Carrie R McDonald1, Rachel L Delfanti1, Anitha P Krishnan1, Kelly M Leyden1, Jona A Hattangadi-Gluth1, Tyler M Seibert1, Roshan Karunamuni1, Pia Elbe1, Joshua M Kuperman1, Hauke Bartsch1, David E Piccioni1, Nathan S White1, Anders M Dale1, Nikdokht Farid1. 1. Department of Psychiatry, University of California, San Diego, La Jolla, California (C.R.M., A.M.D.), Department of Radiology, University of California, San Diego, La Jolla, California (R.L.D., J.M.K., H.B., N.S.W., A.M.D., N.F.), Department of Radiation Medicine, University of California, San Diego, La Jolla, California (C.R.M., J.A.H.-G., T.M.S., R.K.), Department of Neurosciences, University of California, San Diego, La Jolla, California (D.E.P., A.M.D.), Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, California (C.R.M., A.P.K., K.M.L., T.M.S., P.E., J.M.K., H.B., N.S.W., A.M.D., N.F.).
Abstract
BACKGROUND: Diffusion-weighted imaging has shown initial promise for evaluating response to bevacizumab in patients with high-grade glioma (HGG). However, it is well recognized that the apparent diffusion coefficient (ADC) is influenced by bevacizumab-induced reductions in edema, which may limit its prognostic value. We demonstrate that an advanced diffusion-weighted imaging technique, restriction spectrum imaging (RSI), improves the evaluation of response to bevacizumab because unlike ADC, RSI is not affected by resolution of edema. METHODS: RSI and ADC maps were analyzed for 40 patients with HGG prior to and following initiation of bevacizumab. Volumes of interest were drawn for regions of contrast enhancement (CE) and fluid attenuated inversion recovery (FLAIR) hyperintensity and histogram percentiles within volumes of interest were calculated for ADC 10th percentile (ADC-CE10%, ADC-FLAIR10%) and for RSI 90th percentile (RSI-CE90%, RSI-FLAIR90%). Cox proportional hazard models were used to evaluate the relationship between imaging parameters, progression-free survival (PFS), and overall survival (OS). RESULTS: An increase in RSI-FLAIR90% following bevacizumab was the strongest predictor of poor PFS (P= .016) and OS (P= .004), whereas decreases in ADC-FLAIR10% showed a weaker association with OS only (P= .041). Within the CE region, increases in RSI-CE90% alone were associated with poorer OS. Correlational analysis revealed that decreases in FLAIR volume were associated with decreases in ADC-FLAIR10%, but not with changes in RSI-FLAIR90%. CONCLUSION: RSI is less influenced by changes in edema, conferring an advantage of RSI over ADC for evaluating response to anti-angiogenic therapy in patients with HGG.
BACKGROUND: Diffusion-weighted imaging has shown initial promise for evaluating response to bevacizumab in patients with high-grade glioma (HGG). However, it is well recognized that the apparent diffusion coefficient (ADC) is influenced by bevacizumab-induced reductions in edema, which may limit its prognostic value. We demonstrate that an advanced diffusion-weighted imaging technique, restriction spectrum imaging (RSI), improves the evaluation of response to bevacizumab because unlike ADC, RSI is not affected by resolution of edema. METHODS:RSI and ADC maps were analyzed for 40 patients with HGG prior to and following initiation of bevacizumab. Volumes of interest were drawn for regions of contrast enhancement (CE) and fluid attenuated inversion recovery (FLAIR) hyperintensity and histogram percentiles within volumes of interest were calculated for ADC 10th percentile (ADC-CE10%, ADC-FLAIR10%) and for RSI 90th percentile (RSI-CE90%, RSI-FLAIR90%). Cox proportional hazard models were used to evaluate the relationship between imaging parameters, progression-free survival (PFS), and overall survival (OS). RESULTS: An increase in RSI-FLAIR90% following bevacizumab was the strongest predictor of poor PFS (P= .016) and OS (P= .004), whereas decreases in ADC-FLAIR10% showed a weaker association with OS only (P= .041). Within the CE region, increases in RSI-CE90% alone were associated with poorer OS. Correlational analysis revealed that decreases in FLAIR volume were associated with decreases in ADC-FLAIR10%, but not with changes in RSI-FLAIR90%. CONCLUSION:RSI is less influenced by changes in edema, conferring an advantage of RSI over ADC for evaluating response to anti-angiogenic therapy in patients with HGG.
