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Tumor habitat analysis by magnetic resonance imaging distinguishes tumor progression from radiation necrosis in brain metastases after stereotactic radiosurgery

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

The identification of viable tumor after stereotactic radiosurgery (SRS) is important for future targeted therapy. This study aimed to determine whether tumor habitat on structural and physiologic MRI can distinguish viable tumor from radiation necrosis of brain metastases after SRS.

Method

Multiparametric contrast-enhanced T1- and T2-weighted imaging, apparent diffusion coefficient (ADC), and cerebral blood volume (CBV) were obtained from 52 patients with 69 metastases, showing enlarging enhancing masses after SRS. Voxel-wise clustering identified three structural MRI habitats (enhancing, solid low-enhancing, and nonviable) and three physiologic MRI habitats (hypervascular cellular, hypovascular cellular, and nonviable). Habitat-based predictors for viable tumor or radiation necrosis were identified by logistic regression. Performance was validated using the area under the curve (AUC) of the receiver operating characteristics curve in an independent dataset with 24 patients.

Results

None of the physiologic MRI habitats was indicative of viable tumor. Viable tumor was predicted by a high-volume fraction of solid low-enhancing habitat (low T2-weighted and low CE-T1-weighted values; odds ratio [OR] 1.74, p <.001) and a low-volume fraction of nonviable tissue habitat (high T2-weighted and low CE-T1-weighted values; OR 0.55, p <.001). Combined structural MRI habitats yielded good discriminatory ability in both development (AUC 0.85, 95% confidence interval [CI]: 0.77–0.94) and validation sets (AUC 0.86, 95% CI:0.70–0.99), outperforming single ADC (AUC 0.64) and CBV (AUC 0.58) values. The site of progression matched with the solid low-enhancing habitat (72%, 8/11).

Conclusion

Solid low-enhancing and nonviable tissue habitats on structural MRI can help to localize viable tumor in patients with brain metastases after SRS.

Key Points

• Structural MRI habitats helped to differentiate viable tumor from radiation necrosis.

• Solid low-enhancing habitat was most helpful to find viable tumor.

• Providing spatial information, the site of progression matched with solid low-enhancing habitat.

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Abbreviations

CEL:

Contrast-enhancing lesion

SRS:

Stereotactic radiosurgery

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Funding

This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (grant numbers NRF-2020R1A2B5B01001707 and NRF-2020R1A2C4001748).

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Da Hyun Lee, Ji Eun Park & Ho Sung Kim

  2. DYNAPEX LLC, Seoul, Republic of Korea

    NakYoung Kim

  3. Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Seo Young Park

  4. Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Young-Hoon Kim & Young Hyun Cho

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  1. Da Hyun Lee
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Correspondence to Ji Eun Park.

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The scientific guarantor of this publication is Ho Sung Kim.

Conflict of interest

One of the authors of this manuscript (NakYoung Kim) is an employee of DYNAPEX LLC. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (Seo Young Park, 8 years of experience as a statistician).

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Written informed consent was waived by the Institutional Review Board.

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Lee, D.H., Park, J.E., Kim, N. et al. Tumor habitat analysis by magnetic resonance imaging distinguishes tumor progression from radiation necrosis in brain metastases after stereotactic radiosurgery. Eur Radiol 32, 497–507 (2022). https://doi.org/10.1007/s00330-021-08204-1

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  • DOI: https://doi.org/10.1007/s00330-021-08204-1

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