Abstract
PurposeTo prospectively investigate chemical exchange saturation transfer (CEST) MRI in glioblastoma patients as predictor of early tumor progression after first-line treatment.Experimental DesignTwenty previously untreated glioblastoma patients underwent CEST MRI employing a 7T whole-body scanner. Nuclear Overhauser effect (NOE) as well as amide proton transfer (APT) CEST signals were isolated using Lorentzian difference (LD) analysis and relaxation compensated by the apparent exchange-dependent relaxation rate (AREX) evaluation. Additionally, NOE-weighted asymmetric magnetic transfer ratio (MTRasym) and downfield-NOE-suppressed APT (dns-APT) were calculated. Patient response to consecutive treatment was determined according to the RANO criteria. Mean signal intensities of each contrast in the whole tumor area were compared between early-progressive and stable disease.ResultsPre-treatment tumor signal intensity differed significantly regarding responsiveness to first-line therapy in NOE-LD (p = 0.0001), NOE-weighted MTRasym (p = 0.0186) and dns-APT (p = 0.0328) contrasts. Hence, significant prediction of early progression was possible employing NOE-LD (AUC = 0.98, p = 0.0005), NOE-weighted MTRasym (AUC = 0.83, p = 0.0166) and dns-APT (AUC = 0.80, p = 0.0318). The NOE-LD provided the highest sensitivity (91%) and specificity (100%).ConclusionsCEST derived contrasts, particularly NOE-weighted imaging and dns-APT, yielded significant predictors of early progression after fist-line therapy in glioblastoma. Therefore, CEST MRI might be considered as non-invasive tool for customization of treatment in the future.
Highlights
Glioblastoma patients face a dismal prognosis despite optimal standard treatment consisting of resection followed by adjuvant chemoradiotherapy (CRT) [1,2,3,4]
chemical exchange saturation transfer (CEST) magnetic resonance imagin (MRI) might be considered as non-invasive tool for customization of treatment in the future
After the end of treatment, all patient cases were classified as early progression or stable disease based on the updated response assessment in neuro-oncology working group (RANO) criteria [31]
Summary
Glioblastoma patients face a dismal prognosis despite optimal standard treatment consisting of resection followed by adjuvant chemoradiotherapy (CRT) [1,2,3,4]. A protein-weighted CEST-spectrum consists of distinct signals, mainly originating from the nuclear Overhauser effect (NOE) [13,14,15] and the amide proton transfer (APT) [12, 16]. CEST effects are sensitive to biochemical [12, 14, 21, 23,24,25] as well as histopathological [19, 20, 26,27,28] tumor properties, yielding complementary information to current MRI methods [12, 14, 22, 29]. Even an accurate discrimination of distinct treatment-related changes in glioblastoma could be observed [18, 30]
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