A Pilot Study Evaluating the Use of Dynamic Contrast-Enhanced Perfusion MRI to Predict Local Recurrence After Radiosurgery on Spinal Metastases

Kiran A. Kumar, Kyung K. Peck, Sasan Karimi, Eric Lis, Andrei I. Holodny, Mark H. Bilsky, Yoshiya Yamada

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Purpose: Dynamic contrast-enhanced magnetic resonance imaging offers noninvasive characterization of the vascular microenvironment and hemodynamics. Stereotactic radiosurgery, or stereotactic body radiation therapy, engages a vascular component of the tumor response which may be detectable using dynamic contrast-enhanced magnetic resonance imaging. The purpose of this study is to examine whether dynamic contrast-enhanced magnetic resonance imaging can be used to predict local tumor recurrence in patients with spinal bone metastases who undergo high-dose radiotherapy with stereotactic radiosurgery. Materials and Methods: We conducted a study of 30 patients with spinal metastases who underwent dynamic contrast-enhanced magnetic resonance imaging before and after radiotherapy. Twenty patients received single-fraction stereotactic radiosurgery (24 Gy), while 10 received hypofractionated stereotactic radiosurgery (3-5 fractions, 27-30 Gy total). Kaplan-Meier analysis was used to estimate the actuarial local recurrence rates. Two perfusion parameters (Ktrans: permeability and Vp: plasma volume) were measured for each metastasis. Percentage change in parameter values from pre- to posttreatment was calculated and compared. Results: At 20-month median follow-up, 5 of the 30 patients had pathological evidence of local recurrence. One- and 3-year actuarial local recurrence rates were 24% and 44% for the hypofractionated stereotactic radiosurgery cohort versus 5% and 16% for the single-fraction stereotactic radiosurgery cohort (P =.20). The average change in Vp and Ktrans for patients without local recurrence versus those with local recurrence was −76% and −66% versus +28% and −14% (P <.01 for both). With a cutoff point of −20%, Vp had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 98%, 91%, and 100%, respectively, for the detection of local recurrence following high-dose radiotherapy. Using this definition, dynamic contrast-enhanced magnetic resonance imaging identified local recurrence up to 18 months (mean [standard deviation], 6.6 [6.8] months) earlier than standard magnetic resonance imaging. Conclusions: We demonstrated that changes in perfusion parameters, particularly Vp, after high-dose radiotherapy to spinal bone metastases were predictive of local tumor recurrence. These changes predicted local recurrence on average >6 months earlier than standard imaging did.

Original languageEnglish (US)
Pages (from-to)857-865
Number of pages9
JournalTechnology in Cancer Research and Treatment
Issue number6
StatePublished - Dec 1 2017
Externally publishedYes


  • SBRT
  • SRS
  • high-dose RT
  • spine metastases
  • tumor recurrence

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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