Improving the characterization of meningioma microstructure in proton therapy from conventional apparent diffusion coefficient measurements using Monte Carlo simulations of diffusion MRI.
Buizza G; Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy.
Paganelli C; Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy.
Ballati F; Diagnostic Radiology Residency School, University of Pavia, Pavia, 27100, Italy.
Sacco S; Diagnostic Radiology Residency School, University of Pavia, Pavia, 27100, Italy.
Preda L; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy.
Iannalfi A; Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy.
Alexander DC; Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1V6LJ, UK.
Baroni G; Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy.; Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy.
Palombo M; Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1V6LJ, UK.
Medical physics [Med Phys] 2021 Mar; Vol. 48 (3), pp. 1250-1261. Date of Electronic Publication: 2021 Feb 05.
Typ publikacji :
Imprint Name(s) :
Publication: 2017- : Hoboken, NJ : John Wiley and Sons, Inc.
Original Publication: Lancaster, Pa., Published for the American Assn. of Physicists in Medicine by the American Institute of Physics.
MeSH Terms :
Meningeal Neoplasms*/diagnostic imaging
Diffusion Magnetic Resonance Imaging ; Humans ; Monte Carlo Method ; Neoplasm Grading
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Grant Information :
MR/T020296/1 United Kingdom MRC_ Medical Research Council; EP/N018702-1 EPSRC; MR/T020296/1 UKRI Future Leaders Fellowship
Contributed Indexing :
Keywords: Meningioma; diffusion MRI; microstructure; particle therapy; quantitative imaging
Entry Date(s) :
Date Created: 20201228 Date Completed: 20210514 Latest Revision: 20210514
Update Code :
Purpose: Proton therapy could benefit from noninvasively gaining tumor microstructure information, at both planning and monitoring stages. The anatomical location of brain tumors, such as meningiomas, often hinders the recovery of such information from histopathology, and conventional noninvasive imaging biomarkers, like the apparent diffusion coefficient (ADC) from diffusion-weighted MRI (DW-MRI), are nonspecific. The aim of this study was to retrieve discriminative microstructural markers from conventional ADC for meningiomas treated with proton therapy. These markers were employed for tumor grading and tumor response assessment.
Methods: DW-MRIs from patients affected by meningioma and enrolled in proton therapy were collected before (n = 35) and 3 months after (n = 25) treatment. For the latter group, the risk of an adverse outcome was inferred by their clinical history. Using Monte Carlo methods, DW-MRI signals were simulated from packings of synthetic cells built with well-defined geometrical and diffusion properties. Patients' ADC was modeled as a weighted sum of selected simulated signals. The weights that best described a patient's ADC were determined through an optimization procedure and used to estimate a set of markers of tumor microstructure: diffusion coefficient (D), volume fraction (vf), and radius (R). Apparent cellularity (ρ app ) was estimated from vf and R for an easier clinical interpretability. Differences between meningothelial and atypical subtypes, and low- and high-grade meningiomas were assessed with nonparametric statistical tests, whereas sensitivity and specificity with ROC analyses. Similar analyses were performed for patients showing low or high risk of an adverse outcome to preliminary evaluate response to treatment.
Results: Significant (P < 0.05) differences in median ADC, D, vf, R, and ρ app values were found when comparing meningiomas' subtypes and grades. ROC analyses showed that estimated microstructural parameters reached higher specificity than ADC for subtyping (0.93 for D and vf vs 0.80 for ADC) and grading (0.75 for R vs 0.67 for ADC). High- and low-risk patients showed significant differences in ADC and microstructural parameters. The skewness of ρ app was the parameter with highest AUC (0.90) and sensitivity (0.75).
Conclusions: Matching measured with simulated ADC yielded a set of potential imaging markers for meningiomas grading and response monitoring in proton therapy, showing higher specificity than conventional ADC. These markers can provide discriminative information about spatial patterns of tumor microstructure implying important advantages for patient-specific proton therapy workflows.
(© 2020 American Association of Physicists in Medicine.)