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BMC Medical Imaging
Published in: BMC Medical Imaging 1/2014

Open Access 01-12-2014 | Research article

Diffusion-weighted MRI characteristics of the cerebral metastasis to brain boundary predicts patient outcomes

Authors: Rasheed Zakaria, Kumar Das, Mark Radon, Maneesh Bhojak, Philip R Rudland, Vanessa Sluming, Michael D Jenkinson

Published in: BMC Medical Imaging | Issue 1/2014

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Abstract

Background

Diffusion-weighted MRI (DWI) has been used in neurosurgical practice mainly to distinguish cerebral metastases from abscess and glioma. There is evidence from other solid organ cancers and metastases that DWI may be used as a biomarker of prognosis and treatment response. We therefore investigated DWI characteristics of cerebral metastases and their peritumoral region recorded pre-operatively and related these to patient outcomes.

Methods

Retrospective analysis of 76 cases operated upon at a single institution with DWI performed pre-operatively at 1.5T. Maps of apparent diffusion coefficient (ADC) were generated using standard protocols. Readings were taken from the tumor, peritumoral region and across the brain-tumor interface. Patient outcomes were overall survival and time to local recurrence.

Results

A minimum ADC greater than 919.4 × 10-6 mm2/s within a metastasis predicted longer overall survival regardless of adjuvant therapies. This was not simply due to differences between the types of primary cancer because the effect was observed even in a subgroup of 36 patients with the same primary, non-small cell lung cancer. The change in diffusion across the tumor border and into peritumoral brain was measured by the “ADC transition coefficient” or ATC and this was more strongly predictive than ADC readings alone. Metastases with a sharp change in diffusion across their border (ATC >0.279) showed shorter overall survival compared to those with a more diffuse edge. The ATC was the only imaging measurement which independently predicted overall survival in multivariate analysis (hazard ratio 0.54, 95% CI 0.3 – 0.97, p = 0.04).

