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Evaluation of pre-radiotherapy apparent diffusion coefficient (ADC): patterns of recurrence and survival outcomes analysis in patients treated for glioblastoma multiforme. J Neurooncol 2015 May;123(1):179-88 PMID: 25894597

Pubmed ID

25894597

DOI

10.1007/s11060-015-1782-5

Abstract

PURPOSE: To investigate the association of pre-radiotherapy apparent diffusion coefficient (ADC) abnormalities with patterns of recurrence and outcomes in patients with glioblastoma multiforme (GBM).

MATERIALS AND METHODS: Fifty-two patients with recurrent GBM were retrospectively evaluated. Diffusion MRI images were acquired for all patients postoperatively prior to radiotherapy. ADC images were evaluated for geographic regions of diffusion restriction (hypointensity) within the FLAIR volume. If identified, the ADC map and the T1+C MRI at the time of recurrence were registered to the original plan to determine the pattern of recurrence and the coverage of the ADC abnormality by the 60 Gy isodose line (IDL). Progression-free and overall survival was determined for patients with and without an ADC hypointensity.

RESULTS: An ADC hypointensity was identified in 32 (62%) of cases. The recurrence pattern in these cases was central in 27/32 (84%), marginal in 4/32 (13%) and distant in 1/32 (3%). The recurrence overlapped with the ADC hypointensity in 28 (88%) patients. The ADC hypointensity was covered by 95% of the 60 Gy IDL in all cases. Kaplan-Meier analysis revealed inferior progression free survival and overall survival in patients with an ADC hypointensity compared to those without, despite similarities between the groups in terms of age, RT dose, performance status, and extent of resection.

CONCLUSIONS: The presence of an ADC hypointensity on pre-radiotherapy diffusion-weighted imaging is associated with the location of tumor recurrence as demonstrated by frequent overlap in this series, and is associated with a trend toward inferior outcomes. This abnormality may reflect a high risk region of hypercellularity and warrants consideration with respect to radiotherapy planning.

Author List

Elson A, Paulson E, Bovi J, Siker M, Schultz C, Laviolette PS

Authors

Joseph A. Bovi MD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
Peter LaViolette PhD Associate Professor in the Radiology department at Medical College of Wisconsin
Eric Paulson PhD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
Christopher J. Schultz MD Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin
Malika L. Siker MD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin




Scopus

2-s2.0-84929836750   9 Citations

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Brain Neoplasms
Diffusion Magnetic Resonance Imaging
Female
Follow-Up Studies
Glioblastoma
Humans
Image Processing, Computer-Assisted
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Prognosis
Radiotherapy Dosage
Retrospective Studies
Survival Rate
jenkins-FCD Prod-321 98992d628744e349846c2f62ac68f241d7e1ea70