Early and late effects of radiochemotherapy on cerebral blood flow in glioblastoma patients measured with non-invasive perfusion MRI

Petr, Jan; Platzek, Ivan; Seidlitz, Annekatrin; Mutsaerts, Henk‐Jan; Hofheinz, Frank; Schramm, Georg; Maus, Jens; Beuthien‐Baumann, Bettina; Krause, Mechthild; Hoff, Joerg van den

doi:10.1016/j.radonc.2015.12.017

Cited by 34 publications

(30 citation statements)

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“…As proposed by Petr et al ., perfusion variations in healthy tissue can represent a possible bias with regard to reference region selection. 10 Acute and early delayed effects from FRT would, based on our results and other publications, introduce an overestimation of tumour CBV and CBF since the reference normal appearing brain tissue CBV and CBF are the denominator in the ratio. Thus, information from radiation dose plans may assist the selection of a reference WM region, avoiding GM to, if possible, define a region that received as low dose as possible.…”

Section: Discussionsupporting

confidence: 55%

“…an inverse dose-response relationship. 10 A good correlation has previously been reported between arterial spin labelling -MRI and DSC-MRI with regard to measuring regional CBF 13 , 37 , however, an analysis of white matter was not included. Price et al .…”

Section: Discussionmentioning

confidence: 82%

“…Few studies have assessed radiation-induced changes in brain perfusion in normal appearing brain tissue after fractionated radiotherapy (FRT) or stereotactic radiosurgery. 5 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 Contradictory results have been published, however, perfusion techniques and post-processing methods differ extensively between studies. Overall, the published data show a reduction of both cerebral blood volume (CBV) and cerebral blood flow (CBF) after completion of FRT or single fraction stereotactic radiosurgery, with an inverse dose-response relationship.…”

Section: Introductionmentioning

confidence: 99%

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Perfusion magnetic resonance imaging changes in normal appearing brain tissue after radiotherapy in glioblastoma patients may confound longitudinal evaluation of treatment response

Fahlström

Blomquist

Nyholm

et al. 2018

Radiology and Oncology

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BackgroundThe aim of this study was assess acute and early delayed radiation-induced changes in normal-appearing brain tissue perfusion as measured with perfusion magnetic resonance imaging (MRI) and the dependence of these changes on the fractionated radiotherapy (FRT) dose level.Patients and methodsSeventeen patients with glioma WHO grade III-IV treated with FRT were included in this prospective study, seven were excluded because of inconsistent FRT protocol or missing examinations. Dynamic susceptibility contrast MRI and contrast-enhanced 3D-T1-weighted (3D-T1w) images were acquired prior to and in average (standard deviation): 3.1 (3.3), 34.4 (9.5) and 103.3 (12.9) days after FRT. Pre-FRT 3D-T1w images were segmented into white- and grey matter. Cerebral blood volume (CBV) and cerebral blood flow (CBF) maps were calculated and co-registered patient-wise to pre-FRT 3D-T1w images. Seven radiation dose regions were created for each tissue type: 0–5 Gy, 5–10 Gy, 10–20 Gy, 20–30 Gy, 30–40 Gy, 40–50 Gy and 50–60 Gy. Mean CBV and CBF were calculated in each dose region and normalised (nCBV and nCBF) to the mean CBV and CBF in 0-5 Gy white- and grey matter reference regions, respectively.ResultsRegional and global nCBV and nCBF in white- and grey matter decreased after FRT, followed by a tendency to recover. The response of nCBV and nCBF was dose-dependent in white matter but not in grey matter.ConclusionsOur data suggest that radiation-induced perfusion changes occur in normal-appearing brain tissue after FRT. This can cause an overestimation of relative tumour perfusion using dynamic susceptibility contrast MRI, and can thus confound tumour treatment evaluation.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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Perfusion magnetic resonance imaging changes in normal appearing brain tissue after radiotherapy in glioblastoma patients may confound longitudinal evaluation of treatment response

Fahlström

Blomquist

Nyholm

et al. 2018

Radiology and Oncology

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“…However, it is well-established that radiotherapy (RT) leads to long-term side-effects of the healthy brain tissue, e.g., leukomalacia, tissue atrophy, vascular changes or changes of diffusion and perfusion [4] , [5] , [6] , [7] , [8] , [9] . Moreover, the influence of irradiation on cortex thinning and on cerebral blood flow in the GM has recently been reported [10] , [11] . There are several approaches to objectively measure the influence of radiation on normal tissue, e.g., anatomical changes assessed by tissue shrinkage.…”

Section: Introductionmentioning

confidence: 99%

Retrospective assessment of MRI-based volumetric changes of normal tissues in glioma patients following radio(chemo)therapy

