Cerebral blood flow changes after radiation therapy identifies pseudo-progression in diffuse intrinsic pontine gliomas (original) (raw)
Related papers
International journal of radiation oncology, biology, physics, 2017
To use multimodal magnetic resonance imaging (MRI) to quantify treatment-induced changes in the whole volume of diffuse infiltrating pontine gliomas and correlate them with progression-free survival (PFS). This prospective study included 22 children aged 3.3 to 14.7 years (median, 5.9 years). Multimodal MRI was performed at 3 distinct time points: before treatment, the first week following radiation therapy (RT), and 2 months after RT. The imaging protocol included morphologic, multi b-value diffusion; arterial spin labeling; and dynamic susceptibility contrast-enhanced perfusion. Morphologic and multimodal data-lesion volume, diffusion coefficients, relative cerebral blood flow, and relative cerebral blood volume (rCBV)-were recorded at the 3 aforementioned time points. The Wilcoxon test was used to compare each individual parameter variation between time points, and its correlation with PFS was assessed by the Spearman test. Following RT, the tumors' solid component volume dec...
American Journal of Neuroradiology, 2020
BACKGROUND AND PURPOSE: Diffuse intrinsic pontine glioma is a lethal childhood brain cancer with dismal prognosis and MR imaging is the primary methodology used for diagnosis and monitoring. Our aim was to determine whether advanced diffusion, perfusion, and permeability MR imaging metrics predict survival and pseudoprogression in children with newly diagnosed diffuse intrinsic pontine glioma. MATERIALS AND METHODS: A clinical trial using the poly (adenosine diphosphate ribose) polymerase (PARP) inhibitor veliparib concurrently with radiation therapy, followed by maintenance therapy with veliparib + temozolomide, in children with diffuse intrinsic pontine glioma was conducted by the Pediatric Brain Tumor Consortium. Standard MR imaging, DWI, dynamic contrast-enhanced perfusion, and DSC perfusion were performed at baseline and approximately every 2 months throughout treatment. ADC histogram metrics of T2-weighted FLAIR and enhancing tumor volume, dynamic contrast-enhanced permeability metrics for enhancing tumors, and tumor relative CBV from DSC perfusion MR imaging were calculated. Baseline values, post-radiation therapy changes, and longitudinal trends for all metrics were evaluated for associations with survival and pseudoprogression. RESULTS: Fifty children were evaluable for survival analyses. Higher baseline relative CBV was associated with shorter progression-free survival (P ¼ .02, Q ¼ 0.089) and overall survival (P ¼ .006, Q ¼ 0.055). Associations of higher baseline mean transfer constant from the blood plasma into the extravascular extracellular space with shorter progression-free survival (P ¼ .03, Q ¼ 0.105) and overall survival (P ¼ .03, Q ¼ 0.102) trended toward significance. An increase in relative CBV with time was associated with shorter progression-free survival (P , .001, Q , 0.001) and overall survival (P ¼ .004, Q ¼ 0.043). Associations of longitudinal mean extravascular extracellular volume fraction with progression-free survival (P ¼ .03, Q ¼ 0.104) and overall survival (P ¼ .03, Q ¼ 0.105) and maximum transfer constant from the blood plasma into the extravascular extracellular space with progression-free survival (P ¼ .03, Q ¼ 0.102) trended toward significance. Greater increases with time were associated with worse outcomes. True radiologic progression showed greater post-radiation therapy decreases in mode_ADC_FLAIR compared with pseudoprogression (means, À268.15 versus À26.11, P ¼ .01.) CONCLUSIONS: ADC histogram, perfusion, and permeability MR imaging metrics in diffuse intrinsic pontine glioma are useful in predicting survival and pseudoprogression. ABBREVIATIONS: DCE ¼ dynamic contrast-enhanced; DIPG ¼ diffuse intrinsic pontine glioma; K ep ¼ rate constant from extravascular extracellular space back into blood plasma; K trans ¼ transfer constant from blood plasma into extravascular extracellular space; OS ¼ overall survival; PBTC ¼ Pediatric Brain Tumor Consortium; PFS ¼ progression-free survival; rCBV ¼ relative CBV; RT ¼ radiation therapy; TMZ ¼ temozolomide; v e ¼ extravascular extracellular volume fraction; v p ¼ blood-plasma volume fraction
Journal of Neuro-Oncology, 2014
