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01.10.2011 | Diagnostic Neuroradiology

MR perfusion and diffusion imaging in the follow-up of recurrent glioblastoma treated with dendritic cell immunotherapy: a pilot study

verfasst von: Matej Vrabec, Sofie Van Cauter, Uwe Himmelreich, Stefaan W. Van Gool, Stefan Sunaert, Steven De Vleeschouwer, Dušan Šuput, Philippe Demaerel

Erschienen in: Neuroradiology | Ausgabe 10/2011

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Abstract

Introduction

This study aims to determine the potential value of MR-PWI and MR-DWI to differentiate immune therapy-induced inflammatory response from recurrent glioblastoma tumour growth. Both can present as contrast-enhancing lesions on conventional magnetic resonance imaging (MRI).

Methods

Patients with recurrent glioblastoma who could obtain a total or near-total resection were treated with dendritic cell immune therapy according to the HGG-IMMUNO-2003 trial. A retrospective analysis of 32 follow-up MRI examinations (mean follow-up time 21 months) in eight patients was performed for this pilot study. For the statistical analysis, the 32 examinations were divided into three groups: 0—obtained in patients that remained stable during the follow-up period, 1a—obtained in progressive-tumour patients at time points before definite progression and 1b—obtained in patients at or after progression.

Results

Maximum lesional rCBV ratios were highest in group 1b (Student t test, 9.25 ± 2.68; p < 0.001) and were higher in group 1a (4.87 ± 1.61, p < 0.001) compared to group 0 (1.22 ± 0.47). The minimum apparent diffusion coefficients (ADCs) in the contrast-enhancing regions were lower in group 1a (0.62 ± 0.06 × 10⁻³ mm²/s) than in group 0 (1.03 ± 0.43 × 10⁻³ mm²/s, p = 0.01) and higher in group 1b (0.76 ± 0.08) compared to 1a (p = 0.02). The minimum ADCs in the FLAIR-hyperintense region were lower in group 1a (0.62 ± 0.06, p = 0.02) compared to group 0 (0.76 ± 0.16) but not significantly different in group 1b (0.68 ± 0.07) from groups 0 and 1a (p = 0.33, p = 0.10). The mean ADCs of the FLAIR-hyperintense region and the mean ADCs of the contrast-enhancing lesion were not significantly different.

Conclusion

The maximum lesional rCBV ratios and minimum ADC values in the contrast-enhancing area are potential radiological markers to differentiate between immune therapy-induced inflammatory response and recurrent glioblastoma tumour growth in glioblastoma patients treated with immune therapy.

Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996PubMedCrossRef

Mason WP (2008) Emerging drugs for malignant glioma. Expert Opin Emerg Drugs 13:81–94PubMedCrossRef

Gerstner ER, Duda DG, di Tomaso E, Sorensen G, Jain RK, Batchelor TT (2007) Antiangiogenic agents for the treatment of glioblastoma. Expert Opin Investig Drugs 16:1895–1908PubMedCrossRef

Van Gool S, Maes W, Ardon H, Verschuere T, Van Cauter S, De Vleeschouwer S (2009) Dendritic cell therapy of high-grade gliomas. Brain Pathol 19:694–712PubMedCrossRef

Banchereau J, Palucka AK (2005) Dendritic cells as therapeutic vaccines against cancer. Nat Rev Immunol 5:296–306PubMedCrossRef

Rutkowski S, De Vleeschouwer S, Kaempgen E et al (2004) Surgery and adjuvant dendritic cell-based tumour vaccination for patients with relapsed malignant glioma, a feasibility study. Br J Cancer 91:1656–1662PubMed

Wheeler CJ, Black KL, Liu G et al (2008) Vaccination elicits correlated immune and clinical responses in glioblastoma multiforme patients. Cancer Res 68:5955–5964PubMedCrossRef

Yu JS, Liu G, Ying H, Yong WH, Black KL, Wheeler CJ (2004) Vaccination with tumor lysate-pulsed dendritic cells elicits antigen-specific, cytotoxic T-cells in patients with malignant glioma. Cancer Res 64:4973–4979PubMedCrossRef

De Vleeschouwer S, Fieuws S, Rutkowski S et al (2008) Postoperative adjuvant dendritic cell-based immunotherapy in patients with relapsed glioblastoma multiforme. Clin Cancer Res 14:3098–3104PubMedCrossRef

10.

