Abstract:
BACKGROUND:Assessment of treatment response by measuring tumor size is known to be a late and potentially confounded response index. Serial diffusion MRI has shown potential for allowing earlier and possibly more reliable response assessment in adult patients, with limited experience in clinical settings and in pediatric brain cancer. We present a retrospective study of clinical MRI data in children with high-grade brain tumors to assess and compare the values of several diffusion change metrics to predict treatment response. METHODS:Eighteen patients (age range, 1.9-20.6 years) with high-grade brain tumors and serial diffusion MRI (pre- and posttreatment interval range, 1-16 weeks posttreatment) were identified after obtaining parental consent. The following diffusion change metrics were compared with the clinical response status assessed at 6 months: (1) regional change in absolute and normalized apparent diffusivity coefficient (ADC), (2) voxel-based fractional volume of increased (fiADC) and decreased ADC (fdADC), and (3) a new metric based on the slope of the first principal component of functional diffusion maps (fDM). RESULTS:Responders (n = 12) differed significantly from nonresponders (n = 6) in all 3 diffusional change metrics demonstrating higher regional ADC increase, larger fiADC, and steeper slopes (P < .05). The slope method allowed the best response prediction (P < .01, η(2) = 0.78) with a classification accuracy of 83% for a slope of 58° using receiver operating characteristic (ROC) analysis. CONCLUSIONS:We demonstrate that diffusion change metrics are suitable response predictors for high-grade pediatric tumors, even in the presence of variable clinical diffusion imaging protocols.
journal_name
Neuro Oncoljournal_title
Neuro-oncologyauthors
Rodriguez Gutierrez D,Manita M,Jaspan T,Dineen RA,Grundy RG,Auer DPdoi
10.1093/neuonc/not034subject
Has Abstractpub_date
2013-08-01 00:00:00pages
981-9issue
8eissn
1522-8517issn
1523-5866pii
not034journal_volume
15pub_type
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