While pediatric diffuse intrinsic pontine gliomas (DIPG) remain fatal, recent data have shown subgroups with distinct molecular biology and clinical behavior. We hypothesized that diffusion-weighted MRI can be used as a prognostic marker to stratify DIPG subsets with distinct clinical behavior. Apparent diffusion coefficient (ADC) values derived from diffusion-weighted MRI were computed in 20 consecutive children with treatmentnaïve DIPG tumors. The median ADC for the cohort was used to stratify the tumors into low and high ADC groups. Survival, gender, therapy, and potential steroid effects were compared between the ADC groups. Median age at diagnosis was 6.6 (range 2.3-13.2) years, with median followup seven (range 1-36) months. There were 14 boys and six girls. Seventeen patients received radiotherapy, five received chemotherapy, and six underwent cerebrospinal fluid diversion. The median ADC of 1,295 9 10-6 mm 2 /s for the cohort partitioned tumors into low or high diffusion groups, which had distinct median survivals of 3 and 13 months, respectively (log-rank p \ 0.001). Low ADC tumors were found only in boys, whereas high ADC tumors were found in both boys and girls. Available tissue specimens in three low ADC tumors demonstrated high-grade histology, whereas one high ADC tumor demonstrated low-grade histology with a histone H3.1 K27M mutation and high-grade metastatic lesion at autopsy. ADC derived from diffusion-weighted MRI may identify prognostically distinct subgroups of pediatric DIPG. Keywords Diffuse intrinsic pontine glioma (DIPG) Á Diffusion Á Diffusion-weighted imaging (DWI) Á Apparent diffusion coefficient (ADC) Á MRI
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2017
Rationale: To describe baseline (18)F-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) voxel characteristics in pediatric diffuse intrinsic pontine glioma (DIPG) and to correlate these metrics with baseline magnetic resonance (MR) apparent diffusion coefficient (ADC) histogram metrics, progression-free survival (PFS) and overall survival (OS). Methods: Baseline brain FDG-PET and MR scans were obtained in 33 children from Pediatric Brain Tumor Consortium (PBTC) clinical DIPG trials. FDG-PET, post-gadolinium (PG) and ADC images were registered to baseline fluid attenuation inversion recovery (FLAIR) images. Three-dimensional regions of interest on FLAIR and PG images and FDG-PET and ADC histograms were generated. Metrics evaluated included peak number, skewness and kurtosis. Correlation between PET and ADC histogram metrics was evaluated. PET pixel values within the ROI for each tumor were plotted against ADC values. Association of these imaging markers with s...
The Egyptian Journal of Radiology and Nuclear Medicine, 2013
Background: Pediatric diffuse intrinsic pontine glioma (DIPG) remains dismal regardless the new therapeutic and technical advances. Objective: To investigate the value of magnetic resonance imaging (MRI) in predicting DIPG prognosis. Patients and methods: Twenty-five DIPG patients with 95 (initial and post radiotherapy) MR examinations were studied. Hydrocephalus was detected in 6 cases (24%), basilar artery encasement in 20 (80%), ill defined border in 16 (64%), perilesional edema in 2 cases (8%) and none showed leptomeningeal spread. Conformal 3-dimensional radiotherapy (39 Gy/13 fractions or 54 Gy/30 fractions) was applied. Results: The median overall survival (MOS) was 9.3 months (95% CI: 7.9-10.8) and the one year overall survival was 18 ± 8.9%. Post radiation MRI performed 3-6 months after treatment showed regression in 8 cases (32%), stationary course in 5 (20%) and progression in 12 cases (48%). The MOS was higher in children whose MRI showed regression (10.0, CI: 6.3-13.7) than those with
Child's Nervous System, 2014
Purpose The purpose of this study is to evaluate quantitative changes in diffusion tensor imaging (DTI) tractography and fractional anisotropy (FA) of the pons along with clinical correlation, in patients who receive re-irradiation for progressive diffuse intrinsic pontine glioma (DIPG). Methods A retrospective case review of children with progressive DIPG who received re-irradiation at our institution from 2007 to 2011 after approval from the Institutional Review Board was performed. Tractography analysis and FA were analyzed pre and post-re-irradiation, and correlation with clinical features and MR imaging was performed.
