Photodynamic therapy (PDT) subsequent to surgical tumor removal is a novel localized treatment for malignant glioma that provides effective local control. The acute response of malignant glioma to PDT can be detected as linear transient hyperintense signal on diffusion-weighted imaging (DWI) and a decline in apparent diffusion coefficient values without symptoms. However, their long-term clinical significance has not yet been examined. The aim of this study was to clarify the link between hyperintense signal on DWI as an acute response and recurrence after PDT in malignant glioma.
Thirty patients (16 men; median age, 60.5 years) underwent PDT for malignant glioma at our institution between 2017 and 2020. We analyzed the signal changes on DWI after PDT and the relationship between these findings and the recurrence pattern.
All patients showed linear hyperintense signal on DWI at the surface of the resected cavity from day 1 after PDT. These changes disappeared in about 30 days without any neurological deterioration. During a mean post-PDT follow-up of 14.3 months, 19 patients (63%) exhibited recurrence: 10 local, 1 distant, and 8 disseminated. All of the local recurrences arose from areas that did not show hyperintense signal on DWI obtained on day 1 after PDT.
The local recurrence in malignant glioma after PDT occurs in an area without hyperintense signal on DWI as an acute response to PDT. This characteristic finding could aid in the monitoring of local recurrence after PDT.
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Apparent diffusion coefficient
Contrast-enhanced T1-weighted imaging
Fluid-attenuated inversion recovery
Field of view
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We thank Ms. Takiko Uno for molecular analysis of the IDH mutation status of the patients included in this study.
This work was supported in part by Grants-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [grant number: 20K09369 to Takashi Sasayama and 20K09389 to Kazuhiro Tanaka]. The sponsor had no role in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
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All authors declare that they have no conflict of interest.
The study was approved by the institutional review board (protocol number B190100) and conducted according to institutional and national ethical guidelines and in accordance with the Helsinki Declaration.
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Fujita, Y., Nagashima, H., Tanaka, K. et al. Hyperintense signal on diffusion-weighted imaging for monitoring the acute response and local recurrence after photodynamic therapy in malignant gliomas. J Neurooncol 155, 81–92 (2021). https://doi.org/10.1007/s11060-021-03845-0
- Photodynamic therapy
- Diffusion-weighted imaging