The value of 3.0 T MRI functional imaging in differential diagnosis of radiation brain injury and recurrence of glioblastoma multiforme_West China Medical Journal

Authors：

XU Zongsheng ¹ , CHEN Xiaolin ^1,2 ,  WANG Rong ^1,2 , ZHAO Yuanli ^1,2 , LU Changyu ¹

1. Department of Neurosurgery, Peking University International Hospital, Beijing 102206, P. R. China;
2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P. R. China;

Corresponding author：

WANG Rong, Email: ronger090614@126.com

Keywords：

Glioblastoma multiforme; Recurrence; Radiation-induced brain injury; Magnetic resonance imaging; Functional imaging

DOI：

10.7507/1002-0179.201805044

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo explore the value of 3.0 T MRI functional imaging in differential diagnosis of radiation brain injury and recurrence of glioblastoma multiforme.MethodsFrom March 2017 to January 2018, 31 patients diagnosed with brain glioblastoma multiforme in Peking University International Hospital were collected continuously, including 14 cases of tumor recurrence and 17 cases of radiation-induced brain injury. All the patients routinely underwent conventional MRI head scan, three-dimension arterial spin labeling (3D-ASL), dynamic susceptibility contrastperfusion weighted imaging (DSC-PWI), and enhanced MRI scan sequence; related parameters were recorded and compared.ResultsCerebral blood flow (CBF) value of abnormal enhanced area in the recurrence group was significantly higher than that in the brain injury group with 3D-ASL scan (t=3.016, P=0.005), and no difference was found in edema area between the two groups (P>0.05). In the recurrence group, CBF value of abnormal enhanced area was significantly higher than that of the normal area (t=2.628, P=0.014); however, there was no significant difference in the CBF value between the abnormal enhancement foci and the normal areas in the radiation brain injury group (P>0.05). Relative cerebral blood volume (rCBV) ratio (t=2.894, P=0.007) and relative cerebral blood volume (rCBF) ratio (t=2.694, P=0.012) of abnormal enhanced area, as well as rCBV ratio (t=2.622, P=0.013) and rCBF ratio (t=2.775, P=0.010) of edema area in the recurrence group were significantly higher than those in the brain injury group with DSC-PWI scan. No differences were found in relative mean transit time (rMTT) ratio and relative time to peak (rTTP) ratio between the two groups (P>0.05). In the brain injury groupr, CBV ratio (t=2.921, P=0.008) and rCBF ratio (t=3.100, P=0.004) of abnormal enhanced area were significantly higher than those of the edema area, and no difference was found in rMTT ratio or rTTP ratio (P>0.05). In the recurrence group, no difference was found in all focal parameters between abnormal enhanced area and edema area (P>0.05). In diagnosis value analysis, the areas under the curve of CBF in 3D-ASL scan, and rCBF ratio, rCBV ratio in DSC-PWI scan were 0.752, 0.675, and 0.645, respectively; the cut-off values were 34.59, 1.48, and 1.67, respectively; the sensitivities were 79.2%, 61.5%, and 58.3%, respectively; and the specificities were 44.4%, 32.8%, and 22.4%, respectively.ConculsionThe diagnostic value of functional MRI imaging in distinguishing glioblastoma multiforme recurrence and radiation-induced brain injury is high recommendated; further research and clinical application should be needed.

Citation： XU Zongsheng, CHEN Xiaolin, WANG Rong, ZHAO Yuanli, LU Changyu. The value of 3.0 T MRI functional imaging in differential diagnosis of radiation brain injury and recurrence of glioblastoma multiforme. West China Medical Journal, 2018, 33(6): 727-731. doi: 10.7507/1002-0179.201805044 Copy

