CEST imaging of the APT and ssMT predict the overall survival of patients with glioma at the first follow-up after completion of radiotherapy at 3T

Nikolaus von Knebel Doeberitz; Florian Kroh; Johannes Breitling; Laila König; Srdjan Maksimovic; Svenja Graß; Sebastian Adeberg; Moritz Scherer; Andreas Unterberg; Martin Bendszus; Wolfgang Wick; Peter Bachert; Jürgen Debus; Mark E Ladd; Heinz-Peter Schlemmer; Andreas Korzowski; Steffen Goerke; Daniel Paech

doi:10.1016/j.radonc.2023.109694

CEST imaging of the APT and ssMT predict the overall survival of patients with glioma at the first follow-up after completion of radiotherapy at 3T

Radiother Oncol. 2023 Jul:184:109694. doi: 10.1016/j.radonc.2023.109694. Epub 2023 May 6.

Authors

Nikolaus von Knebel Doeberitz¹, Florian Kroh², Johannes Breitling³, Laila König⁴, Srdjan Maksimovic¹, Svenja Graß¹, Sebastian Adeberg⁵, Moritz Scherer⁶, Andreas Unterberg⁷, Martin Bendszus⁸, Wolfgang Wick⁹, Peter Bachert², Jürgen Debus¹⁰, Mark E Ladd¹¹, Heinz-Peter Schlemmer¹², Andreas Korzowski³, Steffen Goerke³, Daniel Paech¹³

Affiliations

¹ Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
² Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany.
³ Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁴ Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
⁵ Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
⁶ Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
⁷ Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
⁸ Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
⁹ Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
¹⁰ Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
¹¹ Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
¹² Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
¹³ Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neuroradiology, University Hospital Bonn, Bonn, Germany. Electronic address: d.paech@dkfz.de.

PMID: 37150450
DOI: 10.1016/j.radonc.2023.109694

Abstract

Background and purpose: Outcome prediction of patients with glioma early after the completion of radiotherapy represents a major clinical challenge. Previously, the prognostic value of chemical exchange saturation transfer (CEST) imaging has been demonstrated in patients with newly diagnosed glioma. The objective of this study was to assess the potential of amide proton transfer (APT)-, relayed nuclear Overhauser effect (rNOE)- and semi-solid magnetization transfer (ssMT)-imaging according to Zhou et al. (APTw_asym), Goerke et al. (MTR_RexAPT, MTR_RexNOE and MTR_RexMT) and Mehrabian et al. (PeakAreaAPT, PeakAreaNOE and MT_const) for the prognostication of the overall survival (OS) of patients with glioma at the first follow-up after the completion of radiotherapy.

Materials and methods: 49 of 72 participants with diffuse glioma, who underwent CEST MRI at 3T between July 2018 and December 2021 4 to 6 weeks after the completion of radiotherapy, were analyzed. Contrast-enhancing tumor (CE) and whole tumor (WT) volumes were segmented on T2w-FLAIR and contrast-enhanced T1w images. Kaplan-Meier analysis and logrank-test were used for statistical analyses.

Results: APTw imaging demonstrated the strongest association with OS (HR = 4.66, p < 0.001). The MT_const (HR = 2.54, p = 0.044) was associated with the OS of participants with residual contrast-enhancing glioma tissue, whilst the MTR_RexAPT (HR = 2.44, p = 0.056) showed a trend in this sub-cohort. The MTR_RexNOE, MTR_RexMT and PeakAreaNOE were not associated with survival.

Conclusion: Imaging of the APT and ssMT at the first follow-up 4 to 6 weeks after the completion of radiotherapy at 3T were associated with the overall survival of study participants with glioma.

Keywords: Amide proton transfer; Chemical exchange saturation transfer MRI; Glioma; Overall survival; Radiotherapy; Semi-solid magnetization transfer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Amides
Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / pathology
Brain Neoplasms* / radiotherapy
Follow-Up Studies
Glioma* / diagnostic imaging
Glioma* / pathology
Glioma* / radiotherapy
Humans
Magnetic Resonance Imaging / methods
Protons

Substances

Protons
Amides