De Vleeschouwer S, Van Calenbergh F, Demaerel P et al (2004) Transient local response and persistent tumor control in a child with recurrent malignant glioma: treatment with combination therapy including dendritic cell therapy. Case report J Neurosurg 100:492–497

11.

Barrett T, Brechbiel M, Bernardo M, Choyke PL (2007) MRI of tumor angiogenesis. J Magn Reson Imaging 26:235–249PubMedCrossRef

12.

Le Bihan D, Turner R, Douek P, Patronas N (1992) Diffusion MR imaging: clinical applications. AJR Am J Roentgenol 159:591–599PubMed

13.

Sugahara T, Korogi Y, Kochi M et al (1998) Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas. AJR Am J Roentgenol 171:1479–1486PubMed

14.

Barajas RFJ, Chang JS, Segal MR et al (2009) Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Radiology 253:486–496PubMedCrossRef

15.

Bobek-Billewicz B, Stasik-Pres G, Majchrzak H, Zarudzki L (2010) Differentiation between brain tumor recurrence and radiation injury using perfusion, diffusion-weighted imaging and MR spectroscopy. Folia Neuropathol 48:81–92PubMed

16.

Jain R, Narang J, Sundgren PM et al (2010) Treatment induced necrosis versus recurrent/progressing brain tumor: going beyond the boundaries of conventional morphologic imaging. J Neurooncol 100(1):17–29

17.

Baehring JM, Bi WL, Bannykh S, Piepmeier JM, Fulbright RK (2007) Diffusion MRI in the early diagnosis of malignant glioma. J Neurooncol 82:221–225PubMedCrossRef

18.

Kikuchi T, Kumabe T, Higano S, Watanabe M, Tominaga T (2009) Minimum apparent diffusion coefficient for the differential diagnosis of ganglioglioma. Neurol Res 31:1102–1107PubMedCrossRef

19.

Chen J, Xia J, Zhou YC et al (2005) Correlation between magnetic resonance diffusion weighted imaging and cell density in astrocytoma. Zhonghua Zhong Liu Za Zhi 27:309–311PubMed

20.

Hein PA, Eskey CJ, Dunn JF, Hug EB (2004) Diffusion-weighted imaging in the follow-up of treated high-grade gliomas: tumor recurrence versus radiation injury. AJNR Am J Neuroradiol 25:201–209PubMed

21.

Rosset A, Spadola L, Ratib O (2004) OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging 17:205–216PubMedCrossRef

22.

Belliveau JW, Kennedy DNJ, McKinstry RC et al (1991) Functional mapping of the human visual cortex by magnetic resonance imaging. Science 254:716–719PubMedCrossRef

23.

Macdonald DR, Cascino TL, Schold SCJ, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280PubMed

24.

Meyzer C, Dhermain F, Ducreux D et al (2010) A case report of pseudoprogression followed by complete remission after proton-beam irradiation for a low-grade glioma in a teenager: the value of dynamic contrast-enhanced MRI. Radiat Oncol 5:9PubMedCrossRef

25.

Roldan GB, Scott JN, McIntyre JB et al (2009) Population-based study of pseudoprogression after chemoradiotherapy in GBM. Can J Neurol Sci 36:617–622PubMed

26.

Sanghera P, Perry J, Sahgal A et al (2010) Pseudoprogression following chemoradiotherapy for glioblastoma multiforme. Can J Neurol Sci 37:36–42PubMed

27.

