Quantitative CEST and MT at 1.5T for monitoring treatment response in glioblastoma: early and late tumor progression dur
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CLINICAL STUDY
Quantitative CEST and MT at 1.5T for monitoring treatment response in glioblastoma: early and late tumor progression during chemoradiation Rachel W. Chan1 · Hanbo Chen2 · Sten Myrehaug2 · Eshetu G. Atenafu3 · Greg J. Stanisz1,4,5 · James Stewart2 · Pejman Jabehdar Maralani6 · Aimee K. M. Chan6 · Shadi Daghighi6 · Mark Ruschin2 · Sunit Das7 · James Perry8 · Gregory J. Czarnota1,2,4 · Arjun Sahgal1,2 · Angus Z. Lau1,4 Received: 8 September 2020 / Accepted: 7 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Quantitative MRI (qMRI) was performed using a 1.5T protocol that includes a novel chemical exchange saturation transfer/magnetization transfer (CEST/MT) approach. The purpose of this prospective study was to determine if qMRI metrics at baseline, at the 10th and 20th fraction during a 30 fraction/6 week standard chemoradiation (CRT) schedule, and at 1 month following treatment could be an early indicator of response for glioblastoma (GBM). Methods The study included 51 newly diagnosed GBM patients. Four regions-of-interest (ROI) were analyzed: (i) the radiation defined clinical target volume (CTV), (ii) radiation defined gross tumor volume (GTV), (iii) enhancing-tumor regions, and (iv) FLAIR-hyperintense regions. Quantitative CEST, MT, T1 and T2 parameters were compared between those patients progressing within 6.9 months (early), and those progressing after CRT (late), using mixed modelling. Exploratory predictive modelling was performed to identify significant predictors of early progression using a multivariable LASSO model. Results Results were dependent on the specific tumor ROI analyzed and the imaging time point. The baseline CEST asymmetry within the CTV was significantly higher in the early progression cohort. Other significant predictors included the T2 of the MT pools (for semi-solid at fraction 20 and water at 1 month after CRT), the exchange rate (at fraction 20) and the MGMT methylation status. Conclusions We observe the potential for multiparametric qMRI, including a novel pulsed CEST/MT approach, to show potential in distinguishing early from late progression GBM cohorts. Ultimately, the goal is to personalize therapeutic decisions and treatment adaptation based on non-invasive imaging-based biomarkers. Keywords Chemical exchange saturation transfer · Magnetization transfer · Glioblastoma · Treatment monitoring · Radiation oncology Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11060-020-03661-y) contains supplementary material, which is available to authorized users. * Rachel W. Chan [email protected] 1
Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
2
3
Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
4
Medical Biophysics, University of Toronto, Toront
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