1.	Tabatabaei P, Visse E, Bergstrom P, et al. Radiotherapy induces an immediate inflammatory reaction in malignant glioma: a clinical microdialysis study. J Neurooncol, 2017, 131(1): 83-92.
2.	Tinkle CL, Orr BA, Lucas J, et al. Rapid and fulminant leptomeningeal spread following radiotherapy in diffuse intrinsic pontine glioma. Pediatr Blood Cancer, 2017, 64(8): e26416.
3.	Bodensohn R, Corradini S, Ganswindt UA, et al. A prospective study on neurocognitive effects after primary radiotherapy in high-grade glioma patients. Int J Clin Oncol, 2016, 21(4): 642-650.
4.	Hu X, Fang Y, Hui XH, et al. Radiotherapy for diffuse brainstem glioma in children and young adults. Cochrane Database Syst Rev, 2016(6): CD010439.
5.	Ryken TC, Parney I, Buatti J, et al. The role of radiotherapy in the management of patients with diffuse low grade glioma: a systematic review and evidence-based clinical practice guideline. J Neurooncol, 2015, 125(3, SI): 551-583.
6.	Durand T, Jacob S, Lebouil L, et al. EpiBrainRad: an epidemiologic study of the neurotoxicity induced by radiotherapy in high grade glioma patients. BMC Neurol, 2015, 15: 261.
7.	Hara S, Tanaka Y, Ueda Y, et al. Noninvasive evaluation of CBF and perfusion delay of moyamoya disease using arterial spin-labeling MRI with multiple postlabeling delays: comparison with O-15-Gas PET and DSC-MRI. AJNR Am J Neuroradiol, 2017, 38(4): 696-702.
8.	Keil VC, Maedler B, Gielen GH, et al. Intravoxel incoherent motion MRI in the brain: impact of the fitting model on perfusion fraction and lesion differentiability. J Magn Reson Imaging, 2017, 46(4): 1187-1199.
9.	Paulson ES, Prah DE, Schmainda KM. Spiral perfusion imaging with consecutive echoes (SPICE) for the simultaneous mapping of DSC-and DCE-MRI parameters in brain tumor patients: theory and initial feasibility. Tomography, 2016, 2(4): 295-307.
10.	Sha L, Cao Q, Lv L, et al. Cerebral radiation injury and changes in the brain tissues of rat models with glioma. Tumour Biol, 2014, 35(3): 2379-2382.
11.	Artzi M, Blumenthal DT, Bokstein F, et al. Classification of tumor area using combined DCE and DSC MRI in patients with glioblastoma. J Neurooncol, 2015, 121(2): 349-357.
12.	Knutsson L, Lindgren E, Ahlgren A, et al. Reduction of arterial partial volume effects for improved absolute quantification of DSC-MRI perfusion estimates: comparison between tail scaling and prebolus administration. J Magn Reson Imaging, 2015, 41(4): 903-908.
13.	Pizzolato M, Boutelier T, Deriche R. Perfusion deconvolution in DSC-MRI with dispersion-compliant bases. Med Image Anal, 2017, 36: 197-215.
14.	Chen WB, Liang L, Zhang B, et al. To evaluate the damage of renal function in CIAKI rats at 3T: using ASL and BOLD MRI. Biomed Res Int, 2015: 593060.
15.	Wells JA, Thomas DL, Saga T, et al. MRI of cerebral micro-vascular flow patterns: a multi-direction diffusion-weighted ASL approach. J Cereb Blood Flow Metab, 2017, 37(6): 2076-2083.
16.	White CM, Pope WB, Zaw T, et al. Regional and Voxel-Wise comparisons of blood flow measurements between dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) and arterial spin labeling (ASL) in brain tumors. J Neuroimaging, 2014, 24(1): 23-30.
17.	Fink JR, Carr RB, Matsusue E, et al. Comparison of 3 tesla proton Mr spectroscopy, Mr perfusion and Mr diffusion for distinguishing glioma recurrence from posttreatment effects. J Magn Reson Imaging, 2012, 35(1): 56-63.
18.	Mitsuya K, Nakasu Y, Horiguchi S, et al. Perfusion weighted magnetic resonance imaging to distinguish the recurrence of metastatic brain tumors from radiation necrosis after stereotactic radiosurgery. J Neurooncol, 2010, 99(1): 81-88.
19.	Warmuth C, Gunther M, Zimmer C. Quantification of blood flow in brain tumors: comparison of arterial spin labeling and dynamic susceptibility-weighted contrast-enhanced Mr imaging. Radiology, 2003, 228(2): 523-532.
20.	Barajas J, Chang JS, Segal MR, et al. Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion Mr imaging. Radiology, 2009, 253(2): 486-496.
21.	Skinner JT, Moots PL, Ayers GD, et al. On the use of DSC-MRI for measuring vascular permeability. AJNR Am J Neuroradiol, 2016, 37(1): 80-87.
22.	Hu HH, Li ZQ, Pokorney AL, et al. Assessment of cerebral blood perfusion reserve with acetazolamide using 3D spiral ASL MRI: Preliminary experience in pediatric patients. Magn Reson Imaging, 2017, 35: 132-140.

