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Serial MR diffusion to predict treatment response in high-grade pediatric brain tumors: a comparison of regional and voxel-based diffusion change metrics

Rodriguez Gutierrez, D.; Manita, M.; Jaspan, T.; Dineen, Robert A.; Grundy, Richard G.; Auer, Dorothee P.

Authors

D. Rodriguez Gutierrez

M. Manita

T. Jaspan

Robert A. Dineen

Richard G. Grundy

Dorothee P. Auer

Abstract

Background

Assessment of treatment response by measuring tumor size is known to be a late and potentially confounded response index. Serial diffusion MRI has shown potential for allowing earlier and possibly more reliable response assessment in adult patients, with limited experience in clinical settings and in pediatric brain cancer. We present a retrospective study of clinical MRI data in children with high-grade brain tumors to assess and compare the values of several diffusion change metrics to predict treatment response.

Methods

Eighteen patients (age range, 1.9–20.6 years) with high-grade brain tumors and serial diffusion MRI (pre- and posttreatment interval range, 1–16 weeks posttreatment) were identified after obtaining parental consent. The following diffusion change metrics were compared with the clinical response status assessed at 6 months: (1) regional change in absolute and normalized apparent diffusivity coefficient (ADC), (2) voxel-based fractional volume of increased (fiADC) and decreased ADC (fdADC), and (3) a new metric based on the slope of the first principal component of functional diffusion maps (fDM).

Results

Responders (n = 12) differed significantly from nonresponders (n = 6) in all 3 diffusional change metrics demonstrating higher regional ADC increase, larger fiADC, and steeper slopes (P < .05). The slope method allowed the best response prediction (P < .01, η2 = 0.78) with a classification accuracy of 83% for a slope of 58° using receiver operating characteristic (ROC) analysis.

Conclusions

We demonstrate that diffusion change metrics are suitable response predictors for high-grade pediatric tumors, even in the presence of variable clinical diffusion imaging protocols.

Journal Article Type Article
Journal Neuro-Oncology
Print ISSN 1522-8517
Electronic ISSN 1523-5866
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 15
Issue 8
Institution Citation Rodriguez Gutierrez, D., Manita, M., Jaspan, T., Dineen, R. A., Grundy, R. G., & Auer, D. P. (in press). Serial MR diffusion to predict treatment response in high-grade pediatric brain tumors: a comparison of regional and voxel-based diffusion change metrics. Neuro-Oncology, 15(8), doi:10.1093/neuonc/not034
DOI https://doi.org/10.1093/neuonc/not034
Keywords ADC, fDM, Pediatric tumor, Response prediction, Serial diffusion.
Publisher URL http://dx.doi.org/10.1093/neuonc/not034
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0




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