Differentiation between vasogenic-edema versus tumor-infiltrative area in patients with glioblastoma during bevacizumab therapy: A longitudinal MRI study

被引:53
作者
Artzi, Moran [1 ,2 ]
Bokstein, Felix [3 ]
Blumenthal, Deborah T. [3 ]
Aizenstein, Orna [1 ]
Liberman, Gilad [1 ,4 ]
Corn, Benjamin W. [1 ,5 ]
Ben Bashat, Dafna [1 ,2 ,6 ]
机构
[1] Tel Aviv Univ, Tel Aviv Sourasky Med Ctr, Funct Brain Ctr, IL-69978 Tel Aviv, Israel
[2] Tel Aviv Univ, Sackler Fac Med, IL-69978 Tel Aviv, Israel
[3] Tel Aviv Univ, Tel Aviv Sourasky Med Ctr, Neurooncol Serv, IL-69978 Tel Aviv, Israel
[4] Bar Ilan Univ, Gonda Multidisciplinary Brain Res Ctr, Ramat Gan, Israel
[5] Tel Aviv Univ, Tel Aviv Sourasky Med Ctr, Inst Radiotherapy, IL-69978 Tel Aviv, Israel
[6] Tel Aviv Univ, Sagol Sch Neurosci, IL-69978 Tel Aviv, Israel
关键词
Glioblastoma; Bevacizumab; Vasogenic-edema; Tumor infiltrative areas; RANO criteria; MAGNETIC-RESONANCE SPECTROSCOPY; HIGH-GRADE GLIOMAS; RECURRENT GLIOBLASTOMA; PERITUMORAL EDEMA; BRAIN-TUMORS; SEGMENTATION; PROGRESSION; PERFUSION; CLASSIFICATION; SUSCEPTIBILITY;
D O I
10.1016/j.ejrad.2014.03.026
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Background: Treatment with bevacizumab is associated with substantial radiologic response in patients with glioblastoma ( GB). However, following this initial response, changes in T2-weighted MRI signal may develop, suggesting an infiltrative pattern of tumor progression. The aim of this study was to differentiate between vasogenic-edema versus tumor-infiltrative area in GB patients. Methods and materials: Fourteen patients with GB were longitudinally scanned, before and during intravenous bevacizumab therapy (5110 mg/kg every 2-weeks). A total of 40 MR scans including conventional, diffusion, dynamic susceptibility contrast, dynamic contrast enhancement imaging, and MR-spectroscopy (MRS) were analyzed. Classification of non-enhancing fluid-attenuation-inversion-recovery (FLAIR) area was performed based on mean diffusivity, cerebral blood volume and flow maps, and further characterized using multiple MRI parameters. Results: The non-enhancing FLAIR lesion area was classified into: vasogenic-edema, characterized by reduced perfusion and increased FLAIR values; or tumor-infiltrative area, characterized by increased perfusion. Tumor-infiltrative area demonstrated a higher malignant pattern on MRS compared to areas of vasogenic-edema. Substantial reductions of the enhanced T-1 -weighted (58 +/- 10%) and hyperintense FLAIR (53 +/- 9%) lesion volumes were detected mainly during the first weeks of therapy, with a shift to an infiltrative pattern of tumor progression thereafter, as detected by an increase in tumor-infiltrative area in the majority of patients, which correlated with progression-free survival (week 8: r = 0.86, p = 0.003, week 16: r= 0.99, p = 0.001). Conclusion: Characterization of non-enhancing hyperintense FLAIR lesion area in GB patients can provide an MR-based biomarker, indicating a shift to an infiltrative progression pattern, and may improve therapy response assessment in patients following bevacizumab therapy. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:1250 / 1256
页数:7
相关论文
共 30 条
[21]   Advances in MRI Assessment of Gliomas and Response to Anti-VEGF Therapy [J].
Pope, Whitney B. ;
Young, Jonathan R. ;
Ellingson, Benjamin M. .
CURRENT NEUROLOGY AND NEUROSCIENCE REPORTS, 2011, 11 (03) :336-344
[22]  
Sentürk S, 2009, DIAGN INTERV RADIOL, V15, P3
[23]   A nonparametric method for automatic correction of intensity nonuniformity in MRI data [J].
Sled, JG ;
Zijdenbos, AP ;
Evans, AC .
IEEE TRANSACTIONS ON MEDICAL IMAGING, 1998, 17 (01) :87-97
[24]   MEASUREMENT OF THE BLOOD-BRAIN-BARRIER PERMEABILITY AND LEAKAGE SPACE USING DYNAMIC MR IMAGING .1. FUNDAMENTAL-CONCEPTS [J].
TOFTS, PS ;
KERMODE, AG .
MAGNETIC RESONANCE IN MEDICINE, 1991, 17 (02) :357-367
[25]   Peritumoral brain edema in intracranial meningiomas evaluated by dynamic perfusion-weighted MR imaging: a preliminary study [J].
Uematsu, H ;
Maeda, M ;
Itoh, H .
EUROPEAN RADIOLOGY, 2003, 13 (04) :758-762
[26]   Standards of care for treatment of recurrent glioblastoma-are we there yet? [J].
Weller, Michael ;
Cloughesy, Timothy ;
Perry, James R. ;
Wick, Wolfgang .
NEURO-ONCOLOGY, 2013, 15 (01) :4-27
[27]   Malignant gliomas in adults [J].
Wen, Patrick Y. ;
Kesari, Santosh .
NEW ENGLAND JOURNAL OF MEDICINE, 2008, 359 (05) :492-507
[28]   Updated Response Assessment Criteria for High-Grade Gliomas: Response Assessment in Neuro-Oncology Working Group [J].
Wen, Patrick Y. ;
Macdonald, David R. ;
Reardon, David A. ;
Cloughesy, Timothy F. ;
Sorensen, A. Gregory ;
Galanis, Evanthia ;
DeGroot, John ;
Wick, Wolfgang ;
Gilbert, Mark R. ;
Lassman, Andrew B. ;
Tsien, Christina ;
Mikkelsen, Tom ;
Wong, Eric T. ;
Chamberlain, Marc C. ;
Stupp, Roger ;
Lamborn, Kathleen R. ;
Vogelbaum, Michael A. ;
van den Bent, Martin J. ;
Chang, Susan M. .
JOURNAL OF CLINICAL ONCOLOGY, 2010, 28 (11) :1963-1972
[29]   Segmentation of brain MR images through a hidden Markov random field model and the expectation-maximization algorithm [J].
Zhang, YY ;
Brady, M ;
Smith, S .
IEEE TRANSACTIONS ON MEDICAL IMAGING, 2001, 20 (01) :45-57
[30]   Rebound tumour progression after the cessation of bevacizumab therapy in patients with recurrent high-grade glioma [J].
Zuniga, Richard M. ;
Torcuator, Roy ;
Jain, Rajan ;
Anderson, John ;
Doyle, Thomas ;
Schultz, Lonni ;
Mikkelsen, Tom .
JOURNAL OF NEURO-ONCOLOGY, 2010, 99 (02) :237-242