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Hyperintense signal on diffusion-weighted imaging for monitoring the acute response and local recurrence after photodynamic therapy in malignant gliomas

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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.

Graphic abstract

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Data availability

The data in this study are available from the corresponding author on reasonable request.

Code availability

No software application or custom code was used in this study.



Apparent diffusion coefficient


Contrast-enhanced T1-weighted imaging


Diffusion-weighted imaging


Fluid-attenuated inversion recovery


Field of view


Isocitrate dehydrogenase


O6-methylguanine-DNA methyltransferase


Magnetic resonance


Photodynamic therapy


Echo time


Inversion time


Repetition time


World Health Organization


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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.

Author information




Conception and design: YF, TS. Collection and assembly of data: YF, HN, KT, MH, TI, TS. Analysis and interpretation of data: YF, HN, KT, TS. Drafting the article: YF. Reviewed submitted version of manuscript: all authors. Approved the final version of manuscript: all authors.

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Correspondence to Yuichi Fujita.

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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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Patient informed consents were waived by the institutional review board due to the retrospective nature of the study and use of anonymized data.

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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).

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  • Glioma
  • Glioblastoma
  • Photodynamic therapy
  • Recurrence
  • Diffusion-weighted imaging