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Diffusion-weighted MRI characteristics of the cerebral metastasis to brain boundary predicts patient outcomes.

Zakaria R, Das K, Radon M, Bhojak M, Rudland PR, Sluming V, Jenkinson MD - BMC Med Imaging (2014)

Bottom Line: Patient outcomes were overall survival and time to local recurrence.This was not simply due to differences between the types of primary cancer because the effect was observed even in a subgroup of 36 patients with the same primary, non-small cell lung cancer.The ATC was the only imaging measurement which independently predicted overall survival in multivariate analysis (hazard ratio 0.54, 95% CI 0.3 - 0.97, p = 0.04).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. rzakaria@nhs.net.

ABSTRACT

Background: Diffusion-weighted MRI (DWI) has been used in neurosurgical practice mainly to distinguish cerebral metastases from abscess and glioma. There is evidence from other solid organ cancers and metastases that DWI may be used as a biomarker of prognosis and treatment response. We therefore investigated DWI characteristics of cerebral metastases and their peritumoral region recorded pre-operatively and related these to patient outcomes.

Methods: Retrospective analysis of 76 cases operated upon at a single institution with DWI performed pre-operatively at 1.5T. Maps of apparent diffusion coefficient (ADC) were generated using standard protocols. Readings were taken from the tumor, peritumoral region and across the brain-tumor interface. Patient outcomes were overall survival and time to local recurrence.

Results: A minimum ADC greater than 919.4 × 10(-6) mm(2)/s within a metastasis predicted longer overall survival regardless of adjuvant therapies. This was not simply due to differences between the types of primary cancer because the effect was observed even in a subgroup of 36 patients with the same primary, non-small cell lung cancer. The change in diffusion across the tumor border and into peritumoral brain was measured by the "ADC transition coefficient" or ATC and this was more strongly predictive than ADC readings alone. Metastases with a sharp change in diffusion across their border (ATC >0.279) showed shorter overall survival compared to those with a more diffuse edge. The ATC was the only imaging measurement which independently predicted overall survival in multivariate analysis (hazard ratio 0.54, 95% CI 0.3 - 0.97, p = 0.04).

Conclusions: DWI demonstrates changes in the tumor, across the tumor edge and in the peritumoral region which may not be visible on conventional MRI and this may be useful in predicting patient outcomes for operated cerebral metastases.

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Related in: MedlinePlus

ADC values of 76 brain metastases by primary cancer of origin. The mean ADCmin value for each primary cancer type is shown +/- standard error and *indicates significant difference from the group at p < 0.05 by independent student t-test. All histological diagnoses were confirmed by neuropathology assessment after biopsy or resection and correlation with clinical data.
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Figure 2: ADC values of 76 brain metastases by primary cancer of origin. The mean ADCmin value for each primary cancer type is shown +/- standard error and *indicates significant difference from the group at p < 0.05 by independent student t-test. All histological diagnoses were confirmed by neuropathology assessment after biopsy or resection and correlation with clinical data.

Mentions: The median ADCmean for cerebral metastases in this series was 1148.1 × 10-6 mm2/s and the median ADCmin was 919.4 × 10-6 mm2/s. There were significant differences in ADC between cerebral metastases from different primary cancers by one-way ANOVA (F = 2.797, p = 0.025). On post hoc comparison, this was seen to be because metastases from the so-called “poorly differentiated” cancers such as melanoma (n = 5) and small cell lung carcinoma (n = 6) had a lower ADC compared to the metastases from carcinomas such as breast (n = 10), ovarian (n = 4) and colorectal (n = 4), as shown in Figure 2.Tissue was only available for 16 of 76 cases. Cellularity assessment by ImageJ software as compared to pathologist assessment appeared to be valid with consistency between the two observers (intraclass correlation coefficient = 0.61, p < 0.05). The mean cellularity was negatively correlated with both the ADCmin and the ADCmean and could be fitted to either of these with a simple linear regression model which was highly significant (for ADCmin, F = 7.99, p = 0.013 and for ADCmean F = 5.56, p = 0.033). ATC was strongly correlated with cellularity as shown in Figure 3 and was predicted by it using a simple linear regression model (F = 9.84, p = 0.007).


