%0 Journal Article
%A Michallek, Florian
%A Dewey, Marc
%A Hero, Barbara
%A Hauptmann, Kathrin
%A Veldhoen, Simon
%A Paulsen, Verena
%A Astrahantseff, Kathy
%A Deubzer, Hedwig E
%A Simon, Thorsten
%A Eggert, Angelika
%A Thole-Kliesch, Theresa M
%T Fractal Dimension of High-Risk Neuroblastoma Vascularity in MRI Is Associated with Chemotherapy Response and Event-Free Survival.
%J Radiology / Imaging cancer
%V 8
%N 1
%@ 2638-616X
%C Oak Brook, IL
%I RSNA, Radiological Society of North America
%M DKFZ-2025-02940
%P e250070
%D 2026
%X Purpose To assess therapeutic and prognostic implications of perfusion characterization by fractal analysis using routine MRI in high-risk primary neuroblastomas and to establish a pathophysiologic connection between vascularity phenotype, perfusion imaging characteristics, and treatment response. Materials and Methods In a retrospective cohort study across 30 centers, MRI data of patients with high-risk neuroblastoma (June 2005-February 2021) were collected at the time point of diagnosis (TP1) and after induction chemotherapy before surgery (TP2), with data split into separate discovery (single-center) and validation cohorts (29 centers). Fractal analysis was performed on contrast-enhanced, fat-saturated, T1-weighted sequences at both time points to obtain voxel-wise local fractal dimension (FD) maps for predicting volumetric tumor response. The association of global FD with event-free survival (EFS) was assessed using a Cox proportional hazards model. Additionally, FD was calculated from CD34-stained endothelium in selected histologic tumor samples. Accuracy of response prediction, prognostic value for EFS, and correlation between FD of immunohistochemical vascularity and MRI-derived perfusion were also evaluated. Results In 73 patients (median age, 3 years [IQR, 3]; 39 male patients; discovery cohort, n = 36; validation cohort, n = 37), local FD maps helped predict volumetric tumor response to induction chemotherapy between TP1 and TP2 with good accuracy (root mean squared error, 47.78 mL; R2 = 0.94; P < .001), visualizing intratumor high perfusion complexity in areas with low response potential. In multivariate Cox proportional hazards modeling, MYCN status (hazard ratio, 2.30; 95
%K Humans
%K Neuroblastoma: drug therapy
%K Neuroblastoma: diagnostic imaging
%K Neuroblastoma: blood supply
%K Neuroblastoma: pathology
%K Male
%K Female
%K Magnetic Resonance Imaging: methods
%K Fractals
%K Retrospective Studies
%K Child, Preschool
%K Child
%K Infant
%K Prognosis
%K Induction Chemotherapy
%K Disease-Free Survival
%K Neovascularization, Pathologic: diagnostic imaging
%K Fractal Analysis (Other)
%K MR-Imaging (Other)
%K Nervous-Peripheral (Other)
%K Pediatrics (Other)
%K Tissue Characterization (Other)
%K Tumor Response (Other)
%F PUB:(DE-HGF)16
%9 Journal Article
%$ pmid:41384821
%R 10.1148/rycan.250070
%U https://inrepo02.dkfz.de/record/307247