Posttreatment recurrence of malignant brain neoplasm

Accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction

Emerson L. Gasparetto, Mikolaj A. Pawlak, Sohil H. Patel, Jason Huse, John H. Woo, Jaroslaw Krejza, Myrna R. Rosenfeld, Donald M. O'Rourke, Robert Lustig, Elias R. Melhem, Ronald L. Wolf

Research output: Contribution to journalArticle

Abstract

Purpose: To determine the accuracy of relative cerebral blood volume (rCBV) fraction for distinguishing high-grade recurrent neoplasm from treatment-related necrosis (TRN) in enhancing masses identified on surveillance magnetic resonance (MR) images following treatment for primary or secondary brain neoplasm. Materials and Methods: This institutional review board approved and HIPAA-com-pliant retrospective study included 30 patients undergoing resection of recurrent enhancing mass appearing after treatment with surgery and radiation, with or without chemotherapy. The enhancing mass volume was manually segmented on three-dimensional T1-weighted images. The rCBV maps were created by using T2-weighted dynamic susceptibility contrast perfusion MR imaging and registered to T1-weighted images, and the fraction of enhancing mass with rCBV above a range of thresholds was calculated. A receiver operating characteristic (ROC) curve was created by calculating sensitivity-specificity pairs at each threshold for rCBV fraction (≤20% or >20%) by using percentage of malignant features at histo-logic evaluation as the reference criterion. Relationships between rCBV and probability of recurrence were estimated by using logistic regression analysis. Results: ROC analysis showed excellent discriminating accuracy of rCBV fraction (area under the ROC curve, 0.97 ± 0.03 [standard error]) and high efficiency (93%) with an rCBV threshold of 1.8 times that of normal-appearing white matter. Logistic regression analysis showed that a unit increase of rCBV is associated with a 254-fold increase (95% confidence interval: 43, 1504, P <.001) of the odds that enhanced tissue is recurrence, adjusting for age, treatment, volume of enhancing tissue, and time to suspected recurrence. Conclusion: The fraction of malignant histologic features in enhancing masses recurring after treatment for brain neoplasms can be predicted by using the rCBV fraction, with improved differentiation between recurrent neoplasm and TRN.

Original languageEnglish (US)
Pages (from-to)887-896
Number of pages10
JournalRadiology
Volume250
Issue number3
DOIs
StatePublished - Mar 2009
Externally publishedYes

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Brain Neoplasms
Recurrence
ROC Curve
Second Primary Neoplasms
Necrosis
Logistic Models
Regression Analysis
Health Insurance Portability and Accountability Act
Cerebral Blood Volume
Magnetic Resonance Angiography
Research Ethics Committees
Therapeutics
Magnetic Resonance Spectroscopy
Retrospective Studies
Confidence Intervals
Radiation
Drug Therapy
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Posttreatment recurrence of malignant brain neoplasm : Accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction. / Gasparetto, Emerson L.; Pawlak, Mikolaj A.; Patel, Sohil H.; Huse, Jason; Woo, John H.; Krejza, Jaroslaw; Rosenfeld, Myrna R.; O'Rourke, Donald M.; Lustig, Robert; Melhem, Elias R.; Wolf, Ronald L.

In: Radiology, Vol. 250, No. 3, 03.2009, p. 887-896.

Research output: Contribution to journalArticle

Gasparetto, EL, Pawlak, MA, Patel, SH, Huse, J, Woo, JH, Krejza, J, Rosenfeld, MR, O'Rourke, DM, Lustig, R, Melhem, ER & Wolf, RL 2009, 'Posttreatment recurrence of malignant brain neoplasm: Accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction', Radiology, vol. 250, no. 3, pp. 887-896. https://doi.org/10.1148/radiol.2502071444
Gasparetto, Emerson L. ; Pawlak, Mikolaj A. ; Patel, Sohil H. ; Huse, Jason ; Woo, John H. ; Krejza, Jaroslaw ; Rosenfeld, Myrna R. ; O'Rourke, Donald M. ; Lustig, Robert ; Melhem, Elias R. ; Wolf, Ronald L. / Posttreatment recurrence of malignant brain neoplasm : Accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction. In: Radiology. 2009 ; Vol. 250, No. 3. pp. 887-896.
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title = "Posttreatment recurrence of malignant brain neoplasm: Accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction",
abstract = "Purpose: To determine the accuracy of relative cerebral blood volume (rCBV) fraction for distinguishing high-grade recurrent neoplasm from treatment-related necrosis (TRN) in enhancing masses identified on surveillance magnetic resonance (MR) images following treatment for primary or secondary brain neoplasm. Materials and Methods: This institutional review board approved and HIPAA-com-pliant retrospective study included 30 patients undergoing resection of recurrent enhancing mass appearing after treatment with surgery and radiation, with or without chemotherapy. The enhancing mass volume was manually segmented on three-dimensional T1-weighted images. The rCBV maps were created by using T2-weighted dynamic susceptibility contrast perfusion MR imaging and registered to T1-weighted images, and the fraction of enhancing mass with rCBV above a range of thresholds was calculated. A receiver operating characteristic (ROC) curve was created by calculating sensitivity-specificity pairs at each threshold for rCBV fraction (≤20{\%} or >20{\%}) by using percentage of malignant features at histo-logic evaluation as the reference criterion. Relationships between rCBV and probability of recurrence were estimated by using logistic regression analysis. Results: ROC analysis showed excellent discriminating accuracy of rCBV fraction (area under the ROC curve, 0.97 ± 0.03 [standard error]) and high efficiency (93{\%}) with an rCBV threshold of 1.8 times that of normal-appearing white matter. Logistic regression analysis showed that a unit increase of rCBV is associated with a 254-fold increase (95{\%} confidence interval: 43, 1504, P <.001) of the odds that enhanced tissue is recurrence, adjusting for age, treatment, volume of enhancing tissue, and time to suspected recurrence. Conclusion: The fraction of malignant histologic features in enhancing masses recurring after treatment for brain neoplasms can be predicted by using the rCBV fraction, with improved differentiation between recurrent neoplasm and TRN.",
author = "Gasparetto, {Emerson L.} and Pawlak, {Mikolaj A.} and Patel, {Sohil H.} and Jason Huse and Woo, {John H.} and Jaroslaw Krejza and Rosenfeld, {Myrna R.} and O'Rourke, {Donald M.} and Robert Lustig and Melhem, {Elias R.} and Wolf, {Ronald L.}",
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T1 - Posttreatment recurrence of malignant brain neoplasm

