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<meta name="DC.Title" content="Diagnostic performance of fast brain MRI compared to routine clinical MRI in patients with glioma grade 3 and 4 -a pilot study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8558" />
<meta name="DC.Date" content="2024-10-30" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2024 by American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: EPIMix is a fast brain MRI technique not previously investigated in patients with glioma grades 3 and 4. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with glioma grades 3 and 4 compared to routine clinical MRI (rcMRI).

MATERIALS AND METHODS: Patients with glioma grades 3 and 4 investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1–3) participated in the radiological assessment applying Response Assessment for Neuro-oncology Criteria (RANO 2.0), of which two (R1–2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrastenhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix vs. rcMRI) were performed using Weighted Cohen’s kappa. The sensitivity and specificity to detect tumor progression (PD) on a follow-up scan were calculated for EPIMix compared to rcMRI with receiver operating characteristic (ROC) curves to assess the area under the curve (AUC).

RESULTS: In 35 patients (mean age 53, 31% females), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at blinded reading in 33% of EPIMix (19/58, R1–2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 vs. rcMRIR1 ϰ= 0.96; EPIMixR2 vs. rcMRIR2 ϰ= 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81–1.00) for R1 and 0.90 (0.68–0.99) for R2, while the specificity was 0.97 (0.86–1.00) for R1–2. The AUC for PD was 0.99 for R1 (EPIMixR1 vs. rcMRIR1) and 0.94 for R2 (EPIMixR2 vs. rcMRIR2), DeLong’s test AUCR1 vs. AUCR2 p=0.20 (R1–2).

CONCLUSIONS: In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high, but slightly lower diagnostic performance than rcMRI.

ABBREVIATIONS: CR = complete response; EPIMix = multi-contrast echo-planar imaging-based technique; PD = progressive disease; PR = partial response; RANO = response assessment in neuro-oncology; R1 = reader 1; R2 = reader 2; R3 = reader 3; rcMRI = routine clinical MRI; SD = stable disease." />
<meta name="DC.Contributor" content="Francesca De Luca" />
<meta name="DC.Contributor" content="Annika Suneson" />
<meta name="DC.Contributor" content="Annika Kits" />
<meta name="DC.Contributor" content="Emilia Palmér" />
<meta name="DC.Contributor" content="Stefan Skare" />
<meta name="DC.Contributor" content="Anna Falk Delgado" />
<meta name="article:published_time" content="2024-10-30" />
<meta name="article:section" content="ORIGINAL RESEARCH" />
<meta name="citation_title" content="Diagnostic performance of fast brain MRI compared to routine clinical MRI in patients with glioma grade 3 and 4 -a pilot study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;ABSTRACT&lt;/h3&gt;
&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;EPIMix is a fast brain MRI technique not previously investigated in patients with glioma grades 3 and 4. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with glioma grades 3 and 4 compared to routine clinical MRI (rcMRI).&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Patients with glioma grades 3 and 4 investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1–3) participated in the radiological assessment applying Response Assessment for Neuro-oncology Criteria (RANO 2.0), of which two (R1–2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrastenhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix vs. rcMRI) were performed using Weighted Cohen’s kappa. The sensitivity and specificity to detect tumor progression (PD) on a follow-up scan were calculated for EPIMix compared to rcMRI with receiver operating characteristic (ROC) curves to assess the area under the curve (AUC).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;In 35 patients (mean age 53, 31% females), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at blinded reading in 33% of EPIMix (19/58, R1–2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 vs. rcMRIR1 ϰ= 0.96; EPIMixR2 vs. rcMRIR2 ϰ= 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81–1.00) for R1 and 0.90 (0.68–0.99) for R2, while the specificity was 0.97 (0.86–1.00) for R1–2. The AUC for PD was 0.99 for R1 (EPIMixR1 vs. rcMRIR1) and 0.94 for R2 (EPIMixR2 vs. rcMRIR2), DeLong’s test AUCR1 vs. AUCR2 p=0.20 (R1–2).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high, but slightly lower diagnostic performance than rcMRI.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: CR = complete response; EPIMix = multi-contrast echo-planar imaging-based technique; PD = progressive disease; PR = partial response; RANO = response assessment in neuro-oncology; R1 = reader 1; R2 = reader 2; R3 = reader 3; rcMRI = routine clinical MRI; SD = stable disease.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2024/10/30" />
<meta name="citation_mjid" content="ajnr;ajnr.A8558v1" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A8558" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="ORIGINAL RESEARCH" />
<meta name="citation_author" content="Francesca De Luca" />
<meta name="citation_author_institution" content="From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP)." />
<meta name="citation_author" content="Annika Suneson" />
<meta name="citation_author_institution" content="From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP)." />
<meta name="citation_author" content="Annika Kits" />
<meta name="citation_author_institution" content="From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP)." />
<meta name="citation_author" content="Emilia Palmér" />
<meta name="citation_author_institution" content="From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP)." />
<meta name="citation_author" content="Stefan Skare" />
<meta name="citation_author_institution" content="From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP)." />
<meta name="citation_author" content="Anna Falk Delgado" />
<meta name="citation_author_institution" content="From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP)." />
<meta name="twitter:title" content="Diagnostic performance of fast brain MRI compared to routine clinical MRI in patients with glioma grade 3 and 4 -a pilot study" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: EPIMix is a fast brain MRI technique not previously investigated in patients with glioma grades 3 and 4. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with glioma grades 3 and 4 compared to routine clinical MRI (rcMRI).

