Balanced Steady-State Free Precession Techniques Improve Detection of Residual Germ Cell Tumor for Treatment Planning

• Published in: American journal of neuroradiology : AJNR 2020-05, Vol.41 (5), p.898-903
• Main Authors: Mehan, Jr, W A, Buch, K, Brasz, M F, Simonis, F F J, MacDonald, S, Rincon, S, Kirsch, J E, Caruso, P
• Format: Article
• Language: English
• Subjects: Adolescent; Algorithms; Brain Neoplasms - diagnostic imaging; Child; Female; Humans; Image Interpretation, Computer-Assisted - methods; Magnetic Resonance Imaging - methods; Male; Neoplasm, Residual - diagnostic imaging; Neoplasms, Germ Cell and Embryonal - diagnostic imaging; Neuroimaging - methods; Pediatrics; Reproducibility of Results; Retrospective Studies
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A6540

Identification of a partial/complete chemotherapy response in pediatric patients with intracranial germ cell tumors is clinically important for radiation treatment and management. Partial/complete response is conventionally determined on postcontrast MR imaging sequences. The purpose of this study was to assess the diagnostic utility of a balanced steady-state free precession sequence as an adjunct to standard MR imaging sequences for the detection of residual tumor in pediatric patients on postchemoreduction pre-radiation planning MR imaging. This was a retrospective study of pediatric patients with intracranial germ cell tumors undergoing postchemotherapy, preradiotherapy MR imaging. Patients underwent 1.5T or 3T MR imaging with pre- and postcontrast T1WIs, T2WIs, and a balanced steady-state free precession sequence. Two neuroradiologists independently reviewed standard MR imaging sequences without the balanced steady-state free precession sequence, then with the balanced steady-state free precession sequence 1 week later. Assessment for partial/complete response was determined using Response Assessment in Neuro-Oncology criteria. A 5-point Likert scale scored the diagnostic confidence of the neuroradiologist rating each study without/with the balanced steady-state free precession sequence. Rates of residual disease concordance and diagnostic confidence levels without/with the balanced steady-state free precession sequence were calculated. Thirty-nine patients were included with 31 males and 8 females (mean age, 14.15 ± 4.26 years). Thirty-one patients had single-site disease; 8 patients had multisynchronous disease (47 sites in total). Compared to review of the standard MR sequences alone, the addition of the balanced steady state free precession sequence resulted in higher rates of tumor partial response categorization and greater diagnostic confidence levels (