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| Home > Publications database > Fractal Dimension of High-Risk Neuroblastoma Vascularity in MRI Is Associated with Chemotherapy Response and Event-Free Survival. > print |
| 001 | 307247 | ||
| 005 | 20251216120119.0 | ||
| 024 | 7 | _ | |a 10.1148/rycan.250070 |2 doi |
| 024 | 7 | _ | |a pmid:41384821 |2 pmid |
| 037 | _ | _ | |a DKFZ-2025-02940 |
| 041 | _ | _ | |a English |
| 082 | _ | _ | |a 610 |
| 100 | 1 | _ | |a Michallek, Florian |0 0000-0002-5475-0873 |b 0 |
| 245 | _ | _ | |a Fractal Dimension of High-Risk Neuroblastoma Vascularity in MRI Is Associated with Chemotherapy Response and Event-Free Survival. |
| 260 | _ | _ | |a Oak Brook, IL |c 2026 |b RSNA, Radiological Society of North America |
| 336 | 7 | _ | |a article |2 DRIVER |
| 336 | 7 | _ | |a Output Types/Journal article |2 DataCite |
| 336 | 7 | _ | |a Journal Article |b journal |m journal |0 PUB:(DE-HGF)16 |s 1765807580_1896241 |2 PUB:(DE-HGF) |
| 336 | 7 | _ | |a ARTICLE |2 BibTeX |
| 336 | 7 | _ | |a JOURNAL_ARTICLE |2 ORCID |
| 336 | 7 | _ | |a Journal Article |0 0 |2 EndNote |
| 520 | _ | _ | |a 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% 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. |
| 536 | _ | _ | |a 899 - ohne Topic (POF4-899) |0 G:(DE-HGF)POF4-899 |c POF4-899 |f POF IV |x 0 |
| 588 | _ | _ | |a Dataset connected to CrossRef, PubMed, , Journals: inrepo02.dkfz.de |
| 650 | _ | 7 | |a Fractal Analysis |2 Other |
| 650 | _ | 7 | |a MR-Imaging |2 Other |
| 650 | _ | 7 | |a Nervous-Peripheral |2 Other |
| 650 | _ | 7 | |a Pediatrics |2 Other |
| 650 | _ | 7 | |a Tissue Characterization |2 Other |
| 650 | _ | 7 | |a Tumor Response |2 Other |
| 650 | _ | 2 | |a Humans |2 MeSH |
| 650 | _ | 2 | |a Neuroblastoma: drug therapy |2 MeSH |
| 650 | _ | 2 | |a Neuroblastoma: diagnostic imaging |2 MeSH |
| 650 | _ | 2 | |a Neuroblastoma: blood supply |2 MeSH |
| 650 | _ | 2 | |a Neuroblastoma: pathology |2 MeSH |
| 650 | _ | 2 | |a Male |2 MeSH |
| 650 | _ | 2 | |a Female |2 MeSH |
| 650 | _ | 2 | |a Magnetic Resonance Imaging: methods |2 MeSH |
| 650 | _ | 2 | |a Fractals |2 MeSH |
| 650 | _ | 2 | |a Retrospective Studies |2 MeSH |
| 650 | _ | 2 | |a Child, Preschool |2 MeSH |
| 650 | _ | 2 | |a Child |2 MeSH |
| 650 | _ | 2 | |a Infant |2 MeSH |
| 650 | _ | 2 | |a Prognosis |2 MeSH |
| 650 | _ | 2 | |a Induction Chemotherapy |2 MeSH |
| 650 | _ | 2 | |a Disease-Free Survival |2 MeSH |
| 650 | _ | 2 | |a Neovascularization, Pathologic: diagnostic imaging |2 MeSH |
| 700 | 1 | _ | |a Dewey, Marc |0 0000-0002-4402-2733 |b 1 |
| 700 | 1 | _ | |a Hero, Barbara |0 0000-0003-4129-890X |b 2 |
| 700 | 1 | _ | |a Hauptmann, Kathrin |0 0000-0003-0590-3674 |b 3 |
| 700 | 1 | _ | |a Veldhoen, Simon |b 4 |
| 700 | 1 | _ | |a Paulsen, Verena |b 5 |
| 700 | 1 | _ | |a Astrahantseff, Kathy |b 6 |
| 700 | 1 | _ | |a Deubzer, Hedwig E |b 7 |
| 700 | 1 | _ | |a Simon, Thorsten |0 0000-0002-3425-8451 |b 8 |
| 700 | 1 | _ | |a Eggert, Angelika |0 P:(DE-HGF)0 |b 9 |
| 700 | 1 | _ | |a Thole-Kliesch, Theresa M |0 0000-0003-2714-6221 |b 10 |
| 773 | _ | _ | |a 10.1148/rycan.250070 |g Vol. 8, no. 1, p. e250070 |0 PERI:(DE-600)2986040-4 |n 1 |p e250070 |t Radiology / Imaging cancer |v 8 |y 2026 |x 2638-616X |
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