Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma

Pejman Jabehdar Maralani; Sten Myrehaug; Hatef Mehrabian; Aimee K.M. Chan; Max Wintermark; Chris Heyn; John Conklin; Benjamin M. Ellingson; Saba Rahimi; Angus Z. Lau; Chia Lin Tseng; Hany Soliman; Jay Detsky; Shadi Daghighi; Julia Keith; David G. Munoz; Sunit Das; Eshetu G. Atenafu; Nir Lipsman; James Perry; Greg Stanisz; Arjun Sahgal

doi:10.1016/j.radonc.2020.12.037

Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma

Pejman Jabehdar Maralani
, Sten Myrehaug
, Hatef Mehrabian
, Aimee K.M. Chan
, Max Wintermark
, Chris Heyn
, John Conklin
, Benjamin M. Ellingson
, Saba Rahimi
, Angus Z. Lau
, Chia Lin Tseng
, Hany Soliman
, Jay Detsky
, Shadi Daghighi
, Julia Keith
, David G. Munoz
, Sunit Das
, Eshetu G. Atenafu
, Nir Lipsman
, James Perry

Greg Stanisz, Arjun Sahgal

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

Abstract

Background: Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome. Methods: 38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADC_T1C, ADC_T2-FLAIR) and perfusion fraction (f_T1C, f_T2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated. Results: Higher ADC_T2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95% CI 1.01–1.15, p = 0.025], lower f_T2-FLAIR at fraction 10 (OR = 2.11, 95% CI 1.04–4.27, p = 0.018), and lack of increase in ADC_T2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95% CI 1.02–1.22, p = 0.02) were associated with early progression. Combining ADC_T2-FLAIR at baseline, f_T2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher f_T2-FLAIR at fraction 10 (HR = 0.72, 95% CI 0.56–0.95, p = 0.018) was associated with longer PFS. Conclusion: ADC_T2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or f_T2-FLAIR at fraction 10 significantly predicted early progression. f_T2-FLAIR at fraction 10 was associated with PFS.

Original language	English (US)
Pages (from-to)	258-265
Number of pages	8
Journal	Radiotherapy and Oncology
Volume	156
DOIs	https://doi.org/10.1016/j.radonc.2020.12.037
State	Published - Mar 2021
Externally published	Yes

Keywords

Diffusion MRI
Glioblastoma
Intravoxel incoherent motion imaging
Progression-free Survival
Radiotherapy
Survival

ASJC Scopus subject areas

Hematology
Oncology
Radiology Nuclear Medicine and imaging

Access to Document

10.1016/j.radonc.2020.12.037

Cite this

Jabehdar Maralani, P., Myrehaug, S., Mehrabian, H., Chan, A. K. M., Wintermark, M., Heyn, C., Conklin, J., Ellingson, B. M., Rahimi, S., Lau, A. Z., Tseng, C. L., Soliman, H., Detsky, J., Daghighi, S., Keith, J., Munoz, D. G., Das, S., Atenafu, E. G., Lipsman, N., ... Sahgal, A. (2021). Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma. Radiotherapy and Oncology, 156, 258-265. https://doi.org/10.1016/j.radonc.2020.12.037

Jabehdar Maralani, P, Myrehaug, S, Mehrabian, H, Chan, AKM, Wintermark, M, Heyn, C, Conklin, J, Ellingson, BM, Rahimi, S, Lau, AZ, Tseng, CL, Soliman, H, Detsky, J, Daghighi, S, Keith, J, Munoz, DG, Das, S, Atenafu, EG, Lipsman, N, Perry, J, Stanisz, G & Sahgal, A 2021, 'Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma', Radiotherapy and Oncology, vol. 156, pp. 258-265. https://doi.org/10.1016/j.radonc.2020.12.037