T2 - Accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction

AU - Gasparetto, Emerson L.

AU - Pawlak, Mikolaj A.

AU - Patel, Sohil H.

AU - Huse, Jason

AU - Woo, John H.

AU - Krejza, Jaroslaw

AU - Rosenfeld, Myrna R.

AU - O'Rourke, Donald M.

AU - Lustig, Robert

AU - Melhem, Elias R.

AU - Wolf, Ronald L.

PY - 2009/3

Y1 - 2009/3

N2 - Purpose: To determine the accuracy of relative cerebral blood volume (rCBV) fraction for distinguishing high-grade recurrent neoplasm from treatment-related necrosis (TRN) in enhancing masses identified on surveillance magnetic resonance (MR) images following treatment for primary or secondary brain neoplasm. Materials and Methods: This institutional review board approved and HIPAA-com-pliant retrospective study included 30 patients undergoing resection of recurrent enhancing mass appearing after treatment with surgery and radiation, with or without chemotherapy. The enhancing mass volume was manually segmented on three-dimensional T1-weighted images. The rCBV maps were created by using T2-weighted dynamic susceptibility contrast perfusion MR imaging and registered to T1-weighted images, and the fraction of enhancing mass with rCBV above a range of thresholds was calculated. A receiver operating characteristic (ROC) curve was created by calculating sensitivity-specificity pairs at each threshold for rCBV fraction (≤20% or >20%) by using percentage of malignant features at histo-logic evaluation as the reference criterion. Relationships between rCBV and probability of recurrence were estimated by using logistic regression analysis. Results: ROC analysis showed excellent discriminating accuracy of rCBV fraction (area under the ROC curve, 0.97 ± 0.03 [standard error]) and high efficiency (93%) with an rCBV threshold of 1.8 times that of normal-appearing white matter. Logistic regression analysis showed that a unit increase of rCBV is associated with a 254-fold increase (95% confidence interval: 43, 1504, P <.001) of the odds that enhanced tissue is recurrence, adjusting for age, treatment, volume of enhancing tissue, and time to suspected recurrence. Conclusion: The fraction of malignant histologic features in enhancing masses recurring after treatment for brain neoplasms can be predicted by using the rCBV fraction, with improved differentiation between recurrent neoplasm and TRN.

AB - Purpose: To determine the accuracy of relative cerebral blood volume (rCBV) fraction for distinguishing high-grade recurrent neoplasm from treatment-related necrosis (TRN) in enhancing masses identified on surveillance magnetic resonance (MR) images following treatment for primary or secondary brain neoplasm. Materials and Methods: This institutional review board approved and HIPAA-com-pliant retrospective study included 30 patients undergoing resection of recurrent enhancing mass appearing after treatment with surgery and radiation, with or without chemotherapy. The enhancing mass volume was manually segmented on three-dimensional T1-weighted images. The rCBV maps were created by using T2-weighted dynamic susceptibility contrast perfusion MR imaging and registered to T1-weighted images, and the fraction of enhancing mass with rCBV above a range of thresholds was calculated. A receiver operating characteristic (ROC) curve was created by calculating sensitivity-specificity pairs at each threshold for rCBV fraction (≤20% or >20%) by using percentage of malignant features at histo-logic evaluation as the reference criterion. Relationships between rCBV and probability of recurrence were estimated by using logistic regression analysis. Results: ROC analysis showed excellent discriminating accuracy of rCBV fraction (area under the ROC curve, 0.97 ± 0.03 [standard error]) and high efficiency (93%) with an rCBV threshold of 1.8 times that of normal-appearing white matter. Logistic regression analysis showed that a unit increase of rCBV is associated with a 254-fold increase (95% confidence interval: 43, 1504, P <.001) of the odds that enhanced tissue is recurrence, adjusting for age, treatment, volume of enhancing tissue, and time to suspected recurrence. Conclusion: The fraction of malignant histologic features in enhancing masses recurring after treatment for brain neoplasms can be predicted by using the rCBV fraction, with improved differentiation between recurrent neoplasm and TRN.

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