Biopsy targeting with dynamic contrast-enhanced versus standard neuronavigation MRI in glioma: a prospective double-blinded evaluation of selection benefits

Abstract

Current biopsy planning based on contrast-enhanced T1W (CET1W) or FLAIR sequences frequently delivers biopsy samples that are not in concordance with the gross tumor diagnosis. This study investigates whether the quantitative information of transfer constant Ktrans maps derived from T1W dynamic contrast-enhanced MRI (DCE-MRI) can help enhance the quality of biopsy target selection in glioma. 28 patients with suspected glioma received MRI including DCE-MRI and a standard neuronavigation protocol of 3D FLAIR- and CET1W data sets (0.1 mmol/kg gadobutrol) at 3.0 T. After exclusion of five cases with no Ktrans-elevation, 2–6 biopsy targets were independently selected by a neurosurgeon (samples based on standard imaging) and a neuroradiologist (samples based on kinetic parameter Ktrans) per case and tissue samples corresponding to these targets were collected by a separate independent neurosurgeon. Standard technique and Ktrans-based samples were rated for diagnostic concordance with the gross tumor resection reference diagnosis (67 WHO IV; 24 WHO III and II) by a neuropathologist blinded for selection mode. Ktrans-based sample targets differed from standard technique sample targets in 90/91 cases. More Ktrans-based than standard imaging-based samples could be extracted. Diagnoses from Ktrans-based samples were more frequently concordant with the reference gross tumor diagnoses than those from standard imaging-based samples (WHO IV: 30/39 vs. 11/20; p = 0.08; WHO III/II: 12/13 vs. 6/11; p = 0.06). In 4/5 non-contrast-enhancing gliomas, Ktrans-based selection revealed significantly more accurate samples than standard technique sample-selection (10/12 vs. 2/8 samples; p = 0.02). If Ktrans elevation is present, Ktrans-based biopsy targeting provides significantly more diagnostic tissue samples in non-contrast-enhancing glioma than selection based on CET1W and FLAIR-weighted images alone.

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Abbreviations

CET1W MRI:

Contrast-enhanced T1-weighted MRI

DSC-MRI:

T2*-dynamic susceptibility-weighted MRI

DCE-MRI:

T1W dynamic contrast-enhanced MRI

DTS:

presumed diagnosis based on target tissue sample only

GTRD:

reference diagnosis from the completely resected gross tumor

kep :

reflux volume transfer constant (of contrast agent)

Ktrans :

efflux volume transfer constant (of contrast agent)

MRS:

MR spectroscopy

ve :

extracellular-extravascular volume fraction (of contrast agent)

WHO:

World Health Organization

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Funding

Neither of the authors did receive any funding from the company or any third parties for this study nor did anybody received payments related to this study. The study is investigator-initiated and received no funding from third parties.

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Correspondence to Dariusch R. Hadizadeh.

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Conflict of interest

V.C.K. received compensation for an invited talk at a Philips User Meeting in Switzerland in 2015. J.G. is employed by Philips Healthcare, the company providing both MRI and software used in this study.

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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.

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

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Keil, V.C., Pintea, B., Gielen, G.H. et al. Biopsy targeting with dynamic contrast-enhanced versus standard neuronavigation MRI in glioma: a prospective double-blinded evaluation of selection benefits. J Neurooncol 133, 155–163 (2017). https://doi.org/10.1007/s11060-017-2424-x

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Keywords

  • Biopsy targeting
  • Selection
  • Glioma
  • Ktrans
  • DCE-MRI
  • Benefit