Consensus Recommendations for a Dynamic Susceptibility Contrast MRI Protocol for Use in High-Grade Gliomas.,Neuro-Oncology

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Consensus Recommendations for a Dynamic Susceptibility Contrast MRI Protocol for Use in High-Grade Gliomas.
Neuro-Oncology ( IF 16.4 ) Pub Date : 2020-06-09 , DOI: 10.1093/neuonc/noaa141
Jerrold L Boxerman _{1,

2,

3,

4} , Chad C Quarles ₅ , Leland S Hu _{3,

6,

7} , Bradley J Erickson _{3,

7,

8,

9} , Elizabeth R Gerstner _{10,

11} , Marion Smits _{12,

13} , Timothy J Kaufmann _{7,

8} , Daniel P Barboriak _{2,

3,

9,

14} , Raymond H Huang _{15,

16} , Wolfgang Wick _{13,

17} , Michael Weller _{13,

18} , Evanthia Galanis _{7,

19} , Jayashree Kalpathy-Cramer ₂₀ , Lalitha Shankar ₂₁ , Paula Jacobs ₂₁ , Caroline Chung _{7,

22} , Martin J van den Bent _{13,

23} , Susan Chang ₂₄ , W K Al Yung ₂₅ , Timothy F Cloughesy _{26,

27} , Patrick Y Wen _{11,

16} , Mark R Gilbert _{28,

29} , Bruce R Rosen ₂₀ , Benjamin M Ellingson _{2,

3,

9,

11,

26,

30,

31} , Kathleen M Schmainda _{2,

32} ,

Affiliation

Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Representative of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group.
Representative of the American Society of Neuroradiology (ASNR).
Representative of the American Society of Functional Neuroradiology (ASFNR).
Department of Neuroimaging Research and Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, Phoenix, Arizona, USA.
Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA.
Representative of the Alliance for Clinical Trials in Oncology.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Representative of the RSNA Quantitative Imaging Biomarker Alliance (QIBA).
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Representative of the Adult Brain Tumor Consortium (ABTC).
Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands.
Representative of the European Organisation for Research and Treatment of Cancer (EORTC).
Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany.
Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Neuro-Oncology Branch, National Cancer Institute (NCI), Bethesda, Maryland, USA.
Representative of the Radiation Therapy Oncology Group (RTOG).
Departments of Radiological Sciences, Psychiatry, and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Representative of the Ivy Consortium for Early Phase Clinical Trials.
Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Despite the widespread clinical use of dynamic susceptibility contrast (DSC) MRI, DSC-MRI methodology has not been standardized, hindering its utilization for response assessment in multicenter trials. Recently, the DSC-MRI Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition issued an updated consensus DSC-MRI protocol compatible with the standardized brain tumor imaging protocol (BTIP) for high-grade gliomas that is increasingly used in the clinical setting and is the default MRI protocol for the National Clinical Trials Network. After reviewing the basis for controversy over DSC-MRI protocols, this paper provides evidence-based best practices for clinical DSC-MRI as determined by the Committee, including pulse sequence (gradient echo vs spin echo), BTIP-compliant contrast agent dosing (preload and bolus), flip angle (FA), echo time (TE), and post-processing leakage correction. In summary, full-dose preload, full-dose bolus dosing using intermediate (60°) FA and field strength-dependent TE (40–50 ms at 1.5 T, 20–35 ms at 3 T) provides overall best accuracy and precision for cerebral blood volume estimates. When single-dose contrast agent usage is desired, no-preload, full-dose bolus dosing using low FA (30°) and field strength-dependent TE provides excellent performance, with reduced contrast agent usage and elimination of potential systematic errors introduced by variations in preload dose and incubation time.

中文翻译：

用于高级别胶质瘤的动态磁敏感对比 MRI 协议的共识建议。

尽管动态磁敏感对比 (DSC) MRI 广泛应用于临床，但 DSC-MRI 方法尚未标准化，阻碍了其在多中心试验中用于疗效评估。最近，快速启动脑肿瘤药物开发联盟的 DSC-MRI 标准化小组委员会发布了更新的 DSC-MRI 共识协议，该协议与高级别神经胶质瘤的标准化脑肿瘤成像协议 (BTIP) 兼容，该协议越来越多地在临床环境中使用，并且国家临床试验网络的默认 MRI 协议。在回顾了 DSC-MRI 协议争议的基础后，本文提供了委员会确定的临床 DSC-MRI 循证最佳实践，包括脉冲序列（梯度回波与旋转回波）、符合 BTIP 的造影剂剂量（预载）和推注）、翻转角 (FA)、回波时间 (TE) 和后处理泄漏校正。总之，使用中间 (60°) FA 和场强相关 TE（1.5 T 时 40–50 ms，3 T 时 20–35 ms）的全剂量预载、全剂量推注给药为脑血容量估计。当需要使用单剂量造影剂时，使用低 FA (30°) 和场强相关 TE 的无预载、全剂量推注给药可提供出色的性能，同时减少造影剂的使用并消除由变化引入的潜在系统误差预载剂量和孵育时间。

更新日期：2020-06-09

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