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Application of diffusion-weighted magnetic resonance imaging to predict the intracranial metastatic tumor response to gamma knife radiosurgery

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Abstract

To evaluate the effect of stereotactic radiosurgery (SRS) on intracranial metastases with diffusion-weighted imaging/apparent diffusion coefficient maps. A total of 107 patients with 144 metastases larger than 1 cm in diameter were retrospectively reviewed. We calculated the DWITumor/white matter ratios (DWIT/WM ratio) between the metastases and the normal, contralateral frontal white matter at each time point. We also recorded the ADC values for metastases (ADCT values). The DWIT/WM ratio and ADCT values were assessed for correlation with the patients’ tumor response, brain edema, and survival. A decrease in DWIT/WM ratios was seen in the controlled metastases, and an increase in the DWIT/WM ratio were seen in the metastases with poor tumor control. On the other hand, an increase in ADCT values was seen in the controlled metastases, and a decrease in ADCT values was seen in the metastases with poor control. The differences were significant (p value: 0.001 and 0.002, respectively). Sensitivity of a decrease in the DWIT/WM ratio to make an early prediction of tumor control was 83.9 %, and specificity was 88.5 %. When using the initial ADCT values of metastases to predict tumor response, sensitivity and specificity were 85.5 and 72.7 %, respectively. DWI/ADC is a practical method for studying the efficacy of SRS and predicting early metastases response progression. A decrease signal on DWI and increased ADC values are indicators of good tumor control, and reflect the beneficial effect of SRS.

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Abbreviations

ADC:

Apparent diffusion coefficient

ARE:

Adverse radiation effect

CTP:

Computed tomography perfusion

DWI:

Diffusion-weighed images

FDG-PET:

Positron emission tomography with 18Ffluoro-2-deoxy-d-glucose

FLAIR:

Fluid attenuated inversion recovery

GI:

Gastrointestinal

GKS:

Gamma-knife surgery

Gy:

Gray

KPS:

Karnofsky Performance Scale

MET-PET:

Positron emission tomography with 11Cmethyl-l-methionine

MR:

Magnetic resonance

MRP:

Magnetic resonance perfusion

MRS:

Magnetic resonance spectroscopy

NSCLC:

Non-small cell lung cancer

rCBV:

Relative cerebral blood volume

SCLC:

Small cell lung cancer

SPECT:

Single photon emission computed tomography

SRS:

Stereotactic radiosurgery

T1WI:

T1-weighted images

T2WI:

T2-weighted images

WBRT:

Whole brain radiotherapy

WM:

White mater

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA

    Cheng-Chia Lee, Zhiyuan Xu, Chun-Po Yen, David Schlesinger & Jason P. Sheehan

  2. Neuroradiology Division, Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA

    Max Wintermark

  3. Department of Neurosurgery Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Chia Lee

  4. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Cheng-Chia Lee

  5. Departments of Radiation Oncology, Neurological Surgery, and Neuroscience, University of Virginia Health System, PO Box 800212, Charlottesville, VA, 22908, USA

    Jason P. Sheehan

Authors
  1. Cheng-Chia Lee
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Correspondence to Jason P. Sheehan.

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Lee, CC., Wintermark, M., Xu, Z. et al. Application of diffusion-weighted magnetic resonance imaging to predict the intracranial metastatic tumor response to gamma knife radiosurgery. J Neurooncol 118, 351–361 (2014). https://doi.org/10.1007/s11060-014-1439-9

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  • DOI: https://doi.org/10.1007/s11060-014-1439-9

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