Bidirectional Contrast agent leakage correction of dynamic susceptibility contrast (DSC)-MRI improves cerebral blood volume estimation and survival prediction in recurrent glioblastoma treated with bevacizumab

Kevin Leu; Jerrold L Boxerman; Albert Lai; Phioanh L Nghiemphu; Whitney B Pope; Timothy F Cloughesy; Benjamin M Ellingson

doi:10.1002/jmri.25227

Bidirectional Contrast agent leakage correction of dynamic susceptibility contrast (DSC)-MRI improves cerebral blood volume estimation and survival prediction in recurrent glioblastoma treated with bevacizumab

J Magn Reson Imaging. 2016 Nov;44(5):1229-1237. doi: 10.1002/jmri.25227. Epub 2016 Mar 12.

Authors

Kevin Leu^{1

2

3}, Jerrold L Boxerman⁴, Albert Lai^{5

6}, Phioanh L Nghiemphu^{5

6}, Whitney B Pope², Timothy F Cloughesy^{5

6}, Benjamin M Ellingson^{7

8

9

10

11}

Affiliations

¹ UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California, USA.
² Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
³ Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, California, USA.
⁴ Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁵ UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, California, USA.
⁶ Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
⁷ UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California, USA. bellingson@mednet.ucla.edu.
⁸ Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. bellingson@mednet.ucla.edu.
⁹ Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, California, USA. bellingson@mednet.ucla.edu.
¹⁰ UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, California, USA. bellingson@mednet.ucla.edu.
¹¹ Department of Biomedical Physics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. bellingson@mednet.ucla.edu.

PMID: 26971534
DOI: 10.1002/jmri.25227

Abstract

Purpose: To evaluate a leakage correction algorithm for T₁ and T2* artifacts arising from contrast agent extravasation in dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) that accounts for bidirectional contrast agent flux and compare relative cerebral blood volume (CBV) estimates and overall survival (OS) stratification from this model to those made with the unidirectional and uncorrected models in patients with recurrent glioblastoma (GBM).

Materials and methods: We determined median rCBV within contrast-enhancing tumor before and after bevacizumab treatment in patients (75 scans on 1.5T, 19 scans on 3.0T) with recurrent GBM without leakage correction and with application of the unidirectional and bidirectional leakage correction algorithms to determine whether rCBV stratifies OS.

Results: Decreased post-bevacizumab rCBV from baseline using the bidirectional leakage correction algorithm significantly correlated with longer OS (Cox, P = 0.01), whereas rCBV change using the unidirectional model (P = 0.43) or the uncorrected rCBV values (P = 0.28) did not. Estimates of rCBV computed with the two leakage correction algorithms differed on average by 14.9%.

Conclusion: Accounting for T₁ and T2* leakage contamination in DSC-MRI using a two-compartment, bidirectional rather than unidirectional exchange model might improve post-bevacizumab survival stratification in patients with recurrent GBM. J. Magn. Reson. Imaging 2016;44:1229-1237.

Keywords: DSC-MRI; bevacizumab; bidirectional contrast agent flux; glioblastoma; leakage correction; perfusion MRI.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Algorithms
Antineoplastic Agents, Immunological / therapeutic use
Artifacts
Bevacizumab / therapeutic use
Blood Volume Determination / methods
Blood Volume*
Brain Neoplasms / diagnostic imaging*
Brain Neoplasms / drug therapy*
Brain Neoplasms / mortality
Extravasation of Diagnostic and Therapeutic Materials / diagnostic imaging*
Extravasation of Diagnostic and Therapeutic Materials / mortality
Female
Glioblastoma / diagnostic imaging*
Glioblastoma / drug therapy*
Glioblastoma / mortality
Humans
Image Enhancement / methods
Los Angeles / epidemiology
Male
Middle Aged
Prevalence
Prognosis
Reproducibility of Results
Retrospective Studies
Risk Assessment / methods
Sensitivity and Specificity
Survival Analysis*
Treatment Outcome

Substances

Antineoplastic Agents, Immunological
Bevacizumab