@article{7d5402ecd4b345bda984b3233902c3a7,

title = "Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma",

abstract = "Background: Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome. Methods: 38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADCT1C, ADCT2-FLAIR) and perfusion fraction (fT1C, fT2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated. Results: Higher ADCT2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95\% CI 1.01{\textendash}1.15, p = 0.025], lower fT2-FLAIR at fraction 10 (OR = 2.11, 95\% CI 1.04{\textendash}4.27, p = 0.018), and lack of increase in ADCT2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95\% CI 1.02{\textendash}1.22, p = 0.02) were associated with early progression. Combining ADCT2-FLAIR at baseline, fT2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3\% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher fT2-FLAIR at fraction 10 (HR = 0.72, 95\% CI 0.56{\textendash}0.95, p = 0.018) was associated with longer PFS. Conclusion: ADCT2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or fT2-FLAIR at fraction 10 significantly predicted early progression. fT2-FLAIR at fraction 10 was associated with PFS.",

keywords = "Diffusion MRI, Glioblastoma, Intravoxel incoherent motion imaging, Progression-free Survival, Radiotherapy, Survival",

author = "\{Jabehdar Maralani\}, Pejman and Sten Myrehaug and Hatef Mehrabian and Chan, \{Aimee K.M.\} and Max Wintermark and Chris Heyn and John Conklin and Ellingson, \{Benjamin M.\} and Saba Rahimi and Lau, \{Angus Z.\} and Tseng, \{Chia Lin\} and Hany Soliman and Jay Detsky and Shadi Daghighi and Julia Keith and Munoz, \{David G.\} and Sunit Das and Atenafu, \{Eshetu G.\} and Nir Lipsman and James Perry and Greg Stanisz and Arjun Sahgal",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = mar,

doi = "10.1016/j.radonc.2020.12.037",

language = "English (US)",

volume = "156",

pages = "258--265",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma

AU - Jabehdar Maralani, Pejman

AU - Myrehaug, Sten

AU - Mehrabian, Hatef

AU - Chan, Aimee K.M.

AU - Wintermark, Max

AU - Heyn, Chris

AU - Conklin, John

AU - Ellingson, Benjamin M.

AU - Rahimi, Saba

AU - Lau, Angus Z.

AU - Tseng, Chia Lin

AU - Soliman, Hany

AU - Detsky, Jay

AU - Daghighi, Shadi

AU - Keith, Julia

AU - Munoz, David G.

AU - Das, Sunit

AU - Atenafu, Eshetu G.

AU - Lipsman, Nir

AU - Perry, James

AU - Stanisz, Greg

AU - Sahgal, Arjun

PY - 2021/3

Y1 - 2021/3

N2 - Background: Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome. Methods: 38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADCT1C, ADCT2-FLAIR) and perfusion fraction (fT1C, fT2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated. Results: Higher ADCT2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95% CI 1.01–1.15, p = 0.025], lower fT2-FLAIR at fraction 10 (OR = 2.11, 95% CI 1.04–4.27, p = 0.018), and lack of increase in ADCT2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95% CI 1.02–1.22, p = 0.02) were associated with early progression. Combining ADCT2-FLAIR at baseline, fT2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher fT2-FLAIR at fraction 10 (HR = 0.72, 95% CI 0.56–0.95, p = 0.018) was associated with longer PFS. Conclusion: ADCT2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or fT2-FLAIR at fraction 10 significantly predicted early progression. fT2-FLAIR at fraction 10 was associated with PFS.

AB - Background: Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome. Methods: 38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADCT1C, ADCT2-FLAIR) and perfusion fraction (fT1C, fT2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated. Results: Higher ADCT2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95% CI 1.01–1.15, p = 0.025], lower fT2-FLAIR at fraction 10 (OR = 2.11, 95% CI 1.04–4.27, p = 0.018), and lack of increase in ADCT2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95% CI 1.02–1.22, p = 0.02) were associated with early progression. Combining ADCT2-FLAIR at baseline, fT2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher fT2-FLAIR at fraction 10 (HR = 0.72, 95% CI 0.56–0.95, p = 0.018) was associated with longer PFS. Conclusion: ADCT2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or fT2-FLAIR at fraction 10 significantly predicted early progression. fT2-FLAIR at fraction 10 was associated with PFS.

KW - Diffusion MRI

KW - Glioblastoma

KW - Intravoxel incoherent motion imaging

KW - Progression-free Survival

KW - Radiotherapy

KW - Survival

UR - https://www.scopus.com/pages/publications/85099625319

UR - https://www.scopus.com/pages/publications/85099625319#tab=citedBy

U2 - 10.1016/j.radonc.2020.12.037

DO - 10.1016/j.radonc.2020.12.037

M3 - Article

C2 - 33418005

AN - SCOPUS:85099625319

SN - 0167-8140

VL - 156

SP - 258

EP - 265

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -

Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this