title: Do perfusion and diffusion MRI predict glioblastoma relapse sites following chemoradiation?
abstract: To assess the value of T2* dynamic-susceptibility contrast MRI (DSC-MRI) and diffusion-weighted imaging (DWI) to predict the glioblastoma relapse sites after chemoradiation. From a cohort of 44 patients, primarily treated with radiotherapy (60 Gy) and concomitant temozolomide for glioblastoma, who were included in the reference arm of a prospective clinical trial (NCT01507506), 15 patients relapsed and their imaging data were analyzed. All patients underwent anatomical MRI, DSC-MRI and DWI before radiotherapy and every 2 months thereafter until relapse. Voxels within the sites of relapse were correlated with their perfusion and/or diffusion abnormality (PDA) pretreatment status after rigid co-registration. The relative cerebral blood volume (rCBV) and apparent diffusion coefficient (ADC) were used as biomarkers. Several PDA areas were thresholded: hyperperfused voxels using a 1.75 fixed rCBV threshold (HPt); hypoperfused (hPg) and hyperperfused (HPg) voxels using a histogram-based Gaussian method; diffusion-restricted voxels (DRg); and HPgvoxels with diffusion restriction (HPg&DRg). Two sets of voxels (2,459,483 and 2,073,880) were analyzed according to these thresholding methods. Positive predictive values (PPV) of PDA voxels were low (between 9.5 and 31.9 %). The best PPV was obtained with HPg&DRgvoxels within the FLAIR hyperintensity, as 18.3 % of voxels without initial PDA were within relapse sites, versus 31.9 % with initial PDA (p < 0.0001). This prospective study suggests that DSC and/or DWI-MRI do not predict the glioblastoma relapse sites. However, further investigations with new methodological approaches are needed to better understand the role of these modalities in the prediction of glioblastoma relapse sites.
authors: INSERM UMR 1214, TONIC (Toulouse NeuroImaging Centre), 31059, Toulouse, France. jonathan.khalifa@hotmail.fr.|Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France. jonathan.khalifa@hotmail.fr.
authors: Jonathan
authors: J
authors: Khalifa
authors: INSERM UMR 1214, TONIC (Toulouse NeuroImaging Centre), 31059, Toulouse, France.
authors: Fatima
authors: F
authors: Tensaouti
authors: INSERM UMR 1214, TONIC (Toulouse NeuroImaging Centre), 31059, Toulouse, France.|Department of Nuclear Medicine, CHU Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France.
authors: Jean-Albert
authors: JA
authors: Lotterie
authors: INSERM UMR 1214, TONIC (Toulouse NeuroImaging Centre), 31059, Toulouse, France.|Department of Radiology, CHU Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France.
authors: Isabelle
authors: I
authors: Catalaa
authors: Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France.
authors: Leonor
authors: L
authors: Chaltiel
authors: Department of Medical Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France.
authors: Alexandra
authors: A
authors: Benouaich-Amiel
authors: Clinical Research Unit, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France.
authors: Carlos
authors: C
authors: Gomez-Roca
authors: Department of Radiation Oncology, Centre Paul Strauss, EA 3430, University of Strasbourg, 3 rue de la Porte de l'Hôpital, 67065, Strasbourg, France.
authors: Georges
authors: G
authors: Noël
authors: Department of Radiation Oncology, Centre Georges-François Leclerc, 1 rue Professeur Marion, 21079, Dijon, France.
authors: Gilles
authors: G
authors: Truc
authors: INSERM UMR 1214, TONIC (Toulouse NeuroImaging Centre), 31059, Toulouse, France.|Université Toulouse III Paul Sabatier, UMR 1214, 31059, Toulouse, France.
authors: Patrice
authors: P
authors: Péran
authors: INSERM UMR 1214, TONIC (Toulouse NeuroImaging Centre), 31059, Toulouse, France.|Department of Nuclear Medicine, CHU Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France.|Université Toulouse III Paul Sabatier, UMR 1214, 31059, Toulouse, France.
authors: Isabelle
authors: I
authors: Berry
authors: Department of Radiation Oncology, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon, France.
authors: Marie-Pierre
authors: MP
authors: Sunyach
authors: Department of Radiation Oncology, Institut du Cancer de Montpellier, 208 avenue des Apothicaires, parc Euromédecine, 34298, Montpellier cedex 5, France.
authors: Marie
authors: M
authors: Charissoux
authors: Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, M20 4BX, UK.
authors: Corinne
authors: C
authors: Johnson
authors: Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France.|Université Toulouse III Paul Sabatier, 31000, Toulouse, France.|INSERM U1037, Centre de Recherches contre le Cancer de Toulouse, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France.
authors: Elizabeth
authors: E
authors: Cohen-Jonathan Moyal
authors: INSERM UMR 1214, TONIC (Toulouse NeuroImaging Centre), 31059, Toulouse, France.|Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France.|Université Toulouse III Paul Sabatier, 31000, Toulouse, France.
authors: Anne
authors: A
authors: Laprie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy; D059248:Chemoradiotherapy / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*
keywords: Diffusion weighted magnetic resonance imaging; Glioblastoma; Perfusion weighted magnetic resonance imaging; Sites of relapse; Voxel-based quantification