Zhibo Zhu¹, Jay Acharya², Yannick Bliesener¹, R. Marc Lebel^3,4, Richard Frayne^3,5, and Krishna S. Nayak^1,2
1Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, United States, ²Department of Radiology, University of Southern California, Los Angeles, CA, United States, ³Radiology and Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgray, AB, Canada, ⁴Global MR Applications & Workflow, GE Healthcare, Calgary, AB, Canada, ⁵Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, AB, Canada

Native T₁ mapping is necessary for quantitative DCE-MRI of brain tumor and may have independent predictive value. Previous investigations using coarse spatial resolution have found tumor to have longer T₁ compared to normal white matter. In this work, we evaluate a recent millimeter-resolution whole-brain T₁ mapping approach in patients with high-grade glioma. T₁ values in tumor and peritumoral regions were higher than that of normal white matter, consistent with literature. We also observed T₁ spatial heterogeneity in these regions, further supporting the need for high resolution pre-contrast T₁ mapping for quantitative DCE-MRI.

Chengxiu Zhang¹, Jingyu Zhong², Yangfan Hu³, Jing Zhang¹, Liping Si², Yue Xing², Jia Geng³, Qiong Jiao⁴, Huizhen Zhang⁴, Weiwu Yao², and Guang Yang^1
1Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China, ²Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, ³Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China, ⁴Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

Osteosarcoma is the most common malignant osseous tumor and neoadjuvant chemotherapy for osteosarcoma has significantly improved survival outcomes. However, not all patients benefit from the current treatment strategy. We constructed a nomogram combined radiomics features from routinely available T2WI images and clinical variables to predict the response to neoadjuvant chemotherapy. The nomogram achieved an AUC of 0.838 (95% CI, 0.700-0.958) and DCA suggested that it has the potential to be used for preoperational prediction of pathological NAC response in osteosarcoma patients.

Chien-Yi Liao¹, Cheng-Chia Lee^2,3,4, Huai-Che Yang^2,3, Wen-Yuh Chung^2,3, Hsiu-Mei Wu^3,5, Wan-Yuo Guo^3,5, Ren-Shyan Liu^1,6,7, and Chia-Feng Lu^1,8
1Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan, ²Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan, Taipei, Taiwan, ³School of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan, ⁴Brain Research Center, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan, ⁵Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan, Taipei, Taiwan, ⁶Department of Medical Imaging, Cheng-Hsin General Hospital, Taipei, Taiwan, Taipei, Taiwan, ⁷Molecular and Genetic Imaging Core, Taiwan Animal Consortium, Taipei, Taiwan, Taipei, Taiwan, ⁸Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan

Patients with non-small cell lung cancer have a high probability to develop brain metastasis during the course of the disease. The prediction of treatment response after Gamma Knife stereotactic radiosurgery (GKRS) can benefit patient management. In addition to the clinically available information (Karnofsky performance status, number of tumors, tumor volume, and primary tumor control), we proposed an MR radiomics approach to provide added values to predict the local tumor control after GKRS. We suggested that imaging characteristics extracted from preradiosurgical MRIs combined with clinical information can effectively predict local tumor control.

Ansje Fortuin^1,2, Sjaak van Asten¹, Andor Veltien¹, Bart Philips¹, Thomas Hambrock¹, Stephan Orzada^3,4, Harald Quick^3,5, Jelle Barentsz¹, Marnix Maas¹, and Tom Scheenen^1,3
1Radboudumc, Nijmegen, Netherlands, ²Radiology, Ziekenhuis Gelderse Vallei, Ede, Netherlands, ³Erwin L Hahn Institute for MR Imaging, Essen, Germany, ⁴University of Heidelberg, Heidelberg, Germany, ⁵University of Duisburg-Essen, Essen, Germany

Lymph node metastases in prostate cancer patients are mainly found in normal sized lymph nodes and detection is a major challenge. USPIO-enhanced MRI with ferumoxtran-10 discriminates between normal and suspicious lymph nodes. We examined 20 prostate cancer patients with high risk of advanced disease with USPIO-enhanced MRI at 3 and at 7 Tesla, and compared the amount, the level of suspicion, and the size of lymph nodes with two readers. More, but on average not larger suspicious nodes were annotated on 7T versus 3T MRI by both readers, with less interobserver variability at 7T. 

Jibin Tang¹, Hongxi Zhang², Zhipeng Shen³, Wenqi Wang¹, Xingwang Yong¹, Junjie Wen¹, Xinchun Chen², Fengyu Tian², Weibo Chen⁴, Dan Wu¹, and Yi Zhang^1
1Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China, ²Department of Radiology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China, ³Department of Neurosurgery, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China, ⁴Philips Healthcare, Shanghai, China

CEST imaging can detect proteins and metabolites in vivo and has been successfully applied to brain tumor grading. In this work, we implemented a radiomic analysis of the APTw images, which were acquired from 40 patients with 20 confirmed high-grade brain tumors and 20 confirmed low-grade tumors. We established predictive models, assessed their performance, and compared them with conventional average APTw image intensities. The average sensitivity and AUC of the selected radiomic feature models for tumor grading were significantly higher than that of conventional mean APTw signals, demonstrating the advantage of radiomics for diagnosing brain tumors.

