Department of Radiology, the Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan.
Université Grenoble Alpes, Grenoble Institut Neuroscience, Inserm, U1216, 38000 Grenoble, France.
Acad Radiol. 2021 Dec;28(12):1711-1720. doi: 10.1016/j.acra.2020.08.015. Epub 2020 Sep 11.
Glioblastoma image evaluation utilizes Magnetic Resonance Imaging contrast-enhanced, T1-weighted, and noncontrast T2-weighted fluid-attenuated inversion recovery (FLAIR) acquisitions. Disease progression assessment relies on changes in tumor diameter, which correlate poorly with survival. To improve treatment monitoring in glioblastoma, we investigated serial voxel-wise comparison of anatomically-aligned FLAIR signal as an early predictor of GBM progression.
We analyzed longitudinal normalized FLAIR images (rFLAIR) from 52 subjects using voxel-wise Parametric Response Mapping (PRM) to monitor volume fractions of increased (PRM), decreased (PRM), or unchanged (PRM) rFLAIR intensity. We determined response by rFLAIR between pretreatment and 10 weeks posttreatment. Risk of disease progression in a subset of subjects (N = 26) with stable disease or partial response as defined by Response Assessment in Neuro-Oncology (RANO) criteria was assessed by PRM between weeks 10 and 20 and continuously until the PRM exceeded a defined threshold. RANO defined criteria were compared with PRM-derived outcomes for tumor progression detection.
Patient stratification for progression-free survival (PFS) and overall survival (OS) was achieved at week 10 using RANO criteria (PFS: p <0.0001; OS: p <0.0001), relative change in FLAIR-hyperintense volume (PFS: p = 0.0011; OS: p <0.0001), and PRM (PFS: p <0.01; OS: p <0.001). PRM also stratified responding patients' progression between weeks 10 and 20 (PFS: p <0.05; OS: p = 0.01) while changes in FLAIR-volume measurements were not predictive. As a continuous evaluation, PRM exceeding 10% stratified patients for PFA after 5.6 months (p<0.0001), while RANO criteria did not stratify patients until 15.4 months (p <0.0001).
PRM may provide an early biomarker of disease progression in glioblastoma.
胶质母细胞瘤的影像评估采用磁共振成像对比增强、T1 加权和非对比 T2 加权液体衰减反转恢复（FLAIR）采集。疾病进展的评估依赖于肿瘤直径的变化，但与生存率相关性较差。为了改善胶质母细胞瘤的治疗监测，我们研究了连续体素层面的解剖配准 FLAIR 信号比较，作为胶质母细胞瘤进展的早期预测指标。
我们使用体素层面参数响应映射（PRM）分析了 52 例患者的纵向归一化 FLAIR 图像（rFLAIR），以监测增强（PRM）、降低（PRM）或不变（PRM）rFLAIR 强度的体积分数。我们通过 rFLAIR 在治疗前和治疗后 10 周之间的反应来确定反应。根据反应评估神经肿瘤学（RANO）标准，对部分患者（n=26）的稳定疾病或部分反应进行了 rFLAIR 之间的亚组分析在第 10 周和第 20 周之间进行，并持续到 PRM 超过定义的阈值。将 RANO 定义的标准与肿瘤进展检测的 PRM 结果进行了比较。
使用 RANO 标准（PFS：p<0.0001；OS：p<0.0001）、FLAIR 高信号体积的相对变化（PFS：p=0.0011；OS：p<0.0001）和 PRM（PFS：p<0.01；OS：p<0.001），在第 10 周时对无进展生存期（PFS）和总生存期（OS）进行了患者分层。PRM 还分层了 10 至 20 周之间反应患者的进展（PFS：p<0.05；OS：p=0.01），而 FLAIR 体积测量的变化则没有预测性。作为连续评估，PRM 超过 10%，在 5.6 个月后对 PFA 进行分层（p<0.0001），而 RANO 标准直到 15.4 个月后才对患者进行分层（p<0.0001）。
PRM 可能为胶质母细胞瘤的疾病进展提供早期生物标志物。
