title: Diffusion MRI quality control and functional diffusion map results in ACRIN 6677/RTOG 0625: a multicenter, randomized, phase II trial of bevacizumab and chemotherapy in recurrent glioblastoma.
abstract: Functional diffusion mapping (fDM) is a cancer imaging technique that quantifies voxelwise changes in apparent diffusion coefficient (ADC). Previous studies have shown value of fDMs in bevacizumab therapy for recurrent glioblastoma multiforme (GBM). The aim of the present study was to implement explicit criteria for diffusion MRI quality control and independently evaluate fDM performance in a multicenter clinical trial (RTOG 0625/ACRIN 6677). A total of 123 patients were enrolled in the current multicenter trial and signed institutional review board-approved informed consent at their respective institutions. MRI was acquired prior to and 8 weeks following therapy. A 5-point QC scoring system was used to evaluate DWI quality. fDM performance was evaluated according to the correlation of these metrics with PFS and OS at the first follow-up time-point. Results showed ADC variability of 7.3% in NAWM and 10.5% in CSF. A total of 68% of patients had usable DWI data and 47% of patients had high quality DWI data when also excluding patients that progressed before the first follow-up. fDM performance was improved by using only the highest quality DWI. High pre-treatment contrast enhancing tumor volume was associated with shorter PFS and OS. A high volume fraction of increasing ADC after therapy was associated with shorter PFS, while a high volume fraction of decreasing ADC was associated with shorter OS. In summary, DWI in multicenter trials are currently of limited value due to image quality. Improvements in consistency of image quality in multicenter trials are necessary for further advancement of DWI biomarkers.
authors: UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
authors: Benjamin M
authors: BM
authors: Ellingson
authors: Center for Statistical Sciences, Brown University, Providence, RI, USA.
authors: Eunhee
authors: E
authors: Kim
authors: Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
authors: Davis C
authors: DC
authors: Woodworth
authors: Center for Statistical Sciences, Brown University, Providence, RI, USA.
authors: Helga
authors: H
authors: Marques
authors: Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
authors: Jerrold L
authors: JL
authors: Boxerman
authors: Radiology Associates of Clearwater, University of South Florida, Clearwater, FL, USA.
authors: Yair
authors: Y
authors: Safriel
authors: Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA.
authors: Robert C
authors: RC
authors: McKinstry
authors: Neuro-Oncology Service, Tel Aviv Sourasky Medical Center, Israel.
authors: Felix
authors: F
authors: Bokstein
authors: Departments of Radiology and Neurosurgery, Henry Ford Hospital, Detroit, MI, USA.
authors: Rajan
authors: R
authors: Jain
authors: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: T Linda
authors: TL
authors: Chi
authors: A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
authors: A Gregory
authors: AG
authors: Sorensen
authors: Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Mark R
authors: MR
authors: Gilbert
authors: Department of Radiology, Duke University Medical Center, Durham, NC, USA.
authors: Daniel P
authors: DP
authors: Barboriak
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011786:Quality Control; D012008:Recurrence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab