Early Detection of Response to Radiation Therapy in Patients With Brain Malignancies Using Conventional and High b-Value Diffusion-Weighted Magnetic Resonance Imaging

Mardor, Yael; Pfeffer, Raphael; Spiegelmann, Roberto; Roth, Yiftach; Maier, Stephan E.; Nissim, Ouzi; Berger, Raanan; Glicksman, Ami; Baram, J; Orenstein, Arie; Cohen, Jack S.; Tichler, Thomas

doi:10.1200/jco.2003.05.069

Cited by 260 publications

(148 citation statements)

References 19 publications

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“…On a patient-bypatient basis, fDM had a sensitivity and a specificity of 100%. This current study significantly extends earlier work accomplished in rodent brain tumors (13,20,21,(23)(24)(25)28) and the preliminary clinical observations in patients with brain and other cancer types (28)(29)(30)(31)(32). The advancement reported in this study was achieved by using coregistered MRI datasets along with thresholding allowing for quantification of change in treatment-induced tumor diffusion values.…”

Section: Discussionsupporting

confidence: 74%

“…However, clinical utility of this approach has been hampered because of tumor heterogeneity and suboptimal methods of digital image analysis (28)(29)(30)(31)(32). Furthermore, although these preliminary studies have shown correlations between ADC change and tumor response, a definitive study demonstrating the ability of diffusion MRI to predict response has not been reported.…”

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confidence: 99%

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Functional diffusion map: A noninvasive MRI biomarker for early stratification of clinical brain tumor response

Moffat

Chenevert

Lawrence

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

592

477

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Assessment of radiation and chemotherapy efficacy for brain cancer patients is traditionally accomplished by measuring changes in tumor size several months after therapy has been administered. The ability to use noninvasive imaging during the early stages of fractionated therapy to determine whether a particular treatment will be effective would provide an opportunity to optimize individual patient management and avoid unnecessary systemic toxicity, expense, and treatment delays. We investigated whether changes in the Brownian motion of water within tumor tissue as quantified by using diffusion MRI could be used as a biomarker for early prediction of treatment response in brain cancer patients. Twenty brain tumor patients were examined by standard and diffusion MRI before initiation of treatment. Additional images were acquired 3 weeks after initiation of chemo-and͞or radiotherapy. Images were coregistered to pretreatment scans, and changes in tumor water diffusion values were calculated and displayed as a functional diffusion map (fDM) for correlation with clinical response. Of the 20 patients imaged during the course of therapy, 6 were classified as having a partial response, 6 as stable disease, and 8 as progressive disease. The fDMs were found to predict patient response at 3 weeks from the start of treatment, revealing that early changes in tumor diffusion values could be used as a prognostic indicator of subsequent volumetric tumor response. Overall, fDM analysis provided an early biomarker for predicting treatment response in brain tumor patients. diffusion MRI ͉ therapeutic response

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Section: Discussionsupporting

confidence: 74%

mentioning

confidence: 99%

Functional diffusion map: A noninvasive MRI biomarker for early stratification of clinical brain tumor response

Moffat

Chenevert

Lawrence

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

592

477

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“…The World health organization classification subcategorizes the pineal parenchymal tumour into three classes: pineocytoma, pineoblastoma, and pineal parenchymal tumour of intermediate differentiation 2,8 . compared to pineocytoma, pineoblastoma is characterized by early onset (first two decades vs third or fourth decades), infiltration into surrounding structures, primitive neuroectodermal cell composition, presence of homer-Wright or Flexner-Wintersteiner rosettes, frequent brain metastasis or spinal seeding and worse prognosis (five-year survival rate: 58% vs 86%) [1][2][3]9 .…”

Section: Discussionmentioning

confidence: 99%

“…In the first step the dataset of ADc maps before and after treatment were co-registered to each other using the software statistical Parametric Mapping (sPM5) (Welcome Department of Imaging Neuroscience, london, UK) 7,8 . Then, for every pixel the percentual increase of ADc was estimated using the equation [(ADc post -ADc pre )/ADc pre x100%], where ADc pre describes the ADc before treatment and ADc post after treatment.…”

Section: Imaging Post-processing and Analysismentioning

confidence: 99%

Diffusion-weighted MR images and pineoblastoma: diagnosis and follow-up

Gasparetto

Cruz

Doring

et al. 2008

Arq. Neuro-Psiquiatr.