MATERIALS AND METHODS: Patients with glioma grades 3 and 4 investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1–3) participated in the radiological assessment applying Response Assessment for Neuro-oncology Criteria (RANO 2.0), of which two (R1–2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrastenhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix vs. rcMRI) were performed using Weighted Cohen’s kappa. The sensitivity and specificity to detect tumor progression (PD) on a follow-up scan were calculated for EPIMix compared to rcMRI with receiver operating characteristic (ROC) curves to assess the area under the curve (AUC).

RESULTS: In 35 patients (mean age 53, 31% females), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at blinded reading in 33% of EPIMix (19/58, R1–2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 vs. rcMRIR1 ϰ= 0.96; EPIMixR2 vs. rcMRIR2 ϰ= 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81–1.00) for R1 and 0.90 (0.68–0.99) for R2, while the specificity was 0.97 (0.86–1.00) for R1–2. The AUC for PD was 0.99 for R1 (EPIMixR1 vs. rcMRIR1) and 0.94 for R2 (EPIMixR2 vs. rcMRIR2), DeLong’s test AUCR1 vs. AUCR2 p=0.20 (R1–2).

CONCLUSIONS: In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high, but slightly lower diagnostic performance than rcMRI.

ABBREVIATIONS: CR = complete response; EPIMix = multi-contrast echo-planar imaging-based technique; PD = progressive disease; PR = partial response; RANO = response assessment in neuro-oncology; R1 = reader 1; R2 = reader 2; R3 = reader 3; rcMRI = routine clinical MRI; SD = stable disease." />
<meta name="og-title" property="og:title" content="Diagnostic performance of fast brain MRI compared to routine clinical MRI in patients with glioma grade 3 and 4 -a pilot study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/10/30/ajnr.A8558" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: EPIMix is a fast brain MRI technique not previously investigated in patients with glioma grades 3 and 4. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with glioma grades 3 and 4 compared to routine clinical MRI (rcMRI).

MATERIALS AND METHODS: Patients with glioma grades 3 and 4 investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1–3) participated in the radiological assessment applying Response Assessment for Neuro-oncology Criteria (RANO 2.0), of which two (R1–2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrastenhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix vs. rcMRI) were performed using Weighted Cohen’s kappa. The sensitivity and specificity to detect tumor progression (PD) on a follow-up scan were calculated for EPIMix compared to rcMRI with receiver operating characteristic (ROC) curves to assess the area under the curve (AUC).

RESULTS: In 35 patients (mean age 53, 31% females), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at blinded reading in 33% of EPIMix (19/58, R1–2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 vs. rcMRIR1 ϰ= 0.96; EPIMixR2 vs. rcMRIR2 ϰ= 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81–1.00) for R1 and 0.90 (0.68–0.99) for R2, while the specificity was 0.97 (0.86–1.00) for R1–2. The AUC for PD was 0.99 for R1 (EPIMixR1 vs. rcMRIR1) and 0.94 for R2 (EPIMixR2 vs. rcMRIR2), DeLong’s test AUCR1 vs. AUCR2 p=0.20 (R1–2).

CONCLUSIONS: In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high, but slightly lower diagnostic performance than rcMRI.