Singhal T, Narayanan TK, Jain V, Mukherjee J, Mantil J (2008) 11C-l-methionine positron emission tomography in the clinical management of cerebral gliomas. Mol Imaging Biol 10:1–18PubMedCrossRef

28.

Hamstra DA, Chenevert TL, Moffat BA et al (2005) Evaluation of the functional diffusion map as an early biomarker of time-to-progression and overall survival in high-grade glioma. Proc Natl Acad Sci U S A 102:16759–16764PubMedCrossRef

29.

Jain R, Scarpace LM, Ellika S et al (2010) Imaging response criteria for recurrent gliomas treated with bevacizumab: role of diffusion weighted imaging as an imaging biomarker. J Neurooncol 96:423–431PubMedCrossRef

30.

Mangla R, Singh G, Ziegelitz D et al (2010) Changes in relative cerebral blood volume 1 month after radiation–temozolomide therapy can help predict overall survival in patients with glioblastoma. Radiology 256:575–584PubMedCrossRef

31.

Padhani AR, Khan AA (2010) Diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for monitoring anticancer therapy. Target Oncol 5:39–52PubMedCrossRef

32.

Provenzale JM, Mukundan S, Barboriak DP (2006) Diffusion-weighted and perfusion MR imaging for brain tumor characterization and assessment of treatment response. Radiology 239:632–649PubMedCrossRef

33.

Tomura N, Narita K, Izumi J et al (2006) Diffusion changes in a tumor and peritumoral tissue after stereotactic irradiation for brain tumors: possible prediction of treatment response. J Comput Assist Tomogr 30:496–500PubMedCrossRef

34.

Cha S (2006) Update on brain tumor imaging: from anatomy to physiology. AJNR Am J Neuroradiol 27:475–487PubMed

35.

Aronen HJ, Perkio J (2002) Dynamic susceptibility contrast MRI of gliomas. Neuroimaging Clin N Am 12:501–523PubMedCrossRef

36.

Barajas RF, Chang JS, Sneed PK, Segal MR, McDermott MW, Cha S (2009) Distinguishing recurrent intra-axial metastatic tumor from radiation necrosis following gamma knife radiosurgery using dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol 30:367–372PubMedCrossRef

37.

Bisdas S, Kirkpatrick M, Giglio P, Welsh C, Spampinato MV, Rumboldt Z (2009) Cerebral blood volume measurements by perfusion-weighted MR imaging in gliomas: ready for prime time in predicting short-term outcome and recurrent disease? AJNR Am J Neuroradiol 30:681–688PubMedCrossRef

38.

Mitsuya K, Nakasu Y, Horiguchi S et al (2010) Perfusion weighted magnetic resonance imaging to distinguish the recurrence of metastatic brain tumors from radiation necrosis after stereotactic radiosurgery. J Neurooncol 99:81–88PubMedCrossRef

39.

Danchaivijitr N, Waldman AD, Tozer DJ et al (2008) Low-grade gliomas: do changes in rCBV measurements at longitudinal perfusion-weighted MR imaging predict malignant transformation? Radiology 247:170–178PubMedCrossRef

40.

Stecco A, Pisani C, Quarta R et al (2010) DTI and PWI analysis of peri-enhancing tumoral brain tissue in patients treated for glioblastoma. J Neurooncol. doi:10.1007/s11060-010-0310-x

41.

Calli C, Kitis O, Yunten N, Yurtseven T, Islekel S, Akalin T (2006) Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol 58:394–403PubMedCrossRef

42.

Sugahara T, Korogi Y, Kochi M, Ushio Y, Takahashi M (2001) Perfusion-sensitive MR imaging of gliomas: comparison between gradient-echo and spin-echo echo-planar imaging techniques. AJNR Am J Neuroradiol 22:1306–1315PubMed

43.

Yang D, Korogi Y, Sugahara T et al (2002) Cerebral gliomas: prospective comparison of multivoxel 2D chemical-shift imaging proton MR spectroscopy, echoplanar perfusion and diffusion-weighted MRI. Neuroradiology 44:656–666PubMedCrossRef

44.

