TY  - JOUR
AU  - Michallek, Florian
AU  - Dewey, Marc
AU  - Hero, Barbara
AU  - Hauptmann, Kathrin
AU  - Veldhoen, Simon
AU  - Paulsen, Verena
AU  - Astrahantseff, Kathy
AU  - Deubzer, Hedwig E
AU  - Simon, Thorsten
AU  - Eggert, Angelika
AU  - Thole-Kliesch, Theresa M
TI  - Fractal Dimension of High-Risk Neuroblastoma Vascularity in MRI Is Associated with Chemotherapy Response and Event-Free Survival.
JO  - Radiology / Imaging cancer
VL  - 8
IS  - 1
SN  - 2638-616X
CY  - Oak Brook, IL
PB  - RSNA, Radiological Society of North America
M1  - DKFZ-2025-02940
SP  - e250070
PY  - 2026
AB  - 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
KW  - Humans
KW  - Neuroblastoma: drug therapy
KW  - Neuroblastoma: diagnostic imaging
KW  - Neuroblastoma: blood supply
KW  - Neuroblastoma: pathology
KW  - Male
KW  - Female
KW  - Magnetic Resonance Imaging: methods
KW  - Fractals
KW  - Retrospective Studies
KW  - Child, Preschool
KW  - Child
KW  - Infant
KW  - Prognosis
KW  - Induction Chemotherapy
KW  - Disease-Free Survival
KW  - Neovascularization, Pathologic: diagnostic imaging
KW  - Fractal Analysis (Other)
KW  - MR-Imaging (Other)
KW  - Nervous-Peripheral (Other)
KW  - Pediatrics (Other)
KW  - Tissue Characterization (Other)
KW  - Tumor Response (Other)
LB  - PUB:(DE-HGF)16
C6  - pmid:41384821
DO  - DOI:10.1148/rycan.250070
UR  - https://inrepo02.dkfz.de/record/307247
ER  -