000307247 001__ 307247
000307247 005__ 20251216120119.0
000307247 0247_ $$2doi$$a10.1148/rycan.250070
000307247 0247_ $$2pmid$$apmid:41384821
000307247 037__ $$aDKFZ-2025-02940
000307247 041__ $$aEnglish
000307247 082__ $$a610
000307247 1001_ $$00000-0002-5475-0873$$aMichallek, Florian$$b0
000307247 245__ $$aFractal Dimension of High-Risk Neuroblastoma Vascularity in MRI Is Associated with Chemotherapy Response and Event-Free Survival.
000307247 260__ $$aOak Brook, IL$$bRSNA, Radiological Society of North America$$c2026
000307247 3367_ $$2DRIVER$$aarticle
000307247 3367_ $$2DataCite$$aOutput Types/Journal article
000307247 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1765807580_1896241
000307247 3367_ $$2BibTeX$$aARTICLE
000307247 3367_ $$2ORCID$$aJOURNAL_ARTICLE
000307247 3367_ $$00$$2EndNote$$aJournal Article
000307247 520__ $$aPurpose 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% CI: 1.16, 4.55; P = .017) and global FD at TP2 (hazard ratio, 0.65; 95% CI: 0.47, 0.88; P = .006) were significantly associated with EFS. Complexity of both CD34-immunohistochemical microvascularity (1.23 ± 0.09 [SD] to 1.44 ± 0.07, P < .001) and MRI perfusion (3.40 ± 0.04 to 3.53 ± 0.07, P < .001) increased throughout induction chemotherapy. Conclusion Fractal analysis of MRI-derived perfusion complexity was associated with spatial heterogeneity of chemotherapy response and stratified prognosis in MYCN nonamplified high-risk neuroblastoma, supporting its potential as an imaging biomarker linked to microvascular architecture. German Clinical Trial Registry: DRKS00023442 Keywords: Pediatrics, MR-Imaging, Nervous-Peripheral, Fractal Analysis, Tissue Characterization, Tumor Response Supplemental material is available for this article. © RSNA, 2025.
000307247 536__ $$0G:(DE-HGF)POF4-899$$a899 - ohne Topic (POF4-899)$$cPOF4-899$$fPOF IV$$x0
000307247 588__ $$aDataset connected to CrossRef, PubMed, , Journals: inrepo02.dkfz.de
000307247 650_7 $$2Other$$aFractal Analysis
000307247 650_7 $$2Other$$aMR-Imaging
000307247 650_7 $$2Other$$aNervous-Peripheral
000307247 650_7 $$2Other$$aPediatrics
000307247 650_7 $$2Other$$aTissue Characterization
000307247 650_7 $$2Other$$aTumor Response
000307247 650_2 $$2MeSH$$aHumans
000307247 650_2 $$2MeSH$$aNeuroblastoma: drug therapy
000307247 650_2 $$2MeSH$$aNeuroblastoma: diagnostic imaging
000307247 650_2 $$2MeSH$$aNeuroblastoma: blood supply
000307247 650_2 $$2MeSH$$aNeuroblastoma: pathology
000307247 650_2 $$2MeSH$$aMale
000307247 650_2 $$2MeSH$$aFemale
000307247 650_2 $$2MeSH$$aMagnetic Resonance Imaging: methods
000307247 650_2 $$2MeSH$$aFractals
000307247 650_2 $$2MeSH$$aRetrospective Studies
000307247 650_2 $$2MeSH$$aChild, Preschool
000307247 650_2 $$2MeSH$$aChild
000307247 650_2 $$2MeSH$$aInfant
000307247 650_2 $$2MeSH$$aPrognosis
000307247 650_2 $$2MeSH$$aInduction Chemotherapy
000307247 650_2 $$2MeSH$$aDisease-Free Survival
000307247 650_2 $$2MeSH$$aNeovascularization, Pathologic: diagnostic imaging
000307247 7001_ $$00000-0002-4402-2733$$aDewey, Marc$$b1
000307247 7001_ $$00000-0003-4129-890X$$aHero, Barbara$$b2
000307247 7001_ $$00000-0003-0590-3674$$aHauptmann, Kathrin$$b3
000307247 7001_ $$aVeldhoen, Simon$$b4
000307247 7001_ $$aPaulsen, Verena$$b5
000307247 7001_ $$aAstrahantseff, Kathy$$b6
000307247 7001_ $$aDeubzer, Hedwig E$$b7
000307247 7001_ $$00000-0002-3425-8451$$aSimon, Thorsten$$b8
000307247 7001_ $$0P:(DE-HGF)0$$aEggert, Angelika$$b9
000307247 7001_ $$00000-0003-2714-6221$$aThole-Kliesch, Theresa M$$b10
000307247 773__ $$0PERI:(DE-600)2986040-4$$a10.1148/rycan.250070$$gVol. 8, no. 1, p. e250070$$n1$$pe250070$$tRadiology / Imaging cancer$$v8$$x2638-616X$$y2026
000307247 909CO $$ooai:inrepo02.dkfz.de:307247$$pVDB
000307247 9101_ $$0I:(DE-588b)2036810-0$$6P:(DE-HGF)0$$aDeutsches Krebsforschungszentrum$$b9$$kDKFZ
000307247 9131_ $$0G:(DE-HGF)POF4-899$$1G:(DE-HGF)POF4-890$$2G:(DE-HGF)POF4-800$$3G:(DE-HGF)POF4$$4G:(DE-HGF)POF$$aDE-HGF$$bProgrammungebundene Forschung$$lohne Programm$$vohne Topic$$x0
000307247 915__ $$0StatID:(DE-HGF)0100$$2StatID$$aJCR$$bRADIOL-IMAG CANCER : 2022$$d2024-12-05
000307247 915__ $$0StatID:(DE-HGF)0200$$2StatID$$aDBCoverage$$bSCOPUS$$d2024-12-05
000307247 915__ $$0StatID:(DE-HGF)0300$$2StatID$$aDBCoverage$$bMedline$$d2024-12-05
000307247 915__ $$0StatID:(DE-HGF)0199$$2StatID$$aDBCoverage$$bClarivate Analytics Master Journal List$$d2024-12-05
000307247 915__ $$0StatID:(DE-HGF)0112$$2StatID$$aWoS$$bEmerging Sources Citation Index$$d2024-12-05
000307247 915__ $$0StatID:(DE-HGF)0150$$2StatID$$aDBCoverage$$bWeb of Science Core Collection$$d2024-12-05
000307247 915__ $$0StatID:(DE-HGF)1050$$2StatID$$aDBCoverage$$bBIOSIS Previews$$d2024-12-05
000307247 915__ $$0StatID:(DE-HGF)1190$$2StatID$$aDBCoverage$$bBiological Abstracts$$d2024-12-05
000307247 915__ $$0StatID:(DE-HGF)9900$$2StatID$$aIF < 5$$d2024-12-05
000307247 9201_ $$0I:(DE-He78)BE01-20160331$$kBE01$$lDKTK Koordinierungsstelle Berlin$$x0
000307247 980__ $$ajournal
000307247 980__ $$aVDB
000307247 980__ $$aI:(DE-He78)BE01-20160331
000307247 980__ $$aUNRESTRICTED