NEURO-ONCOLOGY SOLUTIONS

Let Imaging Biometrics help you unlock a new world of meaning in your Neuro-Oncology imaging studies.

When it comes to brain tumor imaging, analysis software applications are NOT all created equal. Colorized functional maps may appear similar at first glance, but a closer look reveals critical differences in how they are calculated and their underlying meaning. Backed by over 25 years of focused research in Neuro-Oncology, IB's applications are trusted by leading brain tumor centers to provide imaging insights that help guide their most important decisions.

IB sets the standard with a complete suite of applications for analyzing advanced MR images. IB's applications enhance standard anatomical imaging with key physiological information like true regions of contrast enhancement (void of post-surgical blood products), and tumor blood volume and flow, helping radiologists, surgeons and oncologists make better decisions for their patients. For patients who cannot undergo MRI, IB's applications are also compatible with CT images. IB's applications have been proven reliable and accurate in recent ground-breaking multi-center studies, (1,2) and are the most trusted by clinical trials researchers for their imaging needs. (3,4)

With key quantitative insights and standardized metrics shared by your whole team, IB makes comparison to previous studies simple and fast. IB brings you the most powerful and proven tools for advanced analysis to every patient decision.

1. Hu LS, Kelm Z, Korfiatis P, et al. Impact of software modeling on the accuracy of perfusion MRI in glioma. AJNR Am J Neuroradiol 2015;36:2242–49.
2. Hoxworth JM, Eschbacher JM, et al. Performance of Standardized Relative CBV for Quantifying Regional Histologic Tumor Burden in Recurrent High-Grade Glioma: Comparison against Normalized Relative CBV Using Image-Localized Stereotactic Biopsies. AJNR Am J Neuroradiol. Published March 12, 2020 as 10.3174/ajnr.A6486.
3. American College of Radiology Imaging Network 6677
4. American College of Radiology Imaging Network 6684

THE IB CLINIC^® NEURO-ONCOLOGY PORTFOLIO:

LEADING THE WAY IN BRAIN TUMOR MRI ANALYSIS

IB Clinic image processing software is designed to integrate seamlessly into an existing medical imaging workflow. Perfusion and diffusion brain mapping are performed automatically on commonly available MRI studies, and, within seconds, quantitative results are delivered to the patient's entire care team for their review.

IB Clinic software also equips users with powerful, industry-leading tools for in-depth analysis, all via an intuitive and simple-to-learn user interface.

Perfusion Imaging

Perfusion MRI is recommended for imaging brain tumors as a complement to standard anatomical imaging. As brain tumors grow and require more oxygen and nutrients, they often recruit nearby blood vessels to sprout new vessels to create more blood supply. These new, rapidly-created networks of blood vessels in brain tumors often exhibit characteristics that can help distinguish them from normal brain tissue using IB software.

The ACR Practice Parameters for the Performance of Intracranial MR Perfusion Imaging (revised 2017), jointly issued by the American College of Radiology (ACR), the American Society for Neuroradiology (ASNR) and the Society for Pediatric Radiology (SPR), provides educational background and practice parameters for performing perfusion imaging in the brain. Primary indications for perfusion imaging in the diagnosis and characterization of mass lesions are listed as:

Differential diagnosis (tumor versus tumor mimic)
Diagnosis of primary neoplasms (may include grading)
Surgical planning for biopsy or resection: a.Targeting locations for biopsy; b.Guiding resection extent
Therapeutic follow-up: a.Radiation necrosis versus recurrent or residual tumor; b.Chemonecrosis versus recurrent or residual tumor; c.Pseudoprogression and pseudoresponse. Monitor potential transformation of non-resectable low grade neoplasms to higher grade.

The most frequently performed perfusion MRI techniques are dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) MRI. For patients who cannot undergo MRI, perfusion CT imaging is recommended.

IB's software solutions for analyzing perfusion MRI studies have been clinically proven to help identify areas of abnormal vascularity, improving accuracy for tumor grading and for differentiating recurrence from treatment response compared to conventional MRI.

