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Quantitative T1 and T2 mapping in recurrent glioblastomas under bevacizumab: earlier detection of tumor progression compared to conventional MRI

  • Diagnostic Neuroradiology
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Abstract

Introduction

Treatment with the humanized anti-vascular endothelial growth factor (VEGF) antibody bevacizumab in glioblastoma patients suppresses contrast enhancement via the reduction of vascular permeability, which does not necessarily indicate real reduction of tumor cell mass. Therefore, other imaging criteria are needed to recognize tumor growth under bevacizumab more reliably. It is still unknown, whether quantitative T1 mapping is useful to monitor the effects of anti-angiogenic therapy or to indicate a tumor progression earlier and more reliable compared to conventional magnetic resonance imaging (MRI) sequences. This raised the question whether quantitative T1 mapping is more suitable to monitor treatment effects of bevacizumab.

Methods

Conventional and quantitative MRI was performed on six consecutive patients with recurrent glioblastoma before treatment with bevacizumab and every 8 weeks thereafter until further tumor progression. Quantitative T1 maps before and after intravenous application of contrast agent and quantitative T2 maps were performed to calculate serial differential maps and subtraction maps from one time point, subtracting contrast-enhanced T1 maps from non-contrast T1 maps.

Results

In five illustrative cases, tumor progression was documented earlier in differential T1 relaxation time (DiffT1) and T2 relaxation time (DiffT2) maps before changes in the conventional MRI studies were obvious. Four patients showed previous prolongation of T1 relaxation time in the DiffT1 maps, suggesting tumor progression, and subtraction maps revealed faint contrast enhancement matching with the areas of T1 prolongation.

Conclusion

Our results emphasize that quantitative relaxation time mapping could be a promising method for tumor monitoring in glioblastoma patients under anti-angiogenic therapy. Quantitative T1 mapping seems to detect enhancing tumor earlier than conventional contrast-enhanced T1-weighted images.

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Acknowledgments

We thank Stefanie Pellikan and Maurice Harth of the Institute of Neuroradiology and the staff and nurses of the Dr. Senckenberg Institute of Neurooncology who supported this study. Excellent technical assistance was provided by Professor Ralf Deichmann and his staff from the Brain Imaging Center Frankfurt. The Dr. Senckenberg Institute of Neurooncology is supported by the Dr. Senckenberg Foundation and the Hertie Foundation.

Ethical standards and patient consent

We declare that all human and animal studies have been approved by the local Ethics Committee at the University Hospital Frankfurt [Reference number 4/09-SIN 01/09] and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

OB has served as a consultant for Roche, the European distributer of bevacizumab and has received travel grants from Roche.

Author information

Authors and Affiliations

  1. Institute of Neuroradiology, Hospital of Goethe University, Schleusenweg 2-16, Frankfurt am Main, Germany

    Stephanie Lescher, Alina Jurcoane, Andreas Veit & Elke Hattingen

  2. Department of Neurology, Dr. Senckenberg Institute of Neurooncology, Hospital of Goethe University, Frankfurt am Main, Germany

    Oliver Bähr

  3. Brain Imaging Center, Center for Imaging in Neuroscience, Frankfurt am Main, Germany

    Ralf Deichmann

  4. Instiute of Neuroradiology, Hospital of University Bonn, Bonn, Germany

    Elke Hattingen

Authors
  1. Stephanie Lescher
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  2. Alina Jurcoane
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  4. Oliver Bähr
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Correspondence to Stephanie Lescher.

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Lescher, S., Jurcoane, A., Veit, A. et al. Quantitative T1 and T2 mapping in recurrent glioblastomas under bevacizumab: earlier detection of tumor progression compared to conventional MRI. Neuroradiology 57, 11–20 (2015). https://doi.org/10.1007/s00234-014-1445-9

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  • DOI: https://doi.org/10.1007/s00234-014-1445-9

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