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Do perfusion and diffusion MRI predict glioblastoma relapse sites following chemoradiation?

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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 HPg voxels 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&DRg voxels 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.

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Acknowledgments

The authors would like to thank Soléakhena Ken and Amandine Fabre for assistance to collect imaging data.

Funding

None.

Author information

Authors and Affiliations

  1. INSERM UMR 1214, TONIC (Toulouse NeuroImaging Centre), 31059, Toulouse, France

    Jonathan Khalifa, Fatima Tensaouti, Jean-Albert Lotterie, Isabelle Catalaa, Patrice Péran, Isabelle Berry & Anne Laprie

  2. Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France

    Jonathan Khalifa, Elizabeth Cohen-Jonathan Moyal & Anne Laprie

  3. Department of Nuclear Medicine, CHU Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France

    Jean-Albert Lotterie & Isabelle Berry

  4. Department of Radiology, CHU Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France

    Isabelle Catalaa

  5. Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France

    Leonor Chaltiel

  6. Department of Medical Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France

    Alexandra Benouaich-Amiel

  7. Clinical Research Unit, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France

    Carlos Gomez-Roca

  8. Department of Radiation Oncology, Centre Paul Strauss, EA 3430, University of Strasbourg, 3 rue de la Porte de l’Hôpital, 67065, Strasbourg, France

    Georges Noël

  9. Department of Radiation Oncology, Centre Georges-François Leclerc, 1 rue Professeur Marion, 21079, Dijon, France

    Gilles Truc

  10. Université Toulouse III Paul Sabatier, UMR 1214, 31059, Toulouse, France

    Patrice Péran & Isabelle Berry

  11. Department of Radiation Oncology, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon, France

    Marie-Pierre Sunyach

  12. Department of Radiation Oncology, Institut du Cancer de Montpellier, 208 avenue des Apothicaires, parc Euromédecine, 34298, Montpellier cedex 5, France

    Marie Charissoux

  13. Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, M20 4BX, UK

    Corinne Johnson

  14. Université Toulouse III Paul Sabatier, 31000, Toulouse, France

    Elizabeth Cohen-Jonathan Moyal & Anne Laprie

  15. INSERM U1037, Centre de Recherches contre le Cancer de Toulouse, 1 avenue Irène-Joliot Curie, 31100, Toulouse, France

    Elizabeth Cohen-Jonathan Moyal

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  1. Jonathan Khalifa
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  2. Fatima Tensaouti
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  3. Jean-Albert Lotterie
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  8. Georges Noël
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  9. Gilles Truc
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  15. Elizabeth Cohen-Jonathan Moyal
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Correspondence to Jonathan Khalifa.

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Khalifa, J., Tensaouti, F., Lotterie, JA. et al. Do perfusion and diffusion MRI predict glioblastoma relapse sites following chemoradiation?. J Neurooncol 130, 181–192 (2016). https://doi.org/10.1007/s11060-016-2232-8

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