Conclusions

DWI demonstrates changes in the tumor, across the tumor edge and in the peritumoral region which may not be visible on conventional MRI and this may be useful in predicting patient outcomes for operated cerebral metastases.
Appendix
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Literature
1.
Jenkinson MD, Haylock B, Shenoy A, Husband D, Javadpour M: Management of cerebral metastasis: evidence-based approach for surgery, stereotactic radiosurgery and radiotherapy. Eur J Cancer. 2011, 47 (5): 649-655.CrossRefPubMed
2.
Nussbaum ES, Djalilian HR, Cho KH, Hall WA: Brain metastases. Histology, multiplicity, surgery, and survival. Cancer. 1996, 78 (8): 1781-1788.CrossRefPubMed
3.
Young RJ, Sills AK, Brem S, Knopp EA: Neuroimaging of metastatic brain disease. Neurosurgery. 2005, 57 (5 Suppl): S4-10-S14-23.
4.
5.
Kim YJ, Chang KH, Song IC, Kim HD, Seong SO, Kim YH, Han MH: Brain abscess and necrotic or cystic brain tumor: discrimination with signal intensity on diffusion-weighted MR imaging. AJR Am J Roentgenol. 1998, 171 (6): 1487-1490.CrossRefPubMed
6.
Berghoff AS, Spanberger T, Ilhan-Mutlu A, Magerle M, Hutterer M, Woehrer A, Hackl M, Widhalm G, Dieckmann K, Marosi C, Birner P, Prayer D, Preusser M: Preoperative diffusion-weighted imaging of single brain metastases correlates with patient survival times. PLoS One. 2013, 8 (2): e55464-CrossRefPubMedPubMedCentral
7.
Wang S, Kim S, Chawla S, Wolf RL, Zhang WG, O'Rourke DM, Judy KD, Melhem ER, Poptani H: Differentiation between glioblastomas and solitary brain metastases using diffusion tensor imaging. Neuroimage. 2009, 44 (3): 653-660.CrossRefPubMed
8.
Tsuchiya K, Fujikawa A, Nakajima M, Honya K: Differentiation between solitary brain metastasis and high-grade glioma by diffusion tensor imaging. Br J Radiol. 2005, 78 (930): 533-537.CrossRefPubMed
9.
Toh CH, Wei KC, Ng SH, Wan YL, Lin CP, Castillo M: Differentiation of brain abscesses from necrotic glioblastomas and cystic metastatic brain tumors with diffusion tensor imaging. AJNR Am J Neuroradiol. 2011, 32 (9): 1646-1651.CrossRefPubMed
10.
Stadnik TW, Chaskis C, Michotte A, Shabana WM, van Rompaey K, Luypaert R, Budinsky L, Jellus V, Osteaux M: Diffusion-weighted MR imaging of intracerebral masses: comparison with conventional MR imaging and histologic findings. AJNR Am J Neuroradiol. 2001, 22 (5): 969-976.PubMed
11.
Lu S, Ahn D, Johnson G, Law M, Zagzag D, Grossman RI: Diffusion-tensor MR imaging of intracranial neoplasia and associated peritumoral edema: introduction of the tumor infiltration index. Radiology. 2004, 232: 221-228.CrossRefPubMed
12.
Lee EJ, terbrugge K, Mikulis D, Choi DS, Bae JM, Lee SK, Moon SY: Diagnostic value of peritumoral minimum apparent diffusion coefficient for differentiation of glioblastoma multiforme from solitary metastatic lesions. AJR Am J Roentgenol. 2011, 196 (1): 71-76.CrossRefPubMed
13.
Chen XZ, Yin XM, Ai L, Chen Q, Li SW, Dai JP: Differentiation between brain glioblastoma multiforme and solitary metastasis: qualitative and quantitative analysis based on routine MR imaging. AJNR Am J Neuroradiol. 2012, 33 (10): 1907-1912.CrossRefPubMed
14.
Byrnes TJ, Barrick TR, Bell BA, Clark CA: Diffusion tensor imaging discriminates between glioblastoma and cerebral metastases in vivo. NMR Biomed. 2011, 24 (1): 54-60.CrossRefPubMed
15.
Sternberg EJ, Lipton ML, Burns J: Utility of Diffusion Tensor Imaging in Evaluation of the Peritumoral Region in Patients with Primary and Metastatic Brain Tumors. AJNR Am J Neuroradiol. 2014, 35 (3): 439-444.CrossRefPubMed
16.
Kienast Y, von Baumgarten L, Fuhrmann M, Klinkert WE, Goldbrunner R, Herms J, Winkler F: Real-time imaging reveals the single steps of brain metastasis formation. Nat Med. 2010, 16 (1): 116-122.CrossRefPubMed
