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Long-term apparent diffusion coefficient value changes in patients undergoing radiosurgical treatment of meningiomas

  • Original Article - Brain Tumors
  • Published:
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Abstract

Purpose

A noninvasive method to predict the progress or treatment response of meningiomas is desirable to improve the tumor management. Studies showed that apparent diffusion coefficient (ADC) pretreatment values can predict treatment response in brain tumors. The aim of this study was to analyze changes of intratumoral ADC values in patients with meningiomas undergoing conservative or radiosurgery.

Method

MR images of 51 patients with diagnose of meningiomas were retrospectively reviewed. Twenty-five patients undergoing conservative or radiosurgery treatment, respectively, were included in the study. The follow-up data ranged between 1 and 10 years. Based on ROI analysis, the mean ADC values, ADC10%min, and ADC90%max were evaluated at different time points during follow-up.

Results

Baseline ADC values in between both groups were similar. The ADCmean values, ADC10%min, and ADC90%max within the different groups did not show any significant changes during the follow-up times in the untreated (ADCmean over 10 years period: 0.87 ± 0.05 × 10−3 mm2/s) and radiosurgically treated (ADCmean over 4 years period: 1.02 ± 0.12 × 10−3 mm2/s) group. However, statistically significant difference was observed when comparing the ADCmean and ADC90%max values of untreated with radiosurgically treated (p < 0.0001) meningiomas. Also, ADC10%min revealed statistically significant difference between the untreated and the radiosurgery group (p < 0.05).

Conclusions

ADC values in conservatively managed meningiomas remain stable during the follow-up. However, meningiomas undergoing radiosurgery reveal significant change of the mean ADC values over time, suggesting that ADC may reflect a change in the biological behavior of the tumor. These observations might suggest the value of ADC changes as an indicator of treatment response.

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Author information

Authors and Affiliations

  1. Division of Neuroradiology, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland

    Jatta Berberat & Luca Remonda

  2. Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland

    Ulrich Roelcke & Lucia Schwyzer

  3. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Lucia Schwyzer

Authors
  1. Jatta Berberat
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  2. Ulrich Roelcke
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  3. Luca Remonda
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  4. Lucia Schwyzer
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Corresponding author

Correspondence to Jatta Berberat.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee (EKNZ 2016-00854) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Due to the retrospective nature of this study, informed consent was not required.

Additional information

Comments

Berberat et al are addressing a key issue in Radiosurgery (SRS). We know from large series with long term follow up that Radiosurgery in small WHO I Meningiomas is providing a very advantageous safety efficacy ratio on the long term [2,5]. However, meningiomas are indolent slowly growing tumors. Thus, for years, the stability of the MRI T1 contrast enhanced image is not a convincing demonstration of the capability of radiosurgery to control on the very long term the individual tumor.

Neurosurgeons are lacking a marker of response. In this perspective the contribution of Berberat et al is of interest for intracranial meningiomas management. At the difference of meningiomas managed conservatively meningiomas treated by radiosurgery are revealing “significant change of the mean apparent diffusion coefficient (ADC) values over time”. The authors are speculating that this change of ADC over time “may reflect a change in the biological behavior of the tumor” and “might suggest the value of ADC changes as an indicator of treatment response”. However, till now the authors data are not supporting this hypothesis. Only long-term follow-up of patients presenting with meningiomas treated by radiosurgery with ADC on the occasion of each MR follow up could demonstrate if the change of the ADC over time is, or not, a predictor of long-term control! For future studies we recommend to separate skull meningiomas and convexity meningiomas who have clearly not the same biological behavior after SRS. We also recommend not to mix radiosurgery with stereotactic radiotherapy as long as nowadays the radiobiology of these two approaches are demonstrated to induce different biological responses specially at the level of the microvasculature and immune system. This is an important field of research for the future of SRS in general as long as the same question exists for other tumors like vestibular schwannomas or brain metastases with the additional difficulty of pseudo progression phenomenon which is even making more difficult the assessment of tumor response [1,3,4]!

Jean Marie Regis

Marseille, France

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Berberat, J., Roelcke, U., Remonda, L. et al. Long-term apparent diffusion coefficient value changes in patients undergoing radiosurgical treatment of meningiomas. Acta Neurochir 163, 89–95 (2021). https://doi.org/10.1007/s00701-020-04567-4

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