Advanced Brain Tumor 1

Tuesday 13 May 2014

Kathleen M. Schmainda¹, Zheng Zhang², Jerrold Boxerman³, Melissa Prah¹, Bradley Snyder², Devyani Bedekar⁴, A Gregory Sorensen⁵, Mark R Gilbert⁶, and Daniel P Barboriak^7
1Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States, ²Center for Statistical Sciences, Brown University, Rhode Island, United States, ³Diagnostic Imaging, Rhode Island Hospital, Rhode Island, United States, ⁴Medical College of Wisconsin, Milwaukee, Wisconsin, United States,⁵Massachusetts General Hospital, Massachusetts, United States, ⁶Neuro-Oncology, University of Texas, Houston, Texas, United States, ⁷Radiology, Duke University, Durham, North Carolina, United States

RTOG 0625/ACRIN 6677 is a multicenter, randomized, phase II trial of bevacizumab with irinotecan or temozolomide in recurrent glioblastoma (GBM). In this study of 23 patients the percent changes in both normalized and standardized rCBV, derived from DSC-MRI, are predictive of progression free survival (PFS) and overall survival (OS) when measured at 2 and 16 weeks following treatment initiation.

Guro K. Rognsvag¹, Atle Bjornerud^1,2, A. Gregory Sorensen^3,4, Patrick Y. Wen⁵, Tracy T. Batchelor^6,7, Rakesh K. Jain⁶, and Kyrre E. Emblem^1,3
1The Intervention Centre, Oslo University Hospital, Oslo, Oslo, Norway, ²Dept of Physics, University of Oslo, Oslo, Norway, ³Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States,⁴Siemens Healthcare, Malvern, PA, United States, ⁵Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA, United States, ⁶Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States, ⁷Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States

The microvasculature of tumors is abnormal and tortuous with arterio-venous shunts. Shunts are short high-flow vascular pathways that cause parts of the blood flow to bypass capillary regions, thus impairing delivery of oxygen to the tissue and increasing resistance to therapy. Vessel architectural imaging (VAI) has recently been introduced as a new paradigm for in vivo assessment of cancer vasculature. By performing Monte Carlo simulations of normal and shunting tissue, and evaluating MRI data of patients undergoing anti-angiogenic therapy, we show that VAI identifies arterio-venous shunts and help reveal mechanism of normalization during anti-angiogenic therapy.

Martin Thomas Freitag¹, Christian Weber^1,2, Klaus Maier-Hein^1,2, Franciszek Binczyck³, Barbara Bobek-Billewicz⁴, Joanna Polanska³, Rafal Tarnawski⁴, and Bram Stieltjes^1
1Section Quantitative Imaging-based Disease Characterization, Department of Radiology, German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany, ²Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany,³Silesian University of Technology, Gliwice, Poland, ⁴Institute of Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland

Here, the value of multiparametrical diffusion-tensor-imaging (DTI) maps was tested for the often difficult detection of recurrent low-grade glioma in 48 adults. At the time point of recurrence, defined by new contrast uptake, hypointense lesions were seen within the T2-hyperintensity zone in fractional anisotropy, axial, mean and radial diffusitivity maps in every patient representing a hypercellular equivalent. Comparing all tensor-derived maps quantitatively, contrast-to-noise and combined sensitivity/specificity was highest for axial diffusitivity to visualize and detect this hypercellularity. DTI acquisitions should be routinely included for the management of low-grade gliomas as axial diffusitivity maps may provide essential additional diagnostic information.

Antonella Castellano¹, Marina Donativi², Roberta Rudà³, Marco Riva⁴, Giorgio De Nunzio², Antonella Iadanza¹, Matteo Rucco⁵, Luca Bertero³, Lorenzo Bello⁴, Riccardo Soffietti³, and Andrea Falini^1
1Neuroradiology Unit and CERMAC, Università Vita-Salute San Raffaele and Ospedale San Raffaele, Milan, Italy, ²A.D.A.M., Advanced Data Analysis in Medicine, University of Salento, Lecce, Italy, ³Neuro-oncology, Department of Neuroscience and Oncology, University of Torino, Turin, Italy,⁴Neurosurgery, Department of Neurological Sciences, Università di Milano, Istituto Clinico Humanitas, Milan, Italy, ⁵School of Science and Technology, Computer Science Division, University of Camerino, Camerino, MC, Italy

In low-grade gliomas during chemotherapy, changes in Diffusion Tensor Imaging metrics (MD, FA, pure isotropy and pure anisotropy) may be an early signature for Temozolomide response, correlating with clinical response better than conventional MRI criteria: structural changes quantified by DTI-based histogram analysis support the hypothesis of a “shrinkage” of the tumor in response to chemotherapy, especially at the level of margins of infiltration. Quantitative measures derived from this analysis can improve the monitoring of low-grade gliomas treatment response.

Ek T Tan¹, Robert J Young², Kyung K Peck^2,3, Xiaofeng Liu¹, Jonathan I Sperl⁴, Mehrnaz Jenabi², and Luca Marinelli^1
1GE Global Research, Niskayuna, NY, United States, ²Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States, ³Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States, ⁴GE Global Research, Garching, Munich, Germany

Compressed-sensing accelerated diffusion spectrum imaging (CS-DSI) was compared to conventional DTI in ten patients with intracranial brain tumors, whereby DSI clearly provides improved performance in the presence of crossing-fibers and (edema and tumors). DSI acquisition was accelerated by factors of 4 and 5 to achieve scan times under 14 minutes on a conventional 3T system. CS-DSI provided superior tract visualization in all patients. The tract-based dependent measures obtained with CS-DSI were more consistent with pathology-induced changes than those with DTI. These preliminary results suggest that CS-DSI may be helpful in preoperative planning in patients with brain tumors.

