Consensus recommendations for a dynamic susceptibility contrast MRI protocol for use in high-grade gliomas

Jerrold L Boxerman; Chad C Quarles; Leland S Hu; Bradley J Erickson; Elizabeth R Gerstner; Marion Smits; Timothy J Kaufmann; Daniel P Barboriak; Raymond H Huang; Wolfgang Wick; Michael Weller; Evanthia Galanis; Jayashree Kalpathy-Cramer; Lalitha Shankar; Paula Jacobs; Caroline Chung; Martin J van den Bent; Susan Chang; W K Al Yung; Timothy F Cloughesy; Patrick Y Wen; Mark R Gilbert; Bruce R Rosen; Benjamin M Ellingson; Kathleen M Schmainda; Jumpstarting Brain Tumor Drug Development Coalition Imaging Standardization Steering Committee

doi:10.1093/neuonc/noaa141

Consensus recommendations for a dynamic susceptibility contrast MRI protocol for use in high-grade gliomas

Neuro Oncol. 2020 Sep 29;22(9):1262-1275. doi: 10.1093/neuonc/noaa141.

Authors

Jerrold L Boxerman^{1

2

3

4}, Chad C Quarles⁵, Leland S Hu^{6

7

3}, Bradley J Erickson^{8

7

9

3}, Elizabeth R Gerstner^{10

11}, Marion Smits^{12

13}, Timothy J Kaufmann^{8

7}, Daniel P Barboriak^{14

2

9

3}, Raymond H Huang^{15

16}, Wolfgang Wick^{17

13}, Michael Weller^{18

13}, Evanthia Galanis^{19

7}, Jayashree Kalpathy-Cramer²⁰, Lalitha Shankar²¹, Paula Jacobs²¹, Caroline Chung^{22

7}, Martin J van den Bent^{23

13}, Susan Chang²⁴, W K Al Yung²⁵, Timothy F Cloughesy^{26

27}, Patrick Y Wen^{16

11}, Mark R Gilbert^{28

29}, Bruce R Rosen²⁰, Benjamin M Ellingson^{26

30

11

31

2

9

3}, Kathleen M Schmainda^{32

2}; Jumpstarting Brain Tumor Drug Development Coalition Imaging Standardization Steering Committee

Collaborators

Jumpstarting Brain Tumor Drug Development Coalition Imaging Standardization Steering Committee:
David F Arons, Ann Kingston, David Sandak, Max Wallace, Al Musella, Chas Haynes

Affiliations

¹ Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
² Representative of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group.
³ Representative of the American Society of Neuroradiology (ASNR).
⁴ Representative of the American Society of Functional Neuroradiology (ASFNR).
⁵ Department of Neuroimaging Research and Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, Phoenix, Arizona, USA.
⁶ Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA.
⁷ Representative of the Alliance for Clinical Trials in Oncology.
⁸ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
⁹ Representative of the RSNA Quantitative Imaging Biomarker Alliance (QIBA).
¹⁰ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Representative of the Adult Brain Tumor Consortium (ABTC).
¹² Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands.
¹³ Representative of the European Organisation for Research and Treatment of Cancer (EORTC).
¹⁴ Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁵ Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁶ Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA.
¹⁷ Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany.
¹⁸ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
¹⁹ Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA.
²⁰ Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
²¹ Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA.
²² Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
²³ Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
²⁴ Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
²⁵ Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
²⁶ 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.
²⁷ Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
²⁸ Neuro-Oncology Branch, National Cancer Institute (NCI), Bethesda, Maryland, USA.
²⁹ Representative of the Radiation Therapy Oncology Group (RTOG).
³⁰ Departments of Radiological Sciences, Psychiatry, and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
³¹ Representative of the Ivy Consortium for Early Phase Clinical Trials.
³² Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Abstract

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.

Keywords: DSC-MRI; cerebral blood volume; clinical trial; consensus protocol; high-grade glioma.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Algorithms
Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / drug therapy
Consensus
Contrast Media
Glioma* / diagnostic imaging
Glioma* / drug therapy
Humans
Magnetic Resonance Imaging

Substances

Contrast Media

Abstract

Publication types

MeSH terms

Substances

Grants and funding