Chemical Exchange Saturation Transfer MRI for Differentiating Radiation Necrosis From Tumor Progression in Brain Metastasis-Application in a Clinical Setting.
brain metastases
chemical exchange saturation transfer
magnetization transfer
radiation necrosis
stereotactic radiosurgery
Journal
Journal of magnetic resonance imaging : JMRI
ISSN: 1522-2586
Titre abrégé: J Magn Reson Imaging
Pays: United States
ID NLM: 9105850
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
revised:
07
09
2022
received:
15
07
2022
accepted:
08
09
2022
medline:
18
5
2023
pubmed:
12
10
2022
entrez:
11
10
2022
Statut:
ppublish
Résumé
High radiation doses of stereotactic radiosurgery (SRS) for brain metastases (BM) can increase the likelihood of radiation necrosis (RN). Advanced MRI sequences can improve the differentiation between RN and tumor progression (TP). To use saturation transfer MRI methods including chemical exchange saturation transfer (CEST) and magnetization transfer (MT) to distinguish RN from TP. Prospective cohort study. Seventy patients (median age 60; 73% females) with BM (75 lesions) post-SRS. 3-T, CEST imaging using low/high-power (saturation B Voxel-wise metrics included: magnetization transfer ratio (MTR); apparent exchange-dependent relaxation (AREX); MTR asymmetry; normalized MT exchange rate and pool size product; direct water saturation peak width; and the observed T t-Test, univariable and multivariable logistic regression, receiver operating characteristic, and area under the curve (AUC) with sensitivity/specificity values with the optimal cut point using the Youden index, Akaike information criterion (AIC), Cohen's d. P < 0.05 with Bonferroni correction was considered significant. Seven metrics showed significant differences between RN and TP. The high-power MTR showed the highest AUC of 0.88, followed by low-power MTR (AUC = 0.87). The combination of low-power CEST scans improved the separation compared to individual parameters (with an AIC of 70.3 for low-power MTR/AREX). Cohen's d effect size showed that the MTR provided the largest effect sizes among all metrics. Significant differences between RN and TP were observed based on saturation transfer MRI. 3 Technical Efficacy: Stage 2.
Sections du résumé
BACKGROUND
High radiation doses of stereotactic radiosurgery (SRS) for brain metastases (BM) can increase the likelihood of radiation necrosis (RN). Advanced MRI sequences can improve the differentiation between RN and tumor progression (TP).
PURPOSE
To use saturation transfer MRI methods including chemical exchange saturation transfer (CEST) and magnetization transfer (MT) to distinguish RN from TP.
STUDY TYPE
Prospective cohort study.
SUBJECTS
Seventy patients (median age 60; 73% females) with BM (75 lesions) post-SRS.
FIELD STRENGTH/SEQUENCE
3-T, CEST imaging using low/high-power (saturation B
ASSESSMENT
Voxel-wise metrics included: magnetization transfer ratio (MTR); apparent exchange-dependent relaxation (AREX); MTR asymmetry; normalized MT exchange rate and pool size product; direct water saturation peak width; and the observed T
STATISTICAL TESTS
t-Test, univariable and multivariable logistic regression, receiver operating characteristic, and area under the curve (AUC) with sensitivity/specificity values with the optimal cut point using the Youden index, Akaike information criterion (AIC), Cohen's d. P < 0.05 with Bonferroni correction was considered significant.
RESULTS
Seven metrics showed significant differences between RN and TP. The high-power MTR showed the highest AUC of 0.88, followed by low-power MTR (AUC = 0.87). The combination of low-power CEST scans improved the separation compared to individual parameters (with an AIC of 70.3 for low-power MTR/AREX). Cohen's d effect size showed that the MTR provided the largest effect sizes among all metrics.
DATA CONCLUSION
Significant differences between RN and TP were observed based on saturation transfer MRI.
EVIDENCE LEVEL
3 Technical Efficacy: Stage 2.
Substances chimiques
Water
059QF0KO0R
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1713-1725Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 International Society for Magnetic Resonance in Medicine.
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