Radiogenomics in Leptomeningeal Metastasis of Lung Adenocarcinoma: MRI Patterns and Survival Outcomes Following Ommaya Reservoir Chemotherapy.
[BACKGROUND] 10%-30% of patients with lung adenocarcinoma (LUAD) and leptomeningeal metastasis (LM) respond poorly to conventional and targeted therapy.
- p-value p < 0.05
- 95% CI 5.16-7.84
APA
Jia YZ, Zhong Y, et al. (2026). Radiogenomics in Leptomeningeal Metastasis of Lung Adenocarcinoma: MRI Patterns and Survival Outcomes Following Ommaya Reservoir Chemotherapy.. Journal of magnetic resonance imaging : JMRI. https://doi.org/10.1002/jmri.70280
MLA
Jia YZ, et al.. "Radiogenomics in Leptomeningeal Metastasis of Lung Adenocarcinoma: MRI Patterns and Survival Outcomes Following Ommaya Reservoir Chemotherapy.." Journal of magnetic resonance imaging : JMRI, 2026.
PMID
41761417
Abstract
[BACKGROUND] 10%-30% of patients with lung adenocarcinoma (LUAD) and leptomeningeal metastasis (LM) respond poorly to conventional and targeted therapy. The relationship between genetic subtypes and both MRI features and survival outcomes remains poorly understood in this patient population.
[PURPOSE] To explore the genetic phenotypes among LUAD-LM patients who respond poorly to conventional and targeted therapy, and to compare the MRI characteristics and survival outcomes among these genetic phenotypes: STUDY TYPE: Retrospective.
[POPULATION] 110 LUAD-LM patients (LU confirmed by histology, LM by cytology) treated with intrathecal chemotherapy, comprising 43 with epidermal growth factor receptor exon 21 L858R mutations (EGFR 21), 29 with EGFR exon 19 deletions (EGFR 19), and 38 with Non-Classic and Other Mutations (NCOM).
[FIELD STRENGTH/SEQUENCE] 3.0T; axial T- and T-weighted turbo spin echo (TSE), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted echo-planar imaging (DWI), and post-contrast 3D T-weighted gradient-echo sequences (3D T1WI).
[ASSESSMENT] MRI morphologic features (including LM presence, presentation subtype, and lesion distribution) were independently reviewed by three radiologists (Y. J., W. S., and M. Y., with 5, 5, and 15 years of experience, respectively), following standardized criteria. Intracranial progression-free survival (iPFS) and overall survival (OS) were analyzed from the date of LM diagnosis based on clinical follow-up.
[STATISTICAL TESTS] Chi-square or Fisher's exact tests for imaging features; Kaplan-Meier method with log-rank tests for survival analysis; Cox proportional hazards regression for multivariable analysis. A two-sided p < 0.05 was considered significant.
[RESULTS] MRI-negative LM was significantly more frequent in EGFR 19 (65.5%). However, these patients showed no survival advantage (iPFS: p = 0.10, OS: p = 0.64) over other groups. Among MRI-positive LM patients, EGFR 21 affected significantly fewer lobes (< 4 lobes: 85.7%) compared to NCOM (< 4 lobes: 45.5%). Median iPFS in EGFR 21 was significantly longer than in NCOM (12.0 vs. 6.5 months; 95% CI: 5.16-7.84), and OS was also significantly longer (18.0 vs. 10.2 months; 95% CI: 4.79-15.61) DATA CONCLUSION: This radiogenomics study showed that EGFR mutation subtypes are associated with MRI features and survival outcomes in LUAD-LM patients with poor response to conventional and targeted therapies.
[EVIDENCE LEVEL] 3 TECHNICAL EFFICACY STAGE: 4.
[PURPOSE] To explore the genetic phenotypes among LUAD-LM patients who respond poorly to conventional and targeted therapy, and to compare the MRI characteristics and survival outcomes among these genetic phenotypes: STUDY TYPE: Retrospective.
[POPULATION] 110 LUAD-LM patients (LU confirmed by histology, LM by cytology) treated with intrathecal chemotherapy, comprising 43 with epidermal growth factor receptor exon 21 L858R mutations (EGFR 21), 29 with EGFR exon 19 deletions (EGFR 19), and 38 with Non-Classic and Other Mutations (NCOM).
[FIELD STRENGTH/SEQUENCE] 3.0T; axial T- and T-weighted turbo spin echo (TSE), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted echo-planar imaging (DWI), and post-contrast 3D T-weighted gradient-echo sequences (3D T1WI).
[ASSESSMENT] MRI morphologic features (including LM presence, presentation subtype, and lesion distribution) were independently reviewed by three radiologists (Y. J., W. S., and M. Y., with 5, 5, and 15 years of experience, respectively), following standardized criteria. Intracranial progression-free survival (iPFS) and overall survival (OS) were analyzed from the date of LM diagnosis based on clinical follow-up.
[STATISTICAL TESTS] Chi-square or Fisher's exact tests for imaging features; Kaplan-Meier method with log-rank tests for survival analysis; Cox proportional hazards regression for multivariable analysis. A two-sided p < 0.05 was considered significant.
[RESULTS] MRI-negative LM was significantly more frequent in EGFR 19 (65.5%). However, these patients showed no survival advantage (iPFS: p = 0.10, OS: p = 0.64) over other groups. Among MRI-positive LM patients, EGFR 21 affected significantly fewer lobes (< 4 lobes: 85.7%) compared to NCOM (< 4 lobes: 45.5%). Median iPFS in EGFR 21 was significantly longer than in NCOM (12.0 vs. 6.5 months; 95% CI: 5.16-7.84), and OS was also significantly longer (18.0 vs. 10.2 months; 95% CI: 4.79-15.61) DATA CONCLUSION: This radiogenomics study showed that EGFR mutation subtypes are associated with MRI features and survival outcomes in LUAD-LM patients with poor response to conventional and targeted therapies.
[EVIDENCE LEVEL] 3 TECHNICAL EFFICACY STAGE: 4.