Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Eur Radiol. 2019 Sep;29(9):4957-4967. doi: 10.1007/s00330-019-06066-2. Epub 2019 Feb 26.
The purpose of this study was to investigate the association of relaxation-compensated chemical exchange saturation transfer (CEST) MRI with overall survival (OS) and progression-free survival (PFS) in newly diagnosed high-grade glioma (HGG) patients.
Twenty-six patients with newly diagnosed high-grade glioma (WHO grades III-IV) were included in this prospective IRB-approved study. CEST MRI was performed on a 7.0-T whole-body scanner. Association of patient OS/PFS with relaxation-compensated CEST MRI (amide proton transfer (APT), relayed nuclear Overhauser effect (rNOE)/NOE, downfield-rNOE-suppressed APT (dns-APT)) and diffusion-weighted imaging (apparent diffusion coefficient) were assessed using the univariate Cox proportional hazards regression model. Hazard ratios (HRs) and corresponding 95% confidence intervals were calculated. Furthermore, OS/PFS association with clinical parameters (age, gender, O6-methylguanine-DNA methyltransferase (MGMT) promotor methylation status, and therapy: biopsy + radio-chemotherapy vs. debulking surgery + radio-chemotherapy) were tested accordingly.
Relaxation-compensated APT MRI was significantly correlated with patient OS (HR = 3.15, p = 0.02) and PFS (HR = 1.83, p = 0.009). The strongest association with PFS was found for the dns-APT metric (HR = 2.61, p = 0.002). These results still stand for the relaxation-compensated APT contrasts in a homogenous subcohort of n = 22 glioblastoma patients with isocitrate dehydrogenase (IDH) wild-type status. Among the tested clinical parameters, patient age (HR = 1.1, p = 0.001) and therapy (HR = 3.68, p = 0.026) were significant for OS; age additionally for PFS (HR = 1.04, p = 0.048).
Relaxation-compensated APT MRI signal intensity is associated with overall survival and progression-free survival in newly diagnosed, previously untreated glioma patients and may, therefore, help to customize treatment and response monitoring in the future.
• Amide proton transfer (APT) MRI signal intensity is associated with overall survival and progression in glioma patients. • Relaxation compensation enhances the information value of APT MRI in tumors. • Chemical exchange saturation transfer (CEST) MRI may serve as a non-invasive biomarker to predict prognosis and customize treatment.
本研究旨在探讨新诊断的高级别胶质瘤（HGG）患者中弛豫补偿化学交换饱和传递（CEST）MRI 与总生存期（OS）和无进展生存期（PFS）的相关性。
本前瞻性 IRB 批准的研究纳入了 26 名新诊断的高级别胶质瘤（WHO 分级 III-IV）患者。在 7.0-T 全身扫描仪上进行 CEST MRI。使用单变量 Cox 比例风险回归模型评估患者 OS/PFS 与弛豫补偿 CEST MRI（酰胺质子转移（APT）、中继核奥弗豪瑟效应（rNOE）/NOE、场移-rNOE 抑制 APT（dns-APT））和弥散加权成像（表观弥散系数）之间的相关性。计算危险比（HRs）和相应的 95%置信区间。此外，还相应地测试了 OS/PFS 与临床参数（年龄、性别、O6-甲基鸟嘌呤-DNA 甲基转移酶（MGMT）启动子甲基化状态和治疗：活检+放化疗与肿瘤切除术+放化疗）之间的相关性。
弛豫补偿 APT MRI 与患者 OS（HR=3.15，p=0.02）和 PFS（HR=1.83，p=0.009）显著相关。与 PFS 相关性最强的是 dns-APT 指标（HR=2.61，p=0.002）。在 n=22 名 IDH 野生型胶质瘤患者的同质亚组中，弛豫补偿 APT 对比也得到了相同的结果。在测试的临床参数中，患者年龄（HR=1.1，p=0.001）和治疗（HR=3.68，p=0.026）与 OS 相关；年龄与 PFS 相关（HR=1.04，p=0.048）。
新诊断的未经治疗的胶质瘤患者中，弛豫补偿 APT MRI 信号强度与总生存期和无进展生存期相关，因此可能有助于未来定制治疗和反应监测。
• APT MRI 信号强度与胶质瘤患者的总生存期和进展相关。
• 弛豫补偿增强了 APT MRI 在肿瘤中的信息价值。
• CEST MRI 可作为一种无创生物标志物，用于预测预后并定制治疗。
