Can Tumor Location on Pre-treatment MRI Predict Likelihood of Pseudo-Progression vs. Tumor Recurrence in Glioblastoma?-A Feasibility Study

Marwa Ismail; Virginia Hill; Volodymyr Statsevych; Evan Mason; Ramon Correa; Prateek Prasanna; Gagandeep Singh; Kaustav Bera; Rajat Thawani; Manmeet Ahluwalia; Anant Madabhushi; Pallavi Tiwari

doi:10.3389/fncom.2020.563439

Can Tumor Location on Pre-treatment MRI Predict Likelihood of Pseudo-Progression vs. Tumor Recurrence in Glioblastoma?-A Feasibility Study

Front Comput Neurosci. 2020 Dec 14:14:563439. doi: 10.3389/fncom.2020.563439. eCollection 2020.

Authors

Marwa Ismail¹, Virginia Hill^{2

3}, Volodymyr Statsevych², Evan Mason², Ramon Correa¹, Prateek Prasanna⁴, Gagandeep Singh¹, Kaustav Bera^{1

5}, Rajat Thawani¹, Manmeet Ahluwalia⁶, Anant Madabhushi^{1

7}, Pallavi Tiwari¹

Affiliations

¹ Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States.
² Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States.
³ Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
⁴ Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States.
⁵ Maimonides Medical Center, New York, NY, United States.
⁶ Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, United States.
⁷ Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, United States.

Abstract

A significant challenge in Glioblastoma (GBM) management is identifying pseudo-progression (PsP), a benign radiation-induced effect, from tumor recurrence, on routine imaging following conventional treatment. Previous studies have linked tumor lobar presence and laterality to GBM outcomes, suggesting that disease etiology and progression in GBM may be impacted by tumor location. Hence, in this feasibility study, we seek to investigate the following question: Can tumor location on treatment-naïve MRI provide early cues regarding likelihood of a patient developing pseudo-progression vs. tumor recurrence? In this study, 74 pre-treatment Glioblastoma MRI scans with PsP (33) and tumor recurrence (41) were analyzed. First, enhancing lesion on Gd-T_1w MRI and peri-lesional hyperintensities on T_2w/FLAIR were segmented by experts and then registered to a brain atlas. Using patients from the two phenotypes, we construct two atlases by quantifying frequency of occurrence of enhancing lesion and peri-lesion hyperintensities, by averaging voxel intensities across the population. Analysis of differential involvement was then performed to compute voxel-wise significant differences (p-value < 0.05) across the atlases. Statistically significant clusters were finally mapped to a structural atlas to provide anatomic localization of their location. Our results demonstrate that patients with tumor recurrence showed prominence of their initial tumor in the parietal lobe, while patients with PsP showed a multi-focal distribution of the initial tumor in the frontal and temporal lobes, insula, and putamen. These preliminary results suggest that lateralization of pre-treatment lesions toward certain anatomical areas of the brain may allow to provide early cues regarding assessing likelihood of occurrence of pseudo-progression from tumor recurrence on MRI scans.

Keywords: ADIFFI; atlas; glioblastoma; pseudo-progression; tumor recurrence.

Grants and funding

U01 CA248226/CA/NCI NIH HHS/United States