Human Brain Tumors: Response To Therapy
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Tuesday May 10th
Room 710B |
10:30 - 12:30 |
Moderators: |
Meng Law and Brian D. Ross |
10:30 |
244. |
Graded functional
diffusion maps (fDMs) predict survival in recurrent
glioblastoma treated with bevacizumab
![](play.gif)
Benjamin M Ellingson1, Timothy F Cloughesy2,
Albert Lai2, Phioanh L Nghiemphu2,
and Whitney B Pope1
1Radiological Sciences, University of
California Los Angeles, Los Angeles, CA, United States, 2Neurology,
University of California Los Angeles, Los Angeles, CA,
United States
There remains a significant need for sensitive
biomarkers that predict response to anti-angiogenic
treatment for malignant gliomas. We hypothesize that
graded functional diffusion maps (fDMs) are a sensitive
biomarker for early prediction of bevacizumab failure in
recurrent glioblastoma (GBM). Eighty-five patients with
recurrent GBMs were retrospectively examined. The volume
of fDM-classified hypo- and hypercellular tissue in
various categories were tested to determine if they were
predictive of survival. Using graded fDMs, patients
having a large volume of voxels exhibiting a subtle
decrease in ADC had a significantly shorter
progression-free and overall survival compared to those
having a lower volume.
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10:42 |
245. |
Combined 31P and 1H MRSI
in recurrent glioblastomas prior and post antiangiogenetic
therapy ![](play.gif)
Ulrich Pilatus1, Oliver Bähr2,
Joachim Steinbach2, and Elke Hattingen1
1Institute of Neuroradiology, Goethe
University Frankfurt, Frankfurt/Main, Germany, 2Senckenbergisches
Institut für Neuroonkologie, Goethe University
Frankfurt, Frankfurt/Main, Germany
31P and 1H MRSI was performed on recurrent glioblastomas
prior and following treatment with the antiangiogenic
agent Bevazizumab. Untreated tumor tissue revealed
decreased glycerophosphocholine (GPE) and increased pH.
In patients who were responding to the therapy (RANO
criteria), both parameters reverted to normal levels
within 8 weeks of treatment.
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10:54 |
246. |
MR Spectroscopy as a
Biomarker to Predict the Responses of Glioblastoma to an
Anti-angiogenic Treatment ![](play.gif)
Heisoog Kim1, Ciprian Catana1,
Eva-Maria Ratai1, Ovidiu C. Andronesi1,
Tracy T Batchelor2, Rakesh K Jain3,
and A Gregory Sorensen1
1Radiology, A. A. Martinos Center,
Charlestown, MA, United States, 2Neurology,
Massachusetts General Hospital, Boston, MA, United
States, 3Radiation
Oncology, Massachusetts General Hospital, Boston, MA,
United States
In this study, the changes of predominant metabolites in
recurrent glioblastoma (rGBM) were evaluated for
predicting tumor responses to an anti-angiogenic
treatment. While thirty-one rGBM patients were treated
with daily doses of cediranib, chemical shift imaging
data were acquired serially at the specific time points
of treatment. We measured the concentrations of N-acetyl
aspartate (NAA) and choline (Cho) normalized by creatine
in normal tissue (norCre) in enhancing tumor by
categorizing two different survival groups. Notably, NAA/Cho
showed a high prediction to 6-month overall survival in
ROC analysis. These observations have important
implications for treatment management.
|
11:06 |
247. |
Increased Blood Flow
during anti-VEGF Induced Vascular Normalization ![](play.gif)
Kyrre E Emblem1, Pavlina Polaskova1,
Dominique L. Jennings1, Elizabeth R. Gerstner2,
Tracy T Batchelor2, Rakesh K Jain3,
and Gregory Sorensen1
1A. A. Martinos Center for Biomedical
Imaging, Massachusetts General Hospital, Boston,
Massachusetts, United States, 2Pappas
Center for Neuro-Oncology, Massachusetts General
Hospital, Boston, Massachusetts, United States, 3Department
of Radiation Oncology, Massachusetts General Hospital,
Boston, Massachusetts, United States
It is hypothesized that anti-VEGF therapy in combination
with radiation and chemotherapy can normalize brain
tumor vascularity and restore impaired blood flow
characteristics. In this study, we have compared
MR-derived flow characteristics in patients treated with
an anti-angiogenic agent to that of a patient control
group not receiving anti-angiogenic therapy. Our results
support the hypothesis of vascular normalization, where
the patient group undergoing anti-VEGF treatment showed
increased CBF during the vascular normalization window.