Gommlich

Raschke

Wahl

et al. 2018

Clinical and Translational Radiation Oncology

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In glioma patients, linac-based photon beam irradiation is a widely applied therapy, which achieves highly conformal target volume coverage, but is also known to cause side-effects to adjacent areas of healthy tissue. Apart from subjective measures, such as quality of life assessment and neurocognitive function tests, objective methods to quantify tissue damage are needed to assess this impact. Magnetic resonance imaging (MRI) is a well-established method for brain tumor diagnoses as well as assessing treatment response. In this study, we retrospectively assessed volumetric changes of gray matter (GM) and white matter (WM) in glioma patients following photon irradiation using a heterogeneous MRI-dataset obtained in routine clinical practice at different sites with imaging parameters and magnetic field strengths. We found a significant reduction in WM volume at one year (p=0.01) and two years (p=0.008) post radio(chemo)therapy whereas corresponding GM volumes did not change significantly (p=0.05 and p=0.11, respectively). More importantly, we also found large variations in the segmented tissue volumes caused by the heterogeneous MR data, thus potentially masking more subtle tissue changes over time. On the basis of these observations, we present suggestions regarding data acquisitions in future prospective MR studies to assess such volumetric changes.

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“…In MIM Maestro Software (6.8.8, USA), enhanced T1W images before RT were fused with the dose distribution map of RT plan, and rigid auxiliary registration was performed. Individual dose maps were divided into dose regions by categorizing them into 10 Gy steps, and the following six irradiated dose levels were defined: 0-10, 10-20, 20-30, 30-40, 40-50 and > 50 Gy [23]. An example is shown in Fig.…”

Section: Imaging Processingmentioning

confidence: 99%

The Study of Cerebral Blood Flow Variations Following Radiation Dose Gradients for Brain Metastasis Patients During Radiotherapy

Hou

Gong

Wang

et al. 2020

Preprint

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Brackground: Changes of cereberal blood flow in different brain regions of patients with brain metastases after radiotherapy are worth exploring. This study aims to investigate the radiation dose range of normal brain tissue and tumor target area by evaluating the cerebral blood flow(CBF) for brain metastases (BMs) patients applying with 3D arterial spin labeling (ASL).Methods: A total of 26 patients harboring 54 BMs treated with radiotherapy (RT) were imaged with magnetic resonance (MR) before and 30-40Gy post RT. The high signal area of BMs on enhanced T1-weighted images (T1WI), normal brain tissue, and peritumoral edema region were defined as regions of interest (ROIs). Changes and correlation of largest cross-sectional area and maximum CBF in BMs before and after RT were analyzed. Maximum CBF change in the three ROIs under different gradients created by thresholding the individual dose maps at 10 Gy steps were assessed.Results: In terms of 54 BMs, a significant decrease of CBF of 29.64% (P<0.05) compared to largest cross-sectional area of 26.46% (P<0.05). The decrease of CBF was more pronounced for 30-40 Gy (33.75%) than for 40-50Gy and >50Gy (24.61% and 27.55%). In normal brain tissue with dose gradients of 30-40Gy, CBF decreased to the maximum, 20.23% (P<0.05),which was similar to BMs. In contrast, the decrement rate of CBF in the peritumoral edema region increased as the dose gradients increased.Conclusions: CBF decreased significantly during the course of RT. According to CBF variations, the dose to the normal brain tissue should be controlled below 30 Gy as much as possible, whereas tumor with high perfusion and peritumoral edema region should be given a higher dose.

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Early and late effects of radiochemotherapy on cerebral blood flow in glioblastoma patients measured with non-invasive perfusion MRI

Cited by 34 publications

References 30 publications

Perfusion magnetic resonance imaging changes in normal appearing brain tissue after radiotherapy in glioblastoma patients may confound longitudinal evaluation of treatment response

Perfusion magnetic resonance imaging changes in normal appearing brain tissue after radiotherapy in glioblastoma patients may confound longitudinal evaluation of treatment response

Retrospective assessment of MRI-based volumetric changes of normal tissues in glioma patients following radio(chemo)therapy

The Study of Cerebral Blood Flow Variations Following Radiation Dose Gradients for Brain Metastasis Patients During Radiotherapy

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Early and late effects of radiochemotherapy on cerebral blood flow in glioblastoma patients measured with non-invasive perfusion MRI

Cited by 34 publications

References 30 publications

Perfusion magnetic resonance imaging changes in normal appearing brain tissue after radiotherapy in glioblastoma patients may confound longitudinal evaluation of treatment response

Perfusion magnetic resonance imaging changes in normal appearing brain tissue after radiotherapy in glioblastoma patients may confound longitudinal evaluation of treatment response

Retrospective assessment of MRI-based volumetric changes of normal tissues in glioma patients following radio(chemo)therapy

The Study&nbsp;of&nbsp;Cerebral Blood Flow Variations&nbsp;Following Radiation Dose Gradients for Brain Metastasis&nbsp;Patients During&nbsp;Radiotherapy

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The Study of Cerebral Blood Flow Variations Following Radiation Dose Gradients for Brain Metastasis Patients During Radiotherapy