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Response Assessment in Neuro-Oncology criteria, contrast enhancement and perfusion MRI for assessing progression in glioblastoma

  • Functional Neuroradiology
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Abstract

Purpose

The purpose of the study was to evaluate Response Assessment in Neuro-Oncology (RANO) criteria in glioblastoma multiforme (GBM), with respect to the Macdonald criteria and changes in contrast-enhancement (CE) volume. Related variations in relative cerebral blood volume (rCBV) were investigated.

Methods

Forty-three patients diagnosed between 2006 and 2010 were included. All underwent surgical resection, followed by temozolomide-based chemoradiation. MR images were retrospectively reviewed. Times to progression (TTPs) according to RANO criteria, Macdonald criteria and increased CE volume (CE-3D) were compared, and the percentage change in the 75th percentile of rCBV (rCBV75) was evaluated.

Results

After a median follow-up of 22.7 months, a total of 39 patients had progressed according to RANO criteria, 32 according to CE-3D, and 42 according to Macdonald. Median TTPs were 6.4, 9.3, and 6.6 months, respectively. Overall agreement was 79.07% between RANO and CE-3D and 93.02% between RANO and Macdonald. The mean percentage change in rCBV75 at RANO progression onset was over 73% in 87.5% of patients.

Conclusions

In conclusion, our findings suggest that CE-3D criterion is not yet suitable to assess progression in routine clinical practice. Indeed, the accurate threshold is still not well defined. To date, in our opinion, early detection of disease progression by RANO combined with advanced MRI imaging techniques like MRI perfusion and diffusion remains the best way to assess disease progression. Further investigations that would examine the impact of treatment modifications after progression determined by different criteria on overall survival would be of great value.

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Abbreviations

RANO:

Response Assessment in Neuro-Oncology

GBM:

Glioblastoma multiforme

CE:

Contrast enhancement

rCBV:

Relative cerebral blood volume

rCBV75:

The 75th percentile of rCBV

TTP:

Time to progression

MRI:

Magnetic resonance imaging

OS:

Overall survival

RECIST:

Response Evaluation Criteria in Solid Tumours

FLAIR:

Fluid-attenuated inversion recovery

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

DSC:

Dynamic susceptibility contrast

RT:

Radiation therapy

GTR:

Gross total resection

NTR:

Near total resection

STR:

Subtotal resection

TE:

Echo time

TI:

Inversion time

TR:

Repetition time

PET:

Positron emission tomography

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Authors and Affiliations

  1. ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France

    Fatima Tensaouti, Jean Albert Lotterie, Isabelle Berry, Anne Laprie & Vincent Lubrano

  2. Department of Radiation Oncology, Claudius Regaud Institute / Toulouse University Cancer Institute – Oncopole, Toulouse, France

    Jonathan Khalifa, Anne Laprie & Elizabeth Cohen-Jonathan Moyal

  3. Department of Biostatistics, Claudius Regaud Institute / Toulouse University Cancer Institute – Oncopole, Toulouse, France

    Amélie Lusque

  4. Department of Neurosurgery, CHU Toulouse, Toulouse, France

    Benjamin Plas & Vincent Lubrano

  5. Department of Nuclear Medicine, CHU Toulouse, Toulouse, France

    Jean Albert Lotterie & Isabelle Berry

  6. Toulouse Center for Cancer Research (U1037), Inserm, Toulouse, France

    Elizabeth Cohen-Jonathan Moyal

Authors
  1. Fatima Tensaouti
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  2. Jonathan Khalifa
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  3. Amélie Lusque
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  4. Benjamin Plas
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  5. Jean Albert Lotterie
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  6. Isabelle Berry
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  7. Anne Laprie
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  9. Vincent Lubrano
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Corresponding author

Correspondence to Fatima Tensaouti.

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Funding

This study was funded by a grant from the Research Innovation Therapeutics Cancerology (RITC) Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

EC-JM and VL are co-principal investigators and joint last authors.

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Tensaouti, F., Khalifa, J., Lusque, A. et al. Response Assessment in Neuro-Oncology criteria, contrast enhancement and perfusion MRI for assessing progression in glioblastoma. Neuroradiology 59, 1013–1020 (2017). https://doi.org/10.1007/s00234-017-1899-7

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  • DOI: https://doi.org/10.1007/s00234-017-1899-7

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