17.
Leenders WP, Kusters B, Verrijp K, Maass C, Wesseling P, Heerschap A, Ruiter D, Ryan A, de Waal R: Antiangiogenic therapy of cerebral melanoma metastases results in sustained tumor progression via vessel co-option. Clin Canc Res. 2004, 10 (18 Pt 1): 6222-6230.CrossRef
18.
Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R: Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997, 37: 745-751.CrossRefPubMed
19.
Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W: A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008, 70 (2): 510-514.CrossRefPubMed
20.
Zakaria R, Das K, Bhojak M, Radon M, Sluming V, Walker C, Jenkinson MD: The reliability of routine clinical post-processing software in assessing potential diffusion-weighted MRI “biomarkers” in brain metastases. Magn Reson Imaging. 2014, 32 (3): 291-296.CrossRefPubMed
21.
Jenkinson MD, Smith TS, Brodbelt AR, Joyce KA, Warnke PC, Walker C: Apparent diffusion coefficients in oligodendroglial tumors characterized by genotype. J Magn Reson Imaging. 2007, 26 (6): 1405-1412.CrossRefPubMed
22.
Calli C, Kitis O, Yunten N, Yurtseven T, Islekel S, Akalin T: Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol. 2006, 58 (3): 394-403.CrossRefPubMed
23.
Chiang IC, Kuo YT, Lu CY, Yeung KW, Lin WC, Sheu FO, Liu GC: Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion, and perfusion imagings. Neuroradiology. 2004, 46 (8): 619-627.CrossRefPubMed
24.
Duygulu G, Ovali GY, Calli C, Kitis O, Yunten N, Akalin T, Islekel S: Intracerebral metastasis showing restricted diffusion: correlation with histopathologic findings. Eur J Radiol. 2010, 74 (1): 117-120.CrossRefPubMed
25.
Hayashida Y, Hirai T, Morishita S, Kitajima M, Murakami R, Korogi Y, Makino K, Nakamura H, Ikushima I, Yamura M, Kochi M, Kuratsu JI, Yamashita Y: Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity. AJNR Am J Neuroradiol. 2006, 27 (7): 1419-1425.PubMed
26.
Iima M, Reynaud O, Tsurugizawa T, Ciobanu L, Li JR, Geffroy F, Djemai B, Umehana M, Le Bihan D: Characterization of Glioma Microcirculation and Tissue Features Using Intravoxel Incoherent Motion Magnetic Resonance Imaging in a Rat Brain Model. Invest Radiol. 2014, 49 (7): 485-490.CrossRefPubMed
27.
Panagiotaki E, Walker-Samuel S, Siow B, Johnson SP, Rajkumar V, Pedley RB, Lythgoe MF, Alexander DC: Noninvasive quantification of solid tumor microstructure using VERDICT MRI. Cancer Res. 2014, 74 (7): 1902-1912.CrossRefPubMed
28.
Porto L, Jurcoane A, Schwabe D, Kieslich M, Hattingen E: Differentiation between high and low grade tumours in paediatric patients by using apparent diffusion coefficients. Eur J Paediatr Neurol. 2013, 17 (3): 302-307.CrossRefPubMed
29.
Mahmoud OM, Tominaga A, Amatya VJ, Ohtaki M, Sugiyama K, Sakoguchi T, Kinoshita Y, Takeshima Y, Abe N, Akiyama Y, El-Ghoriany AI, Abd Alla AK, El-Sharkawy MA, Arita K, Kurisu K, Yamasaki F: Role of PROPELLER diffusion-weighted imaging and apparent diffusion coefficient in the evaluation of pituitary adenomas. Eur J Radiol. 2011, 80 (2): 412-417.CrossRefPubMed
30.
Barajas RF, Rubenstein JL, Chang JS, Hwang J, Cha S: Diffusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma. AJNR Am J Neuroradiol. 2010, 31 (1): 60-66.CrossRefPubMed
31.
Somoye G, Harry V, Semple S, Plataniotis G, Scott N, Gilbert FJ, Parkin D: Early diffusion weighted magnetic resonance imaging can predict survival in women with locally advanced cancer of the cervix treated with combined chemo-radiation. Eur Radiol. 2012, 22 (11): 2319-2327.CrossRefPubMed
32.
