Chemical Exchange Saturation Transfer MRI for Differentiating Radiation Necrosis From Tumor Progression in Brain Metastasis—Application in a Clinical Setting

Background High radiation doses of stereotactic radiosurgery (SRS) for brain metastases (BM) can increase the likelihood of radiation necrosis (RN). Advanced MRI sequences can improve the differentiation between RN and tumor progression (TP). Purpose To use saturation transfer MRI methods including...

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Bibliographic Details
Published in:Journal of magnetic resonance imaging 2023-06, Vol.57 (6), p.1713-1725
Main Authors: Mehrabian, Hatef, Chan, Rachel W., Sahgal, Arjun, Chen, Hanbo, Theriault, Aimee, Lam, Wilfred W., Myrehaug, Sten, Tseng, Chia‐Lin, Husain, Zain, Detsky, Jay, Soliman, Hany, Stanisz, Greg J.
Format: Article
Language:English
Subjects:
Brain
Brain - diagnostic imaging
Brain - pathology
Brain cancer
brain metastases
Brain Neoplasms - diagnostic imaging
Brain Neoplasms - pathology
Brain Neoplasms - radiotherapy
Brain tumors
chemical exchange saturation transfer
Cohen's d
Female
Field strength
Gadolinium
Histopathology
Humans
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Magnetization
magnetization transfer
Male
Mapping
Median (statistics)
Medical imaging
Metastases
Metastasis
Middle Aged
Necrosis
Neuroimaging
Prospective Studies
Radiation
Radiation dosage
Radiation Injuries - diagnostic imaging
radiation necrosis
Radiosurgery
Saturation
Statistical analysis
Statistical tests
stereotactic radiosurgery
Tumors
Water
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Summary:Background High radiation doses of stereotactic radiosurgery (SRS) for brain metastases (BM) can increase the likelihood of radiation necrosis (RN). Advanced MRI sequences can improve the differentiation between RN and tumor progression (TP). Purpose To use saturation transfer MRI methods including chemical exchange saturation transfer (CEST) and magnetization transfer (MT) to distinguish RN from TP. Study Type Prospective cohort study. Subjects Seventy patients (median age 60; 73% females) with BM (75 lesions) post‐SRS. Field Strength/Sequence 3‐T, CEST imaging using low/high‐power (saturation B1 = 0.52 and 2.0 μT), quantitative MT imaging using B1 = 1.5, 3.0, and 5.0 μT, WAter Saturation Shift Referencing (WASSR), WAter Shift And B1 (WASABI), T1, and T2 mapping. All used gradient echoes except T2 mapping (gradient and spin echo). Assessment Voxel‐wise metrics included: magnetization transfer ratio (MTR); apparent exchange‐dependent relaxation (AREX); MTR asymmetry; normalized MT exchange rate and pool size product; direct water saturation peak width; and the observed T1 and T2. Regions of interests (ROIs) were manually contoured on the post‐Gd T1w. The mean (of median ROI values) was compared between groups. Clinical outcomes were determined by clinical and radiologic follow‐up or histopathology. Statistical Tests t‐Test, univariable and multivariable logistic regression, receiver operating characteristic, and area under the curve (AUC) with sensitivity/specificity values with the optimal cut point using the Youden index, Akaike information criterion (AIC), Cohen's d. P 
ISSN:1053-1807
1522-2586
DOI:10.1002/jmri.28440