|
11:18 |
248. |
Improved Localization of
BOLD Activation in Patients with Brain Tumors using
Vasoreactivity Maps ![](play.gif)
Henning U. Voss1, Kyung K Peck2,
Nicole M Petrovich Brennan2, Amir Iranmahboob2,
Bob L. Hou3, and Andrei I Holodny2
1Dept. of Radiology, Weill Cornell Medical
College, New York, NY, United States, 2Dept.
of Radiology, Memorial Sloan-Kettering Cancer Center,
New York, NY, United States,3Dept. of
Radiology, West Virginia University, Morgantown, VA,
United States
In subjects with brain tumors a global hemodynamic
response function may not be sufficient to yield the
most accurate maps of eloquent cortical areas in
presurgical planning fMRI. We propose to assess local
vasoreactivity by using a breath-holding paradigm and
derive a model that takes altered hemodynamics into
account. We obtain altered task response maps as
compared to maps obtained without breath-holding
information, in particular adjacent to tumors, in half
of the studied cases. Our results suggest that the
inclusion of vasoreactivity data could enhance BOLD
detection in patients with compromised hemodynamics
secondary to pathology.
|
11:30 |
249. |
Serial Changes in
Diffusion Imaging Parameters Vary with Treatment Regimen for
Patients with Newly Diagnosed Glioblastoma Multiforme ![](play.gif)
Laleh Jalilian1, Emma Essock-Burns2,
Yan Li1, Soonmee Cha1,3, Susan
Chang3, Michael Prados3, Nicholas
Butowski3, and Sarah J. Nelson1,2
1Radiology and Biomedical Imaging, UCSF, San
Francisco, CA, United States, 2Bioengineering,
UCSF, San Francisco, CA, United States, 3Neurological
Surgery, UCSF, San Francisco, CA, United States
Despite advances in treatment modalities, patients with
glioblastoma multiforme have an overall survival of 15
months. Anti-angiogenic therapies administered with
temozolomide have been reported to cause restriction on
diffusion-weighted imaging (DWI), which may serve as an
adjunct to the assessment of therapy response. In this
study, 100 newly diagnosed GBM patient were administered
either a) temozolomide alone, b) temozolomide and a
protein kinase C inhibitor, or c) temozolomide and a
VEGF antibody. The results demonstrate that imaging
biomarkers used to predict response and prognosis to
therapy need to be tailored to take into account the
specific treatment regimen being considered.
|
11:42 |
250. |
How Blood Perfusion maps
are analyzed can greatly improve the predictive potential
for assessing survival in patients treated for gliomas ![](play.gif)
Benjamin Lemasson1, Stefanie Galbán2,
Christina Tsien2, Charles R Meyer1,3,
Timothy D Johnson4, Thomas Leonard Chenevert1,
Alnawaz Rehemtulla1,2, Brian Dale Ross1,
and Craig J Galbán1
1Radiology, University of Michigan, Ann
Arbor, Michigan, United States, 2Radiation
Oncology, University of Michigan, Center for Molecular
Imaging, Ann Arbor, Michigan, United States, 3Biomedical,
University of Michigan, Center for Molecular Imaging,
Ann Arbor, Michigan, United States, 4Biostatistics,
University of Michigan, Ann Arbor, Michigan, United
States
We tested the hypothesis that the method used to analyze
the physiological parameter can improve the parameter’s
predictive value. As such we compaired the parametric
response (PRM) map to several common methods for
assessing response. In addition, we evaluated the impact
of the volume of interest (VOI) and the time the
mid-treatment rCBV map was acquired on the predictive
value of one-year and overall survival in a cohort of
glioma patients. Only PRM was predictive of response. In
addition, PRM is shown to be robust with negligible
sensitivity to the VOI or the time the mid-treatment
rCBV map was acquired.
