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Posttreatment DSC-MRI is Predictive of Early Treatment Failure in Children with Supratentorial High-Grade Glioma Treated with Erlotinib

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Abstract

Background and Purpose

The role of perfusion imaging in the management of pediatric high grade glioma is unclear. We evaluated the ability of dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) to determine grade, evaluate post-treatment response and predict treatment failure.

Material and Methods

In this study 22 patients with high-grade glioma underwent biopsy and were treated with concurrent and sequential radiotherapy and erlotinib as part of a phase I/II clinical trial (NCT00124657). Preradiotherapy, immediate postradiotherapy, 6‑month and treatment failure DSC MR images were reviewed, registered, and processed for the ratio of cerebral blood flow (CBF) and cerebral blood volume (CBV). Processed, derived perfusion, and T1-weighted images (T1WI), T2WI, and fluid attenuation inversion recovery (FLAIR) MRI sequences were used for segmentation and extraction of tumor perfusion parameters at all time points. Patient, tumor, treatment, and outcome data were summarized and related to perfusion data.

Results

Regional CBF in tumors increased from diagnosis to postradiotherapy, while they decreased to levels below those at diagnosis from postradiotherapy to 6‑month follow-up. At 6 months, the median regional CBF was higher in tumors that progressed (median 1.16) than in those that did not (median, 0.95; P < 0.05). Patients with regional CBF ratios above 1.4 at diagnosis had shorter survival times than did those with regional CBF ratios below 1.4 (P = 0.77). Tumors with a regional CBV above 1.15 at the postradiotherapy (1–3 months) follow-up scan were associated with an earlier time to death than that of tumors with a regional CBV below 1.15 (P < 0.05).

Conclusion

Posttreatment perfusion characteristics are prognostic and may help predict survival. Overall, perfusion MRI is useful for managing pediatric high-grade glioma and should be incorporated into future clinical trials.

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Abbreviations

HGG:

High-grade glioma

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Funding

American Lebanese Syrian Associated Charities.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS 210, 38105-3678, Memphis, TN, USA

    John T. Lucas Jr., Jinsoo Uh, Chia-Ho Hua & Thomas E. Merchant

  2. Indiana University School of Medicine, Indianapolis, IN, USA

    Brendan J. Knapp

  3. Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Scott N. Hwang & Zoltan Patay

  4. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Alberto Broniscer

  5. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    Alberto Broniscer

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  1. John T. Lucas Jr.
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Correspondence to John T. Lucas Jr..

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Conflict of interest

J.T. Lucas Jr., B.J. Knapp, J. Uh, C.-H. Hua, T.E. Merchant, S.N. Hwang, Z. Patay and A. Broniscer declare that they have no competing interests.

Ethical standards

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

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Lucas Jr., J.T., Knapp, B.J., Uh, J. et al. Posttreatment DSC-MRI is Predictive of Early Treatment Failure in Children with Supratentorial High-Grade Glioma Treated with Erlotinib. Clin Neuroradiol 28, 393–400 (2018). https://doi.org/10.1007/s00062-017-0580-1

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