A 3D quantitative imaging biomarker in pre-treatment MRI predicts overall survival after stereotactic radiation therapy of patients with a singular brain metastasis

医学 生物标志物 立体定向放射治疗 放射外科 成像生物标志物 磁共振成像 放射科 脑转移 神经影像学 放射治疗 核医学 医学物理学 转移 内科学 癌症 精神科 化学 生物化学
作者
Marta Della Seta,Federico Collettini,Julius Chapiro,Alexander Angelidis,Fidelis Engeling,Bernd Hamm,David Kaul
出处
期刊:Acta Radiologica [SAGE Publishing]
卷期号:60 (11): 1496-1503 被引量:21
标识
DOI:10.1177/0284185119831692
摘要

Background Brain metastases (BM) are the most frequent intracranial malignant tumor. Various prognostic factors facilitate the prediction of survival; however, few have become tools for clinical use. Purpose To investigate the role of three-dimensional (3D) quantitative tissue enhancement in pre-treatment cranial magnetic resonance imaging (MRI) as a radiomic biomarker for survival (OS) in patients with singular BM treated with stereotactic radiation therapy (SRT). Material and Methods In this retrospective study, 48 patients (27 non-small cell lung cancer and 21 melanoma) with singular BM treated with SRT, were analyzed. Contrast-enhanced MRI scans of the neurocranium were used for quantitative image analyses. Segmentation-based 3D quantification was performed to measure the enhancing tumor volume. A cut-off value of 68.61% of enhancing volume was used to stratify the cohort into two groups (≤68.61% and > 68.61%). Univariable and multivariable cox regressions were used to analyze the prognostic factors of OS and intracranial progression-free survival (iPFS). Results The level of enhancing tumor volume achieved statistical significance in univariable and multivariable analysis for OS (univariable: P = 0.005, hazard ratio [HR] = 0.375, 95% confidence interval [CI] = 0.168–0.744; multivariable: P = 0.006, HR = 0.376, 95% CI = 0.186–0.757). Patients with high-level enhancement (>68.61% enhancing lesion volume) survived significantly longer (4.9 vs. 10.2 months) and showed significantly longer iPFS rates (univariable: P < 0.001, HR = 0.046, 95% CI = 0.009–0.245). Conclusions Patients with lesions that show a higher percentage of enhancement in pre-treatment MRI demonstrated improved iPFS and OS compared to those with mainly hypo-enhancing lesions. Lesion enhancement may be a radiomic marker, useful in prognostic indices for survival prediction, in patients with singular BM.
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