Purpose or Case Report: Neuroblastoma (NBL) is the most common extracranial solid malignancy of childhood. Biological features are known to affect disease severity. Status of amplification of the MYCN proto-oncogene is among several factors that affect the prognosis. CT texture analysis of tumor provides a step from qualitative to quantitative assessment, with the added bonus of use of routinely acquired images without the need for further tests. The aim of the study is to ascertain the ability to differentiate between MYCN-amplified and non MYCN-amplified neuroblastoma on pre-treatment CT images. The hypothesis is that lesion microenvironment and heterogeneity may differ significantly between MYCN-amplified and non MYCN-amplified tumor. Such differences may be exhibited in first-order texture analysis techniques that could detect more subtle differences in tumor heterogeneity by quantifying both pixel attenuation. This retrospective study objective is to explore the correlation between the first –order CT texture analysis (CTTA) and MYCN amplification status of neuroblastoma.
Methods & Materials: A total of 43 children (23 girls, 17 boys) underwent contrast-enhanced CT of the chest abdomen and pelvis during staging of NBL between January 2009 and December 2017. We exported the pre-treatment contrast enhanced CT imaging data-set of consecutive cases of NBL; texture analysis was performed on each segmented area, computing for each lesion using first-order quantitative parameters. Statistical descriptive analysis was performed using SSPS. Fisher exact test was used to assess the accuracy of the CTTA features to differentiate MYCN amplified and non-MYCN amplified neuroblastoma. Pearson’s chi-squared test was applied to categorical outcomes. Distribution of overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method.
Results: MYCN amplification was seen in 10 patients. Among the first-order CTTA parameters, entropy, uniformity, skewness, kurtosis and standard deviation showed significant difference between MYCN- amplified and non MYCN-amplified tumors. The 3-year overall survival (OS) was 54% and 70% in MYCN-amplified and in non MYCN-amplified patients respectively.
Conclusions: In our series, we showed that first order CT texture analysis could be a potential biomarker to differentiate between MYCN-amplified and non MYCN-amplified neuroblastoma.