Chen Niu¹, Pan Lin², Zhigang Min¹, Rana Netra¹, Qiuli Zhang¹, Xin Liu², Cuiping Mao¹, Faxiu Bao¹, and Ming Zhang^1
1The First Affiliated Hospital of Medical College, Xi¡¯an Jiaotong University, Xi'an, Shaanxi, China, ²Institute of Biomedical Engineering, Xi'an Jiaotong University, Shaanxi, China

Brain plasticity is a continuous process during slow-growing tumor formation, which remodels neural organization and optimizes brain network function. In this study, we aimed to investigate whether motor function plasticity exists in patients with slow-growing brain tumors located in or near to motor areas, and who exhibited no motor deficits. We use resting-state functional magnetic resonance (rs-fMRI) data in the frequency domain, and investigate the relationship between the low frequency band shift and motor functional plasticity changes in patients with brain tumor, and achieve a better understanding of underlying mechanisms.

Eduardo Caverzasi¹, Shawn Hervey-Jumper², Valentina Panara³, Caroline A. Racine², Vanitha Sankaranarayanan⁴, Nico Papinutto¹, Kesshi Jordan⁵, Jing Li², Mitchel S. Berger², and Roland G. Henry^1
1Department of Neurology, University of California, San Francisco, San Francisco, CA, United States, ²Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States, ³ITAB - Institute of Advanced Biomedical Technologies, University G.D'Annunzio, Chieti, Italy, Italy, ⁴Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States, ⁵Graduate Program in Bioengineering, UC Berkeley/UC San Francisco, CA, United States

We show the successful application of q-ball tracking in pre-surgical planning for language pathways in brain tumor patients and for post-surgery white matter tracking in order to assess postoperative tract damages. The rating scales developed for fiber pathways damage were found to be highly reproducible and provided significant correlations with language deficits. The fiber tracking spatial inter-operator reliability was very high considering the intrinsic variability of this technique on a voxel-wise segmentation. Our results confirm the importance of preservation of dorsal stream tracts (arcuate fascicle and temporo-parietal portion of the superior longitudinal fascicle), in order to reduce language morbidity of brain tumor patients.

Ovidiu Cristian Andronesi¹, Franziska Loebel², Wolfgang Bogner³, Malgorzata Marjanska⁴, Elizabeth Gerstner⁵, Andrew Chi⁵, Tracy T. Batchelor⁵, Daniel P. Cahill⁶, and Bruce R. Rosen^1
1Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States,²Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States, ³MR Center of Excellence, Department of Radiology, Medical University Vienna, Vienna, Vienna, Austria, ⁴Center for Magnetic Resonance Research, University of Minnesota, MN, United States, ⁵Pappas Center of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States, ⁶Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States

High levels of 2-hydroxyglutarate (2HG) represent the hallmark metabolic alteration in mutant IDH gliomas. 2HG has been proposed as an ideal biomarker to diagnose and monitor treatment response of mutant IDH gliomas. We show here newly that 3D MR spectroscopic imaging (MRSI) of 2HG is feasible clinically in glioma patients. A novel 3D MRSI sequence was designed to edit reliably and efficiently the 2HG levels. Results obtained serially in mutant IDH glioma patients are shown.

Changho Choi¹, Sandeep Ganji¹, Akshay Madan¹, Zhongxu An¹, and Elizabeth Maher^1
1UT Southwestern Medical Center, Dallas, Texas, United States

Isocitrate dehydrogenases (IDH) 1 and 2 catalyze the NADP+ dependent conversion of isocitrate to Ą-ketoglutarate in the cytosol and mitochondria, respectively. The mutations in these enzymes result in the production of 2-hydroxyglutarate (2HG). We have investigated metabolic correlations in IDH1- vs. IDH2-mutated gliomas (28 and 5 patients, respectively) focusing on 2HG in vivo, using 1H MRS at 3T. Data indicated 2HG levels were highly correlated with choline, NAA, creatine and glutamate. The correlations were stronger in IDH2 mutated gliomas than in IDH1 mutated gliomas.

Armin Biller^1,2, Jens Kleesiek³, Jan Oliver Neumann³, Felix Sahm⁴, Anne Dorothea Hertenstein³, and Armin Michael Nagel^5
1Neuroradiology, University of Heidelberg, Heidelberg, Badem-Württemberg, Germany, ²Radiology, German Cancer Research Center DKFZ, Heidelberg, Badem-Württemberg, Germany, ³University of Heidelberg, Baden-Württemberg, Germany, ⁴Neuropathology, Baden-Württemberg, Germany, ⁵Medical Physics in Radiology, German Cancer Research Center DKFZ, Baden-Württemberg, Germany

In this study we demonstrate a robust correlation between the Ki-67 proliferation index of brain tumor cells and the relaxation weighted ²³Na contrasts (NaR and NaS). Both contrasts represent the signal of ions with short relaxation times. The NaT contrast, which reflects the tissue sodium concentration, exhibited no association with histopathology. Also, statistical analyses revealed no correlation between the Ki-67 index and canonical ¹H-MRI including T1w gadolinium enhanced, T2w and FLAIR imaging. These results emphasize the added benefit of ²³Na-MRI to conventional ¹H imaging in neurooncology. Of note, in contrast to ¹H neuroimaging in oncology ²³Na-MRI requires no contrast media.