Diagnostic performance of fast brain MRI compared to routine clinical MRI in patients with glioma grade 3 and 4 -a pilot study.

Francesca De Luca, Annika Suneson, Annika Kits, Emilia Palmér, Stefan Skare, Anna Falk Delgado
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Abstract

Background and purpose: EPIMix is a fast brain MRI technique not previously investigated in patients with glioma grades 3 and 4. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with glioma grades 3 and 4 compared to routine clinical MRI (rcMRI).

Materials and methods: Patients with glioma grades 3 and 4 investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1-3) participated in the radiological assessment applying Response Assessment for Neuro-oncology Criteria (RANO 2.0), of which two (R1-2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrastenhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix vs. rcMRI) were performed using Weighted Cohen's kappa. The sensitivity and specificity to detect tumor progression (PD) on a follow-up scan were calculated for EPIMix compared to rcMRI with receiver operating characteristic (ROC) curves to assess the area under the curve (AUC).

Results: In 35 patients (mean age 53, 31% females), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at blinded reading in 33% of EPIMix (19/58, R1-2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 vs. rcMRIR1 ϰ= 0.96; EPIMixR2 vs. rcMRIR2 ϰ= 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81-1.00) for R1 and 0.90 (0.68-0.99) for R2, while the specificity was 0.97 (0.86-1.00) for R1-2. The AUC for PD was 0.99 for R1 (EPIMixR1 vs. rcMRIR1) and 0.94 for R2 (EPIMixR2 vs. rcMRIR2), DeLong's test AUCR1 vs. AUCR2 p=0.20 (R1-2).

Conclusions: In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high, but slightly lower diagnostic performance than rcMRI.

Abbreviations: CR = complete response; EPIMix = multi-contrast echo-planar imaging-based technique; PD = progressive disease; PR = partial response; RANO = response assessment in neuro-oncology; R1 = reader 1; R2 = reader 2; R3 = reader 3; rcMRI = routine clinical MRI; SD = stable disease.

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快速脑磁共振成像与常规临床磁共振成像在胶质瘤 3 级和 4 级患者中的诊断性能比较 - 一项试点研究。
背景和目的:EPIMix是一种快速脑部磁共振成像技术,以前从未在3级和4级胶质瘤患者中进行过研究。这项试验性研究旨在调查 EPIMix 与常规临床磁共振成像(rcMRI)相比,在对 3 级和 4 级成年胶质瘤患者进行放射治疗评估时的诊断性能:研究回顾性地纳入了使用rcMRI和EPIMix进行检查的3级和4级胶质瘤患者。三名阅读者(R1-3)参与了采用神经肿瘤学反应评估标准(RANO 2.0)进行的放射学评估,其中两名阅读者(R1-2)在每次随访时通过测量对比增强和非对比增强肿瘤区域,独立评估 EPIMix 和后来的 rcMRI。对于评估结果不一致的病例,由第三位阅读者(R3)进行非盲法并排(EPIMix 和 rcMRI)阅读。不同方法(EPIMix 与 rcMRI)之间的比较采用加权科恩卡帕法进行。通过接收器操作特征曲线(ROC)评估曲线下面积(AUC),计算出 EPIMix 与 rcMRI 相比在后续扫描中检测肿瘤进展(PD)的灵敏度和特异性:在35名患者(平均年龄53岁,31%为女性)的58次随访检查共93次磁共振成像中,33%的EPIMix(19次/58次,R1-2)在盲读时显示出PD,而31%的rcMRI(18次/58次,R1)和34%的rcMRI(20次/58次,R2)在盲读时显示出PD。EPIMix和rcMRI对肿瘤类别的评估几乎完全一致(EPIMixR1 vs. rcMRIR1 ϰ=0.96;EPIMixR2 vs. rcMRIR2 ϰ=0.89)。EPIMix 对 R1 检测 PD 的灵敏度为 1.00(0.81-1.00),对 R2 检测 PD 的灵敏度为 0.90(0.68-0.99),而对 R1-2 检测 PD 的特异性为 0.97(0.86-1.00)。R1(EPIMixR1 vs. rcMRIR1)和R2(EPIMixR2 vs. rcMRIR2)的PD AUC分别为0.99和0.94,DeLong检验AUCR1 vs. AUCR2 p=0.20(R1-2):在这项试验研究中,EPIMix可作为胶质瘤3级和4级患者治疗评估的快速磁共振成像替代方法,其诊断性能较高,但略低于rcMRI:缩写:CR = 完全反应;EPIMix = 基于多对比度回声平面成像技术;PD = 进展性疾病;PR = 部分反应;RANO = 神经肿瘤学反应评估;R1 = 阅读器 1;R2 = 阅读器 2;R3 = 阅读器 3;rcMRI = 常规临床 MRI;SD = 稳定性疾病。
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