Journal of Neuro-Oncology

, Volume 118, Issue 1, pp 123–129 | Cite as

Impact of MRI head placement on glioma response assessment

  • Martin Reuter
  • Elizabeth R. Gerstner
  • Otto Rapalino
  • Tracy T. Batchelor
  • Bruce Rosen
  • Bruce Fischl
Clinical Study


Diagnosis of progressive disease or (partial) response during tumor treatment is based on manual size estimates of enhancing tumor area: an expert measures two perpendicular diameters of the enhancing tumor region in a single MRI slice with the largest enhancing area. This paper analyzes the reliability of the area measure with respect to head placement in the MRI scanner and compares it with 3D volume measures in a dataset of eight subjects (5–7 follow-up scans each) with high-grade glioma. We show that the manual area measure is highly sensitive to head position changes, with a root mean squared error of 22 %, compared to volume estimates with less than 5 % error. In our simulated study using the 2D manual measurements, the majority of subjects would have been incorrectly diagnosed with progressive disease without any true anatomical changes. These results highlight the urgent need for revised and more reliable response assessment criteria, for example, based on increased slice resolution, 3D volume analysis and percent change computation with respect to an average of patient specific longitudinal measurements instead of a single measurement to define progression or response.


High Grade Glioma MRI head placement RANO Macdonald criteria Reliability Treatment assessment 



Support for this research was provided in part by the National Center for Research Resources (P41-RR14075, U24-RR021382, 1UL1-RR025758-01, 1S10-RR023401, 1S10-RR019307, 1S10-RR023043), the National Institute for Biomedical Imaging and Bioengineering (5P41-EB015896-15, R01-EB006758), the National Cancer Institute (5U01-CA154601-03, N01-CM-2008-00060C), the National Institute on Aging (AG022381, 5R01-AG008122-22), the National Center for Alternative Medicine (RC1-AT005728-01), the National Institute for Neurological Disorders and Stroke (R01-NS052585-01, 1R21-NS072652-01, 1R01-NS070963), Merck, the Ellison Medical Foundation (The Autism & Dyslexia Project) and by the National Institute of Health Blueprint for Neuroscience Research (5U01-MH093765 Human Connectome Project).

Conflict of interest

BF has a financial interest in CorticoMetrics, a company whose medical pursuits focus on brain imaging and measurement technologies. BF’s interests were reviewed and are managed by Massachusetts General Hospital and Partners HealthCare in accordance with their conflict of interest policies. CorticoMetrics did not sponsor any part of this research. The other authors declare that they have no conflict of interest.

Ethical standard

Experiments comply with the current laws of the country in which they were performed.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Martin Reuter
    • 1
    • 2
  • Elizabeth R. Gerstner
    • 1
  • Otto Rapalino
    • 2
  • Tracy T. Batchelor
    • 1
  • Bruce Rosen
    • 2
  • Bruce Fischl
    • 2
  1. 1.Department of NeurologyMassachusetts General Hospital Harvard Medical SchoolBostonUSA
  2. 2.Department of RadiologyMassachusetts General Hospital Harvard Medical SchoolBostonUSA

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