Article

Functional Diffusion Map As an Early Imaging Biomarker for High-Grade Glioma: Correlation With Conventional Radiologic Response and Overall Survival

University of Michigan, Ann Arbor, Michigan, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 08/2008; 26(20):3387-94. DOI: 10.1200/JCO.2007.15.2363
Source: PubMed

ABSTRACT

Assessment of radiologic response (RR) for brain tumors utilizes the Macdonald criteria 8 to 10 weeks from the start of treatment. Diffusion magnetic resonance imaging (MRI) using a functional diffusion map (fDM) may provide an earlier measure to predict patient survival.
Sixty patients with high-grade glioma were enrolled onto a study of intratreatment MRI at 1, 3, and 10 weeks. Receiver operating characteristic curve analysis was used to evaluate imaging parameters as a function of patient survival at 1 year. Both log-rank and Cox proportional hazards models were utilized to assess overall survival.
Greater increases in diffusion in response to therapy over time were observed in those patients alive at 1 year compared with those who died as a result of disease. The volume of tumor with increased diffusion by fDM at 3 weeks was the strongest predictor of patient survival at 1 year, with larger fDM predicting longer median survival (52.6 v 10.9 months; log-rank, P < .003; hazard ratio [HR] = 2.7; 95% CI, 1.5 to 5.9). Radiologic response at 10 weeks had similar prognostic value (median survival, 31.6 v 10.9 months; log-rank P < .0007; HR = 2.9; 95% CI, 1.7 to 7.2). Radiologic response and fDM differed in 25% of cases. A composite index of response including fDM and RR provided a robust predictor of patient survival and may identify patients in whom RR does not correlate with clinical outcome.
Compared with conventional neuroimaging, fDM provided an earlier assessment of equal predictive value, and the combination of fDM and RR provided a more accurate prediction of patient survival than either metric alone.

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Available from: Daniel A Hamstra, Sep 08, 2014
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    • "Acquisition sequences for DWI are not completely standardized, but basic techniques are well known and available on systems from all major vendors. There is no established standard for measurement of ADC but recent reports promote voxel-based analysis and volumetric evaluation of ADC (vADC) which is well correlated with cellularity, as shown in gliomas [27,28]. This method also carries the advantages of being less operator-dependent and more reproducible than ROI-based techniques. "
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    • "Determining treatment response early on in the treatment cycle is of vital importance for moving toward personalized medicine with the ability to alter doses or change therapy in those cases where the current treatment is seen to be ineffective. The fDM was previously shown to be an effective biomarker for detecting treatment response earlier than current standard techniques that consist of radiological assessment, in most cases at the end of therapy.13 However, in this analysis, a number of limitations have been identified and studied, which indicates the need to exercise caution when interpreting fDM results. "
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