Multi-molecular saturation-transfer MR fingerprinting for differentiating tumor progression from treatment-related change in post-treatment IDH-wildtype glioblastoma: a feasibility study.

PURPOSE: To determine whether quantitative molecular parameters derived from saturation transfer MR fingerprinting (ST-MRF) can differentiate tumor progression from treatment-related change and provide prognostic information in IDH-wildtype glioblastoma.

MATERIALS AND

METHODS

In this retrospective single-center study, 24 patients (median age, 59.5 years; interquartile range, 47-68.5 years) with histologically confirmed glioblastoma underwent ST-MRF on a 3-T clinical MRI system for suspected progression after concurrent chemoradiation therapy. ST-MRF parameters included amide proton transfer (APT), Amine-CEST, relayed nuclear Overhauser enhancement (rNOE), and magnetization transfer contrast (MTC) components. Tumor progression versus treatment-related change was determined by pathology or clinico-radiologic consensus using RANO 2.0 criteria. Diagnostic performance was assessed with logistic regression and receiver operating characteristic analysis. Overall survival (OS) was evaluated with Cox proportional hazards models and Harrell's concordance index (C-index).

RESULTS

Tumor progression demonstrated significantly higher APT1µT (11.2 ± 0.8% vs. 10.0 ± 0.7%, P < .001) and APT2µT (12.0 ± 1.6% vs. 10.3 ± 1.3%, P = .004), while lower MTCs (all APT-, Amine-, and rNOE-MTC, largest P = .016) compared with treatment-related change. APT1µT showed the highest diagnostic performance (AUC, 0.88; 95% CI: 0.70-0.97), followed by APT2µT (AUC, 0.80; 95% CI: 0.61-0.93). Higher APT1µT (hazard ratio [HR], 1.95; P = .029) and APT2µT (HR, 1.53; P = .037) were significantly associated with shorter OS, with the highest prognostic performance for APT2µT (C-index, 0.70; 95% CI: 0.60-0.80).

CONCLUSION

In this exploratory study, ST-MRF-derived molecular imaging parameters, particularly APT, showed feasibility for differentiating tumor progression from treatment-related change after treatment and potential for providing prognostic information.