ADC histograms predict response to anti-angiogenic therapy in patients with recurrent high-grade glioma
- 430 Downloads
The purpose of this study is to evaluate apparent diffusion coefficient (ADC) maps to distinguish anti-vascular and anti-tumor effects in the course of anti-angiogenic treatment of recurrent high-grade gliomas (rHGG) as compared to standard magnetic resonance imaging (MRI).
This retrospective study analyzed ADC maps from diffusion-weighted MRI in 14 rHGG patients during bevacizumab/irinotecan (B/I) therapy. Applying image segmentation, volumes of contrast-enhanced lesions in T1 sequences and of hyperintense T2 lesions (hT2) were calculated. hT2 were defined as regions of interest (ROI) and registered to corresponding ADC maps (hT2-ADC). Histograms were calculated from hT2-ADC ROIs. Thereafter, histogram asymmetry termed “skewness” was calculated and compared to progression-free survival (PFS) as defined by the Response Assessment Neuro-Oncology (RANO) Working Group criteria.
At 8–12 weeks follow-up, seven (50%) patients showed a partial response, three (21.4%) patients were stable, and four (28.6%) patients progressed according to RANO criteria. hT2-ADC histograms demonstrated statistically significant changes in skewness in relation to PFS at 6 months. Patients with increasing skewness (n = 11) following B/I therapy had significantly shorter PFS than did patients with decreasing or stable skewness values (n = 3, median percentage change in skewness 54% versus −3%, p = 0.04).
In rHGG patients, the change in ADC histogram skewness may be predictive for treatment response early in the course of anti-angiogenic therapy and more sensitive than treatment assessment based solely on RANO criteria.
KeywordsRecurrent high-grade glioma Anti-angiogenic therapy DWI-MRI ADC histograms Skewness
- 20.Pieper S LB, Schroeder W, Kikinis R (2006) The NA-MIC kit: ITK, VTK, pipelines, grids and 3D slicer as an open platform for the medical image computing community. Proceedings of the 3rd IEEE International Symposium on Biomedical Imaging: From Nano to Macro 1:698–701Google Scholar
- 21.Pieper S LB, Schroeder W, Kikinis R (2010) www.3dslicer.org
- 44.Gruber SK ML, Medabalmi P, Gruber DB, Golfinos J, Parker E, Narayana A (2010) Change in pattern of relapse in newly diagnosed high-grade glioma following bevacizumab therapy. J Clin Oncol 28:15s (suppl; abstr 2020)Google Scholar
- 49.Kendall (1998) http://mathworld.wolfram.com/Skewness.html