Henk M. De Feyter¹, Monique A. Thomas¹, Kevan L. Ip¹, Kevin L. Behar², and Robin A. de Graaf^3,4
1Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States, ²Department of Psychiatry, Yale University, New Haven, CT, United States, ³Department of Radiology and Biomedical Imaging, Yale University, NEW HAVEN, CT, United States, ⁴Department of Biomedical Engineering, Yale University, New Haven, CT, United States

Previously we reported high tumor uptake of exogenous choline in rodent brain tumor models when using Deuterium Metabolic Imaging (DMI) during intravenous infusion of [²H₉]-choline. The small differences in chemical shifts of [²H₉]-labeled choline, phosphocholine, glycerophosphocholine and betaine exclude accurate peak assignment, and therefore it is unclear whether blood-borne choline is metabolized intracellularly. Using different ²H-labeling strategies of choline and high resolution ²H NMR in tumor tissue extracts we identified the choline-containing metabolites observed during intravenous infusion, as well as after 24 hrs.

Michael Wenke¹, Jorg Dietrich², Elizabeth Gerstner², Otto Rapalino³, Julian He³, Daniel Kim¹, Melanie Fu¹, Pratik Talati⁴, Mohamed El Abtah¹, Anna Vaynrub¹, Sharif Natheir¹, Mark Vangel³, Isabel Arrillaga-Romany², Forst Deborah², Yi-Fen Yen¹, Ovidiu Andronesi¹, Jayashree Kalpathy-Cramer¹, Tracy Batchelor⁵, Bruce Rosen¹, R. Gilberto Gonzalez³, and Eva-Maria Ratai^1
1Radiology / Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States, ²Neurology / Cancer Center, Massachusetts General Hospital, Boston, MA, United States, ³Radiology, Massachusetts General Hospital, Boston, MA, United States, ⁴Neurosurgery, Massachusetts General Hospital, Boston, MA, United States, ⁵Neurology, Brigham and Women's Hospital, Boston, MA, United States

Patients with recurrent glioblastoma (rGBM) are commonly treated with anti-angiogenic agents such as bevacizumab (BEV), but not all benefit from this therapy. We examined whether MR spectroscopic imaging (MRSI) of myo-inositol (mI) could distinguish short-term survivors from longer term survivors (>9 month). We scanned twenty-two rGBM patients with MRSI at baseline prior to bevacizumab-based therapy, as well as 1-2 days, 4 weeks, 6-8 weeks and 16 weeks after treatment.  We found that low tumoral myo-inositol normalized by creatine (Cr) on the contralateral site (mI/c-Cr) prior to and during anti-angiogenic therapy is predictive of poor survival.

Georgios Batsios¹, Celine Taglang¹, Meryssa Tran¹, Anne Marie Gillespie¹, Joseph Costello², Sabrina Ronen¹, and Pavithra Viswanath^1
1Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States, ²Neurological Surgery, UCSF, San Francisco, CA, United States

Telomerase reverse transcriptase (TERT) expression is essential for tumor proliferation. Since TERT is exclusively expressed in tumor cells, TERT is also an attractive therapeutic target. However, non-invasive methods of imaging TERT are lacking. Here, we show that TERT expression in preclinical patient-derived brain tumor models is associated with elevated steady-state levels of NADH, an effect that can be non-invasively visualized in vivo by deuterium metabolic imaging using [U-²H]pyruvate. Since ²H-MRS can be readily implemented on clinical MR scanners, our results provide an innovative, clinically translatable method of integrating information regarding a fundamental cancer hallmark, i.e. TERT, into glioma patient management.

Marina Radoul¹, Donghyun Hong¹, Anne Marie Gillespie¹, Chloé Najac¹, Pavithra Viswanath¹, Russell O. Pieper^2,3, Joseph Costello², H. Artee Luchman⁴, and Sabrina M. Ronen^1,3
1Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States, ²Neurological Surgery UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States, ³Brain Tumor Research Center, University of California San Francisco, San Francisco, CA, United States, ⁴Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada

Targeting mutant IDH, which is present in ~80% of glioma, is being tested as a new therapeutic approach. In the current study, we investigated metabolic alterations in response to mutant IDH inhibition by either AG-881 or BAY-1436032 in orthotopic patient-derived glioma models. Using high resolution in vivo ¹H MRS we detected, in addition to a decrease in 2HG, an early increase in glutamate and the combined glutamine/glutamate signals. These were associated with slowdown of tumor growth and ultimately longer animal survival. This identifies potential early metabolic biomarkers of glioma response to mutant IDH inhibition.

Friederike Hesse¹, Alan Wright¹, Vencel Somai^1,2, Flaviu Bulat^1,3, and Kevin Brindle^1,4
1Cancer Research UK Cambridge Institute, Cambridge, United Kingdom, ²Department of Radiology, University of Cambridge, Cambridge, United Kingdom, ³Department of Chemistry, University of Cambridge, Cambridge, United Kingdom, ⁴Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom

Metabolic imaging of brain tumor responses to radio-chemotherapy can give an early indication of treatment outcome. We show here that Deuterium Metabolic Imaging (DMI) with ²H-labeled fumarate can be used to detect early evidence of cell death following radio-chemotherapy in an orthotopic patient-derived glioblastoma model. ²H spectra were acquired from tumors, following an injection of ²H-labeled fumarate. Within one week of treatment the rate of tumor malate production increased significantly. Increased levels of labeled malate were also evident in spectroscopic images of the tumors. These measurements were compared with ¹³C MRSI measurements of [1,4-¹³C₂]malate production from hyperpolarized [1,4-¹³C₂]fumarate¹.