Authors: T Sugahara; Y Korogi; M Kochi; I Ikushima; Y Shigematu; T Hirai; T Okuda; L Liang; Y Ge; Y Komohara; Y Ushio; M Takahashi Journal: J Magn Reson Imaging Date: 1999-01 Impact factor: 4.813
Authors: Whitney B Pope; Hyun J Kim; Jing Huo; Jeffry Alger; Matthew S Brown; David Gjertson; Victor Sai; Jonathan R Young; Leena Tekchandani; Timothy Cloughesy; Paul S Mischel; Albert Lai; Phioanh Nghiemphu; Syed Rahmanuddin; Jonathan Goldin Journal: Radiology Date: 2009-07 Impact factor: 11.105
Authors: P Kunkel; U Ulbricht; P Bohlen; M A Brockmann; R Fillbrandt; D Stavrou; M Westphal; K Lamszus Journal: Cancer Res Date: 2001-09-15 Impact factor: 12.701
Authors: Nikdokht Farid; Daniela B Almeida-Freitas; Nathan S White; Carrie R McDonald; Joshua M Kuperman; Abdulrahman A Almutairi; Karra A Muller; Scott R VandenBerg; Santosh Kesari; Anders M Dale Journal: J Neurooncol Date: 2014-08-19 Impact factor: 4.130
Authors: W B Pope; A Lai; R Mehta; H J Kim; J Qiao; J R Young; X Xue; J Goldin; M S Brown; P L Nghiemphu; A Tran; T F Cloughesy Journal: AJNR Am J Neuroradiol Date: 2011-02-17 Impact factor: 3.825
Authors: Rajan Jain; Lisa M Scarpace; Shehanaz Ellika; Roy Torcuator; Lonni R Schultz; David Hearshen; Tom Mikkelsen Journal: J Neurooncol Date: 2009-10-27 Impact factor: 4.130
Authors: B M Ellingson; S Sahebjam; H J Kim; W B Pope; R J Harris; D C Woodworth; A Lai; P L Nghiemphu; W P Mason; T F Cloughesy Journal: AJNR Am J Neuroradiol Date: 2013-10-17 Impact factor: 3.825
Authors: Benjamin M Ellingson; Eunhee Kim; Davis C Woodworth; Helga Marques; Jerrold L Boxerman; Yair Safriel; Robert C McKinstry; Felix Bokstein; Rajan Jain; T Linda Chi; A Gregory Sorensen; Mark R Gilbert; Daniel P Barboriak Journal: Int J Oncol Date: 2015-02-11 Impact factor: 5.650
Authors: N Bahrami; D Piccioni; R Karunamuni; Y-H Chang; N White; R Delfanti; T M Seibert; J A Hattangadi-Gluth; A Dale; N Farid; C R McDonald Journal: AJNR Am J Neuroradiol Date: 2018-04-05 Impact factor: 3.825
Authors: Richard Q Loi; Kelly M Leyden; Akshara Balachandra; Vedang Uttarwar; Donald J Hagler; Brianna M Paul; Anders M Dale; Nathan S White; Carrie R McDonald Journal: Epilepsia Date: 2016-10-13 Impact factor: 5.864
Authors: A P Krishnan; R Karunamuni; K M Leyden; T M Seibert; R L Delfanti; J M Kuperman; H Bartsch; P Elbe; A Srikant; A M Dale; S Kesari; D E Piccioni; J A Hattangadi-Gluth; N Farid; C R McDonald; N S White Journal: AJNR Am J Neuroradiol Date: 2017-03-09 Impact factor: 3.825
Authors: Ryan L Brunsing; Natalie M Schenker-Ahmed; Nathan S White; J Kellogg Parsons; Christopher Kane; Joshua Kuperman; Hauke Bartsch; Andrew Karim Kader; Rebecca Rakow-Penner; Tyler M Seibert; Daniel Margolis; Steven S Raman; Carrie R McDonald; Nikdokht Farid; Santosh Kesari; Donna Hansel; Ahmed Shabaik; Anders M Dale; David S Karow Journal: J Magn Reson Imaging Date: 2016-08-16 Impact factor: 4.813
Authors: Emilie T Reas; Donald J Hagler; Murray J Andrews; Roland R Lee; Anders M Dale; Linda K McEvoy Journal: Neurobiol Aging Date: 2020-07-15 Impact factor: 4.673
Authors: Emilie T Reas; Gail A Laughlin; Donald J Hagler; Roland R Lee; Anders M Dale; Linda K McEvoy Journal: Hypertension Date: 2021-01-19 Impact factor: 10.190