1. Tabatabaei P, Visse E, Bergstrom P, et al. Radiotherapy induces an immediate inflammatory reaction in malignant glioma: a clinical microdialysis study. J Neurooncol, 2017, 131(1): 83-92.
2. Tinkle CL, Orr BA, Lucas J, et al. Rapid and fulminant leptomeningeal spread following radiotherapy in diffuse intrinsic pontine glioma. Pediatr Blood Cancer, 2017, 64(8): e26416.
3. Bodensohn R, Corradini S, Ganswindt UA, et al. A prospective study on neurocognitive effects after primary radiotherapy in high-grade glioma patients. Int J Clin Oncol, 2016, 21(4): 642-650.
4. Hu X, Fang Y, Hui XH, et al. Radiotherapy for diffuse brainstem glioma in children and young adults. Cochrane Database Syst Rev, 2016(6): CD010439.
5. Ryken TC, Parney I, Buatti J, et al. The role of radiotherapy in the management of patients with diffuse low grade glioma: a systematic review and evidence-based clinical practice guideline. J Neurooncol, 2015, 125(3, SI): 551-583.
6. Durand T, Jacob S, Lebouil L, et al. EpiBrainRad: an epidemiologic study of the neurotoxicity induced by radiotherapy in high grade glioma patients. BMC Neurol, 2015, 15: 261.
7. Hara S, Tanaka Y, Ueda Y, et al. Noninvasive evaluation of CBF and perfusion delay of moyamoya disease using arterial spin-labeling MRI with multiple postlabeling delays: comparison with O-15-Gas PET and DSC-MRI. AJNR Am J Neuroradiol, 2017, 38(4): 696-702.
8. Keil VC, Maedler B, Gielen GH, et al. Intravoxel incoherent motion MRI in the brain: impact of the fitting model on perfusion fraction and lesion differentiability. J Magn Reson Imaging, 2017, 46(4): 1187-1199.
9. Paulson ES, Prah DE, Schmainda KM. Spiral perfusion imaging with consecutive echoes (SPICE) for the simultaneous mapping of DSC-and DCE-MRI parameters in brain tumor patients: theory and initial feasibility. Tomography, 2016, 2(4): 295-307.
10. Sha L, Cao Q, Lv L, et al. Cerebral radiation injury and changes in the brain tissues of rat models with glioma. Tumour Biol, 2014, 35(3): 2379-2382.
11. Artzi M, Blumenthal DT, Bokstein F, et al. Classification of tumor area using combined DCE and DSC MRI in patients with glioblastoma. J Neurooncol, 2015, 121(2): 349-357.
12. Knutsson L, Lindgren E, Ahlgren A, et al. Reduction of arterial partial volume effects for improved absolute quantification of DSC-MRI perfusion estimates: comparison between tail scaling and prebolus administration. J Magn Reson Imaging, 2015, 41(4): 903-908.
13. Pizzolato M, Boutelier T, Deriche R. Perfusion deconvolution in DSC-MRI with dispersion-compliant bases. Med Image Anal, 2017, 36: 197-215.
14. Chen WB, Liang L, Zhang B, et al. To evaluate the damage of renal function in CIAKI rats at 3T: using ASL and BOLD MRI. Biomed Res Int, 2015: 593060.
15. Wells JA, Thomas DL, Saga T, et al. MRI of cerebral micro-vascular flow patterns: a multi-direction diffusion-weighted ASL approach. J Cereb Blood Flow Metab, 2017, 37(6): 2076-2083.
16. White CM, Pope WB, Zaw T, et al. Regional and Voxel-Wise comparisons of blood flow measurements between dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) and arterial spin labeling (ASL) in brain tumors. J Neuroimaging, 2014, 24(1): 23-30.
17. Fink JR, Carr RB, Matsusue E, et al. Comparison of 3 tesla proton Mr spectroscopy, Mr perfusion and Mr diffusion for distinguishing glioma recurrence from posttreatment effects. J Magn Reson Imaging, 2012, 35(1): 56-63.
18. Mitsuya K, Nakasu Y, Horiguchi S, et al. Perfusion weighted magnetic resonance imaging to distinguish the recurrence of metastatic brain tumors from radiation necrosis after stereotactic radiosurgery. J Neurooncol, 2010, 99(1): 81-88.
19. Warmuth C, Gunther M, Zimmer C. Quantification of blood flow in brain tumors: comparison of arterial spin labeling and dynamic susceptibility-weighted contrast-enhanced Mr imaging. Radiology, 2003, 228(2): 523-532.
20. Barajas J, Chang JS, Segal MR, et al. Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion Mr imaging. Radiology, 2009, 253(2): 486-496.
21. Skinner JT, Moots PL, Ayers GD, et al. On the use of DSC-MRI for measuring vascular permeability. AJNR Am J Neuroradiol, 2016, 37(1): 80-87.
22. Hu HH, Li ZQ, Pokorney AL, et al. Assessment of cerebral blood perfusion reserve with acetazolamide using 3D spiral ASL MRI: Preliminary experience in pediatric patients. Magn Reson Imaging, 2017, 35: 132-140.

West China Medical Journal

The value of 3.0 T MRI functional imaging in differential diagnosis of radiation brain injury and recurrence of glioblastoma multiforme

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content