Neuro-Oncology, 2020
Abtract Background This study describes imaging features of diffuse intrinsic pontine glioma (DIPG) and correlates with overall survival (OS) and histone mutation status in the International DIPG Registry (IDIPGR). Methods Four hundred cases submitted to the IDIPGR with a local diagnosis of DIPG and baseline MRI were evaluated by consensus review of 2 neuroradiologists; 43 cases were excluded (inadequate imaging or alternative diagnoses). Agreement between reviewers, association with histone status, and univariable and multivariable analyses relative to OS were assessed. Results On univariable analysis imaging features significantly associated with worse OS included: extrapontine extension, larger size, enhancement, necrosis, diffusion restriction, and distant disease. On central review, 9.5% of patients were considered not to have DIPG. There was moderate mean agreement of MRI features between reviewers. On multivariable analysis, chemotherapy, age, and distant disease were predict...
American Journal of Neuroradiology, 2011
In cerebral gliomas, rCBV correlates with tumor grade and histologic findings of vascular proliferation. Moreover, ADC assesses water diffusivity and is inversely correlated with tumor grade. In the present work, we have studied whether combined rCBV and ADC values improve the diagnostic accuracy of MR imaging in the preoperative grading of gliomas. MATERIALS AND METHODS: One hundred sixty-two patients with histopathologically confirmed diffuse gliomas underwent DWI and DSC. Mean rCBV and ADC values were compared among the tumor groups with the Student t test or ANOVA. ROC analysis was used to determine rCBV and ADC threshold values for glioma grading. RESULTS: rCBV had significantly different values between grade II and IV gliomas and between grade III and IV tumors, but there were no significant differences between grade II and III gliomas (P Ͼ .05). Grade II and III tumors also did not differ when astrocytomas, oligodendrogliomas, and oligoastrocytomas were considered separately. ADC values were significantly different for all 3 grades. The ADC threshold value of 1.185 ϫ 10 Ϫ3 mm 2 /s and the rCBV cutoff value of 1.74 could be used with high sensitivity in the characterization of high-grade gliomas. The area under the ROC curve for the maximum rCBV and minimum ADC was 0.72 and 0.75, respectively. The combination of rCBV and ADC values increased the area under the ROC curve to 0.83. CONCLUSIONS: ADC measurements are better than rCBV values for distinguishing the grades of gliomas. The combination of minimum ADC and maximum rCBV improves the diagnostic accuracy of glioma grading. ABBREVIATIONS: DSC ϭ dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging; GBM ϭ glioblastoma multiforme; GBM-O ϭ glioblastoma with oligodendroglial component; IR ϭ inversion recovery; rCBV ϭ relative cerebral blood volume; ROC ϭ receiver operating characteristic analysis; WHO ϭ World Health Organization
Journal of Neuro-Oncology, 2019
There are no actual or potential conflicts of interest. Raf Ceschin and Dr. Ashok Panigrahy had full access to all of the data in the study and had final responsibility for the decision to submit for publication. There are no actual or potential conflicts of interest. Rafael Ceschin declares that he has no conflict of interest. Mehmet Kocak declares that he has no conflict of interest. Sridhar Vajapeyam declares that he has no conflict of interest. Ian F. Pollack declares that he has no conflict of interest. Arzu Onar-Thomas declares that she has no conflict of interest. Ira J. Dunkel declares that he has no conflict of interest. Tina Young Poussaint declares that she has no conflict of interest. Ashok Panigrahy declares that he has no conflict of interest. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: Informed consent was obtained from all individual participants included in the study.