Frankel TL, Gian RK, Jarnagin WR: Preoperative imaging for hepatic resection of colorectal cancer metastasis. J Gastrointest Oncol. 2012, 3 (1): 11-18.PubMedPubMedCentral
33.
Squillaci E, Manenti G, Di Stefano F, Miano R, Strigari L, Simonetti G: Diffusion-weighted MR imaging in the evaluation of renal tumours. J Exp Clin Canc Res. 2004, 23: 39-45.
34.
Lambregts DM, Beets GL, Maas M, Curvo-Semedo L, Kessels AG, Thywissen T, Beets-Tan RG: Tumour ADC measurements in rectal cancer: effect of ROI methods on ADC values and interobserver variability. Eur Radiol. 2011, 21 (12): 2567-2574.CrossRefPubMedPubMedCentral
35.
Matoba M, Tuji H, Shimode Y, Toyoda I, Kuginuki Y, Miwa K, Tonami H: Fractional Change in Apparent Diffusion Coefficient as an Imaging Biomarker for Predicting Treatment Response in Head and Neck Cancer Treated with Chemoradiotherapy. AJNR Am J Neuroradiol. 2014, 35 (2): 379-385.CrossRefPubMed
36.
Raore B, Schniederjan M, Prabhu R, Brat DJ, Shu HK, Olson JJ: Metastasis infiltration: an investigation of the postoperative brain-tumor interface. Int J Radiat Oncol Biol Phys. 2011, 81 (4): 1075-1080.CrossRefPubMed
37.
Baumert BG, Rutten I, Dehing-Oberije C, Twijnstra A, Dirx MJ, Debougnoux-Huppertz RM, Lambin P, Kubat B: A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys. 2006, 66 (1): 187-194.CrossRefPubMed
38.
Neves S, Mazal PR, Wanschitz J, Rudnay AC, Drlicek M, Czech T, Wustinger C, Budka H: Pseudogliomatous growth pattern of anaplastic small cell carcinomas metastatic to the brain. Clin Neuropathol. 2001, 20 (1): 38-42.PubMed
39.
Patel AJ, Suki D, Hatiboglu MA, Abouassi H, Shi W, Wildrick DM, Lang FF, Sawaya R: Factors influencing the risk of local recurrence after resection of a single brain metastasis. J Neurosurg. 2010, 113 (2): 181-189.CrossRefPubMed
40.
Goodman SL, Picard M: Integrins as therapeutic targets. Trends Pharmacol Sci. 2012, 33 (7): 405-412.CrossRefPubMed
41.
42.
43.
Spanberger T, Berghoff AS, Dinhof C, Ilhan-Mutlu A, Magerle M, Hutterer M, Pichler J, Wohrer A, Hackl M, Widhalm G, Hainfellner JA, Dieckmann K, Marosi C, Birner P, Prayer D, Preusser M: Extent of peritumoral brain edema correlates with prognosis, tumoral growth pattern, HIF1a expression and angiogenic activity in patients with single brain metastases. Clin Exp Metastasis. 2013, 30 (4): 357-368.CrossRefPubMed
44.
Serres S, Martin CJ, Sarmiento Soto M, Bristow C, O'Brien ER, Connell JJ, Khrapitchev AA, Sibson NR: Structural and functional effects of metastases in rat brain determined by multimodal MRI. Int J Cancer. 2014, 134 (4): 885-896.CrossRefPubMed
45.
Kelly PJ, Daumas-Duport C, Scheithauer BW, Kall BA, Kispert DB: Stereotactic histologic correlations of computed tomography- and magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. Mayo Clin Proc. 1987, 62 (6): 450-459.CrossRefPubMed
46.
Price SJ, Pena A, Burnet NG, Jena R, Green HA, Carpenter TA, Pickard JD, Gillard JH: Tissue signature characterisation of diffusion tensor abnormalities in cerebral gliomas. Eur Radiol. 2004, 14 (10): 1909-1917.CrossRefPubMed
47.
Berghoff AS, Rajky O, Winkler F, Bartsch R, Furtner J, Hainfellner JA, Goodman SL, Weller M, Schittenhelm J, Preusser M: Invasion patterns in brain metastases of solid cancers. Neuro Oncol. 2013, 15 (12): 1664-1672.CrossRefPubMedPubMedCentral
48.
Metadata
Title
Diffusion-weighted MRI characteristics of the cerebral metastasis to brain boundary predicts patient outcomes
Authors
Rasheed Zakaria
Kumar Das
Mark Radon
Maneesh Bhojak
Philip R Rudland
Vanessa Sluming
Michael D Jenkinson
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2014
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/1471-2342-14-26

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