IB Neuro™ DSC Perfusion Analysis

While conventional contrast-enhanced MRI reveals areas of increased vascularity where the normal blood-brain barrier has been damaged, DSC perfusion provides information about blood volume and flow for leaky and intact blood vessels. These quantities are frequently altered in many types of brain tumors compared to healthy brain tissue, and in general, are higher for more aggressive brain tumors like glioblastomas. In addition, brain tumors tend to be heterogeneous, with areas of higher vascularity ("hot spots") and areas of lower vascularity. These areas cannot be reliably distinguished on conventional contrast-enhanced MRI, and may yield important information for planning the most effective biopsy and surgery strategy.

(L) Conventional post-contrast MR image of an enhancing brain tumor. (R) Relative cerebral blood volume (rCBV) map created using IB Neuro showing heterogeneous distribution of tumor vascularity in the enhancing region.

DSC analysis is also important for assessing whether a tumor is responding to therapy. Standard treatment with combined radiation and chemotherapy can result in a treatment effect in normal brain that can be indistinguishable from recurrent tumor on conventional MRI. DSC perfusion MRI is recommended for assessment of tumors during and after therapy to more reliably distinguish between true tumor regrowth and normal treatment effects.

(L) Conventional post-contrast MR image showing areas of confirmed tumor progression and treatment effect (pseudo-progression). (R) IB Neuro standardized rCBV map showing a region of higher than normal vascularity corresponding to true tumor progression.

IB's proprietary Image Standardization technology is built into IB Neuro. Standardization automatically translates the relative CBV values to a fixed and common scale for easier comparison between timepoints regardless of scanner platform, field strength, timepoint, or patient. Discussions among treatment team members are thereby simplified via these objective measurements using a common scale.

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IB DCE™ MR Perfusion Analysis

IB DCE analysis analyzes post-contrast MR images collected as a series of timepoints over a period during the arrival and washout of the contrast agent. Using this approach, parameters related to tumor vascularity and blood vessel leakiness may be calculated from the series of images. For instance, Ktrans maps may be able to show areas of new blood vessel growth by highlighting regions where the blood-brain barrier is more disrupted.

IB DCE allows users to choose from among several well-studied DCE models, including the Tofts, Extended Tofts and Patlak models. As for IB Neuro, multiple time-consuming steps are automated to save time, and fully automated vascular maps may be created based on the institutions preferred configuration.

Ktrans map created IB DCE showing tumor heterogeneity.

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IB DIFFUSION™ MR DWI Analysis

Diffusion MRI is a powerful imaging method that is used to assess how closely or densely cells are in brain tissue. Some types of brain tumors are often seen as areas of increased cell density, and diffusion MRI can be helpful in diagnosis. Diffusion MRI can help provide important information about the tissue micro-environment in tumors that are spatially inhomogeneous, and for assessing tissue changes resulting from therapy.

IB Diffusion provides tools for analyzing diffusion-weighted images and has the potential to show pathological changes in tissue before gross anatomical changes are evident on standard anatomical MR images.

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IB Delta Suite™ Image Processing

IB Delta Suite allows the user to perform a range of common radiology tasks such as co-registering datasets, creating subtraction maps, and exporting class maps based on user-determined image thresholds. IB Delta Suite is most know for creating IB's Delta T1 (dT1) maps. dT1 maps have demonstrated the ability to aid in the detection of subtle contrast enhancement on post-contrast T1-weighted images. This is enabled by the same proprietary Image Standardization technology used in IB Neuro. This key step eliminates confounding factors such as post-surgical blood products, fat and proteinaceous material, and makes the resulting dT1 maps quantitative. dT1 maps make the delineation of contrast enhancing regions objective, faster, and consistent and comparison to previous time points easier and faster.

dT1 image created with IB Delta Suite clearly shows true areas of enhancement.

dT1 image created using IB Delta Suite increases conspicuity of subtle enhancing lesion not easily visualized on T1-weighted post-contrast images.

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IB Rad Tech™ Post-processing workflow toolkit

IB's workflow wizard, IB Rad Tech, steps users through a series of customizable post-processing steps to generate functional maps, quality assurance output indices, and quantitative measurements using IB's family of Neuro-Oncology applications.

Designed for medical imaging technologists, IB Rad Tech automates time-consuming and subjective aspects of brain tumor analysis workflows, improving consistency and enhancing productivity. With IB Rad Tech, the generation of advanced and sophisticated maps can be performed with very little training or experience.

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