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-Pineoblastomas are uncommon pineal tumors, which demonstrate rapid growing and poor prognosis. We report the case of a 43-year-old man with an enhancing pineal region mass, which showed restriction of the diffusion on diffusion-weighted (DW) MR images. The surgical biopsy defined the diagnosis of pineoblastoma and the therapy was initiated with radiation and chemotherapy. Three months later, the follow-up MR imaging showed areas suggestive of necrosis and the DW images demonstrate no significant areas of restricted diffusion. The differential diagnosis of pineal region masses that could show restriction of diffusion is discussed.Key WoRDs: pineoblastoma, magnetic resonance imaging, diffusion-weighted imaging. imagens pesadas em difusão e pineoblastoma: diagnóstico e acompanhamentoResumo -Pineoblastomas são tumores incomuns da glândula pineal, os quais têm crescimento rápido e prognóstico reservado. os autores objetivam relatar o caso de um homem de 43 anos de idade com uma massa na região pineal com realce pelo contraste, a qual demonstrou restrição da difusão nas imagens de ressonância magnética (RM) pesadas em difusão. A biópsia cirúrgica definiu o diagnóstico de pineoblastoma e o tratamento foi iniciado com radio e quimioterapia. Três meses mais tarde, a RM de controle demonstrou áreas sugestivas de necrose e não mais eram observadas áreas de restrição da difusão da água. o diagnóstico diferencial das massas na região pineal que podem apresentar restrição da difusão é discutido.PAlAvRAs-chAve: pineoblastoma, ressonância magnética, imagens pesadas em difusão. Dr. Emerson L. Gasparetto -Rua Lopes Trovão 88 / 1702B -24220-071 Niterói RJ -Brasil. E-mail: egasparetto@gmail.comPineal parenchymal neoplasms account for less than 15% of all pineal region masses. The pineoblastoma is the malignant variant, composed of undifferentiated or immature cells. This lesion is unencapsulated and often invades directly into the adjacent brain or may spread through the csF 1,2 . Regarding the imaging findings, cT scans may show a pineal mass with calcification and contrast enhancement. The MR images demonstrate a lesion hypoor iso-intense on T1-and hyperintense on T2-weighted images, with heterogeneous enhancement after gadolinium administration. however, there is a considerable overlap of the imaging findings of pineoblastomas and pineocytomas 1-3 . The diffusion-weighted (DW) MR imaging provides information about the movement of the water molecules along random pathways. Many factors may cause restriction of water diffusion in living tissues, such as cellular compartmentalization, cell type and number, cell membrane density, and macromolecule size and type 4 . several authors have studied the application of DW images in brain neoplasms, trying to discriminate tumour tissue from oedema, cyst or necrosis, and even trying to access tumour cellularity and grading 5,6 . however, to our knowledge, the DW imaging findings of pineoblastomas were not previously assessed.We present the DW imaging findings of a patient with pin...

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“…These changes would be expected to be detectable prior to macroscopic changes in mass, size or morphology since removal of tumor macromolecular debris occurs relatively slowly. In fact, clinical studies have shown that dMRI can predict tumor response often several months prior to detectable radiographic changes [13][14][15][16][17][18]. Therefore, we decided to study the effectiveness of dMRI to predict response in patients with pancreatic cancer receiving neoadjuvant chemoradiation therapy.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

Cuneo¹,

Chenevert²,

Feng³

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Early Detection of Response to Radiation Therapy in Patients With Brain Malignancies Using Conventional and High b-Value Diffusion-Weighted Magnetic Resonance Imaging

Cited by 260 publications

References 19 publications

Functional diffusion map: A noninvasive MRI biomarker for early stratification of clinical brain tumor response

Functional diffusion map: A noninvasive MRI biomarker for early stratification of clinical brain tumor response

Diffusion-weighted MR images and pineoblastoma: diagnosis and follow-up

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

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