Diffusion-weighted MRI characteristics of the cerebral metastasis to brain boundary predicts patient outcomes.

Zakaria R, Das K, Radon M, Bhojak M, Rudland PR, Sluming V, Jenkinson MD - BMC Med Imaging (2014)

ADC values of 76 brain metastases by primary cancer of origin. The mean ADCmin value for each primary cancer type is shown +/- standard error and *indicates significant difference from the group at p < 0.05 by independent student t-test. All histological diagnoses were confirmed by neuropathology assessment after biopsy or resection and correlation with clinical data.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126355&req=5

Figure 2: ADC values of 76 brain metastases by primary cancer of origin. The mean ADCmin value for each primary cancer type is shown +/- standard error and *indicates significant difference from the group at p < 0.05 by independent student t-test. All histological diagnoses were confirmed by neuropathology assessment after biopsy or resection and correlation with clinical data.
Mentions: The median ADCmean for cerebral metastases in this series was 1148.1 × 10-6 mm2/s and the median ADCmin was 919.4 × 10-6 mm2/s. There were significant differences in ADC between cerebral metastases from different primary cancers by one-way ANOVA (F = 2.797, p = 0.025). On post hoc comparison, this was seen to be because metastases from the so-called “poorly differentiated” cancers such as melanoma (n = 5) and small cell lung carcinoma (n = 6) had a lower ADC compared to the metastases from carcinomas such as breast (n = 10), ovarian (n = 4) and colorectal (n = 4), as shown in Figure 2.Tissue was only available for 16 of 76 cases. Cellularity assessment by ImageJ software as compared to pathologist assessment appeared to be valid with consistency between the two observers (intraclass correlation coefficient = 0.61, p < 0.05). The mean cellularity was negatively correlated with both the ADCmin and the ADCmean and could be fitted to either of these with a simple linear regression model which was highly significant (for ADCmin, F = 7.99, p = 0.013 and for ADCmean F = 5.56, p = 0.033). ATC was strongly correlated with cellularity as shown in Figure 3 and was predicted by it using a simple linear regression model (F = 9.84, p = 0.007).

Bottom Line: Patient outcomes were overall survival and time to local recurrence.This was not simply due to differences between the types of primary cancer because the effect was observed even in a subgroup of 36 patients with the same primary, non-small cell lung cancer.The ATC was the only imaging measurement which independently predicted overall survival in multivariate analysis (hazard ratio 0.54, 95% CI 0.3 - 0.97, p = 0.04).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. rzakaria@nhs.net.

ABSTRACT

Background: Diffusion-weighted MRI (DWI) has been used in neurosurgical practice mainly to distinguish cerebral metastases from abscess and glioma. There is evidence from other solid organ cancers and metastases that DWI may be used as a biomarker of prognosis and treatment response. We therefore investigated DWI characteristics of cerebral metastases and their peritumoral region recorded pre-operatively and related these to patient outcomes.

Methods: Retrospective analysis of 76 cases operated upon at a single institution with DWI performed pre-operatively at 1.5T. Maps of apparent diffusion coefficient (ADC) were generated using standard protocols. Readings were taken from the tumor, peritumoral region and across the brain-tumor interface. Patient outcomes were overall survival and time to local recurrence.

Results: A minimum ADC greater than 919.4 × 10(-6) mm(2)/s within a metastasis predicted longer overall survival regardless of adjuvant therapies. This was not simply due to differences between the types of primary cancer because the effect was observed even in a subgroup of 36 patients with the same primary, non-small cell lung cancer. The change in diffusion across the tumor border and into peritumoral brain was measured by the "ADC transition coefficient" or ATC and this was more strongly predictive than ADC readings alone. Metastases with a sharp change in diffusion across their border (ATC >0.279) showed shorter overall survival compared to those with a more diffuse edge. The ATC was the only imaging measurement which independently predicted overall survival in multivariate analysis (hazard ratio 0.54, 95% CI 0.3 - 0.97, p = 0.04).

Conclusions: DWI demonstrates changes in the tumor, across the tumor edge and in the peritumoral region which may not be visible on conventional MRI and this may be useful in predicting patient outcomes for operated cerebral metastases.

Show MeSH
Related in: MedlinePlus