Yamada K, Gonzalez RG, OStergaard L et al (2002) Iron-induced susceptibility effect at the globus pallidus causes underestimation of flow and volume on dynamic susceptibility contrast-enhanced MR perfusion images. AJNR Am J Neuroradiol 23:1022–1029PubMed

45.

Kondziolka D, Bernstein M, Resch L et al (1987) Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg 67:852–857PubMedCrossRef

46.

Chawalparit O, Artkaew C, Anekthananon T, Tisavipat N, Charnchaowanish P, Sangruchi T (2009) Diagnostic accuracy of perfusion CT in differentiating brain abscess from necrotic tumor. J Med Assoc Thai 92:537–542PubMed

47.

Chiang IC, Hsieh TJ, Chiu ML, Liu GC, Kuo YT, Lin WC (2009) Distinction between pyogenic brain abscess and necrotic brain tumour using 3-tesla MR spectroscopy, diffusion and perfusion imaging. Br J Radiol 82:813–820PubMedCrossRef

48.

Erdogan C, Hakyemez B, Yildirim N, Parlak M (2005) Brain abscess and cystic brain tumor: discrimination with dynamic susceptibility contrast perfusion-weighted MRI. J Comput Assist Tomogr 29:663–667PubMedCrossRef

49.

Hakyemez B, Erdogan C, Bolca N, Yildirim N, Gokalp G, Parlak M (2006) Evaluation of different cerebral mass lesions by perfusion-weighted MR imaging. J Magn Reson Imaging 24:817–824PubMedCrossRef

50.

Holmes TM, Petrella JR, Provenzale JM (2004) Distinction between cerebral abscesses and high-grade neoplasms by dynamic susceptibility contrast perfusion MRI. AJR Am J Roentgenol 183:1247–1252PubMed

51.

Muccio CF, Esposito G, Bartolini A, Cerase A (2008) Cerebral abscesses and necrotic cerebral tumours: differential diagnosis by perfusion-weighted magnetic resonance imaging. Radiol Med 113:747–757PubMedCrossRef

52.

Kitis O, Altay H, Calli C, Yunten N, Akalin T, Yurtseven T (2005) Minimum apparent diffusion coefficients in the evaluation of brain tumors. Eur J Radiol 55:393–400PubMedCrossRef

53.

Arvinda HR, Kesavadas C, Sarma PS et al (2009) Glioma grading: sensitivity, specificity, positive and negative predictive values of diffusion and perfusion imaging. J Neurooncol 94:87–96PubMedCrossRef

54.

Murakami R, Hirai T, Sugahara T et al (2009) Grading astrocytic tumors by using apparent diffusion coefficient parameters: superiority of a one- versus two-parameter pilot method. Radiology 251:838–845PubMedCrossRef

55.

Sawlani V (2009) Diffusion-weighted imaging and apparent diffusion coefficient evaluation of herpes simplex encephalitis and Japanese encephalitis. J Neurol Sci 287:221–226PubMedCrossRef

56.

Luthra G, Parihar A, Nath K et al (2007) Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol 28:1332–1338PubMedCrossRef

57.

de Vleeschouwer S, Rapp M, Sorg RV et al (2006) Dendritic cell vaccination in patients with malignant gliomas: current status and future directions. Neurosurgery 59:988–999, discussion in 999–1000PubMed

Titel: MR perfusion and diffusion imaging in the follow-up of recurrent glioblastoma treated with dendritic cell immunotherapy: a pilot study
verfasst von: Matej Vrabec
Sofie Van Cauter
Uwe Himmelreich
Stefaan W. Van Gool
Stefan Sunaert
Steven De Vleeschouwer
Dušan Šuput
Philippe Demaerel
Publikationsdatum: 01.10.2011
Verlag: Springer-Verlag
Erschienen in: Neuroradiology / Ausgabe 10/2011
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-010-0802-6

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Abstract

Introduction

Methods

Results

Conclusion

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