ABBREVIATIONS: CR = complete response; EPIMix = multi-contrast echo-planar imaging-based technique; PD = progressive disease; PR = partial response; RANO = response assessment in neuro-oncology; R1 = reader 1; R2 = reader 2; R3 = reader 3; rcMRI = routine clinical MRI; SD = stable disease." />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Francesca De Luca</span>, <span class="highwire-citation-author" data-delta="1">Annika Suneson</span>, <span class="highwire-citation-author" data-delta="2">Annika Kits</span>, <span class="highwire-citation-author" data-delta="3">Emilia Palmér</span>, <span class="highwire-citation-author" data-delta="4">Stefan Skare</span> and <span class="highwire-citation-author" data-delta="5">Anna Falk Delgado</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8558; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8558 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-111645--6528088101" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Francesca De Luca </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Francesca%2BDe%2BLuca%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=De%20Luca%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AFrancesca%2BDe%2BLuca%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Annika Suneson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Annika%2BSuneson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Suneson%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAnnika%2BSuneson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Annika Kits </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Annika%2BKits%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kits%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAnnika%2BKits%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Emilia Palmér </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Emilia%2BPalm%C3%A9r%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Palm%C3%A9r%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AEmilia%2BPalm%25C3%25A9r%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Stefan Skare </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Stefan%2BSkare%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Skare%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AStefan%2BSkare%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Anna Falk Delgado </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology, Karolinska University Hospital, Stockholm, Sweden (FDL); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (AS, AK, SS, AFD); Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden (EP); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (FDL, AK, SS, AFD); Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (EP).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Anna%2BFalk%2BDelgado%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Delgado%20AF&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAnna%2BFalk%2BDelgado%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2 class="">ABSTRACT</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> EPIMix is a fast brain MRI technique not previously investigated in patients with glioma grades 3 and 4. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with glioma grades 3 and 4 compared to routine clinical MRI (rcMRI).</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> Patients with glioma grades 3 and 4 investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1–3) participated in the radiological assessment applying Response Assessment for Neuro-oncology Criteria (RANO 2.0), of which two (R1–2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrastenhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix vs. rcMRI) were performed using Weighted Cohen’s kappa. The sensitivity and specificity to detect tumor progression (PD) on a follow-up scan were calculated for EPIMix compared to rcMRI with receiver operating characteristic (ROC) curves to assess the area under the curve (AUC).</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> In 35 patients (mean age 53, 31% females), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at blinded reading in 33% of EPIMix (19/58, R1–2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 vs. rcMRIR1 ϰ= 0.96; EPIMixR2 vs. rcMRIR2 ϰ= 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81–1.00) for R1 and 0.90 (0.68–0.99) for R2, while the specificity was 0.97 (0.86–1.00) for R1–2. The AUC for PD was 0.99 for R1 (EPIMixR1 vs. rcMRIR1) and 0.94 for R2 (EPIMixR2 vs. rcMRIR2), DeLong’s test AUCR1 vs. AUCR2 p=0.20 (R1–2).</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high, but slightly lower diagnostic performance than rcMRI.</p><p id="p-6">ABBREVIATIONS: CR = complete response; EPIMix = multi-contrast echo-planar imaging-based technique; PD = progressive disease; PR = partial response; RANO = response assessment in neuro-oncology; R1 = reader 1; R2 = reader 2; R3 = reader 3; rcMRI = routine clinical MRI; SD = stable disease.</p></div></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-conflict" id="fn-1"><p id="p-1">The authors declare no conflicts of interest related to the content of this article.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2024 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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      <div class="highwire-cite-title">Diagnostic performance of fast brain MRI compared to routine clinical MRI in patients with glioma grade 3 and 4 -a pilot study</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Francesca</span> <span class="nlm-surname">De Luca</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Annika</span> <span class="nlm-surname">Suneson</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Annika</span> <span class="nlm-surname">Kits</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Emilia</span> <span class="nlm-surname">Palmér</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Stefan</span> <span class="nlm-surname">Skare</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Anna Falk</span> <span class="nlm-surname">Delgado</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8558; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8558 </span></div>
  
  
  
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      <div class="highwire-cite-title">Diagnostic performance of fast brain MRI compared to routine clinical MRI in patients with glioma grade 3 and 4 -a pilot study</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Francesca</span> <span class="nlm-surname">De Luca</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Annika</span> <span class="nlm-surname">Suneson</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Annika</span> <span class="nlm-surname">Kits</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Emilia</span> <span class="nlm-surname">Palmér</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Stefan</span> <span class="nlm-surname">Skare</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Anna Falk</span> <span class="nlm-surname">Delgado</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8558; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8558 </span></div>
  
  
  
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