|
11:54 |
251. |
Treatment effects of
diffuse intrinsic pontine gliomas on tumor and normal
appearing cortical gray matter assessed by arterial spin
labeling perfusion and 3D volumetric measurements ![](play.gif)
Jan Sedlacik1,2, Claudia M Hillenbrand1,
and Alberto Broniscer3
1Radiological Sciences, St. Jude Children’s
Research Hospital, Memphis, TN, United States, 2Neuroradiology,
University Medical Center Hamburg-Eppendorf, Hamburg,
Germany, 3Oncology,
St. Jude Children’s Research Hospital, Memphis, TN,
United States
In a clinical trial of combined antiangiogenic and local
radiation therapy (RT) of brainstem gliomas changes in
tumor and cortical grey matter (GM) perfusion were
closely monitored by arterial spin labeling and
volumetric measurements. Median tumor perfusion was
found to be increased and showing a higher variance
directly after RT suggesting different tumor responses
to treatment compared to tumor volume which decreased in
all patients. A temporary drop in cortical GM perfusion
and volume was found directly after baseline which may
be caused by steroids, given at the beginning of
therapy.
|
12:06 |
252. |
UDP-GlcNAc and UDP-GalNAc,
as detected by 1H MRS, increase in the early phase of
cisplatin –induced cell death in brain tumour cells ![](play.gif)
Xiaoyan Pan1,2, Martin Wilson1,2,
Carmel McConville1, Julian L Griffin3,
Theodoros N Arvanitis2,4, Andrew C Peet1,2,
and Risto A Kauppinen5
1Cancer Sciences, University of Birmingham,
Birmingham, United Kingdom, 2Oncology,
Birmingham Children's Hospital NHS Foundation Trust,
Birmingham, United Kingdom,3Biochemistry,
University of Cambridge, Cambridge, United Kingdom, 4School
of Electronic, Electrical and Computer Engineering,
University of Birmingham, Birmingham, United Kingdom, 5Department
of Radiology, Dartmouth College, Hanover, New Hampshire,
United States
In this work, four brain tumour cell lines with
different sensitivity to cisplatin were studied. DAPI-stained
nuclei of cisplatin treated cells were demonstrated to
identify cell death. 1HMRS was performed on the
cisplatin treated brain tumour cells to investigate the
metabolic change with treatment. The peaks at 7.98, 5.98
and 2.09 ppm assigned to UDP-GlcNAc and UDP-GalNAc were
found to increase in the responding cells in the early
events of cell death but not in non-responders. They
change with similar kinetics to the 1HMRS-detected
lipids during cell death.
|
12:18 |
253. |
Characterization of
microbleed formation from normal brain microvasculature
after radiation therapy ![](play.gif)
Janine M. Lupo1, Susan M Chang2,
Soonmee Cha1,2, and Sarah J Nelson1,3
1Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA,
United States, 2Department
of Neurological Surgery, University of California, San
Francisco, CA, United States, 3Department
of Bioengineering and Therapeutic Sciences, University
of California, San Francisco, CA, United States
Although a mainstay in the standard-of-care for
malignant gliomas, the potential effects of radiation
therapy on normal brain tissue and quality-of-life is
not well characterized. This study uses SWI to evaluate
the evolution of microbleeds in normal-appearing brain
due to radiation therapy in 12 glioma patients, 6 of who
received concurrent anti-angiogenic therapy. Microbleed
counts were found to increase linearly as a function of
time since receiving radiation, with the rate of
microbleed formation escalating after 2 years. The
addition of an anti-angiogenic agent appeared to stall
this processes. Microbleed size varied both within and
across patients with time.
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