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. 2016 Apr 25;8(4):e584.
doi: 10.7759/cureus.584.

Prognostic Value of MR Imaging Texture Analysis in Brain Non-Small Cell Lung Cancer Oligo-Metastases Undergoing Stereotactic Irradiation

Valerio Nardone  1 , Paolo Tini  1 , Michelangelo Biondi  2 , Lucio Sebaste  1 , Eleonora Vanzi  2 , Gianmarco De Otto  2 , Giovanni Rubino  1 , Tommaso Carfagno  1 , Giuseppe Battaglia  1 , Pierpaolo Pastina  1 , Alfonso Cerase  3 , Lorenzo Nicola Mazzoni  2 , Fabrizio Banci Buonamici  2 , Luigi Pirtoli  1
Affiliations

Prognostic Value of MR Imaging Texture Analysis in Brain Non-Small Cell Lung Cancer Oligo-Metastases Undergoing Stereotactic Irradiation

Valerio Nardone et al. Cureus. .

Abstract

BACKGROUND : Stereotactic irradiation is widely used in brain oligo-metastases treatment. The aim of this study is to evaluate the prognostic value of magnetic resonance imaging (MRI) texture analysis (TA) of brain metastases (BM) of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS : This study included thirty-eight consecutive patients undergoing stereotactic irradiation, that is, stereotactic fractionated radiotherapy (SRT) or radiosurgery (SRS), from January 2011 to December 2014 for 1-2 brain BM from NSCLC. Whole-brain radiotherapy (WBRT) was not delivered. The diagnostic MRI DICOM (Digital Imaging and Communications in Medicine) images were collected and analyzed with a homemade ImageJ macro, and typical TA parameters (mean, standard deviation, skewness, kurtosis, entropy, and uniformity) were evaluated for: brain progression-free survival; modality of brain metastatic progression (local progression or/and new metastases); and overall survival, after SRT/SRS.

Results: After SRT/SRS 14 patients (36.8%) experienced recurrence in the brain, with a recurrence in the irradiated site (five patients, 13.2%), new metastases (11 patients, 28.9%), local recurrence and new metastases (two patients, 5.25%). Nineteen patients (50%) died of tumor progression or other causes. Entropy and uniformity were significantly associated with local progression, whereas kurtosis was significantly associated with both local progression and new brain metastases. CONCLUSIONS : These results appear promising, since the knowledge of factors correlated with the modality of brain progression after stereotactic irradiation of brain oligo-metastatic foci of NSCLC might help in driving the best treatment in these patients (association of SRT/SRS with WBRT? Increase of SRT/SRS dose?). Our preliminary data needs confirmation in large patient series.

Keywords: brain metastases; non single cells lung cancer; srs; stereotactic irradiation; texture analysis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Contouring and Histogram of TA
T2-MR Dicom image of a cohort patient (A), with a selected ROI (B) and a histogram of the TA (C).
Figure 2
Figure 2. Mathematical Functions of TA
Mathematical function implemented to calculate the TA parameters.
Figure 3
Figure 3. Kaplan-Meier Analysis
Entropy (e) was significantly associated with L-TTP (no statistics are computed as all the cases in the subgroup over the median value are censored, with no in-field recurrence, p=0.013), as uniformity (u) (no statistics are computed as all the cases in the subgroup under the median value are censored, with no in-field recurrence, p=0.013) (A,B). Kurtosis (k) was significantly associated with L-TTP (mean value: for subgroup A: 22.4 months, standard error 2.27 months, 95% CI 17-26 months; for subgroup B: 8.4 months, standard error 1.12 months, 95% CI 6-10 months, p=0.046) and N-TTP (mean value: for subgroup A: mean 19.68 months, standard error 2.72 months, 95% CI 14-25 months; for subgroup B: 6.72 months, standard error 1.12 months, 95% CI 4-9 months, p=0.023) (C,D).
See this image and copyright information in PMC

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