Histogram analysis of apparent diffusion coefficient within enhancing and nonenhancing tumor volumes in recurrent glioblastoma patients treated with bevacizumab.

Rahman, Rifaquat; Hamdan, Alhafidz; Zweifler, Rebecca; Jiang, Han; Norden, Andrew D.; Reardon, David A.; Mukundan, Srinivasan; Wen, Patrick Y.; Huang, Raymond Y.

doi:10.1200/jco.2014.32.15_suppl.2058

Cited by 4 publications

(10 citation statements)

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“…Moreover, the apparent diffusion coefficient (ADC) is also presumed to reflect the size of the EES (11). ADC and mean diffusivity, which is similar to ADC (32,33), have been found to increase in normal-appearing white matter after radiotherapy (34,35). Based on this, we would expect to find increased V e after radiotherapy.…”

Section: Discussionmentioning

confidence: 67%

Dynamic contrast-enhanced magnetic resonance imaging may act as a biomarker for vascular damage in normal appearing brain tissue after radiotherapy in patients with glioblastoma

Fahlström

Fransson

Blomquist

et al. 2018

Acta Radiologica Open

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BackgroundDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a promising perfusion method and may be useful in evaluating radiation-induced changes in normal-appearing brain tissue.PurposeTo assess whether radiotherapy induces changes in vascular permeability (Ktrans) and the fractional volume of the extravascular extracellular space (Ve) derived from DCE-MRI in normal-appearing brain tissue and possible relationships to radiation dose given.Material and MethodsSeventeen patients with glioblastoma treated with radiotherapy and chemotherapy were included; five were excluded because of inconsistencies in the radiotherapy protocol or early drop-out. DCE-MRI, contrast-enhanced three-dimensional (3D) T1-weighted (T1W) images and T2-weighted fluid attenuated inversion recovery (T2-FLAIR) images were acquired before and on average 3.3, 30.6, 101.6, and 185.7 days after radiotherapy. Pre-radiotherapy CE T1W and T2-FLAIR images were segmented into white and gray matter, excluding all non-healthy tissue. Ktrans and Ve were calculated using the extended Kety model with the Parker population-based arterial input function. Six radiation dose regions were created for each tissue type, based on each patient’s computed tomography-based dose plan. Mean Ktrans and Ve were calculated over each dose region and tissue type.ResultsGlobal Ktrans and Ve demonstrated mostly non-significant changes with mean values higher for post-radiotherapy examinations in both gray and white matter compared to pre-radiotherapy. No relationship to radiation dose was found.ConclusionAdditional studies are needed to validate if Ktrans and Ve derived from DCE-MRI may act as potential biomarkers for acute and early-delayed radiation-induced vascular damages. No dose-response relationship was found.

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Section: Discussionmentioning

confidence: 67%

Dynamic contrast-enhanced magnetic resonance imaging may act as a biomarker for vascular damage in normal appearing brain tissue after radiotherapy in patients with glioblastoma

Fahlström

Fransson

Blomquist

et al. 2018

Acta Radiologica Open

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“…Multiple studies have subsequently suggested that the ADC value could predict the survival of patients with recurrent GBs treated with bevacizumab (29,30). These last studies agree with the results demonstrated by Pope et al.…”

Section: Discussionmentioning

confidence: 99%

ADC quantification to classify patients candidate to receive bevacizumab treatment for recurrent glioblastoma

et al. 2019

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Background Recurrent high-grade gliomas progressing after surgery and temozolomide plus radiation therapy have traditionally been treated using antiangiogenic drugs as the first-line therapy. Since the phase 3 EORTC 26101 trial showed no significant benefit of administering antiangiogenic drugs, the need to identify a biomarker to classify subgroups of potential responders has increased. Purpose To investigate the feasibility of using apparent diffusion coefficient as a predictor of the response of recurrent high-grade gliomas to bevacizumab or classifier for patients showing better response. Material and Methods This retrospective study analyzed magnetic resonance images obtained from 39 patients at the time of high-grade glioma progression who were treated using bevacizumab. The apparent diffusion coefficient maps were quantified and modelled as a mixture of Gaussian functions. The correlation of their descriptors and the time to second progression was studied. Log-rank tests were performed to determine the power of these descriptors as the classifiers for patients exhibiting better survival. Results None of the descriptors showed correlation with time to second progression (r < 0.35) but several of them stratified subgroups showing a better time to second progression passing log-rank tests ( P < 0.02). Conclusion Apparent diffusion coefficient cannot be used to predict the time to second progression of recurrent high-grade gliomas treated with bevacizumab, but it can stratify groups with better time to second progression distributions.

