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Comparison Between Diffusion‐Weighted MRI and 123 I‐mIBG Uptake in Primary High‐Risk Neuroblastoma
Author(s) -
Privitera Laura,
Hales Patrick W.,
Musleh Layla,
Morris Elizabeth,
Sizer Natalie,
Barone Giuseppe,
Humphries Paul,
Cross Kate,
Biassoni Lorenzo,
Giuliani Stefano
Publication year - 2021
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.27458
Subject(s) - medicine , magnetic resonance imaging , effective diffusion coefficient , nuclear medicine , neuroblastoma , diffusion mri , radiology , biology , genetics , cell culture
Background High‐risk neuroblastoma (HR‐NB) has a variable response to preoperative chemotherapy. It is not possible to differentiate viable vs. nonviable residual tumor before surgery. Purpose To explore the association between apparent diffusion coefficient (ADC) values from diffusion‐weighted magnetic resonance imaging (DW‐MRI), 123 I‐meta‐iodobenzyl‐guanidine ( 123 I‐mIBG) uptake, and histology before and after chemotherapy. Study Type Retrospective. Subjects Forty patients with HR‐NB. Field Strength/Sequence 1.5T axial DW‐MRI (b = 0,1000 s/mm 2 ) and T 2 ‐weighted sequences. 123 I‐mIBG scintigraphy planar imaging (all patients), with additional 123 I‐mIBG single‐photon emission computed tomography / computerized tomography (SPECT/CT) imaging (15 patients). Assessment ADC maps and 123 I‐mIBG SPECT/CT images were coregistered to the T 2 ‐weighted images. 123 I‐mIBG uptake was normalized with a tumor‐to‐liver count ratio (TLCR). Regions of interest (ROIs) for primary tumor volume and different intratumor subregions were drawn. The lower quartile ADC value (ADC 25prc ) was used over the entire tumor volume and the overall level of 123 I‐mIBG uptake was graded into avidity groups. Statistical Tests Analysis of variance (ANOVA) and linear regression were used to compare ADC and MIBG values before and after treatment. Threshold values to classify tumors as viable/necrotic were obtained using ROC analysis of ADC and TLCR values. Results No significant difference in whole‐tumor ADC 25prc values were found between different 123 I‐mIBG avidity groups pre‐ ( P = 0.31) or postchemotherapy ( P = 0.35). In the “intratumor” analysis, 5/15 patients (prechemotherapy) and 0/14 patients (postchemotherapy) showed a significant correlation between ADC and TLCR values ( P < 0.05). Increased tumor shrinkage was associated with lower pretreatment tumor ADC 25prc values ( P < 0.001); no association was found with pretreatment 123 I‐mIBG avidity ( P = 0.17). Completely nonviable tumors had significantly lower postchemotherapy ADC 25prc values than tumors with >10% viable tumor ( P < 0.05). Both pre‐ and posttreatment TLCR values were significantly higher in patients with >50% viable tumor than those with 10–50% viable tumor ( P < 0.05). Data Conclusion 123 I‐mIBG avidity and ADC values are complementary noninvasive biomarkers of therapeutic response in HR‐NB. Level of Evidence 4. Technical Efficacy Stage 3.