) 2015. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved.
Keywords: radiation injury; 18f-fdg pet-ct; dce mri perfusion
Journal Title: Neuro-Oncology
Volume: 18
Issue: 6
ISSN: 1522-8517
Publisher: Oxford University Press  
Date Published: 2016-06-01
Start Page: 873
End Page: 880
Language: English
DOI: 10.1093/neuonc/nov301
PROVIDER: scopus
PMCID: PMC4864262
PUBMED: 26688076
DOI/URL:
Notes: Article -- Export Date: 1 July 2016 -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    323 Zhang
  2. Gary Ulaner
    139 Ulaner
  3. Robert J Young
    162 Young
  4. Antonio Marcilio Padula Omuro
    196 Omuro
  5. Kathryn Beal
    187 Beal
  6. Kyung Peck
    91 Peck
  7. T. Jonathan Yang
    111 Yang
  8. Kaitlin Marie Woo
    100 Woo
  9. Jennifer Brooke Rubel
    5 Rubel