Response on imaging is widely used to evaluate treatment efficacy in clinical trials of pediatric gliomas. While conventional criteria rely on 2D measurements, volumetric analysis may provide a more comprehensive response assessment. There is sparse research on the role of volumetrics in pediatric gliomas. Our purpose was to compare 2D and volumetric analysis with the assessment of neuroradiologists using the Brain Tumor Reporting and Data System (BT-RADS) in BRAF V600E-mutant pediatric gliomas.

Manual volumetric segmentations of whole and solid tumors were compared with 2D measurements in 31 participants (292 follow-up studies) in the Pacific Pediatric Neuro-Oncology Consortium 002 trial (NCT01748149). Two neuroradiologists evaluated responses using BT-RADS. Receiver operating characteristic analysis compared classification performance of 2D and volumetrics for partial response. Agreement between volumetric and 2D mathematically modeled longitudinal trajectories for 25 participants was determined using the model-estimated time to best response.

Of 31 participants, 20 had partial responses according to BT-RADS criteria. Receiver operating characteristic curves for the classification of partial responders at the time of first detection (median = 2 months) yielded an area under the curve of 0.84 (95% CI, 0.69–0.99) for 2D area, 0.91 (95% CI, 0.80–1.00) for whole-volume, and 0.92 (95% CI, 0.82–1.00) for solid volume change. There was no significant difference in the area under the curve between 2D and solid (P = .34) or whole volume (P = .39). There was no significant correlation in model-estimated time to best response ( = 0.39, P >.05) between 2D and whole-volume trajectories. Eight of the 25 participants had a difference of ≥90 days in transition from partial response to stable disease between their 2D and whole-volume modeled trajectories.

Although there was no overall difference between volumetrics and 2D in classifying partial response assessment using BT-RADS, further prospective studies will be critical to elucidate how the observed differences in tumor 2D and volumetric trajectories affect clinical decision-making and outcomes in some individuals.

影像学反应广泛用于评估儿科神经胶质瘤临床试验中的治疗效果。虽然传统标准依赖于二维测量，但体积分析可以提供更全面的响应评估。关于体积测量在儿童神经胶质瘤中的作用的研究很少。我们的目的是将 2D 和体积分析与神经放射科医生使用脑肿瘤报告和数据系统 (BT-RADS) 对BRAF V600E 突变儿童神经胶质瘤的评估进行比较。

在太平洋小儿神经肿瘤联盟 002 试验 (NCT01748149) 中，将整个肿瘤和实体瘤的手动体积分割与 31 名参与者（292 项后续研究）的 2D 测量进行了比较。两名神经放射科医生使用 BT-RADS 评估反应。接收器操作特性分析比较了部分响应的 2D 分类性能和体积测量性能。使用模型估计的最佳反应时间来确定 25 名参与者的体积和二维数学模型纵向轨迹之间的一致性。

根据 BT-RADS 标准，31 名参与者中有 20 名有部分反应。首次检测时（中位 = 2 个月）对部分缓解者进行分类的受试者工作特征曲线得出的曲线下面积为 0.84（95% CI，0.69–0.99），二维面积为 0.91（95% CI，0.80） –1.00) 对于全体积，0.92 (95% CI, 0.82–1.00) 对于固体体积变化。二维和实体 ( P = .34) 或整个体积 ( P = .39)之间的曲线下面积没有显着差异。 2D 轨迹和全体积轨迹之间的模型估计最佳响应时间没有显着相关性 (= 0.39，P >.05)。 25 名参与者中，有 8 名参与者的 2D 模型轨迹和全体积模型轨迹从部分缓解到疾病稳定的转变存在 ≥90 天的差异。

尽管在使用 BT-RADS 对部分反应评估进行分类时，体积和 2D 之间没有总体差异，但进一步的前瞻性研究对于阐明观察到的肿瘤 2D 和体积轨迹差异如何影响某些个体的临床决策和结果至关重要。