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“…Diffusion-weighted imaging (DWI) allows quantitative assessment of tissue microstructure. Changes in the apparent diffusion coefficient (ADC) have been associated with clinical outcomes of recurrent high-grade gliomas treated with BEV 17–29 but these results are inconsistent. A decrease, 18–20,22,24,27,30 an increase, 23 or unspecified changes 17,25,26 in the pre- or post-treatment ADC have been associated with poor clinical outcomes in separate studies.…”

Section: Introductionmentioning

confidence: 99%

“…Changes in the apparent diffusion coefficient (ADC) have been associated with clinical outcomes of recurrent high-grade gliomas treated with BEV 17–29 but these results are inconsistent. A decrease, 18–20,22,24,27,30 an increase, 23 or unspecified changes 17,25,26 in the pre- or post-treatment ADC have been associated with poor clinical outcomes in separate studies. These inconsistent findings may arise from complex microstructural changes related to tumor infiltration and BEV treatment, including changes in axonal disorganization, endothelial proliferation, cell density and pseudopalisading necrosis, 13–16,24,28,31–37 which may not be completely characterized by the ADC.…”

Section: Introductionmentioning

confidence: 99%

“…These inconsistent findings may arise from complex microstructural changes related to tumor infiltration and BEV treatment, including changes in axonal disorganization, endothelial proliferation, cell density and pseudopalisading necrosis, 13–16,24,28,31–37 which may not be completely characterized by the ADC. Histogram analysis, 17,19,20,27 functional diffusion maps, 22,23 qualitative diffusion signature 38 and volumetric analysis 28,29 have been used to account for the heterogeneous changes of ADC within the tissue. In addition, advanced DWI methods that quantify diffusional directionality and heterogeneity in tissue 21,39–42 may provide more information about those complex microstructural changes.…”

Section: Introductionmentioning

confidence: 99%

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Early assessment of recurrent glioblastoma response to bevacizumab treatment by diffusional kurtosis imaging: a preliminary report

et al. 2019

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Purpose The purpose of this preliminary study is to apply diffusional kurtosis imaging to assess the early response of recurrent glioblastoma to bevacizumab treatment. Methods This prospective cohort study included 10 patients who had been diagnosed with recurrent glioblastoma and scheduled to receive bevacizumab treatment. Diffusional kurtosis images were obtained from all the patients 0–7 days before (pre-bevacizumab) and 28 days after (post-bevacizumab) initiating bevacizumab treatment. The mean, 10th, and 90th percentile values were derived from the histogram of diffusional kurtosis imaging metrics in enhancing and non-enhancing lesions, selected on post-contrast T1-weighted and fluid-attenuated inversion recovery images. Correlations of imaging measures with progression-free survival and overall survival were evaluated using Spearman's rank correlation coefficient. The significance level was set at P < 0.05. Results Higher pre-bevacizumab non-enhancing lesion volume was correlated with poor overall survival ( r = −0.65, P = 0.049). Higher post-bevacizumab mean diffusivity and axial diffusivity (D∥, D∥10% and D∥90%) in non-enhancing lesions were correlated with poor progression-free survival ( r = −0.73, −0.83, −0.71 and −0.85; P < 0.05). Lower post-bevacizumab axial kurtosis (K∥10%) in non-enhancing lesions was correlated with poor progression-free survival ( r = 0.81, P = 0.008). Conclusions This preliminary study demonstrates that diffusional kurtosis imaging metrics allow the detection of tissue changes 28 days after initiating bevacizumab treatment and that they may provide information about tumor progression.

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Histogram analysis of apparent diffusion coefficient within enhancing and nonenhancing tumor volumes in recurrent glioblastoma patients treated with bevacizumab.

Cited by 4 publications

References 0 publications

Dynamic contrast-enhanced magnetic resonance imaging may act as a biomarker for vascular damage in normal appearing brain tissue after radiotherapy in patients with glioblastoma

Dynamic contrast-enhanced magnetic resonance imaging may act as a biomarker for vascular damage in normal appearing brain tissue after radiotherapy in patients with glioblastoma

ADC quantification to classify patients candidate to receive bevacizumab treatment for recurrent glioblastoma

Early assessment of recurrent glioblastoma response to bevacizumab treatment by diffusional kurtosis imaging: a preliminary report

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