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Mono-exponential, diffusion kurtosis and stretched exponential diffusion MR imaging response to chemoradiation in newly diagnosed glioblastoma

  • Clinical Study
  • Published:
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Abstract

Purpose

To quantify changes and prognostic value of diffusion MRI measurements obtained using mono-exponential, diffusion kurtosis imaging (DKI) and stretched exponential (SE) models prior and after chemoradiation in newly diagnosed glioblastoma (GBM).

Methods

Diffusion-weighted images (DWIs) were acquired in twenty-three patients following surgery, prior chemoradiation and within 7 days following completion of treatment, using b-values ranging from 0 to 5000s/mm2. Mono-exponential diffusion (apparent diffusion coefficient: ADC), isotropic (non-directional) DKI model with apparent diffusivity (Dapp) and kurtosis (Kapp) estimates as well as SE model with distributed-diffusion coefficient (DDC) and mean intra-voxel heterogeneity (α) were computed for all patients prior and after chemoradiation. Median values were calculated for normal appearing white matter (NAWM) and contrast-enhancing tumor (CET). The magnitudes of diffusion change prior and after chemoradiation were used to predict overall survival (OS).

Results

Diffusivity in NAWM was consistent for all diffusion measures during chemoradiation, while diffusivity measurements (ADC, Dapp and DDC) within CET changed significantly. A strong positive correlation existed between ADC, Dapp, and DDC measurements prior to chemoradiation; however, this association was weak following chemoradiation, suggesting a more complex microstructural environment after cytotoxic therapy. When combined with baseline tumor volume and MGMT status, age and ADC changes added significant prognostic values, whereas more complex diffusion models did not show significant value in predicting OS.

Conclusions

Despite increased tissue complexity following chemoradiation, advanced diffusion models have longer acquisition times, provide largely comparable measures of diffusivity, and do not appear to provide additional prognostic value compared to mono-exponential ADC maps.

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Abbreviations

MRI:

Magnetic resonance imaging

DWI:

Diffusion weighted imaging

ADC:

Apparent diffusion coefficient

Dapp:

Diffusion corrected apparent diffusion coefficient

Kapp:

Apparent kurtosis coefficient

DDC:

Distributed diffusion coefficient

α (alpha):

Intra-voxel diffusion heterogeneity

NAWM:

Normal appearing white matter

CET:

Contrast-enhancing tumor

GBM:

Glioblastoma

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Funding

National Brain Tumor Society (NBTS) Research Grant (Ellingson, Cloughesy); American Cancer Society (ACS) Research Scholar Grant (RSG-15-003-01-CCE) (Ellingson); Art of the Brain (Cloughesy); UCLA SPORE in Brain Cancer (NIH/NCI 1P50CA211015-01A1) (Ellingson, Cloughesy); NIH/NCI 1R21CA223757-01 (Ellingson); NIH/NCI 1R21CA167354 (Ellingson).

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Authors and Affiliations

  1. UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA

    Ararat Chakhoyan, Davis C. Woodworth, Robert J. Harris & Benjamin M. Ellingson

  2. Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Ararat Chakhoyan, Davis C. Woodworth, Robert J. Harris, Whitney B. Pope & Benjamin M. Ellingson

  3. Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, USA

    Benjamin M. Ellingson

  4. UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, CA, USA

    Albert Lai, Phioanh L. Nghiemphu, Timothy F. Cloughesy & Benjamin M. Ellingson

  5. Department of Biomedical Physics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Davis C. Woodworth

  6. Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Albert Lai, Phioanh L. Nghiemphu & Timothy F. Cloughesy

  7. Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Linda M. Liau

  8. UCLA Brain Tumor Imaging Laboratory (BTIL), Biomedical Physics, Psychiatry, and Bioengineering, Departments of Radiological Sciences and Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA

    Benjamin M. Ellingson

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  1. Ararat Chakhoyan
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  2. Davis C. Woodworth
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  3. Robert J. Harris
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Correspondence to Benjamin M. Ellingson.

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Chakhoyan, A., Woodworth, D.C., Harris, R.J. et al. Mono-exponential, diffusion kurtosis and stretched exponential diffusion MR imaging response to chemoradiation in newly diagnosed glioblastoma. J Neurooncol 139, 651–659 (2018). https://doi.org/10.1007/s11060-018-2910-9

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  • DOI: https://doi.org/10.1007/s11060-018-2910-9

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