Andrea Franconeri1,2,3, Simone Sacco4,5, Maria Vittoria Raciti6,5,7, Alessia Maggi6,5,7, Shaun Ivan Muzic6,7, Sara Imparato5, Lisa Farina5,8, Ana Bacila5,8, Chiara Paganelli9,10, Giulia Buizza9,10, Giulia Fontana10, Guido Baroni9,10, Giulia Riva11, Alberto Iannalfi11, Ester Orlandi11, Lorenzo Preda6,5,7. 1. Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. afrancon88@gmail.com. 2. Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy. afrancon88@gmail.com. 3. Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy. afrancon88@gmail.com. 4. UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA. 5. Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy. 6. Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. 7. Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy. 8. Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy. 9. Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. 10. Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy. 11. Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy.
Abstract
PURPOSE: To assess early microstructural changes of meningiomas treated with proton therapy through quantitative analysis of intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI) parameters. METHODS: Seventeen subjects with meningiomas that were eligible for proton therapy treatment were retrospectively enrolled. Each subject underwent a magnetic resonance imaging (MRI) including DWI sequences and IVIM assessments at baseline, immediately before the 1st (t0), 10th (t10), 20th (t20), and 30th (t30) treatment fraction and at follow-up. Manual tumor contours were drawn on T2-weighted images by two expert neuroradiologists and then rigidly registered to DWI images. Median values of the apparent diffusion coefficient (ADC), true diffusion (D), pseudo-diffusion (D*), and perfusion fraction (f) were extracted at all timepoints. Statistical analysis was performed using the pairwise Wilcoxon test. RESULTS: Statistically significant differences from baseline to follow-up were found for ADC, D, and D* values, with a progressive increase in ADC and D in conjunction with a progressive decrease in D*. MRI during treatment showed statistically significant differences in D values between t0 and t20 (p = 0.03) and t0 and t30 (p = 0.02), and for ADC values between t0 and t20 (p = 0.04), t10 and t20 (p = 0.02), and t10 and t30 (p = 0.035). Subjects that showed a volume reduction greater than 15% of the baseline tumor size at follow-up showed early D changes, whereas ADC changes were not statistically significant. CONCLUSION: IVIM appears to be a useful tool for detecting early microstructural changes within meningiomas treated with proton therapy and may potentially be able to predict tumor response.
PURPOSE: To assess early microstructural changes of meningiomas treated with proton therapy through quantitative analysis of intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI) parameters. METHODS: Seventeen subjects with meningiomas that were eligible for proton therapy treatment were retrospectively enrolled. Each subject underwent a magnetic resonance imaging (MRI) including DWI sequences and IVIM assessments at baseline, immediately before the 1st (t0), 10th (t10), 20th (t20), and 30th (t30) treatment fraction and at follow-up. Manual tumor contours were drawn on T2-weighted images by two expert neuroradiologists and then rigidly registered to DWI images. Median values of the apparent diffusion coefficient (ADC), true diffusion (D), pseudo-diffusion (D*), and perfusion fraction (f) were extracted at all timepoints. Statistical analysis was performed using the pairwise Wilcoxon test. RESULTS: Statistically significant differences from baseline to follow-up were found for ADC, D, and D* values, with a progressive increase in ADC and D in conjunction with a progressive decrease in D*. MRI during treatment showed statistically significant differences in D values between t0 and t20 (p = 0.03) and t0 and t30 (p = 0.02), and for ADC values between t0 and t20 (p = 0.04), t10 and t20 (p = 0.02), and t10 and t30 (p = 0.035). Subjects that showed a volume reduction greater than 15% of the baseline tumor size at follow-up showed early D changes, whereas ADC changes were not statistically significant. CONCLUSION: IVIM appears to be a useful tool for detecting early microstructural changes within meningiomas treated with proton therapy and may potentially be able to predict tumor response.
Authors: Priscilla K Brastianos; Evanthia Galanis; Nicholas Butowski; Jason W Chan; Ian F Dunn; Roland Goldbrunner; Christel Herold-Mende; Franziska M Ippen; Christian Mawrin; Michael W McDermott; Andrew Sloan; James Snyder; Ghazaleh Tabatabai; Marcos Tatagiba; Joerg C Tonn; Patrick Y Wen; Kenneth Aldape; Farshad Nassiri; Gelareh Zadeh; Michael D Jenkinson; David R Raleigh Journal: Neuro Oncol Date: 2019-01-14 Impact factor: 12.300