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ADC histograms predict response to anti-angiogenic therapy in patients with recurrent high-grade glioma

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Abstract

Introduction

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).

Methods

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.

Results

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).

Conclusion

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.

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Acknowledgments

We thank Mary Margreiter for the critical reading and helpful comments. M. Nowosielski holds a DOC-FORTE Fellowship from the Austrian Academy of Science at the Department of Neurology, Innsbruck Medical University. Özgür Güler’s work was funded by the Austrian Science Foundation (Project 20604-B13).

Conflict of Interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria

    Martha Nowosielski, Gerd Tinkhauser, Günther Stockhammer & Markus Hutterer

  2. Department of Radiology, Innsbruck Medical University, Innsbruck, Austria

    Wolfgang Recheis, Michael Schocke & Thaddaeus Gotwald

  3. Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria

    Georg Goebel

  4. 4D Visualization Laboratory, University Clinic of Oto-, Rhino- and Laryngology, Innsbruck Medical University, Innsbruck, Austria

    Özgür Güler

  5. Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria

    Herwig Kostron

  6. Department of Neurology, Paracelsus Medical University Salzburg–Christian Doppler Hospital, Salzburg, Austria

    Markus Hutterer

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  1. Martha Nowosielski
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Correspondence to Martha Nowosielski.

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Originality and presentations

The authors confirm the originality of this study. Parts of the study were presented at the EANO Meeting 2010 (Sept. 2010, Maastricht)

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Nowosielski, M., Recheis, W., Goebel, G. et al. ADC histograms predict response to anti-angiogenic therapy in patients with recurrent high-grade glioma. Neuroradiology 53, 291–302 (2011). https://doi.org/10.1007/s00234-010-0808-0

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