Diagnostic utility of Restriction Spectrum Imaging in the characterization of the peritumoral brain zone in glioblastoma: Analysis of overall and progression-free survival. Issue 132 (November 2020)

• Record Type: Journal Article
• Authors: Latysheva, Anna; Geier, Oliver Marcel; Hope, Tuva R.; Brunetti, Marta; Micci, Francesca; Vik-Mo, Einar Osland; Emblem, Kyrre E.; Server, Andrés
• Is Part Of: European journal of radiology. Issue 132(2020)
• Publication Date: 2020-11
• Subjects: RSI Restriction Spectrum Imaging -- FA fractional anisotropy -- MD mean diffusivity -- OS overall survival -- PFS progression free survival -- CET contrast-enhancing tumor core -- PBZ peritumoral brain zone -- PEZ peri-enhancing zone -- NZ near zone -- FZ far zone; Restriction spectrum imaging -- Glioblastoma -- IDH-wildtype -- Contrast-enhancing tumor core -- Peritumoral brain zones -- Overall survival -- Progression free survival; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.109289
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Restriction Spectrum Imaging estimates levels of cellularity in different glioblastoma region. The highest RSI-cellularity index values were measured in the contrast-enhancing tumor core. Shorter OS was significant associated with higher RSI-cellularity index in the contrast-enhanced tumor core (HR 3.6, 95 % CI 1.3−9.5, P = 0.002) and in the peri-enhancing zone (HR 3.6, 95 % CI 1.0−12.3, P = 0.041). RSI-cellularity index stratifies survival outcome in patients with glioblastoma more accurately than MD. Abstract: Purpose: We studied the ability of Restriction Spectrum Imaging (RSI), a novel advanced diffusion imaging technique, to estimate levels of cellularity in different glioblastoma regions, evaluated their prognostic value compared with established clinical diffusion metrics such as fractional anisotropy (FA) and mean diffusivity (MD). Methods: Forty-two patients with untreated glioblastoma, IDH- wildtype, were examined with an advanced MRI tumor protocol. The region of interest (ROI) was obtained from the contrast-enhancing part of tumor and the peritumoral brain zones and then co-registered with RSI-cellularity index, FA and MD maps. Histogram parameters of diffusion metrics were assessed for all ROI locations and compared to MGMT promoter methylation status and survival. The ability of RSI-cellularity index, FA, and MD to stratify survival and were assessed by Cox proportional hazard regression, adjusted for significant clinical predictors. Results: The highest RSI-cellularity index was measured in contrast-enhancing tumor core with a negative gradient from tumor core to the periphery of peritumoral zone with predictive accuracy 81 % (P < 0.001). Shorter overall survival was significant associated with higher RSI-cellularity index (hazard ratio (HR) 3.6, 95 % confidence interval (CI) 1.3−9.5, P = 0.002) with synchronal decrease in MD (HR 0.31, 95 %CI 0.1−0.8, P = 0.008) in the contrast-enhanced tumor core. This association was also consistent for RSI-cellularity index value measured in the peri-enhancing zone (HR 3.6, 95 % CI 1.0−12.3, P = 0.041). No statistically significant differences were noted between RSI-cellularity index, FA, nor MD and MGMT promoter methylation. Conclusion: RSI-cellularity index may be used as prognostic biomarker to improve risk stratification in patients with glioblastoma.